Prehospital And Retrieval Medicine podcast

#Emergency Medicine #Prehospital #Care #Trauma #Flight #Retrieval #Minh Le Cong, MD #Minh Le Cong #Science #Medicine #EMS #Critics #Paramedics #Nursing

22:42

We are here recording live at Medallia Experience at the Wynn in Las Vegas, and have been seeing and hearing some amazing things about how AI can enhance the customer experience as well as enable teams at organizations to create more meaningful connections with customers. Today we’re going to talk about how AI can help to create better experiences for customers before, during, and after their interactions. To help me discuss this topic, I’d like to welcome Fabrice Martin, Chief Product Officer at Medallia. RESOURCES Medallia: https://www.medallia.com Catch the future of e-commerce at eTail Boston, August 11-14, 2025. Register now: https://bit.ly/etailboston and use code PARTNER20 for 20% off for retailers and brands Don't Miss MAICON 2025, October 14-16 in Cleveland - the event bringing together the brights minds and leading voices in AI. Use Code AGILE150 for $150 off registration. Go here to register: https://bit.ly/agile150 Connect with Greg on LinkedIn: https://www.linkedin.com/in/gregkihlstrom Don't miss a thing: get the latest episodes, sign up for our newsletter and more: https://www.theagilebrand.show Check out The Agile Brand Guide website with articles, insights, and Martechipedia, the wiki for marketing technology: https://www.agilebrandguide.com The Agile Brand podcast is brought to you by TEKsystems. Learn more here: https://www.teksystems.com/versionnextnow The Agile Brand is produced by Missing Link—a Latina-owned strategy-driven, creatively fueled production co-op. From ideation to creation, they craft human connections through intelligent, engaging and informative content. https://www.missinglink.company…

Prehospital and Retrieval Medicine Podcast

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शृंखला होम•Feed

The aim of this podcast is to discuss and debate prehospital and retrieval medicine--its current practice and controversies. In many ways the philosophy espoused will be that of prehospital critical care. Whereas EMCrit brings upstairs care, downstairs; I aim to bring it out of the hospital. Many prehospital providers are doing this already.

76 एपिसोडस

Prehospital and Retrieval Medicine Podcast

203 subscribers

updated 5 years ago

साझा करें

शृंखला होम•Feed

76 एपिसोडस

#Emergency Medicine #Prehospital #Care #Trauma #Flight #Retrieval #Minh Le Cong, MD #Minh Le Cong #Science #Medicine #EMS #Critics #Paramedics #Nursing

All episodes

Prehospital and Retrieval Medicine Podcast

1
PHARM Podcast 226 A life on the line with Darren Hodge

5 years ago

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Hi folks! I chat to Flight MICA paramedic Darren Hodge about his new book : A Life on the Line Show notes: Links: info@darrenhodge.com Web: https://www.darrenhodge.com Podcast ( available here and on iTunes) https://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2019-11-22-238.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 223 Fear of flying in aeromedical retrieval and a dedication to Loretto Harvey

6 years ago

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The colleagues of Loretto Harvey, who died while competing in the Townsville Triathlon Festival last weekend say she was caring and selfless. The 50-year-old was well known for her nursing role at the Rural Flying Doctor Service. Report on 7NEWS at 6pm. #7NEWS pic.twitter.com/mVIhEwxPLk — 7NEWS Townsville (@7NewsTownsville) August 30, 2019 https://platform.twitter.com/widgets.js Hi folks , this episode dedicated to memory of a friend and nurse colleague Loretto Harvey . Show notes: Anxiety in adult fixed-wing air transport patients FEARFUL FLYERS INCREASING IN NUMBER: SURVEY Podcast ( available here and on iTunes) [https://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2019-08-30-235.mp3] Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 220 Prehospital intranasal ketamine analgesia

