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 modified Valsalva maneuver has been promoted as a safe and effective method for the treatment of supraventricular tachycardia. Serious adverse events associated with the modified Valsalva maneuver are not well documented. Here we report a case of non-sustained polymorphic ventricular tachycardia in a pregnant patient associated with the use of the modified Valsalva maneuver by paramedics in the prehospital setting.
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Emergency Medical Services (EMS) clinicians commonly encounter patients with acute pain. A new set of evidence-based guidelines (EBG) was developed to assist in the prehospital management of pain. Our objective was to describe the methods used to develop these evidence-based guidelines for prehospital pain management. ⋯ We describe a protocol that leveraged established EBG development techniques, the GRADE framework in conjunction with a previous AHRQ systematic review to develop treatment recommendations for prehospital pain management. This process allowed for mitigation of many confounders due to the use of virtual and electronic communication. Our approach may inform future guideline development and increase transparency in the prehospital recommendations development processes.
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The survival rate of patients with out-of-hospital cardiac arrest has improved in recent years; however, it remains low. One approach to improving outcomes in these cases is to implement point-of-care ultrasound as an integral part of advanced cardiac life support management. Due to its growing popularity among emergency physicians, several protocols for this examination have been developed; however, there are little data on its use in the prehospital setting. We present a case report on the role of ultrasound examination in cardiac arrest for both diagnostic and therapeutic management.
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Given that the benefits of helicopter transport vary with geography and healthcare systems, we assessed transport times for rotor wing versus ground transport over a 10 year period in an urban setting. ⋯ In over 25,000 transports over 10 years, in a compact metropolitan area with relatively short transport distances and times, the use of the helicopter was associated with substantial time savings.
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The duration of low flow prior to initiation of extracorporeal cardiopulmonary resuscitation (eCPR) appears to influence survival. Strategies to reduce the low-flow interval for out-of-hospital cardiac arrest have been focused on expediting patient transport to the hospital or initiating extracorporeal support in the prehospital setting. To date, a direct comparison of low-flow interval between these strategies has not been made. ⋯ It would be rare to successfully initiate eCPR by either strategy in fewer than 30 minutes from the time of patient collapse. Using a prehospital cannulation strategy, the entire coverage area could be eligible for eCPR within 60 minutes of patient collapse. The use of predictive modeling can be a low-cost solution to assist with strategic deployment of prehospital resources and may have potential for real-time decision support for prehospital clinicians.