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Introduction: Bradyarrhythmias are a common entity in both emergency and out-of-hospital (OOH) medicine. In unstable bradycardic patients, paramedics will often initiate life-saving therapies in the OOH setting. Clinical guidelines for bradyarrhythmias are largely consistent across the globe, with intravenous (IV) atropine recommended as a first-line therapy, escalating to IV adrenaline or isoprenaline and transcutaneous pacing where atropine is unsuccessful. In this case report, we describe a case in the OOH setting of ventricular standstill following the administration of atropine to a patient with bradycardia and 2:1 heart block. Case presentation: The patient was a 77-year-old female presenting with a symptomatic 2:1 heart block. Following a single dose of 600 micrograms IV atropine, the patient deteriorated into ventricular standstill with a loss of consciousness and decorticate posturing. The patient was successfully managed with an IV infusion of adrenaline and subsequently received an implanted pacemaker in hospital. Conclusion: The paradoxical worsening of this patient’s bradycardia following atropine administration may have been related to the location of the heart block. It has been shown that patients with atrioventricular blocks at the level of the His-Purkinje fibres (infranodal) are at an increased risk of adverse events following atropine administration, while those at the nodal level or secondary to increased vagal tone are more likely to respond favourably. Paramedics should be prepared to manage unexpected adverse events secondary to atropine administration in patients with heart block. [ABSTRACT FROM AUTHOR]

Emergency health services (EHS) have experienced a steady increase in demand from palliative patients accessing 9-1-1 during times of acute crisis, although the majority of these patients do not wish for conveyance to hospital following paramedic treatment. To address this demand, and to provide patients with the right care, the first time, the British Columbia Emergency Health Service (BCEHS) introduced the province's first Assess, See, Treat and Refer (ASTaR) Clinical Pathway. This alternative model of care is intended to improve patient-oriented care by providing care for patients in their own home and reducing the requirement for conveyance to the emergency department, thus reducing the requirement for hospitalization. Launched in June 2019, the ASTaR Pathway includes the early recognition of patients with palliative needs accessing 9-1-1, the use of secondary triage services and the automatic notification and referral of non-conveyed patients to primary healthcare teams for patient follow-up. The following commentary outlines the early integration of the ASTaR Palliative Clinical Pathway into the BCEHS paramedic approach to palliative patient care. [ABSTRACT FROM AUTHOR]

A 30-year-old male presents to emergency medical services profoundly combative with a Richmond Agitation–Sedation Scale of +4 after reported use of intravenous methamphetamines. A preliminary diagnosis of excited delirium syndrome is made based on the history obtained and the decision is made to chemically sedate the patient. While preparing for sedation, you wonder which pharmacological agent will produce the fastest and safest sedation in this patient population. [ABSTRACT FROM AUTHOR]

This article develops a classification system for the orientations to enrolment of part-time students based upon their practical lifelong learning needs. Orientation to enrolment is seen as a complex construct embodying all the reasons, purposes, expectations and motivations that cause students to pick a particular course and elect to study by the part-time mode. Virtually all of the interviewed students had a vocational orientation so some previously used categorisation schemes were not suitable. Instead seven categories relating to lifelong learning needs provided a scheme which covered the cases and related well to explanations given by interviewees for enrolling in the courses. These were re-training or further development for those who need to make a career shift; education for professionals who need to undertake continuing professional development through their careers; an opportunity for a tertiary education for those who did not previously have the chance; an education at the tertiary level for those who did not do sufficiently well at school to qualify for direct entry to university; an alternative to mainstream education; education for adults; and learning for pleasure throughout the lifetime. [ABSTRACT FROM AUTHOR]

Presents information on the book 'Coleridge the Talker,' published in 1940. Narration on the oratory of conversationalist, Samuel Taylor Coleridge in the book; Impact of Coleridge's oratory on the people.

Background: Half of out-of-hospital cardiac arrests (OHCA) are deemed inappropriate for resuscitation by emergency medical services (EMS). We investigated patient characteristics and reasons for non-treatment of OHCAs, and determined the proportion involving illicit drug use.Methods: We reviewed consecutive EMS-untreated OHCA from the British Columbia Cardiac Arrest Registry (2019-2020). We abstracted patient characteristics and categorized reasons for EMS non-treatment: (1) prolonged interval from the OHCA to EMS arrival ("non-recent OHCA") with or without signs of "obvious death"; (2) do-not-resuscitate (DNR) order; (3) terminal disease; (4) verbal directive; and (5) unspecified. We abstracted clinical details regarding a history of, or evidence at the scene of, illicit drug use.Results: Of 13 331 cases, 5959 (45%) were not treated by EMS. The median age was 67 (IQR 54-81) and 1903 (32%) were female. EMS withheld resuscitation due to: non-recent OHCA, with and without signs of "obvious death" in 4749 (80%) and 108 (1.8%), respectively; DNR order in 952 (16%); terminal disease in 77 (1.3%); family directive in 41 (0.69%); and unspecified in 32 (0.54%). Overall and among those with non-recent OHCA, 695/5959 (12%) and 691/4857 (14%) had either a history of or evidence of recent illicit drug use, respectively.Conclusion: A prolonged interval from the OHCA until EMS assessment was the predominant reason for withholding treatment. Innovative solutions to decrease this interval may increase the proportion of OHCA that are treated by EMS and overall outcomes. Targeted interventions for illicit-drug use-related OHCAs may add additional benefit. [ABSTRACT FROM AUTHOR]