The World’s Okayest Medic Podcast

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Listener discretion is advised. Thanks to Melody for coming back on the podcast to tie up some loose ends re: the COPD episode.

Listener discretion is advised (language). References: Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012 Oct 29;16(5):323. Bonilla Arcos D, Krishnan JA, et al. High-Dose Versus Low-Dose Systemic Steroids in the Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Systematic Review. Chronic Obstr Pulm Dis. 2016 Feb 17;3(2):580-588. Fawzy A, Wise RA. Pulse Oximetry Misclassifies Need for Long-Term Oxygen Therapy in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2023 Nov;20(11):1556-1557. Goldberg P, Reissmann H, Maltais F, Ranieri M, Gottfried SB. Efficacy of noninvasive CPAP in COPD with acute respiratory failure. Eur Respir J. 1995 Nov;8(11):1894-900. Jennifer T. Thibodeau, Mark H. Drazner. The Role of the Clinical Examination in Patients With Heart Failure,JACC: Heart Failure, Volume 6, Issue 7, 2018, Pages 543-551. Kartal M, Goksu E, Eray O, et al. The value of ETCO2 measurement for COPD patients in the emergency department. Eur J Emerg Med. 2011 Feb;18(1):9-12. Ni, H., Aye, S., Naing, C. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2022 May 26; 2022(5):CD013506. Pertzov, B., Ronen, M., Rosengarten, D. et al. Use of capnography for prediction of obstruction severity in non-intubated COPD and asthma patients. Respir Res 22, 154 (2021). Pu X, Liu L, Feng B, Wang M, Dong L, Zhang Z, Fan Q, Li Y, Wang G. Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation. Respir Care. 2021 Feb;66(2):316-326. Tyagi D, Govindagoudar MB, et al. Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation. Indian J Crit Care Med. 2021 Mar;25(3):305-309. van Gestel AJ, Steier J. Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD). J Thorac Dis. 2010 Dec;2(4):215-22. doi: 10.3978/j.issn.2072-1439.2010.02.04.5.

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Listener discretion is advised. Thanks to Adam from "Dialed Medics" for coming onto the podcast and talking about EMS education. Follow them on social media @dialedmedics.

LISTENER DISCRETION IS ADVISED. Lavery MD, Aulakh A, Christian MD. Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically Ill and injured patients: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2025 Jan 6;33(1) Other Citations: Bujak K, et al. Does the presence of physician-staffed emergency medical services improve the prognosis in out-of-hospital cardiac arrest? A propensity score matching analysis. Kardiol Pol. 2022;80(6) Fukuda T, et al.. Association of Prehospital Advanced Life Support by Physician With Survival After Out-of-Hospital Cardiac Arrest With Blunt Trauma Following Traffic Collisions: Japanese Registry-Based Study. JAMA Surg. 2018 Jun 20;153(6) Garner et al.. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only. Emerg Med J. 2015 Nov;32(11) Den Hartog et al.. Survival benefit of physician-staffed helicopter emergency medical services (HEMS) assistance for severely injured patients. Injury. 2015;46(7) Hesselfeldt R,et al.. Impact of a physician-staffed helicopter on a regional trauma system: a prospective, controlled, observational study. Acta Anaesthesiol Scand. 2013 May;57(5): Lyons J, et al. Impact of a physician - critical care practitioner pre-hospital service in Wales on trauma survival. Anaesthesia. 2021 Nov;76(11) Maddock A, et al. Prehospital critical care is associated with increased survival in adult trauma patients in Scotland. Emerg Med J. 2020 Mar;37(3):141-145. Moors XRJ, et al. A Physician-Based Helicopter Emergency Medical Services Was Associated With an Additional 2.5 Lives Saved per 100 Dispatches of Severely Injured Pediatric Patients. Air Med J. 2019 Jul-Aug;38(4) Yeguiayan JM, et al. Medical pre-hospital management reduces mortality in severe blunt trauma. Crit Care. 2011;15(1)

Listener discretion is advised. References: Gutierrez, E. (2023). The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals. Hu W, Wang X, Su G. Infective endocarditis complicated by embolic events: Pathogenesis and predictors. Clin Cardiol. 2021 Mar;44(3):307-315. doi: 10.1002/clc.23554. Epub 2021 Feb 1. PMID: 33527443; PMCID: PMC7943911. Marik PE, Farkas JD. The Changing Paradigm of Sepsis: Early Diagnosis, Early Antibiotics, Early Pressors, and Early Adjuvant Treatment. Crit Care Med. 2018 Oct;46(10):1690-1692. doi: 10.1097/CCM.0000000000003310. PMID: 30216303.

