Paramedic specialization: a strategy for better out-of-hospital care.

Demographic, economic, and political forces are driving significant change in the US health care system. Paramedics are a health profession currently providing advanced emergency care and medical transportation throughout the United States. As the health care system demands more team-based care in nonacute, community, interfacility, and tactical response settings, specialized paramedic practitioners could be a valuable and well-positioned resource to meet these needs.

A 48-year-old man with severe shortness of breath.

A 48-year-old man was found by his neighbor unconscious on the floor at his residence. Earlier in the day, his neighbor reported noticing the patient was becoming more short of breath and having some trouble speaking. The neighbor alerted EMS.

Metastatic epidural spinal cord compression.

Metastatic epidural spinal cord compression (MESCC) occurs when cancer metastasises to the spine or epidural space and causes secondary compression of the spinal cord. MESCC is a common complication of malignancy that affects almost 5% of patients with cancer. The most common symptom is back pain.

King airway use by air medical providers.

Background: In cases of difficult or failed endotracheal intubation (ETI), alternate airways are designed to provide adequate oxygenation and ventilation until a definitive airway can be established. The King Laryngeal Tube Disposable (LTD) is a new superglottic alternate airway.

Objective: To describe the use, rates of success, and outcomes of the King airway by highly skilled prehospital providers.

Minimally invasive lumbar discectomy in obese patients.

Objective: To assess patient outcomes and complication rates after minimally invasive lumbar microdiscectomy in an obese patient population.

Methods: A retrospective clinical review of 32 patients with a body mass index of 30 kg/m or greater undergoing lumbar minimally invasive discectomy was performed. The initial chart review was followed by phone interview if all information could not be obtained from chart review.

EMS and emergency department physician triage: injury severity in trauma patients transported by helicopter.

Background: Many trauma patients who are not severely injured arrive at trauma centers via helicopter emergency medical services (HEMS).

Objective: To compare the injury severity of patients sent to trauma centers by HEMS from community emergency departments (EDs) with the injury severity of those triaged by prehospital providers to HEMS directly from accident scenes.

Methods: All records were reviewed from trauma-related missions during 1997for a single HEMS system, extracting information on location, time of day, patient age and gender, mechanism of injury, initial vital signs, Revised Trauma Score (RTS), and the extent of care required during transport.

Intradural mesh: an unusual cause of spinal cord tethering: case report.

A 13-year-old boy with a myelomeningocele experienced progressive foot deformity and lower-extremity pain while walking. Magnetic resonance imaging demonstrated a low-lying spinal cord with scarring near the site of a previous repair. During surgery, the terminal nerve roots were found to have scarred and adhered to a piece of metal mesh lying in the intradural space.