Windows to the Heart Ultrasound use in Acute Coronary Syndromes and Cardiac Arrest
Ray Cadwallader NR-P, FP-C Life Force Air Medical Service
Pre-hospital and critical care transport medicine are rapidly advancing fields with implementation of new technology and research based care. In effort to improve patient outcomes, we continually look for diagnostic measures to confirm clinical impressions. Ultrasound technology is becoming more readily available outside of the hospital and can be used to guide definitive interventions. This presentation discusses the benefits of ultrasound use in the settings of ACS (Acute Coronary Syndromes) and even Cardiac Arrest. US imagery is used to show valve dysfunction, areas of compromised cardiac muscle as well as pericardial effusion/tamponade. Materials covered are basics of image interpretation, optimal probe placement and actual case presentations. These cases demonstrate ways in which US was used to confirm extent of myocardial injury in ACS/STEMI and even myocardial activity in the presence of apparent cardiac arrest. The most interesting case and inspiration for this presentation was a case in which one of our crews responded and assisted with the resuscitation of a patient presumed to be in PEA arrest. Once the Hs&,Ts had been addressed the code was about to be called, but our crew opted to use our US to assess for any myocardial activity. Rhythmic ventricular activity was noted in spite of un-palpable pulses. Vasopressor agents were used producing palpable pulses and the patient was ultimately resuscitated and recovered from the event. The idea is to promote early aggressive diagnostics that support or confirm assessment findings and help improve patient outcomes in our cardiac patients.
Alphabet Soup of Stroke Assessment in the Acute Stroke Patient
Ray Bennett BSN RN SCRN CEN CFRN CTRN NRP RWJ Barnabas Health
This session will improve the assessment of the Acute Stroke patient by breaking down the various stroke scales and incorporating neuro assessment tools and tips to build a systematic approach to identifying the various stroke syndromes and ruling out stroke mimics.
Not Just A Kid Problem Anymore: Transporting Adults With Congenital Heart Disease
Tracy Rojas MSN CCRN C-NPT Ann and Robert H. Lurie Childrens Hospital of Chicago
Nearly 1 million adults in the USA are living with congenital heart disease (CHD). Many adult patients with CHD continue to receive care at pediatric healthcare facilities. This presentation will inform the pediatric and adult transport provider of the many complexities of transporting the adult with CHD.
Unintended Outcomes – Navigating the space between Impulse and Aversion
Jamey Myers EMT-P Shock Trauma Air Rescue Service (STARS)
This interactive discussion will focus on how managers and policy makers react to the variable world of critical care transport. Attendees will be asked to reflect on how these changes affect their own programs and how we can better navigate the space between knee-jerk reactions and opposition to change.
Tight Head: An Etc02 Of 40 With A Square Wave Form May Not Be A Good Thing
Chad Hegge EMT-P, BHSc Shock Trauma Air Rescue Service (STARS)
End tidal carbon dioxide (Etc02) is notoriously unreliable in situations with increased shunt or deadspace. Venous blood gases have significant limitations in shock states. A large percentage of the patients transported with traumatic brain injury (TBI) have been polytraumtized, and neither Etc02 nor pvC02 will be reliable. This talk will review the brain injury mechanical ventilation protocol that our organization (STARS) uses to address this exact scenario.
Logistic Considerations for ECMO Transports
Travis Byerly EMT-P, FP-C and David Zook BSN, CFRN Life Lion Critical Care Transport
A look at the logistics involved for ECMO transports primarily in the rotor wing environment. Discussing specialized equipment, equipment configuration, packaging of patient and equipment, and crew configuration based on current practices in place at Penn State Health Life Lion Critical Care Transport.
It’s Just A Ventilator: Fielding A New Ventilator In A Multi-Disciplinary CCT Program
Christopher Oberg RRT-NPS, Rich Sneed RRT-NPS And Jon Miller RRT-NPS Indiana University Health LifeLine
IU Health Lifeline chose to replace the LTV 1200, a commonly used transport ventilator, with the Hamilton T- 1.This presentation will discuss the challenges we faced from the initial purchase to initial and ongoing training. Lessons learned will be discussed from the point of view of leadership and staff.
