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July 20, 2008 @ 8:51 pm
Welcome to Episode 127
A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- Sponsored by the MedicCast Extra – Extra Content for MedicCast Listeners for less than $1 per week (via Paypal subscription)
MedicCast Listener Deals at GoDaddy.com –
BLOCKBUSTER Total Access — activate coupon for $10 off your first month. ——————————– Link of the Week– Emergency Nursing Today blog and podcast ——————————— News: Paramedics fast-track to nursing career Maryland Governor Announces Interoperablilty Plan Caffeine Behind 4,600 Calls to Poison Control Emergency Patients Don’t Understand Doctor’s Instructions ———————————- Tip/Trick of the Week – Routes of Medication Administration Temple University EMS Powerpoints Page ———————————– Med of the Week– Epinephrine GhettoMedic.com on Epinephrine ———————————– Comment or share ideas at the MedicCast Forums forums.mediccast.com Rate the podcast at iTunes and help others find the MedicCast Visit the MedicCast Store Get the MedicCast Newsletter — Sign up now — it’s free! Other Podcasts: Contact Me! Call the Voice Mail Line — (941) 306-3342 email me at podmedic@mac.com ———————————————— Music from The Podsafe Music Network “Wasting My Time” by Matthew Ebel — Visit Matthew Ebel here and let him know you heard him on the MedicCast Or you can go right to iTunes to check out his music!
Visit the link to check out other Songs from the MedicCast Network Podcasts at the iTunes Store. ————————————– Until next time, Scene safety, BSI! This work is licensed under a July 13, 2008 @ 9:42 pm
Welcome to Episode 126
A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- Sponsored by the MedicCast Extra – Extra Content for MedicCast Listeners for less than $1 per week (via Paypal subscription)
MedicCast Listener Deals at GoDaddy.com –
BLOCKBUSTER Total Access click to activate coupon for $10 off your first month. ——————————– Link of the Week– EMS-Safety NREMT Skills Video ——————————— News: Ambulances - Ambulance Chasing Rural ambulance needs “overlooked” Tip/Trick of the Week – Padding the Voids EMS Responder on Fracture Management ———————————– Med of the Week– Toxtidbit with Lisa Booze of Maryland Poison Control NIH Medline on Acetaminophen Overdoses eMedicine on Acetaminophen Toxicity ———————————– Comment or share ideas at the MedicCast Forums forums.mediccast.com Rate the podcast at iTunes and help others find the MedicCast Visit the MedicCast Store Get the MedicCast Newsletter — Sign up now — it’s free!
Other Podcasts:
Contact Me! Call the Voice Mail Line — (941) 306-3342 email me at podmedic@mac.com ———————————————— Great music by Johanna Stahley (website link) — I’m Not Perfect
Click here to check out other Songs from the MedicCast Network Podcasts at the iTunes Store. ————————————–
Until next time, Scene safety, BSI! This work is licensed under a July 9, 2008 @ 8:00 am
I recently added this video plus some other extras to the Pediatric Assessment page on the MedicCastExtra.com site. You can watch the video on YouTube and you can subscribe to the MedicCast Extra site here. July 8, 2008 @ 12:07 pm
In a recent post over at the MedicCast Forums (forums.mediccast.com), listener Adam posed the question about good resources for 12 lead ecg education. Jennifer posed one answer over there, as did I, and I decided that this one might be of interest to others who don’t usually visit the forums. Here’s my pick for the best book resource: I would most highly recommend Bob Page’s 12-Lead ECG for Acute and Critical Care Providers. Click on the Amazon Link here to get the book delivered now. Bob offers one of the most entertaining and informative seminars on 12 leads via his MultiLead Medics program. His classes are always humorous and educational and you end up reading hundreds of 12 leads in the course of his program. His book is a bit dryer in nature simply because it is a book and he was restrained from presenting his usual wit and commentary by the publisher. Jennifer’s suggestion is a good one, too. Although I have not read it myself, I have heard good things from other providers about it: Dale Dubin’s Rapid Interpretation of EKGs. Dale Dubin’s book is also available in a Spanish language version if that is something you might need: Interpretacion de ECG/ Rapid Interpretation of EKG’s I hope that helps out some other folks out there in the MedicCast community. I’ll try to add more study aid links like this to other posts here on the MedicCast. You will also find some additional resources over at our friend Jim Hoffman’s EMS-Safety.com site at this link. July 6, 2008 @ 8:15 pm
