MCHD Paramedic Podcast

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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 exp…

Montgomery County Hospital District


    • May 19, 2025 LATEST EPISODE
    • monthly NEW EPISODES
    • 27m AVG DURATION
    • 185 EPISODES

    4.9 from 241 ratings Listeners of MCHD Paramedic Podcast that love the show mention: ems, subjects, dr, short, level, information, helpful, informative, keep up the great, thanks, guests, guys, excellent, content, enjoy, awesome, interesting, listening, work, love.


    Ivy Insights

    The MCHD Paramedic Podcast is a must-listen for EMS providers and anyone interested in emergency medicine. Based in Houston, Texas, this podcast is hosted by Dr. Casey Patrick and Dr. Joseph Dixon, who provide valuable insights and education on various medical cases and topics that are relevant to paramedics and other healthcare professionals.

    One of the best aspects of this podcast is the level of expertise and knowledge that the hosts bring to each episode. As medical directors, they have firsthand experience in providing guidance and direction to EMS providers, making their perspectives invaluable. They discuss real-life cases, share their points of view as physicians, and offer practical tips and tricks that can be implemented into practice. The episodes are concise yet packed with information, making it easy for listeners to absorb the content.

    Another great aspect of this podcast is its commitment to pushing the educational edges forward for medics. The hosts delve into complex concepts without watering them down, challenging listeners to think critically about their approach to patient care. This level of depth sets this podcast apart from others in the same genre by providing an enriching learning experience.

    As for drawbacks, there are very few negative aspects to mention about The MCHD Paramedic Podcast. Some listeners might find the episodes too short, wishing for more in-depth discussions on certain topics. Additionally, the sound quality could be improved at times as some listeners have mentioned difficulty hearing one of the hosts clearly.

    In conclusion, The MCHD Paramedic Podcast is an exceptional resource for EMS providers seeking high-quality education and insights from experienced physicians. With engaging discussions on relevant cases and topics, this podcast offers valuable takeaways that can enhance clinical practice and improve patient care. Whether you're a seasoned medic or just starting out in the field, this podcast will undoubtedly broaden your knowledge base and contribute to your professional growth.



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    Latest episodes from MCHD Paramedic Podcast

    Episode 181 - Why You Should Attend The Resuscitation Academy

    Play Episode Listen Later May 19, 2025 37:16


    We're joined by Dallas-area cardiac arrest management thought leaders from Best EMS and Parker County Hospital District to discuss the Resuscitation Academy. Where did this thing start? How can you and your service benefit? What RA lessons have we implemented here at MCHD? Learn how to improve your cardiac arrest survival rates without breaking the bank. REFERENCES 1. https://www.resuscitationacademy.org

    Episode 180 - Orthostatic Vitals - Should They Stay or Should They Go?

    Play Episode Listen Later Apr 21, 2025 20:18


    Orthostatic vitals are taught throughout medical training as a quick and easy way to assess patient volume status objectively. We also frequently see these documented in MCHD charts. Is there any evidence that orthostatics help our clinical decision-making? Has anyone ever evaluated their use in EMS? Could standing a patient to check their heart rate actually be harmful? Join the podcast crew as they address these questions and more. REFERENCES 1. White, JL, Hollander, JE, Chang, AM, et al. (2019). Orthostatic vital signs do not predict 30-day serious outcomes in older emergency department patients with syncope: A multicenter observational study. The American journal of emergency medicine, 37(12), 2215–2223. 2. Shen W, Sheldon R, Yancy C, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of The American College Of Cardiology. August 1, 2017;70(5):e39-e110. Available from: MEDLINE, Ipswich, MA. Accessed May 1, 2018. 3. Cohen E, Grossman E, Sapoznikov B, et al. Assessment of orthostatic hypotension in the emergency room. Blood Press. 2006;15(5):263-267. 4. Aronow WS, Lee NH, Sales FF, Etienne F. Prevalence of postural hypotension in elderly patients in a long-term health care facility. Am J Cardiol. 1988;62(4):336. 5. Ooi WL, Barrett S, Hossain M, et al. Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA. 1997;277(16):1299-1304.

