Transcript
Correct.
Okay.
So, one, I I'd great to be here today, and this is a very different type of a twist on a presentation in that you know, we look at doing base presentations.
You see a lot during that I take the approach of is trying to add a lot of dialogue as part of this process, make us think about what we're doing, and all and then, ultimately, what we're not doing or what we could be doing just to make sure those bases are covered, especially in your emergency action.
In planning, in protocol development, and how you continue your training and things like that.
So the one thing I'll say is as part of this presentation is At the end, I wanna turn we're gonna turn the audio on.
So, you know, the and doctor Harper will lead that, but Really, if you want to if you wanna ask the question, go in the chat on here.
You send it to doctor Harper, and he'll fill those questions, or we'll just turn the audio on.
And we have some I with time of raining just at and we can have that discussion versus just having a typical way as would do this as webinars.
So, again, we're looking at chest pain and use soccer player.
I think there's a unique case that was that came out in a journal not a couple here.
I'll give to that in a little bit, but we'll talk about that and what this looks like.
So just from our disclosures, I am the owner, chief medical officer, or action medicine consultants.
We do have financial relationships with Sampson and Rum Roller.
No presentation.
It's not any endorsement of any particular device or anything we talk about today or any other presentation, just know that it's just used for information purposes.
Obviously, someone that we're gonna talk about, you know, initial care steps and do a decision making process that you will go through as an audience.
Audience is gonna get the vote.
Where what's where we go in this presentation?
Also think about what decision making skills are, and, hopefully, the part of that is is what you're going through and what you can reflect on personally within your own organization and what you do in terms of skill development, etcetera.
Think about critical you know, evaluating possible causes of chest pain in athletes.
Analyze that case study summary, we wanna reinforce knowledge and understanding, then definitely try to recognize what best practices are and really get those to those simple take home points to prevent.
This is a very prevalent topic right now as with any other medical condition.
So I want to kind of give you kind of a first off we're looking at this is in emergency medicine, anything you've probably heard something similar to this is if it's predictable, it's manageable, you know, That's I've heard Instrat do that before.
And then one thing, Kevin, is really good, and I and I use some similar things.
But think about we're in in in Tom's a healthcare provider in emergency in the field, we're in the business of predictable management.
And we have to be able we have to know what those things are, know what the price is, or commitment, what the quantity is, what we need, supply, demand, and where do we get we can succeed in that, or we have an unfavorable unsuccessful outcome.
And I think the thing to keep in mind is we move talk about this and other conditions is, you know, we can have a best outcome.
We have a poor outcome, but we did everything correctly.
And I think there's something we really wanna focus on that's knowing how did we do the things correctly during the good times and in the bad times because we know that that may not be the case all the time.
So how this is gonna flow?
I'm gonna give you the case or sample case pertinent details.
We're gonna jump into several options, and you'll get the vote on your phone or if you pull up a separate screen next to this, you'll be able to use a similar similar screen that you'll see interactive what how people are voting.
So when we get that vote in, take a couple seconds, and then we will make that we'll we'll go off that decision.
I'll give feedback.
So for those of you who've taken the, you know, the written simulation exams and things like that, you may get some test anxiety or something like that going way back when.
And then finally, we're gonna get into just talk about best practice protocols and just what that looks like based of this case and what it looks like as well.
And then we'll follow-up with a discussion.
So journal things to think about in this case or in general, when you're thinking about emergency medicine case standpoint and how you're handling things in the field, First off, just think about what is your minimum equipment check?
Is it available?
Have you done those things to make sure it's operational Is that is or any staff, whether it's a provider or it's a coach or whoever's involved in using base staff.
Are they trained in that equipment?
Is it documented?
Think about the same size up.
If you're actually going into the scene, is the same safe or unsafe and think about what the nature of the injury or mechanism injury.
Also, this get and this will fit definitely into this in this situation of this case.
Do we need additional resources in making sure you're calling that in a in a very effective time manner, prop the primary assessment go through that you have to get that full that quickest rapid assessment in getting those core bite do determine what's happening in the 1st couple of minutes.
So the 1st 2 or 3 minutes moments or it's it's the most critical part of the patient, especially in the case if it could if it was or was not a cardiac arrest where you may have to run the code, if it the the patient's coding, they may run 20, 25 minutes.
And we'll talk about that at the end as well what that looks like from a sample practice guidelines with 1 with an EMS agency.
Patient Management how do you handle that?
Think about rapid trauma assessment that's applicable, and then what interventions you're doing.
And then, really, the the hand off, get that that 32nd hand off or missed report, get it to when they shown sight and be able to give it off effectively.
So we'll talk about that as well.
So here's your first chance.
You can pull that QR code up on your screen and leave that leave your phone on.
We'll go you're it's gonna pull up automatically as we go through the presentation.
But really, here's your first vote is, you know, you're the patient, you know, giving your current setting, how confident in your organization's EAP to give someone a chance to live.
So we'll give that a couple of seconds for everybody to respond.
And we'll look at this as well on the screen as well just because it's fun to do.
Here we go.
And, again, you can do that or look at you can type slide0.com on another screen and just type in that code, and it'll get in.
It'll get you started on the first book.
So just so you know, as we do this, it will the screen your screen will go inactive, and then it will it will still stay there, but it it moves on to the next screen.
When it pops up, they'll do there as well.
Okay.
So we've had little bit to go with here.
And, again, the more feedback of the participating will help out tremendously as we decide we'll get a little bit couple more boats coming in.
Once we get through this first one, it'll it'll move a little bit slower or let me or let me or let me move a little bit faster in the presentation so everybody will know what to look for the first time.
2 more seconds will get started.
Okay.
It's kinda stable off with it.
Okay.
So everybody feels pretty good about their their EAP.
And, hopefully, the process here today is we're evaluating that.
Not just thinking about it.
But we we have that vision.
I'm gonna emphasize something to think about.
We have a vision that's gonna work well.
But when we get in making sure you're going through the processes to make that is is actionable as and not having a false sense of security, so to speak.
So let's see if this will move forward.
Here we go.
Okay.
So let's talk about the patient background in this case.
This patient is a sixteen year old otherwise healthy male soccer employer and no prior history of syncope populations, other extra or illness as well.
Does, you know, family history is negative from you know, any diseases, arrhythmias, sudden cardiac death past social history.
They denied alcohol use cocaine drug use, reported marijuana use 3 weeks prior, and this is when the patient's now presenting in the, you know, in this in this situation after the fact.
And they all the patient also admitted to taking vyvanse till at 5 AM on the day of this event.
And to concentrate for an exam.
So with that being said, let's see if this will move through here.
So here's just a quick situational summary of what happened to get more focused in.
So athlete wakes up, they take an exam, takes a 5 minutes.
7:25 is the first bell.
They go on to students taking an exam, They have a they have a early day game.
So starts they leave bus 15 minutes at 9 o'clock.
11 o'clock gaming.
So you run across town.
Weather conditions are optimal.
It's pretty good for where this case is.
During the match so during the last 5 minutes, the match is about 1 at 12:50 PM.
Affleck took a direct shot hit with a soccer kick.
About, you know, 20 feet away.
Within Tim's pain, there is a host athletic trainer You're not none of the team's athletic new medical staff is there.
You have a they're the visiting in a school.
There's a host athletic trainer.
