Austin-Travis County EMS System Office of the Medical Director » Uncategorized

Today I sit down with Dr. Joseph Martin, (IG: @JaTXerd) a Family Practice and Addiction Specialist who is now an EMS physician, to talk about mental health in our first responders. Spoiler alert: it has a lot to do with sleep deprivation, uncertainty, community, and organizational support.

Cold weather incoming! This is just a quick review of carbon monoxide poisoning treatment options, as well as what differentiates cold water immersion from regular drowning.

We anticipate an increase in the number of Carbon Monoxide (CO) related calls in the system as people use charcoal grills and generators for heating. Symptoms include headache, nausea, vomiting, dizziness, syncope, altered mental status, and neurologic symptoms such as weakness, numbness, or paresthesia. During these winter events we frequently have calls with multiple patients.

Anyone with RED FLAGS should be treated with 100% oxygen and transported to the hospital. These include:

Pregnancy

Cardiac history like arrhythmia, MI, CHF

Significant pulmonary history like COPD or pulmonary fibrosis

Neurological symptoms, even mild ones like paresthesias or numbness

Altered mental status

Emotional changes, which could be indicative of altered mental status

Chest pain

Difficulty breathing

Neurologic symptoms may be subtle so it is vital that you do a thorough neurologic exam and ask specifically about numbness, tingling, and weakness.

Treatment for CO poisoning is administration of 100% oxygen. For those with priority symptoms, hyperbaric treatment may be indicated.

CO >25%: Start 100% oxygen and transport to the hospital, regardless of whether or not they have red flags.

CO <25%:  Start 100% oxygen. If they have red flag symptoms, transport to the hospital. If no red flags, may treat in place with oxygen until symptoms resolve and then complete a refusal. 

CO <15% with no symptoms: No treatment or transport is indicated.

Consider STARFlight and direct transport to University Hospital in San Antonio for hyperbaric treatment for anyone with elevated CO level who is severely ill (unconscious, arrest with ROSC, stroke-like symptoms) 

Sometimes a small dose of epinephrine or norepinephrine can keep a patient from becoming hypotensive during intubation, or may help bridge the patient to a continuous infusion. Dr. Pickett talks about simple methods for mixing and administering push doses of these pressors and how to administer the infusion. NOTE: It is ASSUMED you already know the indications, contraindications, and side effects of these drugs. This video is NOT a comprehensive review of these medications. Available on YouTube, iTunes, Google Play, and Feedburner! https://youtu.be/__PWK4P85xc

Like Starsky and Hutch, like peanut butter and jelly, like Riggs and Murtaugh, the inseparable duo is back together for Medic Mindset for an episode of the Thinking Series, this time on abdominal pain. Feast your ears, ladies and gentlemen, boys and girls. The audio is like butter. Available on YouTube, iTunes, Google Play, and Feedburner! https://youtu.be/qCpk3f3zPP8

Snakebites are a common patient encounter for #EMS here in Texas, though virtually all states have venomous snakes of one kind or another.

Dr. Spencer Greene (@ToxSpencer) walks us through some pearls and pitfalls of caring for these patients.

TL;DW:

“Dry bites” are very uncommon.

Most victims are not drunk young males that are intentionally messing with wildlife. Most are people who didn’t even know the snake was there.

Don’t mess with wildlife.

Snakes are not aggressive. They want to be left alone. Admire from a distance. If you leave them alone, they’ll leave you alone.

Do NOT bring the snake to the ER. Taking a picture of it might be helpful.

Any bruising or swelling from a snakebite indicates envenomation and should be treated aggressively.

For crotalid bites (rattlesnake, copperhead, cottonmouth), raise the affected limb to reduce pain and swelling.

For elapid (coral snake) bites, keep the limb level.

No extractors, no sucking out the venom, none of that silliness.

No tourniquets or constricting bands or pressure dressings. Applying these items may cause more tissue damage and pain.

Snakebites are painful. Treat the pain.

Watch here on YouTube:https://youtu.be/WGjy_mBsZD4

From the City of Austin, TX, this is the Austin/Travis County EMS System Office of the Medical Director channel. We will talk all things prehospital care here. It will be informative, it will be fun, it will be very poorly edited and not rehearsed.

YES I KNOW THE THUMBNAIL HAS EPISODE 4 and it’s episode 49. But we have a YouTube channel now so that’s why we have different episode numbers. It’s less confusing than renumbering everything.

ANYwhomst, this is our takedown of the week long winter weather event that crippled the region starting around Valentine’s Day. The impacts to EMS were many and required a lot of creative thinking by responders. We are so proud of the bravery, ingenuity, and dedication that they showed during this event. Got some time? This is the story.

Vaccines are finally available. I’m getting mine, and you should too. How do they work? Are they safe? What are the side effects? What are the particulars of administration?

Bamlanivimab is a monoclonal antibody for treating mild to moderate COVID-19. You’ve probably heard of it as it has rolled out here in Texas in force. What does it do and how is it given?

Operation Warp Speed is a public-private partnership that has helped speed development of vaccines and treatments for COVID-19. But what does that mean for safety of these treatments? TL;DR: The program does not cut safety corners. It supports industry to rapidly develop capability without the financial risk usually associated with experimental therapies.

This study looks at an intriguing concept: What happens when you give an acutely suicidal patient ketamine in the ED? This study intrigued me so I thought I’d cover it. This study will not change your practice but will hopefully interest you in participating in research on the topic.

TL;DR/TL;DL: DON’T START DOING THIS YET. IT NEEDS MORE STUDY. But it is promising.

Citation: Domany Y, Shelton RC, McCullumsmith CB. Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double-blind, placebo-controlled, proof-of-concept trial. Depress Anxiety. 2020 Mar;37(3):224-233. doi: 10.1002/da.22975. Epub 2019 Nov 16. PMID: 31733088.

Strengths: Randomized placebo controlled design. Disposition and care for patients was determined before randomization, so study drug not likely to affect care delivered. Close assessment at multiple points. Administration protocol was over 5 min, so very conducive to the ED environment.

Weaknesses: Too small to really tell us how effective this treatment is, though there is a body of literature that supports it in other settings. Evaluation of patients was thorough, more than what could be expected of a prehospital provider without substantial training. Study setting was an ED, not EMS. Does not answer the question of whether patients can be safely discharged to outpatient mental health treatment after receiving this drug.