Warren Meyer

Critical Care Paramedic - Clinical Educator, Patient advocate, #FOAMed enthusiast, medical simulation . tweets and views are solely my own

[Warren Meyer @Medic_Warren]

Today we @Ornge completed our second interagency and inter professional simulation with our partner @SickKidsNews This unique collaboration will improve patient care in Ontario by aligning processes and improving work flows. What a pleasure working closely together on this!

[Warren Meyer @Medic_Warren]

@drkeithsiau This looks like evidence of syphilis

[Warren Meyer @Medic_Warren]

Absolutely amazing project with truly dedicated professionals - this is collaboration at its finest!

[Andrew Petrosoniak @petrosoniak]

We ran a 1st of its kind in Ontario - high fidelity pre-hospital to in-hospital trauma care simulation. Collaboration between @UnityHealthTO & @Ornge

Incredible session with 2 high performing organizations to practice, improve & reflect on how we care for trauma pts in Ontario.

[Simulation @ Unity Health Toronto @Sim_UnityHealth]

Interrogating our processes for accepting critically ill patients is an essential practice. Thanks @Ornge for being such a great collaborator in this work! Successful dry run complete, looking forward to May 7th! @UnityHealthTO @UnityHealthEd @petrosoniak

[Simulation @ Unity Health Toronto @Sim_UnityHealth]

An amazing translational simulation event with @Ornge and St Mike’s ED on May 7th! > 100 participants and online observers. These types sim events allow us to stress test our processes, leading to systems-wide impacts. Great work all! @petrosoniak @UnityHealthEd @UnityHealthTO

[Cliff Reid @cliffreid]

Ever heard someone say ‘too sick to be intubated’

No one is

Here’s a ‘physiologically challenging airway’

Intubation for hypoxaemia & septic shock

2 emergency medicine specialists -1 on hemodynamics & oversight, 1 on oxygenation & supervising registrar intubation

Art line in, Peripheral norepi, epi 1:100000 ready to push

POCUS excluded RV failure

Ramped, preox via NIV-ST mode, allowing supported ventilation during induction

Intubated 1st pass over bougie using VL

No desat, no hypotension

Resus nurses all over it

Calm, smooth, safe. Just like we train

A shared mental model in a cohesive trained team leads to effective resuscitation

Resuscitate Before You Intubate!

[Ornge @Ornge]

Happy Birthday @sickkids! We’re so excited to celebrate SickKids 150th Birthday by hosting a Balloon Sculpture. This #SickKids150 moment represents the power of community and the incredible work being done every day at SickKids. 💙

[Warren Meyer @Medic_Warren]

@jerwatts @MurphyGallagher @YorkParamedics @YorkRegionGovt Congratulations Jeremy!!

[Warren Meyer @Medic_Warren]

@YorkParamedics @MurphyGallagher @YorkRegionGovt @jerwatts Well done Jeremy! Well deserved!!

[armyemdoc @armyemdoc]

Should we be reaching for ketamine + midazolam instead of just midazolam for pediatric generalized convulsive status epilepticus?

In this trial, 144 patients 6 months to 16 years of age were randomized to 0.2mg/kg midaz + 2mg/kg of ketamine or midaz + placebo.

The ketamine + midaz arm had:
-Higher percentage with seizure cessation at 5 minutes (76% versus 21%)
-Higher percentage with cessation at 15 minutes (76% versus 24%) and pretty much every time interval
-Less that required repeat doses of midaz (24% versus 79%)
-Less that required intubation 4% versus 21%

It is worth reading their methods as they had a pretty detailed escalation of interventions that involved repeat dosing of midaz, levetiracetam loading, and phenytoin loading.

It also remains unclear if this benefit would translate to IM administration. Based on the pharmacokinetics of IM ketamine, it likely would. This is a consideration since many EMS protocols use IM midaz first-line.

Also, I salute the authors for conducting a study of this nature in children. Pediatric studies that involve waivers of consent (in this case they used a quasi-waiver with verbal approval by the parents) or the exception from informed consent (no, this is not the same thing as waiving consent) are a massive undertaking from the investigator perspective.

https://t.co/qmTFHn5886

#emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #kids #children #pediatrics #medx #medtwitter

[EM Board bombs @EMBoardBombs]

Let’s talk how loop diuretics like furosemide jack up bicarb and lead to metabolic alkalosis (1/6)

[Hospital News @hospitalnewscom]

Canada’s first pre-hospital blood transfusion trial could be a ‘lifeline’ for trauma patients.
https://t.co/CToTiOfw7E
@UnityHealthTO @Ornge @FIRST60_resus

[armyemdoc @armyemdoc]

What is adaptive support ventilation?

So, the case is that you've just intubated a patient but can't get them transferred for several hours. You've tried volume control and pressure control and keep getting alarms. Your only RT for the entire hospital wants to try ASV. Most EM docs are probably not familiar with this.

What is it?

#emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #trauma #respiratory #respiratorytherapist #rt #medx #medtwitter

[Josh Guttman @drjgutt]

1/ Wild cardiac arrest with #POCUS playing a major role

An elderly male was sent from the nursing home in cardiac arrest. Per the prehospital report that we got, the patient was in vfib and refractory to 5 defib attempts. The patient got amio as well as several doses of epi.

[Warren Meyer @Medic_Warren]

@jerwatts @YorkParamedics @cspearen25 Congratulations Jeremy!

[Peter Antevy @HandtevyMD]

5 year old boy drowns in AirBnB pool.

He survived neurologically intact thanks to great — ON SCENE — care by Fort Lauderdale Fire Rescue.

https://t.co/l3SQAVwsP5

@FLFR411 | @Handtevy |

[Giacomo De Luca @jackdeliuc]

...🧵This is a thread about 8.4% sodium bicarbonate (aka bicarb amp) in critical care.

This the first part in a series of three about sodium bicarbonate 🧂in critical care:
🧐I will get in deep to complexities, benefits, risks and clinical implications of this (overused) drug.

[IMCrit @IM_Crit_]

ICU Hemodynamics

We are all familiar w the concept of "protective ventilation": aiming for normal blood gases entails significant risk
What if we apply the same idea in hemodynamics & try to limit the damage associated w excessive vasoconstriction?

Welcome to the CLEAR strategy

[Brian Locke, MD MSCI @doc_BLocke]

I missed this when it came out: 2024 HHS/DKA guidelines:

No more "the gap has closed".

Following the anion gap is no longer recommended.

Instead, follow plasma ketones directly, venous pH, and/or bicarbonate.

[Brodie Nolan @brodie_nolan]

Bringing whole blood to the Canadian prehospital environment for the first time. This is truly a province wide effort! Ontario is in great hands