Clinical Practice

Targeted temperature management: beneficial or not?

Targeted temperature management (TTM), formerly known as therapeutic hypothermia, has been shown to improve survival and neurological recovery in patients following cardiac arrest. Following successes with its in-hospital implementation, many guidelines now advocate its use in the prehospital domain for all out-of-hospital cardiac arrests (OHCAs). It has been suggested that patients presenting with shockable rhythms who receive early initiation of TTM have better survival rates. TTM can be...

Paramedic use of PPE and testing during the COVID-19 pandemic

COVID-19 is the disease caused by the SARS-CoV-2 virus. Paramedics are at the frontline of healthcare delivery, including during the SARS-CoV-2 pandemic. The virus poses specific problems for paramedics. These involve treating and transporting infected patients, as well as considerations around decontamination and disinfection of ambulances and medical equipment. All respiratory infections should be considered COVID-19 until proven otherwise so paramedics should wear personal protective...

Musculoskeletal system part 1

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...

The new coronavirus disease: what do we know so far?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes the new disease COVID-19. Symptoms range from mild to severe with a higher incidence of severe cases in patients with risk factors such as older age and comorbidities. COVID-19 is mainly spread through the inhalation of respiratory droplets from coughing or sneezing or via contact with droplet-contaminated surfaces. Paramedics should be aware that some aerosol-generating procedures may put them at a...

Peripheral vascular system

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...

Paramedics and pneumonia associated with COVID-19

Paramedics are at the frontline of healthcare delivery and this includes during the current coronavirus pandemic. This pandemic poses specific problems for paramedics, which include not only treating and transporting infected patients, but also issues around decontamination and disinfection of ambulances and medical equipment. Of particular concern is the pneumonia associated with the 2019 novel coronavirus. Data on COVID-19 pneumonia are developing. Ongoing research demonstrates that almost all...

Cardiovascular examination

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...

Effect of blood pressure on stroke severity and outcomes in acute cases

Background: Stroke results in impairment of cerebral autoregulation. Systemic blood pressure (BP), whether low or high, may affect cerebral blood flow and cause damage to brain tissue, so is important in the context of stroke. Effective management of BP may result in less severe strokes and better outcomes for patients. Methods: A literature search was performed to answer the research question, using the CINAHL Complete and MEDLINE Complete databases. Inclusion and exclusion criteria were...

Cranial nerves: part 2

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

Triage system performance: consistency and accuracy in the emergency centre

Triage systems have evolved over recent times with the use of tiered acuity to achieve a balance between patient need and resource availability. Triage is a way to sort patients based on acuity, irrespective of the setting, and whether by telephone, in the prehospital environment or in hospital. The growth of the paramedic profession means that paramedics are now working in emergency centres and having to contend with the concept of triage in this setting. The nature of emergency centres and the...

Clinical exam: an introduction

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

Physical health in mental health: considerations for paramedics

Life expectancy for people with a mental illness diagnosis is 15–20 years less than those without, mainly because of poor physical health. Mental ill health affects a significant proportion of paramedics' patients, and practitioners could assess and promote their physical health even though contact time is limited. Factors affecting physical health include substandard and disjointed care, stigma and diagnostic overshadowing—where physical symptoms are dismissed as a feature of mental illness....

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