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Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Fentanyl is a synthetic opiate with approximately 100 times the potency of morphine. It is often used in chronic pain in the form of transdermal patches, but in the acute trauma setting can be administered by nasal, mucosal (lollipop) or intravenous routes. The oral mucosal route lends itself to a patient-controlled type of analgesia and is often seen in rescue situations (for example, mountain-rescue) when patients can use the fentanyl lollipop as required during the rescue. Intravenous fentanyl is a potent analgesic for severe pain with a very rapid onset. Due to its potency, it must only be administered in an environment where advanced airway management and continuous monitoring are available.
When the Classroom is the Workplace
Published in Michael J. Madson, Teaching Writing in the Health Professions, 2021
In most areas of the health professions, providers develop many essential, lifesaving skills, such as intubating patients, suturing, and performing a physical assessment. As first responders, EMS providers learn these skills and earn their training and licensure through accredited programs offered through fire departments, private EMS agencies, community and technical colleges, or 4-year colleges and universities. Depending on the program structure and licensure level offered, the programs last between 3 months to 4 years. Basic EMS training covers foundational elements of prehospital medical care, such as anatomy and physiology, patient and scene assessments, and trauma and medical care. Advanced EMS training at the paramedic level covers more complex medical skills and decision-making, such as pharmacology and advanced airway management. Regardless of training level, all EMS providers are required to take state exams to earn their licensure. Some providers complete national-level exams to earn national licensure, allowing them to practice EMS outside their home state.
The injured child
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Airway obstruction will require immediate resolution and possibly advanced airway management. This should be performed by clinicians competent in paediatric advanced airway management (see Chapter 15). Basic airway management can be tricky, in particular for infants, since small movements can obstruct the airway and constant vigilance and repositioning is required. Maintaining an airway in order to provide bag–valve–mask (BVM) ventilation with the two-person technique is particularly useful in children. Appropriately sized airway adjuncts must be carried to assist in basic airway management.
Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS)
Published in Prehospital Emergency Care, 2022
Sattha Riyapan, Jirayu Chantanakomes, Bongkot Somboonkul, Sang Do Shin, Wen-Chu Chiang
The primary outcome of this study was survival in the ED compared between the nighttime and daytime groups. Survival in the ED was defined from ED disposition status as RTI patients survived to discharge from ED, survived to refer to another hospital, or survived to admit to inpatient. Survival to discharge was extracted from the hospital discharge status, which included the patients who were treated in the hospital and then discharged or transferred to another healthcare facility. We also compared prehospital interventions, including basic airway management, advanced airway management, oxygen supplementation, and total immobilization. Basic airway management included oropharyngeal or nasopharyngeal airway insertion. Advanced airway management consisted of endotracheal intubation or supraglottic airway insertion. Oxygen supplementation comprised nasal canula, face mask, or bag valve mask ventilation. Total immobilization included C-spine or spinal immobilization, femur traction or immobilization, and bandaging at an active bleeding area. The study identified characteristics of RTI patients at night. Alcohol use and substance abuse data was from both biologic evidence and physician’s report. Low- and middle-income countries were grouped according to the World Bank, such as Thailand, Vietnam, India, and Malaysia (see https://data.worldbank.org/income-level/low-and-middle-income).
Advanced Life Support for Out-of-Hospital Chest Pain: The OPALS Study†
Published in Prehospital Emergency Care, 2022
Ian G. Stiell, Justin Maloney, Jon Dreyer, Doug Munkley, Daniel W. Spaite, Marion B. Lyver, Julie E. Sinclair, George A. Wells
Prephospital advanced life support is routinely provided by paramedics to treat patients with chest pain in the United States and in some regions of Canada. Advanced life support includes the ability to provide advanced airway management and intravenous drug therapy. Basic life support includes oxygen administration, electrocardiogram monitoring and the ability to defibrillate and in some cases sublingual nitroglycerin (NTG) and acetylsalicylic acid (ASA). The effectiveness of advanced life support interventions for patients with chest pain has not been clearly demonstrated in the literature. Studies have revealed that paramedics are capable of effectively treating chest pain with the administration of nitroglycerin, ASA, intravenous medications, cardiac monitoring, and more recently 12 lead electrocardiogram performance and interpretation (5–10). Nevertheless, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect important outcomes such as mortality.11
Prehospital Trauma Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Sabina Braithwaite, Christopher Stephens, Kyle Remick, Whitney Barrett, Francis X. Guyette, Michael Levy, Christopher Colwell
The current prehospital traumatic brain injury (TBI) literature underscores two important observations: 1) oxygenation and ventilation are critical to improved TBI outcomes, and 2) while intended to optimize care, advanced airway management may not be associated with controlled oxygenation or ventilation and may be linked to poor outcomes. These overarching observations underscore that optimization of oxygenation and ventilation must receive the highest priority in TBI care. Studies highlighting the importance of oxygenation and ventilation include Davis et al. (27) and Kim et al. (28) Chuck et al. recently published a cross-sectional analysis of statewide EMS guidelines specific to TBI that suggests avoidance of hyperventilation/hypocapnia and hypoxemia (goal SpO2 > 90%) and supports endotracheal intubation only in those patients with depressed respiratory effort (29).