Alexander Kober

Auricular Acupressure as a Treatment for Anxiety in Prehospital Transport Settings

Background Auricular acupuncture at the relaxation point has been previously shown to be an effective treatment for anxiety in the preoperative setting. The purpose of this prospective, randomized, blinded study was to determine whether auricular acupressure can reduce stress and anxiety during ambulance transport. Methods Patients who required ambulance transport secondary to medical conditions were randomized to receive auricular acupressure at the relaxation point (n = 17) or at a sham point (n = 19). A visual analog scale was used to assess state anxiety as well as patient anticipation of hospital medical treatment (estimated waiting period for treatment, anticipated pain during treatment, attitude toward the physicians, and treatment outcomes). These variables were assessed at baseline and on arrival to the hospital. Results Patients in the relaxation group reported significantly less anxiety than patients in the sham group on arrival to the hospital (visual analog scale mean ± SD: 37.6 ± 20.6 to 12.4 ± 7.8 mm vs. 42.5 ± 29.9 to 46.7 ± 25.9 mm, respectively;P = 0.002). Similarly, patient perception of pain during treatment (mean visual analog scale ± SD: 32.7 ± 27.7 to 14.5 ± 8.1 mm vs. 17.2 ± 26.1 to 28.8 ± 21.9 mm, respectively;P = 0.006) and treatment outcomes of their illnesses (mean visual analog scale ± SD: 46.7 ± 29.4 to 19.1 ± 10.4 mm vs. 35.0 ± 25.7 to 31.5 ± 20.5 mm, respectively;P = 0.014) were significantly more positive in the relaxation group than in the sham group. No differences were found in the other variables assessed. Conclusion It was concluded that auricular acupressure is an effective treatment for anxiety in prehospital emergency settings.

Prehospital Analgesia with Acupressure in Victims of Minor Trauma: A Prospective, Randomized, Double-blinded Trial

Untreated pain during the transportation of patients after minor trauma is a common problem in emergency medicine. Because paramedics usually are not allowed to perform invasive procedures or to give drugs for pain treatment, a noninvasive, nondrug-based method would be helpful. Acupressure is a traditional Chinese treatment for pain that is based on pain relief followed by a short mechanical stimulation of specific points. Consequently, we tested the hypothesis that effective pain therapy is possible by paramedics who are trained in acupressure. In a double-blinded trial we included 60 trauma patients. We randomly assigned them into three groups (“true points,” “sham-points,” and “no acupressure”). An independent observer, blinded to the treatment assignment, recorded vital variables and visual analog scales for pain and anxiety before and after treatment. At the end of transport, we asked for ratings of overall satisfaction. For statistical evaluation, one-way analysis of variance and the Scheffé F test were used. P < 0.05 was considered statistically significant. Morphometric and demographic data and potential confounding factors such as age, sex, pain, anxiety, blood pressure, and heart rate before treatment did not differ among the groups. At the end of transport we found significantly less pain, anxiety, and heart rate and a greater satisfaction in the “true points” groups (P < 0.01). Our results show that acupressure is an effective and simple-to-learn treatment of pain in emergency trauma care and leads to an improvement of the quality of care in emergency transport. We suggest that this technique is easy to learn and risk free and may improve paramedic-based rescue systems.

Forehead SpO2 monitoring compared to finger SpO2 recording in emergency transport

Continuous peripheral oxygen saturation monitoring using a finger pulse oximeter is standard in prehospital emergency medicine. Forehead peripheral oxygen saturation monitoring has been enhanced for better performance during movement and in cold ambient temperatures, both of which are common during emergency transport. We compared a new forehead monitor with standard finger pulse oximeter. The forehead technique had significantly fewer mean (SD) alarms per patient (3.0 (2.2)) than the finger pulse oximeter (7.8 (4.0)) and shorter durations of malfunction (76 (60) s compared to 333 (170) s) when using the finger pulse oximeter. We conclude that measuring peripheral oxygen saturation monitoring with a forehead sensor provides better monitoring quality in emergency care.

