The World’s Okayest Medic Podcast

HEED THE REFERENCES: Anand Swaminathan, "REBEL Core Cast 47.0 Nausea and Vomiting", REBEL EM blog, January 13, 2021. Available at: https://rebelem.com/rebel-core-cast-47-0-nausea-and-vomiting/. Beadle KL, Helbling AR, Love SL, April MD, Hunter CJ. Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2015; doi: http://dx.doi.org/10.1016/j.annemergmed.2015.09.031. Furyk, J. S., Meek, R. A., & Egerton-Warburton, D. (2015). Drugs for the treatment of nausea and vomiting in adults in the emergency department setting. The Cochrane database of systematic reviews, 2015(9), CD010106. https://doi.org/10.1002/14651858.CD010106.pub2 Mark Ramzy, "Aromatherapy vs Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients", REBEL EM blog, December 3, 2020. Available at: https://rebelem.com/aromatherapy-vs-oral-ondansetron-for-antiemetic-therapy-among-adult-emergency-department-patients/. Phips, Ashley. (2015). Article Review: RCT of Antiemetic Efficacy in the ED. Available at http://www.emdocs.net/wp-content/uploads/2015/01/AntiemeticUseED-Phipps-.pdf Plewa, Young, Yerman. (20 July 2008). The vomiting patient in the ED: Evaluation and management. Emergency Medicine Reports. Available from https://www.reliasmedia.com/articles/13681-the-vomiting-patient-in-the-ed-evaluation-and-management Scorza K, Williams A, Phillips JD, Shaw J. Evaluation of nausea and vomiting. Am Fam Physician. 2007 Jul 1;76(1):76-84. PMID: 17668843. Wegrzyniak LJ, Repke JT, Ural SH. Treatment of hyperemesis gravidarum. Rev Obstet Gynecol. 2012;5(2):78-84. Yartsev. (2021). Deranged Physiology: Question 10 - Describe the physiology of vomiting. Available from https://derangedphysiology.com/main/cicm-primary-exam/past-papers/2010-paper-1-saqs/question-10p2#answer-anchor

DAS REFERENCES: Bordeianou, L. Yeh, D. Management of SBO in adults. Available at https://www.uptodate.com/contents/management-of-small-bowel-obstruction-in-adults Ellsworth Wright, "REBEL Core Cast – Basics of EM – Diffuse and Flank Abdominal Pain", REBEL EM blog, June 1, 2022. Available at: https://rebelem.com/rebel-core-cast-basics-of-em-diffuse-and-flank-abdominal-pain/. Meadors, K. (n.d.). Abdominal Pain. Retrieved from http://www.emdocs.net/wp-content/uploads/2014/05/AbdominalPain-KMAK.pdf Simon, E. (2017). EM@3AM - Ascending Cholangitis. Available at http://www.emdocs.net/em3am-ascending-cholangitis/ Spangler, R., Van Pham, T., Khoujah, D. et al. Abdominal emergencies in the geriatric patient. Int J Emerg Med 7, 43 (2014). https://doi.org/10.1186/s12245-014-0043-2 PMID 10987108 PMID 32362368 Vercruysse G, Busch R, Dimcheff D, et al. Evaluation and Management of Mechanical Small Bowel Obstruction in Adults [Internet]. Ann Arbor (MI): Michigan Medicine University of Michigan; 2021 Apr. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572336/ Zeretzke-Bien, C. (2016). Appendicitis: Pearls and Pitfalls in Adult and Pediatric Populations. Available at http://www.emdocs.net/appendicitis-pearls-and-pitfalls-in-adult-and-pediatric-populations/

References: PMID 9099184, 34496173, 28338314, 18584497, 15017757, 32383104, 25295027; doi:10.6274/tnd.08108

References: PMID 29606895 http://derangedphysiology.com/main/required-reading/trauma-burns-and-drowning/

Critical care transport is a cerebral logistics game. You need not get analysis paralysis.

