The Inflection Point: Conversations in Care, Culture and Change. Designed for Paramedics. – Details, episodes & analysis

In this episode, Jakob and I dive into the complexities of managing post-arrest patients. We discuss the critical shift in mindset required once a pulse is regained and emphasize the importance of preventing secondary injuries before transport. Key topics include the priorities in post-arrest care, the role of vital signs, the use of dopamine for treating hypotension, and the ideal oxygen saturation and end-tidal CO2 levels for optimizing patient outcomes. We also explore the challenges of pre-hospital care and share practical tips for ensuring the best possible results for post-arrest patients.

Chapters:00:00 Introduction and Initial Thoughts

00:38 Post-Arrest Patient Management

01:11 Prioritizing Patient Stabilization

05:49 Addressing Hypotension and Fluid Responsiveness

08:51 Dopamine Use and Considerations

18:06 Oxygenation and Ventilation Strategies

20:23 End-Tidal CO2 Monitoring

25:08 Conclusion and Final Thoughts

References:

https://www.bmj.com/content/384/bmj-2023-076019https://pmc.ncbi.nlm.nih.gov/articles/PMC8152988/https://pmc.ncbi.nlm.nih.gov/articles/PMC7703417/https://pubmed.ncbi.nlm.nih.gov/32286900/https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00152-3/fulltexthttps://www.ahajournals.org/doi/10.1161/CIR.0000000000001163https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-and-European-Societ.pdf

#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic​ #emt​ #firefighter​#ambulance​ #medic​ #emergency​ #rescue​#firstresponders​ #emtlife​ #ROSC #post-arrest #resuscitation #resuscitations

In this episode, Jakob and I discuss handling pediatric patients in shockable rhythms, including calculating defibrillation dosages—2 joules per kilogram for the first shock and 4 joules per kilogram for subsequent shocks. We delve into antiarrhythmic medications, highlighting that amiodarone and lidocaine are considered equivalent and outlining their dosages. The importance of family presence and communication during resuscitation efforts is stressed, with evidence suggesting it aids in their recovery from traumatic events. A recent trial on standardized intramuscular epinephrine injections to mitigate delays in administration is also explored. Lastly, the episode touches on the impact of socioeconomic factors on pediatric cardiac arrests and emphasizes the role of community paramedicine.

Chapters:

00:00 Introduction to Shockable Rhythms

00:05 Dosage Calculations for Defibrillation

00:56 Antiarrhythmic Medications

02:17 Family Involvement During Resuscitation

04:12 The PRIME Trial

05:55 Pediatric Cardiac Arrest Statistics

07:10 Key Takeaways

References:https://pubmed.ncbi.nlm.nih.gov/28009655/https://caep.ca/periodicals/Volume_16_Issue_6/Vol_16_Issue_6_Page_497_-_501_Motillo.pdfhttps://media.emscimprovement.center/documents/familypresencecpg3eaabb7cf0414584ac2291feba3be481_36JegLp.pdfhttps://www.thrasherresearch.org/grant/01695?lang=enghttps://pmc.ncbi.nlm.nih.gov/articles/PMC10423885/

#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic​ #emt​ #firefighter​#ambulance​ #medic​ #emergency​ #rescue​#firstresponders​ #emtlife​

In this episode, Jakob and I delve into essential aspects of pediatric cardiac arrest management. Key topics include the importance of on-scene resuscitation, differences in pediatric versus adult cardiac arrest causes, optimal treatment strategies, and best practices for airway management. We'll also discuss the significance of early epinephrine administration and the current evidence on supraglottic airways and intubation. Additionally, we touch on the importance of caregiver communication, the PRIME trial, and the impact of social determinants of health on pediatric outcomes.

