Prehospital Hypertonic Saline Administration After Severe Traumatic Brain Injury.

A 25-year old male paient was critically injuried in a high speed motor vehicle collision over an hour from the nearest trauma center. Paramedics diagnosed the patient with a traumatic brain injury and increasing intracranial pressure and transported the patient to a predesignated landing zone for helicopter intercept. During transport paramedics initiated a severe traumatic brain injury protocol which included the adminisration of 3% hypertonic saline.

Patient Care Alterations After Point-of-Care Laboratory Testing During Critical Care Transport.

Objective: Point-of-care laboratory testing (POCT) is associated with a reduced time to testing results and critical decision making within emergency departments. POCT is an essential clinical assessment tool because laboratory data are used to support timely critical decisions regarding acute medical conditions onditions ; however, there is currently limited research to support the use of POCT in the critical care transport environment. Few studies have evaluated the changes in patient care that occur after POCT during critical care transport.

Busting top trauma myths. Exploring best practices for prehospital trauma care.

Evidence-based medicine will continually change the paradigm in which emergency medicine is practiced. Fifteen years ago tourniquets were a last resort and often considered a guaranteed way to lose a limb; today they are a gold standard in hemorrhage control. Believing in, and having practiced, medicine we later learn to be false doesn't make someone a bad provider, nor does it make them wrong.

Surgical cricothyrotomies in prehospital care. Surgical airway placement is indicated when you cannot intubate or ventilate.

Managing the airway does not mean intubation, it means managing the airway. Allowing a patient to breathe on their own with appropriate positioning, bag-valve ventilation and blind insertion devices are all airway management options. The surgical cricothyrotomy is a rare and life-saving procedure when managing patients who are in a "can't intubate, can't ventilate" situation.

Aortic dissections and aneurysms. Prehospital care of these rare but life-threatening emergencies.

Aortic dissections and aneurysms are seen with low frequency and have high risk for deterioration during prehospital care. It is essential to include both dissections and aneurysms in your differential diagnoses whenever evaluating patients with chest or abdominal complaints. Often a good history is the best indication of one of these grave vascular emergencies.

Critical transport decisions. In time-sensitive emergencies, every moment counts--choose wisely.

Time-sensitive emergencies require early recognition and rapid transport to a facility properly equipped to manage the patient's needs. When managing STEMI, cardiac arrest, suspected stroke, trauma or a severe sepsis patient, use your resources smartly. Manage the patient using all of your capabilities on scene and know the destination best prepared to manage the patient upon ED arrival.

Preventing back injuries in EMS. What's the best approach to avoiding harm to providers?

Reducing back injuries requires a holistic approach and investment by all interested parties, from front-line staff to leadership and supporting agencies. As a provider, take the time to ensure you are lifting and moving equipment and patients in a manner that protects both the patient and you.

What's the point of point-of-care testing? Understanding the potential of this evolving capability.

Point-of-care testing is a rapidly evolving yet complex field. As your POCT program grows, take the time to understand the regulations, as they are important to ensuring patient safety. The regualtions established CLIA are designed to ensure consistent and reliable laboratory results that can accurately impact patient care.