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MCHD Paramedic Podcast

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The MCHD Paramedic Podcast is a place for prehospital providers to discuss best practices and offer clinical insights relevant to our daily practice. MCHD Medical Directors Dr. Robert Dickson and Dr. Casey Patrick invite you to explore the many aspects of prehospital care. Along the way you can expect guest appearances by some of the brightest minds that influence modern EMS.

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The MCHD Paramedic Podcast is a place for prehospital providers to discuss best practices and offer clinical insights relevant to our daily practice. MCHD Medical Directors Dr. Robert Dickson and Dr. Casey Patrick invite you to explore the many aspects of prehospital care. Along the way you can expect guest appearances by some of the brightest minds that influence modern EMS.

iTunes Ratings

101 Ratings
Average Ratings
96
2
2
1
0

MCHD Paramedic podcast

By robsmith77 - Jul 11 2018
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An excellent podcast full of useful information no matter what your EMS level may be !

Perfect for busy people

By lgrillon - Apr 22 2018
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Great listen for the car, gym or home. Interesting and relevant topics with some excellent guests.

iTunes Ratings

101 Ratings
Average Ratings
96
2
2
1
0

MCHD Paramedic podcast

By robsmith77 - Jul 11 2018
Read more
An excellent podcast full of useful information no matter what your EMS level may be !

Perfect for busy people

By lgrillon - Apr 22 2018
Read more
Great listen for the car, gym or home. Interesting and relevant topics with some excellent guests.
Cover image of MCHD Paramedic Podcast

MCHD Paramedic Podcast

Latest release on Jan 13, 2020

The Best Episodes Ranked Using User Listens

Updated by OwlTail 5 days ago

Rank #1: Episode 48 - Back To The Basics - COPD Part I

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This episode takes us back to the basics of COPD pathophysiology and treatment. Dr. Dickson and Dr. Patrick start with the differential diagnosis of wheezing and move through the escalating COPD treatment options. We then close with a review of common abnormal breath sounds and set the stage for COPD Part 2 which will be coming soon.

References:
1. http://citeseerx.ist.psu.edu/viewdoc/download doi=10.1.1.624.2777&rep=rep1&type=pdf
2. Ram, et al. NIPPV for treatment of respiratory failure due to exacerbations of COPD. Cochrane Database Syst. Rev. 2004
3. https://www.easyauscultation.com/lung-sounds

Apr 22 2019

24mins

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Rank #2: Episode 15 - Congestive Heart Failure Part 1 - The Basics

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CHF exacerbations are bread and butter emergency medicine. Casey Patrick and Brad Ward begin with some background physiology and review of CHF. They then move on to describing a more detailed framework than the typical “CHF exacerbation” that is commonly taught. You’ll finish this podcast and think you’re a plumber as opposed to a paramedic.
References

https://coreem.net/core/ape/

Jun 25 2018

15mins

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Rank #3: Episode 3 - Syncope

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Syncope is a common and often confusing presentation. Dr. Casey Patrick leads a lecture style discussion with tips to approaching the syncopal patient in the prehospital setting. ECG pointers and an impossible to forget “crappy” mnemonic will leave you with a more focused approach to your next syncopal patient.

References

1. http://www.jem-journal.com/article/S0736-4679(17)30868-5/pdf

LINKS:
1. WPW - https://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/
2. Brugada syndrome - https://www.aliem.com/2013/06/brugada-syndrome-an-ecg-pattern-you-need-to-know/
3. Prolonged QT interval - https://lifeinthefastlane.com/wp-content/uploads/2011/01/waves-of-the-ecg.gif
4. Hypertrophic Obstructive Cardiomyopathy - http://www.wikidoc.org/images/b/b0/Hypertrophic_cardiomyopathy.jpg

Apr 02 2018

14mins

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Rank #4: Episode 37 - Top Ten Meds

