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BMC Pediatrics Sep 2021We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as... (Review)
Review
We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.
Topics: Accidental Falls; Accidental Injuries; Accidents, Traffic; Burns; Child; Child, Preschool; Drowning; Humans; Infant; Risk Factors; Wounds and Injuries
PubMed: 34496772
DOI: 10.1186/s12887-021-02517-2 -
Chest Apr 2021Drowning is "the process of experiencing respiratory impairment from submersion or immersion in liquid." According to the World Health Organization, drowning claims the... (Review)
Review
Drowning is "the process of experiencing respiratory impairment from submersion or immersion in liquid." According to the World Health Organization, drowning claims the lives of > 40 people every hour of every day. Drowning involves some physiological principles and medical interventions that are unique. It occurs in a deceptively hostile environment that involves an underestimation of the dangers or an overestimation of water competency. It has been estimated that > 90% of drownings are preventable. When water is aspirated into the airways, coughing is the initial reflex response. The acute lung injury alters the exchange of oxygen in different proportions. The combined effects of fluid in the lungs, loss of surfactant, and increased capillary-alveolar permeability result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and alveolitis, a noncardiogenic pulmonary edema. Salt and fresh water aspirations cause similar pathology. If the person is not rescued, aspiration continues, and hypoxemia leads to loss of consciousness and apnea in seconds to minutes. As a consequence, hypoxic cardiac arrest occurs. The decision to admit to an ICU should consider the patient's drowning severity and comorbid or premorbid conditions. Ventilation therapy should achieve an intrapulmonary shunt ≤ 20% or Pao:Fio ≥ 250. Premature ventilatory weaning may cause the return of pulmonary edema with the need for re-intubation and an anticipation of prolonged hospital stays and further morbidity. This review includes all the essential steps from the first call to action until the best practice at the prehospital, ED, and hospitalization.
Topics: Combined Modality Therapy; Drowning; Emergency Service, Hospital; Emergency Treatment; Hospitalization; Humans; Near Drowning; Pulmonary Edema; Resuscitation
PubMed: 33065105
DOI: 10.1016/j.chest.2020.10.007 -
The New England Journal of Medicine Jun 2023Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after brain death are limited.
METHODS
We conducted a randomized, noninferiority trial in which adult candidates for heart transplantation were assigned in a 3:1 ratio to receive a heart after the circulatory death of the donor or a heart from a donor after brain death if that heart was available first (circulatory-death group) or to receive only a heart that had been preserved with the use of traditional cold storage after the brain death of the donor (brain-death group). The primary end point was the risk-adjusted survival at 6 months in the as-treated circulatory-death group as compared with the brain-death group. The primary safety end point was serious adverse events associated with the heart graft at 30 days after transplantation.
RESULTS
A total of 180 patients underwent transplantation; 90 (assigned to the circulatory-death group) received a heart donated after circulatory death and 90 (regardless of group assignment) received a heart donated after brain death. A total of 166 transplant recipients were included in the as-treated primary analysis (80 who received a heart from a circulatory-death donor and 86 who received a heart from a brain-death donor). The risk-adjusted 6-month survival in the as-treated population was 94% (95% confidence interval [CI], 88 to 99) among recipients of a heart from a circulatory-death donor, as compared with 90% (95% CI, 84 to 97) among recipients of a heart from a brain-death donor (least-squares mean difference, -3 percentage points; 90% CI, -10 to 3; P<0.001 for noninferiority [margin, 20 percentage points]). There were no substantial between-group differences in the mean per-patient number of serious adverse events associated with the heart graft at 30 days after transplantation.
CONCLUSIONS
In this trial, risk-adjusted survival at 6 months after transplantation with a donor heart that had been reanimated and assessed with the use of extracorporeal nonischemic perfusion after circulatory death was not inferior to that after standard-care transplantation with a donor heart that had been preserved with the use of cold storage after brain death. (Funded by TransMedics; ClinicalTrials.gov number, NCT03831048.).
Topics: Adult; Humans; Brain Death; Graft Survival; Heart Transplantation; Organ Preservation; Tissue and Organ Procurement; Tissue Donors; Death; Patient Safety
PubMed: 37285526
DOI: 10.1056/NEJMoa2212438 -
Journal of Forensic Sciences May 2020Elevators are mechanical transportation devices used to move vertically between different levels of a building. When first developed, elevators lacked the safety...
Elevators are mechanical transportation devices used to move vertically between different levels of a building. When first developed, elevators lacked the safety features. When safety mechanisms were developed, elevators became a common feature of multistory buildings. Despite their well-regarded safety record, elevators are not without the potential for danger of injury or death. Persons at-risk for elevator-related death include maintenance and construction workers, other employees, and those who are prone to risky behavior. Deaths may be related to asphyxia, blunt force, avulsion injuries, and various forms of environmental trauma. In this review, we report on 48 elevator-related deaths that occurred in nine different medicolegal death investigation jurisdictions within the United States over an approximately 30-year period. The data represents a cross-section of the different types of elevator-related deaths that may be encountered. The review also presents an overview of preventive strategies for the purpose of avoiding future elevator-related fatalities.
Topics: Accidental Falls; Accidents, Home; Accidents, Occupational; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Asphyxia; Cause of Death; Child; Crush Injuries; Drowning; Electric Injuries; Elevators and Escalators; Female; Humans; Male; Middle Aged; Multiple Trauma; Occupational Health; Risk-Taking; Sex Distribution; Substance-Related Disorders; Young Adult
PubMed: 31703160
DOI: 10.1111/1556-4029.14235 -
Ugeskrift For Laeger Oct 2023According to the International Life Saving Federation (ILS), integrating lifeguards in the local or regional emergency medical service (EMS) is a necessity to prevent... (Review)
Review
According to the International Life Saving Federation (ILS), integrating lifeguards in the local or regional emergency medical service (EMS) is a necessity to prevent drowning and improve prehospital treatment in selected situations. This review describes the organisation of lifeguards in Denmark, focusing on essential skills and equipment to assist prehospital EMS in drowning, out-of-hospital cardiac arrest, and search and rescue operations. Standardised requirements for the medical education of lifeguards are warranted to improve prehospital treatment and integration in the EMS.
