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Biomedical subjects

S A Pace

Publications and source records attributed to S A Pace.

5 recordsLinked to original sources
PubMed2000

Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics.

STUDY OBJECTIVE: To describe the effectiveness and safety of succinylcholine administration by paramedics to out-of-hospital patients requiring endotracheal intubation. METHODS: A consecutive case series was collected by retrospective review of patient care records from a large, private ambulance agency serving an urban and rural county of 600,000 residents over a 40-month period. All patients for whom endotracheal intubation was facilitated by succinylcholine use were identified. Data were systematically collected on demographics, paramedic diagnosis, intubation attempts, and complications. RESULTS: Succinylcholine was used in 150 patients with a mean age (+/-SD) of 50+/-23 years. Paramedic diagnosis was coma in 43% (64/150; 95% confidence interval [CI] 35% to 51%), trauma in 26% (39/150; 95% CI 19% to 33%), and respiratory failure in 31% (47/150; 95% CI 23% to 39%). No patient was in cardiac arrest at the time of succinylcholine use. The intubation success rate was 92% (138/150; 95% CI 88% to 96%), with success achieved on the first attempt in 82% of patients (123/150; 95% CI 76% to 88%). Four patients who received succinylcholine developed cardiac arrest, and 3 others had symptomatic bradycardia. CONCLUSION: The use of succinylcholine by paramedics to assist intubation appears to aid in intubation of patients who are not in cardiac arrest. However, significant cardiac complications can occur.

Adolescent↗
PubMed1999

Paramedic decisions with placement of out-of-hospital intravenous lines.

To determine the incidence of unused out-of-hospital intravenous line (IV) placements, we prospectively studied IV placement in emergency medical services (EMS) patients. Unused IV placement was defined as any patient having an EMS initiated IV that was not used for fluid bolus or medication administration in the field or in the emergency department (ED). Data were analyzed on placement and use of IV lines in the field and in the ED, transport time, years of paramedic practice, and paramedic student presence. Of 290 patients, 165 had an IV initiated (147) or attempted (18). Twenty-nine percent (84 of 290) of the patients received an unused EMS IV. One hundred twenty-five patients had no IV initiated by EMS. Seven subsequently had an IV started and used in the ED, for an undertreatment rate of 2.4% (7 of 290). The presence of a paramedic student increased the odds of an unused IV 1.4 (95% CI, 1.1 to 2.0). IVs are frequently started and not used.

Adult↗
PubMed1989

Comparison of intraosseous, intramuscular, and intravenous administration of succinylcholine.

The intraosseous route of vascular access has been popularized recently for resuscitation of children. Intraosseous succinylcholine use has been anecdotally reported for airway management. This drug could be utilized for control of the airway in pediatric burns, status epilepticus, or combative head-injured patients. No series quantifying the efficacy of the intraosseous route has been reported for succinylcholine. To accomplish this goal, six sheep serving as their own controls were anesthetized with halothane and subsequently intubated. Succinylcholine (1 mg/kg) was given. The time to respiratory arrest and 100% loss of the forefoot twitch upon stimulation of the anterior tibial nerve were noted. Each animal was successively studied using the intravenous (IV), intraosseous (IO), and intramuscular (IM) routes of administration, with a minimum of seven days separating trials. The average time from administration to respiratory arrest in seconds was 30.8 +/- 7.3 (IV), 57.5 +/- 10.3 (IO), and 230 +/- 106 (IM). The average time from administration to 100% loss of forefoot twitch in seconds was 93.3 +/- 34.0 (IV), 100.8 +/- 24.2 (IO), and 291 +/- 109 (IM). All groups were statistically significantly different using the t-test for the difference of means, with a p value less than 0.0015. We conclude that the intraosseous route of administration of succinylcholine in this series of sheep is comparable to the intravenous route and superior to the intramuscular route.

Animals↗
PubMed1988

Hereditary angioedema.

Although the condition is rare, patients with hereditary angioedema often present because of abdominal pain or airway compromise. A 27-year-old woman presented to the emergency department in acute abdominal distress. Identification of the disease in this patient allowed for proper management and avoidance of invasive procedures. Pathophysiology, clinical manifestations, diagnosis, and therapy of hereditary angioedema are discussed.

Abdomen, Acute↗