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In this conversation, Tyler and Dr. Cynthia Griffin discuss the finger thoracostomy procedure. They cover topics such as when to choose finger thoracostomy over needle decompression, the equipment needed for the procedure, the technique for performing the procedure, and potential complications and tips for success. They also touch on the use of che…
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Alaina Martini, a flight nurse at Allegheny Life Flight, shares her expertise on transporting patients with external ventricular drains (EVDs). She explains the indications for EVD insertion, such as aneurysmal subarachnoid hemorrhage and obstructive hydrocephalus. Alaina discusses the importance of assessing the color and texture of the cerebrospi…
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Dr. John Aho discusses needle decompression and the procedure's indications, techniques, and potential pitfalls. He emphasizes the importance of high clinical suspicion and the limitations of external signs in diagnosing tension pneumothorax. The conversation also covers the choice of needle insertion sites, the use of ultrasound, and the need for …
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An iceberg typically shows only 10% of its mass above water. To appreciate the other 90%, you need to dive deep. That’s precisely what we’re doing in this series—discovering the deeper knowledge about obstetric topics. These topics can be massive, and much of the information is below the ‘surface-level’ knowledge that EMS is presented with. In this…
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The conversation is about a paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have elec…
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Chris Carlstrom is a flight nurse at Life Link III and also works part-time at a ketamine infusion clinic. We’ve had some interesting conversations on shift regarding his experiences with ketamine in the clinic versus emergency medicine and I finally was able to get one of these conversations recorded for the podcast. Enjoy Podcast 163 - What Can W…
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When I became a paramedic, being able to provide pain management was one of the "new interventions" that I looked forward to most. As an EMT, I remember countless times I was without ALS resources and had to watch a patient suffering in pain until we got to the hospital. Trying to obtain any history or perform an assessment on someone writhing in p…
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Taking on pharmacology in EMT school is a big hurdle. We wanted to write something that not only explained the basics of the medications but also helped bridge the gap between what EMTs are taught and what paramedics learn when they go back over these medications in paramedic pharmacology. Each chapter discusses how the medications work, why they'r…
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I had the privilege to bring on two passionate fathers of children with Autism to help me better understand how to approach and communicate with a neuro-diverse child. This episode is chock-full of insight, tips, tricks, and logistics of approaching a child in the field with Autism. Josh Chan is a Life Link III flight paramedic/base lead and a Glen…
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EMS providers encounter various infectious diseases daily and need to know the routes of exposure, risks, and preventive measures to protect themselves and their families. In this episode, We talk with Dr. Hudson Garrett, an infectious disease expert with the medical college of Louisville University, to discuss the practical points of infectious di…
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In this episode, Dan Rauh & Mike Boone from Heavy Lies The Helmet join me to hash out our workflows and drugs of choice for four particular scenarios you may come across. The combative head injury patient that needs to be intubated but has five firefighters holding them down and is actively trying to rip off his collar and IV. The septic hypotensiv…
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Moments after the heart stops the entire circulatory system finally has a chance to bring venous and arterial pressures to equilibrium. Cardiac arrest resuscitation requires the provider to have a strong mental model of physiology and the logistics to carry out a series of interventions crucial to preserving life. This class will serve not as a rou…
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AI will be integrated into everything we do in medicine, perhaps sooner than we think. It will help keep our patients safe, our providers informed, and our communications connected, and change how we think about how we care for patients (if implemented correctly). Systems like ChatGPT are only the beginning, and many companies are already working o…
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We just finished re-recording our pediatric arrest class in Studio and decided to play the unedited version of my discussion with Dr. Paul Banerjee. Banerjee is a prolific researcher and medical director in Florida with a particular emphasis on pediatric arrest. Check out the class in Studio for more information on the logistics.…
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EMS is well-trained in peripheral intravenous as well as intraosseous access. However, central lines remain off-limits for many clinicians in various response areas. If accessing these types of lines is allowed, it’s usually permitted when the patient is (nearly) dead. This isn’t very surprising since the scope of practice of the EMS clinician usua…
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A-a gradient, a/A ratio, and P: F ratio - are all different views of the same item. These formulas do not have a complete view of oxygenation. Oxygenation is a huge topic, and there are more common values that we use: How well is the patient saturating? Is there dyspnea? How do the lungs sound (auscultation) or look (POCUS)? Where is the patient on…
