ALS reduced to first aid.
- Thread starter mycrofft
- Start date
There is emperical evidence and/or limited prehospital scientific evidence to support most treatments provided by Ambulance for example
- Salbuatamol and adrenaline for asthma
- Glucagon and glucose for hypoglycaemia
- Aspirin and GTN for ischaemic chest pain
- Adrenaline and IV fluid for anaphylaxis
- IV fluids for hyperglycaemia/DKA/HONK
- Cardioversion for significantly compromising fast AF/VT/wide complex tachycardias
- Intravenous pain relief
- Midazolam for seizures
Most research is focused on cardiac arrest, major trauma and intubation. There is limited benefit to any advanced procedures in these scenarios but to extrapolate that out to "ALS is bad" is incorrect, everything listed here is considered an "ALS procedure" in the US (and mostly Canada too) ... so could be why Quebec has no ALS?
Absence of evidence does not mean evidence of absence
- Salbuatamol and adrenaline for asthma
- Glucagon and glucose for hypoglycaemia
- Aspirin and GTN for ischaemic chest pain
- Adrenaline and IV fluid for anaphylaxis
- IV fluids for hyperglycaemia/DKA/HONK
- Cardioversion for significantly compromising fast AF/VT/wide complex tachycardias
- Intravenous pain relief
- Midazolam for seizures
Most research is focused on cardiac arrest, major trauma and intubation. There is limited benefit to any advanced procedures in these scenarios but to extrapolate that out to "ALS is bad" is incorrect, everything listed here is considered an "ALS procedure" in the US (and mostly Canada too) ... so could be why Quebec has no ALS?
Absence of evidence does not mean evidence of absence
Smash
Forum Asst. Chief
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Brown has a very valid point.
I'm normally the most rabid "Where's the evidence?!" EBM :censored::censored::censored::censored::censored: there is, but I have to rein myself in occasionally and be sensible about it all. To help me with this, I like to refer to this study, published in the British Medical Journal in 2003.
I'm normally the most rabid "Where's the evidence?!" EBM :censored::censored::censored::censored::censored: there is, but I have to rein myself in occasionally and be sensible about it all. To help me with this, I like to refer to this study, published in the British Medical Journal in 2003.
Do you mean evidence that GTN may help to relieve pain or that it actually improves survival?
Relieves pain, may have a small impact on M&M
SeeNoMore
Old and Crappy
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http://www.emsworld.com/print/EMS-World/CE-Article---The-2010-AHA-ECC-Updates--What-Is-the-Real-Impact-on-EMS-Providers/1$16277
Scroll down to advanced airway section...
This is interesting, maybe others were already aware of it but there seems to be an association between early intubation and 24 hour survival. I know this is not the same measurement as long term survival or neurlogical outcome, but it seems somewhat important to increase the number of patients who may be able to benefit from in hospital post rosc care.
One thing that confused me was whether this measure was 12 minutes from actuall arrest to ALS, or the call to 911 and dispatch. Because if it is measuring time from arrest to intubation, I doubt many systems can mee that, if only because most codes I have been to thus far have involved a loved one finding the pt down after at least a half hour if not half the night.
Still, it's one of the only favorable statement on intubation for cardiac arrest I have seen lately.
As for the rest, I think much of what we do makes sense. Whether interventions "save lives" is not always clear, but much of it certainly imrpoves the care of pts. It's funny, even though most other students are really into trauma, situations in which we are generally of little use or maybe even a detriment, my most satisfying calls have bene hypoglycemic emergencies where we can resolve the situation and leave the pt at home.
Scroll down to advanced airway section...
This is interesting, maybe others were already aware of it but there seems to be an association between early intubation and 24 hour survival. I know this is not the same measurement as long term survival or neurlogical outcome, but it seems somewhat important to increase the number of patients who may be able to benefit from in hospital post rosc care.
One thing that confused me was whether this measure was 12 minutes from actuall arrest to ALS, or the call to 911 and dispatch. Because if it is measuring time from arrest to intubation, I doubt many systems can mee that, if only because most codes I have been to thus far have involved a loved one finding the pt down after at least a half hour if not half the night.
Still, it's one of the only favorable statement on intubation for cardiac arrest I have seen lately.
As for the rest, I think much of what we do makes sense. Whether interventions "save lives" is not always clear, but much of it certainly imrpoves the care of pts. It's funny, even though most other students are really into trauma, situations in which we are generally of little use or maybe even a detriment, my most satisfying calls have bene hypoglycemic emergencies where we can resolve the situation and leave the pt at home.
MonkeySquasher
Forum Lieutenant
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First, I'd say that I agree with Mycrofft to a point, that when faced with 10 possible treatments instead of 3, a provider may try all 10. While these treatments are not wrong and potentially beneficial, they take time, and delay patient arrival at definitive care. A local study conducted by my agency Med Director showed that Medic/Intermediate cars spent longer on scene of critical calls than Medic/Basic, Intermediate/Basic, or Basic/Basic. These are times when the patient needed an intervention that only a hospital could provide (OR, Cath, TPA, etc) yet in an effort to get everything done quicker with two providers, more time was actually wasted than any other crew.
To highlight what my preceptor tried to teach me above all.. "We do our patient the most good in the 'Times' boxes."
Which is where I believe this comes into play in this conversation... ALS skills are not the issue, it's how rapidly they are implimented. A patient suffering a cardiac problem will benefit from ACLS care after 3 minutes more than after 13 minutes, or even 30 minutes. Therapeutic Hypothermia, thrombolytics, surgical trauma intervention, even some sort of glucose therapy... They're, in my opinion, not skill-driven, but just time-dependant.
To highlight what my preceptor tried to teach me above all.. "We do our patient the most good in the 'Times' boxes."
Which is where I believe this comes into play in this conversation... ALS skills are not the issue, it's how rapidly they are implimented. A patient suffering a cardiac problem will benefit from ACLS care after 3 minutes more than after 13 minutes, or even 30 minutes. Therapeutic Hypothermia, thrombolytics, surgical trauma intervention, even some sort of glucose therapy... They're, in my opinion, not skill-driven, but just time-dependant.