Errors in prehospital paediatric resuscitation

paeds

When compared to adult resuscitation, paediatric resuscitation has anatomical, pharmacological, procedural, social, and emotional differences that may make it more difficult and therefore more prone to error.

The authors of this study (full text pdf – NOT hosted on this site) used a simulated paediatric emergency (infant with altered mental status, seizures, and respiratory arrest) to look at errors in paediatric resuscitation by two person EMS teams.

What emerged were issues regarding equipment familiarity/use/misuse, failure to check BSL, and drug errors. Calculations of drug doses were difficult under stress. Failure rates in some of these domains exceeded 50%.

This study, coupled with our low incidence of significant paediatric resuscitation, suggests that we must have ongoing training in paediatric emergencies (simulation and otherwise) to mitigate these risks, and consider new ways of avoiding error. Given the high rate of smartphone use by HEMS personnel, this app is possibly a good start!

 

Oxygen physiology and pulse oximetry lag podcast

corpuls

This podcast, from the Scott Weingart’s superb emcrit.org site, discusses the lag between oxygen delivery commencing following RSI and the rise in saturations on the patient monitor. It is directly relevant to the prehospital setting, given that a colder environment and a shocked/underresuscitated patient results in a longer pulse oximetry lag. The discussion also makes note of several cases where a (probably) successfully placed ETT was removed in the prehospital setting due to pulse oximetry lag.

The emcrit show notes are here

The podcast is here

 

Motion sickness

airsick

Motion sickness among aeromedical staff is an important factor that may limit our ability to deliver effective in-flight patient care. Having experienced this once in the helicopter (an aerial search of the bays of the Manukau Harbour in gusty winds is not an excursion I would recommend to anyone wanting a sightseeing flight!), I can say that it is truly debilitating.

The Emergency Medical Retrieval Service of Scotland have a published SOP relating to air-sickness, including practical non-pharmacological methods of improving symptoms.

A detailed discussion of motion sickness from Medscape can be found here

Algorithm for traumatic cardiac arrest

tension

While traditional teaching is that resuscitation on scene in traumatic cardiac arrest is futile, recent studies have demonstrated higher survival rates than previously thought.

The authors (UK emergency medicine and aeromedical specialists) of this paper have reviewed the literature regarding traumatic cardiac arrest and generated an algorithm that is applicable to both pre-hospital and hospital settings.

“The algorithm aims to rapidly identify and correct reversible causes of TCA. Transport of TCA patients from the pre-hospital to hospital setting with on-going cardiopulmonary resuscitation is usually futile and key interventions need to be performed as soon as possible, usually on-scene. Patients arriving at a hospital in traumatic peri- or cardiac arrest need reversible causes immediately excluded and managed prior to transfer for diagnostic imaging or surgical intervention. The treatment priorities in this algorithm have been applied by a physician-led pre-hospital trauma service to over a thousand TCA’s attended over an eighteen year period. Published results demonstrate that adherence to these principles can result in good survival rates from TCA.”

The algorithm focuses on treatment of reversible pathology that may have led to an arrest:

  • Correction of hypovolaemia
  • Oxygenation
  • Decompression of tension pneumothorax
  • Thoracotomy in the setting of penetrating chest/epigastric trauma
  • Consideration of non-traumatic causes of cardiac arrest

Full text pdf of this paper is available here (secure area limited to ADHB staff only – ADHB has online subscription access to this journal via the Philson Library at the University of Auckland School of Medicine)