Clinical – Core

Sponsored by

Informed Refusal: How To Take No For An Answer
William Selde, MD, FAEMS, Wyoming Life Flight

Patient refusals are a significant source of risk for an EMS organization. The process of informed refusal is a strategy to mitigate this risk and provide optimal patient care. This session will present the concept of informed patient refusal. It will provide an evidenced based assessment of the nature of patient refusals, introduce the concept of informed refusal, and discuss how it can be performed by all ems providers.

Adult Sepsis and Effects an Education Intervention Has on One Organization’s Quality Metrics
Greg Schano, MSN, RN, MBA, CCRN, CMTE, CNML, EMTP, MedFlight of Ohio

The impact of sepsis is great and affects 31 million persons per year globally with mortality as high as 60%.  In the US sepsis is the 2nd most common reason for hospitalization and the most costly hospital condition.  Sepsis is complicated and under recognized by even the most experienced clinician.  Pathogenesis of sepsis is not fully understood – not all infected patients become septic – and yet treatment is time sensitive.  In 2016 a new sepsis consensus definition emerged.  Education for critical care transport providers may affect compliance with organizational quality metrics.

Where There’s Fire, There’s Smoke: Care of Patients with Burn Inhalation Injury
Christopher Stevenson, AGACNP-BC, RN, MSN, EMT-B, VCU Health/Virginia State Police Med-Flight

Inhalation injury is a spectrum of injuries greatly increasing morbidity and mortality in burn patients that includes thermal, chemical and systemic poisons. We will discuss airway management with video review of a spectrum of video intubations of burn patients captured during laryngoscopy. In addition we will discuss initial management of sub-glottic injury and in-patient continuing therapy. We will also discussed the under-reported killer in burn patients, systemic poisoning and pre-hospital steps that can mitigate morbidity and mortality.

Acute Burn Management: Moving Beyond Parkland Resuscitation for Critical Care Providers
Stephanie Steiner, MSN, ACNP-C, CPNP-AC, CFRN, APRN, Akron Childrens Hospital

Caring for the acutely burned adult or pediatric patient can prove to be a challenging resuscitation for any critical care transport provider. While devastating injury clearly visible to the eye can be very distracting, the enormous inflammatory response that lies beneath the visible injury is where attention needs to be focused. Depending on what phase of injury a transport provider interfaces with a burn patient, there are management priorities that can truly influence outcomes. We will explore both the initial an ongoing resuscitation of the acutely burned patient, beyond airway management and initial wound care. We will discuss monitoring resuscitation end points, how to mitigate common pitfalls, and exposure to differing resuscitation models that are crucial for all transport providers. Finally, case scenarios will be presented to exemplify some of the most critically ill burn patients who require additional modalities such as ECMO to survive inhalation injury, sepsis and persistent acidosis.

Vasoactive Drugs in Shock States: What Should You Use?
Cindy Goodrich, RN, MSN, CCRN, Airlift Northwest

Treatment of shock frequently requires the use of vasoactive medications to restore adequate tissue perfusion. These drugs may be classified as vasopressors, inotropes or inopressors based on their effects on the heart and vascular system. Most of these medications interact with adrenergic receptors found in the heart and blood vessels. Selection of the most appropriate vasoactive drug to optimize hemodynamics should be based on the underlying etiology of shock and the pharmacological effects of the drug. The focus of the session is to provide the clinician with a brief overview of the most frequently used vasoactive drugs and their clinical application. Adrenergic receptor physiology will be reviewed prior to the discussion of specific agents. Strategic use of push dose vasopressors will also be addressed during this presentation. Case studies will be used to highlight the appropriate use of selected vasoactive drugs.

Stop Drowning the Burns: A Review of Current American Burn Association Resuscitation Guidelines
Christopher Stevenson, AGACNP-BC, RN, MSN, EMT-B, VCU Health/Virginia State Police Med-Flight

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 invasive 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 invasive hemodynamic monitoring will be emphasized during this presentation.

Not Your Every Day Trauma: Call Me Special Specialty Trauma Populations
Teri Campbell, RN, BSN, CEN, CFRN, PHRN, University of Chicago

This is NOT your everyday adult trauma.  These are a SPECIAL trauma… the ones that make you pucker, the ones you don’t feel confident with, the ones that require your “A” game.  Come to this fascinating case-study based trauma lecture that discusses the specialty trauma consideration for geriatrics, pediatrics, and obstetrics.  This interactive and unfolding lecture will have you at the edge of your trauma-junky seat!

