From Precons to EMS 10 Awards and Nightwatch! #EMSToday2015

Wednesday, February 25, 2015

What an awesome day at EMS Today 2015! Kelly and I headed over to the Convention Center to get registered and ran into our very good friends Nick Nudell (@RunMedic), Chris Montera (@geekymedic), and Anne Robinson Montera (@CaringAnne).

Nick and I started the EKG Club many years ago as an email-based discussion group. It is now a thriving Facebook group that you should check out! We’ve also done some interesting consulting work together in the implantable medical device industry.

Chris and Anne are one of the “power couples” of EMS and are very influential in Community Paramedicine (more on that later).

Advanced Airway Cadaver Lab

After getting registered we headed over to the Advanced Airway Cadaver Lab which is put on by the Paragon Medical Education Group (@ParagonMedEd). It was really great because Kelly and I had met Jim Logan at a previous EMS 10 Awards event and got along great. I had also recently met Joe Holley, M.D. (@joeholley) on Twitter so they were expecting us. What an awesome experience!

As a side note, social media has become an indispensable tool at medical conferences!


Everyone in the cadaver lab was dressed in full PPE including mask, gown, gloves, and hair covers. So it was a surprise when I heard a British accent say, “Are you that blogger Tom?” I said, “Yes, I am!” Well guess what? It was Team London (#TeamLondon)! We started chatting and I couldn’t help but tell them how much respect I have for the London Ambulance Service. When I brought up the Code STEMI Web Series they said, “You know Mark Whitbread is here. He’s over at the Resuscitation Academy right now!”

It’s been 3 years so we had to head over and see it for ourselves!

Resuscitation Academy

The moment we walked into the Resuscitation Academy we were greeted by our good friend Mike Helbock (@medicme). Mike is one of the smartest guys I know and he is always very generous with his time and knowledge. Kelly and I had dinner with him when we were in Seattle and he told us all about the history of King County Medic One, how it got started, and how they operate. It was fascinating.

I said, “Hey Mike do you mind if I take some pictures?” and he said, “You can do anything you want!” which cracked me up.

As it turned out it was getting toward the end of the morning session and they were about to do a full code scenario. Guess who was right in the middle of the action? The one and only Mark Whitbread from the London Ambulance Service!


If you haven’t seen the London episode of the Code STEMI Web Series you need to watch it. It’s an incredible system! It was great to see Mark but we had one more stop to make!

Advanced Community Paramedicine Workshop 

We arrived at the Advanced Community Paramedicine Workshop just in time to see a presentation about 2-1-1 San Diego and how it connects people who are struggling with appropriate resources. Immediately afterward our good friend Chris Montera (@geekymedic) talked about a case study from Eagle County Paramedic Services in Colorado.


After Chris’s presentation Kelly and I had a nice conversation with Matt Zavadsky (@MattZavadsky) from MedStar Mobile Healthcare. He’s a very well known guy in Community Paramedicine so it was nice to hear his perspective about 2-1-1 San Diego. Anyone who wants a nice introduction to Community Paramedicine can attend Introduction to Community Paramedicine today from 10:30 a.m. – 12:00 p.m.

Pratt Street Ale House

After a quick lunch at the Diamond Tavern (and another run-in with Team London) Kelly and I headed over to the Pratt Street Ale House where we met up with Thaddeus Setla (@setla), Scott Kier (@MedicSBK), Jeff Sorenson (@chicagomedic), Michael Herbert (@BigGermanMike), and several others (I hope they will forgive me for leaving them out). Things were just starting to get interesting when it was time for Kelly and I to head back to the room and get ready for the EMS 10 Awards.


Of course we just missed Hayden Drake (@paramedickiwi) from Team AUT!

By the way, the #EMSToday2015 hashtag on Twitter is really blowing up with some great stuff!

EMS 10 Awards

It’s always a real pleasure and distinct honor to share an evening with some of the greatest innovators in EMS and the EMS 10 Awards is a place where that is always guaranteed to happen! But, there’s one group that really stole the show and that was the crew from Nightwatch!


