Explorez tous les épisodes du podcast Practical EMS
| Titre | Date | Durée | |
|---|---|---|---|
| 74 | Burning out on EMS | Sleep deprivation | Raging at dispatch | Daily micro-traumas | 03 Nov 2024 | 00:32:55 | |
Why did Nick switch to law enforcement? He burned out on medicine What does he miss the most: The team mentality. The fire crews that he grew close to. He felt certain they could handle whatever call came their way We talk about the struggles working a 48-hour shift with a rural fire department but also having to manage the expectation from the private ambulance company that you run calls in a much wider radius to include the city when needed Sleep deprivation is a big factor in burnout Nick talks about his heavy caffeine intake and how he started having runs of dysrhythmia that later required a cardiac ablation for atrial flutter What does Nick not miss? Getting up to run calls. The tiredness. The anger and helplessness I remember getting to my absolute wits end on those 48-hour shifts and having to call our supervisor and tell them we were done running calls because we were so tired Nick talks about how he could feel that stress and sleep deprivation damaging him in real time, like if his hand was on fire The stress level of running those calls an hour from the hospital with no other paramedic on scene and having to perform high level skills has not been matched as a PA in the ED Nick talks about how, even in law enforcement, his fear of the next call is not equal to what it was as a paramedic Brent talks about a time when Nick was so angry he started stabbing his seat belt Don’t blame the patient for their medical emergencies and don’t take your frustrations out on them Nick talks about losing his temper on an innocent dispatcher after a hard night Why do we see more resiliency and less burnout on the fire side? Maybe the team mentality on the fire department, ability to move to slower shifts, debriefing We all tend to get support after that horrific call that makes the news, but a bigger problem might be the micro-traumas that we all undergo day in and day out Resiliency needs to be built into the system – you are going to get burned out and have a tough day at some point and it needs to be prepared for We don’t typically lie to ourselves that we are “okay,” we may genuinely feel okay. It’s later that situations and calls may If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| 73 | New panel! | EMS to law enforcement | The lesson from the spine board | 27 Oct 2024 | 00:31:01 | |
Mark (paramedic) | Brent (fire officer and EMT) | Nick (former paramedic and current police officer) Mark has worked in urban and very rural 911 ambulances and does part time EMT education now Brent has stuck with firefighting from his early days as a recruit all the way to becoming a fire officer Nick has transitioned from EMS to law enforcement in the last several years The history of the spine board is a good lesson for new people: The way we practice medicine is a constantly moving target. Best practice is not always based on good data. We used to put EVERYONE on a spine board, but this has turned out to likely be doing more harm than good Even though logically something might make sense, it doesn’t mean it always does in reality. Backboards and epi are big examples of this Mark talks about the history of backboards and how this practice came to be An important point to remember in emergency medicine: If you have nothing really wrong with you, we are more likely to harm you than help you with treatment. This is because nothing comes without risk and if there is truly nothing to treat, the scale weighs entirely to the risk side. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| 72 | Nate’s off-duty call | That human connection | Moral injury vs burnout | Newbie advice | 20 Oct 2024 | 00:32:45 | |
Nate talks about a motorcycle crash he stopped at on his way home and how he was critical in saving an injured patient and how he became close with the family who still talk to him today. Even though the patient ultimately died, the impact he made on that family was immense. Patients remember us We need to remember we treat a person not a complaint or a room number The balance is finding the human connection while not over-empathizing and taking on burdens that are not yours to bare We talk about moral injury vs burnout – I do agree that we do not need to blame the individual for their burnout. It is certainly caused from many factors outside of their control factor BUT I like to place the responsibility for overcoming burnout on the individual because no one is coming to save us. Looking to blame external factors doesn’t help us in the long run Mental health struggles are not always obvious to us in people we spend time with Casey talks about how the cooperate leaders are actually trying to do the right thing for the front-line workers in spite of what we might think about them What advice for yourself 5-10 years ago? Nate: Slow down. Listen to those with experience. Bring your love of the job to someone else, especially new people. Kash: Remember that you don’t have to do everything on your own. EM is a team sport. Aaron: Enjoy teaching the newbies. You can make or break their experience based on your affect. Casey: Journal your days in EMS. The babies you deliver. The skills you perform. Something to look back on can be very valuable. We mean a lot to new people and students so remember the influence you have on people If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| 71 | Rapid sequence intubation changes | How crews can make or break an EMT student’s experience | How those hard calls affect us | Casey talks about the impression he made on a family | 13 Oct 2024 | 00:29:47 | |
The paradigm around rapid sequence intubation is evolving and becoming much safer with more education and procedures. Sometimes in emergency medicine slow is better. We need to stay mindful and calm in chaos and this requires us to detach and be above the fray and walk slowly instead of run. This will actually increase effectiveness and efficiency. Nate recounts his EMT rides with myself and a great paramedic partner I had named Justin Nate actually paid in EMT school to do more third rides so he could learn from the crews that were good at teaching Crews can make or break an EMT students experience Nate talks about how you really have to love EMS. The things we see are difficult, the shifts are long, the pay is not great. Something has to get you through What affects one person may not affect another. Casey talks about how it can be tough when things don’t affect you at all. That can be a form of struggle as well. We talk about some of the hardest things to see in EMS, the cries of a mother or father at the loss of a child. I talk about, how as an ER PA, I am a little more insulated from the death and the conversations with family than I was as a paramedic. Nate talks about looking for the good differences you make with people. His job is not to save a life but to prolong lives. Be intentional about marking those good moments Casey talks about how a patients family remembered him long after a call If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| 70 | Why the big scope differences across state lines | Case review purpose | Teaching the newbies | 06 Oct 2024 | 00:29:13 | |
EMS varies significantly from state to state so you get a wide range in the abilities of EMT’s and paramedics nation wide Case reviews are moving to an educational rather than a punitive model There is no true national standard for EMT’s and paramedic’s which further complicates things The regions that EMS is practiced in vary a ton as well. Skills may need to be performed much more frequently in an urban area vs a very rural area Senior, experienced providers should use opportunities to show the newbies how to do skills rather than perform them themselves One of the hardest parts of being a paramedic is standing back and delegating instead of doing the actual skills EMS still falls under the department of transportation which is the department it was founded under Standardization nationwide for EMS practice is difficult for multiple reasons, a big one is EMS needs and patients can vary a lot from region to region. Call volumes are very different from region to region. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| 69 | New panel! Why emergency medicine | Don’t just do something, stand there | Being proud of what you do | 29 Sep 2024 | 00:36:28 | |
