The Overrun

The Overrun

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The Overrun episodes

  • Episode 107: Cardiac and Non-Cardiac Chest Pain with Dr. Mike Berkenbush

    Summary

    Dr. Mike Berkenbush joins the podcast to discuss the challenges in EMS education on differentiating chest pain. The conversation highlights the need for a broader approach to chest pain, beyond just focusing on heart attacks. The importance of field impressions and open-ended questions in assessment is emphasized. The discussion also explores the physiological differences in chest pain presentation and the potential mimics of chest pain, such as pericarditis and aortic dissection. The role of honesty and patient education, as well as the potential value of point-of-care troponin testing and AI in EKG interpretation, are also discussed.

    Takeaways

    EMS education should focus on a broader approach to chest pain, beyond just heart attacks.

    Field impressions and open-ended questions are crucial in assessing chest pain.

    Physiological differences and potential mimics of chest pain should be considered.

    Honesty and patient education are important in managing patient expectations.

    Point-of-care troponin testing and AI in EKG interpretation have potential value in pre-hospital care.

    Chapters

    00:00 Introduction and Background

    00:42 The Problem with EMS Education on Chest Pain

    03:03 Recognition of Pre-Hospital Care in Cardiac Cases

    04:01 Focus on Time-Sensitive Interventions

    05:00 The Need for a Broader Approach to Chest Pain

    06:07 The Challenge of Teaching Differential Diagnosis

    07:03 Guiding EMTs in Assessing Chest Pain

    08:13 The Importance of Field Impression

    09:00 The Dangers of Casting a Wide Net

    10:16 Physiological Differences in Chest Pain Presentation

    11:19 Mimics of Chest Pain: Pericarditis and Aortic Dissection

    12:25 Other Mimics: Cholecystitis and Pneumonia

    13:00 Differentiating Chest Pain from Other Conditions

    14:14 The Importance of Describing Types of Pain

    16:11 The Role of Open-Ended Questions in Assessment

    18:07 The Challenge of Teaching Assessment Skills

    19:06 The Impact of EMS Communication on Patient Expectations

    20:28 The Importance of Honesty and Patient Education

    22:43 The Potential Value of Point-of-Care Troponin Testing

    25:28 The Role of AI in EKG Interpretation

    26:49 The Potential for BLS Providers to Perform 12-Lead EKGs

    27:11 Conclusion

    https://www.sciencedirect.com/science/article/pii/S2773232023000081

    https://www.sciencedirect.com/science/article/pii/S0735675721000279

    Then, Ed and Dan discuss the challenges and considerations surrounding the assessment and treatment of chest pain by BLS providers. They explore the tendency to over-triage chest pain cases and the need for a more nuanced approach. They emphasize the importance of field provider information in guiding patient care and highlight the role of EMS in the overall healthcare system. The conversation also touches on the need for ongoing learning and skills development, as well as the value of knowing the receiving facility. The episode concludes with final thoughts on the topic.

    Takeaways

    • Avoid over-triaging chest pain cases and consider a more nuanced approach to differential diagnoses.
    • Field provider information is crucial in guiding patient care and can make a difference in the patient’s trajectory through the emergency department.
    • EMS providers should recognize their role in the healthcare system and the importance of their assessments and findings.
    • Continued learning and skills development are essential for providing better care to patients.
    • Knowing the receiving facility and building relationships with the staff can improve patient outcomes.
    • Balancing the fear of litigation with effective assessment is important, and acting in the best interest of the patient is key.
    • BLS providers are expected to know more and do more in the evolving healthcare landscape.
    • Choosing the right center for patients based on their needs and available resources is crucial.
    • A thorough assessment, understanding the patient’s story, and considering associated symptoms are essential in evaluating chest pain cases.
      • 47 min
    • Episode 106: EMS Career Ladders

      Dr. Peter O’Meara discusses the concept of paramedic practitioners and the need for higher education and professional recognition in the field. He compares paramedic practice in the US and Australia, highlighting the similarities in patient populations and the importance of a unified profession. The attrition rates and lack of a career ladder in the US are identified as issues that can be addressed through education and professional development. The role of NEMSAC and previous recommendations for degree programs are discussed, as well as the opposition from organizations like NAEMT. The importance of having a voice and separating paramedics from agencies and the need for modernization in EMS is emphasized. The conversation concludes with discussing paramedic terminology in Australia and the significance of publishing and discussing these topics.

      • The concept of paramedic practitioners and the need for higher education and professional recognition in the field
      • Comparison of paramedic practice in the US and Australia, highlighting similarities and the importance of a unified profession
      • The attrition rates and lack of career ladder in the US can be addressed through education and professional development
      • The importance of having a voice for paramedics and separating paramedics from agencies

        • Then,

        In this conversation, Louis Imperatrice, the National Manager of Clinical Excellence for DocGo, discusses the absence of a clinical ladder and degrees in paramedicine, which he believes is detrimental to the field. He highlights the limitations of EMS and the lack of upward movement, leading to the loss of professionals. The fragmented nature of EMS systems and the need for change are also discussed. Imperatrice emphasizes the need for federal funding and lobbying in EMS, as well as the importance of modern-day leadership and education. He suggests the implementation of clinical and management tracks in EMS education to improve the industry.

