Recently, some paramedics, obstetricians, and EMS medical directors were locked in a room and produced some fantastic collaborative prehospital guidelines for managing post-partum hemorrhage, eclampsia, and pre-eclampsia. Have a listen, take a look at the guidelines (links below), and we'll all take better care of our pregnant/post-partum patients. REFERENCES 1. https://naemsp.org/news/now-available-new-ems-obstetric-emergency-guidelines/

There are always airway management questions floating around the Department of Clinical Services here at MCHD. "Why don't we intubate our cardiac arrest patients like we used to?" "MCHD has been hyper-focused on recording video laryngoscopy over the past year. Why?" Join the podcast crew to discuss recent EMS airway literature that helps us answer these questions and provides invaluable tips. This is part one of a two-part series. REFERENCES 1. Galinski, M., Tazi, G., Wrobel, M., Boyer, R., Reuter, P. G., Ruscev, M., Debaty, G., Bagou, G., Dehours, E., Bosc, J., Lorendeau, J. P., Goddet, S., Marouf, K., Simonnet, B., & Gil-Jardiné, C. (2025). Risk factors for failure of the first intubation attempt during cardiopulmonary resuscitation in out-of-hospital emergency settings: What about chest compression?. Resuscitation, 214, 110623. 2. Brenne, N., Brünjes, N., Rupp, D., Sassen, M. C., Jerrentrup, A., Wulf, H., Heuser, N., & Volberg, C. (2025). Success of airway management in out-of-hospital cardiac arrest using different devices - a prospective, single-center, observational study comparing professions. Scandinavian journal of trauma, resuscitation and emergency medicine, 33(1), 109. 3. Bryan, A., Feltes, J., Sweetser, P. W., Winsten, S., Hunter, I., & Yamane, D. (2025). Hyperangulated video laryngoscopy in the emergency department: An analysis of errors and factors leading to prolonged apnea time. The American journal of emergency medicine, 95, 153–158.

We're lucky to have a special guest on this podcast episode to discuss a topic that, unfortunately, all of us in emergency care encounter all too frequently: the opiate epidemic. Peter Canning is a paramedic who has lived through the epidemic while working on the ambulance in the New England epicenter. This discussion navigates Peter's progression through newer terminology like stigma and harm reduction in an effort to provide compassionate and best-practice care for our OUD patients. REFERENCES 1. https://www.press.jhu.edu/books/title/12438/killing-season?srsltid=AfmBOopOX3Wpf9blJDuiJbwOCKyNCACoxU2IixIMtLg1N1a-wYTGeEmr 2. https://www.press.jhu.edu/books/title/53796/friends-and-family-guide-opioid-overdose-epidemic

We're going to take our "Serial Killers" series and continue into the transition from the ambulance to the emergency department. What happens to the patient with chest pain once the ER doctor takes over? How does the workup advance? What imaging is ordered? What labs? Join us to discuss the "next 30 minutes" for the serial killer chest pain patient.

On this episode, the podcast crew discusses the recent introduction of video laryngoscopy with recording capability at MCHD. What device did you use? How did you train? What lessons have you learned? All these and more will be addressed and answered. REFERENCES: 1. Zhao, Y., Zang, B., & Wang, Q. (2024). The Effectiveness of Bougie Use on First-Attempt Success in Tracheal Intubations. Annals of emergency medicine, 84(3), 331–332. 2. Weingart, S. D., Barnicle, R. N., Janke, A., Bhagwan, S. D., Tanzi, M., McKenna, P. J., Bracey, A., & Resuscitationists Research Group (2023). A taxonomy of key performance errors for emergency intubation. The American journal of emergency medicine, 73, 137–144.

The podcast crew takes on the topic of prehospital analgesia. What pain medication do we choose when facing a complex patient with all analgesics available? Are there better options for hypotensive patients? What about pregnancy and the elderly? On this episode, we'll walk through our MCHD pain medication options, take a moment for a BLS reminder, and discuss some specific situations where certain medications are the best fit. REFERENCES 1. McArthur, R., Cash, R. E., Rafique, Z., Dickson, R., Crocker, K., Crowe, R. P., Wells, M., Chu, K., Nguyen, J., & Patrick, C. (2024). Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review. The Journal of emergency medicine, 67(3), e259–e267. 2. McArthur, R., Cash, R. E., Anderson, J., De La Rosa, X., Peckne, P., Hogue, D., Badawood, L., Secrist, E., Andrabi, S., & Patrick, C. (2025). Fentanyl versus nebulized ketamine for prehospital analgesia: A retrospective data review. The American journal of emergency medicine, 89, 124–128. 3. Powell, J. R., Browne, L. R., Guild, K., Shah, M. I., Crowe, R. P., Lindbeck, G., Braithwaite, S., Lang, E. S., Panchal, A. R., & Technical Expert Panel (2023). Evidence-Based Guidelines for Prehospital Pain Management: Literature and Methods. Prehospital emergency care, 27(2), 154–161. 4. Aceves, A., Crowe, R. P., Zaidi, H. Q., Gill, J., Johnson, R., Vithalani, V., Fairbrother, H., & Huebinger, R. (2023). Disparities in Prehospital Non-Traumatic Pain Management. Prehospital emergency care, 27(6), 794–799.

