Saturday, March 30, 2013

Newborn Class

I had the opportunity to take the Neonatal Resuscitation Program class last week. This is standardized class put together by the American Academy of Pediatrics and jointly sponsored by the American Heart Association. I was clued into it by a few of our providers that have taken it and thought it was time well spent. I figured that I should take that class and learn from it so I can speak the language of the others at Allina Health EMS who are taking care of newborns.

Key points:

There was a lot of information, but a few key things really stuck out and I would like to share them with those of you who have not taken that class.

  • Organization- like all other high stress events we have,  I encourage you to plan ahead. Work with your partner before you arrive and assign tasks. Who is going to place the oxygen?, who is going to ventilate and check the airway? who is going to check the cord and ensure it's clamped?. Being deliberate will help you a ton.
  •  Oxygen- against everything we want to do, we have got to stop reflexively putting oxygen on these newborns. Because of how their circulation transition from fetal to , it is normal for their oxygen saturations to start at 60% and rise to 90% over the next 5-10 minutes. The child is in no danger with those numbers for that period of time. In fact, they are suggesting that there may be problems if we artificially push the oxygen up to 100% immediately.
    • Important- the recommendation is to put the O2 sat monitor on their Right wrist.
Email me if you know why the right side is preferred!
  • Ventilation - it is all about ventilation. When challenged with a decision about intubating or placing an IV/IO, I wanted to place the IO to give epi for a slow heart rate. Then answer was always, put an ET tube in and see if that increases the heart rate. Wait on the IV.
    • So ventiltion is the priority.
Thanks all,

Thursday, March 21, 2013

Conspicuity Podcast

Link to a Podcast

A while ago, when we kicked off our safety initiative at Allina Health EMS, I interviewed my neighbor because he has some unique knowledge about safety. He worked for some time at 3M as a product engineer in their division that develops reflective and fluorescent materials.
If you listen to this, remember he has no EMS background. He is a funny guy.

Wednesday, March 20, 2013

Should a family watch a resuscitation?

Ask anyone in medicine if they think a family member should watch the care of a cardiac arrest, and I think the majority of providers would say "no".
I suspect we as providers are afraid of many things that "might" occur during the event.

What if we mess it up? 
What if I look foolish by missing something obvious?
What if the family gets out of control and tries to interfere with the care?
What if they record it and try to show I am incompetent?

N Engl J Med 2013; 368:1008-1018March 14, 2013

These French researchers showed  a measurable improvement in the family member's well being if they witnessed the resuscitation. The family members had fewer symptoms of anxiety, depression and PTSD if they were present during the event. This is one aspect I had not really put a priority on, but I realize it is a very important thing. In a time like that, we should all strive to do the best we can for the family. 

Other findings from the research?  no increase in medico-legal claims, no added emotional stress to the providers and no change in the characteristics of the care.

I have thought about these things, recently, to my chagrin. I was involved in a case where we were trying to resuscitate a patient who arrested during what was supposed to be a routine transfer. We did our job and the patient did not survive. But during the event, a family member started recording things with her phone.

 I was immediately nervous. What was I thinking?, well .. (see above)

Those are all questions you have when you are not confident in what you are doing. If you know you are doing your best, and you are following community standard, or written protocol, then a recording should not be a concern.

Unless of course, conversation or behaviors are not as professional as they should be.

Integrity: What you do when no one is watching.

Tuesday, March 19, 2013

Transition to EMS Physician on Blogspot

I have transitioned from the EMSMDBlog site for technical reasons. Turns out I am running into technical problems with the transition.
Bare with me and I will get the video running and a new post up soon.


I attended the EMS Today meeting in Washington DC last week. After a rough time getting out there, the conference and expo went pretty well. There was the usual exhibitors and I had already made up my mind about video intubating devices.
But then I was steered towards the Vividtrac 100 by Vivid Medical.

The device is simple, disposable and inexpensive. The thing that really caught my attention is that it does not use a 2 or three inch screen for visualizing the airway. This ingenious device plugs into an existing screen via a USB device. That means you can use the toughbook you need to drag in anyway.

I went home and immediately set it up on a network computer. Our business firewall gave me no problems, and I do not have administrator access.  I took me all of 60 seconds to get the program off their site and onto the computer. After that, I plugged in the device and was ready to go. Just like they told me, their software makes the video screen the priority window and it goes away when you unplug the device.
This is important to me because there will not be any "minimizing" of programs as you try to switch from patient record to video device.

I made a short video, unfortunately this mannequin is sub-optimal.

I think the are on to something with this device. It is low cost, durable and minimizes the need for more equipment.

Kudos to Mina and Shane at Vivid Medical.

Allina Health EMS Video

I am very proud of the people I work with in EMS. This is a good showcase of the people doing the work in our community.