Volume 11 Issue 4

Advanced prehospital stroke triage in the era of mechanical thrombectomy

Direct transport to a comprehensive stroke centre that is capable of endovascular thrombectomy may improve outcomes in patients with large vessel occlusive stroke. A number of prehospital triage tools have been developed to see if clinicians can predict which patients would benefit from this procedure, allowing them to bypass a primary stroke centre in preference for a comprehensive stroke centre. A literature search was performed across a number of medical databases; six triage tools were selected for analysis based on their reported accuracy and prevalence in clinical trials. Additionally, a number of articles were isolated for the analysis of changing systems of care for patients who had had a stroke. This narrative review integrates how these variously accurate triage tools could benefit patients and outlines why changes to the system of care for stroke patients require a ground-upwards, local approach. The accuracy of the triage tools analysed varied, with some lacking specificity and others sensitivity. Triage tools are evolving, and simplistic tools offer comparable accuracy when contrasted with comprehensive alternatives, which require a significantly increased level of assessment skill and time demand. While there is evidence in support of prehospital bypass protocols, this evidence is poorly generalisable owing to a number of variables, with geographical layout being a significant compounding factor.

Fascia iliaca compartment block versus IV morphine for femoral fracture pain

Background: Femoral trauma in the UK is increasing. The fascia iliaca compartment block (FICB) could be a more effective, safer way to ease pain and distress from femoral trauma in the prehospital environment than the current practice of intravenous morphine. Aim: To conduct a systematic review to accumulate evidence concerning prehospital FICB for patients with femoral fracture. Methodology: A systematic review was conducted using the CINAHL, Medline, AMED, PubMed and Embase databases. In addition, a hand search of the Journal of Paramedic Practice and the Australasian Journal of Paramedicine was performed. The search was carried out from 28 March–24 April 2018. Results: Twenty-eight papers were sourced by the methodology, of which four met the inclusion criteria and were subsequently analysed. Conclusion: This review shows that prehospital FICB can be efficacious in a number of prehospital environments and is feasible for a variety of patients with a range of femoral fractures. Additionally, FICB has limited reported adverse side effects in the prehospital environment and would appear to be safe. However, evidence comparing the efficacy of a prehospital FICB to intravenous morphine use for pain management in femoral fractures is limited. This review indicates that more research in this area would be beneficial.

Does digoxin cause more harm than good?

Background: The most recent British National Formulary recommends digoxin therapy for patients with heart failure (HF) and/or supraventricular arrhythmias, particularly atrial fibrillation (AF) and atrial flutter. The positive inotropic and negative chronotropic effects of the drug are undoubtedly desirable when managing these conditions, yet the use of digoxin is decreasing in popularity among prescribers. Aim: The aim of this literature review is to evaluate the use of digoxin for treating HF and/or AF. It will highlight the benefits of digoxin as well as its potential risks. These should be considered by all prehospital staff when assessing patients who are prescribed digoxin. Conclusions: Digoxin has shown positive outcomes for reducing hospital admissions for patients with HF and/or AF. However, clinicians should be aware of the narrow therapeutic index, which results in a high incidence of digoxin toxicity. The adverse effects of digoxin use should be considered during prehospital assessment, inclusive of pro-arrhythmic and thromboembolic complications. Whether digoxin may result in harm depends on the age, underlying pathology and renal function of each individual patient.

Empathy in paramedic practice: an overview

Empathy is generally considered to be the understanding of another person's reactions, thoughts, feelings and problems, and being able to relay this sense of understanding back to the individual. Empathy in healthcare is associated with improved communication, reduced stress, lower complication rates and better clinical outcomes. Low empathy is associated with decreased patient satisfaction and provider burnout. The burden of emotional work in paramedic practice and coping strategies may be contributory factors to lower empathy. Some evidence suggests that the empathy of paramedic students varies between patient groups and can decline over time. Empathy is an interpersonal skill that can be learned and improved upon. In paramedic practice, it is complex and inadequately studied. Its relationship to patient care, paramedic burnout and wellbeing require investigation. Several strategies to teach empathy should be considered by educators.

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