Welcome the field.
Coach is already there.
Said he would be okay.
Just check this and done.
And and the athletes responding.
Catholic stays on the field, but he's he reports to the coach like he it felt like his heart was jumping.
And then after 2 minutes, he sits there and he feels okay, gets up, makes a pelvic kick.
So from there, later that night, you you are covering your athlete trainer at the school, The athlete in this history reports that they go to the base of baseball games in the spring, watches the games, eats hot dog, you know, normal, 8:31, then you get this call out of the dugout.
You know, you need to check Dylan out.
He just started bombing all of a sudden, and he's doing really bad.
So let's go ahead and get started.
So you have some situational context there.
So what do you do?
What's your first action step?
And, again, what what the audience picks here is where we were going to go with this, the most plausible next step.
Great.
So we get some pretty good responses so far.
We got about 31, 32, already responding.
So if you're on and you're able to, please do try to vote.
Helps in in the overall responses here.
And, again, your decision may in case we get something tight here down the line, may make the difference in one direction or the other.
Right?
So it looks like most everybody is the first thing we would wanna do is we wanna check mental status, airway breathing circulation.
We have kind of a split here between do we take in a a patient history?
Are we doing the the vital sign assessment?
So with that, we're gonna go ahead and move ahead.
So we're gonna check mental status.
This is what the first response would be.
So we can go right here.
This is what patients presenting.
They're otherwise alert and oriented to time place, person purpose, GCS is 15, but there are having some of lethargy as a patent airway, breathing, however, increased respiration rate, no abnormal breath sounds you notice, have equal rise and fall of chest circulation, appears that may have some cyanotic lips, weak, rapid pulse, school school planning and diaphoretic.
Okay.
What do you do next?
Or what would you want to do next?
Now that we check mental status.
So those of you already voted already or are voted, you be thinking about this as far as what your they reflect back on your own protocol for emergency care protocol, what this, you know, just general without knowing any other information, not knowing where this case is going to go, think about what those initial those core assessment steps are in any assessment.
Okay.
We got almost there.
Alright.
So we're gonna go next to vital sign assessments.
We've checked, done a check mental status, and we bring in circulation, and looks like the vital sign assessment is the prevalent next step, so we'll do that.
So on assessment, base assessment, heart rates at 170, the rest rates rates at 26, BP is 1160 over 100 and already at a SPO2 of 93%.
So we obviously starting to see there's some issues here.
Now what's the 3rd decision you would want to take?
And this will be the last decision.
We're gonna move in then we'll move into interventions as well.
So we have 3 decisions, 3 critical out of the 5, move from there.
Great.
So, Barbara, if you're having difficulty with any of the voting as well, just make sure to to you can sit in the chat, and doctor Harper can work you through that.
Process.
Okay.
Great.
So we're gonna go to patient history.
There's an overwhelming choice on on this this third decision as well.
So in here okay.
So here's what the what the patient says.
Remember, sixteen year old athlete was otherwise healthy, was not running or doing indoor activity, sitting in the stands, and now after eating.
Says he felt okay after the game, started feeling sick about 10 minutes ago was just sitting in the stands.
I oral intake was, you know, you mentioned before what the type of food it was.
Reported the event history from the game, slight sort of on where the ball hit in the anterior chest, There was slight in human, no visible signs on the inspection.
You there are the patients lethargic, and now they're they're having some nausea and vomiting.
And as I saw if you were able to see that visibly as well in addition to what was said earlier, no past medical history for asthma or other conditions.
Gave info and and also gave info about alcohol, vitamins, and the other drug use.
Okay.
So we've gotten a good pain a picture of what this looks like.
Now let's look into interventions.
So we're gonna have 2 interventions you'll choose from in this next couple of steps.
At least, I'm sorry, 22 rounds of interventions.
So at this point in time, what do you do?
And remember, if you need to, we've got the the vitals.
They were 170, 106 over a 100, respiration rates 26, having vomiting, nausea, etcetera.
And the key thing I wanna emphasize here is as we're go as you're going through this your thought process is we've done that.
And this is a different, you know, kind of a we we visit this and from a from a protocol standpoint or type of condition is think about why you're doing What's your rationale for doing the intervention?
So I just wanted to of another thought process there.
Great.
So we're getting up to about the 33 to 30 30th to to 40 everybody.
I'm ready.
Yes.
Eric has a question and a chat.
If you go back over the vitals real quick, or at least just verbally state down as they think through this?
Yes.
Okay.
So the vitals, they were 170 on the heart rate or the the patient was 160 over 10 106 on the on the blood pressure.
Respirations were 26, and also they were diaphritic, cold climate skin, technology and vomiting, initially was on initial assessment, what at a o AO X Four and GCS at 15.
But So this is now we're moved into the first process.
We moved into the first minute or 2 now that you've gone through doing the vital sign assessment, things like that.
Okay.
So let's now we need to move to activating EAP.
Making that call.
So it's activate e m the EAP.
Alright.
So here's an example.
You you make a call to 9911.
EF, they tell you that EMS will be there in 11 minutes.
And you inform that you give it the a d, persons there, they're gonna go here.
Here's an example of what the EAP or sample EAP you wanna consider having.
I'm just gonna review that for a second.
One is it's base information it tells where it is venue specific.
You have a map.
It shows where relevant equipment is for any venue.
It tells where first responders are, typically, the typical response times are.
You also wanna think about how to communicate gate.
This is just one example as well, and these tiered services off to the right hand side.
Think about what emergency equipment is.
It's it's the basis directions, and this gives you the base information depending on the what on what the the determination of the call is once ALS is there, EMS.
Really important that what you've done in that call, and we talk about that already is what you're giving that information will help drive what that case does.
And and also, the level of response that may occur for that.
So for that.
So we we move on to next next intervention.
So what is your next intervention?
And remember this will be the last intervention we do, and then we'll move on into the case.
Oh, and I forgot to mention all something.
Then this is what the SPO2 was at 93.
Sorry about that.
I left one off.
Give another couple more seconds for a couple others to vote that choose to do so.
Right now, it's looking at most where where it sits on the screen here.
So think we're pretty good with the votes here.
So the decision was made to monitor and reassess violence.
Again, the vitals again were 170 from from rest.
So elevated heart rate, respirations were 26 before this.
You're making the decision to read the earlier was 26.
SPO 2 was 20 I mean, it was 93.
They were the wise conscious and among the vitals.
So the decisions to make monitor and reassess vitals.
Okay.
Now that you reassess vitals, patient now has altered mental status.
They now have a GCS.
Of 12.
Heart rate heart rate is now at 200.
In this week, respirations have increased for 26 to 36.
BP has now dropped to 85 over 56.
Now continue to have school diaphritic cool, clammy skin, and the SPO2 has now dropped to 89.
So now we're moving it that now you can see that with interventions of doing something to control what those vital signs are.
So let's move ahead.
So where do you think this case is with this?
So These are the different options.
I'm gonna move it over to the screen in a second, but you'll see what these are of these different conditions of possible differential diagnosis for this case.
Let's go ahead and move over so you can get into your vote.
Now you can vote vote up to 2 options if you choose preferably 1, but if you think there's 2, then go ahead and you can put you can choose those.
And we'll give a a little bit of time for this that may take some to go through.
Both options.
Yep.
