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Advanced, Specialty & Core Clinical Sessions

"Viscosity" Pediatric Hydrocarbon Ingestion, a Case Study

   Nate Hinze, RN, BSN, CEN, CCRN, CFRN, NRP - AirLife Denver

Many of us have committed to memory the classic one pill killers list. But how much do you know about hydrocarbons? What common household items contain hydrocarbons, who is most vulnerable to an ingestion, what symptoms are associated with an acute hydrocarbon ingestion, and how much of a substance could be lethal? This lecture through an interactive case study will use just culture, and search to find these answers and many more. Be prepared for another low dose killer the acute hydrocarbon ingestion in the pediatric patient.

The World's Longest ECMO Transport

   Amber L. Payne-Gregory, RN, BSN, MBA, CFRN, CMTE - AirMed International
   Brandon Bates, MBA, CMTE - AirMed International
   Jeremy Fails, RN,CFRN,TCRN - AirMed International

When the Covid vaccicne was released and the world started traveling again, we thought that the tough times were behind us. ECMO became a common therapy during COVID. But when you think of performing ECMO in a transport vehicle, for 30+ hours, there were not a lot of historical resources to draw from procedurally. Oxygen consumption, team composition, resource availability are all areas that had to be thoroughly assessed so that a patient could be safely moved from the West Coast of the US back to the Middle East while on ECMO.

A Flight Nurse's Worst Nightmare: OB Trauma

   Alexandra Tang, BSN, CFRN, CNPT, RNC-NIC - UCAN-University of Chicago Aeromedical Network   
   Meaghan Panfil, MSN, CFRN - UCAN

The pregnant trauma patient presents a unique challenge to the transport professional by merging two distinctly different healthcare specialties, trauma and obstetrics. Critical interventions must be considered and implemented swiftly to decrease morbidity and mortality of the trauma patient and her unborn fetus. This informative lecture will not only review essential steps of trauma resuscitation but also incorporate the pathophysiology of certain obstetric complications and its implications on the trauma patient.

Acute Management of DKA in Children: Don't Bolus Anything!

   Jennifer L. Flint, MD - Children's Mercy Hospital

The acute management of diabetic ketoacidosis (DKA) in children can be stressful for adult providers with an urgency for rapid correction of hyperglycemia and acidosis, and the tendency to intubate children with Kussmaul's respirations. This presentation will review the pathologic process at the cellular level that leads to DKA, the typical clinical presentation, and laboratory findings in children who present in DKA using a case study. This talk will review the importance of tight fluid management, slow correction of hyperglycemia, and aggressive electrolyte replacement in the acute management of DKA. This talk will also review the pitfalls to aggressive overcorrection and overresuscitation of DKA that can lead to increased morbidity and mortality.

All That Blisters Isn't a Burn: An In Depth Look at Stevens Johnsons Syndrome and TEN

   Stephanie L. Steiner, MSN, ACNP-C, CPNP-C, CFRN - PHI Air Medical

The spectrum of Stevens Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) can be a highly complex course with a high risk of mortality if not cared for in centers specializing in the care of this particular condition. Blistering and sloughing rashes can be challenging to diagnose for clinicians who are not explicitly familiar with typical presentation and course of this condition. Most often the inciting cause of SJS/TENs is a form of drug reaction, immunologic in nature. However, other disease processes can also incite SJS/TENS. This session will explore the pathophysiology of SJS/TENs and typical course progression. We will also take a look at current evidence that may be successful in reversing or limiting the extent/severity of this syndrome and explore the expected ICU course for these patients.

ALWAYS the Right Answer on the Test: Magnesium Sulfate

   Teri L. Campbell, MSN, RN, PHRN, CEN, CFRN - University of Chicago Medical Center

Preterm labor (PTL) and preeclampsia (pre-e) are the most common complications resulting in ED visits and often, transport. While completely different pathologies, both PTL and Pre-E are usually stabilized with Magnesium Sulfate. Come to this fast-paced and funny lecture to learn the vastly different mechanism of action of this diverse med and how it can safely be used to stabilize an unpredictable OB patient and optimize fetal outcomes. Change your confidence and opinion about hanging Mag from a drag to a brag!

