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The MCHD Paramedic Podcast is a place for prehospital providers to discuss best practices and offer clinical insights relevant to our daily practice. MCHD Medical Directors Dr. Robert Dickson and Dr. Casey Patrick invite you to explore the many aspects of prehospital care. Along the way you can expect guest appearances by some of the brightest minds that influence modern EMS.
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The podcast crew is joined by a special guest, Dr. Andrew Partain, an EMS Fellow from UTSW in Dallas. We will dissect his recent data surrounding ketamine-only intubation from MedStar in Fort Worth. This is not just another boring data rehash. There are some vital and applicable pearls that must be applied to the world of prehospital airway managem…
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Applied EKG interpretation is often a difficult task in EMS and emergency medicine education. Getting bogged down in minutiae can obscure the patient. While an understanding of EKG foundational physiology is an absolute must, consideration of how to combine the 12-lead and patient presentation is vital as well. Join the podcast crew as they start a…
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We've spent countless hours (rightfully so) discussing ischemic stroke management over the past several years. Sometimes, the other 20% of strokes, the hemorrhagic version, can get neglected. No, we don't have stroke-mobiles at MCHD to diagnose an ICH in the field, but there are some patient care keys to emphasize for EMS when we suspect non-trauma…
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MCHD's POCUS program has definitely involved both forward progress and lessons learned. In this episode, we'll discuss some of the reasons POCUS can be a game changer in the prehospital setting. However, unintended consequences do exist. We've begun to make the move to utilizing carotid ultrasound in OHCA, and we'll tell you exactly why.REFERENCES1…
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MCHD paramedic Wes Hall joins the podcast crew to discuss a recent seemingly mundane back pain call. Please listen to find out how avoidance of premature closure, a thorough exam, and professional patient advocacy led to an excellent outcome in a SCARY case.REFERENCES1. https://www.mchd-tx.org/wp-content/uploads/2023/12/Image-Episode-163.jpg…
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We recently made a significant vasopressor protocol change at MCHD, prioritizing norepinephrine in all shock situations except anaphylaxis and bradycardia. The evidence supporting norepinephrine in septic and even cariogenic shock is relatively solid. However, recent data has emerged suggesting norepinephrine may be safer in post-ROSC shock as well…
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MCHD District Chief April Currie joins the podcast crew to discuss an angioedema case that repeatedly left more questions than answers. Dr. Patrick was tasked with managing the airway and definitely has some lessons learned to share with the listeners.由Montgomery County Hospital District
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The podcast crew dives deep into one of the early "STEMI equivalent" ECG patterns: ST elevation in aVR with diffuse ST depression. What does the evidence say about this pattern? Is there a FOAM lesson to be learned? How should we incorporate this ECG into our practice? REFERENCES1. Harhash AA, Huang JJ, Reddy S, Natarajan B, Balakrishnan M, Shetty …
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Dr. Dickson leads the discussion with recent cases involving the PECARN pediatric head injury decision rule and some super sneaky toxicology. There is some high-level detective work happening during this episode. Listen so you don't miss vital clues in your clinical practice.REFERENCES1. Kuppermann N, Holmes JF, Dayan PS, et al; Pediatric Emergency…
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The podcast crew is joined by MCHD In-Charge Paramedics, Ben Breaux, and Jesus Contreras to discuss a critical case that demonstrates why continuing education and intentional mental reps are vital in emergency care. We've discussed the "how-to" when approaching the crashing tracheostomy patient. Let's add an actual MCHD case and a little review on …
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There is nothing more stressful than seeing EMS peri-arrest progress to pulseless. CARES data suggest that cardiac arrest during transport is not an uncommon event. Additionally, there is new evidence that these patients may not be as difficult to recognize as we might've thought. Join the podcast crew as we introduce the MCHD "MOVES" algorithm for…
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Sometimes it's easy on the individual level to miss the positive drift within EMS as systems of care evolve and change toward positive innovation. Dr. Patrick hits the hot seat on this episode to discuss two recent cases where some of MCHD's favorite initiatives come together to improve patient outcomes and diagnostic recognition.REFERENCES:1. Dick…
