Matthew J Douma
University of Alberta, Critical Care Medicine, Faculty Member
- Assistant Adjunct Professor Department of Critical Care Medicine Faculty of Medicine and Dentistry University of Albe... moreAssistant Adjunct Professor
Department of Critical Care Medicine
Faculty of Medicine and Dentistry
University of Alberta
Clinical Nurse Educator
Emergency Department Royal Alexandra Hospital
Edmonton Alberta Canada
Editor
Canadian Journal of Emergency Nursing
Doctoral Student
School of Nursing, Midwifery and Health Systems
University College Dublinedit
Objective: To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). Methods: A... more
Objective: To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). Methods: A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s). Data analysis was performed through descriptive statistics, Student's t-test for continuous variables, Z-test for proportions, and Mann-Whitney U Test for nonparametric data. Outcomes included interventions supported by PHUS, factors associated with incomplete scans, and quality indicators associated with PHUS use. Differences between physician and AMC groups were also assessed. Results: PHUS was used in 455 missions, 318 by AMC and 137 by physicians. In combined trauma and medical patients, in the AMC group interventions were supported by PHUS in 26% of cases (95% CI 18–34). For transport physicians the percentage support was found to be significantly greater at 45% of cases (95% CI 34–56) p = < 0.006. Incomplete PHUS scans were common and reasons included patient obesity, lack of time, patient access, and clinical reasons. Quality indicators associated with PHUS were rarely identified. Conclusions: The use of PHUS by both physicians and non-physicians was found to support interventions in select trauma and medical patients. Key words: emergency medical services; aircraft; helicopter; air ambulance; ultrasonography; emergency care, prehospital; prehospital emergency care
Journal Prehospital Emergency Care
Volume 21, 2017 - Issue 1
http://dx.doi.org/10.1080/10903127.2016.1204036
Journal Prehospital Emergency Care
Volume 21, 2017 - Issue 1
http://dx.doi.org/10.1080/10903127.2016.1204036
Research Interests:
Introduction: Resuscitation can be delayed, or impaired, by insufficient vascular access. This study examines whether dual-intraosseous needles, inserted into a single porcine humerus, can facilitate rapid and concomitant fluid and... more
Introduction: Resuscitation can be delayed, or impaired, by insufficient vascular access. This study examines whether dual-intraosseous needles, inserted into a single porcine humerus, can facilitate rapid and concomitant fluid and medication delivery.
Methods: After inserting one- and then two-intraosseous needles into the same porcine humerus, we determined the rate of fluid administration using (i) an infusion pump set to 999 mL/h, and (ii) a standard pressure-bag set to 300mmHg. Next, we concomitantly infused blood, crystalloid and medications into the same medullary canal, using the two-needle set-up. Humeri were inspected for fluid-leakage, needle-displacement, and bone damage.
Results: Using an infusion pump, the mean normal-saline infusion-rate was significantly higher with dual-intraosseous needles compared to a single-intraosseous needle: the infusion-rate was 16 mL/min using dual-needles versus 8 mL/min for a single needle set-up (p < 0.001). In contrast, using the pneumatic pressure-bag, the infusion rate was not statistically different when comparing dual- intraosseous needles versus single-intraosseous: the infusion-rate was 22 mL/min versus 21 ml/min (p = 0.4) for 500 mL, and 22 ml/min versus 21 ml/min (p = 0.64) for one-litre, respectively. Blood product could be infused at a mean rate of 20mL/min through one needle while tranexamic acid was simultaneously infused through a second. There were no complications with a dual-intraosseous set-up (no fluid leakage; no needle-displacement; no high-pressure alarms, and no external bone-fractures or internal macrohistological damage) during any of our simulated resuscitation scenarios.
Conclusions: This is the first published study evaluating dual-intraosseous needles in a single bone. Despite limitations, this preliminary study (using a porcine humerus) suggests that dual-intraosseous needles are feasible. For critically-ill patients with limited insertion sites, dual-intraosseous (a.k.a. ‘double-barrelled resuscitation’) may facilitate rapid and concurrent resuscitation.
Methods: After inserting one- and then two-intraosseous needles into the same porcine humerus, we determined the rate of fluid administration using (i) an infusion pump set to 999 mL/h, and (ii) a standard pressure-bag set to 300mmHg. Next, we concomitantly infused blood, crystalloid and medications into the same medullary canal, using the two-needle set-up. Humeri were inspected for fluid-leakage, needle-displacement, and bone damage.