I have a polymorphic matricatachycardia, cardiac tamponade, comedocortis, a order disrup dissection unwrupture, myocardial infarction of prolonged QT, hypertrophic cardiomyopathy, and the viral myocarditis.
And, again, all of these just so you just as a review, you go back and these are very common or common and even less are common type of conditions that you may see.
You look at a lot of the look at the literature.
You'll see some of the most common types we see versus less common those fit within the overall instance of cause, like, for example, if it was sudden cardiac arrest, things like other conditions or other related conditions.
That may how they may presume.
Any questions while we're moving through with this?
I mean, but it has any questions just as we're we're point of clarification for that.
I don't have those with me right now.
Doctor Harker, if you would, if you don't mind going through and just retyping those in.
In the in the screen, if you would.
Some of the the key vitals?
Reacting from from the follow-up the 2nd round?
Yes.
Where they are.
Yes.
Are you are you gonna do the initial the initial ones versus that as well?
I can I can relay them?
Yeah.
Give me a second.
Pull those up.
Screen up.
Thank you for asking for real asking that that's something I'll I'll do this next time, I'll I'll definitely have those as a as a cheat sheet so to speak or at least put that in there at that point in time.
But I don't have those pulled up easily.
Okay.
The big thing right now, we know that they they at the second It's a second turn here that came in based on intervention.
You had a regression down to 36 on heart rate.
There's 85 over 56 on blood pressure.
Heart rate was now at 200.
They're tachycardic.
They're definitely decompensating
Yeah.
Heavy moving really into and also the GCS of 12, ultra mental status.
So definitely decompensating And, again, think about what we did what we did now, what the audience did in the process of thinking about what that looks like in terms of the patient's moving in real time.
We're now 2 or 3 minutes in.
And again, it's a rec early recognition during the initial assessment.
In identifying those life threats or potential threats and addressing those through vital through valid data which are vital signs and how they're how the patient's presenting.
So it looks like we've got the Correct.
The button.
What's that?
Well, remind me again the mechanism of injury.
Yep.
So mechanism of injury was it occurred about 12:50 in the after 12:50 during the day, a a direct shot to the chest with a soccer ball, a kick.
And athlete goes down, did not have any loss of consciousness, had some chest pain.
Also, after 2 minutes, they got up and played again.
And then now they throughout the day, when you saw the pavement, when he was in the stands, you're saying that he reported that he felt okay during the day, had some chest soreness or in the area where he was directed in the anterior chest, and then also had or he felt like his heart was jumping, at that point in time earlier, and then now is having the case.
He's now reporting.
He's having a 170.
Now rapidly restarted decompensate also having now is a when a short period of time, moving up to 200 on the heart rate.
And other vitals are also dropping down from 93 to 89 on pulse oximeter.
So definitely happening.
We see When you get kicked in a chest with a ball, how close was that?
Probably 15, 20 feet.
So was unprotected unprotected shot getting hit there as well.
Having definitely having some tachycardic episode as well.
So I think we're pretty much stable here with the in terms of number of votes and stuff here.
So we're looking at is where this the case was, we have some votes for and again, also he had medication.
Use or illicit use of a controlled substance.
You have direct contact involved.
You have some other he's already decompensating.
By having his hemodynamically becoming unstable with the blood pressure dropping, heart rate elevating, all those things as well.
So we've got a couple of things here we look at here for this where people were we we all have voted on.
So let's go ahead and move forward with this.
So let's talk about what this case was.
So this case was actually this is a variation on a case that was published in 2018.
And it's an unusual case of comedocortis resulting in ventricular flutter.
I'm gonna talk about this.
So this was looking at a case like this is And again, this was a successful outcome for the athlete, the sixteen year old, was reporting I made some slight variation in this case and more so just to think about where that would flow and or potentially how it may present.
So there are some similarities you do.
Read the case you'll see where some of the similarities are, but also I did a kind of offtake on this.
It's just thinking about this process and and really the point with this is to challenge give a good challenge point for your emergency response system, your knowledge, your skills along those ways along that as well.
So let's take a quick look at this.
So we said, you know, the diagnosis though was comedocortis resulting in ventricular flutter.
So in a normal it's just a nice, you know, what what typically happens in the heart rate you have you know, s sinus and and AV node electrical activity and going through a normal heartbeat as well.
When you go into ventricular fibrillation, then the athlete was not in ventricular fibrillation.
But what happens is you have the regular erratic quivering in the ventricles, which causes even becoming more humans dynamically unstable.
In this case of ventricular flutter, flutter actually occurs and they caught this at the time.
And then and then the wanna make a distinction.
In this actual case, The athlete reported 8 hours later, so it's kind of a similar time frame, but reported to the emergency room and was having 170 to 200 on the heart rate was still having some of the similar vital signs that you that I we went through during this case.
So relatively had the same time frame, thought, okay.
Start to get worse.
Just reporting into the merge room.
Reporting to merge room would have been no different than coming to us in the your school.
Otherwise, I'm just not feeling well, vomiting, etcetera.
How are they going to respond if they have some different equipment there?
And we'll talk about that in in a manner.
So And the difference is ventricular flutter is a it can be lethal.
It's a precursor to ventricular fibrillation.
It is potentially lethal.
When it occurs.
And what the difference is unlike ventricular fibrillation, what you see on the right, you have these long sight odd slating long sinus waves and it's usually 150 to 300 that's the diagnosis.
And they are moving rapidly unstable.
So the question gets into is when you're looking at a case like this in the field, is what are you what are the life threats and how do you how are you going to treat them effective?
We obviously had think about the pulse oximetry they're having oxygen.
They're they're decompensating.
Now we have other issues that can call that that as well.
So here's this actual case study.
So it occurred during the soccer match, like we referred to, similar circumstances, 8 hours later, patient reports to the emergency room, the diaphritic, shortness of breath, lethargy, nausea, and vomiting.
On the initial stat eval, Heart rates at now 2 to 25 to 240 blood blood pressure, 160 over a 100.
SVO2 was at a 100.
In this particular case, ECG, they diagnosed a ventricular flutter.
They did a and do a synchronized external shot conversion.
And what that what occurs with that is they'll have an e k EKG in the in the in the emergency room.
They have a oh, they can actually put the pads on.
They put a synchronized that.
So when you and it's at a lesser it's at a lesser than we normally see in a, you know, in a semi or automatic AED, the the the nut amount of joules.
It may start around a 100 joules and move up based on what the diagnosis is.
It's also done under medication.
But this patient was conscious but was sedated.
So becomes it's not as uncomfortable as a it would be more painful as a actually putting someone on an AED that we that we carry in the field, but it nonetheless, it's controlling that.
They had an automatic.
They had the the conversion.
BP now, you know, is 106 over 67 becoming more stable.
Eventually, it stabilized.
The patient was transferred to Connecticut Children's Medical Center.
I went through a number of different tests.
Normal graded over a couple of days, normal graded exercise test, peak exercise and recovery.
Patient was permitted to return to play.
With with the chest protector.
No further events more than 1 year out.
They've continued monitoring, and they discovered the obviously, discovered the to be any type of stimulant medications in this case.
So where does this look like here?
So this is part of one cases where can an athlete return to activity after a significant cardiac event.
So the disposition, again, just to reiterate this, they've transferred by EMS to the Children's Medical Center.
