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.ResourcesPARAMEDIC 3Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac ArrestPrehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomesPANDA 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.aspxhttps://paramedics.org/

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