EMS Cast

emscast

High-quality EMS education for EMTs, paramedics, firefighters, and any first responders who take care of patients. read less
EducaciónEducación

Episodios

Ep. 58: Neonatal Resuscitation: Conquering the Fear- a step by step guide for emergency providers
01-02-2024
Ep. 58: Neonatal Resuscitation: Conquering the Fear- a step by step guide for emergency providers
Overcoming Fear in Neonatal Resuscitation: A Step-by-Step Guide Blog post: Neonatal Resuscitation Introduction: Welcome to another episode of EMScast, where high-level education meets real-world emergency medical scenarios. Today, we have Dr. Avery MacKenzie, an ER physician from Southwest Colorado, joining us to discuss a topic that often induces stress – neonatal resuscitation. Dr. MacKenzie shares her experiences and insights into handling neonatal emergencies in rural settings. Summary: Dr. MacKenzie opens the episode by acknowledging the inherent fear associated with neonatal resuscitation, especially in rural emergency departments where one might be the sole provider. She emphasizes that despite the fear, the process is not hard, and providers already possess the necessary skills. Key Takeaways: 1. **Facing the Fear:**    - Dr. MacKenzie encourages listeners to remember that while neonatal resuscitation may seem intimidating, the skills required are well within their expertise. 2. **Algorithm Overview:**    - The neonatal resuscitation algorithm is simplified into manageable steps, beginning with stimulating, warming, and drying the baby for the first 30 seconds.    - The next 30 seconds involve providing positive pressure ventilation to initiate breathing.    - Monitoring the heart rate is crucial, and if it remains below 100, providers should focus on correcting ventilation strategies. 3. **Initial Assessment:**    - Dr. MacKenzie introduces a simple three-question assessment for determining the need for resuscitation: term gestation, good muscle tone, and respiratory effort. 4. **Positive Pressure Ventilation:**    - The trigger for initiating positive pressure ventilation is if the heart rate is less than 100 or the baby is apneic or gasping.    - The emphasis is on adequate ventilation, and adjustments, such as using the MR. SOPA mnemonic, can be made to improve ventilation. 5. **Advanced Airway Considerations:**    - While advanced airways, such as intubation, are possible, Dr. MacKenzie highlights that pre-hospital protocols may favor supraglottic airways due to the challenging nature of neonatal intubation and the need to limit pauses in oxygenation and respiratory support. 6. **Continued Support:**    - The algorithm emphasizes a continuous loop of assessment, correction, and reassessment, with the goal of maintaining the baby's heart rate above 100. Conclusion: Dr. MacKenzie wraps up the episode by reassuring providers that familiarity with the neonatal resuscitation algorithm and periodic mental reviews can alleviate the fear associated with these critical situations. The key is to focus on what providers already know and apply those skills with confidence.
Ep. 55: Managing Postpartum Hemorrhage in the Field
15-12-2023
Ep. 55: Managing Postpartum Hemorrhage in the Field
We delve into the high-stakes world of postpartum hemorrhage management with the esteemed Dr. Maria Moreira. Joins us to demystify the management of postpartum hemorrhage in the pre-hospital setting. Dr. Moreira presents a systematic approach to intervention. Learn about the four T's of postpartum hemorrhage and on-field strategies like tranexamic acid and uterotonic administration. Dr. Moreira guides us through a concise roadmap for effective pre-hospital care. Tune in for critical insights and be prepared for any obstetric emergency!   Episode Summary: Understanding Postpartum Hemorrhage: Postpartum hemorrhage, or excessive bleeding after childbirth, is a significant concern, occurring in approximately 1-5% of deliveries. The mortality rate associated with postpartum hemorrhage is around 2%, but this can vary globally. Some countries experience mortality rates as high as 20%. Additionally, there's a 10-15% risk of recurrence in subsequent pregnancies, emphasizing the importance of understanding and addressing this issue. Physiological Changes and Risks: Pregnancy induces significant physiological changes, resulting in a high-volume, low-resistance state. The uterus receives ten times the normal blood flow during pregnancy, making postpartum hemorrhage a critical concern. Notably, vital signs might not immediately reflect bleeding, making early detection challenging. Pregnant patients can lose up to two liters of blood without immediate changes in vital signs. Recognizing Post-Delivery Physiological Changes: Understanding the physiological changes in vital signs during and after pregnancy is crucial for pre-hospital providers. Pregnancy induces peripheral vasodilation, causing a slight drop in blood pressure. The heart rate increases by 10-15 points, and the respiratory system undergoes changes, requiring increased oxygen. Although the heart rate goes up in a pregnancy and the blood pressure goes down normaly, it is important that any abnormal vital signs such as a heart rate above 100 and a blood pressure below 100 systolic be treated as abnormal until proven otherwise. Four T's: Causes of Postpartum Hemorrhage: Tone: Involving inadequate uterine contraction, the most common cause.Trauma: Typically lacerations that result during delivery and can lead to significant bleeding.Tissue: Relates to retained placental tissue.Thrombin: Referring to coagulopathy or difficulty in clotting.Approach to Postpartum Hemorrhage in the Field: In a pre-hospital setting, managing postpartum hemorrhage involves a systematic approach. Key steps include: Administration of TXA: Tranexamic acid, if available, can help reduce bleeding.Uterotonic Administration: Oxytocin induces uterine contractions. If not available, can have baby latch which will stimulate the production of moms natural occurring oxytocin.Fundal Massage: Applying firm pressure to the uterus to encourage contraction.Addressing Lacerations: Check for lacerations and apply direct pressure to bleeding points if lacerations are visible.Transport to Hospital: Prioritize getting the patient to the hospital immediately for further evaluation and intervention. Secondary Postpartum Hemorrhage: In some cases, bleeding may occur after the initial 24 hours post-delivery, indicating secondary postpartum hemorrhage. Possible causes include retained products, subinvolution of the placental bed, or infection. In such cases, prompt resuscitation aimed at supportive care of abnormal vitals and transport to the hospital are critical. Summary and Takeaways: Dr. Moreira emphasizes the importance of considering postpartum hemorrhage in every pregnant patient. Pre-hospital providers should be prepared to manage complications by following a systematic algorithm. Early recognition, administration of appropriate medications, fundal message, direct pressure and prompt transportation to the hospital are key components of effective intervention. In conclusion, being proactive and vigilant in managing postpartum hemorrhage in the field is crucial for ensuring the well-being of both mother and child. Regular training, awareness, and a systematic approach are vital for pre-hospital providers to navigate these critical situations successfully.