Left-to-right: Titus Tero (@NightwatchTitus), Dan Flynn (@Nightwatch_Dan), Kelly Arashin (@BarefootNurse24), Keeley Williams (@nightwatchmedic), Holly Monteleone (@NightwatchHolly), and Nick Manning (@Nightwatch_Nick)

It was impossible to not be impressed. They are a very genuine, and very gracious, group of top-notch EMS professionals! They really do the EMS profession and the City of New Orleans proud. Ken Bouvier is doing something right. That is obvious! Don’t miss your opportunity to meet the crew from Nightwatch. They will hanging out with the good folks from Physio-Control (@PhysioControl) at Booth 804.

There’s much more to say about the EMS 10 Awards and the very deserving awardees but I must get ready for my first-ever JEMS Editorial Board meeting which is sure to be interesting!

Stay tuned. This conference is just getting started! Follow me on Twitter at @tbouthillet.

The top 10 things about being a nurse…….

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I recently asked readers of my Facebook page to complete the following statement:  The best thing about being a nurse is…..

Here are the answers that were voted top 10:

1. The best thing about being a nurse is getting under the duvet after a night shift – there is no better feeling in the world! – Sally.

2. People…..they’re annoying, amazing, beautiful, challenging, inspiring, depressing……but engaging with people, is what I love most. –Alison.

3. The best thing about being a nurse is all the awesome stories you accumulate from all the weird and whacky situations you find yourself in. – Jade.

4. The fact that even though we moan about working nights and weekends and holidays and stressful situations that we all do it because we genuinely love it. We could be earning the same amount doing something much less stressful but we do it because our personalities mean we genuinely love and care for our patients and go through all the emotions possible in one shift. It’s a weird addiction nursing and no one else other than nurses would understand that. Wouldn’t be anything else! – Emily.

5. Learning wine appreciation — Lucinda.

6. The best thing about being a nurse is helping patients die with dignity. — Sian.

7. Shaking the hand if the patient who cardiac arrested 3 times on your last shift. He thanks you for his life and all you can think of is you have made a family happy. And…. yes another stressful shift has a great outcome. — Anna.

8. The ability to make a positive difference to each and every person we encounter every single day of our working life — Angie.

9. Wearing pajamas to work!! — Brooke.

10. Is knowing that you have made a big difference in someone’s life been though it may seem trivial to others — Sharon.

Original featured image via DFAT photo library.

Reference: 1. (12) The Nurse Path – Complete this thought: “The best thing about… [Internet]. [cited 2015 Feb 26]. Available from:

Elastic compression stockings do not prevent post-thrombotic syndrome following DVT.

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1 in 3 patients with a DVT will go on to develop Post-thrombotic syndrome (PTS) within 5 years.
PTS includes clinical features ranging from minor limb swelling and venous stasis dermatitis to leg ulcerations. It is thought to occur when venous obstruction from the DVT decreases forward blood flow and results in venous hypertension which in turn leads to tissue oedema, inflammation and hypoxia.

A study conducted by Kahn and colleagues into the effectiveness of compression stockings in the prevention of PTS was evaluated and found that compression stocking use following a proximal DVT did not reduce the incidence of PTS.

In a commentary on this study published in Evidence Based Nursing, Arib Kanaan notes the impact this study will have on current clinical practice:

This study provides definitive evidence against the routine use of elastic compression stockings following a first episode of deep vein thrombosis for the prevention of post-thrombotic syndrome (PTS). These findings are not consistent with previously published trials and meta-analyses which supported the use of compression stockings in this indication. In these trials and analyses, limitations in methodology including assessment of PTS prevented generalisability of findings. However, the use of compres- sion stockings to prevent PTS was supported by practice guidelines and continued in practice, even though their use could be challenging due to their cost and potential to cause itchiness, restriction and discomfort.
[…] The findings by Kahn and colleagues will have an impact on current clinical practice as they are generalisable and can be extrapolated to the general population in whom the use of compression stockings would be considered.
[…] While this study does not support the use of elastic compression stockings, other preventive measures can still be implemented to prevent PTS in patients diagnosed with acute DVT. These include modifying patient-specific risk factors, enhancing the time within therapeutic range and optimising duration of therapy when using anticoagulants, prevent- ing recurrent ipsilateral DVT, and surgically intervening on venous valves. Although compression stockings should not be used to prevent PTS after an acute DVT, their role in treating symptoms of established PTS remains understudied and warrants further investigation.


