EMS — Podcast — The Overrun

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

Interview, Chest pain

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 impression 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 impression 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/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.

Aug 22

Aug 22 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

Jul 18

Jul 18 Episode 101: Death Notifications with Steph Leather

Cardiac Arrest, FOAMed, Interview

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.

Jun 21

Jun 21 Episode 100 (!): Dr. Mark Merlin on Where We've Been and Where We're Going

FOAMed, Interview, MD1

For our 100th episode, we sat down with a friend of the show Dr. Mark Merlin of MD1 to discuss how far EMS has come in the last 5 years and where EMS might go in the next 5 years. Dr. Merlin talks about his 2009 study using the MAR method to estimate blood loss as well as the recent Emergency Medicine Match dilemma. Take a listen and let us know what you think. Has EMS gotten better in the last 5 years? What can we do to improve our practice over the next 5 years?

Feb 19

Feb 19 Episode 96: Chief John Moon and Freedom House EMS

We had an amazing talk with Chief John Moon, (ret) of Pittsburgh EMS and Freedom House Ambulance, one of the first paramedics in the United States.

If you don't know the story of Freedom House, you should. Before Seattle, Miami, and yes, even Squad 51, Freedom House was providing bleeding-edge care to the citizens of the Hill and greater Pittsburgh, in a world where they were not regarded as equals in emergency services or healthcare.

With the guidance of Dr. Peter Safar and Dr. Nancy Caroline, (yes, THAT Dr. Caroline) Freedom House showed that timely EMS intervention contributed to improved outcomes.

We owe them all a debt that cannot be repaid.

Buy the book here:

https://www.amazon.com/American-Sirens-Incredible-Americas-Paramedics/dp/0306926075/ref=sr_1_1?crid=3K2DH5O0LSFHY&keywords=american+sirens&qid=1676859470&sprefix=american+sirens%2Caps%2C96&sr=8-1

Dec 22

Dec 22 Episode 94: Better CPR at the end of the year with Josh Lupton and Ken Milne

Cardiac Arrest

We end the year with 2 great interviews about cardiac arrest. Josh Lupton is a physician in Oregon who found in 2021 that there might be an ideal number of rescuers for OHCA. Hint: It's more than you think.

Then Ken Milne joins us from the Skeptics Guide to Emergency Medicine to discuss whether heads-up CPR with a commercial device is ready for prime time.

This is our last episode of the year and we wanted to thank everyone for listening. Check out the website, subscribe to the podcast, and keep an eye out during 2023. Lots of more exciting stuff coming!

Oct 31

Oct 31 Episode 92: American Sirens with Kevin Hazzard

Kevin Hazzard is a paramedic and author who wrote the book A Thousand Naked Strangers, detailing his time as a ground paramedic in Atlanta. He's back with a new story, one that you absolutely need to read.

American Sirens: The Incredible Story of the Black Men who Became America's First Paramedics is the story of a handful of Black men from Pittsburgh who were chosen to become paramedics. It's a story about perseverance, grace under pressure, and dignity that every EMS clinician should read. We were lucky to have Kevin on to speak about the book and his experience in telling the story, and why it matters.

Oct 14

Oct 14 Episode 91: Racism in EMS with Dr. Jamie Kennel

https://www.facebook.com/SaintfisherChurchofEBM/

Conference, Controversy, Interview

Dr. Jamie Kennel is a paramedic and EMS educator in Oregon that focuses on the role of racism in EMS. His researchrecently won the Research Award at the 2022 EMSWorld and has important insights into our unconscious biases in the field. Take a listen and let us know what you think. Do our biases work against us?

Jun 27

Jun 27 SPECIAL: 100,000,000 Little Things (with GLAM)

Anna Ryan

GLAM Crossover, WTAF?!, Interview

GLAM is back, taking on the aftermath of Roe v. Wade. Jess, Anna, and their guest Judyth Brown have a multigenerational conversation about women’ health and rights, where we go from here, and how we can get involved.

Apr 11

Apr 11 Episode 84: So, You Want To Be A MIlitary Medic?

Caroline Schwester

Interview, Medicine

If you've been anywhere in this world the last few weeks, you know what's been going on in Ukraine. Once again, military medicine has taken front row. But what actually is military medicine about? What are some of the misconceptions? And what can we as civilians take away from our colleagues in service?

On this episode, Dan and Ed are civilians talking medicine in the military to Dr. Andrew Fisher, MAJ USA, and the namesake of the Saint Fisher Church of Evidence Based Medicine; and our good friend Peter D'Antuono, who served in combat as a medic with the 173rd Airborne Brigade. We get to shine a light on something not many civilians get to hear about...and why it's important.

