The use of the Soterion Rapid Triage System in children presenting to the Emergency Department.

There has been a recent move toward the adoption of five-level triage systems in the United States. However, there have been no studies in this country that have critically evaluated the use of these systems in children. The purpose of this study was to evaluate the reliability and validity of a new five-level triage system, the Soterion Rapid Triage System, for stratifying acuity levels in children under the age of 13 years.

The Soterion Rapid Triage System: evaluation of inter-rater reliability and validity.

The Soterion Rapid Triage System is a new, computerized, five-level triage acuity system. The purpose of this study was to evaluate the system's inter-rater reliability and validity for stratifying patient acuity. The study was comprised of two components.

The EMS response to the Oklahoma City bombing.

This is a descriptive study of the Emergency Medical Services response to a bombing of a United States Federal Building in Oklahoma City, Oklahoma on 19 April 1995. The explosion emanated from a rented truck parked in the front of the building. The force of the explosion destroyed three of the four support columns in the front of the building and resulted in a pancaking effect of the upper floors onto the lower floors.

Guidelines for the prehospital use of thrombolytic agents.

Recognizing that prehospital thrombolytic therapy may provide benefit to certain subsets of patients, the routine prehospital use of thrombolytic agents should be discouraged pending further scientific delineation and documentation of those subgroups. ACEP encourages further investigation to document feasibility, efficacy, cost-effectiveness, and safety of use of these agents in this environment. Detailed education is needed in such areas as contraindications and the mechanics of drug administration.

Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial.

The safety and efficacy of 7.5% sodium chloride in 6% dextran 70 (HSD) in posttraumatic hypotension was evaluated in Houston, Denver, and Milwaukee. Multicentered, blinded, prospective randomized studies were developed comparing 250 mL of HSD versus 250 mL of normal crystalloid solution administered before routine prehospital and emergency center resuscitation.

Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension.

We report the results of the first clinical study on the use of a hypertonic saline-dextran solution for the prehospital management of hypotensive victims of penetrating trauma. During a 4-month period, 48 trauma patients with penetrating injuries and a prehospital systolic blood pressure of 90 mm Hg or less were infused in-field with 250 ml of either a hypertonic saline-dextran solution or the crystalloid plasmalyte A. There were no complications associated with the infusion of the hypertonic saline-dextran solution, and execution of the protocol by paramedic personnel was both safe and uniformly successful.

Combat casualty care research and informed consent.

Combat casualty care research on far-forward resuscitation is necessary for optimizing the future care of the wounded soldier. Present legal directives pertaining to the use of humans as subjects in Department of Defense (DOD)-funded research require that prior informed consent from the subjects or their legal representatives be obtained. Application of these legal directives to present and future combat casualty care research will ultimately obstruct significant progress toward optimizing the care of the injured soldier.

Resuscitation with 7.5% NaCl in 6% dextran-70 during hemorrhagic shock in swine: effects on organ blood flow.

We previously reported that small volume infusions of 7.5% NaCl in 6% dextran-70 (HSD) are superior to equal volumes of normal saline (NS) or 7.5% NaCl in the ability to resuscitate animals from an otherwise lethal hemorrhage.

Current shock models and clinical correlations.

No useful purpose is served by developing therapeutic interventions that are applicable only in nonexistent patient populations. The history of laboratory hemorrhagic shock research may be a case in point because although many interventions have been proposed on the basis of animal experimentation, few if any have found a place in the treatment of human beings. For a laboratory shock model to have clinical relevance, it must replicate important aspects of shock as seen in human beings during or following massive blood loss.

Epidemiology of trauma: military experience.

Battle injuries sustained in conventional warfare are more likely to be lethal than are injuries sustained by civilians. Depending on the tactical situation, mortality may range from 20% to more than 80% of all casualties. The American experience indicates that about 90% of the total mortality occurs on the battlefield.

Hypertonic sodium chloride solutions for the prehospital management of traumatic hemorrhagic shock: a possible improvement in the standard of care?

Acute hemorrhage is a major cause of death in both civilian and military trauma. The suboptimal effect of the volume of standard crystalloids that can be infused during transport has resulted in a need for a more efficacious fluid for the prehospital management of both civilian and military trauma. Markedly hypertonic sodium chloride solutions have been shown to improve transiently the hemodynamic consequences of shock in animal models.

Lack of efficacy of naloxone in a fixed-volume hemorrhage model.

Animal studies using a reservoir model of hemorrhagic shock have shown the narcotic antagonist naloxone to be of value in reversing the hemodynamic effects of severe hemorrhage. We conducted a study to evaluate the ability of naloxone to limit the deleterious effects of a fixed-volume hemorrhage. Fifteen mongrel dogs were bled 50% of their estimated blood volumes during one hour.

Small-volume infusion of 7.5% NaCl in 6% Dextran 70 for the treatment of severe hemorrhagic shock in swine.

In the initial treatment of the hypovolemic trauma patient, commonly used crystalloids have little clinical benefit in the small volumes generally infused during transport. We evaluated the efficacy of a small-volume infusion of 7.5% NaCl in 6% Dextran 70 as a treatment modality for an otherwise lethal hemorrhage in swine.

Regional blood flow during hypothermic arrest.

Little is known about the efficacy of CPR in the setting of hypothermia-induced cardiac arrest. We measured organ blood flow produced by conventional closed-chest CPR in eight swine following normothermic KCl-induced cardiac arrest and in seven swine surface-cooled until cardiac arrest occurred. Radiomicrospheres were injected in the unanesthetized basal state, after five minutes of CPR, and after 20 minutes of CPR.

Transcutaneous oxygen tension measurements during graded hemorrhage and reinfusion.

Measurement of transcutaneous oxygen tension (PtCO2) has been suggested as a useful monitoring tool in the hypovolemic patient. Our study was undertaken to evaluate changes in PtCO2 that occur during graded hemorrhage and reinfusion, and to compare PtCO2 values to standard cardiorespiratory and biochemical parameters during hypovolemia. Seven mongrel dogs were bled 50% of their estimated blood volume (44 mL/kg) over one hour.

Diaphragmatic rupture during G-maneuvers in a T33 jet trainer.

A 26-year-old white male, radar operator, participated in a flight in a U.S. Air Force T33 jet trainer.