James Boomhower

James Boomhower, BS, FP-C, NR-P, has been involved in EMS for nearly 15 years in a variety of health systems throughout New England. He currently functions in the role of Critical Care Transport Specialist-Paramedic/ Lead Peer Support Director with Boston Medflight of Bedford, Massachusetts, and Crisis and Peer supporter for the ECHO FAST team. James’ passion for EMS education is realized through his position as an instructor for Distance CME’s online continuing education program. His desire to bring mental health awareness to the EMS arena has spurred him to create the Fit for Duty platform. Visit our website for more podcast episodes on Evidence-Based Medicine: http://emsnation.org/ Like us on Facebook: https://www.facebook.com/PrehospitalNation Follow us on Twitter: https://www.twitter.com/EMS_Nation

James Boomhower, BS, FP-C, NR-P, has been involved in EMS for nearly 15 years in a variety of health systems throughout New England. He currently functions in the role of Critical Care Transport Specialist-Paramedic/ Lead Peer Support Director with Boston Medflight of Bedford, Massachusetts, and Crisis and Peer supporter for the ECHO FAST team. James’ passion for EMS education is realized through his position as an instructor for Distance CME’s online continuing education program. His desire to bring mental health awareness to the EMS arena has spurred him to create the Fit for Duty platform. Visit our website for more podcast episodes on Evidence-Based Medicine: <a href="http://emsnation.org/" rel="nofollow" target="_blank">http://emsnation.org/</a> Like us on Facebook: <a href="https://www.facebook.com/PrehospitalNation" rel="nofollow" target="_blank">https://www.facebook.com/PrehospitalNation</a> Follow us on Twitter: <a href="https://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">https://www.twitter.com/EMS_Nation</a>

Episode #101 Fit for Duty with James Boomhower

Ashley Voss-Liebig, RN, BSN, CCRN is the Division Chief for Clinical Performance and Education in Travis County Texas. She is a senior flight nurse and helicopter rescue specialist with STAR Flight. Her research interests include Medical Education, POCUS, Human Performance. She is @ashleyliebig on Twitter

Ashley Voss-Liebig, RN, BSN, CCRN is the Division Chief for Clinical Performance and Education in Travis County Texas. She is a senior flight nurse and helicopter rescue specialist with STAR Flight. Her research interests include Medical Education, POCUS, Human Performance. She is @ashleyliebig on Twitter

Episode #100 Decision Fatigue 

Rachel Liu

A lecture by Rachel Liu, MD FACEP on the ResUScitation in Critical Care during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

A lecture by Rachel Liu, MD FACEP on the ResUScitation in Critical Care during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

Episode #99 ResUScitation in Critical Care with Rachel Liu, MD FACEP

A lecture by Timothy P. Collins, DO, FCCP on the Innovations in the Treatment of Shock during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

A lecture by Timothy P. Collins, DO, FCCP on the Innovations in the Treatment of Shock during the 2nd Annual ResusCon 2019 at the Grandview, September 4, 2019 @VassarCME @VBMCEMS @2019ResusCon

Episode #98 Innovations in the Treatment of Shock

Evie Marcolini

Evie Marcolini, MD is an Assistant Professor of Emergency Medicine and Neurocritical Care.  She has clinical appointments in the Department of Emergency Medicine and the Department of Neurology; and is core faculty in the Emergency Department as well as the Division of Neurocritical Care and Emergency Neurology at Yale. She has board certifications in Emergency Medicine and Neurocritical Care, and is fellowship-trained in Surgical Critical Care from the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.   Evie is Medical Director for the SkyHealth Critical Care helicopter transport service that is shared between Yale-New Haven Health System and Northwell Health. She is a Fellow of the American College of Critical Care Medicine, American Academy of Emergency Medicine (AAEM) and American College of Emergency Physicians (ACEP), and is a member of the Board of Directors for AAEM. She is the past Chair of the Critical Care Section of ACEP, and active in all three societies, with a goal of bringing emergency physicians to the forefront of critical care in all realms. Evie is an active educator and speaker, with an interest in neurocritical care topics as they relate to emergency medicine and bioethics as it relates to emergency medicine and critical care patients. She has, and continues to lecture nationally and internationally, and has won the ACEP Junior Faculty Teaching Award. Evie is very active in bioethics, as a member of the Yale-New Haven Health Ethics Committee and the Society for Critical Care Medicine (SCCM) Ethics committee, and teaches ethics seminars in the ethics of neuroscience and of emergency medicine annually for the Sherwin B. Nuland Summer Institute in Bioethics at Yale. She has been awarded the Grenvik Family Ethics Award from SCCM. Evie is a co-editor of the textbook: Emergency Department Resuscitation of the Critically Ill, which is now in its second edition, is a co-author of an upcoming book on mechanical ventilation in emergency medicine. She has been active as faculty for Wilderness Medical Associates International since 1992, and teaches wilderness medical courses to medical students, residents, faculty and allied health professionals nationally and internationally, as well as having served as Faculty Advisor to wilderness medicine interest groups at the University of Maryland and Yale. When not involved in academic pursuits, Evie loves to spend her time running and skijoring with her two Siberian Huskies. Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource. Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour!

Evie Marcolini, MD is an Assistant Professor of Emergency Medicine and Neurocritical Care.  She has clinical appointments in the Department of Emergency Medicine and the Department of Neurology; and is core faculty in the Emergency Department as well as the Division of Neurocritical Care and Emergency Neurology at Yale. She has board certifications in Emergency Medicine and Neurocritical Care, and is fellowship-trained in Surgical Critical Care from the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.   Evie is Medical Director for the SkyHealth Critical Care helicopter transport service that is shared between Yale-New Haven Health System and Northwell Health. She is a Fellow of the American College of Critical Care Medicine, American Academy of Emergency Medicine (AAEM) and American College of Emergency Physicians (ACEP), and is a member of the Board of Directors for AAEM. She is the past Chair of the Critical Care Section of ACEP, and active in all three societies, with a goal of bringing emergency physicians to the forefront of critical care in all realms. Evie is an active educator and speaker, with an interest in neurocritical care topics as they relate to emergency medicine and bioethics as it relates to emergency medicine and critical care patients. She has, and continues to lecture nationally and internationally, and has won the ACEP Junior Faculty Teaching Award. Evie is very active in bioethics, as a member of the Yale-New Haven Health Ethics Committee and the Society for Critical Care Medicine (SCCM) Ethics committee, and teaches ethics seminars in the ethics of neuroscience and of emergency medicine annually for the Sherwin B. Nuland Summer Institute in Bioethics at Yale. She has been awarded the Grenvik Family Ethics Award from SCCM. Evie is a co-editor of the textbook: Emergency Department Resuscitation of the Critically Ill, which is now in its second edition, is a co-author of an upcoming book on mechanical ventilation in emergency medicine. She has been active as faculty for Wilderness Medical Associates International since 1992, and teaches wilderness medical courses to medical students, residents, faculty and allied health professionals nationally and internationally, as well as having served as Faculty Advisor to wilderness medicine interest groups at the University of Maryland and Yale. When not involved in academic pursuits, Evie loves to spend her time running and skijoring with her two Siberian Huskies. Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource. Checkout the blog at <a href="http://EMSNation.org" rel="nofollow" target="_blank">EMSNation.org</a> and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour!

