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 prehospital electrocardiogram (ECG) allows earlier identification of acute ST-segment elevation myocardial infarction (STEMI). Its utility for detection of other acute cardiac events, as well as for transient ST-segment abnormalities no longer present when the first hospital ECG is performed, is not well characterized. ⋯ Beyond identifying ST-segment elevation earlier, prehospital ECGs detect important transient abnormalities, information not otherwise available from the first emergency department ECG. These data can expedite diagnosis and clinical management decisions among patients suspected of having an acute cardiac event. The prehospital ECG should be fully integrated into emergency medicine practice.
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Advances in the management of heart failure have led to an increasing number of patients living outside the hospital with a variety of ventricular-assist devices (VADs). These implantable pumps may be placed temporarily as a bridge to cardiac transplantation or resolution of a reversible condition, or as destination therapy for the rest of the patient's life. Emergency medical services (EMS) providers may be called to care for such patients experiencing an emergency related to the device itself, the underlying cardiac condition, or a totally unrelated medical or traumatic issue. ⋯ Challenges related to management of patients with VADs include their poor baseline medical status, limitations of traditional prehospital assessment techniques, the relative infrequency with which these patients are encountered, and the rapidity with which device technology is evolving. This article presents a brief history of VADs, with an emphasis on left ventricular-assist devices (LVADs), reviews the relevant anatomy and pathophysiology, and describes the types of devices currently in clinical use. It discusses patient-specific and device-specific complications that may be encountered and concludes with an approach to prehospital patient assessment and care.
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Multicenter Study Comparative Study
Variation in prehospital use and uptake of the national Field Triage Decision Scheme.
The Field Triage Decision Scheme is a national guideline that has been implemented widely for prehospital emergency medical services (EMS) and trauma systems. However, little is known about the uptake, modification, or variation in field application of triage criteria between trauma systems. ⋯ There is large variation between regions in the frequency and type of field triage criteria used. Field uptake of guideline revisions appears to be slow and variable, suggesting opportunities for improvement in dissemination and implementation of updated guidelines.
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Multicenter Study
The role of calling EMS versus using private transportation in improving the management of stroke in France.
To compare the time from symptom onset to brain imaging between patients calling emergency medical services (EMS) and those using private means for transportation. ⋯ The symptom onset-to-brain imaging time was significantly shorter in case of EMS transportation, but most patients did not reach the hospital in time to be eligible for thrombolysis. Efforts are still needed to reduce delays, especially public education and EMS activation. These efforts should be combined with new approaches for the quality management of stroke patients.
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Comparative Study
A comparison of proximal tibia, distal femur, and proximal humerus infusion rates using the EZ-IO intraosseous device on the adult swine (Sus scrofa) model.
We sought to compare the flow rates of the proximal tibia, the distal femur, and the proximal humerus using high pressure (greater than 300 mmHg) through an intraosseous (IO) infusion needle in an adult swine model. ⋯ The humerus is a suitable alternative site for IO placement, with a potential for higher flow rates than the proximal tibia and distal femur when resuscitating a patient.