    Episode 179 - Transcutaneous Pacing Pearls and Pitfalls

    Play Episode Listen Later Mar 19, 2025 38:18


    On today's episode, we're lucky to have a couple of special guests to discuss prehospital transcutaneous pacing. Medics turned medical students and EMS researchers, Josh Kimbrell and Judah Kreinbrook recently published a case series decsribing EMS pacing capture. Like many of our favorite topics this came from a paramedic asking a clinical question with loads of dogma and little evidence. What they found should motivate us all to be skeptical when it comes to determining if TCP is actually working. REFERENCES 1. https://www.mchd-tx.org/wp-content/uploads/2025/03/TCP-Podcast-Figures.pdf 2. Kimbrell, J., Kreinbrook, J., Poke, D., Kalosza, B., Geldner, J., Shekhar, A. C., Miele, A., Bouthillet, T., & Vega, J. (2024). False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehospital emergency care, 28(7), 928–936. 3. https://www.ems12lead.com/post/tcp-in-transit-part-i 4. https://www.ems12lead.com/post/transcutaneous-pacing-part-2 5. https://www.ems12lead.com/post/transcutaneous-pacing-part-3

    Episode 178 - A STEMI Unlike Any Other

    Play Episode Listen Later Feb 18, 2025 21:23


    We often discuss "one in a million" and "once in a career" cases in emergency medicine and EMS, and do we ever have one of those for you in this episode! MCHD Captain, Jason Jones, joins Dr. Patrick to discuss an exeedingly rare STEMI/chest pain presentation with lessons that we can all apply to our daily care. REFERENCES 1. https://www.mchd-tx.org/wp-content/uploads/2025/02/SITUS-Fig-1.pdf 2. https://www.mchd-tx.org/wp-content/uploads/2025/02/SITUS-Fig-2.pdf 3. https://montgomerycountypolicereporter.com/mchd-celebrates-survival-of-one-in-a-million-patient-first-responders-please-read/ 4. https://pubmed.ncbi.nlm.nih.gov/34317454/

    Episode 177 - A-Fib With RVR - A Medic Mindset Collaboration

    Play Episode Listen Later Jan 23, 2025 80:28


    This is a special edition of the MCHD Paramedic Podcast. Ginger Locke, of the absolutely amazing Medic Mindset podcast, invited Dr. Patrick on to discuss rate control of rapid atrial fibrillation in the prehospital setting. She was gracious enough to share the audio for a dual release. This episode has been out in the world on Medic Mindset for a couple of months, but we wanted to offer it to our MCHD Paramedic Podcast listeners as well. Also, like, subscribe to and follow Medic Mindset wherever you listen to podcasts. REFERENCES 1. https://medicmindset.com 2. Elam, K., & Bolar-Softich, K. L. (1997). Dilemmas in the acute pharmacologic treatment of uncontrolled atrial fibrillation. The American journal of emergency medicine, 15(4), 418–419. 3. Abarbanell, N. R., & Marcotte, M. A. (1997). Prehospital use of intravenous diltiazem (cardizem Lyo-Ject) in the treatment of rapid atrial fibrillation. The American journal of emergency medicine, 15(6), 618–619. 4. Abarbanell, N. R., Marcotte, M. A., Schaible, B. A., & Aldinger, G. E. (2001). Prehospital management of rapid atrial fibrillation: recommendations for treatment protocols. The American journal of emergency medicine, 19(1), 6–9. 5. Wang, H. E., O'connor, R. E., Megargel, R. E., Schnyder, M. E., Morrison, D. M., Barnes, T. A., & Fitzkee, A. (2001). The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting. Annals of emergency medicine, 37(1), 38–45. 6. Luk, J. H., Walsh, B., & Yasbin, P. (2013). Safety and efficacy of prehospital diltiazem. The western journal of emergency medicine, 14(3), 296–300. 7. Rodriguez, A., Hunter, C. L., Premuroso, C., Silvestri, S., Stone, A., Miller, S., Zuver, C., & Papa, L. (2019). Safety and Efficacy of Prehospital Diltiazem for Atrial Fibrillation with Rapid Ventricular Response. Prehospital and disaster medicine, 34(3), 297–302. 8. Fornage, L. B., O'Neil, C., Dowker, S. R., Wanta, E. R., Lewis, R. S., & Brown, L. H. (2024). Prehospital Intervention Improves Outcomes for Patients Presenting in Atrial Fibrillation with Rapid Ventricular Response. Prehospital emergency care, 28(7), 910–919.

