JRCALC Clinical Guidelines 2022

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Updated guidance on mechanical chest compression devices and use of ultrasound. Other key changes include: This important eCPD event, designed for all paramedics, offered a unique opportunity to engage with the leaders and authors of the UK Clinical Practice Guidelines 2021.

Once a tracheal tube is in place, continue continuous chest compressions with 10 gentle ventilations per minute. Avoid hyperventilation and high airway pressures during manual ventilation which adversely affect outcome. A revised standalone guideline for the management of breech birth with a new algorithm. This has been informed by evidence where it is available and learning from adverse incidents and coroners inquests. Includes guidance on practical procedures and manoeuvres to deliver a breech baby, with images, photos and links to short video clips. Includes specific guidance on when to leave scene immediately, details around when birth is imminent or not imminent, maternal positioning (semi recumbent and all fours positions), timings and when to perform manoeuvres if needed. The decision to terminate resuscitation has been increased to 30 minutes from 20 minutes: If, following ALS interventions, the patient has been persistently and continuously asystolic for 30 minutes and all reversible causes have been identified and corrected, resuscitation may be discontinued except in cases listed below. New wording around frailty scoring added: consider using the clinical frailty scale, as per local pathways.The first update bundle of 2023 includes a new guideline for Agitated patients. This will sit alongside the existing guidance for acute behavioural disturbance (ABD). JRCALC are also in the process of developing new guidance on delirium. Agitation can have multiple causes and the clinical management can be challenging. The focus should be on identifying and treating, or arranging to treat the underlying cause. Initial adult dose for oral morphine (not end of life) changed from 20mg, to 10-20mg, as it is now indicated for moderate pain. If you have any questions about the guidelines, please visit https://aace.org.uk/jrcalc-qas/ , which publishes answers to commonly asked questions. Dosages amended to ‘N/A’ for birth – at birth babies do not have any stores of glycogen so glucagon does not work.

Adult patients with a cardiac arrest of presumed primary cardiac aetiology should be transported directly to a hospital with 24/7 coronary angiography capability (Both STEMI and Non-STEMI patients). Diazepam oil in water emulsion is now a discontinued medicine, so this presentation will be removed from JRCALC. Diazepam solution will remain. New indication for oral morphine: ‘Oral morphine can be used as a component of managing moderate pain’. This session looks at what will be in the new guideline and indicates how to spot red flags and serious pathologies – along with when and when not to convey – and what are the assessment, management & analgesic options available to paramedics. Dosage and administration: If stronger analgesia is required, patient can cover dilutor hole on the activated carbon chamber with finger during use. (New image included)

Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives. (2019). JRCALC Clinical Guidelines. Cited from: iCPG (2016) (Version XX) [Mobile application software]. Bridgwater: Class Publishing Ltd. Accessed XX. We will endeavour to answer your question promptly having consulted with JRCALC experts as necessary. Of the questions we receive there are often common themes; below is a searchable facility to review the questions and answers given. Do not give nitrous oxide for patients with chest injuries and a clinically suspected pneumothorax. Over 2,000 multiple choice questionson the JRCALC Guidelines, covering the full breadth of paramedic practice, from vulnerable patient groups to obstetrics to trauma.