Category Archives: General PH&RM

HEMS paramedic intubation success

All medical out of hospital cardiac arrests attended by the Warwickshire and Northamptonshire Air Ambulance (WNAA) over a 64-month period were reviewed. There were no significant differences in self-reported intubation failure rate, morbidity or clinical outcome between doctor-led and paramedic-led … Continue reading

Posted in General PH&RM | Tagged , , , | Leave a comment

DC shock? I want my blankie!

A blanket made of nonconducting material was used to allow CPR to continue during defibrillation of arrested swine. Coronary perfusion pressure was maintained when the blanket was used but fell when there was a hands-off interruption for defibrillation. Also, the … Continue reading

Posted in General PH&RM | Tagged , | Leave a comment

Precordial thump

The precordial thump is recommended for witnessed and monitored ventricular fibrillation/ventricular tachycardia (VF/VT) cardiac arrest when a defibrillator is not immediately available. Haman et al investigated the precordial thump in patients in whom VT or VF was initiated during an … Continue reading

Posted in General PH&RM | Tagged | Leave a comment

Naloxone in cardiac arrest

Previous case reports and animal studies have suggested a possible role for naloxone in cardiac arrest even in the absence of opioid overdose. Possible mechanisms include reducing the myocardial depressant effect of endogenous opioids, stimulating catecholamine release, and providing antiarryhthmic … Continue reading

Posted in General PH&RM | Tagged | Leave a comment

Thoracostomy in blunt traumatic arrest

37 patients with blunt traumatic cardiac arrest underwent attempted resuscitation by a HEMS crew over a four year period. Chest decompression was performed in 18 cases (17 thoracostomy, one needle decompression). The procedure revealed evidence of chest injury in 10 … Continue reading

Posted in General PH&RM | Tagged , , , , , , | Leave a comment

Not such a B.I.G. success in the field?

Success rates with the bone injection gun were 71% (10 out of 14) in children <16 years and 73% (19 out of 26) in adults. Less encouraging data than that seen with the EZ-IO device, and consistent with the experience … Continue reading

Posted in General PH&RM | Tagged , | Leave a comment

Ballistic penetrating neck injury and the risk of immobilisation

British military physicians reported the outcomes of patients sustaining penetrating neck injury from the Iraq and Afghanistan conflicts. Three quarters were injured in explosions, one quarter from gunshots. Of 90 patients, only 1 of the 56 survivors to reach a … Continue reading

Posted in General PH&RM | Tagged , , , | 2 Comments

Prehospital Hypocapnia and Poor Outcome After Severe Traumatic Brain Injury

Patients admitted to a level 1 trauma centre with traumatic brain injury whose end-tidal CO2 was kept with the Brain Trauma Foundation recommended limits of 30-35 mmHg (3.9-4.6 kPa) had a lower mortality than those whose CO2 was outside this … Continue reading

Posted in General PH&RM | Tagged , , | Leave a comment

No benefit from drugs in pre-hospital cardiac arrest

A Norwegian randomised controlled trial over five years compared out-of-hospital nontraumatic cardiac arrest outcomes between ACLS protocols with and without access to intravenous drugs (epinephrine/adrenaline, atropine, amiodarone). Patients randomised to the drug group had a higher rate of hospital admission … Continue reading

Posted in General PH&RM | Tagged , | Leave a comment

Characteristic ECG signs of LAD occlusion without ST elevation

In a single centre observational study over 10 years of patients undergoing acute PCI of the left anterior descending (LAD) artery, 35 of 1890 (2%) had a distinct non-ST elevation ECG pattern. The ECG showed ST-segment depression at the J-point … Continue reading

Posted in General PH&RM | Tagged , , | Leave a comment