A STAT Page For Whom?  Emergencies In Usually Non-Emergent Specialties
Michael Frakes, MSN, NEA-BC, CMTE, FACHE, Boston MedFlight

Acute neurologic emergencies are a common reason for critical care transport. This presentation will review flight team management of common neuro-critical care complaints, with a focus on acute intracranial hemorrhage.

Trauma Care: More Than Just a Band-Aid
Rudy Cabrera, RN, CFRN, MSN, EMT-P; Joshua Cools, BS, FP-C, Memorial Hermann Life Flight

As trauma continues to be one of the leading causes of death, Memorial Hermann Life Flight would like to review the most comprehensive prehospital patient care for the injured victim. In addition to tourniquets and wound packing, the Life Flight team will review pelvic binders, JETT devices, REBOA and direct access to the operating room. Additionally, appropriate medication selection and ventilation techniques will also be discussed for hemodynamics and cerebral perfusion.

Sick, Not Sick, BS, OS!!!  Cognitive Biases as Applied to Patient Assessment
Dana McDonald, NRP, CCPM, FP-C, I/C, Air Evac Lifeteam

This topic explores the process by which we make decisions and inadvertently allow our brains and patterns of thinking to get in the way of making patient care decisions.   Case studies and an interactive presentation will be utilized to demonstrate how each of the biases affect patient assessment, treatment, and outcomes.

Mechanical Chest Compressions in Flight: Are We Doing Better?
Dean Hoffman, CEP, FPC, Guardian Air Transport

A follow up to 2018 presentation on chest compressions in flight with a review of Guardian Air Transports implementation of a compression device at two high volume bases with review of cases and first hand experiences.

Complications! Case Presentations of Patient Deterioration
Kevin Collopy, BA, FP-C, CCEMT-P, NRP, CMTE, NHRMC AirLink/VitaLink Critical Care Transport

Sometimes, even when a protocol is followed, patients deteriorate. Every medical procedure comes with risks of complications; when complications do occur, patients suffer. While complications don’t mean someone made a mistake, its easy for a clinician to doubt their own care after the complication occurs. This presentation discusses several common prehospital and critical care transport interventions, the known complications, and their evidence based frequency. After presenting the data behind the complication rates of these common interventions, you’ll hear about three actual cases where things went wrong: hypotension following rapid sequence intubation, intracerebral hemorrhage following fibrinolytics, and respiratory arrest following analgesia and sedation. Hear how clinicians managed their patient’s complications and how structured support was provided following each complication to help support the involved crew members to help improve the care of the crew members and their entire system.

Cabin Pressure: Agitated Delirium in the Sky
Derrick Jacobus, MA, FP-C, NRP, MidAtlantic Medevac and Monroe Township Police Department

On occasion, Law Enforcement, EMS, and Fire personnel are dispatched to the scene of a medical and/or criminal incident that involves a person who is reportedly out of control. Upon arrival on the scene, the emergency responder may be confronted by a person who is violent, highly agitated, irrational, partially dressed, and resists physical restraint with surprising strength. These subjects could be suffering from a “unique syndrome” commonly referred to as Excited Delirium. A person suffering from Excited Delirium (ExDS) may have taken an illicit drug, suffering from a mental illness, or both. This combination of factors and the persons irrational conduct could lead to a very violent confrontation. Significant injuries and/or death to both the officer and ExDS subject are possible outcomes. When this happens at 1,000′ it creates for a unique problem – both for the patient and the crew. First responders need to recognize the fact that these people are suffering from an acute, potentially life threatening medical condition. In addition to this, remorse, normal fear, understanding of surroundings, and rational thoughts for safety are absent in such subjects. Join us for a real life case study of a patient who placed the crew and himself in immediate danger and how the crew handled the incident… Would you have done the same?

Trauma, Just Do It: Embracing the Complexity of Simple
Chris Hartman, MD, FACEP, Franciscan St. Francis Hospital

A simple approach to the multisystem trauma patient is not a simplistic approach. A simple approach does, however, free the provider’s mind of unwanted clutter, enabling us to more effectively treat critically injured patients while our adrenaline is surging. With great appreciation for complex pathophysiology, Dr. Hartman’s session will distill a glut of algorithmic art into a simple approach applicable to any trauma patient.

