The EMS Pulse: Perspectives from the Washtenaw Livingston MCA

In this episode, Dr. Purington, Dr. Louras and Dr. Ghafouri discuss prehospital management of undifferentiated tachyarrhythmias.

Reference:

Fernandez AR, Bourn SS, Duncan D, Slovis CM, Crowe RP, Treichel A, Myers JB. Comparing Prehospital Adenosine Initial Dosing of 6 mg Versus 12 mg for Presumed Paroxysmal Supraventricular Tachycardia (PSVT). Prehosp Emerg Care. 2025 Jun 5:1-6.

Fornage LB, O'Neil C, Dowker SR, Wanta ER, Lewis RS, Brown LH. Prehospital Intervention Improves Outcomes for Patients Presenting in Atrial Fibrillation with Rapid Ventricular Response. Prehosp Emerg Care. 2024;28(7):910-919.

Patrick C, Crowe RP, Ward B, Mohammed A, Keene KR, Dickson R. Feasibility of prehospital esmolol for refractory ventricular fibrillation. J Am Coll Emerg Physicians Open. 2022 Apr 9;3(2):e12700.

American Heart Association. (2020). Advanced Cardiovascular Life Support Provider Manual. American Heart Association.

American Heart Association. (2025). ACLS Guidelines Update: Adult Tachycardia With a Pulse. AHA Scientific Sessions.

National Association of EMS Physicians (NAEMSP). (2023). Model EMS Protocols: Cardiac Dysrhythmias.

Singh S, McKintosh R. Adenosine. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. 

Smith, Jane D., and Robert T. Jones. “Management of Tachydysrhythmias.” Rosen’s Emergency Medicine: Concepts and Clinical Practice, edited by John A. Marx, Robert S. Hockberger, Ron M. Walls, Marianne Gausche-Hill, R. Brooke Jeffrey, and Scott R. Levin, 9th ed., Elsevier, 2018, pp. 1452–1478.

Page, R, Joglar, J, Caldwell, M. et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. JACC. 2016 Apr, 67 (13) e27–e115.

Joglar JA, Chung MK, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(1):109-279.

Sarwar CM, Papadimitriou L, Pitt B, Piña I, Zannad F, Anker SD, Gheorghiade M, Butler J. Hyperkalemia in Heart Failure. J Am Coll Cardiol. 2016 Oct 4;68(14):1575-89.

Nasir M, Sturts A, Sturts A. Common Types of Supraventricular Tachycardia: Diagnosis and Management. Am Fam Physician. 2023 Jun;107(6):631-641.

Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998 Oct 16;82(8A):2N-9N.

Al-Khatib, S, Stevenson, W, Ackerman, M. et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. JACC. 2018 Oct, 72 (14) e91–e220.

Alpar S, Tatlıparmak AC. Evaluating smartwatch-based detection of supraventricular tachycardia and atrial fibrillation in the emergency department. Am J Emerg Med. 2025 Sep;95:101-106.

Nazarian S, Lam K, Darzi A, Ashrafian H. Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis. J Med Internet Res. 2021 Aug 27;23(8):e28974.

Spatz ES, Ginsburg GS, Rumsfeld JS, Turakhia MP. Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine. N Engl J Med. 2024 Jan 25;390(4):346-356.

Magliocca A, Fornari C, Fumagalli F, Merigo G, Rahimi M, Stirparo G, Coppo A, Migliari M, Grasselli G, Cheskes S, Ristagno G. Amplitude spectrum area to predict true shock-refractory ventricular fibrillation during basic life support-treated out-of-hospital cardiac arrest. Resuscitation. 2025 Oct;215:110695.

We are back! In this episode of The EMS Pulse, Dr. Ella Purington is joined by Dr. Julian Campillo and Dr. Graham Smith to discuss the growing role of point-of-care ultrasound (POCUS) in prehospital medicine. The conversation focuses on practical, field-ready applications of ultrasound that help EMS clinicians make better, faster decisions.

