All tagged Paramedic

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 104: Dan Gerard and Whole Blood

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.

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

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

Ed Bauter
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?

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

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

Ed Bauter
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!

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 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 74: The FDNY*EMS Struggle with Michael Greco

Episode 74: The FDNY*EMS Struggle with Michael Greco

Daniel Schwester
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.

Episode 73: Anna Talks Therapy

Episode 73: Anna Talks Therapy

Anna Ryan
Health and Safety, Interview, Mental Health

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/

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 71: What The Actual, Sedgwick?

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

Episode 69: The Problem with Media and EMS

Episode 69: The Problem with Media and EMS

Daniel Schwester
Controversy, Interview

Have you ever wondered why the news media gets EMS stories so messed up? Do you cringe each time you see a news story talk about “ambulance drivers”? Is your agency concerned with sharing your work with the community because of “HIPAA”?

Dan sits down with journalist and clinician Rich Huff (@richmhuff) as well as our good friend Margaret Keavney (www.keavneystreger.com) to discuss the problems with EMS and media, and solutions we can use to tell our stories better to the people we serve.

“We don’t have to be first; we have to be better.”

The story on LA County cardiac arrest transport:

https://www.npr.org/sections/coronavirus-live-updates/2021/01/05/953653359/los-angeles-ambulances-told-to-conserve-oxygen-and-limit-hospital-transfers

EMS Aegis is a great source for training and information for both individual clinicians and agencies looking to do better:

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 64: Ketamine and Dunning-Kruger

Episode 64: Ketamine and Dunning-Kruger

Daniel Schwester
Drugs, Controversy

In the FOAMed world, nothing is more loved than ketamine. There have been multiple podcasts and talks about the drug, and it’s acquired a mythic status on the Internet med ed word.

But is what we think we know causing problems? Is the promise of ketamine as a drug the does it all lull us, and especially new clinicians, into a false sense of security? Has FOAMed put us on the wrong side of the Dunning-Kruger curve?

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