LISTENER DISCRETION IS ADVISED. REFERENCES: Ferrada P, García A, Duchesne J, Brenner M, Liu C, Ordóñez C, Menegozzo C, Salamea JC, Feliciano D. Comparing outcomes in patients with exsanguinating injuries: an Eastern Association for the Surgery of Trauma (EAST), multicenter, international trial evaluating prioritization of circulation over intubation (CAB over ABC). World J Emerg Surg. 2024 Apr 25;19(1):15. doi: 10.1186/s13017-024-00545-8. PMID: 38664763; PMCID: PMC11044388. Salim Rezaie, "Critical Care Updates: Resuscitation Sequence Intubation – Hypotension Kills (Part 1 of 3)", REBEL EM blog, September 26, 2016. Available at: https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-hypotension-kills-part-1-of-3/. Salim Rezaie, "Critical Care Updates: Resuscitation Sequence Intubation – Hypoxemia Kills (Part 2 of 3)", REBEL EM blog, September 29, 2016. Available at: https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-hypoxemia-kills-part-2-of-3/. Salim Rezaie, "Critical Care Updates: Resuscitation Sequence Intubation – pH Kills (Part 3 of 3)", REBEL EM blog, October 3, 2016. Available at: https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-ph-kills-part-3-of-3/. Scott Weingart, MD FCCM. EMCrit 30 – Hemorrhagic Shock Resuscitation. EMCrit Blog. Published on August 15, 2010. Accessed on December 27th 2024. Available at [https://emcrit.org/emcrit/trauma-resuscitation-dutton/ ].

Josh Cooke from the Alert Medic One Podcast came back to the podcast to talk more about his favorite topic, cardiac arrest. We discuss the recent articles on naloxone in cardiac arrest. Listener discretion is advised. References: PMID 39163042 PMID 38848964

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LISTENER DISCRETION IS SERIOUSLY ADVISED. I'm traveling (again) and decided to record a random ramblings episode with some thoughts that have been on my mind. Nothing clinical on this episode: mostly leadership topics.

Listener discretion is advised. References: PMID 28196622 PMID 35166796 PMID 26062607 Salim Rezaie, "Does My Patient with Chest Pain Have Acute Coronary Syndrome?", REBEL EM blog, November 23, 2015. Available at: https://rebelem.com/does-my-patient-with-chest-pain-have-acute-coronary-syndrome/.

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LISTENER DISCRETION IS ADVISED. Steve Wood came back to the podcast to talk about TEMS and more. Check out his new podcast, The Tac Medic Whiskey Podcast, available on Podbean and Apple Podcasts.

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Listener discretion is advised. Chris Wright is a flight paramedic who spent a few months working as a medic in the Ukranian conflict. He came on to talk about tourniquet conversion but we ended up going into all kinds of trauma lessons he learned from his time.

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It was an honor and a privilege to record an episode with Dr. Mark Piehl and Dr. Peter Antevy. They came on to discuss prehospital blood product administration and their recent letter to the editor in Academic Emergency Medicine.

Listener discretion is advised. References: CHOP Croup Clincial Pathway: https://pathways.chop.edu/clinical-pathway/croup-emergency-department-and-inpatient-clinical-pathway General Peds Reference: Lucking, S. Maffei, F., Tamburro, R., & Zaritsky, A. (2021). Pediatric Critical Care. Text and Study Guide. Pediatric Fluid Maintenance: Somers, Michael. (2022). Maintenance intravenous fluid therapy in children. Up-to-Date. Racemic vs. Standard Epi: PMID: 1734400

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LISTENER DISCRETION IS ADVISED References: Anand Swaminathan, "REBEL Cast Ep107: The BOUGIE Trial – Bougie First in All Emergency Intubations?", REBEL EM blog, February 17, 2022. Available at: https://rebelem.com/rebel-cast-ep107-the-bougie-trial-bougie-first-in-all-emergency-intubations/. AirTraq vs. Bougie: PMID 28515522 McGrath vs. AirTraq: PMID 28781449 Bougie vs. Stylet: PMID 29800096 Rigid vs. Standard Stylet: PMID 22273475

