Standing Orders

Doing More With Less – ETCO2 NRB Mask Adaptation

emsso — Fri, 24 May 2013 21:59:55 +0000

Hey guys, Matt and I are on shift together, and we decided to bring you a little video content today. After taking a look at the PHARM site for an idea on how to use waveform C02 detection with a simple mask. well in the interest of trying to be good FOAMeders we wanted to build on the idea.

As much of us in the states have come to realize, budget cuts have become a reality, a reality that a lot of us have tried to ignore. In the video we have used a NRB mask, nebulizer medication dispenser and Zoll M series mainstream C02 detector cable and filter.

The idea behind this set up will allow you to use current materials we all have in the ambulance. If you need waveform detection during sedation/Pre-RSI, then the patient has a NRB on already, you can simply add the waveform filter to the side of the mask. If you have a need for waveform detection in respirator distress patient, but are not in need of NPPV, then you can add medication based on your protocol and continue to have waveform detection.

Check out the above video, it will be much clearer for you. Thank you for watching, and please leave comments…we like them…good or bad.

Happy “pre-hospital medicine” week!

Team Intubation with NODESAT – Kiwi Grip – Pocket Bougie

emsso — Sat, 18 May 2013 05:32:25 +0000

Hi Guys, take a look at this demonstration of several principles we have been practicing lately. For more information please check out the PHARM Podcast and Dr. Minh Le Cong. Also, be sure to check out Dr. Yen Chow’s Vimeo channel for some other cool videos.

Please follow @StandingOrders on Twitter along with myself (@mdfults) and JD (@ajdgraziano).

Comment below to leave feedback or to suggest content for future videos.

Enjoy!

A Novel Approach to SL NTG Administration

emsso — Fri, 17 May 2013 15:13:06 +0000

JD Graziano presents a unique solution to the problem of breaking NiPPV mask seal to administer SL NTG. Please comment and provide feedback.

EMSSO Episode 11 / PHARM Podcast: Equality in Airway Management

emsso — Fri, 17 May 2013 14:32:07 +0000

Hi guys, yesterday JD and I had the opportunity to record a Google Hangout session with two very smart people, Dr. Minh Le Cong of the PHARM (pre-hospital and retrieval medicine) podcast and Dr. Yen Chow of AirwayNautics. Both of these gentlemen have been and continue to provide major contributions to the FOAMed world.

With airway management being a recent focus of conversation in the Twittersphere it seemed appropriate that we discuss that topic. Please follow all of us on twitter and join the conversation.

Matt Fults – @mdfults
Dr. Minh Le Cong – @rfdsdoc
JD Graziano – @ajdgraziano
Dr. Yen Chow – @tBayEDguy

Discussed on this episode:
1) Airway training for doctors vs paramedics..does professional background make a difference?
2) How to stay current in emergency airway skills
3) EMS Standing orders blog and podcast
4) Yen’s vimeo channel and collaborative work with Jim Du Canto
5) We demonstrate how a video of a difficult intubation can be used to teach important technique points

***below is the video demonstration***

EMSSO Episode 10 / EMS Garage #148: Burning Man

emsso — Tue, 07 May 2013 13:03:52 +0000

This is some archived audio. Originally posted by EMS Garage on 10/11/2011, take a listen and gear up for the season of mass gatherings. This episode features tips and information on planning your next large event.

Visit the Burning Man website…

Chris Montera
Dr. Bryan Bledsoe
Pat Songer
Brad Buck

ETI With King-LT in Failed Airway Scenario

emsso — Sat, 04 May 2013 02:15:44 +0000

Hello everyone,
Today JD and I made this video in response to, or in addition to, a video posted on Twitter. In the original video Dr. Yen Chow demonstrated oxygenation during an ETI attempt with an LMA in place. This got us thinking…can this be done easily with a King-LT in place as it isn’t commonplace for us to use an LMA…the results are in. What do you think? Please comment on this post and tell us what you think.

