All in Medicine

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

Ed Bauter
Chest pain, FOAMed, Interview, Medicine

In this episode, Dr. Ken Milne discusses two studies related to emergency medicine. The first study examines the use of small adult ventilation bags in out-of-hospital cardiac arrest. The study found that small bags were associated with a lower rate of return of spontaneous circulation (ROSC) compared to standard bags. However, this was an observational study and more research is needed to draw definitive conclusions. The second study explores the use of nitroglycerin in right ventricular myocardial infarctions (MIs). Traditionally, nitroglycerin has been contraindicated in these cases, but the study found no significant difference in adverse events when nitroglycerin was used. Again, more research is needed to confirm these findings. Overall, these studies highlight the importance of evidence-based practice and the need for further research in emergency medicine. 

Episode 108: DEI in EMS with Dr. Tristan Glenn and Dr. Alicia Rouff

Episode 108: DEI in EMS with Dr. Tristan Glenn and Dr. Alicia Rouff

Ed Bauter
Controversy, Interview, Medicine, Mental Health

A Block

 

Dr. Tristan Glenn discusses diversity, equity, and inclusion (DEI) in the context of EMS. He emphasizes the importance of understanding and valuing individual identities and lived experiences. Microaggressions are explored as harmful behaviors that communicate negative appraisals of individuals. The lack of diversity in EMS is highlighted, and the need for purposeful recruitment and community engagement is discussed. Dr. Glenn suggests embedding DEI principles throughout the entire organization and utilizing technology, such as mixed reality simulations, for training. Overcoming resistance to DEI initiatives requires cultivating a consciousness of the impact each individual has on creating an equitable and inclusive environment.

 

Takeaways

 

DEI involves understanding and valuing individual identities and lived experiences.

Microaggressions are harmful behaviors that communicate negative appraisals of individuals.

Recruitment and community engagement are essential for increasing diversity in EMS.

Embedding DEI principles throughout the organization and utilizing technology can support DEI initiatives.

Overcoming resistance to DEI requires cultivating a consciousness of the impact each individual has on creating an equitable and inclusive environment.

 

B Block

 

Dr. Alicia Rouff joins the podcast to discuss diversity, equity, and inclusion (DEI) in emergency medicine and EMS. The conversation explores the current state of DEI in the field, the challenges faced by underrepresented groups, and the need for proactive change. The importance of recruitment and creating opportunities for people of color in EMS is highlighted. The discussion also emphasizes the importance of cultural understanding and respect when interacting with patients from diverse backgrounds. The episode concludes with a message of showing up as your authentic self and promoting kindness in healthcare.

 

Takeaways

 

DEI in emergency medicine and EMS is an ongoing challenge that requires proactive change.

Recruitment and creating opportunities for people of color in EMS is crucial for increasing diversity in the field.

Cultural understanding and respect are essential when interacting with patients from diverse backgrounds.

Showing up as your authentic self and promoting kindness in healthcare can make a positive impact.

 

Episode 105: 2023 Year in Review

Episode 105: 2023 Year in Review

Ed Bauter
Drugs, FOAMed, Medicine, WTAF?!

Summary

In this episode, Ed and Dan discuss several topics related to medicine and EMS in 2023. They start by reviewing a study on the use of nitroglycerin in acute pulmonary edema and congestive heart failure, highlighting its positive effects on blood pressure and oxygenation. They then move on to a comparison of succinylcholine and rocuronium in rapid sequence intubation (RSI), concluding that the choice of paralytic agent may not significantly impact outcomes. They also discuss a case in which a paramedic impersonated a doctor in Louisiana, highlighting the need for patient advocacy and responsible clinical practice. They conclude by expressing excitement for future episodes and inviting listeners to share their stories.

Takeaways

Nitroglycerin can be effective in improving outcomes in acute pulmonary edema and congestive heart failure.
The choice between succinylcholine and rocuronium in RSI may not have a significant impact on first pass success rates.
Patient advocacy and responsible clinical practice are crucial in preventing incidents of impersonation and ensuring patient safety.
Hindsight is 20-20, and it is important to learn from past mistakes and continuously evolve in the field of medicine and EMS.

Chapters

00:00 Introduction
00:26 Discussion of Nitroglycerin in Acute Pulmonary Edema Link Link
11:22 Comparison of Succinylcholine and Rocuronium in RSI Link
22:34 Case Study: Elijah McClain Case Link
31:04 Case Study: Paramedic Impersonates Doctor in Louisiana Link
36:01 Conclusion and Future Plans

Episode 88: Ceribell and Advancing Seizure Care with Dan Gerard

Episode 88: Ceribell and Advancing Seizure Care with Dan Gerard

Ed Bauter
FOAMed, Medicine

Dan Gerard is a man of many hats. He is the current President of the IAEMSC as well as the EMS Coordinator for Alameda county in California. He has spent his lengthy EMS career pursuing new advancements in pre-hospital medicine and is currently piloting a program in Alameda county that may be a game changer when it comes to recognizing and treating seizures in the field. Ceribell is a device that wraps around a patient's head like a headband and produces real-time EEG tracings that can be interpreted by an EMS clinician with little to no training. The best part about this system is that it is already FDA approved and is being used in hospitals with encouraging results. Take a listen and let us know what you think!