Episode #97 The Dizzy Patient with Dr. Evie Marcolini

Episode #96 Emergency Medicine Grand Grounds with Dr. Evie Marcolini: An Evidence-Based Approach to Traumatic Brain Injury

Dr. Mark Merlin Chair of the NJ EMS Council. He is the Founder of the of the New Jersey EMS Fellowship. He is the Medical Director of Medway Air Ambulance which has 10 fixed wing planes transporting hundreds of medical patients each month throughout the world. He has authored over 100 peer-reviewed manuscripts and abstracts in Emergency Medicine and EMS. Dr. Merlin is the CEO of MD1 which provides Emergency Medical Services in a mobile Emergency Department/Operating Room at no charge to citizens of New Jersey.   https://md1program.org/   Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour!

Dr. Mark Merlin Chair of the NJ EMS Council. He is the Founder of the of the New Jersey EMS Fellowship. He is the Medical Director of Medway Air Ambulance which has 10 fixed wing planes transporting hundreds of medical patients each month throughout the world. He has authored over 100 peer-reviewed manuscripts and abstracts in Emergency Medicine and EMS. Dr. Merlin is the CEO of MD1 which provides Emergency Medical Services in a mobile Emergency Department/Operating Room at no charge to citizens of New Jersey. <a href="https://md1program.org/" rel="nofollow" target="_blank">https://md1program.org/</a> Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at <a href="http://EMSNation.org" rel="nofollow" target="_blank">EMSNation.org</a> and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour!

Episode #95 Life after COVID19, Navigating the Path Ahead with @MD1Program

Perseverance, or more simply stated, Grit, is a common trait amongst EMS providers.  It grants us the ability to endure in the face of hardship when others may consider quitting or failing.  In regards to COVID 19, we are all playing the long game, it is a marathon (unfortunately) rather than a sprint.  We must stay united as a group and stay true to our mission of supporting and protecting our communities despite the pandemic.  That is not to say that we are not human ourselves.  While perseverance is one of the characteristics I value most in EMS providers, another virtue I’d care to juxtapose it to is vulnerability. In any situation that presents a threat — be it physical or emotional — our natural instinct is to protect ourselves. That's just basic survival. We try to defend, hide or deny our own  insecurities and weaknesses. Being vulnerable involves letting yourself feel all things — the good, the bad and the not-so-pretty — and then also letting someone else see it all. Trying to be invulnerable can be exhausting, as much as we’d like to be super heroes protecting the population from medical maladies we must also acknowledge our own humanity.  This is not easy and it’s okay to express that and seek support.  When we numb feelings like fear, embarrassment and pain, we also numb excitement, hope, gratitude and happiness. Allowing vulnerability into our lives can rejuvenate our senses and actually foster, build and restore our community and make us more connected. I’m including the link to Brene Brown’s TED talk on vulnerability that has nearly 50 million views. Thank you all again for always being in service and a very happy EMS Week.   https://www.ted.com/talks/brene_brown_the_power_of_vulnerability   Today’s episode brings us 2 EMS physicians from Stanford on the topic, “Where have all the STEMIs gone?” where we dive into the literature and statistics on cardiac arrest, dying at home, emergency department volume and numerous other items related to COVID19. Interestingly both domestically and abroad there has been a dramatic reduction in heart attacks, strokes and traumas that have been presenting via EMS to the ED.  We discuss potential hypotheses into this phenomenon and also explore other salient details related to COVID.    Bryan David Sloane, MD – Is the current EMS fellow at Stanford University.  He did his residency at Harbor UCLA where he lived out his EMERGENCY! Dreams.  He was an EMT in LA for 6 years before medical school and considers himself an EMT first and a physician second.  He hopes to take an attending position at Kaiser South Sacramento where he will also be working on many local EMS initiatives.   Gregory H. Gilbert, MD - Clinical associate Professor of Emergency Medicine at Stanford University. Medical Director of San Mateo County and EMS Fellowship Director at Stanford University. He grew up in New York State and received his MD, from SUNY Downstate with distinction for investigative scholarship. He completed his emergency medicine training in Atlanta, Georgia at Emory University and is dual boarded in EM and EMS.  Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week! 

Perseverance, or more simply stated, Grit, is a common trait amongst EMS providers.  It grants us the ability to endure in the face of hardship when others may consider quitting or failing.  In regards to COVID 19, we are all playing the long game, it is a marathon (unfortunately) rather than a sprint.  We must stay united as a group and stay true to our mission of supporting and protecting our communities despite the pandemic.  That is not to say that we are not human ourselves.  While perseverance is one of the characteristics I value most in EMS providers, another virtue I’d care to juxtapose it to is vulnerability. In any situation that presents a threat — be it physical or emotional — our natural instinct is to protect ourselves. That's just basic survival. We try to defend, hide or deny our own <a href="https://www.elitedaily.com/dating/insecurities-new-relationship/1199891" rel="nofollow" target="_blank"> insecurities</a> and weaknesses. Being vulnerable involves letting yourself feel all things — the good, the bad and the not-so-pretty — and then also letting someone else see it all. Trying to be invulnerable can be exhausting, as much as we’d like to be super heroes protecting the population from medical maladies we must also acknowledge our own humanity.  This is not easy and it’s okay to express that and seek support.  When we numb feelings like fear, embarrassment and pain, we also numb excitement, hope, gratitude and happiness. Allowing vulnerability into our lives can rejuvenate our senses and actually foster, build and restore our community and make us more connected. I’m including the link to Brene Brown’s TED talk on vulnerability that has nearly 50 million views. Thank you all again for always being in service and a very happy EMS Week. <a href="https://www.ted.com/talks/brene_brown_the_power_of_vulnerability" rel="nofollow" target="_blank">https://www.ted.com/talks/brene_brown_the_power_of_vulnerability</a> Today’s episode brings us 2 EMS physicians from Stanford on the topic, “Where have all the STEMIs gone?” where we dive into the literature and statistics on cardiac arrest, dying at home, emergency department volume and numerous other items related to COVID19. Interestingly both domestically and abroad there has been a dramatic reduction in heart attacks, strokes and traumas that have been presenting via EMS to the ED.  We discuss potential hypotheses into this phenomenon and also explore other salient details related to COVID.  Bryan David Sloane, MD – Is the current EMS fellow at Stanford University.  He did his residency at Harbor UCLA where he lived out his EMERGENCY! Dreams.  He was an EMT in LA for 6 years before medical school and considers himself an EMT first and a physician second.  He hopes to take an attending position at Kaiser South Sacramento where he will also be working on many local EMS initiatives. Gregory H. Gilbert, MD - Clinical associate Professor of Emergency Medicine at Stanford University. Medical Director of San Mateo County and EMS Fellowship Director at Stanford University. He grew up in New York State and received his MD, from SUNY Downstate with distinction for investigative scholarship. He completed his emergency medicine training in Atlanta, Georgia at Emory University and is dual boarded in EM and EMS.  Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at <a href="http://EMSNation.org" rel="nofollow" target="_blank">EMSNation.org</a> and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week!

Episode #94 Where have all the STEMIs gone?

Unfortunately due to the current situation and ongoing pandemic, it's difficult for us to wish you a "Happy" EMS Week, nevertheless, thank you to all the pre-hospital professionals for always being in service.  Today's episode is with EMS Chief Juan Cardona, from the Coral Springs - Parkland Fire Department in Florida.   He explores the operational and logistical challenges in responding to an out of hospital cardiac arrest during the age of COVID19 starting from issues related to dispatch, PPE, the ideal location of BLS/ACLS, How to interact with the family, Infection control maneuvers and also the psychological impact on families and providers to have their loved ones pass during the pandemic. Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at EMSNation.org and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week! 

