Ketamine is a new Prehospital drug in Maine and Mass. We're gonna talk 
about Ketamine like it's our first born child.

EP. 8, Into the K-hole

This week we have the great opportunity to speak with the Chair of the SMCC paramedic program, Eric Wellman.Today we are talking about the Affective Domain. Which is only helpful if you understand the context right? Bloom's taxonomy is a theory on how to create a better learning environment and more involved students.The Three Domains of Learning:Cognitive: mental skills (knowledge)Affective: growth in feelings or emotional areas (attitude or self)Psychomotor: manual or physical skills (skills) Today we are focusing on the affective domain. As we mentioned, This has been introduced into the National Standard Curriculum. “Affective - Students must demonstrate professionalism, conscientiousness and interest in learning. The affective evaluation instruments contained within this curriculum were developed using a valid process and their use is strongly recommended. Just as with cognitive material, the program cannot hold a student responsible for professional behaviors that were not clearly taught. The professional attributes evaluated using this instrument references the material in the Roles and Responsibilities of the Paramedic section of the curriculum. The instruments can be incorporated into all four components of the program: didactic, practical laboratory, clinical and field internship. Students who fail to do so should be counseled while the course is in progress in order to provide them the opportunity to develop and exhibit the proper attitude expected of a paramedic. " (Director, n.d., p. 26) “Using the results of cognitive scores has not guaranteed that students will succeed in a particular academic program. Therefore, finding a method to assess affective domains in potential applicants has been recognized as an important consideration. " (Lyman, 2014, p. 70Thank you for Listening! Please give us a like on Facebook, and subscribe on Itunes or wherever you get your podcast! References Director, P. (n.d.). EMT-PARAMEDIC: NATIONAL STANDARD CURRICULUM. Retrieved from http://www.nhtsa.gov/people/injury/ems/EMT-P/disk_1%5B1%5D/Intro.pdfLyman, K. J. (2014). The Relationship of Affective Domains and Cognitive Performance in Paramedic Students. University of South Florida. Retrieved from http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=6455&context=etd 

EP. 7, Affective Domain in Paramedic Education

Case review of an AA(RCH)A with pericardial effusion!

EP.6 Chest pain, Zebras do exist!

Paramedic students talk about a Cardiac arrest save, What they think is important, and what a new paramedic student should think of.

EP.5 Managing Cardiac Arrest as a Paramedic Student

Thank you for tuning into the MaineCrit podcast and checking out the show notes!  Cardiac Arrest... When to Transport. First, Transporting a patient in cardiac arrest is NOT beneficial unless the receiving facility is prepared and equipped to continue the resuscitation by treating reversible causes that EMS cannot. This is for EMS and ED providers.The Case:A 42 year old man awoke in the middle of the night with sudden, sharp chest pain and shortness of breath.  He had no previous cardiac history and appeared very fit.  His wife called 911.  EMS arrived to find their patient in severe extremis and poorly perfused. He progressed to PEA arrest and the crew performed high quality CPR immediately. Advanced airway Obtained IV access. Several rounds of epinephrine. They worked the code for 20 minutes per protocol but did not get ROSC in the field so they called it. The patient had minor surgery within the last week... The hospital was half a mile away...Take Home Points:Most patients who suffer an OHCA will not survive intact unless ROSC occurs in the field.There are reversible causes that most EMS systems cannot treat but an Emergency Department can.There will be a small subset of viable patients that may be saved if transported expeditiously.It is possible to transport patients in cardiac arrest safely with manual CPR and, perhaps someday, mechanical chest compressions and ventilation will open up additional options for longer transports to tertiary hospitals.We must give every patient a chance for a successful outcome if such a chance exists.  That is what Resuscitationist do!  We must not give up unless there is nothing else that can be done. References/SourcesSMACC/Cliff Reid - When Should Resuscitation StopED ECMO - Annie (May 2013), 60+ minutes of CPRDr. Smith's ECG Blog - 68 minutes with chest compressions, full recovery.Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activityDouble Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac ArrestA simplified and structured teaching tool for the evaluation and management of pulseless electrical activity.

EP.4 Cardiac Arrest... When to Transport.

Dr. John Hinds#NIHEMS change.org petition.
A tribute to @DocJohnHinds via @Eleytherius "Ride On" http://t.co/FAWhxUp8Ql#FOAMed#DeathIsAWankerpic.twitter.com/MgMgTPL2jI
— Salim R. Rezaie (@srrezaie) July 7, 2015SMACCForce - dedicated to John Hinds from Mark Wilson on Vimeo.
Cricothyrotomy, Training, and mental simulation.
#FOAM
Twitter references:Minh Le Cong @ketaminhScott Weingart @emcritCliff Reid @cliffreidAnand Swaminathan @EMSwami
Social mediaLast Mile HealthSMACC
Thank you so much for listening! Stay tuned for more material from MaineCrit!

Medic to medicine part 2, with Michael Lauria.

Review our show notes as you listen to the podcast!Michael Lauria, Paramedic and MS-1MaineCrit traveled down to Hanover, NH to interview flight paramedic and MS-1, Michael Lauria(@ResusPadawan)Toughness Part I with Michael LauriaScott Weingart's interview with Michael on Mental toughness.The Importance of GRITJohn Greenwood's post about GRIT on IteachEM.Hofstra North-Shore"New Med Students Training as EMTs"Victoria Brazil - Evidence-Based Education- What WorksSMACC Gold lecture on what works in education. The answer is yes. The answer is also no.Mental practice: a simple tool to enhance team-based trauma resuscitation(PubMed)Full article: Mental Practice for Trauma Resuscitation http://t.co/k1zOBjPRt8#FOAMed@CJEMonline@ResusPadawan@EMSwami@Inject_Orange — Christopher Hicks (@HumanFact0rz) April 11, 2015And finally, Dat library...Just a small piece. 

Medic to Medicine: Michael Lauria

Shock:  Inadequate perfusion at the cellular level.“The rude unhinging of the machinery of life” ~Samuel D. GrossAdequate Perfusion requires:The Pump (heart)The Fluid (blood)The Container (vasculature)Air Exchange (oxygenation / ventilation)The PumpAdequate Cardiac OutputStroke Volume X Heart Rate (4-8L/minute)Affected by Preload, Contractile Force, and AfterloadThe FluidVolume of blood must fill containerThe ContainerVasculature is properly sizedPre and post capillary sphincters at local levelAir ExchangeO2 into lungs and circulationElimination of CO2 and waste productsREQUIRES:Adequate FiO2 and ventilationDiffusion across alveoli / capillary membraneAdequate number of RBCsEfficient offloading to target cellsStages of ShockCompensatedDecompensatedIrreversibleTypes of ShockHypovolemicCardiogenicDistributiveObstructiveManaging ShockPrimary Survey / ABCsO2BVMC  spineMajor bleedingSupine / Keep warmIV, monitorSpecific TreatmentsFluid challengeEpi / Benadryl (anaphylaxis)Chest decompression (tension pneumothorax)Pericardiocentesis (cardiac tamponade)Dysrhythmias (ACLS)Pressors (fluids first)Narcan (opiod OD)Take Home PointsShock:  Inadequate perfusion at the cellular level.If you think shock, your patient is already there.Know and treat the root causes.Set a target MAP.Be aggressive!~Chip Getchell

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