EMS Cast: Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Ross Orpet, Paramedic turned EMS Physician
Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systemati...
Wide Complex Tachycardia: Get Comfortable With Uncertainty
Learn a systematic approach to management of wide complex tachycardia that doesn't rely on exact rhythm identification or scoring systems with guest Dr. Kevin Butler. By understanding the physiology rather than memorizing a score or algorithm you can use Kevin's approach and ABCD mnemonic to help differentiate between ventricular tachycardia, SVT with aberrancy, and other arrhythmias. Learn how not to miss the vital mimics with his SPAM filter. And finally by understanding which treatments are safe and which treatments potentially dangerous you can understand how to move forward even when you're not exactly sure what the arrhythmia is. Whether you're an EMT, paramedic, or emergency physician, this episode provides the essential principles and stepwise strategies to ensure effective and safe patient management.
00:00 Introduction to Arrhythmia Management
00:29 Personal Anecdote: Lessons from Paramedic School
02:04 Introducing Dr. Kevin Butler
02:16 Sponsor Message: The Recess Tailor
03:35 Welcome to EMS Cast
04:04 Understanding Wide Complex Tachycardia
05:37 Approach to Arrhythmia Management
07:02 Principles of Managing Wide Complex Tachycardia
08:39 Pathophysiology of Wide Complex Tachycardia
18:30 Identifying and Treating Mimics
26:55 Regular vs. Irregular Wide Complex Tachycardia
29:59 Understanding Torsades and Its Management
30:25 Identifying Atrial Fibrillation with Pre-Excitation
32:14 Treatment Considerations for AFib with WPW
35:02 Distinguishing Between VT and SVT with Aberrancy
37:09 Physiological Approach to ECG Interpretation
40:24 ABCD Mnemonic for VT Diagnosis
47:49 EMS Treatment Protocols for Wide Complex Tachycardia
51:54 Pre-Hospital Cardioversion Tips
55:22 Emergency Department Approach to Wide Complex Tachycardia
58:00 Final Thoughts and Key Takeaways
Resources
The Resus Tailor
Episode Blog Post with EKG examples
Survey- Help us learn what content you want
Gear We Like
Good Stethoscope - https://amzn.to/3YJJrf2
Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
Notepad for taking notes on calls - https://amzn.to/3Z1X21J
Sunglasses - https://frontline-optics.com/discount/EMSCAST15
Books we recommend -
The Dichotomy of Leadership - https://amzn.to/4fiCAjN
Extreme Ownership - https://amzn.to/3O1FWfa
Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf
Thinking Fast and Slow - https://amzn.to/4fiJG85
A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2
Guest/Cast/Crew information-
Guest- Dr. Kevin Butler, Emergency Physician, Lead Instructor for DHREM's EKG didactic curriculum
Host- Ross Orpet, Will Berry
Catch up with us after the show
Instagram- @emscast
Twitter- @ems_cast
Website- www.emspodcast.com
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1:00:02
Trailer - EMS Cast
You’ve looked at other paramedic continuing education resources but it’s the same basic material they taught you in school. There’s more you need to know, or you might miss something, someone might get hurt, or worse someone might die. You don’t feel ready. Your goal is to control the chaos. To become an expert in the field of prehospital medicine. And this is all driven by the desire to be there for someone on the worst day of their life. To change an outcome that would have otherwise been catastrophic if you weren’t there.
There’s no resource for the practicing paramedic to plug the holes that were left behind by paramedic school. Everything seems stuck in basic algorithms of “A” then “do B” but what do you do when "A” wasn’t in the book. We need to get away from the algorithmic thinking and instead shift to understanding the principles behind WHY if A then B.
The truth is, you can’t learn it all. Emergency Medicine includes too many pathologies and 911 calls are too unique and chaotic to know the answer to every situation. Instead of trying to learn every answer to every call, you need guiding principles for your knowledge to stand on. If you build these principles they become the foundation for every call no matter the complaint, for every situation, no matter the chaos surrounding you.
