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EMS Nation

EMS Nation - Evidence Based Medicine in EMS Weekly Formatted Podcasts Monday - Interview with Leaders in EMS Tuesday - ALS Simulation Wednesday - EMS Journal Club Thursday - BLS Simulation Friday - Health & Wellness Follow us on Twitter! www.twitter.com/EMS_Nation Like us on Facebook! www.facebook.com/prehospitalnation www.emsnation.org
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Now displaying: 2017
Oct 13, 2017

Join our all star international panel as we discuss the highlights of the Day 2 program from the first ever Tactical Trauma 2017 conference recorded live in Sundsvall, Sweden. The conference was hosted by Dr. Fredrik Granholm @TotalResus

Link to the Tactical Trauma Website:

http://www.trippus.se/web/presentation/web.aspx?evid=quLLWDJBkBKybOhXZJmj8Q==&ecid=MPeU8Z0GCzdyw+SuQMe9Ng==&ln=eng&view=category&template=Desktop

 

Panel Participants:

Dr. Mark Forrest @ObiDoc

Dr. Rick Dutton @TraumaDinosaur

Dr. Kasia Hamptom @KasiaMD

Professor Susan Brundage @TraumaMasters

Dr. Leilani Doyle @DoyleLeilani

Mike Lauria @ResusPadawan

Dr. Andy Johnston @armycritcare

 

And your host Dr. Faizan H. Arshad @emscritcare

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Oct 12, 2017

Join our all star international panel as we discuss the highlights of the day's program from the first ever Tactical Trauma 2017 conference recorded live in Sundsvall, Sweden. The conference was hosted by Dr. Fredrik Granholm @TotalResus

Link to the Tactical Trauma Website:

http://www.trippus.se/web/presentation/web.aspx?evid=quLLWDJBkBKybOhXZJmj8Q==&ecid=MPeU8Z0GCzdyw+SuQMe9Ng==&ln=eng&view=category&template=Desktop

 

Panel Participants:

Dr. Kate Prior @doctorwibble

Dr. Leilani Doyle @DoyleLeilani

Mike Lauria @ResusPadawan

Dr. Mark Forrest @ObiDoc

Matt Libby @MatLibby

Dr. Thomas D @thomas1973 <www.scancrit.com>

And your host Dr. Faizan H. Arshad @emscritcare

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Oct 12, 2017

Continue along for the New York State Collaborative Protocol series with Dr. Chris Fullagar @87MD1 as he reviews the indications, ideal pre-oxygenation strategies, laryngoscopy techniques, confirmation of tube placement as well as guidelines for post-intubation sedation for prehospital providers operating in New York State.

 

Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

 

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~Faizan H. Arshad, MD @emscritcare

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Jun 29, 2017

https://www.smacc.net.au/

 

Anne Creaton – An Emergency Physician & retrievalist HQ’d in Melbourne Australia. She spent the last 4 years in Fiji establishing emergency medicine training in a low resource environment while building capacity in pre-hospital care and disaster response. While living in Fiji she experienced Cyclone Winston first hand and was part of the in-country response. She is an educator in mass gathering medicine and the MIMMS system and was part of the instructor team for a multiagency tabletop simulation of a multi-site terrorist attack in Melbourne. 

 

Lionel Lamhaut – An anesthetist with critical care and emergency training and an associate professor of the SAMU de Paris (excuse my French - Service d'Aide Médicale Urgente), Dr. Lamhaut is not only a disaster response physician but an academician of the highest caliber with recent publications on the prospective deployment of ECPR for refractory cardiac arrest in the Paris area with a multicenter study well underway.  He responded directly to the deadly terror attack of Charlie Hebdo and was instrumental in the after action analysis in the coordinated multi-site terror attack that struck Paris on Friday the 13th of 2015.

 

Raed Arafat – Put a warm round of applause together for the Secretary of State and Minister of Internal Affairs of Romania! Tasked with development of emergency medical care in the country, he is the founder of SMURD – the Mobile Emergency Service for Resuscitation and Extrication. In his current position he leads the Department for Emergency Situations including fire and rescue, civil protection, prehospital emergency medical services, air rescue as well as emergency departments.  Ladies and gentleman… a Knight and Grand Officer of the National Order of Merit in Romania, he has overcome both politics and prejudice in his sterling career as a champion of the highest quality prehospital care.

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

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Jun 1, 2017

https://ampa.org/

 

Happy Friday of #EMSWeek2017!

https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf 

 

Resuscitation - beginning from initial patient contact to the emergency department to the intensive care unit is a continuun of care - though the first few minutes of patient contact with a critically ill patient can have tremendous repercussions on the patient's ultimate outcome.  Whether in critical care transport or in 911 emergency response, patient's may require a medication in small aliquots immediately that would be either unfeasible or cumbersome to administer via infusion on a dedicated pump. 

