In this episode of the PFC Podcast, Dennis interviews Jessica, known as the Combat Midwife, who shares her extensive experience in both paramedicine and midwifery. The conversation delves into the critical issues surrounding postpartum hemorrhage, the mismanagement of obstetrics, and the importance of proper labor management. Jessica emphasizes the need for understanding the physiological process of birth and the risks associated with unnecessary interventions. She also discusses the significance of positioning during labor, the delivery of the placenta, and the risks of infection postpartum. Additionally, Jessica introduces the resources available for further education in maternal care.

Takeaways

Jessica is both a paramedic and a midwife.

Postpartum hemorrhage is a leading cause of maternal death.

Mismanagement in obstetrics often leads to complications.

Birth is a natural physiological process that should not be micromanaged.

Less than 10% of births require medical intervention.

Proper positioning during labor is crucial for a successful delivery.

The delivery of the placenta should be handled with care to avoid complications.

Postpartum care is essential to prevent infections and other issues.

The Combat Midwives Emergency OB Kit is designed for use in austere environments.

Education and resources are available for those interested in maternal care.

Chapters

00:00 Introduction to the Combat Midwife

01:28 Understanding Postpartum Hemorrhage

04:37 The Mismanagement of Obstetrics

06:14 Categories of Postpartum Hemorrhage

15:13 Advice for Managing Labor

19:11 The Importance of Positioning During Labor

21:03 Delivery of the Placenta

27:34 Postpartum Care and Infection Risks

36:06 Addressing Postpartum Hemorrhage and Infection

45:42 The Combat Midwife's Emergency OB Kit

48:41 Resources and Courses for Further Learning

For more information Connect with The Combat Midwife™:

Email: ⁠[email protected]⁠

Website:⁠ https://combatmidwife.com⁠

Classes & Kits:⁠ Workshops & Kits⁠

Instagram:⁠ @CombatMidwife⁠

YouTube:⁠ Combat Midwife on YouTube⁠

Facebook:⁠ Combat Midwife on Facebook⁠

X:⁠ @CombatMidwife⁠

Discount Code for your followers: PFC

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In this episode of the PFC Podcast, Dennis and Kevin dive deep into the complexities of ketamine, exploring its pharmacodynamics, pharmacokinetics, and practical applications in emergency medicine. They discuss the drug's disassociative properties, its analgesic effects, and the importance of individualized dosing based on patient physiology. The conversation also touches on the risks of catecholamine depletion and the management of side effects, particularly in trauma patients. Throughout the discussion, Kevin shares valuable insights and practical advice for medics and healthcare professionals using ketamine in real-life scenarios.

Takeaways

Ketamine is an NMDA receptor antagonist with various effects on the body.

It can cause profound analgesia and disassociation at different doses.

S-ketamine is preferred for its more intense analgesic effects and quicker recovery.

Dosing should be individualized based on patient condition and physiology.

Ketamine can lead to catecholamine depletion, especially in trauma patients.

Smaller doses are safer for patients with compromised vital signs.

Analgesic effects can be achieved without full disassociation at lower doses.

Managing side effects is crucial, especially in the 'party zone' of ketamine use.

Always have a plan for potential complications when using ketamine.

Refer to clinical practice guidelines (CPGs) for best practices.

Chapters

00:00 Understanding Ketamine: Basics and Mechanisms

09:17 Pharmacokinetics of Ketamine: How It Works

15:58 Dosing Ketamine: Individualized Approaches

25:23 Analgesic Properties of Ketamine: Beyond Disassociation

31:39 Managing Side Effects: The Party Zone and Hallucinations

39:19 Catecholamine Depletion: Risks and Considerations

43:05 Practical Advice for Medics: Using Ketamine Safely

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In this episode of the PFC Podcast, Noel discusses the complexities and challenges of maritime medicine, emphasizing the importance of training, knowledge, and operational flexibility. He shares insights from his extensive experience, highlighting the unpredictable nature of the ocean and the necessity of effective communication and integration with host nation partners. Noel advocates for a focus on practical training and the need for a forward-thinking approach to tackle operational challenges in a collaborative manner.

Takeaways

Courage in the absence of fear is stupidity.

Training should focus on knowledge, not just equipment.

The ocean's unpredictability complicates operations.

Effective communication is crucial in maritime environments.

Over-planning can lead to operational failures.

Training is essential for operational success.

Integrating with host nation partners enhances effectiveness.

Technology should be a last resort solution.

Operational flexibility is key in dynamic environments.

A joint effort is necessary for tackling complex challenges.

Chapters

00:00 Introduction and Context of the Mission

02:53 Challenges in Maritime Operations

05:38 Operational Planning and Flexibility

08:30 Communication Strategies in Maritime Environments

11:15 Training and Integration with Host Nation Partners

14:12 Operational Autonomy and Cross-Training

16:50 Emphasizing Training Over Technology

19:25 Conclusion and Call to Action

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In this episode of the PFC Podcast, Dennis and Max discuss the evolving landscape of modern combat injuries, focusing on neck and upper chest injuries. They delve into the anatomy of the neck, the importance of understanding different zones for surgical intervention, and effective hemorrhage control techniques. The conversation emphasizes the critical role of teamwork in trauma care and the necessity of airway management in emergency situations. A case study of a traumatic incident illustrates the practical application of these concepts in real-world scenarios.

