Do you want to be a better
#paramedic
? Grab yourself a physiology textbook...
Physiology is at the core of all that we do. It underpins assessment, diagnosis, critical reasoning and management.
#CPD
So, my frame of reference is going to get significantly smaller in the coming months...
I was successful in my application to the role of trainee Advanced Paramedic Neonatal Intensive Care Retrieval with
@Nestteam1
An unbelievably exciting & progressive new role for
#paramedics
Speaking to student
#Paramedic
recently and was disappointed to hear they had received no training in breaking bad news and all arrest sims end in ROSC.
This sets unrealistic expectations and doesn’t equip our future Paramedics with the right skills.
Fact of the day.
Why are NIBP machines inaccurate? They don’t actually measure BP! Using the oscillometric method they measure MAP & HR then use them to calculate BP.
This is why vibration, irregular pulse, bradycardia, hypotension etc can cause inaccurate readings
#FOAMed
A long term ambition finally realised. MSc Professional Development: Prehospital Critical Care with
@CumbriaUni
. A very proud day.
Brilliant to see so many prehospital colleagues graduating with undergraduate and postgraduate qualifications. The times they are a changin’
Fantastic to see the recognition from
@ResusCouncilUK
that in-hospital courses aren’t suited to prehospital care. We need specific courses targeted to the unique challenges we face in the environment in which we operate
Not sure if this is revolutionary or not. How about nurses, physios, paramedics & docs have the same 1st year at uni?
30 credit A&P module
10 credit pharmacology
20 credit pt assessment/history taking
Promote understand of roles, flexible workforce & platform for progression...
Delighted to see the updated minimum kit list for managing infants born out of hospital, published on the
@ResusCouncilUK
website.
This will hopefully be an important step towards improving and standardising the care delivered to
#newborns
in the
#prehospital
setting
So this is the secret we’ve had to keep quiet.....until now!
Crash3 is published next week and our podcast will be released simultaneously.
We promised this was going to be big! Practice changing? Well, you’ll just have to wait.....
#crash3
#prehospital
#phem
#ambulance
A tube exchange, during a neonatal intensive care transfer, after the ambulance breaks down and looses power....
Because if it happens and you haven’t thought about it and drilled it, how can you expect to perform well?
Ambulance service mandatory training day. We covered:
NLS, APLS, ALS, choking, termination of resus, DNAR, post-resus care, human factors etc etc
Great breadth, but not one mention of breaking bad news. That is one reason why we’re covering it this month on
@TheResusRoom
Thanks to all those who sent good wishes for the Advanced Paramedic Critical Care assessments. Unfortunately, despite giving it my all, I was unsuccessful.
Time to regroup, reflect and move forwards
When I started my journey into
#neonatal
practice I had no idea where it would take me. I still don’t know what the final destination is. But today I’m buzzing.
After successfully completing my instructor candidacy for
#ARNI
, I’m now the first
#paramedic
member of the faculty!
“We can’t expect staff to act compassionately to patients when they themselves are not treated with compassion by their employers”
An incredible talk on psychological well-being in prehospital care by Prof Richard Williams.
#basicsfphc
To be voted in as deputy chair of steering committee to develop RCUK Prehospital Newborn Life Support course is absolutely incredible.
But not as incredible as the opportunity to help shape a course relevant to all practitioners attending out-of-hospital births
#NLS
#newborn
New
#APLS
status epilepticus guideline published.
* Timings are tighter, new intervention every 5 mins
* Levetiracetam is 2nd line agent
Why? 90% self terminate within 4mins, but >5mins = 80% chance of >30min duration = ⬆️ risk of death.
Early intervention crucial
#FOAMed
Fantastic to hear that the IN ketamine PGD has been signed off and ready for SPCCs within
@CareSwasft
This fills a significant gap in our analgesia options, particularly for
#paediatrics
Hey
#paramedics
. Twitter can be a bit dark sometimes, but I still believe we have an amazing role.
So wherever you work, whatever your position, how about you share one thing that made you happy to be a paramedic this week?
#sundayreflections
@ParamedicsUK
I’m concerned for our student/NQP colleagues who may be feeling isolated and short of support right now.