It’s All In The Numbers: Implementing A Sepsis Scoring Tool And Treatment Pathway For Your Pediatric Patients
Trona Milano MSN RN CCRN LP CNPT CMTE and Kristal Mantyh BSN RN EMT Cook Children’s Teddy Bear Transport
Early recognition and treatment of sepsis is critical in decreasing morbidity and mortality of pediatric patients. Learn how our Pediatric / Neonatal Critical Care Transport team implemented our medical center’s Sepsis Scoring Tool and treatment pathway to save time in initiating appropriate care.
It’s All the Rave: Adolescent Street Drugs
Teri Campbell, RN,CFRN University of Chicago Aeromedical
Not my kid. How many times have we heard this from parent of teens that have over-dosed or experienced some deleterious outcome related to using street drugs? What are they taking? Why are they taking it? Where are they getting it? And most importantly for health care professionals, how do we care and manage them? Come to this fast paced, informative and somewhat terrifying lecture to learn how to recognize, treat and mitigate “badness” related to street drug exposures.
No Stroke Left Behind
Ray Bennett BSN RN SCRN CEN CFRN CTRN NRP RWJ Barnabas Health
This session will discuss the increasingly aggressive approach to the treatment of the stroke patient. The changes in Alteplase (rtPA) product literature that has increased usage in the AIS patient. The indications for Mechanical Thrombectomy in AIS. Rational for rapid transfer to comprehensive stroke centers for high level stroke care. This session will also discuss new directions and research in the treatment of the Hemorrhagic stroke patient.
Neonatal Emergencies, It’s the little things…..
Lynette Hemphill RN, NRP, CEN Air Care University Of Iowa
Neonatal patients are infrequent and often come with high stress environments. This lecture is meant to take some of the stressors out of these types of calls.
Improving TeleStroke Care
Joseph DePatto EMT-P, FP-C Life Lion Critical Care
Working in conjunction with the Penn State Health LionNet Stroke program, Life Lion team members log on and view each TeleStroke consult as it happens. This allows Life Lion team members to gather pertinent information specific to the treatment and management of the patient. Once a decision is made to transfer the patient, teams will be able to maintain a continuity of care while transferring a patient to Milton S. Hershey Medical Center. From the beginning, Life Lion administration worked with Penn State Health Neuroscience Institute in designing the LionNet TeleStroke program to be a streamlined process that included the neurology consult, treatment, and transport of stroke patients. Emphasis was placed on time, continuity of care and, and transport. This allowed Life Lion to be more integrated into the build out process. Because crews are on each patient consult, they already know the history of present illness, past medical history, medications, allergies, initial physical exam, lab work, and treatment performed. When the decision is made to transfer, they already have all the information they need. When they arrive bedside, they will obtain a quick patient update, transfer appropriate medications, and ready the patient for transport. This process allows for minimal patient bedside time which in-turn helps increase the interventional time window at tertiary care.
You Want Me To Transport WHAT? A Series Of Pediatric Transport Stories For The Transport Community
Peter Brust RN, MSN, CCRN, CMTE Nemours/ A I DuPont Hospital for Children
This session will describe cases in pediatric and neonatal transport that are slightly different than the average transport. The complexities of unique situations will be explored along with specific disease processes and injuries that are not typically seen will be reviewed.
Stacey Ibanez RRT CHS, MedCenter Air
DIscussing Neonatal Abstience Syndrome and its increasing prevelance in todays world.
Every Breath You Take: Modes Of Mechanical Ventilation And The Mechanical Breath Profile
Jon Inkrott, AS, RRT, Florida Hospital Orlando
There are many ventilator platforms available for critical care professionals, from the transport world to the intensive care unit. Ventilators offer a variety of ventilation modes, but what’s the best mode? Is there a best mode? Do I use volume or pressure? What is PCV, APRV, APV-CMV, PRVC, AC, or SIMV? This presentation will focus on the different ventilation modalities the transport practitioner may encounter and also, what the mechanical breath profile and individualized approach to mechanical ventilation really means to your patient.
