¿Cargar y llevar o quedarse en la escena en el paciente de trauma? / Trauma: Should You Stay or Should You Go?

¿Cargar y llevar o quedarse en la escena en el paciente de trauma? / Trauma: Should You Stay or Should You Go?

TITULAR: 
Cosen a navajazos a un joven a las puertas de una discoteca en Carabanchel
El agredido recibió al menos siete heridas de arma blanca en tórax y espalda, una de ellas penetrante, así como golpes y contusiones en la cara y cabeza

Ese sistema va contra de todo lo estipulado en los libros de trauma, en todo lo visto en congresos por expertos internacionales, dilatar innecesariamente a un paciente en la escena, cuando estamos a minutos de hospitales de trauma de alto nivel y estándar con cirujanos de trauma 24/7/365, con capacidad de transfusion, veo un riesgo a correr con la vida del paciente quedarse a hacer procedimientos realmente dilatorios en la escena. es comun ver estos casos en Europa, pero de verdad prefiero la medicina de acción Americana en la que el paramedico no asume procedimientos dilatorios en la escena y lleva al paciente a la sala de urgencias en donde se sobran personal y recursos. Opinion Personal -Profesional @drramonreyesmd 21/04184 Colegiado en España

¿Digo yo en mi ignorancia como medico, no seria mas facil llevar al paciente al hospital y hacer sus cosas en el camino, al final eso es asunto de cirugia? Digo yo en mi ignorancia como MEDICO... by Dr. Ramon Reyes, MD

Pongo el numero de colegiado en España, por encontrar uno que otro experto en la materia que ante la incapacidad de discutir en base medicina basada en evidencias, pues tratan de descalificar a quien suscribe y a cuantos digan lo contrario de sus acciones,,, pero lo siento, no tengo la capacidad de ver algo que entiendo en base a mas de 30 años en las calles milles de millas recorridas, miles de horas de practicas en salud y educación, pues alguien tiene que decir, la Foto muy bonita, pero please al quirófano, es el destino final y mientras mas rapido, pues mejor, porque sangre se sustituye con sangre y hacer muchos procedimientos en medio de una ciudad, pues como que no,,, diferente si hablamos de medicina de combate, medicina austera, medicina de desastre, medicina remota, etc, ahi si o si, debes de hacer algo mientras puedes evacuar al paciente a una facilidad final de mayor nivel de atención.

 by @DrRamonReyesMD

CREO SER EL UNICO IGNORANTE EN EL MUNDO QUE LO VE,,, PUES CREO QUE SI

Trauma: Should You Stay or Should You Go?

11/22/2012

ACEP

WASHINGTON-The results of a 14-year study of trauma patients brought to a level I trauma center come close to settling the debate over the "load and go" versus "stay and stabilize" approach to patient care in the out-of-hospital setting: the answer depends on whether the injuries are penetrating or blunt ("Emergency Medical Services Out-of-Hospital Scene and Transport Times and Their Association with Mortality in Trauma Patients Presenting to an Urban Level I Trauma Center").

The study—the first of its kind to analyze data spanning more than a decade—was published recently in Annals of Emergency Medicine.

"We observed an association between longer out-of-hospital times, in particular scene times, and mortality in patients with penetrating trauma," said lead study author C. Eric McCoy, MD, MPH, of the University of California Irvine School of Medicine in Orange, Calif. "Given the challenges of providing out-of-hospital care to heterogeneous populations through a heterogeneous delivery system, it is imperative that the medical community identify patients who may benefit from timely care before abandoning the notion that faster is better for all patients in the out-of-hospital setting."

Researchers analyzed records for 19,167 trauma patients. Eighty-four percent of the injuries were blunt and 16 percent were penetrating. For patients with penetrating trauma, higher odds of mortality were observed when treatment delivered at the scene exceeded 20 minutes. Longer transport times were not associated with increased odds of mortality in patients with penetrating trauma. For patients with blunt trauma, there was no association between scene or transport times and increased odds of mortality.

