Prehospital Blood Administration in Pediatric Patients: A Case Report.

Prehospital blood administration programs have demonstrated success both on the battlefield and throughout civilian emergency medical services programs. While previous research often discusses the use of prehospital blood administration for adult trauma and medical patients, few studies have reported the benefits of prehospital blood administration for pediatric patients. This case report describes treatment received by a 7-year-old female gunshot victim who was successfully treated by a prehospital blood administration program in the southern United States.

Emergency Department Operations I: Emergency Medical Services and Patient Arrival.

The emergency department (ED) is by its nature inherently an environment with the potential for chaos because of the high volume and varied types of patients cared for in an ED setting. This article discusses potential system opportunities from the prehospital environment through arrival in the ED before provider evaluation. The Emergency Medical Treatment and Active Labor Act is reviewed in detail. Management and the reduction of risk to waiting room patients and patients who leave without being seen is explored. Description of the risks and mitigation strategies are discussed to decrease risk to patients, providers, and hospitals.

Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics.

BACKGROUND: Pediatric drug dosing errors occur at a high rate in the prehospital environment. OBJECTIVE: To describe paramedic training and practice regarding pediatric drug administration, exposure to pediatric drug dose errors and safety culture among paramedics and EMS agencies in a national sample. METHODS: An electronic questionnaire was sent to a random sample of 10,530 nationally certified paramedics. Descriptive statistics were calculated. RESULTS: There were 1,043 (9.9%) responses and 1,014 paramedics met inclusion criteria. Nearly half (43.0%) were familiar with a case where EMS personnel delivered an incorrect pediatric drug dose. Over half (58.5%) believed their initial paramedic program did not include enough pediatric training. Two-thirds (66.0%) administered a pediatric drug dose within the past year. When estimating the weight of a pediatric patient, 54.2% used a length-based tape, while 35.8% asked the parent or guardian, and 2.5% relied on a smart phone application. Only 19.8% said their agency had an anonymous error-reporting system and 50.7% believed they could report an error without fear of disciplinary action. For solutions, 89.0% believed an EMS-specific Broselow-Luten Tape would be helpful, followed by drug dosing cards in milliliters (83.0%) and changing content of standardized pediatric courses to be more relevant (77.7%). CONCLUSION: This national survey demonstrated a significant number of paramedics are aware of a pediatric dosing error, safety systems specific to pediatric patients are lacking, and that paramedics view pediatric drug cards and eliminating drug calculations as helpful. Pediatric drug-dosing safety in the prehospital environment can be improved.

Diabetic emergencies: new strategies for an old disease.

Diabetic emergencies are common presentations to the emergency department. It is estimated that diabetes affects 25.8 million people in the United States, at an annual total cost of over $174 billion. There are 2 general categories of diabetic emergencies: hyperglycemic and hypoglycemic. The hyperglycemic emergencies include diabetic ketoacidosis and hyperosmolar hyperglycemic state. Management of these conditions requires a careful hydration strategy to restore volume and improve perfusion, intravenous insulin therapy, and electrolyte monitoring. Management of hypoglycemia includes identification of the underlying etiology, oral food and/or glucose, intravenous dextrose, and consideration of glucagon. This review evaluates the current strategies for management of diabetic emergencies and offers new information regarding effective diagnostic strategies, selection of fluids for rehydration, correction of potassium, the use of subcutaneous insulin for mild hyperglycemia, and management of metformin-induced lactic acidosis.

Role of academic institutions in community disaster response since september 11, 2001.

OBJECTIVE: To describe the role of academic institutions in the community response to Federal Emergency Management Agency-declared disasters from September 11, 2001, to February 1, 2009. METHODS: We conducted a review of the published literature and Internet reports to identify academic institutions that participated in the community response to disaster events between September 11, 2001, to February 1, 2009, inclusive. From retrieved reports, we abstracted the identity of the academic institutions and the resources and services each provided. We characterized the resources and services in terms of their contribution to established constructs of community disaster resilience and disaster preparedness and response. RESULTS: Between September 11, 2001, and February 1, 2009, there were 98 published or Internet-accessible reports describing 106 instances in which academic institutions participated in the community response to 11 Federal Emergency Management Agency-declared disaster events that occurred between September 11, 2001, and February 1, 2009. Academic institutions included academic health centers and community teaching hospitals; schools of medicine, nursing, and public health; schools with graduate programs such as engineering and psychology; and 4-year programs. The services and resources provided by the academic institutions as part of the community disaster response could be categorized as contributing to community disaster resilience by reducing the consequences or likelihood of an event or to specific dimensions of public health preparedness and response, or both. The most common dimensions addressed by academic institutions (in order of occurrence) were resource management, enabling and sustaining a public health response, information capacity management, and performance evaluation. CONCLUSIONS: Since September 11, 2001, the participation of academic institutions in community disaster response has contributed to community resilience and the achievement of specific dimensions of disaster preparedness and response.

Fifty-year-old female with facial subcutaneous emphysema: a case report.

Subcutaneous emphysema in itself is a benign condition. However, when present secondary to trauma, it may indicate a more serious problem. We report a patient with subcutaneous emphysema secondary to trauma sustained during a generalized seizure. It is believed that the source of the air in the tissue was from a minor laceration below and into the patient's nose without any fracture of the underlying bones or sinus involvement.