Clinical Practice

Methoxyflurane (Penthrox®)—a case series of use in the prehospital setting

  • February 2019

Methoxyflurane (Penthrox®) is a fluorinated hydrocarbon, which when first used in general anaesthesia was noted to have strong analgesic properties in subanaesthetic dosage. More than 5 million doses have been sold for use in Australia since 1978 and have been found to have an excellent safety profile. After rigorous review by the Medicines and Healthcare Regulatory Agency, methoxyflurane was granted a product licence in 2015 in the UK and Europe for the relief of pain in patients with...

Human factors, cognitive bias and the paramedic

Human factors, cognitive bias and the paramedic

The consequences of human factors and cognitive bias can be catastrophic if unrecognised. Errors can lead to loss of life because of the flawed nature of human cognition and the way we interact with our environment. Seemingly small mistakes or miscommunications can lead to negative outcomes for patients and clinicians alike. It is easy to see therefore why the College of Paramedics now recommends the teaching of human factors at higher education institutions. Using a problem-based approach, this...

Splinting of injuries: best practice guidance

Splinting of injuries: best practice guidance

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. In this instalment, Rory McKelvin discusses the application of splints to fractures and sets out a best practice step-wise approach to assessment, decision-making and application in prehospital settings

Acute traumatic coagulopathy: the lethal triad of trauma

Acute traumatic coagulopathy: the lethal triad of trauma

Trauma is the leading cause of death for people in the UK and North America, especially for those aged 15–24 years. However, if early management regimes of permissive hypotension, high-flow oxygen and administration of tranexamic acid are applied, mortality risk can be reduced significantly. Acute traumatic coagulopathy (ATC) is an internal process that is initiated by significant or massive trauma because of hypoperfusion resulting in hypovolaemic shock, activation of protein C, platelet...

Correct pulse measurement

Correct pulse measurement

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. In this month's instalment, Andrew Kirk discusses common pulse sites and correct technique for obtaining a patient's pulse

Tourniquets in the treatment of prehospital haemorrhage

Tourniquets in the treatment of prehospital haemorrhage

Background:During recent conflicts in Iraq and Afghanistan, tourniquets were a useful tool in the management of non-compressible prehospital catastrophic haemorrhage. Recommendations for use within the civilian setting were then made. However, civilian research supporting this change in practice is limited.Aims:The aim of the research is to evaluate the utility of prehospital tourniquet application through description of the complications associated with use, as well as identification of...

Hyperventilation syndrome: diagnosis and reassurance

Hyperventilation syndrome: diagnosis and reassurance

This article provides an overview of hyperventilation syndrome (HVS). Hyperventilation is to breathe in excess of metabolic requirements; in the absence of an underlying organic cause, it is defined as HVS. Alternative terms used in literature are panic or anxiety attack, panic or anxiety disorder, dysfunctional breathing and breathing pattern disorder. This article explores HVS signs and symptoms beyond the familiar clinical signposts of tachypnoea, chest tightness, paraesthesia and anxiety. It...

Recognising ECG landmarks

Recognising ECG landmarks

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. In this instalment, Karen Simpson-Scott takes an in-depth look at electrocardiograms and the vital readings they provide for clinicians

A brief guide to borderline personality disorder in an emergency setting

A brief guide to borderline personality disorder in an emergency setting

OverviewParamedics and ambulance staff are frequently in contact with patients who have mental health diagnoses This may be the primary reason for contacting the emergency services (e.g. self-harm, crisis or suicide ideation) or it may be incidental to their primary clinical concern. Patients in mental health crisis can be challenging and demanding. Most paramedics will not have had specific guidance on identifying or understanding the features, aetiology and responses to treatment of patients...

Best practice technique in intramuscular injection

Best practice technique in intramuscular injection

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontlines, highlighting the importance of these skills and how to perform them. In this issue, Andrew Kirk discusses the administration of intramuscular injection in pre-hospital care in line with best practice.

GP perspectives of paramedic referrals to urgent and primary care

GP perspectives of paramedic referrals to urgent and primary care

Background:This article stemmed from a search for more understanding about how paramedics relate to urgent and primary care (U&PC).Methods:The current study is qualitative, involving interview with seven general practitioners (GPs) in Wirral, Merseyside. Their verbatim evidence was audio-recorded, transcribed and analysed.Findings:There were three superordinate themes established: variability of referrals; the value of referrals sometimes being overlooked; and the need for skills development to...

Using haemostats effectively in pre-hospital care

Using haemostats effectively in pre-hospital care

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. Here, Rory McKelvin discusses haemostats; what they are, how they work, when and where to use them, and how to do so effectively.

Hand hygiene compliance in the pre-hospital setting

Hand hygiene compliance in the pre-hospital setting

Health professionals' compliance with hand hygiene remains a universal problem in health care. While poor hand hygiene is prevalent in the inpatient and hospital environments, these behaviours are also similar among emergency medical services (EMS) personnel. Studies in infection prevention and control practices and knowledge of transmission of the spread of multidrug-resistant organisms within the EMS have highlighted sub-optimal standards and a need for improvement. This article discusses the...

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