Continuing Professional Development: Understanding arrhythmias: paroxysmal supraventricul artachycardia in the prehospital setting

OverviewParoxysmal supraventricular tachycardia (PSVT) presents a challenging assessment to the prehospital emergency care provider. The nature of PSVT affects all age groups, has a range of aetiologies, is usually well tolerated but may also result in sudden cardiac arrest. It is able to be terminated by a range of therapies and is the subject of an evolving understanding of pathophysiology related to it. Therefore, it is essential that those providing prehospital care have an understanding of the nature and implications of PSVT in order to effectively manage this condition in the field. This module will use a systematic approach to highlight the pathophysiology, epidemiology, interventions, and issues, to arm the reader with the necessary knowledge to approach this patient with confidence.Learning OutcomesAfter completing this module you will be able to:• Discuss the pathophysiology of supraventricular tachycardia (SVT) (atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT)) in relation to physiological effects on the body, specifically perfusion and likely deterioration to lethal arrhythmias.• Discuss the treatment modalities available in the prehospital setting for paroxysmal supraventricular tachycardia (PSVT)—specifically the use of vagal manoeuvres, pharmacological agents, and synchronized cardioversion.• State the evidence-based components of the valsalva manoeuvre (VM), and describe their effect.• Describe the rationale for use of the VM in the setting of haemodynamically stable SVT as a firstline intervention.• Outline the controversies and continued development of the VM, and how this may impact upon current reversion rates for SVT.

Enhancing the leadership and management competency of paramedics

Ambulance services around the world are facing significant management and leadership challenges associated with the rapid growth of call volumes; increasing adoption of sophisticated technology; a broadening scope of clinical practice; greater expectations of citizens, patients and system governors; and the ever increasing complexity of working in both the health and public safety environments. The sustainability of vibrant, healthy and high performing ambulance services depends on competent, experienced and well-educated leaders and managers.

Spotlight on Research

Pulse oximetry is commonly used during out-of-hospital care as a non-invasive method to evaluate and monitor patients, and guide the administration of titrated oxygen therapy. Due to the varied environments encountered within the community, practitioners interpreting pulse oximetry (SpO2) results should consider factors which may contribute to unreliable readings.

Book Review

This text addresses what is very much a multidisciplinary speciality but is of direct relevance to paramedics.

Life as a paramedic: an introduction to blogging

Mark Glencorse, NHS Operational Paramedic Team Leader, Author of 999medic.com, and Co-Host and European Programme Director of ‘The Chronicles of EMS’, introduces the world of blogging and the role it can play in the paramedic profession. Each month, he shall be writing an update for JPP on the main issues that emergency medical services (EMS) blogs are focusing on and the topics that are creating the best discussions. Email for correspondance: mglencorse@yahoo.co.

The neurological outcome of post-cardiopulmonary resuscitation

EMS personnel immediately see the results of resuscitation failures, but rarely are they able to see the long-term positive outcomes of their efforts. Paramedics are occasionally involved in successful cardiopulmonary codes. They have insight into the situation by seeing the location and events surrounding the emergency first-hand, but without having much awareness of the long progression to recovery or of specifically how their team's interventions may have aided that recovery. During medical school, the author had the opportunity to follow such patients and observe their progression daily through the emergency department (ED), intensive care unit (ICU), hospital medical wards, and finally to discharge.This case report discusses the neurological recovery of Mr L, a patient who was successfully resuscitated from a cardiopulmonary code. The case report will highlight his recovery, as well as examine some of the interventions that were made at the prehospital and emergency department level that played a positive role in the patient's recovery. To focus on the specific components of the case which are relevant to EMS, only information essential to the case discussion is presented.

Prehospital cardiac auscultation: friend or foe?

A review of the literature was carried out seeking research into paramedic cardiac auscultation skills. No articles were found which addressed the issue of the accuracy of paramedic cardiac auscultation and a number of potential causes for poor quality auscultation in a prehospital environment were discussed. Furthermore, due to the lack of evidence for or against the effectiveness of paramedic cardiac auscultation, two main areas in which cardiac auscultation is strongly advocated in prehospital care were discussed and the importance of this area of clinical practice was highlighted. The lack of research in this area cannot be equated to a lack of ability in this area and further research is needed to influence professional practice and training.

Left bundle branch block: simplified Sgarbossa criteria applied to prehospital ECGs

In patients presenting with chest pain, the presence of left bundle branch block (LBBB) on the electrocardiogram (ECG) may obscure the diagnosis of acute myocardial infarction (AMI). Patients with LBBB caused by AMI are shown to benefit significantly from rapid provision of reperfusion therapy, yet evidence suggests this is often underprovided. Difficulties in the identification of AMI in these patients is the most commonly cited reason. The aim of the research was to determine whether the application of the simplified Sgarbossa criteria to undifferentiated chest pain patients presenting with ECG changes of LBBB, transmitted during the prehospital phase of care, will be positively predictive of a discharge diagnosis of AMI.

What is our unique selling point?

At the Trauma Care conference that took place in Telford in May 2010, Matt Capsey, Senior Lecturer of Paramedic Science at Teeside University, presented a very interesting discussion, titled ‘Paramedics—what is our unique selling point?’. Here, he discusses this in more detail, arguing that paramedics must develop a stronger sense of identity and value the unique contribution they bring to patient care. He presents a view that if paramedics value their unique skills, then they can contribute to wider healthcare practice—but without a strong sense of professional identity, their voice may be sidelined in future developments.

Preceptorship: key to success

The Department of Health has re-issued its document Preceptorship Framework for Nursing to encompass newly qualified midwives and allied health professionals (Department of Health, 2009; 2010). The aim of preceptorship in the spirit of the new framework is to ensure that newly qualified registrants (preceptees) have expert support to help them apply the academic knowledge they have gained.

Mentorship for paramedic practice: bridging the gap

In the second of a series of four articles on mentorship for paramedic practice, this article focuses on the aspect of the assessment of competence and how these relate to everyday clinical practice in term of mentorship. The article will also address the concept of competence and performance and how these two concepts can be applied to bridging the theory-practice gap that can often be the cause of poor learning and subsequent inadequate clinical practice.