Prehospital treatment of rhabdomyolysis in people who fall

Of people aged 65 and older, 30% will fall at least once per year—for people aged over 80, this rises to 50%. Patients who remain on the floor for a long time are at risk of developing rhabdomyolysis. If a person cannot move or get off the floor, tissue necrosis can occur at the point of contact and skeletal muscle is destroyed, releasing its contents into the bloodstream. This can eventually lead to crush syndrome, which includes rhabdomyolysis, hyperkalemia, dysrhythmias and acute kidney injury, and can be fatal. There are no guidelines for a time period when rhabdomyolysis is more likely to occur nor international consensus on how to best treat this condition in and out of hospital. This article looks at rhabdomyolysis resulting from falls in elderly people, and how to recognise and manage it. The aim is to improve awareness of rhabdomyolysis among prehospital practitioners so they can improve its management and advise patients at home.

Language and care

Patient-centred prescribing, autonomy and concordance

This article in the JPP Prescribing Paramedic series will focus on patient-centred prescribing, autonomy and concordance. Patient-centred prescribing means putting the patient at the centre of everything we do as clinicians. Autonomy means a patient has an inherent right to make decisions about their care. Concordance means the patient takes medication as prescribed, for the correct length of time. This article details how these three aspects of prescribing can be achieved by the paramedic prescriber, detailing strategies to ensure a consultation and prescribing decision is patient-centred while respecting autonomy, and how concordance can be improved. The article uses a patient consultation as a framing device to detail how these essential aspects of prescribing can be achieved.

Diabetic ketoacidosis in paediatrics: tools to assist in recognition of a sick child

Diabetic ketoacidosis (DKA), a complication of diabetes, is a medical emergency in children and is one of the main causes of childhood mortality. It is the first presentation of diabetes in 30–40% children with the condition, and is more common in younger children. However, it is commonly misdiagnosed as the signs and symptoms in children vary. Treatment should be given as soon as possible, and this is usually only possible in a hospital setting. Therefore, early recognition and transportation to hospital by paramedics ensures the best possible outcome. Children are far more likely to have type 1 than type 2 diabetes, and several factors are associated with childhood diabetes, including genetics, medication, viral infections and environmental issues. Several tools and guidelines can be used to assess children prehospitally. These should be used in conjunction with the clinician's knowledge and standard observations. Paramedics should take an appropriate history, as this could prove invaluable for hospital specialists.

Building ad-hoc team social capital through simulation

The concept of high functioning healthcare teams is complex and competencies have been developed primarily from aviation. High-functioning healthcare teams, including those formed in an ad-hoc manner, are crucial to positive patient outcomes. Social capital theory identifies structural, cognitive and relational dimensions involved in the formation of trusting, cohesive relationships. Theories of social capital can be used to advise the development of interprofessional simulation-based education. Interprofessional simulation-based education curricula development must focus on the social sciences if it is to promote strong, healthy team relationships. Simulation-based education should take place in learning environments that promote the development of social capital between team members, especially where teams are formed ad hoc.

Happy hypoxia in COVID-19: pathophysiology and pulse oximetry accuracy

Many patients with COVID-19 have presented to emergency departments with arterial hypoxaemia but without breathlessness; this is called ‘happy hypoxia’ or, more accurately, ‘silent hypoxaemia’. Hypoxaemia needs to be identified correctly in patients with COVID-19 as it is associated with in-hospital mortality. The aetiology of silent hypoxia is unclear, and the pathophysiological processes involved in the relationship between the response to hypoxaemia and the sensation of dyspnoea may explain its clinical presentation. Pulse oximetry is used routinely to measure oxygen saturation. However, recent literature has questioned its accuracy in patients with COVID-19. Inaccuracies in readings, which arise for several reasons, could in part explain silent hypoxaemia. Caution should be taken when interpreting pulse oximeter readings or patients could be given a higher inspired oxygen fraction than necessary. Silent hypoxaemia may also mask disease severity in patients with COVID-19.

Pride in paramedicine: care of LGBTQ+ people

As Pride celebrations take place around the world, Aysha Mendes, editor of the Journal of Paramedic Practice, reflects on the importance of equitable care provision, inclusive research and appropriate care interventions for all people, highlighting some examples of barriers facing people in LGBTQ+ communities

Pride in paramedicine: being an LGBTQ+ paramedic

As Pride celebrations kick off worldwide and the current issue of the Journal of Paramedic Press is sent to the printers on 28 June—the very date in history that the first Pride March was held in New York City in 1970—it seems fitting to celebrate Pride in paramedicine and hear from some paramedics in the LGBTQ+ community

The most surprising law and ethics read for paramedics

Every day a school day

Nearly a year into his career as an NQP, Barry Costello reflects on why a patient-centred approach to care matters and how it will impact him as an ongoing learner in paramedicine

The emergency blues…

In this month's Student Column, Jolyon Price reflects on his choice to transition from acting to paramedicine, as well as everything he gave up, and everything he has gained

Progressing as a trainee ACP

In this instalment of Paramedic Roles, Abbie-Louise Frake sheds some light on her current role as a trainee advanced clinical practitioner, reflecting on where she has been and where she is headed

Spotlight on Research