EMTpro Podcast

In this episode, Steve, Dan, and Holly discuss lung sounds, their treatment modalities, and common misconceptions. Steve leads a Lung Sound recognition game while Dan and Holly square off to see who's the best. After listening to the lung sound, they then discuss the correct sound by reviewing the textbook definition of it and the treatment options for it in the field.

In this episode, Steve, Dan, and Holly talk about cardiac arrest response with the EMS coordinator at Rialto Fire, Joe Powell. After looking at Rialto Fire departments stats, Joe realized they had to do something different. At Rialto Fire, they have committed to the  ‘wheel of survival’ which is a regularly evolving set of steps designed to maximize the interventions of EMS personnel with their patients who are experiencing cardiac arrest. Their stats on cardiac survivability have improved significantly since implementing this and they have multiple studies published in JEMS.

Steve, Dan, and Holly introduce Scotty Bolleter, one of the co-inventors of the EZ-IO. Scotty details how he got started in EMS, and what led him to help create the EZ-IO. Scotty discusses his time as a flight paramedic, and how his time spent training in hospitals pushed him into EMS business ventures. Steve touches on his business ventures in EMS. Scotty walks the trio through his team’s process of modifying older devices to create their version of the EZ-IO. Scotty talks about his inter-disciplinary team of physicians, engineers, and others. The correct process of placing a humeral IO is discussed, from positioning the patient to proper placement for insertion. The process of IO flow is explained. Scotty discusses possible complications if an IO is placed wrong. Scotty discusses the use of the distal femur IO placement in cardiac arrest at his department. IO placement in the femur versus the humerus or the tibia is compared. Pediatric IO placement is reviewed. Scotty highlights the open IO, and when it is indicated. Correct IO placement is recapped, and Scotty touches on why EMS providers should not bury an IO needle into the bone. Steve reviews a call on a patient in status seizure where an IO is used for access.

Steve, Dan, and Holly introduce their guest speaker, Kari, a respiratory therapist/paramedic from Washington. Kari discusses the endotracheal tube and the importance of having a correctly sized and placed tube. Kari highlights how critical it is to understand the disease processes that resulted in the patient being intubated. Ventilation and oxygenation issues are reviewed, along with the importance of PEEP in intubated patients. Kari talks about PEEP in intubated patients with asthma or COPD, as well as variations in tidal volume settings for various disease processes. The group discusses minute volume, and how a patient’s minute volume is calculated on the ventilator. Kari discusses her process of titrating ventilator settings to meet a CO2 goal. Do no harm is reviewed in relation to mechanical ventilation, and the consequences of a patient working against the ventilator are discussed. Assist control (AC) and synchronous intermittent mandatory ventilation (SIMV) modes are compared. Kari details what modes she prefers for specific patient presentations and disease processes. The group discusses volume and pressure control, and review a trauma scenario where the patient is intubated. Peak inspiratory pressure and peak alveolar pressure are reviewed, along with what abnormal values can indicate. The importance of driving pressure is highlighted. The PF ratio is discussed, along with the importance of weaning patients off of 100% FiO2. The group ends on discussing appropriate IE ratios in obstructive patients. The flow rate in both volume and pressure control is reviewed, as well as the effect of flow rate on a patient in both volume and pressure control settings. Another scenario is discussed, a COPD patient that has been intubated. Kari walks through troubleshooting tactics for ventilators and potential fixes for common issues with mechanical ventilators.

Steve, Dan, and Holly introduce themselves, and today’s focus, trauma. Steve reviews his educational background, and how his university set him up for success in paramedicine. He then transitions into his craziest trauma call, dispatched a potential stabbing. Walking into the scene, Steve sees his patient, a 20-something-year-old who has been stabbed two times in the chest and once left arm. The crew bandages the superficial bleeding chest laceration, and places and tourniquet on the left arm laceration. When the patient loses consciousness, Steve has to act quickly to handle a tension pneumothorax. Steve, Dan, and Holly discuss the sequence of assessing a trauma patient. The physiological process of a tension pneumothorax is reviewed. The trio discusses what signs and symptoms indicate the need for a needle decompression in the field. Proper placement of the needle during a chest decompression is outlined. Holly sheds some light on what occurs in the hospital after a patient is dropped off with a decompressed tension pneumothorax. Dan details his craziest trauma call, which began on the way to a public education event. Enroute, Dan and his partner receive a call, a GSW to the face. The team performs a surgical cricothyroidotomy on scene in order to establish a patent airway. Dan discusses his thought process on the call and outlines his preferred method of performing a surgical cricothyroidotomy. Dan, Holly, and Steve review surgical cricothyroidotomy. Holly talks about her trauma call, which began as a search and assist on a mountain top. After assistance from a local volunteer firefighter, Holly and her partner arrive on scene to a single-vehicle MVC off the side of a cliffside. Five patients are present, three alive and two deceased. Holly describes the scene, and discusses challenges to care.

Steve, Holly, and Dan are back with Dr. Brenda Tillman and Ben Wescott in part two of their PTSI series. Dr. Tillman emphasizes how important it is for senior providers to encourage open discussions on mental health. Ben shares his insight on how providers can challenge the stigma of discussing mental health. Ben shares his story and highlights his path to healing. Dr. Tillman and Ben discuss peer support groups and educating departments on PTSI and PTSD symptoms and prevention. Steve, Holly, and Dan field questions to Dr. Tillman and Ben. Dr. Tillman outlines ways departments can implement peer support groups.

Steve, Dan, and Holly introduce Dr. Brenda Tillman and Ben Wescott in their seventh podcast. Dr. Tillman discusses her experience as a clinician, and Ben introduces himself. Dr. Tillman details the difference between PTSD and PTSI, and why those differences are important when diagnosing first responders. Counseling programs for first responders are overviewed, as well as the training process for counselors counseling first responders. Dr. Tillman reviews the process of EMDR and why it is effective for improving symptoms of PTSI and PTSD. The physiological effects of PTSD and PTSI are detailed. Steve talks about his experience with EMDR. Coping mechanisms in first responders are debated. Dr. Tillman talks about the importance of normalizing the symptoms of PTSI in first responders, and why peer support group and counseling is so essential.

Steve, Holly, and Dan begin their sixth podcast discussing the difference between PTSD and PTSI. Steve touches on his journey with PTSI. The initial triggering call is reviewed, and Steve details the emotional and physiological symptoms he dealt with. Steve talks about his experience with counseling. The trio overview common emotional and physiological symptoms of PTSI, as well as behaviors that can manifest from it. They describe the difference between debriefing and defusing. The importance of emergency medical responders taking care of themselves is highlighted.

Steve, Dan, and Holly begin their fifth podcast with a case study on a motorcycle accident. Dan describes the logistics of the call and initial patient presentation. Mistakes made during rapid sequence intubation are discussed. The trio talks about the evolution of airway management procedures, such as the process of intubating patients and pre-oxygenation. Dan discusses his checklist for successful rapid sequence intubation. Steve reviews his checklist, along with his triggers for backup airway placement and cricothyrotomy. Holly recaps a call where she decided against intubation and describes her thought process.

Steve outlines his “craziest” cardiac call for Holly and Dan, which was dispatched as a person down. He discusses logistical issues affecting patient care, and how those issues were addressed. Steve, Dan, and Holly review the call and talk about lessons learned. Dan breaks down his “crazy” cardiac call for Holly and Steve, which was dispatched as a cardiac arrest. The three review patient care rendered prior to arrival and patient care performed by Dan and his team. Lessons learned are discussed.