Afleveringen
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In this episode, we delve into seizure management for pre-hospital settings, beginning with a detailed case study of a 67-year-old male experiencing his first seizure. The discussion covers differential diagnoses, including the use of the 'VITAMINS' acronym to identify potential causes, ranging from infections to metabolic issues. Key seizure management strategies are outlined, emphasizing the importance of immediate intervention and medication administration. Differences between focal, generalized, and unclassified seizures are explained, along with a breakdown of seizure phases and treatments. The conversation also touches on the role of Midazolam, its effects, and the necessary approach to managing a seizing patient effectively in the field. The episode aims to equip EMS professionals with essential knowledge and procedures to optimize patient outcomes.Chapters:00:00 Introduction to Seizure Management00:21 Case Study: First-Time Seizure01:40 Differential Diagnosis and Initial Assessment05:08 Seizure Management Protocols07:16 Pathophysiology of Seizures16:06 Operational Treatment of Seizures📚Referenced Studies & Further Reading:Best practices for seizure management in EMS: PMID: 39531982Improving prehospital seizure outcomes: PMC: PMC8977974Integrated care frameworks in seizure response: IJIC: https://ijic.org/articles/10.5334/ijic.5598Prehospital seizure care gaps: PMID: 33485168Innovations in seizure care delivery: PMC: PMC9650192Paramedic decision-making in neurologic emergencies: PMID: 31722820#ems #science #paramedic #emergencymedicine #prehospitalcare #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #health #healthcare #healthcareheros #simulation #humanfactors #medicine #science #healthcare #healthquality #healthsafetycourse Get in Touch Here or in The Comments:[email protected]: https://www.linkedin.com/in/ryan-cichowski-787b99274/https://www.linkedin.com/in/jakob-rodger-b60571141/Disclaimer:This video is for educational purposes only and does not constitute medical advice. Always follow your local medical directives, protocols, and the guidance of your medical director or regulatory authority.
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About Dr. Callum:https://research.sunnybrook.ca/researchers/jeannie-callum/https://pathology.queensu.ca/faculty-staff/jeannie-callumhttps://www.researchgate.net/profile/Jeannie-Callumhttps://www.youtube.com/watch?v=paAvUuXDChU&t=962s In this insightful part 2 episode, we explore the critical importance of temperature management and the timely administration of Tranexamic Acid (TXA) for trauma patients in pre-hospital settings. The discussion covers the mechanics and benefits of TXA administration, including its proven effects on reducing mortality in trauma and obstetric hemorrhage cases, as well as its applications in various surgical procedures. We examine the evidence from key trials like Crash-2 and the WOMAN trial, and highlight practical aspects such as storage and dosage. Additionally, the episode addresses the importance of maintaining a patient's body temperature and presents initiatives to improve the efficacy of pre-hospital care, including potential research opportunities and strategies to make workflows more efficient for healthcare professionals.Chapters00:00 Introduction to Pre-Hospital Temperature Management00:46 Understanding TXA Administration Timelines02:08 Case Studies and Anecdotal Evidence03:01 Dosage and Safety of TXA07:02 Storage and Temperature Considerations for TXA09:14 TXA in Various Medical Scenarios22:33 Research and Future Directions for TXA31:48 Conclusion and Key TakeawaysReferences:Ontario Transfusion Quality Improvement Plan.Massive Hemorrhage Protocol Toolkit – Version 1 (October 2021).Available at: https://transfusionontario.org/wp-content/uploads/2021/10/MHP_Toolkit_v1_Oct2021.pdfCallum JL, Karkouti K, Lin Y, et al.The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial. JAMA Surg. 2020;155(9):e202243.Available at: https://jamanetwork.com/journals/jamasurgery/fullarticle/2771225Gayet-Ageron A, Prieto-Merino D, Ker K, et al.Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: A meta-analysis. Lancet. 2023;401(10378):1344-1353.Available at: https://pubmed.ncbi.nlm.nih.gov/32897344/Yee DA, Knudson MM, Cohen MJ, et al.Prehospital tranexamic acid is associated with improved survival in severely injured patients with major hemorrhage. J Trauma Acute Care Surg. 2023 Nov;95(5):665–671.Available at: https://pubmed.ncbi.nlm.nih.gov/37928456/Roberts I, Shakur H, Coats T, et al.The CRASH-2 trial: A randomized controlled trial and economic evaluation of the effect of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10):1–79.Available at: https://pubmed.ncbi.nlm.nih.gov/23477634/CRASH-3 trial collaborators.Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomized, placebo-controlled trial. Lancet. 2019;394(10210):1713–1723.Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltextShariff ZA, Joshi N, Reardon PM, et al.Implementation of prehospital tranexamic acid (TXA) in Ontario: A provincial, prospective, collaborative approach. BMC Emerg Med. 2024;24(1):14.Available at: https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01119-2Sperry JL, Guyette FX, Rosario-Rivera BL, et al.Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial. Ann Surg. 2024 Aug 1;280(2):212-221.Available at: https://pubmed.ncbi.nlm.nih.gov/38708880/Relke N, Chornenki NLJ, Sholzberg M.Tranexamic acid evidence and controversies: An illustrated review. Res Pract Thromb Haemost. 2021;5(5):e12546.Available at: https://pubmed.ncbi.nlm.nih.gov/34278187/Disclaimer:Always follow your local medical directives, protocols, and the guidance of your medical director or regulatory authority.
