| 1. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards.
- 2023
-
Ingår i: Scandinavian journal of trauma, resuscitation and emergency medicine. - 1757-7241. ; 31:1
-
Tidskriftsartikel (refereegranskat)abstract
- Mass casualty incidents (MCI) pose significant challenges to existing resources, entailing multiagency collaboration. Triage is a critical component in the management of MCIs, but the lack of a universally accepted triage system can hinder collaboration and lead to preventable loss of life. This multinational study uses validated patient cards (cases) based on real MCIs to evaluate the feasibility and effectiveness of a novel Translational Triage Tool (TTT) in primary triage assessment of mass casualty victims.Using established triage systems versus TTT, 163 participants (1575 times) triaged five patient cases. The outcomes were statistically compared.TTT demonstrated similar sensitivity to the Sieve primary triage method and higher sensitivity than the START primary triage system. However, the TTT algorithm had a lower specificity compared to Sieve and higher over-triage rates. Nevertheless, the TTT algorithm demonstrated several advantages due to its straightforward design, such as rapid assessment, without the need for additional instrumental interventions, enabling the engagement of non-medical personnel.The TTT algorithm is a promising and feasible primary triage tool for MCIs. The high number of over-triages potentially impacts resource allocation, but the absence of under-triages eliminates preventable deaths and enables the use of other personal resources. Further research involving larger participant samples, time efficiency assessments, and real-world scenarios is needed to fully assess the TTT algorithm's practicality and effectiveness in diverse multiagency and multinational contexts.
|
|
| 2. |
- Montán, Kristina Lennquist, et al.
(författare)
-
A method for detailed determination of hospital surge capacity: a prerequisite for optimal preparedness for mass-casualty incidents
- 2022
-
Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1863-9941.
-
Tidskriftsartikel (refereegranskat)abstract
- Background Defined goals for hospitals' ability to handle mass-casualty incidents (MCI) are a prerequisite for optimal planning as well as training, and also as base for quality assurance and improvement. This requires methods to test individual hospitals in sufficient detail to numerically determine surge capacity for different components of the hospitals. Few such methods have so far been available. The aim of the present study was with the use of a simulation model well proven and validated for training to determine capacity-limiting factors in a number of hospitals, identify how these factors were related to each other and also possible measures for improvement of capacity. Materials and methods As simulation tool was used the MACSIM (R) system, since many years used for training in the international MRMI courses and also successfully used in a pilot study of surge capacity in a major hospital. This study included 6 tests in three different hospitals, in some before and after re-organisation, and in some both during office- and non-office hours. Results The primary capacity-limiting factor in all hospitals was the capacity to handle severely injured patients (major trauma) in the emergency department. The load of such patients followed in all the tests a characteristic pattern with "peaks" corresponding to ambulances return after re-loading. Already the first peak exceeded the hospitals capacity for major trauma, and the following peaks caused waiting times for such patients leading to preventable mortality according to the patient-data provided by the system. This emphasises the need of an immediate and efficient coordination of the distribution of casualties between hospitals. The load on surgery came in all tests later, permitting either clearing of occupied theatres (office hours) or mobilising staff (non-office hours) sufficient for all casualties requiring immediate surgery. The final capacity-limiting factors in all tests was the access to intensive care, which also limited the capacity for surgery. On a scale 1-10, participating staff evaluated the accuracy of the methodology for test of surge capacity to MD 8 (IQR 2), for improvement of disaster plans to MD 9 (IQR 2) and for simultaneous training to MD 9 (IQR 3). Conclusions With a simulation system including patient data with a sufficient degree of detail, it was possible to identify and also numerically determine the critical capacity-limiting factors in the different phases of the hospital response to MCI, to serve as a base for planning, training, quality control and also necessary improvement to rise surge capacity of the individual hospital.
|
|
| 3. |
|
|
| 4. |
- Björses, Katarina, et al.
(författare)
-
In vitro and in vivo evaluation of chemically modified degradable starch microspheres for topical haemostasis
- 2011
-
Ingår i: ACTA BIOMATERIALIA. - : Elsevier Science B.V. Amsterdam. - 1742-7061 .- 1878-7568. ; 7:6, s. 2558-2565
-
Tidskriftsartikel (refereegranskat)abstract
- Degradable starch microspheres (DSMs) are starch chains cross-linked with epichlorhydrin, forming glycerol-ether links. DSMs have been used for many years for temporary vascular occlusion and drug delivery in treatment of malignancies. They are also approved and used for topical haemostasis by absorbing excess fluid from the blood and concentrating endogenous coagulation factors, thereby facilitating haemostasis. This mechanism of action is not sufficient for larger bleedings in current chemical formulations of DSMs, and modification of DSMs to trigger activation of platelets or coagulation would be required for use in such applications. Chemical modifications of DSMs with N-octenyl succinic anhydride, chloroacetic acid, acetic anhydride, diethylaminoethyl chloride and ellagic acid were performed and evaluated in vitro with thrombin generation and platelet adhesion tests, and in vivo using an experimental renal bleeding model in rat. DSMs modified to activate platelets in vitro were superior in haemostatic capacity in vivo. Further studies with non-toxic substances are warranted to confirm these results and develop the DSM as a more effective topical haemostatic agent.
|
|
| 5. |
- Elmqvist, Carina, 1964-, et al.
