Category Archives: General PH&RM

Kids need 'proper' CPR if non-cardiac cause of arrest

The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiac arrests, but not for children. These recommendations have new support in a large observational study from Japan examining outcomes in 5170 … Continue reading

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2000 vs 2005 VF guidelines: RCT

One of the key changes in international resuscitation guidelines between the 2000 and 2005 has been to minimise potentially deleterious hands-off time, so that CPR is interrupted less for pulse checks and DC shocks. These two approaches have been compared … Continue reading

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Battlefield resuscitation

An excellent review of the current British military practice to prevent and treat the acute coagulopathy of trauma shock (ACoTS) describes pathophysiology and treatment options and offers an algorithm for management. Key components of the system (when indicated according to … Continue reading

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Sorting ABCD issues pre-hospital

Prospectively collected data on 727 major trauma patients from a Portugese trauma centre registry enabled the comparison of mortality between three groups of patients with a priori defined life threatening ‘ABCD’ problems: those whose ABCD issues were treated in the … Continue reading

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Spine immobilisation in penetrating trauma

In a retrospective study of 45,284 penetrating trauma patients, unadjusted mortality was twice as high in the 4.3% of  patients who underwent spine immobilisation, compared with those who were not immobilised. An accompanying editorial comments: ‘The number needed to treat with … Continue reading

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College of Paramedics stands its ground

Articles in this month’s EMJ demonstrate an interesting conflict within UK pre-hospital care. The Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, heavily represented by anaesthetists, recommend the removal of tracheal intubation from UK paramedic practice. The College of … Continue reading

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Intubation harder on the floor or in an ambulance

An abstract from the The National Association of EMS Physicians® 2010 Scientific Assembly published in a Supplement of Prehospital Emergency Care describes a study comparing cadaveric intubation success rates by paramedics in different positions: on the floor, on an elevated … Continue reading

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Is defibrillation an electric threat for bystanders?

No rescuer or bystander has ever been seriously harmed by receiving an inadvertent shock while in direct or indirect contact with a patient during defibrillation. New evidence suggests that it might even be electrically safe for the rescuer to continue … Continue reading

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Stopping infusions before PCI transfer

An interhospital transport service introduced a no infusions policy for patients being transferred for primary coronary intervention, instead giving a bolus of heparin and glycoprotein 2b-3a inhibitor prior to transfer, along with non-intravenous nitrates (if needed). Discontinuing infusions during transport resulted … Continue reading

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Better TBI outcome with HEMS

A retrospective study from Italy compared outcomes of head injured patients cared for by a ground ambulance service (GROUND) with those managed by a HEMS team that included an experienced pre-hospital anaesthetist. Interestingly 73% of the ground group were also … Continue reading

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