I also had an echocardiogram, had normal ventricular site, systolic function, no other issues, no pericardial effusion, but we would think in terms of like a cardiac tamponade, were regional wall motion abnormalities, arteries were at normal origins with no defects, and they were had some other moved forward without even after Holter monitor monitoring.
They also follow-up.
They demonstrated the head of sinus arrhythmia, with no ventricular pre excitation normal QT interval.
Also, except thus testing was normal, and then they were timed with a chest as as we mentioned.
So, hopefully no.
So let's let's look back a little bit on this is a quick review on Comodo Corners.
One of the facts We know that it's ventricular fibrillation precipitated by a blood trauma, and it occurs at that one specific point where there's not a in a in a key point, that combative quarters is not it's it's the a ventricular ventilator is not attributed to structural damage.
So it's really important we think about our protocols in that looking recognizing what a cardiac arrest is versus a heart attack due to a structural blockage.
Definitely different treaty treat algorithms in what you would in how you're treating that.
From a history standpoint, It's attributed back to ancient Chinese martial art techniques.
So the touch of that technique mechanism of injure mechanism of injuries.
Obviously, you're getting that left troncle trauma with hard hard objects during sport.
So one of the protocols, especially in any, and from an athletic setting you wanna think about is having truncle trauma, similar to this, but also other types of respiratory cardiovascular conditions that may occur.
Less than 30 cases reported annually And we what we do know is that, you know, you have an AED, you have training, that rapid deployment of both end of EMS leads to success while it comes.
The mean age is fifteen.
Usually, you were a few less than 20.
Surprisingly 95% are are male boys.
I'm sorry.
Male an age group.
Survival rates.
Typically, you have a very for whatever, you know, look at this.
It looks some of the survival studies and some of the studies excuse me.
That have that have come out recently looking at some of the statistical data you're seeing this day, especially in college, athletics, and high school representative, especially in the last couple of months, just to be more handling case.
Become greater awareness.
Also, increased mortality with delayed CPR infuse.
So what do we also from a physiologists standpoint, just kind of take a snap back at the or or reef revisit this.
It's no definitive mechanism of injury.
In this case, there's a the patient patient had a direct contact with the heart with the with the anterior chest wall, the left chest wall, and then also developed ventricular arrhythmia, which eventually moved forward to a potentially lethal arrhythmia, if it wouldn't would not have been treated.
The probable scenario that occur, you know, 1% of the cycle, so the one thing I like to emphasize is, like, you know, this is the easy graph that shows.
This is when it curves.
But when we put in perspective, if you do, you know, you're where athletes are more susceptible is if you exercise, you have increased heart rate, which means you have mal, you know, instead of having 60 times a minute at rest, where this one segment occurs, you may now have a 120.
So that whole that number of the opportunity definitely increases over a period of time.
So, again, where it occurs and what how that happens.
If it occurs, if that trauma occurs at or past that peak, on that t wave, it's gonna you think about a complete bundle heart block or a left bundle branch block or even an ST elevation.
Also think about, you know, peaks at, you know, the coming up quarters is really at peaks at 40 mile an hour and what force that could you know, so they think it potentially in the younger population if it's a automobile accident, or it could be other something other type of trauma that can occur.
Again, increased heart rate equals greater, likely that of comedocourse.
So what do we think about from our mandatory is the man you know, on-site minimum action points 1st and foremost is seen in patient safety.
We go through that checklist of what the initial of the core I think that core assessment is a scene safe what's happening.
Assist the situation.
Are they having issue with spine, bleeding, airway breathing circulation?
Do quick rapid assessment.
What their level of consciousness is, checking, you know, those couple of things as well, do a vital sign assessment.
And those are really the kit things you wanna do in the first you know, 3 to 5 minutes.
If you go beyond 5 minutes, especially in a critical case, you're now you're gonna start this rapid decompensation So it's really important to find out where the life thread is, address it.
So for example, if the patient was had uncontrolled bleeding, That's the first thing you're going to do regardless of if anything else.
If you notice having difficulty breathing, you wanna try to control that with and how to do oxygen administration.
Or doing pressure positive pressure ventilation with a BBM.
Airway adjuncts is needed, and then also applying an AD if appropriate.
And the question I throw out here is, does your protocol or your practice guideline have a win versus win not to apply an AD?
You wanna think in mind though that you if your does your your facilities, do you have an automated it's fully automated, or is a Sydney automated.
In that, the semi is thinking, you gotta press a button efficiently do it versus fully automated.
You apply the pads you turn it on, it's gonna detect the rhythm, it's gonna shock.
So think about what that looks like in your in your protocol.
And again, get that rapid patient status, especially in the case of any any case where you're having oxygen deficits have a cardiac arrest, etcetera.
You need in making sure you're making that call to EMS and tell me specific in what that is.
So they know how to divert in certain situations, they may send a a first responder crew in rural area versus they may have a BLS unit versus an ALS unit.
So what you tell and that first or and have someone articulate is very crucial in those first couple of minutes from a response standpoint.
What are minimal skills and equipment needed.
So this pool of this is not necessarily all inclusive, but these are things to think about all the different things to be skillful in, just in managing this this particular case.
The one on the right, you if you're looking at this, you may say, okay.
Have an entitled c 02 or capnography.
You you know, ambulance services will have this.
They're they now have devices now that you can they're in a kit.
They're easy.
They're really, really inexpensive.
But potentially, you wanna determine what that's, you know, thing about where given the full scope of what this person is happening from blood pressure to SPO 2 to ox administration, also how to how to effectively deliver and maintain ventilation risk in in the perfusion rates.
So from a protocol standpoint, there are a number of different protocols or or practice guidelines that I, you know, we could have looked at based on the algorithms, etcetera.
Whether it's written down or a full script down or an algorithm, this has to be clear to particularly these various steps encouraging definitely look at the new 2020 2020 guidelines.
Make does your protocol address this?
This is the best best practice in terms of whether you're doing, you know, repeating CPR, go through the shockable rhythm, And if you're applying medication, if you have that available on-site based on physician or medication direction based on what resources you have there as well.
They're moving through this process as well.
And they and this is the nice gist of when that's applied.
Again, this is a pediatric case as well with a pulse, a pediatric tachycardia with a pulse, which was similar to this case as well whether or not we would need to apply an AED or not if the patient and I think the question, you know, it's just kind of this I've had this conversation about this before as well, this patient was in it was 200.
They're obviously tachycardia and which would indicate they're they're having an uncontrolled rhythm.
So it would necessitate putting an AED on the person to monitor it which they would tell you to shock.
And the question is, are you gonna shock some would would you shock someone if they are conscious?
And that's a that's just a the, you know, just hopefully just a question to think back when you go back and look at your protocols.
What does this look like and do Is that something, you know, where where you are in that case?
Because you know if you don't control what they're gonna go into cardiac arrest, which you definitely don't want, but know this out of that as well.
So I throw this in as a sample.
I did a talk on cardiac arrest, like gaps, and really looking at where a previous talk, and it looks at, like, what what similarities like, the more Hamlin, and this is this actually came from the up in when they were the EMS responded or or a sample protocol.
I'm not saying it is their protocol that they will would use with in that case for the more Hamlin.
But This is gonna be a good example, and it's part of your protocol and your training.
