Does emergency transportation induce stress in ACS patients?

UK ambulance service guidelines note that patients with acute coronary syndrome (ACS) should be transferred to hospital as blue-light emergencies. This study examines whether emergency transportation increases stress levels in patients with ACS. Patients aged between 50 and 90 years with clinical signs of ACS were screened for inclusion in the trial and 32 patients consented to participate. Venous plasma levels of epinephrine, norepinephrine and lactate as well as pain and anxiety scores were measured before and after transportation to hospital. In addition, heart rate, blood pressure and oxygen saturation were recorded every 3 minutes.

Safeguarding children part 2: reporting and acting on abuse

This second of two articles, highlighting child abuse, focusing on the practical aspects of the recognition and the management of child abuse. The article outlines some of the obstacles, looking at alerting features and also some of the clinical presentations to alert health professionals to potential child abuse. The article also set out an action plan – to assist practitioners in managing this difficult aspect of clinical care. This second article also refers to looking after yourself and the role of some of the other agencies involved in child protection, including the role of child protection conferences.

Recognition of life extinct and the processes of death

A paramedic has the responsibility to confirm deaths within the community in which they work and there are distinct protocols to follow. They also have the responsibility to decide whether or not to carry out cardiopulmonary resuscitation on expected and unexpected deaths. The recognition of life extinct (ROLE) protocol included in the Joint Colleges Ambulance Liaison Committee Guidelines (2006) provides guidance on when, and when not, to perform cardiopulmonary resuscitation on patients but does not cover the processes occurring after death. Death is a process which occurs in stages and within certain time constraints, depending on intrinsic and extrinsic factors. This article covers the processes of death and the timelines in which they occur and aims to improve the paramedic's knowledge and ability to make sound judgements and assist with providing justifications of confirming death alongside the ROLE protocol to relatives, the police and the coroner.

Q waves: do they indicate full thickness infarcts?

The link between pathological Q waves and myocardial necrosis was first observed at autopsy in the early 20th century, an observation that has continued to influence ECG interpretation to the present day. As students we are taught that pathological Q waves on an electrocardiogram (ECG) represent permanent, full thickness myocardial necrosis thus implying that the damage is done and subsequent treatment futile: but could advancing technology challenge this widely held perception? With the development of cardiac magnetic resonance imaging (CMRI) and positron emission tomography (PET) the question regarding the significance of Q waves has been asked at a new level.The purpose of this article is to compare theory, pathological observations, CMRI/PET studies and to discuss how myocardial stunning and hibernation are influencing our perception of the Q wave. There are many factors that can influence QRS manifestation which may or may not exhibit Q waves that are permanent or transient, sinister or benign and by oversimplifying the significance of these Q waves many patients could be denied life changing treatment.

To prescribe or not to prescribe?

The Department of Health is currently preparing for a consultation on the implementation of prescribing for advanced paramedics and is seeking support from the College of Paramedics to gather examples of situations where prescribing would benefit patients in mainly non life-threatening conditions and urgent emergency care groups.