Airway & Respiratory, Patient Care, Rescue & Vehicle Extrication

What Current Studies Mean to EMS

Issue 6 and Volume 33.

RECLINED SEATS INCREASE INJURY RISK
Dissanaike S, Kaufman R, Mack CD, et al: ˙The effect of reclined seats on mortality in motor vehicle collisions.Ó„Journal of Trauma. 64(3):614Ï619, 2008.

Automobile crash tests are conducted with the front seats in a full upright position, but many people fully recline the passenger seat to sleep on long trips or partially recline to look ˙coolÓ while driving.„

It turns out these occupants are at greater risk for serious injury and death in a front-end crash. They are thrown forward into the pre-tensioned lap/shoulder belt, causing serious thoracic and abdominal injuries. And without full protection from the air-bag system, occupants slide down and forward and strike their lower extremities on the dashboard and other front-end objects.„

There_s no specific injury pattern that clearly identifies these individuals; however, they_re at increased risk for head and neck injuries because they don_t receive any benefit from the headrest.

Consider these findings during your assessment and extrication of crash victims.

SUCCESSFUL USE of ADENOSINE in PSVT
Xanthos T, Ekmektzoglou KA, Vlachosa IS, et al: ˙A prognostic index for the successful use of adenosine in patients with paroxysmal supraventricular tachycardia in emergency settings: A retrospective study.Ó American Journal of Emergency Medicine. 26(3):304Ï309, 2008.

Adenosine is a first-line treatment for patients with paroxysmal supraventricular tachycardia (PSVT). Most of us are familiar with its ˙heart-stoppingÓ action, but have you ever wondered why it works so well for some people and not so well for others?

The answer lies in discovering whether the individual has ever had PSVT. Successful treatment can be predicted with this formula: (age/heart rate at admission) + number of past PSVT episodes. Individuals with a score less than 1.18 will respond to adenosine; those with a score greater than 1.18 will likely need alternative conversion methods.„

Because adenosine is used only in the treatment of stable patients, you have time to ask a few questions and make this simple calculation. Although it won_t change the immediate treatment, it might be valuable information for the receiving facility or units with long transport times.

TREATING HYPOGLYCEMA WITHOUT TRANSPORT
Strote J, Simons R, Eisenberg M: ˙Emergency medical technician„treatment of hypoglycemia without transport.Ó American Journal of Emergency Medicine. 26(3):291Ï295, 2008.

Treating hypoglycemia in the field has greatly benefited many individuals, but most EMT-Bs are required to request the assistance of a paramedic vehicle when administering medication is required. This increases the time on scene for all the vehicles and delays care. With proper training, couldn_t EMT-Bs adequately treat the hypoglycemic patient? This would certainly free up paramedic units for more serious calls.

EMT-Bs may be just as capable as paramedics at identifying, treating and providing instructions to the hypoglycemic patient. In this study of 402 cases of hypoglycemia, no significant difference existed between the EMT-Bs and paramedics when the researchers evaluated the care of diabetic patients, rate of return visits for the same patient or hospitalizations.„

Allowing EMT-Bs to treat hypoglycemic patients could reduce vehicle wear and tear, fuel costs and the risk of accidents by lowering the number of responding units. Talk to your medical director about modifying your hypoglycemia protocol.

CPAP REDUCES INTUBATION„& MORTALITY
Thompson J, Petrie DA, Ackroyd-Stolarz S, et al: ˙Out-of-hospital„continuous positive airway pressure ventilation versus usual care in acute respiratory failure: A randomized controlled trial.Ó Annals of Emergency Medicine. ePub. April 4, 2008.

Endotracheal intubation is considered the treatment of choice for patients in respiratory failure. However, intubation puts the patient at risk for numerous long-term problems, like higher rates of gastric aspiration from failed attempts or ventilatory acquired pneumonia. The solution may be to institute a non-invasive method of positive pressure support, referred to as continuous positive airway pressure (CPAP).

In this study, the authors randomized adult patients with respiratory distress to either receive standard therapy (intubation or bag/mask support) or CPAP. A total of 71 patients were enrolled in the study. In the standard treatment group, 50% required intubation either in the field or in the emergency department (ED) upon arrival.„

In the CPAP group, 20% required intubation, with none of these intubations occurring in the field. The death rates for the groups were 35% in the standard group and 14% in the CPAP group.

CPAP requires special equipment and some additional training, but if it reduces the need for intubation, either in the field or the ED, then it_s certainly worth a look. JEMS

Elizabeth Criss, NP, MEd, MS, CEN, CCRN, is a nurse practitioner in the emergency department at Tucson Medical Center. She was a founding member of the Board of Advisors of the Prehospital Care Research Forum. Criss has been involved in emergency care and disaster management since 1982.