But Why EMS Podcast

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In this episode, we highlight our sister podcast:

The Air Methods Prehospital EDucation Podcast (AMPED). In this episode, we talk about what happens when a tornado strikes and causes a mass casualty incident (MCI). How does the team integrate itself into a larger team of first responders doing a variety of different jobs? How does the team arrive on the scene when a flight is impossible? And upon successfully saving one life, how does the team reconcile that success with the multiple other lives lost? These questions and a harrowing story await in this edition of the podcast. We are joined by:

Amy Boultinghouse, RN,

Chase Niewoehner, RN,

Kasia Hampton, MD,

Rebecca Tracy, DO,

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

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The But Why EMS Podcast team brings to you a great conversation with

Kim McKenna PhD, RN, EMT-P

about everything about getting rid of the term "Diesel Bolus," the Lights and Sirens Monograph, NAEMSP's joint position statement on Lights and Sirens, and how to educate and unlearn what we've learned!

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

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the But Why EMS Podcast team is proud to bring you our recurring guest,

Dr. Peter Antevy

Pediatric Emergency Physician & EMS Physician

who will talk about issues with the 2020 PALS guidelines.

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

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For paramedics, click here for CE credits.

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Happy 2022 But Why EMS listeners. Welcome to part two of our podcast series on Peds Respiratory Distress! A quick reminder, if you haven't listened to Episode 17: "Peds Respiratory Distress = D Bolus?" go ahead, stop listening to this episode, and download and listen to Episode 17. We'll still be here when you get back. Ready for this episode? In part 2, we cover the spectrum of pediatric airway care with:

Tara Copper MD

Pediatric Emergency Medicine Physician

Joseph Finney MD

Pediatric Emergency Medicine Physician and EMS Fellow

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

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For paramedics, click here for CE credits.

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this timely episode covers that time of year when our pediatric patients get the sniffles. Most of the time, our kids are fine. But every once in a while, those sniffles can become life-threatening. How can you tell the difference? In part 1 of this podcast, our content experts discuss what to look for and what to do when we become concerned about our little patients.

Meet our special guests:

Tara Copper MD

Pediatric Emergency Medicine Physician

Joseph Finney MD

Pediatric Emergency Medicine Physician and EMS Fellow

Click here to check it out today!

Stay tuned for part 2 of this episode in early January!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

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For paramedics, click here for CE credits.

Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time,

this episode covers the evolution of stroke care and how treatments of large vessel occlusion strokes are pivotal upon EMS clinical suspicion and triage destination. Meet our special guest:

Dr. Peter Panagos MD

Vice-Chair for Academic and Faculty Affairs

Professor of Emergency Medicine & Neurology

As well as John Reagan telling us about his "Modified Reagan Stroke Scale."

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

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For paramedics, click here for CE credits.

Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time,

this episode covers the complex nature of traumatic arrests. , Do we treat it the same as a medical arrest? Do we have different treatment and decision priorities for these traumatic patients? What makes caring for these patients in the prehospital environment so unique and how does that affect our care of these patients?

We discuss these questions and more with our special guest:

Dr. Rawan Safa

@rawansafa93

Emergency Medicine Resident at Washington University

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

Noah Bernhardson MD

References

1. Millin MG, Galvagno SM, Khandker SR, Malki A, Bulger EM, Standards and Clinical Practice Committee of the National Association of EMS Physicians (NAEMSP)., Subcommittee on Emergency Services–Prehospital of the American College of Surgeons' Committee on Trauma (ACSCOT). J Trauma Acute Care Surg. 2013 Sep; 75(3):459-67.
2. Lockey, D, Crewdson, K, Davies, G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med 2006; 48:240-244.
3. Russell, RJ, Hodgetts, TJ, McLeod, J, Starkey, K, Mahoney, P, Harrison, K. The role of trauma scoring in developing trauma clinical governance in the Defense Medical Services. Phil Trans R Soc B 2011; 366:171-191.
4. Morrison, JJ, Poon, H, Rasmussen, TE, Khan, MA, Midwinter, MJ, Blackbourne, LH. Resuscitative thoracotomy following wartime injury. J Trauma 2013; 74: 825- 829.
5. Kouwenhoven, WB, Jude, JR, Knickerbocker, GG. Closed-chest cardiac massage. JAMA 1960; 173: 1065-1067.
6. Luna, GK, Pavlin, EG, Kirkman, T, Copass, MK, Rice, CL. Hemodynamic effects of external cardiac massage in trauma shock. J Trauma 1989; 29:1430-1433.
7. Leis C. Traumatic cardiac arrest: should advanced life support be initiated?. Journal of Acute Care Surgery. 2013;74:634-638.
8. Keith J Roberts. The role for surgery in pre-hospital care. 2015; 18(2): 92-100.
9. Escott ME, Gleisberg GR, Kimmel K, Karrer A, Cosper J, Monroe BJ. Simple thoracostomy. Moving beyond needle decompression in traumatic cardiac arrest. 2014 Apr; 39(4): 26-32.
10. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Journal of Trauma and Acute Care Surgery. 2012; 73(6): 1412-1417.
11. Stevens RL, Rochester AA, Busko J, et al. Needle Thoracostomy for Tension Pneumothorax: Failure Predicted by Chest Computed Tomography. Prehospital Emergency Care. 2009; 13(1): 14-17.
12. Inaba K, Ives C, McClure K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012 Sep; 147(9): 813-8.
13. Ball CG, Wyrzykowski AD, Kirkpatrick AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010 Jun; 53(3): 184-8.
14. Brian Wernick, Heidi H Hon, Ronnie N Mubang, et al. Complications of needle thoracostomy: A comprehensive clinical review. Int J Crit Illn Inj Sci. 2015 Jul-Sep; 5(3): 160–169.
15. Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. 2015;108(1):11-16.
16. Leis CC, Hernández CC, Blanco MJ, et al. Traumatic cardiac arrest: Should advanced life support be initiated? J Trauma Acute Care Surg. 2013;74(2):634-638.
17. Jørgensen H, Jensen CH, Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med. 2010;17(5):249-253.

