Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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End-tidal carbon dioxide (EtCO2) monitoring is widely used as a surrogate for the partial pressure of carbon dioxide (PCO2) in critically ill patients receiving manual or mechanical ventilation in prehospital, emergency, and critical care settings. Specific targets for ETCO2 are a key component of Emergency Medical Services (EMS) protocols, especially for specific patient groups such as those with traumatic brain injury. However, the correlation between EtCO2 and venous or arterial PCO2 is uncertain. We aimed to assess the correlation between EtCO2 and PCO2 in intubated patients undergoing critical care transport (CCT), and in specific subgroups of patients. ⋯ We identified substantial differences between EtCO2 and PCO2 across patients with medical and traumatic conditions undergoing critical care transport. The PCO2 assessment should be strongly considered as part of ventilatory management in patients encountered in emergency and critical care settings.
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Trauma-induced coagulopathy remains a significant contributor to mortality in severely injured patients. Fibrinogen is essential for early hemostasis and is recognized as the first coagulation factor to fall below critical levels, compromising the coagulation cascade. Recent studies suggest that early administration of fibrinogen concentrate is feasible and effective to prevent coagulopathy. We conducted a scoping review to characterize the existing quantity of literature and to explore the usage of prehospital fibrinogen concentrate products in improving clinical outcomes in trauma patients. ⋯ Preliminary research suggests that prehospital fibrinogen concentrate administration in traumatic bleeding patients is both feasible and effective, improving clotting parameters. While implementing a time-saving and proactive approach with fibrinogen holds potential for enhancing trauma care, the current evidence is limited. Further studies in this novel field are warranted.
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This prologue to the NAEMSP Prehospital Trauma Compendium describes the rationale for and the process used in developing the compendium manuscripts. It also provides a summary of other contemporary works discussing additional elements of prehospital trauma care including hemorrhage control, airway and ventilation management, pain management, care for traumatic brain injury, and trauma triage.
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The epidemic of opioid use disorder (OUD) remains pervasive in the United States. In an effort to increase the availability and timeliness of medications for opioid use disorder (MOUD), several agencies in the United States (US) offer buprenorphine by prehospital providers to selected patients, though published data remains limited. We describe the preliminary safety and feasibility of training all paramedics within a single agency to administer buprenorphine in the field without online medical control to simultaneously treat opioid withdrawal and initiate MOUD. ⋯ In a single prehospital system, the use of buprenorphine appears to be a feasible and safe strategy for treating patients experiencing acute opioid withdrawal.
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Previous research demonstrated that the numerical Cincinnati Prehospital Stroke Scale (CPSS) identifies large vessel occlusion (LVO) at similar rates compared to dedicated LVO screening tools. We aimed to compare numerical CPSS to additional stroke scales using a national Emergency Medical Services (EMS) database. ⋯ The less complex CPSS exhibited comparable performance to three frequently employed LVO detection tools. The EMS leadership, medical directors, and stroke system directors should weigh the complexity of stroke severity instruments and the challenges of ensuring consistent and accurate use when choosing which tool to implement. The straightforward and widely adopted CPSS may improve compliance while maintaining accuracy in LVO detection.