Not every bradycardic patient is the same, however sometimes their past history gives away their pathology and you need to manage a complex disease in the ED or in transit to the ICU. Remind yourself of the details of the cardiac action potential as Dr. Roblee walks us through a unique case of Long QT Syndrome.Read More
While often alarming, neonatal resuscitation is critical in the care of a neonate. In the critical care transport environment preparations is crucial in optimizing resuscitation success. In this edition of Air Care Series, Dr. Irankunda walks us through neonatal resuscitation in the transport environment.Read More
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.Read More
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.Read More
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
We train for it, we have a healthy fear of it, and we realize that having to perform one is not an admission of failure on our part. But, how often is a cricothyrotomy performed on HEMS. Dr. Andrew Cathers of University of Wisconsin Med Flight walks through a recently published paper on the topic.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
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
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...Read More
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'
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.Read More
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.Read More