Unraveling the Mystery of Sodium Bicarb:  Understanding How It Works and Implications for Clinical Decision Making
Kimberly Smith, RN, MSN, CFRN; Roderick Wold, RN, ND, CNS, CCRN, AirLife Denver 

Sodium Bicarbonate is a staple that all critical care clinical providers have access to through their stocked medications.  Do we really understand how sodium bicarbonate works and when it can be helpful vs. harmful to our patients?  Should we give bicarb for DKA, toxic ingestion, hyperkalemia, or lactic acidosis?  This lecture will take a deep dive into this common medication to help the transport provider make an informed decision regarding the use of sodium bicarbonate. Come get involved in an open discussion of clinical scenarios where sodium bicarbonate may be beneficial as well as situations where the administration of this medication may not be the best choice.

Clinical – Specialty

Sponsored by

A Complicated Delivery: High Risk Obstetrics in the Field
Cherish Brodbeck, BSN, RNC-OB, LP; Carol Wolf, BSN, RNC-OB, NREMT-P, Medical City Healthcare 

Have you encountered an atypical obstetrical presentation in the field?  Would you know what to do?  We will discuss and demonstrate appropriate identification and management of spontaneous vaginal deliveries, breech presentations  and shoulder dystocia presentations, as well as update and review cord prolapse response, and neonatal/newborn resuscitation.

Sweet Little Kids: Prehospital DKA and Diabetes Devices
Joseph Hill, RN, BSN, CFRN CMTE, Air Methods Corporation

The incidence of Type 1 diabetes continues to grow annually at an increase of 1.8% per year.  While the cause is still unknown, many patients are diagnosed with the disease initially after a hospital diagnosis of DKA (diabetic ketoacidosis) which typically requires transport to a tertiary care facility and in-patient treatment.  The critical care level required for transport of these patients either from their home or between care centers can be complex and requires specific knowledge of the disease and the current assessment and lab findings for the patient.  This lecture will review the disease process, the prehospital approach to treatment of these patients, and a review of current diabetes devices to include CGM (continuous glucose monitors) and insulin pumps which may aid in the patient’s care.

Waiting to Exhale: Critical Care Management of the Severe Asthmatic
Jacob Miller, MS, FNP, ACNP, CNS, Cleveland Clinic

Severe asthmatics and status asthmaticus present unique challenges to the emergency and critical-care provider; oxygenation and ventilation strategies are significantly different than other respiratory pathologies. This lecture will review evidence-based recommendations for management of the severe asthmatic exacerbation, including pharmacotherapy and ventilatory strategies.

Acute Management of Ventricular Assist Devices in the Field
Allen Wolfe Jr., MSN, APRN, CFRN, CMTE, Air Methods Corporation

Over 5 million Americans suffer from heart failure with many of them awaiting transplants from a declining donor pool. Ventricular assist devices (VADs) are now able to prolong their lives until a heart transplant is available or indefinitely.  These pumps vary in design and function with some patients presenting with a pulse while others presenting without. The standard medical assessment techniques are questionable at best, typically falling short of useful.   Through a case study analysis approach, invaluable solutions, emerging policies, and evidence based practice will be provided to caring for ventricular assist devices in the emergency and critical care setting.

Ground Transfer of a Critically Ill 600 lb. Patient: Lessons Learned and Best Practice for Bariatric Transports
Scott James, MBA, RN, CFRN, NEA-BC, NRP; Michelle Patrylak-Quint, BSN, RN, CEN, FRN, CTRN, NRP, The George Washington University Hospital, Center for Trauma and Critical Care

This session will begin with the case study presentation of a 600 lb. critically ill patient that required emergent ground transfer to a quaternary care facility.  The team will present their findings, actions, and lessons learned.  Additional discussion will focus on clinical considerations and best practices in caring for this special population.

Are You Making Your Patients Sick?
Karen Swecker, RN, CIC, MedFlight of Ohio

Simple, easy to apply, no cost tactics for the prevention of CAUTI, CLABSI, and ventilator related pneumonia.

Distracting Diagnosis: A Critical Care Transport Professionals Guide to the Autism Spectrum
Amanda Via, MSIHCM, BSN, RN, NRP, CEN, CareFlight Air and Mobile Services

Transportation of an individual on the Autism Spectrum will most likely occur at some point during your career.  Are you prepared?  This session is geared towards helping transport professionals increase their knowledge about  the Autism Spectrum in alignment with the critical care transport of this patient population.   Tips for the provider to to potentially identify an individual on the spectrum with interventions discussed to mitigate challenges that may arise during transport.  If the provider is uneducated about the Autism Spectrum, it may possibly present as distracting diagnosis which could ultimately result in poor patient outcomes.

