The World’s Okayest Medic Podcast

Bartos JA, Clare Agdamag A, Kalra R, Nutting L, Frascone RJ, Burnett A, Vuljaj N, Lick C, Tanghe P, Quinn R, Simpson N, Peterson B, Haley K, Sipprell K, Yannopoulos D. Supraglottic Airway Devices are Associated with Asphyxial Physiology After Prolonged CPR in Patients with Refractory Out-of-Hospital Cardiac Arrest Presenting for Extracorporeal Cardiopulmonary Resuscitation. Resuscitation. 2023 Mar 16:109769. doi: 10.1016/j.resuscitation.2023.109769. Epub ahead of print. PMID: 36933882.

REFERENCES: Nick Costain. (2018). Management Controversies in Traumatic Cardiac Arrest. EM Ottawa Blog. Available at https://emottawablog.com/2018/04/management-controversies-in-traumatic-cardiac-arrest/epi Royal Melbourne Hospital. (2018). Traumatic Cardiac Arrest Guideline. https://www.thermh.org.au/sites/default/files/media/documents/clinical/TRM%2008.12%20Traumatic%20Arrest%20Guideline%20V1.0_08.17.pdf Watts S, Smith JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest. Resuscitation. May 2019. doi:10.1016/j.resuscitation.2019.04.048 Wongtanasarasin W, Thepchinda T, Kasirawat C, Saetiao S, Leungvorawat J, Kittivorakanchai N. Treatment Outcomes of Epinephrine for Traumatic Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis. J Emerg Trauma Shock. 2021 Oct-Dec;14(4):195-200. doi: 10.4103/JETS.JETS_35_21. Epub 2021 Nov 23. PMID: 35125783; PMCID: PMC8780637. Yamamoto, R., Suzuki, M., Hayashida, K. et al. Epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study. Scand J Trauma Resusc Emerg Med 27, 74 (2019). https://doi.org/10.1186/s13049-019-0657-8

References: PMID 26557486 Wood, Owen. (2017). https://www.ditchdocem.com/2017/04/17/racemic-epinephrine/

REFERENCES: Bhardwaj H, Bhardwaj B, Awab A. Revisiting opioid overdose induced acute respiratory distress syndrome. Indian J Crit Care Med. 2014 Feb;18(2):119-20. doi: 10.4103/0972-5229.126095. PMID: 24678160; PMCID: PMC3943122. Elkattawy S, Alyacoub R, Ejikeme C, Noori MAM, Remolina C. Naloxone induced pulmonary edema. J Community Hosp Intern Med Perspect. 2021 Jan 26;11(1):139-142. doi: 10.1080/20009666.2020.1854417. PMID: 33552437; PMCID: PMC7850343. Kummer RL, Kempainen RR, Olives TD, Leatherman JW, Prekker ME. Naloxone-associated pulmonary edema following recreational opioid overdose. Am J Emerg Med. 2022 Mar;53:41-43. doi: 10.1016/j.ajem.2021.12.030. Epub 2021 Dec 17. PMID: 34973491. Saybolt MD, Alter SM, Dos Santos F, Calello DP, Rynn KO, Nelson DA, Merlin MA. Naloxone in cardiac arrest with suspected opioid overdoses. Resuscitation. 2010 Jan;81(1):42-6. doi: 10.1016/j.resuscitation.2009.09.016. Epub 2009 Nov 13. PMID: 19913979. Ventura AL, White CC 4th, Braude D. Letter to the Editor in Response to "Naloxone Cardiac Arrest Decision Instruments (NACARDI) for targeted antidotal therapy in occult opioid overdose precipitated cardiac arrest". Resuscitation. 2021 Jul;164:157-158. doi: 10.1016/j.resuscitation.2021.02.044. Epub 2021 May 9. PMID: 33979667.

REFERENCE: Meyers, P., Weingart, S., Smith, S. (2018). The OMI Manifesto. Available: http://hqmeded-ecg.blogspot.com/2018/04/the-omi-manifesto.html

REFERENCES: August, P., Siabi, B. (2022). Preeclampsia: Clinical Features and Diagnosis. Up-to-Date. Judy AE, McCain CL, Lawton ES, Morton CH, Main EK, Druzin ML. Systolic Hypertension, Preeclampsia-Related Mortality, and Stroke in California. Obstet Gynecol. 2019 Jun;133(6):1151-1159. doi: 10.1097/AOG.0000000000003290. PMID: 31135728.