If you have a question (relevant to paramedicine!) please feel free to DM me. I won’t write your essays but will do my best to help.
#InThisTogether
#paramedics
You NEED to read these 2 studies if you’re involved in prehospital care, in any capacity.
Summary? Self-extrication is the fastest method of extrication and results in least spinal motion. Adding a collar does not change total spinal movement…
#mythbusting
#Paramedic
#FOAMed
If you’re involved in extrication from either a medical or rescue perspective then we’ve got something that should be of interest…
Two new articles. Published today. Free and open access.
Massive thanks to everyone involved!
Teaching
#PHTLS
today & delivering the Respiratory lecture. During my prep I remembered a nice phrase:
“The remarkable thing about breathing is that it is unremarkable”
In other words, if you notice a pt’s breathing, then something must be abnormal about it!
#FOAMed
#FOAMems
On
#WorldPrematurityDay2022
just a friendly reminder to
#ambulance
colleagues that babies born out of hospital <32wks gestation should be put into a plastic bag (head out) and placed onto a heat source (transwarmer/hot water bottle/care giver). Thermal care is everything
From Sept I will work 50% prehospital crit care & 50% neonatal stabilisation & retrieval.
This sort of job plan benefits everyone: patients, organisations and clinicians. It is the future.
Massive thanks to
@gwaac
and
@Nestteam1
for your vision and support
#paramedic
Reflection on new ten second triage after clinical use:
1. It’s intuitive to implement (rather than old HR & RR parameters). Means less cognitive stress and, I think, more consistency
2. It really is ten seconds or less per pt
#FOAMed
#FOAMems
I’m sorry folks, you’re going to have to put up with
@TheResusRoom
for another five years!
Amazing to have the continued support of such a high quality, relevant, free and open access journal.
Very proud of this collaboration with
@SJTREM
In-hospital or pre-hospital, supraglottic airways are playing an increasingly dominant role in our airway management strategies.
This months
@TheResusRoom
episode focuses on everything supraglottic.
So, hit us with your questions and we’ll do our best!
#FOAMed
#FOAMems
Well, after two lockdowns, a 5 month delay, a change in delivery method and a bit of work, I’m registered as a prescriber!
Huge thanks to
@UWE_NMP
for their adaptability and positivity in the face of such challenge. Also to
@GWAAC
for the ongoing support of my development
“Among awake, alert patients, painless straight leg raise can exclude pelvic fractures.” 100% sensitivity in this study (can rule out fracture) and 100% negative predictive value (the result of the test is very reliable)
#FOAMems
#paramedic
Alright folks, the next
@TheResusRoom
podcast is going to be on
#stabbing
.
Heaps to talk about but what do you want to know? Any burning questions? What have your experiences taught you, any clinical pearls? Answers on a tweet please...
#CPD
#paramedic
#ambulance
#FOAMed
With an increasing number of
#specialist
&
#advancedpractice
roles emerging for
#paramedics
, I thought it might be useful to assimilate some thoughts on preparing yourself & your CV for these positions.
I’ve been a bit quiet on the
#FOAMed
front recently, but been a wee bit busy
Working with an amazing faculty to create the Prehospital Newborn Life Support course. Candidates from ambulance, community midwifery & air ambulance teams arriving for proof of concept course tomorrow
I’m extremely honoured to have been asked to speak at
@ParamedicsUK
national conference. What’s more, apparently I’m delivering the keynote presentation?! If you could come along and clap regardless of the quality of my talk I’d be really grateful....
#CPD
#FOAMed
#paramedic
#ParaCon20
presentation: How FOAMed changed the World by
@heli_med_james
from
@theresusroom
talks us through a brief history of FOAMed and how it has changed the way the profession learns and develops.
I’ve realised that
#paramedics
currently work in a multitude of different
#advancedpractice
roles but few of us know what’s actually involved in these positions.
Therefore, on Tuesday 30th, I’m going to tweet about my day in
#neonatal
retrieval
@Nestteam1
Looking at the tiny, fragile life next to me on
#neonatal
transfers; I feel unbelievably responsible.
But, on reflection, this responsibility is no different to any patient the
#ambulance
service cares for.
