EMS Cast: Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers

The Critical Four Minutes: AMAX4 framework for Anaphylaxis

Explore anaphylaxis care from the basics to the critical approach to managing severe anaphylaxis with Bruce Hoffman, FlightBridge ED senior educator. Find out what it means to be aggressive with anaphylaxis care explained through the AMAX4 framework.  Learn how the framework can help reverse anaphylactic shock and prevent catastrophic outcomes. Hear the impactful story behind the framework and gain insight into the most effective practices for treating unresponsive anaphylactic and asthmatic patients. Special thanks to the McKenzie family for their mission-driven educational work. 

• Resource links
  • Episode Blog Post / Show Notes 
  • AMAX4 website
  • Anaphylaxis deep dive
  • Updated Anaphylaxis Definition
  •  EMScast15 - code for 15% off an awesome pair of sunglasses 
  • Help us learn how to make this show better for you
  •  Medic Box - awesome medical gear shipped directly to your door 

Guest/Cast/Crew information-

Guest- Bruce Hoffman- Goodwin University Program Director and Assistant Professor, FlightBridgeED senior educator, Bay State Health Critical Care RN and Paramedic

Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emscast
• Twitter- @ems_cast
• Website- www.emspodcast.com

From Errors to Excellence: Master Your Medics Geoff Murphy on the role of mistakes in EMS education

The Power of Embracing Mistakes- Special guest Geoff Murphy, founder of Master Your Medics, shares how acknowledging and learning from mistakes can save lives in the field of prehospital medicine. Recorded at the Fast 24 conference, this episode emphasizes the importance of cultivating a culture of safety, vulnerability, and continuous learning within EMS teams. Discover actionable strategies to foster a psychologically safe environment where mistakes are openly discussed and used as invaluable learning tools to enhance professional development and patient care. This insightful discussion is a must-watch for anyone looking to elevate their skills and create a high-performing EMS team.

• EMScast15 - code for 15% off an awesome pair of sunglasses
• Enter to Win a FREE Pair of Frontline Optics Sunglasses
• Medic Box - awesome medical gear shipped directly to your door

Guest/Cast/Crew information-

Guest- Geoff Murphy, founder of Master Your Medics

Host- Ross Orpet, Will Berry 

 

Resources

• Ep. 31 You Were Taught Wrong, Traumas Not Algorithmic
• MasterYourMedics.com

Catch up with us after the show

• Instagram- @emscast
• Twitter- @ems_cast
• Website- www.emspodcast.com

00:00 Introduction: The Power of Discussing Mistakes

00:38 Welcome to EMS Cast

00:52 Today's Topic: How Mistakes Can Save Lives

01:16 Embracing Failure: Insights from Jeff Murphy

01:37 Creating a Culture of Safety and Vulnerability

06:29 The Fearless Organization: High vs. Low Performing Teams

11:49 Personal Stories: Learning from Mistakes

19:15 Master Your Medics: The Journey and Vision

23:43 Conclusion: The Path to Mastery

Poisons of the Sea: Not Just a Coastal Problem

Think you only need to worry about toxicities that exist in the sea if you live by an ocean? Think again. No matter where you are fish may be on the menu, or there may be a zoo nearby, or a marine enthusiast with an elaborate home aquarium. These toxicities can be seen in Colorado. They can be in Australia or in the US. No matter where you are you have the potential to see one or many of these. From scombroid poisoning to puffer fish, irukandji syndrome, jellyfish, and sea snakes- tune in to this week's episode to learn all about the various poisons that come from the sea with toxicologist Nik Matsler.

• Website show notes link
• EMScast15 - code for 15% off an awesome pair of sunglasses
• Enter to Win a FREE Pair of Frontline Optics Sunglasses
• Medic Box - awesome medical gear shipped directly to your door

Guest/Cast/Crew information-

Guest- Dr. Nik Matsler

Host- Dr. Ross Orpet and Critical Care Paramedic Will Berry 

Resources

• Other episodes you might like
  • Episode 26: Snake Bites
  • Episode 25: Cocaine Overdose
• Third-party websites where you can learn more
  • Marine Envenomations Journal Article
  • 5 Step Approach to Marine Envenomations

Catch up with us after the show

• Instagram- @emscast
• Twitter- @ems_cast
• Website- www.emspodcast.com

The Critically Sick Runner: Unraveling the Mystery at an Ultra-endurance Event with Dr. Whitney Barrett

Dr. Whitney Barrett, the Medical Director of the Highlonsome 100 mile ultra endurance race, discusses the critical considerations for EMS providers when encountering sick runners during endurance events. Insights on managing ultra-endurance athletes, focusing on conditions such as hyponatremia, dehydration, electrolyte imbalances, and the unique challenges presented by high-altitude races. Learn about effective rehydration and cooling strategies, and the critical role of context in diagnosing and treating affected runners.