Link to Video Kentucky Ballistics: https://www.youtube.com/watch?v=1449kJKxlMQ&t=983s

Takeaways

Modern combat injuries have evolved, necessitating updated medical responses.

Neck and upper chest injuries present unique challenges in trauma care.

Understanding the anatomy of the neck is crucial for effective treatment.

Zone classification helps determine surgical approaches to neck injuries.

Upper extremity junctional injuries are particularly difficult to manage.

Effective hemorrhage control requires teamwork and quick decision-making.

Airway management is critical in trauma situations, especially with neck injuries.

Hands-on techniques, such as packing and suturing, are essential skills for medics.

Training and preparation are key to successful trauma interventions.

Real-world case studies highlight the importance of timely medical responses.

Chapters

00:00 Introduction to Modern Combat Injuries

02:43 Understanding Neck and Upper Chest Injuries

05:38 Anatomy of the Neck: Zones and Surgical Considerations

09:50 Upper Extremity Junctional Injuries

15:36 Management of Hemorrhage in Neck Injuries

21:37 Airway Management in Trauma

26:24 Effective Hemorrhage Control Techniques

30:35 The Importance of Teamwork in Trauma Care

36:22 Surgical Interventions and Techniques

42:25 Case Study: Kentucky Ballistics Incident

48:27 Conclusion and Key Takeaways

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This podcast episode explores the innovative use of maggot therapy in wound care, discussing its historical context, benefits, and applications in various medical settings, particularly in austere environments. The conversation highlights the importance of maggot therapy as a cost-effective and efficient treatment option, especially in the face of rising antimicrobial resistance. The speakers emphasize the need for proper sourcing, preparation, and application techniques for maggot therapy, as well as the potential for integrating this method into modern medical practices.

Takeaways

Maggot therapy has historical roots dating back thousands of years.

Maggots effectively debride wounds and promote healing.

Maggot therapy is cost-effective, especially in low-resource settings.

Chronic wounds often develop biofilms that resist antibiotics; maggots can help.

Maggots can be used in both chronic and acute wounds, including burns.

Maggot therapy can be implemented in austere environments with proper training.

Specific fly species are required for effective maggot therapy.

Maggots can be sourced locally in various environments.

Maggot therapy can be a sustainable alternative to antibiotics in combat situations.

Documentation and sharing of experiences are crucial for advancing maggot therapy.

Chapters

00:00 Introduction to Maggot Therapy

01:16 Historical Context of Maggot Therapy

04:41 Benefits of Maggot Therapy

08:39 Application in Various Wound Types

11:14 Maggot Therapy in Austere Environments

15:32 Sourcing and Preparing Maggots

23:33 Application Techniques for Maggot Therapy

29:32 Patient Management and Treatment Regimens

35:06 Future of Maggot Therapy in Medicine

43:51 Conclusion and Call to Action

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In this episode of the PFC Podcast, the speaker discusses the Ridge Healer exercise, a tactical training program designed for small surgical and resuscitation teams operating in unconventional warfare environments. The conversation covers various aspects of the exercise, including operational challenges, team dynamics, communication strategies, patient care during transport, and the importance of adapting to non-battle injuries. The speaker emphasizes the need for effective decision-making, cross-training, and cultural awareness in high-stress medical situations.

Takeaways

Ridge Healer is a tactical training program for small teams.

Decision-making is crucial in the IW environment.

Surgeons should not be team leaders during operations.

Communication should be clear and concise to reduce cognitive load.

Medivac should focus on improving patient condition, not just transport.

Hypothermia management is critical in cold environments.

Non-battle injuries are common and require attention.

Post-operative care is essential for patient recovery.

Cultural awareness is important in military operations.

Rehearsing procedures is vital for effective execution.

Chapters

00:00 Introduction to Ridge Healer Exercise

00:52 Understanding the Ridge Healer Program

02:16 Operational Challenges in IW Environment

04:08 Team Dynamics and Roles

06:29 Communication and Decision-Making

10:17 Patient Care During Transport

12:48 Managing Hypothermia and Patient Comfort

15:26 Adapting to Non-Battle Injuries

16:52 Post-Operative Care and Monitoring

19:12 Basic Soldiering Skills and Cultural Awareness

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In this episode of the PFC Podcast, Dennis and Alex delve into the topic of forced vital capacity in the context of chest trauma. They discuss a research paper that explores the assessment of forced vital capacity for risk stratification of blunt chest trauma patients in emergency settings. The conversation covers the importance of understanding chest wall injuries, clinical guidelines for treatment, challenges in diagnosing rib fractures, and the implications of the study's findings on patient outcomes and resource allocation in military medicine.

Takeaways

Forced vital capacity is crucial for assessing chest trauma.

Chest wall injuries can significantly impact patient outcomes.

Pain management is a key component of treatment strategies.

