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EMS Nation

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EMS Nation - Evidence Based Medicine in EMSWeekly Style Podcasts:Monday - Interview with a Leader in EMSTuesday - ALS SimulationWednesday - EMS Journal ClubThursday - BLS SimulationFriday - Health & WellnessFollow us on Twitter!www.twitter.com/EMS_NationLike us on Facebook!www.facebook.com/PrehospitalNation www.emsnation.org

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EMS Nation - Evidence Based Medicine in EMSWeekly Style Podcasts:Monday - Interview with a Leader in EMSTuesday - ALS SimulationWednesday - EMS Journal ClubThursday - BLS SimulationFriday - Health & WellnessFollow us on Twitter!www.twitter.com/EMS_NationLike us on Facebook!www.facebook.com/PrehospitalNation www.emsnation.org

iTunes Ratings

17 Ratings
Average Ratings
14
0
1
1
1

Great Podcast!

By Dan and Jen - Jan 22 2016
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Faison has street cred from FDNY, and now he’s bringing cutting edge prehospital care to iTunes. He scored a great interview with Paul Pepe, and the video tutorials on push dose epic and Ketamine DSI will get you up to speed fast. Give it a look.

iTunes Ratings

17 Ratings
Average Ratings
14
0
1
1
1

Great Podcast!

By Dan and Jen - Jan 22 2016
Read more
Faison has street cred from FDNY, and now he’s bringing cutting edge prehospital care to iTunes. He scored a great interview with Paul Pepe, and the video tutorials on push dose epic and Ketamine DSI will get you up to speed fast. Give it a look.
Cover image of EMS Nation

EMS Nation

Latest release on Oct 12, 2019

The Best Episodes Ranked Using User Listens

Updated by OwlTail 2 days ago

Rank #1: Ep #4 - Simulation - Ketamine & Prehospital Delayed Sequence Intubation

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BLS CPAP / JEMS:

http://www.jems.com/articles/print/volume-38/issue-11/patient-care/argument-bls-cpap.html

Optimizing Preoxygenation, Delayed Sequence Intubation:

Must read: http://emcrit.org/preoxygenation

Paper in Annals @emcrit @mdaware: http://www.annemergmed.com/article/S0196-0644(14)01365-1/abstract

LITFL DSI: http://lifeinthefastlane.com/ccc/delayed-sequence-intubation/

Follow us on Twitter:

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD

www.emsnation.org

Dec 03 2015

8mins

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Rank #2: Ep #21 SKEPTIC - Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare

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Ep #21 Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare

Happy #EMSWeek #EMSStrong #EMSNation

SKEPTIC = Safety & Efficacy of Ketamine in Emergent Prehospital Tracheal Intubation – a Case Series

Brand new paper from Sydney HEMS on Ketamine and Shock Index in Annals of EM!

http://www.annemergmed.com/article/S0196-0644(16)30002-6/abstract

Additional References:

