EMSWORLD - By Mark A. Merlin - January 14, 2016
"Each week the New Jersey EMS Fellowship holds a three-hour Journal Club with the latest published literature. From this comes a weekly e-mail with clinical pearls and the latest articles that’s sent to 7,000 medical providers. From the book of clinical pearls comes a yearly review of the top 50 things we hope providers will be doing, or are already, for the new year. Enjoy."
2016 Wish List in Acute Care Medicine
- No more longboards for transport of any patient;
- PEEP valve on every BVM;
- More CPAP on patients short of breath;
- Less utilization of mechanical CPR devices unless patients are being transported;
- More ultrasound in the prehospital/acute care setting, especially on SOB patients;
- Routine chest decompression of every blunt traumatic cardiac arrest patient;
- More sheets around pelvic trauma;
- Earlier use of IM epinephrine for anaphylaxis;
- Less bagging;
- No bagging if sat is 93%;
- High-flow nasal cannula on all patients during intubation;
- High-flow nasal cannula on all patients underneath the CPAP;
- Earlier double sequence defibrillation in refractory v-fib;
- Push-dose epinephrine on all sick patients with SBP < 90 mmHg;
- More TXA in trauma;
- TXA in severe upper GI bleeding;
- Bypassing ED for STEMI patients;
- Cath lab for cardiac arrest patients with ROSC and no STEMI;
- Stop treating patients at mass gatherings the same as MCIs—utilize event medicine techniques;
- No more Kayexalate;
- Earlier calcium IV with bradycardic patients before K is known;
- No more myths about IV calcium being bad in digoxin toxicity;
- No morphine in chest pain—fentanyl;
- More ketamine for violent patients, IM at 4 mg/kg;
- Less etomidate;
- No defasciculating doses of paralytics;
- Rocuronium!;
- Stop nitro paste;
- More routine Zofran at 0.1 mg/kg;
- More intranasal Versed for seizures;
- More routine use of intranasal naloxone;
- More routine use of intranasal fentanyl;
- No oxygen on STEMI patients if sat at least 93%;
- BLS CPAP, ASA, albuterol, finger sticks, epi, IM glucagon;
- Less nitro for STEMIs;
- More atropine for bradycardia with STEMIs;
- Stop saying “PEA” without identifying the rhythm!;
- PEA with narrow complex: no CPR and push-dose pressors;
- Better pressors than dopamine;
- More delayed sequence intubation;
- More pushing IV fluids before intubation on hypotensive patients;
- More Keppra in the ED;
- Lidocaine over amiodarone in kids with v-fib;
- Early tourniquets for uncontrolled bleeding;
- Don’t rush to intubate hypotensive patients. IV push pressors and IV push fluids;
- Don’t focus on the airway in cardiac arrest. If paramedics can’t get the patient intubated, use supraglottic and only intubate after ROSC;
- Hypotensive patients don’t have good pulse ox or urinary output. Focus on getting the BP up, and the other two may resolve;
- Topical TXA for bad nosebleeds;
- Maybe beta blockers in refractory v-fib?;