DUSTOFF Medic Podcast

Dr. Steven Schauer returns to the podcast with Trevor and Morgan to talk about pain management. Managing pain is a complex topic involving both different types of pain and different medications. During the conversation, Dr. Schauer mentions JTS CPG 61, Analgesia and Sedation Management During Prolonged Field Care. You can find this on the link at our website, or by searching "JTS CPG." Military members, use your free UpToDate access to read their article entitled "Pain Control in the Critically Ill Adult Patient." If you don't have UpToDate access yet, read the article at nextgencombatmedic.com on how to get an AVL account. It's worth your time. Finally, Dr. Schauer mentions an article he co-authored last year:

• Bebarta, G. E., Bebarta, V. S., Fisher, A. D., April, M. D., Atkinson, A. J., McGhee, L. L., & Schauer, S. G. (2021). An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital. Military medicine.

Have a listen, and let us know what you think!

Dr. Sean Stuart finishes up a discussion on chest tubes with Claire and Morgan.

This episode discusses some of the finer points of the procedure. Dr. Stuart also describes how to make an inexpensive task trainer so you can practice thoracotomies at your unit.  Finally, he describes an improvised Heimlich valve that you can make with an exam glove if you're in a pinch and don't have a chest drain system immediately available. Photos on our website!

Have a listen and please let us know what you think!

Dr. Sean Stuart joins Claire and Morgan for the first in a two-part series about chest tubes. Dr. Stuart is a Navy emergency medicine physician and is the Research Director of the Combat Trauma Research Group.

This first episode covers a lot of ground, from a detailed discussion of the procedure itself to a thorough exploration of a recent paper contrasting the efficacy of traditional chest tubes against pigtail catheters. 

Dr. Stuart calls out a couple important pearls, notably that oxygenation status is a very late finding for tension hemo/pneumothorax, and separately, that breath sounds are unreliable in determining whether a patient has this type of injury.

A recent paper gets some attention in this episode, and really illustrates why it's important to dig deeper than the abstract and conclusion: 

• Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809–813. 

You can find this paper through your free (to the military) institutional login via OpenAthens. There's also a good summary at criticalcarenow.com.

Have a listen and let us know what you think!

We all learned it.

We've all done it.

And we (mostly) all know that it's wrong.

Dr. Seth Collings Hawkins joins Trevor and Claire to discuss spinal immobilization. Rigid immobilization of trauma patients is entrenched dogma, but we've probably all heard that this procedure is not just without benefit, but is in fact harmful to our patients. Dr. Collings Hawkins is a leader in the wilderness EMS community, and he breaks down the reality of spinal immobilization and how we can all do better. Listen up as he talks about the history of this intervention, discusses appropriate uses for the rigid backboard and c-collar, and then shows how we can do better. This is important information for everyone to hear, from new medics to experienced flight surgeons. Have a listen and let us know what you think!

Captain Madison Anderson, RN, joins Claire and Morgan to discuss the pre-hospital care of sexual assault victims (SMOG SPECIAL POP V). It's a difficult topic, but it is critical for flight medics to understand the specialized care this patient population requires. CPT Anderson is a Sexual Assault Medical Forensic Examiner (SAMFE), and she makes important points about balancing patient care protocols with the need to minimize disturbing the victim. She also speaks extensively about the continuum of care for sexual assault victims, and gives important context to where pre-hospital care fits into a victim's path to healing.

CPT Anderson frequently refers to MEDCOM Regulation 40-36, Medical Facility Management of Sexual Assault, which is available with a CAC at the Army's Office of the Surgeon General MEDCOM Publications Portal.

Take the time to listen to this important conversation, and let us know what you think!

Lt. Col. Joe Maddry joins Max and Morgan to talk about SMOG Medical XIX, Toxic Ingestions. Toxicology is extraordinarily complex, and this discussion ranges beyond ingestions. Dr. Maddry is an emergency medicine physician and has completed a toxicology fellowship. Listen up as he breaks down initial treatment for a range of emergencies from reptile bites to rocket fuel inhalation to intentional overdose.

Dr. Maddry is the Deputy Commander of the Walter Reed Army Institute of Research and is extensively published on a variety of topics, with much of his research devoted to pre-hospital and enroute care. If you don't have an account through the AMEDD Virtual Library yet, check out this article from nextgenerationcombatmedic.com on how to get access to the medical journals where Dr. Maddry and others publish their important research.

And while there is not a poison control center exclusively for the military, all of the domestic poison control centers communicate with each other and can get you help with treating poisoned patients. Keep 1-800-222-1222 in your phone! And whether you're at home or deployed, you're not alone when you're trying to treat a complex toxic emergency. If you need a consult, call the DOD Advanced Virtual Support for Operational Forces program, or ADVISOR: 1-833-ADVSRLN (1-833-238-7756 or DSN 312-429-9089).

New Zealand Army Nursing Officer Captain Buffy Little joins Max and Trevor to talk about her service's rotary-wing MEDEVAC program. New Zealand is one of our closest allies, but their Army's small size and remote geography mean their operations are dramatically different from ours. Listen up for interesting differences in how they equip and crew their aircraft, as well as major differences in their pre-hospital training and certification levels.
Captain Little is an inspiration. She's deployed with the New Zealand Army, beat cancer twice, and was one of the first rescuers on scene of the 2019 White Island volcano eruption. Now she's training to compete in the Invictus Games, and is a founding member of Kaitiaki Ora—Tactical Medicine New Zealand. 
Have a listen and let us know what you think!

COL (ret.) Joseph DuBose joins Trevor and Max to provide an overview of ECMO, and discuss  its use in flight. ECMO isn't a new procedure, but it has become more visible in recent years as its use has expanded. In Europe, there are pre-hospital ECMO teams, and the US Air Force CCAT program has brought the technology far forward. Dr. DuBose has been involved with some of these efforts, along with research supporting its use. Recently, Dr. DuBose co-authored a paper describing a feasibility study of battlefield initiation of ECMO, with follow on rotary-wing evacuation (citation below).
In addition to the ins-and-outs of ECMO, Dr. DuBose discusses the real-world challenges of bringing advanced procedures such as ECMO and REBOA to the battlefield, and makes a very compelling case that just because you can do something, doesn't mean you should.  

Reva, V. A., Pochtarnik, A. A., Shelukhin, D. A., Skvortzov, A. E., Semenov, E. A., Emelyanov, A. A., Nosov, A. M., Demchenko, K. N., Reznik, O. N., Samokhvalov, I. M., & DuBose, J. J. (2020). Battlefield Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest: A Feasibility Study During Military Exercises. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 20(4), 77–83.

Here's the second part of our interview with Joel. Listen as he describes conducting multiple hoists in combat, and listen for some valuable lessons learned. Joel talks about PACE planning, patient handoff techniques, and we explore the dogma that surrounds the transport of deceased patients. 

Have a listen, and let us know what you think. Our comments section, DMs, and email are always open!

We begin with a remembrance of our fallen Navy comrades.

Today's episode is the start of our second AAR series. We talk with Joel, an Army flight medic who conducted a hoist mission in combat. His experience is important for several reasons, not least of which because we have a very frank discussion of what can happen when hoist training and maintenance is de-prioritized.

Have a listen and let us know what you think!