Browsing Publications - North East Ambulance Service by Subject "Advanced Life Support"
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Can paramedics perform and evaluate a focused echocardiogram during a simulated 10-second pulse check, after a one-day training course?Abstract published with permission. Aim ‐ To assess whether paramedics can be trained to perform basic echocardiograms in the 10-second pulse check window during a simulated advanced life support (ALS) resuscitation. Introduction ‐ Cardiac arrest survival in the UK varies between 2% and 12%. Management of cardiac arrests concentrates on the detection of reversible causes, which is limited pre-hospitally due to a lack of equipment. Ultrasound machines are now small enough for pre-hospital use and may assist in the detection of some of these causes. There is currently no evidence to suggest the best methodology or required course duration to train paramedics to use ultrasound, or to indicate whether ultrasound simulation could be beneficial. Methods ‐ Ten volunteer paramedics were trained to perform focused echocardiograms using handheld ultrasounds and an ultrasound simulator. The training involved six hours of teaching and practical training, at the end of which the participants were assessed using objective structured clinical examinations (OSCEs) on an ultrasound simulator with three different pathologies which were relevant in cardiac arrest management. Results ‐ Paramedics were able to get a view of the heart during the assessments in 96.7% of the OSCEs, but were only able to accurately recognise the pathologies of the condition in 50%. Overall, the participants demonstrated simulated competence in 46.7% of the OSCEs. Conclusion ‐ Paramedics can be trained to gain a view of the heart using focused echocardiograms after a one-day course, but are not consistently able to determine the cardiac activity or pathology from the echocardiogram.
A review of the pre-ROSC intranasal cooling effectiveness studyAbstract published with permission. With the publication of the 2010 European Resuscitation Council Guidelines, therapeutic hypothermia has been recommended as part of the treatment algorhythm for the management of adult cardiac arrest. As ambulance services around the world struggle to decide on the best method of cooling a patient at the time of the return of spontaneous circulation (ROSC), the ground-breaking ‘PRINCE’ study has been published describing the novel approach of ‘trans-nasal’ evaporative cooling during the peri-arrest period. This study describes a significant difference found on arrival at hospital between the mean tympanic temperatures of the two groups (cooled vs control) following a period of cooling (34.2 °C [SD 1.5 °C] vs 35.5 °C [SD 0.9 °C], P<0.001). In addition, when looking at survival to discharge following out-of-hospital (OOH) cardiac arrest, there was a statistically significant difference in a subgroup of patients where CPR was commenced within 10 minutes of cardiac arrest (56.5% of trans-nasally cooled patients survived to discharge compared with 29.4% of control patients (P=0.04, relative risk =1.9)). This article examines the PRINCE study and considers the implication of this method of inducing therapeutic hypothermia in the out-of-hospital cardiac arrest patient within the UK.