  1. Carlson JN, Karns C, Mann NC, et al. Procedures performed by emergency medical services in the united states.Prehosp Emerg Care. 2015.
  2. Jacobs PE, Grabinsky A. Advances in prehospital airway management.International Journal of Critical Illness & Injury Science. 2014;4:57-64.
  3. Prekker ME, Kwok H, Shin J, Carlbom D, Grabinsky A, Rea TD. The process of prehospital airway management: Challenges and solutions during paramedic endotracheal intubation.Crit Care Med. 2014;42:1372-1378.
  4. Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management.Prehospital Emergency Care. 2005;9:145-155.
  5. Mace SE. Challenges and advances in intubation: Airway evaluation and controversies with intubation.Emerg Med Clin North Am. 2008;26:977-1000.
  6. Combes X, Jabre P, Jbeili C, et al. Prehospital standardization of medical airway management: Incidence and risk factors of difficult airway.Acad Emerg Med. 2006;13:828-834.
  7. Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76:663-667.
  8. Jackson APF, Dhadphale PR, callaghan ML, Alseri S. Haemodynamic studies during induction of anaesthesia for open-heart surgery using diazepam and ketamine. Br J Anaesth. 1978;50:375-378.
  9. Price B, Arthur AO, Brunko M, et al. Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting. Am J Emerg Med. 2013;31:1124-1132.
  10. Scherzer D, Leder M, Tobias JD. Pro-Con Debate: Etomidate or Ketamine for Rapid Sequence Intubation in Pediatric Patients. J Pediatr Pharmacol Ther. 2012;17:142-149.
  11. Bruder Eric A, Ball Ian M, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.Cochrane Database of Systematic Reviews. 2015
  12. Thompson Bastin ML, Baker SN, Weant KA. Effects of Etomidate on Adrenal Suppression: A Review of Intubated Septic Patients.Hospital Pharmacy. 2014;49:177-183.
  13. Arnold C. The promise and perils of ketamine research Ketamine began its life as an anaesthetic , but has enjoyed a recent renaissance as a potential. Lancet Neurol. 2013;12:940-941.
  14. Craven R. Ketamine. Anaesthesia. 2007;62:48-53.
  15. Perkins ZB, Gunning M, Crilly J, Lockey D, O’Brien B. The haemodynamic response to pre-hospital RSI in injured patients. Injury. 2013;44:618-623.
  16. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug. J Clin Pharmacol. 2009;49:957-964.
  17. Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.J Emerg Med. 2010;38:622-631.
  18. Kohrs R, Durieux ME. Ketamine. Anesth Analg. 1998;87:1186-1193.
  19. Moy RJ, Clerc S Le. Trends in Anaesthesia and Critical Care Ketamine in prehospital analgesia and anaesthesia. Trends Anaesth Crit Care. 2011;1:243-245.
  20. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36(2):186-197.
  21. Porter K. Ketamine in prehospital care. Emerg Med J. 2004;21:351-354.
  22. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25:977-980.
  23. Johansson J, Sjöberg J, Nordgren M, Sandström E, Sjöberg F, Zetterström H. Prehospital analgesia using nasal administration of S-ketamine--a case series. Scand J Trauma Resusc Emerg Med. 2013;21:38.
  24. Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. Can J Emerg Med. 2010;12:154-201.
  25. Himmelseher S, Durieux ME. Revising a Dogma: Ketamine for Patients with Neurological Injury? Anesth Analg. 2005;101:524-534.
  26. Kropf J a., Grossman MD, Genzlinger M a., Stoltzfus J, Stehly CD. 328 Ketamine versus Etomidate for Rapid Sequence Intubation in Traumatically Injured Patients: An Exploratory Study. Ann Emerg Med. 2012;60:S117.
  27. Angus DC, van dP. Severe sepsis and septic shock.N Engl J Med. 2013;369:840-851.
  28. Jabre P, Avenel A, Combes X, et al. Morbidity related to emergency endotracheal intubation-A substudy of the KETAmine SEDation trial. Resuscitation. 2011;82:517-522.
  29. Shafi S, Gentilello L. Pre-Hospital Endotracheal Intubation and Positive Pressure Ventilation Is Associated with Hypotension and Decreased Survival in Hypovolemic Trauma Patients: An Analysis of the National Trauma Data Bank. The Journal of Trauma: Injury, Infection, and Critical Care. 2005;59:1140–1147.
  30. Seymour CW, Band RA, Cooke CR, et al. Out-of-hospital characteristics and care of patients with severe sepsis: A cohort study.J Crit Care. 2010;25:553-562.
  31. Williams E, Arthur a., Price B, Banister NJ, Goodloe JM, Thomas SH. 175 Ketamine versus Etomidate for Use in Helicopter Emergency Medical Services Endotracheal Intubation. Ann Emerg Med. 2012;60:S63-S64
  32. Bruns, B, Gentilello, L, Elliott, A, Shafi, S. Prehospital Hypotension Redefined. The Journal of Trauma: Injury, Infection, and Critical Care. 2008;65:1217–1221.
  33. Seymour, CW, Cooke, CR, Heckbert, SR, et al. Prehospital Systolic Blood Pressure Thresholds: A Community-based Outcomes Study. Acad Emerg Med Academic Emergency Medicine. 2013;20:597–604.
  34. Kristensen AKB, Holler JG, Mikkelsen S, Hallas J, Lassen A. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study.Critical Care. 2015;1:158.
  35. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84:1500-1504.
  36. Salt PJ, Baranes PK, Beswick FJ. Inhibition of neuronal and extraneuronal uptake of noradrenaline by ketamine in the isolated perfused rat heart. Br J Anaesth. 1979;51:835-838.
  37. Sprung J, Schuetz SM, Stewart RW, Moravec CS. Effects of Ketamine on the Contractility of Failing and Nonfailing Human Heart Muscles in Vitro. Surv Anesthesiol. 1999;43:230-231.
  38. Kunst G, Martin E, Graf BM, Hagl S, Vahl CF. Actions of Ketamine and Its Isomers on Contractility and Calcium Transients in Human Myocardium. Anesthesiology. 1999;90:1363-1371.
  39. Lundy PM, Lockwood PA, Thompson G, Frew R. Differential Effects of Ketamine Isomers on Neuronal and Extraneuronal Catecholamine Uptake Mechanisms. Anesthesiology. 1986;64:359-363.
  40. Selde W. Push dose epinephrine. A temporizing measure for drugs that have the side-effect of hypotension.JEMS. 2014;39:62-63.

