Читать книгу Emergency Medical Services - Группа авторов - Страница 251

EMS physicians often use the same approach in the field and the hospital to provide patient care, even though the goals in each area differ. The care of patients with dysrhythmias (defined as any change from normal cardiac electrical rhythm and often used interchangeably with arrhythmia) before hospital arrival focuses on treating all life‐threatening or imminently life‐threatening rhythm changes within minutes. Precision about the specific rhythm change is not the goal of early care, though the information gained during this interval can later aid that task. In the emergency department and in the hospital, more time is available to identify the specific rhythm disturbance and titrate more carefully the next and eventual long‐term treatment.

This chapter discusses a pragmatic method of providing medical oversight and field clinical care for non‐arrest dysrhythmias. We highlight the most important field observations and actions to help focus the approach when giving direct medical oversight, creating written protocols, or providing direct patient care. We offer a “low tech” approach to the problems, emphasizing simple tools, including a brief history, physical examination, and standard 3‐ or 12‐lead field ECG. Similarly, we focus on interventions that are effective and easily provided in the field. In general, the approach offered is consistent with the American Heart Association advanced cardiac life support guidelines, although we highlight areas where simplified or alternative approaches exist.