Кращі подкасти про MCHD Paramedic (2024)

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Episode 174 - Push Dose Norepinephrine 25:27

2M ago25:27

25:27

We recently implemented a "push-dose" norepinephrine protocol at MCHD and have already learned some valuable lessons. Join us for some vasopressor pharmacology and protocol review, accompanied by some of our new teaching points that have arisen following the protocol's release into the wild.REFERENCES:1. Berkenbush, M., Singh, L., Sessa, K., & Saad…

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Episode 175 - The Rear View Mirror - Tunnel Vision 31:09

2M ago31:09

31:09

Dr. Patrick is joined by MCHD District Chief Kelcie Adams to discuss the role of clinical case reviews at MCHD. Why are these so important, and what's the big deal? Kelcie is brave enough to use one of her recent calls as an example of the positives that can come if we get past our egos and allow ourselves to have insight for future cases.…

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Episode 173 - Med Minute - Magnesium 15:15

3M ago15:15

15:15

We're working on a new series focusing on high-yield pharmacology reviews. Dr. Patrick starts us off with some background, mechanism of action discussion and common uses for magnesium sulfate. Mag is one of the true pharmacologic swiss army knives of emergency care.REFERENCES1. Touyz RM, de Baaij JHF, Hoenderop JGJ. Magnesium Disorders. N Engl J Me…

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Episode 172 - The MCHD EKG Manifesto - Part 3 27:12

3M ago27:12

27:12

Our final entry into the EKG Manifesto series moves into the STEMI/OMI world of acute coronary occlusion. Who do we activate and why? Where is the STEMI paradigm headed? Join Dr. Patrick and Dr. Dickson to refresh your EKG knowledge. REFERENCES 1. https://www.emdocs.net/ecg-pointers-stemi-equivalents-from-the-american-college-of-cardiology/…

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Episode 171 - Surgical Airway Lessons With Dr. Al Lulla 32:58

3M ago32:58

32:58

One of the most fear-inducing procedures in all of emergency care is the surgical cricothyrotomy. Dr. Al Lulla from Dallas Fire joins the podcast to discuss our recent collaboration on a retrospective look at MCHD's surgical airway experience over the past decade. Can paramedics successfully perform cricothyrotomies? Who needs surgical airway place…

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Episode 170 - The MCHD EKG Manifesto - Part 2 39:07

5M ago39:07

39:07

Applied EKG interpretation is often a difficult task in EMS and emergency medicine education. Getting bogged down in minutiae can obscure the patient. While an understanding of EKG foundational physiology is an absolute must, consideration of how to combine the 12-lead and patient presentation is vital as well. Join the podcast crew as they start a…

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Episode 169 - Agitation Awareness - Fixed-Dose Ketamine 24:56

6M ago24:56

24:56

We've initiated a multi-pronged, system wide overhaul of our agitation management at MCHD. This included a move to fixed-dose ketamine for the severely agitated patients. Evidently we weren't the only ones thinking of this as there is exciting new data from Buffalo supporting this approach. Join the podcast crew as they review the recent literature…

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Episode 168 - The VTach FACTs 35:50

7M ago35:50

35:50

We've recently had several challenging, wide-complex tachycardia cases here at MCHD, so the podcast crew decided to bring forth some VT vs. SVT with aberrancy knowledge. Learn the V-Tach FACT, and you'll feel more comfortable with your next wide rhythm at a rate of 185.REFERENCES1. https://litfl.com/vt-versus-svt-ecg-library/2. https://www.youtube.…

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Episode 167 - Ketamine Only Intubations With Dr. Andrew Partain 27:16

8M ago27:16

27:16

The podcast crew is joined by a special guest, Dr. Andrew Partain, an EMS Fellow from UTSW in Dallas. We will dissect his recent data surrounding ketamine-only intubation from MedStar in Fort Worth. This is not just another boring data rehash. There are some vital and applicable pearls that must be applied to the world of prehospital airway managem…

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Episode 166 - The MCHD EKG Manifesto - Part 1 35:25

9M ago35:25

35:25

Applied EKG interpretation is often a difficult task in EMS and emergency medicine education. Getting bogged down in minutiae can obscure the patient. While an understanding of EKG foundational physiology is an absolute must, consideration of how to combine the 12-lead and patient presentation is vital as well. Join the podcast crew as they start a…

