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Dissections occur when the tunica intima and tunica media layers of the aorta weaken and tear causing blood to create a false lumen. Different classifications determine severity and treatments. ——Standford Classification—— Type A- Ascending aorta and can continue to the arch and/or the descending aorta. Type B- Involves the descending aorta distal of the left subclavian artery. ——Risk factors/Presentation—— HTN, tissue disorders, Marfans syndrome, age, and male gender. These patients will present with classic ripping/tearing chest pain that radiates to back, sometimes to abdomen depending on location of dissection. Focal neuro defects, BP/pulse deficits, N/V, SHOB, diaphoreses etc. ——Diagnosis—— Initial diagnosis starts with a good history of the patient to see if the qualify with high risk factors, next is imaging. CXR does not rule out a dissection but clue you in with a widened mediastinum. Next is the gold standard which is CT, some complications may arise with decreased renal function and contrast. If patient is stable enough MRI is possible. Other options are TEE (requires ETI), or TTE. These both have restrictions in imaging the full aorta for diagnosis. ——Treatments—— Treatments depends on type of dissection. ——Type A—— Require immediate emergent cardiac surgery. Due to the nature and location of the dissection patient is at risk for hemorrhage, hypo perfusion to vitals organs. Usually repaired with aortic graft/replacement. ——Type B—— Unless complicated with hypo perfusion which would require surgical consult (TEVAR) with stent placement, type B is management with medication. Anti-impulse therapy is initiated long term with medications to control HR and BP.         SUBSCRIBE AND LEAVE A RATING ON ITUNES!!!   If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com

Remember the WPW Triad 1. Short PR Interval 120ms 3. Delta Wave *This is WPW pattern, patients that present symptomatic then have WPW syndrome.* Image Sources   WPW EKG- Notice the slight upstroke into the QRS complex, that's the delta wave! Image Sources   Treatments-  Most people will be asymptomatic with just WPW pattern, monitor for any tachycardia and hypo perfusion. Symptomatic patients receive synchronized cardioversion, remember UNSTABLE GETS THE CABLE!   WPW does not receive ABCD! Adenosine Beta-Blockers Calcium Channel Blockers Digoxin   SUBSCRIBE AND LEAVE A RATING ON ITUNES!!!   If you have any questions please feel free to contact me at pushdosemedic@gmail.com

Ventricular assist devices can be confusing and scary to manage. Having knowledge can increase your confidence and the care delivered to your patient. I talked with Dillon Wenberg, IA MED critical care instructor and co-author of the NEW IA MED MCAD course/book. We discussed all of the commonly asked questions about LVADs in prehospital settings. MyLVAD.com

Join us today as we discuss pulmonary embolisms. This is a common diagnosis you will need to identify and treat within the prehospital setting. Check out some resources below. Enjoy, and don't forget to subscribe on iTunes and leave a rating.    SUBSCRIBE AND LEAVE A RATING ON ITUNES!!!   If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is available through the store. Remember that 75% of proceeds go directly to Uniformed Services Peer Council at https://uniformedhelp.org   V/Q MISMATCH Image Source   Eight Pearls for the crashing PE   Actual EKG from my patient. 26 y/o male, syncopal episode, SHOB, CP. DX- Saddle PE.  ***Note the S1Q3T3*** Source by PushDoseMedic Podcast   Image Source   Image Source

Join in today's episode with a overview of hyperkalemia. Like most topics in paramedic school, this is one that "you don't really need to know". Well turns out its pretty darn important. Check out some resources below and infographics on topics discussed.   Check out LITFL for some awesome hyperkalemia EKG examples https://litfl.com/hyperkalaemia-ecg-library/  Check out IAMED on facebook on Thursdays at 1900 CST for some great updates on COVID-19 and awesome weekly topics with the industries best clinicians.    Mental wellness is important in this busy time! Check out the Motivated Medic and 911 Buddy Check for some great resources on mental wellness and inspiration.    SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! If you have any questions please feel free to contact me at pushdosemedic@gmail.com TWITTER- @pushdosemedic The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is available through the store. Remember that 75% of proceeds go directly to Uniformed Services Peer Council at https://uniformedhelp.org

In this series we looked at DKA and HHNS, two common hyperglycemic calls a paramedic may encounter in the prehospital setting. Part 2 discusses HHNS. How is this different than DKA, and how do we treat it. Tune in and find out.    THANK YOU TO ALL OF OUR PARAMEDICS, EMTS, NURSES, PHYSICIANS, RESPIRATORY THERAPISTS AND MORE. EVERYONE IN HEALTHCARE RIGHT NOW IS FACING A PANDEMIC WITH COVID19. STAY STRONG WE CAN DO IT. WE WILL ALL LEARN FROM THIS. STAY SAFE!   SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is now available through the store. Remember that 50% of proceeds go directly to The Code Green Campaign. 

