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Operating as usual
This article is WELL worth the read. #benice JEMS - Emergency Medical Services
https://www.jems.com/2020/09/24/patch-adams-and-ems/?fbclid=IwAR2UXp6rWS2_5EDm-6WCnvGTTPyCYXMMXyqE6cjBC22uMQP2ELRMV8LFsl0
Anthony "Tony" Correia writes about the benefits of compassion in patient care in the vein of Dr. Patch Adams.
IA MED
Nebulized nitroglycerin for the crashing PE patient decreases pulmonary vascular resistance while sparing MAP. Thoughts?
https://emcrit.org/pulmcrit/ntg/
Rishi Kumar, MD
The Hemolung Respiratory Assist System (RAS) is an investigative extracorporeal carbon dioxide (CO2) removal (ECCO2R) therapy. This system uses a centrifugal pump and blood gas exchanger to create respiratory dialysis - a form of low-flow VV-ECMO - where CO2 is removed and oxygen (O2) is added to the blood through a network of hollow fiber membranes housed within the device cartridge. 😷🏥
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A 15.5 French Hemolung dual lumen catheter is primed and inserted into the internal jugular or femoral vein using the Seldinger technique. The catheter is sutured and secured using gridlock devices. The Hemolung RAS blood tubing is then securely connected to the red and blue lumens using a wet-to-wet technique to ensure there's no air at the interface. During the insertion process, the patient is also systemically anticoagulated for a goal activated clotting time (ACT) of 150 - 180 seconds. By default, the Hemolung starts at a pump speed of of 500 rpm (range 0 - 1500 cc/min) and a sweep gas flow rate of 1.0 L/min (up to 10 L/min). The resulting blood flow rate is dependent on the pump speed, volume status, cannula positioning, blood viscosity, etc. 👨🏽⚕️
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Compared to traditional VV-ECMO, the flows on the Hemolung can be much lower because CO2 is 20-25x more soluble than O2 in blood. This makes its removal much less dependent on flow rate. Furthermore, by offloading much of the CO2 directly, Hemolung promotes lung-protective mechanical ventilation strategies in those who are already intubated. 😃👍🏽
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Have you heard of the Hemolung? Tag a friend who works in healthcare and drop me a comment below with questions! 👇🏽
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Blog: https://rk.md
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Another great podcast from Medic Mindset “thinking series” this one on bradycardia. Check it out.
https://podcasts.apple.com/us/podcast/medic-mindset/id1158760173#episodeGuid=939c94ce-505b-4ed6-9ba8-463a326168a3
Medicine · 2020
EMT 360: The importance of context in EMS education
Training opportunity! Never stop learning.
Free Training opportunity on ventilator management. #EMSEducation
More than ever you are being faced with difficult patients requiring a ventilator. As a way of saying thank you for the work you are doing to keep your communities safe, we are offering our Ventilator Management Course for Free. Rather your working on the ground, in the air, or in the hospitals please use this if you need it and share it with friends or coworkers that could benefit from it. If you like it please let us know. Thanks and please be safe.
#IAMED #FREEVentilatorCourse #RebelEm #HeavyLiesTheHelemet #ECHO #RotorWash #JohnsHopkins #MATC #IAMEDLive #IBSC #BCEN #FPC #CCPC #CFRN #CCRN #FlightParamedic #FlightNurse #ContinuingEducation #CAPCE #CABRN #NREMT #Recertifyonthefly #MedicalEducationReimagined #CMECollective #IAMEDComplete #CCT #CriticalCareTransport #Paramedics #Nurses #COVID
EMSWorld (EMS - EMT - Paramedic - Emergency Medical Services)
A second look at a crafty project sent to us by May Empie at Fairfax County Fire and Rescue Department. Don't toss those old Anne resuscitation trainers—with a little elbow grease you can make them into lifelike trauma manikins. See step-by-step details at www.emsworld.com/article/1224002/repurposing-manikins-making-trauma-mamas
Did you try it? Let us know in the comments!
Check out this awesome article/project written by one of our awesome adjunct faculty! National Association of EMS Educators #EMSEducation #budgetsim
Before you toss those old Annie resuscitation manikins... Thanks to Fairfax County Fire and Rescue Department May Empie
***Training Announcement*** Free 12Lead EKG training. Register at the link below. Virginia Office of Emergency Medical Services Use Code: Fairfax
6/30/20 0800-1600
https://www.eventbrite.com/e/multi-lead-medics-12-lead-ecg-interpretation-workshop-tickets-96204854309
Multi-Lead Medics 12 Lead ECG Interpretation Workshop by Bob Page!