    Episode 176 - Antibiotics & Open Fractures

    Play Episode Listen Later Dec 28, 2024 20:47


    MCHD recently rolled out Ceftriaxone for long-bone open fracture care. The podcast crew welcomes our new assistant medical director, Dr. Mike DePasquale, to discuss some background evidence and danger spots within this protocol. REFERENCES: Lack, W. D., Karunakar, M. A., Angerame, M. R., Seymour, R. B., Sims, S., Kellam, J. F., & Bosse, M. J. (2015). Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. Journal of orthopaedic trauma, 29(1), 1–6. Johnson, J. P., Oliphant, B. W., Dodd, J., Duckworth, R. L., Goodloe, J. M., Lyng, J. W., Sagraves, S. G., & Fischer, P. E. (2024). Prehospital Antibiotic Administration for Suspected Open Fractures: Joint COT/OTA/ACEP/NAEMSP/NAEMT Position Statement. Prehospital emergency care, 28(8), 1063–1067. Muniz, A. D., Gregorio, D. J., Studebaker, S. A., Peth, A. M., Camacho, C. G., Williams, B., Kupas, D. F., & Brown, L. H. (2024). Time Savings and Safety of EMS Administration of Antibiotics for Open Fractures. Prehospital emergency care, 28(8), 1046–1052.

    Episode 174 - Push Dose Norepinephrine

    Play Episode Listen Later Nov 2, 2024 25:27


    We recently implemented a "push-dose" norepinephrine protocol at MCHD and have already learned some valuable lessons. Join us for some vasopressor pharmacology and protocol review, accompanied by some of our new teaching points that have arisen following the protocol's release into the wild. REFERENCES: 1. Berkenbush, M., Singh, L., Sessa, K., & Saadi, R. (2024). Scoping Review: Is Push-Dose Norepinephrine a Better Choice? The western journal of emergency medicine, 25(5), 708–714. 2. Permpikul, C., Tongyoo, S., Viarasilpa, T., Trainarongsakul, T., Chakorn, T., & Udompanturak, S. (2019). Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. American journal of respiratory and critical care medicine, 199(9), 1097–1105.

    Episode 175 - The Rear View Mirror - Tunnel Vision

    Play Episode Listen Later Oct 29, 2024 31:09


    Dr. Patrick is joined by MCHD District Chief Kelcie Adams to discuss the role of clinical case reviews at MCHD. Why are these so important, and what's the big deal? Kelcie is brave enough to use one of her recent calls as an example of the positives that can come if we get past our egos and allow ourselves to have insight for future cases.

    Episode 173 - Med Minute - Magnesium

    Play Episode Listen Later Sep 27, 2024 15:15


    We're working on a new series focusing on high-yield pharmacology reviews. Dr. Patrick starts us off with some background, mechanism of action discussion and common uses for magnesium sulfate. Mag is one of the true pharmacologic swiss army knives of emergency care. REFERENCES 1. Touyz RM, de Baaij JHF, Hoenderop JGJ. Magnesium Disorders. N Engl J Med. 2024 Jun 6;390(21):1998-2009. doi: 10.1056/NEJMra1510603.

