Clinical Practice

Prehospital management of sickle cell crisis: a case report

Sickle cell disease (SCD) covers a group of inherited conditions that affect the red blood cells. It can cause episodes of intense pain called sickle cell crises. This case study outlines a 10-year-old boy's first presentation of sickle cell crisis. The patient presents with typical sickle cell crisis pain in joints that is exacerbated by movement and related to strenuous physical exercise in the cold. This pain is caused by the sickled red blood cells occluding the microvasculature, causing...

Paramedic decision-making and the influence of bias: a case study

Background:Prehospital clinical decision-making is a complex, evolving skill. Typically, there are multiple possible diagnoses and several potential treatment pathways to be considered, and usually prehospital clinicians have to base their decisions on imperfect information. Biases will inevitably compete to influence clinicians as they attempt to weigh the probabilities of diagnoses, degrees of certainty and permissible risks in their decision-making process. With experience, as intuition and...

Use of specialist paramedic dispatch in emergency ambulance control

Optimising patient care through the delivery of specialist resource allocation at the point of injury improves patient outcomes. As identified by the NHS, high-quality call handling and dispatch of the right response, first time, is critical to these outcomes (NHS, 2015). Aim: This article presents an objective literature review and critical analysis of the evidence base concerning clinical dispatch. This study aims to highlight key differences between the triage and dispatch processes of...

Excited delirium syndrome

Excited delirium syndrome involves extreme agitation and aggression in a patient with an altered mental status; around one in ten cases ends in cardiac arrest. It has two main triggers: acute drug use and psychiatric illness. Patients display violent behaviour, increased pain tolerance and great strength; they pose significant risks to themselves and those around them. Maintaining safety on scene is paramount, which can be supported by a dual response by paramedics and law enforcement officers,...

Intravenous ketamine as an analgesia in prehospital adult trauma patients

Background: Prehospital traumatic pain is common, but the quality of pain management in these patients is poor. Current practice recommends morphine as the first-line analgesia in major trauma but this carries high risks and is often contraindicated. Alternative paramedic-administered analgesia does not provide adequate pain relief or may be contraindicated. As a result, many patients remain in pain. Analgesic ketamine is used safely and effectively in international civilian and military...

Assessment and management of issues in early pregnancy

Approximately 5% of the workload of UK emergency ambulance services involves managing obstetric patients. This places pregnancy firmly within the scope of prehospital care but training often focuses on critical illness during pregnancy rather than the range of presentations seen. This clinical review aims to discuss the implications of early pregnancy with a focus on ectopic pregnancy, rhesus incompatibility, miscarriage and hyperemesis gravidarum. Normal presentations of pregnancy and...

Legal aspects of prescribing

Paramedic independent prescribing is in its infancy and there are limitations to the range of medicines that can be prescribed when compared with other professions undertaking independent prescribing. Medication and prescribing errors are common events within the NHS in England, resulting in a substantial number of litigation and fitness-to-practise proceedings against other professions in relation to prescribing and medicines management. It is foreseeable that paramedic independent prescribers...

Pulse oximetry to predict the onset of acute mountain sickness: a literature review

Acute mountain sickness (AMS) is a common illness affecting people ascending to high altitudes. AMS may progress rapidly, and can be fatal if symptoms are neglected, acclimatisation processes fail or if the ascent continues. For many patients with AMS or AMS symptoms, medical assistance is given by mountain rescue and allied health professionals. Currently, the prediction of AMS in the high-altitude environment relies upon recognising and tracking subjective symptoms. However, owing to...

Needle decompression in tension pneumothorax: anterior or lateral approach?

Background: For tension pneumothorax, the UK recommendation is to use a 14 g, 5 cm cannula to decompress the chest. Advice around site selection differs between using the second intercostal space (ICS) mid-clavicular line or the fifth ICS near the mid-axillary line. The aim of this literature review is to determine the best approach for needle decompression using a standard 14 g, 5 cm cannula. Methods: A systematic search of multiple databases was conducted, using inclusion and exclusion...

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...

View all Clinical Practice

Keep up to date with Journal of Paramedic Practice!

Sign up to Journal of Paramedic Practice’s regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month.