Intracranial Emergencies Pt. 2 - Reel Emergency Episode 8
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- Опубліковано 7 лют 2025
- Watch as EMS clinicians stabilize a very sick patient who was struck by a car while riding his bicycle. Pay close attention to their management of his injuries, their impressive teamwork and how quickly they establish a definitive airway and administer blood products. Spoiler alert- the patient survived this traumatic crash and was reunited with his EMS crew.
Join Drs. Antevy, Spiro and Piehl who review this case with special guest Amber Rice, an Emergency Medicine Physician at the University of Arizona and a part of the TBI EPIC Study team in Arizona. Also joining is Maia Dorsett, MD, PhD, Prodigy’s new medical director.
Reel Emergency covers the latest evidence with real cases in emergency and critical care medicine. Produced in partnership with ReelDx, Handtevy and 410 Medical. CE available from Prodigy EMS at www.prodigyems.com.
Follow us @ReelEmergency on UA-cam, FB and Twitter.
Here from EMS 20/20. Amazing breakdown!
Same!!
Same
Same , great episode
Same here, can't wait!
How in the world are there no comments here? This case - this SERIES/Reel Emergency - is epically important, humbling, and inspiring.
I was recently certified as an EMR, and only wish I had started decades sooner.
You folks are truly amazing. Thank you profoundly for this series. I hope, hope, hope, it continues.🕊
Tell everyone, Timothy! We happen to agree with you! What a privilege it is to work with these great educators.
@@reelemergency Putting a megaphone to it, yes! Thank you again.
awesome breakdown and discussion with Zach on EMS 2020 podcast. great work REEL Emergency and Prodigy EMS for doing the ground work and facilitating this excellent quality learning and review material. if only more EMS and Paramedic agencies world wide were as progressive and interested in quality training and education as Prodigy. Many Kudos and thanks!
Glad you enjoyed it!
Love all of these videos, but this is probably my favorite of them all ❤
P.S. - tell Zach the clean-shaven look fits him better 😉
I'll tell him!
Check out our next one! prodigyems.zoom.us/meeting/register/tZwsde-gqjopHNLfalD8Vpvdbr29z-0uve8A
Another super great overview, but in future could emphasise more on better mic so the understanding would be clearer. Thank you❤
Noted!
Here from EMS 20/20. Thanks for this very informative content.
EMS 20/20 sent me!
I agree that a some more resuscitation prior to ETI (BLS airway and aggressive oxygenation, IV/IO, blood, maybe push dose pressor, needle decompression if pneumo was present) would have been advantageous, but I am going to strongly disagree with Dr. Rice when she says “blood is not a necessity to provide good TBI care” or when she states the same applies to intubation/RSI. I read the EPIC study. The implementation of anti-hypoxia and anti-hypotension guidelines is good, but this really should be in the paramedic curriculum in 2022. Further, this is just one element in the bundle care for improving trauma patient outcomes. Look, this patient was lucky to have his severe head injury in Cypress Creek’s and Memorial Hermann’s region. Had he incurred it in >90% of EMS systems with transport times >30 min to a level II or I trauma center, he would’ve died. Normal saline is not the best answer- the Trauma Triad is ominous, and I hesitate to rely on the EPIC study’s findings because they included both isolated TBI and multisystem trauma patients (with isolated TBI patients outnumbering multisystem trauma patients at a 3:1 ratio in both the preintervention and postintervention cohorts). I’d take a gander that saline would be more detrimental in the multisystem cohort with TBI vs the isolated TBI, so I’m not too surprised isotonic fluid input to increase BP improved survival to hospital admission but not survival to discharge. My point? These multisystem trauma patients need blood ASAP, and we are selling them short in those systems without it. I'm getting the vibe that the EPIC study is being used as justification for systems not to take on blood in their scope. We are seeing studies showing that, when done right, RSI and blood leads to better outcomes. This is more reason for EMS systems to step up their game. I know this is controversial to say, but when a system invests in better training, prehospital blood, RSI, VL, and other adjuncts, they’re a superior EMS system and will probably have better patient outcomes. Comparing Arizona EMS’ findings to Cypress Creek is like comparing the NY Yankees to their minor league affiliate- it’s not a fair fight. If anything, this should be reason for the stakeholders in AZ (the state, local municipalities, EMS agencies, UA medical school) to get these adjuncts and trainings out there. Sure, this patient could be BLS’d by the crew with NPAs and OPAs, but when flight arrives, guess what? The patient will get intubated- I’d be blown away if they didn’t. With the various studies in 90s and 2000s (San Diego RSI, LA Pediatric ETI, PART, AIRWAYS, ect.), we talk about BVM like it’s a golden prehospital adjunct. I’d say it’s not; it’s a temporary one. Consider the patients with bad facial anatomy, who are impending aspiration hazards, who have trismus. And let’s not forget there is no way in heck you can commit two secured providers to the airway to ensure good mask seal and bag squeezing coordination once the ambulance starts moving or the helo takes off. The patient’s respiratory status and impending clinical course is clear- the sooner he can be BEST intubated, the better, because that’s less time for flight on scene and faster run to the trauma center (which we know improves survival).