This narrates the this is part of this you need to look at, or I encourage you strongly to look at your general overall guidelines is when you're practicing, you need to think about running the code, especially if it's for cardiac arrest, you'd be able to practice that and what that looks like in real time.
That's saying looks, but actually, you do that over a period of time because in this case, the scenario EMS was not arriving for 11 minutes.
Well, what happens or it could be 30 minutes or whatever the case may be is knowing that you're going to do this, it helps to helps everyone to appreciate the gravity of the situation, but also how they are responding during that.
And it's everyone involved around the situation, whether they are actually managing that medical care or they're they're managing people to prevent them from coming on a field or area and helping to get traffic where they need to go to.
One of the last things here is really important is thinking about that at handoff.
This is one of these skills that is never, I think, is probably one of the most under practice skill points there is in as a first responder and how to do that.
But and and in in athletic training as well is we have to have somebody to make that transfer of care when EMS comes on-site.
I know there are several here on the call, Nancy, that are on I know that are dual credential.
They work in EMS like I've done, Doctor Arper's done, you know, work with them and how that does.
We just need to give them that case what the case presents to have, and this is a really easy template to use and practice.
You could do this with all your staff.
It doesn't take long to practice just, hey.
This is somebody walking up.
I have this, this, and this, this, this, this, what the vinyl signs are, where they are, where they where they were, where they are, it shows what they're having trending vitals, whether they are the 1st and the 2nd set.
So first set's gonna be running every 5 minutes.
You keep running through unless they're stable and they're not regressing, then you could probably extend that to 10 minutes if you need to.
But typically, you've gotta get a couple of vital sets in.
The initial.
And then, you know, it may include may not include blood glucose.
There as well.
Tell them what the what's relevant.
And we know, you know, where they're from or what there's you know, what's what's their favorite app on their phone or anything like that.
Just get down to the nuts and bolts of it.
Put everything on the table that's really relevant, and this does it.
And then what you have done?
What is it intervention?
When did you do it, and how and how what that response is.
That tells tremendous data.
If you apply if you did nothing but monitor vitals, then they're gonna see that there's what interventions wonder, if you put a blanket on someone to keep them warm or you're doing you know, gave them oral fluids or gave them a medicine.
You need to know what that time document the time and know when that occurred as well.
So really critical points here as far as practicing this in terms of your EAP, training, and response.
So and and kinda wrapping this up.
Things to think about.
1 is regular training.
What the you've got to develop and everyone has to develop confidence and confidence, not only in themselves, but but others around as well working with others.
We don't get the opportunity too often, but at least to work with those various scenarios in different situations.
What are your protocols and guidelines if they are rehearsed?
Making sure you're doing a rapid assessment.
You can work on mini mocks, for example, these 5 minute scenarios that come into work not working the full pace, but getting the 1st 5 minutes is the first is the most important things that occur.
Activating your EAP, doing the rapid assessment, determine life threats, And, again, you're determining their clinical trajectory.
What are making sure your mental equipment meet your practice protocols and guidelines.
Also, make sure you have a venue specific EAP.
It's been rehearsed.
It's been practiced.
You have a medical time out that's at this an active process during practices and events.
And, definitely, depending on the situation and you're setting, integrating non healthcare providers into the EAP.
This is gonna happen no matter what, whether you're at a college level or professional.
Otherwise, you have non healthcare providers that are part of the AP.
They're managing crowd control.
They're making the call.
They're helping maybe public you know, assisting you know, getting pointing public safety to the right direction, etcetera.
Those are all critical parts of the EAP.
And then finally, looking communicating with EMS, and really think about what those protocols are.
We don't wanna reinvent the wheel.
We wanna simply give it provide what they're what's being done, and it hands off to them so they're seamless care.
And in certain situations, it definitely would apply as well.
So with that, that's all I have.
And I guess we'll open up for some questions.
And if you want to go live with your question and have that actually talk to question out, then raise your hand and I'm I'll help with that, Doctor Harper, to Yeah.
Absolutely.
Ray, great job.
I know when we reviewed this case, it challenged us in a lot of capacities.
And and somebody asked a question, and it was a question I had when we were talking about this was how how common is Komochia Chorus because you think of a sudden impact like a Demar Hamlin, but that's not necessarily true.
Correct?
Right.
I mean, this is this case, you know, we look back on the data, it's about 30 30 cases a year, typically.
So we're not seeing this very often.
I think far as it delaying, this was the first one I've seen where there was actually a delayed case where they they attributed it may have been those documents is coming to court.
And I've not seen this before.
I think that's probably what drew drew my attention to the reading that is that, okay, this is really something we may not see very it's a high likelihood, but do we see it or not?
So that was probably probably the draw of that, but looking statistically, what that looks like?
You know, there was a very wide range of responses of differential diagnosis.
Right?
As it as it as it should be because you're guessing, you know there's been some kind of cardiac compromise.
This athlete's heart rate continues to rise His blood pressure continues to fall.
He's starting to breathe faster.
He's decompensating.
He has an altered mental status of Something is not happening, tissue is not getting perfused, so we definitely have something wrong with the cardiac compromise.
And so it's difficult in the field to to say what it is.
We just know that the heart is not getting the job done.
And it's time to take action.
And so Jason will get to your question, but I'm gonna slut slide my question in here.
And that is so rate protocol development, like, okay.
So you ask a great question.
When does your AED shock and when does it not shock?
Like, go back and look at your protocol and make sure that you understand the rules that your a your a d has been set up and and be willing to challenge Like, when would the AED be applied?
Do we have to wait for this boy to go unconscious before we applied?
And could your protocol actually allow you to put it on him before he gets unconscious?
Yep.
That's the that's the question I do.
I think the quote you know, just so you all know, the audience knows when talking about the Harper about this.
Like, I had to go back and think about this as well.
Like, okay.
What is if if I evaluate a patient and they are obviously decompensating, they are moving down the you know, it may be further down the line.
We're seeing what that looks like.
That's a you know, I know that this is where there are 200 the question gets I think it really gets into that conversation is where, okay, do we let the person move into unconscious and then shock them?
Obviously, you put a you've monitored on.
But, again, that that device is gonna do that automatically or not.
So you need to know how it goes back to just rereviewing.
This works the way it's supposed to work.
And I need to make sure that protocol accounts for that because Yeah.
You we can do we can measure, you know, using a pulse oximeter, having that in your in your kit.
It's just really it's one of the simplest and best devices there is to help determine clinical trajectory in what you do in those next steps.
Yeah.
I know Ed Ed made a comment here.
You can put it on anytime, turn it on once.
He's responsive, and that's appreciated that comment.
And but, really, as Ray said, it goes back to your protocol.
What are your rules say, what is your device?
What is your medical direction directed you to say?
And that's really the the the key point is technology can do a lot of things, but you have to have your guidelines and your protocol set up.
Yeah.
I think that's I think the ad off to what Ed had, you know, this is where, you know, you're you've gotta know you're gonna train to where if you're getting a vital sign set, and you see it's this and you see 1, you know, they're 180 and they're rest, and they show they that's how they're presenting.
But then also you're thinking, okay.
I need to put the AED on it and then show that what that, you know, is you hit it right on spot at is, you know, knowing what what it will do versus what it will not do, and you recognize they're having this problem.
So you need to practice being in that situation.
That's an uncomfortable situation.
I would think the b n you gotta know how you're gonna respond to that.
