Clinical Practice

Clinical case review: out-of-hospital cardiac arrest following thyroid storm

Acute thyrotoxicosis (thyroid storm) caused by hyperthyroidism is a rare but severe endocrine imbalance which, in extreme cases, may lead to ventricular fibrillation and ultimately, without intervention, death. The authors attended such an incident and, following clinical interventions, achieved return of spontaneous circulation with a good outcome for the patient and subsequent hospital discharge.

Non-medical prescribing for paramedics in primary care

As paramedic roles continue to grow and diversity, the number of paramedics working in primary care is on the rise. Knowledge of non-medical prescribing specifically for paramedics in these settings is necessary, as are new frameworks for medicines management beyond the ambulance services and for general practice in particuar. This instalment in the Prescribing Paramedic series discusses prescribing in primary care settings including some of the more practical aspects of relevance to paramedics.

Prescribing for paramedics: pharmacodynamics

In continuing the Prescribing Paramedic series, this article explores the nature of drug actions that occur within the body. An understanding of these principles allows the paramedic to make an informed decision on the medicines that may be offered, the likely outcomes and possible risks. Often considered a complex subject, this article aims to present a set of principles that the reader can apply to almost all drugs that one may encounter. Where appropriate, relevant case studies have been...

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.

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...

Should ascorbic acid be a primary therapy for sepsis in prehospital settings?

Background: Prehospital emergency medical services (EMS) are believed to be responsible for the initial treatment of 68 000 septic patients annually in the UK, 88% of whom have severely low ascorbic acid levels, which can lead to organ dysfunction, increasing the likelihood of mortality. Objective: This review aims to determine if early therapeutic use of ascorbic acid (vitamin C) could reduce the deterioration of septic patients and therefore overall mortality. Method: A literature review...

Integrating research and evidence-based guidance into prescribing practice

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best...

Miscarriage, SUDI and neonatal death: paramedic experience and practice

This article aims to provide an exploratory investigation into paramedic experiences of attending cases of miscarriage, sudden and unexpected death in infancy (SUDI) and other forms of neonatal loss. It draws on a background literature review, but focuses primarily on exploring issues raised by paramedics during a structured discussion group on this topic. Existing literature highlights the ways in which baby and infant death is one of the most stressful and challenging areas of paramedic...

Paramedic use of IV amiodarone to terminate supraventricular tachycardia

The introduction of specialist services within the hospital network has increased conveyance times for many patients, as paramedics look to deliver them to the most appropriate hospital first time. Patients with potentially life-threatening arrhythmias can decompensate quickly, increasing the need for pharmacological management of these conditions en route. Amiodarone is carried as part of the existing paramedic formulary and is used to terminate paroxysmal supraventricular tachycardia (PSVT),...

Challenges of SARS-CoV-2 and conflicting PPE guidelines

During the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) has become a contentious issue in healthcare settings, no more so than in the prehospital environment. The current severe acute respiratory syndrome 2 virus (SARS-CoV-2) has pathogenic and transmission similarities to previous coronaviruses, severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). There are differences in global and domestic PPE guidelines...

How accurate is the prehospital diagnosis of hyperventilation syndrome?

Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the...

Neurological examination 2

The clinical examination is an important part of any patient consultation. After the primary survey and taking the patient history, a more in-depth examination is sometimes required to aid making a working diagnosis and help negate other differential diagnoses. The extent of this depends on the stability of the patient and may not be possible in time-critical circumstances. However, clinical examination is an increasing part of paramedic practice owing to the continued expansion of the scope of...

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