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Episode 165 - Intracerebral Hemorrhage 32:06

10M ago32:06

32:06

We've spent countless hours (rightfully so) discussing ischemic stroke management over the past several years. Sometimes, the other 20% of strokes, the hemorrhagic version, can get neglected. No, we don't have stroke-mobiles at MCHD to diagnose an ICH in the field, but there are some patient care keys to emphasize for EMS when we suspect non-trauma…

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Episode 164 - EMS HOCUS POCUS 29:20

11M ago29:20

29:20

MCHD's POCUS program has definitely involved both forward progress and lessons learned. In this episode, we'll discuss some of the reasons POCUS can be a game changer in the prehospital setting. However, unintended consequences do exist. We've begun to make the move to utilizing carotid ultrasound in OHCA, and we'll tell you exactly why.REFERENCES1…

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Episode 163 - Back Pain Beware 35:16

12M ago35:16

35:16

MCHD paramedic Wes Hall joins the podcast crew to discuss a recent seemingly mundane back pain call. Please listen to find out how avoidance of premature closure, a thorough exam, and professional patient advocacy led to an excellent outcome in a SCARY case.REFERENCES1. https://www.mchd-tx.org/wp-content/uploads/2023/12/Image-Episode-163.jpg…

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Episode 162 - Post-ROSC Pressor Choice 30:39

1y ago30:39

30:39

We recently made a significant vasopressor protocol change at MCHD, prioritizing norepinephrine in all shock situations except anaphylaxis and bradycardia. The evidence supporting norepinephrine in septic and even cariogenic shock is relatively solid. However, recent data has emerged suggesting norepinephrine may be safer in post-ROSC shock as well…

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Episode 161 - MMQ#9 - The Angioedema Airway 32:57

1y ago32:57

32:57

MCHD District Chief April Currie joins the podcast crew to discuss an angioedema case that repeatedly left more questions than answers. Dr. Patrick was tasked with managing the airway and definitely has some lessons learned to share with the listeners.Montgomery County Hospital District

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Episode 160 - ST Elevation in aVR With Diffuse ST Depression 23:53

1y ago23:53

23:53

The podcast crew dives deep into one of the early "STEMI equivalent" ECG patterns: ST elevation in aVR with diffuse ST depression. What does the evidence say about this pattern? Is there a FOAM lesson to be learned? How should we incorporate this ECG into our practice? REFERENCES1. Harhash AA, Huang JJ, Reddy S, Natarajan B, Balakrishnan M, Shetty …

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Episode 159 - MMQ#8 - The Head and the Heart 25:24

1+ y ago25:24

25:24

Dr. Dickson leads the discussion with recent cases involving the PECARN pediatric head injury decision rule and some super sneaky toxicology. There is some high-level detective work happening during this episode. Listen so you don't miss vital clues in your clinical practice.REFERENCES1. Kuppermann N, Holmes JF, Dayan PS, et al; Pediatric Emergency…

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Episode 158 - Terrible Tracheostomy 2023 21:52

1+ y ago21:52

21:52

The podcast crew is joined by MCHD In-Charge Paramedics, Ben Breaux, and Jesus Contreras to discuss a critical case that demonstrates why continuing education and intentional mental reps are vital in emergency care. We've discussed the "how-to" when approaching the crashing tracheostomy patient. Let's add an actual MCHD case and a little review on …

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Episode 157 - Cardiac Arrest During EMS Care - Making MOVES 23:39

1+ y ago23:39

23:39

There is nothing more stressful than seeing EMS peri-arrest progress to pulseless. CARES data suggest that cardiac arrest during transport is not an uncommon event. Additionally, there is new evidence that these patients may not be as difficult to recognize as we might've thought. Join the podcast crew as we introduce the MCHD "MOVES" algorithm for…

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Episode 156 - MMQ#7 A Shocking Save And Sneaky Serial Killer 23:50

1+ y ago23:50

23:50

Sometimes it's easy on the individual level to miss the positive drift within EMS as systems of care evolve and change toward positive innovation. Dr. Patrick hits the hot seat on this episode to discuss two recent cases where some of MCHD's favorite initiatives come together to improve patient outcomes and diagnostic recognition.REFERENCES:1. Dick…

