When the Classroom is the Workplace
Michael J. Madson in 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.
Traumatized Airway
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
Pre-hospital intubation has failed to show mortality benefit in several studies [5–8]. This also holds true for additional advanced airway devices. Although not specific to trauma patients, a prospective trial of nearly 650,000 patients with out-of-hospital cardiac arrest had worse neurologic outcomes when advanced airway management was employed [9]. This, in combination with the heterogeneity of training in advanced airway management among pre-hospital providers, and the variation of usage of pre-hospital neuromuscular blockade, suggests that the optimal pre-hospital airway is, in fact, an effective ventilation with a bag-valve-mask. Only if ventilation with a bag-valve-mask is unsuccessful, should attempts be made for endotracheal intubation or placement of advanced airway devices. Recommendation: The optimal pre-hospital airway is effective ventilation with a bag-valve-mask.
Psychiatric Emergencies Associated with Drug Overdose
R. Thara, Lakshmi Vijayakumar in Emergencies in Psychiatry in Low- and Middle-Income Countries, 2017
Acute dystonic reactions merit consideration as they are the most common reason for discontinuation of antipsychotics and rare dystonias involving the larynx and esophagus, which are life-threatening. The possibility of laryngeal dystonia should be considered when a patient on antipsychotic therapy presents with acute respiratory distress and stridor. Advanced airway management and even a cricothyroidotomy may be required. The patient should be given supplemental humidified oxygen, along with intravenous centrally acting anticholinergic agents such as diphenhydramine and benztropine. Additionally, benzodiazepines, such as lorazepam, can be given to alleviate anxiety (Reilly and Kirk 2007).
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).
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).
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