MCHD Paramedic Podcast

Hypotension is one of our number one enemies in prehospital care. In this episode, Dr. Patrick and Dickson begin with a review of vasopressor physiology and then they dive into the evidence and rationale behind push dose epinephrine use. References: https://emcrit.org/emcrit/push-dose-pressor-update/ https://www.nejm.org/doi/full/10.1056/NEJMoa0907118

Join Dr. Patrick and Dr. Dan O'Donnell, medical director for Indianapolis EMS/Fire/SWAT, as we discuss multiple hot topics in the world of Tactical EMS.

On today’s cast our medical directors talk traumatic arrest care with Dr. Justin Hensley, the medical director of Robstown EMS, and lover of all things trauma resuscitation related. We'll review the history, training and implementation of the simple finger thoracostomy procedure at MCHD while also discussing our general approach to the traumatic arrest patient. Below are links to the papers and vi...

Dr. Patrick went where? Dr. Dickson interviews Dr. Patrick about his recent medical journey to Uganda. Learn about the state of prehospital medicine in Uganda, several interesting cases that you probably won’t see here in the United States, and find out how you can help the cause. References www.globalemergencycare.org

Tranexamic Acid (TXA) has been a hot topic in emergency medicine over the past several years with increasing acceptance for use in patients with hemorrhagic shock. Casey Patrick and Jordan Anderson review the pharmacology of TXA, discuss the literature supporting its use, and close with MCHD’s TXA administration protocol. References 1. Gayet-Ageron A et al. Effect of Treatment Delay on the Effecti...

Dr. Dickson and Dr. Patrick take on one of our favorite topics here at MCHD - Ketamine and the agitated patient. Agitated patients come in a wide spectrum of severity. This discussion starts with a framework for stratifying agitated patients. We discuss the MCHD ketamine experience along with a less discussed patient population that may need ketamine control quicker than we often think. ***Remembe...

Concussions and management of mild head injury are topics that are rapidly evolving. Dr. Greg Faris joins Dr. Patrick to lend his pediatric emergency expertise on these important and commonly seen injuries. With youth and high school football season coming soon, get your concussion refresher now. References: CDC Heads up. www.cdc.gov/headsup Kupperman N, et al. Identification of children at very l...

Pregnancy complications make us all a little diaphoretic and tachycardic. On this episode, Dr. Patrick and Dr. Dickson break down the must know aspects of caring for the obstetric patient prior to delivery in the EMS setting. References: https://www.acog.org/Clinical-Guidance-and-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy

Dr. Patrick is joined on this episode by Dr. Elizabeth Weinstein. Elizabeth is a dual trained in Emergency Medicine and Pediatrics, and she delivers clinical pearl after clinical pearl on how to recognize and manage non-accidental trauma in the prehospital environment. Resources: http://www.identifychildabuse.org

Join Dr. Patrick for a discussion of common drugs, both OTC and prescription, that can be deadly to our pediatric patients in doses as small as a single pill. This knowledge will allow us to properly educate families and know when to expect a potential crashing kid. References: Michael J.B., Sztajnkrycer M.D. Deadly pediatric poisons: Nine common agents that kill at low doses. (2004). Emergency Me...

Dr. Jerry Snow, a medical toxicologist and emergency medicine physician from Phoenix joins the show for an interesting discussion about the opiate crisis facing America today, with a specific emphasis on fentanyl and its derivatives. We discuss EMS/first responder exposure risks and preventative measures along with patient care pearls when treating patients with fentanyl overdose. References: Amer...

Patients with acute pulmonary edema need rapid preload and afterload reduction and often their volume status is difficult to ascertain. Casey Patrick and Brad Ward discuss a novel approach to using our old friend nitroglycerin in these patients along with the other cornerstones of their care. References 1. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate pl...

