The Podcast Crew is joined by Spokane Valley Fire Paramedic Noah Martinez to discuss a recent patient that he delivered to Dr. Patrick. After you hear what Noah found on the scene, this story will likely not end exactly how you expect. Learn some foundational hypothermia management pearls AND why early emergency neuro-prognostication can be exceedingly difficult.
Chemical sedation is one of the riskiest decisions made in EMS clinical care, period. We've been working overtime at MCHD over the past couple of years to decrease the risk and improve our safety profile for the entire clinical package when we sedate patients for severe agitation in Montgomery County. Join us to learn about the MCHD SNORES safety bundle based on the 5 P's and how you can easily implement this into your service. • Partnerships • Preparation • Pharmacology • Positioning • Possibil...
Join us as Dr. Dickson brings a couple of extremely difficult recent emergency department cases to take a hard look in his own clinical mirror. These will highlight the difficult and often dynamic nature of assessing airway patency and protection in real time. Speaking of dynamic, vascular emergencies like stroke and STEMI often progress unexpectedly. REFERENCES 1. Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists' prediction of...
MCHD paramedic, Lily Trosclair, joins the podcast to discuss some in-depth hyperkalemia treatment details, including BRASH syndrome. We'll also pivot to the dangers of giving amiodarone to a hyperkalemic patient that's mistaken for ventricular tachycardia. REFERENCES 1. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/ 2. https://www.youtube.com/watch?v=UXh8PS9dtmo&t=2s 3. McArthur R, Rafique Z, Ward B, Rodriguez L, Dickson R, Patrick C. Trea...
This may seem like a curveball-type episode upon your initial listen, but this topic should be core material for all emergency medical clinicians. Too much time and emphasis within paramedic education are placed on rare presentations. Dr. Dickson and Dr. Patrick expand on a recent medical podcast/article (see links below), stressing the need to embrace learning and teaching the most common conditions we care for. REFERENCES 1. https://podcasts.apple.com/us/podcast/episode-19-juan-lessing-and-rea...
The podcast crew is joined, live at Texas EMS 2022, by Dr. Gerad Troutman to discuss the world of alternate destination EMS transports, EMS-facilitated telehealth, nurse navigation, and "hospital at home." Dr. Troutman leads the ET3 initiative and is the National Medical Director for Innovative Practice at GMR, so this episode is full of successes, road bumps, and shared experiences with the implementation and execution of each of these leading-edge concepts within prehospital care.
MCHD medics Kelcie Adams and Rich Serra join the podcast to discuss a critically ill trauma patient they delivered to Dr. Patrick in the emergency department. Our default is so often airway, airway, airway first, but prioritizing circulation first was likely life-saving. This is an excellent "Monday Morning Quarterback" case to look back on and dissect with tons of educational pearls.
Special guest alert!! We're lucky to have superstar Aussie medic and University of Melbourne Ph.D. candidate Matt Wilkison-Stokes, on this episode to discuss his recent paper looking at the risk of hypotension with nitroglycerin administration in acute MI. Where is NTG really more likely to cause hypotension in AMI? When is it safest? How often do isolated RVMI's occur, and what are the correct diagnostic criteria? Dr. Patrick changed his practice based on Matt's work and knowledge. See if you m...
We have MCHD Cpt. Megan Powell to thank for this episode as she posed an excellent question about where and how to look for trusted educational information as a practicing paramedic interested in continuing clinical growth and progression. With the amazing and immense amount of free online textbook, blog, and podcast resources available, trying to keep up can be totally daunting. Join Megan and the podcast crew as they discuss tips and strategies to manage the waterfall of open-access EMS educat...
Join this discussion of some of the recent literature surrounding EMS care of traumatic brain injury with Dr. Al Lulla. This is the perfect confluence of advancing evidence, relatively straightforward interventions, and a patient population where we can definitely improve prehospital outcomes. See where the literature, education, and protocol implementation can meet to improve TBI outcomes in your EMS service. REFERENCES 1. Spaite DW, Hu C, Bobrow BJ, et al. Optimal Out-of-Hospital Blood Pressur...
