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By Casey Patrick MD and Brad Ward EMT-P Article: E Baldi, S Schnaubelt, et al. Post-ROSC electrocardiogram timing in the management of out-of-hospital cardiac arrest: results of an international multicentric study (PEACE study). European Heart Journal, Volume 41, November 2020 Background The initial hospital destination for OHCA patients, post-ROSC, has been a moving target over the

by Torie Howarth, NRP and Joshua Stilley, MD FAEMS Scenario You are dispatched for a 78 year old female with a complaint of generalized weakness. On arrival, the patient is sitting in her bedroom and appears pale but alert. You conduct a quick primary survey and find that while her radial pulse is present, you

Article: Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting.  A Position Statement and Resource Document from NAEMSP. Background: Medication dosing errors in pediatrics are a common occurrence. Dosing errors are the result of multiple causes:  infrequent exposure to pediatric patients coupled with complex calculations

In February, we posted the following Discussion Forum stem:   EMS is dispatched to a cardiac arrest at a residence with bystander CPR in progress.  The paramedic and EMT partners arrive on scene to find BLS care being initiated by a company of four firefighters who are credentialed at either the EMR or EMT level.

Article Summary by Casey Patrick, MD, FAEMS @cpatrick_89 Article: Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Winkler W, Yan Y, Kollef MH, Avidan MS, Fuller BM. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med.

by  Kaitlyn Hartnett, MS2 NRP and Joshua Stilley, MD FAEMS Case: You are dispatched to a 60 year old female with a chief complaint of dizziness. Upon arrival, the patient is lying on her bed in a dark room, but is interactive. Vital signs are normal, and her primary survey is unremarkable. She tells you

Article: Crowe, R. P., Myers, J. B., Fernandez, A. R., Bourn, S., & McMullan, J. T. (2020). The cincinnati prehospital stroke scale compared to stroke severity tools for large vessel occlusion stroke prediction. Prehospital Emergency Care, 1-9. Background: Since the first trials demonstrating significant benefit from endovascular therapy for patients with stroke secondary to large vessel

Article: Grunau B, Kime N, Leroux B, et al. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. JAMA. 2020;324(11):1058–1067. doi:10.1001/jama.2020.14185 Background Treatment for a non-traumatic Out-Of-Hospital Cardiac Arrest (OHCA) can occur on scene or during transport. It continues to be the standard in some

Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomized controlled trial. Lancet 2020; Nov 13 Background – ECMO and CPR (eCPR) Refractory ventricular fibrillation (rVF), often called electrical storm, has dismal outcomes which is exceedingly frustrating because

In November, we posted these cases and discussion stem to the blog discussion forum and got a number of insightful comments regarding the use of push dose vasopressors in the prehospital environment.  This commentary is summarized here. The term “Push dose pressors” (also known as Bolus-Dose Vasopressors) refers to the intravenous administration of small, discrete