All tagged EMT

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

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

Ed Bauter
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/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.

 

Episode 102: Jason Patton from Fire Department Chronicles

Episode 102: Jason Patton from Fire Department Chronicles

Ed Bauter
Interview

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

Episode 96: Chief John Moon and Freedom House EMS

Episode 96: Chief John Moon and Freedom House EMS

Daniel Schwester
Interview

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

Episode 92: American Sirens with Kevin Hazzard

Episode 92: American Sirens with Kevin Hazzard

Daniel Schwester
Interview

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.

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

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

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

Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

Episode 83: Fundamentals of Bag Mask Ventilation with Rommie Duckworth

Daniel Schwester
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:

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

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

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

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

Daniel Schwester
Interview

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!

Episode 72: Prehospital Burn Care

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…

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

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

Daniel Schwester
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:

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

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


Episode 68: Transgender Awareness with Taylor Sprecher and Matt Streger

Episode 68: Transgender Awareness with Taylor Sprecher and Matt Streger

Daniel Schwester
Interview, Health and Safety, Medicine

The transgender population is a part of your patient population, and we all need to know how to assess and communicate therapeutically with our trans patients.

Matt Streger introduces us to Taylor Sprecher, a trans man and EMT who has taken the lead in trying to educate clinicians about trans patients, and some clinical pearls for us to utilize.

Did you know that almost one in FOUR trans people avoid seeking out health care because of their fear of how they’ll be treated? Or that trans teens have a significantly higher rate of suicide attempts? Do you know how to address your trans patients’ needs?

Read the stats here:

https://transequality.org/issues/us-trans-survey

Taylor’s webpage, which is a treasure trove of resources:

https://911transedu.com

Streger and Keavney is one of the pre-eminent EMS law firms in the USA, and a good friend of the show. Check them out at:

https://keavneystreger.com

https://emsaegis.com

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

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

https://www.dhs.gov/stopthebleed

https://community.fema.gov/until-help-arrives

Episode 63: Universal Truths with THE ADMIN

Episode 63: Universal Truths with THE ADMIN

Daniel Schwester
Controversy, Interview

Meme culture has come to EMS. And few are doing it better than the meme lord known to his many thousands of followers as simply, THE ADMIN.

His Facebook page, Burned Out Memes for EMS Teams, has over 40,000 followers who check out the material he puts out daily, and more join the page each day. THE ADMIN is one of a small group of EMS clinicians who use the medium of Internet memes as a way to point out inequities, share frustrations, and generally provide a group outlet for a profession trying to get through a pandemic, in addition to the usual job issues, and come out with a smile.

How did this get started? Where is it going? And how does THE ADMIN put out funny stuff on the regular that still makes you think and calls out substandard EMS? Kevin, Jess, and Dan sit down remotely and try to get a side of THE ADMIN you just may not know.

Check out his page on Facebook, or his Teespring store:

https://teespring.com/stores/burned-out-memes-for-ems-teams

Also check out:

Level Zero:

http://www.levelzeroems.com/

Saint Fisher Church of Evidence Based Medicine:

http://stfisherchurchofebm.com/

We will post some of our favorites on our social media as well....

Episode 62: Surviving PTSD with Chris Divver

Episode 62: Surviving PTSD with Chris Divver

Daniel Schwester
Health and Safety, Interview

September is Suicide Awareness and Prevention Month. Dan sits down with Chris Divver, paramedic and fire officer who shares his story about trauma, stress, and growth. Chris is someone who by example has shown people in emergency services that post-trauma stress and survival can be done. We talk about therapy, EMDR, and other tools he’s used to help him survive the injury.

Next Rung is a emergency services focused agency to help those of us with trauma or PTSD. Check them out here:

https://www.nextrung.org

Ashley Fitzpatrick from Episode 61:

https://www.jems.com/2020/07/28/first-responders-and-ptsd-a-literature-review/



Episode 60: Art, Communication, and Healing

Episode 60: Art, Communication, and Healing

Daniel Schwester
Interview, Medicine, Health and Safety

Ed and Dan sit down with fellow colleague and paramedic Kate Bergen about her art series that she created during COVID-19, and how she uses art to help manage her stress levels working in the challenging environment of EMS in the US today, and chronicle the amazing work that EMS has done in this new world.

The important thing to take from this episode is that everyone in EMS NEEDS to have some form of healthy release, a way to quiet your brain and recharge. Whatever you do, it is worth it. YOU are worth it.

Kate's work can be found at:

https://www.jbergenstudios.com/jbergenstudios

Kate has been working with Mission Hope, an organization to help clinicians and responders in the NJ area with mental health. Find out more about them at:

About Us

Kate's spot on ABC:

https://abcnews.go.com/Lifestyle/video/paramedic-turned-paint-brush-cope-pandemic-70770797

Kate's cover story in Real Woman magazine:

Working on the Front Lines of COVID-19 is as Scary as It Sounds

Episode 58: Scot Phelps Interview

Episode 58: Scot Phelps Interview

Daniel Schwester
Interview

“If we don’t sell ourselves, don’t expect others to sell for us”

This is an interview that’s been in the works for quite a while. Dan sits down with Scot Phelps, paramedic, historian, former Office of EMS Director, and attorney to discuss where we are going as a profession, how we need to look back and share our history with our newcomers (it’s much more than 50+ years), and what we must do to move our profession forward.

It’s probably one of the longest episodes we’ve ever had on the show; but it won’t disappoint.

Episode 57: Beercast 4-ICD-10 and Pockets....

Episode 57: Beercast 4-ICD-10 and Pockets....

Daniel Schwester

We get it. The FOAMed world has been a little COVID-19 heavy. You need a small break from the information flooding us all, and a laugh or two might be just the thing for you.

So, we pulled this episode out of the vault!

On the newest Beercast, the gang kicks back with some refreshments, and start off by talking about some of the most out there ICD-10 codes you can find. For example, did you ever wonder how they code your patient involved in a spacecraft accident? We went digging, so you don’t have to!

We also talk about the little things that people carry in their pockets on duty; and why…

Get ready for a change of pace, and an afternoon of fun with the gang!

Episode 54: Gestalt, Thinking, and EMS

Episode 54: Gestalt, Thinking, and EMS

Daniel Schwester
FOAMed

Gestalt. You hear it in almost anything you hear or see in pre hospital as well as the majority of medical education. It's really fancy, chic way of describing something we do every day in the field: make decisions on how and why we treat our patients. It's been termed a hunch, a gut instinct; but it's much more than that.

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