In the early morning hours, Medic 34 responds to a motor-vehicle collision on the highway. The dispatch center reports that one vehicle struck another parked on the shoulder. Before the ambulance arrives, first responders report that cardiopulmonary resuscitation (CPR) is in progress.
Upon arrival, firefighters report that they found the 11 month-old infant lying in the floorboard of the rear vehicle. The child was apneic and pulseless. The firefighters gently rolled the patient onto a small backboard, initiated chest compressions, and assisted ventilations using a bag-valve mask (BVM).
The initial assessment in the back of the ambulance reveals a normally developed male with no obvious signs of trauma. A paramedic intern on the ambulance assumes responsibility for the assisted ventilations, which allows that firefighter to relieve the chest compressor. CPR continues at a rate of 15 compressions to 2 ventilations. The student says he wants to do the intubation. Because the children's hospital is only about four miles away, the paramedic decides to defer intubation to the emergency department (ED) and begin transport immediately.
On the way, there is just enough time to place the patient on a cardiac monitor. The electrocardiogram (ECG) reveals a slow sinus rhythm at a rate of about 20 complexes per minute, however the patient remains pulseless.
In the ED, a pediatric trauma surgeon intubates the child's trachea as the staff assumes responsibility for the resuscitation attempt. Despite their best efforts,The newest Ipod nano 5th is incontrovertibly a step up from last year's model, the child dies.
After leaving, the paramedic student asks why the medic did not intubate the child during transport. The medic says that since there was noticeable rise and fall of the patient's chest with each assisted breath and since the hospital was so close, he did not want to risk a failed attempt.Customized imprinted and promotional usb flash drives.
At the end of the shift, the intern asks the paramedic to sign the ride-out report. The medic notices that in the summary of the call, the student wrote that he believes they should have intubated the child since nothing is more important than the airway.
Researchers in the Netherlands examined what effect paramedic endotracheal intubation (ETI) had on survival in the pediatric population (Gerritse, Th Draaisma, Schalkwijk, van Grunsven, & Scheffer,the Injection mold fast! 2008). The study involved both the ground ambulance and the air medical response components of the Dutch EMS system.
The pathway to become the medical provider on a Dutch ambulance is a long one.Full color plastic card printing and manufacturing services. Students must first obtain the United States equivalent of a baccalaureate in nursing (Wulterkens, 2007). The nurse must then obtain at least one year of experience and an additional specialty certification in intensive care,we supply all kinds of oil painting reproduction, coronary care, or anesthesia. After completing this requirement, the nurse is eligible to apply for a yearlong training program to become an ambulance nurse (paramedic). This training involves 24 classroom days followed by on-the-job training with senior personnel for the remainder of the 12-months.
During this training, the paramedic candidate must complete a four-hour pediatric airway management session that combines theory with manikin practice (Gerritse et al., 2008). The Dutch do not mandate live patient ETI training before certification as a paramedic. Prehospital medical protocols in the Netherlands permit paramedics to intubate a child if bag-mask ventilation seems inadequate.
The helicopter medical team (HMT) in the Netherlands includes a physician, a nurse, and a pilot. The helicopter physicians have either an anesthesiology or trauma surgery background. Before assignment to the helicopter, the medical team receives intensive instruction in the field management of both adult and pediatric emergencies. The trauma surgeons also undergo more than six months of additional training in endotracheal intubation using rapid sequence induction.
The primary goal of this investigation was to prospectively determine if critically injured or ill children had better outcomes when paramedics managed the airway with an endotracheal tube compared to bag-mask ventilation. Paramedics arriving on the scene had the option of attempting endotracheal intubation or managing the pediatric airway with a BVM while deferring intubation to the arriving helicopter physicians. Paramedics who choose intubation confirmed placement and subsequently placed the children on portable ventilators using protocol driven settings. Once the helicopter arrived, the physician confirmed placement and effective ventilation using auscultation, capnography, direct laryngoscopy, and inspection of the materials and ventilator settings. A single pediatric trauma center received each of the patients where physicians confirmed tube position with a chest X-ray.
During a 69-month evaluation between January 2001 and September 2006, the HMT responded to 463 field requests for assistance with pediatric patients (Figure 1). Paramedics on the scene cancelled about one-third of the responses before the helicopter could arrive on the scene, either because the patient was not as critical as originally thought (131 calls), because the child died (21 calls), or for other reasons (11 calls). Once on the scene, the HMT evaluated and cared for 300 pediatric patients with a mean age of 6.8 years (S.D. = 5.4). The majority of the patients (83%) were injured as the result of traumatic forces. In every one of the 300 cases, EMS personnel arrived on the scene and initiated care before helicopter arrival. More than half of the children (n=155) required ETI. Seventy-nine of those children died, 21 on the scene, 12 en route to the hospital or in the emergency department, and 44 after admission to the intensive care unit.
