by David Rayburn MD, MPH Scenario: A crew is dispatched for OB/Childbirth. The baby, delivered as the EMS crew arrives, is pale, limp, and apneic. What are the next steps of care for this patient? How do we prepare to manage this scenario? Review: Delivery of a baby by a prehospital provider is not an
by Aaron Farney, MD Case Presentation EMS is dispatched priority 1 for an 86-year-old female unconscious/fainting call. Despite 911 center implementation of the Medical Priority Dispatch System (MPDS) 36 pandemic card, this incident is coded via the 31 card – unconscious/fainting. On arrival, EMS discovers family in an upstairs bathroom surrounding an elderly female who
by Brent Olson, NRP & Hashim Zaidi, MD Clinical Scenario You answer a call for on-line medical control for a 28-year-old male patient refusing transport to the hospital. The paramedics report that he was initially cyanotic with pinpoint pupils and snoring, shallow respirations. The paramedics administered a single dose of 2 mg intranasal naloxone. The
Article Bites Summary by Clare Wallner MD Infographic by Jeffrey Stirling MSc(c), PCP, @jeffrey_stirlin Article: Sacramento County Prehospital Research Consortium. Out-of-hospital triage of older adults with head injury: a retrospective study of the effect of adding “anticoagulation or antiplatelet medication use” as a criterion. Ann Emerg Med 2017 Aug;70(2):127-38. Background and objectives: The CDC Field trauma triage
The Article: Wang HE, Schmicker RH, et al. (2018). Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest. JAMA, 320(8), 769. doi:10.1001/jama.2018.7044 Background & Objectives: Airway management has long been one of the first steps in the ABC’s of cardiac arrest management, but there
by Erin Brennan, MD, MPH Recently on twitter, one of our colleagues, Joshua Stilley, an EMS Physician, tweeted the following: His description suggests an important change in our lexicon. The way we describe things assigns value – and basic implies that it is easy to do and sounds much less attractive that “advanced”. But there
TL;DR TXA is used to stabilize clots by preventing fibrinolysis Dose: 1g over 10 minutes, then 1g over 8 hours CRASH-2 has shown an improvement in survival Even greater improvement if administered within 3 hours (earlier is better!) CRASH-3 has shown mortality improvement in mild-moderate isolated head trauma (GCS 9-15) TXA rate of vascular occlusive
David Wright, PA-C, NRP & Bridgette Svancarek, MD, FAEMS “There should be a paramedic to Physician Assistant (PA) fast track!” “PAs and paramedics do about the same job!” “Isn’t a PA doing the same job as a paramedic, just in the hospital?” “Paramedics are just as good as nurses” “Why don’t we [paramedics] get paid
by Andra Farcas, MD and Hashim Zaidi, MD Is fatigue an expected work hazard for EMS providers? Based on experience from interacting with paramedics who make runs to the emergency department, it seems as if sleep on shift remains an uncommon occurrence. Many prehospital providers report getting little to no sleep in a 24 hour
Article: Remick K, Redgate C, Ostermayer D, Kaji AH, Gausche-hill M. Prehospital Glucose Testing for Children with Seizures: A Proposed Change in Management. Prehosp Emerg Care. 2017;21(2):216-221. Background: Hypoglycemia is an easily identifiable and quickly reversible cause of seizures in the pediatric patient population. Current recommendations highlight the importance of identifying hypoglycemia prior to initiation
