EMS World

JAN 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | JANUARY 2019 35 steroids is time-dependent. For example, IV dexamethasone will reach peak serum levels roughly one hour after given. 7 Steroids given in the prehospital envi- ronment will reduce patients' length of stay in the emergency department. 8 We will not see the effects before arrival at definitive care. In NASEMSO's Model EMS Clinical Guidelines published earlier this year, evidence showed the use of 5 ml of 0.1 mg /ml of nebulized epinephrine is beneficial in patients with respirator y distress with signs of stridor at rest. 9 Conclusion The takeaway for the prehospital provider is that an upper-airway obstruction of any type is an actual medical emergency. The most important treatment is to remain calm and use caution. Move the patient slowly and prevent any extraneous stimulation. Ad m in is trati o n of co o l h u m i d if i e d ox ygen or medical air ha s historically been used to help relieve some of the discomfort of upper-air way obstruction, and some believe it may even begin to reduce a ssociated s welling, although definitive research is limited and the new NASEMSO model guidelines recommend against it. Keeping our young patients calm and reducing their cr ying can also help prevent the worsening of symptoms. Remember, you're comfortable in your environment. But you're about to take a scared child into the back of your scar y ambulance, strap them to a bed with- out their parent, and go flying down the highway. Slow down, allow a parent to sit next to the patient on the CPR seat, and take a calm, easy drive to the hospital. REFERENCES 1. Var varousi G, Xanthos T, Lappas T, et al. Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/ Large-White swine model. Laboratory Animals, 2011; 45(3): 184–90. 2. Fink E, Prince D, Kaltman J, et al. Unchanged pediatric out-of-hospital cardiac arrest incidence and sur vival rates with regional variation in Nor th America. Resuscitation, 2016; 107: 121–8. 3. Mayo Clinic. Croup, www.mayoclinic.org/diseases- conditions/croup/diagnosis-treatment /drc-20350354. 4. Centers for Disease Control and Prevention. Per tussis (Whooping Cough), www.cdc.gov/per tussis/index.html. 5. Mayo Clinic. Epiglottitis, www.mayoclinic.org/diseases- conditions/epiglottitis/symptoms-causes/syc-20372227. 6. Mayo Clinic. Respirator y sync ytial virus (RSV), www. mayoclinic.org/diseases-conditions/respirator y-sync ytial- virus/symptoms-causes/syc-20353098. 7. Prescribers' Digital Reference. Dexamethasone sodium phosphate—Drug Summar y, www.pdr.net /drug-summar y/ Dexamethasone-Sodium-Phosphate-Injec tion--USP-10-mg- mL-dexamethasone-sodium-phosphate-1725. 8. Bekmezian A, Fee C, Bekmezian S, et al. Emergenc y depar tment crowding and younger age are associated with delayed cor ticosteroid administration to children with acute asthma. Pediatr Emerg Care, 2013 Oc t; 29(10): 1,075–81. 9. National Association of State EMS Of ficials. Model EMS Clinical Guidelines, https://nasemso.org/projec ts/model- ems-clinical-guidelines/. ABOUT THE AUTHOR Roger Smith, NRP, is pediatric EMS coordinator at the Children's Hospital at OU Medicine in Oklahoma City and adjunct faculty for the OSU-OKC paramedicine program. He is a member of the National Association of EMS Educators. NEW Evidence-Based Trauma Education PHTLS is developed in cooperation with the American College of Surgeons' Committee on Trauma, incorporating ATLS 10 th edition guidelines. NEW Focus on XABCDE PHTLS reinforces control of exsanguinating hemorrhage and mirrors the principles of the MARCH assessment. TAKE THE 9 TH EDITION OF PHTLS… The global leader in prehospital trauma care. PHTLS courses improve the quality of trauma care and decrease mortality by treating the unique needs of the multi-system trauma patient. NAEMT.ORG/EDUCATION /NAEMTFriends /NAEMT_ 1-800-346-2368

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