Mchd Paramedic Podcast

Dr. Dickson and Patrick are joined on this special episode by EMS Medical Directors from across Texas to discuss the recent winter storm that ravaged the state. We discuss the varying ways the disaster impacted each service, multiple lessons learned statewide, several unexpected operational and clinical developments, and steps everyone plans to make to improve moving forward. Thanks to Jeff Jarvis, Jason Pickett, and Veer Vithalani for helping arrange this last-minute recording. REFERENCES 1. https://www.dallasnews.com/news/weather/2021/02/11/winter-weather-causes-hazardous-conditions-on-north-texas-roads/ 2. https://www.amazon.com/Grips-4-Ice-Winter-Traction-Over-Shoe-Cleats/dp/B07D9128TD/ref=asc_df_B07D9128TD/?tag=hyprod-20&linkCode=df0&hvadid=312131909651&hvpos=&hvnetw=g&hvrand=18032707165061169024&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9027681&hvtargid=pla-589843109945&psc=1 3. https://www.mayoclinicproceedings.org/article/S0025-6196(19)30486-0/fulltext

Nothing scares an emergency provider quite as much as the “sick infant.” During today’s episode, Dr. Patrick and Dr. Dickson walk through the pediatric general assessment triangle and discuss the finer points that make up each side. They’ll also discuss the singular/#1 Law of the Pediatric Exam. Your next pediatric run will be a breeze after this review. REFERENCES: 1. Leeper, Christine M. MD, MS; McKenna, Christine MSN; Gaines, Barbara A. MD Too little too late: Hypotension and blood transfusion in the trauma bay are independent predictors of death in injured children, Journal of Trauma and Acute Care Surgery: October 2018 - Volume 85 - Issue 4 - p 674-678 2. Balamuth F, Alpern ER, Abbadessa MK, et al. Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification. Ann Emerg Med. 2017;70(6):759-768. 3. Mottled Skin - http://empem.org/wp-content/uploads/2011/12/EMPEM-mottled-legs.jpg 4. Startle R

After 100 episodes and almost 3 years, the podcast crew decided to celebrate a little bit and look back on our successes and failures thus far. Why did we start the podcast in the first place? How has MCHD used the Paramedic Podcast within the EMS service? What have been the most successful episodes and what are the "Take home Points?" Join Dr. Dickson and Dr. Patrick as they discuss the MCHD Paramedic Podcast past, present, and future.

Emergency medical providers are comfortable in the chaos of a crashing medical or trauma patient. We know how to systematically address dangerous medical conditions like hypotension, hypoxia and bradycardia. However, when asked to dip our toes into the legal realm, we are often paralyzed with fear. On this episode, the podcast crew is joined by local legal expert, Andrew James. Mr. James is the vehicular crimes chief with the Montgomery County DA's office, and he has extensive experience working with medics and first responders in the courtroom. Listen and learn some of the basics of what happens when you're called to court as witness.

Anytime we arrive on scene with blaring sirens and flashing lights, this can be exceedingly stressful on patients and families. This is especially true for our patients with autism. We're lucky to have Jennifer Dantzler on the podcast today to discuss autism basics along with some tools that we can use in the prehospital setting to better care for and communicate with our autistic patients. Jennifer is the director of the Including Kids Autism Center and a true expert in the field of autism spectrum disorder. REFERENCES 1. https://www.includingkids.org/our-story/helpful-resources/ 2. https://www.autismspeaks.org

Around the MCHD Clincial Department we’ve had some recurrent themes pop up over the past few months that always make the medical directors shake their heads. During this episode, Dr. Dickson and Dr. Patrick take a shot at dispelling some “medical director myths."

