Blue Crew Medicine

Matt and Will continue discussing the use of fibrinolytics with several other disease processes we commonly see in emergency medicine. This includes STEMIs and pulmonary emboli. As we go through the uses and dosing Will and Matt talk about some of the indications and thought processes that go into using these medications and when to pull the tirgger on utilization.  This is part 2 of 2 with fibrinolytic use.  As always, please feel free to email us at MCESEducation@umc.edu for any questions, comments, or concerns with our podcast.

Matt and Will take the first step in a deep dive into the use of fibrinolytics in the emergent setting. This episode covers some history and considerations when using and discussing fibrinolytic use in patients. We also take an in-depth look at the contraindications and why they are what they are.  This episode primarily focuses on the current most common use of fibrinolytics with strokes. Matt and Will go into discussing as well what to consider and watch for after using one of these medications.  This is part 1 of 2 with fibrinolytic use.  As always, please feel free to email us at MCESEducation@umc.edu for any questions, comments, or concerns with our podcast.

In this episode, we take a little different path than our usual clinical realm and look at spatial disorientation. This is a relatively common occurrence in the aviation world, but also has many other applications from ground EMS to everyday life. We are joined by John Barnes who is the lead pilot at our AirCare 4 base in Greenwood with a military background and single pilot instrument flight rated (SPIFR). Will and John discuss many experiences with spatial disorientation and what we can do remain safe through occurrences like these in the HEMS and EMS industry.   As always any suggestions, comments, or otherwise please email us at MCESEducation@umc.edu

In this episode, Adyn, Dr. Nathan Freeman, and Will discuss some of the biggest aspects of pediatric sepsis, and specifically early identification and management of septic shock. Everything from basic recognition of sick to pressors of choice and standard dosing is discussed by the three. Early identification and management is key to improving the morbidity, mortality and length of stay of some of these challenging patients.   As always if you have any question or want to give feedback to our team, please contact us at mceseducation@umc.edu

We are joined in this episode by Dr. Jessie Harvey of UMMC Critical Care along with Davis and Will to discuss some of the basics behind ventilators and their management. These devices can really make or break a patient's day often times and they are an important tool to be utilized in emergency and critical care medicine.  The group discusses everything from non-invasive to invasive modalities, including what some of the basic rational for "why they do what they do" with respect to changin modalities and settings. Come along with us as we discuss vents! As always if you have any questions, comments, or concerns, please feel free to email us a MCESEducation@umc.edu

Matt and Will discuss adrenals and the disease processes often found in the emergency medicine world that can really cloud a picture clinically. These patients are often very complex and can be quite difficult to diagnose, especially pre-hospital or with limited ability for testing.  Take a deep dive as we discuss topics like, adrenal insufficiency and Cushing's Syndrome. As always if you have any feedback or comments please feel free to reach out via email at MCESEducation@umc.edu

We take a step back from the clinical side in this episode to focus on the clinician and the clinical care team. Cori, Brad, and Will all dive into discussions on defining PTSI and PTSD in the healthcare world, especially with such a heavy spotlight to awareness brought on through COVID. Each share personal experiences, resources, and different avenues to how to identify and work on mental health in public safety and healthcare.   As always if there is anything you would like to comment on please drop us an email below. MCESEducation@umc.edu

In this episode of Blue Crew Medicine Will is joined by Matt and Michael to discuss the ups and downs of thyroids and how these disease processes matter in emergency medicine and the critical care transport realm. Everything from thyroid storm basics on down to considerations in medication utilization are discussed with these patients.    As always, feel free to reach out if you have any questions to our email below. MCESEducation@umc.edu

This is a continuation of our episode at the MS Trauma Foundation Symposium in May of 2023.  This part of the episode starts with Beth who discusses PTSD and trauma and their correlation.We then wrap up the episode talking with Michelle who discusses some great insights into pediatric concussions and their management.   Beth Huffmaster NP Dr. Michelle Goreth NP

