MCHD Paramedic Podcast

roadcasts

MHCD Medic

MCHD

Medic Podcast

mchd podcast

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

Hyperkalemia can send our patients to cardiac arrest in an instant.  Casey Patrick and Jordan Anderson begin with some background physiology review on the importance of potassium to cellular function.  They then move on to describing specific patient characteristics and ECG findings found in patients with hyperkalemia, and close with MCHD’s current protocol to preemptively treat these patients en route to the hospital.

PDF Summary: https://www.mchd-tx.org/media/podcasts/MCHDPP-04.pdf

Episode 4 - Hyperkalemia Management

It's Memorial Hermann Ironman Texas time here in Montgomery County, and our MCHD crews are preparing to staff the 140.6 mile triathlon.  After fielding multiple questions about hyponatremia and hypothermia in ultra-endurance athletes, we decided that a podcast discussion was in order.  The MCHD Paramedic Podcast crew were lucky enough to have Dr. Kevin Schulz, Medical Director for Memorial Hermann Ironman Texas, join us to talk Ironman medicine.  Sit back, relax and enjoy the ride...we promise it won't hurt as bad as 112 miles on a bike!

References:
Hew-Butler T, Rosner MH, et al. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med. 2015 Jul;25(4):303-20.

Episode 6 - MCHD Ironman Medicine 2018 Featuring Dr. Kevin Schulz

Anaphylaxis is a common life threatening disease that prehospital providers encounter on a regular basis.  These patients are in need of early treatment with Epinephrine.  In today’s episode Dr. Casey Patrick, along with Kevin Crocker and Ashton Herring, will be discussing MCHD’s deployment of Epinephrine to the Fire Departments within Montgomery County.  This discussion will cover basic information on what anaphylaxis is and how to best treat it.  We will also discuss how MCHD built Epi kits and how we trained the fire departments in how to safely and effectively manage these anaphylactic patients.

References
https://www.ems1.com/epinephrine/articles/381400048-Anaphylaxis-kits-Easy-epinephrine-deployment-for-first-on-scene/

https://www.dovepress.com/cr_data/article_fulltext/s121000/121733/img/DHPS_121733_F001.jpg

Episode 8 - Anaphylaxis Kits For EMT's - MCHD Back To Basics Series

In the past 24 months, stroke care has evolved in the way we evaluate strokes in the pre-hospital space and how they are worked up and treated in the hospital. Large vessel Occlusion (LVO) stoke is a large caliber vessel clot causing stroke symptoms. New techniques and devices in endovascular retrieval of these clots along with intravenous Tpa has shown great success in five randomized trials published in 2015.(1) The number we need to treat for one improved neurologic outcome at 90 days according to data from these trials is 2.6 patients. This is a massive breakthrough in the way we approach acute stroke care. Improved outcomes in these trials are directly associated with times to reperfusion therapy and EMS must change the way we diagnose and rank stroke patients in order to get them an endovascular capable facility when appropriate. In the first podcast our team will review all of the pertinent data from these trials and suggest how EMS should approach this LVO stroke diagnosis. In the second part of our stroke awareness series we talk with Dr. Peter Antevy, an EMS medical director from Florida who is an expert of developing regional systems of care for these LVO stroke patients. He will discuss development of their system and exciting new data that demonstrates a treatment benefit up to 24 hours after onset of symptoms in some subsets of these stroke patients. (2, 3)

References

1.Hermes Collaboration: Lancet 2016
 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00163-X/abstract
2. Dawn Trial: NEJM 2018
http://www.nejm.org/doi/full/10.1056/NEJMoa1706442
3. DEFUSE 3 Trial: NEJM 2018
http://www.nejm.org/doi/full/10.1056/NEJMoa1713973

Episode 9 - The State Of EMS Stroke Care In 2018

Episode 10 - Stroke Systems Of Care Featuring Dr. Peter Antevy

Today’s show is all about the changes in how we approach intubation in EMS. Dr. Jeff Jarvis will relate how he got interested in the topic of airway management and specifically the process of delayed sequence intubation. Dr. Jarvis is the EMS medical director for Williamson County Texas EMS.  He will present data from the recent Annals of Emergency Medicine paper his group authored on the topic. MCHD quality lead, Kevin Crocker, will present our data following DSI Implementation in Montgomery County. 