Results: Using an infusion pump, the mean normal-saline infusion-rate was significantly higher with dual-intraosseous needles compared to a single-intraosseous needle: the infusion-rate was 16 mL/min using dual-needles versus 8 mL/min for a single needle set-up (p < 0.001). In contrast, using the pneumatic pressure-bag, the infusion rate was not statistically different when comparing dual- intraosseous needles versus single-intraosseous: the infusion-rate was 22 mL/min versus 21 ml/min (p = 0.4) for 500 mL, and 22 ml/min versus 21 ml/min (p = 0.64) for one-litre, respectively. Blood product could be infused at a mean rate of 20mL/min through one needle while tranexamic acid was simultaneously infused through a second. There were no complications with a dual-intraosseous set-up (no fluid leakage; no needle-displacement; no high-pressure alarms, and no external bone-fractures or internal macrohistological damage) during any of our simulated resuscitation scenarios.
Conclusions: This is the first published study evaluating dual-intraosseous needles in a single bone. Despite limitations, this preliminary study (using a porcine humerus) suggests that dual-intraosseous needles are feasible. For critically-ill patients with limited insertion sites, dual-intraosseous (a.k.a. ‘double-barrelled resuscitation’) may facilitate rapid and concurrent resuscitation.
Research Interests:
Study objective: Emergency department (ED) crowding is a common and complicated problem challenging EDs worldwide. Nurse-initiated protocols, diagnostics, or treatments implemented by nurses before patients are treated by a physician or... more
Study objective: Emergency department (ED) crowding is a common and complicated problem challenging EDs worldwide. Nurse-initiated protocols, diagnostics, or treatments implemented by nurses before patients are treated by a physician or nurse practitioner have been suggested as a potential strategy to improve patient flow. Methods: This is a computer-randomized, pragmatic, controlled evaluation of 6 nurse-initiated protocols in a busy, crowded, inner-city ED. The primary outcomes included time to diagnostic test, time to treatment, time to consultation, or ED length of stay. Results: Protocols decreased the median time to acetaminophen for patients presenting with pain or fever by 186 minutes (95% confidence interval [CI] 76 to 296 minutes) and the median time to troponin for patients presenting with suspected ischemic chest pain by 79 minutes (95% CI 21 to 179 minutes). Median ED length of stay was reduced by 224 minutes (95% CI –19 to 467 minutes) by implementing a suspected fractured hip protocol. A vaginal bleeding during pregnancy protocol reduced median ED length of stay by 232 minutes (95% CI 26 to 438 minutes). Conclusion: Targeting specific patient groups with carefully written protocols can result in improved time to test or medication and, in some cases, reduce ED length of stay. A cooperative and collaborative interdisciplinary group is essential to success. [Ann Emerg Med. 2016;-:1-7.]
A B S T R A C T Background: Minimizing haemorrhage using direct pressure is intuitive and widely taught. In contrast, this study examines the use of indirect-pressure, specifically external aortic compression (EAC). Indirect pressure has... more
A B S T R A C T Background: Minimizing haemorrhage using direct pressure is intuitive and widely taught. In contrast, this study examines the use of indirect-pressure, specifically external aortic compression (EAC). Indirect pressure has great potential for temporizing bleeds not amenable to direct tamponade i.e. abdominal-pelvic, junctional, and multi-site trauma. However, it is currently unclear how to optimize this technique. Methods: We designed a model of central vessel compression using the Malbrain intra-abdominal pressure monitor and digital weigh scale. Forty participants performed simulated external aortic compression on the ground, on a stretcher mattress, and with and without a backboard. Results: The greater the rescuer's bodyweight the greater was their mean compression (Pearson's correlation 0.93). Using one-hand, a mean of 28% participant bodyweight (95% CI, 26–30%) could be transmitted at sustainable effort, waist-height, and on a stretcher. A second compressing hand increased the percentage of rescuer bodyweight transmission 10–22% regardless of other factors (i.e. presence/ absence or a backboard; rescuer position) (p < 0.001). Adding a backboard increased transmission of rescuer bodyweight 7–15% (p < 0.001). Lowering the patient from waist-height backboard to the floor increased transmission of rescuer bodyweight 4–9% (p < 0.001). Kneeling on the model was the most efficient method and transmitted 11% more weight compared to two-handed maximal compression (p < 0.001). Conclusions: Efficacy is maximized with larger-weight rescuers who use both hands, position themselves atop victims, and compress on hard surfaces/backboards. Knee compression is most effective and least fatiguing, thus assisting rescuers of lower weight and lesser strength, where no hard surfaces exist (i.e. no available backboard or trauma on soft ground), or when lengthy compression is required (i.e. remote locations). Our work quantifies methods to optimize indirect pressure as a temporizing measure following life-threatening haemorrhage not amenable to direct compression, and while expediting compression devices or definitive treatment.