Don’t ever forget the enormity of our roles.
#PHEM
#paramedic
Teaching the airway station on
#NLS
today, so what are the take homes?
1. Place infants head in neutral alignment. This means the plane of the face is parallel to the ceiling, avoid hyperextension or hyperflexion. This might require a small towel/nappy under the shoulders
What makes a great prehospital clinician?
A really valuable slide from
@gareth_grier
. Anyone can do the procedures or give the drugs. Great care is patient/family centred and delivered with compassion
#CCParaConNI22
Here’s what the magical anti-tangle, glove tidy system for your monitoring wires looks like. As discussed by
@drsgrier
on
@TheResusRoom
episode on transfer. In case you were wondering....
#FOAMed
#FOAMems
So, we’ve been working on a little project.... a new website and app that will log CPD, stream our podcast and much more. And of course, it’s from
@TheResusRoom
, so it’ll be free and open access
#FOAMed
Reaching for a flexible catheter to suction an ETT or tracheostomy tube in an emergency?
Multiply internal diameter of airway by 2 to get the French Gauge of catheter required!
Eg. Size 8ETT = 16Fr catheter
#FOAMed
#FOAMems
Currently working my final shift as a full time SPCC for
@GWAAC
before I head off on secondment as a trainee Advanced Paramedic with
@Nestteam1
. Enormously grateful to the support from
@GWAAC
to be able to take up this opportunity
#careerdevelopment
In the NE currently & reflecting on my career so far. Guess it’s been underpinned by a refusal to accept arbitrary boundaries & a belief in the
#paramedic
profession.
Keep smiling & feed the fires of development. Who knows where you’ll go
@NEAS_Medical
@Nestteam1
@TheResusRoom
What?! Am I missing something here?
Why does the U.K. ambulance service need to move four patients at a time, at mach1, with no ongoing patient care whilst strapped to the wings of jet?
Fact of the Day: The F18A (Ambulance) is the first Fast Air Response Transport to be loaned from
#RAFLuton
to the UK Ambulance Service. The F18A can carry up to 4 patients in pods mounted on the wings.
#AvGeek
This post has pretty much gone viral on
#MedTwitter
and for damn good reason. This is history being made for the paramedic profession and an incredible example of how far we’ve come.
Can’t give enough kudos to
@vickibrown999
for this achievement
#Paramedic
So you think you have a sweet job? Search and a Rescue paramedics in Svalbard 🇳🇴 have the responsibility for transporting sedated polar bears!
#jobenvy
Learning from yesterday: bin CABC assessment in neonates!
For neonates, particularly one with very low birth weight (<1500g) use TABC approach. T = temperature.
Why? Every 1*c drop in temp increases mortality by 28%!!
#neolearning
#FOAMed
UK
#paramedics
, just stop for a minute to consider where we’ve come from. Our profession still has much more room for growth but, folks, we’ve come a long way.
This article from 1987 features an old colleague of mine from the North East
@ParamedicsUK
Help us craft the content for this important
@TheResusRoom
episode. Post any questions, concerns or uncertainties that you’d like addressing. Prehospital or ED.
I’m lining up a heap of experts plus a brilliant guest speaker!
#paramedic
#FOAMEd
#ambulance
#emergencymedicine
Dear
#paramedics
,
I’ve posted similar before, but as I travel to join
#ARNI
faculty in Dundee I was reflecting…
If you doubt the power of your transferable skills, the value you bring to a multidisciplinary team or your potential in this profession
I promise you, we are seen
Attended first grand round in hospital today. Enlightening to see senior clinicians discussing cases, openly welcoming ideas & thoughts of colleagues. I think
#paramedics
can learn from this. We’re very proud of our autonomy but maybe we should share decision making more often?
#paramedic
students. Welcome to the profession. You have an exciting career of learning & development ahead. Embrace the opportunities & challenges.
@TheResusRoom
is here for you. Studying for exams? CPD? Critical appraisal skills? Latest evidence? Poor jokes....?
