Mchd Paramedic Podcast

This episode tackles the definition of "stupidity" and how this relates to prehospital medical care. Dr. Patrick is joined by Kris Kaull to discuss the definition of stupid, risk factors for making stupid moves and how to possibly prevent these in the EMS setting. REFERENCES 1. Episode inspiration - https://fs.blog/2019/01/how-not-to-be-stupid/ 2. Checklist Manifesto - http://atulgawande.com/book/the-checklist-manifesto/ https://www.amazon.com/gp/product/0312430000/ 3. Avalanche TedX talk - https://www.youtube.com/watch?v=kWOgyyDUD2w

We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to spend time with non-emergent/chronic diagnoses, just the ones that are deadly when missed. That’s where we, as emergency providers, must begin. Today we’ll wrap up the series with the killers associated with acute altered mental status.

We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to spend time with non-emergent/chronic diagnoses, just the ones that are deadly when missed. That’s where we, as emergency providers, must begin. Today we’ll address the killers associated with acute abdominal pain.

We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic scene with unstable vitals then filter to an organized differential. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to spend time with non-emergent/chronic diagnoses, just the ones that are deadly when missed. That’s where we, as emergency providers, must begin. Today we’ll address the killers associated with the dyspneic patient. REFERENCES https://www.ebmedicine.net/media_library/files/Calculated%20Decisions%20E1212%20PERC%20Rule.pdf

We often start with a diagnosis and teach from there – for example CHF, asthma, and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic chest pain scene with unstable vitals then filter to a differential of #1 PE, #2 ACS, #3 TAD is often quite challenging. The “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to spend time with non-emergent/chronic diagnoses, just the ones that are deadly when missed. That’s where we, as emergency providers, must begin. Today we’ll kick things off with acute chest pain. REFERENCES 1. http://www.emdocs.net/em-in-5-approach-to-chest-pain/ 2. https://litfl.com/ecg-findings-in-massive-pericardial-effusion/

For the last couple months, we've been talking COVID-19 exclusively here at the MCHD Paramedic Podcast. On this episode, ops takes center stage with a discussion of our PPE/COVID-19 experience. We share our lessons learned and wish list for the future. Take a listen and please hit us up at podcast@mchd-tx.org if you have questions or experiences you'd like to share! REFERENCES: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Unless you live under a rock, you've heard discussions of the pros and cons of using hydroxychloroquine (HCQ) when treating COVID-19 patients. On this episode, Dr. Patrick is joined by our favorite toxicologist, Dr. Jerry Snow, to talk about what happens in a HCQ ingestion situation. With the increased publicity of this drug, we must be on high alert in the prehospital setting for potential accidental and intentional overdoses. Listen and learn what to expect and how to treat someone who's taken too much HCQ...beware, these folks can tank quickly!!

We've had continued rapid local and national developments surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the MCHD specific airway algorithm in the era of COVID-19. REFERENCES: https://www.mchd-tx.org/wp-content/uploads/2020/04/MCHD-COVID-19-FINAL-AIRWAY-.pdf

We've had continued rapid local and national developments over the past week surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the most current evidence surrounding airway management in the era of COVID-19. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html 2. https://emcrit.org/emcrit/some-additional-covid-airway-management-thoughts/ 3. https://www.safeairwaysociety.org/covid19/ 4. VALLEY, T ET AL. ASSOCIATION BETWEEN NONINVASIVE VENTILATION AND MORTALITY AMONG OLDER PATIENTS WITH PNEUMONIA. CRIT CARE MED. 2017 MARCH; 45(3): E246–E254. 5. NEWMAN KB, ET AL. A COMPARISON OF ALBUTEROL ADMINISTERED BY MDI AND SPACER WITH ALBUTEROL BY NEBULIZER IN ADULTS PRESENTING TO AN URBAN ED WITH ACUTE ASTHMA. CHEST. APRIL 2002;121:1036–41.

We've had rapid local and national developments over the past week surrounding COVID-19. On this special release, the podcast crew reconvenes to update our listeners on the most current evidence. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html

Choking babies, seizing kids, and floppy infants turning blue...all of these events are significantly anxiety inducing for both emergency providers and families alike. On this episode, Dr. Patrick is joined by Dr. Manish Shah, a pediatric emergency medicine physician and research expert from Texas Children's Hospital. The discussion will begin with the finer points of febrile seizures and then branch off into the "artist formerly known as ALTE" - the BRUE. Follwing this episode you'll be much better prepared to deal with these patients along with their parents and families. REFERENCES 1. https://www.aap.org/en-us/Documents/echo_session%201_seizures_overview.pdf 2. https://pediatrics.aappublications.org/content/pediatrics/127/2/389.full.pdf 3. https://pediatrics.aappublications.org/content/pediatrics/137/5/e20160590.full.pdf

We all love cardiac arrest with VF as the presenting rhythm. These are the ones that walk out of the hospital. But, what happens when you shock, shock, shock and still VF? Today the podcast team addresses refractory ventricular fibrillation/electrical storm and specifically the role of esmolol in this condition. Esmolol is an emerging treatment for refractory VF that makes absolute physiologic sense, however the data is limited. Dr. Patrick addresses the pathophysiology, evidence and MCHD’s approach this in episode 72. REFERENCES 1. Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J. 2011;32(8):111-21. 2. Lee YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016;107:150-155. 3. Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular brillation. Resuscitation. 2014;85(10):1337-41.

