EMS CT scanner?

[Arctickat]

Well, not quite, but this seems interesting. As the 12 lead did for STEMI treatment in the field, do you think this could eventually be used for treating a stroke in the ambulance as well?

I have a message into the company regarding the cost, but has anyone here seen or used one?

[scubanurse]

I'm not sure providing treatment for stroke in the pre-hospital environment will be a reality, just as STEMI's aren't treated in the field. Early recognition does improve treatment outcomes but there are many variables that make pre-hospital TPA dangerous I would think? This device seems intriguing and may help with early recognition of ischemic strokes, in conjunction with provider judgement.

When STEMI treatments are currently being used in the field other than early identification and activation of a cath lab? Not snarky, just a genuine question.

[chbare]

It's not a CT scanner. It uses infrared and near infrared light to identify possible blood consolidations following traumatic injury. It's utility in this setting will be tested in time, so I cannot comment on its efficacy as of yet, but it's promising and may be of use in special situations. Unfortunately, I'm not sure it can identify intraventricular consolidations or perhaps subarachnoid bleeding in certain areas, so it's utility in identifying ischaemic stroke versus hemorrhagic stroke is probably limited.

I'm not sure providing treatment for stroke in the pre-hospital environment will be a reality, just as STEMI's aren't treated in the field. Early recognition does improve treatment outcomes but there are many variables that make pre-hospital TPA dangerous I would think? This device seems intriguing and may help with early recognition of ischemic strokes, in conjunction with provider judgement.

When STEMI treatments are currently being used in the field other than early identification and activation of a cath lab? Not snarky, just a genuine question.

STEMI's are being treated in some areas with prehospital fibrinolytics but I'm not sure what the data says about these services and the other countries where it occurs more often.

[Arctickat]

I don't see this being used until the percentages become higher. All it's good for now is to confirm a bleed, but there is too much room yet for a false negative and missed deeper or smaller bleeds. 3.5 cm isn't very far into the head. Until it's more reliable to rule out the presence of a bleed I can't see it being used to treat stroke. Also, at a cost of 19k for a device, I can't justify such a purchase when it'll make no difference in the treatment we provide.

I'll keep watching though.

STEMI treatment is becoming more and more common in the field, with TNK, Plavix, Heparin, and more being added to our arsenals.

[ERDoc]

This is not going to have much impact of CVA care as the CVAs we use tPA for are ischemic strokes, not hemorrhagic. I think it is better aimed at trauma care, although you will still need a CT scan anyway and here in the US, every hospital has a CT.

[scubanurse]

Interesting. I was under the impression EMS would recognize a STEMI and activate the cath lab at the receiving hospital to improve door to cath times, I was unaware of all the protocols in place to initiate treatment in the field. Looks like I'm so far out of the loop now!

[Arctickat]

Welcome to nursing.

Looks like I'm so far out of the loop now!

[rock_shoes]

Interesting. I was under the impression EMS would recognize a STEMI and activate the cath lab at the receiving hospital to improve door to cath times, I was unaware of all the protocols in place to initiate treatment in the field. Looks like I'm so far out of the loop now!

For your perusal.

http://eurheartj.oxfordjournals.org/content/26/19/2063.full.pdf

[fab]

There are currently two studies being conducted in Germany, the first one started a few years ago, basically a truck with a CT scanner in it without the ability to transport patients (Homburg). http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2812%2970057-1/abstract

The other one in Berlin with an ambulance eqipped with a CT scanner http://www.berliner-feuerwehr.de/2505.html?&L=1

http://www.youtube.com/watch?v=Ou9xr8CRnrw

They've been doing fairly well, although I would imagine they come with a huge pricetag. A neurologist, a radiology assistant and two paramedics (+radiologist on stand-by who receives the images), additionally the closest ambulance would be dispatched too...

[fakingpatience]

We were looking at getting a small portable ultrasound machine for the ambulances; I've heard that it can be used also for detecting ischemic or hemorrhagic strokes, not sure the details about it though.