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
Article: Harcke, H. T., Curtin, R. N., Harty, M. P., Gould, S. W., Vershvovsky, J., Collins, G. L., & Murphy, S. (2020). Tibial Intraosseous Insertion in Pediatric Emergency Care: A Review Based upon Postmortem Computed Tomography. Prehospital Emergency Care, 1-7. Background: The most commonly used (and recommended) site for intraosseous (IO) access in pediatric patients is
Nightscales, R et al. “Mortality in Patients with Psychogenic Nonepileptic Seizures.” Neurology 95.6 (2020): e643–e652. Neurology. Background Caring for psychogenic nonepileptic seizure (PNES) patients (the condition formerly known as “pseudoseizures”) in the emergency setting can be exceedingly difficult and frustrating. This is understandable because discerning between true seizure activity and a psychogenic event leads to drastically different treatment
By Louis Fornage, MD Over the last 10 years, advances in out of hospital cardiac arrest (OHCA) have resulted in significant improvements in patient outcome. While this has definitely been the case for adult cardiac arrest, this unfortunately has not translated to improved outcomes in pediatric cardiac arrest, which continues lag behind. Even in cases