Meet our new panel Kash (EM physician) Casey (Paramedic) Nate (EMT) Why emergency medicine? Kash: Likes to see results in the short term rather than manage long-term problems. Decided on EM and even an EMS fellowship before starting med school after getting his EMT Aaron: When in PA school you really need to be at least considering primary care but I decided it was not for me. A day in primary care tended to really drag for me while emergency medicine makes the day go by quickly Nate: Initially wanted to be a firefighter but enjoyed the medical side more and eventually got his EMT. He loves the diversity of the patients and the chance to help people. He loves critical care transport with the increased knowledge he has gained Nate: Learn to slow down. Kash: Don’t just do something, stand there. Fix the underlying issue. Don’t just blindly treat numbers. Fix the why, don’t just react. Casey talks about a scenario where slowing down was critical to catching important details during an RSI. Sometimes the whole team gets so focused on individual tasks that simple things (like low O2 sats) can get missed. Checklists can be critical to making sure the simple doesn’t get missed We all need to have humility I address the video that got taken out of context after people thought we were directly comparing EMT’s to CNA’s. That was definitely not the intent. Nate talks about how he is proud and protective about what we do in EMS If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| #68 - Over-reliance on technology, standards for students, don't listen to naysayers, advice for newbies | 22 Sep 2024 | 00:26:17 | |
Matt talks about our reliance on technology and how sometimes it is nice to remember that to assess a patient it is actually really simple without using technology Andrew: I am mostly paid to not get tricked into missing something big. Standards in medical education changing when there is emphasis on getting people through programs Keep holding high standards for your students Advice for the newbies: Andrew: You won’t fail if you are trying your best and making the best decisions you can and caring for the patient Aaron: Take care of yourself before you take care of patients Matt: Ask for help if you need it. Julie: Be content with where you are at Sarah: Progress further in medicine if you can do it Schasny: Don’t listen to the naysayers. Zero to hero is possible because everyone is different You can learn from all providers, even if they haven’t been in the field long. Sometimes experience can be greatly varied even with only a short amount of time in the career If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| #67 - Burnout avoidance, decision fatigue, driving lights and sirens, Where is God in emergency medicine? | 15 Sep 2024 | 00:26:10 | |
Imminent baby delivery stories Burnout tips: avoid the overtime. Sometimes the extra money is not worth the additional life stress. Make sure you get off on time and make that transition to home life. Andrew uses audio books so he has something to look forward to while driving to and from shift. Patients are often not even the source of our stress, it’s operational difficulties, interpersonal difficulties and decision fatigue. Decision fatigue is a big issue we face in our home lives after a significant portion of our day being in fight and flight mode We talk about driving lights and sirens to every call and the dangers associated with this to the crew and public This likely doesn’t save lives in any meaningful way that justifies the danger There is a big push to decrease the emergent responses We talk about the hazards with emergent returns, the confusion other drivers may have, the danger for the patient and crews. Road rage isn’t worth engaging in, remember that the bar to obtain a drivers license is very low and many of the meth-using patients we take care of will drive as well. You never know what kind of person is in that other car. I bring back up the discussion of “Where is God is emergency medicine?” We see the whole spectrum of life and death. We see people come back from the brink of death that logically shouldn’t and those that succumb that logically shouldn’t. We talk about strategies to compartmentalize and move on to the next patient Schasny talks about the traumatic life and medical experiences she has come through and how they have changed her view on religion If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| #66 - Paramedics getting offended, first code as a medical student, making a human connection and measuring success in EMS | 08 Sep 2024 | 00:32:49 | |
The team mentality at all levels in the ED is key to a harmonious, efficient and effective environment In EMS, this can be difficult on a given scene when you may not know the other responders all that well and it can be easy to get offended when no offense was meant Developing a thick skin is important in emergency medicine. You can’t allow negative emotions of others to affect you all day long. Patients can be really mean. This is just a fact that can be expected so you can make a plan to deal with it. One of the cool things about being an emergency medicine provider is that we are the provider that the patient has access to any time of day or night. We are not a expert in any one specialty and that is okay. Sarah talks about a rough shift in the fast-track part of the ED Andrew talks about the first code he ran as a medical student and the impact it had on him It is an honor to be there at a patients last moments and to help their families through it. It is very easy to forget the human side of emergency medicine. Ask yourself how you would act if it was your family, you were taking care of. Slow down. Focus on making a connection. I naturally fall out of making that human connection, so I have to be intentional about connection it or I won’t happen. Paramedics and EMT’s have a tendency to measure success and contentment by the acuity of the calls they run. I would venture to say we need a better metric: human connection. If you can connect with your patients, this will prevent burnout in your own life and improve your patient care as well. Strategies for avoiding burnout: music on shift, nebulizing coffee to neutralize bad smells and planning trips Crazy stickers for comedic relief We talk about the inaccuracy of pain scales and alternate pain scales Schasny talks about a patient with an ingrown toenail that got up and left after hearing multiple traumas and code blues announced overhead. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| New panel, power in detaching, controlled drowning, overwhelm as a new provider | 01 Sep 2024 | 00:29:59 | |
Meet our new panel Matt (EMT) Julie (RN) Sarah (paramedic) Schasny (paramedic) Andrew (EM physician) Advice for the newbies: Don’t panic, it is not your emergency Find the balance of detachment while still making sure the patient feels cared for and understood Part of avoiding burnout is taking some time to access the human side of youself in caring for a patient while also not taking the emotional stuff home with you You don’t know it all when you are new. You have just been deemed safe enough to do the job. Knowing where your limits are is important when you are new Don’t be afraid to ask more questions of those around you in the beginning Being a new paramedic has its own challenges as there really is no one to consult or provide direct feedback after a treatment Some ER physicians are not familiar with EMS protocols so have some grace for this situation In the ED, we must remember that EMS crews have a ton of operational problems to overcome on calls AS WELL as treating the patient for an emergent condition. Confidence and experience only come by running call after call. You must see a lot of patients. Medicine is an art not an exact science Multitasking as an ER provider is just rapidly changing between focuses but is a huge skill you have to develop Be in the chaos but staying organized is key to this “multitasking” Another difficulty as a new ER provider is figuring out the order in which to complete the tasks you have to do Controlled drowning. New people need to be allowed to feel the pressure and the stress while still having a backup so they don’t experience this for the first time by themselves. Find a method to not let tasks get forgotten. I talk about overwhelm when I was a new PA If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Overcoming burnout, having purpose, showing grace for patients while also having healthy boundaries | 25 Aug 2024 | 00:31:20 | |