Dr. Yen Chow’s video with intubation over SGA

Intubation over SGA In Situ (ISIS) simulation from Yen Chow on Vimeo.

EMSSO Episode 9: Owning The Outcome

emsso — Mon, 29 Apr 2013 23:15:50 +0000

Hello and thanks for stopping by! Brad and Matt back again with a nice chat with Dr. Ray Fowler. Dr. Ray has a lot to say in episode 9 of EMS Standing Orders. We discuss, or Dr. Fowler explains, several articles in the October issue of JEMS Magazine.

Find it here…or click the picture.

It has been discussed a few times on this program but out of hospital cardiac arrest is always at the forefront of EMS discussion. Please take the time to read the articles discussed in this episode.

Also, don’t forget to book your trip to the Gathering of Eagles, State of the Science, conference in February!

PS: Sorry about the audio quality…we are investigating and will have this worked out soon.

EMSSO Episode 8: Surviving The Next Shift

emsso — Mon, 29 Apr 2013 22:33:25 +0000

On episode eight of Standing Orders Matt, Brad, JD, and Dr. Russi are joined by Mr. Art Hsieh of EMS1.com and Eric Dickinson (author, police officer, and EMT). Episode eight tackles a wide variety of issues relating to the well being of the EMS provider. From concealed carry to combative patients, this episode includes some great exchanges from the group and some excellent tips on surviving your next shift.

Articles Discussed:
“Survive Your Next Shift” by Eric Dickinson (published in the July 2009 issue of JEMS.
On self defense and being a medic by Mr. Art Hsieh

Mentioned in this episode:
Blink
The Gift of Fear

EMSSO Episode 7: “Promoting a Culture of Safety”

emsso — Mon, 29 Apr 2013 22:03:20 +0000

In episode seven of Standing Orders Matt and Brad record live from EMS World Expo in Las Vegas, NV. Matt and Brad are joined by the editor-in-chief of JEMS Magazine, A.J. Heightman. Also joining the group is Mr. Chuck “CT” Kearns, at large director of the NAEMT. For the second half of the the show Jeramiah Bush takes part in the discussion on the health and safety of providers and patients.

Recorded at the Metronic Foundation Heart Rescue Project Podcast Studio, episode seven is sponsored by the NAEMT (National Association of EMTs).

Episode seven takes a closer look at the NAEMT’s EMS Safety Course as well as several other issues regarding provider and patient safety in EMS. The theme of “promoting a culture of safety” is present throughout this recording of Standing Orders.

Special thanks to Jamie Davis, Chris Montera, Anne Robinson, and Carissa Caramanis-O’Brien for their production of episode seven of Standing Orders. Also, special thanks to Mr. A.J. Heightman of JEMS Magazine, Mr. Chuck “CT” Kearns of the NAEMT, and Mr. Jeramiah Bush of www.jeramedic.com

Left to Right: Jeramiah Bush, A.J. Heightman, Brad Buck, Matt Fults

EMSSO Episode 6: “Posteriorly Speaking” – a novel use of the pre-hospital 12 lead

emsso — Mon, 29 Apr 2013 21:44:32 +0000

In episode six of Standing Orders: The Podcast the group discusses a recent published case study by Dr. Russi and colleagues. The case focuses on the identification and ultimate STEMI alert activation based on the use of an all posterior 12 lead ECG.

This episode features The Rogue Medic – Mr. Tim Noonan, Mr. Russell (RJ) Stine of HybridMedic.com, as well as Brad Buck, Matt Fults, and Dr. Chris Russi D.O.

The article discussed can be found here…

Prehosp Emerg Care. 2011 Jul-Sep;15(3):410-3. Epub 2011 Apr 4.
Prehospital diagnosis of ST-segment elevation myocardial infarction using an “all-posterior” 12-lead electrocardiogram.
Russi CS, Myers LA, Kolb LJ, Steever K, Nestler DM, Bjerke MC, White RD, Ting HH.