Unfortunately due to the current situation and ongoing pandemic, it's difficult for us to wish you a "Happy" EMS Week, nevertheless, thank you to all the pre-hospital professionals for always being in service.  Today's episode is with EMS Chief Juan Cardona, from the Coral Springs - Parkland Fire Department in Florida.   He explores the operational and logistical challenges in responding to an out of hospital cardiac arrest during the age of COVID19 starting from issues related to dispatch, PPE, the ideal location of BLS/ACLS, How to interact with the family, Infection control maneuvers and also the psychological impact on families and providers to have their loved ones pass during the pandemic. Please leave us your thoughts and comments, we'd love to dig further into this topic.  Make sure to leave @EMS_Nation a 5 star review wherever you listen to podcasts and to share the episode with friends and colleagues to pass along this #FOAMed resource.  Checkout the blog at <a href="http://EMSNation.org" rel="nofollow" target="_blank">EMSNation.org</a> and say hello to Dr. Faizan H. Arshad on Twitter and Instagram @emscritcare. Wishing everyone a safe tour and a "happy" EMS Week!

Episode #93 Operationalzing Cardiac Arrest Management During COVID19

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days. 0:10 – Introduction to day 2 wrap up 0:40 – Introduction of the panel 1:15 – Mike Abernethy wraps up his session as a moderator on Day 2. Takeaways include Michael Lauria’s discussion on the preoccupation with protocols and guidelines. 2:45 – Three basic concepts include speed, simplicity, and coordination of care. Tactical medicine boils down to how efficiently one can perform these three tasks using evidence based medicine. Take the lessons learned from the military medicine, and a lot of them can be applied to civilian EMS and in-hospital care. 5:30 – One thing to add, is being able to do the basics very well. These basic skills will lay the foundation for new advanced technologies and interventions. 7:00 – Discussion on Mike Klumpner’s talk on medical best practices at MCI’s. The phrase “Just because you can, doesn’t mean you should” is discussed among the panel members. Being able to look at these mass casualty events, their injuries, and intervention with simplistically is the key. An example here includes an anecdote regarding a vascular neck injury, and the ability to ask “Am I making a difference, or am I delaying definitive care?” 9:30 – The panel discusses the criticism of triage in an MCI setting during day 2. One example given is that during most MCI’s, the triage tags were not used including the Boston Marathon bombing, where triage had to ‘go out the door’. Another example is the way the walking wounded are huddled into a corner and sometimes forgotten, while they may be gravely injured as evidenced in the Manchester bombing. 11:40 – FDNY’s new triage protocols include any penetrating injuries between the clavicle and the pelvis are immediate red tags. 12:15 – Breakout sessions with LEO’s who discussed the medical care of the K9’s. 13:30 – The point on situational awareness with the K9 colleagues is discussed. This includes muzzling them early if gravely injured and in danger. 13:45 – Anesthesiology talks about how dogs have a fenestrated chest cavity, and its importance with a tension pneumothorax. The end result is that the resulting obstructive shock may be worse in dogs. 15:00 – Ketamine takes a hit when it comes to pain control with K9’s for multiple physiologic reasons. Morphine IM 30-50mg was preferred for K9 pain control. 15:35 – Currently, it is a felony in the USA to provide ALS to animals if you are not a veterinarian. Propositions for exclusions for EMS workers trained in animal care are in the works right now. One anecdote is during a NC MCI, kid pools were filled with ice for the explosives K9’s, drawing a parallel to firefighter rehabilitation. 18:05 – Psychosocial aspects when providing medical care is discussed along with PTSD learning points. While feelings of anger and hostility towards your patient may be natural, providers must be able to accept that and continue to give medical care. 19:35 – Learning points in PTSD. One interesting finding was that those with minor injuries who received early intervention developed worse PTSD when compared to those with severe or no injuries. This raises questions on mandatory Critical Incident Stress Management, and how it should always be voluntary. 21:05 – Best practices after tough calls in EMS. Debriefing, assessing for safety, and assuring readiness for the next job are the top priorities. Being able to spend time with your colleagues, who have been through similar experiences versus mandatory CISM is discussed as well. 23:15 – The longer people stay in lockdown during MCI’s, the more likely they are to develop PTSD. Data coming out is showing that school lockdowns are causing PTSD in pediatrics. 24:50 – ‘Just culture’ is discussed, as is the importance of making system level changes to prevent errors. Most of the time, it is organizational culture that leads to mistakes, and not just individual mistakes. 26:10 – No non-discoverable mistakes exist in EMS, as opposed to hospital-based medicine. 26:55 – Takeaways from afternoon lectures including penetrating trauma with Dr. Tom Koenig, tactical medicine in mass casualty events with Dr. Matthew Lengua, OB trauma, and blast injuries. 27:30 – Resuscitative hysterotomies in Finland, and other advanced procedures done quickly and in austere environments. Discussing the decision gap, which the is the time from when the decision to perform a critical procedure is made until when that procedure is performed. 33:30 – Advances in resuscitative hysterotomies and thoracotomies, and there are now clear indications for both. However, this does not mean that Top Cover should be eliminated. 34:00 – Takeaways from blast injuries and penetrating trauma, specifically to the head and neck region. Major points include how EMS Physicians can treat some of these patients in the warm zone with critical interventions. 36:00 – Learning points from the lecture on burn care, and the unpredictability of the burn patient. One takeaway is that due to the current school of thought, providers are over-intubating patients with harm. Studies have also shown that escharotomies performed outside of burn centers are often performed incorrectly and incompletely. 39:30 – Use of vehicles as a weapon of mass destruction has become more common recently. A takeaway is that the extent of injury tends to be worse when the attack is intentional, whether using vehicles or other weapons. Logistically, the scene tends to be complex as it generally encompasses are large area. The discussion is brought up again about how as medical personnel, we can empower and train the general public to help. 48:55 – Next steps include teaching our communities the basic skills that have been proven to save lives, and working together to minimize these threats in the future. 49:15 - Conclusion