Episode 84: So, You Want To Be A MIlitary Medic?

Episode 84: So, You Want To Be A MIlitary Medic?

Caroline Schwester
Interview, Medicine

If you've been anywhere in this world the last few weeks, you know what's been going on in Ukraine. Once again, military medicine has taken front row. But what actually is military medicine about? What are some of the misconceptions? And what can we as civilians take away from our colleagues in service?

On this episode, Dan and Ed are civilians talking medicine in the military to Dr. Andrew Fisher, MAJ USA, and the namesake of the Saint Fisher Church of Evidence Based Medicine; and our good friend Peter D'Antuono, who served in combat as a medic with the 173rd Airborne Brigade. We get to shine a light on something not many civilians get to hear about...and why it's important.

Check out the Church here:

https://sfcebm.com

https://www.facebook.com/SaintfisherChurchofEBM/

Episode 76: A begrudging semi-annual Covid update

Episode 76: A begrudging semi-annual Covid update

Ed Bauter
Controversy, FOAMed, Health and Safety, Medicine

We know. We hate it too.

SARS-CoV-2 is still rampant in the United States, and with the emergence of the Delta variant, and the FDA approval of the Pfizer/BioNTech vaccine we thought it would be a good time to update the data.

What medications work? Are steroids useful? Dr. Antevy jumps in to discuss how to manage kids with Covid.

Give a listen, let us know what your shop is doing to keep their sanity during this time.

CDC Tracker

State of NJ Covid Data

Johns Hopkins updates

Recovery (Dexamethasone Study)

Let us know how you're doing: @OverrunEMS

FB/IG: Overrunproductions

Episode 72: Prehospital Burn Care

Episode 72: Prehospital Burn Care

Daniel Schwester
Medicine, Trauma, Pediatrics

Ed and Dan are back, this time talking about care of burn patients outside of the hospital. Burn injuries are high-acuity, low occurrence events (HALO), and it’s easy to miss things that may have a bigger impact on your patient than previously thought.

We talk about initial basic care, why wet dressings are bad for anything more than a very small burn, fluid resuscitation and the drama that surrounds it, and pain management (in a word, YES).

Dr. Peter Antevy comes in with a Pedatric Pearl, as well…

Episode 68: Transgender Awareness with Taylor Sprecher and Matt Streger

Episode 68: Transgender Awareness with Taylor Sprecher and Matt Streger

Daniel Schwester
Interview, Health and Safety, Medicine

The transgender population is a part of your patient population, and we all need to know how to assess and communicate therapeutically with our trans patients.

Matt Streger introduces us to Taylor Sprecher, a trans man and EMT who has taken the lead in trying to educate clinicians about trans patients, and some clinical pearls for us to utilize.

Did you know that almost one in FOUR trans people avoid seeking out health care because of their fear of how they’ll be treated? Or that trans teens have a significantly higher rate of suicide attempts? Do you know how to address your trans patients’ needs?

Read the stats here:

https://transequality.org/issues/us-trans-survey

Taylor’s webpage, which is a treasure trove of resources:

https://911transedu.com

Streger and Keavney is one of the pre-eminent EMS law firms in the USA, and a good friend of the show. Check them out at:

https://keavneystreger.com

https://emsaegis.com

Episode 60: Art, Communication, and Healing

Episode 60: Art, Communication, and Healing

Daniel Schwester
Interview, Medicine, Health and Safety

Ed and Dan sit down with fellow colleague and paramedic Kate Bergen about her art series that she created during COVID-19, and how she uses art to help manage her stress levels working in the challenging environment of EMS in the US today, and chronicle the amazing work that EMS has done in this new world.

The important thing to take from this episode is that everyone in EMS NEEDS to have some form of healthy release, a way to quiet your brain and recharge. Whatever you do, it is worth it. YOU are worth it.

Kate's work can be found at:

https://www.jbergenstudios.com/jbergenstudios

Kate has been working with Mission Hope, an organization to help clinicians and responders in the NJ area with mental health. Find out more about them at:

About Us

Kate's spot on ABC:

https://abcnews.go.com/Lifestyle/video/paramedic-turned-paint-brush-cope-pandemic-70770797

Kate's cover story in Real Woman magazine:

Working on the Front Lines of COVID-19 is as Scary as It Sounds

Episode 49: MD1 Physician Response

Episode 49: MD1 Physician Response

Daniel Schwester
MD1, Medicine, Interview

Dan sits down in a pre-Conference interview with Dr. Mark Merlin, the head of the New Jersey MD1 physician response program, the largest EMS physician program in the USA

Dr. Merlin discusses the idea of physician response, how EMS physicians interact in the prehospital environment with paramedics and EMTs, the technology that they bring to the table, and using whole blood in resuscitation, to mention just a few things!

Physician response can augment your prehospital care and bring life-saving procedures right to the patient. Check it out!

