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 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.
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Practice Guideline
EMS Care of Adult Hospice Patients- a Position Statement and Resource Document of NAEMSP and AAHPM.
Emergency medical services (EMS) systems are designed to provide care in the field and while transporting patients to a hospital; however, patients enrolled in hospice may not want invasive therapies nor benefit from hospitalization. For many reasons, encounters with hospice patients can be challenging for EMS systems, EMS clinicians, hospice clinicians, hospice patients, and their families.
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EMS was recognized as a subspecialty of Emergency Medicine in 2010. Accreditation of EMS fellowship programs started in 2013. Despite increasing numbers of programs and a decade since recognition, little has been written about the characteristics and offerings of these programs. ⋯ Despite some commonality, especially in required experiences, considerable differences exist between programs in how education is delivered. However, none of them correlate with filling or the size of the program. Involvement in unique areas such as ultrasound or community paramedicine was not universal. It is unclear what if any impact these differences have on career preparation and satisfaction. Programs may wish to consider sharing resources to offer future EMS physicians more comprehensive experiences.