Aortic Emergency: Protocols, Processes, & Disruptive Innovation to Improve Patient Outcomes

   Marcelo Giarelli, MSN, RN, CCRN - Heart & Vascular Services, Tampa General Hospital   
   Kathleen Koch, BSN, RN, CFRN, CMTE, EMT-P - Tampa General Hospital, Aeromed

This session is designed to present evidence-based protocols and processes implemented with regional referring facilities and physicians to improve clinical outcomes of patients with aortic emergency. The presentation will include data with analysis, case presentations to highlight the impact of aggressive protocols, air transport, and transfer processes that directly impact patient outcomes. In addition, the presentation will include information regarding the adoption of disruptive innovation to include cloud based software and a new regional application to contact Heart & Vascular Surgery resources for consultation and to assist with patient management.

The Top Ten List: Articles from 2021-2022 That May Influence Your Practice

     Russell Macdonald, MD, MPH, FCFP, FRCPC, DRCPSC

This presentation provides a summary and critical appraisal of ten articles taken relevant to the prehospital and transport medicine literature in 2021-22 that may influence your air or land critical care transport practice. At the end of the presentation, the participant will have a basic introduction and understanding of the en recent journal articles relevant to prehospital care and transport medicine; and have a critical appraisal of these.

Back to the Future: Current Strategies and Tactics for the Physiologically And/or Anatomically Difficult Airway

   Steve Bott, MD - AirMed, University of Utah

Management of the anatomically difficult airway has been researched, taught, and practiced for decades, but new data continues to evolve our best-practices. The concept of the physiologically difficult airway has gotten lot's of recent attention, because it has recently been identified as a major risk factor for peri-intubation cardiac arrest and other serious airway management complications. This session will talk about what we know about these challenging problems, what we don't know about them yet, and what the current expert opinions and best-practices are to manage these difficult cases. It will wrap up with a few case scenarios to put these concepts into practice.

Bi-pap to Intubation: Managing the COVID Patient on the Brink

   Charles F. Swearignen, BS, NRP, FP-C - University of Mississippi | | North American Rescue

This session will chronicle a difficult case of a COVID-19 patient on bilevel non-invasive pressure ventilation who decompensated requiring mid-flight intubation. Focus will be placed on pre-flight assessment and concerns, modalities to monitor patient condition, and mid-flight changes that led to the need to intubate. Additional light will be illuminated on oxygen needs, consumption, and conservation, as well as mid-flight intubation in a fixed wing aircraft.

Bridging Prehospital and Hospital Based Traumatic Brain Injury Care

   Kevin Collopy, MHL, FP-C, NR-P, CMTE - Novant Health AirLink VitaLink

TBIs impact 69 million persons each year; 1.5 million injuries occur in the United States and over 227,000 are hospitalized. Proper TBI care reduces mortality and long-term morbidity. But, what is this proper care, and how do prehospital interventions influence what happens at the trauma center? Join Kevin as he takes you through traumatic brain injury physiology and links this understanding to transport care. Together we will take the next step and discuss the current evidence supporting, and refuting, prehospital TBI interventions. Are you considering hypertonic saline? Interested in seizure prophylaxis? Is there a role for early antibiotics? Can labs drive our care? Walk away ready to ensure your TBI patient's care is a true bridge from the field to the ICU.

Case Studies in ECG and Polypharmacy

   Michael D. Gooch, DNP, APRN, CCP, ACNP-BC, FNP-BC, ENP-C, CEN, CFRN, CTRN, TCRN, NRP - Vanderbilt University Medical Center and Vanderbilt University

Transport clinicians encounter patients on numerous medications. These have beneficial effects but can also interact with other medications or lead to adverse effects. These adverse effects may be manifested in the ECG tracing. Using case studies and ECGs, this presentation will review common as well as less common ECG findings which may be encountered in transport medicine.

