Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy and is associated with reduced morbidity and mortality for patients with ST-segment elevation myocardial infarction (STEMI). ⋯ Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system.
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We report an emergency medical services (EMS) case of self-limited torsade de pointes after administration of droperidol for nausea and vomiting in a patient with potential predisposing factors for the development of prolonged QT interval. Despite the reported association with torsade de pointes, many clinicians still consider droperidol to be a safe medication. Rare cardiac side effects may be avoided by reviewing risk factors for prolonged QT interval in individual patients prior to administering droperidol.
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To determine the impact of prehospital 12-lead electrocardiograms (ECGs) on door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients prior to the establishment of formally designated STEMI receiving centers. ⋯ Paramedic transport of STEMI patients with prehospital 12-lead ECG acquisition was associated with shorter door-to-balloon times than the times for patients who self-transported to PCI-capable EDs.
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Background. Many critically ill patients are given sedatives and paralytics to facilitate aeromedical transport. Bispectral index (BIS) monitoring is a computer-derived electroencephalography (EEG) analog currently used to monitor the level of awareness of sedated patients. ⋯ Only two patients (4.3%, 95% confidence interval [CI] 0.5% to 14.8%) had at least one BIS score greater than 85, the accepted threshold for recall. Conclusion. These results suggest that patients are adequately sedated during air medical transport.
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Seizure patients are frequently encountered in the prehospital environment and have the potential to need advanced interventions, though the utility of advanced life support (ALS) interventions in many of these patients has not been proven. ⋯ This study showed a lower-than-anticipated level of compliance with an ALS-based prehospital seizure protocol, though patient-specific care appeared appropriate. Prehospital seizure patients have the potential for seizure recurrence and may benefit from focused ALS interventions, but their heterogeneity makes uniform protocols difficult to develop and follow.