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days. 0:10 – Introduction to day 2 wrap up 0:40 – Introduction of the panel 1:15 – Mike Abernethy wraps up his session as a moderator on Day 2. Takeaways include Michael Lauria’s discussion on the preoccupation with protocols and guidelines. 2:45 – Three basic concepts include speed, simplicity, and coordination of care. Tactical medicine boils down to how efficiently one can perform these three tasks using evidence based medicine. Take the lessons learned from the military medicine, and a lot of them can be applied to civilian EMS and in-hospital care. 5:30 – One thing to add, is being able to do the basics very well. These basic skills will lay the foundation for new advanced technologies and interventions. 7:00 – Discussion on Mike Klumpner’s talk on medical best practices at MCI’s. The phrase “Just because you can, doesn’t mean you should” is discussed among the panel members. Being able to look at these mass casualty events, their injuries, and intervention with simplistically is the key. An example here includes an anecdote regarding a vascular neck injury, and the ability to ask “Am I making a difference, or am I delaying definitive care?” 9:30 – The panel discusses the criticism of triage in an MCI setting during day 2. One example given is that during most MCI’s, the triage tags were not used including the Boston Marathon bombing, where triage had to ‘go out the door’. Another example is the way the walking wounded are huddled into a corner and sometimes forgotten, while they may be gravely injured as evidenced in the Manchester bombing. 11:40 – FDNY’s new triage protocols include any penetrating injuries between the clavicle and the pelvis are immediate red tags. 12:15 – Breakout sessions with LEO’s who discussed the medical care of the K9’s. 13:30 – The point on situational awareness with the K9 colleagues is discussed. This includes muzzling them early if gravely injured and in danger. 13:45 – Anesthesiology talks about how dogs have a fenestrated chest cavity, and its importance with a tension pneumothorax. The end result is that the resulting obstructive shock may be worse in dogs. 15:00 – Ketamine takes a hit when it comes to pain control with K9’s for multiple physiologic reasons. Morphine IM 30-50mg was preferred for K9 pain control. 15:35 – Currently, it is a felony in the USA to provide ALS to animals if you are not a veterinarian. Propositions for exclusions for EMS workers trained in animal care are in the works right now. One anecdote is during a NC MCI, kid pools were filled with ice for the explosives K9’s, drawing a parallel to firefighter rehabilitation. 18:05 – Psychosocial aspects when providing medical care is discussed along with PTSD learning points. While feelings of anger and hostility towards your patient may be natural, providers must be able to accept that and continue to give medical care. 19:35 – Learning points in PTSD. One interesting finding was that those with minor injuries who received early intervention developed worse PTSD when compared to those with severe or no injuries. This raises questions on mandatory Critical Incident Stress Management, and how it should always be voluntary. 21:05 – Best practices after tough calls in EMS. Debriefing, assessing for safety, and assuring readiness for the next job are the top priorities. Being able to spend time with your colleagues, who have been through similar experiences versus mandatory CISM is discussed as well. 23:15 – The longer people stay in lockdown during MCI’s, the more likely they are to develop PTSD. Data coming out is showing that school lockdowns are causing PTSD in pediatrics. 24:50 – ‘Just culture’ is discussed, as is the importance of making system level changes to prevent errors. Most of the time, it is organizational culture that leads to mistakes, and not just individual mistakes. 26:10 – No non-discoverable mistakes exist in EMS, as opposed to hospital-based medicine. 26:55 – Takeaways from afternoon lectures including penetrating trauma with Dr. Tom Koenig, tactical medicine in mass casualty events with Dr. Matthew Lengua, OB trauma, and blast injuries. 27:30 – Resuscitative hysterotomies in Finland, and other advanced procedures done quickly and in austere environments. Discussing the decision gap, which the is the time from when the decision to perform a critical procedure is made until when that procedure is performed. 33:30 – Advances in resuscitative hysterotomies and thoracotomies, and there are now clear indications for both. However, this does not mean that Top Cover should be eliminated. 34:00 – Takeaways from blast injuries and penetrating trauma, specifically to the head and neck region. Major points include how EMS Physicians can treat some of these patients in the warm zone with critical interventions. 36:00 – Learning points from the lecture on burn care, and the unpredictability of the burn patient. One takeaway is that due to the current school of thought, providers are over-intubating patients with harm. Studies have also shown that escharotomies performed outside of burn centers are often performed incorrectly and incompletely. 39:30 – Use of vehicles as a weapon of mass destruction has become more common recently. A takeaway is that the extent of injury tends to be worse when the attack is intentional, whether using vehicles or other weapons. Logistically, the scene tends to be complex as it generally encompasses are large area. The discussion is brought up again about how as medical personnel, we can empower and train the general public to help. 48:55 – Next steps include teaching our communities the basic skills that have been proven to save lives, and working together to minimize these threats in the future. 49:15 - Conclusion

Episode #92 TacticalTrauma19 Wrap-Up Episode Day 2

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

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.

Great Podcast!

EMS Nation - Evidence Based Medicine in EMS Weekly Style Podcasts: Monday - Interview with a Leader in EMS Tuesday - ALS Simulation Wednesday - EMS Journal Club Thursday - BLS Simulation Friday - Health &amp; Wellness Follow us on Twitter! <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook! <a href="http://www.facebook.com/PrehospitalNation" rel="nofollow" target="_blank">www.facebook.com/PrehospitalNation</a> <a href="http://www.emsnation.org" rel="nofollow" target="_blank">www.emsnation.org</a>

EMS Nation Podcast

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: 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

BLS CPAP / JEMS: <a href="http://www.jems.com/articles/print/volume-38/issue-11/patient-care/argument-bls-cpap.html" rel="nofollow" target="_blank">http://www.jems.com/articles/print/volume-38/issue-11/patient-care/argument-bls-cpap.html</a> Optimizing Preoxygenation, Delayed Sequence Intubation: Must read: <a href="http://emcrit.org/preoxygenation" rel="nofollow" target="_blank">http://emcrit.org/preoxygenation</a> Paper in Annals @emcrit @mdaware: <a href="http://www.annemergmed.com/article/S0196-0644(14)01365-1/abstract" rel="nofollow" target="_blank">http://www.annemergmed.com/article/S0196-0644(14)01365-1/abstract</a> LITFL DSI: <a href="http://lifeinthefastlane.com/ccc/delayed-sequence-intubation/" rel="nofollow" target="_blank">http://lifeinthefastlane.com/ccc/delayed-sequence-intubation/</a> Follow us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD <a href="http://www.emsnation.org" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #4 - Simulation - Ketamine & Prehospital Delayed Sequence Intubation

Faizan H. Arshad

Ep #21 Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare Happy #EMSWeek #EMSStrong #EMSNation   SKEPTIC = Safety &amp; 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:  Carlson JN, Karns C, Mann NC, et al. Procedures performed by emergency medical services in the united states.Prehosp Emerg Care. 2015. Jacobs PE, Grabinsky A. Advances in prehospital airway management.International Journal of Critical Illness &amp; Injury Science. 2014;4:57-64. 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. Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management.Prehospital Emergency Care. 2005;9:145-155. Mace SE. Challenges and advances in intubation: Airway evaluation and controversies with intubation.Emerg Med Clin North Am. 2008;26:977-1000. 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. Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76:663-667. 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. 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. 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. 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 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. 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. Craven R. Ketamine. Anaesthesia. 2007;62:48-53. 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. 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. Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.J Emerg Med. 2010;38:622-631. Kohrs R, Durieux ME. Ketamine. Anesth Analg. 1998;87:1186-1193. 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. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36(2):186-197. Porter K. Ketamine in prehospital care. Emerg Med J. 2004;21:351-354. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25:977-980. 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. 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. Himmelseher S, Durieux ME. Revising a Dogma: Ketamine for Patients with Neurological Injury? Anesth Analg. 2005;101:524-534. 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. Angus DC, van dP. Severe sepsis and septic shock.N Engl J Med. 2013;369:840-851. 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. 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. 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. 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 Bruns, B, Gentilello, L, Elliott, A, Shafi, S. Prehospital Hypotension Redefined. The Journal of Trauma: Injury, Infection, and Critical Care. 2008;65:1217–1221. 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. 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. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84:1500-1504. 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. 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. 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. 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. 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 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

