This is a special edition of the MCHD Paramedic Podcast. Ginger Locke, of the absolutely amazing Medic Mindset podcast, invited Dr. Patrick on to discuss rate control of rapid atrial fibrillation in the prehospital setting. She was gracious enough to share the audio for a dual release. This episode has been out in the world on Medic Mindset for a couple of months, but we wanted to offer it to our MCHD Paramedic Podcast listeners as well. Also, like, subscribe to and follow Medic Mindset wherever you listen to podcasts.

REFERENCES

1. https://medicmindset.com

2. Elam, K., & Bolar-Softich, K. L. (1997). Dilemmas in the acute pharmacologic treatment of uncontrolled atrial fibrillation. The American journal of emergency medicine, 15(4), 418–419.

3. Abarbanell, N. R., & Marcotte, M. A. (1997). Prehospital use of intravenous diltiazem (cardizem Lyo-Ject) in the treatment of rapid atrial fibrillation. The American journal of emergency medicine, 15(6), 618–619.

4. Abarbanell, N. R., Marcotte, M. A., Schaible, B. A., & Aldinger, G. E. (2001). Prehospital management of rapid atrial fibrillation: recommendations for treatment protocols. The American journal of emergency medicine, 19(1), 6–9.

5. Wang, H. E., O'connor, R. E., Megargel, R. E., Schnyder, M. E., Morrison, D. M., Barnes, T. A., & Fitzkee, A. (2001). The use of diltiazem for treating rapid atrial fibrillation in the out-of-hospital setting. Annals of emergency medicine, 37(1), 38–45.

6. Luk, J. H., Walsh, B., & Yasbin, P. (2013). Safety and efficacy of prehospital diltiazem. The western journal of emergency medicine, 14(3), 296–300.

7. Rodriguez, A., Hunter, C. L., Premuroso, C., Silvestri, S., Stone, A., Miller, S., Zuver, C., & Papa, L. (2019). Safety and Efficacy of Prehospital Diltiazem for Atrial Fibrillation with Rapid Ventricular Response. Prehospital and disaster medicine, 34(3), 297–302.

8. Fornage, L. B., O'Neil, C., Dowker, S. R., Wanta, E. R., Lewis, R. S., & Brown, L. H. (2024). Prehospital Intervention Improves Outcomes for Patients Presenting in Atrial Fibrillation with Rapid Ventricular Response. Prehospital emergency care, 28(7), 910–919.

MCHD recently rolled out Ceftriaxone for long-bone open fracture care. The podcast crew welcomes our new assistant medical director, Dr. Mike DePasquale, to discuss some background evidence and danger spots within this protocol.

REFERENCES:

Lack, W. D., Karunakar, M. A., Angerame, M. R., Seymour, R. B., Sims, S., Kellam, J. F., & Bosse, M. J. (2015). Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. Journal of orthopaedic trauma, 29(1), 1–6.

Johnson, J. P., Oliphant, B. W., Dodd, J., Duckworth, R. L., Goodloe, J. M., Lyng, J. W., Sagraves, S. G., & Fischer, P. E. (2024). Prehospital Antibiotic Administration for Suspected Open Fractures: Joint COT/OTA/ACEP/NAEMSP/NAEMT Position Statement. Prehospital emergency care, 28(8), 1063–1067.

Muniz, A. D., Gregorio, D. J., Studebaker, S. A., Peth, A. M., Camacho, C. G., Williams, B., Kupas, D. F., & Brown, L. H. (2024). Time Savings and Safety of EMS Administration of Antibiotics for Open Fractures. Prehospital emergency care, 28(8), 1046–1052.

We recently implemented a "push-dose" norepinephrine protocol at MCHD and have already learned some valuable lessons. Join us for some vasopressor pharmacology and protocol review, accompanied by some of our new teaching points that have arisen following the protocol's release into the wild.

REFERENCES:

1. Berkenbush, M., Singh, L., Sessa, K., & Saadi, R. (2024). Scoping Review: Is Push-Dose Norepinephrine a Better Choice? The western journal of emergency medicine, 25(5), 708–714.

