Episodes
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Since before any of us did a manual defibrillation, cracked any ribs while
doing compressions, or drilled that first I.O., epinephrine had been used
by all of those medics that have come before us on countless cardiac
arrests. Epinephrine has been around forever as is practically ubiquitous
for the treatment of cardiac arrest. The question is should it be? The
P.A.R.A.M.E.D.I.C.-2 trial was just published in the New England Journal of
Medicine this week and it is further confirming the suspicions of many that
the “Amp of Epi” for every adult arrest is potentially more harmful than
helpful. Take a listen and decide for yourself.
https://www.nejm.org/doi/full/10.1056/NEJMoa1806842
References:
A Myth Revisited: Epinephrine for Cardiac Arrest. (2017, May 23). Retrieved
July 21, 2018, from
http://www.emdocs.net/myth-revisited-epinephrine-cardiac-arrest/
Morgenstern, J. (2018, July 21). Paramedic 2: Epinephrine harms/helps in
out of hospital cardiac arrest. Retrieved July 21, 2018, from
https://first10em.com/paramedic2/#more-6140
Perkins, G. D., Ji, C., Deakin, C. D., Quinn, T., Nolan, J. P., Scomparin,
C., . . . Lall, R. (2018). A Randomized Trial of Epinephrine in
Out-of-Hospital Cardiac Arrest. New England Journal of Medicine.
doi:10.1056/nejmoa1806842
Spiegel, R. (2018, July 20). EM Nerd-The Case of the Costly Compound.
Retrieved July 21, 2018, from
https://emcrit.org/emnerd/em-nerd-the-case-of-the-costly-compound/ -
OK everybody I screwed up, this weeks episode was mean’t to be the first
attempt at a “Vid-cast” but we hit a glitch that would not allow the video
to be sent to iTunes for download. So with my sincere apologies I am going
to release this episode as an audio podcast instead and I will just link to
the intended video instead. I don’t think you lose a ton by not seeing the
video as long as you are familiar with the equipment I am talking about,
but for those truly visual learners I am very sorry.
https://vimeo.com/278968710 Here is the link to the original “Vid-Cast” of
this episode
Capnography for endotracheal tube placement is considered standard of care
by most experts, but the use of non-invasive capnography is widely
dependent from region, service, and even individual providers preference.
This episode reviews the indications for using capnography by non-invasive
means, and ways to use things in your ambulance to make you own sampling
devices so you can provide the highest level of care even when your service
won’t provide you with the optimal supplies. -
Episodes manquant?
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Tubing the critically ill patient is usually a team sport to some extent,
but what would you do if the only ones in the room were you and the
patient. Learn about a piece of equipment and technique that could save you
and your patient when you gotta do that tube solo. -
When your patients pressure is in the toilet fluid resuscitation can only
take you so far in certain clinical scenarios, and occasionally a
vasoactive agent must used to keep them out of the morgue. NYC paramedics
are getting a new vasopressor added to their tool box for treating the
critically ill. In this episode we will briefly review Norepinephrine, and
make comparisons to Dopamine ( previously the only approved vasopressor
infusion in the NYC region). Additionally, the protocols that
Norepinephrine will appear in will be reviewed along with any possible
safety concerns associated with its use. Lastly, the logistics of actually
setting up the drip with use of a dial-a-flow will be covered. Whether
you’re a NYC Medic who is getting Norepinephrine on the truck soon or
you’ve already had it in your system this should be a nice review of a
potentially life saving pressor.
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We all intubate. Tubing the cardiac arrest is usually not as anxiety
provoking as the patient that still has pulses, but regardless of the
reason you have chosen to intubate it is often the initial confirmation
strategy for determining that tubes placement that can be potentially
harmful and even deadly to the patient you have just taken heroic measures
on to save their life. If it is your common practice to initially confirm
your tube's placement with your stethoscope or perhaps a colorimetric
end-tidal device then take a listen to this episode and learn why that may
be hurting your patients. -
Hi, I'm Kevin and I'm a paramedic. Come listen to a short intro that
explains who I am and whats this show all about. Enjoy!
