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Latest Articles
Volume 15, Issue 1: Shock ‒ the perils of poor perfusion
January
Shock ‒ the perils of poor perfusion
You’re heading back after a busy shift so far, an NSTEMI, a suspected PE, some D&V and a case of sepsis, quite a variety you think, but then your crewmate mentions how similar they all were. What can he mean?
CPD benefit
Shock is a life-threatening, acute failure of the circulatory system to adequately perfuse the tissues of the body. If not identified and managed appropriately, shock can lead to multiorgan failure and death. This article outlines the variety of medical or traumatic events that can lead to shock and the stages of shock through which a patient may progress. It also examines how the body responds to inadequate perfusion and the signs and symptoms to help you identify shock or the potential for it to develop. There is useful guidance on the assessment and management of shock in the pre-hospital environment to enable you to respond effectively where this life-threatening condition could be present.
Volume 14, Issue 12: Caring for patients in prolonged care situations – an opportunity to become a HITMAN shouldn’t be MISSED
December
Caring for patients in prolonged care situations – an opportunity to become a HITMAN shouldn’t be MISSED
You are just back from leave and starting your shift when a call comes in to a Category 2 for a 75-year-old man who has fallen and can’t get up. When you arrive the patient says he has been on the floor for two hours and his history indicates that you should convey him to ED. When you arrive at ED the waits are very long – should you have waited before conveying?
CPD benefit
Out-of-hospital care has been changing in recent years, there are longer wait times outside the ED and it has now become normal for pre-hospital clinicians to deliver care for prolonged periods, which is not necessarily what they were educated to do. This article shows how the HITMAN mnemonic can be used by clinicians adapt their practice to keep up with the ever-evolving care environment. There is guidance on each element of the mnemonic demonstrating how you can support your patient and deliver a good level of care during their prolonged ambulance wait. There is also guidance on the related MISSED mnemonic highlighting some of the most crucial conditions and the regular medications that are required to control them.
Volume 14, Issue 11: Carbon monoxide poisoning – the silent killer
November
Carbon monoxide poisoning – the silent killer
It is a cold November day and it has been unusually quiet, as you are heading back to station you receive a call for a 65-year-old female with acute confusion and weakness. Initial assessment does not offer any obvious reason for this – have you considered all the possibilities?
CPD benefit
Carbon monoxide (CO) is a colourless, tasteless and odourless gas that is produced during the incomplete combustion of carbon-based compounds. CO poisoning is potentially life threatening, with around 40 deaths attributed to it in England and Wales every year. This article outlines the epidemiology and pathophysiology of CO poisoning. It provides guidance on how to assess a patient with possible CO poisoning including differential diagnosis, which can be challenging for the pre-hospital clinician. There is also advice on how best to manage the patient including treatment that can be given in the pre-hospital setting and when to convey the patient to the ED.
Volume 14, Issue 10: Migraine – what a headache!
October
Migraine – what a headache!
It’s November – grey, gloomy and damp, the second job of the shift comes in. It’s a call to a 52-year-old female with a “severe headache”. When you arrive you assess the patient and find that she has had migraines in the past, you decide to leave her at home with worsening advice for migraine. Later you start to worry – did you miss some big red flags in her history?
CPD benefit
Migraines are extremely common, experienced by around 12% of people, paramedics will often encounter patients experiencing migraines on the more severe end of the spectrum. This article describes the pathophysiology and signs and symptoms of migraine, it also provides guidance on how to provisionally diagnose migraine which can be challenging in the pre-hospital setting. There is advice on assessment, treatment options and long-term management of the condition to help you effectively manage your patient by excluding red flags and concerns of a secondary headache disorder which might warrant transportation to an ED or onward referral.
Volume 14, Issue 9: Modern slavery and human trafficking – could you be the final piece of the puzzle?
September
Modern slavery and human trafficking – could you be the final piece of the puzzle?
You are a paramedic based in police custody, working as a forensic healthcare practitioner (FHP). A detainee is brought to your attention, she was arrested for shoplifting and resisting arrest. Custody staff noticed physical signs of injury and think she may be a victim of modern slavery and human trafficking (MSHT) but she does not admit to this – should you refer her through the National Referral Mechanism (NRM) even though she does not consent?
CPD benefit
For the year ending June 2023 the UK Home Office reported 22,796 victims of modern slavery brought to their attention. This article outlines the most common types of exploitation such as labour, forced criminality and sex trafficking. It also gives guidance on how to identify a potential victim of modern slavery and human trafficking (MSHT) and the potential effects of exploitation on an individual. There is some useful discussion about treatment and how to make a referral to the police without consent to enter the National Referral Mechanism (NRM). This will enable you, as a paramedic, to support the victim and potentially help many others working to prevent the exploitation of human rights through slavery and trafficking.
Volume 14, Issue 8: Slapped cheek syndrome ‒ red cheeks
August
Slapped cheek syndrome ‒ red cheeks
It’s the start of your shift when your radio alerts you to a call for a five-year-old with a rash. On arrival you meet Hannah sitting with her mum, her cheeks are bright red, she has been off colour all week and now her rash has spread. You begin your assessment, thinking about the differentials – this could be time critical…
CPD benefit
Slapped cheek syndrome is otherwise known as parvovirus B19 or ‘fifth disease’ (as it is fifth on the list of childhood viral skin rashes, with the others being measles, rubella, chicken pox and scarlet fever). Slapped cheek syndrome is most prevalent in children aged 5–10 years and is very common, with 50% of adults and 85% of the elderly having parvovirus antibodies in their blood. This article outlines the signs and symptoms of the disease and how it is transmitted. There is also comprehensive guidance on how to assess a child with a rash, differential diagnosis (including red flags for meningitis and sepsis) and possible complications to be aware of when other medical conditions are present. This will enable you to identify the disease and give reassurance and management advice to the patient and their carers.
Volume 14, Issue 7: Lupus – finding the wolf in sheep’s clothing
July
Lupus – finding the wolf in sheep’s clothing
It is midday on a glorious summer’s day when the MDT flashes up with a new job ‘Category 2 call, 35-year-old female with chest pain’. You postpone lunch and set off, when you arrive the patient tells you she has lupus – is there a connection with chest pain?
CPD benefit
Lupus is an autoimmune disease that can impact multiple body systems with chronic inflammation and can manifest as a complex clinical picture, This article outlines the aetiology and signs and symptoms of the disease. It can be characterised by general flare-up symptoms or manifestations of inflammation to a specific organ or system, which may result in a wide range of complications many of which can be life threatening. There is advice on how Lupus is treated and how it can be investigated and managed in the pre-hospital setting so that you can provide the best possible care for the patient where complications of the disease may be present.