So that just really gets into even as a tabletop exercise with your with your staff, etcetera, what that would look like.
You get what those mental reps?
You know, Jason asked a question about medication, and and and he gave a broad, you know, list here.
But really, in our case, supplemental oxygen, what happens if your state practice static says that that you can't use that or any kind of emergency type medicine, what what's the plan?
Well, I think the the first topic goes back to base skills, if you're in, like, under Jason, you're an athlete, trained on a athlete.
There may there may be some of the non athlete trainers on this.
Go back to what your skill and training is.
And a base level BLS training has BBM working through the, you know, get at least helping them to vent like you're providing some.
It's not as it's not ideal in managing perfusion.
You're just trying to stop it from getting worse.
In that case, doing a bag valve or doing a using a bag if needed.
And that's even to control someone's hyperventilating.
They're too much or too little.
You can it's indication based on their age and what their what the rate is.
It's gonna be an indication that you use to control keep them from going and hyperventilating as well as if they have like, for example, if you have a known, like, a drug overdose, you don't have Narcan.
You don't have oxygen.
What you do have, you have your CPR skills, you have your airway management adjuncts, and and that's the next best thing you have.
Make sure you're putting that in place to the fullest fullest fullest extent you have, and there a lot there you do have an ability to help sustain life.
So Yeah.
That that goes back to protocol development, and you have things that emphasize like budget.
You have influence like staffing.
You have influence like state practice acts.
You have a lot of variables that influence what you can and cannot do.
But you have to have it written down.
So if you don't have this emergency medicine equipment because of the state practice act, then you need to write it down and and at least have your BLS skills, you know, in there.
But at the end of the day, your physician signs off that this is the level of care that will be established based on multitude of factors that are present.
And in some cases, you have to write a practice out and you have to write a scope of practice for coaches, you know, who who don't have the level of training and what level should their protocol development me.
So a lot lot of variables including state practice act squeeze down on the plan of action.
I think focus a lot more.
I think to add to that is, you know, Jason, that's a great question.
I think focus a lot I think we get you can focus on, no, we can't do this.
We think it's a limiting factor.
Focus on the things that you we that you can do within your scope.
What are you best with the emergency care, what you can do and get really good at that and ensure that those skills are that we take for grant, you know, just using We you know, the BLS training, you're going through that already.
The training for it just get really good, that type of training.
And that's that's the that's the thing to get, you know, You don't have to have a lot of fancy equipment to to save a life.
You just have to have the the minimal need equipment to to help give someone a chance to live.
Yeah.
Any other questions, please put them in the q and a.
We got a few more minutes to go.
I have
a question on audio.
We can turn you off.
Yep.
Yep.
Raise your hand.
And Yep.
Raise your hand.
We'll bring you into the room, and you can ask it.
Verbally and have a discussion with us.
So I got a question, Ray.
This athlete got hitting the chest really hard.
He began to decompensate.
It took a little while, but by the time he came to the athletic trainer, he was he was not feeling good at all.
Initial vitals were were not horrible, but but gave indication of concern enough to activate an EAP.
And then within just a short period of time, he started decompensating pretty quickly.
At what point in time do you start doing a positive pressure ventilation with a bag valve mask because his respiration rate is starting to get really rapid, and he's not getting oxygen to his tissues.
It's going in the dead space and it's coming right back out.
I mean, it's not even getting to his to his I feel Now
I'm I'm letting you definitely wanna move that above.
At that point, after 36, you look at I need to about the weather.
I need to go back and recheck the numbers with looking for that as well, but you wanna get definitely, you can use the BVM to control breathing.
That's where like using a posture using a VVM to to work on the control, and it actually slows them down mechanically.
So think about where that that fits into it for that case to be able
to do it.
And, again, again, it's a pro you know, go back in what your pro what you what your ranges are, are you going to do this?
We think of this how doing a BBM on the on the low side.
You're gonna practice it upside as well.
Where they aren't conscious of hyperventilating, they're having their other vital signs as well.
It's just trying to get them under con get them under control.
You know, Randall and Ed add in here, a couple of key points about the NPA, the OPA, the nasal, the oral, as well as It says 80 to 30, s p o 290.
So what that
what are you saying there for a second.
So Yeah.
But what they're really what they're really adding is the protocol.
Like like like, here's what you do if a, b, and c is true.
Right?
And so that comp the compensation element of when somebody goes unconscious and they're still technically breathing is very eye for a lot of people to do a positive pressure ventilation.
When somebody is still technically, mechanically breathing, when you start trying to control their breath by putting air into them with a back valve mask does not come as a natural skill for athletic trainers.
It is not taught in a CPR class, but it definitely needs to be part of your protocol as as Ed gave us some numbers and as Randall commented on the MP and the OPE as you try to establish and maintain their airways.
So Let's let's go off to that with Randall's question, and and and this person's unconscious now.
We're gonna play devil's advocate.
He went unconscious on it.
And are we running a protocol now which says, hey, you put on an AD?
And now the question is, do you bag them?
And the answer starts to say yes.
And now do you put in an n p or an o p?
Right?
Well, I think the one is one if you're having collapsed airway.
That's the first thing, you know, from a from the upper left restful airway standpoint.
So think of where that person's presenting, obviously, if you're having The OPA is gonna be ideal if they're having the if the airway, if you're trying to maintain that through BBM.
They're having a collapse.
It's not able to get airway in.
If you had to know the type of type of trauma, then the the NPA made would work is gonna be the device of choice with you using in in applying oxygen.
So, again, I think that's the way that jaw is dropping back.
You're not and a lot of times, it even goes back into if a patient collapses that we don't think about the the knuckles.
If a if your initial collapse on the field, One of the early things to do is, obviously, if you've made if not it's not C Spine, do that quick modified jaw through it.
Draw thrust maneuver to see it.
That may actually make it into an agony breathing.
You may have to get them to breathing again.
So that may resolve the case itself.
In an immediate collapse.
So, Ray, if he has a gag reflex, then then it's definitely what.
You're gonna do an NPI.
You're definitely gonna try with that as well.
So So
is this can is this person a candidate?
I'm sorry.
Go ahead.
Is this person a candidate for a king tube or an eye gel?
Not right now.
They're not they're not they're not unconscious.
I mean, they have to be they have to be unconscious.
Well, Tom,
I kind of I kind of made him unconscious and going going into respiratory failure.
So yeah.
So I I kinda play If
they don't have a gag reflex, then you would definitely you know, there there are different ways you I've seen where you can actually rub on the eye.
And if they and they flinch their their eye moves, then there that would be, you know, an indication you're not they're they're not fully think unconscious, but, obviously, they start to have a gag reflex.
That's gonna be problematic at putting supraglotic airway in.
So we just sleep out of mind.
Well, maintaining an airway designing how a wind to bag, putting on an AD, activating the EAP, and communicating to the administration, the parents.
Right?
That's a lot to do, man.
There's a lot of moving parts in a scene like this.
What is how does the EAP help reduce the anxiety of this moment?
I think just as if you understand how to the communication is so incredible to any situation, and it is if if People know what they're doing.
Also know what not to do.
I like to say, like, stay in your lane and and teaches people how to do that.
But also prevents people from it it we're not having the process of practicing EAP depending on your setting.
It actually can impede care.
