YES I KNOW THE THUMBNAIL HAS EPISODE 4 and it’s episode 49. But we have a YouTube channel now so that’s why we have different episode numbers. It’s less confusing than renumbering everything.
ANYwhomst, this is our takedown of the week long winter weather event that crippled the region starting around Valentine’s Day. The impacts to EMS were many and required a lot of creative thinking by responders. We are so proud of the bravery, ingenuity, and dedication that they showed during this event. Got some time? This is the story.
Operation Warp Speed is a public-private partnership that has helped speed development of vaccines and treatments for COVID-19. But what does that mean for safety of these treatments? TL;DR: The program does not cut safety corners. It supports industry to rapidly develop capability without the financial risk usually associated with experimental therapies.
This study looks at an intriguing concept: What happens when you give an acutely suicidal patient ketamine in the ED? This study intrigued me so I thought I’d cover it. This study will not change your practice but will hopefully interest you in participating in research on the topic.
TL;DR/TL;DL: DON’T START DOING THIS YET. IT NEEDS MORE STUDY. But it is promising.
Citation: Domany Y, Shelton RC, McCullumsmith CB. Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double-blind, placebo-controlled, proof-of-concept trial. Depress Anxiety. 2020 Mar;37(3):224-233. doi: 10.1002/da.22975. Epub 2019 Nov 16. PMID: 31733088.
Strengths: Randomized placebo controlled design. Disposition and care for patients was determined before randomization, so study drug not likely to affect care delivered. Close assessment at multiple points. Administration protocol was over 5 min, so very conducive to the ED environment.
Weaknesses: Too small to really tell us how effective this treatment is, though there is a body of literature that supports it in other settings. Evaluation of patients was thorough, more than what could be expected of a prehospital provider without substantial training. Study setting was an ED, not EMS. Does not answer the question of whether patients can be safely discharged to outpatient mental health treatment after receiving this drug.
The Health Data Exchange allows the flow of information between EMS charts and the hospital chart, helping us to easily look at outcomes and how EMS care has affected the patient. The best way to check your own knowledge and understanding of prehospital care is to know how the patient turned out. Was your diagnosis right? Did they decompensate after transport? Scan the patient’s sticker into our electronic patient care record and you can find this out. In this episode I sit down with 4 very special guests: Travis Baker, PA-C, our own Paramedic Practitioner; Remle Crowe, PhD, Data Scientist for ESO Solutions; Jason Gilliam, LP, Designated Medical Officer and Captain at ATCEMS; and Bill Leggio, EdD, our Clinical Standards and Practice Coordinator to talk about what we gain from this.
“What if” can be anxiety provoking and can send you down a rabbit hole of undesirable futures. But it can also be a powerful tool for the clinical preceptor and the clinician who is looking to improve their performance.
So, you caught the COVID. You have endured the fever, cough, sore throat, diarrhea, and abject boredom of being home. When can you be let out of this prison? In this micro episode we talk about the return to work criteria. BLUF: No, you don’t have to be in quarantine forever.
Covid is now a pandemic, the real kind, the not-the-zombie-kind. In this episode we talk about what the Office of the Medical Director, Austin Public Health, and Austin/Travis County EMS is doing to respond to what is now a declared disaster.
Buy in from the workforce is necessary to bring any useful change to an organization. While unions and leadership are often set against each other, the things they can accomplish when they work together far exceed those they can accomplish when moving in different directions. The union can give the MD valuable feedback on wants and barriers to implementation, and the MD can get an idea of how to effectively introduce change to the department with wide support. I’m fortunate to get to work with Selena Xie, who is smart, politically savvy, collaborative, and has an eye for the immediate future and years down the line.
Some causes of headache are benign, but the EMS provider would be wise to consider carefully some “bad actors” that cause headache. Here we will talk too about how to manage these patients in the prehospital setting.
Jessica Sasser, RN, is one of the amazing staff at our public safety wellness division which supports the physical and mental health of Austin/Travis County EMS and Austin Fire Department. In this episode she discusses meditation and how it can be useful to the first responder. Hint: it doesn’t just make you feel better, it makes you better. Please don’t meditate while driving.