CHF exacerbations are bread and butter emergency medicine. Casey Patrick and Brad Ward begin with some background physiology and review of CHF. They then move on to describing a more detailed framework than the typical “CHF exacerbation” that is commonly taught. You’ll finish this podcast and think you’re a plumber as opposed to a paramedic. References https://coreem.net/core/ape/

Today’s show is all about the changes in how we approach intubation in EMS. Dr. Jeff Jarvis will relate how he got interested in the topic of airway management and specifically the process of delayed sequence intubation. Dr. Jarvis is the EMS medical director for Williamson County Texas EMS. He will present data from the recent Annals of Emergency Medicine paper his group authored on the topic. MC...

Join Dr. Patrick and Ashton Herring our community outreach coordinator as we discuss adult and pediatric drowning emergencies and best practices in prevention.

With the blazing Texas summer just around the corner, we thought it would be appropriate to discuss heat related emergencies. Dr. Patrick leads a discussion of the various terminology, physical exam findings, differential diagnoses and pre-hospital treatments for heat-illness.

Dr. Jerry Snow, a medical toxicologist and emergency medicine physician from Phoenix joins the show for a fact-filled and often hilarious talk on prehospital management of snakebites. This episode involves copperheads, water moccasins and even unsuccessful car battery therapy (yep, you read that correctly). Stay until the end - you won’t be sorry you did!

In the past 24 months, stroke care has evolved in the way we evaluate strokes in the pre-hospital space and how they are worked up and treated in the hospital. Large vessel Occlusion (LVO) stoke is a large caliber vessel clot causing stroke symptoms. New techniques and devices in endovascular retrieval of these clots along with intravenous Tpa has shown great success in five randomized trials publ...

In the past 24 months, stroke care has evolved in the way we evaluate strokes in the pre-hospital space and how they are worked up and treated in the hospital. Large vessel Occlusion (LVO) stoke is a large caliber vessel clot causing stroke symptoms. New techniques and devices in endovascular retrieval of these clots along with intravenous Tpa has shown great success in five randomized trials publ...

Anaphylaxis is a common life threatening disease that prehospital providers encounter on a regular basis. These patients are in need of early treatment with Epinephrine. In today’s episode Dr. Casey Patrick, along with Kevin Crocker and Ashton Herring, will be discussing MCHD’s deployment of Epinephrine to the Fire Departments within Montgomery County. This discussion will cover basic information...

Join Dr. Casey Patrick and Brad Ward as they discuss a county wide initiative to expedite ROSC patients to definitive care in the cardiac cath lab. They will be discussing the literature and science on why these patients have better outcomes when they are quickly taken to the cath lab. They will also be addressing how MCHD has partnered with our hospitals to implement our new ROSC Cath Lab Activat...

It's Memorial Hermann Ironman Texas time here in Montgomery County, and our MCHD crews are preparing to staff the 140.6 mile triathlon. After fielding multiple questions about hyponatremia and hypothermia in ultra-endurance athletes, we decided that a podcast discussion was in order. The MCHD Paramedic Podcast crew were lucky enough to have Dr. Kevin Schulz, Medical Director for Memorial Hermann I...

EMS implementation of Community Paramedicine and Mobile Integrated Health programs is exploding. Dr. Peter Antevy joins Dr. Dickson for an informative discussion surrounding the role of Community Paramedicine and Mobile Integrated Health in today’s EMS systems. Dr. Antevy has built an impressive CP program from the ground up in South Florida. He shares his experiences and thoughts on both the idea...

Hyperkalemia can send our patients to cardiac arrest in an instant. Casey Patrick and Jordan Anderson begin with some background physiology review on the importance of potassium to cellular function. They then move on to describing specific patient characteristics and ECG findings found in patients with hyperkalemia, and close with MCHD’s current protocol to preemptively treat these patients en ro...

Syncope is a common and often confusing presentation. Dr. Casey Patrick leads a lecture style discussion with tips to approaching the syncopal patient in the prehospital setting. ECG pointers and an impossible to forget “crappy” mnemonic will leave you with a more focused approach to your next syncopal patient. References 1. http://www.jem-journal.com/article/S0736-4679(17)30868-5/pdf LINKS: 1. WP...