 

EMScast15 for 15% Off Frontline Optics Sunglasses

Enter to Win a FREE Pair of Frontline Optics Sunglasses

Blog Post and Critical Runner Algorithm- The Critical Care of the Sick Runner

 

00:00 Introduction and Hosts

00:39 Conference Recap

01:03 Guest Introduction: Dr. Whitney Barrett

01:29 Understanding the Sick Runner

02:29 Medical Considerations for Ultra Marathons

08:15 Common Issues in Ultra Runners

12:45 Responding to Sick Runners

19:42 Fluid Management and Hyponatremia

35:10 Handling Hyperthermia and Hypothermia

44:05 Dealing with Collapsed Runners

53:36 Final Thoughts and Takeaways

EMCRITs Scott Weingart on How to Master the Resuscitation

EMCRIT's Scott Weingart discusses the concept of being a true resuscitationist. The mindset necessary for providing aggressive, excellent care outside hospital boundaries and the emphasis on the importance of preparation, critical thinking, and meticulous attention to detail in emergency medical situations. Dr. Weingart shares insights on mental simulation, embracing challenges, handling crises efficiently, and continuous self-improvement. We conclude our discussion by exploring the philosophy 'Amor Fati' and underscore the broader impact EMS professionals can have beyond simply saving lives.

Enter to Win a FREE Pair of Frontline Optics Sunglasses

EMScast15 for 15% Off Frontline Optics Sunglasses

Blog Post- How to Master the Resuscitation

Building Better Providers: Eric Bauer, Lessons from FlightBridgeED

Will and I recently attended FAST24, an educational conference hosted by FlightBridgeED in Wilmington, North Carolina. We had a fantastic time meeting industry top speakers, including Eric Bauer, one of the original founders of FlightBridgeED. In today's episode, we delve into Eric's journey in EMS education, how FlightBridgeED was conceived, and the importance of continuous learning. We also discuss the challenges of becoming an expert in the field and tips on improving your skills incrementally. Join us as we explore these valuable insights and look forward to upcoming episodes featuring more stellar guests from FAST24!

Enter to Win a FREE Pair of Frontline Optics Sunglasses

EMScast15 for 15% Off Frontline Optics Sunglasses

 

Blog Post- Building Better Providers

Mushrooms: The Perils and Pleasures with Toxicologist Dr. Nik Matsler

In this episode, we delve into the fascinating and often perilous world of mushrooms. Join us as we explore with Dr. Nik Matsler how these fungi can be a culinary delight, a source of psychedelic experiences, or a deadly hazard. We discuss the challenges of identifying mushrooms, even for experts, and why toxicologists rely on mycologists for accurate identification. We'll break down the different types of mushrooms—non-toxic edible varieties, toxic species, and psilocybin-containing "magic mushrooms." Learn the practical tips for EMS professionals on managing mushroom poisoning, including supportive care strategies and specific interventions for severe cases. 

Enter to Win a FREE Pair of Frontline Optics Sunglasses

EMScast15 for 15% Off Frontline Optics Sunglasses

 

Episode Blog Post- The Perils and Pleasures of Mushrooms

Electrical Injuries and Lightning strikes

Derek Miller, outreach coordinator for the UNC JC Burn Center, joins us again to explore electrical injuries and lightning strikes. We discuss the various types of electrical injuries, the mechanisms behind these injuries, and the essential steps EMS providers must take to ensure their safety and provide effective patient care. Through real-life case studies and expert insights, this episode delves into the complexities of managing electrical burn patients, the importance of immediate interventions, and the potential long-term sequelae of such injuries. Tune in for practical advice and essential knowledge to enhance your skills in handling electrical emergencies.

Enter to Win a FREE Pair of Frontline Optics Sunglasses

EMScast15 for 15% Off Frontline Optics Sunglasses

 

 

Blog Post- Electrical Injuries and Lightning Strikes

Here are some additional resources:

Electrical Injuries Overview- Nice overview, though not limited to EMS specifically. The references list at end is also a good jumping off spot for those wanting more.