Sponsored by @PerfectCPR

Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery

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Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

May 20 2016

37mins

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Rank #3: Ep #3 - EMSJC - TXA & Remote Damage Control Resuscitation_ECMO In-Hospital Cardiac Arrest

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Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests

http://www.ncbi.nlm.nih.gov/pubmed/26383007

Tranexamic acid as part of remote damage-control resuscitation in the prehospital setting: A critical appraisal of the medical literature and available alternatives

http://www.ncbi.nlm.nih.gov/pubmed/26002268

Follow us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD

www.emsnation.org

Nov 30 2015

30mins

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Rank #4: Episode #86 BLS Management of a Trauma Patient - Putting it Together

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As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth.

It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

Aug 05 2019

4mins

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Rank #5: Ep #70 Evidence Based Medicine meets Best Practice in PHTLS v9 #NAEMT #WTS18 #EMSWorldExpo2018

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Aug 30 2018

43mins

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Rank #6: Ep #17 A Primer on Intrathoracic Pressure Regulation & The Physiology of CPR with Dr. Keith Lurie

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Ep #17 A Primer on Intrathoracic Pressure Regulation & The Physiology of CPR with Dr. Keith Lurie Happy #EMSWeek #EMSStrong #EMSNation

Sponsored by @PerfectCPR

Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR

PerfectCPR.com

Dr. Keith Lurie is a practicing cardiac electrophysiologist and resuscitation scientist who, over the past 25 years, has devoted himself to study novel ways to resuscitate patients experiencing sudden cardiac arrest.  Dr. Lurie earned his bachelors degree at Yale University and his medical degree at Stanford University. He studied cardiovascular medicine at the University of California in San Francisco and later joined the faculty there.  He has been on the faculty at the University of Minnesota since 1991. As one of the leading innovators in the field, he has helped to develop new devices and methods that optimize cardio-pulmonary resuscitation (CPR) and, in turn, improve survival chances following cardiac arrest. In addition, he has become a respected thought leader in developing and implementing a systems-based approach to managing and treating sudden cardiac death events. Some of his most notable contributions include the development and assessment of various resuscitative techniques such as the impedance threshold device (ITD), active compression-decompression (ACD) CPR and the use of intra-thoracic pressure regulation to modulate cerebral and systemic circulation in states of severe hypotension and head injury. He has also helped to develop devices to treat heart failure and abnormal heart rhythms. He has mentored scores of research and clinical fellows over the past 30 years and he actively collaborates with multiple scientist colleagues worldwide. A professor of Emergency Medicine and Internal Medicine at the University of Minnesota, Dr. Lurie also directs an NIH-funded research laboratory at Hennepin County Medical Center in Minneapolis and he is a consultant for Zoll Medical.

Selected Peer-Reviewed Publications (Selected from over 200 publications):