Single Dose Killers: Pediatric Toxicology
Michael Gooch, DNP, APRN, CFRN, EMT-P, Vanderbilt LifeFlight

Toxicological emergencies are commonly encountered in transport medicine. Some are more serious than others. In pediatric patients, there are a few single dose killers that are a major concern. This presentation will review these agents, discuss their clinical manifestations, and management priorities for the transport provider.

Child Abuse: How the EMS Report and Documentation Can Help Ensure an Abuser Is Convicted
Derrick Jacobus, MA, FP-C, NRP, MidAtlantic Medevac and Monroe Township Police Department

Did you ever respond to a pediatric emergency where the story just did not seem right, the pieces were not coming together, or there was an unexplained gap in the timeline? Trust your instincts. If you suspect something, even when there is not compelling supportive evidence, share and report your suspicions following your organization or state’s policy. Intuition is a valuable instinct; when the details do not add up, follow procedures to report suspicions of child abuse or neglect. When in doubt, report your concerns. Use common sense and good professional judgment. Most often, law enforcement investigators rely on the initial reporting for child abuse cases from medical responders in order to walk an investigation from beginning to end. EMS are the “eyes and ears” and see the environment the child is in, which makes them the ideal reporter. A “hunch,” to the call to the abuse hotline, to the vital, comprehensive documentation are all pieces which will lead to a conviction of the abuser. If one of these pieces are missing, it lessens the case against the abuser and makes the job for detectives more difficult. This lecture by a Federal Bureau of Investigations Child Exploitation Task Force Officer will discuss the details in these cases and why EMS plays a vital role in the investigation of child abuse.

Heavy Lifting: Size Doesn’t Really Matter: Safe And Efficient Bariatric Transport In The Air And On The Ground
Bryan Peterson, RN, BSN, CCRN, CFRN, CMTE, STAT MedEvac

Bariatric patients create unique challenges for transport teams. Many customers are left struggling to care for these patients when the transport services refuse to move them or are not capable of safely transporting bariatric patients to definitive care. Maintaining the commitment to our customers by assuring we will safely transport any patient they ask us to the bariatric population has increasingly challenged us to find more efficient ways to provide safe and rapid transport services. By changing the approach to every aspect of the way we triage, plan and move bariatric patients we have created a process that treats these as the specialty transports they truly are. The implementation of bariatric transport kits at our helicopter bases has standardized the process and reduced the workload and risk of injury to the transport crews. We will discuss the systematic approach taken to mitigate the risk and assure the safety of the patient and crews by changing the process and by implementing the use of air assisted transfer devices.

Critical Care for People with Special Needs
Bryon Denton, MSN, RN, CFRN, PHRN, Air Methods Corporation

When patients that have intellectual disabilities or special needs require critical care transport, crew members are often tense attempting to understand the abilities and disabilities of the individual. This session will provide an overview of the most common types of developmental/intellectual disabilities. The session will also cover the different legal issues regarding decision-making and consent for patients with developmental/intellectual disabilities. Basic tips and strategies to help the transport clinician communicate with patients with disabilities and methods to alleviate anxiety in both the patient and caregiver are included as well. This session will also include basic techniques for assessing individuals with special needs and common abnormalities found in specific conditions.

ECMO, Impella, Balloon Pumps, Let’s Fly! A Nurse Driven Approach to the Mechanical Circulatory Support (MCS) Patient Transport
Kathryn Davis, RN, BSN, CCRN; Kathleen Stoddard, RN, BSN, CCRN, SE-ECMO, University of Utah AirMed

It’s 2:30 in the morning, you’ve been called to transport a 45 year old male from 2 states away that is post cardiac surgery, is in heart failure and is unable to wean off of bypass. The balloon pump they placed isn’t helping and they have now cannulated VA ECMO. The patient is intubated, has 3 chest tubes and is reported to be on 9 drips. The sending facility needs you to transport the patient to the nearest ECMO specialty hospital.  Your team consists of a flight nurse, a flight paramedic, a CVICU specialist RN and a respiratory therapist. Are you prepared for this transport? Is your program ready for these transports? Do you have the skill mix you need?  Do you have all of the equipment you need?  If your answer to any of these questions is no, then come let us show you how our program established an interdisciplinary team for these transports and how you can build your own. This team ranges from mechanics, pilots and transport personnel all the way through a team of cardiothoracic surgeons.  With over 35 specialty MCS RN’s and our transport team, we have successfully completed over 100 MCS specialty transports and are continuing to see positive outcomes in these patients.

