EMS World

JUN 2015

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ADVERTISER INDEX EMSWORLD.com | JUNE 2015 55 detailed images are possible. Youngquist believes TEE has the poten- tial to improve rhythm analysis by identi- fying masked ventricular fibrillation and distinguishing PEA from pseudo-PEA. He said it can also replace the pulse check with a faster, more accurate visualization of whether the heart is still or has experienced return of spontaneous circulation. "TEE can prevent withholding appropri- ate care during long searches for pulses," Youngquist said. "The movement of the heart is readily observable, leading to faster and more accurate treatment decisions." Youngquist said using TEE can also improve hand placement for more effective compressions. He referenced an ED-based study on cardiac output using hand com- pressions conducted on patients with PEA but no heart motion. Forty-four percent of the time, hand placement was actually occluding aortic outflow. "Given the anatomic variations in patients, a one-size-fits-all hand placement may not be optimal," he said. "It appears that a lower sternum placement provides better cardiac outflow than the inter-nipple hand placement." It remains uncertain at this time whether TEE can help classify the cardiac rhythm, but Youngquist said there have been reports of arresting patients showing asystole on the monitor, yet VF activity with a TEE probe. He cited the case of one who was shocked, leading to ROSC. "We don't know how accurate modern monitors are for determin- ing VF versus asystole," he said. PEA shows organized rhythm on the monitor but can be a wide range of nonsur- vivable conditions. In pseudo-PEA the heart is pumping, but ineffectively. The progno- sis is different depending on if the heart is standing still versus showing activity. "TEE may help prevent stopping resusci- tation prematurely," Youngquist said. "Of course, the condition of the heart is not the only consideration. For example, what is the condition of the patient's brain?" Using TEE to identify the cause of arrest has ramifications on patient management. Youngquist cited a study where TEE cor- rectly identified the arrest cause in 65% of patients. For 31%, this changed how they were managed. Youngquist said TEE can reveal signs of pulmonary embolism, car- diac tamponade, aortic rupture, aortic dis- section, papillary muscle rupture and hypo- volemia. Wall motion during compressions can identify tissue damaged by myocardial infarction. Youngquist said field use of TEE is not right around the corner. Key research yet to be done includes gathering more observa- tional data on the epidemiology of PEA. ABOUT THE AUTHOR Ed Mund began his fire and EMS career in 1989. He currently serves with Riverside Fire Authority, a fire-based ALS agency in Centralia, WA. His writing and photos have appeared in several industry publications. Contact him at mund.ed@ comcast.net. Request Free Information at www.emsworld.com/e-inquiry COMPANY PAGE INQ # Ambu, Inc. 60 38 American Military University 21 20 Biomedix Inc 44 36 Bound Tree Medical, LLC 5 12 Columbia Southern University 24 23 Denver Health Medical Center 19 19 Emergency Medical Products 34 25 EMS World EXPO 10-11 Everglades University 37 27 Firehouse/EMS Store 50 GKR Industries 42 34 Graham Professional Medical 42 33 Health & Safety Institute 22 21 Junkin Safety Appliance Co. 40 30 Knox Company 37 28 Lenoir Community College 3 11 Limmer Creative 40 31 COMPANY PAGE INQ # Mac's Lift Gate, Inc. 43 35 Mangar International 12 13 McNeil & Company (ESIP) 18 18 MedaPoint 13 14 Minto Research and Development 14 15 Moore Medical Corp 27 24 NAEMT 16 16 Nasco 23 22 National Awards of Excellence 9 Plano Molding 2 10 Prestan Products 17 17 Rosco Inc 41 32 Simulaids Inc 35 26 Stryker EMS 59 37 University of Wisconsin Oshkosh 38 29 World Trauma Symposium 7

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