EMS

How to Manage Blast Injuries

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Blast injuries combine common polytrauma mechanisms – blunt, penetrating, burns – with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.

Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.

Handy EMS OHCA Handoff Checklist

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In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Try this checklist!

Source
Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff. Resuscitation. 2023 Aug;189:109834. doi: 10.1016/j.resuscitation.2023.109834. Epub 2023 May 16.

Amiodarone or Lidocaine for Early Shockable OHCA?

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In this secondary analysis of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study), researchers found that early administration of amiodarone (within 8 minutes) is associated with greater functional survival in OHCA with initial shockable rhythm when compared to placebo.

Source
Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Mar 4. doi: 10.1111/acem.14716. Epub ahead of print.

Epi for OHCA – ROSC, Survival…But Are We Saving the Brain?

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In this systematic review and meta-analysis, researchers found the epinephrine in standard doses, high doses, and with vasopressin lead to an improvement in ROSC and survival to hospital admission in out of hospital cardiac arrest (OHCA) but did not improve survival to discharge or functional neurologic outcome.

Source
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Jan 31:S0012-3692(23)00165-4. doi: 10.1016/j.chest.2023.01.033. Epub ahead of print.

CPR Fatigue Is REAL – How Do Fit Rescuers Perform?

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In this study of firefighters performing CPR with feedback devices, researchers found that compression depth decreased over the course of a two-minute chest compression cycle while compression rate stayed within goal.

Source
Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest. Resuscitation. 2023 Feb 16;185:109738. doi: 10.1016/j.resuscitation.2023.109738. Epub ahead of print.

EXACT Trial – Oxygen Saturation Targets after Cardiac Arrest

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Targeting a lower oxygen saturation (90-94%), compared to standard care (98-100%), in patients who were resuscitated after out-of-hospital cardiac arrest (OHCA) until admission to the intensive care unit did not significantly improve survival to hospital discharge.

Source
Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701.

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