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Dr. Patrick and Clinical Manager Jordan Anderson run down the 10 most commonly prescribed medications in the US. The medication list can often feel like one more task that’s always partial and incomplete. Jordan and Dr. Patrick try to take a more detective-like approach to demonstrate the utility of anticipating side-effects and potential diagnoses based on medication list clues.
References:
1. http://discovermagazine.com/2010/mar/07-dr-drank-broth-gave-ulcer-solved-medical-mystery
2. Gomes T, et al (2017) Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case–control study. PLoS Med 14(10): e1002396

Dec 17 2018

35mins

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Rank #5: Episode 2 - Pediatric Resuscitation Featuring Dr. Peter Antevy

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Featuring Dr. Peter Antevy

Today’s show will focus on the evolution in the EMS approach to pediatric resuscitations. Historically these high stress resuscitations focused on rapid transport of these children to the hospital and have resulted in sub par resuscitation efforts and increased stress for both providers and families. There is mounting evidence that mirrors the adult resuscitation data that staying on scene and providing focused resuscitation efforts improves outcomes in these patients. Dr. Antevy provides a unique perspective as both a pediatric EM specialist/EMS medical director and inventor of the Handtevy pediatric resuscitation system.

https://www.handtevy.com

Apr 02 2018

20mins

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Rank #6: Episode 36 - Calcium Channel Blocker And Beta Blocker Toxcicity

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Shownotes:
Cardiovascular medication poisoning can produce markedly unstable patient presentations. Dr. Patrick and Brad Ward review some of the basics and more recent therapeutic developments in the treatment and management of beta-blocker and calcium channel blocker toxicity.

References:

1. St-Onge M, Anseeuw K, Cantrell FL, et al. Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Critical Care Medicine. 2017;45(3):e306-e315.

2. Wax P, Erdman A, Chyka P, et al. Beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005; 43(3):131-146.

Dec 11 2018

26mins

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Rank #7: Episode 57 - The Art of the Airway

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We’ve discussed airway management and our MCHD delayed sequence approach on past podcast episodes. On this episode, join the medical directors as they take a scenario based, deep dive into the finer points of tackling the difficult airway.

REFERENCES:
1. https://m.youtube.com/watch?v=wVQFJR7qmrQ

Aug 26 2019

33mins

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Rank #8: Episode 62 - The Next Generation Medic

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Dr. Patrick is joined by two medics on the MCHD recruitment committee, Megan Steely and Russell Carter, to discuss the components of the "next generation" medic. We also dive in to the nuts and bolts of the EMS service of the future as well. Schedule options, compensation issues, service offerings and atmosphere are all addressed during this wide ranging conversation. Only the surface is skimmed here, so please drop a line to the podcast email if you have additional similar/related topics you'd like us to expound on in future podcasts.

Nov 04 2019

27mins

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Rank #9: Episode 16 - Congestive Heart Failure Part 2 - Nitro, Nitro, Nitro

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Patients with acute pulmonary edema need rapid preload and afterload reduction and often their volume status is difficult to ascertain. Casey Patrick and Brad Ward discuss a novel approach to using our old friend nitroglycerin in these patients along with the other cornerstones of their care.
References

1. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389-93.
2. Levy P, Compton S, Welch R, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144-52.
3. Wilson SS, Kwiatkowski GM, Millis SR, et al. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-31.
4. Peacock WF et al. Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis. Emerg Med J 2008; 25: 205 – 209.

Jun 25 2018

16mins

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Rank #10: Episode 28 - Shock States - B2B

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Many of the sickest of the sick patients that we see as EMS providers are hypotensive. These folks are often altered and come with spotty histories at best. This episode turns our B2B series to the prehospital management and recognition of shock. How can we better classify then treat our undifferentiated patients in shock? Dr. Patrick and Dr. Dickson build a framework around common sense pathophysiology and treatment.