View abstract here

Update: RJ is now done with chemotherapy as discussed in the opening of the show.

EMSSO Episode 5: “A Cherry on Top” – a case for pre-hospital induced hypothermia

emsso — Mon, 29 Apr 2013 21:28:30 +0000

In episode five of Standing Orders: The Podcast the gang discusses pre-hospital, post resuscitation hypothermia.

On this episode of Standing Orders Mr. Brad Buck, Mr. JD Graziano, Mr. Luke Myers, and Mr. Tom Bouthillet of ems12lead.com look closely at the implementation of induced cooling in EMS. Titled “A Cherry On Top”, episode five touches on many issues at the forefront of pre-hospital induced cooling.

EMSSO Research Review Episode 4: “Helicopters and the Civilian Trauma System”

emsso — Mon, 29 Apr 2013 21:14:51 +0000

Dr. Russi is back with the fourth installment of Russi’s Research Review. In episode number four Dr. Russi reviews an article from the Journal of Trauma on helicopter EMS. Some interesting conclusions are drawn in this review as always. Contact Dr. Russi with questions and to submit ideas for future episodes.

Brown, J. B., Stassen, N. A., Bankey, P. E., Sangosanya, A. T., Cheng, J. D., & Gestring, M. L. (2010).
Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury
The Journal of trauma, 69(5), 1030-4; discussion 1034-6.

EMSSO Research Review Episode 3: ACD CPR with ResQPod Augmentation

emsso — Mon, 29 Apr 2013 21:10:16 +0000

In episode 3 of the Standing Orders research review series Dr. Chris Russi reviews a recent article published in the Lancett. Dr. Russi discusses the data on ACD CPR (active compression/decompression) with augmentation of negative intrathoracic pressure using the impedance threshold device (ResQPod).

Article Reference:
Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomized trial

Tom P Aufderheide, Ralph J Frascone, Marvin A Wayne, Brian D Mahoney, Robert A Swor, Robert M Domeier, Michael L Olinger, Richard G Holcomb, David E Tupper, Demetris Yannopoulos, Keith G Lurie

To suggest articles for future reviews please contact Dr. Russi or leave a comment.

Disclaimer:
The opinions expressed in this podcast are that of Dr. Chris Russi. No compensation is received for any work presented on this website.

EMSSO Episode 4: Making Sense of Confusion

emsso — Mon, 29 Apr 2013 21:05:27 +0000

In episode four of Standing Orders: The Podcast, “Making Sense of Confusion” Matt Fults and Dr. Chris Russi are joined by Mr. Tom Bouthillet of ems12lead.com for a spirited discussion on the Impedance Threshold Device and ACD CPR.

Several articles were discussed as the show features an in depth discussion on the physiology of the impedance threshold device.

Journal References:
Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial.
Aufderheide, T. P., Frascone, R. J., Wayne, M. A., Mahoney, B. D., Swor, R. A., Domeier, R. M., Olinger, M. L., et al. (2011).
Lancet, 377(9762), 301-311. doi:10.1016/S0140-6736(10)62103-4

Implementing the 2005 American Heart Association Guidelines improves outcomes after out-of-hospital cardiac arrest.
Heart Rhythm: The Official Journal of the Heart Rhythm Society
Volume 7, Issue 10 , Pages 1357-1362, October 2010

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest.
Crit Care Med. 2011 Jan;39(1):194-6.

EMSSO Research Review Episode 2: “Fluid Administration in Traumatic Injury”

emsso — Mon, 29 Apr 2013 20:57:26 +0000

In the second segment of Russi’s Research Review, Dr. Chris Russi reviews a 2010 article from the Annals of Surgery on fluid administration in trauma patients.

Haut et al. Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients. Annals of Surgery (2010) pp. 1

Contact Dr. Russi to submit ideas for future reviews.