Emergency medical services
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Accurate prehospital diagnosis and early initiation of emergency medical treatment for pediatric patients found to have supraventricular tachycardia is a reasonable task to accomplish and one that does not have to be anxiety-provoking. The most important point to remember is that the standard approach to resuscitation and stabilization for pediatric patients with narrow complex tachycardias (and those with aberrant or wide complexes identifiable as WPW) applies to all variations of SVT; thus, it is not necessary to precisely diagnose the variant prior to initiation of treatment, except for WPW, in which adenosine administration is contraindicated. ⋯ Dosages of medications need not be memorized, provided that a readily available guide, such as a Broselow tape or regional tertiary care center laminated resuscitation card, is at hand. Finally, while termination of pediatric SVT, whether spontaneous or by EMS intervention, will also likely terminate the EMS provider's own palpitations, it is essential that these patients be seen in an emergency department immediately in order to accurately diagnose their medical condition and provide the patient and family with an appropriate disposition based on the events surrounding the incident.
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Compartment syndrome is a limb-threatening and occasionally life-threatening injury. It occurs whenever the tissue pressure (referred to as interstitial pressure) within a closed anatomic space is greater than the perfusion pressure. Untreated, compartment syndrome leads to tissue necrosis, permanent functional impairment and, if severe in large compartments, renal failure and death. ⋯ In many cases, such an injury would be referred to as a "stinger" (a temporary neurological deficit due to a sudden and excessive stimulation of a neurologic plexus or junction). But this patient had more swelling in the compartment, resulting in a lack of circulation manifested by a cool extremity, poor capillary refill and decreased pulse oximetry. Luckily, this officer recognized the need for medical evaluation of what appeared to be a minor injury and was returned to duty with no permanent impairment.