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I agree with NMB before intubation as aspiration is most frequent complication of intubation in the field. Insertion of blade just with Midazolam often induce vomiting with full stomach.

Taylor Cynthia Perez Anna Garcia Gary

While it's important to sit him up foot the breathing, isn't it important to stabilize his BP?

Thank you

Another super great overview, but in future could emphasise more on better mic so the understanding would be clearer. Thank you❤

I suspect that the bystander saw agonal respirations.

According to UpToDate, "glucocorticoids are commonly given in the treatment of anaphylaxis; however, there is little evidence of benefit. The onset of action of glucocorticoids takes several hours. Therefore, these medications do not relieve the initial symptoms and signs of anaphylaxis".

Regarding leaving the AED on- for a well-staffed crew, replacing the AED pads with your defibrillator pads shouldn't interfere with compressions and takes very little time. Leaving the AED on means that when you perform the rhythm check you have to stop and analyze while no compressions are being performed. Then the AED has to charge up prior to shock. Even if you resume compressions during the charge-up phase, you aren't perfusing the heart during that time as you lost all of your intrathoracic pressures when you stopped to analyze, and it takes between 15-20 seconds of compressions to get it back. So from the time you stop to analyze to when you resume compressions following shock/no shock, that could easily be 15 seconds or more. Then you still need ramp up time prior to coronary perfusion resuming. Leaving the AED on has to cost you 30-45 seconds of no coronary perfusion during that compression cycle. Yikes. That is not consistent with HP-CPR practices. Switching to the manual defibrillator allows you to have the monitor pre-charged when compressions stop. A good team can recognize shock/no shock in seconds, shock, and resume compressions, possibly even before all intrathoracic pressures are lost. You say it's worked well for you. Maybe you could even be doing...more well.

I'm a lay person (undergrad bio degree). At 20:34 Dr. Georgoff mentions that positive pressure ventilation will reduce venous return. Why? Is this because the positive pressure in the lungs compresses the heart? Would really appreciate some clarification.

Very Strong video ❤ Thank you for so much information. Shout out to rural volunteers . I'm looking forward to future videos expanding on some of the topics you touched on but didn't have time to dive in to.

Two Amubulance rides due to anaphylaxis..once, barely alive....it happens so fast.......cramping tummy, nausea, tingling, massive heat through out the body....throat closed instantly.....loss of vision, dizzy, complete weakness....honestly ...to weak to even apply epi.....last event, face, tounge swelling, all over reddness......these systoms are intense!!! Thankful for great EMTs!!

At the age of 16 I shot myself in the head with a .357magnum I'm 47 now

Paramedic x 21 years in NC. I’m ten minutes in and this is one of the coolest learning experiences I’ve ever experienced. This is an AMAZING format for teaching!!!

I would be interested to hear discussion regarding the decision to transport a pt in cardiac arrest vs work till ROSC/termination on scene. Especially if it's rural and only BLS crew(s) responding.

Excellent case review!! I've always taught my newbies breathing exercises and tell them it is THE MOST important thing to learn!

Nasopharyngeal tube is ok in this case?

Very interesting to watch since I have had a few anaphylaxis episodes. Finally figured I react to inulin, found in powder with stevia packet as well as vegetable forms of inulin. First episode with breathing problems and throat closing, I used liguid benedryl and albuterol iiguid in pressure driven administration until EMTs arrived. I wondered if this patient was on a beta blocker like myself which would impact the effect or lack Thereof the epi. The repeated doses of epi possibly every 5 minutes is important to know. Solumedrol is a drug I will look up.

Was magnesium sulfate ever considered or given?

But what if the seizure is caused by fever. Wouldnt iv/io fluids benefit by reducing temp?

Poison control can be medical direction for us on-scene? I never knew that. That's always a confusing topic for me. This means they can have me go down a treatment pathway of their choice, but can't have me do a procedure itself that I might be trained on yet isn't in the scope in that state?

