Podcasts about Advanced life support

The chain of survival for a cardiac emergency and stroke start the same: 1. preparedness & recognition of an emergency; 2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

In this episode of the JEMS Report, Dr. Ted Lee and Jonathan Epstein from the American Red Cross discuss critical developments in prehospital resuscitation education, especially surrounding Heart Month. Epstein highlights the Red Cross's longstanding commitment to lifesaving training, evolving from traditional community-focused programs to a comprehensive suite that includes Basic Life Support, Advanced Life Support and the newly launched Neonatal Advanced Life Support. The conversation emphasizes the importance of tailored educational offerings for both public and healthcare professionals, aiming to bridge the gap in emergency medical response across diverse communities. The Red Cross's innovative Mission CPR project looks to improve bystander CPR rates in underserved areas, underscoring that every second counts during cardiac emergencies. For EMS providers and healthcare professionals, this initiative represents a significant step forward in achieving better patient outcomes and preparedness in life-threatening situations.

Show Notes for Episode 41 of “The 2 View” – reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, cardiopulmonary resuscitation and emergency cardiovascular care science, prehospital tourniquets, blood pressure, and more. Segment 1 – Reversible cerebral vasoconstriction syndrome and cerebral venous thrombosis Ropper AH, Klein JP. Cerebral Venous Thrombosis. N Engl J Med. Published June 30, 2021. https://www.nejm.org/doi/full/10.1056/NEJMra2106545 Spadaro A, Scott KR, Koyfman A, Long B. Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians. Am J Emerg Med. ScienceDirect. Published December 2021. https://www.sciencedirect.com/science/article/abs/pii/S0735675721008093 Segment 2 – Cardiopulmonary resuscitation and emergency cardiovascular care science, Prehospital tourniquets, and more Greif R, Bray JE, Djärv T, et al. 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; And First Aid Task Forces. Circulation. AHA | ASA Journals. Published November 14, 2024. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001288?utmcampaign=sciencenews24-25&utmsource=science-news&utmmedium=phd-link&utmcontent=phd-11-14-24 Roberts M, Sharma M. The Center for Medical Education. 36 - Marijuana, Sunburns, Pulse Oximetry, Lower UTI's. 2 View: Emergency Medicine PAs & NPs. Published May 31, 2024. https://2view.fireside.fm/36 Roberts M, Sharma M. The Center for Medical Education. The 2 View: Episode 2. 2 View: Emergency Medicine PAs & NPs. Published February 3, 2021. https://2view.fireside.fm/2 Smith AA, Ochoa JE, Wong S, et al. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published January 2019. https://pubmed.ncbi.nlm.nih.gov/30358768/ STB home page. Stop the Bleed. American College of Surgeons. https://www.stopthebleed.org/ Teixeira PGR, Brown CVR, Emigh B, et al. Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. J Am Coll Surg. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published May 2018. https://pubmed.ncbi.nlm.nih.gov/29605726/ Segment 3 – Blood Pressure Bress AP, Anderson TS, Flack JM, et al. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published August 2024. https://pubmed.ncbi.nlm.nih.gov/38804130/ Liu H, Zhao D, Sabit A. Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial. Jamanetwork.com. JAMA Network. JAMA Internal Medicine. Published October 7, 2024. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2824754 Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

This episode of Critical Matters will close 2024 with a year in review. Dr. Sergio Zanotti is going solo and will discuss a couple of relevant clinical guidelines and review five clinical trials. To close, he'll share some of his favorite books for 2024. Additional Resources: Critical Care Management of Patients Post Cardiac Arrest (AHA/NCS): Hirsch KG, Abella BS, Amorim E, et al. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care. 2024;40(1):1-37: https://bit.ly/4087o1w 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support: Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2024: https://bit.ly/4fD4o1R PREOXI Trial. Gibbs KW, Semler MW, Driver BE, et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024;390(23):2165-2177. doi:10.1056/NEJMoa2313680: https://bit.ly/4fD4pCX AMIKINHAL Trial. Ehrmann S, Barbier F, Demiselle J, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-2062. doi:10.1056/NEJMoa2310307: https://bit.ly/4iQQvzU REVISE Trial. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245: https://bit.ly/3Pc4nqH TIGHT K Trial. O'Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. 2024;332(12):979-988. doi:10.1001/jama.2024.17888: https://jamanetwork.com/journals/jama/fullarticle/2823246 BALANCE Trial. Daneman N, Rishu A, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. Published online November 20, 2024. doi:10.1056/NEJMoa2404991: https://www.nejm.org/doi/abs/10.1056/NEJMoa2404991 CMD Study. Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. N Engl J Med. 2024;391(7):598-608. doi:10.1056/NEJMoa2400645: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645 Books Mentioned in this Episode: Slow Productivity: The Lost Art of Accomplishment Without Burnout. By Cal New Port: https://amzn.to/4gTbkJ2 Meditations for Mortals: Four Weeks to Embrace Your Limitations and Make Time for What Counts. By Oliver Burkeman: https://bit.ly/4gURU6N Knife: Meditations After an Attempted Murder. By Salman Rushdie: https://bit.ly/3ZPsAIt

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency;2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Velkommen tilbage til podcasten. Vi kender alle remsen med de fire h'er og de fire t'er, eller har som minimum hørt om den. De otte reversible årsager er en del af vores genoplivningskoncept, hvor vi, som team, skal adressere dem alle otte, så vi måske allerede præhospitalt kan korrigere dem, hvis en af dem skulle være den grundlæggende årsag til hjertestoppet. Men nogle af os kæmper stadig med at huske alle otte og der er også nogle af os, der faktisk ikke helt ved, hvad vi skal gøre ved dem. For vi kan faktisk gøre noget ved alle otte reversible årsager, enten ved at behandle eller transportere. Advanced Life Support instruktør Michael Byskov fortæller os lidt om, hvilke reversible årsager der findes, hvad vi kan gør ved dem, og hvorfor vi skal være langt mere aggressive overfor dem, end vi er I dag. Tillige fortæller læge og medforfatter til ERCs guidelines Freddy Lippert om, hvorfor netop de otte reversible årsager er blevet valgt. Stream der, hvor du streamer. Rigtig god fornøjelse.

The chain of survival for a cardiac emergency and stroke start the same: 1. preparedness & recognition of an emergency;2. activation of EMS;3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility. ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

The chain of survival for a cardiac emergency and stroke start the same:preparedness & recognition of an emergency; activation of EMS; delivery of Advanced Life Support; and transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency; 2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility. ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

The chain of survival for a cardiac emergency and stroke start the same: preparedness & recognition of an emergency; activation of EMS; delivery of Advanced Life Support; and transporting to the most appropriate facility. ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back via PayPal Good luck with your ACLS class!

Bob is joined by first responder Bill Evans on the Penfield car on the railroad tracks, Bob is also joined by the cousin of the Ambulance victim, and he is joined by Advanced Life Support boss Ahmed Mustafa on the Webster ambulance situation.

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency;2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility. Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS). ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI; door to tPA for ischemic stroke; and onset of symptoms to EVT for LVO strokes.EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.**American Cancer Society (ACS) Fundraiser This is the fifth year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS FundraiserTHANK YOU! Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!10 Poisoning Prevention Tips from Ohio Pharmacist, Kim Newlove of The Pharmacist'sVoice Podcast

The chain of survival for a cardiac emergency and stroke start the same: 1. preparedness & recognition of an emergency; 2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility. Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS). ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI; door to tPA for ischemic stroke; and onset of symptoms to EVT for LVO strokes.EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Really quick, if you're impacted or interested in helping the response to the recent flooding in Vermont, please visit www.vermont.gov/flood Here at EM Weekly and The Readiness Lab, we're all about the tech that takes us from "meh" to "wow". Enter Traumasoft, the game-changer that's aiming to give EMS agencies a big efficiency boost and a huge high-five to their hard-working providers. On today's episode is RJ Morrison. Starting as an EMT-B and climbing the ranks to Paramedic, RJ's seen it all, taught a thing or two about EMS, and has filled pretty much every agency role you can think of. Now, he's diving into the world of Traumasoft, convinced by its power to transform the way agencies work and look after their dedicated teams.RJ is not just about tech, he's big on people too. He's part of the board of the Code Green Campaign (https://www.codegreencampaign.org/) and is a staunch advocate for the wellbeing of EMS staff. We dive into the deep stuff, chatting about mental health, wellbeing, the staffing and burnout struggles faced by agencies, and how to make the field better for everyone.As a former EMT myself and someone who helped run an agency, I was really excited to hear his perspective on how we fix EMS and how tech can help.Check out Traumasoft, the only complete EMS software solution: https://traumasoft.com/Find RJ on LinkedIn: https://www.linkedin.com/in/morrisonr/ Join us at Emergency Management Response for Dynamic Populations Course August 29-31! https://www.thereadinesslab.com/dynamic-populations Support our podcast!Everything EM Weekly: www.thereadinesslab.com/em-weekly-linksEM Weekly shirts and merch: https://www.thereadinesslab.com/shop/merchThe Readiness Lab: https://www.thereadinesslab.com/Doberman Emergency Management: www.dobermanemg.comConnect with me! https://www.linkedin.com/in/zborst/ Major Endorsements:L3Harris Technologies's BeOn PPT App. Learn more about this amazing product here: www.l3harris.com Doberman Emergency Management Group provides subject matter experts in planning and training: www.dobermanemg.com #EMWeekly #TheReadinessLab #Traumasoft #EMSInnovation #EMSLeadership #ParamedicLife #HealthcareTech #CodeGreenCampaign #MentalHealthInEMS #EMSWellbeing #EndBurnout #EMSStaffing #EMSManagement #FutureOfEMS #EMTEducation #EmergencyServices #EMSResilience #EMSTech #EMSMentalHealth #emergencymedicalservices #EMS #paramedic

Jessica Shepherd, Gippsland Operational Community Engagement Liaison Coordinator for Ambulance Victoria, discusses the life of an advanced life support paramedic; Professor Peter Azzopardi, Senior Principal Research Fellow at the Murdoch Children's Research Institute, canvasses his work leading an international program of research focusing on adolescent health and well-being; and the team discuss flu treatments, and unpack new legislation that will make medical abortions easier to access. With presenters Dr Training Wheels and Cyber Sioux.Website: https://www.rrr.org.au/explore/programs/radiotherapyFacebook: https://www.facebook.com/RadiotherapyOnTripleR/Twitter: https://twitter.com/_radiotherapy_Instagram: https://instagram.com/radiotherapy_tripler

ComMed is a non-profit community-based emergency medical response service operating in Johannesburg, South Africa. ComMed's aim is to provide life-saving services to those in need, to those who do not have access to private services, to those who need an emergency medical intervention or to those who simply need support. In this episode, Neil Van Der Merwe discusses the unique role they fill in South Africa's EMS system, and how they fulfill their mission of "All Mission, Non-Profit". To learn more about ComMed visit their website.To get in touch directly you can email info@commed.org.za Follow ComMed: Facebook | Instagram – – – – – Overview of ComMed's services (00:25)Intermediate vs Advanced Life Support in South Africa (04:00)Types of calls ComMed responds to (10:20)How ComMed reaches those in need (13:40)How ComMed managed a successful launch during Covid (16:40)Level and methods of training for volunteers (23:15)ComMed's mission, vision and values (27:15)Advice for those wanting to launch a similar service (30:45)Support the show-- -- -- -- --HOST Jason Friesen is the Founder and Executive Director of Trek Medics International, a 501c3-registered nongovernmental organization (NGO) dedicated to improving access to emergency response networks in communities across the globe through innovative mobile phone technologies.Learn more about Trek Medics International by visiting their website, and for more info on the Beacon Crisis Response Platform visit here. Follow Trek Medics on: Instagram | Facebook | Twitter | LinkedInTheme song: "Happy Feliz" by ¡Big Grande! (used with permission).

The chain of survival for a cardiac emergency and stroke start the same:preparedness & recognition of an emergency; activation of EMS; delivery of Advanced Life Support; and transporting to the most appropriate facility. Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS). ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI; door to tPA for ischemic stroke; and onset of symptoms to EVT for LVO strokes.EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Contributor: Travis Barlock, MD Educational Pearls: Sudden Cardiac Arrest (SCA) is defined as when the heart suddenly stops beating. Immediate treatment for SCA includes Cardiopulmonary Resuscitation (CPR) and defibrillation. This event is commonly depicted in medical dramas as an intense moment but often with the patient surviving and making a full recovery (67-75%). This depiction has likely led the general population astray when it comes to the true survivability of SCA. When surveyed, the general population tends to believe that in excess of 50% of patients requiring CPR survive and return to daily life with no long-term consequences. What percent of patients actually survive cardiac arrest? SCA due to Ventricular Fibrillation (VF): 25-40% SCA due to Pulseless Electrical Activity (PEA): 11% SCA due to noncardiac causes (trauma ect.): 11% SCA when the initially observed rhythm is Asystole: Less than 5%, by some measures as low as 2%. References Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med. 1996 Jun 13;334(24):1578-82. doi: 10.1056/NEJM199606133342406. PMID: 8628340. Bitter CC, Patel N, Hinyard L. Depiction of Resuscitation on Medical Dramas: Proposed Effect on Patient Expectations. Cureus. 2021 Apr 11;13(4):e14419. doi: 10.7759/cureus.14419. PMID: 33987068; PMCID: PMC8112599. Engdahl J, Bång A, Lindqvist J, Herlitz J. Can we define patients with no and those with some chance of survival when found in asystole out of hospital? Am J Cardiol. 2000 Sep 15;86(6):610-4. doi: 10.1016/s0002-9149(00)01037-7. PMID: 10980209. Cobb LA, Fahrenbruch CE, Walsh TR, Copass MK, Olsufka M, Breskin M, Hallstrom AP. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. 1999 Apr 7;281(13):1182-8. doi: 10.1001/jama.281.13.1182. PMID: 10199427. Rea TD, Eisenberg MS, Becker LJ, Murray JA, Hearne T. Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective. Circulation. 2003 Jun 10;107(22):2780-5. doi: 10.1161/01.CIR.0000070950.17208.2A. Epub 2003 May 19. PMID: 12756155. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O'Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. doi: 10.1161/CIR.0000000000000916. Epub 2020 Oct 21. PMID: 33081529. Summarized by Jeffrey Olson, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS1  

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency;2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility.Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Diese Folge dient als Handreichung für alle Rettungsdienst Kollegen in Heidelberg und im Raum Rhein-Neckar. Ab sofort können Notärzte und Notfallsanitäter, in einer Reanimationssituation den Einsatz einer ECMO anfordern. Das Team des ‚Medical Intervention Car Heidelberg‘ bringt das Tool ‚eCPR‘ und die Expertise an die Einsatzstelle und ergänzt damit das „Advanced Life Support“ vor Ort … „MIC Update – Das ECMO-Tool kommt zur Einsatzstelle“ weiterlesen Der Beitrag MIC Update – Das ECMO-Tool kommt zur Einsatzstelle erschien zuerst auf Rettungsdienst FM.

