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1 Minute Preceptor 1/7/2025

Have a new kid with you today? Spend a minute with them on differential diagnosis development. The tool I use to teach this and develop these is: SPIT What is most Severe? What can kill them right now? The “never miss” differentials go here. What is most Probable? What is most likely the issue? What is Interesting? What zebra do…

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1 Minute Preceptor 1/11/2025

Have a new kid with you today? Spend a minute with them on differential diagnosis development. The tool I use to teach this and develop these is: SPIT What is most Severe? What can kill them right now? The “never miss” differentials go here. What is most Probable? What is most likely the issue? What is Interesting? What zebra do…

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1 Minute Preceptor 1/15/2025

Have a new kid with you today? Spend a minute with them on differential diagnosis development. The tool I use to teach this and develop these is: SPIT What is most Severe? What can kill them right now? The “never miss” differentials go here. What is most Probable? What is most likely the issue? What is Interesting? What zebra do…

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1 Minute Preceptor 1/19/2025

Have a new kid with you today? Spend a minute with them on differential diagnosis development. The tool I use to teach this and develop these is: SPIT What is most Severe? What can kill them right now? The “never miss” differentials go here. What is most Probable? What is most likely the issue? What is Interesting? What zebra do…

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1 Minute Preceptor 1/23/2025

Have a new kid with you today? Spend a minute with them on differential diagnosis development. The tool I use to teach this and develop these is: SPIT What is most Severe? What can kill them right now? The “never miss” differentials go here. What is most Probable? What is most likely the issue? What is Interesting? What zebra do…

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1 Minute Preceptor 1/31/25

Have a new kid with you today? Spend a minute with them on differential diagnosis development. The tool I use to teach this and develop these is: SPIT What is most Severe? What can kill them right now? The “never miss” differentials go here. What is most Probable? What is most likely the issue? What is Interesting? What zebra do…

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Inside the Mind of a Trauma Doc

Insights in to trauma care with Alert Medic 1 and Dr. Zaffer Qasim. By the end of the conflicts in Iraq and Afghanistan, the US military and its coalition partners touted a near 97% casualty survival rate. Coming on the heels of a number initiatives (they call them orders) that pursued zero preventable deaths from…

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Nurture Their Will To Win – Part 1

What does it mean to actually “take care” of a trainee or new hire? What does good mentorship/preceptorship look like? I think it starts with being the mentor you always wanted, and that goes beyond making sure they “know what they are doing.” I think many times the FTO forgets what it was like for…

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Shokunin – The Ancient Path To Mastery

“The Japanese word shokunin is defined by both Japanese and Japanese-English dictionaries as ‘craftsman’ or ‘artisan,’ but such a literal description does not fully express the deeper meaning. The Japanese apprentice is taught that shokunin means not only having technical skills, but also implies an attitude and social consciousness. … The shokunin has a social obligation…

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Leadership Notes: Valley Forge

In the winter of 1777 through the spring of 1778, the Continental Army was dying. Theres to be some privation expected in soldiering, but not like this. Supply chains and quartermaster runs had all but stopped, and the ones that did show up brought the wrong supplies or it had spoiled by the time they…

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Airway Dogmalysis #4: For HEAVEN’s Sake

I love attending airway training courses. No matter how basic it seems; no matter how routine the information appears to be; I always get something out of it. I either get a new idea or conceptualization of something, or reinforcement of something I had neglected to keep in the forefront of my thinking. One thing…

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The Unforgiving Minute

Ordinary Ops Medic - The Unforgiving Minute

“There comes a precious moment in all of our lives when we are tapped on the shoulder and offered the opportunity to do something very special that is unique to us and our abilities, what a tragedy it would be if we are not ready or willing.” ― Winston S. Churchil The Unforgiving Minute The span…

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Airway Dogmalysis #3: Never Allow Success With Poor Technique

Training Issues and Fixes #3: Allowing Success With Poor Technique. “Nothing is more dangerous in airway management than success with bad technique.” – Scott Weingart “No one cares how long you have been doing it if you are doing it wrong.” – OOM Passing a tube through the vocal cords is the ultimate goal in…

