Mchd Paramedic Podcast

We're excited to announce a new educational offering - MCHD Paramedic Podcast 360. There are many topics in paramedic/EMT education better taught with visual adjuncts that the podcast format cannot provide with audio alone. Podcast 360 will be hosted on the MCHD YouTube channel (see link below) and contain brief, high yield content similar to what you get here at the MCHD Paramedic Podcast. Please subscribe to the channel and check out our initial episode - STEMI Diagnosis. MCHD YouTube Channel: https://www.youtube.com/channel/UC8BURiknprMC92a4mw7Krkw/videos

We’ve recently rolled out a new epistaxis treatment protocol here at MCHD. Join the podcast team as we discuss some nosebleed background information along with the classic and emerging treatment options. Did somebody say TXA?? Yep, we have TXA and this is a perfect opportunity introduce the MCHD epistaxis/TXA treatment protocol. It’s simple, cheap and minimally invasive. With rapidly accumulating evidence that we will improve patient centered outcomes using this treatment, this is an episode that you don’t want to miss. REFERENCES: 1. Klepfish A, Berrebi A, Schattner A. Intranasal tranexamic acid treatment for severe epistaxis in hereditary hemorrhagic telangi- ectasia. Arch Intern Med 2001; 161: 767. 2. Gaillard S, Dupuis-Girod S, Boutitie F, Rivi ere S, Morini ere S, Hatron PY, Manfredi G, Kaminsky P, Capitaine AL, Roy P, Gueyffier F, Plauchu H, for the ATERO Study Group. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rar

This episode takes us back to the basics of toxic ingestions and poisonings to review the topic of toxidromes. Why do we look for specific patterns in poisonings and what are we looking for? Dr. Patrick and podcast toxicology expert, Dr. Jerry Snow, will take us through the major toxidrome groups and you’ll come out on the other side ready to sort through your next undifferentiated overdose patient. REFERENCES: 1. http://www.emdocs.net/the-approach-to-the-poisoned-patient/ 2. https://litfl.com/high-dose-insulin-euglycaemic-therapy/ 3. Toxidromes. Holstege CP, Borek HA. Crit Care Clin. 2012 Oct;28(4):479-98.

On this episode, the medical directors are joined by the MCHD car seat guru, Ashton Herring. The leading cause of death in children is motor vehicle related trauma. We’ll start with some background of the car seat laws that exist here in Texas and how MCHD works in the local community to increase car seat awareness. Ashton will also educate us on some common errors that parents make when installing car seats. In closing, we’ll discuss several excellent resources for car seat education. REFERENCES: 1. https://safekids.org 2. https://www.chop.edu/centers-programs/car-seat-safety-kids 3. https://pediatrics.aappublications.org/content/142/5/e20182460 4. https://csftl.org

REBOA is a hot topic in the world of emergency medicine and prehospital trauma care. Join the medical directors for a review of “resuscitative endovascular balloon occlusion of the aorta.” We’ll discuss the basics, the anatomy, the complications and the evidence. Who is doing this in the EMS world and what are their results? We’ll answer that question along with looking to future possibilities as well. References: 1. Brenner M, Inaba K, Aiol A, et al. Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy in select patients with hemorrhagic shock: early results from the American Association for the Surgery of Trauma’s Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry. J Am Coll Surg. 2018;226(5): 730–740. 2. Lendrum, Robbie et al. Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for exsanguinating pelvic haemorrhage. Resuscitation. 2019. Volume 135, 6 – 13. 3. Osborn LA, Brenner ML, Prater SJ, Moore LJ. Resuscitat

We’ve discussed airway management and our MCHD delayed sequence approach on past podcast episodes. On this episode, join the medical directors as they take a scenario based, deep dive into the finer points of tackling the difficult airway. REFERENCES: 1. https://m.youtube.com/watch?v=wVQFJR7qmrQ