Helman, A. (2022). Pericarditis and Cardiac Tamponade. Emergency Medicine Cases. Available at: https://emergencymedicinecases.com/pericarditis-cardiac-tamponade/ Imazio, M. (2022). Acute Pericarditis: Clinical Presentation and Diagnosis. Up-to-Date. Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A, Pomari F, Coda L, Belli R, Trinchero R. Indicators of poor prognosis of acute pericarditis. Circulation. 2007 May 29;115(21):2739-44. doi: 10.1161/CIRCULATIONAHA.106.662114. Epub 2007 May 14. PMID: 17502574. Swaminathan, A. (2016). Pericarditis. Core EM Blog. Available at https://coreem.net/core/pericarditis/

EPISODE WARNING: SENSITIVE TOPICS, FOUL LANGUAGE

Simply a commentary episode.

Mike, Sarah, Alaina, and Wes discuss various topics and go down rabbitholes.

References: Frank Lodeserto MD, "High Flow Nasal Cannula (HFNC) – Part 1: How It Works", REBEL EM blog, August 20, 2018. Available at: https://rebelem.com/high-flow-nasal-cannula-hfnc-part-1-how-it-works/. Nishimura, Masaji. (2016). High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respiratory Care, 61(4), 529-41. Sharma S, Danckers M, Sanghavi D, et al. High Flow Nasal Cannula. [Updated 2022 Sep 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526071/

August, Phyllis. (2022). Preeclampsia: Clinical Features and Diagnosis. Up-to-Date. Euser, A. & Cipolla, M. (2009). Magnesium sulfate for the treatment of eclampsia. Stroke, 40. Nelson, K. (2019). Determining FHR during air transport. Available: http://survivalflighteducationblog.com/determining-fetal-heart-rate-during-air-transport/lit NHS. The Obs Podcast. Episode: FHT - Part One. Simhan, H. Caritis, S. (2022). Inhibition of Acute Preterm Labor. Up-to-Date.

Listner questions and my (rambling) answers. REFERENCES Baize, Kohman, Stoffel, Weigartz. (2021). Albuterol versus terbutaline in emergency department management of asthma or COPD exacerbation. Critical Care Medicine 49(1 suppl 1): 410. Busti. (2015). Nitroglycerin Use in the Initial Management of Ischemic Pain from Acute Myocardial Infarction (NSTEMI, STEMI). Available: https://www.ebmconsult.com/articles/nitroglycerin-use-in-initial-management-ischemic-pain-acute-myocardial-infarction-nstemi-stemi Mike Sarraille, George Randle, Josh Cotton. The Talent War: How Special Operations and Great Organizations Win on Talent. Salim Rezaie, "The Death of MONA in ACS: Part III – Nitroglycerin", REBEL EM blog, November 5, 2017. Available at: https://rebelem.com/death-mona-acs-part-iii-nitroglycerin/.

References: PMID 30167699, 22664746, 22504150, 220474079, 25461079, 22664746, 35001830

References: Burton LV, Beier K. Papillary Muscle Rupture. [Updated 2022 Jul 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499976/ Jung J, Rice J, Bord S. Rethinking the role of epinephrine in cardiac arrest: the PARAMEDIC2 trial. Ann Transl Med. 2018 Dec;6(Suppl 2):S129. doi: 10.21037/atm.2018.12.31. PMID: 30740450; PMCID: PMC6330609. Thiele, Holger. Abbott, J Dawn. (2022). Acute Myocardial Infarction: Mechanical Complications. Up-to-Date.

References: Campbell & Kelso. (2022). Anaphylaxis: Emergency Treatment. http://www.litfl.com/tip-10-pearls-for-managing-anaphylaxis http://emcrit.org/ibcc/anaphylaxis McLendon and Sternard. Anaphylaxis (2022). NCBI NBK482124. PMID: 29909382, 20028373, 2931426

Sarah Motley, EMT, RN: instructor from IA Med comes on to shoot the breeze and talk about endocrine patients and responding to diabetics.