***Training Announcement*** Free 12Lead EKG training. Register at the link below. Virginia Office of Emergency Medical Services Use Code: Fairfax
6/29/20 0800-1600
https://www.eventbrite.com/e/multi-lead-medics-12-lead-ecg-interpretation-workshop-tickets-96204372869
Multi-Lead Medics 12 Lead ECG Interpretation Workshop by Bob Page!
EMSWorld (EMS - EMT - Paramedic - Emergency Medical Services)
Are all supraglottic airways the same? March’s Resident Eagle column explores.
First Ambulance Service Hit With Major HIPAA Penalty
Until now authorities have gone after bigger violators—that may be changing.
Special Operations Medic Coalition
How many SOF Medics have set this up and how?
@somcoalition lessons learned coming soon!
Reposted from @the_resuscitationist .
TRAUMA TEAM ORGANIZATION AND TEAM LEADER PERSPECTIVE.
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This concept is commonly overlooked & undervalued. My team has out the effort in to understand eachother roles and responsibilities. .
IMAGE: just one example of set up. Theres no "one/ right way"
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PREARRIVAL: assign roles and expectations. Have equipment ready, blood bank called, adjunct resources and meds gathered and assisting services notified (RT, XRAY, subspecialties etc)
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HEAD OF BED: someone well versed with airway management (anesthesia, ed doc, crna). Able to start primary survey of Airway+Breathing. Then gather AMPLE history, control Cspine and start head/neck/upper chest secondary survey. Should call out airway and breathing findings.
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RIGHT SIDE: get IV access, draw first labs, check that side of chest/abdomen. Should call out type of IV and location .
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LEFT SIDE: get IV access, place on monitor, check that side for injury, physical exam. Begin to call out vitals and type/location of access.
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EXTRA MEDIC/NURSE #1: cut off clothing, apply C-Collar or pelvic binder
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EXTRA MEDIC/NURSE #2: cut off clothing, assist with getting backboard, gather medications
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EXTRA MEDIC/NURSE #3: run belmont, get fluids, accessory needs.
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NOTE: the number of extra hands can be variable based on location and resources. Sometimes too many in the trauma bay gets chaotic.
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TEAM LEAD: I prefer foot of bed. It allows me to get "the big picture". Also close to EMS and nursing station to relay communication. Team lead is like a musical conductor. They lead the team through the primary and secondary surveys (M.A.R.C.H). I will call back what the other team members say (closed loop communication) keep the appropriate tempo and gather/interpret information as it appears. Typically responsible for advanced procedures (chest tubes, central lines, running MTP etc) & decision making. I routinely take off shoes, feel distal pulses and check pelvis/pubic symphesis, and back when rolling patient. If no one else trained, team lead also does EFAST.
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#givethegiftoflife #giveblood #liquidgold
Always a great day when Dr. Dan from @ffxfirerescue & Dr. Morgan from #loudounfireandrescue stop in to see us! Thanks for taking time to meet with our highly trained Medical Laboratory Technicians!
To #STEMI or #NonSTEMI that is the question. #EMSEducation #EMS #ACS
https://www.emsworld.com/article/1223791/recognizing-stemi-equivalents
Identifying myocardial infarction vs. other coronary syndromes.
#trainlikeyoufight #EMSEducation EMSWorld (EMS - EMT - Paramedic - Emergency Medical Services) Virginia Office of Emergency Medical Services
Paramedic Students learning more re trauma. Last week students engaged in realistic trauma scenarios to work on trauma assessment/treatment as a lead paramedic. The EMS immersion room added to realism of this injured patient on a highway scenario. #FCFRD #FairfaxCounty #EMS
The new #EMSTraining Challenge coins are in. #EMSEducation
Fairfax County Fire and Rescue Department
Paramedic students are almost at the half-way point! They are currently engaged in cardiology learning simulations. The paramedic program is a flipped classroom model where students meet learning objectives through simulated patient scenarios. #FCFRD #paramedic #FairfaxCounty
Rishi Kumar, MD
The intra-aortic balloon pump (IABP) is a form of mechanical circulatory support (MCS) used in cardiogenic shock, difficult separation from cardiopulmonary bypass (CPB), during percutaneous coronary interventions (PCI), in unstable angina, and in thrombolytic therapy following a myocardial infarction (MI). The device is classically introduced via the femoral artery and guided into the aorta till its tip is just distal to the left subclavian artery takeoff from the aortic arch. Therefore, when properly positioned, the IABP occupies the entire descending thoracic aorta and much of the suprarenal abdominal aorta. Although fluoroscopy/echocardiography can help guide placement, they are not absolutely necessary in emergent situations. 👨🏽⚕️🏥
