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Martin Harpsø,1,2 Asger Granfeldt,3 Bo Løfgren,1,4,5 Charles D Deakin6 1Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Department of Internal Medicine, Regional Hospital of Horsens, Horsens, Denmark; 3Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark; 4Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark; 5Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 6Respiratory Biomedical Research Unit, University Hospital Southampton, UK Purpose: Oxygen supplementation has previously been considered beneficial when managing critically ill patients in order to avoid hypoxia. However, in recent years, studies have shown that hyperoxia may be harmful in critical care patients. The aim of the study was to investigate whether hyperoxia within the first 24 hours of admission following major trauma is associated with 30-day in-hospital mortality. Patients and methods: We conducted a retrospective database study of trauma patients admitted to the general intensive care unit at University Hospital Southampton from October 2008 to October 2014. Hyperoxia was defined as one arterial blood gas with a pO2 ≥40.0 kPa during the first 24 hours of admission. Cox proportional hazards regression was used to compare 30-day in-hospital mortality between the two groups. HRs for death were calculated with 95% CIs and presented as both unadjusted and adjusted for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and number of arterial blood gases. Results: In total, 1,462 patients had trauma as the cause for admission. Of these, 343 patients met the study inclusion criteria, of which 265 were defined as normoxic and the remaining 78 patients as hyperoxic. The cumulative in-hospital risk of death within 30 days was 7.8% (95% CI: 4.9%–12.5%) for the normoxia group and 9.7% (95% CI: 4.4 %–20.4%) for the hyperoxia group. The crude HR for 30-day in-hospital mortality was 1.15 (95% CI: 0.45–2.90) for hyperoxia compared to normoxia. Adjusting for APACHE II, age, sex and number of arterial blood gases yielded an adjusted HR of 30-day in-hospital mortality of 0.65 (95% CI: 0.24–1.73) for the hyperoxia group compared to the normoxia group. Conclusion: In our convenience sample of 343 patients, hyperoxia within the first 24 hours following admission to intensive care with major trauma had no impact on 30-day in-hospital mortality. Keywords: oxygen, APACHE, arterial blood gas, in-hospital mortality

Paramedic tracheal intubation has been practised in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcomes. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate, and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (eg, laryngeal mask airway), which were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative prehospital airway device for paramedics. [ABSTRACT FROM AUTHOR]

BACKGROUND AND PURPOSE: As many as half the patients presenting with acute stroke access medical care through the ambulance service. In order to identify and triage these patients effectively as life-threatening emergencies, telephone-based ambulance software must have high sensitivity and specificity when using verbal descriptions to identify such patients. Software-based clinical coding was compared with the patient's final clinical diagnosis for all patients admitted by ambulance to North Hampshire Hospital (NHH) emergency department (ED) over a 6-month period to establish the ability of telephone-based triage to identify patients with likely stroke accurately. METHODS: All emergency calls to South Central Ambulance Service over a 6-month period resulting in a patient being taken to NHH ED were reviewed. The classification allocated to the patient by ambulance advanced medical priority dispatch software (AMPDS version 11.1) was compared with the final clinical diagnosis made by a doctor in the ED. RESULTS: 4810 patients were admitted to NHH during the study period. Of these, 126 patients were subsequently diagnosed as having had a stroke. The sensitivity of AMPDS software for detecting stroke in this sample was 47.62%, specificity was 98.68%, positive predictive value was 0.49 and negative predictive value was 0.986. CONCLUSIONS: Fewer than half of all patients with acute stroke were identified using telephone triage on the initial emergency call to the ambulance service. Less than one quarter received the highest priority of ambulance response. This first link in the chain of survival needs strengthening in order to provide prompt and timely emergency care for these patients. [ABSTRACT FROM AUTHOR]

The pain of venous cannulation and arterial puncture can be greatly lessened by local anaesthesia. We sought information about the use of local anaesthesia for these procedures by doctors working in medicine, surgery and anaesthetics. A questionnaire was hand-delivered to 178 doctors in eight hospitals, all of whom responded. For insertion of large-bore cannulae, local anaesthesia was used by all the anaesthetists but less than half the medical and surgical doctors. For arterial blood sampling it was used by 60% of anaesthetists and 2% of ward doctors. Previous recommendations to use local anaesthesia seem to have been ignored, and in many instances these procedures are more painful than necessary. [ABSTRACT FROM AUTHOR]