Sep 26 2018

32mins

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Rank #11: Episode 53 - The Fast And The Furious - How To Approach Sinus Tachycardia

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Vital signs are called vital for a reason.  On this episode, Dr. Patrick takes us through a differential for the workup of sinus tachycardia.  This is a finding that we see daily in our practice, but often lack a step-wise approach when managing these patients.

REFERENCES:
1. Bossart P, Fosnocht D, Swanson E. Changes in heart rate do not correlate with changes in pain intensity in emergency department patients. J Emerg Med. 2007;32(1):19–22.

2. Marco CA, Plewa MC, Buderer N, Hymel G, Cooper J. Self-reported pain scores in the emergency department: lack of association with vital signs. Acad Emerg Med. 2006;13(9):974–979.

3. https://www.ncbi.nlm.nih.gov/pubmed/19700579

Jul 01 2019

24mins

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Rank #12: Episode 4 - Hyperkalemia Management

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Hyperkalemia can send our patients to cardiac arrest in an instant. Casey Patrick and Jordan Anderson begin with some background physiology review on the importance of potassium to cellular function. They then move on to describing specific patient characteristics and ECG findings found in patients with hyperkalemia, and close with MCHD’s current protocol to preemptively treat these patients en route to the hospital.

Apr 09 2018

16mins

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Rank #13: Episode 45 - Hypertensive Emergencies - To Treat Or Not To Treat

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Managing markedly elevated blood pressures has to be one of the most common EMS clinical dilemmas. Dr. Dickson joins Dr. Patrick to help dispel some long-standing and persistent hypertension management myths. The concept of “end organ damage” is also introduced as a framework to properly identify those patients with elevated blood pressures who DO warrant emergent treatment in the prehospital setting.

Mar 04 2019

28mins

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Rank #14: Episode 49 - Back To The Basics - COPD Part 2

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Dr. Patrick and Dr. Dickson pick up where they left off on our Back to the Basics COPD Part 1 episode. We’ll delve further into the differential diagnosis one must consider when treating patients with dyspnea and discuss some of the chameleons that can masquerade as COPD. Many of our COPD patients are far from straight forward with multiple co-morbidities. After listening, you’ll run your next dyspnea call with a clear plan and more confidence.

May 06 2019

18mins

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Rank #15: Episode 60 - Toxidromes Part 1 - Back To The Basics

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This episode takes us back to the basics of toxic ingestions and poisonings to review the topic of toxidromes. Why do we look for specific patterns in poisonings and what are we looking for? Dr. Patrick and podcast toxicology expert, Dr. Jerry Snow, will take us through the major toxidrome groups and you’ll come out on the other side ready to sort through your next undifferentiated overdose patient.

REFERENCES:
1. http://www.emdocs.net/the-approach-to-the-poisoned-patient/
2. https://litfl.com/high-dose-insulin-euglycaemic-therapy/
3. Toxidromes. Holstege CP, Borek HA. Crit Care Clin. 2012 Oct;28(4):479-98.

Oct 07 2019

35mins

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Rank #16: Episode 21 - Ketamine For Control

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Dr. Dickson and Dr. Patrick take on one of our favorite topics here at MCHD - Ketamine and the agitated patient. Agitated patients come in a wide spectrum of severity. This discussion starts with a framework for stratifying agitated patients. We discuss the MCHD ketamine experience along with a less discussed patient population that may need ketamine control quicker than we often think. Remember that Ketamine is only to be used for patient protection and is never intended to be used out of convenience.

References:
1. https://www.ems1.com/medical-clinical/articles/78100048-Ketamine-for-Excited-Delirium-Syndrome-Results-of-a-3-year-case-series/
2. Green et al. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation. Ann Emerg Med. 2011; 57:449-61
3. Cole J et al. A prospective study of ketamine as primary therapy for prehospital profound agitation. Am J Emerg Med. October 2017
4. Parsch C et al. Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study. Emerg Med Australas. 2017;29(3):291-296

Aug 14 2018

18mins

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Rank #17: Episode 27 - Slips, Trips, And Falls

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Falls are one of our most common calls in the EMS world. The potential disease processes and injuries can be wide ranging and difficult to sort. Join Dr. Patrick and Dr. Dickson as they break falls down into two main questions that must be answered on every fall patient. Learn the high risk characteristics and diagnoses to consider and rule out.