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency;2. activation of EMS;3. delivery of Advanced Life Support; and4. transporting to the most appropriate facility.Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.Why EMS "Destination Protocols" for suspected stroke and STEMI make adifference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

El International Liaison Committee on Resuscitation (ILCOR) es el organismo internacional que evalúa la ciencia disponible y emite recomendaciones sobre la resucitación de pacientes en paro cardiaco. Los integrantes de ILCOR representan los diferentes concilios de resucitación en el mundo. Los concilios emiten sus propias guías, basadas en las recomendaciones de ILCOR. La revisión anual de la ciencia no es una revisión de todos los temas, sino solamente de aquellas preguntas clínicas que necesitan revisión y/o hay alguna evidencia nueva que justifique un cambio en la recomendación, o simplemente un cambio en el nivel de la recomendación. A veces un tema se vuelve a verificar cuando es prudente incluir los resultados de algún estudio importante reciente. Los estudios no tienen que sugerir un cambio para ser importantes. Usted puede (y debe) leer el documento completo aquí. El documento completo explica el análisis detrás de las recomendaciones y los estudios que fueron considerados en la discusión. Dependiendo de los hallazgos, los diferentes concilios (ej. la American Heart Association) pueden entonces emitir actualizaciones a sus respectivas guías de acuerdo con las recomendaciones de ILCOR. Tratamiento en escena versus RCP durante transporte Sugerimos que los proveedores realicen la resucitación en la escena en vez de realizar el transporte mientras se resucita, a menos que haya una indicación apropiada para justificar el transporte (ej. oxigenación a través de membrana extracorpórea). (Recomendación débil, evidencia de muy baja certeza). Aumento en riesgo de lesiones para los rescatadores. Ahogamiento Las ventilaciones son importantes. Público general: comiencen con compresiones. Profesionales de la salud: comiencen con ventilaciones. Comenzar con las compresiones primero NO supone un retraso significativo. Temperatura pos-paro cardiaco Sugerimos activamente prevenir la fiebre mediante establecer una meta de temperatura igual o menor a 37.5 grados centígrados para pacientes comatosos luego del retorno de circulación espontánea. (Recomendación débil, baja certeza de evidencia) Se sugiere estandarizar la nomenclatura para evitar usar un término que esté vinculado directamente con un protocolo en específico (TTM/MET): Control de temperatura con hipotermia: control activo de temperatura con una meta de temperatura por debajo del parámetro normal. Control de temperatura con normotermia: control activo de temperatura con una meta de temperatura en el rango normal. Control de temperatura con prevención de fiebre: monitoreo de la temperatura y activamente prevenir y tratar la temperatura que esté por encima del rango normal. Ningún control de temperatura: ninguna estrategia de control activo de la temperatura. Sonografía durante el paro cardiaco Sugerimos en contra del uso rutinario de sonografía (POCUS) durante la RCP para diagnosticar causas reversibles del paro cardiaco (recomendación débil, nivel de evidencia muy bajo). Sugerimos que, si la sonografía puede ser realizada por personal experimentado sin interrumpir la RCP, pueda ser considerada como una herramienta diagnóstica adicional cuando hay sospecha clínica presente para una causa reversible (recomendación débil, nivel de evidencia muy bajo). Cualquier uso de sonografía diagnóstica durante RCP debe ser cuidadosamente considerada y sopesada ante el riesgo de interrumpir las compresiones torácicas y malinterpretar los hallazgos sonográficos (declaración de mejores prácticas). En un estudio del 2017, el uso de sonografía durante el paro cardiaco estaba asociado a interrupciones de 21 segundos en promedio. DEA en los niños e infantes. No significa que no se usen. Hay pocos estudios que documentan que un DEA se haya colocado y/o descargado en niños. Los diferentes concilios pueden tomar decisiones sobre sus respectivas guías. Posición de recuperación Colocar al paciente en posición de recuperación. La posición de recuperación no debe afectar la habilidad de verificar la vía aérea, respiración y circulación. Si se dificulta evaluar al paciente, es mejor colocarlo en posición supina. Referencias 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces Myra H. Wyckoff, MD, Robert Greif, MD, MME, Peter T. Morley, MBBS, Kee-Chong Ng, MBBS, Mmed(Peds), Theresa M. Olasveengen, MD, PhD, Eunice M. Singletary, MD, Jasmeet Soar, MA, MB, BChir, Adam Cheng, MD, Ian R. Drennan, ACP, PhD, Helen G. Liley, MBChB, Barnaby R. Scholefield, MBBS, MRCPCH, PhD, Michael A. Smyth, BSc(Hons), MSc, PhD, Michelle Welsford, MD, BSc, David A. Zideman, LVO, QHP(C), MBBS, Jason Acworth, MBBS, FRACP(PEM), Richard Aickin, MBChB, Lars W. Andersen, MD, MPH, PhD, DMSc, Diane Atkins, MD, David C. Berry, PhD, MHA, Farhan Bhanji, MD, MSc(Ed), Joost Bierens, MD, PhD, MCDM, MCPM, Vere Borra, PhD, Bernd W. Böttiger, MD, ML, DEAA, Richard N. Bradley, MD, Janet E. Bray, RN, PhD, Jan Breckwoldt, MD, MME, Clifton W. Callaway, MD, PhD, Jestin N. Carlson, MD, MS, Pascal Cassan, MD, Maaret Castrén, MD, PhD, Wei-Tien Chang, MD, PhD, Nathan P. Charlton, MD, Sung Phil Chung, MD, PhD, Julie Considine, RN, PhD, Daniela T. Costa-Nobre, MD, MHS, PhD, Keith Couper, RN, PhD, Thomaz Bittencourt Couto, MD, PhD, Katie N. Dainty, MSc, PhD, Peter G. Davis, MBBS, MD, Maria Fernanda de Almeida, MD, PhD, Allan R. de Caen, MD, Charles D. Deakin, MA, MD, Therese Djärv, MD, PhD, Michael W. Donnino, MD, Matthew J. Douma, PhD(c), MN, RN, Jonathan P. Duff, MD, Cody L. Dunne, MD, Kathryn Eastwood, PhD, BParamedicStud, BNurse, Walid El-Naggar, MD, Jorge G. Fabres, MD, MSPH, Joe Fawke, MBChB, Judith Finn, PhD, RN, Elizabeth E. Foglia, MD, MA, MSCE, Fredrik Folke, MD, PhD, Elaine Gilfoyle, MD, MMEd, Craig A. Goolsby, MD, MEd, Asger Granfeldt, MD, PhD, DMSc, Anne-Marie Guerguerian, MD, PhD, Ruth Guinsburg, MD, PhD, Karen G. Hirsch, MD, Mathias J. Holmberg, MD, MPH, PhD, Shigeharu Hosono, MD, PhD, Ming-Ju Hsieh, MD, MSc, PhD, Cindy H. Hsu, MD, PhD, Takanari Ikeyama, MD, Tetsuya Isayama, MD, MSc, PhD, Nicholas J. Johnson, MD, Vishal S. Kapadia, MD, MSCS, Mandira Daripa Kawakami, MD, PhD, Han-Suk Kim, MD, PhD, Monica Kleinman, MD, David A. Kloeck, MBBCh, FCPaed, Crit Care (SA), Peter J. Kudenchuk, MD, Anthony T. Lagina, MD, Kasper G. Lauridsen, MD, PhD, Eric J. Lavonas, MD, MS, Henry C. Lee, MD, MS, Yiqun (Jeffrey) Lin, MD, MHSc, PhD, Andrew S. Lockey, MBChB, PhD, Ian K. Maconochie, MBBS, LMSSA, PhD, R. John Madar, MBBS, Carolina Malta Hansen, MD, PhD, Siobhan Masterson, PhD, Tasuku Matsuyama, MD, PhD, Christopher J.D. McKinlay, MBChB, PhD, DipProfEthics, Daniel Meyran, MD, Patrick Morgan, MBChB, DipIMC, RCSEd, Laurie J. Morrison, MD, MSc, Vinay Nadkarni, MD, Firdose L. Nakwa, MBBCh, MMed (Paeds), Kevin J. Nation, NZRN, Ziad Nehme, , PhD, Michael Nemeth, MA, Robert W. Neumar, MD, PhD, Tonia Nicholson, MBBS, BScPsych, Nikolaos Nikolaou, MD, Chika Nishiyama, RN, DrPH, Tatsuya Norii, MD, Gabrielle A. Nuthall, MBChB, Brian J. O'Neill, MD, Yong-Kwang Gene Ong, MBBS, MRCPCH, Aaron M. Orkin, MD, MSc, PHH, PhD, Edison F. Paiva, MD, PhD, Michael J. Parr, MBBS, Catherine Patocka, MDCM, MHPE, Jeffrey L. Pellegrino, PhD, MPH, Gavin D. Perkins, MBChB, MMEd, MD, Jeffrey M. Perlman, MBChB, Yacov Rabi, MD, Amelia G. Reis, MD, PhD, Joshua C. Reynolds, MD, MS, Giuseppe Ristagno, MD, PhD, Antonio Rodriguez-Nunez, MD, PhD, Charles C. Roehr, MD, PhD, Mario Rüdiger, MD, PhD, Tetsuya Sakamoto, MD, PhD, Claudio Sandroni, MD, Taylor L. Sawyer, DO, Med, Steve M. Schexnayder, MD, Georg M. Schmölzer, MD, PhD, Sebastian Schnaubelt, MD, Federico Semeraro, MD, Markus B. Skrifvars, MD, PhD, Christopher M. Smith, MD, MSc, Takahiro Sugiura, MD, PhD, Janice A. Tijssen, MD, MSc, Daniele Trevisanuto, MD, Patrick Van de Voorde, MD, PhD, Tzong-Luen Wang, MD, PhD, JM, Gary M. Weiner, MD, Jonathan P. Wyllie, MBChB, Chih-Wei Yang, MD, PhD, Joyce Yeung, PhD, MBChB, Jerry P. Nolan, MBChB, Katherine M. Berg, MD   In't Veld, M. A. H., Allison, M. G., Bostick, D. S., Fisher, K. R., Goloubeva, O. G., Witting, M. D., & Winters, M. E. (2017). Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation, 119, 95-98.

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency; 2. activation of EMS; 3. delivery of Advanced Life Support; and4. transporting to the most appropriate facility.Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS).ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition.Why EMS "Destination Protocols" for suspected stroke and STEMI make adifference. ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a more appropriate hospital - one capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGood luck with your ACLS class!

The chain of survival for a cardiac emergency and stroke start the same: preparedness & recognition of an emergency; activation of EMS; delivery of Advanced Life Support; and transporting to the most appropriate facility. Depending on where you live, Emergency Medical Services (EMS) may provide prehospital Advanced Life Support (ALS). ALS ambulances are staffed with paramedics who have training in ACLS skills. Paramedics can perform an assessment, obtain a medical history, and provide life-saving care within minutes of recognition. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference. Review ACLS timed benchmarks for: point of first medical contact to PCI for ST elevation MI; door to CT for suspected stroke; door to tPA for ischemic stroke; and onset of symptoms to EVT for LVO strokes. EMS may bypass a close hospital to transport a STEMI or suspected stroke patient to a more appropriate hospital - one capable of 24/7 PCI or a certified stroke center; because time is heart muscle or brain cells. Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

When you review the chain of survival for a cardiac emergency or a stroke outside of the healthcare setting you will notice some similarities.  At the start is preparedness & recognition of the emergency, followed by activation of EMS, delivery of Advanced Life Support, and transporting to the most appropriate facility.  In a heart attack or stroke, time is heart or brain cells. What are ALS ambulances and what care do paramedics provide in the field. What the research says about EMS bypassing a close hospital in favor of a one with 24/7 CT, PCI, & EVT capabilities. For a more detailed discussion on EMS destination protocols, check out the pod resource page for a link to two EMS On Air podcast episodes that explore patient outcomes in the rural vs urban setting. Connect with me: Website:  https://passacls.com (https://passacls.com) https://twitter.com/PassACLS (@PassACLS) on Twitter https://www.linkedin.com/company/pass-acls-podcast/ (@Pass-ACLS-Podcast) on LinkedIn Good luck with your ACLS class!