Keep asking “why” do get to a full understanding of what is going on As providers we do want questions asked of us if someone is not sure about something we ordered Tracey has found techniques to avoid burnout despite 24 years in emergency medicine, she says it is very individualized how you overcome burnout Belligerent patients do cause burnout and the job to be very difficult in general Taking intentional time to connect with your patients will help overcome burnout Tracey has advice to give patients grace Adam: purpose in life is important to avoid burnout. He believes he is called to be here. Exercise, spend time with family, move your body, work less or even work more now to work less later Force yourself to be social on days off, even if you might not feel like it. This will often help your mental well-being. Owning your mistakes is key to avoiding burnout Understand we will make mistakes and even when everything goes perfect, we cannot save the patient every time We really aren’t built to see a lot of the things we have to see in emergency medicine Be patient with the patients we deal with. They are going through something that we are not and have concerns we may not know about. They are scared, they are frustrated. You need to have a sense of humor and the ability to compartmentalize Compartmentalization helps to move on to other tasks that need to be done Kate tells a story about compartmentalization It is okay to set boundaries with patients that push on the limits Deescalating belligerent patients is a skill that can be learned If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| The Dunning-Kruger effect, building confidence, the importance of knowing the "why", when to do nothing | 18 Aug 2024 | 00:39:03 | |
We talk about EKG interpretation Adam talks about the power of teaching Ongoing learning is key to performing well in emergency medicine and medicine in general We discuss confidence in emergency medicine and The Dunning-Kruger effect: People with limited competence tend towards an overestimation of their abilities It is very dangerous at the top of this curve before you recognize your limits Most of us feel this effect when we are new to a new level or field Building confidence depends on the individual I talk about my own overestimation of my abilities as a new EMT Your partner on the ambulance can really encourage or limit your interaction with the Dunning-Kruger Effect Even Adam, who admittedly doesn’t lack confidence, took about 3 years as an attending to gain confidence For Kim, it took about a year to really build confidence, but also notably in a busy system. However, she still wanted time before taking students. She did that at about the 3 year mark. As a PA, I think experience teaches you where your limits are. Adam often talks through complicated problems out loud while working in the ED Kim makes a great point about experienced EMT’s lacking the background knowledge and the “why” behind treatments. This “why” is critical to learn in medicine Adam tells a story about how the “why” is so important. You cannot blindly treat a number. You must take into account the whole clinical picture. Doing nothing is the right answer sometimes. I tell a story about a paramedic, Amanda, and how doing nothing was the right answer for a patient. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Stress exposure in school, zero to hero, advocating for patients | 11 Aug 2024 | 00:33:00 | |
Stress exposure in school is very helpful for real life practice A good analogy for lay people: EMT is like CNA, AEMT is LPN, paramedic is RN. This helps people understand the progression of levels of care better Paramedics need to be learning provider type assessments on rotation not nursing assessments Kim talks about the zero to hero debate: Experience matters not just in emergency medicine. The main difference is the individuals drive and education Kim talks about a hypoglycemic patient when she was a new paramedic Kate talks about the difficulty in bringing up possible concerns with providers and how important it is for the providers and advocating for patients Adam discusses listening to EMS and the patient and the importance of what the patient looked like before they got to you. Understanding your EMS system is important as an ED provider We talk about the value of interpreting lab work in the field If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Only medical provider on a plane, swatting flies in the back of an ambulance, paramedic program changes | 04 Aug 2024 | 00:32:01 | |
We meet our new panelists Kate (EMT) Kim (Paramedic and educator) Tracey (Former paramedic and current PA)
Kate talks about how the public doesn’t know the difference between EMT’s and paramedics Tracey talks about a humbling experience in her early career where she did not know where her equipment was in the ambulance Kim talks about changes in paramedic and EMT education. Historically you retain 20% of the information in a lecture format. That has been increased to 80% retention with new techniques like switching to simulation and active learning techniques Putting the responsibility on the students to perfect their skills is something they will have to maintain in the field as well Switching to competency-based education from hours based has been a huge change Simulation based training is very valuable. It teaches you techniques and de-escalation techniques that you can’t learn from text books We talk about medical scenarios outside of work and how our skills come into play If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Foley buddies and no no zones | 28 Jul 2024 | 00:32:12 | |
Be willing to speak up. Sometimes you might be the only person to notice something important. We need resiliency in this field. We are all still learning, so stand up and advocate for your patient. Regardless of your level of care, you need to advocate for your patient. The hierarchy is largely in your mind. Don't be afraid to approach someone with a perceived higher status than your own. Take ownership over patient care Confidence varies in how long it takes to develop Be willing to be uncomfortable, it is how you will continue to learn Be willing to make mistakes EMS to in-hospital care can be a steep learning curve even as an EMT We talk IV’s and IO’s, staples, “foley buddies and “no no zones” discussion If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Nate's overdose and recovery | 21 Jul 2024 | 00:38:45 | |
Nate (EMT) shares his story and the issues he has been dealing with. Nate overdosed on medication and ended up in inpatient psych care which helped him immensely. He still feels grief from time to time but does have happiness more now. Nate wants people to know that these struggles are real and you are not alone. Don’t be afraid to talk about it. Seek counseling and therapy. The field we work in makes us prone to dealing with mental stress and health. Dark humor is a method we use to move on to the next patient or next call. Our job is to help the body heal itself, sometimes this doesn’t work and we can’t get caught up in the times when it doesn’t work. We must be comfortable outside of that control. We can’t save everyone. A bad partner or burned out partner on the ambulance can really ruin your experience. We all need to be willing to teach in a tactful nonjudgmental way. Sometimes doing nothing is the right answer if a patient needs an OR and a rapid transport is necessary My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and does If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Caring for a gunshot victim when trying to get coffee | 14 Jul 2024 | 00:32:33 | |
We meet our new panel: Eric (EM Physician) Shelby (EMT) Nate (EMT) and returning guest Sam (Prior EMT, ER RN) DeTessa (ER RN)
