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ECG Case Series ECG case series for paramedics: December 2023 Charles Bloe, Lead Nurse for Cardiology, Coronary Care Unit, Raigmore Hospital, Inverness, UK. Email: charles.bloe@nhs.scot 490 This 89-year-old female has presented with collapse and facial trauma. She has lived in a care home for the past 5 years. Despite having lived independently up until then, she was incapable of doing so after suffering from a stroke. She has since developed dementia. She can still mobilise short distances with the aid of a walking frame. Over the last month, she has become increasingly fatigued and short of breath. This was attributed to a recent COVID-19 infection. This morning, while mobilising to the toilet, she collapsed to the floor. She struck her head against the corner of a wall, resulting in a nasty laceration above her eye. The care home staff called for an ambulance. When the paramedics arrived, she was still on the floor but conscious. She was very confused. Staff were applying pressure to a 6 cm laceration above her left eye that was bleeding profusely. Her vital signs were: l Blood pressure: 185/65 mmHg l Pulse rate: 42 beats per minute l Respiratory rate: 18 breaths per minute l Sp02: 93% on air l Temperature: 37.6oC. She was attached to a 5-lead cardiac monitor and her ECG rhythm is shown in Figure 1. Figure 1. ECG of an 89-year-old woman who struck her head during a fall at home What does the ECG show? Interpretation of the ECG rhythm l The heart rhythm is regular l The heart rate is approximately 40 beats per minute l There are P waves l The QRS complexes are regular l The QRS duration is prolonged, i.e. the QRS complex is wide l There is no association between the P waves and QRS complexes. This rhythm is third-degree atrioventricular block or complete heart block. Not all P waves are visible. However, P waves will generally appear at regular intervals. So, if you lay a piece of paper across the rhythm and mark off any obvious P waves, you should then be able to identify any that are ‘hidden’ behind QRS complexes. This lady was admitted to the emergency department. Her head wound required eight stitches. Cardiac monitoring was commenced. Several hours after admission, she experienced a further unresponsive episode, this time while lying in her bed. Her ECG rhythm at the time is shown in Figure 2. Figure 2. ECG during an unresponsive episode after admission to the emergency department Initially, the heart rhythm shows second-degree AV block type 2, with two P waves for every QRS complex. However, she quickly deteriorates to an episode of ventricular standstill, with a succession of P waves and no ventricular response. β 1 and β She was commenced on an intravenous infusion of isoprenaline. This is a non-selective beta adrenergic receptor agonist. Isoprenaline stimulates both 2 adrenoceptors producing an increase in cardiac output by increasing both myocardial contractility and heart rate. It can provide a useful bridge to maintain a patient’s heart rate while they await a permanent cardiac pacemaker implant. This lady had a permanent pacemaker implanted the next day and was discharged back to her care home 2 days later. JPP lthcare Ltd Hea MA 2023 © Vol 15 No 12 • Journal of Paramedic Practice
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Education Confidence levels of students before and after a minor illness/injury placement Sean Carbery (Corresponding Author), Triage Paramedic; Karen Gubbins, Senior Lecturer and Course Lead, Paramedic Science; both at Birmingham City University, School of Health Sciences, Birmingham, UK. Email: sean.carbery@hotmail.co.uk lthcare Ltd Hea MA 2023 © Over recent years, the scope of practice for paramedics in the UK has noticeably changed and expanded. According to Health Education England (2021), changes have been seen within national frameworks and across many clinical settings. A recent report from the College of Paramedics (CoP) (2018) concluded that 60% of paramedics are now going into roles within GP practices, minor injury units, and walk-in centres, focusing on the management of minor illnesses and injuries. A framework including a skill set was initiated by Collier (2021), which outlined the need for more non-ambulance placements within the undergraduate paramedic curriculum. According to Brewster (2018), students that are undertaking a BSc in Paramedic Science, spend a small proportion of their clinical time in nonambulance-based placements. Brewster’s (2018) research has shown that this can affect the student’s overall ability to understand certain conditions and how they are managed in the prehospital environment. Recent research by Proctor (2019) reveals that non-ambulance placements offered to student paramedics include spending time on cardiology wards, emergency and acute assessment wards, cardiac catheterisation labs, primary care, paediatric care, and palliative care placements. Collen (2019) notes that such experiences represent an extensive opportunity for student paramedics to not only experience interdisciplinary learning, but enhance their clinical understanding as well. However, research by Baranowski and Armour (2020) found that further research needed to be done on the confidence levels of students, as his study Abstract Within the UK, the paramedic scope of practice has noticeably changed over recent years. Many paramedics are now going into roles within general practice surgeries, minor injury units, and urgent care treatment centres. A framework including a skill set was therefore initiated outlining the need for more non-ambulance placements within the undergraduate paramedic curriculum. This article reports the findings of a quantitative study, exploring the confidence levels in managing patients both before and after a minor illness/injury placement. It is quite clear that students who undertook the placement in minor illnesses and injury found it beneficial to their overall learning experience and confidence levels, as 85% of participants stated that their confidence had increased after this placement. Key words l Student paramedic l Paramedic placement l Minor injury l Patient care l Confidence levels Accepted for publication:18 October 2023. concluded that alternative placements both hinder and support student paramedics in their learning. The author felt it necessary therefore to establish the confidence levels of student paramedics when managing patients both before and after undertaking a minor illness/injury placement. As a result of this study, a greater understanding of student paramedics’ confidence levels will be gained, enabling both the expansion and development of the future paramedic curriculum. The current article reports the findings of a quantitative study, exploring the confidence levels of student paramedics in managing patients both before and after a minor illness/injury placement. Journal of Paramedic Practice • Vol 15 No 12 491