HELLP Me!  Are You Ready for an OB Emergency?
Elizabeth Lohr Scott, BSN, RN, CCRN, CFRN, NRP; Jermaine Clayborne, BSN, RN, CCRN, CFRN, FP-C, C-NPT, University of Virginia

Obstretrical transport is a high stakes, low volume event where you are treating two patients in one.  This session will review common obstetrical emergencies, discuss laboratory values and vital signs, review fetal heart rate and tocometer tracings and introduce evidence based interventions for improving outcomes for mother and baby.

What To Do If Warm and Blue? A Pediatric Case Study On Acquired Methemoglobinemia
Andrew Baxter, EMT-P; Amanda Bash, RN, BSN, CCRN, EMT, Cleveland Metro Life Flight

Why so blue?  What is blue baby syndrome? Explore this with a critical care ground case study of the pediatric patient with acquired methemoglobinemia. We will discuss how to make this diagnosis and what it means.  Review the etiology, assessment, treatment and its implications in critical care transport.

What to Expect When You’re Not Expecting
Bobbie Carlisle, RN-C, NICU, BSN, RN; Nicole Milne, BSN, CFRN, RN, University of Utah AirMed

Neonatal Resuscitation can be difficult if you are not familiar with the steps. We will break down each step and explain what is occurring in the neonate during each step. We will discuss the new NRP guidelines. We will do a case review of an adult/pediatric RN that had taken NRP 3 weeks prior to responding to a call of a home birth and discuss what steps she felt were most beneficial.

Clinical – Advanced

Acid Basics: Why Does It Have To Be So Hard?
Jonna Cubin, MD, Wyoming Life Flight

This session will use a pediatric case-based format to discuss basic acid-base principles and then build upon these basic tenants to explore more complex concepts. Subsequent to this we will explore basic bedside assessment strategies that provide clues to underlying acid-base disturbances and how this impacts ultimate patient care.

Prevention of Peri-Intubation Cardiac Arrest
Steve Bott, MD, University of Utah, AirMed

Peri-intubation cardiac arrest is surprisingly common, with poor outcomes. Epidemiology data about this high-risk/low frequency procedure suggests it may often be preventable. We’ll review the existing data, and discuss possible etiologies and preventive strategies.

Rapid Reversal: A Novel Approach to Providing Anticoagulation Reversal in a Rural Setting
Abigail Polzin, MD, FACEP, CMTE, Sanford AirMed

The medication Prothrombin Complex Concentrate (4 factor) has been a new addition to reversing anticoagulation for patients with life-threatening bleeding.  Serving a large, mostly rural service area presents many unique challenges.  Representing our flight team, I was able to meet with representatives from Trauma, Neurology, Critical Care and Pharmacy to adopt and develop a program to bring PCC4 (KCENTRA) to outlying facilities through means of our flight team as well as developing a unique lending program for this expensive medication.  We quickly adopted a flat-dosing model (now used system wide) to enable rapid administration of PCC4 for the rapid reversal of anticoagulation in the setting of life threatening hemorrhage.  Since the program started in 2017 we have reached nearly 30 patients and shortened the amount of time from identification of bleeding to reversal by hours, in many cases limiting morbidity and even mortality.

The XABCs of ultrasound in HEMS
Cynthia Griffin, DO NREMT-P, University of Wisconsin Med Flight

This session will review the uses of ultrasound in the HEMS and critical care environment.

Got VAN? Dramatically Improving Time to Treatment in Rural Ischemic Stroke
Kevin Kraal, MD, Air St. Luke’s/Magic Valley Paramedics; Brian Hite, BS, RN, CCRN, CFRN, Air St. Luke’s; Stephanie Shawver, BSN, RN, SCRN, St. Luke’s Health System

Management of Large Vessel Occlusion (LVO) stroke in rural environments presents challenges not present in urban areas.  In this presentation you will see how pre-hospital (RW and Ground ALS) identification of LVO using the VAN tool, upstream notification of air transport, and Interventional Neuroradiologists has resulted in dramatic reduction of open artery times.  In addition, the incorporation of prehospital lab draws has further reduced door to lytic and door to transfer times.

