Background Traumatic haemorrhage is one of the most common causes of death in injured patients. Targeted pre-hospital haemostasis can reduce morbidity and mortality. The use of tourniquets is advisable for external bleeding in the extremities that cannot be treated by compression and wound packing. There are corresponding recommendations for tourniquet use. Little is currently known about the level of training and the frequency of use of the various professional groups of potential tourniquet users. Methods Status survey on the level of training and frequency of use of tourniquets among various pre-hospital professional groups (Emergency Medical Technician / basic emergency medical technicians – EMT, Advanced Emergency Medical Technician / intermediate emergency medical technicians - AEMT, Paramedic / paramedic emergency medical technicians, Helicopter Emergency Medical Services-Technical Crew member - HEMS-TC, Prehospital Physician). In order to obtain an overview of the level of training and use of tourniquets among the various professional groups, we conducted a regional online survey in the ground-based emergency medical services in the region of Halle/Northern Saale District in Saxony-Anhalt, as well as for the helicopter emergency medical services in the Halle/Leipzig metropolitan region. The different professional groups were compared with regard to theoretical and practical training, frequency of use, and adherence to existing guidelines. Results 178 participants (74% male, 26% female) took part and answered the questionnaire, including 47% pre-hospital physician, 32% paramedic, 9% EMT, 8% HEMS-TC, 6% AEMT. The only statistically significant differences were found in theoretical education, with the lowest rate of education in the EMT group (67%) and the highest rate in the paramedic group (96%). When comparing theoretical education of all the emergency medical service personnel (91%) against the pre-hospital physicians (73%), it was significantly higher in the emergency medical service personnel group. No differences were found for practical training, frequency of use, and adherence to existing guidelines. Conclusion Apart from theoretical education, no differences are apparent regarding practical training, frequency of use, and adherence to existing guidelines for potential pre-hospital tourniquet users. However, education and training can still be improved.
Zusammenfassung Die osteoporotische Wirbelkörperfraktur (OWF) stellt aufgrund der alternden Gesellschaft eine wachsende medizinische und sozioökonomische Herausforderung dar. Jedes Jahr werden in Europa etwa 400 000 Fälle diagnostiziert, wobei die Dunkelziffer aufgrund klinisch inapparenter Verläufe deutlich höher liegen dürfte. Die vorliegende Arbeit fasst den aktuellen Stand der Wissenschaft basierend auf der S2k-Leitlinie zur Diagnostik und Therapie osteoporotischer thorakolumbaler Wirbelkörperfrakturen, zusammen. Im Fokus stehen neben der Diagnostik die OF-Klassifikation (Osteoporotic Fracture Classification), der OF-Score als Entscheidungshilfe zwischen konservativer und operativer Therapie, sowie die diversen konservativen wie auch operativen Therapieverfahren.
Introduction: Optimal placement of the femoral neck screw is essential during osteosynthesis of pertrochanteric fractures. A low tip-apex distance (TAD) is crucial to avoid a cut-out of the femoral neck screw. Whether the use of a navigation system during osteosynthesis with Gamma3 nails positively influences the TAD, fluoroscopy time and surgery duration has been assessed differently in the initial clinical applications. We tested the ADAPT system for positioning Gamma3 nails as part of a standardised laboratory experiment. Methods: An inexperienced surgeon and an experienced surgeon each implanted 20 Gamma3 nails in artificial bones. Each surgeon performed 10 conventional interventions and 10 using the ADAPT system. Subsequently, TAD, femoral neck screw positioning, fluoroscopy time, number of X-ray images and surgery duration were compared. The experimental set-up also assessed whether the ADAPT system offers advantages over distal freehand locking for long Gamma3 nails. Results: The inexperienced surgeon was able to implant the nail significantly faster when using the ADAPT system (99.10 s/60.20 s; p = 0.005), while the experienced surgeon required more time to implant the femoral neck screws (59.70 s/94.00 s, p < 0.001). The fluoroscopy times of both surgeons were somewhat shorter when using the ADAPT system. All femoral neck screws were placed correctly with a TAD of less than 20 mm. Only the TAD of the inexperienced surgeon was reduced with the use of the ADAPT system (16.30 mm/12.40 mm; p < 0.001). Conclusions: The ADAPT system could reduce TAD and possibly fluoroscopy time, especially in inexperienced surgeons. For experienced surgeons, there was no influence on TAD and only a minimal effect on fluoroscopy time.
BACKROUND: Nasogastric tube (NGT) insertion is routine in intensive care units (ICUs). To prevent inadvertent delivery of hyperosmolar feeding through a misplaced NGT into the bronchial or pleural space, various methods are available to verify tube position. However, no guideline-based position-control procedure exists, although undetected NGT misplacement is classified as a never event in several countries. Interpreting a chest X-ray remains the gold standard and provides forensic documentation. Meanwhile, pH-measurement in aspirate and point of care ultrasound (POCUS), either direct or with a bubble test (POCUS+BT), offer radiation-free, regionally adopted alternatives. Our pilot study compared the detection rates of these methods in a clinical setting according to our inhouse standard protocol. METHODS: In this study a total of 303 patients underwent NGT placement. Every patient received each of the position control methods in non-randomized order. RESULTS: Of the 303 NGT placements, aspiration and pH-measurement was successfully performed in 281 cases (93 %). The number of successful single tests were 251 (83%), 226 (75%), and 268 (88%) for pH, POCUS single, and POCUS+BT, respectively. POCUS alone did not add any detections to the combination of pH and POCUS+BT, which was successful in all cases, as confirmed by chest X-ray. CONCLUSION: In this single centre pilot study, combining pH-measurement with POCUS+BT provides a reliable bedside method for confirming NGT placement without need for exposing patients to radiation. Multicentre studies with larger and more diverse patient cohorts are needed to validate these findings and establish guidelines for routine clinical use. Trial registration: German clinical trials register (DRKS) DRKS-ID DRKS00029309 Registration date: 14/06/2022
