When That 1% Makes All the Difference

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When That 1% Makes All the Difference

Just prior to SMACC (the Social Media and Critical Care Conference), we were lucky enough to have Dr. Brian Burns of Sydney HEMS stop through Cincinnati.  In the video below you can see his lecture on when the 1% makes all the difference.  Dr. Burns talks about how we should strive for excellence in prehospital care not simply meeting minimum standards.  Watch the lecture below to hear Dr. Burns discuss the importance of incremental changes, cognitive offloading, checklists, and continuous improvement and training through simulation.

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"Flights" - Shaken Recap & Expert Commentary

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"Flights" - Shaken Recap & Expert Commentary

Thanks to everybody who commented and contributed to the discussion on our final “Flight!”  If you missed out on the case, check it out here. Below you’ll find a curation of the comments to each question and a podcast with expert commentary from Jenn Lakeberg, APRN.  This was the final “Flight” for this spring/summer.  Look for the cases to return again in January 2016 as we begin Flight MD Orientation with the next class of future Air Care Flight Docs.

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Endotracheal Intubation vs. Supraglottic Airway Placement for Out-of-Hospital Cardiac Arrest

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Endotracheal Intubation vs. Supraglottic Airway Placement for Out-of-Hospital Cardiac Arrest

If you want to get a group of prehospital providers riled up, simply ask them how the airway should be managed during out-of-hospital cardiac arrest.  "Supraglottic airways are easier!"  "No, you gotta stay with endotracheal intubation!"  "Forget advanced airways, a bag-valve mask is all you need!"  "Only apneic oxygenation!"  Don't believe me?

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A Pain in My Heart - Curated Comments and Expert Commentary

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A Pain in My Heart - Curated Comments and Expert Commentary

Thanks to everybody who chimed in on our last "Flight"! We had a great discussion on the management of the STEMI transfer patient.  These aren't just "milk runs" as pointed out by Dr. Hinckley.  The highlights of the discussion are below with additional commentary on the case by Dr. Bill Hinckley and Air Care Resident Assistant Medical Director Dr. Matt Chinn.  Out final flight will be lifting off June 1 and it's a doozy - looking forward to the discussion!

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Field Amputation

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Field Amputation

Hey, everybody! Today we are going to talk about field limb amputation.

I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life. 

First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011. 

So I was told… 

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Flights - A Pain in My Heart

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Flights - A Pain in My Heart

You are the Pod doc overnight on a particularly quiet Sunday night.  You have been looking for an excuse to leave the pod and do anything other than treat abdominal pain for the past several hours when the tones drop.  You thank whatever celestial being you believe in and grab the blood and run out of the department full of glee.  In route to the helipad you are told it is a Code STEMI.  At this point, even that seems more interesting than sitting in C Pod.

You buckle into the helicopter and take a quick flight to the outside hospital.  You grab a set of gloves and unload the cot carefully and walk inside.

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Flights - A Blow to the Head Recap and Expert Commentary

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Flights - A Blow to the Head Recap and Expert Commentary

Thanks to everybody who commented and contributed to the discussion on our last "Flight!" If you missed out on the case, check it out here.  We had a great discussion which we have recapped here.  Take a look below and a listen to the commentary provided by Dr. Bill Hinckley in the embedded podcast.  Look for our next flight to lift off in the next couple of weeks!

What medications could be used in the care of this patient? If the patient loses his IV, how does your treatment strategy change?

This first question sparked quite a bit of debate within the community.  Everybody agreed that this patient requires sedation, intubation, and more sedation.  There was, however, some significant differences in how the providers would go about attaining adequate sedation.

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Flights - A Blow to the Head

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Flights - A Blow to the Head

You’re working as the Pod-Doc, having just taken the radio from the off-going UH-doc, you just finish admitting the patient in C40 for NSTEMI when the tones go off.

“Air Care 1 and Pod Doc respond to a scene for motorcycle crash, Northern Kentucky”

You call the B-Pod attending, sign out the pod, grab the blood from the blood cooler and head to the helipad.  Flying over the river, landing at a local firehouse’s parking lot you hop out of the back of the helicopter and head to the awaiting squad.

Your patient is a 29 year-old male who was riding his motorcycle (without a helmet) on a local country road.  Coming around a blind corner he unexpectedly found a car stopped in the middle of the road.  Striking the car from behind at ~35mph, he flew over the handlebars and impacted the back of the car.

On EMS’s arrival he was initially unconscious, but since their arrival has become increasingly combative

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EMS Recertification Requirements

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EMS Recertification Requirements

Often times during the EMS continuing education courses we teach, we get questions about recertification requirements for both our state and National Registry certifications.  This podcast is designed to summarize the various recertification requirements as well as discuss the National Registry Transition from EMT-Paramedic to Paramedic.  While much of the discussion focuses on these issues relating to Paramedic certifications, the same principles can be applied to recertification requirements for other levels of pre-hospital providers.  For a complete set of recertification requirements we refer Ohio providers to the Ohio EMS website: ems.ohio.gov.  For details about the National Registry’s requirements for re-certification, we refer everyone to their website: nremt.org.   

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Flights - A Stab in the Dark

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Flights - A Stab in the Dark

You are working overnight as the H2 doc based at Butler County Regional Airport.  It’s bitter cold out (for Ohio that is).  Its only 11 PM and already the temperature has dropped to 9 degrees fahrenheit on its way to a low of 0.  You are in the lounge refamiliarizing yourself with the contents of the critical care cells when the tones go off: “Scene: stab wound – Hamilton Ohio”

You and the nurse grab your equipment, the blood cooler, and head to the helicopter.  You put the critical care cells back in their spot in the rear of the helicopter and then buckle in for the short flight to the scene.

