All tagged EMS

Episode 44: Our Cric Show

We talk about a wide variety of all things cricothyroidotomy: mental prep and training, the difference in the techniques that are out there, which one might work better, and lots of other stuff. We also shoutout to a LOT of other resources that will help you to really understand this low frequency, but critical procedure.

If this is in your scope of practice; or possibly in a situation where a clinician will use this; you need to know about this to be able to care for your patient.

Dr. Rich Levitan’s website:

https://www.airwaycam.com

Dr. Scott Weingart’s website:

https://emcrit.org

The EMCrit podcast can be found on iTunes (just like us!)…it’s one of the best around with literally hundreds of topics!

SMACC was an amazing prehospital/emergency/and critical care conference that changed how many of us looked at conferences and learning. Check out their stuff here:

https://smacc.net.au/blog/

New England Journal of Medicine paper on comparing cric techniques:

https://www.jwatch.org/em200503300000002/2005/03/30/open-cricothyroidotomy-vs-seldinger-technique

Here’s the case study about the NG tube going into the spinal column…

https://www.sciencedirect.com/science/article/abs/pii/S0196070911000755

Episode 41: Fluids and Pressors

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:

Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults

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:

Colloids or crystalloids for fluid replacement in critically people …

https://www.cochrane.org/…/INJ_colloids-or-crystalloids-fluid-replacement-critically-…

Costs involved in using colloids:

Albumin Use Guidelines and Outcome in a Surgical … – JAMA Network

https://jamanetwork.com/journals/jamasurgery/fullarticle/401980

ATLS 10th edition changes:

ATLS 10th edition offers new insights into managing trauma patients



Episode 40-Buprenorphine and New Jersey Paramedics: Perfect Together?

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:

https://www.state.nj.us/health/ems/

National statistics from the Center for Disease Control:

https://www.cdc.gov/drugoverdose/data/statedeaths.html

New Jersey’s statistics on a county level:

https://www.state.nj.us/health/populationhealth/opioid/opioid_deaths.shtml

Federal summary of the New Jersey situation:

https://www.drugabuse.gov/opioid-summaries-by-state/new-jersey-opioid-summary

Journal of Substance Abuse paper on initiating outpatient buprenorphine in high-risk populations:

https://www.ncbi.nlm.nih.gov/pubmed/31229187

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.

https://emupdates.com/helpcard-and-opioid-misuse/



Episode 39: The National Registry

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:

https://www.nremt.org/rwd/public

SPECIAL EPISODE-RECAP of the EMS/MD1 Fellowship Conference!

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:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31553-8/fulltext

The PAMPHER trial:

https://www.nejm.org/doi/full/10.1056/NEJMoa1802345

BOKUTOH criteria study:

https://www.jem-journal.com/article/S0736-4679(17)30471-7/pdf

PARAMEDIC2 study of Epinephrine in OHCA:

https://www.nejm.org/doi/full/10.1056/NEJMoa1806842

Pediatric airway management in cardiac arrest:

https://www.ncbi.nlm.nih.gov/pubmed/30862528

Heads up CPR in OHCA:

https://www.jems.com/articles/supplements/special-topics/state-of-the-future-of-resuscitation/head-up-cpr-may-improve-neurologically-intact-survival-rates.html

And, why it may NOT be ready for EMS use, yet…..

https://www.ems1.com/ems-products/cpr-resuscitation/articles/393699048-Why-heads-up-CPR-is-NOT-ready-for-out-of-hospital-cardiac-arrest-care/

Ultrasound in Cardiac Arrest:

https://www.cureus.com/articles/18740-does-point-of-care-ultrasound-use-impact-resuscitation-length-rates-of-intervention-and-clinical-outcomes-during-cardiac-arrest-a-study-from-the-sonography-in-hypotension-and-cardiac-arrest-in-the-emergency-department-shoc-ed-investigators


Episode 36-Sepsis and Prehospital Care

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:

https://www.nejm.org/doi/full/10.1056/NEJMoa010307

Listen to Dr. Weingart (@emcrit) tale with the author himself in a two-part interview:

Podcast 054 – Dr. Rivers on Severe Sepsis – Part I

https://emcrit.org/emcrit/rivers-sepsis-i/

Copy and paste this URL into your WordPress site to embed

Podcast 055 – Dr. Rivers on Severe Sepsis – Part II

https://emcrit.org/emcrit/rivers-sepsis-ii/

Center for Disease Control sepsis information:

https://www.cdc.gov/sepsis/clinicaltools/index.html

Dutch PHANTASi trial:

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(17)30469-1.pdf

Episode 35-The Last Frontier with Dave Aromin

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:

https://www.customink.com/fundraising/guardianflightalaska


https://www.echoheliops.org/stacie-morse-education-scholarship

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.

Episode 32: One Medic, or Two?

The gang looks at the idea of ALS crew configuration. Is a two paramedic system better for patient care? Is one medic with an EMT better? Does more equate to better, and how do we measure it?

We look at the benefits and downsides, look at some of the (sparse) evidence, and talk about some of the things that may help us figure it out!

OPALS Study for OHCA:

https://www.nejm.org/doi/full/10.1056/NEJMoa040325

Classic Journal Review: The OPALS Study

This includes an excellent breakdown by our friends at www.rebelem.com!

OPALS study for trauma:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292763/

The Rapid Emergency Medicine Score and the potential for EMS:

https://www.jems.com/articles/2018/08/using-the-rapid-emergency-medicine-score-to-zero-in-on-ems-quality.html

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Episode 21-Precepting and Field Training

The gang discusses field training and precasting...as Dan gets put on the spot by three of his former students/rookies!

We talk about what works, what doesn't, because both will have a profound effect on your student or rookie coming into the profession.

Welcome to Rookie World...

Joseph DuCrew:

https://knowyourmeme.com/memes/joseph-ducreux-archaic-rap

Southland is a Warner Bros. production.

Episode 4-Social Media and EMS

The Overrun crew discusses recent events in the social media/FOAMed world and #GuGate. How do you keep your social media posts from becoming a career-extinction event?

Thanks to GomerBlog and @DGlaucomflecken for helping us to understand this mess.

@DGlaucomflecken www.drgcomedy.com

Twitter: @OverrunEMS

Instagram: Overrunproductions

FB: @Overrunproductions

www.overrunproductions.com