Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Comparative Study
Advanced rescuer- versus citizen-witnessed cardiac arrest: Is there a difference in outcome?
Substantial financial and human resources are invested in training and maintaining advanced life support (ALS) skills of paramedics who are deployed to the field in response to out-of-hospital cardiac arrest. It would be expected that patients who experience cardiac arrest in the presence of a trained health care practitioner, such as a paramedic, have better outcomes. ⋯ Among our study population of out-of-hospital cardiac arrest victims, paramedic-witnessed arrests did not appear to have improved survival rates when compared with citizen-witnessed arrests.
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Randomized Controlled Trial
A new defibrillator mode to reduce chest compression interruptions for health care professionals and lay rescuers: a pilot study in manikins.
Chest compression interruptions are detrimental during the resuscitation of cardiac arrest patients, especially immediately prior to shock delivery. ⋯ Preshock pause time is reduced by 80% utilizing a novel technology that employs automated analysis and charging during chest compression. Although chest compression pause time is reduced with the use of the new technology, participants do not excessively fatigue.
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Comparative Study
Prevalence of depression and cognitive impairment in older adult emergency medical services patients.
To characterize the proportion of older adult emergency department (ED) patients with depression or cognitive impairment. To compare the prevalences of depression or cognitive impairment among ED patients arriving via emergency medical services (EMS) and those arriving via other modes. ⋯ Consent was obtained from 1,342 eligible older adults; 695 (52%) arrived via EMS. The median age for those arriving via EMS was 74 years (interquartile range 65, 82), 52% were female, and 81% were white. Fifteen percent of EMS patients had moderate or greater depression, as compared with 14% of patients arriving via other modes (p = 0.52). Thirteen percent of the EMS patients had cognitive impairment, as compared with 8% of those arriving via other modes (p < 0.01). The depressed EMS patients frequently reported a history of depression (47%) and taking antidepressants (51%). The cognitively impaired EMS patients infrequently reported a history of dementia (16%) and taking medications for dementia (14%). Conclusions. In this cohort of community-dwelling older adult ED patients, depression and cognitive impairment were common. As compared with ED patients arriving by other transport means, patients arriving via EMS had a similar prevalence of depression but an increased prevalence of cognitive impairment. Screening for depression and cognitive impairment by EMS providers may have value, but needs further investigation.
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Comparative Study
Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest.
There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. ⋯ This observational study in an unselected population shows that patients in VF/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.
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Abstract A case of prehospital anaphylactic shock that presented atypically, without a known exposure, is discussed. Anaphylaxis is a potentially life-threatening allergic reaction that requires prompt recognition and aggressive treatment. ⋯ These cases can be equally severe, with potentially fatal consequences if missed. The diagnosis and management of anaphylaxis are reviewed, as well as barriers that providers encounter in diagnosing uncommon presentations.