When it comes to exciting educational topics in EMS, oftentimes, the endocrine system, specifically the adrenal glands, can be left off the list. Dr. Patrick is joined by one of our local emergency/trauma nurses, Melanie Gander, to discuss her journey as a parent of a child with congenital adrenal hyperplasia. We'll review basic adrenal physiology and discuss the caveats on how to recognize and treat adrenal crises in the field. REFERENCES 1. https://united4rare.org/ 2. https://caresfoundation.o...
Across the world of health care, everyone is wrestling with how to reduce medication errors. With the decision in the Vanderbilt case, there is now the added fear of potential prosecution for giving an incorrect medication. Join the podcast crew as they try to better define the various types of medication errors while looking at what the literature says about medication errors in EMS. REFERENCES 1. Walker D, Moloney C, SueSee B, Sharples R, Blackman R, Long D, Hou XY. Factors Influencing Medicat...
Join the Podcast Crew as they answer some recent questions submitted to podcast@mchd-tx.org. We discuss a wide range of topics including epinephrine drips, IV Tylenol for pain, Knee-BOA, whole blood in EMS, the green whistle (methoxyflurane), and an awesome "S" for our loss of airway protection teaching files. Thanks to all our listeners out there!! REFERENCES 1. O'Dochartaigh D, Picard CT, Brindley PG, Douma MJ. Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices,...
The Podcast Crew is joined by MCHD District Chief, Spencer Hall, to discuss a recent trauma patient that Chief Hall delivered to Dr. Patrick's ED care. This one encapsulates many of our recent podcast topics including the tenets of DSI and the importance of maintaining oxygenation and blood pressure in TBI patients.
The MCHD Paramedic Podcast would like to welcome EM/EMS physician Dr. Katherine Luu, to Montgomery County. Dr. Luu joins the podcast to discuss anchoring bias and how this impacts medics in the field. Listen and learn how to describe, recognize, and prevent anchoring bias in your practice. REFERENCES 1. https://onlinelibrary.wiley.com/doi/epdf/10.1197/aemj.9.11.1184 2. https://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman-ebook/dp/B00555X8OA/ref=sr_1_1?crid=24FYPXSEKVE8Y&keywords=thinkin...
Brief resolved unexplained what?? MCHD paramedic, Cpt. Clayton Smith, joins Dr. Dickson to discuss an EMS approach to BRUE's. These can often be falsely reassuring to prehospital providers because the event, by definition, has resolved prior to EMS arrival. But don't get too comfortable because up to 4-5% of BRUE's can have severe underlying diagnoses as the cause. We can never talk too much "sick peds" material on the podcast. This episode will make the approach to your next BRUE a breeze. REFE...
The Podcast crew is joined by MCHD In-Charge Paramedic Brady Walding to discuss a recent difficult STEMI case that intersected with Dr. Patrick in the ED. How do we best communicate with our consultants when we disagree? What happens when a paradigm shift is occurring without our consultants (STEMI vs. OMI/NOMI)? We are excited about our new Monday Morning Quarterback Series, where Dr. Patrick and Dickson review their cases with the MCHD medics involved. Hopefully, you will enjoy it as well!! RE...
The podcast crew welcomes newly transplanted Texan EMS physician, Dr. Louis Fornage, to join in on some rapid-fire mythbusting for 2022. We run the gamut from post-ROSC vasopressor evidence to whether or not saying "QUIET" affects emergency department volume. REFERENCES 1. https://www.nremt.org/News/National-Registry-of-EMT-s-Resource-Document-on-Sp#:~:text=NREMT's%20use%20of%20the%20term,most%20trauma%20patients%20is%20unproven 2. https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/s12879-...
Join the podcast crew as they turn their attention from the EMS transport to the First Responders here in Montgomery County. We welcome MCHD FRO Coordinator Bryan Perry and Chief Ray Vaden from Porter Fire to discuss some recent FRO initiatives and advances. It wouldn't be the MCHD Paramedic Podcast if we also didn't slip in some recent CARES research highlighting improved OHCA outcomes when fire and police can initiate life-saving interventions. REFERENCES 1. Salhi RA, Hammond S, Lehrich JL, O'...
