The EMS Lighthouse Project

Part pre-recorded, part LIVE! Dr. Jeff Jarvis, Dr. Jason Pickett, and Mike Verkest discuss the results of the Resuscitation Outcomes Consortium TXA in TBI Trial. Thanks for coming to the channel! Be sure to subscribe here and wherever you listen to podcasts!

Y’all may recall from episode 31 that one of my favorite papers from the last few years was on TXA. Not CRASH or TBIs, but for epistaxis. I love using TXA for nose bleeds. Well, sometimes science can throw you curve balls. My anecdotal evidence is strong that TXA works and I’m certainly biased in favor of using it. In this episode, I discuss a well done RCT (the NoPAC trial) that provides some contradictory results. Join me for a discussion of this new paper and the importance of keeping an open mind about medicine and evidence.

Citation: 
Reuben A, Appelboam A, Stevens KN et al. The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial. Annals of Emergency Medicine 2021.

Have you had patients recently with repeat EMS calls and lots of ED visits for nausea and vomiting? They say the only thing that works for them is scalding hot showers and that drug that starts with a "D." Did they happen to smoke a lot of weed? In this episode, Dr. Jarvis discusses cannabinoid hyperemesis syndrome and reviews an RCT comparing topical capsaicin cream (yes... the stuff of pepper spray fame) vs placebo.

Mike and Dr. Jarvis are joined by Drs. David Wampler and Emily Kidd to discuss their study on the performance characteristics of the VAN score for detecting large vessel strokes. Drs. Jarvis and Kidd run through a case of a patient with a stroke to discuss the thought process of an emergency physician.

We talk about headaches in this episode, specifically an RCT comparing haloperidol to placebo for benign headaches. Special guest Dr. Erin Lincoln (@ErinTWL), EM resident and paramedic, is joining us for this episode. Drs. Jarvis and Lincoln will go through an oral boards-type case of a 45-year-old woman with a headache. We’ll include a review of the literature on headache treatments, hit on why opioids aren’t recommended, and discuss the differential diagnosis of headaches and the red flags that will help find those “can’t miss” diagnoses. This is a new format for us. We want your feedback. Do you like the oral boards-style interview? Drop us a note on Twitter @DrJeffJarvis, or email [email protected]. And don’t forget to give us a review on Apple Podcasts to help other like-minded clinicians find our show.

VL vs. Augmented DL with Special Guest: Dr. George Kovacs. We’re starting a new format with this episode. We kick things off with a review of a paper: Brown CA, et al. Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study. Acad Emerg Med. 2020; 27: 100-108. After discussing the paper, we have a fantastic interview with Dr. George Kovacs (@kovacsgj) to discuss the differences between types of VL devices. He drops some great pearls on some tips for intubation success. Then Mike joins us for a discussion of the paper and interview. We hope you like the new format. Please drop us a line and let us know what you think! As always, please subscribe and give us a 5-star rating on Apple Podcasts. We’d love to hear your thoughts, questions, and suggestions. Join us on Twitter: @DrJeffJarvis, @EMSLighthouse

There has been a lot of talk about the benefits of TXA in major trauma with minor differences in outcomes. If you’re looking for a big treatment benefit for TXA, look no further than the very sexy nose bleeds. This is an easy and safe intervention that EMS can provide that makes a real difference in a growing number of patients. If you like what you hear, please give us a 5-star rating on Apple Podcasts and other premier podcast purveyors and tell your friends to subscribe.

Are you worried about what might happen in your jurisdiction if COVID breaks out in your nursing homes? You should be. Dr. Jarvis reviews a NEJM paper in this episode: Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. Afterward, he’s joined by a special guest, Dr. Jason Pickett. Dr. Pickett is the deputy medical director for Austin-Travis County EMS, assistant local health authority for Austin Public Health, and the host of the EMS podcast with the longest name ever. As always, please subscribe and give us a 5-star rating on Apple Podcasts. We’d love to hear your thoughts, questions, and suggestions. Join us on Twitter: @DrJeffJarvis, @EMSLighthouse.

We are living in a COVID world. And I am a COVID doc. This is a special episode of the EMS Lighthouse Project Podcast. Since the Jarvis household is quarantined in our bunker in Central Texas, I brought the family together to discuss how such a short piece of RNA has changed our world. Oh, and we talk about the MMWR report from Singapore that, apparently, got the CDC to change its stance on the use of public face masks. If you like what you hear, please give us a 5-star rating on Apple Podcasts and other premier podcast purveyors and tell your friends to subscribe. Most importantly, stay safe out there. Thank you for stepping up and caring for others in these difficult times. We appreciate each one of you. I’ve never been prouder to be in EMS.

Remember our podcast about amiodarone and lidocaine improving survival from arrest when given IV but not IO? Wait! There’s more. Another paper dropped looking at the same thing but with epinephrine instead of anti-dysrhythmics. Does this paper show the same thing? Is there something to this IV superiority thing? Dr. Jarvis breaks this new paper down. As always, please subscribe and give us a 5-star rating on Apple Podcasts. We’d love to hear your thoughts, questions, and suggestions. Join us on Twitter: @DrJeffJarvis, @EMSLighthouse

Remember Episode 12, where we reviewed a Houston paper on DSD that showed worse outcomes with DSD? At the end of that pod, I spoke about an ongoing RCT trial comparing DSD to standard therapy AND vector change defibrillation. Well, the pilot phase of that trial is over and has JUST been published. It has some surprising preliminary results. Join us and find out how that study is going. If you like what you hear, please give us a 5-star rating on Apple Podcasts and other premier podcast purveyors and tell your friends to subscribe.