Topics: Humans; Drowning; Emergency Medical Services; Cardiopulmonary Resuscitation; Out-of-Hospital Cardiac Arrest; Denmark
PubMed: 37873984
DOI: No ID Found -
The Medico-legal Journal Mar 2022Internationally, drowning is a leading cause of accidental death that features in many legal cases. In these cases, possible mitigations and the 'pain and suffering' in...
Internationally, drowning is a leading cause of accidental death that features in many legal cases. In these cases, possible mitigations and the 'pain and suffering' in terms of the duration and subjective experience of drowning are often pivotal in determining levels of compensation and outcome. As a result, there is a requirement to understand the stages of the drowning process, and the duration and physiological and subjective responses associated with each stage. In this short review we focus on these issues.
Topics: Drowning; Humans
PubMed: 34791956
DOI: 10.1177/00258172211053127 -
Annals of the Royal College of Surgeons... Sep 2022The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that 'fluid prescribing be given the same value as drug prescribing', yet fluid...
INTRODUCTION
The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that 'fluid prescribing be given the same value as drug prescribing', yet fluid prescription is commonly delegated to junior doctors despite being a notoriously challenging topic. When antibiotics are given as an infusion they are diluted in 100ml of fluid, which is often unaccounted for when thinking about a patient's fluid requirements. This closed-loop audit aimed to assess first, intravenous (IV) fluid therapy and second, electrolyte prescribing compliance with National Institute for Health and Care Excellence (NICE) guidelines, with and without the additional fluid given with antibiotic administration.
METHODS
Two retrospective audits were performed. Total fluid and electrolyte volume received with and without antibiotic fluids was correlated with recommendations in the NICE guidelines. Between cycles 1 and 2, potassium chloride with sodium chloride and glucose (PSG) was introduced as an alternative to IV maintenance fluid, and bolusing of antibiotics was mandatory.
RESULTS
When analysing total fluid volume input per day, 10.4% and 7.45% of patients met their fluid requirement accurately in the first and second cycles, respectively. Within cycle 1, the mean total additional fluid that was given over 3 days with antibiotics was 1,572.73ml. In cycle 2, this decreased to 469.44ml when antibiotics were given as a bolus.
CONCLUSIONS
In this closed-loop audit we noted that patients receiving IV fluids and IV antibiotics received too much additional fluid when the antibiotic dilution fluid was taken into account. Additional fluid was reduced alongside the proportion of electrolyte complications when bolusing of antibiotics was introduced. We recommend that that all nurses are trained to give antibiotics as a bolus because it can help to reduce fluid-related complications.
Topics: Anti-Bacterial Agents; Drowning; Electrolytes; Fluid Therapy; Humans; Retrospective Studies
PubMed: 35639453
DOI: 10.1308/rcsann.2022.0043 -
Families, Systems & Health : the... Mar 2020Presents a brief story about the drowning death of a two year old child, the grief of the parents, and subsequent organ donation. (PsycInfo Database Record (c) 2020 APA,...
Presents a brief story about the drowning death of a two year old child, the grief of the parents, and subsequent organ donation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Topics: Child, Preschool; Critical Illness; Drowning; Humans; Tissue and Organ Procurement
PubMed: 32202841
DOI: 10.1037/fsh0000455 -
International Maritime Health 2022Venturing onto the water for business or pleasure is not a risk-free activity. Despite the dangers facing crew and passengers there is little data on the characteristics... (Review)
Review
BACKGROUND
Venturing onto the water for business or pleasure is not a risk-free activity. Despite the dangers facing crew and passengers there is little data on the characteristics of fatal accidents involving vessels in the water. The goal of this study was to review accident reports from the National Transportation Safety Board (NTSB) to determine characteristics of fatal marine accidents.
MATERIALS AND METHODS
Data was obtained from the Marine Accident Reports issued by the NTSB. Information regarding the number of people involved, fatalities and the accident itself was collected.
RESULTS
Fifty-two accidents involving 5045 people from 1972 to 2019 were included in the study, with 468 fatalities reported. Of the fatalities, 155 (33.1%) were definitely on the vessel when they died, 49 (10.5%) were probably on the vessel, 65 (13.9%) were definitely or likely in the water, and the location of 199 (42.5%) was unknown. The most common cause of death was drowning (88, 18.8%), the most common accident cause was sinking (63.5%), and accidents most often started during nighttime hours (7pm-7am, 30, 57.7%).
CONCLUSIONS
This study found that sinking was the most common accident cause for fatal marine accidents, drowning the most common cause of death, and where fatality location was known most were on the vessel when they died. This suggests that, particularly when a ship is in the process of sinking, it is of paramount importance to ensure passengers and crew are familiar with exit routes, are able to exit the vessel, and are instructed to do so in a timely manner.
Topics: Accidents; Drowning; Humans; Nitrobenzoates; Ships; Water
PubMed: 36217975
DOI: 10.5603/IMH.2022.0022 -
Italian Journal of Pediatrics Jun 2023Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The... (Review)
Review
Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.
Topics: Adolescent; Humans; Child; Drowning; Resuscitation; Oxygen
PubMed: 37316902
DOI: 10.1186/s13052-023-01464-1