(författare)
-
Trauma
- 2016. - 1
-
Ingår i: Omvårdnad & kirurgi. - Lund : Studentlitteratur AB. - 9789144088860 ; , s. 57-74
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 6. |
|
|
| 7. |
- Montán, Carl
(författare)
-
Bleeding in abdominal aortic aneurysm repair
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Massive bleeding in open abdominal aortic aneurysm (AAA) repair is associated with worse outcome. However, few studies have investigated specific problems related to perioperative bleeding and blood transfusion in elective or emergent AAA repair with open (OR) or endovascular (EVAR) aneurysm repair. The overall aim of this thesis project was to investigate the clinical problem of bleeding in open and endovascular repair in both ruptured and elective AAA, including treatment of bleeding and association to risk factors and outcome in this patient group. Patients and Methods: The studies were retrospective and based on medical records (all) and regional and national registries (Papers II-IV). Paper I studied the Fascia Suture Technique (FST) as closure method for hemostasis in 160 femoral access sites after EVAR in AAA patients. Paper II investigated ruptured (rAAA) and non-rAAA cases undergoing EVAR in 525 patients. Perioperative bleeding and the association to mortality and morbidity was investigated. Paper III investigated preoperative coagulation tests and their association to preoperative hypotension and perioperative bleeding and outcome in 91 rAAA patients. Paper IV studied blood transfusion in 369 ruptured AAA (rAAA) patients undergoing OR or EVAR. Timing of blood transfusion and time dependent ratios of blood products were studied and related to method of repair and outcome. Results: In Paper I FST was associated with a 91% success rate. Complications were two pseudoaneurysms (PA) at 30-day follow-up and nine <1cm PA at 1-year. No specific preoperative risk factor for failure of the method was found. In Paper II a perioperative bleeding of >2 liters was independently associated with increased mortality (non-rAAA patients odds ratio 30; 95% CI [3.6, 145], rAAA patients odds ratio 10.7; 95% CI [3.2, 36.1]) and morbidity in non- and rAAA cases. Open femoral access, branched EVAR and larger diameter introducers were associated with increased perioperative blood loss. In Paper III low preoperative fibrinogen concentration (<1.5 g/L) was significantly associated with preoperative hypotension (systolic blood pressure <70 mmHg), increased perioperative bleeding and worse outcome after rAAA. In Paper IV delayed platelet transfusion (>1h) was associated with increased mortality in rAAA patients requiring massive transfusion (>10 units within 24 h or 4 units within 1 h). Fifty-five percent of rAAA patients repaired by EVAR received massive transfusion. Transfusion ratios of 1:1 for fresh frozen plasma (FFP):red blood cells (RBC) were associated with lower mortality. Ratios of platelets (PLT):RBC increased significantly over the study period. Conclusions: • Fascia Suture Technique proved feasible and safe with a low complication rate. Introducer size had no impact on outcome. No preoperative risk factors for failure were found. • A perioperative blood loss exceeding 2 liters in EVAR was independently associated with increased mortality and morbidity in both acute and elective AAA patients. Procedural risk factors for increased perioperative bleeding were open femoral access, fascia suture technique, branched stent grafts and aneurysm diameter. • Preoperative fibrinogen concentrations below 1.5 g/L were associated with a ten-fold increased risk of perioperative bleeding of more than 2 liters in rAAA. Low fibrinogen concentration should be suspected in patients with preoperative hypotension. • A ratio FFP: RBC close to 1:1 in EVAR and open repaired patients was associated with lower mortality. • Delayed (>1h) platelet transfusion was associated with significantly increased mortality. Ratios of PLT:RBC have increased over the last years. • Transfusion strategies in patients undergoing rAAA treatment with EVAR or open repair need further research. Also the definitive role of fibrinogen in patients with rAAA and hemodynamic shock need to be investigated in future studies.
|
|
| 8. |
|
|
| 9. |
- Montan, Carl, et al.
(författare)
-
Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.
- 2011
-
Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 18:6, s. 789-796
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose: To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Methods: Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Results: Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. Conclusion: The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.
|
|
