Curbside to Bedside artwork

Curbside to Bedside

30 episodes - English - Latest episode: about 3 years ago - ★★★★★ - 17 ratings

Free open access Prehospital Medical education for the front line EMS Provider. This podcast does not replace your institutions policies, procedures, protocols, or guidelines. Please go to our website for a full disclaimer:

www.curbtobed.com

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Episodes

Refusal Heuristics

January 21, 2021 00:03 - 36 minutes - 58.7 MB

  Refusal Heuristic Traps:   How to avoid heuristic traps:     Competency Vs Capacity: Competency is a global assessment and legal determination made by a judge in court. Capacity is a functional assessment and a clinical determination about a specific decision that can be made by any clinician familiar with a patient’s case. How does a patient demonstrate capacity? •Understanding – The ability to understand, i.e., knows the information being presented. Consider a patient who...

Chemical Casualties: Incapacitating Agents

June 13, 2020 01:23 - 1 hour - 50 MB

Joined by Peter D. Akpunonu, MD, Haedan Eager and Ben Doty, we discuss their recent paper on "Managing the Effects of Riot Control Agents" and throw in a little trivia - and discuss relevant and practical management principles for patients exposed to incapacitating agents.

Ryan Mynatt, PharmD on Virology

April 08, 2020 00:02 - 1 hour - 54.8 MB

Don't you wish someone explained what viral load, viral shedding, and all those other words we use loosely when talking about COVID-19? Well.... our guest on this podcast did, and we think you'll really enjoy getting back to the basics, and then some. Dr. Ryan Mynatt is a practicing PharmD specializing in infectious disease, and like most academics who know anything about anything, he's responses were a little guarded - which is most appropriate right now. You can view any of his many pub...

COVID-19 Update: Avoiding the Aerosols

March 22, 2020 18:00 - 18 minutes - 24.9 MB

In this podcast we discuss a gift box of items regarding treatment considerations for reducing aerosol generating procedures. As with the previous podcast, this is a dynamic situation, and the information is not guaranteed to be accurate. Please share your thoughts and what you are doing at your own department. 

COVID-19 - EMS Considerations

March 14, 2020 14:28 - 22 minutes - 17.7 MB

Let's start by saying that I am not an expert. But, specific guidance from the CDC for managing these patients is available, but I feel like the dispersal of this information is critical to front line EMS providers. For links to important sites and to see images of the BVM and ventilator setup, go to curbtobed.com

C2B Podcast 24 - Needle Thoracostomy

January 03, 2020 00:05 - 25 minutes - 427 MB Video

In this episode we take a new look at the pathophysiology behind tension pneumothorax and how it presents in the real world population, and discuss why we should pause before inserting the needle in the 2nd intercostal space. 

C2B Podcast 23 - Hyperkalemia

November 19, 2019 00:15 - 40 minutes - 32.7 MB

Hyperkalemia Intro Potassium is primarily an intracellular ion responsible for maintenance of the resting membrane potential for normal cell conduction. Serum measured potassium is typically between 3.5 and 5.0 mEq/L. Serum K greater than 5.0 mEq/L is generally considered the threshold for hyperkalemia. Potassium is mostly excreted via the kidneys, and the "classic" hyperkalemia patient is one who has missed several dialysis appointments complaining of paralysis or diffuse weakness. ...

Diabetic Ketoacidosis

September 30, 2019 00:02 - 29 minutes - 39.9 MB

Transporting a sick DKA patient is challenging. Surprisingly, there's a bit more to it than "just" administering fluid and monitoring an insulin infusion. Read more and find references at curbtobed.com

Rethinking Transcutaneous Pacing

August 19, 2019 21:57 - 22 minutes - 808 MB Video

In our first official “vodcast”, we discuss pearls and pitfalls of transcutaneous pacing, and how it’s much more difficult than “you either have capture or you don’t”. “Phantom” complexes are rarely reported on or discussed in Paramedic school, but one monitor manufacturer appreciates how they can make verifying true electrical capture very difficult. The folks over at ems12lead.com have put a lot of work into providing education and spreading the word around the problem of false capture. 

