Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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The choice of the optimal benzodiazepine to treat prehospital status epilepticus is unclear. Lorazepam is preferred in the emergency department, but concerns about nonrefrigerated storage limits emergency medical services (EMS) use. Midazolam is increasingly popular, but its heat stability is undocumented. ⋯ Lorazepam experiences small but statistically significant temperature-dependent degradation after 60 days in the EMS environment. Additional study is needed to evaluate whether clinically significant deterioration occurs after 60 days. Midazolam shows no degradation over this duration, even in high-heat conditions.
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While self-mutilations with stab wounds are relatively common in psychiatric patients suffering from schizophrenia and personality disorders, they are rarely performed as suicidal attempts. Even in psychotic patients, suicidal stab wounds of the skull are rare in the literature. We report the case of a 34-year-old schizophrenic man whom emergency medical services (EMS) providers cared for at his home because of a complete self-amputation of his right hand, without any other apparent wound than a facial laceration. ⋯ When his neurologic status rapidly declined after hospital admission, a whole-body computed tomography (CT) scan was performed for other injuries. Unexpectedly, cerebral CT scan showed the presence of an intracranial 11-cm-long blade, whose distal tip was located in the left temporal cerebral lobe. Given the nature of the cerebral injuries on CT scan and the major impairment of the neurologic status of the patient, the neurosurgeon considered surgical extraction of the blade to be futile, and the patient's condition rapidly deteriorated to brain death.
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Emergency medical dispatch systems are used to help categorize and prioritize emergency medical services (EMS) resources for requests for assistance. ⋯ A small subset (8% of codes; 7% by call volume) of MPDS codes were associated with greater than 90% predictive ability for ED discharge. Older adults are at increased risk for admission/death in a separate subset of MPDS codes, suggesting that age criteria may be useful to identify higher-acuity patients within the MPDS code. These findings could assist in prehospital/hospital resource management; however, future studies are needed to validate these findings for other EMS systems and to investigate possible strategies for improvements of emergency response systems.
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Despite its long history and current prominence in U.S. communities, only limited data describe the national characteristics of emergency medical services (EMS) care in the United States. We sought to characterize out-of-hospital EMS care in the United States. ⋯ These data highlight the breadth and diversity of EMS demand and care in the United States.
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Review Case Reports
Successful administration of intranasal glucagon in the out-of-hospital environment.
We present a case of successful prehospital treatment of hypoglycemia with intranasal (IN) glucagon. Episodes of hypoglycemia can be of varying severity and often requires quick reversal to prevent alteration in mental status or hypoglycemic coma. Glucagon has been shown to be as effective as glucose for the treatment of hypoglycemia. ⋯ Intranasal administration of glucagon has been shown to be as effective as the IV route and may be used for rapid correction of hypoglycemic episodes where IV access is difficult or unavailable and IM administration is undesirable. We describe the first documentation in the peer-reviewed literature of the successful treatment and reversal of an insulin-induced hypoglycemic episode with IN glucagon in the prehospital setting. We also present a review of the literature regarding this novel medication administration route.