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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

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

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 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.

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

MCHD Paramedic Podcast

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