A Randomized Controlled Trial of Oxygen for Reducing Nausea and Vomiting During Emergency Transport of Patients Older Than 60 Years With Minor Trauma

OBJECTIVE To test the hypothesis that oxygen administration reduces nausea and vomiting in patients with minor trauma during ambulance transport. PATIENTS AND METHODS This study, conducted from January to April 2000, consisted of 100 patients older than 60 years with minor trauma, who were randomly assigned to breathe air or 100% oxygen at 10 L/min through a facemask during ambulance transport. A paramedic, blinded to treatment, recorded vomiting episodes during transport. Patients, also blinded to treatment, rated their levels of pain, nausea, vomiting, anxiety, and overall satisfaction with their care on 100-mm visual analog scales, with greater values indicating more intense sensation. Results from the 2 groups were compared with chi2 or unpaired 2-tailed t tests and presented as means +/- SDs. RESULTS Before randomization, patients subsequently assigned to receive oxygen had significantly greater pain and nausea. On arrival at the hospital, oxygen saturation was higher in the 50 patients given oxygen (99% +/- 1 % vs 96% +/- 2%; P<.001) than in the 50 patients who breathed air. Reported pain remained greater in the oxygen group. However, those given oxygen had less nausea (22 +/- 29 vs 54 +/- 38 mm; P<.001) and vomiting (4 vs 19 episodes; P<.001), lower heart rates (86 +/- 12 vs 94 +/- 13 beats/min; P<.001), and higher overall satisfaction scores (54 +/- 33 vs 33 +/- 23 mm; P<.001). CONCLUSION Our results indicate that supplemental oxygen during ambulance transport reduced nausea scores by 50% and decreased vomiting 4-fold. Consequently, patients reported greater satisfaction with their care. Thus, we recommend that patients be given supplemental oxygen during ambulance transport.

Korean Hand Acupressure for Motion Sickness in Prehospital Trauma Care: A Prospective, Randomized, Double-blinded Trial in a Geriatric Population

Patients with trauma or medical illnesses transported to the hospital by ambulance have a frequent incidence of motion sickness. Because the administration of drugs in the ambulance is prohibited by law in Austria, the noninvasive Korean hand acupressure point at K-K9 may be an alternative against nausea and vomiting. We enrolled 100 geriatric patients with minor trauma, randomizing them into a K-K9 group and a sham acupressure group. We recorded visual analog scores (VAS) for nausea and for the patient’s overall satisfaction with the treatment, hemodynamic variables, and peripheral vasoconstriction. In the K-K9 group, a significant (P < 0.01) increase in nausea was recorded in all cases: from VAS of 0 mm to 25 ± 6 mm. A similarly significant (P < 0.01) increase was registered in the sham group: from VAS of 0 mm to 83 ± 8 mm. However, at the time of arrival in the hospital, nausea scores were significantly different between the K-K9 group and the sham group (P < 0.01). Although all patients had been vasoconstricted at the emergency site before treatment, there was a significant difference (P < 0.01) between groups with regard to the number of vasoconstricted patients at the hospital (4 and 46 constricted and dilated, respectively, in the K-K9 group versus 48 and 2 constricted and dilated, respectively, in the sham group). On arrival in the hospital, a significant difference (P < 0.01) in heart rate was noted between the K-K9 group and the sham group (65 ± 6 bpm versus 98 ± 8 bpm). The patients’ overall satisfaction with the provided care was significantly higher (P < 0.01) in the K-K9 group (19 ± 9 mm VAS) than in the sham group (48 ± 12 mm VAS). Neither group experienced a significant change in blood pressure. K-K9 stimulation was an effective and simple treatment for nausea during emergency care and significantly improved patient satisfaction.

The influence of active warming on signal quality of pulse oximetry in prehospital trauma care.

