"Fed By The Firehose" with Sean The PA

Keywords emergency medicine, critical care, seizures, resuscitation, thrombolysis, patient management, healthcare challenges, medical stories, physician experiences, healthcare humor Summary In this episode of 'Fed by the Firehose', Sean Kelcey shares a series of intense and chaotic experiences from his shift in emergency medicine. He recounts multiple critical cases, including a patient with seizures and infection, a code blue situation requiring resuscitation, and the management of status epilepticus. Throughout the episode, Sean reflects on the challenges faced in emergency care, the importance of teamwork, and the humorous side of working in a high-pressure environment. Takeaways Sean introduces a new series called 'Shit Show Shits with Sean'. He discusses a patient with recurrent seizures and infection. A code blue situation leads to a successful resuscitation. Thrombolysis was organized for a patient in ventricular tachycardia. Managing status epilepticus requires quick action and resources. Challenges arise from limited lab resources in emergency settings. Multiple critical patients can overwhelm a single physician. Sean reflects on the emotional toll of chaotic shifts. He humorously notes the 'black cloud' effect in his career. The episode ends with a promise for more stories in the future. Titles Shit Show Shits: A Day in Emergency Medicine Chaos in the ER: Tales from the Frontline Sound bites "Shit Show Shits with Sean" "We got compressions resumed" "It was about 14 hours" Chapters 00:00 Introduction to Shit Show Shits 00:30 Emergency Case: Seizures and Infection 03:03 Code Blue: Resuscitation and Thrombolysis 05:56 Managing Status Epilepticus 09:03 Handling Multiple Critical Patients 11:56 Reflections on a Chaotic Shift

This epsiode talks about Imposter Syndrome, in the context of what it is, how it feels, and what should be done about it...with some of my personal experience with it and trying to deal with it.

In this comeback episode, I'll be discussing 2 widely different cases of TB that presented to my remote nursing station.

Thanks for your patience on waiting for Season 2 to drop. This episode will be about End of Life Care, regarding a patient I followed and how I felt things went. I'll talk about challenges with personnel and interagency collaboration/cooperation, obtaining medications and work arounds, provider/family/patient dynamics in an end of life/palliative situation, and lastly some lessons learned. I hope you enjoy.

In this episode, my weird sh*t magnet got stuck to my forehead yet again as something that appeared simple turned out to be anything but. Two patients, one sick, the other seemingly not so...turned out they were much sicker than the one that was sick...with profound hyponatremia, hypokalemia, hypochloremia, hyperglycemia, acute kidney injury and renal failure. I'll talk briefly about how slow mental processes get at Zero Dark OMFG in the morning, which can lead to overthinking as not to miss something/mess something up, as well as some decision paralysis that can accompany that...

So I'm doing my Advanced Trauma Life Support course and it's being run where I did my trauma medicine/surgery rotation in PA school...and some of this is bringing up/back some odd feelings that I'll be discussing => some good, some uncomfortable.

In this episode, I'll discuss a case of sepsis that presented much like a PE, the cause of which surprised all of us involved.

In this episode, I'll be discussing a case of a gunshot wound in the new remote community I've started working in. I'll discuss the case itself, results, as well as some general considerations when dealing with gunshot wounds, both in the physical sense as well as the bigger picture regarding safety of your patient and around the medical complex in a rural site.

In this episode, I'll be discussing a case of eye pain/decreased vision that presented here and the difficulties we have in certain places trying to sort out and manage ophthalmic conditions without proper equipment and sometimes abilities to get people out.

This episode discusses what I call "The Fine Line Between Hard and Silly/Dumb/You get the idea, that many, including us and our patients walk daily, often to our/their own detriment. Also, I have an addendum case to the previous episode related to pregnancy concealment and a rather bizarre day this past week.

