Medic in The Middle
@MedicMiddle
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Following
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Pre-Hospital Emergency medicine Podcast featuring a range of guests from critical care to maternity. #FOAMed #PHEM #CPD UK 🇬🇧 #Paramedic Host -Tom Alderson 🚑
Joined February 2021
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Pinned Tweet
An amazing privilege to be joining
@MAA_Charity
as a HEMS Paramedic Fellow. Looking forward to the opportunity to work with a fantastic team 👍
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Do we convey too many patients in the ambulance service that could be safely conveyed by family members/third party <1 hour? 🧐
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Patient calls GP practice - the practice advise patient to call 111, 111 send ambulance, ambulance call GP who calls patient. We experience this all too often
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A calm structured ABCDE approach is such an underrated and often overlooked aspect of managing the unwell patient, particularly returning to the top of the algorithm after any intervention.
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Paramedics need more education around Life threatening cardiomyopathy’s and not just stemis. Brugada, wellens, hypertrophic ventricular cardiomyopathy’s etc. why is this not taught in standardised programmes
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The Paramedic career is a journey and not a race, don’t be disheartened if you are not where you want to be right now in your career and remember to keep focussed, stay hungry, and most importantly, stay humble.
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Excited to announce I have joined
@emas
as a Specialist Practitioner this week. I will be based at Nottinghamshire, looking forward to meeting everyone. 👍 🚑
#criticalcare
#urgentcare
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Med Twitter ! Do you ensure your loved ones have 300mg aspirin at home ‘just in case’ of an ACS episode ? Especially in times of increased ambulance waits
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What a brilliant idea! Preloading the Igel with a suction cathater prior to insertion 🚑 🩺
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Had an incident yesterday where the patient needed intubating and the IGel was insufficient, unfortunately in my locality this skill has been removed from standard paramedic practice. 😡
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Things could be a bit quiet on the medic in the middle front until the new year! As there is a mini medic in the middle who’s joined the crew 👶👨🍼
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Hi
I use this account to teach people about Pre hospital emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 3,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
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Exciting news! There is going to be a Medic in The Middle baby arriving in November 2023! 👶 😁 👨🍼
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Hi
I use this account to teach people about Pre hospital Emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 2,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
1
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Hi
I use this account to teach people about Pre hospital Emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 2,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
0
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Should PHTLS and ALS courses be a core part of HCPC paramedic registration?
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16 year old male notices a ‘high heart rate’ alert on his smart Watch whilst at rest - so calls 999, you attend and do an ECG
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Hi
I use this account to teach people about Pre hospital emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 3,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
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With increased wait times for ambulances turning up to falls and long lie patients, would we benefit from a consensus on Rhabdomyolysis and long lie? - discuss
@GroupCall2
@hepner_alex
@TeemuX8
@JRCALCguidance
@Para_Practice
@ParamedicsUK
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56 yr old male calls 999, complaining of 2 hour Hx of sudden onset left sided chest pain. Past history of hypertension and smoking
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Hi
I use this account to teach people about Pre hospital Emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 2,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
0
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Hi
I use this account to teach people about Pre hospital emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 3,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
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Do you debrief after incidents? Try this debrief tool
1
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On shift today responding for
@EMASNHSTrust
on the Specialist Practitioner FRV. Happy Saturday everyone!
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To settle the age old paramedic debate about the mixing of Salbutamol and Ipratropium-
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It’s a worrying situation to be in when ambulance clinicians are pre-alerting unwell patients to hospitals and arrive with no beds available
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We need to understand as paramedics that decisions can’t always be black and white, and make sure we use our clinical experience and judgement to make rational, justified decisions. Even if this occasionally leads to reading between the lines of guidance
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A pelvic binder is a haemorrhage control device. Not an ‘extrication and packaging device’ 🚑
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This M18 2L o2 Cylinder is filled to 300 bar. That’s 600 litres of o2. That will keep someone running on 2L/min for 5 hours. Or someone on 15L/min for around 40 minutes 🚑 ⛑
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Hi,
I use this account to promote a podcast to teach people around the world about pre hospital care. The content is all completely free, and I don’t advertise. I would love to hit over 1k followers to be able to reach more people
Can I get some follows and RTs to help?
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Do people remember the first ever patient they went to/treated as a clinician ?
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Should there be more specialist paramedic roles in the pre-hospital setting?