Welcome to Episode 125
A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- Sponsored by the MedicCast Extra – Extra Content for MedicCast Listeners for less than $1 per week (via Paypal subscription)
MedicCast Listener Deals at GoDaddy.com –
BLOCKBUSTER Total Access click to activate coupon for $10 off your first month. ——————————– Link of the Week– EMS Live ——————————— News: Brain Injury Key Risk in Falls Employers Can Help Workers Avoid Heart Attacks Tip/Trick of the Week – Communications With Other Medical Personal EMS Responder Article on Documentation Transfer of Care Interviews on the MedicCast — Part I (Tatiana, RN interview) Part II (Peter Canning interview) ———————————– Med of the Week– Nubain (Nalbuphine) ———————————– Comment or share ideas at the MedicCast Forums forums.mediccast.com Rate the podcast at iTunes and help others find the MedicCast Visit the MedicCast Store Get the MedicCast Newsletter — Sign up now — it’s free!
Other Podcasts:
Contact Me! Call the Voice Mail Line — (941) 306-3342 email me at podmedic@mac.com ———————————————— This Week is Codie Prevost with, “Not Just the Beer Talkin” ————————————–
Until next time, Scene safety, BSI! This work is licensed under a @ 10:54 am
Paul is a loyal listener to both the MedicCast and Nursing Show and I was glad to get the chance to pick his brain on being an ER nurse and how he likes that position. You can look forward to hearing more from Paul, as he has agreed to produce some audio segments for the Nursing Show on a variety of emergency related topics. July 4, 2008 @ 10:40 am
The following is written by listener Jerry from Australia and is used with his permission. The article chronicles a transport patient and the presentation of Malignant Hyperthermia. ——————- Malignant Hyperthermia: An on road experience by Jerry Barrett ‘Malignant Hyperthermia [MH] is an inherited myopathic disorder characterised by a marked increase in metabolic rate. The reported incidence varies considerably but is approximately 1:50,000, rapid and effective treatment is essential to avoid mortality: over the last 30 years the fatality rate has fallen from 70% to about 5%.” 1 This paper describes a recent experience with a collapsed patient suffering from MH and the clinical implications of this syndrome to pre-hospital care practitioners. The Case We received a Priority One call for an unresponsive male occupant of a motor vehicle, collapsed at the steering wheel in a shopping centre car park. On arrival, the initial visual assessment presented a middle aged male in the driving seat slumped forward over a car’s steering wheel. Initial verbal prompts failed to illicit a response; the patient had a GCS of 10/15 [E1,V4,M5]. There was no obvious indication of alcohol, CO, or substance abuse however the patient appeared to have a very wet shirt and his skin was hot to touch. A patent airway was evident from incoherent mumblings that could be heard once I approached the patient. A bystander who had commenced initial care of the patient commented that the patient seemed to respond well to cold water being thrown over him [also explaining the wet appearance of the patient]. 1 Following the initial primary survey indicating GCS 10/15, SPO2 99%, pulse 99 bpm, NIBP 170/70 and resps 24, the patient seemed to gain some composure and sat back in his seat. Although not aware of his surroundings the patient volunteered the fact that he suffered from Malignant Hyperthermia and that he had started to feel hot and dizzy in the shopping centre so returned to his vehicle in an effort to drive home. As there was no thermometer available, I had no indication of the actual temperature of this patient and although there was an apparent rise in the GCS to 12/15 [3,4,5] I indicated to my partner that time was of the essence and that we had to extract the patient from the car as soon as possible. Once extracted from the vehicle and secured on the stretcher I commenced treatment. St John Ambulance Western Australia guidelines for hyperthermia tend to concentrate on heat stoke/ hyperglycaemia as the cause and indicate ‘time critical’ and the need for active cooling and IV resuscitation. As I was unable to determine an exact temperature of the patient I feared the worst and inserted a 14G IV cannula prior to urgent transport to the nearest appropriate hospital, less than10 minutes away. One hundred per cent oxygen via a re-breather and 3 lead ECG was applied [confirming tachycardia], and one litre of isothermic normal saline was commenced STAT, a phone call was made to the hospital ED to pre-warn them