EMERGENCY ADULT MEDICAL CARE

Emergency Adult Medical Care
While much of initial Emergency Medical Services care centered on cardiac and traumatic emergencies, interest has evolved in the management of other emergencies by Emergency Medical Services providers as they have broadened their scope of practice. The management of airway obstruction and respiratory arrest is an important function of the Emergency Medical Services system.

Paramedics can achieve airway control by endotracheal and nasotracheal intubation with a high success rate and an acceptable complication rate. Early advanced airway measures for upper airway obstruction from burns, trauma, foreign bodies, or allergic causes may be lifesaving. Neuromuscular paralytic agents, such as succinylcholine, may be used safely by paramedics in the field with appropriate instruction and close medical oversight.

Respiratory distress in patients with chronic obstructive pulmonary disease (COPD) and asthma is a common clinical entity treated in Emergency Medical Services systems. Beta-2 agonists and ipratropium have been shown to be safe and effective bronchodilators for field use. Pulse oximetric studies for the evaluation of occult hypoxemia have become widely used.

Devices capable of delivering continuous positive airway pressure (CPAP) have become available for use on ambulances. There are initial observations indicating that this treatment may add benefit to the care of patients with acute exacerbations of COPD and perhaps also for other disorders such as asthma.

Paramedics are commonly called to evaluate patients with altered mental status. Glucose is given routinely to hypoglycemic patients and naloxone to patients with suspected opioid overdose. Similarly, control of seizures with diazepam or lorazepam and airway support for status epilepticus are important Emergency Medical Services functions.

Pediatric Care
With the development of pediatric emergency care as an area of interest, experts and organizations have started to review the care of children in Emergency Medical Services systems. It is estimated that 5 to 10 percent of an Emergency Medical Services system's volume consists of pediatric cases, and the most common pediatric emergencies are trauma, respiratory emergencies, and seizures.

Cardiac arrest in children is rare (approximately 1 per 10,000 children per year in the United States), usually with a dismal outcome. The ability of paramedics to perform procedures to treat pediatric cardiac arrest, respiratory emergencies, and trauma is extremely variable and age-dependent. For most age groups, endotracheal intubation success rates are comparable with those for adults.

As would be expected, endotracheal intubation and intravenous access have poorer success in infants and small children. Conversely, the benefit of these procedures in the field for pediatric patients remains unproven. For example, a study of pediatric prehospital intubation in Los Angeles County found no increase in patient survival compared with bag-mask ventilation.