Sep 10 2018

29mins

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Rank #18: Episode 47 - High Risk EMS Refusals

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One of the most difficult situations in prehospital care is the high-risk patient refusal of EMS transport. This topic is far from straight forward for both learners and teachers alike. Dr. Patrick introduces a brand new mnemonic that will, hopefully, alleviate your FEARS the next time you care for a complex patient that decides hospital transport just isn’t in the cards.

Apr 08 2019

32mins

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Rank #19: Episode 14 - Delayed Sequence Intubation (DSI) With Dr. Jeff Jarvis

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Today’s show is all about the changes in how we approach intubation in EMS. Dr. Jeff Jarvis will relate how he got interested in the topic of airway management and specifically the process of delayed sequence intubation. Dr. Jarvis is the EMS medical director for Williamson County Texas EMS. He will present data from the recent Annals of Emergency Medicine paper his group authored on the topic. MCHD quality lead, Kevin Crocker, will present our data following DSI Implementation in Montgomery County.

Weingart Emcrit podcast and Annals of EM article
https://emcrit.org/dsi/ http://dx.doi.org/10.1016/j.annemergmed.2014.09.025

Jarvis Annals paper
http://www.annemergmed.com/article/S0196-0644(18)30071-4/abstract

Wilco EMS: https://www.wilco.org/Departments/EMS
2017 SOCs
DSI protocol
DSI checklist for both WCEMS and Marble Falls Area EMS

Jun 19 2018

24mins

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Rank #20: Episode 61 - An EMS Approach To Epistaxis

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We’ve recently rolled out a new epistaxis treatment protocol here at MCHD. Join the podcast team as we discuss some nosebleed background information along with the classic and emerging treatment options. Did somebody say TXA?? Yep, we have TXA and this is a perfect opportunity introduce the MCHD epistaxis/TXA treatment protocol. It’s simple, cheap and minimally invasive. With rapidly accumulating evidence that we will improve patient centered outcomes using this treatment, this is an episode that you don’t want to miss.

REFERENCES:
1. Klepfish A, Berrebi A, Schattner A. Intranasal tranexamic acid treatment for severe epistaxis in hereditary hemorrhagic telangi- ectasia. Arch Intern Med 2001; 161: 767.
2. Gaillard S, Dupuis-Girod S, Boutitie F, Rivi ere S, Morini ere S, Hatron PY, Manfredi G, Kaminsky P, Capitaine AL, Roy P, Gueyffier F, Plauchu H, for the ATERO Study Group. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease. J Thromb Haemost 2014; 12: 1494–502.
3. Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013;31:1389–92.
4. Birmingham AR, Mah ND, Ran R, et al. Topical tranexamic acid for the treatment of acute epistaxis in the emergency department. Am J Emerg Med. 2018;36:1242-1245.
5. Zahed R, Mousavi, Jazayeri MH,Nader iA,et al.Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: randomized controlled trial. Acad Emerg Med. 2018;25:261-266.
6. Akkan, Sedat et al. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Annals of Emergency Medicine, Volume 74, Issue 1, 72 - 78
7. Min, H. J., Kang, H., Choi, G. J., & Kim, K. S. (2017). Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery, 157(6), 921–927.
8. Kikidis D, Tsioufis K, Papanikolaou V, Zerva K, Hantzakos A. Is epistaxis associated with arterial hypertension? A systemic review of the literature. Eur Arch Otorhinolaryngol. 2014; 271(2):237-243

Oct 21 2019

22mins

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