It’s been a while, but PrehospitalFOAM is back after a brief(ish) hiatus. Med School applications had to take precedent, and luckily it was a successful endeavor, so now we can concentrate on finding good FOAM for those in the world of prehospital medicine!
**We’re back after an extended, biochem-organic-chem-induced hiatus!**
I’ve already extolled the virtues of Dr. Scott Weingart enough, but his latest post provides a one-stop-shop to learn the best and latest about cricothyrotomy. On this page, you’ll find a number of resources from how to make a cric trainer to an in-depth look at surgical airway anatomy. And, of course, Weingart’s SMACC lecture bringing it all together.
Feeling a little anxious about the thought of performing a prehospital cric? Stay on the EMCrit site to check out former Air Force PJ Mike Lauria’s (@resuspadawan) lecture on Acute Care Cognition. His lecture brings together a wealth of experience and study all geared towards critical-thinking and decision making in high-stress situations. (I’ll be doing a post soon about my own attempt at a lecture/workshop regarding Responder Conditioning).
The hope is that giving these resources a little more attention can bring the idea of actually performing cricothyrotomy back into the mind of paramedics. One of my current services does annual proficiencies, which requires medics to touch the cric-kit and go through the steps exactly once each year. Clearly that is not enough, and I would love to hear how other prehospital providers incorporate such training on low-frequency procedures into their practice.
In my quest to make a “pocket brain” to keep with me on the truck, I’ve been looking at any
pocket or student reference I can find. One medical student reference I stumbled across is from the University of Washington’s Alpha Omega Alpha Medical Honor Society, and they call it The Turkey Book. I have no idea why, but it’s pretty fantastic.
Medics and EMTs certainly don’t need to know about screening for cervical cancer; however, the internal medicine portion includes very useful information about electrolyte imbalances and acid-base balances, and the emergency medicine portion takes you into the mind of a ED physician conducting an exam AND provides a a cheat sheet for common ED presentations.
If sorting through the different sections and finding the most useful bits isn’t enough, a new App called AgileMD will let you download the whole thing for $20 in a nice digital format (LitFL just reviewed the app here, and the App website is here).
I highly recommend checking out this guide, even if you don’t incorporate it into your daily-reference-library; I’ll be putting the link under the Resources section as well, so you’ll always know how to find it!
They started whacking people in Australia. This is what they found:
Unsurprisingly, defibrillation was substantially more effective. Combining the data from both rhythms, precordial thump resulted in ROSC in 5/103 patients (estimated NNT of 26.2) while defibrillation led to ROSC in 188/325 (estimated NNT 1.7). More concerning, 10/103 (estimated NNH of 10.3) thumped patients shifted into rhythms with poorer prognosis (8 VT -> VF; 1 VF -> PEA; 1 VF -> Asystole).
That’s from BoringEM–all the links to the studies are on his site. Food for thought and kind of fun, if nothing else.
This is your office. You work here for long periods of time and under the most uncertain of conditions. Like most people, you do your best to be proficient. To treat your patients to the best of your ability. Now you have a new tool.
This site is geared for the pre-hospital providers that want to be the best at what they do. Free Open Access Meducation is, like it implies, free and readily available for anyone and everyone, and my hope with this site is to filter down some of the most pertinent resources for those who take their work on the road.
Please contact me with questions, concerns, or leads on new material. I do not claim to be an expert or resource myself; my hope is to serve as a “gateway drug” to the greater FOAM community and all of its resources.
Enjoy, and be safe out there.