    EKG Manifesto 3 - FINAL Mixdown

    Play Episode Listen Later Sep 5, 2024 27:12


    Our final entry into the EKG Manifesto series moves into the STEMI/OMI world of acute coronary occlusion. Who do we activate and why? Where is the STEMI paradigm headed? Join Dr. Patrick and Dr. Dickson to refresh your EKG knowledge. REFERENCES 1. https://www.emdocs.net/ecg-pointers-stemi-equivalents-from-the-american-college-of-cardiology/

    Episode 171 - Surgical Airway Lessons

    Play Episode Listen Later Aug 9, 2024 32:58


    One of the most fear-inducing procedures in all of emergency care is the surgical cricothyrotomy. Dr. Al Lulla from Dallas Fire joins the podcast to discuss our recent collaboration on a retrospective look at MCHD's surgical airway experience over the past decade. Can paramedics sucessfully perform cricothyrotomies? Who needs surgical airway placement in the field? What can we learn for our next "can't oxygenate/can't ventilate" scenario? REFERENCES 1. https://youtu.be/wVQFJR7qmrQ?si=QBUfJd_7oZ3vmEpR 2. Lulla A, Dickson R, Wells M, Gilbert M, Rogers Keene K, Patrick C. Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review. Prehosp Disaster Med. 2024 Apr 23:1-4.

    lessons references surgical airway
    Episode 170 - The MCHD EKG Manifesto - Part 2

    Play Episode Listen Later Jul 14, 2024 39:07


    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 at the end with the killer/"can't miss" EKG patterns and combine those with common chief complaints. Hopefully, this framework will click for you. In Part 2 of this series, we'll discuss bradycardias and tachycardias. REFERENCES 1. https://www.youtube.com/watch?v=UXh8PS9dtmo

    Episode 169 - Agitation Awareness - Fixed-Dose Ketamine

    Play Episode Listen Later Jun 17, 2024 24:56


    We've initiated a multi-pronged, system wide overhaul of our agitation management at MCHD. This included a move to fixed-dose ketamine for the severely agitated patients. Evidently we weren't the only ones thinking of this as there is exciting new data from Buffalo supporting this approach. Join the podcast crew as they review the recent literature and MCHD protocol changes. REFERENCES 1. O'Brien MC, Kelleran KJ, Burnett SJ, Hausrath KA, Kneer MS, Nan N, Ma CX, McCartin RW, Clemency BM. Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation. Am J Emerg Med. 2024 Jul;81:10-15.

    Episode 168 - The VTach FACTs

    Play Episode Listen Later May 20, 2024 35:50


    We've recently had several challenging, wide-complex tachycardia cases here at MCHD, so the podcast crew decided to bring forth some VT vs. SVT with aberrancy knowledge. Learn the V-Tach FACT, and you'll feel more comfortable with your next wide rhythm at a rate of 185. REFERENCES 1. https://litfl.com/vt-versus-svt-ecg-library/ 2. https://www.youtube.com/watch?v=UXh8PS9dtmo 3. Marill KA, Wolfram S, Desouza IS, Nishijima DK, Kay D, Setnik GS, Stair TO, Ellinor PT. Adenosine for wide-complex tachycardia: efficacy and safety. Crit Care Med. 2009 Sep;37(9):2512-8.

    Episode 167 - Ketamine Only Intubations With Dr. Andrew Partain

    Play Episode Listen Later Apr 22, 2024 27:16


    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 management. REFERENCES: 1. Driver BE, Prekker ME, Reardon RF, Sandefur BJ, April MD, Walls RM, Brown CA 3rd. Success and Complications of the Ketamine-Only Intubation Method in the Emergency Department. J Emerg Med. 2021 Mar;60(3):265-272.