Since we were down at the MS Trauma Foundation Symposium May 1st-4th, we had the opportunity to sit down with several people throughout emergency and critical care and discuss some of the hot topics in  the trauma, emergency medicine, EMS, and rural healthcare realm.   John Gardner - MTF Executive Director Mike Cole - Director Covington County EMS Todd Jones - Manager Covington County EMS Dr. Benji Sessums - Program Director JCJC EMS Program Kacey Jones - Nurse Practitioner

This episode highlights the importance of looking at the entire patient during the airway management process and the utilization of hemodynamics in clinical assessment and management. Charlie, Davis and Will discuss in depth some of the findings and adjunct they utilize to help facilitate airway management.

Dr. Doherty and Dr. Duran (PGY5 Neurosurgery Resident) join Will in discussing all things with acute spinal cord injuries. They dive into definitions and differentiations between neurogenic and spinal shock along with assessment and management of these often complex patients. 

In this episode we are joined by Emily Wells and Lauren Russell. These are two of the awesome neonatal nurses who have been a part of AirCare and our neonatal team for the last several years. Will talks with them about some of the basics of neonatal care. Some of the things discussed include APGARs, Dextrose, STABLE, Ventilation and Respiratory management. This episode takes a deep dive into some of the simplest things that these tiny little ones need.    Mixing Dextrose https://ajemjournal-test.com.marlin-prod.literatumonline.com/article/S0735-6757(19)30220-7/fulltext https://pemcincinnati.com/blog/521-50-dextrose-volume-hypoglycemia/#:~:text=To%20make%20D10%25%20from%20an,D25%25%20or%20D10%25%20solutions. ETT Sizes https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Assisting_with_elective_intubation_of_the_neonate_on_the_Butterfly_Ward/  

This is a bonus episode expanding on our Liver Failure episode with Dr. Taylor Wachs, Michael Griggs PharmD, and Will Appleby CCP. We discuss the ever mysterious Blakemore tubes and how one would go about using them. 

We are joined once again by Michael Griggs PharmD, Dr. Taylor Wachs, and Will Appleby to discuss liver failure and its management and complications. We discuss everything from resuscitation management, pharmacology of course, and what are we really mitigating here.  Definition ALF - INR>1.5 with hepatic encephalopathy and no underlying cirrhosis AST - Liver, cardiac, skeletal, kidney, brain, pancreas ALT - SPECIFIC to liver damage AST/ALT Ratio = 1 = Ischemia AST/ALT Ratio > 2.5 = Alcoholism AST/ALT Ratio < 1 = Viral, Ischemia, Toxic HRS = Hepatorenal Syndrome   NAC (Mucomyst) Tylenol Dosing - 150mg/kg over 1 hour, 50 mg/kg over 4 hour ALF mitigating transplant - 150mg/kg over 15 min, 12.5mg/kg/hr for 4 hours then 6.25 mg/kg/hr for 72 hours

This episode includes Davis, Mark, and Will discussing different types of insulins and how they are used in medical practice. This also includes how they come into play with management of patients in the critical care settings and in resuscitation management.   The graphs reference in the episodes can be found at the following: https://www.rn.com/nursing-news/understanding-insulin-administration/ https://www.acoi.org/sites/default/files/uploads/Langer.pdf If you have any questions please feel free to email us at MCESEducation@umc.edu

This is episode 2 of 2 on pediatric toxicology. This episode again discusses peds tox, but more poly-pharmacy and "skittles" induced situations that may arise. Dr. Matt, Brad, Paul, and Will go into depth on many points and tricks they have learned or picked up along the way getting to take care of these patients.  If you have any questions or additional requests, please feel free to email us at MCESEducation@umc.edu

This is episode 1 of 2 on pediatric toxicology discussed by Dr. Matt, Brad, Paul, and Will. This includes several cases and subjects from environmental and situational toxicology.   Please feel free to reach out to us if you have any additional questions or requests for future episodes at MCESEducation@umc.edu