Ep #21 Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare Happy #EMSWeek #EMSStrong #EMSNation SKEPTIC = Safety &amp; 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! <a href="http://www.annemergmed.com/article/S0196-0644(16)30002-6/abstract" rel="nofollow" target="_blank">http://www.annemergmed.com/article/S0196-0644(16)30002-6/abstract</a> Additional References: <ol> <li>Carlson JN, Karns C, Mann NC, et al. Procedures performed by emergency medical services in the united states.Prehosp Emerg Care. 2015.</li> <li>Jacobs PE, Grabinsky A. Advances in prehospital airway management.International Journal of Critical Illness &amp; Injury Science. 2014;4:57-64.</li> <li>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.</li> <li>Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management.Prehospital Emergency Care. 2005;9:145-155.</li> <li>Mace SE. Challenges and advances in intubation: Airway evaluation and controversies with intubation.Emerg Med Clin North Am. 2008;26:977-1000.</li> <li>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.</li> <li>Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76:663-667.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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</li> <li>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.</li> <li>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.</li> <li>Craven R. Ketamine. Anaesthesia. 2007;62:48-53.</li> <li>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.</li> <li>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.</li> <li>Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.J Emerg Med. 2010;38:622-631.</li> <li>Kohrs R, Durieux ME. Ketamine. Anesth Analg. 1998;87:1186-1193.</li> <li>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.</li> <li>Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36(2):186-197.</li> <li>Porter K. Ketamine in prehospital care. Emerg Med J. 2004;21:351-354.</li> <li>Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25:977-980.</li> <li>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.</li> <li>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.</li> <li>Himmelseher S, Durieux ME. Revising a Dogma: Ketamine for Patients with Neurological Injury? Anesth Analg. 2005;101:524-534.</li> <li>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.</li> <li>Angus DC, van dP. Severe sepsis and septic shock.N Engl J Med. 2013;369:840-851.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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</li> <li>Bruns, B, Gentilello, L, Elliott, A, Shafi, S. Prehospital Hypotension Redefined. The Journal of Trauma: Injury, Infection, and Critical Care. 2008;65:1217–1221.</li> <li>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.</li> <li>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.</li> <li>Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84:1500-1504.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>Selde W. Push dose epinephrine. A temporizing measure for drugs that have the side-effect of hypotension.JEMS. 2014;39:62-63.</li> </ol> Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery <a href="http://PerfectCPR.com" rel="nofollow" target="_blank">PerfectCPR.com</a> Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

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

Remote

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

Saving life and brain with extracorporeal cardiopulmonary resuscitation: A single-center analysis of in-hospital cardiac arrests <a href="http://www.ncbi.nlm.nih.gov/pubmed/26383007" rel="nofollow" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/26383007</a> Tranexamic acid as part of remote damage-control resuscitation in the prehospital setting: A critical appraisal of the medical literature and available alternatives <a href="http://www.ncbi.nlm.nih.gov/pubmed/26002268" rel="nofollow" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/26002268</a> Follow us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD <a href="http://www.emsnation.org" rel="nofollow" target="_blank">www.emsnation.org</a>

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

Keith Lurie

Ep #17 A Primer on Intrathoracic Pressure Regulation &amp; 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):    Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M. The physiology of cardiopulmonary resuscitation. Anesth Analg. 11/2015 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 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 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 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 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 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 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 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 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 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. 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. 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. 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. 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 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 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 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 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. Yannopoulos D, Kotsifas K, Lurie KG. Advances in cardiopulmonary resuscitation. Heart Fail Clin. Apr 2011;7(2):251-268, ix. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

Ep #17 A Primer on Intrathoracic Pressure Regulation &amp; 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 <a href="http://PerfectCPR.com" rel="nofollow" target="_blank">PerfectCPR.com</a> 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): <ol> <li>Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M. The physiology of cardiopulmonary resuscitation. Anesth Analg. 11/2015</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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</li> <li>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</li> <li>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</li> <li>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</li> <li>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.</li> <li>Yannopoulos D, Kotsifas K, Lurie KG. Advances in cardiopulmonary resuscitation. Heart Fail Clin. Apr 2011;7(2):251-268, ix.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>Aufderheide TP, <a href="http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOMDIBCL00D&amp;Search+Link=%22Pirrallo+RG%22.au." rel="nofollow" target="_blank"> Pirrallo RG</a>, <a href="http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOMDIBCL00D&amp;Search+Link=%22Provo+TA%22.au." rel="nofollow" target="_blank"> Provo TA</a>, <a href="http://gateway.ut.ovid.com/gw1/ovidweb.cgi?S=IDNJHKJOMDIBCL00D&amp;Search+Link=%22Lurie+KG%22.au." rel="nofollow" target="_blank"> Lurie KG</a>. 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.</li> <li>Pirrallo RG, <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&amp;cmd=Search&amp;term=%22Aufderheide+TP%22%5BAuthor%5D" rel="nofollow" target="_blank"> Aufderheide TP</a>, <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&amp;cmd=Search&amp;term=%22Provo+TA%22%5BAuthor%5D" rel="nofollow" target="_blank"> Provo TA</a>, <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&amp;cmd=Search&amp;term=%22Lurie+KG%22%5BAuthor%5D" rel="nofollow" target="_blank"> Lurie KG</a>. Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation. 2005 Jul;66(1):13-20.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>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.</li> </ol> Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

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

https://ampa.org/ http://www.atacc.co.uk/   Happy Monday of #EMSWeek2017! Roll up your sleeves and mentally prepare for getting your hands dirty.  Chief Flight Physician of University of Wisconsin MedFlight, Dr. Mike Abernethy @FLTDOC1, gives an honest assessment of the current state of discongruity in EMS in America.  An honest assessment of the intricacies of American Prehospital Care and efforts we can take to improve outcomes for all our patients. His Bio &amp; Credentials: http://www.emed.wisc.edu/content/mike-abernethy-md   @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

<a href="https://ampa.org/" rel="nofollow" target="_blank">https://ampa.org/</a> <a href="http://www.atacc.co.uk/" rel="nofollow" target="_blank">http://www.atacc.co.uk/</a> Happy Monday of #EMSWeek2017! Roll up your sleeves and mentally prepare for getting your hands dirty.  Chief Flight Physician of University of Wisconsin MedFlight, Dr. Mike Abernethy @FLTDOC1, gives an honest assessment of the current state of discongruity in EMS in America.  An honest assessment of the intricacies of American Prehospital Care and efforts we can take to improve outcomes for all our patients. His Bio &amp; Credentials: <a href="http://www.emed.wisc.edu/content/mike-abernethy-md" rel="nofollow" target="_blank">http://www.emed.wisc.edu/content/mike-abernethy-md</a> @AmpaDocs #CCTMC17 Mark your calendars for #CCTMC18 April 9-11th 2018 Wyndham Riverwalk - San Antonio Texas Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #54 What's Wrong with American Prehospital Care & How Do we Fix it! #EMSWeek2017

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 &amp; 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

<a href="https://ampa.org/" rel="nofollow" target="_blank">https://ampa.org/</a> Happy Friday of #EMSWeek2017! <a href="https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf" rel="nofollow" target="_blank">https://emcrit.org/wp-content/uploads/push-dose-pressors.pdf</a> 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 &amp; 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: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #58 Push Dose Pressors & Push Dose Nitroglycerin @emscritcare #EMSWeek2017