Chapters:

00:00 Introduction to Pediatric Cardiac Arrest

00:59 Key Differences Between Pediatric and Adult Cardiac Arrest

02:23 Respiratory Causes and Their Impact

07:23 Airway Management Strategies

16:47 Effective CPR Techniques

17:42 The Role of Epinephrine in Cardiac Arrest

19:36 IV vs. IO Access in Pediatric Resuscitation

21:41 The Handtevy Method and Medication Safety

24:31 Using Apps to Reduce Cognitive Load in Pediatric Care

25:35 Cross-Referencing with Partners for Best Practices

26:01 Handling High-Stress Pediatric Emergencies

27:01 Preferred Routes for Cardiac Epi in Pediatrics

27:38 IO Access in Pediatric Patients28:37 Reevaluating the Scoop and Run Approach

29:55 Managing Pediatric Cardiac Arrest on Scene

31:11 Dealing with Drowning and Airway Management

#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic​ #emt​ #firefighter​#ambulance​ #medic​ #emergency​ #rescue​#firstresponders​ #emtlife​

References:

https://www.ahajournals.org/doi/10.1161/circulationaha.116.023821https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/paramedics-success-and-complications-in-prehospital-pediatric-intubation-a-metaanalysis/B6A2D22EE46D2E713E1394F913786391https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.723327/fullhttps://pmc.ncbi.nlm.nih.gov/articles/PMC4540668/

This video explores the critical aspects of pre-hospital airway management, emphasizing the importance of oxygenation and the variables affecting intubation success. The discussion covers systematic reviews, the pros and cons of endotracheal tubes versus SGAs in managing brain injuries, and the latest recommendations from medical guidelines. It highlights the benefits of simulation training in improving first-pass success rates and delves into the logistics of intubation positions, tools, and techniques. Expert insights are shared on the complexities of achieving better procedural outcomes and the importance of a multimodal approach in education and practice. Finally, the video outlines actionable steps and recommendations for enhancing both individual and systemic practices in paramedicine.

Chapters:

00:00 Introduction and Importance of Oxygenation

00:17 Intubation in Pre-Hospital Settings

01:11 SGA vs. Endotracheal Tube

03:24 Challenges in Pre-Hospital Intubation

05:01 Improving First Pass Success Rates

06:30 Education and Training for Better Outcomes

09:20 Future of Simulation in Airway Management

11:36 Global Best Practices and Lessons Learned

13:03 Conclusion and Final Thoughts

https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-021-00533-0

https://pubmed.ncbi.nlm.nih.gov/36106283/

https://www.sciencedirect.com/science/article/pii/S0007091222004287#:~:text=In%20this%20systematic%20review%2C%20the,benefit%20in%20mortality%20and%20morbidity.

https://sjtrem.biomedcentral.com/articles/10.1186/s13049-022-01049-7#Sec9

https://www.bjanaesthesia.org/article/S0007-0912(24)00061-8/fulltext

In this episode, we delve into Jakob's master thesis comparing the first pass success rate and overall success rate of laryngoscopy with video laryngoscopy for intubation by ACPs. The discussion covers the importance of advancing airway management, the challenges faced by paramedics in pre-hospital settings, educational and systemic interventions to improve first pass success rates, and the future of simulation in airway management training. Join us for an in-depth conversation on improving patient outcomes in paramedicine.Chapters:00:00 Introduction to the Master's Thesis00:27 Motivation Behind the Research03:17 Challenges in Pre-Hospital Intubation04:58 Improving First Pass Success Rate07:15 The Role of Bougies in Intubation10:02 Video Laryngoscopy vs. Direct Laryngoscopy14:36 Techniques and Tools for Successful Intubation22:49 Training and Mental Preparation24:27 Cross-Training and Teamwork31:28 Video Laryngoscopes and Quality Assurance31:59 Reducing Airway Trauma with Visual Laryngoscopy

Join us as Jakob and I delve into the complexities of pediatric sepsis in this informative podcast episode. We cover essential topics, including the mean arterial pressure targets for fluid and vasopressor administration, the appropriateness of vasopressors in pre-hospital settings, and the impact of socioeconomic status on sepsis outcomes. Learn about the critical differences between sepsis and septic shock, the main causes of mortality, and the importance of timely antibiotic treatment. We also discuss practical approaches to fluid administration, key clinical signs to look out for, and the role of early warning scores in improving patient outcomes. This episode is packed with valuable insights for healthcare professionals looking to enhance their understanding and treatment of pediatric sepsis.

