Match On A Fire: Medicine and More

In this episode, we dive into the history and science of the new COVID-19 vaccine with Boulder Community Health Infectious Disease Specialist, Amie Meditz. Also: what a 747 has to do with COVID19.

In this episode we focus on Pit Viper bites. We look at the dos and don'ts of treatment and how best to care for your patient. Finally, we explain how antivenom works.

CVA, strokes, are responsible for significant disability and death.  In today’s podcast we go over the ins and outs of stroke physiology and care.  We move from pre-hospital identification and care through the ER workup and treatment with potentially life and function-saving TPA and intraarterial treatment.  Let the healing begin!!

POCUS (Point of Care Ultrasound) is the wave of the future.  It helps guide real time treatment and diagnostic decisions.  Currently POCUS is widely utilized in the emergency department. What if we brought POCUS to the pre-hospital setting and let EMS utilize this valuable tool?  PHUS (Pre-Hospital Ultrasound) is the focus of this podcast.  We look at the utility and feasibility of ultrasound in the field.

In episode number 9 of Match on a Fire:  Medicine and More Podcast, we have a special guest on the show.  Melissa Verseman is a respiratory therapist and critical care flight paramedic.  We dive deeper into COVID-19 and explore the critical physiology that sends people to the ICU.  We get Melissa’s insight as a respiratory therapist dealing with these sick pulmonary patients.

Life is Fragile. 

Today, Match on a Fire:  Medicine and More is going to do something a little different.  We are going to focus on the “more.”  We are talking about Fragile:  Beauty in Chaos, Grace in Tragedy and the Hope that Lives in Between.

A mom puts her child to bed with a cold and in the morning he won’t wake up.  A man goes to work and has no idea his chainsaw blade it going to kick back through his chest.  A simple headache slowly worsens and finally, when she finally decides to have it evaluated, the MRI looks like a dime store nickel machine filled with tumor gumballs.   Or, so suddenly, a pandemic takes over the world and our “normal” life is not so normal.

I started medical school ready to be in the thick of it.  I was cocky, motivated and unstoppable.  I had watched ER on TV, shadowed family friends in the hospital and read all the latest and greatest books on being a doctor.  I thought I was going in with my eyes wide open.

I had no clue.  I thought the hard part of medicine was going to be learning all the material, programming all the facts, procedures and protocols into my neuroanatomy.  I wish.  No doubt that was difficult, like drinking from a fire hydrant, but it paled in comparison to the challenge of working so closely with life and death. 

I was forced to hold the hand of those facing relentless disease and the limitations of my abilities as a doctor.  This wasn’t just a job.  It really was life and death.  Talk about wandering into the hurt cave with no flashlight, I was at a loss. 

Little did I know this was the very place I had to go to really find my true soul.  Something started to happen to me in the depths of my own emotional torture chamber.  I stopped focusing so much on “why.”  Why was there so much suffering?  Why was I so hurt and lonely?  Why am I so worried about me, especially in the face of what I see?  Slowly I began to see life differently.  I began to take in, I mean really take in, the things around me that meant the most:  my kids, my family, my friends.  I stopped worrying about the “why.” I took the time to breath and it felt good.

We only have one life to live, but if we do it right, one life might just be enough.

We are in the midst of pandemic caused by COVID-19. 

In this episode we discuss the basics of COVID-19 and focus on transmission and containment. 

I have a special guest, Dr. Reed Caldwell.  He is Chief of Service, Perelman Department of EM, and serves as the EMS Medical Director for NYU Langone Health System.  New York is currently the hardest hit state and Dr. Caldwell is on the front line in New York City.  He relays his experiences, concerns and advice as the pandemic spreads to other less affected areas.

Remember that we’ve talked about greatness. It’s all about the grind. Committing to your goal every day, day after day. If you find yourself getting off track, focus on 300 seconds a day. It’s a totally doable commitment to get you back on track.

Today, we are talking with Dr. Allen Lim. He is a model of greatness. He is an exercise physiologist and has coached some of the best athletes in the world. He was Lance Armstrong’s cycling coach. He also is the creator and founder of Skratch Labs. “Skratch Labs makes sports nutrition designed to help you perform better without offending your gut or your taste buds because we use real food, starting from scratch.” From internet data, they have an estimated revenue of over 11 million dollars annually.