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days.   0:10 - Introduction of the conference 0:45 – Introduction of the expert panel 1:25 – Reflecting on the Las Vegas Shooting. Description of the original triage station which was not setup for an MCI with major trauma. Severely injured patients were kept on scene for approximately 45 minutes, due to unknown location of gunshots being fired. 2:45 – A big takeaway from this session is to assign a civilian to each patient, as many are willing to help. This way there is someone watching every patient who could report on their overall status (ie. Doing well vs deteriorating), freeing up medically trained resources for the most critical patients. Included in this talk was a discussion in how to involve and empower bystanders, as the first responders may not be on scene within minutes. 4:30 – The concept of an “immediate threat vacuum” is discussed, and defined as a period of time where victims are not being treated by EMS. Currently, this remains an opportunity for improvement. 5:00 – Military success rests on the fact that everyone is trained on tactical casualty care, thus allowing that vacuum to be filled. 5:45 – Hemorrhage control for the bystander needs to continue to be emphasized. A major campaign in America is Stop the Bleed, which emphasizes basic bleeding control techniques for the general public. This has also raised awareness for bleeding control kits, which are now readily available in certain public locations (ie. Schools, airports) Link: https://www.stopthebleed.org 6:15 – Studies into casualties were not done until quite recently, where experts were able to analyze drills and incidents to create real timelines for casualties. It was found that victims were not surviving with current protocols, indicating a need for change. There is now widespread access to data regarding specific wounds and their prognostic factors. 7:15 – A reflection of the Pulse nightclub shooting shows that there may have been fatalities due to decisions that came under fire, as there was previously not much data available to study and prepare adequately. 8:00 – A quick discussion on how pre-hospital providers must be prepared for anything that can occur out of hospitals. There is a quick reminder that not all hot-zones are created equal, therefore every environment is different and professionals must train and adapt to this. 8:35 – Some internet searches have revealed that terrorists are using response tactics to learn and improve their terror plans. 9:30 – Brief reminder on how expanding on experience can come in the form of extensive training, along with length of service. 10:00 – Summary of Michael Lauria’s presentation on Emergency Action Drills. This is adapting the way we train to optimize response and link that to subsequent patient outcomes. One way is to look at how other fields train for high risk scenarios, such as the military and the aviation industry. This presentation looked at the medical side of training, and the opportunity for improvement in training 11:00 – Discussed here are the steps for developing ERADs. 1. Identifying time sensitive threats that need to be addressed first (ie. Massive exsanguination, difficult airway). 2. Looking to literature, and coming up with solutions to these threats. 3. Engraining those steps in our mind during training. This has worked well for other professions in their high-risk trainings (aviation, military combat). This shows the importance of training like you fight, so you can fight like you trained when it comes time for that initial reaction. 15:30 – Wrap-up of Mark Forrest’s preventable deaths by exsanguination. The presentation revisited the topics that had no research, including Hydrogel technology and others that need further research. The bottom line takeaway is stopping the bleed with basic techniques has been proven to save lives, while other technologies may be in the horizon. 17:12 – iTClamp use in head and neck trauma has been shown to be fairly effective in studies, while it performed poorly compared to CAT Tourniquet in the lower extremities. However, 7.5% of military wounds are above the neck and result in very high mortality. The iTClamp has shown success in these situations. One link to a study on animal models: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786550/ 18:05 – Brief update on Junctional hemorrhages. Multiple devices have been shown to be effective in the lab, however their field application has been limited by weight, time, training. SAM has seemed to be the most popular anecdotally. Wound packing and close monitoring is likely the most effective method at the moment. 18:50 – Dr. Kate Prior’s presentation on leadership in a team-based setting with Inclusive Leadership practice. A deeper anecdotal discussion regarding inherent bias in the team environment is discussed here as well. 21:30 – Discussion on the timing of intubation in hypotensive poly-trauma patient. Two main reasons prevailed, the instability that comes with induction, and the negative effects of ventilation. 22:10 – Discussion on the resuscitation of the bleeding pediatric patient. Using the adult knowledge in the pediatric patient, just changing based on weight has more evidence behind it now. 22:55 – Discussion on Damage Control Resuscitation. This depends highly on the setting, and resources available in that setting. Examples of this include consistent hypotension prior to trauma surgery, the use of whole blood, and following the blood pressures being less ideal than signs of perfusion and blood flow using ultrasound. One key point is that each person has a different shock tolerance, and predicting this is virtually impossible. 25:45 – Conclusion of Day 1 Wrap-up.

This episode is a wrap up covering the highlights from the Tactical Trauma international conference on pre-hospital critical care and trauma. This conference emphasizes tactical medicine, with a panel of experts speaking throughout the 2 days. 0:10 - Introduction of the conference 0:45 – Introduction of the expert panel 1:25 – Reflecting on the Las Vegas Shooting. Description of the original triage station which was not setup for an MCI with major trauma. Severely injured patients were kept on scene for approximately 45 minutes, due to unknown location of gunshots being fired. 2:45 – A big takeaway from this session is to assign a civilian to each patient, as many are willing to help. This way there is someone watching every patient who could report on their overall status (ie. Doing well vs deteriorating), freeing up medically trained resources for the most critical patients. Included in this talk was a discussion in how to involve and empower bystanders, as the first responders may not be on scene within minutes. 4:30 – The concept of an “immediate threat vacuum” is discussed, and defined as a period of time where victims are not being treated by EMS. Currently, this remains an opportunity for improvement. 5:00 – Military success rests on the fact that everyone is trained on tactical casualty care, thus allowing that vacuum to be filled. 5:45 – Hemorrhage control for the bystander needs to continue to be emphasized. A major campaign in America is Stop the Bleed, which emphasizes basic bleeding control techniques for the general public. This has also raised awareness for bleeding control kits, which are now readily available in certain public locations (ie. Schools, airports) Link: <a href="https://www.stopthebleed.org" rel="nofollow" target="_blank">https://www.stopthebleed.org</a> 6:15 – Studies into casualties were not done until quite recently, where experts were able to analyze drills and incidents to create real timelines for casualties. It was found that victims were not surviving with current protocols, indicating a need for change. There is now widespread access to data regarding specific wounds and their prognostic factors. 7:15 – A reflection of the Pulse nightclub shooting shows that there may have been fatalities due to decisions that came under fire, as there was previously not much data available to study and prepare adequately. 8:00 – A quick discussion on how pre-hospital providers must be prepared for anything that can occur out of hospitals. There is a quick reminder that not all hot-zones are created equal, therefore every environment is different and professionals must train and adapt to this. 8:35 – Some internet searches have revealed that terrorists are using response tactics to learn and improve their terror plans. 9:30 – Brief reminder on how expanding on experience can come in the form of extensive training, along with length of service. 10:00 – Summary of Michael Lauria’s presentation on Emergency Action Drills. This is adapting the way we train to optimize response and link that to subsequent patient outcomes. One way is to look at how other fields train for high risk scenarios, such as the military and the aviation industry. This presentation looked at the medical side of training, and the opportunity for improvement in training 11:00 – Discussed here are the steps for developing ERADs. 1. Identifying time sensitive threats that need to be addressed first (ie. Massive exsanguination, difficult airway). 2. Looking to literature, and coming up with solutions to these threats. 3. Engraining those steps in our mind during training. This has worked well for other professions in their high-risk trainings (aviation, military combat). This shows the importance of training like you fight, so you can fight like you trained when it comes time for that initial reaction. 15:30 – Wrap-up of Mark Forrest’s preventable deaths by exsanguination. The presentation revisited the topics that had no research, including Hydrogel technology and others that need further research. The bottom line takeaway is stopping the bleed with basic techniques has been proven to save lives, while other technologies may be in the horizon. 17:12 – iTClamp use in head and neck trauma has been shown to be fairly effective in studies, while it performed poorly compared to CAT Tourniquet in the lower extremities. However, 7.5% of military wounds are above the neck and result in very high mortality. The iTClamp has shown success in these situations. One link to a study on animal models: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786550/" rel="nofollow" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786550/</a> 18:05 – Brief update on Junctional hemorrhages. Multiple devices have been shown to be effective in the lab, however their field application has been limited by weight, time, training. SAM has seemed to be the most popular anecdotally. Wound packing and close monitoring is likely the most effective method at the moment. 18:50 – Dr. Kate Prior’s presentation on leadership in a team-based setting with Inclusive Leadership practice. A deeper anecdotal discussion regarding inherent bias in the team environment is discussed here as well. 21:30 – Discussion on the timing of intubation in hypotensive poly-trauma patient. Two main reasons prevailed, the instability that comes with induction, and the negative effects of ventilation. 22:10 – Discussion on the resuscitation of the bleeding pediatric patient. Using the adult knowledge in the pediatric patient, just changing based on weight has more evidence behind it now. 22:55 – Discussion on Damage Control Resuscitation. This depends highly on the setting, and resources available in that setting. Examples of this include consistent hypotension prior to trauma surgery, the use of whole blood, and following the blood pressures being less ideal than signs of perfusion and blood flow using ultrasound. One key point is that each person has a different shock tolerance, and predicting this is virtually impossible. 25:45 – Conclusion of Day 1 Wrap-up.

