Ed and Mike discuss the jump from paramedic to physician….
All tagged Paramedic
Ed and Mike discuss the jump from paramedic to physician….
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:
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:
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.
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:
Classic Journal Review: The OPALS Study
This includes an excellent breakdown by our friends at www.rebelem.com!
OPALS study for trauma:
The Rapid Emergency Medicine Score and the potential for EMS:
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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...
Southland is a Warner Bros. production.
We look at the controversy around paramedic intubation…why, who should do it, and what they need to succeed consistently.
We take a look at some entertaining EMS T-shirts…
Anna and Dan discuss provider mental health and the lack of preparation for those entering the profession.
We talk about all the things that aren’t in your textbook about prehospital stroke care. tPA, stroke units, and why the game has changed.
Is it possible that our culture keeps us from achieving our goals, our place, and our future?
FB: @The Overrun
We take a look at the age-old controversy….ALS or BLS? What works? What doesn’t? And what may be the future of EMS?
The PARAMEDIC-2 study is out…what does it mean for EMS clinicians? Is epinephrine out? We break it down for you right here!
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.