MCHD Paramedic Podcast

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/media/podcasts/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 currently Editor-in-Chief of the European Journal of Emergency Medicine (since 2009) and has served on the Executive and Council of the European Society for Emergency Medicine. Dr. Graham was elected to the Council of the Hong Kong College of Emergency Medicine in 2013 and 2016 and has served as Dean of Students at Morningside College in CUHK since 2016. Dr. Alastair Meyer completed his specialist training in emergency medicine in Scotland and has worked in academic emergency medicine in Melbourne Australia. He is currently the emergency department director at Casey Hospital in Melbourne. He has numerous peer reviewed publications and has lectured both with AU and internationally. Dr. Meyer is an avid cyclist and word traveler in his spare time.

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.

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 address the killers associated with acute abdominal pain.

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 address the killers associated with the dyspneic patient. REFERENCES https://www.ebmedicine.net/media_library/files/Calculated%20Decisions%20E1212%20PERC%20Rule.pdf https://www.mchd-tx.org/media/podcasts/MCHDPP-80-Final-PDF.pdf

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 chest pain scene with unstable vitals then filter to a differential of #1 PE, #2 ACS, #3 TAD is often quite challenging. 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 kick things off with acute chest pain. REFERENCES 1. http://www.emdocs.net/em-in-5-approach-to-chest-pain/ 2. https://litfl.com/ecg-findings-in-massive-pericardial-effusion/ 3. https://www.mchd-tx.org/media/podcasts/MCHDPP-79.pdf

For the last couple months, we've been talking COVID-19 exclusively here at the MCHD Paramedic Podcast. On this episode, ops takes center stage with a discussion of our PPE/COVID-19 experience. We share our lessons learned and wish list for the future. Take a listen and please hit us up at [email protected] if you have questions or experiences you'd like to share! REFERENCES: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Unless you live under a rock, you've heard discussions of the pros and cons of using hydroxychloroquine (HCQ) when treating COVID-19 patients. On this episode, Dr. Patrick is joined by our favorite toxicologist, Dr. Jerry Snow, to talk about what happens in a HCQ ingestion situation. With the increased publicity of this drug, we must be on high alert in the prehospital setting for potential accidental and intentional overdoses. Listen and learn what to expect and how to treat someone who's taken too much HCQ...beware, these folks can tank quickly!!

We've had continued rapid local and national developments surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the MCHD specific airway algorithm in the era of COVID-19. REFERENCES: https://www.mchd-tx.org/media/podcasts/MCHD-COVID-19-FINAL-AIRWAY-.pdf

We've had continued rapid local and national developments over the past week surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the most current evidence surrounding airway management in the era of COVID-19. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html 2. https://emcrit.org/emcrit/some-additional-covid-airway-management-thoughts/ 3. https://www.safeairwaysociety.org/covid19/ 4. VALLEY, T ET AL. ASSOCIATION BETWEEN NONINVASIVE VENTILATION AND MORTALITY AMONG OLDER PATIENTS WITH PNEUMONIA. CRIT CARE MED. 2017 MARCH; 45(3): E246–E254. 5. NEWMAN KB, ET AL. A COMPARISON OF ALBUTEROL ADMINISTERED BY MDI AND SPACER WITH ALBUTEROL BY NEBULIZER IN ADULTS PRESENTING TO AN URBAN ED WITH ACUTE ASTHMA. CHEST. APRIL 2002;121:1036–41.

We've had rapid local and national developments over the past week surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the most current evidence. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html

Choking babies, seizing kids, and floppy infants turning blue...all of these events are significantly anxiety inducing for both emergency providers and families alike. On this episode, Dr. Patrick is joined by Dr. Manish Shah, a pediatric emergency medicine physician and research expert from Texas Children's Hospital. The discussion will begin with the finer points of febrile seizures and then branch off into the "artist formerly known as ALTE" - the BRUE. Follwing this episode you'll be much better prepared to deal with these patients along with their parents and families. REFERENCES 1. https://www.aap.org/en-us/Documents/echo_session%201_seizures_overview.pdf 2. https://pediatrics.aappublications.org/content/pediatrics/127/2/389.full.pdf 3. https://pediatrics.aappublications.org/content/pediatrics/137/5/e20160590.full.pdf

We all love cardiac arrest with VF as the presenting rhythm. These are the ones that walk out of the hospital. But, what happens when you shock, shock, shock and still VF? Today the podcast team addresses refractory ventricular fibrillation/electrical storm and specifically the role of esmolol in this condition. Esmolol is an emerging treatment for refractory VF that makes absolute physiologic sense, however the data is limited. Dr. Patrick addresses the pathophysiology, evidence and MCHD’s approach this in episode 72. REFERENCES 1. Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J. 2011;32(8):111-21. 2. Lee YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016;107:150-155. 3. Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular brillation. Resuscitation. 2014;85(10):1337-41.