While circumstances in which a patient needs a push dose medication may be uncommon, the administration of these drugs can be potentially lifesaving.  There are two prehospital scenarios in which the paramedic carries the necessary medication in their armamentariam and with appropriate instruction and training can safely reconstitute into an appropriate dose for use in out-of-hospital resuscitation for the critically ill patient. 

Push dose pressors are often employed in profoundly hypotensive patients that will require endotracheal intubation.  Rapid Sequence Intubation and Positive Pressure Ventilation are both associated with hypotension, thus in the patient that requires advanced airway and is hypotensive upon EMS arrival, push dose pressors may be employed to effectively "resuscitate before you intubate".  Typically Epinephrine is diluted to an appropriate dose and adminstered in small aliquots (10mcg/ml) for inotropoic support to optimize hemodynamics prior to RSI or intubation.  There is also anaesthesia literature supporting the use of neosynephrine as well as phenylephrine for this purpose, though these medications are less readily available prehospitally.  Even brief episodes of relative hypotension can cause effects seen days later; in critically hypotensive patients these may be even more pronounced.  By using push dose pressors, a field provider can safely and effectively resuscitate their patient in order to mitigate the risks associated with endotracheal intubation prior to securing an advance airway.

Conversely, a separate and distinct class of patients who suffer from decompensated heart failure may present with respiratory distress due to volume overload with pathophysiology associated with marked systemic hypertension. While CPAP is the mainstay of therapy for these patients prehospitally and has significantly reduced intubation of the CHF patient over the past several years, IV Lasix and topical Nitroglycerin play little role in the EMS management of the decompensated heart failure patient.  Nevertheless, these patients often require preload and afterload reduction to manage their symptomatology; it is common to initiate nitroglycerin infusions in critical care transport as well as in the emergency department for management of this hypertension.

 Nitroglycerin lowers preload via venous vasodilation at low doses and lowers after load via arterial vasodilation at higher doses, making the patient's vascular container larger lowering the systemic pressure. Aggressive, high dose NTG paired with the recruitment of the alveoli using CPAP & PEEP make up the mainstay of pre-hospital treatment of APE and decompensated heart failure. Bolus doses as high as 2 mg (2000 mcg) of nitroglycerin have been given safely and effectively in previous studies.

 In emergent resuscitations we need to focus on bolus dose medications in the acute phase versus starting and titrating critical care infusions while a patient is in extremis. The goal is to achieve clinical end points of treatment faster with bolus dosing at the bedside and then begin maintenance infusions once resuscitation goals are met and the hemodynamics are stable.  Similar to push dose pressors in the acutely hypotensive EMS patient requiring resuscitation, patients with decompensated heart failure may benefit acutely with push dose nitroglycerin, a potent vasodilator.

 

@AmpaDocs #CCTMC17

Mark your calendars for #CCTMC18

April 9-11th 2018

Wyndham Riverwalk - San Antonio Texas

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

May 31, 2017

https://ampa.org/

 

Happy Thursday of #EMSWeek2017!

 

David Olvera, AAS, FP-C, EMT-P

LinkedIn: https://www.linkedin.com/in/david-olvera-36048a1b

 

World Health Organization Human Factors PowerPoint-

www.who.int/patientsafety/activities/technical/who_mc_topic-2.ppt

 

Glucometer that monitors blood sugar via phone-

https://www.dexcom.com/

 

Checklist Articles: 

Development of a standard operating procedure and checklist for RSI in the critically ill.( Scandinavian journal of trauma, resuscitation, and emergency medicine, Sept 11th 2014)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172951/

 

A pre-procedural checklist improves the safety of emergency department intubation of trauma patients. (Academic Emergency MedicineAug, 2015)

https://www.ncbi.nlm.nih.gov/pubmed/

 

Greater Sydney Area HEMS Checklist-

https://nswhems.files.wordpress.com/2013/01/prehospital-emergency-anaesthesia-checklist-3-1-final.pdf

 

Failed Attempts at Intubation Associated With More Adverse Events

http://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/02-17/Failed-Attempts-at-Intubation-Associated-With-More-Adverse-Events/40210/ses=ogst?enl=true

 

 

 

@AmpaDocs #CCTMC17

Mark your calendars for #CCTMC18

April 9-11th 2018

Wyndham Riverwalk - San Antonio Texas

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

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May 25, 2017

https://ampa.org/

 

Happy Wednesday of #EMSWeek2017! Definitive airway management in the prehospital sphere for critically ill patients is often forced upon EMS providers especially when encountering failure of traditional challenging airway algorithms.  Failure to ventilate and intubate a patient can results in immediate sphincter tightening for providers.  Being facile with a surgical airway based on one's specific kit and armamentarium is paramount for providers in whom the surgical airway falls within their scope of practice.  Adequate training and skills maintenance are perpetual challenges in this HALO (high acuity low occurrence) procedure.

