The clinical examination is an important part of any patient consultation. After the primary survey and taking the patient history, a more in-depth examination is sometimes required to aid making a working diagnosis and help negate other differential diagnoses. The extent of this depends on the stability of the patient and may not be possible in time-critical circumstances. However, clinical examination is an increasing part of paramedic practice owing to the continued expansion of the scope of the paramedic role in both urgent and emergency care. Education on clinical examination concerning each of the main body systems is now an integral part of undergraduate paramedic curricula.This clinical examination series provides a step-by-step overview for each of the main body systems. Continuing professional development (CPD) is an essential requirement for all clinicians to maintain and demonstrate they are staying up to date and advancing in their roles.This series gives an overview of each type of examination to support students, newly qualified paramedics and paramedics wishing to use these articles as a CPD development activity and an aide-memoire for clinical practice. This article, which explores the peripheral vascular system, gives an overview of initial examination considerations, including first impressions.
Since 2016, critical care paramedics from the South East Coast Ambulance Service have offered neuromuscular blockade to patients for ventilatory/airway control after cardiac arrest.
To examine the first cases of paramedic-delivered neuromuscular blockade, and evaluate the prevalence of its use and safety.
Retrospective service evaluation of patients receiving post-arrest paralysis during the study period from 1 April 2016 until 31 July 2017.
The study included 127 patients. The mean age of administration was 63 years, mean weight was 80 kg (SD: 19 kg), dose was 1 mg/kg and median time from rocuronium administration to hospital was 32 minutes (IQR 20–43 minutes). Three patients (2.3%) experienced a minor adverse incident. There were no major airway complications, nor other significant adverse incidents. Thirty-seven patients (31%) survived to discharge.
From this patient group, paramedic-administered rocuronium in intubated patients who have experienced a cardiac arrest and a return of spontaneous circulation appears to be safe, but further interventional research is required to determine whether this improves patient outcomes.
Paramedics are at the frontline of healthcare delivery and this includes during the current coronavirus pandemic. This pandemic poses specific problems for paramedics, which include not only treating and transporting infected patients, but also issues around decontamination and disinfection of ambulances and medical equipment. Of particular concern is the pneumonia associated with the 2019 novel coronavirus. Data on COVID-19 pneumonia are developing. Ongoing research demonstrates that almost all serious consequences of COVID-19 feature pneumonia, especially in older people and those with comorbidities. Paramedics can have a profound effect on the care of patients with pneumonia. Effective management of COVID-19 pneumonia by the paramedic should centre around prompt recognition, early administration of oxygen and intravenous fluids and transfer to hospital. In some situations, paramedics may need to be involved in the delivery and maintenance of airway adjuncts in patients with COVID-19 pneumonia.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes the new disease COVID-19. Symptoms range from mild to severe with a higher incidence of severe cases in patients with risk factors such as older age and comorbidities. COVID-19 is mainly spread through the inhalation of respiratory droplets from coughing or sneezing or via contact with droplet-contaminated surfaces. Paramedics should be aware that some aerosol-generating procedures may put them at a higher risk of contracting the virus via possible airborne transmission. Use of remote triage clinical assessment is likely to increase as a result of the pandemic. There is no curative drug treatment for the virus and some medications may exacerbate its effects or make patients more susceptible to it. Evidence and guidelines are evolving on SARS-CoV-2 and COVID-19. Paramedics should keep up to date with the latest clinical guidance from their employers.
Emerging research is supporting the implementation of mindfulness-based strategies for NHS staff. It has been shown that, by spending 10 minutes daily on the activity, health professionals can improve their emotional and cognitive functioning, while reducing work-related rumination. Through an exploratory multi-methods approach, this study sets out to quantify the occupational health levels of paramedics, and establish their appreciation of both their employer's health and wellbeing policy and mindfulness as a concept, for the overall purpose of gaining a qualitative insight into whether mindfulness activity could improve occupational health. Paramedics reported high levels of occupational stress, coupled with minimal levels of knowledge or experience of mindfulness as a health-promoting concept. Structured application of mindfulness strategies within prehospital care may promote a range of health benefits for paramedics, lead to improved organisational efficiency for trusts and support positive outcomes for patients.
A large number of people are bitten by dogs—approximately 19 in every 1000 people in the UK per year with even higher proportions in France and the United States. Co-amoxiclav is the most effective antibiotic treatment following a dog bite as it covers the most likely polymicrobial aerobic and anaerobic organisms that infect dog bite wounds (Staphylococci, Streptococci and Pasteurella). Pasteurella is the most infective pathogen in a dog bite so effective antibiotic treatment against it is essential to prevent a metastatic infection. This article explores the normal physiology of human skin including the pathophysiology after sustaining a dog bite. It also examines the pharmacology of co-amoxiclav including critically reviewing the current evidence for the effectiveness of its use in this field as a first-line and prophylactic oral antibiotic treatment.
As emergency measures ramp up in response to the rising numbers of COVID-19, Jolyon Price reflects on how much has changed and on his own role in the evolving crisis