Thomas Bruder

Critical Care Paramedic @BCEHS. Consuming FOAMed and trying to avoid politics. Human factors, airway, HEMS/emerg/critical care retrieval, POCUS

[Thomas Bruder @thomasabruder]

@Northernmedic Everyone’s favourite answer: it depends? What’s the context? Psychosis in the setting of stimulant toxicity might favour benzo, while in a hypoxic TBI probably reach for ketamine.

I’d be interested to hear rationale behind blanket 1°/2° agent or restrictive protocols.

[Thomas Bruder @thomasabruder]

@Okanaganscan @MrCalendarGirl Yup. Retardant bases at Kamloops and Penticton, but not YLW.

[Thomas Bruder @thomasabruder]

@Okanaganscan @DaynaB18 High winds forecast to shift from W and then NW later today. Hwy 97 closure today is certainly possible with 🔥 spotting ranges of several km.

[Thomas Bruder @thomasabruder]

Dramatic success story of @BC_EHS prehospital emergency blood supply program.

[Global BC @GlobalBC]

A Vancouver Island man who survived a grizzly bear attack four years ago says without blood donations he wouldn't be alive today. Now, he's encouraging others donate and potentially save others.
https://t.co/7ka3AadlL9

[Thomas Bruder @thomasabruder]

@BCEHSCCP 169 is gonna be great, but a few years ago I really hoped this lined up a little quicker for the new contract 😍

[Thomas Bruder @thomasabruder]

Up

[Thomas Bruder @thomasabruder]

@mitchpage3 @_Brian_Mc_ Depends a bit on Hx/exam incl. bedside echo impression. For distributive shock, I tend to start pressors with fluids and then titrate back/off if they respond dramatically. Can also easily give 500-1000 before I’ve mixed a bag and programmed a pump. Can just leave on standby.

[Thomas Bruder @thomasabruder]

I worked for BC Wildfire in Vanderhoof when Maddy disappeared 12 years ago. Our crews helped the massive community augmentation of GSAR efforts. We couldn’t find her. Hopefully the investigation succeeds in answering remaining questions.

[Global BC @GlobalBC]

BREAKING: The remains of Madison Scott, who has been missing for 12 years, have now been found on a rural property in Vanderhoof. https://t.co/G3Q06kfbU1

[UC EM Residency @TamingtheSRU]

Air Care Series: Epoprostenol with @joshFerreri @MaxKletsel @waknight44 #FOAMed #FOAMCC https://t.co/XTrsBrTmR9

[Thomas Bruder @thomasabruder]

@AirwayMxAcademy Perfect, thanks!

[Thomas Bruder @thomasabruder]

Reminds me of the first time I needed a blanket over my/patient’s head on a sunny beach for DL.

2 questions:

1. Could brighter light help maintain contrast in high ambient light?
2. Anyone comment on McGrath screen visibility in very bright conditions (say on snow/ski hill)?

[Hans Huitink @AirwayMxAcademy]

Why do companies that manufacture laryngoscopy blades think we use more and more and brighter LED lights? Today I used a disposable Macintosh blade for RSI direct laryngoscopy and because the light reflected on saliva, I could not see the glottis at all until I suctioned the larynx dry. I will need 🕶️ for my next intubation #wedonotneedmorelight @jducanto @airwayGladiator @NaveenEipe @fibroanestesia @bobfunn @cliffreid @EM_RESUS @maffygirl

[Thomas Bruder @thomasabruder]

@traumaicurounds @topknife @najsw @TWCostantini @rwinfield11 @CANUCSurg @bryanacotton1 5 mL/kg of 3% for herniation. 2-3 mL/kg for ⬆️ ICP. Mannitol 2nd line. Match output closely with isotonic crystalloid if not transfusing. Might select one over the other if we have a POC sodium already.

[Thomas Bruder @thomasabruder]

@AndreiAxenov As to the VSD, not that I noticed or thought to put colour Doppler on. Septum looks more solid in this plane on SX view, but there was mention of a possible PFO, which I could believe from this clip

[Thomas Bruder @thomasabruder]

Critical care paramedic retrieval of 68f with cardiogenic shock in the setting of severe fluid overload and new AF RVR. 🎥 post-cardioversion. Hx tight MS and sev PHTN. Recent formal echo “LA size normal” 🫣
#echofirst #CardioTwitter @BCEHS_CPP @critcare_medics

[Thomas Bruder @thomasabruder]

@AndreiAxenov …but I think some chronicity to this? Despite 4+ edema up to neck, IVC still quite variable. Hopefully someone with expertise can chime in on this as my wresting volume assessment.

[Thomas Bruder @thomasabruder]

@AndreiAxenov I’ve got a bunch more clips. RV indeed dilated with septal flattening/D-sign on PSAX (excuse my backward probe orientation here).

[Thomas Bruder @thomasabruder]

@CasselmanRyan but honestly, little formal training on mentoring/coaching from the perspective of the mentor/coach— onus has been on student. Developing reflective practice against competency frameworks and own ideal for practitioner has been well-integrated to all advanced paramedic training.

[Thomas Bruder @thomasabruder]

@CasselmanRyan Mostly appreciating the ways some preceptors have worked with me over the years, along with many notes of behaviours I hope to never replicate toward future learners.

[Thomas Bruder @thomasabruder]

@davidholli @_Brian_Mc_