Dr. Peter Antevy joins Ed to discuss a few pearls about pediatric care and resuscitation in the field. Dr. Antevy wears many hats in EMS and has served as the medical director for Davie fire rescue, Coral Springs-Parkland Fire Rescue, Palm Beach County Fire Rescue. Additionally, he is the President of the Greater Broward EMS Medical Directors’ Association, the 2018 NAEMT Medical Director of the Year, a JEMS top-ten innovator of 2015, and an attending pediatric emergency physician at Joe Dimaggio Children’s Hospital in Hollywood, FL.
Are kids just small adults? How do we handle a pediatric cardiac arrest scene? How involved should parents be in the care of the acutely ill child? Is Ketamine safe to use on children (Spoiler: yes.) These and many more questions are discussed.
Dr. Antevy’s videos and protocols can be found here
Ed, Mike and Dan get nerdy again talking about IV fluids and vasopressors! What works, why, and what do you need to know about the stuff we put into patients…and why it may be hurting more than helping!
2008 JAMA article on fluid resuscitation:
R Bellomo, C Hegarty, D Story, L Ho, M Bailey – Jama, 2012 – jamanetwork.com… “Normal” 0.9 per cent salt solution is neither “normal” nor physiological. JAMA … The
biochemical effects of restricting chloride-rich fluids in intensive care. Crit Care Med … Crit
Care Resusc. 2008;10(3):225-23018798721PubMedGoogle
Cochrane Review on colloids or crystalloids:
Costs involved in using colloids:
ATLS 10th edition changes:
The State of New Jersey, in the throes of an enormous opioid epidemic, has unveiled allowing their Mobile Intensive Care Units (Paramedics) to administer buprenorphine as a part of an optional formulary.
What does this mean? Paramedics and EMTs can rescue patients with naloxone, but are we the right avenue to start people toward recovery? Trail-blazing tactics change in a battle we’ve been losing, or just another windmill to tilt at?
We’re going to discuss buprenorphine, what it does, (and doesn’t), how it can be implemented in the field, and what the potential pearls and pitfalls are for clinicians.
It’s a radical idea. But, just maybe, radical is what we need in this fight.
Check out New Jersey Office of EMS:
National statistics from the Center for Disease Control:
New Jersey’s statistics on a county level:
Federal summary of the New Jersey situation:
Journal of Substance Abuse paper on initiating outpatient buprenorphine in high-risk populations:
Reuben Strayer is an emergency physician in NYC, and is doing amazing work on this topic. If you get a chance to hear him speak, do it. You can find him on Twitter: @emupdates and on the internet at www.emupdates.com. He also has several podcasts on the SMACC podcast.
The National Registry…what is it, and why should it matter to you? As the only national organization of credentialing in the USA, the guidelines and structure they use has a huge impact on your license or certification.
We dig into the Overrun vault to find this episode….let us know what YOU think!
Is NREMT the be-all, end-all solution; or can it be improved to be a truly national licensing standard? We look at the strengths and weaknesses, and what we would like to see from the NREMT!
The National Registry of EMTs is at:
Does absence of evidence indicate evidence of absence? Resuscitative Endovascular Balloon Occulsion of the Aorta (REBOA) is a hot topic in prehospital care, especially with London’s Air Ambulance using it in the field.
What does it require? Are we ready for this? And what’s the benefit to the patient?
We break it down for you in this episode…and you’ll be surprised!
London HEMS can be found at:
Paris SAMU is another program you should look at:
The Knick was a cable series about turn of the century medicine:
Original Journal of Surgery paper on REBOA:
REBOA at the R. Adams Cowley Shock Trauma Center:
The latest study on REBOA:
Dan recaps the MD1 EMS Conference and shares what he learned from a room full of EM/EMS physicians speaking to EMS clinicians! If you saw the Facebook Live and Instagram streams from this show; you know there was an enormous amount of knowledge being put out!
Check out Dr. Mark Merlin on Twitter at : @ccareanywhere
The NJ EMS and Disaster Medicine Fellowship can be found at: www.emsfellowship.com
The MD1 physician response program: www.md1program.org
Dr. Qasim is on Twitter at: @emeddoc
Dr. Callelo: @DrDianeC, @njpoisoncenter, also at @ToxAndHound
The COMBAT trial for prehospital plasma:
The PAMPHER trial:
BOKUTOH criteria study:
PARAMEDIC2 study of Epinephrine in OHCA:
Pediatric airway management in cardiac arrest:
Heads up CPR in OHCA:
And, why it may NOT be ready for EMS use, yet…..
Ultrasound in Cardiac Arrest:
The gang let Anna handle this episode, and she crushed it! Anna talks with Robert (Pip) Piparo, firefighter, paramedic, and driving force behind the 555 Fitness team, bringing physical fitness to public safety professionals!
We ask why, if we're so smart as clinicians, why do we do things we KNOW are bad for us, and why we absolutely have to Do Better.
And here's an easy way to start: Anna and Pip created The Overrun Challenge! All you have to do is commit to walk ONE mile every day for 30 days. That's it! If you commit to the Challenge, let us know on social media and send pics at Day 1 and Day 30! We will share your success and commitment with our audience!
555 Fitness website:
The 555 Fitness APP!