Welcome to Sports Med Res' this week in review podcast where we highlight the news in sports medicine research from the week ending on December 10, 2021. This week's podcast focused on the relationships between medication to treat attention deficit hyperactivity disorder and concussions. * ADHD Diagnosis May Not Lead To Increased Risk for Concussion: Medication May Stimulate Prevention * 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group * Asian Pacific Society of Cardiology Consensus Recommendations for Pre-participation Screening in Young Competitive Athletes * Anabolic-Androgenic Steroid Use in Sports, Health, and Society * Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group * ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise RSS Feed, Apple Podcasts, or Google Podcast Evidence-Based CEU Courses from Sports Med Res and Human Kinetics (3-10 EBP CEUs/course) The post Medications May Impact Concussions appeared first on Sports Medicine Research.

Today's Patreon-fueled shout-out is for the Rivanna Conservation Alliance. What are you doing on September 25? That's the day when RCA staff and volunteers will spend the day at the second annual Rivanna River Round-Up, a community watershed clean-up event. Last year, nearly a hundred people helped remove sixty large bags of trash from waterways that feed into the Rivanna as well as over 120 discarded tires. The Rivanna Conservation Alliance will also accept specific areas that you might want to clean as part of the Round-Up. More information as well as registration can be found at rivannariver.org.On today’s show:Charlottesville Fire Chief Hezedean Smith explains changes to the EMS dispatch system to City Council UVA’s new hotel will have a rooftop bar The area’s regional planning body will be run a familiar face The COVID-19 pandemic continues with another 3,737 cases reported today by the Virginia Department of Health. In the past seven days there have been another 239 fatalities reported in Virginia. The seven-day testing positivity has fallen to 9.8 percent from 10.5 percent a week ago. In the Blue Ridge Health District, there are another 112 cases reported today and the percent positivity is at 7.1 percent. There have been four more fatalities reported since the last edition of this newsletter on September 16, 2021. The Blue Ridge Health District will hold a virtual town hall on the pandemic tonight at 7 p.m. If you have questions, you can send them in advance when you register to be on the Zoom call. (register)The person who has been serving as the interim director of the Thomas Jefferson Planning District has been given the job on a permanent basis. Christine Jacobs has been serving in the position since February and was hired after an extensive search. Jacobs took over the position from Chip Boyles who has been serving as Charlottesville City Manager. The TJPDC is a regional planning body that covers the city and the counties of Albemarle, Fluvanna, Greene, Louisa and Nelson. When the University of Virginia’s new hotel and conference center opens on Ivy Road, there will be a rooftop bar. The Buildings and Grounds Committee of the Board of Visitors will meet Thursday to approve a change to the design for the six-story structure which is part of the Emmet/Ivy Corridor. Another future building is the Institute of Democracy and the Committee will consider design guidelines for that structure as well as a renaming proposal to the Karsh Institute of Democracy. They’ll also consider a proposal to name a new McIntire School building Shumway Hall and will consider the expansion of the Encompass Rehabilitation Hospital at the  Fontaine Research Park. The latter had been originally proposed as a new structure at the North Fork Research Park, but the decision was made to expand in place. “The proposed project will renovate and update nearly 50,000 SF in the existing hospital and construct a 16,400 SF addition, allowing the hospital to convert from 50 beds in semi-private rooms to 60 beds in private rooms,” reads the staff report for the item. (meeting packet)In today's subscriber-fueled public service announcement: Lovers of used books rejoice! The Friends of the Jefferson Madison Regional Library will resume the tradition of their annual Fall Book Sale this October 2nd through October 10 at a new location! The Friends of the Library sale will take place at Albemarle Square Shopping Center from 10 a.m. to 7 p.m. each day. Half-price days on October 9 and October 10. Questions? Visit jmrlfriends.org for more information.Charlottesville Fire Chief Hezedean Smith has been on the job nearly ten months and he had the opportunity Monday to talk about the department as well as to explain changes to the way the fire department dispatches ambulances. Earlier this month, representatives from the Charlottesville Albemarle Rescue Squad critiqued the new “proximity dispatch” system. (Story from September 8, 2021)“I’m appreciative of the many years of contributions from CARS for over 60 years and for our Fire Department for over 165 years and agree that working together collaboratively, we’ll be able to create a model system framework in this region based on 21st century concepts and strategies,” Smith said. In this community, emergency calls are routed through the Charlottesville-UVA-Albemarle Emergency Communications Center. Smith said there are initiatives underway to make the system more efficient.“This medical priority dispatch system will replace an almost 25 or 30 year old system that’s being currently used to triage calls that are sometimes not necessarily 100 percent accurate because it requires on information from the 9-1-1 caller,” Smith said.Smith said EMS services across the nation are working to implement something called EMS Agenda 2050 which seeks to position public safety calls as people-centered. “It talks about how EMS personnel must have immediate access to resources that they need for patients including health care providers, social services, and other community resources,” Smith said. In his tenure, Smith said he has realigned the command structure of the Fire Department to better meet those goals and others. One of those is the Neighborhood Risk Reduction program which seeks to inform residents about the specific hazards that face specific demographics and geographic areas.  A StoryMap on this program is available online:“So for example if you want to look at 10th and Page, what’s going on in 10th and Page, you can see what the community profile looks like and this is a compilation of various data sources that are out there,” Smith said. “This neighborhood is first in cardiac arrests. Third for structure fires, diabetic emergencies, cardiac emergencies, falls.” Smith said knowing that information can help with preparations and community outreach. As it relates to the dispatch system, Smith said everyone wants a system that works but there are disagreements about whether the recent change to the proximity dispatch system has been beneficial. Chief Smith said he is in frequent conversations with Albemarle Fire and Rescue Chief Dan Eggleston. “Chief Eggleston and I have the same vision for this system delivery in this region so we have conversations about what the future should look like in this system,” Smith said. Smith said while he intends to collaborate with CARS but if they cannot meet a desired level of service, the city will provide the service instead with professional crews whose salaries are covered by tax dollars. At issue is how to get service calls to get to the scene more quickly with a travel time target of four minutes. Also at issue is the difference between Advanced Life Support (ALS) and Basic Life Support (BLS). Here’s Deputy Chief Mike Rogers with an explanation. “The basic life support level is emergency medical technician basic,” Rogers said. “That’s a requisite for the jobs that the firefighters here at the Charlottesville Fire Department have and that’s the basic level. Bleeding wound care, CPR to the basic life support level, basic anatomy and physiology of being able to take care of the patient.” Advanced Life Support requires more training to allow care at a trauma level. “And essentially that allows the EMT to begin to place IV’s, give some limited amounts of medication,” Rogers said. Chief Smith said the system that has been in place is due for a replacement to increase the chances of a patients’ survival by ensuring all calls have the chance of receiving ALS. “The triage protocols that are in place are greater than 20 years old so the move to a 21st century protocol and electronic framework is underway currently,” Smith said. “Oftentimes the basic life support if all you have is an EMT who cannot execute any advanced skills, that patient does not have getting anything done pre-hospital unless there’s a call for the Fire Department to come and provide ALC which oftentimes delays care even more.”The proximity dispatch system uses algorithms to dispatch calls using automatic vehicle localities and the global positioning system. Chief Smith acknowledges that that the system has caused concerns, but also notes that Albemarle County initiated proximity dispatch in recent years. He also presented evidence that shows how the system is working to increase response times in some neighborhoods. In all, he gave an hour-long lecture that is a must-view for anyone interested in this topic. (watch on BoxCast)During his hour-long presentation, Chief Smith said that “what can be measured can be improved.” “Seventy-one percent of the time in FY21, the first arriving CARS unit on the scene met the performance benchmark for turnout and time,” Smith said. “Not bad. Actually decent! But there’s opportunities for improvement.”However, CARS’ performance on more advanced calls were much lower. Chief Smith said CARS met these calls on time ten percent in FY21. But here’s where the need for better metrics comes in.“The system is designed in a way that the numbers for ALS versus BLS are not necessarily clearly defined because the protocols vary in how the system was set up but essentially there are opportunities for improvement,” Smith said. Smith said the Charlottesville Fire Department’s results on more advanced calls could also use improvement. “Here we have a 58 percent metric that we’re not doing well,” Smith said. “There’s opportunities for improvement here for CFD as well,” Smith said. During the public comment period, UVA trauma surgeon Forest Calland took the opportunity to ask Smith a series of questions and to question the idea of sending ALS units to as many calls as possible. “There’s just simply no evidence pointing to the benefit of having response teams under four minutes for BLS calls and there’s no evidence that sending paramedics to BLS calls is of any benefit,” Dr. Calland said. Last year, Charlottesville a federal grant from the Federal Emergency Management Agency to hire additional firefighters. Dr. Calland said he is concerned by prioritizing ALScalls, the city will lose the financial benefit of volunteer labor. “Your system is going to cost $2.5 million additional per year once your grant runs out,” Calland said. “Is the City Council prepared to take this money out of the taxpayers’ pockets when CARS has been providing this service for free for the last 50 years?”Chief Smith said his presentation was to prepare for the future, and not debate the past. In addressing the questions, he said the SAFER grant was to ensure firefighting capacity and he acknowledged a need to address capacity issues. “I will not be satisfied having insufficient firefighters on the fireground and potentially risking losing a firefighter,” Smith said. “Ultimately the staffing limits will have to be addressed.”Chief Smith said he would be willing to meet with CARS officials when the time is appropriate. “But the idea is to have a conversation because what we have done for the last 60 years or what we’ve done for the last 165, if we continue to do that I don’t think we will move forward with meeting the needs of this community,” Smith said. Charlottesville’s arrangement with CARS is in a memorandum of understanding that has both an operational and a budgetary component. City Attorney Lisa Robertson had suggested that Chief Smith not meet with CARS management while disputes were ironed out.“I think the two issues were conflating and they need to be separate,” Robertson said. “The financial relates to the other but they’re two separate issues. In both issues, both the city manager and the fire chief will have to sit down with CARS and work through both sets of issues. It has absolutely not ever been by intention to tell anyone that you can’t sit down and talk to each other because of legal issues. These are almost purely operational and financial issues.”If you want to know about how emergency services operates in the area do take a look or listen to the whole discussion. (watch on BoxCast)Thanks for listening! Please forward this on to others, and please ask questions in the comment section below! This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

