For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, the But Why EMS Podcast team is proud to bring you our recurring guest,  Dr. Peter Antevy Pediatric Emergency Physician & EMS Physician who will talk about issues with the 2020 PALS guidelines. Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Please subscribe and review our podcasts on: Apple Amazon Google Podcast Stitcher

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, Happy 2022 But Why EMS listeners.  Welcome to part two of our podcast series on Peds Respiratory Distress!  A quick reminder, if you haven't listened to Episode 17: "Peds Respiratory Distress = D Bolus?" go ahead, stop listening to this episode, and download and listen to Episode 17.  We'll still be here when you get back.  Ready for this episode?  In part 2, we cover the spectrum of pediatric airway care with:  Tara Copper MD  Pediatric Emergency Medicine Physician Joseph Finney MD Pediatric Emergency Medicine Physician and EMS Fellow Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Please subscribe and review our podcasts on: Apple Amazon Google Podcast Stitcher

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this timely episode covers that time of year when our pediatric patients get the sniffles.  Most of the time, our kids are fine.  But every once in a while, those sniffles can become life-threatening.  How can you tell the difference?  In part 1 of this podcast, our content experts discuss what to look for and what to do when we become concerned about our little patients.  Meet our special guests:  Tara Copper MD  Pediatric Emergency Medicine Physician Joseph Finney MD Pediatric Emergency Medicine Physician and EMS Fellow Click here to check it out today! Stay tuned for part 2 of this episode in early January! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Please subscribe and review our podcasts on: Apple Amazon Google Podcast Stitcher

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the evolution of stroke care and how treatments of large vessel occlusion strokes are pivotal upon EMS clinical suspicion and triage destination.  Meet our special guest: Dr. Peter Panagos MD  Vice-Chair for Academic and Faculty Affairs Professor of Emergency Medicine & Neurology   As well as John Reagan telling us about his "Modified Reagan Stroke Scale."  Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Please subscribe and review our podcasts on: Apple Amazon Google Podcast Stitcher

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the complex nature of traumatic arrests. ,  Do we treat it the same as a medical arrest?  Do we have different treatment and decision priorities for these traumatic patients?  What makes caring for these patients in the prehospital environment so unique and how does that affect our care of these patients?  We discuss these questions and more with our special guest: Dr.  Rawan Safa @rawansafa93 Emergency Medicine Resident at Washington University Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD References Millin MG, Galvagno SM, Khandker SR, Malki A, Bulger EM, Standards and Clinical Practice Committee of the National Association of EMS Physicians (NAEMSP)., Subcommittee on Emergency Services–Prehospital of the American College of Surgeons’ Committee on Trauma (ACSCOT). J Trauma Acute Care Surg. 2013 Sep; 75(3):459-67. Lockey, D, Crewdson, K, Davies, G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med 2006; 48:240-244. Russell, RJ, Hodgetts, TJ, McLeod, J, Starkey, K, Mahoney, P, Harrison, K. The role of trauma scoring in developing trauma clinical governance in the Defense Medical Services. Phil Trans R Soc B 2011; 366:171-191. Morrison, JJ, Poon, H, Rasmussen, TE, Khan, MA, Midwinter, MJ, Blackbourne, LH. Resuscitative thoracotomy following wartime injury. J Trauma 2013; 74: 825- 829. Kouwenhoven, WB, Jude, JR, Knickerbocker, GG. Closed-chest cardiac massage. JAMA 1960; 173: 1065-1067. Luna, GK, Pavlin, EG, Kirkman, T, Copass, MK, Rice, CL. Hemodynamic effects of external cardiac massage in trauma shock. J Trauma 1989; 29:1430-1433. Leis C. Traumatic cardiac arrest: should advanced life support be initiated?. Journal of Acute Care Surgery. 2013;74:634-638. Keith J Roberts. The role for surgery in pre-hospital care. 2015; 18(2): 92-100. Escott ME, Gleisberg GR, Kimmel K, Karrer A, Cosper J, Monroe BJ. Simple thoracostomy. Moving beyond needle decompression in traumatic cardiac arrest. 2014 Apr; 39(4): 26-32. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Journal of Trauma and Acute Care Surgery. 2012; 73(6): 1412-1417. Stevens RL, Rochester AA, Busko J, et al. Needle Thoracostomy for Tension Pneumothorax: Failure Predicted by Chest Computed Tomography. Prehospital Emergency Care. 2009; 13(1): 14-17. Inaba K, Ives C, McClure K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012 Sep; 147(9): 813-8. Ball CG, Wyrzykowski AD, Kirkpatrick AW, et al. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010 Jun; 53(3): 184-8. Brian Wernick, Heidi H Hon, Ronnie N Mubang, et al. Complications of needle thoracostomy: A comprehensive clinical review. Int J Crit Illn Inj Sci. 2015 Jul-Sep; 5(3): 160–169. Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. 2015;108(1):11-16. Leis CC, Hernández CC, Blanco MJ, et al. Traumatic cardiac arrest: Should advanced life support be initiated? J Trauma Acute Care Surg. 2013;74(2):634-638. Jørgensen H, Jensen CH, Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med. 2010;17(5):249-253.  

