Annals of emergency medicine
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Some states have enacted legislation authorizing EMS providers to adhere to prehospital advance directives (ADs) in the terminally ill. This study was conducted to assess EMS providers' knowledge of and experience with prehospital ADs. ⋯ Most prehospital care providers recognize the need to withhold resuscitative care in terminally ill patients who have prepared ADs. However, a sizable minority fail to consider prehospital ADs as a routine part of their practice. The majority of our respondents support enactment of prehospital AD statutes to minimize confusion and provide legal authorization to limit resuscitation.
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Rapid evaluation of the hypotensive patient in the emergency department is essential. The availability of ultrasonography in the ED, performed by emergency physicians and surgeons, has made it easier to evaluate the hypotensive trauma patient. We describe a 44-year-old man transferred to our institution from a community hospital for evaluation of syncope and hypotension with no obvious cause. ⋯ A rapid ultrasound examination performed at bedside revealed the presence of intraperitoneal fluid. Examination of the spleen suggested likely rupture. The patient was promptly taken to surgery for splenectomy and discharged home in 4 days.
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To determine whether the use of warning lights and sirens saves a significant amount of time for ambulances responding to requests for medical aid in an urban, 2-tiered EMS setting. ⋯ Code 3 operation by EMS personnel in an urban, 2-tiered EMS setting saved significant time over Code 2 operation when traveling to a call.