  1. Elastic compression stockings fail to prevent post-thrombotic syndrome after a first deep vein thrombosis – Kanaan – Evidence-Based Nursing [Internet]. [cited 2015 Feb 26]. Available from:–2014–101873
  2. Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial – The Lancet [Internet]. [cited 2015 Feb 26]. Available from:–6736%2813%2961902–9/abstract
  3. Post-thrombotic (postphlebitic) syndrome [Internet]. [cited 2015 Feb 26]. Available from:
  4. Chronic Venous Insufficiency and Postphlebitic Syndrome: Peripheral Venous Disorders: Merck Manual Professional [Internet]. [cited 2015 Feb 26]. Available from:

Nauka USG za bezcen :-)

Niby utarło się, iż w życiu nic nie ma za darmo… Jednakże, w medycynie ratunkowej coraz więcej zasobów edukacyjnych najwyższej jakości dostępnych jest właśnie „za friko”. Niech żyje #FOAMed!!! Uprzejmie donoszę, iż wielbiciele USG pierwszego kontaktu (point-of-care ultrasonography), z racji swych technicznych (żeby nie powiedzieć gadżeciarskich) skłonności, niejako przodują w dostarczaniu darmowych blogów, e-książek i aplikacji.

Na stronie Ultrasound Training Solutions znajdziecie długą listę odnośników do zasobów internetowych. Poza tym jest też kilka bardzo cennych książek i aplikacji, które można nabyć za bezcen ;-)

Cenne E-Książki Za Bezcen

Introduction to Bedside Ultrasound – część 1 & 2 [Inkling]

Introduction to Bedside Ultrasound – część 1 [iBook]

Introduction to Bedside Ultrasound – część 2 [iBook]

The ICU Ultrasound Pocket Book [iBook]

Trauma Ultrasound eBook [iBook]

Rapid Ultrasound: Basics & RUSH exam [iBook]

Handheld Cardiac Ultrasound: Case Series [iBook]

Practical Ultrasound Series: Deep Venous Thrombosis [iBook]

Ultrasound-Guided Regional Anesthesia: Interactive Guide 4 Beginners [iBook]

Aplikacje za bezcen

One Minute Ultrasound [Apple]

One Minute Ultrasound [Android]

Ohio State U/S Guide [Apple]

SonoAccess by SonoSite [Apple]

SonoAccess by SonoSite [Android]

Pocket Emergency Ultrasound [Apple]

Emergency Ultrasound Handbook [Apple]

Echo Guided Life Support [Apple]

Epocrates Echocardiography Atlas [Apple]

Read QXMD app

Tak na zakończenie wspomnę jeszcze o bardzo ciekawej aplikacji READ by QxMD. Dzięki niej można w bardzo łatwy sposób śledzić nowości pojawiające się w literaturze naukowej. Oczywiście nie tylko na temat USG. Jeżeli wprowadzi się dane proxy uczelnianej biblioteki, to można też wiele artykułów w całości ściągnąć na telefon.

Research and Reviews in the Fastlane 072

Research and Reviews in the Fastlane

Welcome to the 72th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

Critical Care
R&R Hall of Famer - You simply MUST READ this!Vincent JL et al. Ten big mistakes in intensive care medicine. Intensive Care Med. 2014. PMID 25502093

PediatricsR&R Game Changer? Might change your clinical practiceAdelgais KM et al. Intra-Abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries. J Pediatr. 2014; 165(6):1230-1235. PMID 25266346

