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

We’re going to attempt a new recurring podcast series based around the amazing pathology seen on a daily basis by MCHD medics.  Cpt. Travis Clay joins the podcast to discuss the current MCHD “Case of the Quarter”.  Listen in and learn how to approach the patient with acute, bilateral lower extremity paraplegia and pain.

REFERENCES
1.  https://www.ems1.com/patient-assessment/articles/i-cant-feel-or-move-my-legs-mchd-critical-case-report-eVk3jFR1l6DPbwGS/

Episode 107 - "My Legs Won't Work" - MCHD Case of the Quarter Q2 2021

The best clinical discussions always stem from real-life cases.   MCHD paramedic Jarrett Kenning had a run of recent bradycardia patients and developed the idea for a bradycardia breakdown with the podcast crew.    Bradycardia treatment can vary wildly depending on the underlying cause(s).  Joint Jarrett and Dr. Patrick as they discuss several bradycardia cases and present a framework for creating your differential the next time you run on a patient with a pulse in the 30's.

REFERENCES

https://www.mchd-tx.org/wp-content/uploads/2022/08/MCHDPP-109-Final-PDF.pdf

Episode 109 - Bradycardia Breakdown

Charting is one of the more neglected skills from an EMS educational emphasis standpoint.  As a result, what the medical director ends up reading during chart review is often wildly variable.  Join the MCHD Paramedic Podcast team as they discuss some charting pitfalls to avoid and some specific tips on improving your ePCR narratives.

Episode 110 - EMS Charting Pearls And Pitfalls

Join the podcast crew as they discuss a recent study investigating the risk of being awake while paralyzed when intubated in the emergency department setting.  This is definitely an under-discussed topic in the EMS world, especially considering the recent swing from succinylcholine to rocuronium for prehospital medication assisted intubation.  This conversation should make us all a bit nervous and better focused the next time we intubate.

REFERENCES
1.  https://www.annemergmed.com/article/S0196-0644(20)31314-7/fulltext

Episode 112 - Awake And Paralyzed...BEWARE

It seems as though each week brings some crazy and bizarre COVID-19 related news.  MCHD Cpt. Megan Powell joins the podcast to spread the word about a harrowing COVID related case that made us all stop and do a literature search.  Listen and in and learn yet another clinical consideration when caring for complex COVID-19 patients.

REFERENCES
1.  Wang Y, Wang Z, Tse G, Zhang L, Wan EY, Guo Y, Lip GYH, Li G, Lu Z, Liu T. Cardiac arrhythmias in patients with COVID-19. J Arrhythm. 2020 Jul 26;36(5):827-836. doi: 10.1002/joa3.12405.

2.  https://www.tandfonline.com/doi/full/10.1080/10903127.2021.1924325

Episode 114 - COVID And Asystole?

**NOTE - THIS EPISODE WAS RECORDED PRIOR TO THE DELTA SURGE**
The MCHD clinical crew (Pre-Delta, obviously)attended an actual in-person EMS meeting – EAGLES 2021.  One of the most interesting talks was by friend of the podcast/EMS research superstar, Dr. Remle Crowe.  Join Dr. Patrick and Dr. Crowe as they discuss the “AHORA” stroke tool and how it has the potential to positively impact prehospital stroke care.

REFERENCES
1.  Keenan KJ, Kircher C, McMullan JT. Prehospital Prediction of Large Vessel Occlusion in Suspected Stroke Patients. Curr Atheroscler Rep. 2018 May 21;20(7):34.

2.  https://www.ems1.com/stroke-care/articles/the-time-for-spanish-language-stroke-community-outreach-efforts-is-ahora-xxJdr9dKClRMXJn5/

3.  https://www.mchd-tx.org/blog-post/mchd-ems-joins-campaign-to-bring-stroke-education-to-the-spanish-speaking-community/

Episode 113 - The "AHORA" Stroke Scale With Dr. Remle Crowe

Everything occlusion MI isn't always STEMI.  After a recent discussion of "STEMI equivalents" during MCHD continuing education, Dr. Patrick cared for a textbook hyperacute T wave patient in his emergency department practice.  On this episode, we review some hyperacute T wave tips, in addition to addressing how to deal with resistant consultants.

REFERENCES:
1. https://tinyurl.com/3aser4j5

2. Tzimas, Georgios et al. “Atypical Electrocardiographic Presentations in Need of Primary Percutaneous Coronary Intervention.” The American journal of cardiology 124.8 (2019): 1305–1314

3. Aslanger EK, ET AL. DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study). Int J Cardiol Heart Vasc. (2020) Jul 30;30:100603

4. Pendell Meyers H, ET AL. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. Int J Cardiol Heart Vasc. (2021) Apr 12;33:100767

Episode 116 - Hyperacute T Waves

Like the rest of the country and world, our Montgomery County hospital partners and ED's have been under severe strain due to a myriad of factors related to the COVID-19 pandemic.  This had led to a significant increase in EMS wall times which, in turn, places that severe strain back on the prehospital system.  The podcast crew takes an operational turn with MCHD Chief of Operations, Jacob Shaw, to discuss some of our operational adaptations to try and combat our ED delays.  We'd love for this episode to open up discussions on how listeners are approaching these problems with their services.

Episode 111 - Attacking Pandemic ED Wall Time Delays

We’ve recently rolled out a new medication protocol here at MCHD.  Join the medical directors to discuss the why, when, and how behind MCHD’s droperidol protocol.  Like many pharmacologic treatments in emergency medicine, old becomes new again!

REFERENCES
1. Page CB, Parker LE, et al. A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance. Prehosp Emerg Care. 2018 Nov-Dec;22(6):713-721.

