Kmedic82

An excellent read by FOAMFrat. An introduction to fluid resuscitation and cautions there of. https://www.foamfratblog.com/post/the-sodium-trap?fbclid=IwAR2dwx-AvRSw8gBB1GyPpl_Rwp2c-HeAc3-k6wkmxZ5jTFIioAjA9jSmrfY_aem_AcRQYH3b3e3NdPGZHu20QhrQnf7RGfqFKEh7PwwGIFcvOALtfrFuWkUV2uvPLy3exw9EHKNaxVvuCFKp1IMEiB2WHZSMmKFHfHCkdFHKwweZSw View the full article

This podcast is a panel discussion from providers in Australia. Their EMS sounds like light years ahead of where I work. They utilize blood products, plasma, and can activate a trauma OR. It’s amazing to hear what other places are doing. Especially when you feel lost in your own career and wish to see your service progress. Please give it a listen and tell me what you think! TLDR (or didn’t listen): lives can be saved if all departments work together! RAGE Podcast – Resuscitology: Bleeding Patients View the full article

Advanced airways in EMS are in heated debate today. There are two extremes. Give it or cut it. Some medical directors are granting crews RSI (rapid sequence intubation) in the field. While others are cutting intubation as a whole and utilizing devices like the iGel. There are so many combinations of medications you can use for induction in a chemically assisted intubation. The one that was recently brought to my attention was Ketamine. Ketamine has been a wonder drug in EMS. It has been beneficial in taking down the giant muscled bound tweeker that’s fighting a gaggle of police officers. It is excellent in pain management. But, as an induction agent in intubation it has been scrutinized highly as there is a lot of complications that come with a wonder drug. This paper discusses some of those complications. Ketamine lost in the unfair fight against RSI. There were too many variables including spontaneous breathing and vomiting. Take a look for yourself! Click to access Driver-Ketamine-Only.pdf View the full article

Let’s talk about TXA and brain injuries. Maybe we can put to rest the suspicion that TXA creates further injury in patient’s with a TBI. TXA is an amazing tool to use for our trauma patients. There has been so much success TXA that there are trials to see how effective it is for GI bleeds. As with most medications new to a service (mine has had standing orders on TXA for about a year), there are always questions and concerns. One that continually comes forward is, “does TXA create further harm in a patient with a brain injury?” Curious and in an effort to self educate, I searched and found an article on my favorite blog, EMcrit. The CRASH studies were used to see the effectiveness of TXA and the trauma patient. The CRASH 3 study was specifically a sub study for the TBI patient. It was ran as a pragmatic study. Meaning, it was a non-controlled atmosphere and based in a real life setting with unpredictable variables. Much like a bad trauma patient. “CRASH-3 was designed to further investigate using tranexamic acid for patients with traumatic brain injury. This study utilized the following inclusion criteria: Enrollment within hours of injury Either Glasgow Coma Scale <13 or intracranial hemorrhage on CT scan No major extracranial bleeding This was a massive, pragmatic, double-blind RCT involving 175 hospitals in 29 countries, with a target enrollment of 10,000 patients. Patients were randomized to receive either saline or tranexamic acid (1 gram loading dose over 10 minutes followed by a second gram infused over the following 8 hours; this is the same regimen used in CRASH-2). The primary endpoint was head injury-related death in the hospital within 28 days of injury.” The utilized saline as the placebo versus TXA. The results showed a reduced mortality rate in patient’s with non-severe TBIs. With an emergency room study such as this, the results were “not statistically significant.” The criteria for a TBI patient is vast. There are too many complications. What proceeded forward was the need to take out the obviously brain dead patients (GCS>9 and fixed pupils). The severe TBI patients would not benefit from TXA just due to the impact of their injury. More severe, the less of a chance of effectiveness. Now, the mildly injured patient’s proved effective. There was a significant increase in the decrease of mortality with in 28 days of the patients who received TXA while suffering from a brain injury. To receive the proper and fair outcome, it was just a matter realizing that some patients were too sick to save. “ Subgroup analysis shows benefit from tranexamic acid among patients with a greater hope of recovery. Specifically, tranexamic acid reduced head injury-related death in the subgroup of patients with GCS>8 and also the subgroup of patients with reactive pupils.” What were the take away and conclusions of the study? “The conclusion of this article sums things up nicely: “tranexamic acid is safe in patients with TBI and treatment within 3 hours of injury reduces head injury-related death. Patients should be treated as soon as possible after injury.” The greatest strength of this study might be an extremely thorough evaluation for possible adverse events among 12,639 patients. Tranexamic acid was found to be safe, without increased rates of any adverse events (including thrombosis, seizure, and stroke). The primary endpoint of this study was technically negative (p-value slightly above 0.05). This likely reflects the inclusion of moribund patients, who diluted out the signal of benefit from tranexamic acid. Numerous subgroup analyses indicate that among patients with a greater hope of recovery, tranexamic acid is beneficial (figure below). As a statistical rebel, I would consider this trial to be positive, despite having a technically negative primary endpoint.” Check out the article at; https://emcrit.org/pulmcrit/crash3/ View the full article