of our impending arrival. En route we began active cooling of the patient by using cold packs under the axilla and groin as well as a wet burn dressing to the head and air conditioning redirected onto the patient. This initial ‘cool down’ made a significant improvement to the patient’s condition and his GCS rose to 15/15. Once the patient had regained his composure he confided that he had been experiencing headaches and episodes of feeling hot and dizzy in the weeks prior to this event but did not wish to go to hospital. Although he had been told that he had MH, and was aware that it was potentially fatal he refused to buy a Medical Alert bracelet for the reason that it might put up the price of his medical insurance! It was explained to him the implications of not having any indication of his condition should he have another episode and not be able to convey his condition verbally to emergency medical services. Malignant Hyperthermia “Malignant Hyperthermia [MH] is a rare pharmacogenetic disorder” however it does exist in the general population and can possibly be induced by stress or the use of Methylenedioxymethamphetamine [Ecstacy] as well as the common trigger agents such as Scoline and Halothane. In Western Australia Methoxyflurane is still in current use with St John Ambulance as an analgesic agent and its close relationship to Halothane makes it a possible trigger agent for MH, and in WA is therefore contraindicated in susceptible patients. 2, 3, 4 “There are unquantifiable rare things in life such as ‘hens teeth’, rocking horse poo and honest politicians and quantifiable rare things such as winning the Oz Lotto 1:8,000,000 or risk of death by lightning strike 1:1,000,000 or coming across MH 1:50,000.” 2 There is no clinical sign or cluster of signs to indicate MH, MH is a clinical chameleon. All signs of MH are non specific and may arise from multiple causes. Exposure to known triggering agents without reaction does not exclude MH susceptibility and there are many possible differential diagnoses for the various signs and symptoms: such as Sepsis, Hyperglyceamia or Substance [Ecstasy/ Amphetamine] abuse. 2 Etiology of Malignant Hyperthermia MH is an inherited disorder. The genetics of MH are complex. Mutations in the human ryanodine receptor in skeletal muscle [a calcium release channel with a role in excitation-contraction coupling] are apparent in some families. Predisposition to MH has been defined in only three rare clinical myopathies. Inheritance of the MH gene and contact with specific agents can trigger abnormal calcium release from the sarcoplasmic reticulaum into the cytoplasm. This leads to myofibrillar contraction, depletion of high energy muscle phospate stores, accelerated metabolic rate, increased carbon dioxide and heat production, increased oxygen consumption and metabolic acidocis. The usual triggering agents are succinylcholine or any volatile anaesthetic agents. 3 Clinical Indicators of Malignant Hyperthermia As previously noted, MH presents as a clinical chameleon1 even in the clinical setting. Therefore the ability to recognise this condition in the pre-hospital phase of assessment or treatment can be very difficult. Below is a list of classic signs/ symptoms associated with a patient suffering from MH:
A visual alert that the patient suffers from this rare condition would be of great advantage when trying to resuscitate a tachycardic, pyrexic patient with possible tachypnoea of unknown cause This will not always be the case, even in the clinical setting and one may need to rely on verbal indication of such conditions being suspected. These symptoms plague us every weekend on the streets with Ecstasy overdoses. Management of Malignant Hyperthermia MH is a clinical emergency and in the pre-hospital environment is an acute situation due to the rapid progression of this condition and the high mortality factor associated with it. A suggested guideline for treating patients suffering from MH might include: Administer 100% Oxygen Gain IV access with large bore IV [possibly prior to the active cooling stage in order to maintain optimal conditions for IV access]. ECG monitoring Active Cooling: chemical ice packs to axilla and groin regions, vehicle air conditioning flow directed onto patient and latent evaporation to head using damp swap/ dressing. And if available isothermic or cool IV fluid. Urgent transport to an appropriate medical facility. This should also include a call to the ED to advise them of the condition of the patient and give the medical staff time to prepare for their arrival. Summary Malignant Hyperthermia is a rare but deadly condition. The rapid administration of Dantrolene Sodium is an effective treatment of MH once it has started its acute cycle; the drop of mortality from 80% to approximately 5% now gives us hope that rapid diagnosis and intervention reduces mortality. The price, short shelf life and rare use of Dantrolene make its supply limited, and there appears to be no national guidelines determining what supply level is mandatory in critical care environments. ——————– Jerry has been a Paramedic since the early 80’s and served in several Middle Eastern Armed Forces after leaving the British Armed Forces. Moving to Perth in 2003 with his family he initially worked in the Operating Theatres as a Senior Anaesthetic Technician before joining St John Ambulance in 2004. Also gaining a qualification in Traditional Chinese Medicine Jerry also operates a First Aid Training company and has always been passionate about teaching. Jerry operates out of Cockburn Station in the Southern suburbs of Perth. References
Other Links: Malignant Hyperthermia Association of the United States WebMD on Malignant Hyperthermia July 3, 2008 @ 2:23 pm
The two new EMTs competed against 50 other teams from around the country and were stunned when they won. Check out the full article here. The MedicCast of medical podcasts out their congratulations to all who competed in this competition for EMS excellence, especially the winners. It is programs like this that raise the level of EMS service to the level of Medical Professional. Look around in your communities and find out how you can work to raise interest in similar competitions at the local level. Encourage providers to hone their skills to a razor’s edge. It’s what is expected of us by the public we serve. Most importantly, it’s what we should expect of ourselves! July 2, 2008 @ 2:05 pm
The first article has to do with one region turning to more strict collections policies regarding unpaid ambulance billing. I know that many areas are very relaxed in their collection practices. These services believe that people shouldn’t be hounded to pay their medical bills in the light that if they could afford to pay, they would. However, I know that this is not always the case. Many times, these bill dodgers have been sent a check in their name for the bill from their ambulance service and then are supposed to forward the money plus any remaining balance to the ambulance or fire company who performed the transport. For some people, this is apparently a license to steal from their insurance, their community, and their local ambulance service. The second article demonstrates another tactic for raising funds when people won’t or can’t pay, raise prices on those who can pay! This is what I meant in the previous paragraph when I said the non-payers steal from their communities. The costs have to get picked up by somebody. That left over money comes from the whole region in the form of higher taxes, higher transport fees, and sometimes less ambulance coverage. The cause of lack of adequate funding, lack of payment, poor coverage is primarily due to a couple of factors. Overuse of the EMS system for primary care medical problems is one aspect. Another is the increasing high price of diesel fuel. As both of these issues seem to be too hard for our government to handle, plan an even earlier collapse of our EMS system in some areas as the volunteer pools continue to shrink and more an more regions try to come up with ways to put paid ambulance services in place without enough call volume and tax base support to pull it off! July 1, 2008 @ 12:18 pm
So what do we do? We come up with solutions. This is why I like to see what kind of great inventions and product improvements that we come up with as a group. That’s what one pair of California paramedics did when they saw people succumbing to the desert heat in their region. Their company, called Chill Vests, Inc. has a variety of different products to keep people cool in high heat condition. Their products range from wrist and head bands that cool for 5 hours when wet all the way to camo design, military body armor with circulating fluid coils to cool off soldiers. Check out their company site at ChillVests.com. I’d love to hear from any of the listeners or readers if they have any experience with these products and how well they work. This is a great illustration of what we can do with our first hand view of the patients in their natural habitat. We see the bad habits, poor living conditions, or the aftermath of bad ideas. |
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