My Patient Is A Crime Scene: Evidence Preservation 101
Leonard Mascaro NRP, CCEMT Fairfax County Police Helicopter Division
Many scene flights involve patients related to criminal activities. Traumatic injuries such as shootings and stabbings often require evidence preservation during transport. This presentation will focus on preserving evidence, not only physical evidence, but also evidence contained inside the body.
The Clinical Nurse Specialist in the Transport Setting: What is a CNS?
Susan Toberman MSN, RN, APRN, ACCNS-AG, CCRN, CFRN, EMT University of Tennessee Medical Center
This presentation will introduce the role of the clinical nurse specialist in transport. The presentation will speak to the advantages of having the Clinical Nurse Specialist oversee the clinical operations of the critical care transport team. The clinical nurse specialist works in partnership with the Medical Director to commit to patient safety, improve outcomes and seek evidence-based best practices. The CNS oversees orientation, clinical practice, protocols, clinical QA/QI and clinical research.
Use Of An Education Committee To Develop And Maintain Staff Competencies For A Neonatal/Pediatric Critical Care Transport Team
Cynthia Japp MSN,RN, APRN-CNS, C-NPT, Emily Colyer BSN, RN, CEN, CTRN, NREMT-P, Mikele Wissing BSN, RN, CEN, CCRN, Justin Parsley BSN, RN, CCRN, Sally Nord MS, RN, CPN Children’s Hospital & Medical Cetner
In a hospital based neonatal/pediatric critical care transport team, there is an institutional commitment to share governance. The transport program utilizes crew members in all aspects of program administration, including education. This lecture will outline the steps taken to develop the Education Committee, the role of the Education Committee in designing quarterly competencies and on-going education. This lecture will discuss those items that were easily accomplished and worked well and the lessons learned as the Education Committee developed processes.
The Bloody and Viscious Trauma Triad of Death
Daniel Mills NR-P FPC Haynes Life Flight
We all love a good pre-hospital trauma. Too often we see the trauma care part performed poorly. We will take an indepth evidence based look into the trauma triad of death and how we are affecting our patients in a negative way with our treatment.
I’ve Been Exposed To…WHAT? Post-Exposure Management Of Infectious Diseases
David Wuertz MS, RN, CFRN, LP PHI Air Medical
Super bugs are in the news. Contact with infectious diseases by health care workers is a fact of life, however, the challenging world of air medical makes follow-up after exposure difficult. This presentation will explore the CDC isolation guidelines, strategies to protect flight crews from disease transmission, and post-exposure treatment of high-risk infectious diseases.
Hocus POCUS: Beyond the FAST exam… Next Level Aeromedical Ultrasound Applications
Sean Smith BSN, NREMT-P, C-NPT, FP-C, TP-C, CCRN-CMC, CCRN-K, CEN, CFRN, CPEN Critical-Care Professionals International / Vector Aeromedical and Benjamin Abo DO, NREMT-P, CCEMT-P, FAWM ShandsCair
Does your team do scene calls or transfers from rural ERs/ICUs? This lecute is for YOU! Point Of Care Ultra Sound…(POCUS) by now, the FAST exam (Focused Abdominal Sonography for Trauma) is old news…It was formally fully integrated into ATLS in 2012… (and written into the TNCC Shock guidelines in 2013 by the presenter of this proposal). Are you ready to take your ultrasound knowledge to the next level? Last year’s news is old news! Join a flight nurse/paramedic with extensive austere medicine experience and the Medical Director Leadership of ShandsCair flight program as we explore and share the rapidly evolving world of POCUS, cutting edge equipment, Aeromedical relevance and how you can meaningfully integrate the lastest developments into your clinical practice!
You Only Get Three… Selecting Lab Values With Meaning For Five Critical Patients
Amy Rynes MSN, FNP-BC, CFRN and Laurie Smith FPC LifeLink III
When faced with complex patients for transport it can become overwhelming when the sending facility staff is rattling off lab values as you are packaging you patient. You may ask yourself which numbers should I care about at this point with this patient? This lecture is designed for you to gain a greater understanding for just three lab values per patient class to better focus your attention. Lab definitions, normal and abnormal will be discussed. In addition, the advantages and disadvantages to retesting will also be touched upon. All with the hope that you can walk away from the lecture knowing three more lab values then when you started.
