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Purpose: Evaluation of trauma patients with chest tube malposition using initial emergency computed tomography (CT) and assessment of outcomes and the need for chest tube replacement., Methods: Patients with an injury severity score > 15, admitted directly from the scene, and requiring chest tube insertion prior to initial emergency CT were retrospectively reviewed. Injury severity, outcomes, and the positions of chest tubes were analyzed with respect to the need for replacement after CT., Results: One hundred seven chest tubes of 78 patients met the inclusion criteria. Chest tubes were in the pleural space in 58% of cases. Malposition included intrafissural positions (27%), intraparenchymal positions (11%) and extrapleural positions (4%). Injury severity and outcomes were comparable in patients with and without malposition. Replacement due to malfunction was required at similar rates when comparing intrapleural positions with both intrafissural or intraparenchymal positions (11 vs. 23%, p = 0.072). Chest tubes not reaching the target position (e.g., pneumothorax) required replacement more often than targeted tubes (75 vs. 45%, p = 0.027). Out-of-hospital insertions required higher replacement rates than resuscitation room insertions (29 vs. 10%, p = 0.016). Body mass index, chest wall thickness, injury severity, insertion side and intercostal space did not predict the need for replacement., Conclusions: Patients with malposition of emergency chest tubes according to CT were not associated with worse outcomes compared to patients with correctly positioned tubes. Early emergency chest CT in the initial evaluation of severely injured patients allows precise detection of possible malposition of chest tubes that may require immediate intervention.

Background: In Germany more than 110,000 helicopter emergency medical service (HEMS) missions are carried out annually. A considerable number of patients are ventilated during the flight. So far, structured surveys with respect to the ground transport from the helipad to the hospital facility and handover of ventilated patients in the emergency room (ER) are not available in the German-speaking HEMS system. The handover of ventilated HEMS patients in the ER (HOVER I study) explored the use of the helicopter ventilator and medical equipment during the transport from the hospital landing site to the ER., Method: After approval by the HEMS operators, emergency medical doctors and HEMS technical crew members (HEMS-TC) of 145 German-speaking HEMS bases were invited to participate in an anonymous online survey (period: 1 February 2018-1 March 2018). Each participant was only allowed to submit the survey once., Results: Data of 569 participants were completely analyzed, with responses from 429 emergency physicians and 140 HEMS-TC (75% from Germany, 13% Switzerland, 11% Austria, 1% Italy and Luxembourg). The most frequent type of aircraft used was the Eurocopter (EC)/Airbus helicopter (H) 135 (60.5%) followed by the EC/H 145 (33%). The majority of the respondents (53%) principally used the helicopter ventilator machine for patient transport from the helipad to the ER, 38% used it depending on the circumstances and 7% never used it. Of the participants 52% always took the emergency backpack for patient transport to the ER, 43% depending on the situation and 5% never took it along. The availability of oxygen or a ventilator at the helipad was considered to be helpful (59% and 45%, respectively), obligatory (25% and 14%, respectively) but was also considered unnecessary by some participants (16% and 40%, respectively). The collection of the HEMS team by a hospital team at the helipad was rated as helpful (64%) or mandatory (19%), 12% considered it to be unimportant and 5% even disturbing. For most respondents (58.5%) the responsibility for the patient ended after a structured handover on reaching the internal hospital target area (e.g. the ER)., Conclusion: The management of the handover of ventilated emergency patients in German-speaking HEMS is heterogeneously structured. Only approximately 50% of the participants frequently carried the helicopter ventilator and emergency equipment during patient transport to the ER. Depending on the situation, more than 90% of the respondents used the helicopter ventilator and emergency backpack during the transport. The collection of the HEMS team by a hospital team at the helipad was appreciated by the majority of participants. The use of the helicopter ventilator for patient transport to the ER needs to be explored in future studies. The study was registered at the Research Registry ( www.researchregistry.com ) under the following number: researchregistry2925.

The objective of this study was to analyze the prehospital use of a Glidescope video laryngoscope (GSVL) due to anticipated and unexpected difficult airway in a helicopter emergency medical service setting in which emergency physicians (EP) are experienced anesthetists. Retrospective observational study and survey of the experiences of EP were conducted for more than a 3-year period (July 2007-August 2010). In 1675 missions, 152 tracheal intubations (TI) were performed. GSVL was used in 23 cases (15%). A total of 17 patients presented with multiple traumas, including nine with cervical spine immobilization, three with burns, and three with nontraumatic diagnoses. Eight patients experienced previously failed TI with conventional laryngoscopy (five by nonhelicopter emergency medical service EP). In two patients, the EP required two attempts with GSVL to obtain a successful TI. Since the introduction of the GSVL, no other backup airway device was necessary. GSVL may be a valuable support instrument in the prehospital management of difficult airways in emergency patients., (© 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.)