Episode #91 TacticalTrauma19 Wrap-Up Episode Day 1

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

Justin McClean

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

Ep #29 Operationalizing REBOA and Prehospital Implications w/ Dr. Justin McClean @WildernessMD AMPA – Air Medical Physicians Association <a href="https://www.ampa.org/" rel="nofollow" target="_blank">https://www.ampa.org/</a> #CCTMC17 Training Announcement – Critical Care Transport Medicine Conference <a href="http://www.iafccp.org/events/EventDetails.aspx?id=177507" rel="nofollow" target="_blank">http://www.iafccp.org/events/EventDetails.aspx?id=177507</a> 4/10/2017 to 4/12/2017 When: April 10 - 12, 2017 Where: <a href="http://www.iafccp.org/events/EventDetails.aspx?id=177507" rel="nofollow" target="_blank">Map this event »</a> Wyndam River Walk Hotel 111 E. Pecan St. San Antonio, Texas  78205 United States Contact: Pat Petersen <a href="mailto:ppeter1111@aol.com">ppeter1111@aol.com</a> Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery <a href="http://PerfectCPR.com" rel="nofollow" target="_blank">PerfectCPR.com</a> Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

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

Ep #9 - Simulation - Double Sequential Defibrillation in refractory VF &amp; 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

Ep #9 - Simulation - Double Sequential Defibrillation in refractory VF &amp; Lecture by @ccareanywhere on #DSED Hot off the press! Our case series on #DSED just accepted for publication in Prehospital Emergency Care: <a href="http://www.tandfonline.com/eprint/ZQsRHp54MWXAIkCsUiAi/full" rel="nofollow" target="_blank">http://www.tandfonline.com/eprint/ZQsRHp54MWXAIkCsUiAi/full</a> REBEL EM: Beyond ACLS <a href="http://rebelem.com/beyond-acls-dual-simultaneous-external-defibrillation/" rel="nofollow" target="_blank">http://rebelem.com/beyond-acls-dual-simultaneous-external-defibrillation/</a> EMS World: Hold the Coroner <a href="http://www.emsworld.com/article/10318805/double-sequential-defibrillation" rel="nofollow" target="_blank">http://www.emsworld.com/article/10318805/double-sequential-defibrillation</a> PEC: Cabanas et al <a href="http://www.ncbi.nlm.nih.gov/pubmed/25243771" rel="nofollow" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/25243771</a> Follow us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

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

Joe Bart

Ep #7 – Simulation Episode – Selective Spinal Immobilization with Dr. Joe Bart (Full HD video on YouTube) https://www.youtube.com/watch?v=Lh44vQHpQvk&amp;feature=iv&amp;src_vid=PkNRiJm6FRY&amp;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 &amp; 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&amp;A with Dr. Bart   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

Ep #7 – Simulation Episode – Selective Spinal Immobilization with Dr. Joe Bart (Full HD video on YouTube) <a href="https://www.youtube.com/watch?v=Lh44vQHpQvk&amp;feature=iv&amp;src_vid=PkNRiJm6FRY&amp;annotation_id=annotation_4084272705" rel="nofollow" target="_blank">https://www.youtube.com/watch?v=Lh44vQHpQvk&amp;feature=iv&amp;src_vid=PkNRiJm6FRY&amp;annotation_id=annotation_4084272705</a> Joseph A. Bart DO – EMS division – Operations Medical Director, Deputy Fellowship Director University of Buffalo Profile Page: <a href="https://medicine.buffalo.edu/content/medicine/faculty/profile.html?ubit=jabart" rel="nofollow" target="_blank">https://medicine.buffalo.edu/content/medicine/faculty/profile.html?ubit=jabart</a> National Center for Security &amp; Preparedness: <a href="http://www.albany.edu/ncsp/" rel="nofollow" target="_blank">http://www.albany.edu/ncsp/</a> -- Eliminate the Standing Take Down -- Selective use of the C-collar -- The Backboard as an Extrication Device -- The Role of Alternate Devices -- Q&amp;A with Dr. Bart Follow us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

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

https://ampa.org/   Join our distinguished Panel Discuss the Highlights of Day 1!   @MedFlightDoc Dr. Ryan Wubben @DrewCathers Dr. Andrew Cathers @CMGrffn Dr. Cynthia Griffin @TotalResus Dr. Fredrik Granholm @MikeSteuerwald Dr. Mike Steuerwald @87MD1 Dr. Chris Fullagar @UCAirCareDoc Dr. Bill Hinckley @FLTDOC1 Dr. Mike Abernethy @EMSCritCare Dr. Faizan H. Arshad   Sponsored by @AmpaDocs #CCTMC17     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

<a href="https://ampa.org/" rel="nofollow" target="_blank">https://ampa.org/</a> Join our distinguished Panel Discuss the Highlights of Day 1! @MedFlightDoc Dr. Ryan Wubben @DrewCathers Dr. Andrew Cathers @CMGrffn Dr. Cynthia Griffin @TotalResus Dr. Fredrik Granholm @MikeSteuerwald Dr. Mike Steuerwald @87MD1 Dr. Chris Fullagar @UCAirCareDoc Dr. Bill Hinckley @FLTDOC1 Dr. Mike Abernethy @EMSCritCare Dr. Faizan H. Arshad Sponsored by @AmpaDocs #CCTMC17 Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #52 Day 1 Wrap-Up #CCTMC17 

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 Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org

Ep #23 EMS Based Fire Systems - Challenging Tradition with Dr. Craig Manifold Happy #EMSWeek #EMSStrong #EMSNation Dr. Craig Manifold <a href="http://emergencymedicine.uthscsa.edu/faculty/manifold.asp" rel="nofollow" target="_blank"> http://emergencymedicine.uthscsa.edu/faculty/manifold.asp</a> <a href="https://www.linkedin.com/in/craig-manifold-75218052" rel="nofollow" target="_blank"> https://www.linkedin.com/in/craig-manifold-75218052</a> NAEMT Position Statement on House Bill HR4365: <a href="https://www.naemt.org/docs/default-source/advocacy-documents/emshd-documents/2016-requests-to-congress/2016-hr4365-patientmeds-final.pdf?sfvrsn=4" rel="nofollow" target="_blank"> https://www.naemt.org/docs/default-source/advocacy-documents/emshd-documents/2016-requests-to-congress/2016-hr4365-patientmeds-final.pdf?sfvrsn=4</a> HR4365 - Sponsor - Rep Hudson, Richard {R-NC-8} Introduced 1/12/16 <a href="https://www.congress.gov/bill/114th-congress/house-bill/4365" rel="nofollow" target="_blank"> https://www.congress.gov/bill/114th-congress/house-bill/4365</a> Congressional EMS Caucus: <a href="https://www.naemt.org/advocacy/ems-caucus" rel="nofollow" target="_blank"> https://www.naemt.org/advocacy/ems-caucus</a> REBOA: <a href="http://lifeinthefastlane.com/ccc/resuscitative-endovascular-balloon-occlusion-aorta-reboa/" rel="nofollow" target="_blank"> http://lifeinthefastlane.com/ccc/resuscitative-endovascular-balloon-occlusion-aorta-reboa/</a> NAEMSP Selective Spinal Immobilization: <a href="http://www.naemsp.org/Documents/Position%20Papers/EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard_Resource%20Document.pdf" rel="nofollow" target="_blank"> http://www.naemsp.org/Documents/Position%20Papers/EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard_Resource%20Document.pdf</a> <a href="http://www.naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf" rel="nofollow" target="_blank"> http://www.naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf</a> Fire-Based EMS - The Myth of the Perfect model @EMSWorldExpo <a href="http://www.emsworld.com/article/10322477/the-myth-of-the-perfect-model" rel="nofollow" target="_blank"> http://www.emsworld.com/article/10322477/the-myth-of-the-perfect-model</a> Sponsored by @PerfectCPR Apple Watch App with Audio and Taptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery <a href="http://www.PerfectCPR.com" rel="nofollow" target="_blank">www.PerfectCPR.com</a> Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

