Med Inspired

Resuscitation sequenced intubation!! Great podcast/vodcast.

https://m.youtube.com/watch?fbclid=IwAR2hUYpXjB0QeUCo3ojxDKIA0C46YrEayxHDGUUjcFkVdrgialPbvLGr0zE_aem_ATsE0CAAn1jCZmQa3fd7sbJbN5Foh3fyOaNfsGv1KcSzKxSMu42O9zP3r_w7y8zLQp8&v=qI9dRp9Hb5k&feature=youtu.be

Resuscitation Sequenced Intubation In this Episode of the PCHD EMS Podcast we discuss Resuscitation focused, Sequenced Intubation, and delayed movement of sick patients. Supervisor Jeff McNew ...

Beware of the patient with right ventricular failure!

Identifying right ventricular failure POCUS, ECG and assessment findings to look for to avoid the RV spiral of death

VL improves view at laryngoscopy but also the efficacy & effectiveness of tracheal intubation.

This is no longer usefully debatable

https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD011136.pub2&doi=10.1002/14651858.CD011136.pub2&type=cdsr&contentLanguage=

Thoughts?

Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest Little is known about the impact of tidal volumes delivered by emergency medical services (EMS) to adult patients with out-of-hospital cardiac arrest …

Fantastic study on key performance issues in emergency intubation. We should be structuring our training around mitigating these errors!

https://m.facebook.com/story.php?story_fbid=824835952977286&id=100063526660051

EMCrit 360 - A Taxonomy of Key Performance Errors for Emergency Intubation (Primer) We categorized intubation errors and published a paper about it...

https://www.sciencedirect.com/science/article/pii/S1067991X23002195?dgcid=coauthor

Ketamine Efficacy for Management of Status Epilepticus: Considerations for Prehospital Clinicians Current first-line therapies for seizure management recommend benzodiazepines, which target gamma-aminobutyric acid type A channels to stop the seizur…

Hyper acute T-waves in early diagnosis if AMI.

Neither sensitive nor specific because of lack of exact definition.

Very subjective

You should worry if significant T:QRS disproportion is present! AKA: you can fit T wave into QRS.

👇🏻 study below!

Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction - PubMed Hyperacute T waves, when defined as increased T-wave amplitude exceeding the 95th percentile, did not provide useful information in diagnosing myocardial infarction in this sample.

🥊 battle of the vasopressers! 🥊

Which is better post ROSC?

https://www.facebook.com/100009858604961/posts/2040265129645421/?mibextid=cr9u03

✅ Which is better post-ROSC for OHCA.... Epinephrine or Norepinephrine?

A recent study titled "Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest" was conducted by Emma R. Wender and team from Seattle. Here are the key takeaways:

🔹 Study Overview:
‣ The research included OHCA cases in Seattle, WA from 2014-2021.
‣ Out of 451 OHCA patients with return of spontaneous circulation (ROSC) followed by vasopressor infusion:
◘ 253 (56%) received norepinephrine
◘ 198 (44%) received epinephrine

🔹 Key Findings:
‣ Patients on epinephrine were more likely to rearrest in the prehospital setting: 55% vs 25% for those on norepinephrine.
‣ After adjustment for various factors, the odds of rearrest for epinephrine patients were 3.28 times higher.
‣ The odds of having pulses upon hospital arrival were lower for the epinephrine group (OR 0.52).
‣ Overall survival to hospital discharge was 14%, with 10% having a favorable neurological outcome.
‣ No significant difference was found between the two groups in terms of survival or neurological outcome.

🔹 Conclusion:
Epinephrine infusion was associated with higher odds of prehospital rearrest compared to norepinephrine yet there was no difference in neuro-intact survival. The findings emphasize the need for further randomized controlled trials on this topic.

For a deeper dive into the research and its implications, check out the full study: https://ow.ly/E5hg50PIBiK

Stay informed and stay safe!

Ultrasound for the lungs.

A comprehensive review encompassing 222 studies of more than 26,000 participants undergoing tracheal intubation further supported the superiority of video laryngoscopy.