Resources for ATCEMS and AFD employees can be found at: atxpublicsafetywellness.com
Insight Timer can be downloaded from the Apple app store.
If you are not using #EtCO2 during airway management and monitoring, then you are wrong. Fix yourself. Dr. Pickett tells you why. #EMS #Prehospital #Paramedic #maybeifIsqueezethisbagashardandfastasIcanthepatientwillgetbetter #morewavylines #butIjustlearnedEKGs #Isawthetubegothroughthecords #sodideveryonewhoevermisplacedanETtube
Do you get nervous when you are faced with a patient with a tracheostomy tube? This short episode covers common problems and how to troubleshoot them. Be nervous no more. #paramedic #EMS #prehospital #criticalcare
In this episode, I make reference to a couple of great YouTube videos on the subject. One is from RT Clinic on the ins and outs of tracheostomy devices. The other is from The Crashing Patient Series from the University of Maryland and goes into greater depth on care of the crashing tracheostomy patient.
We undertook the unenviable task of revising our clinical operating guidelines to make them more usable, more manageable, and easier to read. We want to foster a clinician mindset and embrace the clinical flexibility medics need to take care of our patients in a very fluid environment. We also created new credentialing levels for medics to expand their current horizons.
Heat illness ranges from the benign and temporary to the life-threatening. We dive into management of heat cramps, heat syncope, heat exhaustion, and heat stroke. Rule #1: Stay on scene to cool them down.
For patients with #stroke outside of 4.5 hr #tPA window, they may benefit from thrombectomy up to 24 hours since last seen well. Take to comprehensive stroke center and perform MRI safety screen. #EMS #paramedic
This is a short episode on the response to and care for bombing victims for #EMS, #Firedepartement and #Police. A longer episode will follow that covers #prehospital care in detail, but this is the initial response and considerations. #packagebombmurders #austinbombings @ATCEMS @Austin_police @austinfiredepartment @TxDPS @TravisCoSheriff @CommitteeTECC @CommitteeonTCCC @NTOATEMS Find us on @iTunes and @GooglePlay and @feedburner
From the National #Counterterrorism Center, this chart gives #evacuation distances for #explosives of different sizes. Time, distance, shielding. Minimize the TIME you are in a threat zone, increase DISTANCE between you and the device, and seek SHIELDING in the form of cover from hard buildings or terrain. #packagebombmurders #austinbombings #EMS #prehospital #paramedic #firedepartment
Neither rare nor mysterious, Cannabis Hyperemesis Syndrome causes pain and vomiting that can be difficult to treat.
Marijuana use is growing for medical purposes and recreational abuse. With this has come a rise in Cannabis Hyperemesis Syndrome which is marked by recurrent, severe abdominal pain and vomiting that does not respond well to the usual antiemetics. Dr. Pickett discusses the causes and treatment of this disorder which we will recognize in increasing numbers with increased marijuana availability.
In this episode we sat down with Dr. Steven Warach the Director of the Clinical Research Institute and Vascular Neurologist from Dell Seton Medical Center to talk about acute MRI for stroke and how we might be able to reduce the time to treatment.
3 questions comprise the safety screen:
Do you have any implanted electronics like a pacemaker or defibrillator?
Some people have the natural gift of teaching. For others it does not come easily. Teaching is all about connecting with your student, finding out their abilities and weaknesses, and helping build them into stronger clinicians. Teaching is a learned skill that can be molded and honed no matter how good a teacher you are. I sat down with Ginger Locke, Associate Professor of EMS Education at Austin Community College and the producer of the Medic Mindset podcast to see what tips and tricks we can offer the field preceptor.
Ever had that patient that you just weren’t sure what pathway they fit in?
You have a 75 yo F who called 911 due to palpitations and increasing shortness of breath. She looks fairly comfortable with belies the rate of 180 seen on the monitor. She does endorse some chest discomfort. No previous drug use, no recent surgery/ Rhythm might be irregular but it’s too hard to tell at that rate. Should I cardiovert? Should I give them diltiazem? Could this tachycardia be reactive to something, and I should look for other potential issues?
