May 23

May 23 Episode 110: EMS WEEK with Dr. Zaffer Qasim

Cardiac Arrest, FOAMed, Interview, Trauma

Summary

In this episode, Dr. Zaf Qasim discusses advances in medical resuscitation and the future of cardiac arrest care. The conversation covers topics such as compression-only CPR, the controversy surrounding head-up CPR, the use of band and piston-driven devices, and the potential of extracorporeal cardiopulmonary resuscitation (eCPR). The importance of good dispatch and patient selection is emphasized as key factors in improving outcomes. The episode concludes with a discussion on the need for a paradigm shift in how we approach cardiac arrest care. Then, Dr. Zaf Qasim discusses updates in trauma resuscitation. The focus is on the use of whole blood in trauma resuscitation, the importance of meaningful intervention in the pre-hospital setting, the role of ultrasound in trauma resuscitation, and the use of ketamine and fentanyl in RSI and trauma scenarios. Dr. Qasim emphasizes the need for resuscitation before intubation and the importance of controlling bleeding and restoring volume. He also highlights the potential of technology, such as ultrasound and sending real-time information to the trauma team. The conversation ends with a call for hope in the future of pre-hospital medicine.

Takeaways

Advances in medical resuscitation have focused on basic life support (BLS) interventions, such as compression-only CPR and early defibrillation.
The effectiveness of head-up CPR in improving outcomes is still under debate, and more research is needed to determine its role in human resuscitation.
While band and piston-driven devices have shown variable results in improving outcomes, they can be useful logistically in certain situations.
Extracorporeal cardiopulmonary resuscitation (eCPR) shows promise for refractory ventricular fibrillation patients, but its implementation requires system-wide changes and good patient selection.
Good dispatch and patient selection are crucial in improving cardiac arrest care and should be prioritized in system design and protocols.
A paradigm shift is needed to move from a one-size-fits-all approach to cardiac arrest care to a more individualized approach based on patient outcomes and preferences.

The use of whole blood in trauma resuscitation is gaining traction and has shown to improve outcomes.
Meaningful intervention in the pre-hospital setting, such as giving blood and controlling bleeding, is crucial for improving trauma outcomes.
Ultrasound can provide valuable information in trauma resuscitation, including assessing the heart and identifying pericardial effusion.
Ketamine is still a great drug for RSI in trauma, but dosage and patient physiology should be considered.
Technology, such as ultrasound and real-time information sharing, has the potential to enhance trauma resuscitation.
There is hope for the future of pre-hospital medicine, with a focus on improving pre-hospital interventions and outcomes.

Nov 5

Nov 5 Episode 104: Dan Gerard and Whole Blood

Ed Bauter

FOAMed, Interview, Trauma

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.

May 5

May 5 Episode 72: Prehospital Burn Care

Daniel Schwester

Medicine, Trauma, Pediatrics

Ed and Dan are back, this time talking about care of burn patients outside of the hospital. Burn injuries are high-acuity, low occurrence events (HALO), and it’s easy to miss things that may have a bigger impact on your patient than previously thought.

We talk about initial basic care, why wet dressings are bad for anything more than a very small burn, fluid resuscitation and the drama that surrounds it, and pain management (in a word, YES).

Dr. Peter Antevy comes in with a Pedatric Pearl, as well…

Apr 12

Apr 12 Episode 71: What The Actual, Sedgwick?

Daniel Schwester

Controversy, Trauma, WTAF?!

Ed and Dan are the hosts for our latest “What The Actual…” episode, where we take a look at an EMS train wreck and try to learn from it…or at least try to figure out what the heck happened.

This time, we travel to Sedgwick County, Kansas, where a prehospital attempt at palliative care goes way off the rails, resulting in everyone involved being sanctioned…except the one you’d think

Nov 23

Nov 23 Episode 65: Bringing Battlefield Care to the Street with Dr. Andrew Fisher

Daniel Schwester

Trauma, FOAMed, Interview

On this episode, Dan gets to sit down virtually with Dr. Andrew Fisher, otherwise known as “Saint” Fisher, of the Saint Fisher Church of Evidence Based Medicine. He’s been an EMT, Paramedic, PA, surgical PGY-1, Army Ranger, and author of a lot of what works in trauma care, especially in prehospital environments.

This is long episode, but there’s a TON of information…everything from tourniquets, pain management, blood vs. crystalloid, “scoop and run”, and much, much more. We also talk about education, and how The Church is looking to educate while still having a laugh or two.

Dr. Fisher’s Twitter feed:

https://twitter.com/fisherad1?lang=en

Kotwal, et al. study on the 75th Ranger Regiment:

https://pubmed.ncbi.nlm.nih.gov/21844425/

the PAMPER trial on prehospital plasma:

https://www.nejm.org/doi/full/10.1056/NEJMoa1802345

Fisher on ketamine:

https://pubmed.ncbi.nlm.nih.gov/25399363/

Ketamine and PTSD:

https://pubmed.ncbi.nlm.nih.gov/18376165/

Stop the Bleed information:

https://www.stopthebleed.org