6 years ago

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UBC professor finds ketamine alleviates acute pain during ambulance rides – UBC Faculty of Medicine https://t.co/wQyU9JcNAZ — Minh Le Cong (@ketaminh) June 20, 2019 The Gene Benoit Hi folks! Show notes: Media coverage – ketamine for pain Prehospital Analgesia With Intranasal Ketamine (PAIN-K): A Randomized Double-Blind Trial in Adults Follow these authors of this paper on podcast on twitter @mededgene and @gandalfattoNV Podcast ( available here and on iTunes) https://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2019-06-22-232.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 218 The Women Doctors who fought to serve

6 years ago

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Vera Scantlebury (later Scantlebury-Brown) and Rachel Champion (later Shaw) were two of the first women graduates of the University of Melbourne Medical School. They are pictured here serving at London’s Endell Street Military Hospital, in WW1. Picture: Imperial War Museum . This image and contents of podcast are reproduced here under this Creative Commons licence Hi folks! A reading of an essay from University of Melbourne on Australian Women Doctors in World War One Show Notes: THE WOMEN DOCTORS WHO FOUGHT TO SERVE Podcast ( available here and on iTunes) https://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2019-05-01-230.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 175 Battlefield fluid resuscitation in 2017

8 years ago

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Hi folks on todays episode I discuss a recent paper in regard to battlefield analgesia Here’s the abstract: Fluid Resuscitation in Tactical Combat Casualty Care: Yesterday and Today Podcast ( available here and on iTunes) http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2017-06-20-183.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 146 CPR induced Consciousness with Matt Shepherd

9 years ago

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CPRIC-Health Professionals experience with this clinical presentation https://t.co/oNYF1Z5UdF @ketaminh @SASCONSULTPARA @AmbulanceVic — Matt Shepherd (@mattshep71) August 3, 2016 Hi folks, I chat to MICA paramedic Matt Shepherd on CPR induced conciousness. yes its a real thing and yes you should know what to do about it if it happens . Show notes: CPR-induced consciousness: A cross-sectional study of healthcare practitioners’ experience Cardiac arrest sedation – towards best practice with ketamine Case Study: Combative Cardiac Patient Podcast ( available here and on iTunes) http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2016-08-04-152.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM PODCAST 127: A ketamine protocol & intubation rates for psychiatric aeromedical retrieval