In today’s first Patreon-fueled shout-out is for the Plant Northern Piedmont Natives Campaign, an initiative that wants you to grow native plants in yards, farms, public spaces and gardens in the northern Piedmont. Native plants provide habitat, food sources for wildlife, ecosystem resiliency in the face of climate change, and clean water.  Start at the Plant Northern Piedmont Natives Facebook page and tell them Lonnie Murray sent you! On today’s show:Charlottesville’s Fire Department releases an annual report and the chief defends critiques of a new dispatch system City Council discusses the firing of Police Chief RaShall Brackney An incumbent drops out of the race for Charlottesville City Council Nikuyah Walker is withdrawing from the 2021 election and will be a one-term City Councilor. Walker made the announcement in a Facebook post this morning in which she stated that another Black candidate in the race is being used by the Democratic Party. She said racism she experienced at last night’s City Council meeting was “the final straw.” In the Facebook post, Walker blasted Council for being advocates of white power and called for reform of the city’s city-manager form of government. More on that at the end of today’s newsletter. Walker has so far raised no money during the campaign process. Democrats Brian Pinkston and Juandiego Wade have raised about $70,000 each. Independent Yas Washington has raised $315. The next campaign finance report is due next Wednesday. (VPAP data)The Virginia Department of Health reports another 4,474 new cases of COVID today, with a seven day average of 3,364. There have been 406 deaths since August 9. The seven-day percent positivity has decreased to 10. In the Blue Ridge Health District, there are another 92 cases reported today. There have been a total of 239 fatalities in the district with 146 of them reported in the current calendar year. Those seeking to file new unemployment claims in Virginia will now have to wait a week after enrolling with the Virginia Employment Commission.  The VEC issued a release today to notify people that a temporary suspension of “Waiting Week” first made at the beginning of the pandemic is now over. “In March 2020, Governor Ralph Northam waived the waiting week policy for all Virginia UI claimants as part of the COVID-19 pandemic emergency declaration,” states the release. “The reinstatement coincides with the end of temporary Federal benefit programs on September 4, 2021.”For more on Waiting Week, visit the VEC’s website.The Charlottesville Fire Department has released its annual report for the fiscal year that ended on June 2021. In the past year there is a new chief in Hezedean Smith, recruited 22 new firefighters, and boosted work in community risk reduction. There are 114 total employees in the fire department, including six civilians. There were 5,717 calls for service, with 2,105 of those for fire calls and 3,612 medical calls. Last week, the fire department issued a press release announcing a process change made in July called “proximity dispatch” where automatic vehicle locators and the global positioning system are used.  Council will have a work session on this change on September 20. “When an emergency prompts a 911 call, the region's Emergency Communications Center activates an automated process that immediately finds the closest emergency resources,” reads the release. “Based on the proximity of the vehicles and the city's roadway network, the emergency communication center dispatches the closest units.” At last night’s City Council, Dr. Forest Calland spoke out in objection to the new system. He’s a trauma surgeon at the University of Virginia Health system concerned that Charlottesville - Albemarle Rescue Squad (CARS) units are not being used efficiently. “The system that has been designed and implemented is not well-conceived,” Dr. Calland said. “Survival in an urban EMS system is inversely proportional to the number of paramedics that are deployed out in the city.” Later on in the meeting, CARS chief Virginia Leavell gave a specific example of how the new system is not working. There are a lot of acronyms in this soundbite to explain first. ALS stands for Advanced Life Support and offers advanced care for critical patients. BLS stands for basic life support. “On July 27, two fire engines and a CARS BLS ambulance were dispatched to an ALS level chest pain call because [Charlottesville Fire Department]’s ALS unit was on a BLS call and unavailable,” Leavell said. “CARS had three BLS ambulances in service and available within 1.2 miles of that BLS call at the time of dispatch.” Chief Leavell said CARS should be handling those basic calls. “The new dispatch protocol is an ineffective system in the city,” Leavell said. “It has not resulted in improved patient care. In fact it puts those at the highest risk in jeopardy.”Leavell said she has attempted to meet with Fire Chief Smith but has not been able to do so. In this year’s budget cycle as well as the last, Leavell and others made the claim that the fire department was not holding up its end of a memorandum of agreement related to funding. “I raised the concern last year that I thought what was happening last year to the rescue squad and their budget was grossly unfair to them,” Snook said. “I’m concerned that this year —I don’t know the details but I would like to know more — I’m concerned that we appeared to be headed toward a situation where the present EMS providers to not value the contributions of the rescue squad, which has really been a beloved institution in this town for many, many years.” Remember that quote. We’re going to need it later on. Later on in the meeting, Chief Smith was asked to comment. “Ultimately the enhancements that have been adopted are appropriate for the ten square miles in a city and it is used in other regions that provide EMS and fire services,” Smith said. “We don’t have to look far as it relates to proximity dispatch. Albemarle County right next to us has implemented proximity dispatch since 2016 or 2017. Proximity dispatch ensures that our residents and visitors get the closest appropriately staffed ambulance and or first response vehicles based on established national standards and best practices.” Smith said the changes have lowered response times to the Tenth and Page neighborhood. The conversation on September 20 will shed more light on what may become a legal issue. City Attorney Lisa Robertson said a meeting was to have been held between Chief Smith and CARS, but a string of correspondence from CARS attorney led to that being delayed. Thanks for reading Charlottesville Community Engagement. In today’s second Patreon-fueled shout-out. A concerned Charlottesville parent wants to make sure the community participates in the Middle School Reconfiguration process that is currently underway. After years of discussion, concrete plans are being put forward. You can learn more and contribute at the City of Charlottesville Schools/VMDOs information page at charlottesvilleschools.org/facilities.The Charlottesville City Council meeting on September 7, 2021 was dominated by one of its members’ opposition to the termination on September 1 of former Police Chief RaShall Brackney. No official explanation has been given. Council selects one of its own every two years to serve as Mayor, a position held since January 2018 by Nikuyah Walker. At the beginning of the meeting, a fellow Councilor requested to add an item for discussion that was not previously on the agenda. “Madam Mayor, I would like to ask to add one thing to the agenda,” said Councilor Lloyd Snook. “It would be to move to add the discussion of an appointment of an acting [Americans with Disabilities Act] coordinator.”“And I would like to also request to add the discussion of the termination of the police chief,” Walker said. Snooks’ request was granted on a unanimous vote, but Walker could not get a second to add her discussion to the official agenda. But her opposition would be felt throughout the entire meeting including a few minutes later when she used the Proclamations section of the meeting to thank Brackney for her three years of service to Charlottesville. “I would just like to thank Chief Brackney for her leadership and apologize on behalf of the city for a termination that has tarnished her reputation when she was doing exactly as someone who sat around a table to hire her and was able to participate in that democratic process which as apparently has changed,” Walker said. The powers of City Council are outlined in Chapter 2, Article II of the Charlottesville city code and further detailed in the City Charter. Council appoints a city manager to serve as an executive, and also appoints a finance director and a clerk. Council plays no official role in selecting a police chief.“All departments of city government, including the fire department and police department, shall be under the general supervision of the city manager,” reads Section 5.01 of the charter. The charter is also clear that all Councilors have the same powers. “The mayor, or vice-mayor when performing the duties of the mayor, shall be entitled to a vote on all questions as any other councilor, but in no case shall they be entitled to a second vote on any question,” reads a portion of Section 9. Brackney terminated on September 1City Manager Chip Boyles opted to terminate Brackney’s contract on September 1, 2021 and immediately placed her on administrative leave through November 1, the end of a 90-day period of notification. (read the press release)During the proclamations period, Walker took nearly nine minutes to talk about Brackney’s firing, and to tell future employers that she was treated poorly. She spoke of the need to address systemic racism and to tell Council why the termination was the wrong choice. None of the other Councilors responded and the body moved on to the consent agenda, which Walker voted against. The meeting proceeded with updates from City Manager Chip Boyles. “Staff has developed a formal application process to create roadside memorials along certain city streets for family members of those fatally injured in auto accidents,” Boyles said. “This program should be available by October 1.” Then Council moved on to one of two public comment periods known as Community Matters, where several members addressed the issue. Attorney Jeff Fogel called Council rude for not responding to complaints the firing. “We expect an answer,” Fogel said. “If you meet me on the street and ask me a question on the street, dammit I’m going to answer it? You got a problem? Get off the Council.” Melvin Burruss thanked Walker for speaking out about the firing, and said it was all based on hearsay related to an informal survey conducted by the Police Benevolent Association. An unsigned statement in response to the survey was posted on the city’s website on August 20 shortly after 5 p.m on a Friday. Addressing Boyles, Burruss accused Councilor Snook of acting to remove the chief.“I’m really disappointed there wasn’t an investigation,” Burruss said. “Snook counseled you and he was part of it with you on the termination. You didn’t go to the Council and discuss it with all of them because they are acting… if you did, they are acting kind of ‘I don’t know what happened.’ Or that’s the conveyance they are giving to us. You should do better than that, Chip. We thought better of you when you took over this position.”When it was Council’s turn to speak, Snook wanted to respond why he did not second Walker’s desire to place Brackney’s termination on the record. Virginia’s open meetings law allows for elected bodies to discuss personnel in closed session. (code)“I asked the question when we were in closed session what would be the ground rules if we did so,” Snook said. “Nobody could answer. I am concerned that if we have a public discussion without any ground rules, recognizing that there are libel, slander, other procedural issues that may come up, that we’re opening ourselves up for more problems and I just don’t know what the ground rules are.”Councilor Michael Payne said the timing of the firing created doubt in the minds of the community. “What are we going to do to ensure and ensure for the public that we do not go backwards on reform and that is a real concern,” Payne said. “Has this sent a signal that it is time to go back to the old ways of doing things? I desperately hope that it’s not.”Payne said city leadership must demonstrate that Brackney’s firing was not motivated by a sense that reform was going too far in the department. Councilor Heather Hill said she also did not feel comfortable discussing the matter in public.“These are personnel discussions and I am really sensitive to how much we will discuss publicly at this time without really understanding what the scope of that discussion would be,” Hill said. Vice Mayor Sena Magill did not comment. In rebuttal, Walker took issue with the comment Councilor Snook made about the Charlottesville - Albemarle Rescue Squad. “You used the words ‘grossly unfair’,” Walker said. “So maybe you don’t know how to monitor yourself but that would be a good time to do that. You would need to find out more information without critiquing employees publicly when you and Councilor Hill already have a lot of information because you’ve been meeting with them.” To be clear, Snook did not mention the names of any employees of the fire department.  Council is to have a work session on these issues. Walker said she hoped the process would be fair. But back to the termination. Walker noted that Dr. Brackney was on the call and willing to have a public conversation. “And so if there’s any questions about whether there is a willingness to have that conversation and if it’s about personnel, then we can ask her that question,” Walker said.“It would also involve personnel discussions of other people than Chief Brackney,” Snook said. “Well the other people were not terminated,” Walker said. “Doesn’t matter, “ Snook said. “They still have rights to confidentiality that we are bound legally to respect.” In another back and forth, Walker pressed Hill on whether she was involved in the decision to terminate Brackney. “I have not influenced this process,” Hill said. “I found at the same time at the rest of this Council. That decision has been made. Do I support that decision? I do.”Walker said the time has come for reform of the way Charlottesville is governed. “I know there’s been a lot of discussion about one-fifth means, and I know there’s been a lot of confusion about the fact that I’m a strong Black woman and people don’t like that,” Walker said. Walker said the city manager position should be elected.“Not because I see myself in the position,” Walker said. “But because of the power of that position. I hope the community is understanding that while that is not something that today, this is your community and deciding whether you want someone who doesn’t have to answer your questions to be able to make a decision this important behind closed doors and never answer.”The last time the topic of elections came up was in 2004 when an election study task force was commissioned. Review the results here.Walker asked each Councilor to say if they supported the decision. Vice Mayor Magill went on the record.“I feel that this is a decision of the City Manager, and we hired the City Manager and this is his job,” Magill said. “It is his job to run the city under our overarching policies. I feel like he talks to us, I feel he communicates with us and fundamentally this is his decision and I’m behind him on it, period.”Walker accused the rest of the Council of speaking with Boyles before the termination. “Mayor Walker, one of your fundamental premises is correct,” Snook said. “I have never recommended to Mr. Boyles that he fire Chief Brackney and I’ve told you that.” Walker has more questionsAfter that, Council moved on to other business, business we’ll cover in a future newsletter. After that business concluded, Walker had several questions about what happened with the police chief. Some dealt with comments made by Bellamy Brown, the chair of the Police Civilian Review Board, related to the Police Benevolent Association survey. “The August 20th press release was also unsigned and that was a concern, where people thought this was something the chief forced out,” Walker said. “I would like a public response to who worked on that survey and why their name was left off of it. Specifically, for the city manager. Why wasn’t your name on it?”Walker also wanted to know when the decision was made to place Chief Brackney on leave. Walker also wants to know if Assistant Chief James Mooney will receive special dispensation after rescinding his retirement in order to lead the department in the interim. In the second public comment period at the end of the meeting, Michael Wells of the Central Virginia Chapter of the Police Benevolent Association thanked Boyles for terminating Brackney. “Unfortunately for Dr. Brackney, the Police Benevolent Association climate survey is largely focused not on policy but internal procedural justice issues,” Wells said. “I just want to tell you guys that you have a real issue in Charlottesville City. You have a few people that speak up all the time and those people garner your attention all the time. Now I’m going to be one of those people. Because I’m involved, I want to be involved. I want the city to have a good chief. I wish it had worked out with Dr. Brackney but it did not.”When he was done, Walker took the opportunity to question Wells. That exchange is fully documented in the audio version of this newsletter. Here is some of it:Walker: “Do you think that internal procedural justice is important than healing the wrongs that have been done by policing in this community?” Wells: “I think if you want your police officers to take on other policies and procedures that you have to have buy-in from them.”Walker: “So, 21st century reform, you think our focus should be getting buy-in from police officers?”Wells: “I think your focus should be safe streets because about every other night you have shootings now, so I think your focus needs to be on supporting your officers.”Walker: “So you think throughout the history of policing that there hasn’t been a need for reform?” Wells: “No, I think it’s important for officers to have confidence in their command in order to be most effective, and effective officers are what you need and deserve… you can’t afford a police department with limitless internal distractions and non-existent morale. There’s work to be done.”Walker: “They surveys talked about the reform was causing that low [morale].”Wells: “No, you’re wrong. You’re wrong. You’re wrong. How long have you been a cop?”Walker: “I’m telling you what I read. Your survey also said that both the citizens of the community and the command were a problem.”Wells: “That’s right. They need support from the community…. the community is what’s most important and that means everyone, every race and color and not just Black and brown. Everyone.”Walker: “So the community that’s most affected by policing practices, you don’t believe…”Wells: “Where are your facts about racist policing? Where is that? Provide it?”At this point, a report on 21st Century Policing came up. Have you read it? Here’s a link to a 36-page document with its results. (report)Another resource that was not discussed was the Disproportionate Minority Contact report from January 2020. (report)Walker: “Why did President Obama institute that task force?”Wells: “I think we know why.”Walker: “Tell me!”Wells: “Good day, Mayor.”Walker then addressed Council. “That’s what you just signed on for and you all should be ashamed because as I told you in closed session, they’re not coming for your kids.” Walker said. “They’re not going to target you.”To conclude today, I want to draw your attention to legislation that passed the General Assembly in a special session held in the summer of 2020. Localities in Virginia are subdivisions of the state government. Legislation in that session included:Officers are now required to intervene if they see a fellow officer using excessive force Law enforcement agencies are no longer allowed to purchase surplus military gearPolice civilian review boards received additional oversight powers Neck restraints are explicitly banned Attorney general obtained more power to pursue civil suits against law-enforcement officersDepartment of Criminal Justice required to add implicit bias training to uniform curriculum for sworn officerCreation of the Marcus Alert system to create reform of how government first-responders operate in mental health crisesSome of this legislation was discussed in the pilot episode of a new program on Radio IQ that I helped produce. William Fralin moderates a discussion of police use of force with guests Claire Gastañaga, formerly of the Virginia ACLU, and Chief Maggie DeBoard, of the Virginia Association of Chiefs of Police. Take a listen.What’s next in Charlottesville? Not sure. As you can hear in this newsletter, the community faces a lot of problems. This newsletter intends to try to track as much of it as I can and I appreciate your reading and listening. I do not know the answers and my role is never to tell you what to think. Thanks for reading. This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

