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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To describe interfacility transfer (IFT) intervals, transfer vehicle type, and levels of care in patients with large vessel occlusion (LVO) strokes transferred for emergent endovascular therapy (EVT). ⋯ At longer distances, rotor transport saved significant time specifically in the total IFT interval of patients with LVO strokes. Emphasizing processes to reduce the resource activation interval and the sending hospital interval may help reduce the overall time-to-EVT.
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We report the initial six pediatric patients treated with ketamine for benzodiazepine-resistant status epilepticus in an urban, ground-based emergency medical services (EMS) system. Evidence for ketamine as a second-line agent for both adult and pediatric refractory seizure activity in the hospital setting has increased over the past decade. The availability of an inexpensive and familiar second-line prehospital anti-epileptic drug option is extremely desirable. We believe these initial data demonstrate promising seizure control effects without significant respiratory depression, indicating a potential role for ketamine in the EMS treatment of pediatric benzodiazepine-refractory seizures.
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Cardiac arrest guidelines recommend epinephrine every 3-5 minutes during cardiac arrest resuscitation. However, it is unclear if multiple epinephrine doses are associated with improved outcomes. The objective of this study was to determine if a single-dose epinephrine protocol was associated with improved survival compared to traditional multidose protocols. ⋯ A prehospital single-dose epinephrine protocol was associated with similar survival to hospital discharge, but decreased ROSC rates compared to the traditional multidose epinephrine protocol.
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Non-exertional heat stroke is defined as exposure to high outdoor temperatures, core body temperature >40 °C, and alteration of mentation. Early identification and treatment are imperative to reduce morbidity and mortality in these patients. Cold water immersion therapy is the most efficient and efficacious modality in treating heat stroke, yet it is rarely initiated in the prehospital setting. ⋯ He was treated with cold water immersion using a body bag in the back of the ambulance and cooled to 104.1 °F during transport. During the 9-minute transport, the patient regained consciousness, followed basic commands, and answered basic questions. This case highlights the novel use of body bag cold water immersion as early initiation of treatment for heat stroke patients.