Today I'll be talking about patients hiding conditions, particularly pregnancy, in my remote community, and the potential issues with this, given what we have available to enable a safe delivery. There are some reasons behind this, often communicated to us under the category of "my body, my choice"; however, there are other issues at play, varying from being away from family, cultural/racism issues, worries about apprehension, etc.

This is an extension of sorts of Episode 2 where I use two trauma cases I had my last rotation to illustrate some of the issues working in remote and austere/limited settings. Case 1 is of a mid 30's male, Ped Struck (Pedestrian) by a van, resulting in severe right sided injuries to the thorax, lungs, abd, pelvis and lower limb. He presented hypotensive, tachypneic and tachycardic, with serious bilateral rib fractures, lung contusions, hemo/pneumothoraces, displaced iliac wing fracture and fracture of the right leg. Case 2 is of a mid 40's female, history of substance use and cirrhosis that was assaulted and stomped on their right upper quadrant, resulting in internal bleeding. In review, I discuss limitations of what's available to treat folks in an appropriate manner, as well as evacuating them.

Intro - I'd like to start off by apologizing for taking so long to get back out here. Thanks to everyone that listened to my first episode, I hope you come back now that I've got this new one out. Special shout out to the listener from Samoa that made this the #1 Health Podcast in their region for a few days!! Land Acknowledgement - I recorded this on Treaty 6 Land, homeland of the Oji-Cree, Ojibway, Cree, Dene and Inuit peoples and the place where I'm employed to help care for some of these people. Topics - Remoteness, Patients, Health Issues/Social Determinants, Administrative issues. I work in a fly in community in Northeastern Manitoba, roughly 600km from WInnipeg, which is the main health care referral centre for us. There is an ice road here in the winter, but for the most part things are flown in, including health care providers. Unfortunately, this also means patients often need to be flown out. Patients are often complex - it's a rarity when something is straight forward. They're also often difficult to contact, sometimes reluctant to come in. They're also sometimes quite reluctant to be sent out, even if they really need it, as they're concerned about family separation, especially if people are critically ill. There are a lot of health issues here that revolve around diabetes and hypertension and the downstream effects from those. There is a dialysis unit here due the kidney disease burden here. There are a wide variety of infectious diseases here - MRSA skin infections, TB, syphilis and other STI's. There are some issues with substance use/abuse as well. Housing is an issue here - there is often a lot of crowding within homes, water comes from holding tanks or cisterns. Food is expensive here, particularly fruits and vegetables. There are many admin challenges here - paper charting, formulary issues, patient movement and transport, who's going to pay for things people need. An often tiring issue is finding a hospital/ED to accept patients, since most of them are getting hammered due to bed blockages. Despite all this, the work is very interesting and rewarding. Take care and see you next time :-)

This is my inaugural episode of FBTFH with Sean The PA, I just wanted to introduce myself, discuss how I see this podcast evolving and then talk about what a Physician Assistant is and where we fit into the Canadian Health Care landscape. 00:00 Intro 00:31 Land acknowledgment 00:52 Who Am I 3:32 What's a Physician Assistant 4:38 How are we trained? 8:26 What can I/we do? I'm going to get curb stomped by a couple folks if I don't mention this, since I failed to mention that PA's also work in neurosurgery, thoracic surgery, and in critical care... Also, as I noted, I was in diving medicine for some time in the military - this entailed me actually working in recompression chambers as part of my day to day work - very interesting. We could also get trained in aviation medicine to look after pilots and other aircrew. Might just talk about some of the sidebars of being a military PA on another episode :-) 11:59 Are you an NP? 13:34 When are you done with medical school? 16:55 Closing remarks, some websites. Websites: Canadian Association of Physician Assistants (CAPA) - capa-acam.ca Manitoba Society of Physician Assistants - msofpa.ca Ortho PA Network - orthopa.ca Ongomiizwin Health Services - umanitoba.ca/ongomiizwin/health-services

"Fed By The Firehose" with Sean The PA (Trailer)