  1. Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M. The physiology of cardiopulmonary resuscitation. Anesth Analg. 11/2015
  2. Kwon Y, Debaty G, Puertas L, Metzger A, Rees J, McKnite S, Yannopoulos D, Lurie K. Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: A non-randomized interventional cross-over study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2015;23:83
  3. Debaty G, Metzger A, Lurie K. Evaluation of zoll medical's resqcpr system for cardiopulmonary resuscitation. Expert review of medical devices. 2015;12:505-516
  4. Smith G, Dwork N, O'Connor D, Sikora U, Lurie K, Pauly J, Ellerbee A. Automated, depth resolved estimation of the attenuation coefficient from optical coherence tomography data. IEEE transactions on medical imaging. 2015
  5. Lurie KL, Gurjarpadhye AA, Seibel EJ, Ellerbee AK. Rapid scanning catheterscope for expanded forward-view volumetric imaging with optical coherence tomography. Optics letters. 2015;40:3165-3168
  6. Debaty G, Metzger A, Rees J, McKnite S, Puertas L, Yannopoulos D, Lurie K. Enhanced perfusion during advanced life support improves survival with favorable neurologic function in a porcine model of refractory cardiac arrest. Crit Care Med. 2015;43:1087-1095
  7. Salzman JG, Frascone RJ, Burkhart N, Holcomb R, Wewerka SS, Swor RA, Mahoney BD, Wayne MA, Domeier RM, Olinger ML, Aufderheide TP, Lurie KG. The association of health status and providing consent to continued participation in an out-of-hospital cardiac arrest trial performed under exception from informed consent. Acad Emerg Med. 2015;22:347-353
  8. Metzger A, Rees J, Kwon Y, Matsuura T, McKnite S, Lurie KG. Intrathoracic pressure regulation improves cerebral perfusion and cerebral blood flow in a porcine model of brain injury. Shock. 2015;44 Suppl 1:96-102
  9. Debaty G, Shin SD, Metzger A, Kim T, Ryu HH, Rees J, McKnite S, Matsuura T, Lick M, Yannopoulos D, Lurie K. Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest. Resuscitation. 2015;87:38-43
  10. Bartos JA, Matsuura TR, Sarraf M, Youngquist ST, McKnite SH, Rees JN, Sloper DT, Bates FS, Segal N, Debaty G, Lurie KG, Neumar RW, Metzger JM, Riess ML, Yannopoulos D. Bundled postconditioning therapies improve hemodynamics and neurologic recovery after 17 min of untreated cardiac arrest. Resuscitation. 2015;87:7-13
  11. Gold B, Puertas L, Davis SP, et al. Awakening after cardiac arrest and post resuscitation hypothermia: are we pulling the plug too early? Resuscitation. Feb 2014;85(2):211-214.
  12. Metzger A, Rees J, Segal N, et al. "Fluidless" resuscitation with permissive hypotension via impedance threshold device therapy compared with normal saline resuscitation in a porcine model of severe hemorrhage. The journal of trauma and acute care surgery. Aug 2013;75(2 Suppl 2):S203-209.
  13. Frascone RJ, Wayne MA, Swor RA, et al. Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device. Sep 2013;84(9):1214-1222.
  14. Yannopoulos D, Segal N, Matsuura T, et al. Ischemic post-conditioning and vasodilator therapy during standard cardiopulmonary resuscitation to reduce cardiac and brain injury after prolonged untreated ventricular fibrillation. Aug 2013;84(8):1143-1149.
  15. Sarraf M, Sharma A, Caldwell E, McKnite S, Aufderheide T, Lurie K, Neumar R, Riess M, Yannopoulos D. Postconditioning with inhaled sevoflurane at the initiation of cpr improves hemodynamics and mitigates post-cardiac arrest myocardial injury after 15 min of untreated ventricular fibrillation. Crit Care Med. 2012;40:1-328
  16. Yannopoulos D, Segal N, McKnite S, Aufderheide TP, Lurie KG. Controlled pauses at the initiation of sodium nitroprusside-enhanced cardiopulmonary resuscitation facilitate neurological and cardiac recovery after 15 mins of untreated ventricular fibrillation. Crit Care Med. 2012;40:1562-1569
  17. Segal N, Matsuura T, Caldwell E, Sarraf M, McKnite S, Zviman M, Aufderheide TP, Halperin HR, Lurie KG, Yannopoulos D. Ischemic postconditioning at the initiation of cardiopulmonary resuscitation facilitates functional cardiac and cerebral recovery after prolonged untreated ventricular fibrillation. Resuscitation. 2012;83:1397-1403
  18. Convertino VA, Parquette B, Zeihr J, Traynor K, Baia D, Baumblatt M, Vartanian L, Suresh M, Metzger A, Gerhardt RT, Lurie KG, Lindstrom D. Use of respiratory impedance in prehospital care of hypotensive patients associated with hemorrhage and trauma: A case series. The journal of trauma and acute care surgery. 2012;73:S54-59
  19. Yannopoulos D, Matsuura T, Schultz J, et al. Sodium nitroprusside enhanced cardiopulmonary resuscitation improves survival with good neurological function in a porcine model of prolonged cardiac arrest. Crit Care Med. Jun 2011;39(6):1269-1274.
  20. Yannopoulos D, Kotsifas K, Lurie KG. Advances in cardiopulmonary resuscitation. Heart Fail Clin. Apr 2011;7(2):251-268, ix.
  21. Lurie KG, Coffeen P, Shultz J, McKnite S, Detloff B, Mulligan K. Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve. Circulation 1995;91(6):1629-32.
  22. Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, Ecollan P, Gruat R, Cavagna P, Biens J and others. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group. N Engl J Med 1999;341(8):569-75.
  23. Lurie KG, Voelckel WG, Zielinski T, McKnite S, Lindstrom P, Peterson C, Wenzel V, Lindner KH, Samniah N, Benditt D. Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest. Anesth Analg 2001;93(3):649-55.
  24. Lurie KG, Zielinski T, McKnite S, Aufderheide T, Voelckel W. Use of an inspiratory impedance valve improves neurologically intact survival in a porcine model of ventricular fibrillation. Circulation 2002;105(1):124-9.
  25. Aufderheide TA, Sigurdsson G, Pirrallo RG, Yannopoulos D, McKnite S, van Briesen C, Sparks C, Conrad CJ, Provo CA, Lurie KG. Hyperventilation-induced hypotension during CPR. 2004;109:1960-65.
  26. Aufderheide TP, Pirrallo RG, Provo TA, Lurie KG. Clinical evaluation of an inspiratory impedance threshold device during standard cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest. Critical Care Medicine. 2005, Apr;33(4):734-40.
  27. Pirrallo RG, Aufderheide TP, Provo TA, Lurie KG. Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation. 2005 Jul;66(1):13-20.
  28. Aufderheide T, Alexander C, Lick C, Myers B, Romig L, Vartanian L, Stothert J, S. M, Matsuura T, Yannopoulos D and others. From laboratory science to six emergency medical services systems: New understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest. Crit Care Med 2008;36(Suppl):S397-S404.
  29. Lurie KG, Yannopoulos D, McKnite SH, Herman ML, Idris AH, Nadkarni VM, Tang W, Gabrielli A, Barnes TA, Metzger AK. Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Respir Care 2008;53(7):862-70.
  30. Metzger A, Yannopoulos D, Lurie KG. Instrumental Management of CPR. Severe Acute Heart Failure Syndromes:  A Practical Approach for Physicians. Mebazaa, A., Gheorghiade, M., Zannad, F., Parrillo, J.E. (eds.). Springer-Verlag, London Ltd. 2008, pp. 43-51.
  31. Metzger A, Lurie K. Harnessing Cardiopulmonary Interactions to Improve Circulation and Outcomes After Cardiac Arrest and Other States of Low Blood Pressure. In: Iaizzo PA, editor. Handbook of Cardiac Anatomy, Physiology, and Devices: Springer Science; 2009. p 583-604.
  32. Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino VJ, Callaway CW, Menon V, Bass RR, Abella BS and others. Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association. Circulation;121(5):709-29.
  33. Yannopoulos D, Matsuura T, McKnite S, Goodman N, Idris A, Tang W, Aufderheide TP, Lurie KG. No assisted ventilation cardiopulmonary resuscitation and 24-hour neurological outcomes in a porcine model of cardiac arrest. Crit Care Med;38(1):254-60.

Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

May 16 2016

1hr 21mins

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Rank #7: Ep #73 EMS Grit- Resilience, Stigma & Self Care in Prehospital Medicine #EMSWorldExpo2018

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An in depth and personal interview with Brian LaCroix, president of Allina health who has helped develop the EMSgrit.org website.  Bringing a toolkit to mental health and helping develop the core attributes of Resilience and Self care while mitigating social stigma.

Jan 31 2019

39mins

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Rank #8: Ep #65 Controversies in Needle Decompression #WTS17 #PHTLS #EMSWorldExpo17

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The World Trauma Symposium: 

https://www.naemt.org/events/world-trauma-symposium

NAEMT: 

http://naemt.org/

EMS World Expo:

http://www.emsworldexpo.com/

Episode #65 Controversies in Needle Decompression #WTS17 #PHTLS #EMSWorldExpo17 with Julie Chase, MSED, FAWM, TP-C @ISDMedic

Julie Chase is a tactical medicine instructor in Berryville, Va.  She has worked in public and private venues as a firefighter, paramedic, educator and administrator, and has taught in many countries, assisted with remote clinics and emergency services and is a National Disaster Medical System Response Team Member.  She was an operational and tactical medicine instructor at a federal agency, a curriculum developer, contributing author, and reviewer for publication and accreditation organizations.  Julie holds a Master in Postsecondary and Adult Education, a Bachelor in Paramedicine, and an Associate in Applied Arts and Sciences in Fire Science. 

Query us on Twitter:

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Wishing everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Feb 28 2018

21mins

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Rank #9: Ep #58 Push Dose Pressors & Push Dose Nitroglycerin @emscritcare #EMSWeek2017

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https://ampa.org/

Happy Friday of #EMSWeek2017!

https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf

Resuscitation - beginning from initial patient contact to the emergency department to the intensive care unit is a continuun of care - though the first few minutes of patient contact with a critically ill patient can have tremendous repercussions on the patient's ultimate outcome.  Whether in critical care transport or in 911 emergency response, patient's may require a medication in small aliquots immediately that would be either unfeasible or cumbersome to administer via infusion on a dedicated pump. 

While circumstances in which a patient needs a push dose medication may be uncommon, the administration of these drugs can be potentially lifesaving.  There are two prehospital scenarios in which the paramedic carries the necessary medication in their armamentariam and with appropriate instruction and training can safely reconstitute into an appropriate dose for use in out-of-hospital resuscitation for the critically ill patient. 

