Centre for Paramedic Education and Research

All done!

That wraps it up for #MedTalk2024 from CPER. Thanks for following along online. We look forward to your thoughts on the subjects covered today.

Got questions for AskMED? Hit us up at askmed@cper.ca

Study of Whole blood in Frontline Trauma (SWiFT): implementation study protocol - PubMed ISRCTN23657907; EudraCT: 2021-006876-18; IRAS Number: 300414; REC: 22/SC/0072.

"Study of Whole blood in Frontline Trauma (SWiFT):" #MedTalk2024

Implementation study protocol:

The 2024 Western Trauma Association indications for resuscitative thoracotomy:

- Penetrating Thoracic Trauma: prehospital CPR for <15 min
- Blunt Trauma: signs of life upon initial eval, prehospital CPR <10 min
- Penetrating Neck or Extremity Injury: prehospital CPR <5 minutes.

Pericardial tamponade -> Thoracotomy/needle pericardiocentesis
Tension pneumothorax -> Thoracostomy
Thoracic hemorrhage -> Thoracotomy
Abdominal hemorrhage -> Thoracotomy/REBOA
Extremity hemorrhage -> Tourniquet Application
Hypoxia -> Definitive airway management
#MedTalk2024

Why do trauma patients arrest?

- Exsanguination.
- Brain Injury
- Tension/pressure conditions of the chest.
- High-spinal cord injury.

#MedTalk2024

"Witnessed prehospital traumatic arrest: predictors of survival to hospital discharge."

For EMS witnessed arrests, 10% survived to hospital discharge, 22% with ROSC but did not leave hospital, 68% pronounced deceased on arrival or within the ED. #MedTalk

https://buff.ly/3Z3JuUr

"Trauma is the ultimate team sport." #MedTalk2024

Introduction slide.

Next a talk from Dr. Paul Engels, from the Trauma Program at Hamilton Health Sciences. "Traumatic Cardiac Arrest" #MedTalk2024

We see you.

What do paramedic do well? What needs to improve? What is the priority? FOCUS ON THE BASICS BECAUSE THEY MATTER

In pediatric resuscitation, what do paramedics do well? A smattering of feedback from some other medical professionals.

Be comfortable that paramedics are good at this stuff. You have the skills you need.

#MedTalk2024

The PRIME Trial (Prehospital Administration of IM Epinephrine in Pediatric Cardiac Arrest) is a study that will gather date over a 5 year period, looking at the effect of early administration of IM epinephrine in pediatric cardiac arrest patients.

The PRIME Study is looking at whether IM epinephrine added to the standard of care will improve outcomes in pediatric cardiac arrest patients. Some of our CPER services are participants in this important research study. #MedTalk2024

https://buff.ly/3UPzpIq

Don't cut your care to expedite transport. #MedTalk2024
'
"Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children"

Paper: https://buff.ly/48QQgjx

Redirecting

"Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival."

Don't forget. As paramedics, you have what these kids need. #MedTalk2024

"Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis." #MedTalk2024

Remember that intubation is PART of airway management. It is not the same as airway management. - Johnathan Lee, #MedTalk2024

High quality CPR is one of the few things we do in resuscitation that has really good evidence to support that it makes a difference.

Don't forget the basics.

#MedTalk2024

@ThatJonLee's Twitter profile pic. Look at that smile. LOOK AT IT..

Thanks, Jeff. Next up is the incomparable Jonathan Lee with his talk on' "Everything You Wanted To Know About Pediatric Arrest But Were Too Afraid To Ask" #MedTalk2024

Work with law enforcement on as minimal restraint as possible, remember this is YOUR patient. Consider moving to chemical sedation rapidly, and monitor, monitor, monitor.#MedTalk2024

Chemical sedation doesn't come /after/ physical restraint. It's not sequential. Consider them concurrently, and with just enough physical restraint to get chemical sedation on board and expedite your patient to the definitive medical care they need. #MedTalk2024

The role of restraint in fatal excited delirium: a research synthesis and pooled analysis - PubMed The purpose of the present study was to perform a comprehensive scientific literature review and pooled data risk factor analysis of excited delirium syndrome (ExDS) and agitated delirium (AgDS). All…

(Strömmer 2022) - Literature review of all studies on "excited delirium" or "agitated delirium" up to April 2020. The restraint rate in those with a fatal outcome was 90%, with "forceful restraint" markedly increasing the rate. #MedTalk2024

A very difficult look at what went wrong in the 2022 in-custody death of Ladamonyon “DeeDee” Hall. #MedTalk2024

This is the Physicians for Human Rights report (PDF) mentioned by Jeff Bilyk
in the current talk. Physical restraint plays the major role in in-custody deaths. #MedTalk2024

https://buff.ly/4fMC5ye

Hyperactive delirium is a syndrome of severe agitation. It is not a diagnosis. Make sure to assess for underlying causes: CNS/neuro, tox, psychiatric and mental health crisis, traumatic, metabolic, etc. #MedTalk2024

The American College of Emergency Physicians (ACEP) recognizes the existence of hyperactive delirium syndrome with severe agitation, a potentially life threatening clinical condition characterized by a combination of vital sign abnormalities (e.g., elevated temperature and blood pressure), pronounced agitation, altered mental status, and metabolic derangements...

Defining "Hyperactive Delirium." See also the recent statement from ACEP that provides their definition. #MedTalk2024

Sensationalized reporting, misinformation challenges, expert communication, and ethical reporting guidelines.

The portrayal of "excited delirium" in the media certainly hasn't helped. #MedTalk2024

ACEP Reaffirms Positions on Hyperactive Delirium Today, the American College of Emergency Physicians (ACEP) reaffirmed several positions regarding the use of the term “excited delirium.”

"ACEP’s 2009 White Paper Report on Excited Delirium Syndrome is outdated and does not align with the College’s position based on the most recent science and better understanding of the issues surrounding hyperactive delirium." #MedTalk2024

How do you define "excited delirium?" You don't. Because it doesn't exist. Let's talk about Hyperactive Delirium with Severe Agitation instead. #MedTalk2024

Jeff Bilyk leading up the afternoon with his talk "The Curious Case of Bruce Banner: A New Lens for Severe Agitation." #MedTalk

Brain-based definition of death An animated video developed by the Canadian Critical Care Society (CCCS) in partnership with Canadian Blood Services (CBS) and the Canadian Medical Association (CMA…

Video from Dr. Healey's talk about the brain-based definition of death. #Medtalk2024