9 years ago

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Podcast ( available here and on iTunes) http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2015-11-12-131.mp3 Right Click and Choose Save-as to Download the Podcast. Show notes: Management of the acutely agitated patient in a remote location Management of patients with Acute Severe Behavioural Disturbance in Emergency Departments A Prospective Study of Ketamine versus Haloperidol for Severe Prehospital Agitaiton (7) The Use of Ketamine for Agitated Patients in the Prehospital Setting: A Systematic Review of the Literature (38) Use of Intranasal Ketamine for the Severely Agitated or Violent ED Patient A ketamine protocol & intubation rates for psychiatric aeromedical retrieval Minh Le Cong, MBBS, FRACGP, FACRRM, FARGP, GDRGP, GCMA, and Ian Humble, BSc MBChB Royal Flying Doctor Service, Mount Isa Base, Mount Isa, Queensland, Australia Cairns Hospital Emergency Department, Cairns, Queensland, Australia Address for correspondence: Minh Le Cong, MBBS, FRACGP, FACRRM, FARGP, GDRGP, GCMA, Royal Flying Doctor Service, Mount Isa Base, 11 Barkly Highway, Mount Isa, QLD, Australia 4825, mlecong@rfdsqld.com.au (This is the accepted manuscript to Air Medical Journal and available here under their licensing/authorship rights listed here . A free download link to the published article is available here until January 12th 2016 Abstract Objective The aeromedical transfer of psychiatric patients with acute agitation is a regular requirement in only a few countries, with ours (Australia) as one of them. The optimal strategy has yet to be well described, ranging from physical restraints to general anesthesia with endotracheal intubation. In an Australian aeromedical service, Royal Flying Doctor Service (RFDS), Queensland Section (QLD), rates of endotracheal intubation required for patient management were retrospectively compared prior to and following implementation of a ketamine sedation protocol for this patient population Methods A systematic retrospective review was performed, utilizing 9 years of data in the RFDS QLD electronic database (2004 – 2013). Coding for mental health as primary diagnosis and intubation were search criteria. Results A total of 1478 patients were transferred during the study period, with 44 requiring intubation. This equates to intubation rates of 3.5% prior to protocol utilization, compared to 2.3% following protocol implementation. Conclusion In an Australian aeromedical service, implementation of a ketamine sedation protocol for management of the acutely agitated patient requiring air transfer has reduced the number of intubations in this patient group. Introduction The aeromedical transfer of psychiatric patients with acute agitation is a regular requirement in only a few countries, with ours (Australia) as one of them. Sedation of the agitated patient in the course of aeromedical transport is challenging due to the high degree of agitation that may exist, the large doses of sedative medications that may have been used prior to transport, and the risks involved if inadequate sedation is achieved during the flight. The optimal sedation strategy for the air transport of psychiatric patients remains unclear. At times, this has resulted in starkly divergent approaches taken by aeromedical providers ranging from use of physical restraints, or refusal to transport at all, to tracheal intubation and general anesthesia with chemical paralysis. Many patients with acute agitation can be transported safely using conventional benzodiazepine therapy. There is, however, a small subset of agitated patients who do not respond adequately to these first line sedating agents, and who require urgent air transport to progress their mental health care. In this situation, the resort to intubation and general anesthesia has often occurred despite its attendant risks. The Queensland section of the Royal Flying Doctor Service of Australia has a total of 7 operational bases for aeromedical missions that cover an area the size of 1,852,642 km² – a combined territory equivalent to three times the land area of France. A population density of 2.70/km² means that long distance aeromedical retrieval is often warranted. It is not uncommon for transfer times of up to 3 hours with Far North Queensland. Rural and remote communities rely upon the Flying Doctor for emergency and primary health care. When these remote sites have any residential health services at all, they are generally small community health centres staffed by remote-area nurses and visited by RFDS medical staff for several days each week. These clinics are not staffed after-hours, except for emergencies, and have no facilities to deal with acute presentations of major psychotic disorders. The exceptions are the small rural hospitals, which have several doctors and an after-hours ward, but no facilities for the acute mentally disturbed patient and no secure areas. As a result, even a single presentation of a psychotic or suicidal patient places great strain on the local resources, especially if they require constant restraint and supervision after-hours. Due to safety concerns, nationwide guidelines require transfer of