Push dose pressors are often employed in profoundly hypotensive patients that will require endotracheal intubation.  Rapid Sequence Intubation and Positive Pressure Ventilation are both associated with hypotension, thus in the patient that requires advanced airway and is hypotensive upon EMS arrival, push dose pressors may be employed to effectively "resuscitate before you intubate".  Typically Epinephrine is diluted to an appropriate dose and adminstered in small aliquots (10mcg/ml) for inotropoic support to optimize hemodynamics prior to RSI or intubation.  There is also anaesthesia literature supporting the use of neosynephrine as well as phenylephrine for this purpose, though these medications are less readily available prehospitally.  Even brief episodes of relative hypotension can cause effects seen days later; in critically hypotensive patients these may be even more pronounced.  By using push dose pressors, a field provider can safely and effectively resuscitate their patient in order to mitigate the risks associated with endotracheal intubation prior to securing an advance airway.

Conversely, a separate and distinct class of patients who suffer from decompensated heart failure may present with respiratory distress due to volume overload with pathophysiology associated with marked systemic hypertension. While CPAP is the mainstay of therapy for these patients prehospitally and has significantly reduced intubation of the CHF patient over the past several years, IV Lasix and topical Nitroglycerin play little role in the EMS management of the decompensated heart failure patient.  Nevertheless, these patients often require preload and afterload reduction to manage their symptomatology; it is common to initiate nitroglycerin infusions in critical care transport as well as in the emergency department for management of this hypertension.

 Nitroglycerin lowers preload via venous vasodilation at low doses and lowers after load via arterial vasodilation at higher doses, making the patient's vascular container larger lowering the systemic pressure. Aggressive, high dose NTG paired with the recruitment of the alveoli using CPAP & PEEP make up the mainstay of pre-hospital treatment of APE and decompensated heart failure. Bolus doses as high as 2 mg (2000 mcg) of nitroglycerin have been given safely and effectively in previous studies.

 In emergent resuscitations we need to focus on bolus dose medications in the acute phase versus starting and titrating critical care infusions while a patient is in extremis. The goal is to achieve clinical end points of treatment faster with bolus dosing at the bedside and then begin maintenance infusions once resuscitation goals are met and the hemodynamics are stable.  Similar to push dose pressors in the acutely hypotensive EMS patient requiring resuscitation, patients with decompensated heart failure may benefit acutely with push dose nitroglycerin, a potent vasodilator.

@AmpaDocs #CCTMC17

Mark your calendars for #CCTMC18

April 9-11th 2018

Wyndham Riverwalk - San Antonio Texas

Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Jun 01 2017

37mins

Play

Rank #10: Ep #55 Using DSI To Prevent Rapid Sequence Death #EMSWeek2017

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Checkout EMS Today 2018!

http://www.emstoday.com/index.html 

Happy Tuesday of #EMSWeek2017! You've asked and you shall receive... Optimizing your patient's airway prior to pulling the trigger for RSI.  Delayed Sequence Intubation in the prehospital realm to prevent Rapid Sequence Death.  Dr. Jeff Jarvis, a paramedic from Williamson County Texas turned EMS Medical Director of Williamson County Texas challenges traditional thought processes to bring the best possible medical care to 911 patients.  "It's medical decision making that saves lives... not a plastic tube through the trachea!!!!" Here is story from conception of the idea, to education and roll out, to challenges experienced interfacing with local emergency departments as well as preliminary results for prospectively collected data.

His Bio & Credentials:

https://www.wilco.org/Departments/EMS/Leadership/Jeff-Jarvis (Williamson County)

http://www.sw.org/Dr-Jeffrey-L-Jarvis (Baylor Scott & White)

@EMSToday #EMSToday2017

Mark your calendars for #EMSToday2018

February 21-23, 2018

Charlotte, NC Convention Center

Registration Link: http://www.emstoday.com/register.html

Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

May 24 2017

56mins

Play

Rank #11: Ep #9 - Simulation - Double Sequential Defibrillation in refractory VF & Lecture by @ccareanywhere on #DSED

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Ep #9 - Simulation - Double Sequential Defibrillation in refractory VF & Lecture by @ccareanywhere on #DSED

Hot off the press! Our case series on #DSED just accepted for publication in Prehospital Emergency Care:

http://www.tandfonline.com/eprint/ZQsRHp54MWXAIkCsUiAi/full

REBEL EM: Beyond ACLS

http://rebelem.com/beyond-acls-dual-simultaneous-external-defibrillation/

EMS World: Hold the Coroner

http://www.emsworld.com/article/10318805/double-sequential-defibrillation

PEC: Cabanas et al

http://www.ncbi.nlm.nih.gov/pubmed/25243771

Follow us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Feb 06 2016

16mins

Play

Rank #12: Ep #23 EMS Based Fire Systems - Challenging Tradition with Dr. Craig Manifold

