In the first of our "half episode" series which focuses on a various of melting pot of prehospital topics, I sit down with Jay Loosley. Jay is the Superintendent of Education for the Middlesex-London Paramedic service. Jay along with some colleagues at his service and local hospitals (along with more I'm sure) put together a fantastic research project on this topic which we delve into.

Paramedic Research Poster:

Can't see the image above or want to download the high resolution PDF? CLICK HERE

Additional studies

Blog: John P. Schuman: Can Paramedics Find Out About Patient Outcomes?

Research: Academic Emergency Medicine Education & Training: Clinical Performance Feedback to Paramedics: What they receive and what they need.

Research: Canadian Medical Association Journal: Patient and paramedic engagement in prehospital emergency medicine research.

The Case:

Male in his 20's in the early morning hours unconscious. Upon arrival the patients father came home and found his son unconscious on the living room floor. House is not in disarray, no trauma is noted to the patient, and nothing around the patient. Father states he has no diagnosed medical history, no Rx meds, however years ago the patient struggled with cocaine abuse. Despite such his understanding is the patient has been cocaine free for the last 8 months. States it would be unlikely for him to consume excessive alcohol, no other Rx or recreational drug use, and the fathers Rx meds are all accounted for.

Initial vitals: GCS 3, flushed, sweaty HR 128 Reg, RR shallow 22, SPO2 88% ra, BGL 7.2, 82/54, T37.5C, Pupils sluggish at 4-5mm.

Prehospital 12-Lead ECG here:

If the 12-Lead is not showing properly you can click HERE to open it up in a browser window.

Sympathomimetic toxidrome Clinical features: delusions / paranoia / tachycardia / hypertension / hypotension (severe) / hyperthermia / sweating / piloerection / mydriasis / hyperreflexia / seizures

Useful Links (will open in separate browser windows):

Internet Book of Critical Care - Sodium Channel Blocker Toxicity https://emcrit.org/ibcc/nacb/

Internet Book of Critical Care - Sympathomimetic intoxication https://emcrit.org/ibcc/symp/

StatPearls - Cocaine Toxicity https://www.ncbi.nlm.nih.gov/books/NBK430976/

Medscape - Cocaine Toxicity (free registration required) https://emedicine.medscape.com/article/813959-overview

Life in the Fast Lane - Cocaine Toxicity https://litfl.com/cocaine-toxicity-ccc/

The Remember That Patient Podcast - Introduction or Episode 0

This brief trailer will highlight our ideas, and what we hope to accomplish going forward on our show.