Freestanding emergency departments are becoming more and more common across the United States. Here at MCHD, we feel that EMS transport to these sites can be beneficial to both our system and the community as well. During today's episode, Dr. Patrick is joined by multiple hospital partners for some enlightening FSED myth-busting.
Thankfully, we finally have some positive COVID-19 news to discuss. Join the medical directors for a discussion of vaccine basics and some of the specific issues EMS and public health will likely encounter with COVID-19 vaccine administration. REFERENCES 1. https://podcasts.apple.com/us/podcast/stimulus/id1501107371?i=1000494006283 2. https://www.chop.edu/centers-programs/vaccine-education-center/making-vaccines/prevent-covid 3. https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccin...
We’ve discussed burnout on the podcast in the past. When thinking about ways to combat burnout, a word that often comes up is resilience. Emergency care was stressful enough, then 2020 decided to add COVID to the mix. Join the podcast crew and special guest Kris Kaull as we talk about ways to foster resilience as an EMS provider which will hopefully extinguish burnout before it spreads. REFERENCES 1. https://www.kevinmd.com/blog/2020/08/7-habits-of-highly-resilient-physicians.html 2. https://www...
Sometimes in medicine, we do things just because they’ve always been done that way, which is terrible reasoning. Valsalva maneuver followed by the two-syringe technique for adenosine administration has been standard practice in PSVT management for decades. Recent data suggests that both of these approaches may have better alternatives. Join Dr. Patrick and Brad Ward as they provide updates on both non-pharmacologic and pharmacologic management of PSVT. REFERENCES 1. McDowell M et al. Single-Syri...
If there is one topic that we love at MCHD, it’s discussing bolus dose nitroglycerin in acute pulmonary edema patients. We’re lucky to have more positive evidence supporting it’s use thanks to Mike Perlmutter and his colleagues from North Memorial in Minneapolis. Join Dr. Patrick and Mike as they geek out over high dose nitrate use in EMS. REFERENCES 1. https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/prehospital-treatment-of-acute-pulmonary-edema-with-intravenou...
When thinking of what strikes fear in paramedics, most would think of answers like pediatric arrests, precipitous deliveries, and unstable bradycardias. A hidden source of misery here at MCHD is the fear of the oral scenario exams for advancement. Yes, these are artificial and do not always reflect reality, but they are a necessary evil. Join Dr. Dickson and Dr. Patrick as they try and provide some framework for attacking and succeeding when taking oral scenario exams. REFERENCES https://www.mch...
The capnography tracing is an excellent tool that gives us insight into cellular metabolism, perfusion, and ventilation. This can yield vital information in multiple critical patient care decision processes. Join Dr. Patrick and Dr. Dickson as they walk through some ETCO2 interpretation basics. We are limited on the amount of objective information available during prehospital care, don’t ignore this vital piece of our puzzle. REFERENCES 1. https://www.cambridge.org/core/journals/prehospital-and-...
Join Dr. Dickson and our esteemed colleagues from across the globe to hear how their systems have responded to the COVID-19 pandemic and what they have learned from the experience thus far. Dr. Colin Graham is an EM specialist from Hong Kong who practiced there for the first SARS outbreak and is now tackling Corona Part 2. Additionally, we’ll be joined by Dr. Al Meyer, an EM specialist in Melbourne, Australia. This episode truly gives us a worldwide COVID-19 perspective. Colin Graham qualified f...
We're joined by a special guest, Dr. Jeff Jarvis, to talk about his recent PEC manuscript investigating potential life-saving interventions in the prehospital setting and their association with "lights and sirens" usage. Be prepared for some dogma challenging discussion! REFERENCES: https://www.tandfonline.com/doi/abs/10.1080/10903127.2020.1797963
The firehose of information that is COVID-19 has slowed somewhat since we last discussed the pandemic, but the first wave has obviously persisted. On this episode, Dr. Patrick and Dr. Dickson address some of the recent COVID developments in treatment, return-to-work policy updates from the CDC and crazy complications seen in pediatric patients. REFERENCES 1. https://www.cebm.net/covid-19/what-is-the-effectiveness-of-protective-gowns-and-aprons-against-covid-19-in-primary-care-settings/ 2. https:...
We’ve discussed TXA, both for trauma and for epistaxis, on the podcast previously. Medics often ask about TXA in the acute GI bleed patients who are in hemorrhagic shock...“What can it hurt? It’s worth a try, right?” While TXA may seem like a harmless hail Mary, on this episode, Dr. Patrick reviews the HALT-IT study and discusses why TXA for acute GI bleeds is likely harmful and probably dead in the water as a treatment option. REFERENCES: 1. https://www.thelancet.com/journals/lancet/article/PII...
This episode tackles the definition of "stupidity" and how this relates to prehospital medical care. Dr. Patrick is joined by Kris Kaull to discuss the definition of stupid, risk factors for making stupid moves and how to possibly prevent these in the EMS setting. REFERENCES 1. Episode inspiration - https://fs.blog/2019/01/how-not-to-be-stupid/ 2. Checklist Manifesto - http://atulgawande.com/book/the-checklist-manifesto/ https://www.amazon.com/gp/product/0312430000/ 3. Avalanche TedX talk - http...
We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to sp...
We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to sp...
We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to sp...