Random discussion at my basement bar. Topics covered: An old school code Body armor How to get into critical care EMS

Follow up to my Damage Control Resus episode and random rambling. References: PMID 35082563, 21178760, 9971864

Bill and I kill time at work and discuss two patients with fast heart rates. Hear us muddle awkardly through AVRC and then we go down a bunch of rabbit holes.

Not a sexy topic but I talk about geriatric falls. References: PMID 33060534 PMID 25983268 PMID 22971148 PMID 22971148 Rezaie. (2015). Minor Head Trauma in Anticoagulated Patients: Admit for Obs or D/C? RebelEM. https://rebelem.com/minor-head-trauma-in-anticoagulated-patients-admit-for-observation-or-discharge/

References: Bradford. (2022). RePhill. https://www.thebottomline.org.uk/summaries/icm/rephill/ Smith IM, Crombie N, Bishop JR, McLaughlin A, Naumann DN, Herbert M, Hancox JM, Slinn G, Ives N, Grant M, Perkins GD, Doughty H, Midwinter MJ; RePHILL Trial Collaborators. RePHILL: protocol for a randomised controlled trial of pre-hospital blood product resuscitation for trauma. Transfus Med. 2018 Oct;28(5):346-356. doi: 10.1111/tme.12486. Epub 2017 Nov 28. PMID: 29193548. US Army Joint Trauma System’s Damage Control Resuscitation website: https://jts.amedd.army.mil/index.cfm/PI_CPGs/damage_control

I wasn't going to do another episode this week but so many people reached out and asked my opinion on this case that I felt compelled to post an episode. I didn't go crazy on the editing so I apologize for the "umms" and needless Philadelphia "sooooo's."

Worthwhile articles I mentioned: Bell, John. (2017). In Vogue: Ketamine for Neuroprotection in Acute Neurologic Injury. International Anesthesia Research Study. http://www.anethsesia-analgesia.org Torres, A. C., Bebarta, V. S., April, M. D., Maddry, J. K., Herson, P. S., Bebarta, E. K., & Schauer, S. (2020). Ketamine Administration in Prehospital Combat Injured Patients With Traumatic Brain Injury: A 10-Year Report of Survival. Cureus, 12(7), e9248. https://doi.org/10.7759/cureus.9248 Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care. 2014 Aug;21(1):163-73. doi: 10.1007/s12028-013-9950-y. PMID: 24515638.

This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

Do I need to ACS everyone that is having chest pain? Do I need to do a 12-lead on everyone who complains of chest pain? Is it BS when the chest pain is right sided or reproducible? This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

Smith, Mike. (2012). Analysis Paralysis. EMS World. https://www.hmpgloballearningnetwork.com/site/emsworld/article/10526554/analysis-paralysis Van Horne, Riley. "Left of Bang" This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

Ashley and Mike debrief the randomness of the last two weeks at work. This is really an episode about nothing. Also, this is my first attempt at using two microphones - I apologize for any audio issues. This podcast is hosted by ZenCast.fm

A discussion about prehopsital physicians in the US and volunteer EMS: the good, the bad, and the ugly. Please don't listen to this if you are easily offended. You were warned. This podcast is hosted by ZenCast.fm

Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA. 2018 Aug 28;320(8):779-791. doi: 10.1001/jama.2018.11597. PMID: 30167701; PMCID: PMC6142999. Bernhard M, Becker TK, Gries A, Knapp J, Wenzel V. The First Shot Is Often the Best Shot: First-Pass Intubation Success in Emergency Airway Management. Anesth Analg. 2015 Nov;121(5):1389-93. doi: 10.1213/ANE.0000000000000891. PMID: 26484464. Culbreth RE, Gardenhire DS. Manual bag valve mask ventilation performance among respiratory therapists. Heart Lung. 2021 May-Jun;50(3):471-475. doi: 10.1016/j.hrtlng.2020.10.012. Epub 2020 Nov 1. PMID: 33138977; PMCID: PMC7604178. Ioannidis JP. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philos Ethics Humanit Med. 2008;3:14. Published 2008 May 27. doi:10.1186/1747-5341-3-14 Sackles, et. al. (2013). The importance of first pass success when performing orotracheal intubation in the ED. Acad Emerg Med, 20(1). Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018 Aug 28;320(8):769-778. doi: 10.1001/jama.2018.7044. PMID: 30167699; PMCID: PMC6583103. This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm

Some start of a new year ramblings: EMTALA, ED wait times, COVID, royal medical directors REFERENCES: Gulya, K. (2017). Seventh Circuit Case Highlights Potential Conflict Between Powers of Medical Director and City in Discharging EMS Staff When Losing "Credentials". National Law Review. Accessed at https://www.natlawreview.com/article/seventh-circuit-case-highlights-potential-conflict-between-powers-medical-director Wolfberg, Wirth. (16 Nov 2021). Ambulances held hostage: Can the hospital make you stay? Accessed at https://www.ems1.com/ambulance/articles/ambulances-held-hostage-can-the-hospital-make-you-stay-jQESFoe1BQTrtUYc/ This podcast is hosted by ZenCast.fm

Carley, S. (2004). Suicide at Christmas. EMJ Online. Available at http://emj.bmj.com/content/emermed/21/6/716.full.pdf CDC. (2004). Fall-Related Injuries During the Holiday Season --- United States, 2000–2003. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5348a1.htm Long, Brit. (2018). EM@3AM: Esophageal Foreign Bodies. EMDocs Blog. Available at http://emdocs.net/em3am-esophageal-foreign-bodies/ Rohrer-Mirtschink S, Forster N, Giovanoli P, Guggenheim M. Major burn injuries associated with Christmas celebrations: a 41-year experience from Switzerland. Ann Burns Fire Disasters. 2015;28(1):71-75. Shaw, et. al. (2018). Death and readmissions after hospital discharge during the Dec holiday period. BMJ, 363. Shuja, Winston, Rahman, Mitty, Jaber, & Keo. Esophageal food impaction during cultural holidays and national athletic events. Gasteroenterology Report, 5(1). Smith, Allan, Greenlaw, Findlay, & Isles. (2013). EM admissions., deaths ant weekends and the public holiday effect. Emerg Med J, 31(1). This podcast is hosted by ZenCast.fm

Omicron update, COVID stats, assessment of the hypoxic COVID patient Reference: Dhont, S., Derom, E., Van Braeckel, E. et al. The pathophysiology of ‘happy’ hypoxemia in COVID-19. Respir Res 21, 198 (2020). https://doi.org/10.1186/s12931-020-01462-5

DISCLAIMER: bad words, adult topics Cologne, Ault. (2012). Rectal foreign bodies: what is the current standard? Clin Colon Rectal Surg, 25, 214-18. This podcast is hosted by ZenCast.fm

Not really anything Thanksgiving related....random topics and rantings This podcast is hosted by ZenCast.fm

References: http://www.aviationchief.com NASA. (2014). The Cost of Silence: Normalization of Deviance and Groupthink. Retrieved from: https://sma.nasa.gov/docs/default-source/safety-messages/safetymessage-normalizationofdeviance-2014-11-03b.pdf?sfvrsn=4 Mullane, Mike. Normalization of Deviance — IAFF. Available at http://www.youtube.com/watch?v=Ljzj9Msli5o This podcast is hosted by ZenCast.fm

Thoughts on the "differential diagnosis." This podcast is hosted by ZenCast.fm

Bill is my HEMS partner, mentor, and friend. He started his career in EMS in 1976. Here is his introduction, some of his insights, and discussion on generation gaps and career progression. Also, sorry about the background noise: we were at work at the airport. Planes were taking off and the office chairs we were sitting in were creaking. This podcast is hosted by ZenCast.fm

