9 episodes

The Paramedic Practitioner provides high-quality medical education for prehospital providers through podcasts and website content.

The Paramedic Practitioner Andrew Merelman

    • Science
    • 4.9, 42 Ratings

The Paramedic Practitioner provides high-quality medical education for prehospital providers through podcasts and website content.

    Altered Airways – A dive into asthma and COPD – Part II

    Altered Airways – A dive into asthma and COPD – Part II

    This is Part II of my discussion with Michael Perlmutter on asthma and COPD management. In this episode we discuss interventions used for advanced/severe asthma exacerbations including magnesium, epinephrine, ketamine, non-invasive positive pressure ventilation, and advanced airway management.




    Facebook: https://www.facebook.com/paramedicpractitioner/ Instagram: @paramedicpractitioner Email: amerelman@gmail.com Twitter: @amerelman




    Image: PulmCrit



    References and Further Reading UpToDatehttps://emedicine.medscape.com/article/296301-overview https://canadiem.org/management-of-severe-asthma/ http://www.emdocs.net/critical-asthma-patient-pearlspitfalls-of-management/ https://rebelem.com/rebelcast-crashing-asthmatic/ https://emcrit.org/ibcc/asthma/ https://asthma.net/treatment/prevention/ https://www.jems.com/2018/04/01/a-modern-approach-to-basic-airway-management/ https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-6723.2009.01195.x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157154/ https://err.ersjournals.com/content/22/129/227.full https://www.ncbi.nlm.nih.gov/books/NBK430901/ https://www.ncbi.nlm.nih.gov/pubmed/11406055 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743582/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434661/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169834/ https://www.ncbi.nlm.nih.gov/pubmed/23235634 https://www.ncbi.nlm.nih.gov/pubmed/22479740 https://www.ncbi.nlm.nih.gov/pubmed/26033128 https://www.ncbi.nlm.nih.gov/pubmed/25447559 https://www.ncbi.nlm.nih.gov/pubmed/27289336 a

    Altered Airways – A dive into asthma and COPD – Part I

    Altered Airways – A dive into asthma and COPD – Part I

    In this two-part series I discuss asthma and COPD. These diseases are complex and have a spectrum of severity and presentation. The sickest of these patients require prompt, aggressive care to prevent further deterioration so a thorough understanding of the disease is essential. Michael Perlmutter, flight/critical care paramedic and medical student, joins me for a great conversation on prehospital management of these diseases. This is Part I which covers pathophysiology, diagnosis, and early management. Part II will be released in a couple weeks and will cover treatments used in our more critical patients and advanced stages of exacerbations. As always, please follow us on our various social media accounts and let me know if you have any questions, feedback, or personal experiences to share.




    Note: in the podcast at one point I say ipratropium and tiotropium are muscarinics but they are muscarinic antagonists.




    Facebook: https://www.facebook.com/paramedicpractitioner/ Instagram: @paramedicpractitioner Email: amerelman@gmail.com Twitter: @amerelman




    Below are some quick guides to home management of asthma and COPD. The treatment approaches between the two diseases vary. One of the biggest differences is that asthma patients are started on inhaled steroids relatively early in their progression but if you see a patient with COPD on an inhaled steroid, they are likely late in their disease process. By looking at a patient’s home medications you can infer some information about the severity and pathophysiology of their underlying disease.












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    SVT is Not a Rhythm

    SVT is Not a Rhythm

    http://www.cmaj.ca/content/188/17-18/E466



    Mechanism of Slow-Fast AVNRThttp:// https://litfl.com/supraventricular-tachycardia-svt-ecg-library/



    AVNRT versus AVRThttp:// https://litfl.com/supraventricular-tachycardia-svt-ecg-library/



    Sinus tachycardia with P waves at the end of the T-wave. Theses can be less obvious and the EKG can be mistaken for AVNRT or AVRThttp:// https://litfl.com/sinus-tachycardia-ecg-library/



    img src="https://www.paramedicpractitioner.net/wp-content/uploads/2019/10/5-1024x561.jpg" alt="" class="wp-image-2250" srcset="https://www.paramedicpractitioner.net/wp-content/uploads/2019/10/5.jpg 1024w, https://www.paramedicpractitioner.net/wp-content/uploads/2019/10/5-300x164.jpg 300w, https://www.paramedicpractitioner.net/wp-content/uploads/2019/10/5-768x421.jpg 768w, https://www.paramedicpractitioner.net/wp-content/uploads/2019/10/5-500x274

    How We Make Easy Airways Hard – Part 2

    How We Make Easy Airways Hard – Part 2

    This is part 2 of a 2 part series called “how we make easy airways harder”. In this episode I focus on improving endotracheal intubation and avoiding common errors that make airway interventions less likely to be successful.