Let’s talk about TXA and brain injuries. Maybe we can put to rest the suspicion that TXA creates further injury in patient’s with a TBI. TXA is an amazing tool to use for our trauma patients. There has been so much success TXA that there are trials to see how effective it is for GI bleeds. As with most medications new to a service (mine has had standing orders on TXA for about a year), there are always questions and concerns. One that continually comes forward is, “does TXA create further harm in a patient with a brain injury?” Curious and in an effort to self educate, I searched and found an article on my favorite blog, EMcrit. The CRASH studies were used to see the effectiveness of TXA and the trauma patient. The CRASH 3 study was specifically a sub study for the TBI patient. It was ran as a pragmatic study. Meaning, it was a non-controlled atmosphere and based in a real life setting with unpredictable variables. Much like a bad trauma patient. “CRASH-3 was designed to further investigate using tranexamic acid for patients with traumatic brain injury. This study utilized the following inclusion criteria: Enrollment within hours of injury Either Glasgow Coma Scale <13 or intracranial hemorrhage on CT scan No major extracranial bleeding This was a massive, pragmatic, double-blind RCT involving 175 hospitals in 29 countries, with a target enrollment of 10,000 patients. Patients were randomized to receive either saline or tranexamic acid (1 gram loading dose over 10 minutes followed by a second gram infused over the following 8 hours; this is the same regimen used in CRASH-2). The primary endpoint was head injury-related death in the hospital within 28 days of injury.” The utilized saline as the placebo versus TXA. The results showed a reduced mortality rate in patient’s with non-severe TBIs. With an emergency room study such as this, the results were “not statistically significant.” The criteria for a TBI patient is vast. There are too many complications. What proceeded forward was the need to take out the obviously brain dead patients (GCS>9 and fixed pupils). The severe TBI patients would not benefit from TXA just due to the impact of their injury. More severe, the less of a chance of effectiveness. Now, the mildly injured patient’s proved effective. There was a significant increase in the decrease of mortality with in 28 days of the patients who received TXA while suffering from a brain injury. To receive the proper and fair outcome, it was just a matter realizing that some patients were too sick to save. “ Subgroup analysis shows benefit from tranexamic acid among patients with a greater hope of recovery. Specifically, tranexamic acid reduced head injury-related death in the subgroup of patients with GCS>8 and also the subgroup of patients with reactive pupils.” What were the take away and conclusions of the study? “The conclusion of this article sums things up nicely: “tranexamic acid is safe in patients with TBI and treatment within 3 hours of injury reduces head injury-related death. Patients should be treated as soon as possible after injury.” The greatest strength of this study might be an extremely thorough evaluation for possible adverse events among 12,639 patients. Tranexamic acid was found to be safe, without increased rates of any adverse events (including thrombosis, seizure, and stroke). The primary endpoint of this study was technically negative (p-value slightly above 0.05). This likely reflects the inclusion of moribund patients, who diluted out the signal of benefit from tranexamic acid. Numerous subgroup analyses indicate that among patients with a greater hope of recovery, tranexamic acid is beneficial (figure below). As a statistical rebel, I would consider this trial to be positive, despite having a technically negative primary endpoint.” Check out the article at; https://emcrit.org/pulmcrit/crash3/ View the full article

My AHA BLS quiz application was just released on Android. Check it out! https://play.google.com/store/apps/details?id=com.wBLSQuiz2019_9477418 View the full article

