RESUMEN
Ketamine is a unique medication with a long history of use in the emergency department. Out-of-hospital indications for ketamine have been explored and are currently expanding in some systems. This article provides background on ketamine history and pharmacology, its use in the hospital environment and possible applications for emergency medical services usage of this medication. Contraindications and adverse reactions are discussed to provide education on the nuances of ketamine administration and mitigation strategies. Out-of-hospital indications for ketamine are discussed including airway management, rapid sequence induction, analgesia, sedation, and treatment of excited delirium.
RESUMEN
BACKGROUND: The White House "Stop the Bleed" campaign has renewed interest in public-access bleeding kits and the use of tourniquets by the lay public. The objective of this study was to determine which type of tourniquet could be applied most effectively by the lay public using only manufacturer instructions included with each tourniquet. METHODS: This prospective study randomized participants to one of four different tourniquets (SOFTT-W, CAT, RMT, SWAT-T). Participants were all over 18 years of age. Individuals with prior military, EMS, or patient-care medical experience were excluded. Using only the manufacturer's packaging instructions, participants were asked to apply a tourniquet on a simulated bleeding arm. A trained observer noted if tourniquet application by the participant was effective, partially effective, or ineffective based on reduction or cessation of simulated blood flow. Participant's application of the tourniquet was also timed (in seconds) by the observer. The primary outcome of our study was the effectiveness of application for each of the four tourniquets. Secondary outcome was time to effective application. RESULTS: A total of 176 participants were enrolled. For untrained laypersons the RMT had the highest effective application rate of 64.4% and was also the most rapidly applied at 100.9 ± 8.8 seconds (95% confidence interval [CI] = 83.1 to 118.6). The SWAT-T had the highest ineffective application rate (55.5%) than any other tourniquet type (p = 0.002). There was no effect of age or education on time to application for any tourniquet type. Effective applications were performed significantly faster than partially effective or ineffective applications (93.4 ± 5.8 [95% CI = 81.7 to 104.9] vs. 136.7 ± 8.7 [95% CI = 118.8 to 154.7] vs. 151.9 ± 8.3 [95% CI = 135.2 to 168.6]; p ≤ 0.001). There was no difference in time between partial and ineffective applications (p = 0.261). CONCLUSIONS: Our study suggests that laypersons could benefit from prior training to effectively apply tourniquets in emergency situations. Of the tourniquets studied, the RMT was the most effectively and most rapidly applied.
Asunto(s)
Hemorragia/terapia , Torniquetes/clasificación , Adolescente , Adulto , Medicina de Emergencia/educación , Femenino , Humanos , Masculino , Maniquíes , Estudios Prospectivos , Distribución Aleatoria , Torniquetes/efectos adversos , Adulto JovenAsunto(s)
Sistema Nervioso Autónomo/efectos de los fármacos , Sistema Nervioso Autónomo/fisiología , Conducta de Elección , Auxiliares de Urgencia/educación , Neurotransmisores/farmacología , Neurotransmisores/uso terapéutico , Farmacología , Fármacos del Sistema Nervioso Autónomo/uso terapéutico , HumanosRESUMEN
OBJECTIVE: Growing rates of opioid abuse and overdose throughout the nation have lead some community organizations to develop naloxone administration programs. METHODS: In Pitt County North Carolina, two of our law enforcement agencies were trained in the identification of opioid overdose and use of naloxone therapy. RESULTS: Attributed partially to introduction of fentanyl into the illicit drug market, our community experienced a 48-hour period in which officers successfully deployed five doses of antagonist medication to four individuals. CONCLUSION: This article presents case descriptions demonstrating the feasibility and safety of law enforcement naloxone programs.