Summary: Podcast by Tyler Christifulli & Sam Ireland
Welcome to the Polar Vortex 2019 #povo, I hope you are all are staying warm. Since I’ve been seeing more cold, etoh, and confused patients I thought I’d out a quick podcast discussing some hypothermia physiology and prehospital patient care info. Here are some of the highlights.
Podcast 70 - Pediatric Ventilation w/ The Hamilton T1 by Tyler Christifulli & Sam Ireland
In order to be the best clinician possible, we need to first take care of ourselves. In this podcast Sam and I talk about the science of weight gain, and how to avoid it. What is the advice society typically tells people? "Eat less and move more." You’ve got to go on a calorie restricted diet and exercise. That advice almost guarantees long term failure.
Awhile back Aidan Baron (@Aidan_Baron) tweeted, "If you can't explain the pre-test probability, then you don't get to pick up the ultrasound.. no stats-no scan." This got me thinking about the way we approach testing in the pre-hospital setting. Are we performing EKG's, POC Labs, Ultrasound scans, and screens on patients just because we need to check off a box on our PCR, or do we truly believe the pre-test probably is high enough to justify the test? My thought process had always been that this is a way of triaging your mental bandwidth, and that it was only applicable when seeing more than just one patient. A physician, PA, or NP could not physically perform every test on every person without complications and decreased attention to top tier priorities. In this podcast Chip Lange from TOTAL EM, and I discuss if pre-test probability and risk stratification is applicable to EMS. www.foamfrat.com
How do we know which patients need to actually have the clot mechanically retrieved? This decision could be huge in regards to patient neurological outcome. There are several screening tools available. The RACE is the only large vessel occlusion (LVO) screen that is validated. In this podcast Brandon Means and I discuss the cortical signs of LVO, and how you can modify your current stroke screen to detect these.
I wanted to expound on this a little more and discuss my thoughts on when it makes sense to give sodium bicarbonate to a patient in a metabolic acidosis. Check out the show notes for further reading and pics.
I will openly admit that when Dr. Weingart first coined the term "Push Dose Pressor," I drank the Kool Aid.. I remember pitching it to my organization and discussing the concept with the guys at my station. I think the early adoption was due to: 1. Cool Name 2. Easy To Mix 3. Weingart 4. Was better than pushing 500 mcg of cardiac epi when the patient starts circling the drain. Now I'm questioning this techniques application in EMS. Join Michael Perlmutter, Bryan Winchell, and myself as we discuss the finer points of PDP. www.FOAMfrat.com
It has become a staple in HEMS to carry and deliver blood products to trauma patients who need them. Some agencies will carry plasma, packed red blood cells, and platelets. The majority will only carry packed red blood cells (PRBC's). From the curb this makes sense. If a patient is losing blood, we should replace it. However there is heterogeneous views on when this should be done and how. www.foamfrat.com
We all have grown to love the bougie, and many are rightfully utilizing it on their first attempt to optimize success. However, just like we found with the cool kid ketamine, if not done right you can meet some difficulty. The tool is only as good as its handler. In this podcast we will discuss a few tips, tricks, and pitfalls of becoming a bad@$$-bougie-master. www.foamfrat.com
Michael Perlmutter (@DitchDoc14) did a blog piece a few months ago suggesting we re-think how we control airways in pre-hospital medicine. Whenever you discuss or propose putting a skill on trial, you will be met with resistance. That being said, yesterday two papers were published comparing the SGA vs ETT in cardiac arrest (PART & AIRWAYS2). I highly anticipate deep scrutinization of the paper by the pre-hospital community. My hope was that by bringing the senior authors on the podcast, I could help the discerned reader avoid assuming false motives and extended assumptions as to the fatality of paramedic intubation.
In this podcast Dr. Peter Antevy helps us answer these questions... "I don't like using intra-nasal meds because they never seem to work." "Is the IM dose of ketamine for a kid seriously the same as a dude freaking out on bath salt?" "I can't seem to find the sweet spot for analgesic ketamine dosing." www.foamfrat.com
Occasionally we find ourself asking.. Is the hypotension being caused by the rate? Is the rate compensating for the hypotension? I reached out to Josh Farkas from PulmCrit (EMcrit)in hopes he would help me come up with an algorithm or mental-flow that could be used to formulate a decision when faced with this situation. Come listen in on our conversation at www.foamfrat.com
was snooping around FaceBook the other day and came across a video of a flight service putting their clinicians through an interesting obstacle course. The man behind the coordination of this video was Darrin Buchta. He is taking the lead in helping a group of new flight clinicians prepare for precision work under stressful conditions. I asked Darrin to come on the show and talk about his training tactics and the inspiration that made him take this extra step.
My brethren Eric Bauer recently did a podcast with Mike Herman on the Five Hottest Questions In Mechanical Ventilation. I want to challenge a few concepts that he discusses in regards to the driving pressure strategy in a pressure driven mode, the mode of choice in increased airway resistance patients, and practicality of the P-V loop with a decelerating flow delivery.
PDP is the cool kid on the block these days, but it is a bridge to an infusion.