Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Introduction: The necessity of rapid preload and afterload reduction in patients with decompensated congestive heart failure (CHF) and acute pulmonary edema (APE) is well established. In the hospital setting, intravenous (IV) nitroglycerin demonstrates improved patient morbidity and mortality. However, prehospital treatment is typically limited to sublingual nitroglycerin at doses that often do not affect afterload. ⋯ Conclusion: This case series found that patients who were treated by paramedics with IV NTG had improved systolic blood pressure and oxygen saturation upon ED arrival as compared to their initial presentation. Over 90% of these patients were correctly identified by paramedics as having CHF with APE based on ED evaluation. Only one patient had an adverse event, which was transient hypotension that did not require intervention.
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Randomized Controlled Trial
Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher.
Introduction: One of the greatest casualty-care improvements resulting from US military operations in Iraq and Afghanistan has been the reduction of preventable death from massive extremity hemorrhage - largely due to the widespread use of limb tourniquets. More recently, tourniquet use in civilian, prehospital settings has shown promise in reducing deaths in cases of catastrophic arterial limb hemorrhage. Telephone instructions by trained emergency medical dispatchers (EMDs) on applying an available tourniquet may help achieve such a benefit. ⋯ Median tourniquet pressure was 256 mmHg and median-end blood loss was 1,365 mL. A total of 198 participants (80.49%) were able to completely stop the bleeding while 16 participants (6.5%) had the tourniquet applied with some bleeding still occurring, and 32 participants (13.01%) exceeded the threshold of 2,500 mL of blood loss, resulting in the "patient" not surviving. Conclusions: The study findings demonstrated that untrained bystanders provided with instructions via phone from a trained Emergency Medical Dispatcher applied a tourniquet and successfully stopped the bleeding completely in most cases.
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Airway management is one of the critically important skills in practicing emergency medicine. However, intubation in the prehospital setting is quite different from those done in controlled environment and still poses significant risks for serious complications. ⋯ Studies have shown that the verification of tube placement utilizing bronchoscopy is an easy and highly reliable methods and this is especially beneficial in the prehospital settings. Although the use of bronchoscopy in prehospital setting currently is somehow limited, this new, rapidly advancing technology and technique is believed to be a game changer in our prehospital intubation/post-intubation practice in the near future.
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Background: Air ambulance services are commonly used to expedite interfacility transport of injured patients to trauma centers. There is a lack of evidence surrounding risk factors for delays in interfacility transport of these patients. The purpose of this study was to examine patient, paramedic, and institutional-related characteristics for delay and identify specific causes of delays in interfacility transfers by air ambulance. ⋯ Third, interfacility transport times are heavily skewed and delays disproportionately affect longer patient transports. Conclusions: Ventilator dependence, paramedic level of care, classification of sending facility and helipad availability are associated with delays to interfacility transport of injured patients. Efforts can be made at both the air ambulance and institutional levels to ensure timely and efficient transports.