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Theresa Bowden is a rockstar flight nurse who specializes in NICU transports. In this episode, you will listen in as Theresa explains anything and everything you have ever wondered about NICU interfacility transports. Topics include: Who gets prostaglandin? IO or IV catheter for UVC Cardiac vs. Respiratory Initial Vent Settings Get credit for this …
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The thyroid is a butterfly-shaped gland. But for some, it can be more like a bullet to the neck. The number of systems that our thyroid helps regulate truly is incredible, and an over or under-active thyroid can cause a whole host of acute and chronic issues. On the one hand, imagine a patient who has a thyroid history and is cold, weak, and has a …
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I reached out to @medtwitter asking for help finding a guest to talk about the respiratory syncytial virus (RSV). It may seem weird to be talking about RSV when everyone is thinking about the current pandemic, but I find the virology and mechanism of symptoms of RSV exciting. Twitter did not let me down, my friend Ashley Liebig recommended Natalie …
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A young pediatric patient is having nausea and vomiting at school and is said to not be 'staying awake very well.' You discover assessment findings such as hypotension, hypoglycemia, and maybe even peaked T waves on the ECG. You receive information indicating that the child has something called "CAH". Or, perhaps... An older patient is having dizzi…
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In this episode, we talk with Matt Schneider, a Battalion Chief and Paramedic for the Mequon fire department in Ozaukee County. Sam and I had the privilege of sitting in on a guideline update presented by Matt a few weeks ago. One of the guidelines that caught our attention was the decision to remove nitroglycerin from the STEMI guideline. Listen i…
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One of my first calls as a paramedic was to our local ski hill for a 26-year-old guy who crashed into a tree while snowboarding. The ski patrol brought him down to the patrol room and we met them inside. The guy was literally screaming in pain and saying: "just put me out, man!" I could see his leg was obviously deformed below the knee. Now, this d…
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Welcome to the third installment of this metabolic panel series, where we're exploring what happens when these lab values hit their limits, or beyond. Previously we've explored Cations (located here) and Anions (located here), but don't feel like you need to read these in any particular order. These blogs are meant as a reference for you to come ba…
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Welcome to the second installment of this metabolic panel series, where we're exploring what happens when various lab values reach their outer limits (or beyond). Each part in the series can be read on its own, but if you want to start at the beginning, go check out the first blog on cations HERE. This series of blogs and podcasts are meant as a re…
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Lab value interpretation sadly wasn't included in my initial paramedic education. I was absolutely ecstatic to attend a critical care program and learn about lab values - I had always found it very impressive when people could interpret lab values. I wanted to be a lab value wizard too! Unfortunately, in critical care class, our lectures and resour…
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200 comment Facebook post where I asked, "what questions would you like me to ask the NREMT?" These are the questions that seem to be the most popular. 200 comment Facebook post where I asked, \"what questions would you like me to ask the NREMT?\" These are the questions that seem to be the most popular.","type":"unstyled","depth":0,"inlineStyleRan…
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In this episode, Tyler interviews Tom Bouthillet and Dr. Stephen Smith on who exactly should get a right-sided ECG. Do not delay transport to PCI to grab a right-sided ECG. If you do decide to perform a right-sided ECG, it should not be for the decision on whether or not to give nitro. If time permits, it may be helpful and confirm your suspicions …
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We've been exposed to gas laws our whole life, and we have intuition about what will happen to gas under certain conditions. For example, people notice that the pressure in their tires might become low on a very cold day. Or perhaps you've been at very high altitudes and you've been short of breath. And everyone knows that if you shake a carbonated…
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The concept of taking blood out of the body, oxygenating it, removing the CO2, and then putting back in, fascinates me. A few years ago I admittedly knew very little about extracorporeal membrane oxygenation (ECMO) and its indications. I remember going to a class on ECMO at Life Link III and having questions like: Are we actually pumping blood back…
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Before the July 4th weekend hits, I wanted to address two main questions whose answers may come in handy on a call you'll run very soon... Should EMS use a burn formula? What's the best way to manage pain for the burn patient? For a sense of a well-rounded blog on burns, I've included some quick facts about burn care at the end that are unrelated t…
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Invasive arterial blood pressure (IABP) monitoring techniques have enjoyed a rich history of use throughout the mid-to-late 20th century in the peri-operative setting and are now a standard of care intensive care units. While there are a variety of IABP monitoring options, one of the most common techniques is percutaneous radial arterial catheteriz…
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Traditionally transcutaneous pacing involves a paramedic placing pads anterior/posterior (preferred), and turning up the milliamps until electrical capture is obtained. Electrical capture is obtained when a pacing spike is followed by a wide complex. The clinician will then try to palpate a pulse to confirm mechanical capture. Because the contracti…
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