mchd podcast

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

Dr. Dickson and Dr. Patrick take on one of our favorite topics here at MCHD - Ketamine and the agitated patient.  Agitated patients come in a wide spectrum of severity.  This discussion starts with a framework for stratifying agitated patients.  We discuss the MCHD ketamine experience along with a less discussed patient population that may need ketamine control quicker than we often think. ***Remember that Ketamine is only to be used for patient protection and is never intended to be used out of convenience.***

References:
1.	https://www.ems1.com/medical-clinical/articles/78100048-Ketamine-for-Excited-Delirium-Syndrome-Results-of-a-3-year-case-series/
2.	Green et al. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation. Ann Emerg Med. 2011; 57:449-61
3.	Cole J et al. A prospective study of ketamine as primary therapy for prehospital profound agitation.  Am J Emerg Med. October 2017
4.	Parsch C et al. Ketamine reduces the need for intubation in patients with      acute severe mental illness and agitation requiring transport to definitive care: An observational study. Emerg Med Australas. 2017;29(3):291-296

Episode 21 - Ketamine For Agitation

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.

Episode 21 - Ketamine For Agitation

MCHD Paramedic Podcast

Related tracks