The evolution of emergent stroke care has rapidly evolved over the past decade. With the increased emphasis on recognizing large vessel occlusion (LVO) strokes, communication and cooperation between EMS and our receiving hospitals has become vital. On this episode, Dr. Dickson is joined by an expert group of neurointerventionalists to discuss the current literature and guidelines shaping stroke management standard of care in 2019. REFERENCES: 1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00163-X/fulltext 2. https://www.nejm.org/doi/full/10.1056/nejmoa1706442 3. https://www.nejm.org/doi/full/10.1056/NEJMoa1713973 4. https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000158

Last year, we rolled out the MCHD “ROSC to Cath” protocol via the podcast. Recently, some compelling data from the COACT trial has led us to reassess and reconsider this protocol. On this episode, Dr. Patrick reviews COACT and discusses the MCHD changes coming as a result. REFERENCES: 1. https://www.nejm.org/doi/full/10.1056/NEJMoa1816897 2. http://clinicaltrialresults.org/Slides/ACC2019/Lemkes_COACT.pdf

During a recent continuing education session at MCHD, one of the educational points of emphasis was recognizing and reporting human trafficking as a paramedic/first responder. The podcast crew was lucky enough to have Sarah Koransky, from United Against Human Trafficking (UAHT), join us to share some of the key points when encountering this vulnerable patient group. Sarah is knowledgable and passionate about this cause and she has loads of high yield information to share on this episode. REFERENCES 1. United Against Human Trafficking www.uaht.org 713-874-0290 2. National Human Trafficking Hotline www.nationalhumantraffickinghotline.org 888-373-7888 3. HEAL Trafficking www.healtrafficking.org 4. Department of Homeland Security’s Blue Campaign https://www.dhs.gov/blue-campaign

Vital signs are called vital for a reason.  On this episode, Dr. Patrick takes us through a differential for the workup of sinus tachycardia.  This is a finding that we see daily in our practice, but often lack a step-wise approach when managing these patients. REFERENCES: 1. Bossart P, Fosnocht D, Swanson E. Changes in heart rate do not correlate with changes in pain intensity in emergency department patients. J Emerg Med. 2007;32(1):19–22. 2. Marco CA, Plewa MC, Buderer N, Hymel G, Cooper J. Self-reported pain scores in the emergency department: lack of association with vital signs. Acad Emerg Med. 2006;13(9):974–979. 3. https://www.ncbi.nlm.nih.gov/pubmed/19700579

We've addressed the ten most commonly encountered medications seen in EMS on a prior podcast. In this episode, Brad Ward joins Dr. Patrick to focus on a less common, but often more impactful group of medications, the antiplatelets and anticoagulants. The combination of complex pharmacology and some relatively new drugs in both classes, make this an area prime for discussion and review. REFERENCES 1. https://www.ajemjournal.com/article/S0735-6757(12)00169-6/pdf 2. http://www.emdocs.net/emin5-noacs-novel-oral-anticoagulants/

We have been fortunate here at MCHD to develop an ongoing educational partnership with Victoria University in Melbourne, Australia. A group of 11 paramedic students and instructors just finished a three-week study-abroad program here in the Greater Houston area. The podcast crew thought this would be the perfect chance for our Aussie colleagues to discuss the differences and similarities between EMS practice and education in Australia versus the United States. Our paramedic education supervisor, Lee Gillum, joins the podcast today to talk about how this international relationship started and the ways it has benefited the teachers and students alike. REFERENCES 1. https://www.yourconroenews.com/neighborhood/moco/news/article/Montgomery-County-Hospital-District-welcomes-13894356.php

