Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To determine whether the use of warning lights and siren saves a significant amount of time for ambulances responding to requests for emergency medical aid in a rural emergency medical services (EMS) setting. ⋯ Code 3 operation by EMS personnel in a rural EMS setting saved significant time over code 2 operation when traveling to a call.
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End-tidal carbon dioxide (ETCO2) monitoring is an exciting technology and has the potential to become a very useful tool in the prehospital setting. It can be useful in verifying endotracheal tube position and during cardiopulmonary resuscitation in the field. ⋯ The new American Heart Association guidelines require secondary confirmation of proper tube placement in all patients by exhaled CO2 immediately after intubation and during transport. This article covers the terminology, the basic physiology, the technology (both colorimetric detectors and infrared capnometers), and the clinical applications of ETCO2 monitoring with special reference to the pediatric patient.
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To describe the prehospital use of a continuous positive airway pressure (CPAP) system for the treatment of acute respiratory failure presumed to be due to cardiogenic pulmonary edema. ⋯ For patients with acute respiratory failure and presumed pulmonary edema, the prehospital use of CPAP is feasible and may avert the need for ETI. Future controlled studies are needed to assess the utility and cost-effectiveness of prehospital CPAP systems.
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To examine the reasons for failed prehospital endotracheal intubation (ETI) and to identify how the airway was subsequently managed in the emergency department (ED). ⋯ Paramedic intubation failures result from a variety of factors. Less than half of field intubation failures were remedied in the ED by the use of neuromuscular-blocking agents. A similar number were intubated without the use of RSI. A fraction of failed field ETIs may have resulted from inadequate operator training or experience. A small percentage of field patients were "truly difficult" and required advanced resources in the ED to facilitate airway management. Medical directors should be cognizant of the numerous factors affecting intubation performance when designing and implementing approaches to difficult prehospital airways.
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To test the hypothesis that pretransport variables can predict in-hospital mortality that will correlate with major interventions and unplanned events during interfacility transport. ⋯ Four pretransport variables predicted in-hospital mortality. Risk of mortality correlated with the incidence of major patient interventions, and the occurrence of unplanned events increased as well. This model might be useful in comparing different transport systems using severity-adjusted assessment of children requiring interfacility transport.