True anaphylactic shock can be one of the most harrowing calls in all of EMS and emergency medicine. However, as is true with much of our core clinical content, dogma and myths persist. MCHD District Chief Spencer Hall joins the podcast crew to discuss anaphylaxis diagnostic criteria, treatment, and much more. REFERENCES 1. Anagnostou K, Turner PJ. Myths, facts, and controversies in the diagnosis and management of anaphylaxis. Arch Dis Child. 2019 Jan;104(1):83-90. 2. Pumphrey RS. Lessons for ma...
Join Dr. Patrick and MCHD District Chief and Bike Team lead, Scott Sanders, as they discuss the MCHD Bike Team. What does it take to be an MCHD bike team medic? How does patient care differ from the truck vs. when on the bike? Learn how the MCHD Bike Team fills multiple invaluable roles in the county. Photo Link - https://www.mchd-tx.org/media/podcasts/Bike-Team.jpg
Friend of the podcast emergency physician, addiction specialist, and toxicologist extraordinaire, Dr. Jerry Snow joins the podcast crew to discuss a scary and potentially deadly twist in the opiate crisis…xylazine. Dr. Snow will school us all about xylazine pharmacology and treatment tips and why EMS high-dose naloxone may not be ideal. REFERENCES 1. https://www.acep.org/tacticalem/newsroom/oct-2021/xylazine-an-emerging-adulterant/ 2. https://www.kxan.com/news/drug-responsible-for-recent-overdos...
There is no possible way to improve ketamine, right? Join Dr. Patrick for a discussion of exciting recent literature investigating the effectiveness and safety of nebulized ketamine for emergency department analgesia. Everyone's favorite EMS medication may be primed for an enhanced delivery option. REFERENCES 1. Dove D, et al. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Cl...
Join the podcast crew, District Chief Kevin Mifflin and In-Charge Payden Seals as they discuss our MCHD Case of The Quarter for Q1 2022. This case is a prime example why field providers must keep wide differentials with a keen awareness of the initial scene situational factors. REFERENCES 1. https://coreem.net/core/hypothermia/ 2. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-environmental/hypothermia
The medical directors revisit one of our old favorites "The Serial Killers Series" to discuss 5 trauma killers to keep in your front brain as you are preparing or caring for a sick trauma patient. If you've not considered your differential diagnosis until patient contact and initial evaluation then you're too late. Following this episode, you'll be ready to evaluate, act and prevent acute hemorrhage, obstructive shock, hypoxia, traumatic brain injury and DIC in your sickest trauma patients. PDF ...
Join Dr. Dickson and the podcast crew as they dive into the MCHD approach to mass casualty incidents. We're lucky to be joined by MCHD Safety and Preparedness Officer, Sean Simmonds and MCHD District Chief Ryan Davenport. These are field medics talking about actual logical field pearls for MCI management.
Episode 127 - Airway Patency Vs. Protection by Montgomery County Hospital District
On Episode 126, the podcast crew was able to catch up with the one and only Dr. Jeff Jarvis at Texas EMS in Austin. Dr. Jarvis is a longtime fan of droperidol for multiple uses in the prehospital setting ranging from acute headache treatment to sedation and as an anti-emetic. Let this be a warning, we're all droperidol zealots in this discussion. Listen and learn practical ways to implement droperidol into your EMS practice.
Texas has been the epicenter of the ground-based EMS integration of whole blood programs for hemorrhagic shock in the prehospital setting. The MCHD clinical staff have been watching the evidence closely and feeling the push from our own medics. Join Dr. Dickson and Dr. Patrick as they discuss the "why" behind no whole blood at MCHD (yet...). Send any requests, questions or ideas to podcast@mchd-tx.org REFERENCES - https://bit.ly/3M6De5N
Join the podcast crew and MCHD medic Lily Trosclair as she discusses our MCHD Case of The Quarter for Q4 2021. This one began with a pediatric cardiorespiratory arrest but fortunately has a happy ending. REFERENCES 1. Heffner AC, Swords D, Kline JA, Jones AE. The frequency and significance of postintubation hypotension during emergency airway management. J Crit Care. 2012 Aug;27(4):417.e9-13. 2. http://www.emdocs.net/critical-asthma-patient-pearlspitfalls-of-management/