On Episode 7 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the August 2021 issue of Stroke: “Stroke Risks in Adult Survivors of Preterm Birth: National Cohort and Cosibling Study” and “Roles of Phytoestrogen in the Pathophysiology of Intracranial Aneurysm.” She also interviews Drs. Nirav Bhatt and Diogo Haussen about their article “Reliability of Field Assessment Stroke Triage for Emergency Destination Scale Use by Paramedics: Mobile Stroke Unit First-Year Experience.” Dr. Negar Asdaghi: 1) Can preterm birth be associated with increased risk of stroke in adulthood? 2) Can a plant-based diet high in phytoestrogens reduce the risk of aneurysm formation and aneurysmal rupture in postmenopausal women? 3) What is the predictive ability of FAST-ED score in detection of large vessel occlusion? We will review these questions in today's podcast. You're listening to the Stroke Alert Podcast. Stay with us. Dr. Negar Asdaghi:         From the Editorial Board of Stroke, welcome to the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The August 2021 issue of Stroke covers a wide range of topics from examining if the presence of spot sign modifies the treatment effect of tranexamic acid in patients with intracerebral hemorrhage to the results of the PRESERVE randomized clinical trial examining whether intensive blood pressure lowering in patients with severe cerebral small vessel disease can be associated with progression of white matter damage as detected by diffusion tensor imaging or MRI studies, which I encourage you to review in addition to our podcast today. Dr. Negar Asdaghi:         Later in today's podcast, I have the pleasure of interviewing Drs. Diogo Haussen and Nirav Bhatt from Emory University on their work on reliability of FAST-ED scale when used by the paramedics in mobile stroke units and learn about the implementation of mobile stroke units in Atlanta. But first with these two articles. Dr. Negar Asdaghi:         Preterm birth, defined as birth prior to 37 weeks of gestation, affects approximately 11% of births worldwide. Today, with the advent of modern neonatal and pediatric care, the majority of preterm babies survive into adulthood. Multiple studies have shown that adult survivors of preterm birth are at increased risk of developing vascular risk factors, such as diabetes and hypertension, and have a higher incidence of ischemic heart disease as compared to their age-matched individuals born at term, though the association between preterm birth and risk of stroke is not well studied. Dr. Negar Asdaghi:         In the current issue of the journal, Dr. Casey Crump from Departments of Family Medicine and Community Health and Population Health Science and Policy at Icahn School of Medicine, Mount Sinai, New York, examined whether preterm birth is associated with an increased risk of stroke and its major subtypes in adulthood. The authors use the prenatal and birth information obtained from the Swedish Birth Register, which contains information for nearly all births in Sweden since 1973. The study cohort included over 2,200,000 singleton live births in Sweden from 1973 to 1994. These years were chosen to allow for sufficient follow-up into adulthood. The study cohort was examined for the earliest diagnosis of stroke from the time the participants turned 18 through September 31, 2015, and the maximum age of included population is 43 years. Stroke was identified using ICD codes from all primary and secondary diagnosis in the Swedish Hospital and Outpatient Registries and all deaths attributed to stroke in the Swedish Death Register. Dr. Negar Asdaghi:         Cosibling analyses assess for potential shared, familial confounding factors, such as genetic and environmental factors, that could contribute to development of stroke. In 28 million person-years of follow-up, 4861, or 0.2% persons, were diagnosed with stroke between 18 to 43 years of age. The authors found that low gestational age at birth was associated with a significantly higher risk of first-time stroke in adulthood. In their adjusted model, as compared to those born at full-term, the hazard ratio for any stroke associated with early preterm, that is birth between 22 to 33 weeks of gestation, was 1.4, and the hazard ratio for late preterm, that is birth between 34 to 36 weeks of gestation, was 1.22, both of which were statistically significant. Interestingly, each additional week of gestation was, on average, associated with a 3% lower risk of first stroke in adulthood. Dr. Negar Asdaghi:         Similar associations were found in men and women and for both hemorrhagic and ischemic strokes. These findings were only partially explained by shared genetic or environmental risks of preterm birth and stroke within families, suggesting important direct effects of preterm birth on risk of stroke. Multiple putative mechanisms that could potentially link preterm birth with increased stroke risk were discussed in the paper as well, including interaction of fetal angiogenesis during the critical developmental period leading to reduced capillary density and increased arterial stiffness, to persistently elevated levels of anti-angiogenic factors, which are correlated with increased blood pressure development and development of hypertension in adulthood. In summary, the study findings suggest that preterm birth should be recognized as a risk factor for stroke later in life, and survivors need early preventive evaluation and long-term clinical follow-up into adulthood to reduce their lifetime risk of stroke. Dr. Negar Asdaghi:         The incidences of intracranial aneurysm and aneurysmal subarachnoid hemorrhage are high in postmenopausal women, suggesting estrogen may be protective against aneurysm formation or aneurysmal rupture. However, estrogen-containing hormone replacement therapy is also associated with an increased risk of other significant adverse outcomes, such as increased risk of breast cancer and ischemic stroke, and is not routinely recommended for primary prevention of chronic conditions in postmenopausal women. Isoflavones, a type of phytoestrogen, are plant-based, diet-derived compounds with properties similar to estrogen. Two types of isoflavones, genistein and daidzein, are found in soybeans, chickpeas, and lentils and are thought to be the most potent phytoestrogens that exert estrogenic activities with tissue and receptor specificity. Regular consumption of isoflavones has been shown to alleviate the vasomotor symptoms of estrogen deficiency and associated with reduced incidence of estrogen-dependent diseases in postmenopausal women. Daidzein, once ingested, is converted to its bioactive metabolite, equol, which preferentially binds to estrogen receptor beta, a receptor subtype responsible for the protective effect of estrogen against the formation and rupture of intracranial aneurysms. Dr. Negar Asdaghi:         In the paper titled "Roles of Phytoestrogen in the Pathophysiology of Intracranial Aneurysm," Dr. Tomoki Hashimoto from the Barrow Aneurysm and AVM Research Center, Departments of Neurosurgery and Neurobiology, the Barrow Neurological Institute, and colleagues investigated whether the phytoestrogens daidzein and its bioactive form, equol, are protective against the formation and rupture of intracranial aneurysms in ovariectomized female mice. Intracranial aneurysms were induced by combining systemic hypertension and a single injection of elastase into the CSF at the right basal system. Ovariectomized mice were fed with an isoflavone-free diet. The systemic treatment with equol delivered via an implanted mini-osmotic pump in the treatment group (0.5 mg/kg/day) or vehicle (in the control group) began one week before aneurysm induction and was continued for four weeks thereafter. So, what they found was that equol treatment significantly reduced the incidence of aneurysm formation compared to vehicle, and there was a trend for equol-treated mice to have a lower incidence of aneurysmal rupture than control mice, while there was no difference in the blood pressure noted between the two groups. Dr. Negar Asdaghi:         Furthermore, systemic treatment through equol decreased mRNA expression of proinflammatory cytokines, such as IL-6 and interleukin-1β. Importantly, equol seems to require estrogen receptor beta, as the observed protected effects of equol against aneurysm formation was not duplicated in ovariectomized estrogen receptor beta knockout mice. The authors further demonstrated that dietary daidzein reduced the incidence of aneurysm formation, an effect that was dependent on the conversion of daidzein to equol as the beneficial effect of this dietary supplement was abolished in mice that were fed vancomycin, which prevented the intestinal microbial conversion of daidzein to equol. In summary, this study showed that both dietary oral daidzein or the systemic use of its bioactive metabolite, equol, protect against aneurysm formation in ovariectomized female mice through the activation of estrogen receptor beta and subsequent suppression of inflammation. These results indicate a potential therapeutic value of phytoestrogen in prevention of intracranial aneurysm formation and related subarachnoid hemorrhage. Dr. Negar Asdaghi:         Early recognition of stroke-like symptoms, combined with increased utilization of revascularization therapies, have greatly improved the clinical outcomes of patients with acute ischemic stroke, but have similarly resulted in an ever-growing demand on the stroke systems of care. In the era of endovascular thrombectomy, a prehospital scoring tool with predictive abilities for detection of a target vessel occlusion can greatly assist in the appropriate triage, transfer, and activation of the endovascular team for eligible patients, all the while preventing the inevitable fatigue that accompanies the overuse of the system by properly triaging out those who have a lower likelihood of needing endovascular therapy. For any scoring system used in the prehospital setting, the need for precision needs to be balanced with notions such as ease of administration, time consumption, and reproducibility, as decisions made in the field are invariably fast and frequently made in unstable situations. The Field Assessment Stroke Triage for Emergency Destination, or the FAST-ED scale, is one such stroke scale that meets many of the above-stated criteria in patients with stroke-like presentations to predict a possible large vessel occlusion. Dr. Negar Asdaghi:         In the paper titled "Reliability of FAST-ED Scale Use by Paramedics: Mobile Stroke Unit First-Year Experience," Drs. Nirav Bhatt and Diogo Haussen and colleagues, from the Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, and the Department of Neurology at Emory University School of Medicine in Atlanta, report on the reliability of the FAST-ED score in the prehospital setting when used by the paramedics in a mobile stroke unit. I'm joined now by Drs. Bhatt and Haussen to discuss this paper. Good afternoon, Nirav and Diogo. Thank you very much for joining us. Dr. Nirav Bhatt:               Thank you so much for the invitation. I'm very happy to be here. Dr. Diogo Haussen:         Thank you very much. It is a great pleasure to join you. Dr. Negar Asdaghi:         Right. In this paper, the FAST-ED score was administered by the paramedics in a mobile stroke unit. So Nirav, to get us started, please tell us about the concept of a mobile stroke unit, how long it's been implemented in Atlanta, and what it means for patients with stroke-like symptoms who would possibly have a large vessel occlusion. Dr. Nirav Bhatt:               The mobile stroke unit, or the MSU, is an ambulance equipped with a CT scanner and state-of-the-art telemedicine capabilities and is operated by the Grady Emergency Medical Services that covers majority of Metro Atlanta and many of its suburbs, caring for a population of a little over 500,000. It was specifically incorporated to expedite care amongst patients with suspected strokes and went into operations on 30th May, 2018, Monday through Saturday, 12 hours a day, 8 a.m. through 8 p.m. It is operated by a group consisting of an EMT driver, a paramedic, an emergency medicine registered nurse, and a CT technician. So, when a patient has symptoms suspicious for a stroke, the MSU is activated either through 911 dispatch or by an ALS ambulance crew evaluating a possible stroke alert patient in the field. After the initial stroke triage performed by the MSU crew, if there is a persistent suspicion for stroke, the patient is transferred to the MSU and a noncontrast CT scan of the brain is immediately performed. Dr. Nirav Bhatt:               These CT images are transmitted via the telemedicine platform and are available for review by the vascular neurologist and neuroradiologist in real time. With the help of telemedicine technology, a remotely located vascular neurologist then examines the patient. So, with the help of telemedicine and CT scanner, it allows the remotely located vascular neurologist to identify patients who may qualify for IV alteplase, which is then administered in the MSU to qualifying patients, and these patients get subsequently transported to a stroke treatment center. Now, if the neurological exam is concerning for a large vessel occlusion and the non-contrast CT scan does not show corresponding early ischemic changes, these patients get transferred specifically to a comprehensive stroke center for consideration of thrombectomy. At our centers, some of these patients get directly transported to the neuro-angio suite for further imaging and possible thrombectomy. Thus, the MSU serve a very important goal of expediting critical neurological care for a stroke patient, not only by administering IV alteplase in the field to qualifying patients, but also early triage and transport of qualifying patients to the neuro-angio-suite and with earlier activation of neuroangiosuite. Dr. Negar Asdaghi:         Perfect, Nirav. An important and a growing concept, bringing treatment to patients and helping with triaging them appropriately, as you mentioned, which I'm sure we'll see more of in the United States and across the world. Now, Diogo, over to you. Can you tell us about the FAST-ED score, its components, then about the reliability of FAST-ED score in the prehospital setting prior to your current study? Dr. Diogo Haussen:         So, the landmark trials published in 2015 defined mechanical thrombectomy as this very effective and powerful treatment of large vessel occlusion stroke patients, and the clinical and the public health impact of this treatment are certainly highly dependent on the rapid triage of these folks into the appropriate destination. So, this involves the prompt identification of patients with severe symptoms by the emergency medical system personnel, and obviously the transportation of them for a thrombectomy capable center. So, some scales had been proposed earlier on, and the FAST-ED was then developed, and it aimed to help with the identification of patients with a higher probability of having a large vessel occlusion stroke. So, in 2017, we validated the scale on stroke patients that had undergone contrast-enhanced vascular images, which had not been done before, in this publication led by Fabricio Lima and Raul Nogueira in Stroke, in the Stroke journal. Dr. Diogo Haussen:         So, this paper demonstrated that FAST-ED had higher accuracy than RACE and CPSS. The main limitation at the time was the fact that the FAST-ED score derived from the NIH Stroke Scale and, therefore, had to be validated in the field. The FAST-ED scale stands for the important features that are involved with stroke care and recognition and triage, such as facial palsy, arm weakness, speech changes, and time. Then we complimented this with findings of critical dysfunction illustrated by eye deviation and also denial/neglect. So, the FAST-ED has the following scoring system: So, facial palsy scored from zero to one; arm weakness from zero to two; speech changes, which is aphasia, from zero to two; time is just for documentation, but not for really any decision-making in terms of the scale itself. So, eye deviation goes from zero to two, and denial/neglect from zero to two, and again, was designed based on the items of the NIH Stroke Scale with higher predictive value for large vessel occlusion strokes. I think Nirav is going to discuss a little bit more about why we chose those cutoffs, but they're all designed in a specific way. Dr. Negar Asdaghi:         Perfect. So a quick score that can be administered easily by different healthcare personnel. So, please tell us, before we go back to Nirav, about your paper's methodology. What were you hoping to expand on the existing knowledge with this paper? Dr. Diogo Haussen:         I'm just going to repeat a few things, but our mobile stroke unit is equipped obviously with a CT machine and is staffed by an EMT driver and emergency medicine registered nurse, a paramedic, and a CT technician. So, a remote evaluation of patients by a vascular neurologist is then performed through this video-based telemedicine platform. The MSU, as he mentioned, is routinely accompanied by an Advanced Life Support–staffed ambulance, which responds to the suspected stroke calls, and sometimes then calls in or calls off the potential of our stroke code. And as part of this MSU evaluation, the FAST-ED is then administered by the MSU paramedic via the FAST-ED smartphone application that was designed. And then an independent NIH is performed by the registered nurse within the MSU. So, subsequently, the patient is transferred into the MSU itself and a non-conscious CT is performed. Once the scan is completed, the patient is evaluated by the vascular neurologist in a two-way video conference where the FAST-ED is then estimated by the physician. Dr. Diogo Haussen:         So, all patients are then transferred to the comprehensive stroke center, where further evaluation, including vascular imaging, is performed. The vascular imaging data was formerly read by neuroradiology and then followed by an independent read by the vascular neurologist for the identification of large vessel occlusion strokes, which we define in this paper as an intracranial occlusion off the internal carotid, the M1 or the M2 branches of the middle cerebral artery or the basilar artery. The study encompassed our initial experience, which was from May of 2018 till August of 2019. And we have some other goals, but the initial experience was planned to allow us to investigate, once again, this most important feature, which is the potential reliability of the estimation of the FAST-ED score by paramedics in the field. Dr. Negar Asdaghi:         Perfect. Thank you for this background, Diogo. Now Nirav, we're ready to hear about the study results. Dr. Nirav Bhatt:               So, in the first 15 months of operation of the mobile stroke unit, we analyzed data on 173 eligible patients. We had an almost equal distribution of our patients in terms of gender. We had 52.6% females, and the majority of our patients were Black. We found that FAST-ED scores matched perfectly between paramedics and vascular neurologists 56% of the time, and there was only a zero to one point difference in 91% of the cases. Cases in which the discrepancy of the FAST-ED score between the paramedic and vascular neurologist was two points or higher were less than 9%. Overall, the intraclass correlation of FAST-ED score between the paramedic and the vascular neurologist was 0.94, indicating excellent interrater reliability. Dr. Negar Asdaghi:         Thank you. You found a higher interrater reliability between the paramedics and vascular neurologists for scores of three or above on the FAST-ED scale. Higher FAST-ED scales also were more specific in terms of detection of a target vessel occlusion. How should your results be interpreted in our day-to-day practice, Nirav? Dr. Nirav Bhatt:               That is correct. When vascular neurologists recorded a FAST-ED score greater than or equal to three, paramedics also recorded a FAST-ED score greater than or equal to three in 87.5% of the instances, and when a vascular neurologist recorded a FAST-ED score of greater than or equal to four, the paramedics also recorded a FAST-ED score of greater than or equal to four in 92% of the instances. This is suggestive that when the patients presented with a moderate to a severe stroke, that EMS paramedics were highly reliable in identifying the neurological severity of these patients. This provides a sound basis for more widespread utilization of FAST-ED as a simple and reliable tool that can be utilized by paramedics to identify stroke severity in the field. Dr. Negar Asdaghi:         Thank you, Nirav. Simple indeed. I know Diogo briefly alluded to this, but can you also tell us a little more about how FAST-ED compares to the other prehospital scoring systems in terms of their interrater reliability and LVO prediction? And what should be our takeaway message from your paper? Dr. Nirav Bhatt:               Yes, absolutely. So, just to give you an example, the Los Angeles Motor Scale, LAMS, tests for facial droop, arm drift, and grip strength, but does not really test for cortical signs. We know that a lot of patients with subcortical strokes will have those features, meaning facial droop, arm drift, and decreased grip strength. Similarly, while RACE is very similar to FAST-ED, it tests for leg weakness in addition to what FAST-ED does. It also puts a lot more emphasis on the facial droop as compared to FAST-ED. And with that, I want to draw your attention to a study that we cited in our paper where these scales were compared head to head, and while the accuracies of all the prehospital scales were found to be acceptable, the accuracy of RACE and LAMS were slightly higher than that of FAST-ED. However, it should be noted that in almost 35% of the cases, a complete FAST-ED score could not be reconstructed largely due to data and availability regarding patients' neglect. Dr. Nirav Bhatt:               This percentage for data and availability for RACE was even higher, meaning we have to consider the feasibility of these scales when we recommend the widespread adoption of these scales into our communities. Overall, the takeaway from this entire study is we strongly believe that there needs to be a system in place for prehospital stroke triage in order to identify and transport the patients to the right destination rapidly. However, the choice of individual scales should be made after consideration of the geographical characteristics of a particular community, and also that experience and that comfort with the level of training required for reliable performance of each of these scales by the EMS personnel. Dr. Negar Asdaghi:         Thank you so much, Nirav. More to come on this, I'm sure, in the future. Thank you for joining us on the podcast today. Dr. Nirav Bhatt:               Thank you so much. It was our pleasure. Dr. Negar Asdaghi:         Thank you, Drs. Nirav Bhatt and Diogo Haussen. Thank you for joining us on the podcast today, and we look forward to covering more of your work in the future. This concludes our podcast for the August 2021 issue of Stroke. Please be sure to check out the August table of contents for the full list of publications, including a special report on the safety of the mobile stroke units and a descriptive review of the amount of radiation exposure to the public, patients, and staff from these mobile units. With that, as our work to save every brain cell from ischemic and hemorrhagic damage continues, we invite you to stay alert with Stroke Alert. Dr. Negar Asdaghi: This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

