Air Care Series: Man Meets Machine

Air Care Series: Man Meets Machine

In this edition of the Air Care series we take a look at the LVAD via post and podcast, introducing you to the meeting of man and machine. Adam Gottula, MD interviews Liz Powell, MD and Paige Barger, NP covering the spectrum of LVAD basics from common functions to life threatening complications.

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The Head and the Heart: Hemodynamic Derangement in Isolated TBI

The Head and the Heart: Hemodynamic Derangement in Isolated TBI

We know that alterations in hemodynamics do not only occur in hemorrhagic shock.  Both obstructive (such as from tension pneumothorax) and neurogenic shock (for example, from a spinal cord transection), can result in hemodynamic compromise that would not be corrected by blood product administration.  There have been some studies that have shown isolated traumatic brain injury (TBI) can also cause hemodynamic derangements. This article looks at a paper which attempts to examine the incidence of cardiovascular instability in patients with TBI.

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Air Care Series: Burns Management

Air Care Series: Burns Management

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.

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Air Care Orientation Case #4

Air Care Orientation Case #4

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!

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AirCare Series: Pre-Hospital Ultrasound

AirCare Series: Pre-Hospital Ultrasound

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. 

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Air Care Orientation Case #3

Air Care Orientation Case #3

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?

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Air Care Orientation Case #2

Air Care Orientation Case #2

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.

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Air Care Orientation Case #1

Air Care Orientation Case #1

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!

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Flights - Un-Break My Heart

Flights - Un-Break My Heart

It is early October and you are the flight doc in C-pod on a brisk but clear Saturday morning. The day starts out with several challenging patients with vague complaints and has just begun to ramp up in volume when a patient rolls into your pod by EMS, restrained face-down to the cot, covered in feces and urine, screaming about hearing voices. You begin to take report from EMS when, as if by divine intervention, the tones drop and you are dispatched for an inter-facility transfer. You gleefully (almost too gleefully…) give a brief patient sign-out to your staff, grab the blood cooler, and head to the roof...

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Grand Rounds Recap 9/16

Grand Rounds Recap 9/16

Air Care Grand Rounds

What do I need to assess before I load this patient in the heli?

  •  Does your patient need plastic? (ETT, needle/finger thoracostomy)
    • Get breath sounds / anticipate your possible interventions you may need
  • Is your patient in shock?
    • Don't have a lactate? Hyperglycemia in the absence of diabetes, thirst and diaphoresis should lend you towards 'yes'
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When That 1% Makes All the Difference

When That 1% Makes All the Difference

Just prior to SMACC (the Social Media and Critical Care Conference), we were lucky enough to have Dr. Brian Burns of Sydney HEMS stop through Cincinnati.  In the video below you can see his lecture on when the 1% makes all the difference.  Dr. Burns talks about how we should strive for excellence in prehospital care not simply meeting minimum standards.  Watch the lecture below to hear Dr. Burns discuss the importance of incremental changes, cognitive offloading, checklists, and continuous improvement and training through simulation.

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"Flights" - Shaken Recap & Expert Commentary

"Flights" - Shaken Recap & Expert Commentary

Thanks to everybody who commented and contributed to the discussion on our final “Flight!”  If you missed out on the case, check it out here. Below you’ll find a curation of the comments to each question and a podcast with expert commentary from Jenn Lakeberg, APRN.  This was the final “Flight” for this spring/summer.  Look for the cases to return again in January 2016 as we begin Flight MD Orientation with the next class of future Air Care Flight Docs.

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A Pain in My Heart - Curated Comments and Expert Commentary

A Pain in My Heart - Curated Comments and Expert Commentary

Thanks to everybody who chimed in on our last "Flight"! We had a great discussion on the management of the STEMI transfer patient.  These aren't just "milk runs" as pointed out by Dr. Hinckley.  The highlights of the discussion are below with additional commentary on the case by Dr. Bill Hinckley and Air Care Resident Assistant Medical Director Dr. Matt Chinn.  Out final flight will be lifting off June 1 and it's a doozy - looking forward to the discussion!

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Field Amputation

Field Amputation

Hey, everybody! Today we are going to talk about field limb amputation.

I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life. 

First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011. 

So I was told… 

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