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MAC Run Review WebCasts
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Medical Advisory Committee Run Review Webcasts

Nor-Cal EMS Medical Advisory Committee (MAC) Run Reviews are presented by Dr. Eric Rudnick, MD, FACEP, FAAEM, Medical Director for Nor-Cal EMS and recorded live in front of an audience during the patient care record run review at the monthly Medical Advisory Committee meetings.

The purpose of these webcasts are to perform personal care record run reviews for continuous quality improvement as well as to aid and train emergency medical personnel.

A printout of each presentation is available on the respective webcast page for reference while you view the webcast.

MAC Run Review August 2017
           Watch For 2 CEs       Just Watch FREE

Two case studies:

  • HPI: Patient was last scene normal at 2100 hours the night before going to bed. Roommate heard a noise from the patient's room and found the patient on the floor next to the bed. Patient was unresponsive with rapid breathing. What are the potential diagnoses at this point? What history do you want? What diagnostic interventions do you want to perform and why? Physical exam at 0412. Head is atraumatic and normocephalic. Neurologic exam: Pupils are equal in size at 4mm but sluggish to react. Doll's eyes not tested response. GCS is 3. There is no posturing. Patient does not make any purposeful movement. Babinski sign not tested for.
  • Dispatched to residence for abdominal pain in a 17 year old femail. What is the differential diagnosis at this point? Dispatched 1822. En route 1824. On scene 1842. Patient contact 1843. Left scene 1846. Time on scene 4 minutes. Time to destination 47 minutes. Primary impression: abdominal pain. Narrative: At 1843 made contact with a 17 year old female. The patient was transported to hospital "x". Found patient seated with her mother with complaints of abdominal pain. This was after a MVA. Onset of symptoms 1812. "So this was approximately 1/2 hour earlier." Patient was wearing a lap and shoulder restraint. Front passenger of a slow 15 to 20 mph "side swipe" with no LOC.

MAC Run Review September 2016
           Watch For 1 CE       Just Watch FREE

Four case studies:

  • Call Type: Fall in a 91 year old female. Arrived to find an a/o x 3, GCS 14, 91 year old female sitting upright in a chair at home c/o right hip pain and right arm pain.
  • Call type: Abdominal pain in a 6 year old male. Responded code 2 for report of a male complaining of abdominal pain. First on scene and performed an assessment and obtained vital signs. Patient complains of chest discomfort and a "funny feeling" in his hands and fingers. Patient's family states that the patient has been yawning and that the patient states he can not yawn and "get the air out".
  • Call type: unknown 20 year old female. Dispatched to a vehicle and found 20 year old female, in the third row of the vehicle she was in, on freeway, with Fire assessing her, who was involved in a motor vehicle accident. The patient is the restrained passenger, in the third row on the right side, of SUV, with air bag deployment, with 1 foot intrusion into the passenger compartment from the rear of the SUV, that was stopped on the freeway, and rear ended by a vehicle going 50 to 70 mph.
  • Call Type: Seizure/Convulsions 2 year old male. Arrived on scene private residence, to find 2 year old male sitting in foster mother’s lap, in no apparent distress, with Fire at side. Patient AxO to baseline. Per guardian, he was sitting on the couch, and was about to fall asleep, when he was witnessed to have a full body tonic-clonic seizure lasting approximately 1 minute, followed by focal bilateral arm activity x 1 minute. He had a straight stare the entire time and remained pink, warm and dry the entire time.

MAC Run Review May 2016
           Watch For 1 CE       Just Watch FREE

Two case studies:

  • HPI: Upon arrival, we found a 29 year-old male patient presenting with a chief complaint of code blue/hanging, which began: April 27,2016; First responder on scene was Fire FD and Law Enforcement; We were staged prior to being allowed at scene; History of event: Upon arrival found a 29 year-old male hanging from the inside his garage from a roof beam by a rope, unresponsive; Per law enforcement it was unknown down time, patient was asystole and no audible heart tones.
  • Dispatched to stage for male GSW to abdomen; Responded code 3 from station; Arrived at staging area at 0406; Law enforcement cleared scene and advised to continue code 2 at 0417 hours; Due to nature of injury and location, next available air ambulance requested; First air provider declined and second provider launched delayed due to weather. Then cancelled by EMS due to stable vital signs.

MAC Run Review March 2016
           Watch For 1 CE       Just Watch FREE

Three case studies:

  • Dispatched for a 64 year old male with chest pain. Responded code 3 for chest pain. Arrived to find patient sitting on his couch attend by spouse. Patient is pale, warm, clammy and experiencing nausea.
  • Dispatched for a 54 year old female with syncope. Responded code 3 to address for a report of a fall with head injury. General impression of patient upon visualization was 54 year old lying supine with small amounts of blood on the floor behind her head with abrasions to the right side of face, and incontinent on the floor, talking on her cell phone. Bystanders at scene said they witnessed her walking and collapse on the floor, hitting her head with a loss of consciousness from a period of time from thirty seconds to one minute, with the onset time being twenty minutes prior to EMS arrival.
  • Dispatched for unknown medical. Found a 70 year old male with Altered Level of Consciousness. Chief complaint: Altered Level of Consciousness. At 0829 made contact with a 70 year old male. Arrived to find a 70 Y/O male patient sitting on couch. Significant aphasia, garbled speech only. No obvious sign of trauma.

