The World’s Okayest Medic Podcast

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/

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