Critical Levels Critical Levels

“No statistical difference”
On today’s episode of Critical Levels, we chat with Dr. Ken Milne of the Skeptics’ Guide to Emergency Medicine (https://thesgem.com; @thesgem).
We start with a high-level discussion and literature and evidence, and then apply these concepts to ‘lyse’ and ‘bust’ some of the predominate prehospital myths.
Find links to the primary literature on our website.
We examine:
2:00 - The importance of primary literature
4:10 - Why? 
10:10 – Literature, critically appraising articles, & levels of evidence
13:20 – Evidence Based Medicine
17:30 – Guidelines & Protocols
22:22 – Epinephrine in Cardiac Arrest
28:30 – Sodium Bicarbonate in Cardiac Arrest
32:10 – Advanced Airways
36:10 – “Treat the patient, not the monitor”
42:05 – TTM (Targeted Temperature Management)
48:22 – “Be Skeptical”
51:15 – TBI Management/TXA
61:05 – Final Thoughts
 

Paramedics receive little education on grief and bereavement. As paramedicine integrates palliative approaches to care, it has become very apparent paramedics are under-prepared for the crucial role they play in supporting patients and families in grief and recognizing and responding to their own grief reactions.
In this episode we talk to Cheryl Cameron and Tyne Lunn about how paramedicine is evolving to include the provision of palliative care. We start by defining palliative care and talk about how paramedics are well positioned to support patients with palliative care needs, already seeing this patient population in our routine 911 caseload, but needs to do better to align the care we provide with people’s wishes.
·      MyGriefToolbox as one strategy and tool to address gaps in education/supports for paramedics
·      Scale and spread of this approach across Canada
·      Importance of person, family and caregiver centered approach
·      Psychosocial support, system navigation, and compassion can be provided by all levels of paramedics
·      De-bunking some myths about providing palliative care
They’ll introduce us to MyGriefToolbox, a set of free resources that have been developed in collaboration with Canadian Virtual Hospice to support paramedics as we provide a palliative care approach and psychosocial support to grieving individuals, families, and caregivers.
 

On today’s episode, we carry on last month’s conversation about cardiac arrest management and care. 
 
Recorded at the Paramedicine Across Canada Expo (PACE) Conference in Saskatoon in September 2022, we’re sitting down with Mike Humphrey and Adam Perrett of Lethbridge Fire and Emergency Services to talk about how they’ve revolutionized the care provided to the citizens of Lethbridge, Alberta. 
 
We walk through how they train, evaluate, and feedback data with respect to cardiac arrests; how they use a culture of excellence to deliver high performance CPR leading to improved ROSC rates; and they use real time data to track opiate overdoses in their community.  

On today's episode, we chat with Dr. Sheldon Cheskes, principal investigator of the landmark DOSE VF trial. 
In this study, published in the New England Journal of Medicine, Dr. Cheskes and his team wanted to evaluate DSED and VC defibrillation as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest.
In this episode, we walk through the study design, methodology, results, and perhaps most importantly, critically appraise the study to see how it works in the real world!
Timestamps:
02:48: Dr. Cheskes Intro
06:15: Study Intro
16:45: Patients
18:18: Intervention – Vector Change
25:45: Intervention – DSED
37:12: Comparison/Outcome
40:23: Results
54:15: Critical Appraisal

Pain is a condition that we often see in the prehospital world, yet for a variety of reasons, we're bad at treating it.
On today's episode with pain expert Dr. Samina Ali, we go through what pain is, pain assessment, barriers to providing analgesia, and then discuss how we actually treat pain, using both non-pharmacologic and pharmacologic interventions

Join us this month as we chat with Dr. Simon Hatcher, psychiatrist at the Ottawa Hospital and Ottawa Inner City Health, about First Responder Mental Health
 
Who gets PTSD, what’s the pathway/differences to mental health professionals, how do we heal, and how do we get people back to work are all topics we cover, plus more!