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Ep #23 EMS Based Fire Systems - Challenging Tradition with Dr. Craig Manifold

Happy #EMSWeek #EMSStrong #EMSNation

Dr. Craig Manifold

http://emergencymedicine.uthscsa.edu/faculty/manifold.asp

https://www.linkedin.com/in/craig-manifold-75218052

NAEMT Position Statement on House Bill HR4365:

https://www.naemt.org/docs/default-source/advocacy-documents/emshd-documents/2016-requests-to-congress/2016-hr4365-patientmeds-final.pdf?sfvrsn=4

HR4365 - Sponsor - Rep Hudson, Richard {R-NC-8} Introduced 1/12/16

https://www.congress.gov/bill/114th-congress/house-bill/4365

Congressional EMS Caucus:

https://www.naemt.org/advocacy/ems-caucus

REBOA:

http://lifeinthefastlane.com/ccc/resuscitative-endovascular-balloon-occlusion-aorta-reboa/

NAEMSP Selective Spinal Immobilization:

http://www.naemsp.org/Documents/Position%20Papers/EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard_Resource%20Document.pdf

http://www.naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf

Fire-Based EMS - The Myth of the Perfect model @EMSWorldExpo

http://www.emsworld.com/article/10322477/the-myth-of-the-perfect-model

Sponsored by @PerfectCPR

Apple Watch App with Audio and Taptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery

www.PerfectCPR.com

Query us on Twitter:

www.twitter.com/EMS_Nation

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Jun 03 2016

1hr 24mins

Play

Rank #13: Ep #7 - Simulation - Selective Spinal Immobilization with Dr. Joe Bart

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Ep #7 – Simulation Episode – Selective Spinal Immobilization with Dr. Joe Bart

(Full HD video on YouTube) https://www.youtube.com/watch?v=Lh44vQHpQvk&feature=iv&src_vid=PkNRiJm6FRY&annotation_id=annotation_4084272705

Joseph A. Bart DO – EMS division – Operations Medical Director, Deputy Fellowship Director

University of Buffalo Profile Page: https://medicine.buffalo.edu/content/medicine/faculty/profile.html?ubit=jabart

National Center for Security & Preparedness: http://www.albany.edu/ncsp/

-- Eliminate the Standing Take Down

-- Selective use of the C-collar

-- The Backboard as an Extrication Device

-- The Role of Alternate Devices

-- Q&A with Dr. Bart

Follow us on Twitter:

www.twitter.com/EMS_Nation

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD

www.emsnation.org

Jan 26 2016

23mins

Play

Rank #14: Ep #10 @davidpage Prehospital Care Research Forum Annual Summit

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Ep #10 – Prehospital Care Research Forum – Annual Summit Recap with @davidpage. 

For more with Dave Page & the PCRF podcast: http://www.pcrfpodcasts.org/

FISDAP Research: http://www.fisdap.net/research

For a quick introduction to research instructors can send students to www.fisdap.net/research101 a free online course.  

http://www.emsreference.com/

Round Table PCRF Summit:

Alan Batt - Critical Care Paramedic

Keith Widmeier BA, NRP, FP-C

University of Cincinnati College of Medicine

Christiana Corrado EMT-P

Adjunct Professor

Westchester Community College 

Ron Lawler BUS NRP

Director

Sanford Health EMS Education

North Dakota State College Sciences

Kelly Walsh, RN BSN PHRN

EMS Academy Program Director

Creighton University-Advanced Medical Transport of Central Illinois Paramedic Consortium

Follow us on Twitter:

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Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Feb 10 2016

38mins

Play

Rank #15: Ep # 47: Complications of Vaginal Delivery - NYS Collaborative

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Complications of Delivery (Including Postpartum Hemorrhage, Shoulder Dystocia, Breech, Etc.)

This module demonstrates the field management of a number of complications of delivery as outlined in the 2017 NYS collaborative EMS protocols.

Cast in Alphabetical Order: Michael T. Benenati, BS, AAS, EMT-P Tyler F. Cominsky, NRP Seth Goldstein, BA, AS, AEMT-P/CIC Susie Surprenant, BBA, BS, NRP David Violante, MPH, MPA, AEMT-P

Faizan H. Arshad, MD @emscritcare Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

Mar 21 2017

9mins

Play

Rank #16: Episode #82 The Importance of BLS Assessment

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As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth.

It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

Aug 05 2019

8mins

Play

Rank #17: Ep #34 A Case Series of Double Sequence Defibrillation w/ @emscritcare & @ccareanywhere

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Ep #34 A Case Series of Double Sequence Defibrillation w/ @emscritcare & @ccareanywhere

Dr. Phil Moy of the @PECPodcast expertly interviews me regarding our recent publication in this month’s Prehospital Emergency Care.  We dive into the inspiration behind the study, the challenges behind the protocol and the development and deployment of our treatment algorithms.  We conclude with our overall experience and directions for future research. 