Are we Placing mCPR Devices too Early?

June 16, 2019 18:46 - 12 minutes - 17 MB

First, there are two proposed mechanisms of CPR, brilliantly summarized in this paper: Cardiac Pump Mechanism: “blood is squeezed from the heart into the arterial and pulmonary circulations, with closure of the mitral and tricuspid valves, preventing retrograde blood flow, and opening of the aortic and pulmonary valves in response to forward blood flow. Air is thought to move freely in and out of the lungs, so that the intrathoracic pressures do not significantly rise and the pulmonary ci...

An Assault on Preventable Trauma Deaths With Andrew Fisher

May 21, 2019 11:25 - 1 hour - 90.5 MB

Join us as we interview Andrew Fisher on the multiplicity of managing civilian trauma patients. Although the complexity of trauma management is often understated, the basics are often not managed appropriately, and can have an appreciable affect on trauma outcomes. We discuss TEG, blood product administration, acute traumatic coagulopathy, the MARCH algorithm, and when it comes to permissive hypotension, just how low can you go?

Wailing for Risk Reduction

April 08, 2019 00:44 - 40 minutes - 33 MB

Wantabe et al. (2018) "Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes?" was the first to definitively link L&S use with ambulance crashes.   Data extrapolated from Wantabe et al. (2018) Response Crash Rate: 4.6 / 100,000 without L&S 5.4 / 100,000 with L/S Transport Crash Rate: 7 / 100,000 without L&S 17.1 / 100,000 with L&S The authors theorize a driving reason behind their observations as such: “During response two providers are in t...

Under Pressure - Vasopressor PEARLS with Dr. Regan Baum

March 03, 2019 13:41 - 1 hour - 61.5 MB

Goals on Initiation Reverse shock and increase tissue perfusion: Improve blood flow BP (MAP >65) perfuse coronaries and brain Mental status End tidal CO2 Maybe:  urine output (if Foley present) & capillary refill time Increase venous return Avoid ischemia & other adverse events Which vasopressor do I choose? It depends. For the prehospital provider, most of these are not an option. However, having one pressor that you're familiar with that can be implemented safely and rapid...

Pulse Oximetry Basics and Biases

February 03, 2019 19:04 - 45 minutes - 36.7 MB

Topics Discussed in the Podcast: Provider bias and the pulse oximeter. CO oximetry. Pulse oximeter lag.  Approach to the well-appearing patient with a low SpO2 reading.  Relation of vascular tone to pleth wave amplitude and variability.  Using the pulse ox waveform to confirm mechanical capture during transcutaneous pacing. Odds and ends... Pulse oximetry is more than just a measurement of oxygenation: The pulse oximetry plethysmograph is a pulsatile waveform that can be thou...

Modern Spinal Care

December 22, 2018 21:01 - 1 hour - 56.7 MB

The following is a short list of salient points related to the podcast and the corresponding source literature. As always, read the source literature and critically appraise it for yourself. Take none of the following as a substitution for local protocol or procedure. 2018 NAEMSP Spinal Immobilization paper https://naemsp.org/resources/position-statements/spinal-immobilization/ Securing a patient to the stretcher mattress significantly reduces lateral motion: Am J Emerg Med. 2016 Apr;3...

Seeing Wisely: Decoding Stroke Care with Dr. Ben Newman

November 03, 2018 18:54 - 1 hour - 70.8 MB

“The value of experience is not in seeing much, but in seeing wisely.” ― Sir William Osler   Deciphering signal from noise as it relates to modern stroke care can be challenging and conflicting, especially as it pertains to the out of hospital environment. In this podcast, we brought the knowledge and experience of Dr. Ben Newman: a neurosurgeon and endovascular therapy expert to discuss advances, challenges, and strategies in caring for our stroke patients. When to Bypass Perhaps t...

