A Comparison of Non-Invasive Blood Pressure Measurement Strategies with Intra-Arterial Measurement.

Introduction: It is difficult to obtain an accurate blood pressure (BP) measurement, especially in the prehospital environment. It is not known fully how various BP measurement techniques differ from one another.

Study Objective: The study hypothesized that there are differences in the accuracy of various non-invasive blood pressure (NIBP) measurement strategies as compared to the gold standard of intra-arterial (IA) measurement.

Measuring Agreement Among Prehospital Providers and Physicians in Patient Capacity Determination.

Objectives: If a patient wishes to refuse treatment in the prehospital setting, prehospital providers and consulting emergency physicians must establish that the patient possesses the capacity to do so. The objective of this study is to assess agreement among prehospital providers and emergency physicians in performing patient capacity assessments.

Methods: This study involved 139 prehospital providers and 28 emergency medicine physicians.

Retrospective Analysis of Mosh-Pit-Related Injuries.

Objectives: Moshing is a violent form of dancing found world-wide at rock concerts, festivals, and electronic dance music events. It involves crowd surfing, shoving, and moving in a circular rotation. Moshing is a source of increased morbidity and mortality.

Altitude-Related Change in Endotracheal Tube Cuff Pressures in Helicopter EMS.

Introduction: Over-inflation of endotracheal tube (ETT) cuffs has the potential to lead to scarring and stenosis of the trachea.1, 2,3, 4 The air inside an ETT cuff is subject to expansion as atmospheric pressure decreases, as happens with an increase in altitude. Emergency medical services helicopters are not pressurized, thereby providing a good environment for studying the effects of altitude changes ETT cuff pressures.

Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport.

Introduction: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring.

Familial Anaphylaxis after Silkworm Ingestion.

Herein, we present a case of anaphylaxis in multiple family members after ingesting silkworms, an Asian delicacy. While food allergies, including anaphylaxis are unfortunately common, there are no previous reports of multiple family members suffering an anaphylactic reaction after eating silkworms. In addition, both family members required multiple doses of epinephrine and eventually an epinephrine infusion to improve their blood pressures.

Pitfalls of intranasal naloxone.

We present a case of failed prehospital treatment of fentanyl induced apnea with intranasal (IN) naloxone. While IN administration of naloxone is becoming more common in both lay and pre-hospital settings, older EMS protocols utilized intravenous (IV) administration. Longer-acting, higher potency opioids, such as fentanyl, may not be as easily reversed as heroin, and studies evaluating IN administration in this population are lacking.

Transporting without infusions: effect on door-to-needle time for acute coronary syndrome patients.

Background: Standard of care for patients with acute coronary syndrome/ST-segment elevation myocardial infarction (ACS/STEMI) is rapid revascularization of ischemic myocardium. Current optimal treatment is primary percutaneous coronary intervention (PCI) within 90 minutes after the patient accesses the health care system, and strategies to lower this time may improve outcomes.

Objective: To compare interhospital transport times (TTs) before and after instituting a no-medication-infusion policy during transport of ACS patients.

Evaluation of an emergency medical services-based social services referral program for elderly patients.

Objective: To describe the preliminary experience of an emergency medical services (EMS)-based follow-up program providing elderly patients access to community-based social services.

Methods: This was a retrospective, case series report. Inclusion criteria were adults aged 60 years and older requesting EMS for fall or lift assist; against medical advice (AMA) refusal of transport for a medical complaint; any social service or home care needs; request for nonmedical transportation; multiple prior EMS visits; or cases of elder abuse or neglect.