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Zijn er afleveringen die ontbreken?
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Dr. Jeannie Callum: The Architect of Prehospital TXA in OntarioWhat does it take to change an entire province’s approach to trauma care? For Dr. Jeannie Callum—hematologist, transfusion medicine specialist, and researcher—it took relentless advocacy, bold data, and a vision for saving lives before patients even reach the hospital. Known internationally for her expertise in bleeding disorders and transfusion science, Dr. Callum played a pivotal role in bringing tranexamic acid (TXA) out of the hospital and into the hands of Ontario paramedics.About Dr. Callum:https://research.sunnybrook.ca/researchers/jeannie-callum/https://pathology.queensu.ca/faculty-staff/jeannie-callumhttps://www.researchgate.net/profile/Jeannie-Callumhttps://www.youtube.com/watch?v=paAvUuXDChU&t=962s Join us as we delve into the critical topic of TXA in trauma treatment with one of the leading specialists in the field. Our guest, a renowned hematologist and transfusion medicine expert, shares her journey, expertise, and the importance of TXA in improving patient outcomes. Discover the intricacies of traumatic coagulopathy, the significance of timely TXA administration, and its application from pre-hospital to in-hospital settings. Chapters:00:00 Introduction to TXA and Trauma00:26 Expert Background and Journey02:58 The Importance of Early TXA Administration07:36 Mechanism and Benefits of TXA11:43 Addressing Concerns and Misconceptions16:53 Pre-Hospital and In-Hospital TXA Protocols25:33 Pediatric Considerations and Future Research30:00 Conclusion and Final ThoughtsReferences:Ontario Transfusion Quality Improvement Plan.Massive Hemorrhage Protocol Toolkit – Version 1 (October 2021).Available at: https://transfusionontario.org/wp-content/uploads/2021/10/MHP_Toolkit_v1_Oct2021.pdfCallum JL, Karkouti K, Lin Y, et al.The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial. JAMA Surg. 2020;155(9):e202243.Available at: https://jamanetwork.com/journals/jamasurgery/fullarticle/2771225Gayet-Ageron A, Prieto-Merino D, Ker K, et al.Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: A meta-analysis. Lancet. 2023;401(10378):1344-1353.Available at: https://pubmed.ncbi.nlm.nih.gov/32897344/Yee DA, Knudson MM, Cohen MJ, et al.Prehospital tranexamic acid is associated with improved survival in severely injured patients with major hemorrhage. J Trauma Acute Care Surg. 2023 Nov;95(5):665–671.Available at: https://pubmed.ncbi.nlm.nih.gov/37928456/Roberts I, Shakur H, Coats T, et al.The CRASH-2 trial: A randomized controlled trial and economic evaluation of the effect of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10):1–79.Available at: https://pubmed.ncbi.nlm.nih.gov/23477634/CRASH-3 trial collaborators.Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): A randomized, placebo-controlled trial. Lancet. 2019;394(10210):1713–1723.Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltextShariff ZA, Joshi N, Reardon PM, et al.Implementation of prehospital tranexamic acid (TXA) in Ontario: A provincial, prospective, collaborative approach. BMC Emerg Med. 2024;24(1):14.Available at: https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01119-2Sperry JL, Guyette FX, Rosario-Rivera BL, et al.Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial. Ann Surg. 2024 Aug 1;280(2):212-221.Available at: https://pubmed.ncbi.nlm.nih.gov/38708880/Relke N, Chornenki NLJ, Sholzberg M.Tranexamic acid evidence and controversies: An illustrated review. Res Pract Thromb Haemost. 2021;5(5):e12546.Available at: https://pubmed.ncbi.nlm.nih.gov/34278187/
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In this second episode, we delve into the crucial role of psychological safety within medical teams, particularly in high-stress environments like trauma care. The discussion highlights the importance of the phrase 'What else am I missing?' as a tool for team leads to flatten hierarchies and encourage open communication. Case studies, such as Elaine Bromley's tragic story, are explored to underline the significance of teamwork and decision-making. The episode further discusses techniques like pre-briefings, signposting decisions, and setting clear objectives to ensure optimal team performance and patient safety. Practical advice and strategies are shared for both current and aspiring medical professionals to implement in their practices.