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Training Notes: Take Feedback Like a Pro

There’s no shortage of tips out there for instructors that are aimed at improving giving feedback . But there is not a lot for us to go on for how to receive performance feedback. Most of what is out there is about ego problems as if all we have to do is sit there and…

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Airway Dogmalysis #2: Get Real

A Story: A colleague of mine jogged up to me before a course once, rather excitedly, he grabbed my arm and jogged me into the lab to see none other than Fred the Head taped to the bottom of a desk. “Man, we are gonna ‘mess’ with them.” He said with a dubious grin. When…

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Airway Dogmalysis #1: Stop Teaching the Way You Were Taught.

Instructors must be well read and prepared before they begin teaching something as dangerous (and litigious) as airway management skills. Intubation is a singular skill within the larger system of airway management. The focus should be on teaching approaches that reduce the likelihood of multiple attempts, desaturation, and peri/post intubation hypotension.

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Vent-ED: SKiPS DEEP

Over the years of moving vented patients and watching new clinicians get their heads around the vented patient, I have come to observe the same mistakes/oversights with some frequency. With respect to DOPE and SCOPE for troubleshooting some of the alarms that may be encountered, I have a different acronym that I use as more…

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FREE Airway Management Resources II

If you clicked on part II, thinking there was a list of links to free things you can purchase to improve airway management outcomes, you will find no such link. A silver bullet solution that will enhance your patient outcomes in airway management and/or reduce the risk of the procedure in the prehospital environment does…

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You Don’t Have to Know Everything

I picked up a new book the other day called The Personal MBA by Josh Kaufman, and within the first few pages, I got hit with a couple of fantastic gems that translate so well to our world. I will be adapting some of Josh’s concepts to us, and hopefully, you can walk away with some of…

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Clinical Notes: FREE Airway Management Resources Part 1

If you read this all the way to the bottom you are either going to be really appreciative or really upset with me. You will find that there is no link to a store that is selling a silver bullet solution that promises to enhance your patient outcomes in airway management and/or reduce the risk…

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Beating The Odds

FlightBridgeED - Beating The Odds - The Impact of LVADs in Critical Care Transport

In the dynamic landscape of cardiac care, Left Ventricular Assist Devices (LVADs) stand out as a beacon of hope and innovation. For patients grappling with advanced heart failure, where traditional medications and lifestyle adjustments fall short, LVADs offer a lifeline, bridging the gap between illness and a chance at extended life. These sophisticated devices are…

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Embark on the EMS Odyssey: EMT to Critical Care Paramedic

The realm of emergency medical services (EMS) is one of constant evolution, where professionals are continually called upon to enhance their skills, knowledge, and expertise. The transition from an EMT to a Critical Care Paramedic epitomizes this commitment to growth and excellence. This journey, enriched by mentorship and continuous learning, is both challenging and rewarding….

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The STOP Card: Enhancing Patient Safety in Healthcare

FlightBridgeED - The STOP Card

In the fast-paced and high-stress world of air medical services, where every second counts, patient safety is paramount. However, a lingering challenge in this critical field is the reluctance of healthcare providers to voice their concerns or speak up when they notice safety issues. This reluctance can stem from various factors, including the hierarchical nature…

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Learning From the Past

September 11, 2001, and the Mental Health of First Responders The tragic events of September 11, 2001, have left an indelible mark on the world’s collective memory. The devastating terrorist attacks on the World Trade Center and the Pentagon resulted in the loss of thousands of innocent lives and left countless others traumatized. While the…

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Brief Resolved Unexplained Event

Brief Resolved Unexplained Event by Sara Moore Gruver

The electricity had gone off on that hot July day. The mother’s phone kept dinging with texts from the power company with an estimated fix time, which kept growing longer and longer. Meanwhile, the temperature in the house kept climbing, and the three small children grew more upset. After an hour, the mother decided it…

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The Remarkable Versatility of Ketamine: A Review of Pre-Hospital and Critical Care Use

The Remarkable Versatility of Ketamine: A Review of Pre-Hospital and Critical Care Use

