JEMS : a journal of emergency medical services
-
Since 2000, many studies of advanced emergency airway management have appeared in the medical literature. Although most described patients in the operating room, intensive care unit or emergency department, studies of video laryngoscopy in the field are in progress and beginning to appear in the literature. ⋯ Price reductions as more devices, some specifically intended for EMS, enter the market will lower the entry costs for adoption. It is my prediction that in five years, video laryngoscopy will be the method of choice for endotracheal intubation in the field.
-
Although most thoracic trauma may be treated non-operatively, major thoracic trauma accounts for 25% of trauma deaths. Except for provision of a definitive airway and/or relief of a tension pneumothorax with a needle decompression, the vast majority of thoracic trauma is best served with "load and go," high-flow oxygen, placement of an IV line and administration of crystalloid solutions as the clinical scenario would indicate. Understanding the mechanism of injury is helpful in establishing both prehospital and in-hospital management priorities. ⋯ Practicing chest assessment skills is vital to being a good prehospital provider. Ultrasound, NIRS tissue oxygenation and telemedicine will likely become more commonly employed as prehospital monitoring options. PEEP, or "over bagging," may exacerbate a simple or open pneumothorax, converting it to a tension pneumothorax.