 

His Bio & Credentials:

Kevin T. Collopy, BA, FP-C, CCEMT-P, NR-P, CMTE, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the clinical education coordinator for AirLink/VitaLink in Wilmington, NC. Contact him at ktcollopy@gmail.com.

LinkedIn: https://www.linkedin.com/in/ktcollopy

 

Kevin's #CCTMC16 Podcast: Taking a "Time Out" before Initiating RSI Improves Patient Safety and First Pass Success

http://emsnation.libsyn.com/ep-30-taking-a-time-out-before-initiating-rsi-improves-patient-safety-1st-attempt-success-with-kevin-collopy-ktcollopy

 

NYS Collaborative Training Video for Surgical Airway:

http://emsnation.libsyn.com/ep-48-surgical-cricothyroidotomy

 

@AmpaDocs #CCTMC17

Mark your calendars for #CCTMC18

April 9-11th 2018

Wyndham Riverwalk - San Antonio Texas

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

May 24, 2017

 

Checkout EMS Today 2018!

http://www.emstoday.com/index.html 

 

Happy Tuesday of #EMSWeek2017! You've asked and you shall receive... Optimizing your patient's airway prior to pulling the trigger for RSI.  Delayed Sequence Intubation in the prehospital realm to prevent Rapid Sequence Death.  Dr. Jeff Jarvis, a paramedic from Williamson County Texas turned EMS Medical Director of Williamson County Texas challenges traditional thought processes to bring the best possible medical care to 911 patients.  "It's medical decision making that saves lives... not a plastic tube through the trachea!!!!" Here is story from conception of the idea, to education and roll out, to challenges experienced interfacing with local emergency departments as well as preliminary results for prospectively collected data.

His Bio & Credentials:

https://www.wilco.org/Departments/EMS/Leadership/Jeff-Jarvis (Williamson County)

http://www.sw.org/Dr-Jeffrey-L-Jarvis (Baylor Scott & White)

 

 

@EMSToday #EMSToday2017

Mark your calendars for #EMSToday2018

February 21-23, 2018

Charlotte, NC Convention Center

Registration Link: http://www.emstoday.com/register.html

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

May 23, 2017

https://ampa.org/

http://www.atacc.co.uk/

 

Happy Monday of #EMSWeek2017! Roll up your sleeves and mentally prepare for getting your hands dirty.  Chief Flight Physician of University of Wisconsin MedFlight, Dr. Mike Abernethy @FLTDOC1, gives an honest assessment of the current state of discongruity in EMS in America.  An honest assessment of the intricacies of American Prehospital Care and efforts we can take to improve outcomes for all our patients.

His Bio & Credentials:

http://www.emed.wisc.edu/content/mike-abernethy-md

 

@AmpaDocs #CCTMC17

Mark your calendars for #CCTMC18

April 9-11th 2018

Wyndham Riverwalk - San Antonio Texas

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Apr 12, 2017

https://ampa.org/

http://www.atacc.co.uk/

 

Join our distinguished Panel Discuss the Highlights of Day 2!

 

@MedFlightDoc Dr. Ryan Wubben

@BritFltDoc Dr. David Hindle

@DrewCathers Dr. Andrew Cathers

@CMGrffn Dr. Cynthia Griffin

@TotalResus Dr. Fredrik Granholm

@MikeSteuerwald Dr. Mike Steuerwald

@87MD1 Dr. Chris Fullagar

@UCAirCareDoc Dr. Bill Hinckley

@FLTDOC1 Dr. Mike Abernethy

@emeddoc Dr. Zaf Qasim

@MattRoginski Dr. Matthew Roginski

@EMSCritCare Dr. Faizan H. Arshad

 

Sponsored by @AmpaDocs #CCTMC17

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

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Apr 11, 2017

https://ampa.org/

 

Join our distinguished Panel Discuss the Highlights of Day 1!

 

@MedFlightDoc Dr. Ryan Wubben

@DrewCathers Dr. Andrew Cathers

@CMGrffn Dr. Cynthia Griffin

@TotalResus Dr. Fredrik Granholm

@MikeSteuerwald Dr. Mike Steuerwald

@87MD1 Dr. Chris Fullagar

@UCAirCareDoc Dr. Bill Hinckley

@FLTDOC1 Dr. Mike Abernethy

@EMSCritCare Dr. Faizan H. Arshad

 

Sponsored by @AmpaDocs #CCTMC17

 

 

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

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Mar 28, 2017

PerfectCPR for Apple Watch

Metronome devices have been shown to improve the quality of compressions during CPR. This module reviews the importance of high quality CPR and provides a solution to optimize compression rate for those who have an Apple Watch. This free Apple Watch App, PerfectCPR, provides haptic feedback so the provider can accurately time their compressions with the best-practice rate that is reflected in the protocols.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Avulsed Tooth