Avoiding Airway Disasters with Dr. Jeff Jarvis

September 30, 2018 18:20 - 1 hour - 58.2 MB

In this episode, we're graced by the presence of Airway Jedi Dr. Jeff Jarvis. We discuss a novel approach to the standardization of airway management in order to prevent peri-intubation hypoxia and valuable insight into the organizational culture required to make it successful. Link to Dr. Jarvis' paper "Implementation of a Clinical Bundle to Reduce Out-of-Hospital Peri-intubation Hypoxia": (Note, at the time of publishing, this article was open-access). https://www.annemergmed.com/articl...

Acute Pulmonary Edema

September 12, 2018 18:10 - 22 minutes - 17.7 MB

What is SCAPE? For this podcast, we're discussing the acute pulmonary edema presentation. This patient is hypertensive (SBP >140mmHg), severely dyspneic, with diffuse rales and clearly anxious. The "no-shitter, drowning-before-your-very-eyes" type of pulmonary edema.  This is the SCAPE patient. SCAPE = Sympathetic Crashing Acute Pulmonary Edema. Patho Quick Hits The core causative factor in the SCAPE patient is an acute increase in left ventricular filling pressure. There are a...

FEELing for a Pulse and Shocking Asystole with Walt Lubbers

July 31, 2018 18:27 - 43 minutes - 46.3 MB

This podcast is based on the Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients (FEEL) Study, and inferences made from it. The study was to determine the feasibility of prehospital ultrasound, but there were more astonishing results: 74.5% of patients in (pseudo) PEA had cardiac activity. 35% of patients in (suspected) asystole had cardiac activity.  We brought on EMS Physician Walt Lubbers to answer whether or not ultrasound would inform o...

Drowning

July 19, 2018 23:43 - 28 minutes - 30.3 MB

Terminology Wet, dry, or near drowning are not medically accepted terms and should not be used. There is nothing “near” about drowning. It happened or it didn’t. Drowning is: “the process of experiencing respiratory impairment due to submersion or immersion in liquid.”   Drowning has three outcomes. This is a uniform way of reporting data after a drowning event is using the Utstein template: 1) Morbidity 2) No morbidity 3) Mortality Submersion or immersion incident without ...

Exertional Heatstroke

July 12, 2018 15:44 - 52 minutes - 60.6 MB

Intro Heat Stroke is broadly defined as a core temperature above 104 F with central nervous system abnormalities following strenuous exercise or environmental heat. - Wilderness Medical Society. Heat cramps, exhaustion, illness, stroke etc. are a spectrum of a single illness (systemic non drug related hyperthermia) rather than each being an individual entity. THE CARDINAL SIGN OF HEAT STROKE IS ALTERED MENTAL STATUS Anhydrosis is not a reliable finding, and should not be used as a clini...

The Great White Fright

June 01, 2018 15:39 - 55 minutes - 44.2 MB

Narcan and Synthetic Opioids: vive la résistance? Probably not. Read this absolutely brilliant piece from The Tox & The Hound here. (They did all the hard work and we stole their sources.) Opioid "resistance" to naloxone is most likely not a thing, per se. The reported effect from synthetic and novel opioids are unlikely to be due to the agent's binding affinity for receptors within the brain, but rather from an ability to rapidly permeate the blood brain barrier much faster than "tradi...

Prehospital Cardiac Arrest with Walt Lubbers

May 06, 2018 17:34 - 1 hour - 76.7 MB

For this episode, we bring in an expert and an esteemed guest to answer all of your burning questions about resuscitation of cardiac arrest. Part man, part mystery, but wholly dedicated to furthering excellence in out of hospital care: Dr. Walt Lubbers, MD. Some background: Walt is an Emergency and Prehospital Medicine physician who holds board certification in both EM and EMS. He's also an Assistant Professor of Emergency Medicine and Attending Physician at University of Kentucky Medical ...