Video Laryngoscopy for the Win: The DEVICE trial was... : Emergency Medicine News An abstract is unavailable.

https://www.dropbox.com/scl/fi/fnw650cnek3p0txaixbeo/The-Association-of-Combined-Prehospital-Hypotension-and-Hypoxia-With-Outcomes-Following-Out-of-Hospital-Cardiac-Arrest-Resuscitation.pdf?rlkey=ljx5teapfa91pm2vf6een8wwu&dl=0

The Association of Combined Prehospital Hypotension and Hypoxia With Outcomes Following Out of Hospital Cardiac Arrest Resuscitation.pdf Shared with Dropbox

Announcement!! Med Inspired LLC is proud to announce a new medical director! So happy to have Dr. Root on board and will help take Med Inspired to the next level of medical education!! And he likes breakfast burritos! Who doesent! 👇🏻

Chris Root is an emergency medicine physician, flight physician and a former New York City paramedic. His career in EMS has spanned urban and rural, 911 and interfacility, clinical practice and education, and critical care transport by ground and by air. He earned his medical degree from the Icahn School of Medicine at Mount Sinai in New York City. He completed his emergency medicine residency at the University of New Mexico in sunny Albuquerque. He is currently completing a fellowship in EMS at UNM and working as a flight physician for UNM Lifeguard Air Emergency Services. His research interests include prehospital airway management, education, ultrasound, cardiac arrest management and also breakfast burritos.

New podcast episode out!! I sit down and talk all things airway with anesthesiologist, inventor and master airway educator Dr. Jim Ducanto! We discuss the SALAD technique, VL vs DL, and airway education.

https://podcasts.apple.com/us/podcast/airway-management-with-dr-jim-ducanto/id1613009262?i=1000614730777

‎Med Inspired: Airway Management with Dr. Jim Ducanto on Apple Podcasts ‎Show Med Inspired, Ep Airway Management with Dr. Jim Ducanto - May 27, 2023

Thoughts?

https://www.sciencedirect.com/science/article/abs/pii/S0883944123000667

Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials We performed a meta-analysis of randomized controlled trials to evaluate if etomidate impacted mortality in critically ill adults when compared with o…

New content up on the CME collective on the chief complaint of dizziness! Red flags you should be concerned about, utility of the HINTS exam and a structured approach to identifying life threatening etiologies. Proud to partner with IA Med and the CME collective!
https://training.iamed.com/courses/dizziness-with-dr-evie-marcolini

Dizziness with Dr. Evie Marcolini In this course, you will learn to: Be able to differentiate red flags of dizziness on physical exam and history. Be able to perform a targeted physical exam that is specific for posterior stroke Be able to discuss and describe what the HINTS exam is

https://twitter.com/dglaucomflecken/status/1463169629292015636?s=21&t=Mo0T1CYqDFcXzLWlzJMp-Q

Dr. Glaucomflecken on Twitter “The emergency medicine residency interview https://t.co/mOo4BDgDEc”

New study on the safety of intranasal fentanyl in pediatric patients!! 

Why does intranasal Fentanyl in pediatrics often fail? Here are the three primary reasons.

1. The dose used is too low (most use 1 mcg/kg; max 100 mcg)
2. Absorption in the nasal mucosa is not ideal
3. The dead space in the MAD device chews up 0.1 mL of volume

While we have advocated that EMS systems use at least 1.5 - 2 mcg/kg (max 100 mcg), it wasn't clear if even this dose was high enough.

We now have a clear answer.

A recent study from Le Bonheur Children's Hospital in Tennessee evaluated whether high dose intranasal Fentanyl was safe for the pediatric population.

Researchers looked at an intranasal (IN) fentanyl dose between 2 - 5 mcg/kg (with a max of 200 mcg) and evaluated for adverse events.

What were the results?
During the study period, a total of 3205 patients received greater than 100 mcg of IN fentanyl. The mean patient age was 13.7 years, ranging from 5 to 18 years, and 60.7% were male.

The mean initial total dose given was 162 mcg (an average of 2.62 mcg/kg) 👍

But wait there's more:
Fentanyl IN was given in combination with midazolam IN a total of 879 times, with a median initial dose of 10 mg (0.2 mg/kg).

Even with the addition of versed the study found no documented episodes of apnea, respiratory failure or hypotension. The only safety events recorded were due to incorrect route (the drug was given IV instead of IN).