If you have the foundation you can be stable when the storm comes. You can know when to push forward or when to change course. And then each additional piece of advanced content that you learn can be added to that foundation to build on, because mastery is not a destination, it’s a journey and the journey never ends.
We are your hosts, Ross Orpet & Will Berry and this is EMS Cast.
Come on this journey with us to mastering emergency medicine. We will cover topics in more depth than you learned in paramedic school, we will teach one step further and talk about what will happen to that patient in the Emergency Department after you drop them off. And we will connect all of this back to the principles that will guide you not just on this call but on all the calls. These principles will allow you to answer the question, at the end of the day, what’s really important to me, the paramedic, in the field, in that moment.
You may not feel ready, you may not feel like you know enough, but you can understand the principles and that will make all the difference. Because what you do matters.
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2:45
From Novice to Navigator: Mastering the Art of EMS Field Training
Joined by Josh, Cody, and Moose from the AlertMedicOne podcast, we explore key principles of good training, leadership, and the importance of making mistakes in a safe learning environment. We discuss strategies to foster critical thinking, introspection, and continuous improvement among trainees in the EMS field. A big part of EMS is learning to be a leader and a teacher no matter what level you are at so whether you are a trainee, a field trainer, teach students during their rides, or merely work with a partner there's something for everyone to learn in this one. Tune in for an insightful discussion on how to develop and become excellent EMS professionals through solid training and leadership.
00:00 Whitewater Rafting Adventure
00:25 The Importance of Training
01:02 Creating a Safe Learning Environment
01:43 Introducing the AlertMedicOne Podcast
02:06 Meet the Hosts
04:37 Whitewater Rafting Lessons for EMS
05:48 Encouraging Autonomy in Training
08:01 Balancing Guidance and Independence
10:25 The Role of Field Training Officers
15:03 Ownership and Leadership in EMS Training
24:50 Handling Mistakes and Failures
31:33 Striving for Continuous Improvement
34:11 Embracing Continuous Improvement
34:34 Learning from Experienced Paramedics
35:35 The Importance of Preparation
36:47 Humility and Self-Awareness
38:23 Handling Mistakes and Growth
40:12 Training and Mental Health
41:54 Effective Preceptorship
43:13 Teaching Techniques in Action
45:12 Building Confidence in Trainees
47:21 The Role of a Trainer
01:03:06 Final Thoughts and Reflections
Resources
Contact The Resus Tailor
Watch this episode on YouTube
Read the blog post for this episode
Other episodes you might like:
Values Driven Leadership with Chris Pfingsten from EMS 20/20 podcast
10 lessons from a real austere rescue
How to Master the Resuscitation - EMCRITs Scott Weingart
Podcast announcements- Big news coming in 2025! Stay Tuned!
Survey- Help us learn what content you want
Gear We Like
Good Stethoscope - https://amzn.to/3YJJrf2
Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
Notepad for taking notes on calls - https://amzn.to/3Z1X21J
Sunglasses - https://frontline-optics.com/discount/EMSCAST15
Books we recommend -
The Dichotomy of Leadership - https://amzn.to/4fiCAjN
Extreme Ownership - https://amzn.to/3O1FWfa
Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf
Thinking Fast and Slow - https://amzn.to/4fiJG85
A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2
Guest/Cast/Crew information-
Guest- Josh, Cody, Moose
Host- Ross Orpet, Will Berry
Catch up with us after the show
Instagram- @emscast
Twitter- @ems_cast
Website- www.emspodcast.com
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1:06:34
The Difference Between Equal and Equitable Care
Explore the crucial distinction between providing equal care versus equitable care within emergency medical services (EMS). We give you an in-depth discussion with Ritu Sani from The EMS Show podcast, highlighting the importance of focusing on outcome-driven quality improvement projects and addressing disparities in care. Learn how different demographics face unique barriers to healthcare, and why recognizing these differences is essential to improving outcomes across various communities. Watch as real-life examples illustrate the need for equitable interventions and the systemic factors that contribute to inequities in EMS.