In this episode we are joined by Dr. Rachael Morris of UMMC Maternal and Fetal Medicine along with Davis and Will. This episode goes into detail on recognition and management of mothers pre and post partum who are at risk or have preeclampsia and may progress to eclampsia.    We discuss our STORK class in this episode and if you would like to attend or are interested in more information about STORK or our MCES app, please contact us at AirCareEducation@umc.edu

in this episode Will is joined by Dr. Weiland  from the UMMC Pediatric Cardiology department. We will discuss some of what are CHDs, what are some of the management and recognition tricks. How each diagnosis presents can sometimes be a challenge, and some of stuff we discuss is the more "later onset" of these patients two to three weeks after birth. These patients also have several considerations when transporting to a tertiary center, there is some discussion about transport considerations as well.  We also discuss several management techniques and pharmacological management of several of these patients between surgeries and how complex some of those patients can be. 

In this episode, Davis and Will discuss GI bleed management. Although many of these patients are not truly critical care management, when they do fall into that category it can be complex, especially when trying to get these patients definitive care. They discuss everything from blood products, airway management, NG/OG tubes, to pharmocology management. Enjoy!

In this episode, we are joined again by Dr. Zaza and Dr. Wachs to discuss chest injuries and their management. Everything from needle decompression, to complex pericardial injuries, is on the table. As always these are designed for clinicians of all levels, and on evidence-based medicine. 

This is a continuation of the series on heart failure with Audi, Mark, and Will. This episode deals with treatment and management strategies for these patients.    Some of the topics discussed include: Hemodynamic Support Optimizing Cardiac Perfusion Inotropes Airway Management Strategies Definitive Management  

In this episode, one of our cardiology fellows, Dr. Sabharwal, Mark, and Will all discuss heart failure. This is a two-part series with this episode focusing on assessment, identification, and ultrasound use.  Some of the topics discussed include: Physical exam Pertinent Labs Utilizing Mixed Venous Gases Invasive monitoring Trending Ultrasound Use

In this episode Dr. Freeman, Dr. Browning, and Will discuss seizure assessment and management in both adults and pediatrics. 

In this episode, Will, Nathan, Blake, and Stephen all discuss DKA with specific regard to pediatrics. This includes a little pathophysiology as always but is very detailing management. Including what labs and management are important and some pearls to watch for along the way. As always this is based upon current evidence-based medicine and standard of care. 

This is part 2 of 2 on pediatric asthma management. In this episode, Dr. Maready, Ben, Matt, and Will discuss the asthmatic airway management for both invasive and non-invasive modalities. They discuss the use of Hi-Flow, BiPAP, and intubation along with different management and settings associated with each modality. 

This is part 1 of 2 on pediatric asthma management. In this episode, Dr. Maready, Ben, Matt, and Will discuss the definition and diagnosis of asthma in the pediatric population. They go on to discuss the management of these patients using pharmacological adjuncts like magnesium, epinephrine, and terbutaline. Included in the discussion of each adjunct is what respective triggers for utilization of those adjuncts may be.     

In this episode, Don, Ben, Adyn, and Will discuss several of the common vital signs we are given or can calculate on our patients in primarily emergency medicine. Mean arterial pressure (MAP), temperature, SpO2/FiO2 Ratios, Shock Index are just a few that are discussed in this episode.   Mean Arterial Pressure MAP = ( DBP +DBP +SBP ) / 3 Shock Index (SI) = Heart Rate / SBP Urine Output 0.5 - 1 cc/kg/hr Temp 96.8 F = 36.0 C and 100.4 F = 38 C

This is a bonus episode where Dr. Zaza, Dr. Wachs, and Will cover several common dogmas in trauma management from backboards to ketamine administration.

In this episode, Dr. Zaza (UMMC Trauma Surgery Attending Physician), Dr. Wachs (EM Resident), and Will cover several common dogmas in trauma management from permissive hypotension to sodium bicarb to vasopressors. 