UNLABELLED Victims of trauma such as contusions and simple fractures are usually transported by paramedics. Because many victims are intoxicated with alcohol or other drugs, they are vulnerable to some risk of inadequate respiration. Thus, their oxygenation is monitored by noninvasive pulse oximetry. We tested the hypothesis that active warming of the whole body during transport to the hospital can improve the reliability of arterial oxygen saturation (SpO(2)) monitoring. Twenty-four trauma patients transported to hospital were included in the study and randomly assigned to two groups: one group (n = 12) was covered with normal wool blankets, and the other group (n = 12) was treated with resistive heating blankets during transport. We recorded core temperature, shivering, skin temperature at the forearm and finger, SpO(2), and hemodynamic variables. Before randomization, both groups were comparable. On arrival at the hospital, the actively warmed patients had significantly warmer core (36.1 +/- 0.3 degrees C versus 35.5 +/- 0.3 degrees C; P < 0.001) and skin (34.1 +/- 1.5 degrees C versus 24.9 +/- 1.4 degrees C; P < 0.001) temperatures. In the actively warmed group, the pulse oximeter had significantly fewer alerts (31 versus 58) and a significantly less time of malfunction (146 +/- 42 s versus 420 +/- 256 s) and provided more constant measurements in the actively warmed group (P < 0.001). In this study we showed that active warming improves pulse oximeter monitoring quality in trauma patients during transport to the hospital. IMPLICATIONS Clinical trials show that pulse oximeter signal quality is limited by hypothermia. In this study we show that active whole-body warming of trauma victims improves monitoring quality during transport to the hospital.

Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care.

PURPOSE Acute renal colic is one of the most anguishing forms of pain in humans. We hypothesized that TENS is an effective pain treatment in patients with acute renal colic. MATERIALS AND METHODS A total of 100 patients with acute flank pain and suspected renal colic consented to participate in our study. Paramedic 1 recorded baseline parameters at the emergency site and at the end of transportation. Paramedic 2 performed TENS in patients randomly assigned to G1 with actual TENS or to G2 with sham TENS. Pain and anxiety were measured using paper based visual analog scales on a scale of 0 to 100 mm. RESULTS Of 100 screened patients 73 had renal colic, including 39 in G1 and 34 in G2. There was no significant difference with regard to potentially influencing factors, such as patient age, sex, weight, height, blood pressure and heart rate, pain, nausea and anxiety between the groups before treatment. G1 showed a significant mean pain decrease +/- SD of more than 50% (85.7 +/- 10.5 to 33.3 +/- 16.0 mm, p <0.01). G2 showed no variation in mean pain scores (85.8 +/- 18.0 to 82.6 +/- 14.3 mm). G1 showed changes in the mean anxiety score (69.0 +/- 8.4 to 37.7 +/- 15.1 mm, p <0.01), nausea score (90.7 +/- 9.2 to 44.9 +/- 22.0 mm) and heart rate (92 +/- 10 to 64 +/- 8 bpm), while G2 showed nonsignificant changes. CONCLUSIONS This trial shows that local TENS is a rapid and effective treatment for renal colic pain. We found TENS to be a good nondrug therapy under the difficult circumstances of out of hospital rescue.

Active warming of critically ill trauma patients during intrahospital transfer: A prospective, randomized trial

ZusammenfassungHintergrundHypothermia ist ein oft beobachtbares Phänomen bei Traumapatienten während der Akutversorgung. Bekannte Komplikationen einer akzidentellen Hypothermie sind Wundheilungsstörungen, kardiale Komplikationen, hämodynamische Instabilität, Defizite im Immunsystem und vermehrter Blutverlust. In der folgenden Studie verglichen wir passiv gewärmte vs. aktiv gewärmte Patienten auf dem Transport von einer Intensivstation zum CT.MethodenDreißig Intensivpatienten wurden randomisiert zur einer aktiv gewärmten Gruppe, abgedeckt mit einer Carbonfiberwärmedecke (42°C) während des gesamtem Transport und zur einer passiv gewärmten Gruppe, die mit einer ausgeschalteten Carbonfiberdecke versorgt waren. In beiden Gruppen waren die Carbonfiberdecke mit konventionellen Wolldecken abgedeckt. Es wurden die Vitalparameter und die Körpertemperaturen gemessen.ErgebnisseDie Ausgangsdaten der Patienten waren in beiden Gruppen vergleichbar. Die Ausgangstemperatur in Gruppe A war 36,4°C±0,2°C und blieb stabil bei 36,4°C±01°C, die Temperatur in Gruppe B startete bei 36,4°C±0,2°C und sank statistisch signifikant auf 34,7°C±0,6°C.SchlussfolgerungenDie Hypothermie ist ein gängiges Problem, wenn Patienten wegen der diagnostischen Maßnahme einen innerklinischen Transport benötigen. Das aktive Wärmen dieser Patienten während des Transports kann die Körpertemperatur stabil normotherm halten. We können daher zur Erhaltung der Normothermia das aktive Wärmen von Patienten während eines Transports empfehlen.SummaryObjectiveHypothermia in trauma victims is a frequently observed phenomenon in acute care. Known complications of hypothermia are impaired wound healing, cardiac complications, hemodynamic instability, impaired immune function and increased blood loss. We compared active warming versus passive warming in hypothermia in critical-care patients undergoing intrahospital transfer from ICU to computer tomography (CT).MethodsThirty critically ill patients were randomized either to an actively warmed group, covered with a carbon-fiber heating blanket (set to 42°C) during the entire transport including the time spent in the CT, or to a passively warmed group, covered with a carbon-fiber heating blanket (switched off) during the entire transport and in the CT. The carbon-fiber blanket was covered with a conventional wool blanket in both groups. Vital parameters and core temperatures were recorded.ResultsPatients’ characteristics and vital parameters were similar in each treatment group. Initial average core temperature in group A was 36.4°C±0.2°C and remained stable at 36.4°C±0.1°C; core temperature in group B started at 36.4°C±0.2°C but decreased to 34.7°C±0.6°C.ConclusionsHypothermia is common when critically ill trauma patients require intrahospital transport for diagnostic procedures. Resistive heating during intrahospital transport kept the core temperature stable and assured normothermia in all actively warmed patients. We therefore recommend active warming for critically ill trauma patients during intrahospital transport.

