Think carbon monoxide: A timely reminder

Krishna Channarayapatna discusses efforts to raise awareness on carbon monoxide (CO) poisoning this winter, and why paramedics should keep it in mind as a possible cause of illness

Addressing a lack of obstetrics skills

Anxiety is felt by many paramedics and technicians when called upon to manage an obstetric emergency, partly as a result of limited exposure to such emergencies and partly as a result of sub-optimal training.

Accuracy of bag ventilation in simulated resuscitation

The efficacy of manual bag ventilation during cardiopulmonary resuscitation (CPR) is often a difficult task to undertake, however, very little is known about its accuracy.AimsThe objective of this study was to evaluate operator delivery of ventilation rate, tidal volume and minute volume in a simulated cardiac arrest using two different capacity self-inflating bags in an undergraduate paramedic cohort.MethodsAn observational single blinded study with third year university undergraduate paramedic students using a mechanical lung model and a simulated adult cardiac arrest to assess their ventilation ability. Students ventilated using 1600 ml and 1000 ml bag for 2 minutes at a rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated.ResultsMean tidal volumes were significantly higher for the 1600 ml bag: 528.4 ml (95% CI 491.3–565.5) versus 648.7 ml (95% CI 603.7–693.7) (P < 0.0001), while no statistically significant differences were found in mean ventilation rates and minute volumes between the two bags.ConclusionSmaller self-inflating bags reduce the incidence of overzealous tidal volumes and produce greater guideline-consistent results for cardiac arrest patients.

The future of the ambulance service in the NHS

Liz Kendall explains how the Ambulance Service Network fits into the bigger picture, and outlines the vision for the role of the ambulance service in the UK

Arterial blood gas and electrolyte measurement on air ambulances

Arterial blood gas and electrolyte analyses are routinely conducted for critically unwell patients in the hospital setting. Modern and portable point-of care analysers now allow these tests to be performed in the pre-hospital setting. A small number of studies have looked at the potential for performing these tests in the prehospital setting and identified that on-scene testing can alter management of these critical patients. AimsTo look at the feasibility of introducing a point-of-care arterial blood gas and electrolyte analyser onto a medically-led air ambulance service.MethodsA retrospective review of the mission data for Warwickshire and Northamptonshire Air Ambulance (WNAA) for all missions between 1st January 2007 and 31st December 2007 was conducted. Patients who could potentially benefit from pointof- care analysis were identified. The physical properties of the i-STAT machine were analysed, specifically the operating temperature range. Air ambulance crew members were asked for their opinions on the potential of point-of-care analysers.ResultsThe i-STAT machine could potentially have been used in 174 out of 414 patients (42%) transferred by the air ambulance. The most common indication for use would have been head-injured patients. The operating temperature range of the point-of-care analyser (16–30°C) and the associated temperature drop when the aircraft is flying at 1000 feet means that the machine would only be functional between June and late August (assuming normal seasonal maximum temperatures). Crew members felt that due to the short flight time for primary transfer to hospital, the impact on patient outcome would not be significant for the majority of patients.ConclusionsThe benefit of performing point-of-care analysis on air ambulance patients remains uncertain. The operating temperature range will also limit the i-STAT machine use on air ambulances.

Spotlight on research

An audit of 400 inhospital patients' records (representing 387 patients as 13 cases were duplicated) was conducted at an emergency department (ED) in a district general hospital to examine the frequency of the recording of patients' vital signs (VS) within the first 15 minutes of admission and again within 60 minutes.

Is prehospital thrombolysis beneficial to patients suffering acute MI?

Prehospital thrombolysis (PHT) plays an important role in enabling health care trusts to achieve the call-to-needle time of 60 minutes in England and Wales, but its potential value for each patient must be weighed up by the attending paramedic, taking into account local demographics, availability of alternatives such as primary coronary angioplasty (PCA) and the restrictions of the JRCALC guidelines regarding eligibility of the patient.In light of the deteriorating effectiveness of PHT over time and its expense, in some areas money may well be better spent educating the public to call for help at an earlier stage, as well as encouraging direct admission where available to PCA by paramedics as an alternative to PHT. However, until there is an equal eligibility of patients for thrombolysis in both the prehospital and hospital settings, it is difficult for paramedics in the field to weigh up the relative effectivenes of one against the other.

An introduction to pharmacokinetics

This article illustrates the important principles of pharmacokinetics: the effect that the body has on drugs or other foreign chemicals. A basic understanding of this aspect of clinical pharmacology will assist health professionals in understanding the action of drugs they may administer, and ensure safe and effective practice.

Drug regimes for acute cardiogenic pulmonary oedema

Cardiovascular disease management has met with success through programmes such as the National Service Framework for Coronary Heart Disease. However, this has led to increased survival and therefore higher prevalence of patients living with impaired cardiac function. Acute cardiogenic pulmonary oedema (ACPO) is one of a number of distinct clinical conditions that result from abnormal cardiac function, primarily referred to as acute heart failure. This article will review current evidence-based pharmacological management of ACPO and make recommendations for future practice in prehospital care. Current drugs used in both prehospital and emergency care will be analysed for safety and efficacy in the management of ACPO.