This micro learning module reviews the avulsed tooth protocol. We discuss indications and contraindications for re-implantation as well as strategies to manage both scenarios.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Eye irrigation / Morgan Lens

This micro learning module demonstrates techniques for ocular irrigation in the field. Included in this video are the use of the Morgan Lens and the administration of tetracaine, an ocular anesthetic.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Surgical Cricothyroidotomy (Bougie Assisted)

A surgical cricothyroidotomy is indicated by the 2017 NYS EMS collaborative protocols to be performed by paramedics when the patient cannot be adequately ventilated and oxygenated by any other method. In these “can’t intubate, can’t oxygenate” (CICO) situations, a rapid, effective surgical cricothyroidotomy may be lifesaving.  This module depicts a simple and effective technique for emergent field surgical cricothyroidotomy utilizing equipment commonly found on the ambulance.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Complications of Delivery (Including Postpartum Hemorrhage, Shoulder Dystocia, Breech, Etc.)

This module demonstrates the field management of a number of complications of delivery as outlined in the 2017 NYS collaborative EMS protocols.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Massive Bleeding (With Hemostatic Wound Packing and Clot Removal)

This micro learning module demonstrates the approach to a patient with peripheral exsanguinating hemorrhage. Direct pressure, tourniquet application, and would packing with hemostatic gauze after clot removal are depicted.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Double Sequential Defibrillation

Double sequential defibrillation is a procedure that may be helpful in the treatment of refractory ventricular fibrillation (RVF) in the out of hospital environment. This module demonstrates the procedure of double sequential defibrillation which is included as a medical control consideration for instances in which ventricular fibrillation persists after five shocks. Further research will be required to determine the optimal treatment strategies for RVF. Double sequential defibrillation is not considered part of the minimum standard of care at this time. Nonetheless, providers will be instructed on how to properly perform this procedure in the event that a medical control order is granted for this treatment option.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Formal Debrief of Critical Patient Management Scenario (Critiques Scenario and Models Formal Call Review Sessions)

Previously, in episode 42, we demonstrated how debriefing can occur in an informal situation. In this video we model a more formal quality improvement session that involves the agency medical director and continuous quality improvement (CQI) director. We strongly believe that these sessions should be educational in nature and anything that requires “disciplinary” action should be handled via a different process entirely. This episode encompasses a critique of the “Management of the Critical Patient / RSI” scenario; episode 43.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21, 2017

Critical Patient Management with RSI

RSI is often regarded as the pinnacle of advanced life support skills. Indeed, this skill can be beneficial in the right circumstances. That said, like any advanced intervention, performing a particular skill must be done in the context of the overall situation. The procedure itself is fairly straightforward. The judgement, experience, and education of the provider dictate how he or she will manage the nuances of treating a critical patient. Expertise involves not only performing a skill correctly but performing the skill in the right situation at the right time, anticipating the potential complications before they occur, and mastering the basic skills that are requisite for advanced care.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Feb 22, 2017

Informal Debrief of Neonatal Resuscitation (Critiques Scenario and Models Informal Call Review)

Informal debriefing with your colleagues is an important part of continuous quality improvement and should be a regular part of your practice. In addition, being able to reflect on your own performance in a productive manner is an important skill to hone for personal growth. Fostering a culture that is supportive of these discussions allows providers to benefit from the experience and perspective of their colleagues. This video provides an example of how we would conduct such a debriefing in the context of the protocols and how we would address some of the issues and concerns that you may have identified regarding the patient care delivered in the previous two episodes. 

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

 

Feb 4, 2017

Neonatal Resuscitation Simulation - NYS Collaborative

Uncomplicated delivery in the field is fairly straightforward. Unfortunately, things do not always go as planned. Thankfully, resuscitating a neonate in distress is a rare event but something that requires acute clinical acumen. This video depicts a newborn that is not responding to initial interventions. Review the neonatal resuscitation protocol along with this video. The next episode will depict an informal debrief of both this scenario as well as the OB field delivery scenario covered in the previous episode.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Feb 4, 2017

OB Field Delivery Simulation - NYS Collaborative 

Delivery of a neonate in the field environment poses a number of challenges. This video depicts a scenario that involves EMS field delivery. The delivery is fairly quick and uncomplicated but the neonate is in distress. The video covers the uncomplicated delivery process. Episode 47 will review complications of delivery and how they are managed by EMS in the context of the current protocols. The resuscitation of the neonate will be covered in the next episode.

Cast in Alphabetical Order:

Michael T. Benenati, BS, AAS, EMT-P
Tyler F. Cominsky, NRP
Seth Goldstein, BA, AS, AEMT-P/CIC
Susie Surprenant, BBA, BS, NRP
David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare
Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

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