Part of the fun part of the ER is getting to start from scratch and figure out the puzzle Stories do change as the patient talks with different providers We are not equipped to diagnosis or resolve chronic problems in the ED, we can’t provide every answer for every symptom The mindset of the public of what the ER is vs reality is often quite different We do need to understand that waiting for your ER work up can be very difficult as a patient, especially when you are in pain. We need to have grace for this patient perspective We talk about GSW patients and chaos that is present on scene and in the hospital My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is fo If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Resilient Response: Self-Care Strategies for Emergency Medicine Part 2 | 07 Jul 2024 | 00:44:55 | |
Chris and I talk about my background and motivation for my podcast. I talk about a pediatric arrest I ran that had a huge impact on me. We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique. Emergency standards are standards I have developed working in the ER. One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency. Mindfulness practices are key to mitigating anxiety and stress. Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can. Let the shift go before you get home. Refocus on the rest of your life. Take care of yourself before you take care of patients. Self-care is critical. Overtime is often needed when you need to focus on making money, but this cannot be sustained long term. Daily, consistent discipline will prevent a crisis or emergency down the road. Debriefing and talking through cases can help you process and heal from them. Acute and chronic burnout are different problems and require different solutions. Focus on the factors you have control over. Know your why. A powerful why can overcome a lot of how’s. Check out Mind the Frontline below and help their mission to improve lives of first responders: Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org) If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Resilient Response: Self-Care Strategies for Emergency Medicine Part 1 | 30 Jun 2024 | 00:33:12 | |
Chris and I talk about my background and motivation for my podcast. I talk about a pediatric arrest I ran that had a huge impact on me. We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique. Emergency standards are standards I have developed working in the ER. One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency. Mindfulness practices are key to mitigating anxiety and stress. Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can. Let the shift go before you get home. Refocus on the rest of your life. Take care of yourself before you take care of patients. Self-care is critical. Overtime is often needed when you need to focus on making money, but this cannot be sustained long term. Daily, consistent discipline will prevent a crisis or emergency down the road. Debriefing and talking through cases can help you process and heal from them. Acute and chronic burnout are different problems and require different solutions. Focus on the factors you have control over. Know your why. A powerful why can overcome a lot of how’s. Check out Mind the Frontline below and help their mission to improve lives of first responders: Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org) If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Are paramedics well equipped to go to PA school? | 23 Jun 2024 | 00:29:52 | |
Wrapping up our conversation with Brian and Kristina (PA’s and prior paramedics) and Casey (paramedic) Shadow PAs in different specialties so you really know what the career looks like practically. Use this to find out what specialties you like, school doesn’t always give you enough time and you may not get a job in your desired specialty every time. You must know WHY you want to be a PA. Have a very clear understanding. Don’t be completely set on working in the ER as a new PA. There are a lot of other valuable specialties to gain experience in before going to the ER. Paramedics are well equipped with knowledge and experience for PA school. There is a lot more to learn but, in many ways, paramedics are one of the best careers to transition to PA from. Most of medicine does not understand the high level of training that paramedics receive. If you are an EMT planning on PA school, learn from your paramedics. In EMS, learn from those with experience regardless of their provider level.
My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t repre If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Finding mentors, being ready to teach, PA school difficulties | 16 Jun 2024 | 00:38:04 | |
We jump back into our conversation with Brian, Kristina and Casey Advice for newbies Reflect on the calls that you run. What went well and what went poorly? Are there providers that did a great job that are worth emulating? Find those mentors that are worth emulating. Also make note of those that are worth avoiding. Keep in mind there are multiple right ways to do things. All of us in emergency medicine need to be ready to teach. Students and patients. The ability to teach demonstrates true understanding. Teach your thought process. Going from EMS to PA. It is not a quick process, and it is very expensive. It is hard on your family. You need a support system. You may be lonely. Paramedics, in a lot of ways, are well prepared to go to PA school but their skill set is not equipped to manage diseases long term. A lot of what most PA’s do is specialty work on disease processes long term and not emergent conditions. Being an ER PA is a lot different than it may appear from the outside. A lot of our job is care provided away from the patient. We tend to be the limiting factor, so we have to use our time efficiently. We are isolated from tasks that allow you to do the work reflexively. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| The transition from paramedic to PA | 09 Jun 2024 | 00:38:04 | |
We meet our new panelists Brian and Kristina (PA’s and former paramedic’s). Casey is back! Transitioning from paramedic to PA Professionalism is a big emphasis in PA school. This was something I learned as an EMT from a great paramedic partner early in my career as well. Professionalism in EMS is a cultural and personal aspect to strive for. PA school also wants you to keep in mind you are representing their program and PA’s in general. Teaching the newbies We all need to have the confidence to pull aside the newbies and make them aware of dangerous overconfidence and arrogance when we see it. Even though it is confrontational. Seek out mentors when you are new. Be a mentor for new people because sometimes they aren’t confident enough to ask for one. We don’t really have to find the exact problem that the patient is having, we are trying to figure out what the patient needs. Be an investigator. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us ar If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| The medical hierarchy, identity outside of the profession and creating healthy rituals | 02 Jun 2024 | 00:39:40 | |
We discuss what things we want others to know about our careers. In EMS we can tend to jump immediately to being confrontational, even when the other person isn’t meaning to be confrontational. We all have different scopes and different levels of knowledge. Casey wants people to know that paramedic’s get extensive training in 12 lead interpretation. Lucas wants people to know that doctors are not the boss or supervisor or the manager, we are a team and we each have our roles. Egos tend to make people see the system in a hierarchy. We all need to be willing to teach and check our ego. A good EMT will catch things that paramedics are missing. Nurses are hard workers and tend to be on their feet longer than paramedics. Advice for newbies: You can’t save everyone, regardless of how well you function. The job is not all emergencies. Take care of yourself before you take care of others. There may be times when you must prioritize other things in life, but long term, you must take care of yourself. Have an identity outside of your profession. Create rituals that help you perform during your day. Casey prays every day before his shift to be his best self and take the best care of his patients. Keep a journal. You may want the specifics of certain details later in life. Create healthy hobbies.