MD1 is a fully-charity funded program, no patient or agency receives a bill; EVER. Check them out at:

www.md1program.org

The New Jersey EMS Fellowship:

https://emsfellowship.com

University of Pittsburgh EMS Fellowship:

https://www.emergencymedicine.pitt.edu/fellowships/ems-fellowship

Paper on the impact of EMS Physicians on OHCA:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706668/

EMS Physicians on decision making at scenes:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492931/

A couple items on the use of fresh whole blood in field resuscitation:

https://prolongedfieldcare.org/wp-content/uploads/2015/08/75th-rangers-norsof-tactical-damage-control-resuscitation-july-2015.pdf

https://www.emra.org/emresident/article/group-o-whole-blood/

Here’s evidence that shows interruption of compressions for any reason has a negative impact on patient survival:

https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.115.014016

Episode 44: Our Cric Show

Episode 44: Our Cric Show

Ed Bauter
FOAMed, Medicine, Airway Management

We talk about a wide variety of all things cricothyroidotomy: mental prep and training, the difference in the techniques that are out there, which one might work better, and lots of other stuff. We also shoutout to a LOT of other resources that will help you to really understand this low frequency, but critical procedure.

If this is in your scope of practice; or possibly in a situation where a clinician will use this; you need to know about this to be able to care for your patient.

Dr. Rich Levitan’s website:

https://www.airwaycam.com

Dr. Scott Weingart’s website:

https://emcrit.org

The EMCrit podcast can be found on iTunes (just like us!)…it’s one of the best around with literally hundreds of topics!

SMACC was an amazing prehospital/emergency/and critical care conference that changed how many of us looked at conferences and learning. Check out their stuff here:

https://smacc.net.au/blog/

New England Journal of Medicine paper on comparing cric techniques:

https://www.jwatch.org/em200503300000002/2005/03/30/open-cricothyroidotomy-vs-seldinger-technique

Here’s the case study about the NG tube going into the spinal column…

https://www.sciencedirect.com/science/article/abs/pii/S0196070911000755

Episode 39: The National Registry

Episode 39: The National Registry

Daniel Schwester
Medicine, Controversy

The National Registry…what is it, and why should it matter to you? As the only national organization of credentialing in the USA, the guidelines and structure they use has a huge impact on your license or certification.

We dig into the Overrun vault to find this episode….let us know what YOU think!

Is NREMT the be-all, end-all solution; or can it be improved to be a truly national licensing standard? We look at the strengths and weaknesses, and what we would like to see from the NREMT!

The National Registry of EMTs is at:

https://www.nremt.org/rwd/public

Episode 36-Sepsis and Prehospital Care

Episode 36-Sepsis and Prehospital Care

Daniel Schwester
Medicine, FOAMed

Ed, Jess, and Dan discuss where we've been with sepsis, where we are, and maybe where we're going. Fluids, pressers, scoring....there's a LOT of information out there, and we try to sort through it for you

The Early Goal-Directed Therapy paper from 2001:

https://www.nejm.org/doi/full/10.1056/NEJMoa010307

Listen to Dr. Weingart (@emcrit) tale with the author himself in a two-part interview:

Podcast 054 – Dr. Rivers on Severe Sepsis – Part I

https://emcrit.org/emcrit/rivers-sepsis-i/

Copy and paste this URL into your WordPress site to embed

Podcast 055 – Dr. Rivers on Severe Sepsis – Part II

https://emcrit.org/emcrit/rivers-sepsis-ii/

Center for Disease Control sepsis information:

https://www.cdc.gov/sepsis/clinicaltools/index.html

Dutch PHANTASi trial:

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(17)30469-1.pdf

Episode 35-The Last Frontier with Dave Aromin

Episode 35-The Last Frontier with Dave Aromin

Daniel Schwester
FOAMed, Interview, Medicine

Dan sits down with flight paramedic Dave Aromin to discuss the amazing state of Alaska, and the challenges of providing emergency and retrieval care to the largest state. We discuss the logistics involved in his area, the unique clinical practice involved, and the people who take on this role in one of the most unforgiving environments in the United States and the world.

The EMS community in Alaska suffered a huge blow with the loss of a Guardian Flight fixed-wing crew on January 29, 2019, when their aircraft crashed and all aboard, including a patient were lost. There has been memorial and scholarship funds established for the families of the Guardian Flight crew, and they can be found at the following links:

https://www.customink.com/fundraising/guardianflightalaska


https://www.echoheliops.org/stacie-morse-education-scholarship

This episode is presented in the memories of:

Pilot Patrick Coyle

Flight Paramedic Margaret Langston

Flight Nurse Stacie Rae Morse

and the patient who they were caring for on their last mission.

Episode 30-Mental Health and Heroism

Episode 30-Mental Health and Heroism

Daniel Schwester
Medicine

The gang goes back to mental health, and post-traumatic stress. Anna takes the lead in discussing the FIRST program for clinicians to address and work with stress on the job.

We discuss the idea of heroism, the concept of "toxic heroism", and maybe how we should look at honor, rather than being a "hero" as a way to move forward in the profession.

There's also random comments about being generally maladjusted, as only we can do...

Check out Yoga for First Responders here:

www.yogaforfirstresponders.org

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