Learn more about Dr. Petrosoniak's work: https://research.unityhealth.to/profiles/andrew-petrosoniak/ https://t.co/XYAzUMg9xz.https://advancedperformance.ca/
Learn more about Dr. Hicks' work:
https://scientific.acoep.org/speakers/chris-hicks-md/
Chapters:
00:00 The Power of Asking 'What Else Am I Missing?'
00:42 Overcoming Hierarchical Barriers in Healthcare
01:17 The Importance of Psychological Safety
03:06 The Tragic Story of Elaine Bromley
06:29 Understanding the Sunk Cost Fallacy in Medical Decisions
09:05 Signposting Decisions to Mitigate Errors
14:43 Pre-Briefing and Shared Mental Models in Trauma Care
23:01 Final Thoughts and Reflections on Success
References:
Airway Management & Human Factors
FutureLearn – “Airway Matters” course:
A free online course exploring the human and system factors behind airway complications and how to prevent them.
👉 Access the courseBarriers to Speaking Up in Healthcare
BMC Health Services Research (2020):
A peer-reviewed study on why healthcare workers hesitate to speak up about patient safety concerns—and how culture and hierarchy influence this behaviour.
👉 Read the articleCreating Psychological Safety in Healthcare
Healthcare Excellence Canada:
A practical toolkit and guidance on building safe environments where healthcare workers feel comfortable seeking and offering peer support.
👉 View the resourcePsychological Safety for Patients
ISMP Canada Bulletin:
Highlights how psychological safety extends to patients, and why it's essential for preventing medication and communication errors.
👉 Read the bulletin#ems #science #paramedic #emergencymedicine #prehospitalcare #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #health #healthcare #healthcareheros #simulation #humanfactors #medicine #science #healthcare #healthquality #healthsafetycourse
Get in Touch Here or in The Comments:[email protected]: https://www.linkedin.com/in/ryan-cichowski-787b99274/https://www.linkedin.com/in/jakob-rodger-b60571141/
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In this episode, we delve into the PACKMaN trial, a recent study comparing ketamine and morphine for the treatment of traumatic pain. The discussion covers critical appraisal methods, study methodologies, sample size considerations, and the implications of the study's findings for paramedic practice in Ontario. We also explore the side effects, patient populations, and operational contexts in which ketamine and morphine might be chosen. This educational content is aimed at providing paramedics with evidence-based insights and supplemental knowledge for their practice.Chapters:00:00 Introduction to Ketamine vs. Morphine00:44 Overview of the Pac-Man Trial01:12 Critical Appraisal of the Study01:19 Understanding Critical Appraisal02:17 Research Question and Methodology02:58 Study Protocol and Applicability04:55 Blinding and Ethics in Research07:14 Sample Size and Statistical Significance12:03 Primary and Secondary Outcomes14:57 Operational Implications and Pain Management18:19 Understanding Dosage Nuances19:20 Ketamine's Safety and Side Effects20:23 Combining Opiates and Ketamine21:09 Contextual Considerations in Pain Management22:33 Operational Insights and Practical Tips27:25 Mechanisms and Effects of Ketamine30:43 Concluding Thoughts and RecommendationsReferences:https://warwick.ac.uk/fac/sci/med/research/ctu/trials/packman/overview/https://pubmed.ncbi.nlm.nih.gov/38001541/https://pmc.ncbi.nlm.nih.gov/articles/PMC9621014/https://www.tandfonline.com/doi/full/10.1080/10903127.2021.2018073https://pmc.ncbi.nlm.nih.gov/articles/PMC7223585/https://pubmed.ncbi.nlm.nih.gov/32328972/https://pmc.ncbi.nlm.nih.gov/articles/PMC7689093/#ems #science #paramedic #emergencymedicine #prehospitalcare #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #health #healthcare #healthcareheros #simulation #humanfactors #medicine #science #healthcare #healthquality #healthsafetycourse Get in Touch Here or in The Comments:[email protected]: https://www.linkedin.com/in/ryan-cichowski-787b99274/https://www.linkedin.com/in/jakob-rodger-b60571141/Disclaimer:This video is for educational purposes only and does not constitute medical advice. Always follow your local medical directives, protocols, and the guidance of your medical director or regulatory authority.
