Volume 13 Issue 2
Pharmacokinetics in paramedic prescribing
This instalment in the Prescribing Paramedic series introduces the concept of pharmacokinetics. This is not only relevant to those undertaking a non-medical prescribing course but it is also important information for any paramedic, as a knowledge of pharmacokinetics is critical to understanding why our medications do what they do and how their effects may vary on a patient-to-patient basis.
Mechanical chest compressions and survival in the emergency setting
Advances in cardiac arrest management have led to the use of a mechanical chest compression device in an attempt to improve outcomes in cardiopulmonary resuscitation (CPR). This systematic review set out to identify whether the inclusion of the mechanical device improves survival rates in the cardiac arrest patient within the emergency setting, and explored the themes: training, environment and time of device deployment. The systematic review measured the value of mechanical chest compression devices versus standard manual compressions in respect to resuscitation outcomes (return of spontaneous circulation). Ten studies with data from 12 894 adult patients, who presented with out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA), were included. Results demonstrated an equality between manual and mechanical CPR with a statistical increase in survival when the mechanical device is used. Training, time of deployment, guideline adherence and timing of rhythm check/defibrillation presented challenges in the analysis of the data.
Understanding right ventricular myocardial infarction in prehospital care
Right ventricular myocardial infarction (RVMI) most commonly occurs in relation to an inferior myocardial infarction. Patients with this condition where the culprit right coronary artery (RCA) is occluded have a poor prognosis. Early recognition and the specific treatment pathway for RVMI differ from the treatment for general acute coronary syndrome (ACS) which could help the paramedic to treat this condition more appropriately. This article explores current guidelines for the recognition and treatment of RVMI and the possible application of specific guidelines in a prehospital setting with regards to using right-sided precordial ECG, the administration of fluids and potential complications arising from vasodilatory drugs. Furthermore, the purpose of this article is to help educate and develop the understanding of RVMI in this high-risk subgroup who have an increased morbidity and mortality.
Student paramedic decision-making: a critical exploration of a patient interaction
Clinical decision-making is a multifaceted construct, requiring the practitioner to gather, interpret and evaluate data to select and implement an evidence-based choice of action. Clinical reasoning is a difficult skill for students to develop due in part to the inability to guarantee awareness or opportunity to develop within time spent in practice. While professional developments within the past few years have established a supportive preceptorship programme within NHS trusts for new paramedic registrants, enhancing activities to develop these crucial skills within a pre-registrant programme should be prioritised to enhance the abilities of students and subsequent new registrants. A better understanding of the reasoning processes used during clinical decision-making may help health professionals with less experience to develop their processes in their own clinical reasoning. To embed such awareness and enhanced practice, the lead author, a third-year student paramedic at the time of writing, presents a reflective consideration of a patient encounter using the hypothetico-deductive model to evaluate and critically explore his own reasoning and processing within a meaningful patient interaction.
Where to now? Searching beyond Medline
This article looks at the tools available to you to extend your search beyond the major bibliographic sources. The article identifies the type of literature you can find and which tools are suitable to use to find them. It aims to help you to broaden the scope of your search to find more relevant material. There is a warning about predatory journals and the need to take a critical approach to material that has not been peer-reviewed.
Exploring multiple paths
Since graduating as a newly qualified paramedic in June amid COVID-19, Mahdiyah Bandali has chosen the unconventional path of exploring multiple avenues within paramedicine and, in her first contribution, shares her reflections and lessons learned on this journey to date
Reaching out to others
As he progresses through his final year towards becoming a fully qualified paramedic and the autonomy that comes with the role, Jolyon Price reflects on how to embrace this clinical independence while not being afraid to reach out to colleagues for fresh perspectives
A day as a prison paramedic
In this second instalment of Paramedic Roles, Rachel Hodgett shares what a day in the life of a prison paramedic looks like, alongside what led her there, and the job's unique challenges and rewards.
The role of the paramedic in identifying modern slavery
Background: Modern slavery is the recruitment or harbouring of people through the use of force and coercion for exploitation. Paramedics have significant potential and unique opportunities regarding the detection, prevention and combating of modern slavery. Aim: To analyse the literature relating to modern slavery and synthesise it for paramedic practice. Method: Following a structured literature review, a comparative analysis was undertaken of articles concerning the relationships between modern slavery and healthcare. Findings: Five major themes were identified: barriers to healthcare access; causes of missing the indicators of trafficking; clinician knowledge; the need for training and education; and trauma-informed practices. Conclusions: Paramedics are in an optimal position to identify and intervene in cases of modern slavery. The introduction of survivor-centred education is recommended to better understand the barriers to healthcare access.