Critical Levels

• Data-Driven Resuscitation & Seamless Transitions

  In this episode of Critical Levels, we dive into the cutting-edge strategies shaping pre-hospital and emergency department care. Our guests discuss how data-driven decision-making, high-performance CPR, and improved handover processes are revolutionizing patient outcomes. Key Topics Covered: ✅ High-Performance CPR: The role of real-time feedback, mechanical CPR devices, and quality metrics in improving survival rates. ✅ Data-Driven Protocols: How data influences resuscitation techniques, including push-dose epinephrine, early vasopressor administration, and optimizing CPR pauses. ✅ Seamless Transitions of Care: Addressing the challenges of pre-hospital to hospital handover, minimizing interruptions, and ensuring continuity of life-saving interventions. ✅ Training & Coaching: The impact of structured CPR coaching, debriefing sessions, and real-time monitoring in refining paramedic performance. ✅ Future Directions: Exploring nurse-led ACLS, multidisciplinary teamwork, and technology-driven improvements in emergency medicine. Key Takeaways: 🔹 Data analysis is critical in refining protocols and enhancing patient survival. 🔹 Effective communication and structured handovers reduce adverse events. 🔹 Continuous training and feedback loops lead to better resuscitation outcomes. Join us as we explore how collaboration, innovation, and data are shaping the future of emergency medical care.

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• K9 Medicine - Dr. Jason Donohoe

  🔹 Key Topics: 🔸 Why medics need to understand K9 trauma care The overlap between human and canine emergency medicine Common injuries in police, military, and search-and-rescue dogs 🔸 MARCH for Canines—What’s Different? The first "M" stands for Muzzle—securing the dog’s “weapon” before treatment Understanding the similarities in trauma care between humans and dogs Key differences in how canines respond to injury and shock 🔸 Massive Hemorrhage Control—Why Tourniquets Don’t Work on Dogs Anatomical challenges—why dogs' limbs aren’t suited for tourniquets When to use direct pressure, wound packing, and hemostatic agents Junctional bleeding—where life-threatening hemorrhages happen in dogs 🔸 Airway & Breathing—Why Intubating a Dog Is Easier Than You Think How to recognize respiratory distress vs. normal panting Why dogs have larger, straighter airways than humans Needle decompression for pneumothorax—landmarks and technique 🔸 Transporting an Injured K9—Avoid These Mistakes Best positions and vehicles for safe transport What paramedics, police, and handlers need to plan for before an emergency 🔸 Shock & Fluid Resuscitation—The Critical Role of Femoral Pulse Checks How to assess perfusion in a dog without a blood pressure cuff Why EZ-IO is the best choice for vascular access in canines When and how to administer fluids, TXA, and blood products 🔸 CPR for Dogs—Does It Work? When CPR can save a dog—and when it won’t How to perform chest compressions correctly Naloxone for K9 opioid overdoses—it works, but dosing is different 🔸 Medications & Pain Management—What Paramedics Can Safely Use NSAIDs are dangerous for dogs—avoid them in trauma cases Opioids, TXA, ketamine, and antibiotics—what’s safe and effective?

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  54:34
• Frostbite - Dr. Maria Doubova

  In this episode of Critical Levels, we tackle frostbite with Dr. Maria Doubova, exploring its pathophysiology, symptoms, and treatment. From outdoor enthusiasts to vulnerable populations, frostbite affects diverse groups. Learn about early early recognition and management of frostbite - from mild frostnip to severe cases requiring advanced interventions - and the latest classification system to improve outcomes in this insightful discussion.   What You’ll Learn in This Episode:   What frostbite is and who is most at risk. Symptoms and early detection techniques. Frostbite classifications and their significance for prognosis. Practical pre-hospital and hospital management strategies. How frostbite overlaps with hypothermia and what to watch for.

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  41:03
• TXA - Dr Erik Vu

  Welcome to the first episode of 2025! This month, we’re diving into the critical role of Tranexamic Acid (TXA) in pre-hospital trauma care. Dr. Erik Vu, a critical care flight paramedic, emergency physician, and intensivist, joins us to discuss the latest insights and applications of TXA, particularly in dynamic and tactical environments. From its role in stabilizing clots to its use in mass casualty scenarios, we break down everything you need to know about this cost-effective and life-saving medication. Learn about the benefits of intramuscular (IM) administration, the importance of timely intervention, and how TXA fits into modern trauma care systems. What You’ll Learn in This Episode: What TXA is and how it works. The history and research behind its pre-hospital use. Why IM administration is a game-changer in tactical and unpredictable environments. Best practices for dosing and administration. TXA’s role in mitigating hemorrhagic shock and improving patient outcomes. Practical tips for integrating TXA into your trauma care toolkit.

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  17:06
• Prehospital Blood - Dr. Antevy

  On this month’s episode, we are going to talk about prehospital blood administration with Dr. Peter Antevy Some topics covered are: Historical trauma management  Blood why  blood components  administration ratios  blood type  Blood administration who do we give blood to medical vs trauma (blunt vs penetrating)  elderly vs peds  vital sign parameters when do we administer it  how do we give it IO vs IV (size matters…) temperature  Logistics how do we get it patient side cold chain storage temperature management  training (initial and ongoing) minimizing waste Challenges consent religion administering to females of child bearing age transfusion reaction Blood Adjuncts  TXA  calcium  other What’s the data showing? Next steps 

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