MCHD Paramedic Podcast

With the recent transition of IV acetaminophen from patent to generic, it's a good time to discuss MCHD's 2021 NAEMSP abstract describing our prehospital experience with IV tylenol for pain.  If you've not looked into bringing this tool into your service, listen today to be convinced why IV Tylenol is an option worth considering across EMS.

REFERENCES
1. Mahshidfar B, Rezai M, et al. Intravenous Acetaminophen vs. Ketorolac in Terms of Pain Management in Prehospital Emergency Services: A Randomized Clinical Trial. Adv J Emerg Med. 2019 May 8;3(4):e37

2.Bijur PE, Friedman BW, et al. Randomized Clinical Trial of Intravenous (IV) Acetaminophen as an Adjunct to IV Hydromorphone for Acute Severe Pain in Emergency Department Patients. Acad Emerg Med. 2020 Aug;27(8):717-724.

Episode 117 - Prehospital IV Tylenol

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.

Episode 126 - Droperidol With Dr. Jeff Jarvis - Live From Texas EMS

Wherever you turn in the world today, social media is present with constantly expanding visibility and influence.  Join MCHD's Chief of EMS James Campbell and Public Information Officer Misti Willingham as they discuss some lessons and ground rules on how to successfully integrate an active social media program into your EMS service.

Episode 123 - Social Media and EMS - Live From Texas EMS

It’s time to review some recent cardiac arrest literature.  Both of today’s articles come from Resuscitation and address predictors of OHCA survival.  Should we take a third attempt at intubating an OHCA patient, should we intubate OHCA at all?  What about PEA arrest, can ETCO2 help identify pseudo-PEA?  Listen to get some hot off the press OHCA literature updates.

REFERENCES
1. Murphy DL et al. Fewer tracheal intubation attempts are associated with improved neurologically intact survival following out-of-hospital cardiac arrest. Resuscitation. 2021 Oct;167:289-296.

2. Crickmer M, et al. The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity. Resuscitation. 2021 Oct;167:76-81.

3. Bergum D, et al. ECG patterns in early pulseless electrical activity-Associations with aetiology and survival of in-hospital cardiac arrest. Resuscitation. 2016 Jul;104:34-9.

Episode 122 - Cardiac Arrest Literature Update

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/

Episode 124 - Awful Asthma - MCHD COTQ Q4 2021

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

Episode 125 - Why No MCHD Whole Blood (Yet...)

Welcome to MCHD's Paramedic Podcast - a biweekly podcast dedicated to EMS Providers across the world.

Introduction to THE MCHD Paramedic Podcast

Featuring Dr. Peter Antevy

Today’s show will focus on the evolution in the EMS approach to pediatric resuscitations. Historically these high stress resuscitations focused on rapid transport of these children to the hospital and have resulted in sub par resuscitation efforts and increased stress for both providers and families. There is mounting evidence that mirrors the adult resuscitation data that staying on scene and providing focused resuscitation efforts improves outcomes in these patients. Dr. Antevy provides a unique perspective as both a pediatric EM specialist/EMS medical director and inventor of the Handtevy pediatric resuscitation system.

https://www.handtevy.com

Episode 2 - Pediatric Resuscitation Featuring Dr. Peter Antevy

Syncope is a common and often confusing presentation.  Dr. Casey Patrick leads a lecture style discussion with tips to approaching the syncopal patient in the prehospital setting.  ECG pointers and an impossible to forget “crappy” mnemonic will leave you with a more focused approach to your next syncopal patient.

References

1.	http://www.jem-journal.com/article/S0736-4679(17)30868-5/pdf

LINKS:
1.  WPW - https://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/
2.  Brugada syndrome - https://www.aliem.com/2013/06/brugada-syndrome-an-ecg-pattern-you-need-to-know/
3.  Prolonged QT interval - https://lifeinthefastlane.com/wp-content/uploads/2011/01/waves-of-the-ecg.gif
4.  Hypertrophic Obstructive Cardiomyopathy - http://www.wikidoc.org/images/b/b0/Hypertrophic_cardiomyopathy.jpg

Episode 3 - Syncope

Dr. Patrick and Clinical Manager Jordan Anderson discuss intubation and ventilator settings to help avoid lung injuries in the intubated patient.

Episode 1 - Lung Protective Ventilation

Patients with acute pulmonary edema need rapid preload and afterload reduction and often their volume status is difficult to ascertain.  Casey Patrick and Brad Ward discuss a novel approach to using our old friend nitroglycerin in these patients along with the other cornerstones of their care.


References

	1.	Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389-93.
	2.	Levy P, Compton S, Welch R, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144-52.
	3.	Wilson SS, Kwiatkowski GM, Millis SR, et al. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-31.
	4.	Peacock WF et al. Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis. Emerg Med J 2008; 25: 205 – 209.

Episode 16 - Congestive Heart Failure Part 2 - Nitro, Nitro, Nitro

Dr. Patrick is joined on this episode by Dr. Elizabeth Weinstein.  Elizabeth is a dual trained in Emergency Medicine and Pediatrics, and she delivers clinical pearl after clinical pearl on how to recognize and manage non-accidental trauma in the prehospital environment.

Resources:
http://www.identifychildabuse.org

Episode 18 - Pediatric Non-Accidental Trauma With Dr. Elizabeth Weinstein

The MCHD Paramedic Podcast is a place for prehospital providers to discuss best practices and offer clinical insights relevant to our daily practice. MCHD Medical Directors Dr. Robert Dickson and  Dr. Casey Patrick invite you to explore the many aspects of prehospital care. Along the way you can expect guest appearances by some of the brightest minds that influence modern EMS.

Episode 117 - Prehospital IV Tylenol

MCHD Paramedic Podcast

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