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In this episode, we dive deep into the life-saving benefits of Tranexamic Acid (TXA) for trauma patients. We discuss what TXA is, how it works, and why it is considered one of the safest and most effective drugs in critical care. Join us as we explore the evidence supporting its use, common concerns, contraindications, and the importance of timely administration. Whether administered intravenously or intramuscularly, TXA has been proven to significantly reduce morbidity and mortality in trauma cases. Learn about its application in various scenarios, from pre-hospital care to emergency departments, and understand why TXA is a game-changer in modern medicine.
Chapters:
00:00 Introduction and Overview
00:36 What is TXA?
02:03 TXA in Trauma Care
05:43 TXA for Other Conditions
07:22 Administration Guidelines
10:52 Contraindications and Special Cases
17:30 Conclusion and Future Directions
References:
https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01119-2#data-availability
https://pmc.ncbi.nlm.nih.gov/articles/PMC10455131/#sec19
https://pmc.ncbi.nlm.nih.gov/articles/PMC11642692/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10455131/#sec19
https://pubmed.ncbi.nlm.nih.gov/23477634/
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltexthttps://pubmed.ncbi.nlm.nih.gov/37928456/
https://pubmed.ncbi.nlm.nih.gov/33605702/https://journals.sagepub.com/doi/10.1177/14604086221145317?icid=int.sj-abstract.similar-articles.4
https://www.ontario.ca/files/2025-04/moh-advanced-life-support-als-patient-care-standards-pcs-5.4-en-2025-04-23.pdf
#ems #science #paramedic #emergencymedicine #prehospitalcare #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #health #healthcare #healthcareheros #simulation #humanfactors #medicine #science #healthcare #healthquality #healthsafetycourse
Get in Touch Here or in The Comments:[email protected]: https://www.linkedin.com/in/ryan-cichowski-787b99274/https://www.linkedin.com/in/jakob-rodger-b60571141/
Disclaimer:
This video is for educational purposes only and does not constitute medical advice. Always follow your local Medical Directives, protocols, and the guidance of your medical director or regulatory authority. -
This is a clip from our first podcast episode. In this powerful episode, Dr. Andrew Petrosoniak shares what it takes for trauma teams to perform under extreme pressure. From human factors to psychological safety, this conversation dives deep into how elite medical teams make decisions, stay focused, and save lives—even in total chaos.🎯 Topics covered:High-stakes decision-making in trauma careBuilding psychological safety in medical teamsLessons from simulation and real-world casesFlattening hierarchies to improve outcomesThe question every team leader should ask: "What else am I missing?"🎙 Hosted by Jakob Rodger and Ryan Cichowski – Paramedic Educators & Podcast Hosts🔗 Subscribe for more insights on prehospital care, leadership, and performance👍 Like, comment, and share if this resonated with you!#TraumaCare #EmergencyMedicine #HumanFactors #MedicalLeadership #PsychologicalSafety #AndrewPetrosoniak #ParamedicPodcast #MedicalPodcast #PrehospitalCare #paramedic #paramediceducation
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In this episode, Dr. Andrew Petrosoniak, an emergency and trauma doctor at St. Michael's Hospital in Toronto and Medical Director at Unity Health, shares his expertise in optimizing team performance in high-stress situations. He discusses the importance of designing systems that promote correct actions, the lessons learned from his work in simulation and design, and the value of borrowing strategies from other industries like aviation and athletics. Dr. Petrosoniak highlights the significance of interprofessional training, team coordination, and iterative feedback in improving clinical outcomes.
Learn more about Dr. Petrosoniak's work: https://research.unityhealth.to/profiles/andrew-petrosoniak/ https://t.co/XYAzUMg9xz.https://advancedperformance.ca/
Learn more about Dr. Hicks' work:https://scientific.acoep.org/speakers/chris-hicks-md/
Chapters:
00:00 Introduction to Effective Training and Design
00:37 Guest Introduction and Background
02:12 Journey into Simulation and Performance Optimization
05:04 Lessons from Aviation and Other Industries
11:56 Importance of Environment and Iteration
19:10 Interprofessional Training and Team Dynamics
23:28 Frameworks for Effective Team Coordination
26:19 Conclusion and Final Thoughts
#ems #science #paramedic #emergencymedicine #prehospitalcare #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #health #healthcare #healthcareheros #simulation #humanfactors #medicine #science #healthcare #healthquality #healthsafetycourse
Get in Touch Here or in The Comments:[email protected]
LinkedIn: https://www.linkedin.com/in/ryan-cichowski-787b99274/
https://www.linkedin.com/in/jakob-rodger-b60571141/
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Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Paramedics (EVAP) program and co-leads the Violence Against Paramedics project with Dr. Donnelly. Connect with Justin on LinkedIn, follow him on Twitter, or see more of his work on ResearchGate.
