MCHD Paramedic Podcast

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

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. 4. Parker-Cote, J. L., et al. "Challenges in the diagnosis of acute cyanide poisoning." Clinical Toxicology 56.7 (2018): 609-617.

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. Ranieri VM, Rubenfeld GD, Thompson BT, et al. The ARDS definition task force. Acute respiratory distress syndrome. JAMA 2012;307:2526–2533. 4. (No authors listed). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301–1308. 5. Austin Michael A, Wills Karen E, Blizzard Leigh, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial BMJ 2010; 341 6. Turner JS, et al. Feasibility of upright patient positioning and intubation success rates at two academic emergency departments, American Journal of Emergency Medicine 2017. 7. Stoltze AJ, Wong TS, Harland KK, et al. Prehospital tidal volume influences hospital tidal volume: A cohort study. J Crit Care. 2015 Jun;30(3):495–501.

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 Cardiac Arrests: A Nationwide, Population-Based Cohort Study." Circulation 134(25): 2046-2059. Capizzani AR, et al. Assessment of termination of trauma resuscitation guidelines: are children small adults. J of Peds Surg; 2010: 45, 903-907.

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

Tranexamic Acid (TXA) has been a hot topic in emergency medicine over the past several years with increasing acceptance for use in patients with hemorrhagic shock. Casey Patrick and Jordan Anderson review the pharmacology of TXA, discuss the literature supporting its use, and close with MCHD’s TXA administration protocol. References 1. Gayet-Ageron A et al. Effect of Treatment Delay on the Effectiveness and Safety of Antifibrinolytics in Acute Severe Haemorrhage: A Meta-Analysis of Individual Patient-Level Data From 40138 Bleeding Patients. Lancet 2017. 2. Effects of Tranexamic Acid on Death, Vascular Occlusive Events, And Blood Transfusion in Trauma Patients With Significant Haemorrhage (CRASH-2): A Randomised, Placebo-Controlled Trial. Lancet 2010. 3. Effect of Early Tranexamic Acid Administration on Mortality, Hysterectomy, and Other Morbidities in Women with Post-Partum Haemorrhage (WOMAN): An International, Randomised, Double-Blind, Placebo-Controlled Trial. Lancet 2017.

Dr. Dickson and Dr. Patrick take on one of our favorite topics here at MCHD - Ketamine and the agitated patient. Agitated patients come in a wide spectrum of severity. This discussion starts with a framework for stratifying agitated patients. We discuss the MCHD ketamine experience along with a less discussed patient population that may need ketamine control quicker than we often think. ***Remember that Ketamine is only to be used for patient protection and is never intended to be used out of convenience.*** References: 1. https://www.ems1.com/medical-clinical/articles/78100048-Ketamine-for-Excited-Delirium-Syndrome-Results-of-a-3-year-case-series/ 2. Green et al. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation. Ann Emerg Med. 2011; 57:449-61 3. Cole J et al. A prospective study of ketamine as primary therapy for prehospital profound agitation. Am J Emerg Med. October 2017 4. Parsch C et al. Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study. Emerg Med Australas. 2017;29(3):291-296

Concussions and management of mild head injury are topics that are rapidly evolving. Dr. Greg Faris joins Dr. Patrick to lend his pediatric emergency expertise on these important and commonly seen injuries. With youth and high school football season coming soon, get your concussion refresher now. References: CDC Heads up. www.cdc.gov/headsup Kupperman N, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374: 1160-70. McCrory P, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;0:1–10. Davis GA, et al. Sports Concussion Assessement Tool 5th Edition. Br J Sports Med 2017;0:1–8

Pregnancy complications make us all a little diaphoretic and tachycardic. On this episode, Dr. Patrick and Dr. Dickson break down the must know aspects of caring for the obstetric patient prior to delivery in the EMS setting. References: https://www.acog.org/Clinical-Guidance-and-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy

Dr. Patrick is joined on this episode by Dr. Elizabeth Weinstein. Elizabeth is a dual trained in Emergency Medicine and Pediatrics, and she delivers clinical pearl after clinical pearl on how to recognize and manage non-accidental trauma in the prehospital environment. Resources: http://www.identifychildabuse.org

Join Dr. Patrick for a discussion of common drugs, both OTC and prescription, that can be deadly to our pediatric patients in doses as small as a single pill. This knowledge will allow us to properly educate families and know when to expect a potential crashing kid. References: Michael J.B., Sztajnkrycer M.D. Deadly pediatric poisons: Nine common agents that kill at low doses. (2004). Emergency Medicine Clinics of North America, 22, 1019-1050.