My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| The price we pay | 26 May 2024 | 00:22:59 | |
Meaningful patient interactions – Hold on to them. The mundane calls, the rude patients, the horrible things we see - those are the price we pay for the one call where you save someone or have a meaningful interaction. It is an honor to take care of patients that can’t get help in any other medical setting except the ER. Find one thing every shift that you find fulfilling. Be intentional. Find that thing. Someone sweet, someone grateful, someone you helped. You need the right expectations. Not every patient is dying, and too much high acuity will actually take its toll on you as well. Micaela talks about the MCI she ran and her question of how could God be present in the destruction. She came to realize that God is not in the event, He’s in the healing and the processing of the event. Providers should be educating those with less education and that want to learn. Some things get easier with time, and you don’t have to think about them as much.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affilia If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| How to heal and move past the difficult things | 19 May 2024 | 00:34:08 | |
Our new panelists: Lucas- ER Physician, Micaela- Paramedic, Alex- Paramedic, Rebecca- ER RN, Casey- Paramedic We discuss struggles with caring for patients that have perpetrated violent crimes. Recognize your own bias and your personal history that may affect patient care. It’s important to have a good self-care plan because you can’t pour from an empty cup. Pediatric calls will stick with you. They require intentionality to overcome. We all carry scars with us. Understand that we are human, and it is normal to feel emotions, but we owe it to our next patient to continue to be our best self. Don’t miss opportunities to tell your family and friends you love them. Life is fragile. Find the “thing” that works for you to help you heal from the things we see. Exercise, walk, talk with someone, watch a movie. Overcome the challenges in a healthy way. Healing instead of coping. Embrace the beautiful moments. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and en If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Micaela's Black Cloud, The Power of Touch, Running Mass Shootings | 12 May 2024 | 00:55:27 | |
Struggles in emergency medicine Casey struggles with keeping up with the changes, especially the technological changes. If you worry about keeping up, put yourself in a position to teach the new people. They will force you to learn as well. Micaela talks about her personal struggle with burnout and the significantly high acuity calls she has run She ran a ton of high acuity in a short amount of time. She had difficult partners and students. She was a critical part of a shooting that made national news. She was medical control on a significant MCI as well. Some paramedics will have periods of time that are much higher acuity than normal. Some EMS systems are so busy that you gain experience much faster than others. Casey talks about a pediatric cardiac arrest that we were able to get back and had a good outcome. Making that human connection is important to preventing burnout. But it needs to be done with some wisdom. We cannot pick up burdens all day that our not ours to bear. Physical touch has power. We all want to connect with patients, but this is difficult in certain settings. You must balance this with the emergent patients that require more of your time. Burnout is avoided by connecting with patients. If you get to know them, they might surprise you with their amazing stories. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Moving from ER RN to ER NP and critical field procedures | 05 May 2024 | 00:36:53 | |
We welcome our new panelists. Micaela (paramedic) Simone (former ER RN and now ER NP) Paramedic’s Alex and Casey returning. Simone gives us a glimpse into the tough transition from ER RN to ER NP. You need to love the medicine. Having to know so much of so many things was one of the toughest parts. You must be second best at every specialty. Alex talks about the transition from EMT to paramedic. Being in a system that creates strong EMT’s makes the process easier. Being able to think back to times when you were an EMT and what your paramedic did in certain scenarios is a great frame of reference. Transitions like this are difficult to explain until you have lived them. Not having that safety net is a big difference. Confidence only comes after practice in the field, not in school. Don’t make the mistake of thinking you know everything. It can be a dangerous mentality. Critical procedures should always be taken with the seriousness they deserve. Casey talks about pericardiocentesis (please follow your protocols) Cricothyrotomy stories Casey takes about doing this in the back of a helicopter. Think about having to cric every time you intubate a difficult airway. RSI discussion
My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individual If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Emergent Standards | 28 Apr 2024 | 00:27:30 | |
Emergent Standards I address a comment about how we mentally handle the patients we care for that have committed violent crimes. We still care for them to the best of our ability; in fact we often learn the whole story after we have finished caring for them. We don’t judge because that is not our role. We find ways to move on from the horrible situation. Emergency standard: Take care of yourself before you take care of patients. 75 Hard has completely changed my mindset. I actually stick consistently to goals that I set for myself like never before. I can get up early before work and get myself in the right mental space to take care of patients to the best of my ability. Practical tips: Pack your food. Pack your water. Track calories and macros. Wake up early. Daily exercise. Leave for work early. Wake up before your family.
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My favorite pre-workout supplement
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Conflict on scene | 21 Apr 2024 | 00:37:07 | |
Confidence in EMS: Nate talks about how he was reaffirmed when learning ALS meds and a physician agreed with his treatment plan. School does not make you confident. As a provider, give the crews feedback because it helps them grow and confirm their plans and treatments were accurate. Don’t just give negative feedback. Some students do need an extra push to make them uncomfortable enough to progress or realize how far they still must go. They need to develop critical thinking for when they have no safety net.
Running calls when you don’t agree with the other responders/providers: Be blunt when you believe a treatment can be negligent. You must advocate for your patient even when this means confrontation. Certain treatments have the potential to harm. Aggressive treatment is not always needed. State where you stand when you disagree. It can be difficult to broaden the differential when another provider is totally fixated on the initial impression. We need to approach as a team. Have discussions. Be willing to consider your rationale for why you believe what is the right treatment path. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Accidents while driving lights and sirens | 14 Apr 2024 | 00:28:20 | |
Random stories episode! We often don’t want to talk about the “craziest” call we’ve ever seen. I tell a story about a fireplace fueled by batteries and no real medical reason for the call. We talk about things that surprised you about emergency medicine Dealing with drunk people is a challenge. Other great random stories: Thoric dissection’s, triple A’s, rhythm changes, driving lights and sirens, hitting deer, getting into accidents. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Minutes between grandma cardiac arrest to delivery of baby girl | 07 Apr 2024 | 00:36:45 | |
Jumping back into our discussion on alcohol abuse in EMS. Everyone is susceptible to overuse of alcohol so abstaining can be powerful even without it being your vice. Interpersonal communication skills are key to developing in EMS. We need to connect with our patients. Patients care more about being understood and listened to than good medicine. Advise for newbies: It’s hard to admit when you have a problem but that is the first step to fixing it. It’s okay to fail but you need to pick yourself quickly back up. Know you are not alone with these vices, be it alcohol or something else. You must be prepared for that next difficult call or life event. Because it is always coming. It is helpful to have friends that do EM and friends that don’t do EM so you aren’t always centered around work. Our dark humor in EM is needed to help put things on the back burner so we can move on in the moment, run that next call or see that next patient and deal with it later. Sarah tells a story about a grandma that passed away then immediately running a baby being born. Nate tells a story about connecting with a patient and that how that is the exact reason he got into medicine. Kate talks about how it’s worth taking the time to explain things to patients.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| What makes a great EMT? | 31 Mar 2024 | 00:32:43 | |
New panel! We welcome Alex, paramedic and Kate, EMT. Welcoming back Sarah, paramedic and Nate, EMT.
What makes a great paramedic? Treat your EMT’s like a partner. Talk about calls. Teach your EMT’s. Educate without belittling. Create an environment where your partners can question the plan if they don’t understand it. Learn from those that have been doing this for awhile. What makes a great EMT? Ask questions. Have desire to improve. Nate talks about his struggle with alcohol When you crave alcohol or vice in general, you usually have one of the following: HALT: hunger, anger/anxiety, loneliness, tiredness.