LinkedIn: https://www.linkedin.com/in/justinmausz/Twitter:
https://x.com/i/flow/login?redirect_after_login=%2Fi%2Fflow%2FloginViolence Against Paramedics: https://www.protectparamedics.com/
Part 2:
In this insightful episode, we delve into the importance of having a sense of self, purpose, and the role of diversified sources of fulfillment in protecting psychological health and wellbeing, especially in high-stress professions like being a paramedic. The discussion touches on generational differences in values regarding work-life balance, the potential for early career mental health screenings, and the impact of occupational trauma. The conversation also addresses the types of violence paramedics face, the role of mental health and substance use in these incidents, and strategies to improve safety for both paramedics and patients. Join us as we explore how to support and sustain the mental health and safety of our essential emergency responders.
References:
https://peelregion.ca/sites/default/files/2024-03/paramedic-experiences-with-workplace-violence.pdfhttps://pubmed.ncbi.nlm.nih.gov/24830544/https://pubmed.
ncbi.nlm.nih.gov/35206301/https://www.researchgate.net/profile/Paige-Masonhttps://www.protectparamedics.com/the-teamhttps://www.insighthealthsolutions.com/launch-of-peel-region-paramedic-services-partnership-with-thp-for-mental-health-services/https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2019-ctn-pln-ptsi/index-en.aspx?wbdisable=true
Chapters:
00:00 Introduction: The Importance of Purpose and Meaning
00:19 Generational Shifts in Work-Life Balance
01:00 Early Career Mental Health Screening
01:30 Challenges in Psychological Assessments
03:33 The Role of Resilience in Mental Health
05:23 Personal Struggles and Professional Challenges
09:10 Violence Against Paramedics: A Growing Concern
15:20 Addressing Mental Health Crises in the Field
17:36 Legal and Ethical Considerations
19:47 Conclusion: Ensuring Safety for All
Get in Touch Here or in the Comments:[email protected]
LinkedIn: https://www.linkedin.com/in/ryan-cichowski-787b99274/
https://www.linkedin.com/in/jakob-rodger-b60571141/
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About Justin:
Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Paramedics (EVAP) program and co-leads the Violence Against Paramedics project with Dr. Donnelly. Connect with Justin on LinkedIn, follow him on Twitter, or see more of his work on ResearchGate.In this episode, we discuss the unacceptable nature of violence against paramedics and shed light on how it affects their mental health and job performance. The conversation explores the efforts made by paramedics like Mandy Johnston and researchers to gather data, understand the prevalence of violence, and implement effective risk mitigation strategies. The program delves into the impact of reporting violence, changes in organizational culture, and the importance of mental health resources. Hear about the personal experiences that led to this crucial research, the training initiatives to de-escalate violent situations, and the ultimate goal of creating a safer and more supportive environment for paramedics.
Support Justin:
https://www.protectparamedics.com/the-team
Chapters:
00:00 Introduction: Addressing Violence Against Paramedics
01:01 Personal Motivations and Research Beginnings
02:16 Documenting and Measuring Violence
03:12 Barriers to Reporting and Cultural Change
04:57 Impact of Reporting and Training
06:52 Mental Health Studies and Personal Stories
09:45 Challenges in Paramedic Mental Health
14:31 Systemic Issues and Resource Allocation
24:03 Historical Context and Physical Injuries
25:38 The Reality of Early Career Paramedics
26:10 Role Identity and Paramedic Identity Mismatch
26:54 Building Resilience: Individual and Organizational Strategies
28:34 The Swiss Cheese Model and Mental Health Screening
References:https://pubmed.ncbi.nlm.nih.gov/24830544/https://pubmed.ncbi.nlm.nih.gov/35206301/https://www.researchgate.net/profile/Paige-Masonhttps://www.protectparamedics.com/the-teamhttps://www.insighthealthsolutions.com/launch-of-peel-region-paramedic-services-partnership-with-thp-for-mental-health-services/https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2019-ctn-pln-ptsi/index-en.aspx?wbdisable=true#ems #science #paramedic #emergencymedicine #prehospitalcare
#paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife
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In this episode, we delve into the best practices for intubation and the administration of epinephrine during emergency scenarios. Our discussion focuses on avoiding the use of epinephrine through the ETT, the importance of IV and IO routes, the benefits of video laryngoscopy, and the significance of preparation and teamwork. We also touch on airway management challenges, especially in cases with potential C-spine injuries, and emphasize the importance of setting up a systematic and well-coordinated approach to maximize patient outcomes.