    Episode 166 - The MCHD EKG Manifesto - Part 1

    Play Episode Listen Later Mar 25, 2024 35:25


    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 at the end with the killer/"can't miss" EKG patterns and combine those with common chief complaints. Hopefully, this framework will click for you. REFERENCES 1. https://www.youtube.com/watch?v=UXh8PS9dtmo 2. Walker P, Jenkins CA, Hatcher J, Freeman C, Srica N, Rosell B, Hanna E, March C, Seamens C, Storrow A, McCoin N. 2022. Seamens' Sign: a novel electrocardiogram prediction tool for left ventricular hypertrophy. PeerJ 10:e13548

    Episode 165 - Intracerebral Hemorrhage

    Play Episode Listen Later Feb 26, 2024 32:06


    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-traumatic, acute intracranial bleeding. REFERENCES 1. Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016 Sep 15;375(11):1033-43. 2. Zeiler FA, Sader N, West M, Gillman LM. Sodium Bicarbonate for Control of ICP: A Systematic Review. J Neurosurg Anesthesiol. 2018 Jan;30(1):2-9.

    Episode 164 - EMS HOCUS POCUS

    Play Episode Listen Later Jan 29, 2024 29:20


    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. REFERENCES 1. Badra K, Coutin A, Simard R, Pinto R, Lee JS, Chenkin J. The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation. 2019 Jun;139:17-23. 2. Kang SY, Jo IJ, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Shin TG, Kim K, Shim JS, Yoon H. Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation. Resuscitation. 2022 Oct;179:206-213. 3. Clattenburg EJ, Wroe P, Brown S, Gardner K, Losonczy L, Singh A, Nagdev A. Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study. Resuscitation. 2018 Jan;122:65-68. 4. Clattenburg EJ, Wroe PC, Gardner K, Schultz C, Gelber J, Singh A, Nagdev A. Implementation of the Cardiac Arrest Sonographic Assessment (CASA) protocol for patients with cardiac arrest is associated with shorter CPR pulse checks. Resuscitation. 2018 Oct;131:69-73. 5. Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I. Competence of health professionals to check the carotid pulse. Resuscitation. 1998 Jun;37(3):173-5. 6. Zengin S, Gümüşboğa H, Sabak M, Eren ŞH, Altunbas G, Al B. Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients. Resuscitation. 2018 Dec;133:59-64.

    Episode 163 - Back Pain Beware

    Play Episode Listen Later Jan 2, 2024 35:16


    MCHD paramedic Wes Hall joins the podcast crew to discuss a recent seemingly mundane back pain call. 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. REFERENCES 1.

    Episode 162 - Post-ROSC Pressor Choice

    Play Episode Listen Later Dec 4, 2023 30:39


    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. REFERENCES 1. Bougouin W, Slimani K, Renaudier M, et al; Sudden Death Expertise Center Investigators. Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022 Mar;48(3):300-310. 2. Wender ER, Counts CR, Van Dyke M, et al. Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest. Prehosp Emerg Care. 2023 Sep 14:1-6.

    Episode 161 - MMQ#9 - The Angioedema Airway

    Play Episode Listen Later Nov 6, 2023 32:57


    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.

    Episode 160 - ST Elevation in aVR With Diffuse ST Depression

    Play Episode Listen Later Oct 9, 2023 23:53


    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? REFERENCES 1. Harhash AA, Huang JJ, Reddy S, Natarajan B, Balakrishnan M, Shetty R, Hutchinson MD, Kern KB. aVR ST Segment Elevation: Acute STEMI or Not? Incidence of an Acute Coronary Occlusion. Am J Med. 2019 May;132(5):622-630. 2. https://www.mchd-tx.org/wp-content/uploads/2023/10/ST-elevation-AVR-ECGs-DeIDd.pdf

    Episode 159 - MMQ#8 - The Head and the Heart

    Play Episode Listen Later Sep 11, 2023 25:24


    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. REFERENCES 1. Kuppermann N, Holmes JF, Dayan PS, et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. 2. https://www.mchd-tx.org/wp-content/uploads/2023/09/Sodium-Channel-Blocker-Before-1.pdf 3. https://www.mchd-tx.org/wp-content/uploads/2023/09/Sodium-Channel-Blocker-After-2.pdf