all involuntary high-risk mental health patients to a facility with inpatient specialist mental health teams . Annually, an average of 161 patients with a primary mental health diagnosis require aeromedical transfer for acute assessment and management. Where a patient is so acutely unwell that they are deemed a risk to themselves or others such that they require inpatient medical care or locked ward supervision, they are clearly a serious in-flight risk to aeromedical staff and the safety of the aircraft. Any patient that is deemed a risk to themselves or others such that they require transfer to a psychiatric facility is not, by definition, safe for travelling on an aircraft. As noted previously, management of these patients has varied greatly, up to and including intubation and chemical paralysis. A recent meta-analysis has shown pre-hospital RSI is associated with first pass success rate of 90%. Unsuccessful endotracheal tube insertion can result in significant morbidity and mortality, such as esophageal intubation, hypoxia, and cardiac arrest. If a strategy avoiding resort to tracheal intubation could be implemented safely in the aeromedical setting, this could potentially improve overall patient care. A ketamine sedation protocol was first introduced by Dr Minh Le Cong in Cairns RFDS Base in 2007. As a sedative of choice for prolonged pre-hospital psychiatric retrieval, ketamine has a number of unique advantages. The dissociative nature significantly reduces the in-flight risk to patient and staff. Long term review and more recent studies suggest that Ketamine may in fact be beneficial in acute suicidality and depression. Airway reflex retention and cardiopulmonary stability make this an ideal agent for use in austere environments with limited staff and possibly skill mix. A move towards pre-hospital RSI and procedural sedation has been advocated by a number of worldwide helicopter emergency medical services owing to the safety profile of Ketamine After publication of a case series of 19 retrievals without adverse event, the protocol was rolled out across Queensland in 2010. Uptake was greatest in Cairns, Mount Isa and Charleville. These bases are manned by both RFDS medical and nursing staff. The other bases employ RFDS retrieval specialist nurses and outsource medical assistance to other retrieval companies such as Careflight. Research Question We had 2 objectives: (1) to compare the incidence of tracheal intubation rates before and after introduction of a ketamine sedation protocol for psychiatric patients requiring aeromedical transfer, (2) to compare the number of intubated patients between RFDS bases. Methods Study design A retrospective analysis of the RFDS Queensland electronic database was performed, utilizing statistical data involving primary diagnosis of a mental health condition and the use of intubation and ventilation during aeromedical retrieval. Any patient coded with a primary mental health diagnosis, in accordance with the International Classification of Diseases version 10, regardless of age, was included. The study timeframe covered a nine year period from Jan 2004 to December 2013, allowing for review of 3 years historical data, prior to and following introduction of the ketamine sedation protocol. Ethics approval for the study was granted by the Queensland Health Human Research Ethics Committee (Cairns, Queensland, Australia). Those patients transferred that did not include a primary mental health diagnosis were excluded; for example, those intubated due to post-hanging airway obstruction resultant from their suicide attempt secondary to schizophrenia. Results A total of 1472 mental health patients were transported during the specified time period, a mean of 163 per year. Of these, 44 required intubation, or 4.9 per year. The total number requiring intubation was 44 or 3%. The breakdown and comparison of mental health (MH) patients transferred and the numbers requiring intubation can be found in Table 1. The table has been divided into pre and post protocol integration, with further delineation between bases that have resident RFDS doctors (Cairns, Mt Isa & Charleville) vs those without such doctors (Brisbane, Townsville, Rockhampton & Bundaberg). In the latter case, flight doctors are provided by Careflight Medical Services, working with RFDS flight nurses and pilots. Cairns RFDS base implemented the Ketamine sedation protocol in 2007. It has consistently performed the highest number of psychiatric related aeromedical retrievals in Queensland, followed by the other bases. Table 1: Mental Health Patients Requiring Intubation Pre and Post Implementation of Ketamine Sedation Protocol. Discussion To our knowledge, this is the largest review of ketamine sedation and tracheal intubation in mental health aeromedical retrievals to date. Prior to implementation of the ketamine sedation protocol, the Cairns Base intubated 6 of 164 patients, and post 2007 (implementation), intubation for safe transfer was required in 4 of 332 retrievals, reflecting a reduction from 3.6 % to 1.2 %. This trend was noted in other bases staffed by RFDS doctors (Mount Isa, Charleville) after the 2010 rollout of the ketamine