Chapters:
00:00 Introduction: Epinephrine Administration Dilemma
00:45 Optimizing Intubation Success
01:51 Video Laryngoscopy and Airway Management
04:07 Preparation and Team Approach
09:21 Debriefing and Continuous Learning
20:47 Conclusion and Final Thoughts
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitationsReferences:https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194https://www.ilcor.org/publicationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8951653/https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf
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In this podcast episode, we dive deep into pre-hospital management strategies for drowning incidents, focused on both adult and pediatric patients. We explore the critical differences between drowning in cold and warm water, the impact of these factors on patient outcomes, and key considerations for initial resuscitation. The discussion covers scene safety, airway management, the effectiveness of PEEP and CPAP in treating pulmonary edema, and the role of epinephrine in these emergencies. The hosts also share best practice guidelines, evidence-based approaches, and practical tips to optimize patient care and improve outcomes.
Chapters:
00:00 Introduction and Overview
00:56 Understanding Drowning: Cold vs Warm Water
01:22 Pediatric Drowning: Unique Considerations
05:10 Initial Resuscitation Steps
06:27 Airway Management Techniques
11:33 The Role of PEEP and CPAP
20:00 Hemodynamic Resuscitation
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitations
References:
2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | Circulation - American Heart Association Journals, accessed April 4, 2025, https://www.ahajournals.org/doi/10.1161/CIR.0000000000001274Prehospital Cross-Sectional Study of Drowning Patients Across the United States - PMC, accessed April 4, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9052871/2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | Pediatrics, accessed April 4, 2025, https://publications.aap.org/pediatrics/article/154/6/e2024068444/199870/2024-American-Heart-Association-and-AmericanDrowning resuscitation Special considerations for prehospital management - ResearchGate, accessed April 4, 2025, https://www.researchgate.net/publication/374738312_Drowning_resuscitation_Special_considerations_for_prehospital_managementhttps://www.anzcor.org/home/new-guideline-page-3/guideline-9-3-2-resuscitation-in-drowning/downloadpdfHighlights of the 2020 ILCOR Guidelines Update - SaveaLife.com, accessed April 4, 2025, https://nhcps.com/highlights-of-the-2020-ilcor-guidelines-update/European Resuscitation Council Guidelines 2021: Systems saving lives, accessed April 4, 2025, https://www.erc.edu/assets/documents/RESUS-8901-SSL.pdfA systematic review of interventions for resuscitation following drowning - ResearchOnline@JCU, accessed April 4, 2025, https://researchonline.jcu.edu.au/79100/1/79100.pdfA systematic review of interventions for resuscitation following drowning - PMC, accessed April 4, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10323217/https://journals.physiology.org/doi/full/10.1152/physiol.00002.2015https://www.anzcor.org/assets/anzcor-guidelines/guideline-9-3-2-resuscitation-in-drowning-275.pdfhttps://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2020.00524/fullhttps://journals.sagepub.com/doi/abs/10.1177/0883073811415269
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In this comprehensive episode, we delve into the nuances of post-arrest care, focusing on the role of epinephrine, the importance of 12-lead ECG timing, and understanding false positives. The discussion covers essential post-resuscitation strategies, optimizing patient outcomes, and effective communication during patient handover. We also explore the ongoing changes in post-arrest care, including recommendations for paramedics to improve patient safety and outcomes. Key takeaways include the importance of slowing down after ROSC, thorough assessment, and detailed reporting to receiving hospitals.