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the challenge of the prehospital airway. The But Why team covers unique ways to secure the airway that include  "Ghosting the Airway" and "Romantic Hands."   Hear the But Why EMS Podcast team discuss this situation with:   Dr. Robert Stephens Emergency Medicine Resident at Washington University Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD   References: 1. Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20(1):71-78. 2. Sakles JC, Mosier J, Stolz U. In reply. Acad Emerg Med 2013;20(9):966. 3. Limkakeng A, Broder JS, Theiling BJ. Chicken or egg? Risks of misattribution of cause-effect relationships in studies of association. Acad Emerg Med 2013;20(9):965. 4. Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011;15(5):R236. 5. Clemency BM, Roginski M, Lindstrom HA, et al. Paramedic intubation: patient position might matter. Prehosp Emerg Care 2014;18(2):239-243. 6. Murphy DL, Rea TD, McCoy AM, et al. Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. Am J Emerg Med 2019;37(5):937-941. 7. Turner JS, Ellender TJ, Okonkwo ER, et al. Feasibility of upright patient positioning and intubation success rates At two academic EDs. Am J Emerg Med 2017;35(7):986-992. 8. Levitan RM, Kinkle WC, Levin WJ, et al. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med 2006;47(6):548-555. 9. Snider DD, Clarke D, Finucane BT. The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anaesth 2005;52(1):100-104. 10. Tournadre JP, Chassard D, Berrada KR, et al. Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 1997;86(1):7-9. 11. Chassard D, Tournadre JP, Berrada KR, et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth 1996;43(4):414-417. 12. Garrard A, Campbell AE, Turley A, et al. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59(5):435-439. 13. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick's manoeuvre. Br J Anaesth 1996;76(6):877-878. 14. Notcutt W. Oesophageal rupture and cricoid pressure. Anaesthesia 1991;46(5):424-425. 15. Savino PB, Reichelderfer S, Mercer MP, et al. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med 2017;24(8):1018-1026. 16. Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehosp Emerg Care 2011;15(1):30-33. 17. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA 2018;319(21):2179-2189. 18. Driver B, Dodd K, Klein LR, et al. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med 2017;70(4):473-478 e471. 19. Latimer AJ, Harrington B, Counts CR, et al. Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting. Ann Emerg Med 2021;77(3):296-304. 20. Braude D, Richards M. Rapid Sequence Airway (RSA)--a novel approach to prehospital airway management. Prehosp Emerg Care 2007;11(2):250-252. 21. Braude D, Southard A, Bajema T, et al. Rapid sequence airway using the LMA-Supreme as a primary airway for 9 h in a multi-system trauma patient. Resuscitation 2010;81(9):1217. 22. Moss R, Porter K, Greaves I, et al. Pharmacologically assisted laryngeal mask insertion: a consensus statement. Emerg Med J 2013;30(12):1073-1075.  