So think about people wanting to step in on the field or doing other types of you know, running on the field a a a hysterical parent or someone else who may be coming in that situation.
So we've got to just, you know, Calm is contagious, but knowing what to do and how to do it and move through it very deliberately, that's really probably the I think in that I've seen over the years it's having it's really just and as bad as it is, things slow down.
And you've you, you know, if you practice enough, you know that, okay, now things move into a into a a very rapid situation.
Just trying to slow that down.
It's not gonna make that much of a difference.
You know, you look at what EMS does and they're not running heavily into a scene.
You gotta be able to process that in that short time, you know, unless, you know, be the difference between, say, like, me running versus you're saying bolt running, that probably be the you know, running a hundred yards.
But those are that that level of speed is not gonna make a difference.
It gives you a chance to be get you under your self under control.
But also, if you're running something into a situation, it automatically elevates the awareness of what's or or at least the the anxiety that people have in that situation.
So just gotta be aware of what that practice it and knowing where people are going to go.
It could be basic.
It's just like the medical time out.
It doesn't take 20 minutes to do a medical time out.
Like, for example, work with referees.
You do that.
Give them this the situation knowing where different scenarios are.
In 2 or 3 minutes, they get to know who you are and vice versa.
Getting everybody on the same page, and that's just probably one of the more critical components that I've seen working, you know, whether it's from like, football leagues to bigger events.
Let's just let's just take a step back and let's see where we're going, what what the overall impact is.
So let me let me see if I can put you on a spot.
Right?
I apologize later if it's if it's if I I shouldn't have.
But I so this thing is turning south.
We we we're bagging them.
We got an AD on them.
We're controlling the crowd.
We're we're we're contacting in a lot of parts for AP Emotion.
Here comes EMS walking up.
Right?
Not running.
Walking up.
You're ready to do a hand off report.
Give us your best hand off report.
As you said earlier, what does that sound like?
Give it to us and run us through what you should be saying to EMS as they're walking up because you gotta give them the cliff notes.
So I think the next thing is you're not giving I'm not gonna stop in doing care.
I think that's the they're gonna recognize what's happening there.
You're continuing to do care or you're in in the position by yourself, whether you're monitoring, they may walk in the middle of you doing vitals.
It doesn't mean you stop.
You're just gonna continue fit process.
Very simply, I'm gonna say, hey.
I'm Ray.
I'm an athlete trainer.
This is a fifteen year old athlete come had a main complaint of it getting hit in the chest as the incident occurred about, you know, given the time or the estimated time initial vitals.
Know the history of injury, whether whether vinyls.
This is what they occur at.
This is the time block.
This is what I've done.
I've given oxygen or I've done a VVM and in the position, and that's the time blocking where we are right now.
It just kinda goes through that.
I mean, trying to be as basic as it is with that, but then we're going through that.
And then they start bringing in their equipment, and there's one case here as well doing the same thing, just giving them, and they're gonna come back and redo those vitals.
That's what they're if if I was if I was an ambulance or anybody, you know, anybody else their by their protocol, they're still going to do a reset on vitals.
It's just they're getting that information to know where it is at the point in time.
So So they Absolutely.
They have to do that it's a standard protocol, and they're getting the vital assessment.
And then you start integrating the care and then, okay.
Now it's time to hand off.
The key point is if you're managing this patient's care, you you have control over that patient.
That's not people think, oh, come in when EMS takes over.
It's not the case.
So just gotta be aware of how you're handing that patient over as to what they're what you're doing with them at that point in time.
I mean, Ray get talking about this.
We'll talk we'll talk for hours about the past and the passing we would should take, and and then we always come back to, you know, what what does the protocol say, and and then practicing those steps.
To where it's automatic and its second nature and doing that as much as you possibly can within the time frame and resources that you have.
But the at your facility.
Because at the end of the day, when you lay your head on your pillow at night, you just gotta know that you did the absolute best that you could do in preparation and in execution.
So, Ray, we're getting close to the end of our time here.
I don't wanna rush anybody.
We're still holding on to our our audience.
Let's do kind of a wrap up.
And and if anybody else wants to join us, y'all y'all can definitely join us and and ask verbally.
You raise your hand.
We'll let you in.
We think that's a a good way to make this as interactive as possible.
If you have insight, into what we've been saying and you wanna verbally share that, you're welcome to.
And then while we wait on those individuals to possibly do that.
Ray, let's kinda wrap this up.
Let's let's let's talk about 2 or 3 key takeaways that we've covered today.
Go ahead.
Well, I think the first thing is going back to that bullet point of things that we need to you need to think about in your EAP, go back in, just hopefully, you use this as opportunity to rereview not only what your EAP is doing, and is it functioning well with what various situations are, but also think about the training.
Is it an is it a definite is it potential gap or deficit in your EAP that may have been exposed.
Hopefully, that's not the case, but that's the case of trying to move through that.
I think this the the point of continual practice, like working on how to hand off not practice, not only the skill itself, but those that type of that Nuance situation where you're not really sure where to do this or you do it.
I think even in the practice side of At the tail end of this, you have EMS coming on-site.
You are still part of that process.
Continue taking vitals.
Continue That's one area where you're moving on and how you how you frame those practice sessions up.
You don't have to do a 15 minute session with a full skill, but it may be dropping in like a mini mini mock that you wanna refer to as do the first 5 minutes and stop.
Okay.
What did what were those things have done well?
Maybe move midway in or just walking into someone.
What someone's already doing care If you're an athletics, you may not you're used to being the first person there, but maybe have somebody else just doing it in a in a scenario and just and Okay.
Now walk into it and what you're doing midstream.
And that may expose something.
It's like, okay.
Then think about how I how I need to integrate my own in the patient care as well, or am I am I needed in that case?
I'm just there to support the person that needed.
Yeah.
I know as we head out into this fall season and it's already, you know, going in in full steam ahead, and we have a lot of exposure to a lot of heat, a lot of physical stress, and and our sports, our activities, and I know whatever I would Welcome to an arena, practice a game, and I and my brain would say, what's the worst thing that could happen today?
And am I ready?
Right?
And I always got to no breathing, no pulse, and whatever leads up to that in physical contact like the sport of football, I think today's session was a good reminder that we need to think beyond normal medical conditions.
We need to understand the role of decompensation and how that can that can happen very quickly in a pediatric patient.
It can go south in a hurry, monitoring good vital signs, and tracking those over time, being prepared to communicate and activate your EAP in the middle of chaos, and then communicating that to the medical professions that show up in a very organized and concise way as you make that medical transfer.
So We've covered a lot of ground today, and we definitely appreciate your attendance and your time and your contribution to this session.
And we look forward to having more of these in the future.
We love the grays creative mind in a way that he puts these together.
We've got a lot of exciting things coming up in the future, and Ray, I'll let you talk about some of those things that are on the horizon for action medical consultants here this year.
Yeah.
Great.
Probably that we'll send this out pretty soon.
The next one we're going to do is thank you again for attending this session.
Just as a sidebar or at the end of this, we'll you'll get information on how to use this course as a CEU event.
Has on demand through the system that'll bring a couple days, but you'll be able to get that we'll send that information to you.
As far as other things we're doing next next our next webinar is gonna be actually on using artificial intelligence.
Now we use that in developing and protocols and evaluating protocols.
So that'll be that'll be next month, and we have other symposium coming up later this month as well or later in this in the fall as well.