We will interview our ALS Division Officer Thearon Shipman and talk about this invaluable service and feature of the City FD. We talk terms, tools, and terminology!

Cardiac Advanced Life Support (CALS) is a course   that covers the management of the deteriorating and/or arresting patient following cardiac surgery. The CALS algorithm is considered the standard to optimally manage an arresting cardiothoracic patient and this podcast will explore the elements of this protocol. Join us as we chat to Dr Chris Hebel an ICU intensivist who runs the CALS course at GCUH and Sarah Croton, ICU CN who assists with the CALS course and has also been involved in multiple re-opens. Please find below the CALS algorithm...  

View the full show notes on Google Docs here: http://bit.ly/3cpvlJc 2020 BLS/ACLS Guideline Changes Merchant RM, Topjian AA, Panchal AR, et al. Part 1: Executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Published October 21, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918 Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association. Published 2020. Accessed January 20, 2021. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts2020eccguidelinesenglish.pdf Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. Published April 9, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.047463 Topjian A, Aziz K, Kamath-Rayne BD, et al. Interim Guidance for Basic and Advanced Life Support in Children and Neonates with Suspected or Confirmed COVID-19. Pediatrics. Published 2020. Accessed January 20, 2021. https://pediatrics.aappublications.org/content/early/2020/04/13/peds.2020-1405 Hunt EA, Jeffers J, McNamara L, et al. Improved Cardiopulmonary Resuscitation Performance with CODE ACES2: A Resuscitation Quality Bundle. Journal of the American Heart Association. Published December 7, 2018. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/JAHA.118.009860 Procedural Pearl of the Month - Fish Hooks Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 20, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Fishing Out the Fishhook. Emergency Medicine News. Published September 1, 2020. Accessed January 20, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=108 Droperidol DeFranco, C, DO. Oldie but a Goodie: 10 Pearls of Droperidol. Acep.org. Published 2021. Accessed January 20, 2021. https://www.acep.org/how-we-serve/sections/pain-management/news/may-2020/oldie-but-a-goodie-10-pearls-of-droperidol/ Ho, J, FAAEM MD, Perkins J, FAAEM MD. Clinical Practice Statement: Safety of Droperidol Use in the Emergency Department. Aaem.org. Published September 7, 2013. Accessed January 20, 2021. https://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf Cisewski, D MD. Droperidol Use in the Emergency Department – What's Old is New Again. Emdocs.net. Published August 1, 2019. Accessed January 20, 2021. http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ Ken's Third View SGEM#315: Comfortably Numb with Topical Tetracaine for Corneal Abrasions. Thesgem.com. Published January 16, 2021. Accessed January 20, 2021. http://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/ Shipman S, Painter K, Keuchel M, Bogie C. Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial. Ann Emerg Med. Published October 27, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33121832/ SGEM#316: What A Difference an A.P.P. Makes? Diagnostic Testing Differences Between A.P.P.S and Physicians. Thesgem.com. Published January 23, 2021. Accessed January 24, 2021. http://thesgem.com/2021/01/sgem316-what-a-difference-an-a-p-p-makes-diagnostic-testing-differences-between-a-p-p-s-and-physicians/ Pines JM, Zocchi MS, Ritsema TS, Bedolla J, Venkat A, US Acute Care Solutions Research Group. Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. Acad Emerg Med. Published November 21, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33107088/ Gonorrhea Questions Answered Scully BE, Fu KP, Neu HC. Pharmacokinetics of ceftriaxone after intravenous infusion and intramuscular injection. Am J Med. Published October 19, 1984. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/6093511/ Meyers BR, Srulevitch ES, Jacobson J, Hirschman SZ. Crossover study of the pharmacokinetics of ceftriaxone administered intravenously or intramuscularly to healthy volunteers. Antimicrob Agents Chemother. Published November 1983. Accessed January 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC185948/ Shatsky M. Evidence for the use of intramuscular injections in outpatient practice. Am Fam Physician. Published February 15, 2009. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/19235496/ Trivia Question: Send answers to 2viewcast@gmail.com Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That's right, ANY CCME course you want. You can buy it for yourself or give it to a friend - it's your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com, that's the number 2, view, cast @gmail.com and tell us who you want to give a shout-out to.

In part 2 of the cardiac arrest series,  Dr. Rebecca Gragg, an ER pharmacist at a pediatric trauma center, discusses some key points from the 2020 PALS guidelines.References:Antevy, P. Handtevy method helps providers rapidly calculate pediatric drug dosages. JEMS. 2013; 8 (38). Available at: https://www.jems.com/2013/08/20/handtevy-method-helps-providers-rapidly/Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S469- 523

In part 1 of the cardiac arrest series, we review some key recommendations and clinical pearls from the 2020 adult BLS and ACLS guidelines. References: Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19. Circulation. 2020; 141 (25): e933- 943Velissaris D, Karamouzos V, Pierrakos C, et al. Use of sodium bicarbonate in cardiac arrest: current guidelines and literature review. J Clin Med Res. 2016; 8 (4): 277-283Murchison C. Sodium bicarbonate therapy does not work in cardiac arrest. Updated November 5, 2018. Accessed December 1, 2020. http://www.emdocs.net/sodium-bicarbonate-therapy-does-not-work-in-cardiac-arrest/

What is dual/double defibrillation? How does it work? Does it improve patient outcomes? Find out this week! References:Miraglia D, Miguel LA, Alonso W. Double defibrillation for refractory in- and out-of-hospital cardiac arrest: a systematic review and meta-analysis. J Emerg Med. 2020; 59 (4): 531-541Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468

Recently, Alberta Health Services announced ambulance dispatch services will be consolidated across the province, pulling Calgary, Lethbridge, Red Deer and Wood Buffalo into existing EMS dispatch centres. Lethbridge Fire Department (LFD) has been providing Ambulance/EMS services to citizens since 1912, and have always been the dispatch service as well. They are currently under contract to AHS EMS to provide the EMS service as well as the Dispatch service. The Dispatch service provides coverage not only to the City of Lethbridge, but many other EMS services in the area. LFD has several concerns with Alberta Health Service Emergency Medical Services decision to remove local EMS dispatch from Lethbridge and move it to Calgary. They feel this will create delays in dispatching of Fire units that also provide Advanced Life Support to our citizens. They also have concerns that AHS EMS provided dispatch will eliminate the City EMS units, leaving the service short of units. As well, a lack of familiarity with this area will arguable create additional delays. The speaker will elaborate and explain how crucial quick response times are when trying to save lives. Speaker: Warren Nelson Warren Nelson is the President of the International Association of Fire Fighters' Local 237, Lethbridge. He has been with the Lethbridge Fire Department for 22 years and involved with their Union since 2001. Date and time: Thursday, September 3, 2020 at 10am Mountain Time YouTube Live link: https://www.youtube.com/watch?v=E2XEhTrqhnw In order to ask questions of our speaker in the chat feature of YouTube, you must have a YouTube account and be signed in. Please do so well ahead of the scheduled start time, so you'll be ready. Go the YouTube Live link provided in this session flyer and on the top right of your browser click the “sign in” button. If you have Google or Gmail accounts, they can be used to sign in. If you don't, click “Create Account” and follow along. Once you are signed in, you can return to the live stream and use the chat feature to ask your questions of the speaker. Remember you can only participate in the chat feature while we are livestreaming. Link to SACPA's YouTube Channel: https://www.youtube.com/channel/UCFUQ5mUHv1gfmMFVr8d9dNA