Taking TXA Beyond Trauma
Rick Erickson NRP, FP-C AirMethods Corporation and Klint Kloepping NRP, FP-C, C-NPT Midwest MedAir
Tranexamic acid (TXA) has become common place in critical care transport in the management of. This presentation addresses current research in conditions beyond trauma including post-partum bleeding, head bleeds, DIC, and GI bleeds. We will look at current thoughts and future implementation into critical care practice through case based presentations.
Something Wicked This Way Comes…Mind the Gap! Emerging Trends in Toxicology
Sean Smith BSN, NREMT-P, C-NPT, FP-C, TP-C, CCRN-CMC, CCRN-K, CEN, CFRN, CPEN Critical-Care Professionals International and Ben Abo DO, NR-EMTP, CCEMTP, FAWM ShandsCair
Are you a technician or a Clinician? Do you truly understand what is happening at the cellular level with both toxins and their antidotes and its clinical relevance? Do you know what a high Anion Gap metabolic Acidosis is and how it relates to toxicology? After this lecture, you will. What do lidocaine and tricyclc antidepressants have in common? What do toxins that prolong QT interval have in common with congenital sudden cardiac death? Why does adenosine cause your patient to take a systolic holiday? Join a former research scientist turned flight nurse/paramedic and the Medical Director Leadership of ShandsCair to get updated on the latest emegering trends in clinical toxicology and fully explore the vital relevance of molecular pharmacology and toxicology to your clincal practice as a cutting edge aeromedical health care provider.
Sepsis, What’s Time Got To Do With It?
Daniel Mills NR-P FPC Haynes Life Flight
Sepsis kills more people than AIDS, breast cancer and prostate cancer combined, yet sepsis goes unrecognized and underdiagnosed in hundreds of thousands of patients. Sit back and join in on an in depth conversation about sepsis and its deadly effects on the body. When you think sepsis, act fast!
Transport Hemodynamics: Do You Know Your Numbers and Lines?
Cindy Goodrich RN, MS, CCRN Airlift Northwest
Critical care transport requires specialized knowledge and skills related to hemodynamic monitoring. Use of these technologies allows for assessment of cardiopulmonary status and responses to therapy. Clinicians must be familiar with hemodynamic monitoring technologies and have the knowledge and skill to provide safe and effective care during transport. The focus of the presentation is to provide the clinician with a brief overview of pressure monitoring and some of the most commonly used hemodynamic technologies in the transport setting. This will include a discussion of arterial lines, central venous catheters and pulmonary artery catheters. Key safety factors and the unique consideration related to transport of patients with hemodynamic monitoring will be emphasized during this presentation
Fearless Analgesia, Sedation and Induction: Customizing Your Approach in Tough Situations
Bryan Winchell RN, EMT-P, CNP-T, CCRN, CFRN, FP-C, CCP-C Flight For Life
We know that applying a standard RSI to patients in shock can be dangerous: both compensated and frank shock require special handling. Managing pain, providing anxiolysis, or sedating patients is no exception. Clinicians will learn important insights to help them wield critical meds skillfully in hemodynamic compromise, obesity, and organ failure. This lecture provides clear, evidenced-based insights to keep your patients safe AND comfortable.
New Ways to Determine Ischemia in LBBB
Bryan Winchell RN, EMT-P, CNP-T, CCRN, CFRN, FP-C, CCP-C Flight For Life
The presence of LBBB has traditionally confounded STEMI interpretation, resulting in both unneeded cath lab activations and missed AMIs. We will discuss current evidence and learn a straightforward way to decide when and when not to activate the cath lab in patients with LBBB, using real ECGs and outcomes from patients flown in a two-year study.
More Than ‘Just The Shakes’: Real Alcohol Emergencies
Michael Frakes MSc, APRN, CFRN, CCNS, CNPT, EMTP, FACHE Boston MedFlight
The intoxicated patient may be the stereotypical emergency services patient. What sometimes gets overlooked is that these patients can represent true critical illness, with mortality rates up to 40% for some conditions. This talk will describe the spectrum of alcohol withdrawal syndromes and emergencies, from benign to critical,and will prepare transport teams to understand and manage them all. As a bonus, it will also unravel the mystery of the Banana Bag.