Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Establishing vascular access is vital in the resuscitation of critically-ill children and adults. Intraosseous infusion (IOI) is a viable route for providing vascular access when traditional intravenous methods cannot be accomplished. ⋯ The authors review the history, anatomy, technique, and clinical application of IOI. They also highlight the use of IOI in the prehospital setting.
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Acute congestive heart failure (CHF) is one of the most common syndromes encountered in emergency care settings. Correct diagnosis and treatment for pulmonary edema, the most common acute manifestation of CHF, are of primary importance as misdiagnosis can result in deleterious consequences to patients. The pathogenesis of acute pulmonary edema (APE) is currently believed to arise primarily from the redistribution of intravascular fluid to the lungs secondary to acutely elevated left ventricular (LV) filling pressures. ⋯ Noninvasive positive pressure ventilation methods are effective adjuncts to current treatment, but their mode of delivery presents technical challenges. The development of novel rapid diagnostic tools, currently in progress, might prove valuable for emergency medical services (EMS) personnel in the future. But for now, EMS personnel must rely on their fundamental skills of history taking and physical examination for accurate diagnosis of CHF.
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Current Advanced Cardiac Life Support (ACLS) guidelines and emergency medical services (EMS) clinical protocols usually recommend immediate defibrillation for victims of out-of-hospital cardiac arrest who have ventricular fibrillation (VF). However, animal studies and results from a small number of clinical investigations now suggest that a short period of chest compressions or ACLS procedures delivered before defibrillation may improve the outcome of patients with prolonged VF. Although the basic science and clinical data supporting a chest-compression-first procedure are compelling, large, multicenter randomized trials are still necessary to determine whether such protocols do indeed improve outcome. ⋯ Recent literature has shown that in certain circumstances, CPR instructions involving chest compressions alone may be given more quickly and can yield an equivalent, if not better, chance of survival. Although this practice is controversial, the general consensus is that any CPR is better than none at all. Therefore, telephone CPR protocols that recommend the immediate initiation of chest compressions may be preferred, particularly for callers who have no previous training in CPR.
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The World Health Organization has estimated that by the year 2020, neuropsychiatric disorders will become one of the five most common causes of morbidity, mortality, and disability among children (U. S. Department of Health and Human Services. ⋯ The purpose of this article is to present summary information from a national consensus conference regarding the current state of emergency mental health resources for children and adolescents. The intended audience includes community health care providers, emergency care workers, and researchers. Major issues explored in this paper include the questions: Are emergency mental health services for children and adolescents readily available in communities? Is access to care possible for all children? Are resources and services in place to ensure that the mental health needs of this vulnerable population are not neglected? The authors would like to see the development of local, regional, and national systems that facilitates coordination between emergency medical services (EMS), emergency medicine, and mental health communities to ensure appropriate local resources are in place and to allow the emergent identification and treatment of mental health needs in the pediatric and adolescent population.
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Cardiopulmonary resuscitation (CPR) involving manual external chest compression combined with artificial respiration was first described in 1960 by Kouwenhoven et al. (Kouwenhoven W, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960; 173:1064-7). ⋯ To date, only IAC (in-hospital only) and ACD have been shown to improve long-term survival in clinical studies. Circumferential chest compression and minimally invasive cardiac massage, on the other hand, have not yet been adequately tested in large clinical trials. Despite the difficulty and expense in studying these CPR techniques, additional research is necessary to evaluate their effectiveness in improving survival after sudden cardiac arrest.