00:00 Introduction: Equal vs. Equitable Care
00:23 Case Study: CPR Training Disparities
01:09 Understanding Barriers to Equitable Care
03:31 Guest Introduction: Ritu Sani from EMS Show Podcast
04:33 Interactive Exercise: Demonstrating Inequity
06:36 Quality Improvement: Focusing on Outcomes
08:09 Challenges in Achieving Equitable Care
09:25 Diversifying EMS Workforce
10:11 Systemic Factors and Data-Driven Solutions
11:03 Starting with Equitable Care
11:17 Key Areas to Focus On
11:26 Analyzing Data for Disparities
12:12 Addressing Provider Reactions
13:00 Implementing Quality Improvement
13:35 Implicit Bias and Introspection
14:17 Patient Outcome Driven Approach
14:33 Challenges and Structural Abnormalities
15:16 Conclusion and Final Thoughts
Gear We Like
Good Stethoscope - https://amzn.to/3YJJrf2
Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
Notepad for taking notes on calls - https://amzn.to/3Z1X21J
Sunglasses - https://frontline-optics.com/discount/EMSCAST15
Books we recommend -
The Dichotomy of Leadership - https://amzn.to/4fiCAjN
Extreme Ownership - https://amzn.to/3O1FWfa
Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf
Thinking Fast and Slow - https://amzn.to/4fiJG85
A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2
Guest/Cast/Crew information-
Guest- Ritu Sani, MD and Co-host of The EMS Show podcast
Host- Ross Orpet, Chris Pfingsten from EMS 20/20
Catch up with us after the show
Instagram- @emscast
Twitter- @ems_cast
Website- www.emspodcast.com
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16:12
Life Over Limb: Field Amputation, Preparing for the Unthinkable
Dr. Avery McKenzie interviews Dr. Eric Adler, regional medical director for Flight for Life, about the challenging and rare procedure of field amputations. They discuss the importance of being prepared for the unexpected, the steps involved in developing a protocol for such emergencies, and the logistical challenges faced during the process. Dr. Adler shares insights from real-life cases and emphasizes the critical need for planning and knowing the resources available in urgent scenarios.
00:00 Emergency Field Amputation: A Real-Life Scenario
00:25 The Reality of Unlikely Medical Emergencies
02:04 Introducing Today's Episode and Guest
04:26 Dr. Eric Adler's Experience and Protocol Development
05:46 Indications and Procedures for Field Amputation
10:50 Challenges in Creating a Field Amputation Protocol
14:23 Final Thoughts and Preparedness
Resources
Website show notes link (picture of the kit and copy of the protocol): https://emspodcast.com/life-over-limb-field-amputation-preparing-for-the-unthinkable/
Other episodes you might like: Episode 31- You Were Taught Wrong, Traumas Not Algorithmic
Gear We Like
Good Stethoscope - https://amzn.to/3YJJrf2
Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
Notepad for taking notes on calls - https://amzn.to/3Z1X21J
Sunglasses - https://frontline-optics.com/discount/EMSCAST15
Books we recommend -
The Dichotomy of Leadership - https://amzn.to/4fiCAjN
Extreme Ownership - https://amzn.to/3O1FWfa
Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf
Thinking Fast and Slow - https://amzn.to/4fiJG85
A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2
Guest/Cast/Crew information-
Guest- Erik Adler
Host- Ross Orpet, Avery Mackenzie
Catch up with us after the show
Instagram- @emscast
Website- www.emspodcast.com
About EMS Cast: Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. EMS cast is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters.
Listen to EMS Cast: Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers, The Mel Robbins Podcast and many other podcasts from around the world with the radio.net app
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