My AHA BLS quiz application was just released on Android. Check it out! https://play.google.com/store/apps/details?id=com.wBLSQuiz2019_9477418 View the full article

2,000 law suits and appeals have been pushed forward against Johnson and Johnson. The state of Oklahoma has started proceeding in regards to damages done to the state. As stated in the New York Times; ” Oklahoma had said it would need $17 billion to repair the damage done by the epidemic. About 6,000 Oklahomans have died from opioid overdoses since 2000, according to officials there.” It is about time some one has step forward and pursued dealers in this rich man drug war! View the full article

2,000 law suits and appeals have been pushed forward against Johnson and Johnson. The state of Oklahoma has started proceeding in regards to damages done to the state. As stated in the New York Times; ” Oklahoma had said it would need $17 billion to repair the damage done by the epidemic. About 6,000 Oklahomans have died from opioid overdoses since 2000, according to officials there.” It is about time some one has step forward and pursued dealers in this rich man drug war! View the full article

There was a time I was burnt out. Well, that’s not exactly true. There was a time that every three months I was burnt to the core. I wanted to quit. I wanted to go to nursing school. Hell, I even put in an application to Fed Ex. Unfortunately, there was one time that my burn out led to injuring a patient. You see, I was burning the candle from all ends. I was going through a terrible separation with a woman who had two kids I cared for and adored. I was a supervisor of a shift that was falling apart. I worked nights, went to school during the day, and had to attend meetings in the mid afternoon (peak night shift sleep hours). I turned into the medic who would blow up about too many gloves being on the truck. Trash cans would fly across the bay floor after a mighty frustrated kick. Mop handles would shatter on the side of the ambulance like I was swinging a samurai sword. My off shift drinking was constant. My anger was out of control and would occasionally come out on a patient. My refusal numbers were rising and the end of the road was coming closer. One morning, my partner and I were called out to a patient complaining of abdominal pain. Before the call even came in, we were in the mood that this patient was going to be a refusal. We were both exhausted from outside life and had no intention of transporting. We were a dangerous crew that had lost all interest in their job. We wanted to be anywhere except on the ambulance. We arrived at the home of the patient and in all honesty, I barely remember the call. I am sure I talked her out of going. I probably made her feel stupid for calling 911. I probably took the anger of my personal life out on her. The only thing I remember was waking up in the afternoon to numerous missed calls from members of our upper leadership. The patient ended up have a ruptured appendix and was rushed to surgery after another crew, an hour after we left the residence, did their job and transported the patient. I was close to being fired. I was close to losing my license. I was having the biggest wake up call in not only my career, but my life. I hurt someone. Yes. She signed the refusal AMA form. But at what cost? And with how much encouragement? I like to share my mistakes for others to learn from. Burn out is dangerous. Burn out hurts patients. In the paper posted on Medium, the greatest cure for burn out is to regain the awe of your job, or life. “If this path to burn out is, as Aldous Huxley wrote, ‘a reducing valve’ of awareness, it’s awe that helps to open us back up. Dacher Keltner, a professior of psychology at the University of California, Berkeley, has shown that awe is tied directly to feeling of expansiveness, transcendence, and connection.” I was working too much OT and my personal life was falling apart. I had to make huge changes in my life, step down from positions, say no to projects, and budget my spending so I could say no to OT shifts. I stepped down as supervisor (surprisingly, I didn’t get demoted) and transferred myself to a county known to be strict. I wanted to remind myself why I not only got into the field, but to also get back to the basics of patient care. I was not taking care of people and most of all, I was not taking care of myself. My love for the job came with helping people. Where did my love for care go? My personal life was spiraling out of control and I was not feeding myself creatively. My tank for the awe was ran dry. “Awe doesn’t just shift the way we think, it changes our biology. According to a 2015 study in the journal Emotion, awe, more than any other positive feeling, is linked to lower loves of a molecule called Interleukin-6, which is associated with stress and inflammation.” The awe for the job came back when I chose to learn again. There is something to learn every shift. You just have to look for it. Even if I haven’t taken the chance to learn about something, I enjoy creating hilarious back stories for patient’s and their family. Everyone has a story. “Perspective allows me to see that ‘my’ world is tiny when compared to the actual world. I feel more open and energetic, and less burnt out.” It’s all about perspective and reminding myself why I got into the job in the first place. It’s the greatest way to help someone and it’s so damn interesting. Check out the article; “The natural cure for burnout is profound and utter awe” by Brad Stulberg on the site Medium. View the full article

