Keeping up with the ever-increasing medical literature that is directly applicable to EMS is growing more difficult each day. More and more journals in more and more specialties are publishing articles that affect our care in the field.
At EMS Today 2017, Dr. Corey Slovis—who chairs the department of emergency medicine at Vanderbilt University Medical Center and is medical director of the Nashville fire department and international airport—presented a number of potentially practice-changing articles in his session, The Most Important Published Articles for EMS Providers.
Slovis discussed the recent New England Journal of Medicine article when he compared amiodarone with lidocaine and a placebo, along with a meta-analysis of this study and others. He concluded that it’s difficult to show any real efficacy to antiarrhythmic drugs if the patient has been in arrest for more than a few minutes. Slovis stressed that the focus of EMS needs to be on prevention of arrests, rapid defibrillation and high-quality CPR. He then discussed something that paramedics and treating physicians need to be careful of: being sure to wait until after the second AED shock to give epinephrine. Administration before the second shock will decrease ROSC, survival and good neurological outcomes.
Slovis then talked about aggressive use of naloxone early in pulseless electrical activity (PEA) arrests, as an increasing number of hypoxia-induced PEA arrests are due to IV heroin overdoses.
Other articles included in Slovis’ presentation covered the following topics:
- Hypothermia in the field;
- The efficacy of newly proposed CPR enhancements and technologies;
- Termination of resuscitation (TOR) criteria and some TOR controversies;
- Hands-on defibrillation;
- The modified Valsalva maneuver;
- Nitroglycerin in acute myocardial infarction (AMI) and its induction of hypotension in AMI types;
- Use of Dextrose 10% (D10);
- Anaphylaxis treatment ;
- And selective use of spinal immobilization.