Author Archives: SWORBHP

TOTW: Determining the Frequency of Contractions

TOTW: Determining the Frequency of Contractions
Posted on: September 24th, 2021

TOTW: Determining the Frequency of Contractions

From the Emergency Child Birth online module:

Contraction frequency is measured from the START of the first contraction to the START of the following contraction.

Important to know because timing of contractions signals the active/2nd stage of labor, meaning pushing will occur next.

  • Primips (1st delivery) q2-3 minutes
  • Multips (2nd or more delivery) q 5 minutes
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In the Toradol protocol it simply uses term "current/active bleed" as a contraindication, the companion document provides little clarification as to how this applies to trauma pts as trauma was removed as a contraindication. Would trauma with high index of suspicion for internal bleeding (MVC, Motorcycle accident, fall from height) be a contraindication? Would multisystem trauma pts? Or would the better course of action be to treat their pain? Thanks!

Is there anywhere to go and practice scenarios with an educator for those of us who learn better hands on and want to freshen up on some skills and directive (including the companion doc, and bypass rules)?

What is the correct course of action if a pt goes VSA while crew is on scene, (ex. 1st analyses reveals VF, pt shocked, then 2 more analyses 2 min apart- both PEA), then pt starts spontaneously breathing and has pulse (ROSC)...then rearrests 2 min later and is in VF so crew shocks...CPR continued as pt still pulseless. Keep in mind crew is still on scene waiting for fire to show up as crew needs help with extrication.. this situation has happened and 1 crew member had called BHP for direction as it's 'grey" area as normally you are transporting by then and would do 1 analysis following rearrest and shock if necessary and continue with transport/CPR.. BHP was not clear just kept saying "follow your protocol" when in fact the crew was but at that point was very "grey". Would we treat it as a whole new medical cardiac arrest protocol as its a re-arrest on scene until fire arrives? Or what would be the best course of action?

You have a patient that is VSA from penetrating trauma. The bls states you transport to trauma hospital if less than 30 min. The als pcs states that if your patient VSA from trauma and a TOR does not apply (pt in PEA) you transport to closet ED. So which one is correct the BLS to trauma hospital or ALSPCS to closest ED.

Why do the pandemic guidelines allow for the administration of 2 doses of epinephrine (<50y) in bronchoconstriction (asthma exacerbation) vs the ALS PCS allowing only a single dose (without age guideline)?

TOTW:2020 AHA Guidelines Recommends Early administration of Epinephrine (ACP-Scope)

TOTW:2020 AHA Guidelines Recommends Early administration of Epinephrine (ACP-Scope)
Posted on: Sepetmeber 10th, 2021

TOTW:2020 AHA Guidelines Recommends Early administration of Epinephrine (ACP-Scope)

New to the 2020 AHA guidelines is a recommendation for epinephrine administration as early as possible in non-shockable cardiac arrest for both adult and pediatric postulations.

A systematic review and met analysis showed increased ROSC and survival to hospital discharge in those given epinephrine. Observational data suggest there are better outcomes when epinephrine is given sooner.

For more great evidence based recommendations, check out your 2021 MCME Precourse module on the AHA Guidelines Update!

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Can we just wear a surgical mask and goggles for all AGMPS and optional gown if we want to? Shouldn't there be an update for our PPE as well and not just our screening tool, now that we know a little bit more about COVID? Thank you!

TOTW: 2020 AHA Guidelines Recommends IV Over IO (ACP-Scope)

TOTW: 2020 AHA Guidelines Recommends IV Over IO (ACP-Scope)
Posted on: February 17th, 2021

2020 AHA Guidelines Recommends IV Over IO (ACP-Scope)

New to the 2020 AHA guidelines is the preference for IV medication administration during ACLS, over IO administration.

A recent systematic review found better clinical outcome in patients that received ACLS drug administration via IV vs IO.

 

Consistent with the current ALS-PCS treatment, they state IO access is acceptable if IV access is unavailable.

For more great evidence based recommendations, check out your 2021 MCME Precourse module on the AHA Guidelines Update!

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2020 AHA Guidelines Recommends Resuscitation Debriefing

TOTW: 2020 AHA Guidelines Recommends Resuscitation Debriefing
Posted on: February 17th, 2021

2020 AHA Guidelines Recommends Resuscitation Debriefing

New to the 2020 AHA guidelines is that recommendation for performance-focused debriefing after resuscitation.

Post event debriefing = a discussion between 2 or more individuals in which aspects of performance are analyzed, with the goal of improving care.

There is evidence that shows these debrief sessions (formal and informal) resulted in improved quality of resuscitation (i.e. Increased chest compression fraction, reduced pause) in future resuscitations.

See more great evidence based recommendations in your  2021 MCME Precourse AHA update module!

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