Death by Ventilator: Managing Peri-intubation Problems
Chuck Sheppard, MD, FACEP, FAAEM, Mercy Health System

The peri-intubation period is a high risk time in the emergency intubation.  There is more and more evidence that the importance of “resuscitation before intubation” is becoming more and more important. This talk will address the importance of preventing peri intubation hypoxia and hypotension.  Discussion of the risk factors for peri-intubation arrest. In addition, the importance of preventing ventilator associated complications will be reviewed.  There will be discussion of how to minimize the risks of “downstream complications” from being intubated including pain management, types of sedation, and level of sedation.

I’m not dead, yet!: The Mobile ECMO Project and How the Helicopter Program Relates To It
Ralph Frascone, MD; Kolby Kolbet, RN, MSN, CFRN, CMTE, Life Link III

This session will discuss ECMO, extracorporeal cardiac life support (ECLS), the mobile ECLS project, and the data that supports it. It will also discuss how the helicopter program staffs and manages the project, and the challenges that it presents.

You Want Me to Take a Reciprocating Saw and Do WHAT?
Christopher Galton, MD, NRP, FP-C; Jeremy Cushman, MD, MS, EMT-P, FACEP, FAEMS, Mercy Flight Central

This session will start with a description of crush physiology and the current best practices.  We will then highlight some of the analgesic and regional anesthetic techniques for these specific patients.  The session will round out with a discussion about field amputation and a description of our crush and impingement response program.  We will be using audience participation software with integrated case management questions throughout.

Managing Severe Obstructive Respiratory Failure
Matthew Roginski, MD, Dartmouth Hitchcock Advanced Rescue Team

We will discuss the pathology and physiology behind severe obstructive respiratory failure to understand principles behind ventilator management. Starting with the pathology of asthma and COPD we will transition to the physiology of airflow obstruction including discussion of resistance and compliance, expiratory flow limitation, dynamic hyperinflation, and effect on respiratory rate on lung zones with different time constants. Finally, we will discuss strategies of ventilator management and commonly encounter problems including progressive hypercapnia, high airway pressures, inspiratory flow patters and improving alveolar minute ventilation.

Don’t Leave Me Breathless: A Proactive Approach to Pediatric Reactive Airway Disease/Asthma.
Samantha Gee, MD, FAAP; Caleb Carmin, RN, CCRN, CMTE, Nationwide Children’s Hospital

Asthma is one of the most common chief complaints for children presenting to the emergency department, often requiring interfacility transport to the nearest tertiary care center. Transport clinicians have the ability to rapidly improve their patient’s clinical status or let the disease progress. This lecture will demonstrate the effectiveness of prompt, aggressive asthma treatment through protocol implementation and case presentations. The days of “we just gave an aerosol” are history.

Aortic Emergencies:  It’s Only the Biggest Vessel in the Body…
Christopher Galton, MD, NRP, FP-C, Mercy Flight Central; David Lyons, MD, University of Rochester School of Medicine and Dentistry

This session will briefly review the anatomy associated with the aorta to set the stage for building an understanding of the hemodynamic implications of the very different physiologic problems with various aortic emergencies.  He will follow this with the highlights of the air medical management principles and current GAMUT data points for these patients.  Dr. Galton will discuss the evidence behind some of the novel medications for blood pressure and heart rate control.  He will finish up with the surgical treatment options for these patients.  There will be audience response software used throughout the presentation that will specific case management options.

Little Hearts. Big Problems: Critical Congenital Heart Disease on Transport
Nathan Lepp, MD, MPH, PHI Air Medical

Infants with critical congenital heart disease (CCHD) are often the most ill infants that neonatal transport teams must care for. Their complex anatomy and physiology pose several challenges. Using a case-based approach and audience response system, attendees will leave the session with a better understanding of critical congenital heart disease, its presentation, its challenges, and the skills to care for them on transport.

Guiding Resuscitation with Point of Care Ultrasound
Benjamin Smith, MD, Carolina Air Care

Ultrasound is already standard practice in most emergency departments and ICUs.  It is also becoming much more widely used in the prehospital and critical care transport environment.  This lecture will explore how point of care ultrasonography can be used to guide resuscitation of critically ill and injured patients.  Using multiple case presentations, the lecture will show how point of care ultrasonography can provide critical diagnostics that affect medical decision making and will cover the current research guiding prehospital and critical care ultrasonography.