Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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This article discusses a case of antipsychotic-induced, focal lingual dystonia causing airway obstruction that was managed completely in the out-of-hospital environment by emergency medical services (EMS) providers. With the ever-increasing use of antipsychotic medications by the general population, it is important for EMS providers and emergency medicine physicians to be aware of rare presentations of dystonic reactions that can sometimes be life-threatening when they involve the lingual, pharyngeal, or laryngeal musculature. This article identifies the medications most likely to induce dystonic reactions, risk factors that predispose individuals to the development of dystonia, and the pathophysiology behind these adverse reactions. It also discusses differential diagnoses to consider, and emergent treatment options.
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In the setting of ST-segment elevation myocardial infarction (STEMI), early reperfusion yields better patient outcomes. Emergency medical services (EMS) is the first medical contact for half of the afflicted population, and prehospital thrombolysis may result in considerably faster reperfusion compared with percutaneous coronary intervention (PCI) in rural settings. However, there are few reports of prehospital thrombolysis in rural EMS systems. ⋯ In this retrospective review of rural STEMI patients, tenecteplase was administered 36 minutes prior to hospital arrival, saving approximately two hours over typical PCI strategies and resulting in aborted infarctions in one-fourth of patients. In a rural setting with lengthy transport times to PCI facilities, tenecteplase appears to be a feasible prehospital intervention. Randomized controlled trials are needed to fully evaluate the safety and effectiveness of this intervention prior to widespread adoption.
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Prehospital providers are exposed to various infectious disease hazards. Examining specific infectious exposures would be useful in describing their current trends as well as guidance with appropriate protective measures an emergency medical services (EMS) system should consider. ⋯ Trends in our data suggest increasing exposures to viral respiratory illnesses, whereas exposures to needlestick injuries were relatively infrequent. Efforts should continue to focus on proper respiratory protection to include eye protection in order to mitigate these exposure risks.
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Practice Guideline
The use of epinephrine for out-of-hospital treatment of anaphylaxis.
The National Association of EMS Physicians (NAEMSP) believes that all levels of emergency medical services (EMS) providers should be allowed to carry and administer epinephrine for the treatment of anaphylaxis. This document is the official position of the NAEMSP.
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Little is known about the types of injuries and medical problems encountered by fire department personnel during suppression of large campaign-type wildland fires. Such information could help to plan for response to medical incidents during future wildfires. ⋯ Most firefighter injuries and illnesses encountered during the Los Angeles Station Fire were minor. The prevalence of injuries observed should be taken into consideration in creation of protocols and mandatory equipment lists for fireline paramedics. Furthermore, advanced training for paramedics in the diagnosis and treatment of minor medical conditions may be useful.