Paramedic-Performed Carotid Artery Ultrasound Heralds Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Case Report.

Point-of-Care Ultrasound (POCUS) has been demonstrated to have multiple applications in the care of critically ill and injured patients, especially given its portability and ease of use. These characteristics of POCUS make it ideal for use in the prehospital environment as well. We present a case that highlights a novel application of ultrasound in the prehospital management of out-of-hospital cardiac arrest (OHCA).

Harness Suspension Stress: Physiological and Safety Assessment.

: Hanging motionless in a full body harness may result in unwanted events, such as acute hypotension and syncope, which has been termed harness suspension stress (HSS). The etiology of HSS has not been explored, and it is unknown if the type of harness influences the HSS response. OBJECTIVES: Evaluate hemodynamics, subjective discomfort, and biological markers of muscle damage during 30-minutes suspension; and evaluate differences between harness attachment (frontal or dorsal). METHODS: Heart rate, blood pressure, biological markers of muscle damage, and subjective discomfort were measured. RESULTS: Trial time was shorter in the dorsal versus frontal point of attachment. Hemodynamic shift resulted in the dorsal trial which indicated possible perfusion abnormalities. CONCLUSIONS: Hemodynamic adjustments contributed to early termination observed in the dorsal trial. A frontal point of attachment may be more suitable for extended harness exposure.

Radiographic evaluation of carotid artery compression in patients with extraglottic airway devices in place.

OBJECTIVES: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-of-hospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs. METHODS: The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck. These studies were reviewed by a neuroradiologist to determine if mechanical compression of the carotid arteries was present. RESULTS: None of the 17 cases reviewed had radiographically evident mechanical compression of the carotid artery. CONCLUSIONS: Until further studies are performed in which cerebral perfusion is evaluated prospectively in both hemodynamically stable and unstable human subjects, there is insufficicent evidence to recommend against the use of extraglottic airways in the emergency setting on the basis of carotid artery compression.

Injury patterns at Isle Royale National Park: an epidemiologic review of injuries and illnesses sustained in a remote environment.

OBJECTIVE: Isle Royale National Park is a remote island in northern Lake Superior that attracts 16,000 visitors annually. The epidemiology of injuries and illnesses sustained by Isle Royale׳s visitors has not been previously studied. The purpose of this study is to examine these data and evaluate them for injury patterns. METHODS: This is a retrospective observational study examining the epidemiology of injuries and illnesses sustained during the period from 2008 to 2012. Incident reports completed by park rangers were reviewed and the data sorted according to time of year, time of day, type of medical encounter, and whether the patient was stable, unstable, or required transport. RESULTS: Two hundred and seventy patient care reports were obtained from the National Park Service. Sixty-four percent of encounters occurred in July and August, and most patients sought care in the afternoon. Care was provided by park rangers, the majority of whom were trained to the level of emergency medical technician. Fifty-eight percent of cases were trauma related, and 20% of all cases were evacuated. CONCLUSIONS: The majority of incidents were trauma related. The majority of the rangers on the island are trained to the level of emergency medical technician-B and appear to offer appropriate care to the island's many visitors, utilizing the National Park Service treatment protocols and comprehensive medical kits. In addition, access to advanced medical care is readily available by air and water evacuation.