Alcohol abuse is a huge problem in EMS. It being so socially acceptable makes it more difficult to overcome. Alex and Nate open up about how they have had success overcoming this vice. EMT schools sound like they are doing a better job at preparing EMT’s in the skills needed to verbally deescalate a situation and empathize with patients.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| We are there for a lot of people’s last moments | 24 Mar 2024 | 00:21:58 | |
You guys ever see a dead family member in a patient? Like they look similar, act similarly? No? Maybe it’s just me. Nate talks about his life experiences and how it helps him talk with patients that are struggling with mental health. He talks about a patient experience where he really connected with a patient and how the patient was seen years later having changed his life. We talk about God in EMS and the really unfair and tragic things we see. How this will test your faith. Kiley talks about how, seeing so much death, it’s seeing the patients themselves in their last moments that convincing her there is a God. Burnout Lean into your coworkers, share your feelings. Talk with people to help heal. Follow up on that critical patient you are worried about. Avoid substances. Talk with people about how you feel. Use those frustrations to exercise or do something productive. Calls add up over time. Sometimes it not just one call, its multiple in a row If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Feeling burned out? Bring your patient a coke. | 17 Mar 2024 | 00:28:32 | |
Leadership in emergency medicine Good nurse to patient ratios is very important to good patient care and allowing those little moments where you can spend some extra time making sure the patient feels cared for. Management doesn’t always equal good leadership. Part of being a good leader is being the calming presence in a chaotic scene or situation. Walk, don’t run. Be mindful. You can be freaking out internally but externally you must show confidence and calmness. Sarah tells a story about going the extra mile to simply get a patient a coke. Sometimes these small things that we overlook make a huge difference to the patient and pay huge dividends to you personally. It doesn’t take hardly any effort to go above and beyond. Casey talks about a patient that he went the extra mile for and how it completely changed the patients’ affect from mean and grumpy to much happier and gracious with the staff. He remembers that case from 30 years ago because it made such a difference to him and made the job worthwhile. This job is about service for others. If you don’t want to serve, you are in the wrong job. A big risk with going zero to hero is you may have done a lot of work to find you don’t like the career. You must be willing to teach and be taught in this field. Burnout can really be decreased when we take short moments to make a patient feel cared for and listened to. We need to make patients feel heard and treat them like human beings. Casey tells another cool story about a stroke patient with resolved symptoms after he was able to deliver fast treatment. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Don’t miss the privilege that we all have | 10 Mar 2024 | 00:38:52 | |
Is burnout moral injury? Is it out of your control? ZDoggMD talks about burnout being moral injury. Link here: We jump back into our discussion on the video. Casey says one of the great things about this job is that we have the privilege to be with people on their worst day. Nate talks about the conflict we sometimes have one scene when treatment plans are not agreed upon. He talks about burnout from not trying to get to the source of a patient’s psychiatric problem and just medicating them. Kiley talks about the reality of practice vs school and that we can’t fix every problem we encounter. We can take the time to be empathetic and this can help combat burnout if you allow it. The sorrowful aspect of our job is really difficult. You must know your limitations. Kiley discusses how sometimes we can’t do much to help or even do adequate alleviation of pain, and all we can do is hold the patients hand. We all got into this job to serve others and we can lose sight of that. We need to remember to express appreciation for each other in the quick moments we have before chaos descends again. Leadership is key at every level in emergency medicine. Saying no to a bad plan takes some confidence and leadership skills. A good leader takes weight off other people’s shoulders by leading well. By doing everything we can for a patient. A good leader can take criticism and remains humble. They take the opinions of others into account. When something goes well, give away the credit. When something goes wrong, take responsibility. Good leaders know when to follow. They are not dictators. When everyone leads at their own level, chaotic cases come together smoothly. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear tod If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| She sat up, yelling “What happened!” | 03 Mar 2024 | 00:29:00 | |
Jumping back into Principles in Emergency Medicine Nate- People lie. Despite the fact that we are not judging them, and just need to know accurate details to provide the best possible care. Casey- Expect the unexpected. EMS is long periods of boredom punctuated by moments of sheer terror. Adam- the job is always out to get you. We see the 1%, it is a self-selected population. So, if you are going to consider a rare or uncommon diagnosis, you are more likely to find it in these patients. He found a passive pulmonary embolism in a patient with very mild and vague symptoms. Casey- Arrogance can really cloud your judgment. You must be more confident in what you don’t know than what you do know. Nate- pay attention to those subtle details like bradycardia. It could indicate a bigger problem than initially thought. Watch your ego because it may cause you to focus too much on a differential and ignore details to the contrary. Casey tells a story about a woman who was assumed to be drunk but just had a low blood sugar. Adam- Know the difference between confident and cocky. Kiley- A confident provider with a clear plan is very helpful to nursing staff because they can convey this to the patient, and everyone is on the same page. I always plan on a negative work up because a positive work up will dictate the plan. Sarah- Don’t stop learning. Look things up. Learn every day. ZDoggMD talks about burnout being moral injury. Link here: I agree with certain aspects of what he is discussing but I also believe there will always be aspects of our job we cannot control so we must remain focused on the things we do have control over. Ourselves. Our patient care. How we show up. Adam- The emergency department is unique in medicine because we don’t have a lot of oversight and rules from the insurance companies. We can order the tests and take care of the patients regardless of their race, gender, insurance coverage. We are the safety net of society. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Take care of yourself BEFORE you take care of patients. | 25 Feb 2024 | 00:35:01 | |
We meet our new panel and some returning guests! Kiley – ER RN and new NP Sarah – Paramedic in EMS for 8 years Welcome back Adam ( ER MD), Casey (paramedic) and Nate (EMT). Nate talks about the transition from field EMT to ER EMT. It’s a new world with new things to learn. Sometimes a change in environment can get you out of a rut. Sarah also worked in the ER but as a paramedic and loved learning new aspects of medicine but her scope was diminished compared to the field. Paramedics are still a new asset in the ED and have a fluid job description. Principles in emergency medicine 1. We do not diagnose in the ER. 2. Take care of yourself before you take care of patients. Sarah recommends outlets and hobbies that are totally separate from medicine. Make yourself a priority or you will end up neglecting yourself. Sleep deprivation will affect you more than you think. Casey talks about how you can get lolled into relaxing by low acuity calls but then you may be tested to your limits the very next call. Kiley talks about patient autonomy and how it is our job to present options and educate but the patient must ultimately decide to accept or reject our options whether we agree with it or not.