In recognition of EMS Week 2019, the MCHD Paramedic Podcast crew decided to directly address one of the most pressing issues in current EMS practice – paramedic and EMT wellness and burnout prevention. Dr. Remle Crowe, Research Scientist and Project Manager with ESO, joins the podcast to lend her tremendous burnout expertise. Burnout is a fluid and dynamic process that varies with time and the individual. Therefore, proactive prevention techniques have to be flexible and adaptable as well. After listening to this episode, you’ll be armed with multiple tools to recognize and attack burnout within your EMS system. REFERENCES 1. Remle P. Crowe, Julie K. Bower, Rebecca E. Cash, Ashish R. Panchal, Severo A. Rodriguez & Susan E. Olivo-Marston (2017): Association of Burnout with Workforce-Reducing Factors among EMS Professionals, Prehospital Emergency Care, DOI: 10.1080/10903127.2017.1356411 2. Tage S. Kristensen, Marianne Borritz, Ebbe Villadsen & Karl B. Christensen (2005) The Copenhagen Burnout In

Dr. Patrick and Dr. Dickson pick up where they left off on our Back to the Basics COPD Part 1 episode. We’ll delve further into the differential diagnosis one must consider when treating patients with dyspnea and discuss some of the chameleons that can masquerade as COPD. Many of our COPD patients are far from straight forward with multiple co-morbidities. After listening, you’ll run your next dyspnea call with a clear plan and more confidence.

This episode takes us back to the basics of COPD pathophysiology and treatment. Dr. Dickson and Dr. Patrick start with the differential diagnosis of wheezing and move through the escalating COPD treatment options. We then close with a review of common abnormal breath sounds and set the stage for COPD Part 2 which will be coming soon. References: 1. http://citeseerx.ist.psu.edu/viewdoc/download doi=10.1.1.624.2777&rep=rep1&type=pdf 2. Ram, et al. NIPPV for treatment of respiratory failure due to exacerbations of COPD. Cochrane Database Syst. Rev. 2004 3. https://www.easyauscultation.com/lung-sounds

One of the most difficult situations in prehospital care is the high-risk patient refusal of EMS transport. This topic is far from straight forward for both learners and teachers alike. Dr. Patrick introduces a brand new mnemonic that will, hopefully, alleviate your FEARS the next time you care for a complex patient that decides hospital transport just isn’t in the cards.

This episode is loaded with tactical EMS pearls. Houston Fire Department Assistant Medical Director, Dr. Kevin Schulz, joins the podcast again to lend his TEMS expertise. MCHD’s tactical leader, Patrick Langan, leads the discussion and provides a Montgomery County perspective.

Managing markedly elevated blood pressures has to be one of the most common EMS clinical dilemmas. Dr. Dickson joins Dr. Patrick to help dispel some long-standing and persistent hypertension management myths. The concept of “end organ damage” is also introduced as a framework to properly identify those patients with elevated blood pressures who DO warrant emergent treatment in the prehospital setting.

With the explosion continuing education options, how do we decide who and what to believe? Dr. Tony Seupaul, evidence based medicine expert, joins the podcast crew to discuss tips on how to best manipulate and master medical information in the social media/FOAMed era. We touch on the hierarchy of medical evidence, provide clues on how to best spot flimsy evidence, and tout some of our favorite sites and Apps to add to your educational armamentarium. References: 1. Hierarchy of medical evidence - https://canberra.libguides.com/c.php?g=599346&p=4149721 2. www.tripdatabase.com 3. www.thennt.com 4. www.bestbets.org 5. www.rebelem.com 6. www.litfl.com 7. www.thesgem.com 8. www.emcrit.org 9. www.coreem.net 10. ACEP Toxicology App - https://itunes.apple.com/us/app/acep-toxicology-section-antidote/id959303490?mt=8 11. MD Calc App - https://itunes.apple.com/us/app/mdcalc-medical-calculator/id1001640662

The MCHD Podcast Crew just received word that we have a documented measles case here in Montgomery County. We decided to try and get out in front of this story and provide our listeners with some basic information on clinical presentation, transmission and prevention of the measles virus. References: 1. https://www.cdc.gov/measles/index.html 2. https://www.cdc.gov/measles/about/signs-symptoms.html 3. https://phil.cdc.gov/details.aspx?pid=132