Mike and Ashley discuss random stuff: imposter syndrome, dispatch, and "the brand" among other topics.

References: Karl A. Sporer, Nicholas J. Johnson, Clement C. Yeh & Glen M. Youngblood (2008) Can Emergency Medical Dispatch Codes Predict Prehospital Interventions for Common 9-1-1 Call Types?, Prehospital Emergency Care, 12:4, 470-478, DOI: 10.1080/10903120802290877 Torlén, K., Kurland, L., Castrén, M. et al. A comparison of two emergency medical dispatch protocols with respect to accuracy. Scand J Trauma Resusc Emerg Med 25, 122 (2017). https://doi.org/10.1186/s13049-017-0464-z PMID: 29223194, 22824188, 18256298, 18584494, 19189610

REFERENCES: Farkas, Josh. (Feb 14, 2021). Acute Liver Failure. Internet Book of Critical Care. Available: https://emcrit.org/ibcc/alf/ Forkin, Katherine T. MD; Colquhoun, Douglas A. MBChB, MSc, MPH†; Nemergut, Edward C. MD,‡; Huffmyer, Julie L. MD*. The Coagulation Profile of End-Stage Liver Disease and Considerations for Intraoperative Management. Anesthesia & Analgesia: January 2018 - Volume 126 - Issue 1 - p 46-61 doi: 10.1213/ANE.0000000000002394 Mayo Clinic. Liver Function Tests. Available from: https://www.mayoclinic.org/tests-procedures/liver-function-tests/about/pac-20394595 Montreif, Tom. (Nov 25, 2018). Acute Liver Failure: Evidence-Based Evaluation and Management. EM Docs blog. Available: http://www.emdocs.net/acute-liver-failure-evidence-based-evaluation-and-management/ Northup PG, Caldwell SH. Coagulation in liver disease: a guide for the clinician. Clin Gastroenterol Hepatol. 2013 Sep;11(9):1064-74. doi: 10.1016/j.cgh.2013.02.026. Epub 2013 Mar 16. PMID: 23506859.

This episode is literally just my partner Bill and I shooting the proverbial breeze with a microphone between us.

Reference: Chris Nickson. (2020). GCS. Available at http://www.litfl.com/glasgow-coma-scale

*READ THE TOPICS COVERED BEFORE LISTENING*** Case study of a 92 year old with delirium Causes of delirium Geriatric toxicology Geriatric STI's and sexual health REFERENCES: Alex Yartsev. Pharmacology and toxicology in old age. June 30, 2016. Deranged Physiology. Available from https://derangedphysiology.com/main/required-reading/pharmacology-and-toxicology/Chapter%201.3.4/pharmacology-and-toxicology-old-age Frankowski AC, Clark LJ. Sexuality and Intimacy in Assisted Living: Residents' Perspectives and Experiences. Sex Res Social Policy. 2009 Dec 1;6(4):25-37. doi: 10.1525/srsp.2009.6.4.25. PMID: 25568640; PMCID: PMC4283937. Kristen Fontes MD, Alex Koyfman MD, Brit Long MD. Common ED Medication Errors: Polypharmacy. EmDocs. July 3, 2017. Available from http://www.emdocs.net/common-ed-medication-errors-polypharmacy/ Nat. Research Council (US) Cute on Chemical Toxicology and Aging. Aging in Today’s Environment. Washington (DC): National Academies Press (US); 1987. 4, Principles of Toxicology in the Context of Aging. Available from: https://www.ncbi.nlm.nih.gov/books/nbk218724/ Rashid, M.H., Sparrow, N.A., Anwar, F. et al. Interleukin-6 mediates delirium-like phenotypes in a murine model of urinary tract infection. J Neuroinflammation 18, 247 (2021). https://doi.org/10.1186/s12974-021-02304-x Stanford Medicine 25. Website: Fundoscopic/Opthalomoscopic Exam. Available from https://stanfordmedicine25.stanford.edu/the25/fundoscopic.html https://www.theseniorlist.com/sti-older-americans/