Upon arrival, firefighters report that they found the 11 month-old infant lying in the floorboard of the rear vehicle. The child was apneic and pulseless. The firefighters gently rolled the patient onto a small backboard, initiated chest compressions, and assisted ventilations using a bag-valve mask (BVM).
The initial assessment in the back of the ambulance reveals a normally developed male with no obvious signs of trauma. A paramedic intern on the ambulance assumes responsibility for the assisted ventilations, which allows that firefighter to relieve the chest compressor. CPR continues at a rate of 15 compressions to 2 ventilations. The student says he wants to do the intubation. Because the children's hospital is only about four miles away, the paramedic decides to defer intubation to the emergency department (ED) and begin transport immediately.
On the way, there is just enough time to place the patient on a cardiac monitor. The electrocardiogram (ECG) reveals a slow sinus rhythm at a rate of about 20 complexes per minute, however the patient remains pulseless.
In the ED, a pediatric trauma surgeon intubates the child's trachea as the staff assumes responsibility for the resuscitation attempt. Despite their best efforts,The newest Ipod nano 5th is incontrovertibly a step up from last year's model, the child dies.
After leaving, the paramedic student asks why the medic did not intubate the child during transport. The medic says that since there was noticeable rise and fall of the patient's chest with each assisted breath and since the hospital was so close, he did not want to risk a failed attempt.Customized imprinted and promotional usb flash drives.
At the end of the shift, the intern asks the paramedic to sign the ride-out report. The medic notices that in the summary of the call, the student wrote that he believes they should have intubated the child since nothing is more important than the airway.
Researchers in the Netherlands examined what effect paramedic endotracheal intubation (ETI) had on survival in the pediatric population (Gerritse, Th Draaisma, Schalkwijk, van Grunsven, & Scheffer,the Injection mold fast! 2008). The study involved both the ground ambulance and the air medical response components of the Dutch EMS system.
The pathway to become the medical provider on a Dutch ambulance is a long one.Full color plastic card printing and manufacturing services. Students must first obtain the United States equivalent of a baccalaureate in nursing (Wulterkens, 2007). The nurse must then obtain at least one year of experience and an additional specialty certification in intensive care,we supply all kinds of oil painting reproduction, coronary care, or anesthesia. After completing this requirement, the nurse is eligible to apply for a yearlong training program to become an ambulance nurse (paramedic). This training involves 24 classroom days followed by on-the-job training with senior personnel for the remainder of the 12-months.
During this training, the paramedic candidate must complete a four-hour pediatric airway management session that combines theory with manikin practice (Gerritse et al., 2008). The Dutch do not mandate live patient ETI training before certification as a paramedic. Prehospital medical protocols in the Netherlands permit paramedics to intubate a child if bag-mask ventilation seems inadequate.
The helicopter medical team (HMT) in the Netherlands includes a physician, a nurse, and a pilot. The helicopter physicians have either an anesthesiology or trauma surgery background. Before assignment to the helicopter, the medical team receives intensive instruction in the field management of both adult and pediatric emergencies. The trauma surgeons also undergo more than six months of additional training in endotracheal intubation using rapid sequence induction.
The primary goal of this investigation was to prospectively determine if critically injured or ill children had better outcomes when paramedics managed the airway with an endotracheal tube compared to bag-mask ventilation. Paramedics arriving on the scene had the option of attempting endotracheal intubation or managing the pediatric airway with a BVM while deferring intubation to the arriving helicopter physicians. Paramedics who choose intubation confirmed placement and subsequently placed the children on portable ventilators using protocol driven settings. Once the helicopter arrived, the physician confirmed placement and effective ventilation using auscultation, capnography, direct laryngoscopy, and inspection of the materials and ventilator settings. A single pediatric trauma center received each of the patients where physicians confirmed tube position with a chest X-ray.
During a 69-month evaluation between January 2001 and September 2006, the HMT responded to 463 field requests for assistance with pediatric patients (Figure 1). Paramedics on the scene cancelled about one-third of the responses before the helicopter could arrive on the scene, either because the patient was not as critical as originally thought (131 calls), because the child died (21 calls), or for other reasons (11 calls). Once on the scene, the HMT evaluated and cared for 300 pediatric patients with a mean age of 6.8 years (S.D. = 5.4). The majority of the patients (83%) were injured as the result of traumatic forces. In every one of the 300 cases, EMS personnel arrived on the scene and initiated care before helicopter arrival. More than half of the children (n=155) required ETI. Seventy-nine of those children died, 21 on the scene, 12 en route to the hospital or in the emergency department, and 44 after admission to the intensive care unit.
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