Super excited about this project. As well as logging ALL your CPD. Every
@TheResusRoom
episode we release will have a bank of questions to help consolidate your learning and, on completion, which will generate a certificate for your portfolio. Free and open access
#FOAMed
We’re building the modules to go with our Free CPD platform and app. Giving a layer of consolidation of the learning points from the podcasts.
Looking forward to the full launch in the next few weeks!
#prehospital
colleagues, if managaing a patient with
#heatstroke
during
#heatwaveuk
, please remember:
MORBIDITY & MORTALITY from heatstroke directly related to magnitude & duration of body temp >40*c.
Cool on scene unless impossible/can’t manage A or B issue.
#FOAMems
New infographic from
@ResusCouncilUK
on resuscitation of
#COVID19
patients in hospital.
#paramedic
and
#ambulance
colleagues take note. Hospital walls are no barrier to
#COVID19
, we need to follow this guidance too. JRCALC update to follow.
FULL PPE before starting CPR
A really valuable paper:
*Approx 1.5 prehosp births PER DAY attended by
@swasFT
*2.7% neonates had temp recorded
*72% were hypothermic
Better kit, better training/awareness and specific
#neonate
section on EPCR may improve this?
@laurakgoodwin
#phem
Having listened to this episode today, prior to its release on Thursday, I don’t think it’s being dramatic to say that it’s possibly one of the most important episodes we’ve done so far.
Bringing evidence to extrication. Standby…
#FOAMed
#FOAMems
#CPD
#Paramedic
#Ambulance
Delighted
@JoshEason6
& I now have permanent positions with
@Nestteam1
as
#advancedparamedics
.
In 12mnths we have:
>130 retrievals
Completed competency framework
NLS & ARNI provider
6x assessed retrievals
Positive 360’s
Activity in all 4 adv prac domains
Independent prescribing
How do we recognise cardiac arrest in elite athletes? Be aware they may present differently. In the first few seconds after arrest they may still be breathing rapidly and not displaying agonal breathing
#RCUKAC2022
Attention all
#paramedics
. From
@ParamedicsUK
“We strongly recommend that Level 3 PPE is used for ALL cardiac arrest situations or airway management where there is any possibility of COVID-19 being present”
Read full statement here:
Wow! Pretty humbled to discover that my little blog on the management of asthmatic cardiac arrest has had the highest number of views on the RCEM Learning website.
Thank you to all who have read it
Last but not least, it’s time to reveal our
#Magnificent7
blog!
A wealth of contenders but we can confirm that Arrest Asthma has come out on top with over 8,000 PVs!
#RCEMLearning1000
Read it here 👉
I haven’t contributed a huge amount to twitter in recent weeks as had head down studying for Advanced Paramedic in Critical Care assessments.
Day 1 of 2 today and my brain feels like it’s been wrung out and put back in my head! 🤯
For those interested in the process…
Welcome to The Resus Room 2021. No fancy re-brands, no glitzy launch party, no gimmicks.
Just the three of us, a bit of experience and a dollop of evidence versus an
#emergency
#medicine
topic.
Let’s do this
#FOAMed
#FOAMems
Brilliant webinar with Prof Ian Roberts about TXA use by
#paramedics
. Lessons:
* Patients not consistently getting TXA rapidly enough
* IM use = therapeutic levels within 15mins
* Inclusion criteria may be broadened to ensure capture of all who could benefit
#FOAMems
#FOAMed
Actions required for a
#stabbing
victim with central stab wounds?
Think STAB-5.
Rapid assessment
Rapid haemorrhage control
Rapid transport
Don’t be reassured by “superficial” wounds or a pt who is GCS15
Great resource from
@gwaac
colleagues
Seeing an ⬆️ no. of tweets from
#ambulance
colleagues who feel frustrated & broken by new policies.
I understand services are under pressure but if polices affect moral & don’t meet basic needs, service provision is going to decrease, therefore negating the policy change
2021 will bring our first The Resus Room conference!
We thought we’d build on
@robfenwick
&
@heli_med_james
exceptional talent of making people fall asleep whilst they listen to them and therefore we’ll be covering...
SEDATION; prehospitally & in the ED
More details to follow
Prospective study of 2500 paed burn pts.
