The EMS Lighthouse Project

National guidelines for the management of seizures recommend midazolam 10 mg IM as first-line therapy. The big question is how often EMS follows this guideline or how well that guideline matches up to real-world use. Dr. Jarvis makes a road trip to ESO headquarters to discuss this paper using the ESO research dataset with newly minted Texan Mike Verkest and special guest Dr. Remle Crowe. As we get our nerd on, we go deep into the very interesting methodology used in this paper!

Citation: Guterman EL, Sporer KA, Newman TB, et al. Real-World Midazolam Use and Outcomes With Out-of-Hospital Treatment of Status Epilepticus in the United States. Annals of Emergency Medicine. Published online August 2022. doi:10.1016/j.annemergmed.2022.05.024

First, there was Episode 31: TXA for Epistaxis (the Zahed RCT from Tehran), then Episode 40: TXA for Epistaxis, Part Deux (the NoPAC trial), and now Episode 64: TXA for Epistaxis, Part Trois, another Iranian RCT.

 So, we have conflicting evidence, all from RCTs, about whether TXA works for epistaxis. Dr. Jarvis reviews the prior trials and then provides a more detailed analysis of the new evidence. He then discusses how he handles conflicting evidence. 

Citation: Hosseinialhashemi M, Jahangiri R, Faramarzi A, et al. Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis: A Double-Blind Randomized Clinical Trial. Annals of Emergency Medicine. 2022;80(3):182-188. doi:10.1016/j.annemergmed.2022.04.010

COVID sucks, no doubt about it. Vaccination has been a game changer for how we live through the pandemic, but we still need therapeutics for those breakthrough cases and the unvaccinated amongst us. Paxlovid is a novel anti-viral agent that showed promise in an initial industry-sponsored trial among unvaccinated patients with the delta strain. But does it hold up in the real world where vaccination is common, and omicron has pushed delta to the wayside? Dr. Jarvis reviews the initial RCT and a recent Israeli observational trial where more than 75% of patients were vaccinated. He also covers the contraindications for its use. Finally, he’ll no doubt massacre the almost impossible-to-pronounce generic names for the drugs in Paxlovid.

Citations: Najjar-Debbiny R, Gronich N, Weber G, et al. Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients. Clinical Infectious Diseases. Published online June 2, 2022:ciac443. doi:10.1093/cid/ciac443 2.Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJMoa2118542

Our good friends at Montgomery County Hospital District EMS in suburban Houston brings us a nice feasibility study about the use of esmolol for refractory v-fib. Dr. Jarvis discusses why this is a helpful study. 

If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us out and subscribe on the FlightBridgeED channel. Drop your questions/comments/suggestions for future pods at [email protected] or @DrJeffJarvis.

Dr. Jarvis interviewed several EMS industry leaders, discussing why we should use Red Lights & Sirens as a clinical intervention and only as indicated. This podcast is part of the first-ever national EMS quality improvement effort led by NEMSQA (https://www.nemsqa.org/lights-and-siren).

Join us for interviews with Drs. Doug Kupas, Lawrence Brown, Michael Redlenner, and Mike Taigman to hear about The Case Against Lights & Sirens. Did you know all of our podcasts are also available in video versions? Check them out on the FlightBridgeED YouTube channel.

During my FAST22 talk, I received a great question about what to make of two different papers, seemingly on the same topic, that give different results. In this case, it was about the Prague study Mike and I spoke about on the last episode (E59) and the one from Minneapolis (the ARREST trial). It was a great question that I’ll discuss in this episode. I’ll also talk more about the ARREST trial.

 If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us out and subscribe on the FlightBridgeED channel. Drop your questions/comments/suggestions for future pods at [email protected] or @DrJeffJarvis.

Mikey V. and Dr. Jarvis get together again “live” from Planet Hollywood in Las Vegas for FAST22! We took the opportunity to sit down and discuss two papers on cardiac arrest. Should we stay and play, or should we load and go? In other words, should we work our arrests to a conclusion where we find them or rapidly transport them? In a paper from Prague, we discuss whether early transport with LUCAS directly to the cath lab for ECMO and PCI improves survival.

As a foretaste of a pod to come, we’ll discuss the apparent contrasting results between the Prague ECMO study and one from Minneapolis (The ARREST trial) in a future episode. If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us out and subscribe on the FlightBridgeED channel. Drop your questions/comments/suggestions for future pods at: [email protected] or @DrJeffJarvis

Y’all have had lots of questions about using sodium bicarbonate in cardiac arrest after we ran an interview with Dr. Menegazzi about an abstract he presented showing a benefit with bicarb. You wanted more, so here it is! Dr. Jarvis reviews a paper from British Columbia from 2017 that looks at just this thing!

If you like the show, please give us a 5-star rating wherever you get your podcasts.
Did you know our podcast is on YouTube, too? Check us out and subscribe to the FlightBridgeED channel.

Drop your questions/comments/suggestions for future pods at:
[email protected] or @DrJeffJarvis

Citations:
1. Kawano T, Grunau B, Scheuermeyer FX, et al. Prehospital sodium bicarbonate use could worsen long-term survival with favorable neurological recovery among patients with out-of-hospital cardiac arrest. Resuscitation. 2017;119:63-69. doi:10.1016/j.resuscitation.2017.08.008

Join us for a joint release of the first episode of The Pediatric EMS Podcast. We collaborated with the great folks from the PEC podcast and MedicMindset to introduce this new podcast. We discuss the assessment and management of pediatric pain.

Do y'all treat a-fib? Have you wondered what the best method of rate control is? Should you use diltiazem or metoprolol? How about the best pad placement for electrical Cardioversion? Should you go anterior-posterior or anterior-lateral? Great questions! Dr. Jarvis reviews two recent papers to help shed the bright light of science on these two questions.