Thank you for these videos! I am in the field of military pre-hospital medicine and getting blood delivered earlier and faster, especially whole blood, has been the big push in pre-hospital field care. Its interesting to see what information the civilian side has to compare with military medicine. Low titer whole blood has been a big push for us as well. We usually use pressure bags for the blood which with a 16g- 14g catheter and no saline lock we can get it in in about 2-3 min. The life flow device looks promising though I would be concerned about the different tubing that it has and the device itself getting lost in transport/evac.

love these educational videos! I'm surprised you have those open-wound earrings in your ears where Splash contaminants can get in.

Thank you for this educational resus!

As someone who works on the hospital side, during codes a) we still use ami, and 2) when we push epi, a LOT of people say that we only do it to make us feel better. There is a growing number of intensivists that that don’t believe it does anything.

I wonder how long ago the bystander the bystander got cpr training. He was doing them at more or less 60 compressions a minute, which I believe was the recommendation in the 80s, not to mention the straddling and the rolling. So I wonder if he received training a long time ago and that was what was taught to him

Wow this is amazing. Dr. Moskwitz was my brain surgeon. I've been looking for him for 2 1/2 yrs. He saved my life three yrs ago in Gainesville. I have three more aneurysms needing repair. One on the back of my left eye ball and the other two in the brain.

This would be considered a patient and should have soft cuffs/restraints. This prevents injury to limbs since patient will be pulling hard on steel cuff. Another benefit is that the person is not locked to the stretcher and can be released quickly. Most EMS providers know that traditional restraints take a lot of time to apply, so utilizing police handcuffs is understandable but not ideal. That’s why we created XDcuff stretcher-integrated soft restraints, deploys quickly and is safe for both patients and providers.

Haven't heard, unless I missed it, TXA in the field. Or is this not a scope for US operators.

Love the series. Cant wait till the next one

Thanks for sharing these! They are very helpful to us in the prehospital field.

Beautiful.

I don't mean to sound immature but why is he totally naked? Aren't they supposed to keep his waist covered?

Interesting Video, RSI in a patient with haemorrhagic shock is always a very risky endeavor. If the patient is shocked prior to RSI they are highly likely to be shocked post intubation with the high risk of hypoxia and hypotension with the induction medications, even with a unit or two of blood. Load and go is the best option with these patients, they generally need to be enrolled in massive transfusion protocols in hospital prior to RSI. The finger was well called for

Regarding cardioversion while submerged: As long as the machine itself is dry and nobody else has their hand in the tank, it's not all that dangerous (theoretically speaking).

Versed vs. ketamine?

It sounded like one of the crew mentioned something about a femoral pulse right after they got ROSC (around 25 minutes on the timer). That’s one of the best paramedic tips I’ve gotten, especially since the patient is already supine, and if you have the time to locate it while someone else is doing compressions, I find it easier to find than the carotid in many instances.

Stay & play was highlighted very nicely during the recent NFL game too. Kudos to the first responders!

Holy crap - 8 minutes in arrest before (slow but aggressive) compressions started and still got ROSC?!? Wow.

Love these videos, and am a huge fan of the importance of high quality BLS (and minimizing hands-off chest time too). (Hate that I wasn’t able to join.) And Zach - Lookin’ much better with the trimmed up beard, brother! 😉

Thank you so much for providing this Reel series ! We have such a need for seasoned, higher level providers like yourselves to educate in a way like this that blend’s prehospital and ED care so well, and does it in a noncondescending manner. Keep it up.

Thank you. 👍👏👍

👍

Thank you :-)

This is amazing content!

Awesome content for paramedic students👍

It's inappropriate to post patients suffering online. I don't care if it's for education show it in a class room don't post it online so the man can be embarrassed for life. It's obvious they didn't have concent because they blurred his face.

Love all of these videos, but this is probably my favorite of them all ❤

We have to feel it ourself.... It is the worst and most panic thing we can ever feel....

Can’t wait for another episode! Keep ‘em coming please!!

43:06 - What an awesome pearl of wisdom! ❤