Audit of the prehospital management of severe head injured patients in the "Pays-de-la-Loire" region

Annales Françaises D'anesthèsie Et De Rèanimation
G BouhoursL Beydon

Abstract

To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005. Prospective and multicenter. All patients managed by Samu with GCS</=8 on the field, starting from a GCS</=10. We report on 125 patients (88% of all SHIP managed in 2005), including 114 with a GCS less or equal to eight on which analysis was performed: age: 37+/-20 years, men: 4/1, road accident: 73%, fall: 20%, (polytrauma: 53%, artificial ventilation: 92%). Delays: field medical care 54+/-28 min, transportation: 32+/-29 min, total time to hospital: 1 h 55+/-48 min. Direct admission in a center with neurosurgery on site: 68%; 47% of patients admitted in general hospitals were transferred to a tertiary hospital (71% to neurosurgery). Mortality before 24th hour (23%) was associated (p<0.05) with shorter transfer time, older patient, persistent shock, fluid loading greater than 1500 ml, continuous infusion of vasopressors, focal neurological deficit. Problems were reported by Samu teams (21% of cases): medical care (32%), emergency ambulance availability (20%), alerting process (16%), on field care before Samu (12%). Of note, mannitol was never used, despite a mydriasis. We observed...Continue Reading

References

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Citations

Mar 31, 2012·Annales Françaises D'anesthèsie Et De Rèanimation·A PuidupinUNKNOWN groupe d’experts Sfar-SFMU
Feb 4, 2011·Acta Anaesthesiologica Scandinavica·K TazarourteB Vigué

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