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Join the podcast crew as they discuss one of the more sticky situations in all of emergency care: stable vs. unstable narrow complex tachycardia.1. How do we even define unstable?2. Is it cardiac versus an underlying illness?3. How do we approach undifferentiated rapid atrial tachycardia in the ED setting?…
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The concept of emphasizing, discussing, and training on giving prehospital death notification is, unfortunately for medics and our patient's families, a relatively new concept. Additionally, newer evidence shows that an increased frequency of fatality exposure increases EMS burnout rates. So...everyone wins by an increased focus on improving our sk…
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The Podcast Crew is joined by Spokane Valley Fire Paramedic Noah Martinez to discuss a recent patient that he delivered to Dr. Patrick. After you hear what Noah found on the scene, this story will likely not end exactly how you expect. Learn some foundational hypothermia management pearls AND why early emergency neuro-prognostication can be exceedi…
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Chemical sedation is one of the riskiest decisions made in EMS clinical care, period. We've been working overtime at MCHD over the past couple of years to decrease the risk and improve our safety profile for the entire clinical package when we sedate patients for severe agitation in Montgomery County. Join us to learn about the MCHD SNORES safety b…
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Join us as Dr. Dickson brings a couple of extremely difficult recent emergency department cases to take a hard look in his own clinical mirror. These will highlight the difficult and often dynamic nature of assessing airway patency and protection in real time. Speaking of dynamic, vascular emergencies like stroke and STEMI often progress unexpected…
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MCHD paramedic, Lily Trosclair, joins the podcast to discuss some in-depth hyperkalemia treatment details, including BRASH syndrome. We'll also pivot to the dangers of giving amiodarone to a hyperkalemic patient that's mistaken for ventricular tachycardia. REFERENCES1. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-…
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This may seem like a curveball-type episode upon your initial listen, but this topic should be core material for all emergency medical clinicians. Too much time and emphasis within paramedic education are placed on rare presentations. Dr. Dickson and Dr. Patrick expand on a recent medical podcast/article (see links below), stressing the need to emb…
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The podcast crew is joined, live at Texas EMS 2022, by Dr. Gerad Troutman to discuss the world of alternate destination EMS transports, EMS-facilitated telehealth, nurse navigation, and "hospital at home." Dr. Troutman leads the ET3 initiative and is the National Medical Director for Innovative Practice at GMR, so this episode is full of successes,…
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MCHD medics Kelcie Adams and Rich Serra join the podcast to discuss a critically ill trauma patient they delivered to Dr. Patrick in the emergency department. Our default is so often airway, airway, airway first, but prioritizing circulation first was likely life-saving. This is an excellent "Monday Morning Quarterback" case to look back on and dis…
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Special guest alert!! We're lucky to have superstar Aussie medic and University of Melbourne Ph.D. candidate Matt Wilkison-Stokes, on this episode to discuss his recent paper looking at the risk of hypotension with nitroglycerin administration in acute MI. Where is NTG really more likely to cause hypotension in AMI? When is it safest? How often do …
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We have MCHD Cpt. Megan Powell to thank for this episode as she posed an excellent question about where and how to look for trusted educational information as a practicing paramedic interested in continuing clinical growth and progression. With the amazing and immense amount of free online textbook, blog, and podcast resources available, trying to …
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Join this discussion of some of the recent literature surrounding EMS care of traumatic brain injury with Dr. Al Lulla. This is the perfect confluence of advancing evidence, relatively straightforward interventions, and a patient population where we can definitely improve prehospital outcomes. See where the literature, education, and protocol imple…