Recently, Alberta Health Services announced ambulance dispatch services will be consolidated across the province, pulling Calgary, Lethbridge, Red Deer and Wood Buffalo into existing EMS dispatch centres. Lethbridge Fire Department (LFD) has been providing Ambulance/EMS services to citizens since 1912, and have always been the dispatch service as well. They are currently under contract to AHS EMS to provide the EMS service as well as the Dispatch service. The Dispatch service provides coverage not only to the City of Lethbridge, but many other EMS services in the area. LFD has several concerns with Alberta Health Service Emergency Medical Services decision to remove local EMS dispatch from Lethbridge and move it to Calgary. They feel this will create delays in dispatching of Fire units that also provide Advanced Life Support to our citizens. They also have concerns that AHS EMS provided dispatch will eliminate the City EMS units, leaving the service short of units. As well, a lack of familiarity with this area will arguable create additional delays. The speaker will elaborate and explain how crucial quick response times are when trying to save lives. Speaker: Warren Nelson Warren Nelson is the President of the International Association of Fire Fighters' Local 237, Lethbridge. He has been with the Lethbridge Fire Department for 22 years and involved with their Union since 2001. Date and time: Thursday, September 3, 2020 at 10am Mountain Time YouTube Live link: https://www.youtube.com/watch?v=E2XEhTrqhnw In order to ask questions of our speaker in the chat feature of YouTube, you must have a YouTube account and be signed in. Please do so well ahead of the scheduled start time, so you'll be ready. Go the YouTube Live link provided in this session flyer and on the top right of your browser click the “sign in” button. If you have Google or Gmail accounts, they can be used to sign in. If you don't, click “Create Account” and follow along. Once you are signed in, you can return to the live stream and use the chat feature to ask your questions of the speaker. Remember you can only participate in the chat feature while we are livestreaming. Link to SACPA's YouTube Channel: https://www.youtube.com/channel/UCFUQ5mUHv1gfmMFVr8d9dNA

PMC 2020 - Day 2 - Synopis of Basic _ Advanced Life Support - Dr. Chidozie Osuoji

Dr. Felipe Teran joins Drs. Cindy Hsu and Hans van Schuppen to discuss recent guidance regarding cardiac arrest resuscitation during the COVID-19 pandemic. Key publications referenced in this episode:  Couper K, Taylor-Phillips S, Grove A, et al. COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review. Resuscitation. 2020; 151:59-66. https://pubmed.ncbi.nlm.nih.gov/32325096/ Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians. Circulation. 2020 https://pubmed.ncbi.nlm.nih.gov/32270695/ Perkins GD, Morley PT, Nolan JP, et al. International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights. Resuscitation. 2020; 151:145-147. https://pubmed.ncbi.nlm.nih.gov/32371027/ Perkins GD, Couper K. COVID-19: long-term effects on the community response to cardiac arrest? Lancet Public Health. 2020 https://pubmed.ncbi.nlm.nih.gov/32473112/

Dr. Usha Mantha MD is the founder and CEO of Verve Weight Loss and Laser Aesthetics, a medical spa located in Upland, California in the greater Los Angeles area. Having trained and received membership from the Royal College of Obstetricians and Gynaecologists in London, U.K., Dr. Mantha has been a Women’s Health expert for over 30 years. Not only is Dr. Mantha a dual Board-Certified physician in Obesity Medicine in California and Family Medicine in Pennsylvania, but she is also a Provider, Instructor, and Advisory Faculty in Advanced Life Support in Obstetrics and Advanced Cardiac Life Support in adults. After decades specializing in women’s health, Dr. Mantha trained and became an expert in weight loss management, and has helped hundreds of patients in the Inland Empire with offices in Pomona and Upland, California over the past 15 years. She is Director of Weight and Wellness clinic at Casa Colina Hospital for Rehabilitation, where she treats overweight and obese patients in pre- and post-operative care. She is also a visiting faculty instructor at School of Medicine at Riverside and teaches Family Medicine and PM&R residents at both Casa Colina and Pomona Valley Hospital Medical Centers. She is now the proud founder and CEO of Verve Weight Loss and Laser Aesthetics, where she continues to help patients be healthy from the inside and beautiful on the outside. Visit www.vervemedspa.com to learn more about Dr. Mantha’s extensive range of treatments and options for your individual needs. During this major pandemic and unprecedented time, obesity, along with its all inherent, extensive metabolic disorders, has played a key role in mortality among the victims. Normalizing weight is key in improving and boosting immunity to Covid-19 with outside pollutants. Therefore, focused weight loss activities and maintenance of weight have never been more important than now. So today, we will talk to Dr. Mantha about what are some ways we can stay healthy, reduce weight and improve our immunity to treat the COVID19 infection.

La resucitación cardiopulmonar (RCP, o CPR) es un procedimiento que genera aerosoles, lo que aumenta el riesgo para las personas alrededor. En este artículo discutimos el uso de RCP mecánica en pacientes con COVID19 para reducir el riesgo a los rescatistas. La American Heart Association publicó unas guías interinas de resucitación cardiopulmonar (RCP, o CPR) para pacientes con COVID19. En este episodio presentamos la entrevista a Adiel García, de ADIEL acerca de su experiencia en la implementación de los dispositivos de RCP mecánica y cómo esto puede ser útil en el contexto del paciente con COVID19. Muerte Súbita + COVID19 Los pacientes que tienen muerte súbita de etiología cardiaca pueden tener buenas posibilidades de sobrevivencia si se intenta resucitar de la mejor forma que sabemos hacer hoy día. Aunque la etiología del paro cardiaco sea presumiblemente por isquemia coronaria o arritmia, durante la crisis del COVID19 todos los pacientes se tratan bajo la premisa de que están contagiados con COVID19 y son potencialmente infecciosos a pesar de que no hayan tenido signos o síntomas previo al paro cardiaco. Entonces, tenemos que buscar formas creativas de minimizar el riesgo al personal que realiza las compresiones cardiacas y el manejo de la vía aérea durante el paro cardiaco. Objetivos durante el paro cardiaco La protección del personal se suma ahora a los objetivos del manejo. Si miramos el problema desde una perspectiva macro, el intento de reanimar al paciente en paro cardiaco busca proteger el cerebro (manteniendo una perfusión adecuada al cerebro a través de las compresiones y ventilaciones), mientras se corrige la causa del paro (arritmia, u otras causas tratables). A esto le tenemos que sumar el hacerlo sin aumentar el riesgo a los rescatistas. Cómo minimizar el riesgo Algunas de las intervenciones que pueden ayudar a reducir el riesgo a las personas alrededor del paciente es: Todo rescatista debe tener su equipo de protección personal. En este momento se está recomendando que las personas tengan su propia mascarilla cuando están en público. Los profesionales de la salud que atienden a pacientes en el lugar de trabajo deben colocarse su equipo de protección personal antes de entrar al lugar donde se encuentra el paciente. Limitar el número de personas que están presentes en la escena o el cuarto del paciente Colocar alguna barrera sobre la boca del paciente (una mascarilla de no-reinhalación si no se va a ventilar de inicio, realizar una intubación endotraqueal que aisle la vía aérea, y/o alguna tela o mascarilla que minimice la aerosolización de las gotas exhaladas. Colocar un dispositivo de compresiones mecánicas Nuevos algoritmos para pacientes con paro cardiaco Puede ver los nuevos algoritmos aquí: BLS Adult Cardiac Arrest BLS Pediatric Cardiac Arrest for the Single Rescuer BLS Pediatric Cardiac Arrest for 2 or More Rescuers ACLS Cardiac Arrest PALS Cardiac Arrest Dispositivos de compresiones mecánicas versus compresiones manuales Usualmente toma varios minutos el poder colocar un dispositivo de compresiones mecánicas a un paciente en paro cardiaco. Con mucho entrenamiento y práctica, algunos sistemas han logrado colocarlo consistentemente en un promedio poco menor a 1 minuto. Los retrasos en la colocación del dispositivo pueden traer efectos adversos y reducir la tasa de sobrevivencia del paciente. Los servicios de emergencias médicas que deseen implementar el uso de dispositivos de RCP mecánica para pacientes en paro cardiaco con covid19 deben reconocer que no es solamente comprar el dispositivo y colocarlo en un vehículo de respuesta rápida. La implementación requiere un abordaje efectivo a varios temas tales como el entrenamiento, el seguimiento de la data, y  la integración de los demás elementos que hacen que el paciente en paro cardiaco tenga una mejor oportunidad de sobrevivir (instrucciones de RCP provista por el despachador, DEAs en la comunidad, respuesta inicial de primeros respondedores, unidad de cateterismo 24/7, etc.). Debido a estos retos, el uso de un dispositivo de compresiones cardiacas no ha resultado en mejores tasas de sobrevivencia en estudios que lo comparan con la RCP convencional de alta calidad ofrecida por equipos que optimizan su ejecutoria para tener un alto rendimiento y alta perfusión. COVID19 es el nuevo status quo En esta entrevista discutimos con Adiel García qué hacer si su sistema ya cuenta con un equipo de RCP mecánica para pacientes con covid19, o si desea implementarlo. Referencias Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With the Guidelines®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in Collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: Supporting Organizations: American Association of Critical Care Nurses and National EMS Physicians [published online ahead of print, 2020 Apr 9]. Circulation. 2020;10.1161/CIRCULATIONAHA.120.047463. doi:10.1161/CIRCULATIONAHA.120.047463 Wang PL, Brooks SC. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev. 2018;8(8):CD007260. Published 2018 Aug 20. doi:10.1002/14651858.CD007260.pub4

Dr. Usha Mantha answers your questions about Non-Alcoholic Fatty Liver Disease in this educational interview on being beautiful and healthy from the inside out.Get info: https://vervemedspa.com/medicalweightloss/“Every one of us have a thing or two that we would like to change or fix on our face and body.I thrive to help you make that change safely and effectively with non-invasive lasers.​With a motto of Be You Be Beautiful, we will bring your inside beauty out and make you the best version of You.”Dr. Usha Mantha has served Inland empire for over 10 years, with active practices in Upland and Pomona, California. Her family practice, located in Pomona, embraces residents of all ages, and she uses a compassionate, whole-person approach to treating the physical, emotional, and social challenges facing her patients. She treats diverse diseases found through all stages of life, while encouraging preventive medicine. Dr. Mantha specializes in weight loss and is board certified in family medicine, obstetrics and gynecology, and obesity medicine.​After receiving a medical degree from S.S. Medical College in India, Dr. Mantha completed residencies in hospitals in England in the fields of obstetrics, gynecology, pediatrics, and geriatric medicine. She moved to the United States to complete training and become board certified in family practice. She supervised the residents of the Latrobe Family Practice Residency Program in Latrobe, Pennsylvania, and served as the Prenatal Services Coordinator, with teaching responsibilities in obstetrics and gynecology.After moving to California, Dr. Mantha established her private family practices in Upland and Pomona. She’s currently the Chair of the Medical Staff Well-Being Committee and the Director of the Weight and Wellness Program at Casa Colina Hospital for Rehabilitation in Pomona. Dr. Mantha provides medical care to seniors in nursing homes and assisted living facilities, treats her patients in hospice care, and offers home visits to seniors who are housebound. Residents and medical students experience her passion for teaching as she instructs them in Advanced Life Support in Obstetrics.As a local resident, Dr. Mantha enjoys staying involved in the Upland community. She’s proud to say that the community reciprocates with great respect for her excellent and courteous care. She stays active in grassroots organizations, where she raises funds for underprivileged girls in India. When she takes time to pursue personal interests, Dr. Mantha enjoys dancing and socializing with friends, writing, or curling up with a good book.Usha Mantha, MD, is Board Certified in Family Medicine and Diplomate in Obesity Medicine with over 25 years’ experience and extensive knowledge and empathy for women’s healthcare. Dr. Mantha incorporates knowledge and experience of a family physician with expertise of a specialist Obstetrician and Gynecologist, offering best of both fields.The Optimal Health Showhttps://businessinnovatorsradio.com/optimal-health-show/

Dr. Usha Mantha answers your questions about Non-Alcoholic Fatty Liver Disease in this educational interview on being beautiful and healthy from the inside out.Get info: https://vervemedspa.com/medicalweightloss/“Every one of us have a thing or two that we would like to change or fix on our face and body.I thrive to help you make that change safely and effectively with non-invasive lasers.​With a motto of Be You Be Beautiful, we will bring your inside beauty out and make you the best version of You.”Dr. Usha Mantha has served Inland empire for over 10 years, with active practices in Upland and Pomona, California. Her family practice, located in Pomona, embraces residents of all ages, and she uses a compassionate, whole-person approach to treating the physical, emotional, and social challenges facing her patients. She treats diverse diseases found through all stages of life, while encouraging preventive medicine. Dr. Mantha specializes in weight loss and is board certified in family medicine, obstetrics and gynecology, and obesity medicine.​After receiving a medical degree from S.S. Medical College in India, Dr. Mantha completed residencies in hospitals in England in the fields of obstetrics, gynecology, pediatrics, and geriatric medicine. She moved to the United States to complete training and become board certified in family practice. She supervised the residents of the Latrobe Family Practice Residency Program in Latrobe, Pennsylvania, and served as the Prenatal Services Coordinator, with teaching responsibilities in obstetrics and gynecology.After moving to California, Dr. Mantha established her private family practices in Upland and Pomona. She’s currently the Chair of the Medical Staff Well-Being Committee and the Director of the Weight and Wellness Program at Casa Colina Hospital for Rehabilitation in Pomona. Dr. Mantha provides medical care to seniors in nursing homes and assisted living facilities, treats her patients in hospice care, and offers home visits to seniors who are housebound. Residents and medical students experience her passion for teaching as she instructs them in Advanced Life Support in Obstetrics.As a local resident, Dr. Mantha enjoys staying involved in the Upland community. She’s proud to say that the community reciprocates with great respect for her excellent and courteous care. She stays active in grassroots organizations, where she raises funds for underprivileged girls in India. When she takes time to pursue personal interests, Dr. Mantha enjoys dancing and socializing with friends, writing, or curling up with a good book.Usha Mantha, MD, is Board Certified in Family Medicine and Diplomate in Obesity Medicine with over 25 years’ experience and extensive knowledge and empathy for women’s healthcare. Dr. Mantha incorporates knowledge and experience of a family physician with expertise of a specialist Obstetrician and Gynecologist, offering best of both fields.The Optimal Health Showhttps://businessinnovatorsradio.com/optimal-health-show/

ALS, or Advanced Life Support, is an essential piece of training that most Australian nurses will undergo throughout their careers. In today’s episode, I break down what ALS is, what the training day involved, and what I’m able to do, within the Emergency Department, now that I’ve competed the training.