LISTENER DISCRETION IS VERY ADVISED Topics: Meta-Analysis Fallout, NREMT stuff, Offensive idiot at EMS Expo

LISTENER DISCRETION IS REALLY ADVISED. References: Meta-Analysis Civ Prehospital Transfusion: PMID 38517320 COMBAT: PMID 30032977 PamPER: PMID 30044935 RePhill: PMID 35271808 COMBAT/PamPER Post-Hoc Analysis: PMID 31851290

Listener discretion is advised. EMS training guru Rick Maricle came onto talk about the regional blood program in Southern Texas and to talk unscripted about prehospital blood.

LISTENER DISCRETION IS ADVISED Gauer, R. (2017). Severe Asymptomatic Hypertension: Evaluation and Treatment. Am Family Physician. 95(8). Oras, et. Al. (2019). Elevated BP in the ED. Hypertension 75(1). Yaphe, J, Atzema, C, Helman, A. Hypertensive Emergencies. Emergency Medicine Cases. February, 2014.

LISTENER DISCRETION IS ADVISED References: Mag Sulfate for A-Fib: PMID 17449500, 34950320 Eclampsia: PMID 21154341

Listener discretion is advised. Two "newer" medics - Ashlynn and Cameron (my partner) come onto the podcast to talk about the struggles and growth potential of being a new paramedic.

LISTENER DISCRETION IS ADVISED. Safety: culture of safety, buzzword, HEMS safety, ground safety, and more

Listener discretion is advised.

Listener discretion is advised. References (PMID): Compressions: 29132577, 35549924 Junctional TQ/Pelvic Binders: 31910475, 29889959, 38226570, 30507857 Vasopressors: 33908898, 23697682, 28716309 Blood: 34390843, Hazelton, et. al. (2022). Whole blood vs. component therapy for transufsion in trauma pts., McCartney (2023). Whole blood in resuscitating trauma is making a comeback.

Random talk with Wes Nelson...listener discretion is advised

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Listener discretion is advised Cody (@ordinaryopsmedic) and Moose - both from the Alert Medic One team - came on to have a totally random and agendaless discussion about....well....give it a listen...

Paramedic, Nurse Practitioner, Associate Professor, and Bioethicist Stephen Wood came onto the podcast to talk about implementing prehospital blood and to do what I love: dispelling "the narrative."

LISTENER DISCRETION IS ADVISED References: Band RA, Salhi RA, Holena DN, Powell E, Branas CC, Carr BG. Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med. 2014 May;63(5):608-614.e3. doi: 10.1016/j.annemergmed.2013.11.008. Epub 2014 Jan 2. PMID: 24387925; PMCID: PMC5912155. Inaba K, Jurkovich GJ. Police Transport for Penetrating Trauma-Lessons From Patients in Philadelphia. JAMA Netw Open. 2021 Jan 4;4(1):e2035122. doi: 10.1001/jamanetworkopen.2020.35122. PMID: 3349Time 2370. Maher, et. Al. (2021). Police transport of Firearm-Injured patients- more often and more injured. Journal of Acute Care Surgery. PMID 34108420 Winter, et al. (2021). Association of Police Transport with Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania. JAMA Open Network. PMID 33492375 Winter E, Byrne JP, Hynes AM, Geng Z, Seamon MJ, Holena DN, Malhotra NR, Cannon JW. Coming in hot: Police transport and prehospital time after firearm injury. J Trauma Acute Care Surg. 2022 Nov 1;93(5):656-663. doi: 10.1097/TA.0000000000003689. Epub 2022 May 20. PMID: 36282621.

Josh from the Alert Medic One Podcast came on to debrief a recent cardiac arrest call he ran and discuss some cardiac arrest topics.

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Listener discretion is advised. References: Grossman, Dave. (2004). On Combat. http://www.litfl.com http://deployedmedicine.com PMID: 26566339 (Pelvic Ring) PMID 2025808 (LeFort and anatomical pathology) PMID: 36147139 (Lefort III Management) PMID: 31626153 (CICO)

The enchanting and brilliant Melody Bishop, RT came back on to the podcast to answer your respiratory/vent/blood gas/monitoring questions. We are also joined by one of my mentors, Dave Salati (flight nurse, ER nurse, pediatric nurse, and OG urban paramedic) who made his podcasting debut.

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