Clinical guidelines help in managing chest injuries effectively.

Risk stratification is essential for resource allocation in trauma care.

The study highlights the importance of forced vital capacity measurements.

Understanding patient dispositions is vital in emergency settings.

Challenges exist in diagnosing rib fractures in the field.

The study's methodology raises questions about its applicability.

Future research is needed to refine treatment approaches for chest trauma.

Chapters

00:00 Introduction to the Podcast

00:30 Exploring Forced Vital Capacity

02:02 Understanding Chest Trauma

04:56 The Importance of Chest Wall Injuries

08:37 Clinical Guidelines and Treatment Algorithms

10:21 Challenges in Diagnosing Rib Fractures

12:33 Pain Management and Treatment Strategies

16:25 Dispositions and Resource Allocation

19:02 Risk Stratification in Chest Injuries

22:39 Forced Vital Capacity and Its Relevance

27:16 Study Overview and Methodology

32:29 Outcomes and Implications of the Study

36:41 Critical Analysis of the Research

46:38 Reflections on the Study's Impact

52:12 Conclusion and Future Directions

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In this episode of the PFC Podcast, Dennis and Doug discuss the critical aspects of analgesia and sedation in emergency and critical care settings. They emphasize the importance of patient safety, comfort, and effective communication among medical teams. The conversation covers decision-making processes for sedation, the types of medications used, and the significance of sedation wake-up trials to assess patient status. The hosts also address the management of over-sedation and the need for clear communication in patient assessments.

Takeaways

Keep the patient alive as the top priority.

Sedation may be necessary for patient safety.

Decision-making for sedation involves assessing comfort and safety.

Different medications serve specific purposes in sedation and analgesia.

Light to moderate sedation can help minimize PTSD risks.

Daily sedation wake-up trials are essential in critical care.

Communication using standardized scales aids in patient assessment.

Over-sedation management requires a systematic approach.

Medazolam and Propofol are preferred sedatives in critical care.

Start sedation at lower doses and adjust based on patient response.

Chapters

00:00 Priorities in Analgesia and Sedation

04:16 Decision-Making for Sedation Needs

07:47 Understanding Sedative Medications

14:32 Guiding Sedation Management in Critical Care

20:49 Sedation Wake-Up Trials

26:46 Communication and Neuro Exam in Sedation

31:25 Managing Over-Sedation and Emergencies

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This podcast episode discusses the challenges and strategies for sustaining distributed medics in denied environments, focusing on unconventional warfare and the importance of medical support as a force multiplier. It explores historical lessons from World War II, modern resupply techniques, and innovative delivery systems for medical supplies, emphasizing the need for sustainability and recycling in medical logistics.

Takeaways

Medical is not the mission; it supports the mission.

Medical support is crucial for building resistance forces.

Unconventional warfare requires strong medical logistics training.

Historical lessons from World War II can inform modern strategies.

Innovative delivery systems are essential for medical supplies.

Sustainability in medical logistics is critical for long-term operations.

Combat feeding is important for maintaining troop health.

Recycling medical supplies can extend operational capabilities.

Advanced manufacturing could revolutionize medical supply chains.

Understanding the environment is key to effective resupply.

Chapters

00:00 Introduction to Distributed Medics in Denied Environments

02:52 Understanding Unconventional Warfare and Medical Support

05:44 Planning Considerations for Unconventional Warfare Resupply

08:29 Historical Context: Lessons from World War II

11:49 Modern Techniques and Technologies for Resupply

14:36 Innovative Delivery Systems for Medical Supplies

17:33 Future of Medical Logistics in Combat

20:32 Sustainability and Resource Management in Warfare

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In this podcast episode, Dr. John Holcomb discusses the management of traumatic brain injury (TBI) and the innovative use of plasma as a treatment option. He emphasizes the importance of understanding the glycocalyx and its role in preventing edema and managing intracranial pressure (ICP). The conversation also highlights the limitations of current guidelines in TBI treatment and the need for practical considerations in administering plasma. Dr. Holcomb advocates for a shift in practice towards using plasma early in the treatment process to improve patient outcomes.

Takeaways

• Plasma is used as a drug to prevent edema in TBI patients.
• The glycocalyx plays a crucial role in brain injury management.
• Preventing increased ICP is more effective than treating it.
• Current guidelines often lag behind clinical practice.
• Understanding the physiology behind treatments is essential for medics.
• Monitoring blood pressure is critical in TBI management.
• Plasma can repair the blood-brain barrier and reduce edema.
• Practical considerations are necessary for administering plasma in the field.
• The outcomes of TBI treatment should focus on functional recovery.
• Future directions in TBI management include more research on plasma use.

Chapters

00:00 Introduction to TBI Management and Plasma Use

03:04 Understanding Plasma as a Drug for TBI

05:39 The Role of Glycocalyx in Brain Injury

08:47 Preventing Edema and Managing ICP

11:31 Guidelines and Their Limitations in TBI Treatment

14:33 Practical Considerations for Administering Plasma

17:29 The Importance of Patient Monitoring and Judgment

20:44 Outcomes and Future Directions in TBI Management

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