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

https://ampa.org/   Join our distinguished Panel Discuss the Highlights of Day 2!   @CMGrffn Dr. Cynthia Griffin @87MD1 Dr. Chris Fullagar @MattRoginski Dr. Matt Roginski @ALatimer13 Dr. Andrew Latimer @ChuckSheppard Dr. Chuck Sheppard @LuigisDad Sam Matta RN, East Coast Heli Ops  @UCAirCareDoc Dr. Bill Hinckley @Crit_Care_Excel Michael C. Berrier NRP, FP-C, NPT, AAS @AshleyLiebig Ashley Liebig (all around badass) Dr. Damon A. Darsey AND your Host @EMSCritCare Dr. Faizan H. Arshad   Hosted by @AmpaDocs #CCTMC18     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

<a href="https://ampa.org/" rel="nofollow" target="_blank">https://ampa.org/</a> Join our distinguished Panel Discuss the Highlights of Day 2! @CMGrffn Dr. Cynthia Griffin @87MD1 Dr. Chris Fullagar @MattRoginski Dr. Matt Roginski @ALatimer13 Dr. Andrew Latimer @ChuckSheppard Dr. Chuck Sheppard @LuigisDad Sam Matta RN, East Coast Heli Ops  @UCAirCareDoc Dr. Bill Hinckley @Crit_Care_Excel Michael C. Berrier NRP, FP-C, NPT, AAS @AshleyLiebig Ashley Liebig (all around badass) Dr. Damon A. Darsey AND your Host @EMSCritCare Dr. Faizan H. Arshad Hosted by @AmpaDocs #CCTMC18 Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #68 Critical Care Transport Medicine Conference - Day 2 Wrap-Up #CCTMC18 @AMPADocs

Ep #31 Hypertonic Saline vs. Mannitol in the Transport Environment with Dr. Drew Cathers @DrewCathers 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

Ep #31 Hypertonic Saline vs. Mannitol in the Transport Environment with Dr. Drew Cathers @DrewCathers AMPA – Air Medical Physicians Association <a href="https://www.ampa.org/" rel="nofollow" target="_blank">https://www.ampa.org/</a> #CCTMC17 Training Announcement – Critical Care Transport Medicine Conference <a href="http://www.iafccp.org/events/EventDetails.aspx?id=177507" rel="nofollow" target="_blank">http://www.iafccp.org/events/EventDetails.aspx?id=177507</a> 4/10/2017 to 4/12/2017 When: April 10 - 12, 2017 Where: <a href="http://www.iafccp.org/events/EventDetails.aspx?id=177507" rel="nofollow" target="_blank">Map this event »</a> Wyndam River Walk Hotel 111 E. Pecan St. San Antonio, Texas  78205 United States Contact: Pat Petersen <a href="mailto:ppeter1111@aol.com">ppeter1111@aol.com</a> Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery <a href="http://PerfectCPR.com" rel="nofollow" target="_blank">PerfectCPR.com</a> Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #31 Hypertonic Saline vs. Mannitol in the Transport Environment with Dr. Drew Cathers @DrewCathers

https://ampa.org/   Join our distinguished Panel Discuss the Highlights of Day 1!   @87MD1 Dr. Chris Fullagar @ktcollopy Kevin T. Collopy, BA, FP-C, CCEMT-P, NRP, CMTE   @UCAirCareDoc Dr. Bill Hinckley @CMGrffn Dr. Cynthia Griffin @LuigisDad Sam Matta RN, NRP @AshleyLiebig Ashley Liebig (all around badass) @EMSCritCare Dr. Faizan H. Arshad   Hosted by @AmpaDocs #CCTMC18     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

<a href="https://ampa.org/" rel="nofollow" target="_blank">https://ampa.org/</a> Join our distinguished Panel Discuss the Highlights of Day 1! @87MD1 Dr. Chris Fullagar @ktcollopy Kevin T. Collopy, BA, FP-C, CCEMT-P, NRP, CMTE @UCAirCareDoc Dr. Bill Hinckley @CMGrffn Dr. Cynthia Griffin @LuigisDad Sam Matta RN, NRP @AshleyLiebig Ashley Liebig (all around badass) @EMSCritCare Dr. Faizan H. Arshad Hosted by @AmpaDocs #CCTMC18 Query us on Twitter: <a href="http://www.twitter.com/EMS_Nation" rel="nofollow" target="_blank">www.twitter.com/EMS_Nation</a> Like us on Facebook: <a href="http://www.facebook.com/prehospitalnation" rel="nofollow" target="_blank">www.facebook.com/prehospitalnation</a> Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare <a href="http://www.emsnation.org/" rel="nofollow" target="_blank">www.emsnation.org</a>

Ep #67 Critical Care Transport Medicine Conference - Day 1 Wrap-Up #CCTMC18 @AMPADocs

Resilience

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.

An in depth and personal interview with Brian LaCroix, president of Allina health who has helped develop the <a href="http://EMSgrit.org" rel="nofollow" target="_blank">EMSgrit.org</a> website.  Bringing a toolkit to mental health and helping develop the core attributes of Resilience and Self care while mitigating social stigma.

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

Neonatal Resuscitation Simulation - NYS Collaborative Uncomplicated delivery in the field is fairly straightforward. Unfortunately, things do not always go as planned. Thankfully, resuscitating a neonate in distress is a rare event but something that requires acute clinical acumen. This video depicts a newborn that is not responding to initial interventions. Review the neonatal resuscitation protocol along with this video. The next episode will depict an informal debrief of both this scenario as well as the OB field delivery scenario covered in the previous episode. 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

Neonatal Resuscitation Simulation - NYS Collaborative Uncomplicated delivery in the field is fairly straightforward. Unfortunately, things do not always go as planned. Thankfully, resuscitating a neonate in distress is a rare event but something that requires acute clinical acumen. This video depicts a newborn that is not responding to initial interventions. Review the neonatal resuscitation protocol along with this video. The next episode will depict an informal debrief of both this scenario as well as the OB field delivery scenario covered in the previous episode. 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 <a href="https://twitter.com/emscritcare" rel="nofollow" target="_blank">@emscritcare</a> Christopher J. Fullagar, MD, EMT-P, FACEP <a href="https://twitter.com/87md1" rel="nofollow" target="_blank">@87MD1</a>

Ep #41: Neonatal Resuscitation Simulation - NYS Collaborative

The Best Multi-Part Documentaries, with documentaries on Obama, Federer vs Nadal, the making of Star Wars, Netflix vs Blockbuster and more. Add episodes you're interested into your queue below!

Best Multi-Part Documentaries

The best podcast episodes on global issues affecting everyone. Covering topics such as the #metoo movement, climate change, the impact of technology and some of the biggest global issues facing us right now. For anyone interested in learning more about the world, and some of the issues we're facing, pick an episode below and start listening! Add episodes you're interested into your queue below!