Chapters:00:00 Introduction and Anecdotes
00:37 Medication Strategies Post-ROSC
00:51 Importance of 12-Lead ECG
02:19 Study on False Positives in ECG
06:18 Neurological Outcomes Post-Arrest
12:04 Patient Handover Best Practices
16:32 Evolving Field of Post-Arrest Care
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10455131/https://www.sciencedirect.com/science/article/pii/S1755599X21000355file:///Users/ryancichowski/Downloads/AmbulancetoEDstaffhandover-Pre-publicationfinalversion.pdfhttps://academic.oup.com/eurheartj/article/41/Supplement_2/ehaa946.1851/6005196#google_vignette https://www.ahajournals.org/doi/10.1161/CIR.0000000000001163https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001163?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitations
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In this episode, Jakob and I dive into the complexities of managing post-arrest patients. We discuss the critical shift in mindset required once a pulse is regained and emphasize the importance of preventing secondary injuries before transport. Key topics include the priorities in post-arrest care, the role of vital signs, the use of dopamine for treating hypotension, and the ideal oxygen saturation and end-tidal CO2 levels for optimizing patient outcomes. We also explore the challenges of pre-hospital care and share practical tips for ensuring the best possible results for post-arrest patients.
Chapters:00:00 Introduction and Initial Thoughts
00:38 Post-Arrest Patient Management
01:11 Prioritizing Patient Stabilization
05:49 Addressing Hypotension and Fluid Responsiveness
08:51 Dopamine Use and Considerations
18:06 Oxygenation and Ventilation Strategies
20:23 End-Tidal CO2 Monitoring
25:08 Conclusion and Final Thoughts
References:
https://www.bmj.com/content/384/bmj-2023-076019https://pmc.ncbi.nlm.nih.gov/articles/PMC8152988/https://pmc.ncbi.nlm.nih.gov/articles/PMC7703417/https://pubmed.ncbi.nlm.nih.gov/32286900/https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00152-3/fulltexthttps://www.ahajournals.org/doi/10.1161/CIR.0000000000001163https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-and-European-Societ.pdf
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife #ROSC #post-arrest #resuscitation #resuscitations
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In this episode, Jakob and I discuss handling pediatric patients in shockable rhythms, including calculating defibrillation dosages—2 joules per kilogram for the first shock and 4 joules per kilogram for subsequent shocks. We delve into antiarrhythmic medications, highlighting that amiodarone and lidocaine are considered equivalent and outlining their dosages. The importance of family presence and communication during resuscitation efforts is stressed, with evidence suggesting it aids in their recovery from traumatic events. A recent trial on standardized intramuscular epinephrine injections to mitigate delays in administration is also explored. Lastly, the episode touches on the impact of socioeconomic factors on pediatric cardiac arrests and emphasizes the role of community paramedicine.
Chapters:
00:00 Introduction to Shockable Rhythms
00:05 Dosage Calculations for Defibrillation
00:56 Antiarrhythmic Medications
02:17 Family Involvement During Resuscitation
04:12 The PRIME Trial
05:55 Pediatric Cardiac Arrest Statistics
07:10 Key Takeaways
References:https://pubmed.ncbi.nlm.nih.gov/28009655/https://caep.ca/periodicals/Volume_16_Issue_6/Vol_16_Issue_6_Page_497_-_501_Motillo.pdfhttps://media.emscimprovement.center/documents/familypresencecpg3eaabb7cf0414584ac2291feba3be481_36JegLp.pdfhttps://www.thrasherresearch.org/grant/01695?lang=enghttps://pmc.ncbi.nlm.nih.gov/articles/PMC10423885/
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife
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In this episode, Jakob and I delve into essential aspects of pediatric cardiac arrest management. Key topics include the importance of on-scene resuscitation, differences in pediatric versus adult cardiac arrest causes, optimal treatment strategies, and best practices for airway management. We'll also discuss the significance of early epinephrine administration and the current evidence on supraglottic airways and intubation. Additionally, we touch on the importance of caregiver communication, the PRIME trial, and the impact of social determinants of health on pediatric outcomes.
