Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

Sorry to carry on about this, but I can’t help myself…

The other night SBS television in Australia aired a special on stroke (found online here)  It brought together some stroke survivors, neurologists, emergency doctors and so on to discuss stroke and stroke treatment.  Of course the issue of tPA for stroke reared it’s ugly head again and it is clear that the debate over this has not been settled. 

I wonder if the authors of the October 4th’s NEJM Journal Watch Alert saw the irony?

Firstly a review of a paper which examined the utility of the precordial thump for out of hospital cardiac events.

Nehme Z, Andrew E, Bernard SA, Smith K.  Treatment of monitored out-of-hospital ventricular fibrillation and pulseless ventricular tachycardia utilising the precordial thump. Resuscitation 2013 Aug 29

The author’s abstract (I’m too stingy to buy the complete paper) suggests that few studies have described the value of the precordial thump as first-line treatment of monitored out-of-hospital cardiac arrest from ventricular fibrillation and pulseless ventricular tachycardia.

Using data from the Victorian Ambulance Cardiac Arrest Registry  out-of-hospital cardiac arres witnessed by paramedics between 2003 and 2011. The study outcomes were: impact of first shock/thump on return of spontaneous circulation and more importantly, survival to hospital discharge.  434 cases met the eligibility criteria. Seventeen patients (16.5%) observed a precordial thump induced rhythm…

From The Intensive Care Network – another podcast from the SMACC 2013 conference. This is Dr Karel Habig, Medical Director of the Greater Sydney Area HEMS, discussing how experience from aeromedical retrieval can improve medical practice.

Click HERE for the audio (right click to open it in a new tab), accompanying slides are below:

 

In the latest edition of Air Medical Journal the British Columbia Ambulance Service’s AirEvac And Critical Care Operations has published a case series detailing the use of tranexamic aid by flight paramedics.

The abstract for the paper can be found HERE. The paper details 13 patients who recieved TXA over a 4 month period, with 9 patients from MVAs, 3 patients who had fallen, and one industrial accident. The average time to administration of TXA from first patient contact was 32 minutes. No complications were reported.

The authors make the point that while tranexamic acid in theory has more benefit in major trauma the earlier it is administered, the importance of it should not be overplayed. Its use occurs in their protocol after a primary survey has occurred, critical interventions have been done, and transport has been initiated. They also mention several cases where the patient met the criteria…