Abdominal-pelvic hemorrhage (i.e., originates below the diaphragm and above the inguinal ligaments) is a major cause of death. It has diverse etiology but is typically associated with gunshot or stab ...wounds, high force or velocity blunt trauma, aortic rupture, and peripartum bleeds. Because there are few immediately deployable, temporizing measures, and the standard approaches such as direct pressure, hemostatics, and tourniquets are less reliable than they are with compressible extremity injuries, risk for death resulting from abdominal-pelvic hemorrhage is high. This review concerns the exciting potential of proximal external aortic compression (PEAC) as a temporizing technique for life-threatening lower abdominal-pelvic hemorrhage. PEAC can be accomplished by means of a device, two locked arms (manual), or a single knee (genicular) to press over the midline supra-umbilical abdomen. The goal is to compress the descending aorta and slow or halt downstream hemorrhage while not delaying more definitive measures such as hemostatic packing, tourniquets, endovascular balloons, and ultimately operative repair.
Clinical review of the Ovid MEDLINE, In-Process, & Other Non-Indexed, and Google Scholar databases was performed for the period ranging from 1946 to 3 May 2019 for studies that included the following search terms: proximal external aortic compression OR vena cava compression AND (abdomen or pelvis) OR (hemorrhage) OR (emergency or trauma). In addition, references from included studies were assessed.
Sixteen studies met the inclusion criteria. Evidence was grouped and summarized from the specialties of trauma, aortic surgery, and obstetrics to help prehospital responders and guide much-needed additional research, with the goal of decreasing the high risk for death after life-threatening abdominal-pelvic hemorrhage.
This is the summary publication of the International Liaison Committee on Resuscitation’s 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most ...recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.
The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.
A focus group (N = 36) consisting of board of trustee members, community college presidents, senior administrators, administrators, and faculty members from community colleges around the United ...States developed the top six critical issues faced with respect to instructional planning and services; planning, governance, and finance; and workforce development. Thereafter, the delegation of more than 100 voted on various aspects of these issues. The findings detail a shift away from pragmatic problems or opportunities of today, such as K-20 alignment, retention, and sustainability, to more life-long learning, globalization, and focus upon innovation and partnerships.
Deciding to post a manuscript preprint Castner, Jessica; Amberson, Taryn; Lee Gillespie, Gordon ...
Nurse author & editor,
December 2020, 2020-12-00, Letnik:
30, Številka:
4
Journal Article
•From 560 screened references, we included 4 studies. Out of 5978 patients, 2893 (48%) reported a cooling duration of ≥20 min•IWe found no association between duration of cooling and size/depth of ...burn, days to re-epithelialization or skin grafting.•Confidence in the estimate of effect, for the outcomes evaluated, was very low due to very serious risk of bias
Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations.
To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications?
We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness.
The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation.
Historians working in the classical liberal tradition believe that individual decision-making and individual rights matter in the making of history. History written in the classical liberal tradition ...emerged largely in the nineteenth century, when the field of history was first professionalized in Europe and the Americas. Professional historical research was then imbued with liberal values, which included rigorous attention to the sources, historicist suspicion of an ultimate mover, an honest and dispassionate rational outlook, and humility towards what could be known. Above all, liberals wanted to chart the history of liberty, warn against threats to liberty, and defend it in an evolving political world. They believed history was real, and that it had lessons to teach, but that these lessons could not provide sufficient knowledge to predict the future or reorganize society around a central plan. This book demonstrates how the classical liberal tradition in historical writing persists to this day, but how it is often neglected and due for renewal. The book contrasts the classical liberal view on history with conservative, progressive, Marxist, and post-modern views. Each of the eleven chapters address a different historical topic, from the development of classical liberalism in nineteenth century America to the the history of civil liberties and civil rights that stemmed from this tradition. Authors give particular attention to the importance of social and economic analysis. Each contributor was chosen as an expert in their field to provide a historiographical overview of their subject, and to explain what the classical liberal contribution to this historiography has been and should be. Authors then provide guidance towards possible tools of analysis and related research topics that future historians working in the classical liberal tradition could take up. The authors wish to call upon other historians to recognize the important contributions to historical understanding that have come and can be provided by the insights of classical liberalism.
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