Rounding out the trifecta of wonderful nurse guests this month on Maybe Medical is Flight Nurse Colleen R.! We covered how she feels you need to be able to fly by the seat of your pants to perform in her role, as well as have an emergency and critical care background. We talked about work and home partnerships and how to balance it all while supporting each other. She was extremely inspirational and I can not express my gratitude enough for her taking the time to sit down with us. Thank you Colleen!   Registered Nurses* Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.   2017 Median Pay: $70,000 per year ($33/hour)   Educational Degree: Initially Associate's Degree or Bachelor's Degree   Number of US jobs in 2016: 2,955,200   10 Year Job Outlook: 15% growth, much faster then avg.   *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, on the Internet at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited November 16, 2018).       Terms Covered in Episode American Nurses Association Trauma Surgery - Surgical field dealing with acute traumatic injuries such as falls, motor vehicle crashes, gunshots, blunt and penetrating injuries, etc. Pulmonology - A medical specialty that deals with diseases involving the respiratory tract. Consult - When asked to weigh in officially with your medical opinion from your specialty on a patient managed by another team. Perforated Bowel - Opening in the intestines due to trauma (knife, bullet, etc) or disease (infection, cancer, etc).  Is a surgical emergency.  Yuck. Sepsis - A potentially life-threatening condition caused by the body's response to an infection. Ventilator - To move breathable air into and out of the lungs, to provide breathing for a patient who is physically unable to breathe, or breathing insufficiently. "Coding" - What we casually use to describe a cardiopulmonary arrest in which there is a sudden loss of function of the heart or loss of respiratory function that requires immediate intervention in a life or death situation. IR (Interventional Radiology) -  A subspecialty of radiology that uses minimally invasive, image-guided procedures to diagnose and treat diseases in nearly every system or organ of the body. CVA (Cerebral Vascular Assault, Stroke) – Possible permanent damage to the brain from a loss of blood flow from either rupture of a blood vessel or obstruction from a tumor, clot, plaque, etc. MI (Miocardial Infarction) - "Heart Attack" refers to a blocked coronary artery that has caused, or is moments away from causing, irreversible cardiac (heart) tissue damage. ET (Endotracheal) Tube - A tube of varied sizes that is inserted into the trachea for establishing and maintaining a patient's airway. Choose Your Own Adventure Books ER (Emergency Room, Emergency Department, Emergency Ward, Accident & Emergency Dept) - Department that must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention that arrive unplanned by walk-in, private vehicle, or ambulance. ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.  May consist of intubated, sedated, and ventilated patients. Bachelor's Degree - On average four to five year University Program to pursue a degree in a specific field. Sacred Heart University College of Nursing Bridge Program - A postgraduate program that is usually shorter then traditional programs that take into account previous experience. Physical Therapist - An important medical provider and part of the rehabilitation team to help assist with treatment, recovery, and overall well being of patients with chronic conditions, illnesses, or injuries. Prerequisites - Classes you may need to take before further applying to a program.  Usually a focus on science/math for the medical field. PA (Physician Assistant) - Providers who practice medicine on teams with physicians and other healthcare workers. They examine, diagnose, and treat patients autonomously and as part of a team in all various specialties of medicine. On average a Master's level degree of education. NP (Nurse Practitioner) - A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans.  They may work in a solo practice independently or they may work within part of a hospital system.  They graduate from a Master's or Doctorate level medical program. ASN/ADN - Associate’s Degree in Nursing.  Usually around two years. EMT/Paramedic - Emergency medical technicians and paramedics care for the sick or injured in emergency medical settings by responding to emergency calls, performing medical services and transporting patients to medical facilities as needed. ER Techs - Staff who in all aspects of patient care under the supervision of the Practitioners and Nursing staff.  Many have a paramedic/firefighting background. Travel RN - Nurse who travels for limited contracts working in all variety of places and roles.  On average 8 to 13 week contracts. Smart Pumps Compact Nursing States NCLEX (National Council Licensure Examination) - A standardized exam that each state board of nursing uses to determine whether or not a candidate is prepared for practice. Wake Forest School of Medicine PA Program Harborview Medical Center King County Medic One "Board & Collared" - Refers to the practice of placing a patient on scene on a very hard and rigid backboard to immobilize them and place a neck collar on them to prevent any head movement in the event of a spine injury while they are transported to the hospital.  They are incredibly uncomfortable. Intubated - When an ET Tube, or similar artificial airway, is placed, either in an emergency, where there is loss of respiratory function or planned such as in surgeries. First Responder - Generally refers to the first on scene in an event.  May be police officers, firefighters, or paramedics for example. "Packaged" - Patient is ready to be transported.  IVs are in, airway is secure if one is present, patient is strapped in, paperwork is read.  Let's roll!   EZ-IO - Used to gain access for medications or fluids when unable to get a line in a blood vessel.  Using a drill a hollow bore is inserted into the broad side of a bone.  Yeah, you drill into bone. "Push Line" - An IV that gives you access for medications that need to be administered over a short amount of time.  Pain meds, sedatives, cardiac meds, etc.   Vasopressors - Class of Antihypotensive medications that are used to raise blood pressure by contracting blood vessels.   EJ - An IV placed into the external jugular of the neck.   Central Line - Larger then an traditional IV placed into veins in the neck, chest, groin, or through veins in the arms.   EMS (Emergency Medical Services) - Services that treat illnesses and injuries that requiring an urgent medical response, providing out-of-hospital treatment and transport to definitive care.  Paramedics, Police, Firefighters, etc.   Level One Trauma Center - A Level I Trauma Center is capable of providing total care for every aspect of injury – from prevention through rehabilitation and includes teaching residents and medical students in all fields.   Med/Surg/Floor Nursing - Refers to what you would think of "general hospital patients." Those with pneumonia, new cardiac issues, skin infections, etc that do not require focal subspecialty involvement (cardiac, neuro, ortho, etc) or critical care support.   Nocturnist - Hospital-based practitioner who only works overnight.   Admit - To be brought in to the hospital for specific medical care.  Entails obtaining a medical history, making a medical diagnosis, writing orders for treatment and other diagnostic procedures, diet, activity, etc.   Post-Op/Recovery Room - The period right after surgery.   GI (Gastroenterology) - The branch of medicine focused on the digestive system.   Orthopedics - Branch of surgery concerned with conditions involving the musculoskeletal system.   Neurology - The area of medicine focused on the nervous system.  This includes the nerves, brain, and spine.   Potassium - A naturally occurring mineral and electrolyte consumed in our diet.  Involved in metabolism, hormone secretion, blood pressure control, fluid and electrolyte balance, and more.  Normal standard range is around 3.5-5mEq/L. Critical Values - Any values considered to be too high or low and requires immediate medical attention to prevent further issues. "Bagging" - The act of using a manual balloon like bag that is squeezed for each breath to a patient. "Titrate a Drip" - To adjust the flow rate or dose delivered of medication in a IV or central line. Peggy Sue - Badass Patient Advocate "Shake and Bake" - Hyperthermic Intraperitoneal Chemotherapy is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. Patient Advocacy - Doing what is best for the patient in all facets of care provided. Listening to and understanding their needs. Multi System Organ Failure - A cascading domino like effect where multiple organ systems start to shut down due to injury/illness. Krista Haugen and Survivors’s Network Post Resuscitation - The fragile period after performing CPR or similar resuscitation of a patient. M&M (Morbidity and Mortality Meeting) - Where we dissect individual challenging cases to identify what other choices could have been made for possible alternate outcomes. Off-Label - Using a medication that may not necessarily be the indication that it was originally intended for.  For example Demerol that is a pain medication is excellent for post-operative rigors (shakes).  A small dose works like magic...fun! IV Fluids - Intravenous fluids are given through an IV, central line, or IO and usually consist of normal saline or lactated ringer's solution. Levophed (norepinephrine bitartrate) - Medications used to raise blood pressure in critical patients. Used to be referred to as "Leave 'em dead" as any patient sick enough to require norepinephrine to manage their shock, then they were most likely going to die.  Very commonly used nowadays. Epinephrine - Endogenous hormone that is given to patient's to treat a number of conditions including anaphylaxis, cardiac resuscitation, and bleeding.  Inhaled epinephrine is used to help treat symptoms of croup.  Is used in the ICU and cardiac unit to help maintain a high enough blood pressure.   PRBC (Packed Red Blood Cells) – Blood that is transfused after finding the right compatible blood type for the patient.   Plasma – Fluid in blood that is responsible for carrying red blood cells, white blood cells, platelets, etc. Is often used during blood transfusion to help stop the active bleeding by adding pro-clotting factors.   Credo Cube   Transfusion Guidelines Airlift NorthWest   MONA - Morphine, Oxygen, Nitroglycerin, and Aspirin are all meds that should be administered to a patient experiencing chest pain.   Emergency Nurse Association   Balloon Pumps - Intra-Aortic Balloon Pumps use a thin flexible tube that is inserted into the aorta of the heart to pump blood artificially in a heart-like fashion.   ECMO (Extra Corporeal Membrane Oxygenation) - Treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a very ill patient.  Provides heart-lung bypass support outside of the body.  You are damn near dead at this point   Skills Lab/”Sims” - Focused area to learn new medical techniques or further practice known skills.   Society of Critical Care Medicine PFCCS - Pediatric Fundamental Critical Care Support ACLS - Advanced Life Support PALS - Pediatric Advanced Life Support Certification NRP - Neonatal Resuscitation Program ATLS - Advanced Trauma Life Support Certification   CCRN - Critical Care Registered Nurse CEN - Board Certification of Emergency Nurses Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.  

In recent months ER24 has responded to a number of drownings. The number of drowning incidents will most likely increase leading up to the summer months and the festive holidays. Natasha Kriel, an Advanced Life Support paramedic at ER24’s South Metro branch in the Western Cape, spoke to us about drownings and what safety tips to follow when spending time next to the pool or at the beach.

Bicarbonate use in cardiac arrest. The topic still provokes debate and multiple publications on the topic still hit the press reels. People talk of the increased rate of ROSC and the improvement in metabolic state, whilst others talk of the increase in mortality and worsening of intracellular acidosis. A recent paper in Resuscitation looked at a huge cohort of patients receiving bicarbonate in arrest prehospitally. In this episode we take a look at the paper, review the guidelines and give our take on the current situation with regards bicarb in arrest We hope you enjoy it and would love to hear your feedback! Simon &  Rob References & Further Reading Prehospital Sodium Bicarbonate Use Could Worsen Long Term Survival with Favorable Neurological Recovery among Patients with Out-of-Hospital Cardiac Arrest. Kawano T, et al. Resuscitation. 2017 Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature. Velissaris D, et al. J Clin Med Res. 2016 Effect of Sodium Bicarbonate on Advanced Cardiac Life Support. Jungyoup Lee. Circulation 2014 Advanced Life Support; Bicarbonate guidance

Tom Condon and Loan Nguyen discuss advanced life support and give a talk through of the key algorithms to be aware of by the end of third year.

The Topton American Legion Community Ambulance Services provide Basic and Advanced Life Support to the community involving eleven different municipalities. Their goal is to provide the best quality care to the people they serve. In 2015, Topton Ambulance responded to over 1200 calls. Tyler Bard, Chief of Emergency Medical Services for the ambulance company has been involved with Topton Ambulance Services for the past 10 years. Tyler states he has always wanted to help others and his passion grew even more when he attended EMT classes. In his role, Tyler works in collaboration with the Council on Chemical Abuse to facilitate training for the residents of Berks County about Naloxone and how to treat someone who has overdosed from using opioids. Naloxone also known as Narcan is an opioid antagonist and reverses the effects of opioid overdose. Tyler states it is important that individuals administering Naloxone receive training on how to administer the drug and to contact 911. Tyler says that he has administered Naloxone and believes everyone should be aware of its benefits – it is a life saver.

This podcast presents a basic overview of the Pediatric Advanced Life Support protocol from the 2015 American Heart Association guidelines. It will review basics of pediatric cardiopulmonary resuscitation, bag-mask ventilation, advanced airways, defibrillation and post-cardiac arrest care. This podcast was written by Colin Siu with the help of Dr. Melissa Chan, a pediatric emergency physician and Clinical Lecturer at the University of Alberta.  These podcasts are designed to give medical students an overview of key topics in pediatrics.  The audio versions are accessible on iTunes.  You can find more great pediatrics content at www.pedscases.com.   Related Content: Podcast: Approach to Shock

Jellybean #10.1; Sarah Webb of the Royal North Shore ICU; Nurse Leadership in Advanced Life Support by Doug Lynch @TheTopEnd

Jon Gatward is an intensivist from Royal Prince Alfred Hospital, Sydney, with an interest in simulation and teaching. He gave this lecture at Bedside Critical Care 2012 (#BCC3) following a simulated resuscitation scenario. He describes the latest updates in Advanced Life Support and discusses some recent literature on the topic.

Jon Gatward, is an intensivist from Royal Prince Alfred Hospital, Sydney, with an interest in simulation and teaching. He gave this lecture at Bedside Critical Care 2012 following a simulated resuscitation scenario. He describes the latest updates in Advanced Life Support and discusses some recent literature on the topic. Listen to this fantastic talk, watch the video and add comments your comments on www.intensivecarenetwork.com. The music snippet can be bought here. 

John Hogan, Bioengineering Branch NASA Ames Research Center, discusses research in life support systems that could be used to create a sustainable and regenerative environment in space. (March 2, 2010)