UCONN Emergency Medicine Interest Group

Posts Tagged ‘EMS’

Journal Article Synopsis: Vascular Access during Out-of-Hospital Cardiac Arrest

In JOURNAL CLUB on October 16, 2011 at 8:00 AM

Summary ofJournal Article Synopsis: Intraosseous Versus Intravenous Vascular Access During Out-of-Hospital Cardiac Arrest: A Randomized Controlled Trial,” Reades, Rosalyn, MD; Studnek, Jonathan R., PhD, NREMT-P; Vandeventer, Steven, EMT-P; Garret, John, MD.  Annals of Emergency Medicine. 2011 Aug 17. [Epub ahead of print]

What is already known on this topic:
Intraosseous vascular access was originally used mainly in children.  However, it has recently been shown that this method is also a rapid and effective way to obtain vascular access in the adult population, especially when a peripheral intravenous line fails.  Therefore, this technique is used commonly in out-of-hospital settings when rapid vascular access is needed during cardiac arrest.  Emergency Medical Services (EMS) protocols in the US list sternal, humeral, and tibial locations as available sites for intraosseous vascular access.

What question this study addressed:
The humeral and tibial locations are better sites during cardiac arrest due to constant chest compressions.  However, data regarding the effectiveness of the humeral site versus the tibial site are limited.  This study assessed the frequency of first-attempt success between humeral intraosseous, tibial intraosseous, and peripheral intravenous routes during out-of hospital cardiac arrest.

What was the study design:
This study was a prospective, nonblinded, triple-arm, randomized control trial of 182 adult patients over 18 years of age experiencing a non-traumatic out-of-hospital cardiac arrest in which resuscitation was initiated.  Patients were randomized to one of 3 vascular access routes: tibial intraosseous, humeral intraosseous, or peripheral intravenous.  Paramedics received extensive training in each method.  The outcome measure was first-attempt success, defined as secure needle position in the marrow cavity or a peripheral vein with normal fluid flow.  If a needle dislodged, it was considered a failure.

What this study adds to our knowledge:
Tibial intraosseous vascular access was determined to be the optimal method with regards to highest success rate and fastest time to access.  However, peripheral intravenous access was associated with a higher volume of infused fluid.

How this is relevant to clinical practice:
Tibial intraosseous vascular access is beneficial for patients in who are in cardiac arrest or unconscious and who are unlikely to need large-volume fluid resuscitation.  Its location is more removed from the primary site of resuscitation efforts, and is generally not beneath large amounts of soft tissue.

Other considerations:
The cost of intraosseous vascular access is much greater than the cost of peripheral intravenous vascular access.  Further studies should be conducted to determine the cost effectiveness of tibial intraosseous over peripheral intravenous access.

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Journal Article Synopsis: Air mattress vs. backboard in patient comfort and tissue pressure

In JOURNAL CLUB on July 7, 2011 at 3:26 PM

Summary for “Revolutionary advances in enhancing patient comfort on patients transported on a backboard” by Richard F. Edlich, Shelley S. Mason, Rober J, Vissers, et al. American Journal of Emergency Medicine Vol 29 (2); pp. 181-186.  2011.

What is already known on this topic:
Spinal cord injuries can cause short term discomfort and lead to long term disability. Stabilization of patients with spinal cord injuries is an import aspect of prehospital care. Care of trauma patients involves the use of backboards to immobilize the patient’s head, neck, and back. Studies have shown that the use of backboards causes discomfort and frequently leads to the formation of pressure ulcers.

What question this study addressed:
The Back Raft system is designed to reduce skin interphase pressure as well as patient discomfort. The purpose of this study is to record the rating of patient pain and to measure the tissue interface pressures at the occipital, scapula, and sacral regions.

What was the study design:
The Back Raft is an inflatable air mattress that can be applied to standard 16 and 18 inch spinal backboards. Ten healthy volunteers who had taken no pain medication and were not experiencing back pain were studied lying on backboards with and without the raft for 30 minutes. Pain was measured at the start and in 15 minute intervals using the 10-point Visual Analog Scale. Additionally, patients were asked to access their comfort level. Contact pressures between the patients and surface of the raft or backboard were measured at the occipital, scapula, and sacrum regions using a Tactilus pressure evaluator. Tactilus software converts the pressure recording in measurements of millimeters of mercury.

What this study adds to our knowledge:
Subjects of different genders and BMIs reported there was a less drastic difference in pain level during the 30 minutes when using the Back Raft. Tissue interface pressure levels were higher in all subjects when using only the backboard.

How this is relevant to clinical practice:
In addition to providing an increase in patient comfort, use of the Back Raft could benefit the cost of care because the use of the raft lowers the risk of developing pressure ulcers. Implementing the raft in prehospital care of trauma patients can help avoid the development of hospital acquired conditions. Additionally, the Back Raft is radiolucent, a characteristic that would be beneficial in time critical situations.

Other considerations:
This study was only conducted on healthy patient subjects. One would hope patients with injuries would report the same benefits from using the Back Raft.

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