Advances in prehospital immediate care.
Although studies documenting the influence of prehospital care on patient outcome are most urgently needed, recent techniques and innovations being examined in the field setting may improve the clinical care delivered. The basic manoeuvres for airway and breathing have been in need of emphasis for some time. Sellick's manoeuvre has been resuscitated and is being emphasized in most training programmes. Bag-mask ventilation, notoriously difficult in field settings in the hands of emergency medical personnel, has been improved with the recent improvement of mask design. Endotracheal intubation has been shown to influence patient outcome, and can be performed with surprising success by paramedics. Complication rates continue to cause concern, and a study to document the incidence of tube misplacement has just begun in the United States and Canada. Transillumination and translaryngeal jet ventilation have been refined as adjunct techniques to field intubation. Patient monitoring has improved through the more common use of pulse oximetry and a recently-introduced "CO2 Detector" that is designed to indicate via a colour change, oesophageal placement of an endotracheal tube. Automatic external defibrillators have come under some scrutiny, and early data suggest their safe use by lay persons, a minimal effect on outcome in high-risk patients, and a significant effect on outcome only when combined with other essential elements of prehospital care. The role of IV fluids in prehospital trauma care has been clarified, as well as that of the pneumatic antishock garment. Transcutaneous pacemakers have been developed and shown effective if used early, and thrombolytic therapy has been examined for the prehospital management of acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Stewart
R D
RD
University of Toronto, Ontario, Canada.
D004632:Emergency Medical Services; D006801:Humans