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Today we used alternative pathways to treat and leave a palliative heart failure patient at home - diuretics upped, opiates prescribed and Distric Nursing package put in place - Leaving appropriate patients at home is such a rewarding part of the paramedic role 😎
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JRCALC has removed The IV route for Chlorphenamine, are UK paramedic colleagues still giving it IV as it is included in the BNF for IV, the drug is covered under HMR 2012 legislation does that justify use Stepping outside of JRCALC administration routes ?
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@Hannahroyal27
@mohammedtalhak
This is why paramedics who don’t want to mentor shouldn’t be forced to mentor, it’s a shame because it Creates a negative learning environment
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Hi
I use this account to teach people about Pre hospital emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 3,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
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TXA and Co-Amoxiclav are contraindicated to be given through the same IV line - useful bit of guidance that is perhaps not so well known From
@JRCALCguidance
@AACE_org
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Hi
I use this account to teach people about Pre hospital Emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 2,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
0
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One of the best parts of my role is being able to educate new students on the road whilst also attending 999 calls day to day 😁🤓 📚
#theyarethefuture
#education
#paramedic
#nhs
#leadership
#clinicalteammentor
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Really starting to enjoy more rural ambulance work, new clinical decision making and longer transfer times have been a great new challenge to my practice
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Every paramedic has popped this move on a pre-alert at some point in their career
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Today marks my last day working for
@OFFICIALWMAS
. It’s been a blast of a 7 year journey 👍 🚑 onto the next adventure 😎
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There should be more training and focus in the paramedic curriculum on how to deal with cognitive strain and how to manage stressful situations calmly, I honestly believe it would lead to better decision making and better patient outcome
@ParamedicsUK
@GroupCall2
@heli_med_james
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I use this account to teach people about Pre hospital emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 3,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
2
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40 year old Male - presents to ambulance c/o recurrent syncope (fainting spells) and palpitations. 🚑 He reports a family history of sudden adult deaths in his father and an uncle.
Examination:
•Vital signs are stable.
•Physical examination is unremarkable, denies any pain
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Pushing fluids through and want to speed up the process? Try using a 3 way tap and a 10 or 20ml syringe to draw up fluids and push them through 👍 💧
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Buzzed to have been accepted onto the PGCert at
@uniofwarwick
@warwickmed
starting in October! 😁🤓
#selfdevelopment
#paramedic
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Don’t forget about Sgarbossa in suspected LBBB M.I’s 😎
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There are days as paramedics where I firmly believe we are kept alive by caffeine and paracetamol 😂
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I use this account to teach people about Pre hospital emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 3,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
0
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“The beautiful thing about learning is that no one can take it away from you” - B.B King 🎸
Today I start my new venture as a CTM, thanks to all those who have supported the journey so far! 🚑 😄
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Hi all - I’m going to start ECG Mondays. 57-year-old man is seen in GP surgery following two weeks of episodic left chest pain. HR 73, BP 134/64, SpO2 97 . No pain at time of ECG on crew asx. Answers posted Tuesdays !
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There can sometimes be a bit of resistance from clinicians when it comes to using checklists, but it is evidentially proven to reduce cognitive load and thus improve patient care 👍
Student Paramedics and Ambulance Techs - don’t forget these cards can help you out too, whether it be OSCE practice and prep to using them on the road as the base of your clinical practice. Checklists increase your ability to perform and increases bandwidth.
How do you use yours?
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Hugely proud of this episode with the awesome mind 🧠 that is
@heli_med_james
from
@TheResusRoom
@theSONARteam
@GWAAC
joining to share his font of knowledge on the topic
Be great to hear your thoughts on this one!
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Very Excited to announce we will be recording our next episode at the end of this month with
@heli_med_james
from
@TheResusRoom
. The Episode will be on neonatal management/care. please do message in any questions you want answering/topics you want covering! 😎 🚑
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Excited to be recording later in the month with HART Critical care paramedic
@JBPara999
- topic for the month is drownings! Send any questions you want answering this way!
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@paramattharri84
Always find narcan intra arrest an interesting topic, cause of arrest of these patients is most likely going to be coming from an Airway or oxygenation issue, and as paramedics we need to be careful not to become sidetracked with prioritising narcan over reversible causes 🤓
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Excited to start my new role at work as a Clinical team mentor, hard work and determination pays off 💪
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Always treat the patient based off what is best for the patient at that time and not out of fear of litigation of simply ‘not doing something’
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Hi
I use this account to teach people about Pre hospital Emergency practice and promote the podcast. I don’t use advertisements and my content is also free. I’m trying to hit 2,000 followers to be able to reach more people
Can I get some RTs and follows to help me get there?🚑
0
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Certainly do miss having my handy service issue pocket JRCALC instead of relying on an app… think it’s time to invest 💵
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Just wrapped up a great podcast with
@JBPara999
from
@YorkshireHart
on drownings💧 can’t wait for it to be released! Keep eyes peeled 👀
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Hypoventilation of TBI patients however will lead to an increase in Co2 and cause cerebral blood vessels to dilate and cause a rise in ICP - this can be dangerous for the Brain injured patient, and cause worsening secondary brain injury 🧠
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Didn’t get the job I applied for today, but grateful for the experience of selection and a lesson to stay humble and stay thirsty 😎
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Never be afraid to use aid memoirs. For anything!
