Severely burned patients can be intimidating for even the most seasoned critical care transport providers. These patients often require aggressive resuscitation and multiple procedures in a relatively short period of time. It is often easy for providers to become overwhelmed, necessitating an algorithmic approach to the patient, similar to traumatically injured patients, is crucial. By advancing through the primary survey and stabilizing the patient while starting aggressive but goal directed crystalloid resuscitation, critical care transport providers can bring ICU level care to one of the sickest pre-hospital patient populations.Read More
In HEMS, there are rare instances where ‘stay and play’ is the safest thing for the patient. Exsanguinating variceal bleed is one of those conditions. This week Dr. Whitford takes us step-by-step through the placement and confirmation of balloon tamponade placement (Minnesota Tube) for stabilization of these bleeds. We hope by reading this, it gives you another 6 months of this not happening on your next transport or ED shift...Read More
Cardiogenic shock presents many challenges in both the transport environment and hospital setting. We aim to review the current state of evidence pertaining to the medical management in the critical care transport environment.Read More
Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of savvy resuscitationists. Not because we cannot deftly manage shock, or because we are anything but hardy intubators, but because the swiftest way to transform a living patient into a dying patient or a dying patient into a dead patient is to brazenly intubate someone who is in shock. What are the root causes of endotracheal intubation's (ETI) hemodynamic effects and, most importantly, how do we circumnavigate them? Read on to learn how to safely intubate the patient in shock…Read More
May brought the fourth case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of sepsis. Should we just transfer the patient as quickly as possible, or are there other things we should do first? Read on to find out!Read More
This month's AirCare Series post is the first podcast in the series! In this podcast one of our current interns, Adam Gottula, interviews a graduate of our program, Andrew Latimer. Dr. Latimer is currently a Senior EMS Fellow at the University of Washington. In this interview, Dr. Latimer discusses how they use pre-hospital ultrasound at his flight program as well as his thoughts on the future applications of this technology.Read More
April brought the third case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of STEMI, seemingly simple, right… but what happens next?Read More
Air Care Series is back! This time with one of the most feared procedures in pre-hospital medicine: the Resuscitative Hysterotomy (aka peri-mortem c-section). Pregnant patients scare us, but coding pregnant patients scare us even more. Read on to learn not only when to perform this procedure, but how to perform it properly and safely.Read More
This is Case #2 of our Air Care Orientation Curriculum! This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians. These cases are discussed amongst our training flight docs and this is the resultant learning points. In this case, we discuss a critical patient with a head injury. What interventions need to be performed? In what order? Who should do them? Read on to find out.Read More
This is Case #1 of our Air Care Orientation Curriculum! This curriculum is designed to help prepare our rising R2's for their new responsibility as flight physicians. These cases are discussed amongst our training flight docs and this is the resultant learning points. In this case, we discuss a sick trauma patient that needs multiple interventions. But what interventions need to be done? In what order? And who should do them? Read on to find out!Read More
The first installment of our new AirCare series! We start off with one of the most anxiety provoking scenarios we encounter on AirCare: the pediatric airway. Read on to learn how to calmly and methodically manage this difficult patient.Read More
Welcome to the Final Recap of our “Flights” Case Series!
Thanks to all those who participated in the discussion and to those who tuned into the “Flights” cases throughout the spring and summer. The final "Flights" cases centered in on several challenging airway scenarios. Penetrating neck trauma with a tracheal injury; GSW to the face with significantly altered anatomy; and a tracheostomy displaced and a patient with critical hypoxia - airway management in the field requires a nimble mind and knowledge of one's own equipment. Take a look at our thoughts on the cases and see what you might do in similar situations.Read More
Welcome to the Fourth Case in our Air Care and Mobile Care Flight Orientation Curriculum for 2016!
It is a beautiful sunny Memorial Day and you arrive early for your C-pod shift, energized by the knowledge that you will be getting out early with time to enjoy the day. Your patients are an enjoyable mix of pathology and acuity and everyone is quite polite and gracious. The tones drop just before it is time to hand over the radio to the dedicated flight doc and you can’t but marvel at your good fortune. You grab the blood and head up to the helipad for your flight...Read More
Welcome to the Recap of the 3rd case in our Air Care and Mobile Care Flight Orientation Curriculum!
Approximately 1 month ago we presented and talked through a particularly challenging patient flight scenario. As a refresher, if you don’t recall, check out the post here. Following the posting of the case, I sat down with ACMC Medical Director Dr. Bill Hinckley and Resident Assistant Medical Director for Air Care, Dr. Andrew Latimer, and recorded a podcast with their reaction to the case and to some of the curveball scenarios posed in the question and discussion section.Read More
It is late on a blustery grey and rainy day in November and you are the dedicated flight doc on Air Care One (the “UH”) nearing the end of your shift. Your pilot has had to turn down two flights already due to high winds and reduced visibility as bands of storms moved through the area. Against your better judgment, you are standing in the sushi line in the hospital cafeteria to grab dinner when you hear “Air Care One Pilot, weather check for a patient coming back to the U” squawk out over your portable radio. Your excitement rises as “we can do that” echoes over the radio and you hear the tones drop for your flight. You grab the blood cooler and meet your crew for takeoff on the roof...Read More