Prehospital Surgical Airway Management Skills in a Rural Emergency Medical Service System.

BACKGROUND: The objective of this study is to describe the education, training, and use of prehospital surgical airways in a rural Emergency Medical Service (EMS) system. MATERIALS AND METHODS: We conducted an internet-based survey instrument of all advanced life support (ALS) EMS agencies in a seven-county rural EMS system in Pennsylvania. ALS agencies were queried regarding basic demographic information as well as the number of surgical airways performed in the previous 10 years as well as the education and training of EMS providers in surgical airways. RESULTS: The survey was completed by 11 of 20 ALS EMS agencies in our region (55% rate of return). The content and frequency of training varied considerably among EMS agencies. Only four prehospital surgical airways were performed during the study period. One patient survived to hospital discharge to home. CONCLUSION: Surgical airways are an infrequently performed procedure in the rural prehospital setting. There is no universally accepted standard for teaching or evaluating the competency of this potentially life-saving procedure. Further efforts to establish a core educational curriculum appear warranted.

An unusual presentation of spontaneous spinal epidural hematoma.

We report a rare case of spontaneous spinal epidural hematoma. Various presentations may occur, most commonly including neck pain, interscapular pain, radicular pain, and paralysis. This condition is frequently associated with paralysis and long-term disability. This case is unique because it presented with right hand cyanosis, in addition to pain. A 69-year-old Caucasian female presented with cyanosis of the right hand, and severe right upper extremity pain which awakened her approximately 11 hours earlier. The pain was exacerbated on extending her head. The patient further reported bilateral shoulder pain and interscapular pain. She reported no motor weakness or paralysis. She denied any history of trauma. The patient was taking aspirin 81 mg/d for the past 2 months. Physical examination revealed cyanosis of the digits of the right hand as well as mildly diminished right biceps reflex and right grip strength. No edema or rashes were noted. Skin was warm and dry. Pulses were +2 in all extremities. Vital signs were within normal limits. The remainder of the physical examination was unremarkable. Magnetic resonance imaging of the cervical/thoracic spine revealed a right posterior-lateral epidural hematoma extending from the 3rd cervical level to the 1st thoracic level of the spinal cord. There was also evidence of cord compression at the 4th-5th and 5th-6th cervical levels. Given the potential for significant complications, clinicians should maintain a high index of suspicion for spinal epidural hematoma, particularly in those patients taking anticoagulation. Symptoms, including extremity cyanosis, pain, and paralysis all are suggestive of the diagnosis.