荷兰急救医疗服务中高级医疗人员的手术镇静:一项回顾性研究

Risco van Vliet, Lennert Breedveld, Annemieke A.J. Heutinck, Bram H.A. Ockeloen, Arnoud W.J. van ’ Hof, Xavier R.J. Moors
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引用次数: 0

摘要

程序性镇静和镇痛(PSA)是一种使用镇静剂的技术,目的是让病人在保持心肺功能的同时,能够忍受疼痛的程序,这是院前经常需要的一种状态。在提供镇痛和镇静方面,非医生的院前临床医生的执业范围往往有限;有时会导致机组人员请求配备医生的院前服务机构提供支援"。如果需要镇静,情况也是如此。高级医疗服务提供者 (APP) 拥有合法授权并接受过相关培训,可在没有或无法及时提供由医生提供的服务时执行该程序。本研究旨在了解 2019 年 1 月至 2022 年 12 月在荷兰救护车服务机构 "RAV Brabant MWN "工作的 APP 使用异丙酚进行 PSA 或提供镇静的情况。通过这项回顾性观察记录研究,我们描述了患者和救护车运行的特点,并对干预措施的安全性进行了评估。在研究期间,APPs 共使用异丙酚 157 次,用于 135 例 PSA,22 例用于镇静。最常见的适应症是肌肉骨骼创伤,如骨折护理或关节脱位复位。在使用异丙酚的情况中,91%达到了预定目标,如骨折肢体对位、关节脱位复位或提供镇静。有 12 个病例记录了一个或多个不良事件,所有不良事件均由 APP 成功解决。没有发生喉痉挛、气道阻塞或过敏性休克。没有一起不良事件导致意外住院或死亡。在研究期间,APP 共执行了 135 次 PSA,提供了 22 次镇静。预定目标的成功率高于文献报道。虽然出现了一些副作用,但其发生率低于文献报道,而且这些副作用都在护理过程中由 APP 解决。在急救中心 "RAV Brabant MWN",APP 应用 PSA 似乎是安全的,成功率也很高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Procedural sedation by advanced practice providers in the emergency medical service in the Netherlands: a retrospective study
Procedural sedation and analgesia (PSA) is a technique of administering sedatives to induce a state that allows the patient to tolerate painful procedures while maintaining cardiorespiratory function, a condition that is frequently desired prehospital. Non-physician prehospital clinicians often have a limited scope of practice when it comes to providing analgesia and sedation; sometimes resulting in a crew request for back-up from physician-staffed prehospital services.“. This is also the case if sedation is desirable. Advanced practice providers (APPs), who are legally authorized and trained to carry out this procedure, may be a solution when the physician-staffed service is not available or will not be available in time. The aim of this study is to gain insight in the circumstances in which an APP, working at the Dutch ambulance service “RAV Brabant MWN” from January 2019 to December 2022, uses propofol for PSA or to provide sedation. With this a retrospective observational document study we describe the characteristics of patients and ambulance runs and evaluates the interventions in terms of safety. During the study period, the APPs administered propofol 157 times for 135 PSA and in 22 cases for providing sedation. The most common indication was musculoskeletal trauma such as fracture care or the reduction of joint dislocation. In 91% of the situations where propofol was used, the predetermined goal e.g. alignment of fractured extremity, repositioning of luxated joint or providing sedation the goal was achieved. There were 12 cases in which one or more adverse events were documented and all were successfully resolved by the APP. There were no cases of laryngospam, airway obstruction, nor anaphylaxis. None of the adverse events led to unexpected hospitalization or death. During the study period, the APPs performed 135 PSAs and provided 22 sedations. The success rate of predetermined goals was higher than that stated in the literature. Although there were a number of side effects, their incidences were lower than those reported in the literature, and these were resolved by the APP during the episode of care. Applying a PSA by an APP at the EMS “RAV Brabant MWN” appears to be safe with a high success rate.
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