Your patient is a 23 year-old female who was in an argument with her boyfriend earlier in the evening.  The verbal argument quickly escalated, her boyfrienf pulling a knife and stabbing her multiple times in the right arm and right chest.  He fled the scene and she managed to call 911.  The first responders found the patient with significant active bleeding from her arm as well as chest.  She was initially responsive, but is now only awake to painful stimuli.

You meet the EMS crew in the back of the squad truck and assess the patient from the head of the bed.

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Flights - One Road too Far

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Flights - One Road too Far

You are working as the UH-doc.  Driving into your shift with the windows down and music playing, you figured the first warm day of the year would result in a busy day for you and the rest of the Air Care 1 crew.  You arrive for your shift, grabbing the radio from the Pod doc when the tones go off for your first flight of the day.  You grab the blood cooler head to helipad, checking your pager you find you’ll be responding to Southeastern Indiana for a “MVC rollover, entraped.”

You strap into the helicopter and fly over the city and to the rolling hills of Southeastern Indiana.  Landing on the 4 lane divided state road, you unstrap and head to your patient who is waiting with the BLS squad.

You open the side door of the EMS truck and head to the head of the bed to assess your patient...

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Ketamine Fight Club: Ketamine in TBI

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Ketamine Fight Club: Ketamine in TBI

There has long been a concern for increases in ICP with administration of ketamine primarily stemming from reports of increased ICP in the Neurosurgery and Neuroanesthesia literature.  These increases were described primarily in patients usually with CSF outflow obstruction undergoing elective neurosurgical procedures.  In the time since these articles were published, the use of ketamine in a wide variety of patients with neurologic compromise has been reported.  In fact, there have been a couple of recent systematic reviews and meta-analyses on this topic.  These systematic reviews and meta-analyses have essentially analyzing all the same existing literature (which is generally poor in quality).  

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Might As Well Face It: We’re Addicted to SMACC

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SMACC Chicago

Social Media And Critical Care

Here at Taming the SRU, where we’ve been SMACC-infatuated for more than a year now, it’s easy for us to forget that many of you out there are still unfamiliar with what the fuss is all about.  SMACC is the Social Media and Critical Care conference.  Its next iteration, the third annual (and first to occur in North America), is coming in late June in Chicago, and wild horses couldn’t keep us away.  Taming The SRU is honored and stoked to be an Affiliated SMACC Website.

Isn’t this just another CME conference, you ask?  Emphatically, no.  Weingart has called it “simply the greatest medical conference in the history of the world,” and we don’t think this is hyperbole.  SMACC aims not only to educate; SMACC aims to entertain, and mostly, to inspire.  To quote smacc.net.au: “SMACC is a high impact academic meeting fused with cutting edge online social media to deliver innovation with education.  The underlying ethos is to provide free online education with open access, in what has come to be known as ‘FOAM’ (Free Open Access Meducation).”  Get this: all sessions will be recorded and released as videos or podcasts online on the affiliated SMACC websites following the actual conference, for free!  And yet, hundreds of us will flock to Chicago to attend in person.  Why?  We’re addicted to the inspiration of FOAMed, and the maximum dose of this inspiration attainable is SMACC, live and in person.  (Plus, we’re sick of just ‘favoriting’ Minh Le Cong’s Tweets, and we want to shake his hand or give him a big ‘ol bear hug.)  This is not your father’s medical conference.  It’s infinitely better.

SMACC also aims to connect people across boundaries, and succeeds in doing so like no conference ever has.  Wherever you practice critical care (prehospital, ED, OR, ICU), SMACC is for you.  Whatever your discipline (student, EMT, medic, nurse, PA, NP, CNS, CRNA, doc), SMACC is for you.  Whatever your specialty, whatever your experience level, whatever country you call home, whatever your clinical setting: as long as you seek inspiration to be as good as you can be at optimizing your sick patients’ outcomes,  SMACC is for you.  Right now, go to the brochure and look at it for just 60 seconds.  Can you get a witness?  You bet.  Listen to this brief podcast in which Bill Knight, Jeff Hill, and I testify about the reasons for our excitement about our upcoming road trip to Chi-town.  Still not sure?  Check out the archives from SMACC 2014 (Gold Coast, Australia).  We think you’ll be convinced.  But, be forewarned: there’s no cure for SMACC addiction.

Prehospital Care, An International Perspective

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Prehospital Care, An International Perspective

The State of Affairs

     The morbidity and mortality of trauma on a global perspective is humbling.  Aside from HIV/AIDS and TB, trauma is the chief cause of mortality for 15 to 45 years of age (based on 2002 WHO data).  5.8 million deaths annually.  5.2 million of those deaths, or 90%, occur in low-and-middle-income countries (LMIC’s).  Prehospital care in LMIC’s varies immensely.  Total prehospital time, the training level of prehospital providers, transportation method, and access to emergency medical systems (EMS) are some of the better described aspects of prehospital care in LMIC’s.  The attributes of the prehospital health care delivery system differ significantly on a country by country basis.

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Cyanide Poisoning - Recognition and Treatment

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Cyanide Poisoning - Recognition and Treatment

Hey everybody! Dr.’s Hinckley, Steurwald, and myself sat down recently to talk a little bit about hydroxocobalamin (Cyanokit) and put together the attached podcast. 

Here are a few take home points and additions regarding this cherry-colored elixir of wonder: 

  • Think about hydroxocobalamin in your hemodynamically unstable or otherwise SICK patients who have a history of smoke exposure in an enclosed space or a known industrial exposure to CN containing material. This stuff works fast and can be life saving.
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