#checklistssavelives
Teaching PILS course today.
I cannot remember kiddy normal values. I just don’t have the bandwidth for it.
Aide-memoires are very useful in such situations
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Great first day at
@uniofwarwick
@warwickmed
on day 1 of the PgCert course!
#learning
#Selfdevelopment
#paramedic
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50 y/o male found collapsed on floor. GCS 13/15, hr 90 , bp 176/90, rr 20, sats 93% on arrival, appears sweaty and pale
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Are we seeing less and less self care in this modern day and age? Would we benefit from a public education campaign?
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Civility saves lives.
I also think Humility saves lives. How many times are decisions made or not made out of fear of being ‘incorrect’ or feeling ‘daft’ for speaking up or asking for help
#humilitysaveslives
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After being unsuccessful myself in a recent assessment it’s humbling and reassuring to see a mind as brilliant as fellow podcaster
@heli_med_james
being open about set backs and positive attitude 👍 thank you James 😎 onwards and upwards mate.
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
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Plug for anyone who’s interested in learning more about capnography in the pre hospital setting, Troy Valente has done a brilliant job. Would recommend giving it a read!
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Used this technique today in practice for a difficult airway, results were - hugely improved oxygenation and airway patency 🚑
Silo technique in airway- get it right the first time when pre-oxygenating
@DocJohnHinds
#RCEMBelfast
#FOAMed
http://t.co/YnIXizMCoo
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My partner wins the prize for best cupcakes for the leaving drinks 🍻 🧁
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Stepping outside of scope of practice/guidelines to benefit the patient? Discuss
@GroupCall2
@hepner_alex
@robfenwick
@heli_med_james
@emergprehosp
@PARAMEDICAST_
@TeemuX8
—->
@MallinsonT
sums this conundrum up beautifully ‘Clinical courage’
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I was unsuccessful at a job interview recently. Time to regroup, reflect and move forward. The
#paramedic
career is a journey and not a destination.
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Looking forward to starting the next module of my post grad at
@uniofwarwick
tomorrow!
#criticalcaretransfer
@warwickmed
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Did you know? -
#Nof
patients can lose anything between 100-1000mls in volume pre operatively 🦴 🩸
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Who out there uses venous blood 🩸 when taking a BM during cardiac arrest? Interesting excerpt from
@JRCALCPlus
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“People don’t leave bad jobs, they leave bad leaders” - leadership first
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68 Year old female complaining of a week long history of Shortness of breath, dizziness and occasional chest discomfort
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I feel as Healthcare professionals we become Jedi’s at multi tasking. In what other career are you assessing the patient, taking obs, completing paperwork, administering medication, communicating with family members, making a plan of conveyance or no conveyance
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Good morning! Very lucky to work where I do and enjoy views such as these. Have a good day everyone 👍
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Ambulance crew debate of the day… at what age do we stop saying “they fell over” and start saying “they’ve had a fall” 🧐 50? 60? 70?
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Debriefing after jobs is invaluable for provider welfare and continual improvement of practice. What tools do you use?
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Medic in the middle will be back with some fresh episodes in the upcoming months! We are busy planning some really amazing guests to feature - stay tuned! 👀 🎙️ 🚑
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OUT NOW! Latest episode featuring
@robfenwick
from
@TheResusRoom
on Hypothermia ❄️ ⛄️ 🚑
#FOAMed
#cpd
#ambulance
#paramedic
#winter
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Been an amazing experience in NYC - Florida - Bahamas and now back to NYC before flying home tomorrow ✈️ Back on shift Monday 🚑 and lots of exciting podcast stuff coming up 👀
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Brilliant to see this coming into practice in the ambulance service sector 👍
We’re delighted to have introduced Penthrox into our suite of pain-relieving drugs.
In a UK ambulance service first, our volunteers are also being trained to administer the drug, which is used to help patients with a traumatic injury, like a fracture 👉
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Another year on and we have double the listeners listening and sharing the podcast 😁 🙏 thanks to every listener for your support
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