MedGrind

In this episode, Rebecca and Juan discuss a case centered around pediatric seizures.

In the first of our Coffee Talk Episodes, we discuss our current times and how perception shapes our outlook. Coffee Talk episodes will become a staple for every fifth episode giving us an ability to talk about some of our thoughts and focus on casual conversations that typically happen when we're not recording.

Mental health and job stress have an impact on all of us, especially with the current pandemic. In this episode, we have a candid discussion about our personal experiences with mental health, and our hopes for a healthy mental health future.Chucks full letter:"Call my dad," "Please call my dad," "I cannot, not right now, we need to get you to the hospital." I remember the day, sunny, working with one of my best friends. Stand by fire! Excited, usually one of those calls that we get to stand there and hope no one gets hurt.As we were en route, we started to receive updates via our truck computer… house on fire, neighbors state its an abandoned house, I remember telling my partner "oh, another one." Next update, neighbors report there's a man on fire walking down the street. Jaw drops, we hoped it wasn't right, or some feeble attempt to get the fire department there faster.I remember turning the corner and seeing him. He stood on the corner silent, not waving his hands, not yelling, not doing anything but standing there. Still smoldering, naked, all of his hair was gone, anything to make him recognizable gone — just a human figure standing there. His eyes matched the neighbors who witnessed the event, wider then I have ever seen. "Am I going to die?"… "not now"….. "call my dad"…. "not now"... What else could I say to him? The 23-year-old has suffered more burns than I have seen on some dead people, and yet he was talking to me. "what happened?" "They said if I told anyone they would do this to each of my family members..." Silence. "Tell us something before you pass out."En route to the hospital, we did everything we could do for him. We gave him medications, started IVs, called the hospital, and let them know we were coming and get everyone to the trauma bay. We arrived at the hospital and started our update... 23 y/o male … "He's dead!" The doctor said. I couldn't even get through my report, and the doctor took a 4 ft away assessment and told us he was dead. "He's still talking sir" I remember uttering back. "It doesn't matter; he is dead or is going to be." He then went on to explain that he had full-thickness burns 100% of his body, and there was nothing they could do but delay death. Three nurses then left the room, crying.I remember walking out of the room with tears building in my own eyes. I stood outside the room for a moment to gather myself and remember overhearing the social worker talking on the phone, "get here now sir, I know you're busy, but this is urgent." She laid down the phone, knowing she couldn't tell him what had happened, just that he needed to be there, now with his dying son.This is just one of the hundreds of people that live now in my memories. They may not show up every day, but they do show up. I find that certain events trigger these people back into the images in my mind, regressed is some dark place. Things like a house fire or "Call my dad" bring them back. I re-live it like I was there, what could I have done differently? Maybe if I... has replayed hundreds of times in my head. In school, I was told not to burden any of the blame when people die because of their own poor decisions; however, what was never taught is it is impossible to be a compassionate human being and not burden any fault when a person dies. As Paramedics, EMTs, Dispatchers, Firefighters, and Police Officers, we are faced with more trauma in one week than most people will see in their lifetime.What's the worse thing you have seen? That's a famous line at every family gathering. Well, welcome back to all the people living in my head. Some of them are the many ones, the ones you don't want to talk about. The kid being sexually and mentally assaulted by the live-in boyfriend. The elderly man that died months ago, but the family needed to live off his checks, the young mother who just lost her life in an MVA surrounded by her family, while the children escaped relatively unharmed. Yet still, only the tip of the iceberg.The phone rang, "are you ready for in-service?". No, I want to go and hug my family and tell them that I love them, I want to be anywhere but here right now focused on the kid who was dying in the other room, waiting for his father to come to the hospital. Most of all, I want just a minute to think about what just happened, decompress, gather myself, and talk about what I just saw. "In-service," " ok, you got one" onto the next call.It's part of the job. That's old school thinking, and it's time for a change. Years ago, we used not to wear gloves either, and doctors used to smoke while assessing patients, we have since found out that wasn't good. It's time to change the way that we also treat mental health with first responders. Mental health is just as if not more important than physical health.Cleveland EMS is broken, Cleveland Public Safety is broken. It used to be a respected profession. Now we are spit on... When we try and go to administration with concerns, we are spit on by them. It's almost impossible to go home healthy after that. I couldn't do it. I wasn't strong enough, and bless those who are. The City of Cleveland broke me, and I had to leave to try and fix me.The City of Cleveland has thousands of public safety workers. They make them wear things like ballistic vests, turnout jackets, and helmets to protect them physically. However, they do not want to protect them mentally. In 13 years, I have seen more people die due to suicide than due to a line of duty death, yet this is a non-issue for the city. Suicide is the final event that is a culmination of many events, yet that is when the city acknowledges that person. Those deaths fall directly on your inactions to address the issues. Every day I say a prayer to help those who help you, and hope today wasn't their last.Charles Cali (Former #235, EMS)Newspaper article on Chuckhttps://www.cleveland.com/news/2020/01/cleveland-ems-workers-suffer-trauma-too-so-why-wont-city-help-its-helpers-andrea-simakis.htmlNational Suicide Prevention Websitehttps://suicidepreventionlifeline.orgAtlantic Articlehttps://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/Micropractices For Burnout Preventionhttps://www.jacr.org/article/S1546-1440(20)30290-8/pdfCOVID-19 Pandemic Response Resourceshttps://www.cstsonline.org/resources/resource-master-list/coronavirus-and-emerging-infectious-disease-outbreaks-response

In this episode, we discuss more ARDS, filters and some thoughts in regards to COVID-19. The Society of Critical Care Medicine recently released guidelines that were developed in conjunction with the Surviving Sepsis Campaign. We go through the guidelines step by step and discuss the rationale behind the recommendations.https://www.sccm.org/getattachment/Disaster/SSC-COVID19-Critical-Care-Guidelines.pdf?lang=en-UShttps://www.sccm.org/getattachment/Disaster/SCCM-COVID-19-Infographics1.pdf?lang=en-UShttps://www.sccm.org/getattachment/Disaster/SCCM-COVID-19-Infographics2.pdf?lang=en-UShttps://emcrit.org/ibcc/covid19/https://heavyliesthehelmet.com/2018/03/17/017/

In this episode, the MedGrind team discusses the ARDS protocol and how it's often misused. These protocols were created to help guide ventilator care in these challenging patients and need to be used in their entirety for optimal patient outcomes. Juan discusses how providers often fall short when attempting to utilize these protocols. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253180/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034123/http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565761/

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