Ketamine is a non-barbiturate dissociative anesthetic originally synthesized in the 1960s. In lower doses, ketamine acts as a potent analgesic, causing it to be adapted to manage pain during the Vietnam War.(1,2) Ketamine acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. NMDA receptors are a type of glutamate receptor, which bind with glutamate, the principal excitatory…

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The Intricacies of Pre-Hospital Trauma Triage: a Look into Special Considerations

Pre-Hospital Trauma Triage

Introduction A crew responds to a motor vehicle collision involving a passenger vehicle into a tree. The scene size-up illustrates moderate front-end damage and airbag deployment. Further analysis of the car shows no apparent signs of passenger compartment intrusion, steering wheel deformity, dash deformity, evidence of rollover, or window spidering. Your patient (75 male), a…

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I Have a Crush on You!

FlightBridgeED - I have a crush on you - everything you need to know about crush injuries and how to manage them from a pre-hospital, critical care transport medicine perspective. How EMT s and Paramedics can make a difference in improving patient outcomes in trauma

Introduction Severe crush injuries have the power to shatter lives in an instant. Imagine the sheer force of an external crushing weight bearing down on the human body, inflicting direct tissue trauma and triggering a cascade of devastating consequences. From muscle necrosis to neurologic dysfunction, the aftermath of a severe crush injury can be a…

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A Twist on Pre-Hospital and Critical Care Transport Medicine

FlightBridgeED - Stop the Bleed® - EMS Week - Tourniquets

Tourniquets: a simple, time-honored device with roots dating back to the battlefields of ancient civilizations. If you’re picturing a ragtag concoction of sticks and bandages, give your mental image a 21st-century makeover! Today, tourniquets are sophisticated, researched, and increasingly vital tools in pre-hospital and critical care transport. Recently, there’s been an influx of research examining…

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Pediatrics: Integrating Telemedicine

FlightBridgeED - EMS Week - EMS for Children - Integrating Telemedicine

Pediatric pre-hospital and critical care transport medicine is undergoing a revolutionary change due to the ongoing evolution and expansion of telemedicine. This trending topic is currently reshaping the nature of patient care, enabling healthcare professionals to provide quality care regardless of the distance between them and the child in need. Telemedicine in Pediatric Care Telemedicine…

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FRATs Aren’t Just for Bruhs

FlightBridgeED - EMS Week - Day 3 Safety

Introduction: When you hear the term “FRAT,” you might think of wild parties, toxic masculinity, and college shenanigans (“Toga, Toga, Toga, Toga…”) But in the world of air medical and critical care transport medicine services, FRAT takes on a whole new meaning. Flight Risk Assessment Tools (FRAT) are the superheroes of safety, ensuring smooth and…

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Unlocking Success: Empowering Flight Paramedics (FP-C) and Critical Care Paramedics (CCP-C) through Advanced Training

Unlocking Success: Empowering Flight Paramedics (FP-C) and Critical Care Paramedics (CCP-C) through Advanced Training - EMS Week 2023

Introduction Welcome to EMS Week 2023 day 2, “EMS Education Day.” We celebrate your unwavering dedication and heroic efforts as flight paramedics or critical care paramedics. At FlightBridgeED, we understand the pivotal role advanced paramedic education plays in your success in the dynamic and high-stakes environments you operate in. Every decision you make can make…

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Unmasking the Unsung Heroes

Unmasking the Unsung Heroes: Challenges Faced by EMS Professionals and Solutions for Change - EMS Week 2023

Challenges Faced by EMS Professionals and Solutions for Change Emergency Medical Services professionals, including paramedics (of all types) and emergency medical technicians, are critical in providing life-saving care during medical emergencies. Despite their invaluable contributions, EMS professionals often face challenges such as the lack of public awareness and appreciation, mental and emotional strain, inadequate staffing…

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SUSPECTED INTERNAL INJURIES

Suspected Internal Injuries - by John Yeary - FlightBridgeED

You are the first responder dispatched to a multi-casualty incident (MCI) for a motor vehicle collision on the interstate, with multiple cars on fire and bodies strewn all over the highway. You arrive in the “controlled” chaos with the roadway barely shut down. You immediately smell smoke and see fire everywhere, seeing danger at every…

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Thoughts from a Clinician: DO YOU DRESS REHEARSE?