REFERENCES: Blevins, Charles. (2021). Intubating Asthma. American Academy of Emergency Medicine. Available at https://www.aaem.org/UserFiles/file/CCMS_CSJanFeb21.pdf Josh Farkas. (Aug 5, 2021). Waveform capnography in the intubated patient. Internet Book of Critical Care. Available at https://emcrit.org/ibcc/co2/ Pearson SD, Patel BK. Noninvasive Ventilation for Acute Asthma: The Neglected Sibling. Am J Respir Crit Care Med. 2020 Dec 1;202(11):1491-1493. doi: 10.1164/rccm.202007-2876ED. PMID: 32755489; PMCID: PMC7706170. Vasileiadis, I., Alevrakis, E., Ampelioti, S., Vagionas, D., Rovina, N., and Koutsoukou, A. (2019). Acid-base disturbances in patients with asthma: A literature review and comments on their pathophysiology. Journal of Clinical Medicine, 8, 563.

References (I didn't alphabetize them...sorry): Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. Ann Transl Med. 2018 Sep;6(18):355. doi: 10.21037/atm.2018.04.39. PMID: 30370282; PMCID: PMC6186545. Bendjelid K, Schütz N, Suter PM, et al. Does continuous positive airway pressure by face mask improve patients with acute cardiogenic pulmonary edema due to left ventricular diastolic dysfunction? Chest 2005;127:1053-8. 10.1378/chest.127.3.1053 Frey, Michael. (2011). CPAP and Cardiogenic Pulmonary Edema. RT Magazine. Available at https://rtmagazine.com/disorders-diseases/chronic-pulmonary-disorders/asthma/cpap-and-cardiogenic-pulmonary-edema/ Chakraborty RK, Hamilton RJ. Calcium Channel Blocker Toxicity. [Updated 2022 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537147/ Salim Rezaie, "Pearls from ResusX Rewired 2020", REBEL EM blog, October 10, 2020. Available at: https://rebelem.com/pearls-from-resusx-rewired-2020/. Joshua Bucher. “Cervical Collars for C-Spine Trauma: The Facts” EMDOCS Blog. Available at: http://www.emdocs.net/cervical-collars-for-c-spine-trauma-the-facts/ Jugdutt, BI, & Warnica, JW. (1988). Intravenous nitroglycerin therapy to limit infarct size, expansion, and complications. Effect of timing, dosage, and infarct location. Circulation, 78(4). Salim Rezaie, "The Death of MONA in ACS: Part III – Nitroglycerin", REBEL EM blog, November 5, 2017. Available at: https://rebelem.com/death-mona-acs-part-iii-nitroglycerin/. http://derangedphysiology.com/main/required-reading/trauma-burns-and-drowning/

REFERENCES: Capone J, Gluncic V, Lukic A, Candido KD. Physiologically Difficult Airway in the Patient with Severe Hypotension and Metabolic Acidosis. Case Rep Anesthesiol. 2020 Sep 4;2020:8821827. doi: 10.1155/2020/8821827. PMID: 32953182; PMCID: PMC7487120. Kim HJ, Son YK, An WS. Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis. PLoS One. 2013 Jun 5;8(6):e65283. doi: 10.1371/journal.pone.0065283. PMID: 23755210; PMCID: PMC3673920. https://www.openanesthesia.org/co2_transport_bicarbonate/ 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/.

Brian Collins is a paramedic, EMS training coordinator, and educator.

Not a nice topic to discuss but necessary for what we do as EMS providers. References: Adams, S., Good, M. And Defranco, G. (2009). Sudden infant death synd. American Family Physician 79(10): 870-874. Helman, A, DeCaen, A, Crocco, A. PALS Guidelines. Emergency Medicine Cases. March, 2017. https://emergencymedicinecases.com/uti-myths-misconceptions/. Accessed [8 July 22]. PMID 30035966, 32019512 Ravera, Joe. (2022). Pediatric Small Talk - The 1, 3, 5 approach to pediatric cardiac arrest. Available from http://www.emdocs.net/pediatric-small-talk-the-135-approach-to-pediatric-cardiac-arrest/