An out-of-hospital perspective on hyperventilation syndrome

OverviewA variety of causes and conditions are associated with hyperventilation, including acute and chronic hyperventilation syndrome (HVS). The characteristics of HVS are not well defined but it results from a reduction in carbon dioxide and altered pH in the body from overbreathing. Symptoms vary between individuals but usually include altered sensations in the extremities, nausea and headache. Diagnosing patients with this condition can be difficult; diagnostic tools include the hyperventilation provocation test, voluntary overbreathing, the Nijmegen questionnaire and the exclusion of physiological causes in the acute situation. There are various prehospital patient presentations and differentiating between potential underlying causes is vital to appropriate treatment and patient safety. Treatments vary in nature, depending on the desired effect and the clinician's scope of practice. Some aim to reduce the frequency and intensity of attacks while others combat the attack when it strikes. This review briefly discusses some treatments available to a clinician with a basic skill level. Research with a focus on the out-of-hospital environment is recommended.

Knowing our specialist roles

Look at the patient and follow your gut

In this month's issue, Abbygail Elsey shares the best advice she received as a student paramedic, and how it is only now making its impact in her role as a new clinician

Interdisciplinary work integrated learning: a pilot evaluation instrument

Background: Work integrated learning (WIL) activities—sometimes termed student placements, practice-based learning, cooperative education or workplace learning activities—are embedded into university course curricula to prepare students for future professional environments. Aims: This study evaluates an interdisciplinary and multiagency WIL activity undertaken by university students (<i>n</i>=14). Methods: Pre- and post-activity survey instruments were used to gain perspectives on student expectations and experiences relating to the WIL activity. The survey instruments were based on five common themes of quality within WIL activities. Findings: The WIL activity facilitated professionally relevant learning, delivered diverse experiences, and enabled the development of professionally meaningful relationships. Discussion: A pilot evaluation instrument for similar undergraduate paramedic WIL programmes is presented for further consideration. Limitations of the study are also discussed.

What value does peer-assisted learning have in the training of student paramedics?

Peer-assisted learning is now being recognised as an effective learning strategy to support the development of health professionals. Furthermore, adopting coaching style dialogue and conversation enhances learning and development for both the coach and coachee and, in this instance, for year 1 and year 3 student paramedics. This article describes how the implementation of peer-assisted learning into the classroom setting can help to support student paramedics in the development of their own clinical skills and knowledge. It describes broadly the evaluation findings of a session whereby year 3 student paramedics coached year 1 student paramedics to further develop a range of clinical skills through demonstration and discussion. A summary overview of the findings reflects the multiple benefits of this innovative approach to facilitate learning, including a notable increase in professional knowledge and skills for both groups of students.

The impact of paramedic shift work on the family system: a literature review

Aim: The current review investigates the impacts of paramedic work on the family system. Paramedics are taking time off or leaving through stress, and career decisions could be influenced by this perceived impact. Method: A systematic literature review was conducted and the literature critiqued. Two themes were identified: emotional labour and work-family fit. Results: Paramedics rely on families for emotional support, putting them at risk of vicarious trauma. The historical male coping culture of paramedic practice deters processing at work, detrimentally carrying this processing into the home environment. Additionally, several shift characteristics contribute to work-family conflict, child-rearing conflict and difficulties maintaining a social life. Conclusions: Key organisational culture change is needed from denigrating staff for showing emotions and struggling to find work-life balance, to one that improves experiences at work and therefore at home as well. Recent movement towards almost equal gender balance may present a particular opportunity to deliver culture change. Further research is required to better understand the impact that shift work has on the family.

Clinical suspicion regarding needle decompression for patients with chest trauma

Background: Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax. Aim: To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it. Methods: Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax. Context: Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.

Stamping out poor attitudes and raising the rainbow flag

Critical thinking in paramedic practice

Digoxin toxicity (2019)