Ed, Jess, and Dan discuss where we've been with sepsis, where we are, and maybe where we're going. Fluids, pressers, scoring....there's a LOT of information out there, and we try to sort through it for you
The Early Goal-Directed Therapy paper from 2001:
Listen to Dr. Weingart (@emcrit) tale with the author himself in a two-part interview:
Podcast 054 – Dr. Rivers on Severe Sepsis – Part I
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Podcast 055 – Dr. Rivers on Severe Sepsis – Part II
Center for Disease Control sepsis information:
Dutch PHANTASi trial:
Dan sits down with flight paramedic Dave Aromin to discuss the amazing state of Alaska, and the challenges of providing emergency and retrieval care to the largest state. We discuss the logistics involved in his area, the unique clinical practice involved, and the people who take on this role in one of the most unforgiving environments in the United States and the world.
The EMS community in Alaska suffered a huge blow with the loss of a Guardian Flight fixed-wing crew on January 29, 2019, when their aircraft crashed and all aboard, including a patient were lost. There has been memorial and scholarship funds established for the families of the Guardian Flight crew, and they can be found at the following links:
This episode is presented in the memories of:
Pilot Patrick Coyle
Flight Paramedic Margaret Langston
Flight Nurse Stacie Rae Morse
and the patient who they were caring for on their last mission.
Our resident flight crew member Kevin Mazza takes the lead in our discussion about helicopter use in EMS (HEMS).
What goes on when we call for a helicopter, why does it take time, and what can we do as a team to work together and maximize the use of this expensive (and risky) resource for our patients? Kevin breaks it down for the gang and gives us insight on what HEMS can (and can't) do.
Using the FALTER mnemonic:
The costs of air ambulance use:
Using a standardized handoff method and MIST:
The National Air Medical Memorial:
As we end 2018 and head into the New Year, Dan shares what he’s learned about moving into a command-level position…and what the pitfalls are for those of us who choose to take the path.
We’ve all been there. The cardiac arrest that may or may not have a positive outcome depending on what we do as providers. We know that walking into an arrest, our goal is to help the patient in any way that we can, and to get them to walk out of the hospital and home to their family. On paper, this is an easy thing to do. Hell, it’s our job. It’s what we do every day. But with the mountain of data that’s been coming out over the past year or so, it can be difficult to know what “the right thing” actually is. Sure, we always tryto do the right thing, but how can we be sure? What if I intubate someone and find out a week later that it wasn’t the right intervention? When do we use an endotracheal tube, or a supraglottic airway? What about a BVM? Should I RSI this patient? What about a DSI? If I do either of those and I fail, what’s my back up? These are all questions that are certainly valid and worth exploring. Let’s dive in.
We’ve all been in those classes where we phone it in. Someone is going to stand in front of the class, power point slides glowing behind them, and preach about a topic we haven’t heard about since our initial classes. The slides will be lightly animated, maybe there will be a video clip that highlights the point of the lecture (like salt makes sugar taste a little sweeter but in a weird way), and the bullet points will be read out word for word. You don’t even have to make the effort to read. Someone in the back of the room is balancing a checkbook, the co-worker who has been there for 20+ years is knitting a baby blanket, the rest are on their phones in a group chat trying to figure out where to go and get a drink at lunch. The class is required, and man does it feel that way.
Why should you spend your hard-earned money and time off at a conference? Dan breaks down why he goes, and why you should, too.
The current role of mostprehospital stroke care for a majority EMS providers is a rapid diesel bolus or an IV line, with the occasional intubation if the patient is imminently ill. With the recent podcast discussing what the current stroke care is out there and the differences in what we can do better, we wanted to ask the question: where is stroke care going, especially for us out in the field? I think this question is best answered by three major literature advances within the last year!
“Empathy is a requirement, sympathy is the price we pay.”
Let’s dissect that statement here. Empathy, specifically affective empathy, is what we need to possess in order to properly and completely care for out patients. “’Affective empathy’ refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety.” In order to treat the whole patient, and not just the monitor, we need to be able to sense their pain, fears, and anxiety. They teach this in nursing school, often called a holistic approach, and it’s something we do not do a good job teaching pre-hospital providers.
Thomas Jefferson wore the first pedometer
Yes, that Thomas Jefferson. While walking through the streets of Philadelphia, and later at his home in Monticello, Thomas Jefferson never stopped his pursuit of knowledge. Jefferson was someone who loved to measure things. So, after the tools were available to make a measurement device to track his steps, Jefferson went about making the first pedometer. He took so much pleasure in this device that he sent one to James Madison in 1788 with instructions on how to customize it.
This series so far has focused on clinical applications and knowledge gaps between the classroom and the application of medicine in the pre-hospital environment. Certainly, these are important topics, and it’s something we at The Overrun will continue to explore; but I wanted to take a slightly different approach to this entry. I’m going to take about the social aspects, and indeed the life changing aspects that medic school had for me.
On this first installation of The Overrun’s What I Wished I Learned in Medic School, I’m going to discuss topics I was introduced to during my Obstetrics and Gynecology clerkship in medical school, or those that were refreshed from my medic school time. I chose topics that I think can either have a direct impact on your prehospital care, or that you can recognize and understand what is going on in your patient while you’re with them before you transfer care at the Labor and Delivery unit or the ED. I tried to steer clear of topics that are normally covered routinely during classes or refreshers (except a couple) – to give you all something new and exciting!