A proper sleeping environment is vital for infant safety. On this episode Dr. Patrick is joined by two "safe sleep" experts - MCHD's own, Aston Herring and Dr. Lisa Owens from Texas Children's Hospital. After listening, you'll know how to recognize what exactly constitutes unsafe sleep and more importantly understand the impact that sleep environment can have on otherwise healthy infants. Join us as we attempt to shine a light on a potentially deadly problem with surprisingly simple solutions. REFERENCES 1. https://cribsforkids.org 2. https://pediatrics.aappublications.org/content/138/5/e20162938 3.https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Safe-Sleep-for-Babies.aspx

Over the past week we’ve had several local false alarms with possible patients presenting with the 2019 Novel Coronovirus. On this special release, the podcast crew will discuss the impact of this worrisome viral infection on EMS providers. REFERENCES 1. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html 2. https://jamanetwork.com/journals/jama/pages/jama-author-interviews

Tracheostomy patients can be intimidating and confusing with complex recent medical histories and unfamiliar terminology surrounding the surgical hole placed in their neck. Join Dr. Patrick as he attempts to demystify the tracheostomy tube and provide a framework to utilize when approaching the crashing trached patient. REFERENCES 1. http://www.tracheostomy.org.uk/storage/files/Patent%20Airway%20Algorith m.pdf 2. http://www.tracheostomy.org.uk 3. Mcgrath BA et al. Guidelines Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. N Anaesthesia 2012; 67 (9), 1025–1041.

While attending the 2019 Texas EMS Conference, Dr. Dickson and Chief Crocker were lucky enough to sit down with Dr. Jeff Jarvis from Williamson County EMS to discuss the background and evolution of the Texas CARES registry. We'll introduce the purpose of Texas CARES along with the ways in which it can benefit your service. REFERENCES 1. https://tx-cares.com

Join Dr. Dickson as he takes a trip down under to talk with Dr. Alastair Meyer about the often dreaded chief complaint of dizziness. Dr. Meyer is the Director of Emergency Medicine for Monash Health in Melbourne. The differential diagnosis for the commonly encountered dizzy patient is broad and consists of many non-emergent conditions along with deadly pathology as well. This combination can be a recipe for disaster. This episode will leave listeners with the deadly dizzy diseases and a framework to approach your next dizzy run.

Continuing with the dizziness theme for the 2019 holiday season, Dr. Dickson is joined on episode 67 by Dr. Jeremiah Johnson. Dr. Johnson is a neurosurgeon here in Montgomery County where he's the Director of the Comprehensive Stroke program at CHI-St. Luke's Hospital in The Woodlands. We all recognize the combination of aphasia with face and extremity weakness that occurs in anterior circulation strokes. But, how do posterior strokes present? How common are they? Are posterior strokes time sensitive and amenable to TPA and/or clot retrieval in the same manner as anterior strokes? For answers to all these questions and many more, take a listen and hear from a true expert in the rapidly advancing field of endovascular treatment for acute stroke.

Our population is aging, and heart failure is only going to increase. This will inevitably lead to an increase of patients with left ventricular assist devices. New technology can be intimidating and confusing with complex recent medical histories and unfamiliar terminology surrounding the various LVAD brands. Join the podcast crew as we attempt to simply an EMS approach to the LVAD patient. REFERENCES: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123099/pdf/wjem-19-834.pdf 2. https://emj.bmj.com/content/34/12/842.long 3. Goebel et al. (2019) An Urban 9-1-1 System’s Experience with Left Ventricular Assist Device Patients, Prehospital Emergency Care, 23:4, 560-565 4. Shinar et al. Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs). Resuscitation. 2014;85(5):702-704

MCHD is excited for the county wide roll out of the PulsePoint app. Community Outreach Coordinator, Ashton Herring, joins Dr. Patrick to discuss the importance of bystander CPR in increasing survival in cardiac arrest patients. After listening, download PulsePoint and let’s get hands on chest as quickly as possible which we know is a recipe for saving lives. REFERENCES 1. https://apps.apple.com/us/app/pulsepoint-respond/id500772134