Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Case Reports
Out Of Hospital Transesophageal Echocardiogram For Cardiac Arrest Resuscitation: The Initial Case.
Objective: The use of transesophageal echocardiogram (TEE) during cardiac arrest in the emergency department (ED) is a newer concept. TEE provides dynamic evaluation of chest compressions and rhythm analysis. ⋯ Results: This case is a proof of concept that TEE can be successfully performed and contribute to clinical care of cardiac arrest in the out of hospital setting. Conclusion: Further research needs to be performed to determine the clinical benefit, indications, and curriculum for emergency providers to successfully deliver this potentially valuable resource prior to widespread adoption.
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Objective: The purpose of this study was to examine the attitudes and behaviors of emergency medical technicians (EMTs) and Paramedics when faced with the decision to care for patients with suspected Ebola Virus Disease (EVD) and to illicit suggestions for improvement of infectious disease (ID) preparedness. Methods: A convenience sample of 22 EMT/Paramedics were recruited from an emergency department at one of the designated Ebola centers. Each provider participated in one of three on-site focus groups. ⋯ Suggestions for improvement of ID preparedness included continuing education, tiered training models, peer training models, collaboration between emergency medical services (EMS) systems, better communication between departments, and the development of an infectious disease response team. Conclusions: Although first responders were excited to be a part of the response to EVD, this did not come without hesitation and emotional distress. Some of these concerns may be mitigated by first providing a clear definition of "duty to care," followed by interventions such as the development of clear and consistent ID preparedness training and interventions that address the emotional distress experienced by these providers.
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Background: Syncope is a common condition that may be prevented. There are non-pharmacological interventions that may be of benefit during the acute episode preceding syncope (presyncope), including physical counter-pressure maneuvers (PCM) or change of body position. We performed a systematic review of interventions that may be applied during presyncope as an immediate, first aid tactic. ⋯ No adverse events were reported. Conclusion: While there is a minimal amount of evidence available and the findings were mixed, PCM may provide benefit for prevention of syncope during acute episodes of presyncope and may be tried in the first aid setting. No evidence was found for other non-pharmacologic interventions or for the use of PCM in children.
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Observational Study
Effect of Specialized Critical Care Transport Unit on Short-Term Mortality of Critically Ill Patients Undergoing Interhospital Transport.
Objective: To minimize risk and prevent harmful incidents during interhospital transport, the critical care transport unit service called Seoul Mobile Intensive Care Unit (SMICU) was organized and initiated its service within the city of Seoul. We sought to evaluate the effectiveness of critical care transport units on outcomes of critically ill patients undergoing interhospital transport in Seoul. Methods: A retrospective observational case-control study was designed to evaluate the effectiveness of critical care transport units on outcomes of critically ill patients undergoing interhospital transport. ⋯ Patients transported by SMICU had a higher proportion of severe emergency disease and use of a mechanical ventilator. The adjusted odds ratio for 24-hour mortality after interhospital transport was 0.45 (95% CI: 0.26-0.81) in total cohort and was 0.34 (95% CI: 0.16-0.71) in a one-to-one propensity-matched cohort. Conclusions: Transport by specialized critical care transport unit for patients undergoing interhospital transport was associated with lower 24-hour mortality, demonstrating the benefits of the SMICU.
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Catecholaminergic Polymorphic Ventricular Tachycardia is a rare but often lethal genetic disorder that affects approximately 1 in 10,000 people. It often first manifests as stress or exercise-related syncope or sudden unexplained cardiac death, primarily in the pediatric and young adult population. We present a case of a 6-year-old male who had a sudden unexplained prehospital cardiac arrest after being scared by a domestic animal and who presented in ventricular fibrillation. ⋯ During the course of care, medications with beta-1 and -2 agonist properties were administered, followed by multiple further episodes of polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF). Once these medications were discontinued and beta blockers were administered, the patient had no further episodes of PVT/VF and was subsequently discharged from hospital 7 days later, completely neurologically intact. This case suggests the need for caution when considering administering beta agonists in a pediatric cardiac arrest patient with no known history of heart disease who presents in VF or PVT after an incident of extreme stress or strenuous physical activity.