Mchd Paramedic Podcast

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.

On this episode, we’re lucky 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://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.

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

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.

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

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.

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

**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/

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

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.

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.

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.

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???

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/

There may not be any hotter topic in EMS right now than whole blood administration for patients with hemorrhagic shock. Dr. Patrick is joined on today’s episode by Joe Cuthbertson from St. John Ambulance Service in western Australia. St. John's serves the largest land mass of any EMS service worldwide and they are on the forefront of international prehospital whole-blood administration. REFERENCES 1. https://clinical.stjohnwa.com.au/medications/packed-red-blood-cells

There has been significant development and change surrounding which patients are best served by immediate revascularization post-ROSC over the past 12-18 months. On that note, we discussed the COACT study previously on the podcast, but uncertainty still exists. OHCA and post-ROSC patients are wildly heterogenous and one size will never fit all. What if we could simply change the timing of our post-ROSC ECG and better select those with true acute coronary occlusions that warrant emergent catheterization? That’s the topic of our journal review on this episode. A simple, logical idea that has potentially powerful ramifications, listen in for the details… REFERENCES 1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774740

May is Mental Health Awareness Month, so the podcast crew decided to dedicate an entire episode to discussing EMS provider mental health issues and resources. Dr. Patrick and Sean Simmonds are joined by Justin Farris from Cypress Creek Behavioral Health Hospital. Topics range from recognizing mental health warning signs in your partner, to accessing proper mental health resources through programs such as "Honor Strong" at Cypress Creek Hospital. REFERENCES: https://www.cypresscreekhospital.com/behavioral-health-programs/honor-strong-program/

We have all been guilty of caring for labeling and judging “pseudoseizures.” First of all, this term is outdated, and this episode looks at a study examining the mortality in psychogenic seizure patients. This is a debilitating disease that needs more attention and improved treatment options. Come, have your prior assumptions shattered, and leave a better and more empathetic provider. REFERENCES: 1. https://n.neurology.org/content/95/6/e643

This episode was directly drawn from a recent MCHD educational need surrounding ventilator management and a summary of our approach to using the vent in the EMS setting. We've touched on aspects of many of these topics before, but this is our first effort at providing a true "MCHD ventilator overview." Join Dr. Patrick and Dr. Dickson as they discuss a stepwise approach to EMS ventilator management and how to first and foremost prevent patient harm.

Is there a more daunting time than those first few shifts as a new paramedic? Yes, clinical knowledge and operational knowledge are key, but how are new medics supposed to synthesize this mountain of information? Dr. Patrick is joined by Cpt. Michael Wells-Whitworth to discuss some "Rules of the Road" for new paramedics. TOP TEN RULES OF THE ROAD FOR NEW MEDICS 1. Be on time 2. Failing to prepare, is preparing to fail 3. Know your protocols 4. Pour a solid BLS foundation 5. Be like a lamprey - latch on to sharks 6. You need patience - be realistic with your goal pathway 7. Lots of patients - patient contacts are absolutely key 8. Treat other providers with respect 9. Think about what happens next 10. Value handoff communication and scripting