Electrical storm has dismal outcomes. It is most frustrating because we know the cause is very likely coronary occlusion (~75%)! We have added esmolol to our tool belt here at MCHD to try and improve refractory VF outcomes. Others are trying early ECMO in this patient population. Prior eCPR studies have all been retrospective. Join the podcast crew as they discuss a recent Lancet article looking at eCPR vs. standard ACLS in refractory VF. Randomized, prospective, and quite amazing. REFERENCES https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32338-2/fulltext

Freestanding emergency departments are becoming more and more common across the United States. Here at MCHD, we feel that EMS transport to these sites can be beneficial to both our system and the community as well. During today's episode, Dr. Patrick is joined by multiple hospital partners for some enlightening FSED myth-busting.

Thankfully, we finally have some positive COVID-19 news to discuss. Join the medical directors for a discussion of vaccine basics and some of the specific issues EMS and public health will likely encounter with COVID-19 vaccine administration. REFERENCES 1. https://podcasts.apple.com/us/podcast/stimulus/id1501107371?i=1000494006283 2. https://www.chop.edu/centers-programs/vaccine-education-center/making-vaccines/prevent-covid 3. https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf

We’ve discussed burnout on the podcast in the past. When thinking about ways to combat burnout, a word that often comes up is resilience. Emergency care was stressful enough, then 2020 decided to add COVID to the mix. Join the podcast crew and special guest Kris Kaull as we talk about ways to foster resilience as an EMS provider which will hopefully extinguish burnout before it spreads. REFERENCES 1. https://www.kevinmd.com/blog/2020/08/7-habits-of-highly-resilient-physicians.html 2. https://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X/ref=sr_1_1?crid=2O1RTLPJFYHVE&dchild=1&keywords=breath+becomes+air&qid=1604872706&sprefix=breath+be%2Caps%2C191&sr=8-1 3. https://podcasts.apple.com/us/podcast/the-accumulation-of-marginal-gains-with-salim-rezaie/id1501107371?i=1000487654581

Sometimes in medicine, we do things just because they’ve always been done that way, which is terrible reasoning. Valsalva maneuver followed by the two-syringe technique for adenosine administration has been standard practice in PSVT management for decades. Recent data suggests that both of these approaches may have better alternatives. Join Dr. Patrick and Brad Ward as they provide updates on both non-pharmacologic and pharmacologic management of PSVT. REFERENCES 1. McDowell M et al. Single-Syringe Administration of Diluted Adenosine. Acad Emerg Med 2020, Jan;1:62-63. 2. Choi SC et al. A Convenient Method of Adenosine Administration for Paroxysmal Supraventricular Tachycardia. J Korean Soc Emerg Med 2003, Aug;14(3):224-227. 3. Weberding NT, Saladino RA, Minnigh MB, et al. Adenosine administration with a stopcock technique delivers lower-than-intended drug doses. Ann Emerg Med 2018;71:220–4. 4. https://www.youtube.com/watch?v=8DIRiOA_OsA

If there is one topic that we love at MCHD, it’s discussing bolus dose nitroglycerin in acute pulmonary edema patients. We’re lucky to have more positive evidence supporting it’s use thanks to Mike Perlmutter and his colleagues from North Memorial in Minneapolis. Join Dr. Patrick and Mike as they geek out over high dose nitrate use in EMS. REFERENCES 1. https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/prehospital-treatment-of-acute-pulmonary-edema-with-intravenous-bolus-and-infusion-nitroglycerin/B7B78C8CC0A32A2E0048AECCC177DF69/share/3b38ce9a134027bde58af415173c72b9f3fe8ac4 2. https://www.tandfonline.com/doi/full/10.1080/10903127.2020.1711834

When thinking of what strikes fear in paramedics, most would think of answers like pediatric arrests, precipitous deliveries, and unstable bradycardias. A hidden source of misery here at MCHD is the fear of the oral scenario exams for advancement. Yes, these are artificial and do not always reflect reality, but they are a necessary evil. Join Dr. Dickson and Dr. Patrick as they try and provide some framework for attacking and succeeding when taking oral scenario exams. REFERENCES https://www.mchd-tx.org/wp-content/uploads/2020/09/MCHD-Oral-Board-Prep-Sheet.pdf