package. Cairns, Mount Isa and Charleville intubated 11 (or 2.7%) of 411 patients transferred pre- 2010. Post 2010, 419 patients were retrieved, with intubation rates reduced to 4 of 419 patients (or 0.95%). Intubation rates have not changed in the bases without any resident RFDS doctors. , 18 of 414 patients transferred (or 4.3%) pre-protocol were intubated, while post-protocol, this actually rose to 11 intubations in 234 patients (4.7%). These bases are staffed with flight doctors from Careflight Medical Services, and adoption of the ketamine protocol was the slowest to be implemented in these bases. The other significant aspect of this study is for the first time ever to our knowledge, a statistical benchmark key performance indicator for psychiatric aeromedical retrieval care can be extrapolated from this data. Tracheal intubation as a means of patient restraint has no known published data regarding the aeromedical setting, although it is a frequently utilized method anecdotally. The data suggests that a benchmark percentage of 5% of all aeromedical patients with a primary mental health diagnosis, be considered as the threshold for flagging inappropriate or excessive use of such a restrictive means of patient care. This study also suggests that it is feasible to achieve a performance of less than 3% reliance upon tracheal intubation, using a standardized ketamine sedation protocol. Limitations of Study This electronic database required accurate coding of entries. It is possible that not all cases were coded correctly. We cannot establish causality from this type of study i.e. other reasons for reduction in intubation rates post protocol. For example, increased awareness and focus on improving sedation care may have resulted in higher rates of adequate preflight oral sedation, leading to reduced arousal prior to air transfer and hence reduced requirement for deep sedation and tracheal intubation. Recommendation and Implications for Emergency Medicine Ketamine sedation has been successfully implemented in a large aeromedical patient population, reducing the need for intubation by half in those managed by RFDS medical staff. Inter-hospital Emergency department transfer of acutely agitated patients using a ketamine sedation protocol should be considered. Conclusion This study has demonstrated that in our setting, the implementation of clear guidelines and a protocol-based approach can reduce the number of intubations required for aeromedical retrieval of the acutely agitated mental health patient. Further work Future study could examine complication rates over this same study period No competing interests are declared. This study has in part been funded by the Flying Doctor Retrieval Sedation Registry by RFDS QLD. Lahti AC, Warfel D, Michaelidis T, Weiler MA, Frey K, Tamminga CA. Long-term outcome of patients who receive ketamine during research. Biol Psychiatry. 2001 May 15;49(10):869-75. Murrough JW, Charney DS. Cracking the moody brain: lifting the mood with ketamine. Nat Med. 2010 Dec;16(12):1384-5. Ballard ED, Ionescu DF, Vande Voort JL, Niciu MJ, Richards EM, Luckenbaugh DA, Brutsché NE, Ameli R, Furey ML, Zarate CA Jr. Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety. J Psychiatr Res. 2014 Nov;58:161-6. Covvey JR, Crawford AN, Lowe DK. Intravenous ketamine for treatment-resistant major depressive disorder. Ann Pharmacother. 2012 Jan;46(1):117-23. Scheppke KA, Braghiroli J, Shalaby M, Chait R. Prehospital use of im ketamine for sedation of violent and agitated patients. West J Emerg Med. 2014 Nov;15(7):736-41. Jennings PA, Cameron P, Bernard S. Ketamine as an analgesic in the pre-hospital setting: a systematic review. Acta Anaesthesiol Scand. 2011 Jul;55(6):638-43. Bredmose PP, Lockey DJ, Grier G, Watts B, Davies G. Pre-hospital use of ketamine for analgesia and procedural sedation. Emerg Med J. 2009 Jan;26(1):62-4. Sibley A, Mackenzie M, Bawden J, Anstett D, Villa-Roel C, Rowe BH. A prospective review of the use of ketamine to facilitate endotracheal intubation in the helicopter emergency medical services (HEMS) setting. Emerg Med J. 2011 Jun;28(6):521-5. Mental Health Act 2000, http://www.health.qld.gov.au/mha2000/ Pritchard A, Le Cong M. Ketamine sedation during air medical retrieval of an agitated patient. Air Med J. 2014 Mar-Apr;33(2):76-7. Lossius HM, Røislien J, Lockey DJ. Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care. 2012 Feb 11;16(1):R24. von Vopelius-Feldt J, Benger JR. Prehospital anaesthesia by a physician and paramedic critical care team in Southwest England. Eur J Emerg Med. 2013 Dec;20(6):382-6 Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, Size MJ, Kennedy F, Hoyt DB. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004 Jul;57(1):1-8; discussion 8-10. Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, Walker T, Std BP, Myles P, Murray L, David, Taylor, Smith K, Patrick I, Edington J, Bacon A, Rosenfeld JV, Judson R. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Ann Surg. 2010 Dec;252(6):959-65. Le Cong M, Gynther B, Hunter E, Schuller P. Ketamine sedation for patients with acute agitation and psychiatric illness requiring aeromedical retrieval. Emerg Med J. 2012 Apr;29(4):335-7.…

