Episode 1

Transcript

0:00

Welcome to Pulse Check, Wisconsin. Good morning, good afternoon, good evening, whatever time it may be for you. My name is Chris Ford. I'm an emergency medicine doctor here in Milwaukee, Wisconsin, and I want to thank you for joining us here today. The idea for this podcast came out of my day to day seeing patients in the emergency department and at the end of the visit, giving information to patients regarding what brought them into the emergency department. Some of the more so social determinants of health that affected that presentation, and also kind of getting people plugged into community resources with social work and staff as well. And so I thought that it may be good to give the opportunity for some information to be gleaned outside of that brief interaction that I had with patients, because I get feedback a lot of times that, you know, this information is helpful for people. And it's something that they would tell family members and something that they would take to their primary care doctor's office. And so I wanted to do that outside of the emergency department. In addition to being an emergency medicine doctor, I'm also a volunteer in many aspects of my life. So one aspect is with community service. So I'm a big advocate for health policy as well as for, health equity, social justice, things of that nature. And so I do community walks in the city of Milwaukee. So it's a program that's called Walk with a Doc MKE, where we do bi weekly walks in partnership with AARP Wisconsin to kind of help promote a healthier lifestyle for a lot of the folks in the community to give a safe environment to do that as well. So, in addition to that I've worked in many different aspects, so I'm a volunteer board member for the Children's Health Alliance of Wisconsin, where we serve to provide assistance to pediatric patients as they're growing up in terms of helping reduce the amount of lead exposure. So, we have lead initiatives that we work with as well. We have asthma initiatives, things of that nature. And so During the duration of this podcast, what I'll be doing is I'll be inviting some folks on that I work with in a lot of these different avenues to kind of help provide you some of that information as to what we're doing as well as to how you can help out if you have any family members that are interested or anyone else that, you know, you know, can benefit from it, these, these podcasts will be easily available and this information will be available as well later on in the website. Another thing that I have been involved with are some of the larger legal cases in the state of Wisconsin. And so, you know, one thing is is the redistricting efforts in the State of Wisconsin. And so in 2020, I was involved in a commission that was created by the executive order by the governor of Wisconsin at the time, who was Tony Evers, who is Tony Evers at this time still, and the commission was called the People's Maps Commission. What this commission was was modeled after. Other commissions throughout the country similar makeup in terms of removing politicians away from the the spectrum of redistricting. So removing, you know, any political pools, any political gains, things like that. And so. We were compiled, compiled as a commission in order to help folks, you know, give their testimony to help provide what they think that those lines should have been drawn. And in that, we ended up coming up with maps that we presented to legislators as well as presented to the governor and the governor eventually ended up taking on. As you know, our process you know, I'll be it completed in 2021. The process of redistricting is still ongoing right now. There's a lot in the news right now about the Supreme Court whose makeup has changed since we submitted our maps. Who may be taking a look and taking a consideration at making either their own maps from independent council or taking up one of the six maps that were submitted to them from different entities throughout the state, including the governor himself and some members of the legislator. And so we'll be getting into that. A little bit more too. One of the reasons why I got involved in the redistricting case get involved in the the commission was because there is a large tie from healthcare as well as representation at the state level. And as a lot of you may already know, especially those who are just first now picking up this, this, this podcast, there's a huge correlation between. Your representation at the state level, as well as your day to day life. As we talk about, you know, most politics are local and the important politics are local for you as well. So, you know, the presidential election, albeit important, does not have as much stake in your day to day life as you know, your local elections, your school board elections, your assembly, your Senate and congressional district elections. And so those are going to be the folks that are going to be making the decisions for your day to day life when it comes to, you know, your housing. When it comes to your general health when it comes to your ability to afford your medications and afford your health care as well as, you know, the access to health care in your communities. So all those things are correlated and what we'll do is we'll bring on some folks to talk about that as well. To give you some better context so that was a huge spiel about redistricting, but we'll, we'll get into that in future episodes as well. So in addition to that, I'm also involved in a in the Dobbs case in the state of Wisconsin. I'm one of three physician intervenors in the in the decision for Roe v. Wade here in the state of Wisconsin. And so. The reason why I got involved in that was kind of similar to the redistricting efforts as well. It was more so out of the safety of my patients. And so a lot of what we were seeing post 2022, I believe it was in June when the Supreme court, the federal Supreme court struck down the Roe V Wade decision, what we were seeing was the. Inability to access the full gamut of maternal health care including elective abortions. Now that didn't mean that abortions, you know, w stopped being something that was available to folks in the country. That just meant state by state basis each individual state got to determine. What their what their allowment would be for for abortion care. And so in the state of Wisconsin as you all may know we reverted back to the laws that were on the books that were essentially archaic and were not based in any of the current. Guidelines that we have in medicine. In fact, you know, a lot of these rules in place were put in place before we knew the bacteria and viruses caused illnesses, right? And that's how far back that ruling was. So what we'll do is I will have on some folks regarding that case as well to kind of talk about folks. Where we are and where we are going just to kind of give you a better understanding of, you know, where we are at in the state for that and what the, what the risks are at this current time for our pregnant patients that we're seeing in the emergency department. So that's, that's kind of all the things that I'm involved with in a nutshell right now. There are more and we'll talk about it as we go to future episodes. So, what we'll do is I'll kind of break down the structure of the