The capnography tracing is an excellent tool that gives us insight into cellular metabolism, perfusion, and ventilation. This can yield vital information in multiple critical patient care decision processes. Join Dr. Patrick and Dr. Dickson as they walk through some ETCO2 interpretation basics. We are limited on the amount of objective information available during prehospital care, don’t ignore this vital piece of our puzzle. REFERENCES 1. https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/utilizing-endtidal-carbon-dioxide-to-diagnose-diabetic-ketoacidosis-in-prehospital-patients-with-hyperglycemia/DE85722FCDD5C24D7949C2FCCBC58E99 2. http://www.emdocs.net/interpreting-waveform-capnography-pearls-and-pitfalls/

Join Dr. Dickson and our esteemed colleagues from across the globe to hear how their systems have responded to the COVID-19 pandemic and what they have learned from the experience thus far. Dr. Colin Graham is an EM specialist from Hong Kong who practiced there for the first SARS outbreak and is now tackling Corona Part 2. Additionally, we’ll be joined by Dr. Al Meyer, an EM specialist in Melbourne, Australia. This episode truly gives us a worldwide COVID-19 perspective. Colin Graham qualified from the University of Glasgow in 1994 and completed basic surgical training and then specialist training in emergency medicine in Scotland. He came to the Accident and Emergency Medicine Academic Unit at the Chinese University of Hong Kong in 2004; he was promoted to Professor in 2007 and was appointed Director in 2015. He has broad research interests within emergency medicine and has published widely. Dr. Graham is an active clinical teacher and he co-authors the Oxford Handbook of Emergency Medicine. He is also c

We're joined by a special guest, Dr. Jeff Jarvis, to talk about his recent PEC manuscript investigating potential life-saving interventions in the prehospital setting and their association with "lights and sirens" usage. Be prepared for some dogma challenging discussion! REFERENCES: https://www.tandfonline.com/doi/abs/10.1080/10903127.2020.1797963

The firehose of information that is COVID-19 has slowed somewhat since we last discussed the pandemic, but the first wave has obviously persisted. On this episode, Dr. Patrick and Dr. Dickson address some of the recent COVID developments in treatment, return-to-work policy updates from the CDC and crazy complications seen in pediatric patients. REFERENCES 1. https://www.cebm.net/covid-19/what-is-the-effectiveness-of-protective-gowns-and-aprons-against-covid-19-in-primary-care-settings/ 2. https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html 3. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/infographic-mis-c.html 4. https://www.nejm.org/doi/full/10.1056/NEJMoa2021436 5. https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

We’ve discussed TXA, both for trauma and for epistaxis, on the podcast previously. Medics often ask about TXA in the acute GI bleed patients who are in hemorrhagic shock...“What can it hurt? It’s worth a try, right?” While TXA may seem like a harmless hail Mary, on this episode, Dr. Patrick reviews the HALT-IT study and discusses why TXA for acute GI bleeds is likely harmful and probably dead in the water as a treatment option. REFERENCES: 1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30848-5/fulltext

This episode tackles the definition of "stupidity" and how this relates to prehospital medical care. Dr. Patrick is joined by Kris Kaull to discuss the definition of stupid, risk factors for making stupid moves and how to possibly prevent these in the EMS setting. REFERENCES 1. Episode inspiration - https://fs.blog/2019/01/how-not-to-be-stupid/ 2. Checklist Manifesto - http://atulgawande.com/book/the-checklist-manifesto/ https://www.amazon.com/gp/product/0312430000/ 3. Avalanche TedX talk - https://www.youtube.com/watch?v=kWOgyyDUD2w

We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to spend time with non-emergent/chronic diagnoses, just the ones that are deadly when missed. That’s where we, as emergency providers, must begin. Today we’ll wrap up the series with the killers associated with acute altered mental status.