Prehospital and Retrieval Medicine Podcast

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PHARM PODCAST 112 : So that others may learn, so that others may live – Martin Bromiley & Nicholas Chrimes

10 years ago

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Hi Folks On today’s show, we chat to our good friends Martin Bromiley and Nicholas Chrimes. They have collaborated to make two new medical education videos to help highlight issues around management of the unexpected difficult airway. They are works of fiction based on the real world event of the death of Martin’s first wife, Elaine Bromiley during an elective operation. Martin established the Clinical Human Factors Group in 2007 to help promote the issue of human error and patient safety in clinical medicine. In 2014, he was awarded the Difficult airway Society Medal in recognition of his work in advancing the study and teaching of non technical skills in anaesthesia and airway management. Register for SMACC please! SIGN THE PETITION FOR #EZdrugID campaign Show notes: Clinical human factors group How to cause more hurt The Elaine Bromiley case – Simpact Now, onto the PODCAST! [audio http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2014-12-13-115.mp3%5D Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 82 – Intraosseous lines and abstracts

11 years ago

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Today on the podcast, a quick one to promote SMACC GOLD Abstract submissions and ETM Course Also quick tutorial on IO lines! WARNING! DONT COPY THE DEMONSTRATION VIDEO AT HOME BY TRYING TO DRILL A NEEDLE INTO YOUR OWN BONE! THIS VIDEO WAS DONE BY QUALIFIED DOCTORS SHOW NOTES: Confirmation of intraosseous cannula placement based on pressure measured at the cannula during squeezing the extremity in a piglet model Feasibility of point-of-care colour Doppler ultrasound conﬁrmation of intraosseous needle placement during resuscitation EZIO demo 1 Podcast ( available here and on iTunes) http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/PHARM-2013-11-06-084.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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GET FOAMEd rural masterclass session : Spotting the Crook!

12 years ago

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Hi folks! We have an idea for another FOAMEd educational series..its called GET FOAMEd ( Generalist Education & Training via Free Open Access Meducation) Our intent is to aim it at the rural generalist doctor, remote nurse or paramedic, or if you are working in remote areas and need to make do with less toys and resources. I know we have lots of listeners from rural and remote Canada, USA and Europe. For the first episode we decided to talk on Spotting the Crook! This is a very peculiar Australian vernacular term, which essentially means identifying the deteriorating and critically ill patient at an early stage. Crook is Australian for sick, not criminal! We might introduce our international listeners to other weird Australian terms , as we progress through the series! Here is the screencast.. GET #FOAMEd rural masterclass spotting the crook_edit Now on to the Podcast http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/GET_FOAMEd_rural_masterclass_spotting_the_crook_edit.mp3 Right Click and Choose Save-as to Download the Podcast. SHOW NOTE References: Clinicians gut feeling about serious infection in children : an observational study Monitoring vital signs using early warning scoring systems :a review of the literature ED Adult Sepsis screening tool Why lactate is like a pap smear Point of care lactate testing predicts mortality of severe sepsis in a HIV population…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 32 : Dr Brian Burns and a pitlane DSI case

13 years ago

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Brian and I do a quick case presentation on DSI and retrieval medicine human factors Hi there. Remember Brian, awesome Irish emergency physician, prehospital and retrieval consultant specialist and mate of Cliff Reid, Karel Habig and the greater GSA HEMS team in Sydney? He is back! We talk about a recent DSI case he performed last week where a team approach to airway management in the high risk patient led to successful safe airway intervention. Also I review a short correspondence in the July edition of Anaesthesia and Intensive care by the GSA HEMS team on their new difficult airway intubation technique using an Ambu Ascope disposable endoscope and iGel supraglottic airway and trauma shears! enjoy our chat! Minh Now on to the Podcast http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/Brian_Burns_and_DSI_case.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 31 : ED chronic pain management

13 years ago

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Seth and I do a quick overview of the challenges of managing chronic pain presentations in the ED Hi there. A week ago, we read a tweet about the challenges of managing chronic pain presentations to the ED. I thought it was worthwhile having a discussion of the options in dealing with such presentations. What we discuss: Harm minimisation strategy with limited prescribing Alternatives to opioids General approach to pain in the ED Systems in Australia and US to monitor drug addiction and seeking prescription drugs for illicit sale The repeat presenter Now on to the Podcast http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/seth_on_pain_management_in_ED.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 30 : Respiratory Therapy Profession with Sean Marshall