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Episode 155 - MMQ#6 - A Rapid AFib Riddle 29:12

1+ y ago29:12

29:12

Join the podcast crew as they discuss one of the more sticky situations in all of emergency care: stable vs. unstable narrow complex tachycardia.1. How do we even define unstable?2. Is it cardiac versus an underlying illness?3. How do we approach undifferentiated rapid atrial tachycardia in the ED setting?…

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Episode 154- Death Notification Lessons Learned 21:37

1+ y ago21:37

21:37

The concept of emphasizing, discussing, and training on giving prehospital death notification is, unfortunately for medics and our patient's families, a relatively new concept. Additionally, newer evidence shows that an increased frequency of fatality exposure increases EMS burnout rates. So...everyone wins by an increased focus on improving our sk…

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Episode 153 - MMQ#5 From The PNW - Spokane Frozen Solid 30:11

1+ y ago30:11

30:11

The Podcast Crew is joined by Spokane Valley Fire Paramedic Noah Martinez to discuss a recent patient that he delivered to Dr. Patrick. After you hear what Noah found on the scene, this story will likely not end exactly how you expect. Learn some foundational hypothermia management pearls AND why early emergency neuro-prognostication can be exceedi…

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Episode 152 - The MCHD SNORES Sedation Safety Bundle 29:35

2y ago29:35

29:35

Chemical sedation is one of the riskiest decisions made in EMS clinical care, period. We've been working overtime at MCHD over the past couple of years to decrease the risk and improve our safety profile for the entire clinical package when we sedate patients for severe agitation in Montgomery County. Join us to learn about the MCHD SNORES safety b…

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Episode 151 - MMQ#4 - Dr. Dickson's Strokes 38:48

2y ago38:48

38:48

Join us as Dr. Dickson brings a couple of extremely difficult recent emergency department cases to take a hard look in his own clinical mirror. These will highlight the difficult and often dynamic nature of assessing airway patency and protection in real time. Speaking of dynamic, vascular emergencies like stroke and STEMI often progress unexpected…

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Episode 150 - Hyperkalemia, BRASH syndrome, And Amiodarone BEWARE 30:31

2y ago30:31

30:31

MCHD paramedic, Lily Trosclair, joins the podcast to discuss some in-depth hyperkalemia treatment details, including BRASH syndrome. We'll also pivot to the dangers of giving amiodarone to a hyperkalemic patient that's mistaken for ventricular tachycardia. REFERENCES1. https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-…

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Episode 149 - Finding Joy In The Common 27:12

2y ago27:12

27:12

This may seem like a curveball-type episode upon your initial listen, but this topic should be core material for all emergency medical clinicians. Too much time and emphasis within paramedic education are placed on rare presentations. Dr. Dickson and Dr. Patrick expand on a recent medical podcast/article (see links below), stressing the need to emb…

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Episode 148 - ET3 And Beyond With Dr. Gerad Troutman 35:30

2y ago35:30

35:30

The podcast crew is joined, live at Texas EMS 2022, by Dr. Gerad Troutman to discuss the world of alternate destination EMS transports, EMS-facilitated telehealth, nurse navigation, and "hospital at home." Dr. Troutman leads the ET3 initiative and is the National Medical Director for Innovative Practice at GMR, so this episode is full of successes,…

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Episode 147 - MMQ#3 - CAB For The Win 36:25

2y ago36:25

36:25

MCHD medics Kelcie Adams and Rich Serra join the podcast to discuss a critically ill trauma patient they delivered to Dr. Patrick in the emergency department. Our default is so often airway, airway, airway first, but prioritizing circulation first was likely life-saving. This is an excellent "Monday Morning Quarterback" case to look back on and dis…

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Episode 146 - NTG In RVMI With Matt Wilkinson-Stokes 36:03

2y ago36:03

36:03

Special guest alert!! We're lucky to have superstar Aussie medic and University of Melbourne Ph.D. candidate Matt Wilkison-Stokes, on this episode to discuss his recent paper looking at the risk of hypotension with nitroglycerin administration in acute MI. Where is NTG really more likely to cause hypotension in AMI? When is it safest? How often do …