What is the conclusion:
Fentanyl can be safely administered intranasally at doses of up to 200 mcg without any significant adverse outcomes, even with intranasal midazolam.

We'd recommend 2 mcg/kg IN with a max of 200 mcg. Keep this study in hand at your next protocol meeting.

Before you go:
Keep in mind, a dose of 200 mcg of fentanyl equates to 4 mL which exceeds the 2 mL max (1 mL per nare). We recommend you still only give 1 mL per nare and wait for a short time before giving the next 1 mL.

Read the full study here: http://ow.ly/NIpj50IF1GF

T waves get no respect!!

T- waves get no respect This video presentation gives a short overview on the 2 types of 2 wave findings you may see on the ECG.

New podcast out!! Dizziness with Dr. Evie Marcolini!

https://podcasts.apple.com/us/podcast/med-inspired/id1457260838?i=1000553051184

👉New podcast out!! I discuss all things dizziness with Dr. Evie Marcolini

👉Central vs peripheral causes
👉 The can’t miss red flags of posterior stroke
👉 The HINTS exam
👉Tips to beef up your neuro exam
👉BPPV vs vestibular neuritis vs cerebellar infarction
👉And so much more!!!

Dr. Evie Marcolini is an emergency physician and neurointensivist that lectures nationally and internationally.

https://podcasts.apple.com/us/podcast/med-inspired/id1457260838?i=1000553051184

‎Med Inspired: Dizziness with Dr. Evie Marcolini on Apple Podcasts ‎Show Med Inspired, Ep Dizziness with Dr. Evie Marcolini - Mar 5, 2022

Excited about new addition to office. New podcast recorded today and can’t wait until it’s released!

Case conclusion. This ECG has excessive discordance in V1-V2 per Smiths modified Scarbossas criteria. Patient was found to have a 99% stenosis of the ostial left circumflex vessel, 70% stenosis in the early mid left circumflex vessel .

https://qxmd.com/calculate/calculator_487/smith-modified-sgarbossa-s-criteria-for-mi-in-left-bundle-branch-block

75y/o with chest pain for 2 hours. LBBB on 12 lead ECG. Occlusion or no occlusion?

You can now listen to the Med Inspired podcast on Spotify as well as iTunes. So do yourself a favor and go on over and hit subscribe!! Go on do it now! You won’t regret it! New episodes coming out soon with some of the biggest names in emergency medicine and critical care

https://open.spotify.com/show/6A9HekA7dRcB7rIacYLid4?si=VoUSicQrScqcAAUexLueww&dl_branch=1

Med Inspired Listen to Med Inspired on Spotify. The Med Inspired Podcast is where we have conversations with healthcare providers to gain insight and perspectives that will help you grow both personally and professionally. Powerful stories that will both inspire and educate!

Check out our new YouTube page for great new medical content! Emergency medicine and pre-hospital medical lectures coming!
This lecture highlights key findings in the syncope patient.

Syncope When is it serious? This medical lecture highlights a structured approach to the patient with the chief complaint of syncope.

Med Inspired is honored to be part of this incredible team of medical educators and content creators! What’s this mean for you? You can receive CE credit for all the great content included in the CME collective including the Med Inspired podcast! That’s right! Just by listening to the Med Inspired podcast you can earn CE!

Courses are launching into The CME Collective tomorrow! 🤓👏

We cannot wait to finally offer you these exclusive full courses to our members! Make sure you grab your membership today so you can access this amazing training.👇

https://training.iamed.us/bundles/the-cme-collective-annual-subscription

👉New podcast out!!

I sit down with former flight nurse, paramedic, and international seminar leader Scott DeBoer and discuss all things pediatric resuscitation. From his approach to the sick child, vascular access tips and tricks, physical exam pearls, cognitive approach to pediatrics and much more!
https://podcasts.apple.com/us/podcast/med-inspired/id1457260838 =27ea0ec6-ea6b-46d1-aaca-8ccc31f9099d

‎Med Inspired on Apple Podcasts ‎Medicine · 2021

Rapid Sequence intubation training today!

Some pediatric and surgical airway training today!