    Airway Checklist Examples















    Anything worse than grade 2a is ideally managed using a bougie. Image: nurse-anesthesia.com



    Grade 3a should be optimized if possible but can usually be managed using a bougie. Grade 3b cannot be intubated and must be optimized.



    Reference:
    EMCrit Checklist page
    SALAD Airway
    Rich Levitan on epiglottoscopy
    Video discussion

    How We Make Easy Airways Hard – Part 1

    How We Make Easy Airways Hard – Part 1

    This is part 1 of a 2 part series called “how we make easy airways harder”. In this episode I focus on improving basic airway skills and avoiding common errors that make airway interventions less likely to be successful.




    Ear-to-sternal-notch positioning



    Patient sitting upright with ear-to-sternal notch positioning. Known as back up, head elevated (BUHE)







    The ideal mask seal using a BVM. The index and middle fingers pull the mandible forward maintaining airway patency.



    Reference:
    A Modern Approach to Basic Airway Management
    Bougie and Positioning
    Simulation Scenario Resource
    DuCanto Suction Catheter
    Deep Survival Book
    Khandelwal N, Khorsand S, Mitchell SH, Joffe AM. Anesth Analg. 2016 Apr;122(4):1101-7. doi: 10.1213/ANE.0000000000001184.

    Turner JS, Ellender TJ, Okonkwo ER, Stepsis TM, Stevens AC, Sembroski EG, Eddy CS, Perkins AJ, Cooper DD. Am J Emerg Med. 2017 Jul;35(7):986-992. doi: 10.1016/j.ajem.2017.02.011. Epub 2017 Feb 5.

    Turner JS, Ellender TJ, Okonkwo ER, Stepsis TM, Stevens AC, Eddy CS, Sembroski EG, Perkins AJ, Cooper DD. Intern Emerg Med. 2017 Jun;12(4):

    Traumatic Cardiac Arrest

    Traumatic Cardiac Arrest

    In this episode I discuss prehospital management of
    traumatic cardiac arrest, broken into penetrating and blunt. In recent years
    the pendulum has swung away from a nihilistic approach towards one that
    maximizes outcomes in the highest number of patients. This requires taking a
    standardized, aggressive approach when treating viable patients with traumatic arrest.
    In penetrating traumatic arrest, addressing reversible causes based on the
    location of the injury is essential. This primarily means hemorrhage control
    and volume restoration (ideally with blood products). It may also mean chest
    decompression (ideally with finger thoracostomy) for treatment of pneumothorax
    or hemothorax.




    In blunt arrest it is more difficult to determine an
    underlying cause of arrest so a rehearsed, pre-planned “bundle” of care
    directed at reversible causes should be delivered early. Chest compressions
    should not be expected to be effective until volume is restored or tension
    physiology is reversed. This approach is attributed by most people to Dr. John Hinds.




    Primary interventions include:




    Aggressive control of external hemorrhage.Maintenance of airway and ensuring oxygenation,
    ideally with intubationDecompression of both sides of the chest,
    ideally with finger thoracostomy but needle thoracostomy at minimumApplication of a pelvic binderReduction of all long bone fractures







    References


    Scott Weingart. EMCrit Podcast 135 – Trauma Thoughts with John Hinds. EMCrit Blog. Published on October 19, 2014. Accessed on May 24th 2019. Available at [https://emcrit.org/emcrit/trauma-thoughts-john-hinds/ ].

    Traumatic cardiac arrest: a unique approach.
    Harris T, Masud S, Lamond A, Abu-Habsa M.
    Eur J Emerg Med. 2015 Apr;22(2):72-8. doi: 10.1097/MEJ.0000000000000180. Review.

    Konesky KL, Guo WA.
    Eur J Trauma Emerg Surg. 2018 Dec;44(6):903-908. doi: 10.1007/s00068-017-0875-6. Epub 2017 Nov 25.

    Escutnaire J, Genin M, Babykina E, Dumont C, Javaudin F, Baert V, Mols P, Gräsner JT, Wiel E, Gueugniaud PY, Tazarourte K, Hubert H; on behalf GR-RéAC.
    Resuscitation. 2018 Oct;131:48-54. doi: 10.1016/j.resuscitation.2018.07.032. Epub 2018 Jul 27.

    Evans CC, Petersen A, Meier EN, et al. Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81(2):285–293. doi:10.1097/TA.0000000000001070



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Customer Reviews

4.9 out of 5
42 Ratings

42 Ratings

Gerads ,

fantastic #foamed resource

As a physician (internist) and I found this to be a wonderful resource and great review. Really great content that keeps my mind engaged at the gym. Binged through all of the episodes- can’t wait for more!
Gerald @ GrepMed

bizzy522 ,

Great stuff

My favorite podcast! Keep it up guys.

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Outstanding

One of the best podcasts out there!

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