2. Permpikul, C., Tongyoo, S., Viarasilpa, T., Trainarongsakul, T., Chakorn, T., & Udompanturak, S. (2019). Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. American journal of respiratory and critical care medicine, 199(9), 1097–1105.

Dr. Patrick is joined by MCHD District Chief Kelcie Adams to discuss the role of clinical case reviews at MCHD. Why are these so important, and what's the big deal? Kelcie is brave enough to use one of her recent calls as an example of the positives that can come if we get past our egos and allow ourselves to have insight for future cases.

We're working on a new series focusing on high-yield pharmacology reviews. Dr. Patrick starts us off with some background, mechanism of action discussion and common uses for magnesium sulfate. Mag is one of the true pharmacologic swiss army knives of emergency care.

REFERENCES

1. Touyz RM, de Baaij JHF, Hoenderop JGJ. Magnesium Disorders. N Engl J Med. 2024 Jun 6;390(21):1998-2009. doi: 10.1056/NEJMra1510603.

Our final entry into the EKG Manifesto series moves into the STEMI/OMI world of acute coronary occlusion. Who do we activate and why? Where is the STEMI paradigm headed? Join Dr. Patrick and Dr. Dickson to refresh your EKG knowledge.

REFERENCES

1. https://www.emdocs.net/ecg-pointers-stemi-equivalents-from-the-american-college-of-cardiology/

One of the most fear-inducing procedures in all of emergency care is the surgical cricothyrotomy. Dr. Al Lulla from Dallas Fire joins the podcast to discuss our recent collaboration on a retrospective look at MCHD's surgical airway experience over the past decade. Can paramedics successfully perform cricothyrotomies? Who needs surgical airway placement in the field? What can we learn for our next "can't oxygenate/can't ventilate" scenario? REFERENCES 1. https://youtu.be/wVQFJR7qmrQ?si=QBUfJd_7oZ3vmEpR 2. Lulla A, Dickson R, Wells M, Gilbert M, Rogers Keene K, Patrick C. Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review. Prehosp Disaster Med. 2024 Apr 23:1-4.

Applied EKG interpretation is often a difficult task in EMS and emergency medicine education. Getting bogged down in minutiae can obscure the patient. While an understanding of EKG foundational physiology is an absolute must, consideration of how to combine the 12-lead and patient presentation is vital as well. Join the podcast crew as they start at the end with the killer/"can't miss" EKG patterns and combine those with common chief complaints. Hopefully, this framework will click for you. In Part 2 of this series, we'll discuss bradycardias and tachycardias.

REFERENCES

1. https://www.youtube.com/watch?v=UXh8PS9dtmo

We've initiated a multi-pronged, system wide overhaul of our agitation management at MCHD. This included a move to fixed-dose ketamine for the severely agitated patients. Evidently we weren't the only ones thinking of this as there is exciting new data from Buffalo supporting this approach. Join the podcast crew as they review the recent literature and MCHD protocol changes.

REFERENCES

1. O'Brien MC, Kelleran KJ, Burnett SJ, Hausrath KA, Kneer MS, Nan N, Ma CX, McCartin RW, Clemency BM. Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation. Am J Emerg Med. 2024 Jul;81:10-15.

We've recently had several challenging, wide-complex tachycardia cases here at MCHD, so the podcast crew decided to bring forth some VT vs. SVT with aberrancy knowledge. Learn the V-Tach FACT, and you'll feel more comfortable with your next wide rhythm at a rate of 185.

REFERENCES

1. https://litfl.com/vt-versus-svt-ecg-library/

2. https://www.youtube.com/watch?v=UXh8PS9dtmo

3. Marill KA, Wolfram S, Desouza IS, Nishijima DK, Kay D, Setnik GS, Stair TO, Ellinor PT. Adenosine for wide-complex tachycardia: efficacy and safety. Crit Care Med. 2009 Sep;37(9):2512-8.