Focused ultrasound in out-of-hospital cardiac arrest by advanced paramedics | Journal Of Paramedic Practice

Background:
This study describes and evaluates advanced paramedic practitioner (APP) use of focused cardiac ultrasound (FoCUS) in out-of-hospital cardiac arrest (OHCA), and relates ultrasound findings with decisions to terminate resuscitation. The authors report characteristics of patients who do/do not undergo a FoCUS examination by APPs, ultrasound probe positions used and whether FoCUS findings were associated with decisions to terminate resuscitation or to convey patients to an emergency department (ED) with ongoing resuscitation.
Method:
A retrospective, observational cohort study of all adult medical OHCA patients attended by APPs in Greater London during 2018 was carried out using data from emergency medical services (EMS) and APP databases.
Results:
Twenty-eight APPs attended 1444 OHCA patients in 2018, of whom 744 underwent FoCUS. The subcostal probe position was used most frequently (74%), followed by the parasternal long axis (19%), with significantly smaller use of the parasternal short axis and apical windows. Absence of spontaneous cardiac motion (SCM) was associated with resuscitation being terminated (333 out of 391; 85%) and the presence of SCM was associated with conveyance to the emergency department (213 out of 264 patients; 80%). All decisions to terminate resuscitation were within the APP scope of practice.
Conclusion:
The authors believe this is the largest prehospital study involving FoCUS in OHCA. An association between FoCUS findings and decisions made to either convey patients to hospital or terminate resuscitation was found. The SC window was most used and ROLE decisions were deemed to be in accordance with local guidance and practice.
— Read on www.paramedicpractice.com/features/article/focused-ultrasound-in-out-of-hospital-cardiac-arrest-by-advanced-paramedics

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient | SpringerLink

Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CA
— Read on link.springer.com/article/10.1007/s12630-021-02007-0

Dr James DuCanto with SALAD

our next patient: 42 year old male; alcoholic liver disease; unwell for several days; lethargic/confused; jaundiced; tense ascitic abdomen. The patient starts to vomit fresh red blood, initially a few cupfuls, then profuse and unrelenting. They’re choking and unable to protect their own airway; sats dip to 88%; RR goes up to 32. Normal suctioning and positioning are not helping. You decide to intubate but naturally, you’re nervous. How do you increase the chance of first-pass success? How do you adequately clear the ororpharynx and avoid blood contaminating your view? How do you best maintain airway suction during intubation? Join Jim DuCanto for this online, on-demand airway management course where you’ll learn simple tips to more easily manage the heavily soiled airway. To find out more, visit https://bit.ly/3xNrI7g

Supraglottic airway devices — Don’t Forget the Bubbles

Cite this article as: Jessica Rogers. Supraglottic airway devices, Don’t Forget the Bubbles, 2021. Available at:https://doi.org/10.31440/DFTB.32780 Endotracheal intubation (ETI) in children is thankfully rare and our first pass success rate could definitely do with some improvement. It is difficult to compare the efficacy of various advanced airway techniques in children. There are ethical implications, of…

Supraglottic airway devices — Don’t Forget the Bubbles