Case Studies in the Emergency Management of Ventricular Assist Devices (VADs)

   Allen C. Wolfe, Jr., MSN, CNS, APRN, CFRN, CCRN, CTRN, TCRN,CMTE, FAASTN - Life Link III

Advances in the management of heart failure have led to an increasing number of patients living outside the hospital with a variety of ventricular-assist devices (VADs). These implantable pumps may be placed temporarily as a bridge to cardiac transplantation or resolution of a reversible condition, or as destination therapy for the rest of the patient's life. Emergency medical services (EMS) providers may be called to care for such patients experiencing an emergency related to the device itself, the underlying cardiac condition, or a totally unrelated medical or traumatic issue. This lecture will use case studies to provide the learner with specific examples of how to assess and manage VAD patients in emergencies.

Chief Complaint: My Brain Hurts. the Evaluation of Traumatic Brain Injuries Using CT Imaging

   Paula E. Mickan, MSN, APRN-CNP, AGACNP-BC, CCRN, EMT-B - Cleveland Metro Life Flight

Traumatic brain injuries account for a significant number of air and ground critical care transports today. In this lecture, attendees will be given the opportunity to see and understand 5 common types of insults to the brain including EDH, SDH, Anoxic brain injury, GSW, and an infratentorial hemorrhage. A large portion of this lecture will show you the full series of CT images and will follow with the patient assessment, treatment plans and hospital course.

Cold Weather Emergencies and Frostbite - a Time Sensitive Diagnosis

   Stephanie L. Steiner, MSN, ACNP-C, CPNP-C, CFRN - PHI Air Medical

Hypothermia and frostbite is a cold weather emergency that can be encountered many of our colder weather environments. Evaluation of these patients can be time critical not only to manage their immediate life threatening temperature regulation, but also to mitigate the potential outcomes of morbidity/mortality for these patients. Frostbite care has come a long way with allowing now time sensitive care with thrombolytics and advanced imaging to monitor progression or regression of the endangered tissues involved. Transfer of these patients to centers specializing in frostbite care is advantageous, as well as those familiar with the needs of patients who require likely complex medical management surrounding their injury.

Don't Let This Bounce Sink You: the Critically Ill Newborn Who Returns to the Hospital

   Michael A. Frakes, APRN, CMTE, FCCM, FAASTN, FACHE - Boston MedFlight

Caring for critically ill newborns and young infants can be a stressful and high risk encounter for all involved. Many teams work in environments where newly born patients are cared for by specialty providers and teams, but that can create a false confidence. The neonatal period extends to 28 days of life, and nearly all of us will be called to manage critically ill babies who are born outside the hospital or who are discharged and return for emergency care. This presentation will help to prepare you for this eventuality by providing a physiological foundation and simple algorithmic approach to the resuscitation, differential diagnosis, and initial management of very young, very ill patients.

Facial Trauma and Advanced Airway Management: A Case Study

   Allen C. Wolfe, Jr., MSN, CNS, APRN, CFRN, CCRN, CTRN, TCRN,CMTE, FAASTN - Life Link III

Management of the difficult airway is one of the most relevant issues for transport crews. Despite revolutionary innovations in airway management, innovative techniques are an important tool. The difficult airway is a rare phenomenon. The incidence of difficult face-mask ventilation ranges from 1.4 to 5.0%, and the incidence of impossible ventilation from 0.07 to 0.16%. Management of the difficult airway is an important issue since even small changes in the performance of airway management are highly relevant to the outcome.

From Pawtrol to Patient: Developing and Implementing K9 Transport Protocols for the Air Medical Environment

   James Huston, FP-C CCP-C C-NPT - Tampa General Hospital Aeromed   
   Aurelia Miller, RN, CEN, EMT-P - Tampa General Hospital Aeromed
   Donny Richardson, BSN, Paramedic, CEN - Aeromed
   Michael Abesada, Paramedic - U.S. Airforce
   Britt Martinez, Police Officer, K9 Handler - Tampa Police Department
   William Cooney - 927th AMDS
   Alexis Kirkland - 927 ASTS

In this session, these speakers will discuss the creation of K9 transport protocols, training to transport an injured K9 officer, and gain insight from a Tampa PD officer on approaching an injured K9 officer.