This is a very well done reconstruction of the mass shooting in Las Vegas. Several things to note here: varying reactions in the crowd (you can see some individuals standing and staring in disbelief as others run to cover), care under fire and members of the crowd organizing others to help, and the police who charged into the gunfire to end the shooting.
Decided to address some reader comments with this one. Dextrose, hemostatic agents, chest seals. Little bit of medicine, little bit of trauma.
Why did we change over from D50 to D10 for hypoglycemia? And should we be treating hypoglycemic diabetics the same way we did 30 years ago? Should I have a hemostatic gauze in my kit? And how useful are chest seals really?
When the EMS provider has to convey patient information, there are 3 distinct settings in which this should occur. You don’t want to waste time on the phone when you (and they) need to be doing other things, and you don’t want to leave out critical details when you need an order or you are handing off care to another provider.
Report to the receiving hospital to obtain a bed and mobilize any necessary resources, such as a trauma team.
This report should be brief and include only enough information to mobilize the appropriate resource.Details such as what medications have been delivered need not be given, as well as the details of how the injury occurred or an explicit history of present illness. Key thing is that this should be BRIEF. You have better things to do than talk on the phone, and so do they.
In the case of a trauma, it requires a report of mechanism of injury, MAJOR injuries (can exclude most bruises, lacerations, and abrasions), vital signs, GCS, and whether or not the bleeding and airway are controlled. This is enough injury to determine what level of trauma response will be needed at the hospital (Category 1, Alpha, or whatever their terminology is) and whether blood should be brought to the trauma bay.
For stroke, the current symptoms and LAST TIME KNOWN WELL are paramount to determine if the stroke team needs to be mobilized.
For STEMI, EKG findings, age, and vitals are important. If the patient has a cardiologist, knowing who this is may be important if the hospital has more than one cardiology group that takes ER patients.
Report to online medical control physician, usually to obtain advice or permission to execute some part of the protocol or deviate from protocol.
This usually requires a more detailed report to paint the picture. Make sure you know who you are talking to before you launch into this report. It won’t do for you to give a detailed report to to the person that picks up the phone only to repeat the whole thing when the physician gets on the line.
Start with your BLUF (bottom line up front) and tell them what you are asking for. If you need an order for something, say so. “Doc, I need an order to repeat the ketamine dose in this patient. 45 yo M in a rollover MVC…” “Doc, I have a patient here that wants to refuse transport and I don’t think that’s in her best interest. This 65 yo F was found today…”
Handoff to another provider such as another EMS provider, nurse or physician at the receiving hospital.
This report should be detailed, including all treatments rendered and the patient’s response. Concerning findings or clues of the patient’s history are conveyed then.
If it is a time critical situation such as a trauma, you probably have only 30-60 seconds to deliver this info. Don’t rush through it but give a concise history and summary of injuries and last vitals. Summarize any medications given especially pain medications, sedatives, or paralytics.
You can always give the summary report to the resuscitation team, then fill in the details with the nurse who is the “recorder” documenting the resuscitation.
For handoff to another prehospital provider, it is good practice for that provider to read back the summary report to you to make sure everything was understood.
Staging during large scale attacks has a real cost in terms of lives. We must balance the tiny theoretical risk to rescuers with the huge known risk to patients who are already bleeding and dying. Rescue Task Force programs are the way to mitigate the risk and stop the clock of life threatening hemorrhage. Vegas did it right.
BLUF: Epi in patients with beta blockers does not cause seem to cause unopposed vasoconstriction and hypertensive crisis. Use standard doses of 0.3-0.5mg IM.
ETA: If the patient isn’t responding to epinephrine, give them IV Glucagon. It activates the same cGMP pathway in the cell. BUT you have to give higher doses than the 1mg you might have. 4-6mg, even 10 mg. And you can always go up on the epi dose!