Prehospital nausea and vomiting after trauma: Prevalence, risk factors, and development of a predictive scoring system

4A after access: a new mnemonic to aid timely administration of IV/IO treatment in trauma patients

Administration of medication is a well-established part of prehospital trauma care. Guidance varies on the types of recommended medications and when they should be administered. Mnemonics have become commonplace in prehospital medicine to facilitate recall and retention. However, there is no comprehensive aid for the administration of medication in trauma patients. We propose a new mnemonic for the delivery of relevant intravenous or intraosseous medications in trauma patients. A '4A after Access' approach should enhance memory recall for the efficient provision of patient care. These 4As are: antifibrinolysis, analgesia, antiemesis and antibiotics. This mnemonic is designed to be used as an optional aide memoire in conjunction with existing treatment algorithms in the military prehospital setting.

Analysis of two treatment modalities for the prevention of vomiting after trauma: Orogastric tube or anti-emetics

INTRODUCTION

Vomiting in the emergency department after trauma occurs frequently and might lead to aspiration of gastric content. An orogastric tube (OGT) is a way to prevent emesis. However, this is an inconvenient procedure and may actually trigger vomiting. Therefore, a change in policy was applied from preferably an OGT to the administration of anti-emetics in a selected population. The aim of this study was to analyse the prevention of vomiting in trauma patients after OGT or anti-emetics.

MATERIALS AND METHODS

Retrospective cohort study. Data of all trauma patients presented at the crash room of the emergency department between July 1st 2013 and July 1st 2014 were collected from the local trauma registry and electronic patient documentation system and comprising 6 months preceding and 6 months after change of policy. Vomiting and nausea after trauma were recorded. Furthermore, complications such as aspiration and cardiac arrhythmias were documented.

RESULTS

A total of 1446 patients were presented after trauma. 230 patients were promptly intubated. An additional 763 patients were fully responsive and did not complain of nausea. The remaining 453 patients were further analysed. 44 patients received OGT placement procedure and 409 patients received anti-emetics. Significant difference was found in patients vomiting after OGT placement or anti-emetics (20.5% vs. 2.7%; P<0.001). Patients who received anti-emetics were not more at risk for cardiac arrhythmias. After matched control analysis, there was still a significant difference was found.

DISCUSSION AND CONCLUSION

Administration of anti-emetics is suitable and effective for the prevention of vomiting after trauma in this selected population, without an increased risk for complications.

Preventing and alleviating patients' symptoms of nausea and vomiting while in the care of the ambulance service - a qualitative study

AIM

The aim of this study was to describe the ambulance personnel's experiences of preventing and alleviating patients' symptoms of nausea and vomiting.

BACKGROUND

Nausea is a common symptom in patients taken care of by the ambulance service. It is a complex subjective phenomenon and can cause several different illnesses. The ambulance personnel have an important assignment in preventing and alleviating nausea through early interventions.

METHOD

A descriptive and qualitative design including 16 semi-structured interviews and content analysis was used.

RESULTS

One main category was identified: Adjusting care and medical treatment based on the individual patient's needs. By adjusting the care and medical treatment based on patients' individual needs and previous experience, the ambulance personnel experienced a possible relief of the patients' suffering caused by nausea and vomiting. In addition to the known multitude of underlying pathologies of nausea, the way of driving and the environment in the ambulances also may have an impact on the patients' nausea.

CONCLUSION

A variety of nursing interventions and medical treatments are reported to be used to alleviate nausea for patients cared for by the ambulance service, but further research is needed to evaluate if and how the interventions have an effect on the patients' experiences. The findings in our study can be used when developing guidelines on how to care for patients suffering nausea and vomiting.