Great Vessel, Great Problems: Managing Aortic Emergencies

   Michael A. Frakes, APRN, CMTE, FCCM, FAASTN, FACHE - Boston MedFlight

It would seem to be enough of a challenge simply to manage diseases in the body's biggest artery, where patients can die at a rate of one percent per hour, and where that deterioration can be almost instantaneous. Clinicians complicate these cases by not understanding the anatomy, physiology, and language that are important to good management, then patients complicate them by requiring completely opposite therapies in different circumstances. This talk will clarify this confusing mass of information to help you understand what is happening, what to do, and when to do it for patients with "aortic disease" everywhere on the spectrum from stable to pear-arrest.

Harnessing the Hamilton: Tips and Tricks to Tune in This Ventilator

   Charles F. Swearignen, BS, NRP, FP-C - University of Mississippi | | North American Rescue

In this lecture, Charlie Swearignen will cover some common and not so common features of the Hamilton T1 ventilator and how it relates to various patient types. The session will cover the basic setup, as well as all of the Hamilton‘s specific features, including its advanced monitoring parameters. The learner will be presented with various ways to harness and use this information in the transport setting.

Helipad to OR Protocol

   David E. Meyer, MD - Memorial Hermann Life Flight

Hemorrhage remains the leading cause of potentially preventable death in trauma patients. Multiple studies have that shown that the majority of these deaths occur within three hours of injury, and delays to operative intervention increase the risk of mortality. In an attempt to combat delays in reaching definitive hemorrhage control, Life Flight and Memorial Hermann Hospital at Texas Medical Center have developed a policy for bypassing the emergency department and proceeding directly to the operating room upon hospital arrival. This policy, which was implemented in 2018, relies on skilled assessment by air medical crews, the use of handheld ultrasound in the field for the performance of prehospital FAST examinations, and direct communication with the on-call trauma surgeon via Life Flight dispatchers. Activation of the Helipad to OR protocol also automatically activates the hospital's massive transfusion protocol. Typically, the first MTP cooler arrives in the OR even before the patient arrives. This protocol helps to eliminate time unnecessary time spent in the ED and decrease the time to definitive hemorrhage control.

Implementation and Review of a Successful Helicopter Air Ambulance Thrombolytic ST Elevation Myocardial Infarction (STEMI) Program

   Lesley Osborn, MD - Memorial Hermann Life Flight

Helicopter air ambulance programs are often called on to manage interfacility STEMI patients. It is well understood that rapid access to interventional cardiology/PCI is beneficial to this patient population. Over the last 3 years, the greater Houston area has experienced an increase in both scene flight and interfacility requests for management of STEMI patients. As part of this program, administration of thrombolytics in the aircraft has been standard of care since 2017. This session will describe the implementation of our STEMI thrombolytics program, review the data from the previous 5 years, and discuss important recent changes implemented to this program.

Make the Call: Management of a Pediatric Respiratory Arrest Patient in a Halo Spinal Restriction Device

   Matthew Jensen, BN RN BHlthSci CFRN CEN - VCU Health LIFEEVAC   
   Garett Freeman, BS, FP-C, NRP - VCU LIFEEVAC

Join full-time flight partners, Matt Jensen CFRN and Garett Freeman FP-C, as they lead you through a Make The Call case study. Experience the sights and sounds of a complicated scene call as you are dispatched to a pediatric respiratory arrest patient wearing a Halo spinal motion restriction device. Matt and Garett will utilize live polling and interactive technology to put you in the flight suit as treatment decisions, logistics, and operations unfold in real-time, giving you a chance to work a once-in-a-career call with unparalleled complexity.

Open Chests and Broken Hearts: Central V-A ECMO

   Chase Niewoehner, BSN, RN, CFRN, CCRN-CMC, CES-A - Air Methods

This session will provide an overview of central Venoarterial ECMO as well as discuss the management and transport of post-operative cardiothoracic surgical patients on ECMO support. Central V-A ECMO, specifically CT surgical patients transitioned from cardiopulmonary bypass, are less frequently encountered and pose unique challenges for a transport clinician. Discussion will include conditions such as Post-cardiotomy shock, Vasoplegic Syndrome, and post-operative hemorrhagic shock as well as therapies such as Methylene Blue and Epicardial pacing.