Key Topics Covered

• How POCUS is routinely used in emergency departments and how that workflow translates to EMS
• Why modern handheld ultrasound devices have made field use realistic and scalable
• Using IVC ultrasound to guide fluid resuscitation in critically ill patients
• Focused cardiac ultrasound during critical care transport with Survival Flight
• Ultrasound-guided IV access for patients with difficult vascular access
• Using ultrasound during cardiac arrest to differentiate true PEA from pseudo-PEA
• How pseudo-PEA patients often respond to additional fluids or vasopressors
• FAST exam use in trauma to support triage and destination decisions
• Future applications including portable transesophageal echocardiography (TEE)

Why This Matters for EMSPoint-of-care ultrasound is no longer limited to hospitals. With focused training and clear protocols, EMS clinicians can use ultrasound to individualize resuscitation, improve diagnostic accuracy, and streamline patient care before hospital arrival.

Selected References

Atkinson P et al. EMS ultrasound — the new frontier? Emerg Med J.

Gaspari R et al. Pseudo-PEA and outcomes in cardiac arrest. Acad Emerg Med.

Blyth L et al. Bedside ultrasound and cardiac arrest outcomes. Resuscitation.

Kirkpatrick AW et al. FAST exam in trauma care. Injury.

Gottlieb M et al. Ultrasound in resuscitation and shock. Am J Emerg Med.

Join us for a discussion of the role of the EMS physician in advocacy, training, field response, and more!

Featuring:

Christine Brent MD, FAEMS, FACEP

Clinical Assistant Professor - Emergency Medicine

Chief - Division of Emergency Medical Services

Program Director - Emergency Medical Services (EMS) Fellowship

Assistant Director - Survival Flight

Co-Deputy Medical Director - Washtenaw/Livingston County Medical Control Authority

Kevin Argentieri, MD

Emergency Medical Services (EMS) Fellow

Rolando (Israel) Castillo Salcedo, DO

Emergency Medical Services (EMS) Fellow

Nicholas Valentini, MD

PGY4 Emergency Medicine Resident

Incoming EMS Fellow - Brown Emergency Medicine

Join Drs. Ella Purington, Brad Feldman, Nick Valentini and Nate Hunt for a discussion of patient report, and giving handoff using the DeMIST format.

Join Dr. Woody Sams and Dr. Ina Prevalska as they discuss the prehospital presentation and management of flash pulmonary edema.

Learn all about the student-run University of Michigan EMS Club including their work with HVA Unit 8170 and some exciting on-campus recruitment and harm reduction initiatives!

Introduction by Nate Hunt, MD

Featuring:

Mitchell Walsh, EMT-P - Co-President

Thomas Chen, EMT-B - Vice President of Operations

Noor Majhail, EMT-P - Vice President of Education

Nicholas Valentini, MD - Advisor

Article regarding the 8170 Project:

https://www.michigandaily.com/multimedia/um-emt-a-michigan-daily-ride-along-with-the-student-run-ambulance/

Article about the UM Nalox Box: 

https://www.michigandaily.com/news/public-safety/naloxone-initiatives-continue-to-expand-on-and-off-campus/

Join us for an excellent discussion behind the science, art, and teamwork of high performance CPR!

Featuring:

Graham Smith, MD - Associate Medical Director for W/L MCA

Stephen Dowker, BS, FF/EMT, Medical Student, and M-RISE Study Coordinator

Nicholas Valentini, MD - PGY4 Emergency Medicine Resident

For additional resources on how to improve CPR performance, check out the resources below:

https://www.savemiheart.org

https://www.911.gov/assets/CPR_LifeLinks_Toolkit_2023_Final.pdf

Join Dr. Sam Malakhovsky and Dr. Nate Louras as they discuss the clinical utility and importance of end-tidal capnography (ETCO2) and it's use in the pre-hospital environment.

Join Dr. Ella Purington and Dr. Nate Hunt for a discussion of common toxicology presentations and the importance of early care provided by EMS!

Join us for a discussion of the ongoing "naloxone leave behind" project in the MCA with guest hosts Dr. Emily Ager and Dr. Nathan Hunt. We'll cover indications and evidence behind this harm reduction initiative as well as a discussion of some key teaching points in providing care to those with opiate use disorder.