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Episode 145 - Where Do We Look? Who Do We Trust? 34:14

2y ago34:14

34:14

We have MCHD Cpt. Megan Powell to thank for this episode as she posed an excellent question about where and how to look for trusted educational information as a practicing paramedic interested in continuing clinical growth and progression. With the amazing and immense amount of free online textbook, blog, and podcast resources available, trying to …

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Episode 144 - The TBI "H-Bombs" With Dr. Al Lulla 34:54

2y ago34:54

34:54

Join this discussion of some of the recent literature surrounding EMS care of traumatic brain injury with Dr. Al Lulla. This is the perfect confluence of advancing evidence, relatively straightforward interventions, and a patient population where we can definitely improve prehospital outcomes. See where the literature, education, and protocol imple…

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Episode 143: Adrenal Crisis in EMS 34:08

2y ago34:08

34:08

When it comes to exciting educational topics in EMS, oftentimes, the endocrine system, specifically the adrenal glands, can be left off the list. Dr. Patrick is joined by one of our local emergency/trauma nurses, Melanie Gander, to discuss her journey as a parent of a child with congenital adrenal hyperplasia. We'll review basic adrenal physiology …

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Episode 142 - Reducing Medication Errors 33:50

2y ago33:50

33:50

Across the world of health care, everyone is wrestling with how to reduce medication errors. With the decision in the Vanderbilt case, there is now the added fear of potential prosecution for giving an incorrect medication. Join the podcast crew as they try to better define the various types of medication errors while looking at what the literature…

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Episode 141 - Podcast Q&A 24:44

2y ago24:44

24:44

Join the Podcast Crew as they answer some recent questions submitted to podcast@mchd-tx.org. We discuss a wide range of topics including epinephrine drips, IV Tylenol for pain, Knee-BOA, whole blood in EMS, the green whistle (methoxyflurane), and an awesome "S" for our loss of airway protection teaching files. Thanks to all our listeners out there!…

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Episode 140 - MMQ#2 - A TBI Conundrum 24:04

2y ago24:04

24:04

The Podcast Crew is joined by MCHD District Chief, Spencer Hall, to discuss a recent trauma patient that Chief Hall delivered to Dr. Patrick's ED care. This one encapsulates many of our recent podcast topics including the tenets of DSI and the importance of maintaining oxygenation and blood pressure in TBI patients.…

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Episode 139 - Anchoring Bias In EMS 35:48

2+ y ago35:48

35:48

The MCHD Paramedic Podcast would like to welcome EM/EMS physician Dr. Katherine Luu, to Montgomery County. Dr. Luu joins the podcast to discuss anchoring bias and how this impacts medics in the field. Listen and learn how to describe, recognize, and prevent anchoring bias in your practice.REFERENCES1. https://onlinelibrary.wiley.com/doi/epdf/10.119…

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Episode 138 - Beware of the BRUE - MCHD COTQ Q2 2022 19:38

2+ y ago19:38

19:38

Brief resolved unexplained what?? MCHD paramedic, Cpt. Clayton Smith, joins Dr. Dickson to discuss an EMS approach to BRUE's. These can often be falsely reassuring to prehospital providers because the event, by definition, has resolved prior to EMS arrival. But don't get too comfortable because up to 4-5% of BRUE's can have severe underlying diagno…

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Episode 137 - Monday Morning Quarterback - STEMI vs. OMI/NOMI 33:34

2+ y ago33:34

33:34

The Podcast crew is joined by MCHD In-Charge Paramedic Brady Walding to discuss a recent difficult STEMI case that intersected with Dr. Patrick in the ED. How do we best communicate with our consultants when we disagree? What happens when a paradigm shift is occurring without our consultants (STEMI vs. OMI/NOMI)? We are excited about our new Monday…

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Episode 136 - Mythbusters 2022 39:33

2+ y ago39:33

39:33

The podcast crew welcomes newly transplanted Texan EMS physician, Dr. Louis Fornage, to join in on some rapid-fire mythbusting for 2022. We run the gamut from post-ROSC vasopressor evidence to whether or not saying "QUIET" affects emergency department volume. REFERENCES1. https://www.nremt.org/News/National-Registry-of-EMT-s-Resource-Document-on-Sp…