There was a time I was burnt out. Well, that’s not exactly true. There was a time that every three months I was burnt to the core. I wanted to quit. I wanted to go to nursing school. Hell, I even put in an application to Fed Ex. Unfortunately, there was one time that my burn out led to injuring a patient. You see, I was burning the candle from all ends. I was going through a terrible separation with a woman who had two kids I cared for and adored. I was a supervisor of a shift that was falling apart. I worked nights, went to school during the day, and had to attend meetings in the mid afternoon (peak night shift sleep hours). I turned into the medic who would blow up about too many gloves being on the truck. Trash cans would fly across the bay floor after a mighty frustrated kick. Mop handles would shatter on the side of the ambulance like I was swinging a samurai sword. My off shift drinking was constant. My anger was out of control and would occasionally come out on a patient. My refusal numbers were rising and the end of the road was coming closer. One morning, my partner and I were called out to a patient complaining of abdominal pain. Before the call even came in, we were in the mood that this patient was going to be a refusal. We were both exhausted from outside life and had no intention of transporting. We were a dangerous crew that had lost all interest in their job. We wanted to be anywhere except on the ambulance. We arrived at the home of the patient and in all honesty, I barely remember the call. I am sure I talked her out of going. I probably made her feel stupid for calling 911. I probably took the anger of my personal life out on her. The only thing I remember was waking up in the afternoon to numerous missed calls from members of our upper leadership. The patient ended up have a ruptured appendix and was rushed to surgery after another crew, an hour after we left the residence, did their job and transported the patient. I was close to being fired. I was close to losing my license. I was having the biggest wake up call in not only my career, but my life. I hurt someone. Yes. She signed the refusal AMA form. But at what cost? And with how much encouragement? I like to share my mistakes for others to learn from. Burn out is dangerous. Burn out hurts patients. In the paper posted on Medium, the greatest cure for burn out is to regain the awe of your job, or life. “If this path to burn out is, as Aldous Huxley wrote, ‘a reducing valve’ of awareness, it’s awe that helps to open us back up. Dacher Keltner, a professior of psychology at the University of California, Berkeley, has shown that awe is tied directly to feeling of expansiveness, transcendence, and connection.” I was working too much OT and my personal life was falling apart. I had to make huge changes in my life, step down from positions, say no to projects, and budget my spending so I could say no to OT shifts. I stepped down as supervisor (surprisingly, I didn’t get demoted) and transferred myself to a county known to be strict. I wanted to remind myself why I not only got into the field, but to also get back to the basics of patient care. I was not taking care of people and most of all, I was not taking care of myself. My love for the job came with helping people. Where did my love for care go? My personal life was spiraling out of control and I was not feeding myself creatively. My tank for the awe was ran dry. “Awe doesn’t just shift the way we think, it changes our biology. According to a 2015 study in the journal Emotion, awe, more than any other positive feeling, is linked to lower loves of a molecule called Interleukin-6, which is associated with stress and inflammation.” The awe for the job came back when I chose to learn again. There is something to learn every shift. You just have to look for it. Even if I haven’t taken the chance to learn about something, I enjoy creating hilarious back stories for patient’s and their family. Everyone has a story. “Perspective allows me to see that ‘my’ world is tiny when compared to the actual world. I feel more open and energetic, and less burnt out.” It’s all about perspective and reminding myself why I got into the job in the first place. It’s the greatest way to help someone and it’s so damn interesting. Check out the article; “The natural cure for burnout is profound and utter awe” by Brad Stulberg on the site Medium. View the full article

My PALS study app went live today for Android. If you are getting ready to take PALS, check it out. https://play.google.com/store/apps/details?id=com.wPALSQuiz2019_9326200 PALS Study Quiz 2019 I am new to developing and plan on making more. I would like some constructive criticism!

My new PALS study app just went live today! If you are an android and getting ready to take PALS, check it out! https://play.google.com/store/apps/details?id=com.wPALSQuiz2019_9326200 View the full article

My new PALS study app just went live today! If you are an android and getting ready to take PALS, check it out! https://play.google.com/store/apps/details?id=com.wPALSQuiz2019_9326200 View the full article