Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Airway management is one of the critically important skills in practicing emergency medicine. However, intubation in the prehospital setting is quite different from those done in controlled environment and still poses significant risks for serious complications. ⋯ Studies have shown that the verification of tube placement utilizing bronchoscopy is an easy and highly reliable methods and this is especially beneficial in the prehospital settings. Although the use of bronchoscopy in prehospital setting currently is somehow limited, this new, rapidly advancing technology and technique is believed to be a game changer in our prehospital intubation/post-intubation practice in the near future.
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Background: Out-of-Hospital Cardiac Arrest (OHCA) incidence and survival rates are known to vary between seasons in some locations. The winter of 2017 saw the highest ever incidence and lowest survival rate of OHCA recorded in Victoria at the time. Seasonal variation of OHCA has not previously been examined in Australia and there may be a significant effect. ⋯ Conclusion: In winter the incidence of OHCA was at its highest and survival to discharge was at its lowest compared to other seasons. Recent respiratory infection was associated with lower odds of survival to discharge. Measures targeted to vulnerable groups, such as preventative public health measures for respiratory infections and the influenza vaccine may reduce the incidence of OHCA and improve survival rates.
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Objective: Use of point-of-care (POC) troponin (cTn) testing in the Emergency Department (ED) is well established. However, data examining POC cTn measurement in the prehospital setting, during ambulance transport, are limited. The objective of this study was to prospectively test the performance of POC cTn measurement by paramedics to detect myocardial infarction (MI) among patients transported to the ED for acute chest pain. ⋯ Compared to POC cTn, the central lab cTn measurement of prehospital blood resulted in a higher sensitivity of 67.9% (95% CI 53.7-80.1%, p < 0.0001), but lower specificity of 92.4% (95% CI 88.4-95.4%, p = 0.0001). Conclusions: Prehospital POC i-STAT cTn measurement in patients transported with acute chest pain was highly specific for MI but had low sensitivity. This suggests that prehospital i-STAT POC cTn could be useful to rule-in MI, but should not be used to exclude MI.
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Objective: Retrospective analysis evaluating and comparing the feasibility, effectiveness and safety of intranasal fentanyl (INF) and subcutaneous fentanyl (SCF) for pain management of patients with acute severe pain in a rural/suburban Emergency Medical Services (EMS) system. Methods: Pre- and post-pain management data of all patients (aged ≥14 years) who were transported to the emergency department (January 2015-August 2017) were extracted from EMS and online medical control center records, and compared for groups receiving INF or SCF. Kaplan-Meier analysis and the log-rank test were used to describe and compare the percentage of patients in both groups who experienced relief according to their clinically significant pain relief score. ⋯ Conclusion: This retrospective analysis of prehospital patients in the Chaudière-Appalaches EMS system demonstrates that both IN and SC are feasible, effective and safe routes for administering fentanyl. The observed effects of INF were found to be greater among patients ≥70 years. Further research is required to compare these routes with more conventional methods of pain management.
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This commentary discusses the findings of the CONDI-2/ERIC-PPCI trial in the context of the existing literature on the topic, and the implications for prehospital and Emergency Medicine in terms of clinical practice and research relating to ischemic conditioning.