Chapters:

00:00 Introduction to Pediatric Sepsis

01:15 Understanding Sepsis and Septic Shock

02:30 Mortality Rates and Socioeconomic Factors

03:46 Immune Response and Analogies

06:06 Age Groups and Vulnerability

08:15 Clinical Manifestations in Newborns and Infants

09:58 Common Signs and Symptoms in Older Children

15:30 Differentiating Sepsis from Other Conditions

20:57 Pre-Hospital Interventions and Early Recognition

22:56 Streamlining Sepsis Response

24:40 The Role of Fluids in Pediatric Sepsis

27:31 Administering Fluids Safely

29:18 Vasopressor Therapy Considerations

33:28 Dopamine vs. Epinephrine Debate

38:36 Addressing Hypoglycemia in Sepsis

40:01 Demographics and Risk Factors

42:28 Communicating with Families

43:17 Empowering Paramedics

44:36 Conclusion and Next Episode Preview

In this episode, Dr. Andrew Petrosoniak, an emergency and trauma doctor at St. Michael's Hospital in Toronto and Medical Director at Unity Health, shares his expertise in optimizing team performance in high-stress situations. He discusses the importance of designing systems that promote correct actions, the lessons learned from his work in simulation and design, and the value of borrowing strategies from other industries like aviation and athletics. Dr. Petrosoniak highlights the significance of interprofessional training, team coordination, and iterative feedback in improving clinical outcomes.

Learn more about Dr. Petrosoniak's work: https://research.unityhealth.to/profiles/andrew-petrosoniak/ https://t.co/XYAzUMg9xz.https://advancedperformance.ca/

Learn more about Dr. Hicks' work:https://scientific.acoep.org/speakers/chris-hicks-md/

Chapters:

00:00 Introduction to Effective Training and Design

00:37 Guest Introduction and Background

02:12 Journey into Simulation and Performance Optimization

05:04 Lessons from Aviation and Other Industries

11:56 Importance of Environment and Iteration

19:10 Interprofessional Training and Team Dynamics

23:28 Frameworks for Effective Team Coordination

26:19 Conclusion and Final Thoughts

#ems #science #paramedic #emergencymedicine #prehospitalcare #paramedic​ #emt​ #firefighter​#ambulance​ #medic​ #emergency​ #rescue​#firstresponders​ #emtlife​ #health #healthcare #healthcareheros #simulation #humanfactors #medicine #science #healthcare #healthquality #healthsafetycourse

Get in Touch Here or in The Comments:theteneightshow@gmail.com

LinkedIn: https://www.linkedin.com/in/ryan-cichowski-787b99274/

https://www.linkedin.com/in/jakob-rodger-b60571141/

Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Paramedics (EVAP) program and co-leads the Violence Against Paramedics project with Dr. Donnelly. Connect with Justin on LinkedIn, follow him on Twitter, or see more of his work on ResearchGate.

LinkedIn: https://www.linkedin.com/in/justinmausz/Twitter:

https://x.com/i/flow/login?redirect_after_login=%2Fi%2Fflow%2FloginViolence Against Paramedics: https://www.protectparamedics.com/

Part 2:

In this insightful episode, we delve into the importance of having a sense of self, purpose, and the role of diversified sources of fulfillment in protecting psychological health and wellbeing, especially in high-stress professions like being a paramedic. The discussion touches on generational differences in values regarding work-life balance, the potential for early career mental health screenings, and the impact of occupational trauma. The conversation also addresses the types of violence paramedics face, the role of mental health and substance use in these incidents, and strategies to improve safety for both paramedics and patients. Join us as we explore how to support and sustain the mental health and safety of our essential emergency responders.

