Total Em - Tools Of The Trade And Academic Learning In Emergency Medicine

When a patient needs to be given to EMS for transfer to another facility, it is important to have a solid hand-off.  The last podcast was about the EMS to ED hand-off process and it was the most popular podcast to date.  With paramedic Geoff Horning the discussion continues with his thoughts about how EMS and ED can work together to make an even better transfer of care.  

When EMS brings a patient to the ED, there are many factors that can make that hand-off either good or bad.  It seems like no matter how hard each side tries, the message does not always carry over.  A lot of it comes down to not addressing the basics of EMS hand-offs to the emergency department.  Today, we will be covering how to make that hand-off better with our paramedic friend, Geoff Horning.

There was a lot of coverage for the original Vortex Approach and the revised version has also caught some attention. Others like Minh Le Cong have covered it and the British Journal of Anesthesia has the paper available for free (at this time). It is definitely worth going to the Vortex Approach website as well for details, especially regarding training.

The Vortex Approach is another game changer in airway management.  This podcast features Dr. Nicholas Chrimes reviewing this technique to manage the airway.  He also ties in some Star Trek in there (listen to the podcast to know who his favorite character is).

If you have worked in emergency medicine for any length of time, you have seen an abscess.  No, it's not a spider bite, it's almost always an abscess.  With abscess management, there are a number of approaches.  We are going to review a relatively evidence based approach to treating these pus filled pockets of joy.  Grab your eye protection and masks as this can get messy.

This is not your usual podcast.  To be fair, what has been the usual podcast with us?  We have gone over certain papers and a few interviews, but this is a young podcast.  It was important to give everyone an update on what is currently going on, and that is exactly what this podcast is all about.

We are back for the second half of our conversation with Jeff Jarvis.  If you missed the first half, go back and listen to Podcast #10 as it will make more sense.  We discussed his EMS system that only uses video laryngoscopy (VL) with intubation.  This is huge and unique with this group.  However, it was a process to find what was best for him and where he acts as a medical director. In this part of the conversation, we talk about the benefits of VL and how he chose the King Vision.  He also reviews some of the protocols in place for their management of intubations in some unique settings including getting the tall device into the mouth during certain situations such as during cardiac arrest and  patients with a soiled airway.

You read that right!  Dr. Jeff Jarvis is a medical director who only uses video laryngoscopy (VL) for the EMS agencies he acts as a medical director.  Not only that, but in his own practice in emergency medicine, he uses a VL system.   What is so great with VL that they ditched traditional direct laryngoscopy?  Well for that, you will need to listen to the show.  However, there are some key points discussed that we wanted to include in our show notes for our readers.

Have you heard of Jim DuCanto?  If not, then you missed our last podcast.  You can listen to either of them in any order, but since you are here, go ahead and listen to this one first.  However, we highly recommend that you go to Podcast #8 after that to see what our guest has been up to recently.  If you manage airways take a listen as it has some interesting findings.   In this podcast, Jim DuCanto tells us more about himself and answers questions from Twitter.  Go to totalem.org to read some of the highlights and to listen to the podcast.  Remember, we are now also on iTunes Podcasts for your listening pleasure.

You may not have heard of Jim DuCanto specifically, but you have probably heard about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination technique. Click on the links that we have here if you have not heard of him or his technique including this one from Life in the Fast Lane. Don't worry, we will wait right here... Are you back now?  Does it make sense?  We will talk about it more soon.  However, we had a very unique conversation about something you most likely have not heard of yet.  On August 28, 2016 he completed an experiment regarding supraglottic airways.  The next day we interviewed him with this podcast being all about the experiment.  Go to totalem.org for some of the key points from our talk.  

After our talk with Minh Le Cong from the PHARM podcast, we decided it was appropriate to discuss the POKER Trial.  No, it is not about cards, but rather about if propofol mixed with ketamine is better than propofol alone. In addition to this podcast, there have been a few other blogs such as St. Emlyn's and REBEL EM that reviewed this study. At this time, we believe that this is the only podcast to create an audio discussion in detail on the subject (we may have missed someone and we apologize). For that reason, we wanted to make sure there was a way you could listen to a detailed analysis of this study soon as it is still a relatively recent publication.

The image above is the chemical structure of ketamine, and that is exactly what we are talking about today.  This is the second half of our conversation with Minh Le Cong who is best known for his involvement on Twitter with the FOAMED world and his PHARM podcast.  If you did not listen to the first half, please go back to Podcast #5 to listen to that portion.  Otherwise, get ready for the second half of this excellent conversation.    

Minh Le Cong is known worldwide especially on Twitter and his PHARM website.  On August 16, 2016 he agreed to get on Skype and discuss ketamine in detail with me.  Although we lost some of the original audio due to a mistake on my end, we still recorded approximately one hour's worth of audio.  Due to the length, we are breaking up the discussion into two separate podcasts.  The second one will come out next week.  So sit back, relax, and enjoy the conversation.  

Yes, that oh so common complaint that brings patients into the ER.   With acute back pain, everyone seems to have their own cocktail for treatment, but what has been shown to work?  In this reviewed of a trial in JAMA published October 20, 2015 we review a randomized control trial that looked into just this issue.

You have waited long enough!  It is time for some real information and that has come in the form of a paper I find very important.  The REACT-2 study was published online with The Lancet on June 28, 2016.  I started looking at it right away but did not get the chance to actually post about the topic until now.  Listen to the podcast, read the blog, but do not forget to read the original paper, too!

I realized in my last podcast that I really did not mention much about myself.  This second podcast includes details about myself and my background.  There is still much to tell but hopefully this will give you enough information for us to get started.  

It has finally happened!  We have our very first podcast up and running.  It is short and to the point with only some quick information as to the TOTAL EM project in podcast form.  Click below to learn more about what is mentioned in the podcast and to listen to the podcast itself.