Emergency medicine journal : EMJ
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Case Reports
Neurological symptoms occurring in the context of ruptured abdominal aortic aneurysm: a paramedic's perspective.
Ruptured abdominal aortic aneurysm (RAAA) classically presents with sudden onset, severe ripping or tearing abdominal pain radiating through to the back. This case report describes features of an atypical presentation of a patient with RAAA and highlights the difficulties and uncertainties surrounding the prehospital assessment, appropriate treatment and management of these patients. All prehospital care educators and practitioners should be made aware of the wide spectrum of clinical manifestations for this condition.
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A review was performed looking at the first 100 intubation procedures performed or solely supervised by one emergency medicine trainee. Over the 5 year period during which the procedures were performed the author performed 93 and supervised 7 procedures. There were 90 rapid sequence intubation procedures and 10 intubations without drugs. ⋯ This study suggests that as a trainee gains experience in performing intubation procedures, the nature of the complications arising changes. Initial complications involved misplacement of the tube, whereas later complications involved not obtaining an adequate view, latterly in increasingly difficult airways. Truly difficult airways are not common and may not be experienced until much later in a trainee's career.
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Capnometry is a non-invasive monitoring technique which allows fast and reliable insight into ventilation, circulation, and metabolism. In the prehospital setting it is mainly used to confirm correct tracheal tube placement. ⋯ It helps to confirm the diagnosis of pulmonary thromboembolism and to sustain adequate ventilation in mechanically ventilated patients. In patients with haemorrhage, capnometry provides improved continuous haemodynamic monitoring, insight into adequacy of tissue perfusion, optimisation within current hypotensive fluid resuscitation strategy, and prevention of shock progression through controlled fluid administration.