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https://www.readbyqxmd.com/read/29441840/the-ethics-of-real-time-ems-direction-suggested-curricular-content
#1
Jay M Brenner, Andrew L Aswegan, Laura E Vearrier, Jesse B Basford, Kenneth V Iserson
Ethical dilemmas can create moral distress in even the most experienced emergency physicians (EPs). Following reasonable and justified approaches can help alleviate such distress. The purpose of this article is to guide EPs providing Emergency Medical Services (EMS) direction to navigate through common ethical issues confronted in the prehospital delivery of care, including protecting privacy and confidentiality, decision-making capacity and refusal of treatment, withholding of treatment, and termination of resuscitation (TOR)...
February 14, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29421001/thrombus-aspiration-and-prehospital-ticagrelor-administration-in-st-elevation-myocardial-infarction-findings-from-the-atlantic-trial
#2
Sinem Kilic, Enrico Fabris, Arnoud W J Van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Anne Tsatsaris, Abdourahmane Diallo, Eric Vicaut, Gilles Montalescot
BACKGROUND: The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580). METHODS: This analysis included 1,630 patients who underwent primary PCI...
February 2018: American Heart Journal
https://www.readbyqxmd.com/read/29404658/-miscommunication-as-a-risk-focus-in-patient-safety-work-process-analysis-in-prehospital-emergency-care
#3
S Wilk, L Siegl, K Siegl, C Hohenstein
BACKGROUND: In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety. OBJECTIVES: An out-of-hospital workflow analysis collects data about key work processes and risk areas...
February 5, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29381489/abdominal-prehospital-ultrasound-impacts-treatment-decisions-in-a-dutch-helicopter-emergency-medical-service
#4
Rein Ketelaars, Jasper J M Holtslag, Nico Hoogerwerf
OBJECTIVE: The aim of this study was to determine the impact of abdominal prehospital ultrasound (PHUS) on patient care in a Dutch physician-staffed Helicopter Emergency Medical Service (HEMS) and to determine its diagnostic performance. PATIENTS AND METHODS: We carried out a retrospective analysis of abdominal ultrasound (US) examinations performed by the HEMS of Nijmegen, the Netherlands, from January 2007 until December 2016. Data including patient demographics, type of incident, abdominal US findings, impact on treatment decisions, and the physicians' narrative report were retrieved from the HEMS database and analyzed...
January 29, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29373217/an-effective-treatment-in-the-austere-environment-a-critical-appraisal-into-the-use-of-intra-articular-local-anesthetic-to-facilitate-reduction-in-acute-shoulder-dislocation
#5
REVIEW
Fraser John Gould
Acute shoulder dislocation is a common injury in the outdoor environment. The objective of this systematic review of the literature was to determine if intra-articular local anesthetic (IAL) is an effective treatment that could have prehospital application. A methodical search of MEDLINE, PubMed, and EMBASE databases targeted publications from January 1, 1990 until January 1, 2017. Eligible articles compared IAL with other analgesic techniques in patients 16 years or older experiencing acute glenohumeral dislocation...
January 16, 2018: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/29367334/2018-guidelines-for-the-early-management-of-patients-with-acute-ischemic-stroke-a-guideline-for-healthcare-professionals-from-the-american-heart-association-american-stroke-association
#6
REVIEW
William J Powers, Alejandro A Rabinstein, Teri Ackerson, Opeolu M Adeoye, Nicholas C Bambakidis, Kyra Becker, José Biller, Michael Brown, Bart M Demaerschalk, Brian Hoh, Edward C Jauch, Chelsea S Kidwell, Thabele M Leslie-Mazwi, Bruce Ovbiagele, Phillip A Scott, Kevin N Sheth, Andrew M Southerland, Deborah V Summers, David L Tirschwell
BACKGROUND AND PURPOSE: The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise...
January 24, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29362272/what-fluids-are-given-during-air-ambulance-treatment-of-patients-with-trauma-in-the-uk-and-what-might-this-mean-for-the-future-results-from-the-rescuer-observational-cohort-study
#7
David N Naumann, James M Hancox, James Raitt, Iain M Smith, Nicholas Crombie, Heidi Doughty, Gavin D Perkins, Mark J Midwinter
OBJECTIVES: We investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority. SETTING: The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services...