Check out the Church here:

https://sfcebm.com

Mar 21

Mar 21 Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

https://www.hmpgloballearningnetwork.com/site/emsworld/original-contribution/edge-there-better-grip-face-mask-ventilation

Airway Management, FOAMed, Interview

One of the most misunderstood pieces of equipment we have is the bag valve mask. Easy to operate, but hard to master, it’s one of the fundamental skills we need to master.

Rommie Duckworth is a nationally-known paramedic and educator in Connecticut who is truly passionate about education and ventilation, and Dan gets to pick his brain and talk about what really matters when we have to breathe for our patients who can’t do it for themselves.

Check out Rommie here:

https://romduck.com

If we’re talking airway or ventilation, Dr. Jim DuCanto isn’t far from the discussion. We talk about his method of BVM grip in the episode, and you can learn more here:

Here’s a paper Dan did with some colleagues showing smaller sized BVMs gave a more physiologically appropriate tidal volume and pressure:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234703/

The Refresh 2021 program is still available until March 31…..EMTs and Paramedics should jump on this, it’s totally FREE!

https://www.prodigyems.com/refresh2021

Jan 16

Jan 16 Episode 81: Staying Cool When the Heat is On with Dr. Mike Lauria

If you were at the National Association of EMS Physicians Conference this past week, you would have been able to see Dr. Michael Lauria speak. Mike is a USAF veteran, Pararescueman, flight paramedic, and currently an emergency medicine physician in the US. He has appeared on the EMCrit podcast and numerous others to talk about stress and managing it in the field of medicine.

Dan got to sit with him and discuss how keeping cool on scene in stressful situations actually is better for you and your patients, some simple techniques to use, and why we need to incorporate stress inoculation into all our EMS training.

The stuff we talked about is proven to help you think more clearly and function better when things are going into the weeds....it's definitely worth the time!

Jul 6

Jul 6 Episode 74: The FDNY*EMS Struggle with Michael Greco

Health and Safety, Interview, Mental Health

Controversy, Interview

Michael Greco is the Vice President of Local 2507, who represents the EMTs, Paramedics and Fire Inspectors of the Fire Department of the City of New York. You may remember we had him on last in Episode 29, and unfortunately, conditions have not improved much since our last talk.

The FDNY*EMS members will be boycotting the ticker-tape parade held for the City’s “Hometown Heroes”, because quite simply, while New York City will give them a parade; they will not pay them a fair living for the critical job they do in one of the most expensive places to live in the world.

Jun 23

Jun 23 Episode 73: Anna Talks Therapy

Anna Ryan

We’re going to circle back to our mental health for this episode! Anna sits down with Troy Longo, paramedic and licensed counselor, and Dan Gaudette from Hackensack Meridian JFK EMS; who is a critical care transport nurse with a background in psychiatric emergency care.

They discuss what post-traumatic stress is; how you recognize it, and they get into the basics of therapy and why it can be a real help.

We also have another segment of Pediatric Pearls with none other than Dr. Peter Antevy! This one talks about the importance of accurate fluid resuscitation for kids…it’s en eye-opener!

Troy’s practice is located at:

https://www.letstalkhw.com

Anna has written for EMS1, you can find her articles here:

https://www.ems1.com/columnists/anna-ryan/

May 19

May 19 Special: Requiem for EMS Week

Controversy

Happy EMS Week! We got together to discuss our worst EMS Week gifts, why night shift never gets any fresh food, and why we should change EMS Week to better work for our profession!

May 5

May 5 Episode 72: Prehospital Burn Care

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?

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

Mar 28

Mar 28 Episode 70: Pediatric Cardiac Arrest and Improving Outcomes with Dr. Peter Antevy

https://www.ahajournals.org/doi/epub/10.1161/JAHA.119.014330

Conference, FOAMed, Interview

For most places in EMS, how we treat cardiac arrests in adults is drastically different than how we do it in pediatric patients. And the results show it.

Ed and Dan sit down with Dr. Peter Antevy and talk about how we can do better with pediatric arrests. Dr. Antevy’s programs in Florida have dramatically improved their pediatric survival from cardiac arrest, by focusing on the basics, staying on scene to resuscitate before moving to the hospital, and by engaging parents with WHY we are doing what we do on scene.

This is a critically important topic that we don't talk about. But we need to prepare for these low-frequency, high-stress events to give out patients every possible chance to survive.

On another note, go to https://www.prodigyems.com/refresh2021 to see the talk that inspired this episode. This is some of the best paramedic level training out there today, and it’s NREMT approved, and FREE!

Check out Dr. Antevy’s stuff at:

https://www.handtevy.com

Early epinephrine administration improving outcomes:

We talk about the AHA PALS guidelines for 2020, here they are:

https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000000901

The Polk County study on pediatric OHCA:

https://pubmed.ncbi.nlm.nih.gov/30412719/

Time on scene in pediatric arrest matters:

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.116.023821

Feb 23

Feb 23 Episode 69: The Problem with Media and EMS