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| He was dead for an hour, then sat up, talking. | 18 Feb 2024 | 00:37:43 | |
We revisit the question “Where is God is emergency medicine? Doug- I’m a believer in science and a believer in God. There are some occurrences that we can’t explain with modern medicine. He tells the story of a cardiac arrest that woke back up an hour after pronouncement. Sarah- God has given us the science to learn and be able to use. We often see the victim of a horrible tragedy as well as the person that caused the trauma. It’s hard to believe there is a God when we see such injustice in the world. I talk about the difficulty taking care of a drunk driver who was the reason for the death of his friend in the passenger seat. Casey prays every day before work for the safety of his partners and that he would be the best paramedic he can be. Casey tells an awesome story of recovery from a horrible head injury. How it redeemed this person from a bad path in life. Advise for those struggling: EMS changes every day. So, stick around and don’t give up. Avoid substance abuse. Don’t neglect your emotions. Hold on to the good calls. Find something you’re passionate about outside of emergency medicine. Use it to get the frustration and the things that bother you out. Take a break. Talk to someone. If you are a nurse. Know that you have to be true to yourself and you can always switch nursing specialties if you need to. Write down the victories. You must be intentional with your mental health. Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Jan Panel - Got stabbed by a dildo? | 11 Feb 2024 | 00:31:34 | |
Crazy stories episode Delivering babies! Not something most of us look forward to but it happens, nonetheless. Casey talks about a breech presentation birth that, thankfully, turned out just fine despite delivering at 28 weeks in an ambulance as well as a prolapsed cord case. Stabbing victims! In a sex shop, in their homes, we run them everywhere. Butt stories! Stuck vibrators with full batteries, flashlights you name it. Shitting in a trash can. This episode has it all. Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Jan Panel - That heart wrenching scream. Never being “Just an EMT”. | 04 Feb 2024 | 00:25:31 | |
Pronouncing in the field is a difficult part of EMS. In a lot of ways, the ED insulates us from some of the aspects of this that make it challenging when you are in the patients actual home. The ED is mentally taxing in other ways. High volume, high acuity, multitasking, consulting etc. Nate talks about how “you’re just an EMT” gets thrown around a lot. Just because it’s a lower-level of education doesn’t mean that EMT’s don’t have valuable information and knowledge level. Collaborate with your EMT’s and other providers to give patients better care. It takes experience to understand that, regardless of care level or education level, everyone needs to be allowed to speak up. Newer ED providers, LISTEN to the entire EMS report. Casey- one of the most difficult things to hear is that heart wrenching scream that family gives when they arrive in the ED to find a dead loved one. Casey tells a moving personally story about his son that died of cancer. How you return to the job after that kind of loss. He talks about the family of public health and safety people that surrounded him and carried him through. It is very difficult to see certain patients and not take it personally. Child abuse cases are on the rise. Have a high suspicion with pediatric trauma. Listen to the details on scene and document them. Casey talks about a traumatic call involving child abuse. Sometimes we must take care of the perpetrator of horrible crimes. Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| January Panel - Real Stories - Don't allow vices to control you. Develop mental toughness. | 28 Jan 2024 | 00:30:00 | |
Challenges in emergency medicine Burnout can creep up on you and can occur even in one shift. Nate got burned out working nights and started drinking heavily and almost got into blows with his partner. He went through a tough period and came out the other side. Substances will become an easy outlet and a way to avoid dealing with real problems if you allow them. Everyone has their coping strategies; you need healthy ones. Casey- If you run 2000 calls a year or more you may burnout, if you less than 200 calls you may burnout. You need a balance at a certain point. Being the right kind of busy can give you energy as well. I cannot overemphasize how amazing the 75 hard program is. In emergency medicine we need to be MENTALLY TOUGH Try cold plunging. Doug- recognize you are burned out. Some variety and less hours overtime can really help extend your time in EM. Sarah- Recognize burnout in yourself. As a nurse you have job flexibility if you are getting burned out. No one is going to remember that extra shift you worked except your family. Life is not easy to balance and sometimes work will take priority or money will take priority but the more you keep your family on the back burner the more they will suffer. Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| January Panel - Real Stories - Oops, patient is in V-tach. Admit your mistakes. | 21 Jan 2024 | 00:29:03 | |
Jumping back into failures in emergency medicine Doug, ER physician, discusses how he missed a traumatic intraabdominal injury and an ectopic pregnancy. It’s easier in hindsight to see the things we could have done better. Admitting you screwed up can be difficult. Leave work at work as much as possible Nate talks about a patient that was initially written off as flu like symptoms, with no initial vitals being obtained that end up being in V-tach. Anchoring bias is a big problem. Overcome your bias or you will miss something. Doug, ER physician: The waters of emergency medicine are deep. You may be walking around in shallow water and then suddenly end up over your head. Objective reports are much more helpful than biased ones Nate, EMT: What’s the worst-case thing that could be going on with your patient? Start with the worst differential and work your way backwards. Sarah, ER Nurse: We all strive for excellence, no one wants to miss something, but we are all capable of it. Hopefully we learn from the mistakes. She tells a story of working a presumed cardiac arrest before checking a pulse. She talks about a time where another nurse had to step in for her and advocate for a patient and she learned a tough lesson that she needs to be the one that steps up, no matter how uncomfortable and advocate for her patient. Nate messes up an IO but initially didn’t want to admit his mistake. FAIL STANDS FOR FIRST ATTEMPT IS LEARNING Doug, ER physician: You must be able to move past a failure or this job isn’t for you. Things don’t always go right. If you haven’t failed yet, you will. Casey, paramedic: You’re going to make mistakes. The culture is changing to make it easier to discuss mistakes with preceptors rather than be ridiculed. HAVE EXTREME OWNERSHIP OVER YOUR FAILURES Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose a If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| January Panel - Real Stories - Failed to diagnose PE, Gave the wrong medicine | 14 Jan 2024 | 00:24:29 | |
January Panel Episode 1 We’ve got some awesome experience here today. Physician, Nurse, PA, paramedic and EMT! We introduce Sarah, 9 year nurse with 4 years of experience in the ER. She is inspired by the team mentality in the ED as well as the unique situations. Inspired by her grandmother who was a nurse when emergency medicine was a developing specialty. We welcome back Casey. Long time, experienced paramedic, practicing here for 30 years. Nate is back. EMT for 9 years. Comes from a heavy past with suicide attempts, drug and alcohol abuse and has a passion for helping those in similar situations. We welcome Doug, emergency medicine physician of 24 years. His love for science lead to him pursuing medicine and ultimately emergency medicine. We talk about how medicine ends up so ingrained in you that doing something different really becomes impossible at a certain point. I may have gotten myself stuck in a bathroom during a night and had to be saved by the lock picking abilities of talented ER physician. Failures in emergency medicine I talk about my failure to diagnose a PE in a patient and how, fortunately, my physician college was able to find it and the patient did well. But I learned, if you think about ordering the test, just order it. Casey talks about how he gave the wrong medicine. He talks about complacency and the danger that can present to a patient when we are not diligent. He talks about missing an MI and how these things do happen, even to experienced people. TAKE OWNERSHIP FOR FAILURES Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| December Panel - Real Stories Part 5 - Where is God in emergency medicine? | 07 Jan 2024 | 00:48:47 | |