    Episode 158 - Terrible Tracheostomy 2023

    Play Episode Listen Later Aug 14, 2023 21:52


    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 top of that previous foundation. REFERENCES 1.https://www.tracheostomy.org.uk/storage/files/NTSP_GREEN_Tracheostomy_Algorithm.pdf

    Episode 157 - Cardiac Arrest During EMS Care - Making MOVES

    Play Episode Listen Later Jul 17, 2023 23:39


    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 a proactive approach to providing a safety net before transporting our critical patients. REFERENCES 1. Clemency BM, Murk W, Moore A, Brown LH. The EMS Modified Early Warning Score (EMEWS): A Simple Count of Vital Signs as a Predictor of Out-of-Hospital Cardiac Arrests. Prehosp Emerg Care. 2022 May-Jun;26(3):391-399. 2. Burnett SJ, Innes JC, Varughese R, Frazer E, Clemency BM. A Qualitative Analysis of the Experiences of EMS Clinicians in Recognizing and Treating Witnessed Cardiac Arrests. Prehosp Emerg Care. 2022 Sep 28:1-9.

    Episode 156 - MMQ#7 A Shocking Save And Sneaky Serial Killer

    Play Episode Listen Later Jun 19, 2023 23:50


    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. Dickson RL, Crowe RP, Patrick C, Crocker K, Aiken M, Adams A, Gleisberg GR, Nichols T, Mason C, Panchal AR. Performance of the RACE Score for the Prehospital Identification of Large Vessel Occlusion Stroke in a Suburban/Rural EMS Service. Prehosp Emerg Care. 2019 Sep-Oct;23(5):612-618. 2. Patrick C, Crowe RP, Ward B, Mohammed A, Keene KR, Dickson R. Feasibility of prehospital esmolol for refractory ventricular fibrillation. J Am Coll Emerg Physicians Open. 2022 Apr 9;3(2):e12700.

    Episode 155 - MMQ#6 - A Rapid AFib Riddle

    Play Episode Listen Later May 22, 2023 29:12


    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?

    Episode 154- Death Notification Lessons Learned

    Play Episode Listen Later Apr 24, 2023 21:37


    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.

    Episode 153 - MMQ#5 From The PNW - Spokane Frozen Solid

    Play Episode Listen Later Mar 27, 2023 30:11


    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.

    Episode 152 - The MCHD SNORES Sedation Safety Bundle

    Play Episode Listen Later Mar 13, 2023 29:35


    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.

    Episode 151 - MMQ#4 - Dr. Dickson's Strokes

    Play Episode Listen Later Feb 27, 2023 38:48


    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.

    Episode 150 - Hyperkalemia, BRASH syndrome, And Amiodarone BEWARE

    Play Episode Listen Later Feb 13, 2023 30:31


    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.

    Episode 149 - Finding Joy In The Common

    Play Episode Listen Later Jan 30, 2023 27:12


    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

    Episode 148 - ET3 And Beyond With Dr. Gerad Troutman

    Play Episode Listen Later Jan 16, 2023 35:30


    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.

    Episode 147 - MMQ - CAB For The Win

    Play Episode Listen Later Jan 2, 2023 36:25


    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.

    Episode 146 - NTG In RVMI With Matt Wilkinson-Stokes

    Play Episode Listen Later Dec 19, 2022 36:03


    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

    Episode 145 - Where Do We Look? Who Do We Trust?

    Play Episode Listen Later Dec 5, 2022 34:14


    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.

    trust ems megan powell
    Episode 144 - The TBI "H-Bombs" With Dr. Al Lulla

    Play Episode Listen Later Nov 21, 2022 34:54


    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.

    Episode 143: Adrenal Crisis in EMS

    Play Episode Listen Later Nov 7, 2022 34:08


    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/

    Episode 142 - Reducing Medication Errors

    Play Episode Listen Later Oct 24, 2022 33:50


    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.