Addendums on the calcium episode and the heart failure episode...as always...random ramblings as well... Citations: Anand IS, Gupta P. Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies. Circulation. 2018 Jul 3;138(1):80-98. doi: 10.1161/CIRCULATIONAHA.118.030099. PMID: 29967232. Hayes. (2013). Mythbuster: Calcium Gluconate Raises Serum Calcium as Quickly as Calcium Chloride. Retrieved at https://www.aliem.com/mythbuster-calcium-gluconate-raises-serum-calcium-as-calcium-chloride/ Calcium Chloride. RK.MD Blog. (2018). Retrieved at https://rk.md/2018/calcium-chloride/ Maak CA, Tabas JA, McClintock DE. Should acute treatment with inhaled beta agonists be withheld from patients with dyspnea who may have heart failure? J Emerg Med. 2011 Feb;40(2):135-45. doi: 10.1016/j.jemermed.2007.11.056. Epub 2008 Jun 24. PMID: 18572345. Ponn, B. (2017). Clinical Question: Can Ventolin improve wheeze in heart failure? CanadiEM Blog. Retrieved from https://canadiem.org/can-ventolin-improve-wheeze-in-heart-failure/ Silverberg DS, Wexler D, Iaina A. The role of anemia in the progression of congestive heart failure. Is there a place for erythropoietin and intravenous iron? J Nephrol. 2004 Nov-Dec;17(6):749-61. PMID: 15593047. This podcast is hosted by ZenCast.fm

I think I might have gone a little hard in the paint on this one... TOPICS: Corporate greed Staffing shortages Incentive pay Working conditions This podcast is hosted by ZenCast.fm

As always: real talk, no BS, and maybe controversial views of when narcissism pervades the culture in EMS agencies... Duchon & Drake. (2009). Organizational narcissism and virtuous behavior. Journal of Business Ethics 85, 301-308. This podcast is hosted by ZenCast.fm

Faine. (n.d.). The calcium quandry. EP Monthly. http://epmonthly.com/article/the-calcium-quandry Farkas. (2020). IBCC. Available at http://emcrit.org/ibcc Graudins, et. al. (2016). Calcium channel antagonist and beta blocker overdose: antidotes and adjunct therapies. Br J Clin Pharm 81(3). Nickson. (2020). Hypocalcemia. LITFL Blog. Available at http://litfl.com/hypocalcemia Sauter, et al. (2015). Calcium disorders in the ED: independent risk factors for mortality. PLoS One 10(7). Swaminathan. (2017). CORE EM: Hypocalcemia. Available at http://www.emdocs.net/core-em-hypocalcemia Webster, et. al. (2016). Ionised calcium levels in major trauma patients who received blood in the ED. Emer Med J 33(8). This podcast is hosted by ZenCast.fm

Cook C. Is clinical gestalt good enough?. J Man Manip Ther. 2009;17(1):6-7. Jeanmonodod, Asuka, Jeanmonodod. (2021). Inborn Errors of Metabolism. Accessed https://www.ncbi.nlm.nih.gov/books/NBK459183/ Van Horne, P., & Riley, J. (2014). Left of Bang. New York: First Black Irish Entertainment This podcast is hosted by ZenCast.fm

Topics discussed: Albuterol and CHF Staffing shortages 12-lead EKG indications Being a "rat" TEMS Imposter Syndrome This podcast is hosted by ZenCast.fm

References: 2021 Pennsylvania EMS Protocols. Spaite DW, Hu C, Bobrow BJ, et al. The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Ann Emerg Med. 2017;69(1):62-72. doi:10.1016/j.annemergmed.2016.08.007 Jain V, Choudhary J, Pandit R. Blood Pressure Target in Acute Brain Injury. Indian J Crit Care Med. 2019;23(Suppl 2):S136-S139. doi:10.5005/jp-journals-10071-23191 This podcast is hosted by ZenCast.fm

This podcast is hosted by ZenCast.fm