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Introduction: Appropriate triage of the trauma patient is critical. Low end-tidal carbon dioxide (ETCO2) is associated with mortality and hemorrhagic shock in trauma, but the relationship between low ETCO2 and important clinical variables is not known. This study investigates the association of initial in-hospital ETCO2 and patient outcomes, as well as the utility of ETCO2 as a predictive aid for blood transfusion.Methods: Adult patients who presented to a Level One trauma center from 2019 to 2020 were eligible. Trauma bay ETCO2 measured by side-stream capnography was prospectively obtained for all trauma activations at time of initial evaluation. Using the Liu method of cut point estimation, patients were stratified as having low (≤29.5 mmHg) or normal ETCO2 (>29.5 mmHg). Multivariable regression was used to estimate the association of low ETCO2 with patient outcomes.Results: A total of 955 patients underwent initial in-hospital ETCO2 measurement. Median time from arrival to ETCO2 measurement was 4 min. Among admitted patients (N = 493), 48.9% had low ETCO2. Compared to patients with normal ETCO2, those with low ETCO2 were older (median age 53 vs 46, p = 0.01) and more likely to have the highest trauma activation (27.4% vs 19.8%, p = 0.048). There was no difference in head injury. After adjustment, patients with low ETCO2 had greater odds of blood transfusion (OR 4.65, 95%CI 2.0-10.7), mortality (OR 5.10, 95%CI 1.1-24.9), inferior disposition (OR 1.64, 95%CI 1.1-2.6), and complications (OR 3.35, 95%CI 1.5-7.4). ETCO2 was more predictive of early blood transfusion than Shock Index (area under ROC = 67.6% vs 58.2%).Conclusions: Low trauma bay ETCO2 remains significantly associated with inferior clinical outcomes after adjustment. In comparison to other triage tools, low ETCO2 values may be more predictive of the need for blood transfusion. Further studies are needed to evaluate the role of ETCO2 as a decision making tool for early trauma management. [ABSTRACT FROM AUTHOR]

The introduction of solar energy systems in the Sydney Olympic Village represents a remarkable case of network knowledge renewal that involves competence development among the range of actors in the industry. Sets of key success factors by following this case are identified.

Patient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital. This project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure. After data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries. A multifactorial approach was an effective strategy to decrease patient falls in the emergency department. [ABSTRACT FROM AUTHOR]

The paucity of up-to-date recommendations and evidence-based models, whether it is physician-initiated or initiated by other healthcare professionals, for humidified high flow oxygen therapy among children. The inclusion criteria included the following: 1) use of high flow oxygen therapy (≥15 L/min); 2) published studies from the year 2000 and onwards; 3) research article in a peer-reviewed journal; 4) studies conducted in a hospital setting involving paediatric patients <18 years old; 5) availability of full article online. From March to April 2018, electronic databases such as PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica Database, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, SCOPUS, Ovid, Informit, and Google Scholar were accessed. The systematic search initially yielded 41 studies. Eventually, three eligible studies were reviewed and appraised. Overarching themes were identified: 1) the lack of weaning standards; 2) the limited focus on young population in intensive care settings; and 3) the paucity of weaning models. The lack of studies suggested that this is a fertile area for research. In this light, this paper challenged researchers, clinicians, and experts to develop evidence-based standards and models of weaning towards efficient and better quality of care. This review may lead to the development of nurse-led or nurse-initiated weaning protocols to enable timely weaning intervention for children and thus reduce the need for prolonged oxygen use. Furthermore, this may also instigate an economic evaluation of a nurse-lead weaning against current models of medically lead weaning. • This is the first integrative review about high flow oxygen weaning among children. • There is a paucity of evidence on high flow oxygen weaning among children. • Despite efforts to standardise, there is no internationally agreed weaning standards. • Non-physician led weaning models are lacking. • This review may lead to the development of nurse-led or initiated weaning protocols. [ABSTRACT FROM AUTHOR]

This article conceptualises the work of non-state organisations in the refugee and migrant settlement sector with a focus on universal services, bureaucratic process and social dimensions of settling in a new country. In so doing it augments conceptualisations of 'social infrastructure', to encompass the social, emotional and administrative dimensions of social connection in diverse societies. Drawing on analysis of non-state organisations in the settlement services sector in Melbourne, Australia, we reveal the crucial work of organisations in developing programs and initiatives that recognise the complexity of mainstream welfare services, engage with the intangible social and emotional aspects of service provision, and that contribute to the accumulation of knowledge and expertise of complex and opaque services landscape. Moving beyond conceptualisations of social infrastructure as everyday community spaces, we introduce the concept of 'bridging infrastructure' to denote the work of organisations in interpersonal facilitation of social networks that enable access to wider services; the creation of friendly and welcoming community spaces; and the development of knowledge and expertise about a complex services landscape. Recognising the crucial role of the non-state sector in the dynamic process of humanitarian settlement, we contend that limited conceptualisations of social infrastructure risk removing 'the social' from bureaucratic and non-state services landscapes that support settlement lifeworlds. [ABSTRACT FROM AUTHOR]

Introduction: Current guidelines continue to lead to under- and over-triage of injured patients in the pre-hospital setting. End-tidal carbon dioxide (ETCO2) has been correlated with mortality and hemorrhagic shock in trauma patients. This study examines the correlation between ETCO2 and in-hospital outcomes among non-intubated patients in the pre-hospital setting.Methods: We retrospectively studied a cohort of non-intubated adult trauma patients with initial pre-hospital side-stream capnography-obtained ETCO2 presenting via ground transport from a single North Carolina EMS agency to a level one trauma center from January 2018 to December 2018. Using the Liu method, the optimal threshold for low ETCO2 was ≤ 28.5 mmHg.Results: Initial pre-hospital ETCO2 was recorded for 324 (22.0%) of 1473 patients with EMS data. Patients with low ETCO2 (N = 98, 30.3% of cohort) were older (median 58y vs 45y), but mechanisms of injury and scene vital signs were similar (p>0.05) between low and normal/high ETCO2 cohorts. Median injury severity score (ISS) did not differ significantly between the low and normal/high ETCO2 groups (5 vs 8, p=0.48). Compared to normal/high ETCO2, low ETCO2 correlated with increased unadjusted odds of mortality (OR 5.06), in-hospital complications (OR 2.06), and blood transfusion requirement (OR 3.05), p<0.05. Low ETCO2 was associated with 7.25 odds of mortality (95% CI 2.19,23.97, p=0.001) and 3.94 odds of blood transfusion (95% CI 1.32-11.78) after adjusting for age, ISS, and scene GCS. All but one of the massive transfusion patients (N = 8/9) had a low pre-hospital ETCO2.Conclusions: Low initial pre-hospital ETCO2 associates with poor clinical outcomes despite similar ISS and mechanisms of injury. ETCO2 is a potentially useful pre-hospital point-of-care tool to aid triage of trauma patients as it may identify hemorrhaging patients and predict mortality. [ABSTRACT FROM AUTHOR]