"Our findings support the 'golden hour' concept of trauma care and are consistent with the previously demonstrated hospital-based beneficial effect on survival," said Dr. McCoy. "Our study also supports the conclusion that even if transport time is longer because of geographical distance from the scene to a trauma center, seriously injured patients benefit by being transported to trauma centers for hospital-based care."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.

https://www.emsworld.com/news/10832964/trauma-should-you-stay-or-should-you-go

Prehospital care - scoop and run or stay and play?

Injury. 2009 Nov;40 Suppl 4:S23-6. doi: 10.1016/j.injury.2009.10.033. Smith RM1, Conn AK.

Author information

Abstract

Improved training and expertise has enabled emergency medical personnel to provide advanced levels of care at the scene of trauma. While this could be expected to improve the outcome from major injury, current data does not support this. Indeed, prehospital interventions beyond the BLS level have not been shown to be effective and in many cases have proven to be detrimental to patient outcome. It is better to "scoop and run" than "stay and play". Current data relates to the urban environment where transport times to trauma centres are short and where it appears better to simply rapidly transport the patient to hospital than attempt major interventions at the scene. There may be more need for advanced techniques in the rural environment or where transport times are prolonged and certainly a need for more studies into subsets of patients who may benefit from interventions in the field.

PMID:

 

19895949

 

DOI:

 

10.1016/j.injury.2009.10.033 .  

https://www.ncbi.nlm.nih.gov/pubmed/19895949

Prehospital trauma care: a clinical review.

Beuran M1, Paun S, Gaspar B, Vartic N, Hostiuc S, Chiotoroiu A, Negoi I.

Author information

Abstract

INTRODUCTION:

There are many controversies related to the trauma patient care during the pre-hospital period nowadays. Due to the heterogeneity of the rescue personnel and variability of protocols used in various countries, the benefit of the prehospital advanced life support on morbidity and mortality has been not established.

METHOD:

Systematic review of the literature using computer search of the Library of Medicine and the National Institutes of Health International PubMed Medline database using Entre interface.We reviewed the literature in what concerns the basic and advanced life support given to the trauma patients during the prehospital period.

RESULTS:

Although the organization of the medical emergency system varies from a country to another, the level of patient'scare can be classified into two main categories: Basic Life Support (BLS) and Advanced Life Support (ALS).There are many studies addressing what to be done at the scene.The prehospital care can be divided into two extremes: stay and play/treat then transfer or scoop and run/load and go.

CONCLUSIONS:

A balance between "scoop and run" and "stay and play" is probably the best approach for trauma patients. The chosen approach should be made according to the mechanism of injury (blunt versus penetrating trauma), distance to the trauma center (urban versus rural) and the available resources.

RevistaChirurgia.  https://www.ncbi.nlm.nih.gov/pubmed/23116846

https://www.abc.es/espana/madrid/abci-cosen-navajazos-joven-puertas-discoteca-carabanchel-201903301816_noticia.html#vca=rrss&vmc=abc-es&vso=fb&vli=cm-general

https://www.reddit.com/r/ems/comments/8k2t0g/stay_and_play_or_transport_with_a_cardiac_arrest/

Hemos avanzado en el manejo prehospitalario en los ultimos años con la entrada de la TELEMEDICINA, REBOA, ECOFAST, etc 


Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? by Endovascular Resucitation and Trauma Management / Uso actual del balón de resucitación aórtico endovascular (REBOA) en trauma 
https://emssolutionsint.blogspot.com/2017/09/resuscitative-endovascular-balloon.html

TEMPUS PRO vital signs monitor with integrated telemedicine, use in remote medicine

http://emssolutionsint.blogspot.com/2018/05/tempus-vital-signs-monitor-with.html

Dr Ramon REYES, MD,
Por favor compartir nuestras REDES SOCIALES @DrRamonReyesMD, así podremos llegar a mas personas y estos se beneficiarán de la disponibilidad de estos documentos, pdf, e-book, gratuitos y legales..