References:

https://peelregion.ca/sites/default/files/2024-03/paramedic-experiences-with-workplace-violence.pdfhttps://pubmed.ncbi.nlm.nih.gov/24830544/https://pubmed.

ncbi.nlm.nih.gov/35206301/https://www.researchgate.net/profile/Paige-Masonhttps://www.protectparamedics.com/the-teamhttps://www.insighthealthsolutions.com/launch-of-peel-region-paramedic-services-partnership-with-thp-for-mental-health-services/https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2019-ctn-pln-ptsi/index-en.aspx?wbdisable=true

Chapters:

00:00 Introduction: The Importance of Purpose and Meaning

00:19 Generational Shifts in Work-Life Balance

01:00 Early Career Mental Health Screening

01:30 Challenges in Psychological Assessments

03:33 The Role of Resilience in Mental Health

05:23 Personal Struggles and Professional Challenges

09:10 Violence Against Paramedics: A Growing Concern

15:20 Addressing Mental Health Crises in the Field

17:36 Legal and Ethical Considerations

19:47 Conclusion: Ensuring Safety for All

Get in Touch Here or in the Comments:theteneightshow@gmail.com

LinkedIn: https://www.linkedin.com/in/ryan-cichowski-787b99274/

https://www.linkedin.com/in/jakob-rodger-b60571141/

About Justin:

Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Paramedics (EVAP) program and co-leads the Violence Against Paramedics project with Dr. Donnelly. Connect with Justin on LinkedIn, follow him on Twitter, or see more of his work on ResearchGate.In this episode, we discuss the unacceptable nature of violence against paramedics and shed light on how it affects their mental health and job performance. The conversation explores the efforts made by paramedics like Mandy Johnston and researchers to gather data, understand the prevalence of violence, and implement effective risk mitigation strategies. The program delves into the impact of reporting violence, changes in organizational culture, and the importance of mental health resources. Hear about the personal experiences that led to this crucial research, the training initiatives to de-escalate violent situations, and the ultimate goal of creating a safer and more supportive environment for paramedics.

Support Justin:

https://www.protectparamedics.com/the-team

Chapters:

00:00 Introduction: Addressing Violence Against Paramedics

01:01 Personal Motivations and Research Beginnings

02:16 Documenting and Measuring Violence

03:12 Barriers to Reporting and Cultural Change

04:57 Impact of Reporting and Training

06:52 Mental Health Studies and Personal Stories

09:45 Challenges in Paramedic Mental Health

14:31 Systemic Issues and Resource Allocation

24:03 Historical Context and Physical Injuries

25:38 The Reality of Early Career Paramedics

26:10 Role Identity and Paramedic Identity Mismatch

26:54 Building Resilience: Individual and Organizational Strategies

28:34 The Swiss Cheese Model and Mental Health Screening

References:https://pubmed.ncbi.nlm.nih.gov/24830544/https://pubmed.ncbi.nlm.nih.gov/35206301/https://www.researchgate.net/profile/Paige-Masonhttps://www.protectparamedics.com/the-teamhttps://www.insighthealthsolutions.com/launch-of-peel-region-paramedic-services-partnership-with-thp-for-mental-health-services/https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2019-ctn-pln-ptsi/index-en.aspx?wbdisable=true#ems #science #paramedic #emergencymedicine #prehospitalcare

#paramedic​ #emt​ #firefighter​#ambulance​ #medic​ #emergency​ #rescue​#firstresponders​ #emtlife​

In this episode, we delve into the best practices for intubation and the administration of epinephrine during emergency scenarios. Our discussion focuses on avoiding the use of epinephrine through the ETT, the importance of IV and IO routes, the benefits of video laryngoscopy, and the significance of preparation and teamwork. We also touch on airway management challenges, especially in cases with potential C-spine injuries, and emphasize the importance of setting up a systematic and well-coordinated approach to maximize patient outcomes.

Chapters:

00:00 Introduction: Epinephrine Administration Dilemma

00:45 Optimizing Intubation Success

01:51 Video Laryngoscopy and Airway Management

04:07 Preparation and Team Approach

09:21 Debriefing and Continuous Learning

20:47 Conclusion and Final Thoughts

#ems #science #paramedic #emergencymedicine #pediatriccare #prehospitalcare #cardiacarrest #pediatricmedicine #paramedic​ #emt​ #firefighter​#ambulance​ #medic​ #emergency​ #rescue​#firstresponders​ #emtlife​ #ROSC #post-arrest #resuscitation #resuscitationsReferences:https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194https://www.ilcor.org/publicationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8951653/https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf