In this podcast episode, Dennis interviews David Hardin, a general surgeon with experience in austere environments. They discuss the differences between surgeons in first-world and austere environments, the importance of improvisation, training and manpower considerations, supplies and procedures in austere surgery, moving patients in austere environments, preparing for austere surgery, making decisions in austere environments, logistics and equipment, dealing with loss, preparing for unknowns, ...
Feb 19, 2024•42 min
In this podcast episode, Dennis talks with Mark, a trauma surgeon, about lower extremity trauma and limb salvage. They discuss the decision-making process for determining if a limb is salvageable or not, the risk vs reward of tourniquet approximation, assessing motor function and arterial supply, the importance of preserving limb length, and the use of traction in pelvic fractures. They also touch on the struggles medics face in making these decisions and the importance of training and experienc...
Feb 16, 2024•39 min
In this podcast episode, Dennis and Antonio discuss the challenges and friction points that arise when working with providers from different countries. They explore how to iron out these issues efficiently to provide good care. The conversation covers topics such as common friction points on the ground, resolving conflicts and revamping protocols, establishing leadership, and learning from local providers. They also discuss the importance of adapting to different practices and resolving conflict...
Feb 12, 2024•30 min
In this podcast episode, Dennis and Doug discuss the importance of team dynamics in critical care, specifically when dealing with critically injured patients. They highlight the challenges that arise when team members work individually and fail to communicate effectively. The conversation explores the team dynamics at Baltimore Shock Trauma, where roles and positions are protocolized to ensure efficient patient care. The role of the team leader is emphasized as crucial in overseeing the entire r...
Feb 09, 2024•28 min
In this podcast episode, Dennis interviews JR Pickett, an ER physician and EMS medical director, about excited delirium. They discuss the definition and history of excited delirium, the challenges faced by law enforcement and medical providers in managing these cases, and the importance of timely intervention. They also explore the differences between excited delirium and other conditions, such as combative patients in combat situations. The conversation highlights the need for proper assessment...
Feb 05, 2024•48 min
Dr. Mark Shapiro discusses resilience and teamwork in the medical field during the COVID-19 pandemic. He highlights the differences between the civilian medical system and the military's approach to stress and resilience training. Dr. Shapiro emphasizes the importance of identifying and teaching resilience in medical professionals, as well as integrating stress inoculation into medical education. He also discusses the challenges of working in a crisis and the need for effective team composition ...
Feb 02, 2024•50 min
Today I chat with the Godfathers of PFC and discuss the concept of Prolonged Field Care (PFC) and its importance in military and civilian medical settings. It highlights the need for PFC in situations where evacuation is delayed or not possible, and the challenges faced by medics in providing care in such scenarios. The conversation also explores the civilian analog of PFC and the importance of risk management and training. It emphasizes the principles and evidence-based medicine behind PFC and ...
Jan 29, 2024•55 min
Dr. Ryan Maves discusses clinical medicine topics, specifically malaria and other tropical diseases. He emphasizes the importance of preventing infections when traveling in tropical and remote areas through vaccination, hand hygiene, malaria prophylaxis, insect repellents, and safer sex habits. He also provides resources for pre-deployment information. Dr. Maves shares a cautionary tale of a Marine Corps Lance Corporal with severe malaria and highlights the need for vigilance in diagnosing and t...
Jan 26, 2024•29 min
In this podcast episode, Dennis and Jeff discuss anoxic brain injury, its causes, progression, and treatment. They emphasize the importance of preventing anoxic brain injury by following the March algorithm and maintaining blood flow, airway patency, and oxygenation. They also discuss the role of monitoring and airway management in identifying and treating anoxic brain injury. The podcast covers the decision-making process for airway management and the importance of maintaining adequate oxygenat...
Jan 22, 2024•32 min
In this podcast episode, Dennis discusses the history and evolution of medical support in guerrilla warfare. He explores the role of unconventional warfare in the Army and provides examples of guerrilla warfare campaigns. Dennis also delves into the importance of surgical teams and the challenges of providing medical care in prolonged field care scenarios. He highlights the shift from the golden hour concept to the need for prolonged care in remote areas. Dennis concludes by discussing the futur...
Jan 19, 2024•28 min
In this podcast episode, Dennis interviews Eric and Ted from Prytime Medical about the P-REBOA catheter. They discuss the training process in Ukraine, the differences between the P-REBOA and the original REBOA catheter, the benefits of the P-REBOA in terms of balloon times and blood product use, and the complications and monitoring for reperfusion injury. They also address the placement of the catheter and the challenges of using it in the field. The episode concludes with information about futu...
Jan 15, 2024•43 min
In this podcast episode, Dennis interviews Ian, an ER physician with experience in wilderness medicine, about spinal trauma. They discuss the initial approach to spinal trauma, the process of clinically clearing the spine, the neuro exam for spinal trauma, and the treatment of neurogenic shock. They also cover the goals of fluid resuscitation, the use of vasopressors, and the prevention of complications such as pressure injuries and hypothermia. The episode concludes with a discussion on the use...
Jan 12, 2024•28 min
In this episode, Sean McKay discusses the challenges and considerations of subterranean mobility and rescue. He emphasizes the importance of understanding the geology and environmental pathology of underground environments, as well as the need for continuous training and innovation in equipment usage. McKay also highlights the significance of risk assessment and uncertainty management in rescue operations. Additionally, he explores the complexities of communication and coordination in subterrane...
Jan 08, 2024•1 hr 14 min
In this podcast episode, Nate, a Special Forces Detachment Commander, discusses the importance of incorporating medical training into team operations. He shares his journey of realizing the limitations of his own medical knowledge and the need to improve his personal medical capabilities. Nate emphasizes the importance of creating formalized Standard Operating Procedures (SOPs) for team clinics and the need to test and refine these plans. He also highlights the need for training medical reps in ...
Jan 05, 2024•25 min
In this episode, Dennis and Brad discuss the use of fentanyl in medical settings. They provide an overview of the background and development of fentanyl, highlighting its reliability and predictability as an opioid. They explain the characteristics and benefits of fentanyl, including its rapid onset, peak effect, and short duration. The conversation also covers the side effects and considerations of fentanyl, such as respiratory depression and histamine release. The appropriate administration an...
Jan 01, 2024•49 min
Dennis is interviewing Dr. John Quinn who's on the ground working Role 1 medical operations for an NGO somewhere in Ukraine. The lessons being learned by John and others during the early days of this conflict and the past 8 years can be used to help those on the ground now and into the future. This is an amazing opportunity to stay informed of current events and prepare ourselves by narrowing expectations and tweaking training. During the interview John stated that anything that can be done to f...
Dec 29, 2023•1 hr 6 min
Today, I'm joined by Rick, a senior medic with 18 years of experience in AFSOC and the Green Berets. We dive into lessons learned from mass casualty events, focusing on reactive and proactive scenarios. Rick recounts a harrowing mission in Eastern Afghanistan, where planning mishaps led to a challenging situation. They had to adapt on the fly, dealing with casualties and limited resources. Rick emphasizes the importance of improvisation, quick thinking, and knowing your available assets. He also...
Dec 27, 2023•1 hr 28 min
Merry Christmas...Today, we're diving into the nitty-gritty of ketamine – that mind-bending stuff, you know? So, ketamine's like this receptor blocker, messing with your brain's signals. It's a mixed bag, really. In low doses, it kills pain like a champ. But crank it up, and bam! You're in a world of dissociation. Picture it: brain's top half talking gibberish with the bottom half, and you're floating in a weird dream world. Thank you to Delta Development Team for in part, sponsoring this podcas...
Dec 25, 2023•53 min
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Dec 22, 2023•1 hr 8 min
This Podcast was from June of this year. This is Dennis, and today I'm joined by Anri, a Ukrainian medic who will share some lessons learned from the battlefield. Anri talks about how wound patterns change in urban versus rural areas, with urban areas having more trauma from shrapnel and secondary trauma from debris. He mentions the challenges medics face in treating these complex wounds, including fractures and extensive tissue damage caused by multiple waves of explosions. Anri also discusses ...
Dec 20, 2023•1 hr 8 min
In the latest episode of the PFC podcast, I spoke with Evan and Doug about airway management. As experienced airway takers in both pre-hospital and hospital settings, they had some valuable insights. We discussed the controversy over intubation versus cricothyrotomy. Evan and Doug raised some valid points, such as the need for suctioning and the difficulty of obtaining post-intubation sedation medication in resource-limited environments. We also talked about the importance of ongoing training to...
Dec 18, 2023•1 hr 16 min
In today's podcast, I chat with Aebhric OKelly the founder and Dean Emeritus of the College of Remote and Offshore Medicine (COROM) about Improvised medicine. I will be the first to say, as cool as it is to learn Improvised techniques, this is an emergency plan, not a way to lighten your ruck. We run through items for MARCH and principles to apply to this problem. This is only part one, so plenty more in the next episode, when we go through PFC and improvised gear. Thank you to Delta Development...
Dec 15, 2023•1 hr 7 min
Dennis and Kevin Worth talk about combat anesthesia. The podcast discusses the four pillars of anesthesia, which are amnesia, analgesia, akinesia, and autonomic stability. The focus is on the importance of autonomic stability in combat situations. The best medication for amnesia in a downrange environment is Midazolam or Versed, and ketamine is a potent analgesic. The podcast also covers the MAP (mean arterial pressure) and how to maintain it in trauma patients. Finally, the podcast discusses va...
Dec 13, 2023•48 min
Now, let's dive into treating tension pneumothorax. Joined by Andy Fisher, our favorite surgery resident and social media provocateur. We're talking IFAC essentials and the needle decompression debate. Andy's been stirring the pot, suggesting ditching Needle D's from the IFAC due to lack of official backing. The IFAC's about saving lives for non-medics, but is it hemorrhage, not tension, we should focus on? Special ops pushed decompression needles, but is it justified? Andy questions the success...
Dec 11, 2023•50 min
For the rest of the month, every Mon, Wed, and Fri, I will be posting the top 10 podcasts of '23. I will resume with the regular schedule on New Year's Day. Happy Holidays. This podcast discusses the importance of patient positioning in prolonged field care. The guest, Ethan Miles, a board-certified family medicine physician with extensive military experience, emphasizes that patient positioning is a forgotten aspect of medical training and that simple, low-cost interventions are often overlooke...
Dec 08, 2023•38 min
Dennis discusses MDMA therapy for PTSD with guest Emily, a pharmacist. They explore how MDMA is being researched as a treatment for combat-related PTSD, especially when conventional medications like SSRIs and SNRIs fall short. MDMA offers a unique approach by providing stimulating effects while fostering empathy and helping patients reprocess traumatic memories. Emily emphasizes the importance of integration in therapy. Clinical trials have shown promising results, with 67% of participants achie...
Dec 04, 2023•35 min
Dr. Givens talks about dealing with CBRNE patients in the field. They discuss the need for standardized approaches and clinical guidelines. I'm all about simplifying things and making them user-friendly. The hot zone requires quick thinking and auto injectors for CBRNE agents. They emphasize the importance of TCCC and teamwork. Dr. Givens covers various agents like nerve agents, cyanide, chlorine, and more, offering practical insights for handling them. Thank you to Delta Development Team for in...
Dec 01, 2023•38 min
"Correction: The correct initial dose of lipid emulsion is 1.5mL/kg, not 1 mL/kg" Dennis interviews Sandeep, an anesthesiologist with military experience, about the use of IV lidocaine for acute pain management. Sandeep explains that IV lidocaine can be a useful opioid-sparing option, especially in austere environments with limited resources. While it has a narrow therapeutic window, proper dosing can provide analgesia and reduce opioid consumption. Sandeep emphasizes the importance of safety co...
Nov 27, 2023•55 min
Dennis hosts two special guests, Stacy Shackelford and Doc Rush, to discuss rethinking triage. They emphasize the need for a shift in the way medics are trained and how triage is approached. They challenge traditional triage algorithms and encourage a more flexible, data-driven approach that prioritizes time-sensitive interventions such as hemorrhage control and airway management. The conversation also touches on the importance of training medics in trauma care, the role of team leaders in risk ...
Nov 24, 2023•1 hr
Just in case....
Nov 23, 2023•29 min