In May of 2012 Google changed the way their search engine results are displayed. The tech giant began including a Google Knowledge Graph “that understands facts about people, places and things and how these entities are all connected”... more
In May of 2012 Google changed the way their search engine results are displayed. The tech giant began including a Google Knowledge Graph “that understands facts about people, places and things and how these entities are all connected” whose purpose is to “provide answers, not just links.”1 This changed the results users see, from a list of text starting with sponsored links, to tailored multimedia search results (see Fig. 1). The change represents an important and significant opportunity to provide concise infographic instructions for out-of-hospital cardiac arrest when related terms are searched for, such as: CPR, cardiac arrest, hands-only CPR, basic life support, mouth-to-mouth and/or chest compressions.
Research Interests:
Abstract Background Ultrasound examination of trauma patients is increasingly performed in prehospital services. It is unclear if prehospital sonographic assessments change patient management: providing prehospital diagnosis and... more
Abstract
Background
Ultrasound examination of trauma patients is increasingly performed in prehospital services. It is unclear if prehospital sonographic assessments change patient management: providing prehospital diagnosis and treatment, determining choice of destination hospital, or treatment at the receiving hospital.
Objective
This review aims to assess and grade the evidence that specifically examines whether prehospital ultrasound (PHUS) of the thorax and/or abdomen changes management of the trauma patient.
Methods
A systematic review was conducted of trauma patients who had an ultrasound of the thorax or abdomen performed in the prehospital setting. PubMed, MEDLINE, Web of Science, (CINAHL, EMBASE, Cochrane Central Register of Controlled Trials) and the reference lists of included studies were searched. Methodological quality was checked and risk of bias analysis performed, a level of evidence grade was assigned, and descriptive data analysis performed.
Results
992 unique citations were identified, which included eight studies that met inclusion criteria with a total of 925 patients. There are no reports of randomized controlled trials. Heterogeneity exists between the included studies which ranged from a case series to retrospective and prospective non-randomized observational studies. Three studies achieved a 2+ Scottish Intercollegiate Guidelines Networks grade for quality of evidence and the remainder demonstrated a high risk of bias. The three best studies each provided examples of prehospital ultrasound positively changing patient management.
Conclusion
There is moderate evidence that supports prehospital physician use of ultrasound for trauma patients. For some patients, management was changed based on the results of the PHUS. The benefit of ultrasound use in non-physician services is unclear.
Keywords:
Ultrasound, Prehospital, Systematic Review, Sonography, Emergency Medical Services, Air medical transport, Helicopter, Trauma, FAST, EFAST
Background
Ultrasound examination of trauma patients is increasingly performed in prehospital services. It is unclear if prehospital sonographic assessments change patient management: providing prehospital diagnosis and treatment, determining choice of destination hospital, or treatment at the receiving hospital.
Objective
This review aims to assess and grade the evidence that specifically examines whether prehospital ultrasound (PHUS) of the thorax and/or abdomen changes management of the trauma patient.
Methods
A systematic review was conducted of trauma patients who had an ultrasound of the thorax or abdomen performed in the prehospital setting. PubMed, MEDLINE, Web of Science, (CINAHL, EMBASE, Cochrane Central Register of Controlled Trials) and the reference lists of included studies were searched. Methodological quality was checked and risk of bias analysis performed, a level of evidence grade was assigned, and descriptive data analysis performed.
Results
992 unique citations were identified, which included eight studies that met inclusion criteria with a total of 925 patients. There are no reports of randomized controlled trials. Heterogeneity exists between the included studies which ranged from a case series to retrospective and prospective non-randomized observational studies. Three studies achieved a 2+ Scottish Intercollegiate Guidelines Networks grade for quality of evidence and the remainder demonstrated a high risk of bias. The three best studies each provided examples of prehospital ultrasound positively changing patient management.
Conclusion
There is moderate evidence that supports prehospital physician use of ultrasound for trauma patients. For some patients, management was changed based on the results of the PHUS. The benefit of ultrasound use in non-physician services is unclear.
Keywords:
Ultrasound, Prehospital, Systematic Review, Sonography, Emergency Medical Services, Air medical transport, Helicopter, Trauma, FAST, EFAST