Clinical Updates: November 2024
Episode description
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
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
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James: @JamesOz1
Ben: @ben_meadley