Chapters:
00:00 Introduction to Pediatric Cardiac Arrest
00:59 Key Differences Between Pediatric and Adult Cardiac Arrest
02:23 Respiratory Causes and Their Impact
07:23 Airway Management Strategies
16:47 Effective CPR Techniques
17:42 The Role of Epinephrine in Cardiac Arrest
19:36 IV vs. IO Access in Pediatric Resuscitation
21:41 The Handtevy Method and Medication Safety
24:31 Using Apps to Reduce Cognitive Load in Pediatric Care
25:35 Cross-Referencing with Partners for Best Practices
26:01 Handling High-Stress Pediatric Emergencies
27:01 Preferred Routes for Cardiac Epi in Pediatrics
27:38 IO Access in Pediatric Patients28:37 Reevaluating the Scoop and Run Approach
29:55 Managing Pediatric Cardiac Arrest on Scene
31:11 Dealing with Drowning and Airway Management
#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic #emt #firefighter#ambulance #medic #emergency #rescue#firstresponders #emtlife
References:
https://www.ahajournals.org/doi/10.1161/circulationaha.116.023821https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/paramedics-success-and-complications-in-prehospital-pediatric-intubation-a-metaanalysis/B6A2D22EE46D2E713E1394F913786391https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.723327/fullhttps://pmc.ncbi.nlm.nih.gov/articles/PMC4540668/
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This video explores the critical aspects of pre-hospital airway management, emphasizing the importance of oxygenation and the variables affecting intubation success. The discussion covers systematic reviews, the pros and cons of endotracheal tubes versus SGAs in managing brain injuries, and the latest recommendations from medical guidelines. It highlights the benefits of simulation training in improving first-pass success rates and delves into the logistics of intubation positions, tools, and techniques. Expert insights are shared on the complexities of achieving better procedural outcomes and the importance of a multimodal approach in education and practice. Finally, the video outlines actionable steps and recommendations for enhancing both individual and systemic practices in paramedicine.
Chapters:
00:00 Introduction and Importance of Oxygenation
00:17 Intubation in Pre-Hospital Settings
01:11 SGA vs. Endotracheal Tube
03:24 Challenges in Pre-Hospital Intubation
05:01 Improving First Pass Success Rates
06:30 Education and Training for Better Outcomes
09:20 Future of Simulation in Airway Management
11:36 Global Best Practices and Lessons Learned
13:03 Conclusion and Final Thoughts
https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00533-0
https://pubmed.ncbi.nlm.nih.gov/36106283/
https://www.sciencedirect.com/science/article/pii/S0007091222004287#:~:text=In%20this%20systematic%20review%2C%20the,benefit%20in%20mortality%20and%20morbidity.
https://sjtrem.biomedcentral.com/articles/10.1186/s13049-022-01049-7#Sec9
https://www.bjanaesthesia.org/article/S0007-0912(24)00061-8/fulltext
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In this episode, we delve into Jakob's master thesis comparing the first pass success rate and overall success rate of laryngoscopy with video laryngoscopy for intubation by ACPs. The discussion covers the importance of advancing airway management, the challenges faced by paramedics in pre-hospital settings, educational and systemic interventions to improve first pass success rates, and the future of simulation in airway management training. Join us for an in-depth conversation on improving patient outcomes in paramedicine.Chapters:00:00 Introduction to the Master's Thesis00:27 Motivation Behind the Research03:17 Challenges in Pre-Hospital Intubation04:58 Improving First Pass Success Rate07:15 The Role of Bougies in Intubation10:02 Video Laryngoscopy vs. Direct Laryngoscopy14:36 Techniques and Tools for Successful Intubation22:49 Training and Mental Preparation24:27 Cross-Training and Teamwork31:28 Video Laryngoscopes and Quality Assurance31:59 Reducing Airway Trauma with Visual Laryngoscopy
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Join us as Jakob and I delve into the complexities of pediatric sepsis in this informative podcast episode. We cover essential topics, including the mean arterial pressure targets for fluid and vasopressor administration, the appropriateness of vasopressors in pre-hospital settings, and the impact of socioeconomic status on sepsis outcomes. Learn about the critical differences between sepsis and septic shock, the main causes of mortality, and the importance of timely antibiotic treatment. We also discuss practical approaches to fluid administration, key clinical signs to look out for, and the role of early warning scores in improving patient outcomes. This episode is packed with valuable insights for healthcare professionals looking to enhance their understanding and treatment of pediatric sepsis.
Chapters:
00:00 Introduction to Pediatric Sepsis
01:15 Understanding Sepsis and Septic Shock
02:30 Mortality Rates and Socioeconomic Factors
03:46 Immune Response and Analogies
06:06 Age Groups and Vulnerability
08:15 Clinical Manifestations in Newborns and Infants
09:58 Common Signs and Symptoms in Older Children
15:30 Differentiating Sepsis from Other Conditions
20:57 Pre-Hospital Interventions and Early Recognition
22:56 Streamlining Sepsis Response
24:40 The Role of Fluids in Pediatric Sepsis
27:31 Administering Fluids Safely
29:18 Vasopressor Therapy Considerations
33:28 Dopamine vs. Epinephrine Debate
38:36 Addressing Hypoglycemia in Sepsis
40:01 Demographics and Risk Factors
42:28 Communicating with Families
43:17 Empowering Paramedics
44:36 Conclusion and Next Episode Preview