January 23, 2018: BMJ Open
https://www.readbyqxmd.com/read/29352670/poor-outcomes-of-out-of-hospital-cardiac-arrest-at-dinnertime-in-the-elderly-diurnal-and-seasonal-variations
#8
Akira Yamashita, Tetsuo Maeda, Yasuhiro Myojo, Keisuke Ohta, Hideo Inaba
PURPOSE: To investigate differences in chronological variations in characteristics and outcomes of out-of-hospital cardiac arrests (OHCAs) between elderly and non-elderly patients. METHODS: We retrospectively analyzed bystander-witnessed OHCAs without prehospital involvement of physicians between January 2007 and December 2014 in Japan. We considered the following time periods: night-time (23:00-5:59) and non-night-time; we further divided non-night-time into dinnertime (18:00-20:29) and other non-night-time...
January 8, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29336652/detection-of-stemi-using-prehospital-serial-12-lead-electrocardiograms
#9
Alain Tanguay, Johann Lebon, Lorraine Lau, Denise Hébert, François Bégin
OBJECTIVE: Repeated or serial 12-lead electrocardiograms (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment elevation (STE) or with a ST-segment elevation myocardial infarction (STEMI) that evolves over time. However, there is a minimal amount of scientific evidence available to support the clinical utility of this method. Our objective was to evaluate the use of serial 12-lead ECGs to detect STEMI in patients during transport in a Canadian emergency medical services (EMS) jurisdiction...
January 16, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29333893/syringe-administration-of-epinephrine-by-emergency-medical-technicians-for-anaphylaxis
#10
Andrew J Latimer, Sofia Husain, Jonathan Nolan, Vinod Doreswamy, Thomas D Rea, Michael R Sayre, Mickey S Eisenberg
OBJECTIVE: In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the "Check and Inject" program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1 mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction...
January 15, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29298741/-posterior-fossa-infarct-misdiagnosed-as-acute-peripheral-vestibulopathy
#11
Karen Stepanidis, Mads Klokker
Patients with acute central vestibular syndrome (AVS) can mimic acute peripheral vestibulopathy, which can mislead to a diagnosis of posterior fossa infarcts. Delayed diagnosis will prevent relevant treatment and may lead to severe disability and in worst case death. Understanding of AVS is extremely relevant for physicians in hospital and prehospital care to insure the right treatment. I this case report of a 35-year-old male patient with AVS the correct diagnosis was made relatively late.
January 1, 2018: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29297735/national-assessment-of-quality-programs-in-emergency-medical-services
#12
Michael Redlener, Patrick Olivieri, George T Loo, Kevin Munjal, Michael T Hilton, Katya Trudeau Potkin, Michael Levy, Jeffrey Rabrich, Michael R Gunderson, Sabina A Braithwaite
OBJECTIVE: This study aims to understand the adoption of clinical quality measurement throughout the United States on an EMS agency level, the features of agencies that do participate in quality measurement, and the level of physician involvement. It also aims to barriers to implementing quality improvement initiatives in EMS. METHODS: A 46-question survey was developed to gather agency level data on current quality improvement practices and measurement. The survey was distributed nationally via State EMS Offices to EMS agencies nation-wide using Surveymonkey©...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29287058/activities-of-the-thor-aabb-working-party
#13
Mark H Yazer, Philip C Spinella
The AABB (formerly the American Association of Blood Banks) is an international authority on transfusion medicine and tissue banking. The Trauma, Hemostasis and Oxygenation Research (THOR) Network is an international multidisciplinary network of civilian and military providers ranging from first responders and medics to critical care physicians, and from basic scientists to clinical trialists. The THOR Network's vision is to improve outcomes from traumatic hemorrhagic shock by optimizing the acute phase of resuscitation...
