Volume 14 Issue 10

Attempting to prevent hyperoxaemia after out-of-hospital resuscitation

Survival to discharge in the UK after an out-of-hospital cardiac arrest is significantly lower than in other similarly developed countries (7.3% in the UK compared with the rest of Europe at 11.7%). One modifiable factor that could be contributing to this is the oxygen administered by paramedics after a successful out-of-hospital resuscitation. Randomised controlled trials on the topic are limited, and most research is observational and often does not differentiate according to the location of the cardiac arrest, leading to conflicting results. Overall, hyperoxaemia may be beneficial for the patient after a successful resuscitation until a critical level is reached; in the prehospital setting, it is not always possible to measure PaO2 as this is outside of the scope of practice of a paramedic in the UK. Above a critical level, excess oxygen becomes damaging and worsens patient outcomes. After a successful resuscitation, where possible, paramedics should consider titrating a patient's oxygenation to a peripheral oxygen saturation of 94–98% unless a more accurate measurement, such as point-of-care arterial blood gas results are available to guide titration.

Experiences of personal protective equipment and reasons for non-compliance

Background: The COVID-19 pandemic created challenges in prehospital care. Paramedics have been required to adhere to strict protocols regarding infection control and the use of personal protective equipment (PPE). These protocols have evolved as the pandemic progressed. Understanding the experiences of paramedics in using PPE and their reasons behind not adhering to recommended guidelines should improve the limited evidence base and assist healthcare organisations to form tailored PPE guidance, enabling better protection of paramedics. Aim: This study aimed to analyse evidence on paramedics' experiences of using PPE and explore the reasons behind non-compliance to inform PPE policies. Methods: Searches of five key databases identified papers relating to frontline practitioners' experiences of using PPE; frontline was defined as working in patient-facing roles in prehospital, emergency department or critical care settings. Articles were then subject to thematic analysis as part of this narrative review. Results: Three themes emerged: physical and emotional wellbeing; impact on patient care and clinical effectiveness; and PPE fatigue. The evidence explores health professionals' experiences of working in this difficult environment but very little data exist regarding the impact of PPE, specifically on UK paramedics or their reasons for not adhering to PPE protocols. Conclusion: PPE affects wearers in a variety of ways. Factors behind non-adherence are multifactorial. A paucity of literature exists regarding paramedics' experiences of using PPE.

The effect of COVID-19 on student opportunities to acquire airway skills

Background: To protect healthcare providers during the COVID-19 pandemic, substantial changes were made to clinical care guidelines across the United States. Alongside these changes, emergency medical services call volume decreased nationwide. These made it difficult for paramedic students to practise and master the practical skills necessary for skill competency and graduation. The aim of this study was to explore the changes in the number of opportunities available to paramedic students during the COVID-19 pandemic. Methods: A retrospective study of student records was carried out to explore airway procedure variables before and after the beginning of the COVID-19 pandemic. Results: Statistically significant differences in case exposure were found between the periods before and after the start of the COVID-19 pandemic. Case volume and opportunities to practise most airway procedures decreased post COVID-19. However, procedures associated with higher-acuity patients, such as intubation, increase in frequency. Conclusion: The pandemic gave rise to difficulties for paramedic educators in preparing students for qualification and the current study has highlighted such unique challenges. Consideration must be given to developing a more flexible, adaptable and scalable way to measure a student's competency in paramedicine in times of significant disruption.

To what extent is end-tidal carbon dioxide a predictor of sepsis?

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a major cause of death worldwide; 245 000 cases are reported in the UK annually with a mortality rate of 20.3%. Rapid diagnosis and rapid treatment of sepsis can significantly reduce mortality but sepsis can be difficult to diagnose. End-tidal carbon dioxide (EtCO<sub>2</sub>) is the measurement of expired CO<sub>2</sub> using capnometry and waveform capnography. For CO<sub>2</sub> to be exhaled, it must be metabolised and transported before being exhaled by effective ventilation; EtCO<sub>2</sub> can therefore provide an indication of metabolism, circulation and ventilation. EtCO<sub>2</sub> has already been shown to be an indicator of other metabolic acidosis conditions so this review aims to identify the usefulness of EtCO<sub>2</sub> in identifying sepsis. Methods: A systematic literature search was conducted between March and April 2021 using the CINAHL Plus and MEDLINE databases. The results were screened and evaluated. Results: Of the 44 papers identified in the original search, seven were included in this review. Conclusion: This review suggests an EtCO<sub>2</sub> of ≤25 mmHg (3.3 kPa) in patients with a suspected infection is diagnostic of sepsis and therefore could be used to increase the speed and accuracy of diagnosis and potentially reduce sepsis mortality. It also identifies gaps in research around UK practice and in comparing EtCO<sub>2</sub> against UK sepsis guidelines and diagnostic tools such as the UK Sepsis Trust guidelines.

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