Clinical Updates: November 2024

Clinical Conversations

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 [email protected].

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

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James: ⁠⁠⁠@JamesOz1⁠⁠

Ben: ⁠@ben_meadley⁠

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