20mins of cooling significantly reduces:
• full thickness burn depth (OR 0.4)
• skin grafting (OR 0.6)
29% did not get full duration of cooling.
#dothebasicswell
#burns
#paramedic
2 years ago,
@laing_simon
approached me with an idea....
Being involved in the Roadside to Resus series has been an absolute privilege. But the thanks lands at your door; for listening, engaging, discussing. It is you who continues to make this enjoyable and educational
Another year, another 12 episodes of Roadside to Resus ahead
@TheResusRoom
. Who knows what fun and learning awaits…
What I do know, is that this month we’re talking about narrow complex tachycardia. So get your thinking caps on and let us know any questions!
#FOAMed
#FOAMems
One day you’re down and the next you’re up!
After some lobbying from extremely supportive colleagues, the clinical leads at
@ResusCouncilUK
have changed their regulations allowing me to take up my instructor potential nomination for the
#ARNI
course.
Thank you to all involved
The
#NHS
long term workforce plan has just been published. I thought I’d have a spin through and see what it might mean for
#paramedics
.
It’s 151 pages long so bear with me…
Great day at
@CumbriaUni
delivering the
@ResusCouncilUK
#OHNLS
course to an awesome group of midwives, paramedics and prehospital doctors. Looking forward to doing it all tomorrow!
So today I led a simulation which included the delivery of an RSI to a neonate. Drug dosages as followed:
Fentany 9mcg = 0.2ml
Rocuronium 3mg = 0.3ml
Yes, neonatology is still blowing my mind!
#neolearning
#neoparamedic
Have had a couple of reminders recently, that mental modelling on the way to a job can be really valuable. But this prep needs to be equally matched by the mental agility to change plans when the scene isn’t what you expect!
#reflections
#PHEM
#paramedic
Top Transwarmer tips for
#prehospital
colleagues:
Full activation in 90sec (white crystals form - Y in pic)
Massage pack to increase efficacy of activation
Lay baby on fabric side (whilst in plastic bag if <32 weeks)
Warm for 2hrs
Useful video:
#FOAMems
Alright team, this months
@TheResusRoom
topic is ventilation. That inevitably means a question for you all….
Anyone using ventilators during CPR? If so, when/why/how?!
And in return, if you have any questions or us then we’ll do our best to find out!
#FOAMed
Whilst you’ve all been enjoying the good weather,
@TheResusRoom
team have been popping vitamin D tablets and preparing for this months episode on subarachnoid haemorrhage.
As ever, really keen to hear your thoughts and questions to shape the content further...
#FOAMed
#CPD
Recently completed my 80th neonatal retrieval with
@Nestteam1
. So what does that look like?
• Ave weight 2.3kg (500g-4.2kg)
• 80% had respiratory support
• 50% ventilated
• 10% inotropic support
• 80% as lead clinician
• 4% air, 96% ambulance
#AdvancedPractice
#paramedic
Speaking to student
#Paramedic
recently and was disappointed to hear they had received no training in breaking bad news and all arrest sims end in ROSC.
This sets unrealistic expectations and doesn’t equip our future Paramedics with the right skills.
@emmajoyfulford
We should absolutely promote infection control measures & safety of patients, but prehospital environment not clean. Often no way to follow “5 moments of hand hygiene”. Wrist watch is vital for obs, logging interventions, running arrests etc Fob watch covered by jackets/other PPE
#Paramedic
and
#ambulance
colleagues. Read this....
Looks like we should be carrying out blood glucose assessments on all patients we are currently seeing.
The disagreement between PHE and RCUK continues
Not sure which side of the arguement I land on. Having the read the systematic review, evidence for CPR being an AGP is v poor. But “expert option” features in hierarchy of evidence for a reason. My inclination is to follow RCUK
RCUK are deeply concerned by Public Health England (PHE)’s continued insistence on designating chest compressions as non Aerosol Generating Procedures (AGPs). Read our latest statement (published 20 April 2020):
With renewal of UK
#paramedic
registration looming closer, it got us thinking.... wouldn’t it be cool to generate and record CPD after listening to one of the podcasts and get some credit for putting up with us for an hour?! Thoughts please?
#CPD
#ambulance