7-12-23 Conference Notes

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  • Not so e(FAST)
    • Do not bias yourself against doing an eFAST (especially if intoxicated and concerned for blunt trauma)
    • Novice scanners need around 600mL blood for FAST to be positive
    • Serial FAST can increase the sensitivity of the exam and decrease false negatives by 50%
    • Head injury and mild abdominal pain are associated with false negative FAST (be cautious with your FAST conclusions)
    • Caudal tip of the liver is the most common location for free fluid on RUQ view
    • A-lines originating from peritoneal stripes are suggestive of pneumoperitoneum
  • Intro to Peds ED
    • “Peds ED T” lists of all ED order setsPrioritize PICU -> general floor -> discharge notes.edhighacuitytemplate and .edlowacuitytemplate are the pre-organized notes for residents.admitresidentnotification is the phrase for TigerText in note
    • Louisvillepemresources.wordpress.com
  • Basics of EMS
    • Types of Providers
      • EMR (BLS): operate an emergency vehicle, BVM, OPA/NPA, Narcan, tourniquet, oxygen, CPR and AED
        • Not used in Jefferson County
      • EMT-B (BLS): 56 hours, Igels and LMAs, CPAP and BiPAP, blood glucose, EKG acquisition, LUCAS device, cannot start IV, can give ASA, glucose, IM epi, albuterol, Tylenol, ibuprofen
      • EMT-A (ALS): 228 hours, can start peripheral IV and IOs, can give D50, code dose IV epi, fentanyl, morphine, ketamine, nitro, zofran
      • Paramedic (ALS): 11 mo to 2 yrs, intubation, needle chest decompression, cricothyrotomy, interpret EKG, cardioversion, cardiac pacing, many drugs
        • None of the Jefferson County services have paralytics for RSI
    • Louisville Metro EMS and St. Matthews – Raymond Orthober, MD
    • Anchorage/Middletown EMS – Tim Price, MD
      • Uses Heads Up CPR, levophed for post ROSC, droperidol
    • Fern Creek EMS – Jeff Thurman, MD
    • Okolona EMS – Evan Kuhl, MD
    • Pleasure Ridge Park EMS – Dan O’Brien, MD
    • Patients can only decline transport if alert and oriented, not intoxicated, and decisional
    • Criteria to cease resuscitation: unresponsive, apnea, absence of palpable pulse at carotid, bilateral fixed and dilated, asystole in 2 leads (except in trauma or DNR)
      • Think twice before ceasing efforts for PEA in the field

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