I discuss the position of an ER PA and how it relates to the physician role. I strongly believe in practicing as a team with physicians, I see this as integral to the PA career. We talk about autonomy as a EMT/paramedic or PA. EMT’s and paramedic are a perfect career to step into the role of a PA because of their autonomy. Teaching is a key part of medicine and especially important for physicians to teach others. Adam explains what he would want people to know about being an ER physician. Difficulty with understanding EM as a specialist. Les explains how in one shift a cardiologist was astounded by the fact that he performed a c-section and an obstetrician astounded by him putting in a pacemaker. We talk about good reports from EMS crews and how we always need to start broad in our work ups. WHERE IS GOD IN EMERGENCY MEDICINE? I talk about a hard call I ran a few years ago, a pediatric arrest that made me question where God is in emergency medicine? Casey talks about how he still believes in God with all that we see. How he is just an instrument. If it turns out bad or good, he was supposed to be there. Ashaley believes that what she does is actually more special because of our limited time on this earth and the impact she has on her patients and the impact they have on her. Les discusses the evil that we see every day and difficulty in the transition into our safe and normal family life. Casey argues that there is more good than evil if you look for it. Adam talks about his life experience and how he does not have the faith to be an atheist. Kierra talks about how she can sustain her career because of her faith. She talks about a baby girl that was coded her in her ED. How she was left alone with the baby after she was pronounced. How she showed her love even though the baby wasn’t really there anymore. Nathan talks about his struggles and how he takes care of patients. That he can still be someone’s answer to prayer and they can keep their faith if he helps them. We actually make the transition to funny stories to end on a lighter note. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| December Panel - Real Stories Part 4 - Overlooking the simple and advocating for a patient | 31 Dec 2023 | 00:28:07 | |
Welcome Dr. Les to the show. Finished his EM residency in 1999, 24 years spend as an attending, estimates 130K patient seen in that time. He tells us about a busy night shift in the ED where he had to take care of an easy laceration but how the busyness of the night made him overlook something simple. I follow this up with a story that makes me look like an idiot but sometimes it’s okay to laugh at yourself. Les would tell his younger self that all the work he has done is worth it but some things don’t matter. Grinding is not always appreciated so killing yourself for the convenience of people is probably going to go unnoticed a lot of time. Nathen talks about how EMT’s are often not listened to. If you aren’t listening to your EMT, you are missing a lot of valuable info and they can help you avoid getting stuck on a differential that no longer fits the picture. Ashaley talks about challenges in critical care and flight vs the ambulance. The benefit of listening to/valuing volunteers and how much they care about their communities. Casey talks about how TV shows will often depict paramedics as stupid and give the impression that they save everyone when the reality is they have a huge knowledge base and saving lives isn’t always possible. Kierra gives us a story about advocating for your patient and sticking with it even when the provider disagrees. I hope you guys enjoyed this episode. We have one more December panelist episode coming next week where we discuss a big topic I think you will really appreciate. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| December Panel - Real Stories Part 3 - Shocking a patient back to life and finding a dead body in a car | 24 Dec 2023 | 00:43:27 | |
We welcome a new panelist. Flight paramedic Ashaley. She has been in emergency medicine for 11 years. Ashaley tells us about an impactful story from a patient that told her “Make sure you take moments. Life will always get out of control but, stop and go look at the sunset because sometimes you have things you can’t get back.” Kierra talks about some stories she has from when she was newer nurse and was overwhelmed vs the ability and confidence that comes with experience. She shocked a patient BACK TO LIFE before a provider could even get in the room to see the patient. Casey stress the importance of making a difference in just ONE patients life. If you can make an impact on just one person in all your years in emergency medicine, that IS ENOUGH. Adam describes a scene where he had to go outside of the ED to find a DEAD BODY in a car. I describe a call when I was an new EMT, running a cardiac arrest and trying to put on a brave face to impress an EMT student that took it really hard and started crying. I realized in that moment that it IS OKAY TO CRY. Ashaley talks about a pediatric cardiac arrest and a partner that reminded her that it’s ok to take time to process after a call. You don’t always have to be ready to go out again immediately. Adam stresses the importance of finding someone to help you OFFLOAD the hard things you see. Seek admin time and other uses of your time so you don’t have to spend it all in clinical shifts as an ER physician. Kierra tells us that ER nurses don’t tend to last longer than a couple of years. She gives the advice that you should avoid working too many hours and overtime. Be patient as you learn. Figure out your why. Why are you doing this work? You need the why because the job is very draining without it. Casey tells us to start a 401K and keep a journal about things you see and do. You may want that clarity later in life. Nathan tell us how EMT’s ARE PROVIDERS and should be seeking to gain more knowledge. This episode has a lot of takeaways. My biggest one was the fact that it is OKAY NOT TO BE OKAY. The culture of holding everything in is not healthy. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| December Panel - Real Stories Part 2 - Healing From Tragedy, Impactful Patients | 17 Dec 2023 | 00:34:09 | |
Warning: This episode starts pretty heavy If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| December Panel - Real Stories Part 1 - V-tach Arrest Save | 10 Dec 2023 | 00:26:15 | |
Real Stories in Emergency Medicine Part 1 By the end of this episode you will realize that you are not alone, you can succeed in this career and can leave your shift without being beaten down and discouraged. I have struggled with burnout, discouragement and frustration at many times and still struggle with it. My name is Aaron, I’ve been in emergency medicine for 15 years as an EMT, paramedic and now EM PA and I am the host of the Practical EMS podcast. Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This causes huge highs and deep lows in our own emotions and can cause us to leave work on to of the world or crushed under its weight. If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Teaser for the Burned-Out Paramedic | 03 Dec 2023 | 00:06:26 | |
Full episode finally coming next Sunday! If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||
| Story for the Burned Out ER Nurse | 26 Nov 2023 | 00:12:18 | |
Real Stories in Emergency Medicine If you want to support the show, follow the links below for some great health and fitness products. My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed... | |||