We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic chest pain scene with unstable vitals then filter to a differential of #1 PE, #2 ACS, #3 TAD is often quite challenging. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses th...
For the last couple months, we've been talking COVID-19 exclusively here at the MCHD Paramedic Podcast. On this episode, ops takes center stage with a discussion of our PPE/COVID-19 experience. We share our lessons learned and wish list for the future. Take a listen and please hit us up at podcast@mchd-tx.org if you have questions or experiences you'd like to share! REFERENCES: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
Unless you live under a rock, you've heard discussions of the pros and cons of using hydroxychloroquine (HCQ) when treating COVID-19 patients. On this episode, Dr. Patrick is joined by our favorite toxicologist, Dr. Jerry Snow, to talk about what happens in a HCQ ingestion situation. With the increased publicity of this drug, we must be on high alert in the prehospital setting for potential accidental and intentional overdoses. Listen and learn what to expect and how to treat someone who's taken...
We've had continued rapid local and national developments surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the MCHD specific airway algorithm in the era of COVID-19. REFERENCES: https://www.mchd-tx.org/media/podcasts/MCHD-COVID-19-FINAL-AIRWAY-.pdf
We've had continued rapid local and national developments over the past week surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the most current evidence surrounding airway management in the era of COVID-19. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html 2. https://emcrit.org/emcrit/some-additional-covid-airway-management-thoughts/ 3. https://www.safeairwaysociety.org/covid19/ 4. VALLEY, T ET AL. ASSOCIATION BETWEEN NONINVASI...
We've had rapid local and national developments over the past week surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the most current evidence. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html
Choking babies, seizing kids, and floppy infants turning blue...all of these events are significantly anxiety inducing for both emergency providers and families alike. On this episode, Dr. Patrick is joined by Dr. Manish Shah, a pediatric emergency medicine physician and research expert from Texas Children's Hospital. The discussion will begin with the finer points of febrile seizures and then branch off into the "artist formerly known as ALTE" - the BRUE. Follwing this episode you'll be much be...
We all love cardiac arrest with VF as the presenting rhythm. These are the ones that walk out of the hospital. But, what happens when you shock, shock, shock and still VF? Today the podcast team addresses refractory ventricular fibrillation/electrical storm and specifically the role of esmolol in this condition. Esmolol is an emerging treatment for refractory VF that makes absolute physiologic sense, however the data is limited. Dr. Patrick addresses the pathophysiology, evidence and MCHD’s appr...
A proper sleeping environment is vital for infant safety. On this episode Dr. Patrick is joined by two "safe sleep" experts - MCHD's own, Aston Herring and Dr. Lisa Owens from Texas Children's Hospital. After listening, you'll know how to recognize what exactly constitutes unsafe sleep and more importantly understand the impact that sleep environment can have on otherwise healthy infants. Join us as we attempt to shine a light on a potentially deadly problem with surprisingly simple solutions. R...
Over the past week we’ve had several local false alarms with possible patients presenting with the 2019 Novel Coronovirus. On this special release, the podcast crew will discuss the impact of this worrisome viral infection on EMS providers. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html 2. https://jamanetwork.com/journals/jama/pages/jama-author-interviews
Tracheostomy patients can be intimidating and confusing with complex recent medical histories and unfamiliar terminology surrounding the surgical hole placed in their neck. Join Dr. Patrick as he attempts to demystify the tracheostomy tube and provide a framework to utilize when approaching the crashing trached patient. REFERENCES 1. http://www.tracheostomy.org.uk/storage/files/Patent%20Airway%20Algorith m.pdf 2. http://www.tracheostomy.org.uk 3. Mcgrath BA et al. Guidelines Multidisciplinary gu...
While attending the 2019 Texas EMS Conference, Dr. Dickson and Chief Crocker were lucky enough to sit down with Dr. Jeff Jarvis from Williamson County EMS to discuss the background and evolution of the Texas CARES registry. We'll introduce the purpose of Texas CARES along with the ways in which it can benefit your service. REFERENCES 1. https://tx-cares.com
Continuing with the dizziness theme for the 2019 holiday season, Dr. Dickson is joined on episode 67 by Dr. Jeremiah Johnson. Dr. Johnson is a neurosurgeon here in Montgomery County where he's the Director of the Comprehensive Stroke program at CHI-St. Luke's Hospital in The Woodlands. We all recognize the combination of aphasia with face and extremity weakness that occurs in anterior circulation strokes. But, how do posterior strokes present? How common are they? Are posterior strokes time sens...
Join Dr. Dickson as he takes a trip down under to talk with Dr. Alastair Meyer about the often dreaded chief complaint of dizziness. Dr. Meyer is the Director of Emergency Medicine for Monash Health in Melbourne. The differential diagnosis for the commonly encountered dizzy patient is broad and consists of many non-emergent conditions along with deadly pathology as well. This combination can be a recipe for disaster. This episode will leave listeners with the deadly dizzy diseases and a framewor...
Our population is aging, and heart failure is only going to increase. This will inevitably lead to an increase of patients with left ventricular assist devices. New technology can be intimidating and confusing with complex recent medical histories and unfamiliar terminology surrounding the various LVAD brands. Join the podcast crew as we attempt to simply an EMS approach to the LVAD patient. REFERENCES: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123099/pdf/wjem-19-834.pdf 2. https://emj.bm...