Weingart Emcrit podcast and Annals of EM article
https://emcrit.org/dsi/
http://dx.doi.org/10.1016/j.annemergmed.2014.09.025

Jarvis Annals paper
http://www.annemergmed.com/article/S0196-0644(18)30071-4/abstract

Wilco EMS: https://www.wilco.org/Departments/EMS
2017 SOCs 
DSI protocol
DSI checklist for both WCEMS and Marble Falls Area EMS

Episode 14 - Delayed Sequence Intubation (DSI) With Dr. Jeff Jarvis

CHF exacerbations are bread and butter emergency medicine.  Casey Patrick and Brad Ward begin with some background physiology and review of CHF.  They then move on to describing a more detailed framework than the typical “CHF exacerbation” that is commonly taught.  You’ll finish this podcast and think you’re a plumber as opposed to a paramedic.


References

https://coreem.net/core/ape/

Episode 15 - Congestive Heart Failure Part 1 - The Basics

Dr. Jerry Snow, a medical toxicologist and emergency medicine physician from Phoenix  joins the show for an interesting discussion about the opiate crisis facing America today, with a specific emphasis on fentanyl and its derivatives.  We discuss EMS/first responder exposure risks and preventative measures along with patient care pearls when treating patients with fentanyl overdose.


References:

American Academy of Clinical Toxicology Statement on Fentanyl Exposure Risks - https://www.acmt.net/_Library/Fentanyl_Position/Fentanyl_PPE_Emergency_Responders_.pdf

https://www.whitehouse.gov/ondcp/key-issues/fentanyl/

Bonus Episode - Fentanyl Fever: Unnecessary Hysteria

Too much of a good thing can always end up being bad.  On this episode, Dr. Patrick summarizes the ever increasing evidence that not only does supplemental oxygen not help in patients with reasonable O2 saturations, it likely is harmful in many commonly encountered disease states.  Join us for some first-class mythbusting.

References: 
1.	https://dundeechest.wordpress.com/2009/08/12/why-do-copd-patients-retain-co2-when-given-too-much-oxygen/

2.	Chu DK et al. Mortality and Morbidity in Acutely Ill Adults Treated with Liberal Versus Conservative Oxygen Therapy (IOTA): A Systematic Review and Meta-Analysis. Lancet 2018.

Episode 31 - Hyperoxygenation - Too Much of a Good Thing??

Dr. Dan O’Donnell serves as the Medical Director for Indianapolis EMS, as well as Medical Director for the Indianapolis Metropolitan Police S.W.A.T. team.  Central Indiana has been one of the epicenters for the growing opiate epidemic and Dan joins us to discuss a novel approach that IEMS has taken to combat this devastating public health crisis.

Episode 32 - EMS Opiate Interventions With Dr. Dan O'Donnell

The decision to administer paralytics may well be the most significant decision that we make as emergency providers.  We have to understand and know paralytic pharmacology 100% stone cold.  Join Dr. Patrick today for a review of our two most commonly encountered paralytic medications - succinylcholine and rocuronium.  Homage to the old school and an investigation of newer practice shifts will be given equal airtime.      


References: 

1.	Tran DT et al. Rocuronium Versus Succinylcholine for Rapid Sequence Induction Intubation. Cochrane Database Syst Rev 2015.

2.	Shoenberger JM, Mallon WK. Rocuronium Versus Succinylcholine Revisited:   Succinylcholine Remains the Best Choice. Ann Emerg Med 2018; 71(3): 398-9.

3.	Swaminathan A, Mallemat H. Rocuronium Should Be the Default Paralytic in Rapid Sequence Intubation. Ann Emerg Med 2018; 71(3): 397-8.

Episode 33 - Paralytic Pharma Phun

What would you do if you encountered a patient who you were unable to transport or even extract due to extremity entrapment?  At MCHD, we asked ourselves this exact question and decided provide an answer in the form of a field amputation protocol.  Dr. Justin Hensley joins the MCHD medical directors to discuss the details and pitfalls associated with implementing a plan to amputate a limb in the field.

Episode 34 - Field Amputations With Dr. Justin Hensley

Join Dr. Dickson and Dr. Patrick live from the Texas EMS Conference with a special guest! Today we’ll discuss prehospital ventilator management as a precursor to the lectures Dr. Patrick and Clinical Chief Jordan Anderson will be giving at the conference.

Episode 35 - Live From Texas EMS Conference, It's Saturday Night!

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 Director Dr. Casey Patrick invites 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.