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Education

Confidence levels of students before and after a minor illness/injury placement

Sean Carbery (Corresponding Author), Triage Paramedic; Karen Gubbins, Senior Lecturer and Course Lead, Paramedic Science; both at Birmingham City University, School of Health Sciences, Birmingham, UK. Email: sean.carbery@hotmail.co.uk lthcare Ltd

Hea

MA

2023

©

Over recent years, the scope of practice for paramedics in the UK has noticeably changed and expanded. According to Health Education England (2021), changes have been seen within national frameworks and across many clinical settings. A recent report from the College of Paramedics (CoP) (2018) concluded that 60% of paramedics are now going into roles within GP practices, minor injury units, and walk-in centres, focusing on the management of minor illnesses and injuries. A framework including a skill set was initiated by Collier (2021), which outlined the need for more non-ambulance placements within the undergraduate paramedic curriculum.

According to Brewster (2018), students that are undertaking a BSc in Paramedic Science, spend a small proportion of their clinical time in nonambulance-based placements. Brewster’s (2018) research has shown that this can affect the student’s overall ability to understand certain conditions and how they are managed in the prehospital environment.

Recent research by Proctor (2019) reveals that non-ambulance placements offered to student paramedics include spending time on cardiology wards, emergency and acute assessment wards, cardiac catheterisation labs, primary care, paediatric care, and palliative care placements. Collen (2019) notes that such experiences represent an extensive opportunity for student paramedics to not only experience interdisciplinary learning, but enhance their clinical understanding as well. However, research by Baranowski and Armour (2020) found that further research needed to be done on the confidence levels of students, as his study

Abstract

Within the UK, the paramedic scope of practice has noticeably changed over recent years. Many paramedics are now going into roles within general practice surgeries, minor injury units, and urgent care treatment centres. A framework including a skill set was therefore initiated outlining the need for more non-ambulance placements within the undergraduate paramedic curriculum. This article reports the findings of a quantitative study, exploring the confidence levels in managing patients both before and after a minor illness/injury placement. It is quite clear that students who undertook the placement in minor illnesses and injury found it beneficial to their overall learning experience and confidence levels, as 85% of participants stated that their confidence had increased after this placement. Key words l Student paramedic l Paramedic placement l Minor injury l Patient care l Confidence levels

Accepted for publication:18 October 2023.

concluded that alternative placements both hinder and support student paramedics in their learning.

The author felt it necessary therefore to establish the confidence levels of student paramedics when managing patients both before and after undertaking a minor illness/injury placement. As a result of this study, a greater understanding of student paramedics’ confidence levels will be gained, enabling both the expansion and development of the future paramedic curriculum.

The current article reports the findings of a quantitative study, exploring the confidence levels of student paramedics in managing patients both before and after a minor illness/injury placement.

Journal of Paramedic Practice • Vol 15 No 12

491

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