Dr. Jerry Snow, a medical toxicologist and emergency medicine physician from Phoenix joins the show for an interesting discussion about the opiate crisis facing America today, with a specific emphasis on fentanyl and its derivatives. We discuss EMS/first responder exposure risks and preventative measures along with patient care pearls when treating patients with fentanyl overdose. References: American Academy of Clinical Toxicology Statement on Fentanyl Exposure Risks - https://www.acmt.net/_Library/Fentanyl_Position/Fentanyl_PPE_Emergency_Responders_.pdf https://www.whitehouse.gov/ondcp/key-issues/fentanyl/

Patients with acute pulmonary edema need rapid preload and afterload reduction and often their volume status is difficult to ascertain. Casey Patrick and Brad Ward discuss a novel approach to using our old friend nitroglycerin in these patients along with the other cornerstones of their care. References 1. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389-93. 2. Levy P, Compton S, Welch R, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144-52. 3. Wilson SS, Kwiatkowski GM, Millis SR, et al. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-31. 4. Peacock WF et al. Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis. Emerg Med J 2008; 25: 205 – 209.

CHF exacerbations are bread and butter emergency medicine. Casey Patrick and Brad Ward begin with some background physiology and review of CHF. They then move on to describing a more detailed framework than the typical “CHF exacerbation” that is commonly taught. You’ll finish this podcast and think you’re a plumber as opposed to a paramedic. References https://coreem.net/core/ape/

Today’s show is all about the changes in how we approach intubation in EMS. Dr. Jeff Jarvis will relate how he got interested in the topic of airway management and specifically the process of delayed sequence intubation. Dr. Jarvis is the EMS medical director for Williamson County Texas EMS. He will present data from the recent Annals of Emergency Medicine paper his group authored on the topic. MCHD quality lead, Kevin Crocker, will present our data following DSI Implementation in Montgomery County. Weingart Emcrit podcast and Annals of EM article https://emcrit.org/dsi/ http://dx.doi.org/10.1016/j.annemergmed.2014.09.025 Jarvis Annals paper http://www.annemergmed.com/article/S0196-0644(18)30071-4/abstract Wilco EMS: https://www.wilco.org/Departments/EMS 2017 SOCs DSI protocol DSI checklist for both WCEMS and Marble Falls Area EMS

Join Dr. Patrick and Ashton Herring our community outreach coordinator as we discuss adult and pediatric drowning emergencies and best practices in prevention.

With the blazing Texas summer just around the corner, we thought it would be appropriate to discuss heat related emergencies. Dr. Patrick leads a discussion of the various terminology, physical exam findings, differential diagnoses and pre-hospital treatments for heat-illness.

Dr. Jerry Snow, a medical toxicologist and emergency medicine physician from Phoenix joins the show for a fact-filled and often hilarious talk on prehospital management of snakebites. This episode involves copperheads, water moccasins and even unsuccessful car battery therapy (yep, you read that correctly). Stay until the end - you won’t be sorry you did!

In the past 24 months, stroke care has evolved in the way we evaluate strokes in the pre-hospital space and how they are worked up and treated in the hospital. Large vessel Occlusion (LVO) stoke is a large caliber vessel clot causing stroke symptoms. New techniques and devices in endovascular retrieval of these clots along with intravenous Tpa has shown great success in five randomized trials published in 2015.(1) The number we need to treat for one improved neurologic outcome at 90 days according to data from these trials is 2.6 patients. This is a massive breakthrough in the way we approach acute stroke care. Improved outcomes in these trials are directly associated with times to reperfusion therapy and EMS must change the way we diagnose and rank stroke patients in order to get them an endovascular capable facility when appropriate. In the first podcast our team will review all of the pertinent data from these trials and suggest how EMS should approach this LVO stroke diagnosis. In the second part of our stroke awareness series we talk with Dr. Peter Antevy, an EMS medical director from Florida who is an expert of developing regional systems of care for these LVO stroke patients. He will discuss development of their system and exciting new data that demonstrates a treatment benefit up to 24 hours after onset of symptoms in some subsets of these stroke patients. (2, 3) References 1.Hermes Collaboration: Lancet 2016 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00163-X/abstract 2. Dawn Trial: NEJM 2018 http://www.nejm.org/doi/full/10.1056/NEJMoa1706442 3. DEFUSE 3 Trial: NEJM 2018 http://www.nejm.org/doi/full/10.1056/NEJMoa1713973

In the past 24 months, stroke care has evolved in the way we evaluate strokes in the pre-hospital space and how they are worked up and treated in the hospital. Large vessel Occlusion (LVO) stoke is a large caliber vessel clot causing stroke symptoms. New techniques and devices in endovascular retrieval of these clots along with intravenous Tpa has shown great success in five randomized trials published in 2015.(1) The number we need to treat for one improved neurologic outcome at 90 days according to data from these trials is 2.6 patients. This is a massive breakthrough in the way we approach acute stroke care. Improved outcomes in these trials are directly associated with times to reperfusion therapy and EMS must change the way we diagnose and rank stroke patients in order to get them an endovascular capable facility when appropriate. In the first podcast our team will review all of the pertinent data from these trials and suggest how EMS should approach this LVO stroke diagnosis. In the second part of our stroke awareness series we talk with Dr. Peter Antevy, an EMS medical director from Florida who is an expert of developing regional systems of care for these LVO stroke patients. He will discuss development of their system and exciting new data that demonstrates a treatment benefit up to 24 hours after onset of symptoms in some subsets of these stroke patients. (2, 3) References 1.Hermes Collaboration: Lancet 2016 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00163-X/abstract 2. Dawn Trial: NEJM 2018 http://www.nejm.org/doi/full/10.1056/NEJMoa1706442 3. DEFUSE 3 Trial: NEJM 2018 http://www.nejm.org/doi/full/10.1056/NEJMoa1713973