  • The leading cause of mortality in children is accidental injuries. Fortunately, the majority of kids that you see after injuries will not have severe trauma, but sorting out those who are at risk of serious abdominal trauma can be difficult. This is a reminder that you can rely on your exam… when the child has a normal GCS. As the GCS declines, the reliability of your exam declines as well.
  • Recommended by Sean Fox

Research and Critical AppraisalR&R Mona Lisa -Brilliant writing or explanation” width=Sedgwick P. Sample size: how many participants are needed in a cohort study? BMJ. 2014 Oct 31;349:g6557. PMID 25361576

  • This is really just to highlight the excellent series that Phillip Sedgwick [@statistics_man] writes for the BMJ. Sadly not #FOAMed but a great resource for those looking to learn for the UK FCEM exam. Here’s a link to every single one below.
  • Recommended by: Andy Neil

AirwayR&R Hot Stuff - Everyone’s going to be talking about thisR&R Game Changer? Might change your clinical practiceSheren PB et al. Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill. Scand J Trauma Resusc Emerg Med. 2014; 22(1): 41. PMID 25209044

  • An excellent, evidence based review of the critical components of RSI. The authors use this evidence to build a standard operating procedure with an airway checklist and kit dump that can aid in building team dynamics and decrease the incidence of adverse events.
  • Recommended by Anand Swaminathan

Critical CareR&R Game Changer? Might change your clinical practiceLoubani OM, Green RS. A Systematic Review of Extravasation and Local Tissue Injury from Administration of Vasopressors through Peripheral Intravenous Catheters and Central Venous Catheters. J Crit Care 2015. PMID 25669592

  •  We’re taught to administer vasopressors through central lines and this may delay these medications. These authors searched the literature to find extravasation and local tissue complications of vasopressors and came up with case reports (n=305 from 270 patients). They found that local tissue injury attributable to peripheral administration tends to occur in distal IV sites following long durations of infusions (average infusion duration before extravasation: 35.2 h). If a patient needs a pressor, they can get it peripherally temporarily while you’re obtaining central access.
  • Recommended by Lauren Westafer

TraumaR&R Game Changer? Might change your clinical practiceMutschler M et al. The ATLS(®) classification of hypovolaemic shock: A well established teaching tool on the edge?.Injury 2014; 45 Suppl 3:S35-8. PMID 25284231

  •  The ATLS shock classification has been taking a beating lately. The classification in it self has very little scientific back up – studies have shown that more than 90% of all trauma patients could not be classified according to system. Irrespective of mechanism of injury the classification it may overestimate the degree of tachycardia associated with hypotension and underestimate mental disability in the presence of hypovolaemic shock. Does the ATLS faculty believe it? – Doesn’t seem so. In a survey among 383 European ATLS course instructors and directors the actual appreciation and confidence in this tool during daily clinical trauma care was assessed. Less than half (48%) of all respondents declared that they use the system in their own practice. Overall it seems that the ATLS shock classification today serves only on purpose – namely to test the students attending the course. Hopefully future ATLS manuals will revise the current classification.
  • Recommended by Søren Rudolph

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

The post Research and Reviews in the Fastlane 072 appeared first on LITFL.

Migraine Headache: Prochlorperazine + diphenhydramine versus Metoclopramide + diphenhydramine

​Pediatrics published an article regarding Migraine treatment in children. This is a retrospective study that has shown us non opioid medication has pretty significant effects in the treatment of Migraine. The treaatment plan is very regular that we usually practice. Compazine, Reglan, Benadryl, NSAIDS,… Patient with Metcolopramid returned to ED visit more often than group who received Prochlorperazine. 5.8 % of patient with Prochlorperazine treatment returned within 3 days vs 7.5 % in Metoclopramide group. when it combined with diphenhydramine, Prochlorperazine + diphenhydramine had 5.5% return visit versus 8.6 % in Metoclopramide + diphenhydramine. We have already known that Prochlorperazine is superior tometoclopramide, but this study has some limitations that we need to take into account:

1. Retrospectve!
2. We do not know reasons for revisit of Patients to ED???
3. we do not have the dosage that they used!
4. we do not have standard pain scales to know 10/10 came back or 5/5 returned!