podcast now, just to let you know how each episode will be delineated and how we will sort of organize each episode to, to give you a better understanding of what I do as an emergency medicine doctor and how it could be beneficial for you and ultimately how it can potentially keep you out of the emergency department. So yeah. We'll start out each podcast with a case. The initial case that we'll do will be something correlating most of the time with each individual episode topic. And so what we'll do is I'll give you an interesting case in the very beginning of the episode. Kind of put you in the shoes of the emergency medicine physician, either myself or one of my colleagues and then discuss kind of what led up to that presentation. And then at the end, you know, give you some advice and give you some tips and tricks preventative that can keep you out of the emergency department because, you know, as you, as the old adage goes, one ounce of prevention is worth a pound of cure. And so that's kind of what we'll be doing. We're going to go ahead and start this initial episode out with a case that I have, I did a lot of international work my wife and I both, my wife is a pediatrician and we did travels in Central America as well as in Africa in order to participate in global health through the University of Wisconsin as well. As the Medical College of Wisconsin where we attended medical school. So this first case will be taking place in one of the hospitals that I had the privilege of working at learned a lot from in Addis Ababa, Ethiopia. This is in Black Lion Hospital in the capital. So without further ado, here is the first case. So it's midday patient comes into the emergency department with difficulty in breathing patient is a 30 year old male and he's unable to talk, clutching at his throat the family who has arrived with the patient states that he's been having difficulty breathing all day and a little bit yesterday and today he has been unable to talk and it's getting worse. So they decided to bring him into the hospital. At the time of his arrival, the patient's oxygen is at about 85%. For reference, above 90 percent is what we consider to be normal. And so because it's so low, the residents spring into action, given his presentation, as well as given how he looks. So they bring the patient to the back of the critical care section of the emergency department. Seeing that his airway is compromised, the residents decide appropriately to place a breathing tube. As they are concerned at this time that the airway is closing imminently, which, if it does, can lead to death relatively quickly. So the first resident tries to place what we call an endotracheal tube or a breathing tube. Unfortunately, this is unsuccessful. And so she tries a second time and remains unsuccessful with that passage. It was then, right at that time, that the airway starts to become filled with blood and the patient's oxygen, which was previously 85% drops even further. And now the patient is no longer clutching at his throat. He is looking like he's almost unconscious at this point. The second resident attempts to place the endotracheal tube and after suctioning the tube is no longer able to be seen because the airway is filled up with blood and the tube passage is unsuccessful after that. As the residents prepare to do a procedure that we call a surgical airway, which is usually reserved for the most difficult of airways the chief resident kind of hears everything going on and walks over. He confidently picks up a pair of forceps from the now open surgical airway kit and he places it inside of the patient's mouth. After around 15 seconds of manipulation in the airway, he then proceeds to pull out the largest leech I have ever seen. The patient's saturations improve after bagging him a little bit, providing him some supplemental oxygen, and the patient begins to wake up. so, like I said at the beginning of this case, a lot of this is more so supposed to be educational eventually we'll get into cases that will be everyday bread and butter emergency medicine and presentations that we see here stateside. But I thought that this one would be an interesting case just to start out with because you know, you're not going to see this every day at least here in the United States, but so it's a couple of things in this that are important. The first thing in emergency medicine that we harp on when you're first learning emergency medicine and late into your career or what we call the ABCs of emergency medicine and so ABC stands for airway, breathing and circulation. And the reason why we stress this is because airway is important it's important to maintain your body's safe level of oxygen throughout to kind of keep the heart going, and if that airway becomes occluded in this case by a leech you can run into some dangerous situations where the oxygen drops significantly, relatively quickly, and the heart can stop. In any airway, case, you're going to have a high level of anxiety and high level of stress because you have to provide definitive treatment. In this case, it was removal of the leech, but in other cases, you know, it's providing an airway with a breathing tube that we talked about before. And so you saw in this case to the hierarchy of emergency medicine. And so we see you know, the residents will essentially get the first go at airways, especially in teaching hospitals. And so the first resident tried to place the airway and couldn't. And so therefore a more senior resident came and tried to place it. And then finally. Kind of the hero of the case, who was the chief resident was able to definitively make the diagnosis and provide the treatment that was life saving for this patient. And just some background this chief resident was from the same rural region of Ethiopia that the patient was and sort of had some previous knowledge of similar presentations. And so, as he told me people would commonly drink from smaller ponds in this region that would commonly have leech ovum or leech eggs in the water. And so, when you would drink the water. Sometimes the leech eggs would be ingested and sometimes you can get some very small leeches too that in this case could latch on to some aspects of your body parts, including your airway in this case. So again, you know, this is just a. A cool case that was seen. Fortunately had a good outcome. Not much to really glean out of this one in terms of any preventative things to keep you out of the emergency department except to say if you're ever in rural Ethiopia, try not to drink from the ponds. The leech for all animal lovers out there was not harmed. It's important to know that the leech as a last time I was in Ethiopia, which was in 2016 was in a two liter bottle where the leech was housed, and it was the official pet of the resident room. So the leech may still be there to this day. So that was the airway case and hope you enjoyed it. So that's it. That's the first episode in the books. I want to thank everybody for listening today. Um, feel free to listen to the next episode. I will be having a very special guest. We will be discussing further health topics and how it affects your day to day life. So until next time, feel free to subscribe, take care of yourselves, take care of each other, and if you need me, don't hesitate to come in and see me.