A randomized controlled trial of femoral nerve blockade administered preclinically for pain relief in femoral trauma.

BACKGROUND:Analgesia at the location of the accident and on transport for femoral trauma is often delayed or insufficient. In this prospective, randomized, controlled study, we evaluated the preclinical use of femoral nerve blockade for reducing pain and anxiety compared with IV analgesia using metamizol. METHODS:Patients with painful femoral trauma, such as fracture or severe contusion, were randomized to receive at the site of the accident a femoral nerve blockade (n = 31) or IV analgesia with metamizol (n = 31). A visual analog scale (VAS) was used to assess pain and anxiety. Variables were assessed at baseline, during transport and upon arrival at the hospital. RESULTS:In patients receiving the femoral nerve blockade, pain values decreased by half from VAS 86 ± 6 mm at the site of the accident to VAS 41 ± 15 mm during transport. Anxiety decreased by half from VAS 84 ± 11 mm to VAS 39 ± 14 mm. Heart rate decreased by 20 ± 5 bpm. In the metamizol group, pain, anxiety, and heart rate did not decrease (P < 0.001). Time of treatment was 7.4 ± 3.5 min longer in the femoral nerve blockade group. CONCLUSION:Preclinically administered femoral nerve blockade effectively decreases pain, anxiety, and heart rate after femoral trauma. Regional blockade is an option for out-of-hospital analgesia administered by a trained physician.

Femoral nerve blockade administered preclinically for pain relief in severe knee trauma is more feasible and effective than intravenous metamizole: a randomized controlled trial.

BACKGROUND Before clinical treatment and during transportation, the analgesic therapy offered to patients with painful knee trauma may be quite insufficient. We hypothesize that a femoral nerve blockade for analgesia can be administered in a preclinical setting at the injury site and provides better pain relief than intravenous metamizole, whose analgesic effect is comparable with that of opioids. METHODS After an initial clinical investigation, 52 patients were randomized according to computer-generated codes; 26 patients received a femoral nerve blockade and 26 received metamizole. The treatment was started at the injury site and the level of pain on the 100-mm visual analog scale was assessed at the beginning and the end of treatment. RESULTS Pain and anxiety scores were significantly reduced by half in the femoral nerve blockade group; peripheral vasoconstriction was noted in 26 patients at the injury site and dropped to six at the time of arrival at the hospital. Two of 26 patients in the blockade group did not benefit from the treatment. In the metamizole group, pain and anxiety did not decrease significantly; vasoconstriction persisted in all patients. CONCLUSION Patients with painful knee trauma benefited from femoral nerve blockade administered before hospitalization. The treatment can be administered safely in the preclinical setting and provides effective analgesia.