Photo examples- Variety of pictures

As mentioned at the end, fireworks safety- https://www.safefireworksnc.com/

Stroke Care on the Streets, What Actually Matters? Bridging Research and Real-World EMS

Explore the nuances of stroke assessments, the challenges EMS professionals face in the field, and the impact of prehospital interventions on patient outcomes. Coco Wham, a former paramedic who's transitioned to a physician, and Dr. Layne Dylla, an associate professor of emergency medicine join us to dive into their ongoing research efforts aimed at defining what matters in prehospital stroke care and refining stroke response protocols. Hear firsthand how evidence-based practices are developed from the ground up in EMS settings. This episode is packed with valuable information to enhance your practice and understanding of stroke care in prehospital environments.

Enter to Win a FREE Pair of Frontline Optics Sunglasses

EMScast15 for 15% Off Frontline Optics Sunglasses

 

 

Blog Post- Stroke Care on the Streets

 

The Critically Burned Patient Part 2- What You learned About Fluids Was Wrong, A Simpler Approach

This is Part 2. Derek, an experienced clinician in burn care, joins us to delve into the intricacies and challenges of treating burn patients. This discussion provides valuable insights into the unique aspects of burn injuries, the importance of a comprehensive assessment, and the latest trends in burn treatment.

Enter to Win a FREE Pair of Frontline Optics Sunglasses

EMScast15 for 15% Off Frontline Optics Sunglasses

 

Blog post- The Critically Burned Patient

Key Topics Covered

• Complexity of Burn Injuries: Derek begins by explaining why burn patients require a unique approach compared to other trauma patients. He highlights the potential for burns to mask other critical injuries, underscoring the necessity of a thorough and trauma-informed initial assessment.

• The 'Big Three' Considerations: The conversation shifts to what Derek refers to as the "big three" — polytrauma, airway loss, and inhalation injuries — which are crucial early considerations in burn care. He stresses the importance of recognizing these potentially life-threatening conditions alongside the burn injury itself.

• Fluid Resuscitation: A significant portion of the discussion is dedicated to fluid resuscitation, a critical aspect of burn care. Derek talks about the Parkland formula for calculating fluid needs based on the total body surface area affected by burns but a better simpler method is-

  • 500 ml/hr for an adult (<13 yo)
  • 250 ml/hr for a young kid (6-13 yo)
  • 125 ml/hr for a child (<5 yo)

• Pain Management and Ethical Concerns: Derek addresses the ethical and practical aspects of pain management in burn victims. Effective pain control not only improves patient comfort but also aids in overall patient management and long term healing, making it a critical component of the initial response.

• Assessment Tools and Techniques: Various assessment tools such as the Rule of Nines and the Palmer Method are discussed. Derek explains their applications and limitations, emphasizing that while these tools are helpful for initial assessments, more detailed evaluations are typically conducted at specialized burn centers. A link from ABA that may be helpful: https://ameriburn.org/resources/burnreferral/ Includes brief overview of severity/depth (with diagrams, not pictures), Rule of Nines & Palmar Method, plus a link for ABA referral criteria.

  Here is another great article for a deeper dive into pros & cons of different methods of estimating TBSA, although not exhaustive, per se.

  Gretchen C., Burn size estimation: A remarkable history with clinical practice implications,Burns Open, Volume 8, Issue 2, 2024, Pages 47-52, ISSN 2468-9122

  Evaluation and Optimization of the Wallace Rule of Nines for the Estimation of Total Body Surface Area in Obese and Nonobese Populations, The Journal of Emergency Medicine, Volume 65, Issue 4, 2023, Pages e320-e327.
• Burn depth estimates: There are free diagrams out there, but for actual real wound pictures, very little is open-license. UpToDate has a decent starting place, with four pictures embedded, and likely accessible for most.

https://www.uptodate.com/contents/assessment-and-classification-of-burn-injury?search=burn%20depth&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1

Other Scientific papers mentioned-

Burn resuscitation

First article is an overview of evolution of burn fluid resuscitation formulas & philosophy – although again, not exhaustive, per se.

Bacomo, F. K., & Chung, K. K. (2011). A primer on burn resuscitation. Journal of emergencies, trauma, and shock, 4(1), 109–113.  

Next article underscores the risks of fluid creep. Starting too high, being reluctant to titrate down, and the fact that giving too much fluid can actually CAUSE an increased need for fluids (vicious cycle).

Chung KK, Wolf SE, Cancio LC, Alvarado R, Jones JA, McCorcle J, King BT, Barillo DJ, Renz EM, Blackbourne LH. Resuscitation of severely burned military casualties: fluid begets more fluid. J Trauma. 2009 Aug;67(2):231-7; discussion 237. doi: 10.1097/TA.0b013e3181ac68cf. PMID: 19667873.