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?

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 skills and comfort with telling families that their loved ones have died. We were initially leery of doing an episode on death notification as The Medic Mindset podcast recently hit a home run on this topic recently. But, after educating over 500 EMS professionals, Dr. Dickson and I learned some valuable lessons from our crews that we felt were worth sharing. Enjoy! REFERENCES 1. https://medicmindset.com/2023/01/09/death-notification-choreography/ 2. Hobgood C, Mathew D, Woodyard DJ, et al. Death in the field: teaching paramedics to deliver effective death notifications using the educational intervention "GRIEV_ING". Prehosp Emerg Care. 2013 Oct-Dec;17(4):501-10. 3. Campos A, Ernest EV, Cash RE, et al. The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals. Prehosp Emerg Care. 2021 Jul-Aug;25(4):539-548. 4. Toy J. Family-Witnessed Cardiopulmonary Resuscitation during Emergency Department Cardiac Arrest Care: A Resident Perspective. Ann Emerg Med. 2023 Feb 23:S0196-0644(23)00041-0.

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 exceedingly difficult.

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 bundle based on the 5 P's and how you can easily implement this into your service. • Partnerships • Preparation • Pharmacology • Positioning • Possibilities REFERENCES 1. Nørskov AK, Rosenstock CV, Wetterslev J, et al. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia. 2015 Mar;70(3):272-81.

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 unexpectedly. REFERENCES 1. Nørskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrøm LH. Diagnostic accuracy of anaesthesiologists' prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia. 2015 Mar;70(3):272-81.

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. REFERENCES 1. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/ 2. https://www.youtube.com/watch?v=UXh8PS9dtmo&t=2s 3. McArthur R, Rafique Z, Ward B, Rodriguez L, Dickson R, Patrick C. Treatment of Presumed Hyperkalemia in the Prehospital Setting. Prehosp Disaster Med. 2022 Oct;37(5):693-697.

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 embrace learning and teaching the most common conditions we care for. REFERENCES 1. https://podcasts.apple.com/us/podcast/episode-19-juan-lessing-and-read-pierce-teaching-more/id1603333202?i=1000560289032 2. https://www.amjmed.com/article/S0002-9343(22)00134-6/fulltext

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, road bumps, and shared experiences with the implementation and execution of each of these leading-edge concepts within prehospital care.

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 dissect with tons of educational pearls.

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 isolated RVMI's occur, and what are the correct diagnostic criteria? Dr. Patrick changed his practice based on Matt's work and knowledge. See if you might do the same. REFERENCES 1. Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2022 Sep 30:emermed-2021-212294. 2. Ferguson JJ, Diver DJ, Boldt M, et al. Significance of nitroglycerin-induced hypotension with inferior wall acute myocardial infarction. Am J Cardiol 1989;64:311–4. 3. matt.wilkinsonstokes@student.unimelb.edu.au

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 keep up can be totally daunting. Join Megan and the podcast crew as they discuss tips and strategies to manage the waterfall of open-access EMS education that exists today.

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 implementation can meet to improve TBI outcomes in your EMS service. REFERENCES 1. Spaite DW, Hu C, Bobrow BJ, et al. Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59. 2. Spaite DW, Bobrow BJ, Keim SM, et al. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA Surg. 2019 Jul 1;154(7):e191152.

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 and discuss the caveats on how to recognize and treat adrenal crises in the field. REFERENCES 1. https://united4rare.org/ 2. https://caresfoundation.org/ 3. https://www.magicfoundation.org/Growth-Disorders/Congenital-Adrenal-Hyperplasia/

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 says about medication errors in EMS. REFERENCES 1. Walker D, Moloney C, SueSee B, Sharples R, Blackman R, Long D, Hou XY. Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review. Prehosp Emerg Care. 2022 Jun 27:1-18. 2. Morrow D, North R, Wickens CD. Reducing and Mitigating Human Error in Medicine. Reviews of Human Factors and Ergonomics. 2005;1(1):254-296. 3. Hoyle JD Jr, Crowe RP, Bentley MA, Beltran G, Fales W. Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics. Prehosp Emerg Care. 2017 Mar-Apr;21(2):185-191. 4. Misasi P, Keebler JR. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. Ther Adv Drug Saf. 2019 Jan 21 5. Reason J. Human error: models and management. BMJ. 2000 Mar 18;320(7237):768-70.

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!! REFERENCES 1. O'Dochartaigh D, Picard CT, Brindley PG, Douma MJ. Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices, Manual Pressure, or a Single Knee: An Integrative Review of Proximal External Aortic Compression and Even "Knee BOA". J Spec Oper Med. 2020 Summer;20(2):110-114.

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.

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. REFERENCES 1. https://onlinelibrary.wiley.com/doi/epdf/10.1197/aemj.9.11.1184 2. https://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman-ebook/dp/B00555X8OA/ref=sr_1_1?crid=24FYPXSEKVE8Y&keywords=thinking+fast+and+slow&qid=1662524196&sprefix=thinking%2Caps%2C104&sr=8-1

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 diagnoses as the cause. We can never talk too much "sick peds" material on the podcast. This episode will make the approach to your next BRUE a breeze. REFERENCES 1. Tieder JS, Sullivan E, et al; Brief Resolved Unexplained Event Research and Quality Improvement Network. Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study. Pediatrics. 2021 Jul;148(1) 2. Banerjee, P. R., Ganti, L., et al. (2019). Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival. Resuscitation, 135, 162-167.

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 Morning Quarterback Series, where Dr. Patrick and Dickson review their cases with the MCHD medics involved. Hopefully, you will enjoy it as well!! REFERENCES 1. Meyers HP et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. Journal of Emergency Medicine 2020. 2. https://www.nuemblog.com/blog/dont-forget-avl 3. https://www.youtube.com/watch?v=dWrG8d3YXq4

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. REFERENCES 1. https://www.nremt.org/News/National-Registry-of-EMT-s-Resource-Document-on-Sp#:~:text=NREMT's%20use%20of%20the%20term,most%20trauma%20patients%20is%20unproven 2. https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/s12879-022-07337-y.pdf 3. https://www.tandfonline.com/doi/full/10.1080/10903127.2021.1992053 4. https://rebelem.com/using-the-word-quiet-in-the-ed/?fbclid=IwAR1yAtVPnUSJqWnGWDWy9yhgXNHSie0AgAxWctGq-zwd_xczFrsvaexwvgw 5. https://journalfeed.org/article-a-day/2022/battle-of-the-catecholamines-epi-vs-norepi-for-post-resuscitation-shock/