A proper sleeping environment is vital for infant safety. On this episode Dr. Patrick is joined by two "safe sleep" experts - MCHD's own, Aston Herring and Dr. Lisa Owens from Texas Children's Hospital. After listening, you'll know how to recognize what exactly constitutes unsafe sleep and more importantly understand the impact that sleep environment can have on otherwise healthy infants. Join us as we attempt to shine a light on a potentially deadly problem with surprisingly simple solutions. REFERENCES 1. https://cribsforkids.org 2. https://pediatrics.aappublications.org/content/138/5/e20162938 3.https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Safe-Sleep-for-Babies.aspx

Over the past week we’ve had several local false alarms with possible patients presenting with the 2019 Novel Coronovirus. On this special release, the podcast crew will discuss the impact of this worrisome viral infection on EMS providers. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html 2. https://jamanetwork.com/journals/jama/pages/jama-author-interviews

Tracheostomy patients can be intimidating and confusing with complex recent medical histories and unfamiliar terminology surrounding the surgical hole placed in their neck. Join Dr. Patrick as he attempts to demystify the tracheostomy tube and provide a framework to utilize when approaching the crashing trached patient. REFERENCES 1. http://www.tracheostomy.org.uk/storage/files/Patent%20Airway%20Algorith m.pdf 2. http://www.tracheostomy.org.uk 3. Mcgrath BA et al. Guidelines Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. N Anaesthesia 2012; 67 (9), 1025–1041.

While attending the 2019 Texas EMS Conference, Dr. Dickson and Chief Crocker were lucky enough to sit down with Dr. Jeff Jarvis from Williamson County EMS to discuss the background and evolution of the Texas CARES registry. We'll introduce the purpose of Texas CARES along with the ways in which it can benefit your service. REFERENCES 1. https://tx-cares.com

Continuing with the dizziness theme for the 2019 holiday season, Dr. Dickson is joined on episode 67 by Dr. Jeremiah Johnson. Dr. Johnson is a neurosurgeon here in Montgomery County where he's the Director of the Comprehensive Stroke program at CHI-St. Luke's Hospital in The Woodlands. We all recognize the combination of aphasia with face and extremity weakness that occurs in anterior circulation strokes. But, how do posterior strokes present? How common are they? Are posterior strokes time sensitive and amenable to TPA and/or clot retrieval in the same manner as anterior strokes? For answers to all these questions and many more, take a listen and hear from a true expert in the rapidly advancing field of endovascular treatment for acute stroke.

Join Dr. Dickson as he takes a trip down under to talk with Dr. Alastair Meyer about the often dreaded chief complaint of dizziness. Dr. Meyer is the Director of Emergency Medicine for Monash Health in Melbourne. The differential diagnosis for the commonly encountered dizzy patient is broad and consists of many non-emergent conditions along with deadly pathology as well. This combination can be a recipe for disaster. This episode will leave listeners with the deadly dizzy diseases and a framework to approach your next dizzy run.

Our population is aging, and heart failure is only going to increase. This will inevitably lead to an increase of patients with left ventricular assist devices. New technology can be intimidating and confusing with complex recent medical histories and unfamiliar terminology surrounding the various LVAD brands. Join the podcast crew as we attempt to simply an EMS approach to the LVAD patient. REFERENCES: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123099/pdf/wjem-19-834.pdf 2. https://emj.bmj.com/content/34/12/842.long 3. Goebel et al. (2019) An Urban 9-1-1 System’s Experience with Left Ventricular Assist Device Patients, Prehospital Emergency Care, 23:4, 560-565 4. Shinar et al. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014;85(5):702-704

MCHD is excited for the county wide roll out of the PulsePoint app. Community Outreach Coordinator, Ashton Herring, joins Dr. Patrick to discuss the importance of bystander CPR in increasing survival in cardiac arrest patients. After listening, download PulsePoint and let’s get hands on chest as quickly as possible which we know is a recipe for saving lives. REFERENCES 1. https://apps.apple.com/us/app/pulsepoint-respond/id500772134

On this episode, Dr. Patrick and MCHD Paramedic Podcast toxicologist extraordinaire, Dr. Jerry Snow, pick up where they left off in our recent discussion of the classic toxidromes. We'll branch out into some topics that veer from the textbook such as the Alpha 2 agonists that can mimic opiate toxicity and why toxicologists fear methadone ingestions. We'll also touch on some "tox" current events such as vaping associated pulmonary injury, imodium overdoses and why this is an increasing phenomenon, and finally a brief discussion of kratom chemistry and overdose findings. REFERENCES: 1. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

Dr. Patrick is joined by two medics on the MCHD recruitment committee, Megan Steely and Russell Carter, to discuss the components of the "next generation" medic. We also dive in to the nuts and bolts of the EMS service of the future as well. Schedule options, compensation issues, service offerings and atmosphere are all addressed during this wide ranging conversation. Only the surface is skimmed here, so please drop a line to the podcast email if you have additional similar/related topics you'd like us to expound on in future podcasts.

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 rare disease. J Thromb Haemost 2014; 12: 1494–502. 3. Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013;31:1389–92. 4. Birmingham AR, Mah ND, Ran R, et al. Topical tranexamic acid for the treatment of acute epistaxis in the emergency department. Am J Emerg Med. 2018;36:1242-1245. 5. Zahed R, Mousavi, Jazayeri MH,Nader iA,et al.Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: randomized controlled trial. Acad Emerg Med. 2018;25:261-266. 6. Akkan, Sedat et al. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Annals of Emergency Medicine, Volume 74, Issue 1, 72 - 78 7. Min, H. J., Kang, H., Choi, G. J., & Kim, K. S. (2017). Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery, 157(6), 921–927. 8. Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systemic review of the literature. Eur Arch Otorhinolaryngol. 2014; 271(2):237-243

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. Resuscitative endovascular balloon occlusion of the aorta: current evidence. Open Access Emerg Med. 2019;11:29–38. Published 2019 Jan 14.

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 Inventory: A new tool for the assessment of burnout, Work & Stress, 19:3, 192-207, DOI: 10.1080/02678370500297720

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.