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this But Why EMS Podcast episode is a continuation of our last episode.  If you haven't heard our last episode: Shake Your Sillies Out, click here to check it out.  In this episode, we discuss a unique case study that is terrifying for any healthcare clinician: a child in the field who is in status epilepticus that won't respond to typical treatments.  What then? Hear the But Why EMS Podcast team discuss this situation with  Dr. Rejean M. Guerriro DO  Pediatric Neurologist at Saint Louis Children's Hospital Dr. Joseph Finney MD Pediatric Emergency Physician and EMS Fellow at Saint Louis Children's Hospital/Barnes Jewish Hospital Nikki Bain EMT-P & Brandon Treiber EMT-P  Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD    

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this But Why EMS podcast covers the frightening presentation of a pediatric seizure that hasn't responded to traditional medications.  What do you prioritize?  How do you handle your treatment options? Hear the But Why EMS Podcast team discuss answers to these questions with Joseph Finney MD Pediatric Emergency Medicine Fellow & EMS Fellow & Michael Kim MD @michaelkim_md Third-year Emergency Medicine Resident Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD P.S.  Here are the anticonvulsant medication pharmacokinetics that Dr. Kim and Dr. Finney mentioned below AND Peds Vital Signs that Gina promised would be on this page :).

For paramedics click her for CEU credits. Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this But Why EMS podcast covers the sneaky chameleon known as Pseudo PEA.  Hear the But Why EMS Podcast team discuss with: Dr. Ian Ferguson  & Dr. Keith Marill  What Pseudo-PEA is, how to diagnose it, and more! Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD Works Cited 1. Mehta C, Brady W. Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram. Am J Emerg Med. 2012;30(1):236-9. 2. Littmann L, Bustin DJ, Haley MW. A simplified and structured teaching tool for the evaluation and management of pulseless electrical activity. Med Princ Pract. 2014;23(1):1-6. 3. Bergum D, Skjeflo GW, Nordseth T, Mjolstad OC, Haugen BO, Skogvoll E, et al. ECG patterns in early pulseless electrical activity-Associations with aetiology and survival of in-hospital cardiac arrest. Resuscitation. 2016;104:34-9. 4. Nordseth T, Olasveengen TM, Kvaloy JT, Wik L, Steen PA, Skogvoll E. Dynamic effects of adrenaline (epinephrine) in out-of-hospital cardiac arrest with initial pulseless electrical activity (PEA). Resuscitation. 2012;83(8):946-52. 5. Hogan TS. External cardiac compression may be harmful in some scenarios of pulseless electrical activity. Med Hypotheses. 2012;79(4):445-7. 6. Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity. Circ J. 2011;75(3):580-8. 7. Gaspari R, Weekes A, Adhikari S, Noble V, Nomura JT, Theodoro D, et al. A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. Resuscitation. 2017;120:103-7. 8. Testa A, Cibinel GA, Portale G, Forte P, Giannuzzi R, Pignataro G, et al. The proposal of an integrated ultrasonographic approach into the ALS algorithm for cardiac arrest: the PEA protocol. Eur Rev Med Pharmacol Sci. 2010;14(2):77-88. 9. Badra K, Coutin A, Simard R, Pinto R, Lee JS, Chenkin J. The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation. 2019;139:17-23. 10. Paradis N.A., Martin G.B., Goetting M.G., Rivers E.P., Feingold M., Nowak R.M.Aortic pressure during human cardiac arrest. Identification of pseudo-electromechanical dissociation. Chest, 101 (1992), pp. 123-128  

