Clinical Practice

Appropriateness of oral clopidogrel for prehospital STEMI management

Introduction: Clopidogrel is an anticoagulant commonly used in the prehospital environment for the management of ST-elevation myocardial infarction (STEMI). Some ambulance services have incorporated this into their treatment regimens; however, others hold a variety of alternative pharmacological interventions. Aims: The purpose of this study is to examine and determine the pharmacological efficacy and safety of clopidogrel in the management of patients with STEMI and assess whether ambulance...

Tranexamic acid and international ambulance services

Introduction: Severe haemorrhage may lead to pathologic release of fibrinolytic enzymes, which break down blood clots. Tranexamic acid (TXA) is a drug that inhibits the fibrinolysis of blood clots. Aim: The purpose of this review is to explore current literature regarding prehospital TXA administration for patients suffering severe haemorrhage following trauma, and to discuss whether this drug should be more widely used across modern international ambulance services. Methods: Literature...

Lion's mane jellyfish sting

The authors present the case of an Irukandji-like syndrome resulting from cnidarian envenomation, following multiple stings from the lion's mane jellyfish (Cyanea capillata) encountered by a sea swimmer in the coastal waters of the UK. This case presents the initial features of Irukandji-like syndrome in this 45-year-old female, her management in the emergency department and subsequent discharge. Envenomation from the lion's mane species and the Irukandji syndrome are briefly discussed.

Triage systems around the world: a historical evolution

The process of triaging patients has come a long way. Stemming from the battlefield, it is the ability to sort casualties on the severity of their injuries that has improved the allocation of resources. In modern emergency centres, there is a constant struggle to balance limited resources against the ever-growing patient need. Since the late 1980s, when triage became the mainstream standard for sorting patients, many different systems have developed throughout the world. There was a rise in...

An out-of-hospital perspective on hyperventilation syndrome

Hyperventilation and tachypnoea both involve breathing at an increased rate. There are a variety of causes of hyperventilation and conditions associated with it, including acute and chronic hyperventilation syndrome (HVS). The characteristics of HVS are not well defined. It results from a reduction in carbon dioxide and altered pH in the body from overbreathing. Symptoms vary between individuals but usually include altered sensations in the extremities, nausea and headache. Diagnosing patients...

Pre-hospital medicine: South Africa vs. the United Kingdom

In an introductory overview, the differences and similarities between emergency medicine in South Africa (SA) and the United Kingdom (UK), predominantly in the paramedical area of practice, are explored. The author discussed areas of interest, as well as a potential future direction. The current article focuses on the more prevalent similarities and differences identified. However, it is worth noting that not all trusts and/or organisations work identically regardless of country-specific...

Successful use of percussion pacing in a pre-hospital p-wave asystole and ventricular standstill

Background: The use of percussion pacing (PP) using a clenched fist as an external cardiac pacemaker is not scientifically supported. However, European Guidelines for resuscitation 2015 recommend PP as an initial intervention for haemodynamically unstable patients with bradyarrhythmias or p-wave asystole. We describe a case where paramedics witnessed a patient developing p-wave asystole with ventricular standstill, and treated the patient successfully with PP until transcutaneous pacing was...

Experiences of two paramedics deployed to the Phillipines in response to Typhoon Haiyan

This article describes the experiences of two paramedics from the UK International Emergency Trauma Register (UKIETR) who deployed as part of the UK-Med response to Typhoon Haiyan in 2013. Each had a key role in the deployed teams, both targeting distinct but differing health needs following the Typhoon. Tim Byrom was a member of the first team activated on 13 November 2013. He formed part of a surgical, anaesthetic and rehabilitation team that assisted the Australian Medical Assistance Team...

Prevention, assessment and management of altitude sickness

With the growing prevalence of adventure holidays and international travel, exposure to the extremes of altitude is becoming more and more common. With this increase in adventure travel the need for expedition medics is expanding, although education in this area is understandably lacking from most medical and allied health professional core training. This article provides a brief overview of the pathophysiology, assessment and management of high-altitude disorders. It does not discuss the...

Providing medical aid to Brazzaville, the Republic of Congo

Following five explosions in Brazzaville, the Republic of Congo on 4 March 2012, a field hospital was flown in from South Africa to help deal with the aftermath. Donated by the Ichikowitz Family Foundation, it aimed to treat the injured patients who were in excess of 2 300.On arrival, a singular old-style army tent, sponsored by the French petroleum company Total, was the only medical service on the site. The tent was manned by staff from the French charity Médecins d'Afrique.Building the...

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