You can argue about blood is better but 95% of EMS Ambu doesn't carry blood cause its storage is tricky on a mobile setting and it is expensive to just discard when not use. This is a sad reality. I hope certain studies will let us carry viable blood always or there will be more accessible facilities for this.
But great video overall. Keep it up
Blood storage on an ambulance = a basic cooler.
Blood wastage? Before it's expired, blood just goes back into the hospital system you got it from to be used there.
It really doesn't have to be a hard thing to set up.
@@hughman3241 100%. And it's not like every ambulance needs it. You have a system, rural, suburban, or urban. It has X number ambulances; blood only needs to be on a small fraction of them so long as they can go to those big calls. I approach it the same as RSI: not every medic needs to have that capability, but you need a supervisor or cadre of select medics who have those capabilities. Else your shortchanging those critically sick pts
Absolutely hit the nail on the head with everything. Basic adjuncts only go so far, and yeah I’d argue you’re better off bagging with an OPA/NPA if you’re 10min out from a trauma center and you have good bag compliance and you’re able to keep sats up, especially if you have to facilitate/RSI, but when you’ve got extended transport times or have to fly out a tube is going to be the better option. Not even to mention that like you said, when facial features don’t allow for a good seal ie a beard, trauma, bony face, etc or when the patient is at a greater risk for aspiration then an advanced airway is going to save your patient. And yeah an SG might be faster, but there’s a reason ET is still the gold standard for securing an airway.
@@cam5084 it’s not so much ETT is a gold standard, but weighing relative risks. Let’s say the team did an RSA and dropped a King, but flight felt the need to put an ETT in. The question has to be “why?”. Time is of the essence in this pt, and the last thing we need is to be routinely utilizing progressive airway techniques in the time sensitive pt. If the patient has a shotgun blast to the face, you aren’t gonna try to BVM them with all your BLS adjuncts, then go to the SGA, then make two ETT attempts, and then cric; you’re gonna do apneic oxygenation, maybe an ETT attempt, and then cric. It’s pt dependent. That’s why I love the Difficult Airway Course by Ron Walls; your airway approach will vary pt to pt, and good airway management depends on good pt management (BP, drug types, oxygenation, ect).
Hello from EMS 20/20.
Hello there! Thanks for viewing!
Dr Antevy where can we get the slides you were discussing?
Haven't heard, unless I missed it, TXA in the field. Or is this not a scope for US operators.
TXA is definitely in the US EMS Scope, depends on the agency in terms of who is using it. Thanks for watching!
First that Paramedic understood the situation, and what the patient needed. Outstanding work Paramedics.
Second , those Docs need to speak with a softer tone , if you haven’t work on critical patients in a ambulance , as a full time job . Lower your voice when talking about others doing a tough job in austere environments with limited resources.
Recording patient care is a bad idea , no surgeon would allow go pros recording their surgeries. It’s a dangerous practice that has lots of 2nd and 3rd order effects …
Again outstanding work paramedics , if my times comes, I hope prehospital providers like Zak are there.
I wish more surgeries were filmed for pt transparency and QA/QI purposes despite the surgeons not being fans of it. But back on topic. Physician insight on EMS performance has always been a tough thing to balance. Physicians have a ton more medical training than even the most seasoned paramedics. They often encounter a larger, more diverse patient population during their training and careers. They read a ton of research, and often do research on illness and injuries. Granted there are many physicians who don’t have an accurate perception of what EMS does. However, most of these physicians know what it’s like for paramedics and EMTs to treat a critical pt in the back of a box. Drs. Antevy and Dorsett are board certified in EMS and have done extensive EMS research. Drs. Piehl and Rice have done a good extent of EMS research. I don’t see much pertaining to EMS research on Dr Spiro’s page, but he brings valuable insight to the discussion despite that. One of the tough things about EMS is QA/QI and the ability to receive criticism and use it as a learning experience for them and other EMS providers. You have to do it though. If you go to an M&M rounds, you will see physicians do the same thing amongst themselves. Yes, there was stuff this paramedic could’ve done better to optimize patient outcomes; that doesn’t mean he shouldn’t get a degree of praise for how tough a case it was and the good pt outcome. It's a just culture.
I don't mean to sound immature but why is he totally naked? Aren't they supposed to keep his waist covered?
Eric, when examining a trauma patient, we expose their entire body to make sure we don't miss any wounds or problems. This is standard practice in emergency medicine. Thanks for watching!