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Don't you wish someone explained what viral load, viral shedding, and all those other words we use loosely when talking about COVID-19? Well.... our guest on this podcast did, and we think you'll really enjoy getting back to the basics, and then some. Dr. Ryan Mynatt is a practicing PharmD specializing in infectious disease, and like most academics…
 
Hyperkalemia Intro Potassium is primarily an intracellular ion responsible for maintenance of the resting membrane potential for normal cell conduction. Serum measured potassium is typically between 3.5 and 5.0 mEq/L. Serum K greater than 5.0 mEq/L is generally considered the threshold for hyperkalemia. Potassium is mostly excreted via the kidneys,…
 
In our first official “vodcast”, we discuss pearls and pitfalls of transcutaneous pacing, and how it’s much more difficult than “you either have capture or you don’t”. “Phantom” complexes are rarely reported on or discussed in Paramedic school, but one monitor manufacturer appreciates how they can make verifying true electrical capture very difficu…
 
First, there are two proposed mechanisms of CPR, brilliantly summarized in this paper: Cardiac Pump Mechanism: “blood is squeezed from the heart into the arterial and pulmonary circulations, with closure of the mitral and tricuspid valves, preventing retrograde blood flow, and opening of the aortic and pulmonary valves in response to forward blood …
 
Join us as we interview Andrew Fisher on the multiplicity of managing civilian trauma patients. Although the complexity of trauma management is often understated, the basics are often not managed appropriately, and can have an appreciable affect on trauma outcomes. We discuss TEG, blood product administration, acute traumatic coagulopathy, the MARC…
 
Wantabe et al. (2018) "Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes?" was the first to definitively link L&S use with ambulance crashes. Data extrapolated from Wantabe et al. (2018) Response Crash Rate: 4.6 / 100,000 without L&S 5.4 / 100,000 with L/S Transport Crash Rate: 7 / 100,000 without L&S 17.1 / 10…
 
Goals on Initiation Reverse shock and increase tissue perfusion: Improve blood flow BP (MAP >65) perfuse coronaries and brain Mental status End tidal CO2 Maybe: urine output (if Foley present) & capillary refill time Increase venous return Avoid ischemia & other adverse events Which vasopressor do I choose? It depends. For the prehospital provider,…
 
Topics Discussed in the Podcast: Provider bias and the pulse oximeter. CO oximetry. Pulse oximeter lag. Approach to the well-appearing patient with a low SpO2 reading. Relation of vascular tone to pleth wave amplitude and variability. Using the pulse ox waveform to confirm mechanical capture during transcutaneous pacing. Odds and ends... Pulse oxim…
 
“The value of experience is not in seeing much, but in seeing wisely.” ― Sir William Osler Deciphering signal from noise as it relates to modern stroke care can be challenging and conflicting, especially as it pertains to the out of hospital environment. In this podcast, we brought the knowledge and experience of Dr. Ben Newman: a neurosurgeon and …
 
In this episode, we're graced by the presence of Airway Jedi Dr. Jeff Jarvis. We discuss a novel approach to the standardization of airway management in order to prevent peri-intubation hypoxia and valuable insight into the organizational culture required to make it successful. Link to Dr. Jarvis' paper "Implementation of a Clinical Bundle to Reduc…
 
This podcast is based on the Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients (FEEL) Study, and inferences made from it. The study was to determine the feasibility of prehospital ultrasound, but there were more astonishing results: 74.5% of patients in (pseudo) PEA had cardiac activity. 35% of patien…
 
Terminology Wet, dry, or near drowning are not medically accepted terms and should not be used. There is nothing “near” about drowning. It happened or it didn’t. Drowning is: “the process of experiencing respiratory impairment due to submersion or immersion in liquid.” Drowning has three outcomes. This is a uniform way of reporting data after a dro…
 
For this episode, we bring in an expert and an esteemed guest to answer all of your burning questions about resuscitation of cardiac arrest. Part man, part mystery, but wholly dedicated to furthering excellence in out of hospital care: Dr. Walt Lubbers, MD. Some background: Walt is an Emergency and Prehospital Medicine physician who holds board cer…
 
Why is “prime the pump”, dying? It’s now accepted that sepsis has more to do with vasodilation, and less to do with vascular permeability. Administering a vasopressor turns unstressed volume into stressed volume and improves venous return. Not every patient will respond to fluid administration with an increase in cardiac output. How much fluid do w…
 
Know what a normal LBBB “looks” like: 1) QRS duration greater than 120 ms 2) Negative QRS Complex in V1 3) Positive QRS Complex in lateral leads (I, aVL, V5-V6) LBBB causes a repolarization abnormality: Consider a “repol” abnormality when there is a “general pattern of ST discordance”, meaning the ST segment opposite the QRS in nearly every lead (c…
 
ETCO2 is a representation of 1) The concentration of CO2 in the blood, and 2) Perfusion of blood to the lungs, with the second being the primary determinant of your ETCO2 numerical value in the prehospital field. Without taking this into consideration, mistakes in diagnosis and treatment in PHEM are likely. Listen to how you can, in conjunction wit…
 
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