I was reading an article on research By Dave Page of Inver Hills Community College Paramedic Program. In this article Dave Page reviews a Epinephrine study ( Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012;307(11):1161-1168)
This study consisted of a review of 417,188 cardiac arrests in a Japanese cardiac arrest database. The study found that 18.5 % (2,786 of 15,030) of patients with epinephrine administration survived while 4,7 % did not get epinephrine survived, and 2.2% had good neurological outcome.
Dave Page stated “We must be careful drawing inferences from this study because effective outcome -driven cardiac arrest management is multi-factorial.” What Dave Page means is when studying the process of cardiac arrest management we begin by looking at each link in the survival chain. The outcome of hospital discharge is our ultimate goal, but the process and all its components contribute to the outcome.
Dave Page is a intelligent EMS professional who uses good judgement and understands the nature of research and improving resuscitation, step by step. Our ulitmate goal of research is increased survival and better patient care.
1) Be careful not to make broad assumptions based on one or two studies you read
2) Registry data may have limitations and is used out of context.
3) Always read more into the study and understand the possible areas of variation (i.e.what kind of CPR being done, skill level of provider, length of time perfoming skills).
4) look at the number or patients studied and how this study applies to your system (i.e. a study in a rural EMS system may not pertain to an urban system)
Remember what I always say, Research is the process of shining a light into a dark room to study a problem. The problem grows when looking into a dark room with a flashlight , we don’t know if the leg we see is of a table, a chair or a patient.
Additional points to review: 1) Registry sources for research, process management.
Steven Kanarian, MPH, EMT-P
I would like to welcome David Aber to Paramedicmastery.com as a contributor. Dave has been involved in the EMS service for over 20 years and is a passionate educator and conference speaker. While still working full time as a paramedic for an all 911 service he also serves as the Training and Education Coordinator. Dave believes that EMS does an amazing job but can do much better for our systems, co-workers, and most of all our patients.
Paramedics save lives and make the difference every day. Now that you have decided to take the next step in your EMS career what concerns do you have about paramedic education? Are you concerned about finding the time for class? Maybe you have been out of school for a while and want to know how to get conditioned for the challenge of medic school. Subscribe to my blog and learn how to prepare for medic class from the Medic Mentor. Leave a comment to let me know what concerns you about medic class.
So, now it is time to go back to ACLS class. LIke many of us you are nervous about being evaluated. You realize you do not use all of the information your practice each day. Don’t worry, not many people do use all the info in ACLS every day. That is why there are refreshers every two years.
Let me help you prepare for ACLS CLass:
- Review the current 2010 CPR standards before you start class.
- Review the alogarythyms (Hint Atropine has been taken out of PEA!)
- Look up the key meds like vasopressin, epinephrine and Amiodarone
- Review ECGs (Vfib, VTach, 3rd Degree blocks)
Lastly, relax, prepare and enjoy the class. Click here for more information on how to prepare for ACLS
Want to learn more about Epinephrine research? Click here
What would you like to know about to prepare for ACLS Class? Post your comment below
I am pleased to share with you a recording I made during an interview with a great Flight Paramedic who shared his insight to getting a job in this highly competitive paramedic specialty.
Clinical Manifestation and Assessment of Respiratory Disease, by Terry Des Jardins and George C. Burton is an awesome respiratory book for the EMT or paramedic who wants to gain in-depth medical knowledge in respiratory disease.
This book is one of my all-time favorite medical books because it has an extraordinary view of the cardiac and respiratory system and their diseases that affect patients. The combination of respiratory and cardiac diseases together is practical and intuitive. This book discusses in detail the examination of the patients, the use of accessory muscles, the anatomy and pathophysiology of respiratory diseases as well as cardiac issues.
This text also covers ECGs, heart sounds and cardiac emergencies -
“I have found students gain deeper knowledge when they learn from different sources .”
I especially like the illustrated graphics that show in detail the alveoli, bronchioles and changes during disease.
About The Book:
Respiratory Diseases is broken into several sections including Assessment of Respiratory Diseases, Clinical Data, Obstructive Pulmonary Diseases, Newborn and Early Childhood Respiratory Diseases.
Included in this book are sections are cardiac assessment, heart sounds and the ECG. When learning a topic like assessment the student benefits by reading from different sources and shared views of a topic.
- Pathophysiology of respiratory diseases
- Patient interview and assessment
- General management of respiratory diseases
- Case Studies and Self-Assessments
This book is available on-line and is published by Mosby. Mosbybooks.com
- Respiratory Health in New York City Neighborhoods Most Affected by #Sandy (securityblog.jcrcny.org)
- Vehicle Pollution Linked to Respiratory Illness in Children (motortrend.com)
Gaumard Scientific has released a new airway training simulator which is useful for intubation, King LT, Needle Cric. pneumothorax and tension pneumo decompression. This simulator requires no batteries, no plug. Utilizes air pressure to function. Great for airway and continuing education training.
The simulator allows you to select tongue edema, laryngospasm, pharyngeal swelling, or pneumothorax. All powered pneumatically, allowing the simulator to operate in remote places without electricity. Air reservoir is charged using a BVM.
The cost is very reasonable compared to similar difficult airway simulators.