Emergency medicine journal : EMJ
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To measure the possible delays in intravenous nitroglycerine administration. ⋯ Despite limitations, this study outlines the importance of cannula type, infusion accessories and carrier lines. Larger cannulae and greater priming volumes substantially delay drug delivery, whereas carrier lines/drive lines substantially accelerate drug delivery. Our study also shows how patients could be exposed to clinical delays, as well as incorrect presumptions about drug dosage. Guidelines, and education efforts, should highlight the clinical importance of factors that affect bag-to-bloodstream time.
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Survival rates from out-of-hospital cardiac arrest (OHCA) vary, with figures from 2% to 12% reported nationally. Our ambulance service introduced a dedicated cardiac arrest response unit (CARU) as a trial in order to improve local patient outcomes by focussing training, extending the scope of practice and increasing exposure to cardiac arrests. CARU launched in January 2014 using a rapid response car staffed by senior paramedics responding to cardiac arrests within a 19 minute radius of their location. emermed;32/6/503-b/EMERMED2015204979TB1T1EMERMED2015204979TB1 CARU Service (CARU removed) 2012 OHCA Registry Cardiac arrests where resuscitation was attempted 54 705 1,853 ROSC (Sustained to hospital) 35.2% 25.8% 23.0% Survival to discharge (Based on latest available data) 13.0% 3.3% 7.0% ⋯ Based on these figures CARU appears to have a positive impact on ROSC and a significant impact on survival to discharge rates compared with the rest of the service (p<0.01, Fisher's exact test). Further work is needed to explore how CARU delivers this impact and how the CARU model can be implemented beyond the trial setting in a sustainable fashion.
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Pain is one of the most frequently reported symptoms to UK ambulance services and pain management is a known area for improvement. This is especially true for paediatric patients who may not be able to communicate their levels of pain as effectively as adults. ⋯ Further improvement is required to ensure every paediatric patient has their pain assessed and managed effectively. The laminated card has been redesigned and distributed, in conjunction with a pain training strategy. In addition, further analgesic options for paediatric patients have been investigated.
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Intraosseous access (IO) is becoming increasingly accepted in adult populations as an alternative to peripheral vascular access; however, there is still insufficient evidence in large patient groups supporting its use. ⋯ IO access can be used to administer a wide variety of life-saving medications quickly, easily and with low-complication rates. This highlights its valuable role as an alternative method of obtaining vascular access, vital when resuscitating the critically injured trauma patient.