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The IABP’s goal is to improve coronary perfusion pressure (CPP). The balloon inflates rapidly with helium (an inert gas less dense than air that creates less turbulent flow and faster inflation/deflation) during diastole and creates an “augmented diastolic pressure“ higher than the normal diastolic pressure. It is this diastolic pressure which is a primary determinant in CPP. 👍❤️
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With the onset of systole, the balloon deflates dropping the afterload and improving cardiac output. Because of this constant mechanical agitation within the aorta, absolute contraindications include severe aortic insufficiency, aortic dissection, and severe peripheral vascular disease. 😷💉
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Although newer forms of MCS are beginning to replace the IABP, it's still important to understand how this device works! ☺️
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Tag a friend who should know about the IABP, let me know where you’ve seen it used, and drop me a comment with questions! 👇
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Blog: https://rk.md
Instagram.com/rishimd
Facebook.com/rkmdblog
Youtube.com/c/rishikumarmd
Twitter.com/rkmd
Congrats Dr Dan. Well deserved!!!!!! #VaEMS2019 Virginia Office of Emergency Medical Services EMSWorld (EMS - EMT - Paramedic - Emergency Medical Services)
Congratulations to our winner of the for Frank M Yeiser trophy for the Physician with Outstanding Contribution to EMS - Dr. Dan Avstreih #VaEMS2019
https://rebelem.com/are-antibiotics-for-sepsis-in-one-hour-feasible-in-the-ed/
Are Antibiotics for Sepsis in One Hour Feasible in the ED? Based on prior experience with arbitrary time to antibiotic administration such recommendations are likely to increase inappropriate use of antibiotics, distract clinicians from more important tasks and have minimal effect on patient outcome...
REBEL EM
Slide Design Tip: How Does an Eyedropper Improve Slides?
https://rebelem.com/slide-design-tip-how-does-an-eyedropper-improve-slides/
#FOAMed #MedEd #presentationdesign #REBELprez
MI look alike. The stress is real!
REBEL CORE Cast 20.0: Takotsubo's Cardiomyopathy with Anand Swaminathan, MD & Jenny Beck-Esmay, MD
https://rebelem.com/rebel-core-cast-20-0-takotsubos-cardiomyopathy/
#FOAMed #corecontent
Comparison of end-tidal carbon dioxide and arterial blood bicarbonate levels in patients with metabolic acidosis referred to emergency medicine.
https://www.qxmd.com/r/27777693
Read by QxMD is copyright © 2019 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.
Free #capnography webinar opportunity. #EMSEducation
https://www.ems1.com/ems-products/medical-equipment/airway-management/articles/webinar-the-value-of-end-tidal-carbon-dioxide-monitoring-it-aint-just-for-tube-confirmation-anymore-mshJoInoD8db2vGF/
Learn how end-tidal carbon dioxide monitoring can be a powerful tool for detecting physiological changes associated with sepsis, diabetes and more
The Updated VAOEMS #NREMT Recert Guide is live. Follow the directions EXACTLY and it will save you hours of time!! Thank you #VAOEMS
Guide to Completing National Registry Recertification 2.0 Application Effective: October 1, 2019
http://www.vdh.virginia.gov/content/uploads/sites/23/2018/10/Quick-Guide-Completing-National-Registry-Recertification-Application-2019.pdf
Another RCT of the Modified Valsalva Maneuver - REBEL EM - Emergency Medicine Blog
The authors of this trial performed a RCT evaluating the effectiveness of standard valsalva vs modified valsalva vs carotid sinus massage, at not only terminating SVT, but also having a sustained effect up to 5 minutes.
REBEL EM
CRASH-3: TXA for ICH?
https://rebelem.com/crash-3-txa-for-ich/
#FOAMed #FOAMcc #trauma #TXA
#bougieforlife
http://thesgem.com/2019/10/sgem271-bougie-wonderland-for-first-pass-success/
Date: October 17th, 2019 Reference: Driver et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emer…
REBEL EM
CRASH-3: TXA for ICH?
https://rebelem.com/crash-3-txa-for-ich/
#FOAMed #FOAMcc #trauma #TXA
A great ketamine for pain article. #EMSEducation
Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain
AEM Journal - September 2019
#AEM #AcademicJournal #EM
First Author: Debryna D. Lumanauw MD
Read Online: http://ow.ly/aBtf50vWLzO
#capnoisking
Measuring Intubation in the Emergency Department: Is It Time to Include End‐tidal Carbon Dioxide to Determine the Onset of Apnea?
AEM Journal - September 2019
#AEM #AcademicJournal #EM
First Author: Jason R. West MD
Read Online: http://ow.ly/2n1e50whZqS"
Another #POCUS use......
Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement
AEM Journal - September 2019
#AEM #AcademicJournal #EM
First Author: Brit Long MD
Read Online: http://ow.ly/be4950vWMcl
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