13 years ago

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This is Sean, a Canadian respiratory therapist. Tune in and learn about his profession! Hi folks! This interview I talk to Sean Marshall, a respiratory therapist in Ontario, Canada. We do not have this profession in Australia and I believe it is mainly in North America and Canada. So I wanted to learn more about it and the training and daily role these RTs provide. Things we discuss : RT training RT daily routine and duties RT scope of practice Hypothetical severe asthma case in ED and role of RT within the ED resuscitation team Critical care air transport and RT role The ideal transport ventilator Why RT profession and other non doctor professions may have trouble establishing themselves in Australia Sean provided some commentary and reference link below: Hi Minh, This article may be an appropriate citation, I’ll let you be the judge. http://www.ncbi.nlm.nih.gov/pubmed/21233157 There are many studies such as this one. They are often used to advocate that ventilator management by a Respiratory Therapist following a protocol achieves better success than physician’s managing the ventilator. I support this view but feel it is a bit of an extrapolation from the actual findings of the studies to say one group of professionals does a better job than another. Although I can’t seem to find a good reference, I would also make the following pitch for RTs: During a night shift in hospital, it is often a single physician responsible for the medicine wards. It may be a Resident or specialist Attending that does not have a great deal of experience with critical care and airway management. I feel that especially at times of day when staffing is less, that a Respiratory Therapist brings experience and confidence to airway management and ventilation, allowing the physician to step back and lead the whole team through a resuscitation. I feel this is a safer model of care than requiring the MD to simultaneously take in all the facts and lead an effective resuscitation while at the same time searching for vocal cords to pass a tube or initiating mechanical ventilation. And if you staff multiple physicians to address that situation, RTs can fill the need more cost-effectively. I understand it’s political, but I felt compelled to advocate for my profession. Thanks again, Sean Minh here – Sean, I agree with you. Its not about egos in airway management and frankly I dont really care who sticks the plastic past the cords as long as they do it safely and defend oxygenation at all times. The lone wolf attitude to critical care airway procedures and ventilation must be culturally displaced and a team approach adopted where the doctor maybe best utilised as a team leader if appropriately skilled and confident to act in such a role. Operational silos of clinical practice do not help patient safety and quality of care and we should all be sharing skills, knowledge and experience rather than defending professional territories.Rant ends enjoy the podcast Minh Now on to the Podcast http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/sean_marshall_interview.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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PHARM Podcast 015 – MICA Service of Victoria with Flight Paramedic Ben Meadley

13 years ago

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Flight Paramedic Ben Meadley(middle back of picture) tells us about MICA Victoria Hi folks! Ben Meadley has a great prehospital blog . He is proud of his service, MICA Victoria . Things that we talk about during the interview are Adult Retrieval Services in Victoria ( ARV ), check out the weblink for some fantastic resources on retrieval medicine! We discuss the training of a MICA paramedic and here is a great presentation from a MICA Flight team manager, Anthony De Wit, on the outdoor training aspects . Prehospital research trials are discussed and references to these can be found on Ben’s blog article, CHILLOUT . I mention iSOBAR clinical handover tool and I recommend you all check it out. The key to prehospital and retrieval medicine is effective communication. During the case scenario, we discuss management of status epilepticus and I mention ketamine. Here are some references for its use in refractory seizures. Mayo Clinic overview of management of status epilepticus Lowenstein 2006 overview on status epilepticus and mention of ketamine as alternative agent to preserve haemodynamics Stay safe and enjoy the interview Minh Now on to the Podcast http://media.blubrry.com/prehospitalpodcast/content.blubrry.com/prehospitalpodcast/MICA_paramedic_Ben_Meadley.mp3 Right Click and Choose Save-as to Download the Podcast.…

Prehospital and Retrieval Medicine Podcast

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DASH -1A Emergency Airway Concepts with Dr Bill Hinckley

13 years ago