Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Advances in the management of heart failure have led to an increasing number of patients living outside the hospital with a variety of ventricular-assist devices (VADs). These implantable pumps may be placed temporarily as a bridge to cardiac transplantation or resolution of a reversible condition, or as destination therapy for the rest of the patient's life. Emergency medical services (EMS) providers may be called to care for such patients experiencing an emergency related to the device itself, the underlying cardiac condition, or a totally unrelated medical or traumatic issue. ⋯ Challenges related to management of patients with VADs include their poor baseline medical status, limitations of traditional prehospital assessment techniques, the relative infrequency with which these patients are encountered, and the rapidity with which device technology is evolving. This article presents a brief history of VADs, with an emphasis on left ventricular-assist devices (LVADs), reviews the relevant anatomy and pathophysiology, and describes the types of devices currently in clinical use. It discusses patient-specific and device-specific complications that may be encountered and concludes with an approach to prehospital patient assessment and care.
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Identifying ST-segment elevation myocardial infarctions (STEMIs) in the field can decrease door-to-balloon times. Paramedics may use a computer algorithm to help them interpret prehospital electrocariograms (ECGs). It is unknown how accurately the computer can identify STEMIs. ⋯ Prehospital computer interpretation is not sensitive for STEMI identification and should not be used as a single method for prehospital activation of the cardiac catheterizing laboratory. Because of its high specificity, it may serve as an adjunct to interpretation.
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Outcomes of patients who fall from bridges lower than 160 feet above water have been poorly characterized. Pittsburgh offers a unique setting in which to study these patients as the city has 41 major bridges, only four of which are above 70 feet. ⋯ People who jump from low- to medium-rise bridges may suffer injuries, but most often die from drowning. EMS interventions beyond water rescue are typically not helpful, emphasizing the importance of prevention and a water rescue plan.
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Emergency management of myocardial infarction (MI) is time-critical, because improved patient outcomes are associated with reduced time from symptom onset to definitive care. Previous studies have identified that women are less likely to present with chest pain. ⋯ Ambulance dispatch officers (and paramedics) need to be aware of potential sex differences in MI presentation in order to ensure appropriate ambulance response.
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Unstable conditions during ambulance transportation are not conducive to the performance of high-quality cardiopulmonary resuscitation by emergency medical technicians. ⋯ Chest compression is performed mainly through flexion and extension of the hip joint while kneeling on the floor and through the elbow and shoulder joints while standing in a moving ambulance. Therefore, the low quality of chest compression during ambulance transportation may be attributable to an altered technique of performing the procedure.