Hyperglycemia is a common call a provider will encounter, wether in the prehospital setting or the emergency room.  As a prehospital provider our interventions are limited, but it is still important to understand the pathophysiology of this disease.  In this two part series lets break down two manifestations of hyperglycemia, DKA and HHNS.     FlightBridgeEd Episode- Know your labs, diagnosing DKA using beta-hydroxybutyrate     SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is now available through the store. Remember that 50% of proceeds go directly to The Code Green Campaign. 

Join me today as we take a deeper look into antihypertensive medications. We go over some of the most common medications you may see including, beta blockers, CCB, ARB's, and more.      SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! Follow us on Twitter- @pushdosemedic If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is now available through the store. Remember that 50% of proceeds go directly to The Code Green Campaign. 

  Let’s break down the RAAS system! It’s super simple and easy to understand! So the renin-angiotensin-aldosterone-system is a complex pathway and regulatory system, that responds to decreased pressure and volume within the body. This system is important for blood pressure management but can be altered in chronic medical conditions. This system involves multiple organs and enzymes including the kidneys, liver, lungs, and heart.    I recommend taking a look below at this nephron to familiarize yourself with renal vocabulary.    SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is now available through the store. Remember that 50% of proceeds go directly to The Code Green Campaign. 

Today we take a look at capnography! Capnography is a useful tool used mainly in the prehospital setting, that reveals a plethora of information. Now we all know that we use capnography on our respiratory patients, but how else can we use it? Ever heard of monitoring perfusion status while pacing? Check out this weeks episode as I sit down with John Carrico. John Carrico is a flight paramedic who is passionate about anything and everything respirtory. We sit down today to talk all things capnography.      Check out Bob Page's website on capnography-"Slap the Cap" Applications of End-Tidal Carbon Dioxide Monitoring Small study on capnography reliability   SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is now available through the store. Remember that 50% of proceeds go directly to The Code Green Campain.         

We all know pediatric calls can be stressful, complicated, and chaotic. There has always been a stigma that pediatric patients should be treated differently, this puts a mental block in our heads that affect us and the patient. I invite you to listen to Dr. Antevy, and myself as we discuss pediatric care guidelines and PEARLS. In this two-part series, we will discuss, multiple topics from pitfalls in EMS in regards to pediatrics, to creating closure with families.  Subscribe to iTunes!       http://bit.ly/HandtevyDemo - Handtevy App Demo https://youtu.be/PnqUtpygojc - i-Gel Airway https://www.handtevy.com/wp-content/uploads/2019/01/Banerjee-Pepe-Resuscitation-2019.pdf - Pediatric resuscitation paper   Follow Dr. Antevy on the following social media.   If you have any questions in regard to pediatric care, feel free to reach out!   Twitter: @HandtevyMD Facebook: Handtevy YouTube: Handtevy and Palm Beach County Fire Rescue

We all know pediatric calls can be stressful, complicated, and chaotic. There has always been a stigma that pediatric patients should be treated differently, this puts a mental block in our heads that affect us and the patient. I invite you to listen to Dr. Antevy, and myself as we discuss pediatric care guidelines and PEARLS. In this two-part series, we will discuss, multiple topics from pitfalls in EMS in regards to pediatrics, to creating closure with families.  Subscribe to iTunes!       http://bit.ly/HandtevyDemo - Handtevy App Demo https://youtu.be/PnqUtpygojc - i-Gel Airway https://www.handtevy.com/wp-content/uploads/2019/01/Banerjee-Pepe-Resuscitation-2019.pdf - Pediatric resuscitation paper   Follow Dr. Antevy on the following social media.   If you have any questions in regards to pediatric care, feel free to reach out!   Twitter: @HandtevyMD Facebook: Handtevy YouTube: Handtevy and Palm Beach County Fire Rescue

Motivation, attitude, positivity, these are all key non-clinical components to maintain a successful and rewarding career. In EMS we have a high tendency to face burnout and lose sight of why we chose to enter this career. Listen in as me and Tony talk about staying motivated and facing burnout. Be sure to check out Tony's podcast MotivatedMedic for more awesome, uplifting resources.  Check out the Motivated Medic- https://motivatedmedic.com/ Also, follow him on Facebook and Instagram @motivatedmedic  Rotor Wash- A ECHO heliops clinical podcast- https://www.podbean.com/podcast-detail/cn26i-6d149/Rotor-Wash-Podcast    911 Buddy Check- https://www.911buddycheck.org/ Facebook and Instagram @911buddycheck   Stayfit4duty - @stay_fit4duty on Facebook and Instagram   For excellent education resources, prep classes, and to enter the CME collective visit https://training.iamed.us/pages/cme-collective. You can earn CEU while you listen to your favorite podcasts! For more information visit the link above to get started.    ECHO Future Flight Crew- http://www.echoheliops.org/      