December 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29239965/videolaryngoscopy-for-physician-based-prehospital-emergency-intubation-a-prospective-randomized-multicenter-comparison-of-different-blade-types-using-a-p-advance-c-mac-system-and-kingvision
#14
Erol Cavus, Sebastian Janssen, Florian Reifferscheid, Amke Caliebe, Andreas Callies, Martin von der Heyden, Peer G Knacke, Volker Doerges
BACKGROUND: Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied. METHODS: We conducted this prospective, randomized, multicenter study at 4 German prehospital emergency medicine centers...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29239899/stroke-severity-quantification-by-critical-care-physicians-in-a-mobile-stroke-unit
#15
Maren R Hov, Jo Røislien, Thomas Lindner, Erik Zakariassen, Kristi C G Bache, Volker M Solyga, David Russell, Christian G Lund
BACKGROUND: Cerebral revascularization in acute stroke requires robust diagnostic tools close to symptom onset. The quantitative National Institute of Health Stroke Scale (NIHSS) is widely used in-hospital, whereas shorter and less specific stroke scales are used in the prehospital field. This study explored the accuracy and potential clinical benefit of using NIHSS prehospitally. PATIENTS AND METHODS: Thirteen anesthesiologists trained in prehospital critical care enrolled patients with suspected acute stroke in a mobile stroke unit...
December 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29234837/injury-severity-in-polytrauma-patients-is-underestimated-using-the-injury-severity-score-a-single-center-correlation-study-in-air-rescue
#16
C Schröter, F Urbanek, C Frömke, M Winkelmann, P Mommsen, C Krettek, C Zeckey
PURPOSE: Prehospital estimation of injury severity is essential for prehospital therapy, deciding on the destination hospital and the associated emergency room care. The aim of this study was to compare prehospital estimates of the abbreviated injury scale (AIS) and the Injury Severity Score (ISS) by emergency physicians with the values of AIS and ISS of injury severity determined at the conclusion of diagnostics. METHODS: In this prospective study, the ISS was determined prehospital by emergency physicians...
December 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29209788/-reform-of-emergency-physician-training-in-austria-finally-up-to-date
#17
REVIEW
H Trimmel, M Baubin, J Kreutziger, G Frank, G Prause
During the last 20 years Austrian prehospital emergency medical services (EMS) have significantly improved. The structure and organization of Austrian EMS comply with European standards but training requirements for prehospital EMS physicians are insufficient when compared with other countries. Although some EMS systems follow the German or Swiss postgraduate training concepts, the legal requirements in Austria defining the scope of mandatory training for physicians in the prehospital setting are only minimal...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29209787/-different-levels-of-experience-with-anesthetic-agents-of-german-emergency-physicians-results-of-an-online-survey
#18
A Luckscheiter, M Fischer, W Zink
BACKGROUND AND OBJECTIVE: In 2015 practice management guidelines on prehospital emergency anesthesia in adults were published in Germany. The aim of the present study was to evaluate whether emergency physicians follow these guidelines in daily practice and to assess their level of experience with the use of anesthetic agents. MATERIAL AND METHODS: In an online survey the way of induction of preclinical anesthesia (including preoxygenation time and applied monitoring techniques) was assessed with the help of virtual scenarios based on the guidelines...
December 5, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29208018/noise-exposure-during-prehospital-emergency-physicians-work-on-mobile-emergency-care-units-and-helicopter-emergency-medical-services
#19
Mads Christian Tofte Hansen, Jesper Hvass Schmidt, Anne C Brøchner, Jakob Kjersgaard Johansen, Stine Zwisler, Søren Mikkelsen
BACKGROUND: Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS). A second objective was to identify any occupational hearing loss amongst prehospital personnel. METHODS: Noise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet...
December 6, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29189297/are-on-scene-blood-transfusions-by-a-helicopter-emergency-medical-service-useful-and-safe-a-multicentre-case-control-study
#20
Joost H Peters, Pascal S H Smulders, Xavier R J Moors, Stef J M Bouman, Claartje M E M Meijs, Nico Hoogerwerf, Michael J R Edwards
INTRODUCTION: In the prehospital setting, crystalloid fluids are frequently used, but only erythrocytes are capable of transporting oxygen to tissues. The aim of this study was to establish the efficacy and safety of the prehospital use of uncross matched type O rhesus-negative packed red blood cells (URBC) by the Dutch physician-staffed helicopter emergency medical service. We hypothesized that prehospital URBC transfusions are safe and more effective with respect to survival than resuscitations with crystalloids...
November 17, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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