So we'll share more about that through social media channels, other things as well.
The other thing, that's pretty much it.
Thank you again for attending.
And if you wanna turn on a line, we're gonna stop it here, but we have this open conversation.
Well, I'll stay on here for a couple minutes, and we'll we'll turn the audio mic on.
We did this before, and it worked.
Just got a lot of great just everybody in the audience just communicating and and asking questions outside of may may be related to this talker as well.
So I'll we'll stay on here till the last person signs off.
A lot.
Thank you very much for attending.
I appreciate your time and going through this interactive case scenario.
And if you'd like to go online, go live, we'll just turn your audio on.
Just raise your hand if you would.
Let's see here.
There we go.
Let's see.
Jim, how are you doing?
You're turning your audio on if you did?
Yep.
A alright.
Do you hear me better now?
You're kidding.
Loud and clear.
Okay.
Sorry.
An interesting question about when to put the AED on and let me ramble for just a minute.
As an instructor, you know, we teach people unresponsive and not breathing, apply the AED, and then let it let it do its job.
And then you've got Doctor.
Dresner's new video, what sudden cardiac arrest looks like, and eyes rolled back to their head, unresponsive, but they could still be breathing and that And then but if you put the AED on somebody, I think y'all addressed this, but they were they were conscious, but because of the vitals you were concerned, machines gonna shock them automatically, I guess.
And if they were responsive and it shocked them that's not going to harm them necessarily.
It's gonna be a big shock.
Right?
Any of that makes sense.
It'll it'll it'll it'll definitely go for a punch.
It's definitely it's it's not indicated to apply to shock someone who's conscious.
You need their It's gonna
be yeah.
Of course, obviously.
So just keep that I think they're willing to keep it in mind.
You're not there you won't see a protocol.
Hey.
Go ahead and shock them.
Whether you're monitoring, that's another that's another process in itself.
Again, one part of the focus today was really think about what is the what is your does your protocol 1, the type of equipment you have available?
What you're going to do with that type of equipment when it applies?
And knowing that, you know, that's a unique situation that, you know, obviously, you wanna do a synchronized cardio version, if that was the case in certain situations.
So more of those just getting that having that conversation with your medical direction as to what that's going to look like.
Because what would happen is if you put that, you're not paying attention or even you had a ED and plug it in and they are in their they could be conscious and they're 200.
I mean, this patient, you know, in that case, was 200 plus and which was deaf you know, it could be their their if they're tachycardic or they're in V fib, that would have been the case.
But if it was not gonna do it as an an an atrial fib relation So that's the one thing as example.
It would not it would show us not, but being able to know how to handle that situation is part of that.
Right.
I think Eric raised his hand to come
Got it.
Got it.
Got
it.
Okay.
Got it.
Got it.
Okay.
Got it.
Answer your question.
No.
It's not necessarily a question other than kind of a statement to you.
Is He could have tried a basal vehicle technique to bring that heart rate down because it is proven.
It's very basic skill.
And then another one is actually, if you've catch your ice immersion there, have them put their face down, which sounds counterproductive into that water, but that mammalian diode reflex velocity to take PT ventricular tachycardia down sometimes.
So not your typical response, but some other things when you're when you're got a person with the pulse, they're in you know, VTech, and you don't wanna shock them because you can't courteous thing.
So Yeah.
And that's gonna well, I I bet you brought that, like, even the the bagel base of bagel maneuver.
You can that that would be that that would that's typical be a first line immediate.
You know, emergency room, etcetera.
Again, you need to be trained in you need to be trained in that and being able to win to do that maneuver.
So which is definitely the, you know, something to consider down the line.
Are you reviewing protocols?
Are you trained to do that?
As a manual technique.
I agree.
Yep.
Great.
Any any other questions or comments?
You know, I want to raise their hand and just have a conversation.
This has got a open mic and open conversation till the last person hangs on or is on the line.
So I guess one guy who missed it, Jim, is Doctor Dressner, some of the research he's done, some of the studies he's done as a you know, are we on cardiac arrest that some of the data that that's really good data from a couple of years ago that he that a couple of studies that came out looking at historical data on cardiac arrest incidents looking at the other case as well that there's some really good information that's out there.
I think the other thing along that lines is is you know, and you even showed the video of
the
Polycom player player.
But the fact is is that still public operators tend to not wanna push that shock button because If you listen to the person when advised her to shock, she's looked at the parents.
Should I really shock your daughter?
And so the fully automated versus the semi automated depending on how they're being stationed could be a good thing.
Right.
Yeah.
That's where that was you know, and part of this was it got me thinking when we're looking.
I was looking at this case study is, okay, what type of device, you know, what type of device it is, how to to put that into play, how to practice that scenario in both cases because I guess what you just said is, okay.
If we're gonna apply that with an automated we need to know what that's gonna hap what's gonna happen.
And, you know, without without any any hesitation versus automated, it will tell you if that's the case and when they do that and especially if they're conscious or it's easy if they're unconscious.
That's an easy decision.
But if they aren't, if they're still conscious, what that this it's worth just going that tabletop exercise is that walk through it at a minimum with your staff with staff.
Anything else?
I liked your I liked your idea of of the pass off information.
And and like Ronnie said, there's so many moving parts, and it's almost like you've got to add that one person.
Take notes of everything I say or turn the recorder on of all my documentation and of of all the vitals and things like that because there's just so many things happening at once.
But as you said, when you practice it, you can kinda slow it down, so to speak.
Yeah.
And, again, just trying to shock.
I mean, try when you're thinking about that, just work through the process is how to excuse me.
Again, think about the scenarios.
A lot of it is just to be tabletop exercises.
We know what that looks like as well.
But having different forms, even doing a case study is an example.
This helps in just kind of treating the the brain is an exercise or doing as an exercise point.
It's rapid.
Everybody's busy, but at least provides deliberate process even a monthly meeting for you, a 30 minute meeting, part of your staff meeting, enrolled through that project, reviewing different process as well.
So
one quick question, Ray.
I may miss this.
What did you say about your slides being available?
I'd like to share this with our EMS person that we work with in in our high school coordinator of athletic training so that we can come up with, like, a tabletop or something like this.
Yes.
I'm going to this this presentation, once we're done, I have to process it, and then we'll make it I'll make it live as a CPU course, the free CU course.
So we'll push that everybody's attended, and if they couldn't attend, we'll push that out to everybody, hopefully, in the next day or so.
So I think the latest might be in 2 days from now, so with that.
So Alright.
Thank you.
Thank y'all so much for attending.
And I know we've come up with 12 o'clock here going a little bit longer than we wanted to, but I I've I've unfortunately gotta stop.
Right now.
So jump off for some other obligations anyway.
Thank you all for attending any feedback you have on future topics like this.
Definitely welcome those as well.
And I hope you've enjoyed this session.
Doctor Harper.
Yeah.
I mean, thank you, Ray.
Great job.
Thank you.
CRITICAL DECISION POINTS 2.0: Audience-Driven Management of Chest Pain in a Youth Soccer Player
General Course Information
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Presentation (Video)
Updated Jan 22, 2024
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SPECIAL NOTE:
This course was originally listed on the presentation as "BOC 1.25 Category A CEUs". The presentation content was longer and therefore now available as 1.50 Category A CEUs.
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