Point of Care Ultrasound: Small Probe, Big Clinical Impact

   Benjamin Smith, MD - Carolina Air Care

Point of care ultrasonography has seen increasing use over the last decade, including during the pre-hospital and inter-facility transport phases of patient care. While previous literature highlights the feasibility of pre-hospital point of care ultrasonography by non-physicians as well as the effects on patient care with physician staffed helicopters, little data exists about the clinical impact of ultrasonography when performed by flight nurses and paramedics. This session will utilize real cases of point-of-care ultrasound performed during air-transport to demonstrate clinical impact of point-of-care ultrasound, including outcomes for selected cases.

Pulmonary Embolism: From Field to Finish

   Stacie G. Foutty, RN - Novant Health AirLink VitaLink

Pulmonary Embolism beyond the basics. This session will guide you through the case study of a massive saddle PE from start to finish; defining risk, signs, symptoms, classifications, and treatment beyond thrombolytics. This is a chance for you to look through the eyes of the provider as he/she makes the decision to stay at local at a community based hospital or move quickly to a tertiary care facility. This session highlights the innovative treatment of the Inari FlowTriever removing twenty plus clots from one single patient. Come take a dive into knowledge and improving patient outcomes when Pulmonary Embolism could be the culprit.

Quick! Grab the Calcium!

   Johanna Thompson, FP-C, CCP-C, CNP-T - Life Link III

Calcium administration in trauma has been a hot topic. There has been movement to change the Trauma Triad of Death to a Diamond, incorporating Calcium. Facilitated by case studies, Johanna will review the pros and cons of calcium administration. At the end of this presentation, you will determine whether calcium administration in trauma and hemorrhagic shock are best practice and if the patient should receive it and when.

T is for Trauma: Pediatric Trauma Resuscitation According to Cookie Monster

   Maria Mandt, MD - Children's Hospital Colorado

The traumatically injured child can be a highly stressful event for any provider. While the pediatric population is resilient, subtle findings can greatly impact care and outcomes. The approach to trauma care in this population should include a healthy understanding of the many ways in which children are similar to the adult population, the important components that make them different, and the utilization of the tools, signs and symptoms that can change your course of care. From the pediatric ABCs to use of new trauma-related tools and technology, this discussion will bring you up-to-date on pediatric trauma care. By working through a difficult case, this interactive session will present pediatric trauma pearls and core pediatric principles in trauma care for all levels of provider.

Telenicu: Tiny Transports Rural to Referral

   Bobbie Carlisle, MSN - University of Utah AirMed   
   Kelli C. Lund, MD, MCR - University of Utah Division of Neonatology

During the pilot of our TeleNICU program, we learned many lessons. One of these lessons occurred after a devastating incident at a referral facility. We streamlined the process of getting our neonatologist on the call and added the flight team to our Guardian Angel program. The flight team is now involved from the initiation of the call and is able to give guidance and gain invaluable patient information. We also identified many needs of rural facilities. These include basic and advanced tele- and in-person education for continuity of patient care, policy reviews, and continuous practice of the system from the beginning to different possible ends of a call. During the pilot phase of our TeleNICU, we gathered a well diversified group of experts to create new processes and programs that improved outcomes. This case review will discuss how changes we made with this program improved transportations and outcomes for our tiny patients.

The ABC’s of Pediatric Ventilation

   Melissa Verseman, RRT, FP-C, CNPT - Medevac

This session will go over pediatric airway and ventilation differences as well as techniques to overcome their challenges. We take a deep dive into ventilator modes and Respiratory pathophysiology with treatment strategies and evidence-based research.

(Don't) HOp to it! Intubating the Physiologically Difficult Airway

   Jacob Miller, MS, MBA, ACNP, FNP, ENP-C, CNS, CCRN, CFRN, NRP, CCP-C, FP-C - University of Cincinnati Air Care

Many airway courses teach us about the physical task of intubation. Similarly, most "difficult airway" courses cover psychomotor and procedural challenges encountered in airway management. This session will focus on the physiologic difficulties that can lead to clinical deterioration during the peri-intubation period and how to mitigate them. Next time you have to perform airway management, DON'T just "HOp to it," make sure your patient's physiology has been optimized first!