 One of my first calls as a paramedic was to our local ski hill for a 26-year-old guy who crashed into a tree while snowboarding. The ski patrol brought him down to the patrol room and we met them inside. The guy was literally screaming in pain and saying: "just put me out, man!" I could see his leg was obviously deformed below the knee.  Now, this dude was covered in gear, and starting an IV was going to take a little while. I looked at my partner and remembered we had just got this new gadget that connects to the end of a syringe and lets you inject medication into someone's nose. It was called a mucosal atomizer device (MAD). I pulled up 100 mcg (2 ml) and gave 1 ml per nare.  I told the guy that he would be feeling reeeeallll good anytime now.  we waited..  and waited..

Podcast 136 - Intranasal Delivery (or not)

Prehospital emergency and critical care podcast by Tyler Christifulli & Sam Ireland

Medicine

Science & Medicine

Health & Fitness

Dr. John Aho discusses needle decompression and the procedure's indications, techniques, and potential pitfalls. He emphasizes the importance of high clinical suspicion and the limitations of external signs in diagnosing tension pneumothorax. The conversation also covers the choice of needle insertion sites, the use of ultrasound, and the need for proper training and practice.  Dr. Aho provides insights into the anatomical considerations and common mistakes made during needle decompression. He also explores the possibility of instant feedback to confirm successful decompression. The conversation discusses the problem of needle decompression failure rates and the need for a reliable indicator of successful decompression.  The guest introduced the Cap-No-Spot, a device that uses colorimetric indicator paper to detect CO2 and determine if a needle decompression procedure was successful. The device has been shown to have higher sensitivity and specificity than human judgment. The conversation also touches on the importance of proper training and the device's potential applications beyond pneumothorax detection.

Podcast 168 - Procedure Preppers (Needle Decompression) w/ Dr. Aho

An iceberg typically shows only 10% of its mass above water. To appreciate the other 90%, you need to dive deep. That’s precisely what we’re doing in this series—discovering the deeper knowledge about obstetric topics. These topics can be massive, and much of the information is below the ‘surface-level’ knowledge that EMS is presented with.  In this episode, Demi Wilkes & I will discuss Placenta Previa and the closely associated Placenta Accrete Spectrum.

Podcast 167 - Placenta Previa w- Demi Wilkes

The conversation is about a paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have electrical capture when they do not. They emphasize the importance of confirming electrical capture before assuming mechanical capture. They also discuss the challenges of pulse palpation and the need for more rigorous research in EMS and ED settings. The conversation discusses the challenges and considerations in transcutaneous pacing, specifically focusing on the verification of mechanical capture. The speakers explore the use of various methods to confirm mechanical capture, such as feeling for a pulse, using pulse oximetry, and utilizing ultrasound. They also discuss the difficulty of accurately assessing mechanical capture and the potential for false electrical capture. The conversation concludes with a discussion on the transfer of pacing from one device to another and the importance of verifying capture during the process.

Podcast  166 - Transcutaneous Pacing & False Capture

In this episode we discuss whether the concept of having a "max dose" of your pressor has any evidence or physiological backing. Joining me in this discussion are Dan Rauh, Shane O'Donnell, and Shad Ruby.  

Podcast 165 - Should Pressors Have A Max Dose?

 How do you talk to a patient experiencing suicidal ideation? What if you're the one having these thoughts?  We're interviewing James Boomhower from Stay Fit 4 Duty in this episode. We discuss suicidal ideation, therapeutic communication, and verbal de-escalation.  

Podcast 136 - Intranasal Delivery (or not)

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