MAC Run Review January 2016
           Watch For 1 CE       Just Watch FREE

Two case studies:

  • Responded code-3 to a private residence for a 78 year old female having chest pain; Arrived to find the patient sitting in a chair on the porch with fire personnel; Patient stated she has had multiple MI's and stated she last had a myocardial infarction 3 months ago; She self administered baby aspirin and 3 nitroglycerin with no relief.
  • Dispatched code-3 to a private business for a patient experiencing possible s/s consistent with an unspecified illness/injury; Arrived to find an 8 year old female patient lying in bed with both parents and fire personnel in attendance; Parent's are speaking Spanish only and a translator is utilized during assessment.

MAC Run Review December 2015
           Watch For 1 CE       Just Watch FREE

Three case studies:

  • Dispatched code 3 to a private residence for a patient experiencing s/s consistent with an unspecified illness/injury. Arrived to find a 21 year old male patient (~79 kg) sitting upright on the floor with Fire in attendance. C/C: Possible syncopal episode.
  • Ambulance responded code 3 for a two vehicle collision. Arrived to find Fire assessing all occupants of vehicles involved and conducting traffic control. The two vehicles involved on the right shoulder of the highway.
  • Dispatched code 3 for an unresponsive female at a private residence. Upon arrival found pt sitting in the drivers seat of her vehicle parked in front of apartment (Mom’s apartment) in care of Fire personnel and family.

MAC Run Review July 2015
           Watch For 1 CE       Just Watch FREE

Three case studies:

  • Dispatched code 3 for chest pain at an urgent care secondary to a motorcycle accident earlier in the day. Patient was riding ATV approximately 20 mph when he was ejected and then run over by the empty trailer that the ATV was towing.
  • Chief complaint: Cardiac Arrest. Arrived at scene to find patient sitting on the toilet with his wife holding him up.
  • Dispatched code 3 for possible stroke. Patient says he woke up partially in his bathtub which is next to the toilet.

MAC Run Review May 2015
           Watch For 1 CE       Just Watch FREE

Five case studies:

  • 84 year old female with Syncope/decreased heart rate;
  • Arrived at scene to find patient in a recliner C/O chest pain describing the pain as dull and achy and radiates through his left arm;
  • 86 year old female complaining of rapid heart rate;
  • 81 year male with a C/O CP with SOB and nausea;
  • Dispatched code 3 for a pedestrian was struck by a Honda CRV while traveling at approximately 35 mph;
  • Bonus case!

MAC Run Review March 2015
           Watch For 1 CE       Just Watch FREE

Five case studies:

  • Dispatched code 3 to a local veterinary clinic to find a 39 year old female in front of the clinic with co-workers and history of reoccurring SVT;
  • Responded code 2 for a female with a possible stroke;
  • Dispatched code 3 for a 55 year old female with abdominal pain; Chief complaint: N/V/Back pain;
  • Dispatched code 2 to a private residence for chest discomfort and elevated heart rate (280 / 140 mm Hg);
  • Dispatched code 3 to an MVA; patient was driving full sized Dodge truck and was unsure of how many times the truck rolled.

MAC Run Review February 2015
           Watch For 1 CE       Just Watch FREE

Four case studies:

  • Chest pain in a 75 year old male patient located in living room;
  • Chief complaint 55 year old female with CP and Difficulty breathing lying in bed attended to by husband;
  • Chief complaint fall in 78 year old male;
  • Chief complaint: Internal Defib Shocking.

MAC Run Review January 2015
           Watch For 1 CE       Just Watch FREE

Five case studies:

  • Pregnancy / Childbirth / Diabetic Problem;
  • Dispatched for an unconscious person;
  • Private code 3 for chest pain in a 52 year old female;
  • Dispatched for anxiety 79 year old female and found fire;
  • Dispatched code 3 to address noted for man down; Fire also dispatched.

MAC Run Review November 2014
           Watch For 1 CE       Just Watch FREE

Four case studies:

  • Fall in a 91 year old female;
  • Abdominal pain in a 6 year old male;
  • Unknown 20 year old female;
  • Seizure/Convulsions 2 year old male.

MAC Run Review September 2014
           Watch For 1 CE       Just Watch FREE

Five case studies:

  • Dispatched for a male with chest pain; 41 year old male with a history of WPW as a teen; Always has had a "racing heart"; Takes no medications to slow his heart down; Uses breathing techniques to slow the rate; Drinking tonight and had "8 to 10 beers"; Had palpitations and chest pain for approximately 1 hour prior to his wife calling 911;
  • Chief complaint: Difficulty breathing; Primary symptom : Breathing problem Other; Associated: N/V;
  • Code 3 for a patient complaining of chest pain with shortness of breath;
  • Dispatched code 3 to an allergic reaction; Arrived to find a 89 year old female pink, warm, and dry; Complains of being stung by a wasp while refilling her hummingbird feeder;
  • Arrived on scene to find 69 year old, alert, oriented X 4; Patient increasing weakness throughout the week; History of narcotic abuse and trying to detox off of methadone and oxycontin.

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