Submersion Injuries are the most common among pediatric males ages 1 - 5 in the summer months, and in the southern states. As it is now beginning to warm up, with people getting outside to enjoy the warmer months, Don, Ben, Dr. Chris, and Will discuss submersion injuries and their management. In this disease process, early management can make a big difference in a patient's ability to walk out of the hospital.   This episode includes a discussion on the presentation and the management of these injuries with a pediatric case scenario at the end of the episode. 

Traumatic Brain Injuries are something that everyone in all walks of emergency medicine from first responders to critical care physicians gets to see routinely every day. These can be challenging patients simply because the diagnosis is so generic and can present in many different ways, sometimes taking hours or longer to appear.    Adyn, Dr. T.A., and Will discuss TBIs in adults and pediatrics from injury to reaching the ICU. 

In this episode, Shyann and Will with our guest Shalotta from the MS Coalition Against Sexual Assault discuss strangulation injuries. This is designed for not only emergency medicine, but all first responders including law enforcement to identify and manage these patients appropriately.    Jeff Strickler, Alberto Bonifacio, Assessing Cranial Nerves With a Stick of Gum, (https://www.sciencedirect.com/science/article/pii/S0099176709005510)   For more information about MS Coalition Against Sexual Assault, you can email Shalotta at ShalottaSharp@aol.com

This is an interesting case review of when a flight request had an unusual underlying diagnosis... Beer Potomania. Kevin, Michael, and Will discuss the case, along with the signs, symptoms, and treatment of Beer Potomania. 

Kevin, Adam, and Will discuss the basics of using ETCO2 in both the pre-hospital and inter-hospital settings. 

This episode is pure management of inhalation injuries and their identification. This discusses not only initial first responder/EMS management but also critical access hospital considerations and critical care management. Inhaled Heparin Heparin/N-acetylcysteine: an adjuvant in the management of burn inhalation injury: a study of different doses.AUElsharnouby NM, Eid HE, Abou Elezz NF, Aboelatta YA SOJ Crit Care. 2014 Feb;29(1):182.e1-4. Epub 2013 Aug 8.  Inhaled anticoagulation regimens for the treatment of smoke inhalation-associated acute lung injury: a systematic review.AUMiller AC, Elamin EM, Suffredini AF SOCrit Care Med. 2014;42(2):413.  Inhaled Milrinone  https://www.bjanaesthesia.org/article/S0007-0912(21)00354-8/fulltext EmCrit Link to inhaled pulmonary vasodilators https://emcrit.org/ibcc/pulmvaso/

Dr. Doherty, Dr. Wachs, Dr. Griggs, and Will discuss inhalation injuries from top to bottom on their physiology. This discussion includes what some of the current treatments are and where they came from.    Inhaled Heparin Heparin/N-acetylcysteine: an adjuvant in the management of burn inhalation injury: a study of different doses.AUElsharnouby NM, Eid HE, Abou Elezz NF, Aboelatta YA SOJ Crit Care. 2014 Feb;29(1):182.e1-4. Epub 2013 Aug 8.  Inhaled anticoagulation regimens for the treatment of smoke inhalation-associated acute lung injury: a systematic review.AUMiller AC, Elamin EM, Suffredini AF SOCrit Care Med. 2014;42(2):413.  Inhaled Milrinone  https://www.bjanaesthesia.org/article/S0007-0912(21)00354-8/fulltext EmCrit Link to inhaled pulmonary vasodilators https://emcrit.org/ibcc/pulmvaso/

In this epiosde, Will discusses MIS-C with several providers from the pediatric emergency department at UMMC. Dr. Freeman, Adyn Dancy, and Will Holyfield all give tips and tricks they use everyday to help identify and manage these patients.

This is a discussion with Dr. Doherty, Dr. Wachs, and Will on clinical pearls and treatment on patients with angioedema. 

This is an overview and discussion on airway management in patients with angioedema. Dr. Doherty, Dr. Wachs, and Will Appleby discuss in detail thoughts on airway management in these patients.