Droplet Formation in Drugs During Extreme Temperature Conditions in the Emergency Medical Service, a Problem?

Objective: Because of high-altitude operations, cold exposure is common for helicopter emergency medical services. However, drug emulsions such as propofol and etomidate are prone to degradation and the formation of lipid droplets, possibly large enough to cause pulmonary embolism, when frozen. Amiodarone may be prone to crystallization, possibly causing phlebitis, when exposed to cold temperatures.

Simulated ventilation of two patients with a single ventilator in a pandemic setting.

Simultaneous ventilation of two patients may lead to hypoventilation in one patient and hyperinflation in the other patient. In a simulation of ventilation in two patients using artificial lungs, we voluntarily directed gas flow to one patient by using three-dimensional-printed Y-adapters and stenosis adapters during volume- and pressure-controlled ventilation in the first set up. We continuously modified the model using a special one-way valve on the flow-limited side and measured it in pressure-controlled ventilation with the flow sensor of the ventilator adjusted on both sides in a second and third setup.

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation.

Background: Recently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side.

Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study.

Background: Pain is one of the major prehospital symptoms in trauma patients and requires prompt management. Recent studies have reported insufficient analgesia after prehospital treatment in up to 43% of trauma patients, leaving significant room for improvement. Good evidence exists for prehospital use of oral transmucosal fentanyl citrate (OTFC) in the military setting.

Identification of the Optimal Position of a Nasal Oxygen Cannula for Apneic Oxygenation: A Technical Simulation.

Background: In a cannot-ventilate-cannot-intubate situation, careful preoxygenation with high FiO2 allowing subsequent apneic oxygenation can be life-saving. The best position for an oxygen supply line within the human airway at which oxygen insufflation is more effective than standard preoxygenation with a face mask is unknown. Methods: In this experimental study, we compared the effectiveness of preoxygenation by placing an oxygen cannula at the nose entrance, through the nose at the soft palatine, or at the base of the tongue; as a control we used ambient air.

Influence of positive end-expiratory pressure on arterial blood pressure in mechanically ventilated trauma patients in the field: a retrospective cohort study.

Ventilation with positive end-expiratory pressure (PEEP) may result in decreased venous return to the heart and therefore decrease cardiac output. We evaluated the influence of PEEP ventilation on arterial blood pressure in the field in 296 posttraumatic intubated patients being treated by a helicopter emergency medical service in a retrospective cohort study. Initial systolic blood pressure on the scene, upon hospital admission and their mean difference were compared between patients being ventilated with no/low PEEP (0-0.

Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study.

Study Objective: Drugs stored in rescue helicopters may be subject to extreme environmental conditions. The aim of this study was to measure whether drugs stored under the real-life conditions of a Swiss helicopter emergency medical service (HEMS) would retain their potency over the course of 1 year.

Methods: A prospective, longitudinal study measuring the temperature exposure and concentration of drugs stored on 2 rescue helicopters in Switzerland over 1 year.

Airway management in a Helicopter Emergency Medical Service (HEMS): a retrospective observational study of 365 out-of-hospital intubations.

Background: Airway management is a key skill in any helicopter emergency medical service (HEMS). Intubation is successful less often than in the hospital, and alternative forms of airway management are more often needed.

Methods: Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland.

Nature Interest Scale - Development and Evaluation of a Measurement Instrument for Individual Interest in Nature.

Interest is an important factor for successful learning that has been the subject of intensive research for decades. Although interest in nature is of great importance for environmental education, to date there is no valid and reliable measurement tool. Therefore, the purpose of this study was to develop and test a scale for interest in nature, the Nature Interest Scale (NIS).

Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland.

Objective: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions.

Methods: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019.

Results: During the study period, 9,963 (88.

Nasal nalbuphine analgesia in prehospital trauma managed by first-responder personnel on ski slopes in Switzerland: an observational cohort study.

Background: Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in the case of trauma. When there is mountainous topography, as in Switzerland, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders may improve overall treatment.

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland.

Background: Over the past years, several emergency medical service providers have introduced mechanical chest compression devices (MCDs) in their protocols for cardiopulmonary resuscitation (CPR). Especially in helicopter emergency medical systems (HEMS), which have limitations regarding loading weight and space and typically operate in rural and remote areas, whether MCDs have benefits for patients is still unknown. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system.

Temperature loss by ventilation in a calorimetric bench model.

In intensive care medicine heat moisture exchangers are standard tools to warm and humidify ventilation gases in order to prevent temperature loss of patients or airway epithelia damage. Despite being at risk of hypothermia especially after trauma, intubated emergency medicine patients are often ventilated with dry and in winter probably cold ventilation gases. We tried to assess the amount of temperature-loss due to ventilation with cold, dry medical oxygen in comparison to ventilation with warm and humidified oxygen.

Safer employment of nitrous oxide in anesthesia machines-a technical simulation.

Several incidents of anesthesia-attributed mortality in the past were caused by misconnection of gas pipelines resulting in ventilation with pure nitrous oxide. A simple safety feature may be to "mark" nitrous oxide with a lower pressure than oxygen and room air within the hospital's gas pipeline system. Then, any misconnection of gas pipelines could be detected by pressure differences with a manometer in the anesthesia machine.

Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis.

Background: Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce.

Objectives: The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations.

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

Background: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely.

2015 Revised Utstein-Style Recommended Guidelines for Uniform Reporting of Data From Drowning-Related Resuscitation: An ILCOR Advisory Statement.

Background: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely.

A domestic porcine model for studying the effects of radiation on head and neck cancers.

Background: Radiation therapy (RT) of the head and neck region is often accompanied by serious side effects. Research in this area is needed to improve treatment outcomes and ameliorate therapy tolerance. Laboratory rodents are barely matching today's clinical standards in RT research.