Anaphylaxis is a common life threatening disease that prehospital providers encounter on a regular basis. These patients are in need of early treatment with Epinephrine. In today’s episode Dr. Casey Patrick, along with Kevin Crocker and Ashton Herring, will be discussing MCHD’s deployment of Epinephrine to the Fire Departments within Montgomery County. This discussion will cover basic information on what anaphylaxis is and how to best treat it. We will also discuss how MCHD built Epi kits and how we trained the fire departments in how to safely and effectively manage these anaphylactic patients. References https://www.ems1.com/epinephrine/articles/381400048-Anaphylaxis-kits-Easy-epinephrine-deployment-for-first-on-scene/ https://www.dovepress.com/cr_data/article_fulltext/s121000/121733/img/DHPS_121733_F001.jpg

Join Dr. Casey Patrick and Brad Ward as they discuss a county wide initiative to expedite ROSC patients to definitive care in the cardiac cath lab. They will be discussing the literature and science on why these patients have better outcomes when they are quickly taken to the cath lab. They will also be addressing how MCHD has partnered with our hospitals to implement our new ROSC Cath Lab Activation. References AHA Updates http://circ.ahajournals.org/content/132/18_suppl_2/S465 Tanveer Rab, Karl B. Kern, Jacqueline E. Tamis-Holland, Timothy D. Henry, Michael McDaniel, Neal W. Dickert, Joaquin E. Cigarroa, Matthew Keadey, Stephen Ramee, Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient, Journal of the American College of Cardiology, Volume 66, Issue 1, 2015, Pages 62-73, ISSN 0735-1097, https://doi.org/10.1016/j.jacc.2015.05.009.

It's Memorial Hermann Ironman Texas time here in Montgomery County, and our MCHD crews are preparing to staff the 140.6 mile triathlon. After fielding multiple questions about hyponatremia and hypothermia in ultra-endurance athletes, we decided that a podcast discussion was in order. The MCHD Paramedic Podcast crew were lucky enough to have Dr. Kevin Schulz, Medical Director for Memorial Hermann Ironman Texas, join us to talk Ironman medicine. Sit back, relax and enjoy the ride...we promise it won't hurt as bad as 112 miles on a bike! References: Hew-Butler T, Rosner MH, et al. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med. 2015 Jul;25(4):303-20.

EMS implementation of Community Paramedicine and Mobile Integrated Health programs is exploding. Dr. Peter Antevy joins Dr. Dickson for an informative discussion surrounding the role of Community Paramedicine and Mobile Integrated Health in today’s EMS systems. Dr. Antevy has built an impressive CP program from the ground up in South Florida. He shares his experiences and thoughts on both the ideal role and future of CP.

Hyperkalemia can send our patients to cardiac arrest in an instant. Casey Patrick and Jordan Anderson begin with some background physiology review on the importance of potassium to cellular function. They then move on to describing specific patient characteristics and ECG findings found in patients with hyperkalemia, and close with MCHD’s current protocol to preemptively treat these patients en route to the hospital. PDF Summary: https://www.mchd-tx.org/media/podcasts/MCHDPP-04.pdf

Syncope is a common and often confusing presentation. Dr. Casey Patrick leads a lecture style discussion with tips to approaching the syncopal patient in the prehospital setting. ECG pointers and an impossible to forget “crappy” mnemonic will leave you with a more focused approach to your next syncopal patient. References 1. http://www.jem-journal.com/article/S0736-4679(17)30868-5/pdf LINKS: 1. WPW - https://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/ 2. Brugada syndrome - https://www.aliem.com/2013/06/brugada-syndrome-an-ecg-pattern-you-need-to-know/ 3. Prolonged QT interval - https://lifeinthefastlane.com/wp-content/uploads/2011/01/waves-of-the-ecg.gif 4. Hypertrophic Obstructive Cardiomyopathy - http://www.wikidoc.org/images/b/b0/Hypertrophic_cardiomyopathy.jpg

Featuring Dr. Peter Antevy Today’s show will focus on the evolution in the EMS approach to pediatric resuscitations. Historically these high stress resuscitations focused on rapid transport of these children to the hospital and have resulted in sub par resuscitation efforts and increased stress for both providers and families. There is mounting evidence that mirrors the adult resuscitation data that staying on scene and providing focused resuscitation efforts improves outcomes in these patients. Dr. Antevy provides a unique perspective as both a pediatric EM specialist/EMS medical director and inventor of the Handtevy pediatric resuscitation system. https://www.handtevy.com

Welcome to MCHD's Paramedic Podcast - a biweekly podcast dedicated to EMS Providers across the world.

Dr. Patrick and Clinical Manager Jordan Anderson discuss intubation and ventilator settings to help avoid lung injuries in the intubated patient.