Lindsey Ewing (IG's The Prehospitalist) joins us to discuss updates and questions surrounding the EMS management of traumatic arrest. Sure, we must address the "reversible" causes, but what about ACLS/compressions/epinephrine? Which patients are exceptions to the rules? Lindsey had a tough case, asked some hard questions, and will provide solid answers—our favorite recipe for a jam-packed educational session. REFERENCES 1. Witt, C. E., Shatz, D. V., Robinson, B. R. H., Campion, E. M., Shapiro, M. L., Bui, E. H., Meizoso, J. P., & Dorlac, W. C. (2025). Epinephrine in Prehospital Traumatic Cardiac Arrest-Life Saving or False Hope?. Prehospital emergency care, 1–9. 2. Breyre, A. M., George, N., Nelson, A. R., Ingram, C. J., Lardaro, T., Vanderkolk, W., & Lyng, J. W. (2025). Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest - A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP. Prehospital emergency care, 1–15. 3. https://www.anzcor.org/assets/anzcor-guidelines/guideline-11-10-1-management-of-cardiac-arrest-due-to-trauma-253.pdf

We're joined by Dallas-area cardiac arrest management thought leaders from Best EMS and Parker County Hospital District to discuss the Resuscitation Academy. Where did this thing start? How can you and your service benefit? What RA lessons have we implemented here at MCHD? Learn how to improve your cardiac arrest survival rates without breaking the bank. REFERENCES 1. https://www.resuscitationacademy.org

Orthostatic vitals are taught throughout medical training as a quick and easy way to assess patient volume status objectively. We also frequently see these documented in MCHD charts. Is there any evidence that orthostatics help our clinical decision-making? Has anyone ever evaluated their use in EMS? Could standing a patient to check their heart rate actually be harmful? Join the podcast crew as they address these questions and more. REFERENCES 1. White, JL, Hollander, JE, Chang, AM, et al. (2019). Orthostatic vital signs do not predict 30-day serious outcomes in older emergency department patients with syncope: A multicenter observational study. The American journal of emergency medicine, 37(12), 2215–2223. 2. Shen W, Sheldon R, Yancy C, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of The American College Of Cardiology. August 1, 2017;70(5):e39-e110. Available from: MEDLINE, Ipswich, MA. Accessed May 1, 2018. 3. Cohen E, Grossman E, Sapoznikov B, et al. Assessment of orthostatic hypotension in the emergency room. Blood Press. 2006;15(5):263-267. 4. Aronow WS, Lee NH, Sales FF, Etienne F. Prevalence of postural hypotension in elderly patients in a long-term health care facility. Am J Cardiol. 1988;62(4):336. 5. Ooi WL, Barrett S, Hossain M, et al. Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA. 1997;277(16):1299-1304.

On today's episode, we're lucky to have a couple of special guests to discuss prehospital transcutaneous pacing. Medics turned medical students and EMS researchers, Josh Kimbrell and Judah Kreinbrook recently published a case series decsribing EMS pacing capture. Like many of our favorite topics this came from a paramedic asking a clinical question with loads of dogma and little evidence. What they found should motivate us all to be skeptical when it comes to determining if TCP is actually working. REFERENCES 1. https://www.mchd-tx.org/media/podcasts/TCP-Podcast-Figures.pdf 2. Kimbrell, J., Kreinbrook, J., Poke, D., Kalosza, B., Geldner, J., Shekhar, A. C., Miele, A., Bouthillet, T., & Vega, J. (2024). False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehospital emergency care, 28(7), 928–936. 3. https://www.ems12lead.com/post/tcp-in-transit-part-i 4. https://www.ems12lead.com/post/transcutaneous-pacing-part-2 5. https://www.ems12lead.com/post/transcutaneous-pacing-part-3

We often discuss "one in a million" and "once in a career" cases in emergency medicine and EMS, and do we ever have one of those for you in this episode! MCHD Captain, Jason Jones, joins Dr. Patrick to discuss an exeedingly rare STEMI/chest pain presentation with lessons that we can all apply to our daily care. REFERENCES 1. https://www.mchd-tx.org/media/podcasts/SITUS-Fig-1.pdf 2. https://www.mchd-tx.org/media/podcasts/SITUS-Fig-2.pdf 3. https://montgomerycountypolicereporter.com/mchd-celebrates-survival-of-one-in-a-million-patient-first-responders-please-read/ 4. https://pubmed.ncbi.nlm.nih.gov/34317454/