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Episode 135 - First There Matters 35:52

2+ y ago35:52

35:52

Join the podcast crew as they turn their attention from the EMS transport to the First Responders here in Montgomery County. We welcome MCHD FRO Coordinator Bryan Perry and Chief Ray Vaden from Porter Fire to discuss some recent FRO initiatives and advances. It wouldn't be the MCHD Paramedic Podcast if we also didn't slip in some recent CARES resea…

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Episode 134 - All Things Anaphylaxis 26:57

2+ y ago26:57

26:57

True anaphylactic shock can be one of the most harrowing calls in all of EMS and emergency medicine. However, as is true with much of our core clinical content, dogma and myths persist. MCHD District Chief Spencer Hall joins the podcast crew to discuss anaphylaxis diagnostic criteria, treatment, and much more. REFERENCES1. Anagnostou K, Turner PJ. …

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Episode 133 - MCHD Bike Team 19:22

2+ y ago19:22

19:22

Join Dr. Patrick and MCHD District Chief and Bike Team lead, Scott Sanders, as they discuss the MCHD Bike Team. What does it take to be an MCHD bike team medic? How does patient care differ from the truck vs. when on the bike? Learn how the MCHD Bike Team fills multiple invaluable roles in the county.Photo Link - https://www.mchd-tx.org/wp-content/…

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Episode 132 - Xylazine Update 27:04

2+ y ago27:04

27:04

Friend of the podcast emergency physician, addiction specialist, and toxicologist extraordinaire, Dr. Jerry Snow joins the podcast crew to discuss a scary and potentially deadly twist in the opiate crisis…xylazine. Dr. Snow will school us all about xylazine pharmacology and treatment tips and why EMS high-dose naloxone may not be ideal.REFERENCES1.…

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Episode 131 - Nebulized Ketamine, What?? 13:28

2+ y ago13:28

13:28

There is no possible way to improve ketamine, right? Join Dr. Patrick for a discussion of exciting recent literature investigating the effectiveness and safety of nebulized ketamine for emergency department analgesia. Everyone's favorite EMS medication may be primed for an enhanced delivery option.REFERENCES1. Dove D, et al. Comparison of Nebulized…

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Episode 130 - A Super Cool Case - MCHD COTQ Q1 2022 23:15

2+ y ago23:15

23:15

Join the podcast crew, District Chief Kevin Mifflin and In-Charge Payden Seals as they discuss our MCHD Case of The Quarter for Q1 2022. This case is a prime example why field providers must keep wide differentials with a keen awareness of the initial scene situational factors. REFERENCES1. https://coreem.net/core/hypothermia/2. https://www.saem.or…

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Episode 129 - Serial Killer Series - Trauma 35:28

2+ y ago35:28

35:28

The medical directors revisit one of our old favorites "The Serial Killers Series" to discuss 5 trauma killers to keep in your front brain as you are preparing or caring for a sick trauma patient. If you've not considered your differential diagnosis until patient contact and initial evaluation then you're too late. Following this episode, you'll be…

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Episode 128 - MCI MCHD Style 26:45

2+ y ago26:45

26:45

Join Dr. Dickson and the podcast crew as they dive into the MCHD approach to mass casualty incidents. We're lucky to be joined by MCHD Safety and Preparedness Officer, Sean Simmonds and MCHD District Chief Ryan Davenport. These are field medics talking about actual logical field pearls for MCI management.…

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Episode 127 - Airway Patency Vs. Protection 36:32

2+ y ago36:32

36:32

Episode 127 - Airway Patency Vs. Protection by Montgomery County Hospital DistrictMontgomery County Hospital District

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Episode 126 - Droperidol With Dr. Jeff Jarvis - Live From Texas EMS 28:42

3y ago28:42

28:42

On Episode 126, the podcast crew was able to catch up with the one and only Dr. Jeff Jarvis at Texas EMS in Austin. Dr. Jarvis is a longtime fan of droperidol for multiple uses in the prehospital setting ranging from acute headache treatment to sedation and as an anti-emetic. Let this be a warning, we're all droperidol zealots in this discussion. L…

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