    Episode 141 - Podcast Q&A

    Play Episode Listen Later Oct 10, 2022 24:44


    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.

    Episode 140 - MMQ#2 - A TBI Conundrum

    Play Episode Listen Later Sep 26, 2022 24:04


    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.

    Episode 139 - Anchoring Bias In EMS

    Play Episode Listen Later Sep 12, 2022 35:48


    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

    Episode 138 - Beware of the BRUE - MCHD COTQ Q2 2022

    Play Episode Listen Later Aug 29, 2022 19:38


    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.

    Episode 137 - Monday Morning Quarterback - STEMI vs. OMI/NOMI

    Play Episode Listen Later Aug 15, 2022 33:34


    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

    Episode 136 - Mythbusters 2022

    Play Episode Listen Later Aug 1, 2022 39:33


    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/

    Episode 135 - First There Matters

    Play Episode Listen Later Jul 18, 2022 35:52


    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 research highlighting improved OHCA outcomes when fire and police can initiate life-saving interventions. REFERENCES 1. Salhi RA, Hammond S, Lehrich JL, O'leary M, Kamdar N, Brent C, Mendes de Leon CF, Mendel P, Nelson C, Forbush B, Neumar R, Nallamothu BK, Abir M; CARES Surveillance Group. The association of fire or police first responder initiated interventions with out-of-hospital cardiac arrest survival. Resuscitation. 2022 May;174:9-15.

    Episode 134 - All Things Anaphylaxis

    Play Episode Listen Later Jul 5, 2022 26:57


    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. REFERENCES 1. Anagnostou K, Turner PJ. Myths, facts, and controversies in the diagnosis and management of anaphylaxis. Arch Dis Child. 2019 Jan;104(1):83-90. 2. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy. 2000 Aug;30(8):1144-50. 3. Prince BT, Mikhail I, Stukus DR. Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities. J Asthma Allergy. 2018 Jun 20;11:143-151.

    Episode 133 - MCHD Bike Team

    Play Episode Listen Later Jun 20, 2022 19:22


    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/uploads/2022/06/Bike-Team.jpg

    Episode 132 - Xylazine Update

    Play Episode Listen Later Jun 6, 2022 27:04


    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. REFERENCES 1. https://www.acep.org/tacticalem/newsroom/oct-2021/xylazine-an-emerging-adulterant/ 2. https://www.kxan.com/news/drug-responsible-for-recent-overdoses-in-austin-travis-county-identified-by-officials/ 3. Reyes, J. C., et al. "The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico." Journal of Urban Health 89.3 (2012): 519-526. 4. Ruiz-Colón, Kazandra, et al. "Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: a comprehensive review of the literature." Forensic Science International 240 (2014): 1-8. 5. Nunez, Jacqueline, Maura E. DeJoseph, and James R. Gill. "Xylazine, a veterinary tranquilizer, detected in 42 accidental fentanyl intoxication deaths." The American Journal of Forensic Medicine and Pathology 42.1 (2021): 9-11. 6. Johnson, Jewell, et al. "Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010–2019." Injury prevention 27.4 (2021): 395-398. 7. Friedman, Joseph, et al. "Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis." Drug and Alcohol Dependence (2022): 109380. 8.https://www.mdpoison.com/media/SOP/mdpoisoncom/ToxTidbits/2019/Jan%202019%20ToxTidbits.pdf 9. https://www.deadiversion.usdoj.gov/drug_chem_info/Xylazine.pdf

    Episode 131 - Nebulized Ketamine, What??

    Play Episode Listen Later May 23, 2022 13:28


    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. REFERENCES 1. Dove D, et al. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Ann Emerg Med. 2021 Dec;78(6):779-787. 2. Rhodes AJ, et al. Nebulized ketamine for managing acute pain in the pediatric emergency department: A case series. Turk J Emerg Med. 2021 Apr 9;21(2):75-78.

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