In today's episode, we discuss smoke inhalation, specifically the toxic gases carbon monoxide and cyanide. Cyanide is a toxic gas formed from the combustion of plastic and petroleum products, which is basically everything a modern home/building is made out of. We discuss the mainstays of prehospital treatment for smoke inhalation, Oxygen, as well as cyanide antidotes carried by prehospital personnel in some EMS agencies in the US and Europe. 

References:

Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation.

Borron SW, Baud FJ, Barriot P, Imbert M, Bismuth C. Ann Emerg Med. 2007;49:794-801

Sodium thiosulfate or hydroxocobalamin for the empiric treatment of cyanide poisoning?

Alan H Hall 1, Richard Dart, Gregory Bogdan. Ann Emerg Med. 2007;49:806-813.

Much attention has been paid to opioid abuse in recent years; yet, in the Central Valley, we can trace many drug related accidents and illness to Methamphetamine. Co-host and resident Toxicologist Dr. Armenian has a wealth of knowledge to give you the tools you need, from history, to clinical presentation, to treatment. It may change how you care for your next patient. Our guest this episode is Derek Ratzel. Thank you Derek, for recognizing and treating some of the most unpredictable presentations.

Please join us and Special guest Mato Parker from the EMS Agency have an evidence based discussion surrounding the quality improvement initiatives for the Central California EMS Agency (CCEMSA).  



SHOW NOTES:

Brown J, Rosengart M, et al. Not all prehospital time is equal, Influence of scene time on mortality

J Trauma Acute Care Surg. 2016 Jul; 81(1): 93–100.

Nasser A, Nederpelt C, et al. Every Minute Counts: The impact for pre hospital response time and scene time on mortality of penetrating trauma patients.  American Journal of Surgery 2019, 220:1, 240-244.

Haroon C, Ratner D, Pozo M, et al. Prehospital delay and its impact on time to treatment in ST-elevation myocardial infarction. Am J Emerg Med. 2011;29(4):396–400.

McNally B, Stokes A, Crouch A, Kellermann AL; CARES Surveillance Group. CARES: Cardiac Arrest Registry to Enhance Survival. Ann Emerg Med. 2009;54(5):674-683.e2. doi:10.1016/j.annemergmed.2009.03.018

Non-accidental trauma is something no one wants to talk about, but it is something you should always be thinking about. In this episode, the team discusses specific findings that should make you suspicious, or at least think twice, while you are transporting a child. You can be the difference between a healthy child and a fatal case report. Thank you to our guest, Ben Garcia, American Ambulance's Operation Manager, for his contribution to this episode, his knowledge and insight provided the perfect complement to our hosts’ discussion. 

Diabetic complications are a common complaints faced by EMS daily. Tune in to hear paramedic Chris Zaczek share his story and listen to an evidence based discussion of hypoglycemia and other diabetic emergencies.

The Central Valley gets hot. Really hot. One of the most dangerous conditions that we see all of the time, yet tend to look over, is heat illness. This can range from mild exhaustion to lethal heat stroke. What’s the fastest way to cool a patient in the back of an ambulance? Our guest this episode is Paramedic Lonnie Taylor. Thank you Lonnie, for your incredible dedication and hard work each and every day.

Trauma calls can be chaotic, and code situations can be the most stressful call EMS providers receive. What happens if a patient codes in the setting of trauma? What do you need to remember to do differently? What is going to save that person’s life? Our guest this episode is Paramedic Lonnie Taylor. Thank you Lonnie, for staying cool in the most tense situations and being someone we can aspire to be.

Lightning strikes are not common; however, about 30% of those struck by lightning die and up to 70% have permanent disabilities. Within one hour of injury, respiratory failure and arrhythmias can be lethal. The teams gives you the practical knowledge you can use if you are ever in this unique situation. Our guest this episode is John-Mark Bergen. Thank you John-Mark, for sharing your experiences so that we can all learn.