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this episode covers the challenge of the prehospital airway. The But Why team covers unique ways to secure the airway that include "Ghosting the Airway" and "Romantic Hands."

Hear the But Why EMS Podcast team discuss this situation with:

Dr. Robert Stephens

Emergency Medicine Resident at Washington University

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

Noah Bernhardson MD

References:

1. Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20(1):71-78.

2. Sakles JC, Mosier J, Stolz U. In reply. Acad Emerg Med 2013;20(9):966.

3. Limkakeng A, Broder JS, Theiling BJ. Chicken or egg? Risks of misattribution of cause-effect relationships in studies of association. Acad Emerg Med 2013;20(9):965.

4. Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011;15(5):R236.

5. Clemency BM, Roginski M, Lindstrom HA, et al. Paramedic intubation: patient position might matter. Prehosp Emerg Care 2014;18(2):239-243.

6. Murphy DL, Rea TD, McCoy AM, et al. Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. Am J Emerg Med 2019;37(5):937-941.

7. Turner JS, Ellender TJ, Okonkwo ER, et al. Feasibility of upright patient positioning and intubation success rates At two academic EDs. Am J Emerg Med 2017;35(7):986-992.

8. Levitan RM, Kinkle WC, Levin WJ, et al. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med 2006;47(6):548-555.

9. Snider DD, Clarke D, Finucane BT. The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anaesth 2005;52(1):100-104.

10. Tournadre JP, Chassard D, Berrada KR, et al. Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 1997;86(1):7-9.

11. Chassard D, Tournadre JP, Berrada KR, et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth 1996;43(4):414-417.

12. Garrard A, Campbell AE, Turley A, et al. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59(5):435-439.

13. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick's manoeuvre. Br J Anaesth 1996;76(6):877-878.

14. Notcutt W. Oesophageal rupture and cricoid pressure. Anaesthesia 1991;46(5):424-425.

15. Savino PB, Reichelderfer S, Mercer MP, et al. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med 2017;24(8):1018-1026.

16. Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehosp Emerg Care 2011;15(1):30-33.

17. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA 2018;319(21):2179-2189.

18. Driver B, Dodd K, Klein LR, et al. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med 2017;70(4):473-478 e471.

19. Latimer AJ, Harrington B, Counts CR, et al. Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting. Ann Emerg Med 2021;77(3):296-304.

20. Braude D, Richards M. Rapid Sequence Airway (RSA)--a novel approach to prehospital airway management. Prehosp Emerg Care 2007;11(2):250-252.

21. Braude D, Southard A, Bajema T, et al. Rapid sequence airway using the LMA-Supreme as a primary airway for 9 h in a multi-system trauma patient. Resuscitation 2010;81(9):1217.

22. Moss R, Porter K, Greaves I, et al. Pharmacologically assisted laryngeal mask insertion: a consensus statement. Emerg Med J 2013;30(12):1073-1075.

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this But Why EMS Podcast episode is a continuation of our last episode. If you haven't heard our last episode: Shake Your Sillies Out, click here to check it out. In this episode, we discuss a unique case study that is terrifying for any healthcare clinician: a child in the field who is in status epilepticus that won't respond to typical treatments. What then?

Hear the But Why EMS Podcast team discuss this situation with

Dr. Rejean M. Guerriro DO

Pediatric Neurologist at Saint Louis Children's Hospital

Dr. Joseph Finney MD

Pediatric Emergency Physician and EMS Fellow at Saint Louis Children's Hospital/Barnes Jewish Hospital

Nikki Bain EMT-P & Brandon Treiber EMT-P

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

Noah Bernhardson MD

For paramedics, click here for CE credits.

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this But Why EMS podcast covers the frightening presentation of a pediatric seizure that hasn't responded to traditional medications. What do you prioritize? How do you handle your treatment options?

Hear the But Why EMS Podcast team discuss answers to these questions with

Joseph Finney MD

Pediatric Emergency Medicine Fellow & EMS Fellow

&

Michael Kim MD

@michaelkim_md

Third-year Emergency Medicine Resident

Click here to check it out today!

Thank you for listening!

Hawnwan Philip Moy MD

Gina Pellerito EMT-P

John Reagan EMT-P

Noah Bernhardson MD

P.S. Here are the anticonvulsant medication pharmacokinetics that Dr. Kim and Dr. Finney mentioned below AND Peds Vital Signs that Gina promised would be on this page :).