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When it comes to exciting educational topics in EMS, oftentimes, the endocrine system, specifically the adrenal glands, can be left off the list. Dr. Patrick is joined by one of our local emergency/trauma nurses, Melanie Gander, to discuss her journey as a parent of a child with congenital adrenal hyperplasia. We'll review basic adrenal physiology …
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Across the world of health care, everyone is wrestling with how to reduce medication errors. With the decision in the Vanderbilt case, there is now the added fear of potential prosecution for giving an incorrect medication. Join the podcast crew as they try to better define the various types of medication errors while looking at what the literature…
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Join the Podcast Crew as they answer some recent questions submitted to podcast@mchd-tx.org. We discuss a wide range of topics including epinephrine drips, IV Tylenol for pain, Knee-BOA, whole blood in EMS, the green whistle (methoxyflurane), and an awesome "S" for our loss of airway protection teaching files. Thanks to all our listeners out there!…
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The Podcast Crew is joined by MCHD District Chief, Spencer Hall, to discuss a recent trauma patient that Chief Hall delivered to Dr. Patrick's ED care. This one encapsulates many of our recent podcast topics including the tenets of DSI and the importance of maintaining oxygenation and blood pressure in TBI patients.…
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The MCHD Paramedic Podcast would like to welcome EM/EMS physician Dr. Katherine Luu, to Montgomery County. Dr. Luu joins the podcast to discuss anchoring bias and how this impacts medics in the field. Listen and learn how to describe, recognize, and prevent anchoring bias in your practice.REFERENCES1. https://onlinelibrary.wiley.com/doi/epdf/10.119…
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Brief resolved unexplained what?? MCHD paramedic, Cpt. Clayton Smith, joins Dr. Dickson to discuss an EMS approach to BRUE's. These can often be falsely reassuring to prehospital providers because the event, by definition, has resolved prior to EMS arrival. But don't get too comfortable because up to 4-5% of BRUE's can have severe underlying diagno…
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The Podcast crew is joined by MCHD In-Charge Paramedic Brady Walding to discuss a recent difficult STEMI case that intersected with Dr. Patrick in the ED. How do we best communicate with our consultants when we disagree? What happens when a paradigm shift is occurring without our consultants (STEMI vs. OMI/NOMI)? We are excited about our new Monday…
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The podcast crew welcomes newly transplanted Texan EMS physician, Dr. Louis Fornage, to join in on some rapid-fire mythbusting for 2022. We run the gamut from post-ROSC vasopressor evidence to whether or not saying "QUIET" affects emergency department volume. REFERENCES1. https://www.nremt.org/News/National-Registry-of-EMT-s-Resource-Document-on-Sp…
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Join the podcast crew as they turn their attention from the EMS transport to the First Responders here in Montgomery County. We welcome MCHD FRO Coordinator Bryan Perry and Chief Ray Vaden from Porter Fire to discuss some recent FRO initiatives and advances. It wouldn't be the MCHD Paramedic Podcast if we also didn't slip in some recent CARES resea…
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True anaphylactic shock can be one of the most harrowing calls in all of EMS and emergency medicine. However, as is true with much of our core clinical content, dogma and myths persist. MCHD District Chief Spencer Hall joins the podcast crew to discuss anaphylaxis diagnostic criteria, treatment, and much more. REFERENCES1. Anagnostou K, Turner PJ. …
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Join Dr. Patrick and MCHD District Chief and Bike Team lead, Scott Sanders, as they discuss the MCHD Bike Team. What does it take to be an MCHD bike team medic? How does patient care differ from the truck vs. when on the bike? Learn how the MCHD Bike Team fills multiple invaluable roles in the county.Photo Link - https://www.mchd-tx.org/wp-content/…
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Friend of the podcast emergency physician, addiction specialist, and toxicologist extraordinaire, Dr. Jerry Snow joins the podcast crew to discuss a scary and potentially deadly twist in the opiate crisis…xylazine. Dr. Snow will school us all about xylazine pharmacology and treatment tips and why EMS high-dose naloxone may not be ideal.REFERENCES1.…
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There is no possible way to improve ketamine, right? Join Dr. Patrick for a discussion of exciting recent literature investigating the effectiveness and safety of nebulized ketamine for emergency department analgesia. Everyone's favorite EMS medication may be primed for an enhanced delivery option.REFERENCES1. Dove D, et al. Comparison of Nebulized…
