Clinical Updates: November 2024
A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Quick summary (0:30) Patient Safety (1:30) Discussing the lessons from specific adverse events is challenging due to patient privacy/consent, crew psychological safety, and investigation timelines. We need to find a way to collectively share these lessons in a safe way. Plans for quarterly clinical forums (2025) to foster psychologically safe discussions. Clinical Updates (4:52) IV Cannulation for STEMI:Avoid sites near the radial artery to support PCI access. Extrication Monitoring: Monitoring is sometimes removed during extrication, especially self-extrication. Associated with adverse events. We need to emphasise monitoring (especially ECG/pulse oximetry) during extrication. Ectopic Pregnancy: Patient safety Assume ectopic pregnancy for women of childbearing age with abdominal pain and shock. Cardiac Arrest: Always prioritize high-performance CPR over antiarrhythmics. Clarification on stacked shocks and their intended use. CWI out soon. ALS paramedics encouraged to consult for post-ROSC hypotension management. Guideline Monitoring (12:36) Success of expanded croup guidelines: increased dexamethasone use and reduced hospital transports. Research Updates (14:20) PANDA Trial: Comparing noradrenaline and adrenaline in cardiogenic shock. IV vs IO Access: Preference for IV first in cardiac arrest; IO as backup. ROSC Blood Pressure: Minimum diastolic pressure of 35mmHg linked to better outcomes. Equipment Notices (19:20) Normal saline shortages persist; substitute with Hartmann’s or PlasmaLite. New ketone strips now available—use carefully. Professional Development (20:11) CPD resources from the Australasian College of Paramedicine and Victorian Ambulance Union. Links to registration standards and CPD tools in the show notes. Resources PARAMEDIC 3 Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes PANDA trial - If you want to learn more about the study or have any questions, search for PANDA on the AV intranet or contact the team at PANDA@ambulance.vic.gov.au. Pain research with Monash - Get involved: Paramedic confidence & barriers to paediatric pain management External development opportunities https://www.paramedicineboard.gov.au/professional-standards/faq/faq-cpd.aspx https://paramedics.org/education https://paraed.vau.org.au/events Get in touch X / Twitter James: @JamesOz1 Ben: @ben_meadley Linkedin James Ben