Grand Rounds Recap 5.3.23

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Grand Rounds Recap 5.3.23

Join us to recap our Grand Rounds session from the first week in May. Starting with the April M&M report expertly delivered by Dr. Broadstock- featuring atypical ACS, as well as the aggressive management of a CCB overdose. Followed by Dr. Mullen taking us through a set of cases involving near misses, as she reflects on things she learned during her four years in residency. Next up, Dr. Hajdu educated us about the presentation, pathophysiology, and evidence-based management of mild TBI’s/concussions in the ED. Lastly, we finish off with Air Care GR featuring details about the TOWAR study, review of management of pediatric seizures, as well as tips & tricks to improve our flight-related documentation.

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Air Care Series: Epoprostenol/VELETRI: a Skybridge to Somewhere?

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Air Care Series: Epoprostenol/VELETRI: a Skybridge to Somewhere?

Ever have that critical pneumonia ARDS patient that just cannot be safely transported without a temporizing (or longer) fix? Join Dr. Ferreri on a case study and deep dive into the physiology behind Epoprostenol use in Transport Medicine.

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Grand Rounds Recap 2.15.23

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Grand Rounds Recap 2.15.23

Check out this week’s MASSIVE recap with Dr. Connelly’s poignant lessons from her time with Sydney HEMS, Dr. Broadstock’s R4 case follow up of HIV myositis, Dr. De Castro’s extensive Vitamin deficient review, Small Groups on task saturation and ITE review and a Palliative Medicine lecture by dual trained Dr. Kiser.

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Air Care Series: Critical Care Transport Medicine (CCTM) Ultrasonography: Past, Present, and Future

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Air Care Series: Critical Care Transport Medicine (CCTM) Ultrasonography: Past, Present, and Future

Come and see what the future of ultrasound and HEMS looks like through a year of case based experience with POCUS on Air Care with Dr. Gottula and Dr. Lane and examine what the future could look like bringing ED level care to the patient.

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Air Care Series: Accidental Hypothermia

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Air Care Series: Accidental Hypothermia

Stuck in the Polar Vortex? Consider this. Hypothermia often requires unique approaches to the traditional management of classic pathology in the critical care transport environment. Take a deep dive into the classifcation and management of patients suffering from accidental hypothermia - from rewarming to cardiac arrest management and ECMO.

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Non-Invasive Estimation of Optimal PEEP

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Non-Invasive Estimation of Optimal PEEP

As a general rule, mechanical ventilation of obese patients is more complex and difficult than in those with a normal body habitus. Obese patients have decreased chest wall compliance due to increased truncal adiposity, amongst other factors. They are also predisposed to other comorbidities that can lead to more involved physiologic challenges.

Critical Care Transport teams commonly transport patients who are intubated and mechanically ventilated. These patients are intubated for a variety of reasons, from altered mental status to hypercapnea to hypoxia. One of the more common challenges we face in our patients who are mechanically ventilated is difficulty with oxygenation – whether the patient is suffering primary or secondary hypoxemic respiratory failure.

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Air Care Series: Electrocution

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Air Care Series: Electrocution

Electruction is a significant cause of morbidity and mortality with a widely variable injury pattern. Join the Air Care Series and Annals of B Pod teams as we dive into the pathophysiology and literature surrounding electrocution.

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Air Care Series: Status Epilepticus Update

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Air Care Series: Status Epilepticus Update

The diagnoses and treatment of status epilepticus continutes to evolve. Review the latest evidence for status epliepticus management in the critical care transport medicine environment, including an evolving role for Ketamine!

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Hypocalcemia in Trauma

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Hypocalcemia in Trauma

We are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis.  We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements.  In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.

One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy.  Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis).  However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.

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Air Care Series: Acute Ischemic Stroke Updates

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Air Care Series: Acute Ischemic Stroke Updates

The treatment of Acute Ischemic Stroke is a rapidly evolving field with critical care transport medicine playing an increasing role in the treatment of these patients. Dr. Irankunda explores CCTM specific management and historical musts when treating this unique patient population. Dr. Gottula provides a brief review of the literature supporting IV alteplase and endovascular thrombectomy.

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Air Care Series: No Lung No Problem - VV ECMO

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Air Care Series: No Lung No Problem - VV ECMO

No Lung? No problem! Join Liz Powell, Paige Barger and Adam Gottula as they take a look at the basics of VV ECMO in the transport environment.

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Is a Bag Enough?

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Is a Bag Enough?

Trauma scene flights are often the first thing people think of when they think of Helicopter EMS. Although we know that HEMS and Critical Care Transport involves much more than just scene flights, they are still a critical part of most HEMS programs’ mission and capabilities. In addition, many flights are “modified scenes” or “scene intercepts,” meaning the HEMS crew meets the EMS crew at an outlying hospital helipad, or arrives shortly after the patient’s arrival to an under-resourced ED. Many of these patients are critically ill, and a subset will require intubation and ventilation. Once intubated is bag valve ventilation enough? Or should all these patient’s be placed on a mechanical ventilator?

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Air Care Series: Machines Inside of Machines - CPR in flight

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Air Care Series: Machines Inside of Machines - CPR in flight

While high-quality CPR delivers the best outcomes in cardiac arrest, this is challenging in a transport environment. Dr. Connelly reviews the evidence behind mechanical chest compression in CPR, exploring its practicality to the Helicopter EMS (HEMS) environment.

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

Damage Control Resuscitation, Permissive Hypotension, Fluid Restrictive Resuscitation… Regardless of name, with all the enthusiasm surrounding permissive hypotension in the actively bleeding trauma patient, what do we do when they have a TBI? Take a dive into the literature surrounding ideal perfusion pressures of patients suffering from TBIs and traumatic injury to find out if we know what pressure is really the best.

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