Article Link: http://www.ncbi.nlm.nih.gov/pubmed/26848018

PEC Podcast: http://pecpodcast.libsyn.com/

PEC Journal: http://naemsp.org/Pages/pecjournal.aspx

NAEMSP Website: http://naemsp.org/Pages/default.aspx

Also find my friends and fellow prehospital physician podcasters on Twitter:

Joelle Donofrio @PEMEMS

Jeremiah Escajeda @JerEscajeda

Scott Goldberg @EMS_Boston

Sponsored by @PerfectCPR

Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery

PerfectCPR.com

Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Aug 31 2016

25mins

Play

Rank #18: Ep #29 Operationalizing REBOA and Prehospital Implications w/ Dr. Justin McClean @WildernessMD

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Ep #29 Operationalizing REBOA and Prehospital Implications w/ Dr. Justin McClean @WildernessMD

AMPA – Air Medical Physicians Association

https://www.ampa.org/

#CCTMC17 Training Announcement – Critical Care Transport Medicine Conference

http://www.iafccp.org/events/EventDetails.aspx?id=177507

4/10/2017 to 4/12/2017

When:

April 10 - 12, 2017

Where:

Map this event » Wyndam River Walk Hotel 111 E. Pecan St. San Antonio, Texas  78205 United States

Contact:

Pat Petersen ppeter1111@aol.com

Sponsored by @PerfectCPR

Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery

PerfectCPR.com

Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Jun 30 2016

32mins

Play

Rank #19: Ep #62 Tactical Trauma 2017 - Wrap-Up Podcast 2

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Join our all star international panel as we discuss the highlights of the Day 2 program from the first ever Tactical Trauma 2017 conference recorded live in Sundsvall, Sweden. The conference was hosted by Dr. Fredrik Granholm @TotalResus

Link to the Tactical Trauma Website:

http://www.trippus.se/web/presentation/web.aspx?evid=quLLWDJBkBKybOhXZJmj8Q==&ecid=MPeU8Z0GCzdyw+SuQMe9Ng==&ln=eng&view=category&template=Desktop

Panel Participants:

Dr. Mark Forrest @ObiDoc

Dr. Rick Dutton @TraumaDinosaur

Dr. Kasia Hamptom @KasiaMD

Professor Susan Brundage @TraumaMasters

Dr. Leilani Doyle @DoyleLeilani

Mike Lauria @ResusPadawan

Dr. Andy Johnston @armycritcare

And your host Dr. Faizan H. Arshad @emscritcare

Query us on Twitter:

www.twitter.com/EMS_Nation

Like us on Facebook:

www.facebook.com/prehospitalnation

Wishing Everyone a safe tour!

~Faizan H. Arshad, MD @emscritcare

www.emsnation.org

Oct 13 2017

1hr 8mins

Play

Rank #20: Episode #80 Concepts in BLS Management of a Critical Patient

Podcast cover
Read more

As EMS Medical Directors we value the incorporation of best practice and evidence-based medicine into delivering high quality prehospital care. The Statewide protocols present a historic opportunity for us to collectively take our game to the next level.  We have worked hard to make these videos worth your while. We value your time as an EMS provider and using simulation videos as scaffolding to help bridge your knowledge of the new protocols can be invaluable.  There is, however, no substitute for reviewing the new protocols you will be exercising in depth.

It is challenging to produce something for a wide range of providers from new CFRs and new EMS physicians to experienced providers; nevertheless BLS is the keystone of all of our practice and we set out to give it the attention it deserves. New providers will notice language and terms that may be challenging but understandable from the context or definitions provided within. We encourage providers who have participated in our educational initiatives in the past to view this video series with a critical eye. Experienced providers are likely also teachers and field training officers. In that role, look for things that you could use to teach your students. Also, look for things that the actors could do differently in their scenarios and think about how you would address them if they were your trainees. As a note, while these videos all have lessons and take away learning points, many are intentionally designed to present patient care that could in fact be provided better.  Whether paid or volunteer, we wish you the best of luck in your EMS career. It is a noble field filled with many challenges. Be safe and never stop learning. We also wanted to specifically thank our partner in production of these videos - Laerdal Medical Corporation.  Their mission – Helping Save Lives – could not be more tantamount when discussing the nature of BLS care.  Learning to incorporate simulation into one’s regular practice can initially be challenging; however, a consistent well-designed program can be invaluable to providers in advancing multiple modalities of care from specific skills to psychosocial training and empathic communication.  

Jul 31 2019

17mins

Play