2. https://www.mchd-tx.org/wp-content/uploads/2022/08/MCHDPP-115.pdf

Episode 115 - Digging Up Droperidol

We sure do love myth busting on the MCHD Paramedic Podcast and there are definitely some persistent myths surrounding burn care in EMS.  Join the podcast crew as they provide updates on burn staging, fluid resuscitation and the basics of burn wound care.  This episode will keep you from getting burned during your next burn transport.

REFERENCES
1. Parvizi D, Kamolz LP, et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind. Burns. 2014 Mar;40(2):241-5.

2. Swords DS, Hadley ED, Swett KR, Pranikoff T. Total body surface area overestimation at referring institutions in children transferred to a burn center. Am Surg. 2015 Jan;81(1):56-63.

Episode 121 - Burn Baby Burns

In this episode, we’re lucky to have a special guest from Texas Children's Hospital, pediatric sedation and pain management expert, Dr. Corrie Chumpitazi.  Nitrous oxide has been in our protocols here at MCHD for some time, but probably doesn’t get the recognition and appreciation that it deserves.  We’ll discuss NO history, dosing, indications, contraindications, and side effects.   Listen to learn why we all should be incorporating more Nitrous Oxide into our daily EMS practice.

https://emscimprovement.center/education-and-resources/peak/peak-pediatric-pain/

https://www.acep.org/patient-care/map/map-nitrous-oxide-tool/

REFERENCES
1.	Ducassé JL et al (2013). Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial. Acad Emerg Med. 2013 Feb;20(2):178-84.
2.	Annequin D and Carbajal R, et al; Fixed 50% Nitrous Oxide Oxygen Mixture for Painful Procedures: A French Survey. Pediatrics. 2000; 105; e47.
3.	 Collado V, Emmanuel N, et al; Expert Opinion: a Review of the Safety of 50% Nitrous Oxide/Oxygen in Conscious Sedation. Drug Safety. 2007, 6(5): 559-571. 
4.	Sanders R, Weimann J, Maze M; Biologic Effects of Nitrous Oxide. Anesthesiology. 2008, 109: 707-722 
5.	Gall O, Annequin D, et al; Adverse Events of Premixed Nitrous Oxide and Oxygen for Procedural Sedation in Children. Lancet. 2001; 358: 1514-15. 
6.	Tobias, JD, Review Article: Applications of Nitrous Oxide for Procedural Sedation in the Pediatric Population. Pediatric Emergency Care. 2013; 29: 245-265. 
7.	Onody P, Gil P, Hennequin M. Safety of Inhalation of a 50% Nitrous Oxide/Oxygen Premix: A Prospective Study of 35,828 Administrations. Drug Safety. 2006; 29(7):633-640. 
8.	American Academy of Pediatric Dentistry. (2013). Guideline on use of nitrous oxide for pediatric dental patients. Retrieved September 3, 2013, from www.aapd.org: http://www.aapd.org/media/Policies_Guidelines/G_Nitrous.pdf 
9.	Heinrich M, Menzel C, Hoffmann F, et al. Self-administered procedural analgesia using nitrous oxide/oxygen (50:50) in the pediatric surgery emergency room: effectiveness and limitations. Eur J Pediatr Surg. 2015;25(3):250-6.
10.	28.	Pasaron R, Burnweit C, Zerpa J, et al. Nitrous oxide procedural sedation in non-fasting pediatric patients undergoing minor surgery: a 12-year experience with 1,058 patients. Pediatr Surg Int. 2015;31(2):173-80.
11.	29.	Zier JL, Liu M. Safety of high-concentration nitrous oxide by nasal mask for pediatric procedural sedation: experience with 7802 cases. Pediatr Emerg Care. 2011;27(12):1107-12.
12.	30.	Gamis AS, Knapp JF, Glenski JA. Nitrous oxide analgesia in a pediatric emergency department. Ann Emerg Med. 1989;18(2):177-81.
13.	31.	Martin HA, Noble M, Wodo N. The Benefits of Introducing the Use of Nitrous Oxide in the Pediatric Emergency Department for Painful Procedures. J Emerg Nurs. 2018;44(4):331-5.

Episode 119 - Nitrous Oxide in EMS With Dr. Corrie Chumpitazi

Within EMS, significant time is spent learning high risk, low frequency procedures and the pharmacology and physiology surround these events.  In most EMS services consultations or checklist verifications are required in some fashion surrounding these events.  Often times, though, we tend to overlook and fail to provide a structure for best practices in how to complete a clear and concise clinical consultation.  MCHD District Chief, Ashley Fillmore, joins the podcast to discuss a framework for successful EMS consultations.  

REFERENCES
1.  https://bit.ly/3HEhJXJ

Episode 118 - A Conversation on Clinical Consults

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

Join the podcast crew and Dr. Taylor Ratcliff as they discuss the dangers of the "Lift Assist" calls in EMS.  These responses can be under-appreciated with hidden diagnoses such as sepsis, GI bleeding and even fractures.  How can we better create checklists to better assess these calls?  What are the warning signs in these patients?  Do lift assists even require an ALS evaluation?  Listen and get these answers and more!

REFERENCES
1.  Leggatt L, Van Aarsen K, Columbus M, et al. Morbidity and mortality associated with pre-hospital “Lift-Assist.” Prehosp Emerg Care. 2017;21(5):556-562.

Episode 120 - Live From Texas EMS - Respect The Lift Assist With Dr. Taylor Ratcliff

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...)

Join Dr. Dickson as he discusses all things French emergency medicine, EMS and prehospital care with Dr. Eric Revue - Emergency Department and EMS Chief - Louis Pasteur Hospital.  Docs on ambulances...what???

Episode 108 - EMS Worldwide - The French Perspective

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.