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Foundation year trainees
Published in David McGowan, Helen Sims, Making the Most of Your Medical Career, 2021
Examples of courses include: Advanced Life Support - essential for core training applications and could be a discussion station at interviewAdvanced Trauma Life Support - do this if applying for surgery, anaesthetics, or accident and emergencyPaediatric Life Support - not essential, but looks positive if applying for paediatrics or anaesthetics.
Obstetric and Gynaecological Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Modifications to advanced life support (ALS): Hypoxaemia is common due to reduced functional residual capacity and increased oxygen demand.Intubation is more difficult during pregnancy secondary to some of the physical factors outlined in (2) (iii) be prepared to use an endotracheal tube that is 0.5–1.0 mm smaller in diameter than expected, as the airway may be narrower secondary to laryngeal oedema.Do not use the femoral veins for venous access. Drugs administered via this route may not reach the maternal heart until after the fetus has been delivered.Continue to use all the usual recommended resuscitation procedures and drugs for circulatory support.
EMS support of executive protection and counter-terrorism operations
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
David M. La Combe, Christopher M. Grande
After a candidate is successfully recruited it is essential to orient him or her as to how the team functions. Be specific with regard to the job performance expectations and limitations. For example: Where will the medical specialist be posted? What action should the specialist take during a threat to the protectee. Is the specialist allowed to carry a weapon? Will the medical specialist perform advanced life support skills? If so, and using an EMT or paramedic, does the protective team have a contract with a licensed physician that clearly delineates the permitted scope of practice for the physician extension?
Are Pediatric Manual Resuscitators Only Fit for Pediatric Use? A Comparison of Ventilation Volumes in a Moving Ambulance
Published in Prehospital Emergency Care, 2023
Gregory Sun, Susan Wojcik, Jennifer Noce, Nicholas Cochran-Caggiano, Tracie DeSantis, Steven Friedman, Derek R. Cooney, Chrisitan Knutsen
Lastly, results were broken down by certification level. EMTs are often called upon to assist with manual resuscitator ventilations while the paramedic performs additional interventions (15). Because of this, and the varied training for each clinician, it is important to assess not only the paramedic but also the EMT as both are expected to deliver adequate ventilations. It was noted that the EMTs were consistent in delivering 50% less volume than that of their paramedic counterparts. Average differences ranged from 112 ml to 249 mL, indicating a sizable and presumably clinically significant difference. These data correlated with the general observations made by the principal author while conducting the trial. To affirm these findings, the principal author ventilated the manikin after each EMT completed the trial in order to determine if there was any defect or air leak, though none were found. A potentially related finding in a study by Kurz et al. was a greater return of spontaneous circulation rate in out-of-hospital cardiac arrest cases when advanced life support clinicians were present earlier along with basic life support clinicians, implying a difference in performance (16). Further study to investigate differences in basic airway management and other elements of initial resuscitation care by advanced and basic life support clinicians is warranted.
ALS and BLS, an Historical Perspective: Time for a New Paradigm!
Published in Prehospital Emergency Care, 2022
Kristi L. Koenig, David C. Cone
While “advanced” life support generally denotes the performance of more “invasive” procedures, such as the establishment of advanced airways or intravenous lines, from a patient-centered, outcomes-based viewpoint, there are relatively few out-of-hospital interventions that are critical and time-sensitive. Treatments that can be immediately life, limb, or brain saving include:DefibrillationEpinephrine for anaphylaxisNaloxone for reversal of opioid overdoseDirect pressure/tourniquet for external hemorrhage controlAirway obstruction reversalGlucose for hypoglycemiaOxygen for hypoxemia
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