Next episode we’ll get back into the grind of learning some more medicine!

Welcome back to Match on a Fire. Today we’re talking about epinephrine because it’s such a hot topic. While we know a lot about it, we need to take a step back to really look at it and see if we’re doing the right things. We’ll be giving you a little background on epinephrine, covering a recent study that everyone’s been talking about, and what that all means for our practice.

What are the benefits of push-dose? What are the benefits of epi when it comes to cardiac arrest and what does the data say? Why might not epi be the best for our patients? What have the recent studies uncovered and why is everyone talking about it? What is the tradeoff when it comes to the outcomes of using epinephrine? What are the ethics questions involved?

 We are not academic-centered. We aren’t affiliated with any hospital or any education center. These stories and our knowledge is based on our 20+ years in the medical field. If you have any questions, comments, or concerns about things we’ve said or topics you want to discuss, please send us an email.

 Quotes/Tweets

01:38 - “The thing about epinephrine is that everyone just assumes we know everything about it because we’ve had it forever but then realize, ‘Wow there’s a lot of things to be concerned about.” Shannon Solvndal

06:45 - “I love the one to one thousand. I love push-dose because you can very easily micromanage it. I furthermore like it with kiddos because it keeps you from fluid overloading your kiddos as well.” Steph Solvndal

 03:32 - “The way that I remember the receptor sites is, ‘Beta one, one heart; Beta two, two lungs.” - Steph Solvndal

01:45 - “We’re finally starting to look at epi and say, ‘We know it does a lot of good things, but is it as great as we thought it was.’” Steph Solvndal

 19:35 - “Epi is great at restarting hearts but not so great at getting favorable neurological outcomes.’” Steph Solvndal

 Resources:

Email: [email protected]

Dr. Shannon Sovndal website

Welcome back to Match on a Fire. Today we’re covering the second half of our Shock series. Of the four different types of shock, today we are focusing on hemorrhagic shock. Why do we have to be aggressive when we treat it? What is the triad of death? What are the five parts of “damage control” when it comes to hemorrhagic shock? How can we make sure we get them from the point of impact, back home?

We are not academic-centered. We aren’t affiliated with any hospital or any education center. These stories and our knowledge is based on our 20+ years in the medical field. If you have any questions, comments, or concerns about things we’ve said or topics you want to discuss, please send us an email.

Talking Points:

A quick review of the four different types of shock, and the vicious circle of shock

What is hemorrhagic shock?

What is happening when someone goes into hemorrhagic shock?

How we were taught to treat shock

What kills trauma patients?

What is the triad of death?

How can hypothermia kill trauma patients?

The complications that come from a patient being acidotic

How does coagulopathy mean death for trauma patients?

The five parts of “damage control”

How to reverse the triad of death

What to look for when you read studies

What is the best solution for someone who has low blood pressure?

How saline affects the triad of death

 Quotes/Tweets

 11:29 - “The other part of this is, when I become more stressed because of the trauma, my factors that remain does not work as well as they should. And that’s just from the stress of the trauma.” - Shannon Solvndal, on why coagulopathy can mean death for a trauma patient

 11:58 - “If you think about what our goal is, as providers, it’s really, ‘taking a patient from the moment of impact and getting them home.” - Shannon Solvndal

 07:53 - “We know of three things that kill trauma patients and they are in the geometric shape of a triangle.” - Steph Solvndal

 19:49 - “When our heart squeezes, one-third of the time it’s in systole and two-thirds of the time, it’s in diastole so squeeze, rest, rest...” - Steph Solvndal

 27:22 - “Some of the big things we should be focusing on pre-hospital--right, before we do the chest pump, before we do the high fives-- is, we really need to make sure we’re being awesome at our hypothermia treatment. So just still make sure you still gotta get them trauma naked but then cover them back up. You should be sweating, not cause you’re nervous but you should be sweating in that ambulance because it’s hot.” - Steph Solvndal

 Resources:

Email: [email protected]

Dr. Shannon Solvndal, website