        Takeaways

        • The absence of a clinical ladder and degrees in paramedicine is detrimental to the EMS field, leading to a lack of upward movement and the loss of professionals.
        • EMS systems are fragmented, and there is a need for change and standardization.
        • Federal funding and lobbying are necessary to support EMS and promote necessary changes.
        • Modern-day leadership and education are crucial in improving the EMS industry.

          • Dr. O’Meara’s Paper

          Louis Imperatrice’s Papers

          45 min
        • Episode 105: 2023 Year in Review

          Summary

          In this episode, Ed and Dan discuss several topics related to medicine and EMS in 2023. They start by reviewing a study on the use of nitroglycerin in acute pulmonary edema and congestive heart failure, highlighting its positive effects on blood pressure and oxygenation. They then move on to a comparison of succinylcholine and rocuronium in rapid sequence intubation (RSI), concluding that the choice of paralytic agent may not significantly impact outcomes. They also discuss a case in which a paramedic impersonated a doctor in Louisiana, highlighting the need for patient advocacy and responsible clinical practice. They conclude by expressing excitement for future episodes and inviting listeners to share their stories.

          Takeaways

          Nitroglycerin can be effective in improving outcomes in acute pulmonary edema and congestive heart failure.
          The choice between succinylcholine and rocuronium in RSI may not have a significant impact on first pass success rates.
          Patient advocacy and responsible clinical practice are crucial in preventing incidents of impersonation and ensuring patient safety.
          Hindsight is 20-20, and it is important to learn from past mistakes and continuously evolve in the field of medicine and EMS.

          Chapters

          00:00 Introduction
          00:26 Discussion of Nitroglycerin in Acute Pulmonary Edema Link Link
          11:22 Comparison of Succinylcholine and Rocuronium in RSI Link
          22:34 Case Study: Elijah McClain Case Link
          31:04 Case Study: Paramedic Impersonates Doctor in Louisiana Link
          36:01 Conclusion and Future Plans

          38 min
        • Episode 104: Dan Gerard and Whole Blood

          Dan Gerard is the president of the International Association of EMS Chiefs, who authored a position statement in August of 2023 supporting the use of whole blood as the standard of care for hemorrhagic injury. IAEMSC joins a growing list of national and international organizations that support this change. In this interview, Ed and Dan talk to Dan Gerard who explains the rationale behind the position statement and the change they hope to make with the position statement.

          IAMESC Paper can be read here

          Follow The Overrun on TikTok @TheOverrun

          This episode was recorded on October 30, 2023.

          29 min
        • Episode 103: Updates in Stroke Care

          Drs. Mike and Mike join Ed to discuss updates in prehospital stroke care. Are we using the right stroke scale for our patients? Are we taking them to suitable hospitals? The gang discusses stroke care in 2023 and where we can go from here.

          From the episode notes:

          Treatment of LVO patients

          1. Thrombolytics (tPA, tenecteplase)
          2. Mechanical thrombectomy discussion
            1. a)  NNT 2.5
            2. b)  NNT= # needed to treat (how many people receive medicine before there is a benefit)
            3. Aspirin NNT is 64
            4. Benefits of mechanical thrombectomy
              1. a)  Significantly reduced mRS
              2. b)  Longer treatment window (up to 24 hours)
              3. c)  Net monetary benefit $95-175 million USD(1) Discuss net monetary benefit(2) tPA alone $72-135 million USD
              4. d)  Gained quality of life years 2
              5. Potential Harms
                1. a)  New intracranial hemorrhage
                2. b)  Access site problems
                3. c)  New embolization

                  4. Rankin Scale Calculator

                  Mechanical Thrombectomy for Acute Ischemic Stroke Paper

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                  43 min
                4. Episode 102: Jason Patton from Fire Department Chronicles

                  Jason Patton is a firefighter with 17 years of experience that discusses EMS and Firefighting misadventures on his Tiktok channel (@firedepartmentchronicles). Jason joins Ed, Jess, and Kevin to discuss how we can use social media to advance the message of EMS and improve the industry.

                  Follow The Overrun on IG: @OverrunProductions

                  Follow The Overrun on TikTok: @TheOverrun

                  Follow The Overrun on Youtube: Youtube.com/theovverun

                  Follow Jason Patton on Tiktok: @Firedepartmentchronicles

                  39 min
                5. Episode 101: Death Notifications with Steph Leather
                  We're bad at notifying families what's happening during a cardiac arrest event. We're even worse on ourselves. The average person may see 3 or 4 dead people in their lives and EMS workers often see that many in a shift. The Overrun's new team member Steph Leather, a national speaker on death notifications and a director of a clinical psychology practice takes us through the steps to make death notifications easier on ourselves and on families of our patients.
                  39 min
                7. Episode 99: Alcohol Withdrawal
                  Alcohol withdrawal is a commonly missed syndrome for EMS providers. In this episode, the gang discusses the pathophysiology of alcohol withdrawal syndrome and what EMS providers can do to treat this too often overlooked patient population.
                  38 min

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