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 prehospital electrocardiogram (ECG) allows earlier identification of acute ST-segment elevation myocardial infarction (STEMI). Its utility for detection of other acute cardiac events, as well as for transient ST-segment abnormalities no longer present when the first hospital ECG is performed, is not well characterized. ⋯ Beyond identifying ST-segment elevation earlier, prehospital ECGs detect important transient abnormalities, information not otherwise available from the first emergency department ECG. These data can expedite diagnosis and clinical management decisions among patients suspected of having an acute cardiac event. The prehospital ECG should be fully integrated into emergency medicine practice.
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The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACS-COT) believe that it is appropriate to withhold resuscitation for certain trauma patients for whom death is the predictable outcome. This paper is the official statement on the withholding of resuscitation that has jointly been passed by the NAEMSP and ACS-COT.
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Multicenter Study
Diagnostic accuracy of a rapid checklist to identify delirium in older patients transported by EMS.
The presence of delirium in elderly patients is common and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. Early recognition of delirium in the prehospital setting has the potential to improve outcomes, but is not feasible without valid assessment tools. ⋯ A rapid delirium checklist can identify 63% of patients with delirium, but performed no better than the GCS. Future research should determine whether a rapid test of cognition improves early identification of elderly patients with delirium.
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Comparative Study
A comparison of proximal tibia, distal femur, and proximal humerus infusion rates using the EZ-IO intraosseous device on the adult swine (Sus scrofa) model.
We sought to compare the flow rates of the proximal tibia, the distal femur, and the proximal humerus using high pressure (greater than 300 mmHg) through an intraosseous (IO) infusion needle in an adult swine model. ⋯ The humerus is a suitable alternative site for IO placement, with a potential for higher flow rates than the proximal tibia and distal femur when resuscitating a patient.
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Comparative Study
A quantile regression analysis of ambulance response time.
Shorter ambulance response time (ART) contributes to improved clinical outcomes. Various methods have been used to analyze ART. ⋯ The quantile regression model is more useful than the OLS model for estimating ART, revealing that in Singapore, ART is influenced heterogeneously by the volume of emergency calls in the past one hour.