Thoughts From a Clinician: Do You Dress Rehearse?

Too much training is still being done without simulation. The value-added component of simulation is nearly immeasurable, especially for the critical care provider. As commonplace as it has become, simulation still gets the hairy eyeball from some. Perhaps the pushback comes from the cost of simulation or simply the available resources to do simulation training.

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WHOLE BLOOD: READY FOR PRIMETIME?

Whole Blood: Ready for Primetime?

If you’ve been reading about trauma care in the last few years, you have undoubtedlyseen something about the use of whole blood in trauma resuscitation. Born out ofmilitary medicine experience, we are starting to see civilian EMS programs in both airand ground using this treatment to save lives from traumatic injury and massivehemorrhage. But what…

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Diabetic Ketoacidosis: The Right Ingredients for Recovery

Diabetic Ketoacidosis: The Right Ingredients for Recovery

This article is the first of a series of three articles about managing adult patients with diabetic ketoacidosis (DKA). This patient population can be quite challenging for even the most seasoned provider. Indeed, DKA is characterized by unique physiology that includes, amongst other things, severe fluid deficit and mild to severe metabolic acidosis. This patient…

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Updated CAMTS standards for nurses

The Commission on Accreditation of Medical Transport Systems (CAMTS) is a non-profit organization that accredits air and ground medical transport programs in the United States and Canada. One of the recent changes to the 12th edition standards specifies that nursing certification will become transport specific (such as the Certified Flight Registered Nurse [CFRN] or Certified…

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Dialysis Disequilibrium Syndrome

Clinical Scenario: You respond as an ALS ambulance to a local dialysis center for a middle-aged male with altered mental status. Upon arrival, you find a conscious male being gently held in his dialysis chair by staff members. They report the patient was partially through his dialysis treatment when he developed acute delirium. Medical History…

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Do We Understand Oxygenation?

The Oxyhemoglobin Dissociation Curve can be confusing… However, it’s essential to understand oxygen physiology in critical care. Think of it as a “Manual for Dating.” In a healthy relationship, you have a good date, and really like that person, but don’t mind dropping them off after an evening out because you know you’ll see them again….

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EDS in the ED

Overview A 27-year-old woman arrived at the emergency room late at night, her face crumpled in pain. She reported feeling sick this morning and vomiting, but that didn’t strike her as unusual as her young children have had stomach flu the last few days. Since then, she has had severe and acute neck and head…

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Alternative uses of EtCO2 in the pre-hospital and critical care settings

End-tidal capnography in clinical practice originated in the field of anesthesia around the 1950s but has also become established in the pre-hospital setting. EMS providers commonly use end-tidal CO2 values as an adjunct to cardiac arrest and airway management. Continuing to learn about end-tidal CO2 is critical because this device is easily applied, readily available,…

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Flight Paramedic OR Critical Care Paramedic?

FlightBridgeED - FP-C, CCP-C, CFRN, CFRN, CTRN, TCRN, Flight Nurse, Flight Paramedic

OVERVIEW The Flight Paramedic (FP-C) exam tests the knowledge of experienced, master-level paramedics working as part of a medical flight crew. The Critical Care Paramedic (CCP-C) exam is a bit broader in scope. It is designed to test the knowledge of adept paramedics working in critical care environments, from transport to in-hospital. Which exam should…

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What It Takes to Become a Certified Flight Nurse

A flight nurse is a registered nurse with the training and experience to provide critical care in transport environments. This can be either rotor (helicopter) or fixed-wing, typically working alongside other medical providers such as paramedics, other nurses, respiratory therapists, nurse practitioners, or physicians; they’re essential for providing top-level patient care when it matters most!

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How To Become a Certified Flight Paramedic

Flight Paramedic Career Overview Helicopter EMS (HEMS), also known as air ambulance services, are critical in saving lives. Air medical transport teams must have the right experience, skills, and training. A certified flight paramedic is a pre-hospital, critical care, and emergency healthcare professional. If you’re ready to take your career in this direction, read on…

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