Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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This article is a support paper for the National Association of EMS Physicians' position paper on induced therapeutic hypothermia in resuscitated cardiac arrest patients. Induced hypothermia is one of the newest treatments aimed at increasing the dismal neurologically intact survival rate for out-of-hospital cardiac arrest patients. Two landmark studies published in 2002 by the New England Journal of Medicine led to the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care IIa recommendation of cooling unconscious adult patients with return of spontaneous circulation after out-of-hospital cardiac arrest due to ventricular fibrillation to 32 degrees C to 34 degrees C for 12 to 24 hours. ⋯ Finally, the literature provides no evidence to support mandating induced hypothermia in the prehospital setting. Given limited prehospital resources, sometimes consisting of only two providers, attention first needs to be given to providing the basic care with the utmost skill. Once the basics are being delivered expertly, consideration can be given to the use of prehospital cooling for the resuscitated cardiac arrest patient in the setting of continued cooling in the hospital.
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Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy and is associated with reduced morbidity and mortality for patients with ST-segment elevation myocardial infarction (STEMI). ⋯ Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system.
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We report an emergency medical services (EMS) case of self-limited torsade de pointes after administration of droperidol for nausea and vomiting in a patient with potential predisposing factors for the development of prolonged QT interval. Despite the reported association with torsade de pointes, many clinicians still consider droperidol to be a safe medication. Rare cardiac side effects may be avoided by reviewing risk factors for prolonged QT interval in individual patients prior to administering droperidol.
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To determine the impact of prehospital 12-lead electrocardiograms (ECGs) on door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients prior to the establishment of formally designated STEMI receiving centers. ⋯ Paramedic transport of STEMI patients with prehospital 12-lead ECG acquisition was associated with shorter door-to-balloon times than the times for patients who self-transported to PCI-capable EDs.
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Background. Many critically ill patients are given sedatives and paralytics to facilitate aeromedical transport. Bispectral index (BIS) monitoring is a computer-derived electroencephalography (EEG) analog currently used to monitor the level of awareness of sedated patients. ⋯ Only two patients (4.3%, 95% confidence interval [CI] 0.5% to 14.8%) had at least one BIS score greater than 85, the accepted threshold for recall. Conclusion. These results suggest that patients are adequately sedated during air medical transport.