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Join the podcast crew, District Chief Kevin Mifflin and In-Charge Payden Seals as they discuss our MCHD Case of The Quarter for Q1 2022. This case is a prime example why field providers must keep wide differentials with a keen awareness of the initial scene situational factors. REFERENCES1. https://coreem.net/core/hypothermia/2. https://www.saem.or…
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The medical directors revisit one of our old favorites "The Serial Killers Series" to discuss 5 trauma killers to keep in your front brain as you are preparing or caring for a sick trauma patient. If you've not considered your differential diagnosis until patient contact and initial evaluation then you're too late. Following this episode, you'll be…
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Join Dr. Dickson and the podcast crew as they dive into the MCHD approach to mass casualty incidents. We're lucky to be joined by MCHD Safety and Preparedness Officer, Sean Simmonds and MCHD District Chief Ryan Davenport. These are field medics talking about actual logical field pearls for MCI management.…
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Episode 127 - Airway Patency Vs. Protection by Montgomery County Hospital District由Montgomery County Hospital District
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On Episode 126, the podcast crew was able to catch up with the one and only Dr. Jeff Jarvis at Texas EMS in Austin. Dr. Jarvis is a longtime fan of droperidol for multiple uses in the prehospital setting ranging from acute headache treatment to sedation and as an anti-emetic. Let this be a warning, we're all droperidol zealots in this discussion. L…
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Texas has been the epicenter of the ground-based EMS integration of whole blood programs for hemorrhagic shock in the prehospital setting. The MCHD clinical staff have been watching the evidence closely and feeling the push from our own medics. Join Dr. Dickson and Dr. Patrick as they discuss the "why" behind no whole blood at MCHD (yet...). Send a…
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Join the podcast crew and MCHD medic Lily Trosclair as she discusses our MCHD Case of The Quarter for Q4 2021. This one began with a pediatric cardiorespiratory arrest but fortunately has a happy ending.REFERENCES1. Heffner AC, Swords D, Kline JA, Jones AE. The frequency and significance of postintubation hypotension during emergency airway managem…
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Wherever you turn in the world today, social media is present with constantly expanding visibility and influence. Join MCHD's Chief of EMS James Campbell and Public Information Officer Misti Willingham as they discuss some lessons and ground rules on how to successfully integrate an active social media program into your EMS service.…
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It’s time to review some recent cardiac arrest literature. Both of today’s articles come from Resuscitation and address predictors of OHCA survival. Should we take a third attempt at intubating an OHCA patient, should we intubate OHCA at all? What about PEA arrest, can ETCO2 help identify pseudo-PEA? Listen to get some hot off the press OHCA litera…
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We sure do love myth busting on the MCHD Paramedic Podcast and there are definitely some persistent myths surrounding burn care in EMS. Join the podcast crew as they provide updates on burn staging, fluid resuscitation and the basics of burn wound care. This episode will keep you from getting burned during your next burn transport.REFERENCES1. Parv…
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Join the podcast crew and Dr. Taylor Ratcliff as they discuss the dangers of the "Lift Assist" calls in EMS. These responses can be under-appreciated with hidden diagnoses such as sepsis, GI bleeding and even fractures. How can we better create checklists to better assess these calls? What are the warning signs in these patients? Do lift assists ev…
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In this episode, we’re lucky to have a special guest from Texas Children's Hospital, pediatric sedation and pain management expert, Dr. Corrie Chumpitazi. Nitrous oxide has been in our protocols here at MCHD for some time, but probably doesn’t get the recognition and appreciation that it deserves. We’ll discuss NO history, dosing, indications, cont…
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Within EMS, significant time is spent learning high risk, low frequency procedures and the pharmacology and physiology surround these events. In most EMS services consultations or checklist verifications are required in some fashion surrounding these events. Often times, though, we tend to overlook and fail to provide a structure for best practices…
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