"Prime the Pump" is Dead

April 01, 2018 01:54 - 29 minutes - 23.4 MB

Why is “prime the pump”, dying?   It’s now accepted that sepsis has more to do with vasodilation, and less to do with vascular permeability. Administering a vasopressor turns unstressed volume into stressed volume and improves venous return.   Not every patient will respond to fluid administration with an increase in cardiac output.   How much fluid do we give in septic shock, and when do we start a vasopressor?   “Just the right amount”, and as soon as it’s evident the patie...

Anaphylaxis

February 17, 2018 21:36 - 28 minutes - 23 MB

Patients DO NOT have to present with integumentary involvement to be in anaphylaxis - up to 20% of patients experiencing anaphylaxis will have absent or unrecognized skin signs. Patients DO NOT have to exhibit hypotension to diagnose ongoing anaphylaxis. Anaphylaxis is unpredictable in time to onset, and the severity of presenting signs and symptoms exist on a spectrum. Stay ahead of the curve and give epi early. World Allergy Organization's Clinical Criteria for Anaphylaxis [1]: Anaph...

Rethinking Oxygenation

January 10, 2018 01:41 - 24 minutes - 20 MB

Critically hypoxic or bradypneic patients need aggressive and effective oxygenation - quickly. In most cases, a standard BVM ventilation or NRB at 15L/min is sufficient to improve oxygenation. However, in a small subset of patients, a standard, unmodified BVM or NRB isn’t enough. Usually if a patient does not improve with supplemental oxygen alone, the most reasonable explanation is shunt. Physiologic shunt occurs when the lungs are perfused normally but oxygen delivery to the alveoli is i...

Diagnosing STEMI in Left Bundle Branch Block

December 20, 2017 03:08 - 23 minutes - 18.8 MB

Know what a normal LBBB “looks” like: 1) QRS duration greater than 120 ms 2) Negative QRS Complex in V1 3) Positive QRS Complex in lateral leads (I, aVL, V5-V6) LBBB causes a repolarization abnormality: Consider a “repol” abnormality when there is a “general pattern of ST discordance”, meaning the ST segment opposite the QRS in nearly every lead (can be caused by LVH, LBBB, WPW, etc.). In a LBBB there is normally ST elevation in some leads at baseline. 2013 AHA STEMI Guidelines: ...

Massive Hemorrhage Control

November 22, 2017 21:04 - 31 minutes - 34.9 MB

BLUF: Aggressive control of massive external hemorrhage is always a priority. Tourniquet application is rarely a failure of the device, and more so of the provider applying it. Amenable vs Non-Amenable Hemorrhage Amenable: Limb hemorrhage that will facilitate tourniquet use Non-Amenable: Junctional or internal hemorrhage that tourniquet use will have little to no effect on. Tourniquet Pearls & and Pitfalls Pearls: 1) Place the tourniquet on an amendable site. 2) TIGHTEN THAT BA...

C2B Podcast 1 - Physiology and Technical Aspects of ETCO2 Monitoring

September 16, 2017 19:40 - 11 minutes - 11.9 MB

ETCO2 is a representation of 1) The concentration of CO2 in the blood, and 2) Perfusion of blood to the lungs, with the second being the primary determinant of your ETCO2 numerical value in the prehospital field. Without taking this into consideration, mistakes in diagnosis and treatment in PHEM are likely. Listen to how you can, in conjunction with your clinical and physical assessment, use ETCO2 to your advantage. 

Physiology and Technical Aspects of ETCO2 Monitoring

September 16, 2017 19:40 - 11 minutes - 11.9 MB

ETCO2 is a representation of 1) The concentration of CO2 in the blood, and 2) Perfusion of blood to the lungs, with the second being the primary determinant of your ETCO2 numerical value in the prehospital field. Without taking this into consideration, mistakes in diagnosis and treatment in PHEM are likely. Listen to how you can, in conjunction with your clinical and physical assessment, use ETCO2 to your advantage. 

Twitter Mentions

@rp_mynatt 1 Episode