Is sepsis the silent killer in pre-hospital medicine? We as clinicians need to be diligent and take control to identify these patients and get them the correct care. Remember TIME is TISSUE.    This is my small rendition on sepsis     Surviving Sepsis Campain 1-hour bundle WWW.PUSHDOSEMEDIC.COM IS NOW LIVE!!!   Check out the website for more education tips, tricks, merchandise, and podcast episodes.    Thank you for your support!   pushdosemedic@gmail.com    

 If you were like me when I graduated, I was terrified of the whole RSI concept. Thrown into the world ready to take an airway...NOT! Listen along as we discuss common drugs and procedure to facilitate a smooth RSI.    EMCrit published a great podcast/blog on intubation checklists. This is crucial in the preparation phase.  https://emcrit.org/emcrit/emcrit-intubation-checklist/ RebelEM on intubating hypotensive patients. https://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-hypotension-kills-part-1-of-3/ NO DESAT Publication  http://epmonthly.com/article/no-desat/   WWW.PUSHDOSEMEDIC.COM IS NOW LIVE!!! Check out the website for more education tips, tricks, merchandise, and podcast episodes.    Thank you for your support! pushdosemedic@gmail.com    

This week I'm rolling out a new segment where I'll discuss research papers of interest. Today we are comparing the Airways 2 and the PART trial. These are similar papers discussing data on airway management in OHCA. Thanks for listening, hope you enjoy. If you have any ideas for future topics, please let me know.  For more information on these trials follow these links. http://www.airways-2.bristol.ac.uk/ https://jamanetwork.com/journals/jama/fullarticle/2698493 https://jamanetwork.com/journals/jama/fullarticle/2698491   If you have any questions please feel free to contact me at pushdosemedic@gmail.com The Push Dose Medic website is now live!!!  www.pushdosemedic.com Merchandise is now available through the store. Remember that 50% of proceeds go directly to The Code Green Campain.   

Let's kick off this initiative this year and make a change. This is for you and everyone around you, 8-12 million people are trained in CPR annually, not its time for everyone to be trained in hemorrhage control. Take a class and bring a friend,  you won’t regret the information or fun!   Stop by bleedingcontrol.org for local classes near you! If you are unable to locate a class, visit your local EMS station for more information. Bleeding control kits can be purchased through bleedingcontrol.org   Check out Andrew’s information at stopthebleedmonth.org   If you train, attend or share this message, use #NSTBM19 so we know! Make sure you follow and share all platforms! #NSTBM19 Facebook- National Stop The Bleed Month Instagram- stopthebleedmonth Twitter- @NSTBM19   Below are 3 different styles of tourniquets.  1. Fake CAT7- Notice no significant markings on the pressure plate. 2. CoTCCC approved CAT 3. CoTCCC SOF-T Wide   If you have any questions please feel free to contact me at pushdosemedic@gmail.com

Tylenol...who knew something so simple and OTC can be so deadly. Tylenol toxicity can be complicated so let's break it down in simple terms.    Please feel free to contact me at pushdosemedic@gmail.com  Stickers are available! Contact me for ordering.   Check out this easy breakdown of the stages of toxicity! Below are some additional resources that breakdown toxicity a little further. Check them out. IBCC Resource- https://emcrit.org/ibcc/acetaminophen/#epidemiology_&_pharmacokinetics Video Resource- https://youtu.be/Is41fA5_XGQ 

All aboard the trauma train!! Let's break down the trauma triad of death a little bit for us new medics. Of course, this can be a complicated concept but it doesn't have to be! Trauma can be fun if we do it correctly!! Please feel free to contact me at pushdosemedic@gmail.com    A further breakdown of the trauma triad. https://www.jems.com/articles/2018/03/three-reasons-not-to-use-saline-or-crystalloids-in-trauma.html  

The season is among us! Pediatric respiratory emergencies are important to identify and treat correctly.  Please feel free to contact me at pushdosemedic@gmail.com    For more information on racemic epi check out Owen Wood's podcast "DitchDocEM" https://www.ditchdocem.com/2017/04/17/racemic-epinephrine/    Quick and easy chart for comparison!!                   Notice the "steeple" airway shape. CVS             https://www.youtube.com/watch?v=MPgCxPyeTkk                                     Notice the enlarged epiglottic structure  EBT