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Biomedical subjects

R J O'Malley

Publications and source records attributed to R J O'Malley.

10 recordsLinked to original sources
PubMed1994

Neuromuscular blockade-assisted oral intubation versus nasotracheal intubation in the prehospital care of injured patients.

STUDY OBJECTIVE: To compare nasotracheal intubation (NTI) to neuromuscular blockade-assisted oral intubation (NMB-assisted oral intubation) in the prehospital care of injured patients. DESIGN: Prospective, randomized study conducted over 21 months. SETTING: A university hospital-sponsored helicopter service. PARTICIPANTS: Consecutive adult (more than 12 years old) injured patients at the accident scene with an initial Glasgow Coma Scale of 8 or less in whom the airway was not managed immediately by unrelaxed oral intubation or cricothyrotomy. Subjects were randomized by 24-hour time blocks into NTI or NMB-assisted oral intubation treatment groups. Forty-four were entered into the NTI group (39 randomized, two crossed over to NMB-assisted oral intubation), and 33 were entered into the NMB-assisted oral intubation group (38 randomized, seven crossed over to NTI). INTERVENTIONS: NMB-assisted oral intubation (succinylcholine 1.5 mg/kg IV) or NTI was carried out according to standard protocols. RESULTS: The success rate for NTI was 79.5% (35 of 44) and was similar to that of NMB-assisted oral intubation, 75.8% (25 of 33; chi 2 = .16; P = .69). There were no significant differences between the NTI and the NMB-assisted oral intubation groups with regard to sex, age, outcome, and Glasgow Coma Scale. For those patients in whom the initial technique was successful, NTI was significantly quicker than NMB-assisted oral intubation (mean time of NTI, 2.9 minutes; mean time of NMB-assisted oral intubation, 5.9 minutes; Mann-Whitney U, 168.0; P < .01). CONCLUSION: In the prehospital management of severely injured patients, there is no significant difference between NMB-assisted oral intubation and NTI in the rate at which endotracheal intubation is achieved. However, practitioners may prefer NTI because it requires significantly less time to perform than NMB-assisted oral intubation.

Adult↗
PubMed1994

Monitoring the appropriateness of air medical transports.

INTRODUCTION: With pending changes in the health-care system, there are increasing pressures for each aspect of health care to justify its use. Several organizations, including the Association of Air Medical Services (AAMS), have published position papers listing appropriate indications for air medical services. Additionally, the Commission on Accreditation of Air Medical Services (CAAMS) specifies that air medical services monitor their flights for appropriateness. The purpose of this study was to determine how often the air medical transports by this program met at least one of the AAMS criteria. METHOD: The AAMS position paper was paraphrased into an equivalent checklist and a category, "None of the above criteria met," was added. Immediately after each transport, a flight nurse indicated on the checklist which criteria the patient met supported by documentation in the flight care record. RESULTS: During a one-year period (March 1, 1992 through February 28, 1993), 558 patients were transported. Of these, 547 (98%) met at least one of the AAMS appropriate-use criteria. CONCLUSION: The AAMS "Appropriate Use of Air Medical Services" position paper provides a foundation to monitor the utilization of an air medical transport program, which can be used to meet both government payer requirements for justification and the CAAMS requirement for utilization review.

Air Ambulances↗
PubMed1990

Differences in air ambulance patient mix demonstrated by physiologic scoring.

Severity of illness or injury should be the primary justification for aeromedical transport. To determine whether differences in patient severity were detectable in air transport programs, helicopter-transported patients were examined by three established physiologic scores: the Trauma Score, the Acute Physiology and Chronic Health Evaluation Score, and the Rapid Acute Physiology Score. These scores were obtained prospectively on 1,868 consecutive patient transfer requests from six air medical services for periods ranging from two to six months. A patient meeting strict physiologic criteria was considered critically ill. Overall, 42.6% of the patients (range, 34.8% to 53.3%) were considered critically ill. Patients transported from inpatient hospital units and patients with cardiac disease were less likely to be critically ill than those transported emergently from scenes of accident or from emergency departments. There were also significant differences between programs with regard to the percentage of critically ill patients transported. This study suggests that physiologic scoring may be useful in comparing air ambulance programs and that a majority of patients transported by these services may not be critically ill.

Aircraft↗
PubMed1990

The effect of an airway algorithm on flight nurse behavior.

This study examined the effects of a clinical algorithm (based on Glasgow Coma Scale) on the airway management of patients transported from the scene of accident or illness by a helicopter emergency medical service staffed with two flight nurses. The year before institution of the algorithm was compared to the subsequent year. Patients from the two years were similar with regard to diagnoses and physiologic status. Patients transported after the introduction of the algorithm were over twice as likely to have had an airway maneuver attempted. An algorithm defining when airway maneuvers ought to be attempted in the field may assist flight nurses in more aggressively managing airways.

