Mchd Paramedic Podcast

The MCHD Paramedic Podcast wants to help all of our listeners stay up to date. Earlier this year, we discussed TXA (Tranexamic Acid) following our MCHD TXA protocol roll-out. New TXA research just popped up on the radar, join Dr. Patrick for a quick journal club discussion of the Cal-PAT study. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225940/pdf/wjem-19-977.pdf

Despite Dr. Patrick's fear, we're delivering the second installment of our Obstetrics series. This is a potentially frightening topic that was actually requested by several MCHD medics. Part one focused on emergencies encountered prior to delivery and part two progresses into difficult deliveries and the postpartum period. References: http://www.emdocs.net/the-complicated-delivery-what-do-you-do/ https://coreem.net/core/shoulder-dystocia/

Join Dr. Patrick for a “phast” pharmacology update on hydromorphone/dilaudid. We’ll discuss its uses, relative strength, side-effects and the future role of dialudid at MCHD.

Continuing with our recent theme of increased fire related inhalational risks with colder weather, MCHD Paramedic Podcast toxicology guru, Dr. Jerry Snow, joins us again to discuss cyanide poisoning. We’ll discuss ways to recognize cyanide toxicity and when to empirically treat. Combining this episode with our recent carbon monoxide podcast will make you razor sharp when you run on your next house fire. References: 1. Curry, Steven C., and Meghan B. Spyres. "Cyanide: hydrogen cyanide, inorganic cyanide salts, and nitriles." Critical care toxicology (2016): 1-21. 2. Purvis, M. V., et al. "Prehospital hydroxocobalamin for inhalation injury and cyanide toxicity in the United States-analysis of a database and survey of ems providers." Annals of burns and fire disasters 30.2 (2017): 126. 3. Kaita, Yasuhiko, et al. "Cyanide poisoning is a possible cause of cardiac arrest among fire victims, and empiric antidote treatment may improve outcomes." The American journal of emergency medicine 36.5 (2018): 851-853.

Dr. Patrick is joined today remotely by toxicologist and friend of the podcast, Dr. Jerry Snow, to talk about the nuts and bolts of Carbon Monoxide poisoning. All of your questions are answered - from the use of portable CO devices, to the presentation and recognition of CO poisoned patients. We’ll hit on all the cold weather, carbon monoxide high yield information.

Dr. Patrick and Clinical Manager Jordan Anderson run down the 10 most commonly prescribed medications in the US. The medication list can often feel like one more task that’s always partial and incomplete. Jordan and Dr. Patrick try to take a more detective-like approach to demonstrate the utility of anticipating side-effects and potential diagnoses based on medication list clues. References: 1. http://discovermagazine.com/2010/mar/07-dr-drank-broth-gave-ulcer-solved-medical-mystery 2. Gomes T, et al (2017) Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case–control study. PLoS Med 14(10): e1002396

Shownotes: Cardiovascular medication poisoning can produce markedly unstable patient presentations. Dr. Patrick and Brad Ward review some of the basics and more recent therapeutic developments in the treatment and management of beta-blocker and calcium channel blocker toxicity. References: 1. St-Onge M, Anseeuw K, Cantrell FL, et al. Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Critical Care Medicine. 2017;45(3):e306-e315. 2. Wax P, Erdman A, Chyka P, et al. Beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005; 43(3):131-146.

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.

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.

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.

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.

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.

Lowering tidal volumes in effort to reduce lung injury following initiation of mechanical ventilation is far from a new idea, the original ARDS-NET data are nearly 20 years old. Lung protective ventilatory strategies have progressively been shown, from the ICU and now into the ED setting, to decrease ventilator days, ICU/hospital stay and overall mortality. This discussion covers the original ARDS-NET study, causes of ventilator induced lung injury, and closes with MCHD’s efforts to initiate lung protective settings in ventilated patients in the prehospital setting. References: 1. Fuller BM, Ferguson I, Mohr NM, et al. Lung-protective ventilation initiated in the emergency department (LOV-ED): a study protocol for a quasi-experimental, before-after trial aimed at reducing pulmonary complications BMJ Open 2016;6:e010991. 2. Boyer AF, Schoenberg N, Babcock H, et al. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 2015;147:68–81. 3

Peds EMS wizard, Dr. Greg Faris, joins us again on the podcast to discuss pediatric out-of-hosiptal cardiac arrest. This topic gives us all a bit of nausea and tachycardia. We’ll review some recent literature that will, hopefully, nudge us to change the practice of “scoop and run” in our pediatric cardiac arrests. Pediatric OHCA References Tijssen JA, et al. Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest. Resuscitation. 2015 September; 94: 1-7. Munoz MG, et al. An ethical justification for termination of resuscitation protocols for pediatric patients. Pediatric Emerg Care 2017; 33: 505-515. American College of Surgeons Committee on, T., et al. (2014). "Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest." Pediatrics 133(4): e1104-1116. Goto, Y., et al. (2016). "Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital C

Many of the sickest of the sick patients that we see as EMS providers are hypotensive. These folks are often altered and come with spotty histories at best. This episode turns our B2B series to the prehospital management and recognition of shock. How can we better classify then treat our undifferentiated patients in shock? Dr. Patrick and Dr. Dickson build a framework around common sense pathophysiology and treatment.

Falls are one of our most common calls in the EMS world. The potential disease processes and injuries can be wide ranging and difficult to sort. Join Dr. Patrick and Dr. Dickson as they break falls down into two main questions that must be answered on every fall patient. Learn the high risk characteristics and diagnoses to consider and rule out.

Hypotension is one of our number one enemies in prehospital care. In this episode, Dr. Patrick and Dickson begin with a review of vasopressor physiology and then they dive into the evidence and rationale behind push dose epinephrine use. References: https://emcrit.org/emcrit/push-dose-pressor-update/ https://www.nejm.org/doi/full/10.1056/NEJMoa0907118

Join Dr. Patrick and Dr. Dan O'Donnell, medical director for Indianapolis EMS/Fire/SWAT, as we discuss multiple hot topics in the world of Tactical EMS.

On today’s cast our medical directors talk traumatic arrest care with Dr. Justin Hensley, the medical director of Robstown EMS, and lover of all things trauma resuscitation related. We'll review the history, training and implementation of the simple finger thoracostomy procedure at MCHD while also discussing our general approach to the traumatic arrest patient. Below are links to the papers and video training that are mentioned in the episode. Journal of Emergency Medicine MCHD Simple Thoracostomy Paper: https://www.jem-journal.com/article/S0736-4679(18)30598-5/fulltext JEMS Simple T: https://www.jems.com/articles/print/volume-39/issue-4/features/simple-thoracostomy-moving-beyond-needle.html Tension pneumothorax model video: https://www.youtube.com/watch?v=kCKZ4y843ts Dr Hensley’s website: http://ebmgonewild.com/ The late Dr. John Hinds on traumatic arrest care: https://emcrit.org/emcrit/trauma-thoughts-john-hinds/

Dr. Patrick went where? Dr. Dickson interviews Dr. Patrick about his recent medical journey to Uganda. Learn about the state of prehospital medicine in Uganda, several interesting cases that you probably won’t see here in the United States, and find out how you can help the cause. References www.globalemergencycare.org