Category Archives: Tip of the Week

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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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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TOTW: Symptomatic Bradycardia

TOTW: Symptomatic Bradycardia
Posted on: May 12th, 2021

TOTW: Symptomatic-Bradycardia

Please remember when treating a patient with Symptomatic Bradycardia:

The patient is required to be:
1.BRADYCARDIC (HR < 50)
2. HEMODYNAMICALLY Unstable (refers specifically to SBP <90)
3. ≥18 years

Please remember the 12 LEAD (as early as possible)!

Treatment Pearls:
Dopamine = Starts at 5 mcg/kg/min titrate SBP to ≥ 90 to < 110
Pacing = start at 80 beats/min and then increase mA until capture (mechanical/electrical) then go 10 mA above to lock it in.

*See the OBHG Companion Document (v4.9) for further pearls and considerations regarding this Medical Directive

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TOTW: ALARM Mnemonic for Shoulder Dystocia

TOTW: ALARM Mnemonic for Shoulder Dystocia
Posted on: March 19th, 2021

TOTW: What Information Should You Relay at the Start of a BHP Patch

Early recognition and management of Shoulder Dystocia is key in mitigation of critical irreversible hypoxic injury in newborns.
Remember to watch for tell-tale “turtle sign”, when the head emerges and then retracts against the perineum, due to the shoulder stuck on the maternal symphysis pubis (anterior shoulder) or sacral promontory (posterior shoulder).

Then use the ALARM pneumonic to manage these critical deliveries:

A: Ask for help (You will require 2 people)

L: Lift legs, hyperflex thighs (McRoberts Maneuver)

A: Adduct shoulder (Apply suprapubic pressure

R: Roll over (Gaskins Maneuver)

M: Manually delivery of posterior arm (if visible at the perineum)

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TOTW: What Information Should You Relay at the Start of a BHP Patch

TOTW: What Information Should You Relay at the Start of a BHP Patch
Posted on: March 10th, 2021

TOTW: What Information Should You Relay at the Start of a BHP Patch

Ensuring the following information is relayed at the beginning of a BHP patch:

Full name, Service, Run Number if available, designation and reason for patch (“I am calling for a TOR”, I am calling for an order for midazolam), then proceed into providing details of call.  There is no need to provide an oasis number to the BHP

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TOTW: Neonatal Temperate Control

TOTW: Neonatal Temperate Control
Posted on: March 5th, 2021

Neonatal Temperate Control

Neonates are not as adaptable to temperature changes in comparison to adults. Preterm neonates are even more so at risk:

  • A neonate’s surface is about three times greater (and about 4 times greater in preterm deliveries) than an adult’s, compared to the weight of his/her body. Therefore, more heat is lost.
  • Neonates do not use the same mechanisms of heat generation and temperature regulation as adults. They utilize non-shivering thermogenesis (NST) , burning oxygen and adipodse tissue to generate heat. Premature and low-birth-weight babies usually have little body fat and may be too immature to regulate their own temperature, even in a warm environment.
    *This is incredibly important as neonates (with preterm and low-birth-weight, especially) are at risk of hypoglycemia from trying to stay warm using this NST.
    When considering long transport times, ensure you are utilizing every tool at your disposal to reduce heat loss, and consider rechecking a blood glucose after long transport times following delivery.
  •  
    What can we do to help? Mitigate heat loss and rewarm our patient with the tools at our disposal:

• Dry off your patient immediately following birth and during rapid assessment
• Increase the ambient air temperature within the room or ambulance
• Cover the neonate’s skin (swaddle with blankets, dress with hat/tuke, apply clothing)
• Apply passive rewarming with heating pads outside of the clothing or blankets
• Reassess the patient’s temperature when taking vital signs
• Plan your extrication and reduce skin exposure to the elements

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TOTW: Neonatal Thermogenesis

TOTW: Neonatal Thermogenesis
Posted on: February 17th, 2021

Neonatal Thermogenesis

At birth, the neonate rapidly cools. Without external support, newborns can readily lose heat and body temperature through all four mechanisms of heat loss, including:

• Evaporation (still wet with amniotic fluid, the conversion of gas to liquid cools the body)
• Conduction (Direct physical contact is now lost)
• Radiation (Electromagnetic waves from a relatively cooler extra-uterine environment)
• Convection (Heat loss to air and water vapor molecules circulating around the body)

But remember, that neonates don’t shiver like we do. They regulate their temperature through non-shivering thermogenesis (NST): Burning oxygen and adipose tissue to increase heat production. This can cause significant hypoglycemia and other critical metabolic issues if left untreated.

This highlights the importance of the old adage “WARM (minimize radiation loss), DRY (minimize evaporation heat loss), and STIMULATE(allow for conductive heat gain)” following birth!

https://pubmed.ncbi.nlm.nih.gov/15673956/

https://neoreviews.aappublications.org/content/14/4/e161

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TOTW: How to assess the timing and intensity of contractions

How to assess the timing and intensity of contractions
Posted on: February 10th, 2021

How to assess the timing and intensity of contractions Break it down into 3 categories:

1) Frequency: refers to the length of time from the beginning of one contraction to the beginning of the next

2) Length: measure the length of contraction from beginning to end

3) Strength: this can be assessed by placing your fingertips at the top of uterus and feeling how tight the muscle is at peak contraction

Prepare for imminent delivery with strong contractions, 60-90 seconds in length, and frequency 2-3 minutes apart (Primips) or 5 minutes or less (Multips).

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Using A Personal Phone For BHP Patches

Using A Personal Phone For BHP Patches
Posted on: February 3rd, 2021
Remember to Reassess Vitals after Procedures and Medication Administration (i.e. Valsalva, Adenosine [ACP])

If using your personal phone for BHP patches, please ensure that you have the correct numbers programmed in. We continue to see the Secondary BHP being utilized as the Primary BHP due to this. The correct numbers can be found in memo’s circulated on November 27th,2020 and December 17th, 2020 or you can inquire with your Service Leads for the correct numbers.

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