Aircraft↗
PubMed1990

APACHE II scoring in the injured patient.

The purpose of this study was to measure the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE II) with respect to mortality in a group of seriously injured patients and to compare this predictive power with that of the Trauma Score (TS) and the Injury Severity Score (ISS). Six hundred ninety-one helicopter-transported patients were studied. Individual logistic regressions demonstrated that all three scores had significant predictive power when considered individually (TS chi 2 = 136, p less than .0001; APACHE II chi 2 = 171, p less than .0001; ISS chi 2 = 109, p less than .0001). In addition, each severity score added significantly to the predictive power in a stepwise logistic regression (TS chi 2 = 15, p less than .0001; APACHE II chi 2 = 45, p less than .0001; ISS chi 2 = 15, p less than .0001). Areas under the receiver operating curves for the three scores were not significantly different (TS 0.8116, SD 0.0245; APACHE II 0.8515, SD 0.0204; ISS 0.7967; SD 0.0223). APACHE II is a good predictor of mortality, and its predictive power is complemented by TS and ISS.

Adolescent↗
PubMed1990

Rapid acute physiology scoring in transport systems.

A multi-institutional study was undertaken to define the predictive power for mortality of the Rapid Acute Physiology Score (RAPS) in a large and diverse group of transported patients. RAPS is a truncated version of the Acute Physiology and Chronic Health Evaluation (APACHE II) score that uses definitions and weighting consistent with APACHE II, but is modified to provide a consistent score just before transport, just after transport, and to use the most deranged (worst) physiologic values during the initial 4 h after arrival at the receiving hospital. During an 8-month period, 1,927 patients transported by six helicopter emergency medical service programs were studied. Over 97% (1,881) of the patients had RAPS obtained before and after transport to the receiving hospital and 92.6% (1,785) had APACHE II scoring completed after hospital admission. Receiver operating curves demonstrate similar predictive power for RAPS and APACHE II (both based on the most deranged physiologic values during the initial 24 h after admission). Before- and after-transport RAPS were also highly predictive of mortality. RAPS appears to be a reliable and highly predictive measure of patient severity/physiologic stability before and after transport to critical care.

Adult↗
PubMed1988

Field airway management of the trauma patient: the efficacy of bag mask ventilation.

There is no consensus on what constitutes appropriate field airway management in the seriously injured semiconscious patient. The respiratory complications in a selected group of patients who were transported from the scene of an accident by a helicopter service whose policy was to perform endotracheal intubation on only deeply obtunded patients and manage others with bag mask ventilation are reported. Respiratory compromise was defined as follows: partial pressure of oxygen less than 65 torr on initial hospital arterial blood gases, partial pressure of carbon dioxide greater than 45 torr on initial hospital arterial blood gases, or radiographic and clinical evidence of aspiration pneumonitis within 5 days of admission to the hospital. From a total of 116 patients transported from the scene of an accident during the period of this investigation, there were 42 patients with Trauma Scores between 4 and 14 whose records were studied in detail. Ten of these patients ha adequate perfusion and abnormal arterial blood gases after arrival at the receiving hospital. Five patients might have benefited from endotracheal intubation in the field, but there were no preventable deaths. Neurologic status of the patient appeared to be more useful than respiratory status in predicting respiratory compromise.

Aircraft↗
PubMedDate not supplied

Contribution of air medical personnel to the airway management of injured patients.

INTRODUCTION: Air medical services are being pressured to demonstrate their value. Airway management is the first priority of care when treating injured patients in the prehospital setting. Injured patients with decreased Glasgow Coma Scale (GCS) are candidates for advanced airway procedures and air medical transport. RESEARCH QUESTION: The purpose of this study was to determine the extent of air medical crews' contributions to the airway management of the injured patient in the prehospital setting. METHOD: A study of adult (age > 12 years) injured patients encountered in a field setting, whose GCS on the arrival of the air medical crew was < or = 8, was conducted for 21 months (Feb. 1, 1991-Oct. 31, 1992). RESULTS: During the study period, 174 patients who met the criteria were transported by the air medical crew. All but one received advanced airways including oral tracheal intubation, nasal tracheal intubation or cricothyrotomy. Of those, 68 (39%) of these procedures were completed by ground personnel (ground group), and 105 (61%) were completed by the air medical personnel (air group). The mean GCS for the ground group was 3.69 and for the air group was 4.69. The distributions were significantly different (Wilcoxon Rank Test p = 0.0002). Nineteen percent (13/68) of the patients whose airways were successfully managed by the ground personnel had a GCS of 5 to 8, as did 44% (46/105) of the air group's patients. The groups' patients were not significantly different in age or sex distribution. CONCLUSION: Properly trained air medical personnel positively contribute to the prehospital care of injured patients by establishing definitive airways in patients with higher GCSs.

Adolescent↗