For paramedics, click here for CE credits! We all know the standard phrase in EMS But did you know that, in this episode, the But Why team added, "squirt mustard on the chest" to the EMS mantra?   Find out how the mustard phrase arose in this hilarious episode that covers cardiac arrest treatment history and myths with Dr. Adam Heilman Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P   Works Cited 1. American Heart Association. (n.d.). History of CPR. cpr.heart.org. https://cpr.heart.org/en/resources/history-of-cpr. 2. Bonnes JL, Brouwer MA, Navarese EP, Verhaert DV, Verheugt FW, Smeets JL, de Boer MJ. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies. Ann Emerg Med. 2016 Mar;67(3):349-360.e3. doi: 10.1016/j.annemergmed.2015.09.023. Epub 2015 Nov 19. PMID: 26607332. 3. Cheskes S, Dorian P, Feldman M, McLeod S, Scales DC, Pinto R, Turner L, Morrison LJ, Drennan IR, Verbeek PR. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation. 2020 May;150:178-184. doi: 10.1016/j.resuscitation.2020.02.010. Epub 2020 Feb 19. PMID: 32084567.https://pubmed.ncbi.nlm.nih.gov/32084567/ 4. Delorenzo A, Nehme Z, Yates J, Bernard S, Smith K. Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2019 Feb;135:124-129. doi: 10.1016/j.resuscitation.2018.10.025. Epub 2018 Oct 26. PMID: 30612966. 5. Fig Leaf Times Two by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/ Source: http://incompetech.com/music/royalty-free/index.html?isrc=USUAN1200096 Artist: http://incompetech.com/ 6.  Kette F, Ghuman J, Parr M. Calcium administration during cardiac arrest: a systematic review. Eur J Emerg Med. 2013 Apr;20(2):72-8. doi: 10.1097/MEJ.0b013e328358e336. PMID: 22990036. 7.  Landry A, Foran M, Koyfman A. Does calcium administration during cardiopulmonary resuscitation improve survival for patients in cardiac arrest? Ann Emerg Med. 2014 Aug;64(2):187-9. doi: 10.1016/j.annemergmed.2013.07.510. Epub 2013 Aug 30. PMID: 23992943. 8. Mapp JG, Hans AJ, Darrington AM, Ross EM, Ho CC, Miramontes DA, Harper SA, Wampler DA; Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group. Prehospital Double Sequential Defibrillation: A Matched Case-Control Study. Acad Emerg Med. 2019 Sep;26(9):994-1001. doi: 10.1111/acem.13672. Epub 2019 Jan 6. PMID: 30537337. 9.  Mount DB (2020).  Treatment and Prevention of Hyperkalemia in Adults. In T.W. Post Sterns RH, Forman JP (Eds.). UpToDate. Available from:  https://www-uptodate-com.beckerproxy.wustl.edu/contents/treatment-and-prevention-of-hyperkalemia-in-adults?search=hyperkalemia%20treatment&sectionRank=1&usage_type=default&anchor=H462542914&source=machineLearning&selectedTitle=1~150&display_rank=1#H462542914 10. Poole K, Couper K, Smyth MA, Yeung J, Perkins GD. Mechanical CPR: Who? When? How? Crit Care. 2018 May 29;22(1):140. doi: 10.1186/s13054-018-2059-0. PMID: 29843753; PMCID: PMC5975402. 11.  Pozner CN, Link MS (2020). Supportive data for advanced cardiac life support in adults with sudden cardiac arrest. In T.W. Page RL, Walls RM, Dardas TF (Eds.).  UpToDate.  Available from:  https://www-uptodate-com.beckerproxy.wustl.edu/contents/supportive-data-for-advanced-cardiac-life-support-in-adults-with-sudden-cardiac-arrest?search=calcium%20cardiac%20arrest&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 12. Vallentin MF, Granfeldt A, Holmberg MJ, Andersen LW. Drugs during cardiopulmonary resuscitation. Curr Opin Crit Care. 2020 Jun;26(3):242-250. doi: 10.1097/MCC.0000000000000718. PMID: 32348092. 13. Velissaris D, Karamouzos V, Pierrakos C, Koniari I, Apostolopoulou C, Karanikolas M. Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review. J Clin Med Res. 2016 Apr;8(4):277-83. doi: 10.14740/jocmr2456w. Epub 2016 Feb 27. PMID: 26985247; PMCID: PMC4780490.