Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The use of arterial tourniquets in prehospital emergency care has been fraught with controversy and superstition for many years despite the potential utility of these tools. This review examines this controversy in the context of the history of the tourniquet as well as its recent use in surgery and modern battlefield casualty care. Safe prehospital tourniquet use is widespread in the military and is based on sound physiologic data and clinical experience from the surgical use of tourniquets. ⋯ Beyond this, we present arguments for tourniquet use in more routine EMS settings, in which it may be beneficial but has heretofore been considered inappropriate. Protocols that foster safe, effective prehospital tourniquet use in these settings are then presented. Finally, we discuss future directions in which tourniquet research and other initiatives will further enhance the safe, rational use of this potentially life-saving tool.
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To characterize the reasons pediatric emergency department (PED), patients access emergency medical services (EMS) for transport to the pediatric ED. To describe the acceptability of other modes of transport and alternative sites of care. ⋯ Adults access the EMS system for children because of concerns regarding the acuity of illness and for the security of EMS transport. They were generally uninterested in transport by any mode other than EMS. However, they would accept transport to alternative sites for immediate care.
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The use of prehospital needle thoracostomy (NT) is controversial as it is not without risk. Issues such as inappropriate patient selection, misplacement causing iatrogenic injury, treatment failures in obese patients, and delaying definitive tube thoracostomy in the emergency department contribute to this controversy. The purpose of this study is to evaluate a cohort of patients undergoing NT by paramedics for tension pneumothorax and review the indications for use, complications, and emergency department outcomes of NT. ⋯ The use of NT appears to be a safe procedure when preformed by paramedics in an urban EMS system. Prehospital NT resulted in four cases of unexpected survival.
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Comparative Study
Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest.
To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. ⋯ We found no difference in ROSC or survival to hospital discharge between MTE and BTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation.
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This study tested the hypothesis that pulmonary end-tidal CO(2) (PETCO(2)) tracks reductions in central blood volume in human volunteers exposed to progressive central hypovolemia. ⋯ Although PETCO(2)tracked decreases in SV in this human model of progressive central hypovolemia, reductions in PETCO(2)were small relative to the range of baseline values. Thus, monitoring such small reductions in PETCO(2) as an early warning of imminent cardiovascular collapse during hemorrhage may not be clinically useful without monitors capable of providing continuous trending.