Annals of emergency medicine
-
Before the implementation of an intraosseous infusion protocol by the City of Pittsburgh paramedics, we undertook a study to compare the establishment of a simulated intraosseous infusion in three different prehospital settings. The purpose of this study was to determine the time to establish an intraosseous infusion and the success rate at the scene and en route to the hospital using this model. ⋯ Using a simulated model, IO access can be established successfully in the prehospital setting. The minimal time delay in establishing IO infusion may make it an appropriate technique for use at the scene or en route to the hospital.
-
Randomized Controlled Trial Clinical Trial
Dose-response evaluation of oral labetalol in patients presenting to the emergency department with accelerated hypertension.
Dose-response evaluation of oral labetalol (100, 200, or 300 mg) on heart rate and systemic blood pressure in emergency department patients with hypertensive urgency (diastolic blood pressure, 110 to 140 mm Hg, and no end-organ evidence of hypertensive emergency). ⋯ Labetalol provides safe and effective treatment for hypertensive urgencies when administered orally in doses of 100 to 300 mg.
-
This study evaluated the efficacy of glucagon for prehospital therapy of hypoglycemia in patients without IV access. ⋯ Glucagon is safe and effective therapy for hypoglycemia in the prehospital setting.
-
Most prehospital interventions, both pharmacologic and procedural, have been accepted without clear demonstrations of their abilities to impact patient outcomes or without clear indications that withholding or delaying the intervention pending arrival at a definitive emergency department will adversely affect the patient. Interventions that have the benefit of supportive research have been applied equally to urban and nonurban emergency medical services environments. In selecting interventions, inadequate consideration has been given to the differences in emergency medical services personnel training, frequencies of their exposure to patients, frequencies of skill use, and availabilities of effective continuing education programs in the urban and nonurban environments. These issues are discussed, and the necessary focus of the future of emergency medical services in urban, suburban, and rural environments is predicted.