What the Hell is a ParaIntensivist, Anyway?

Hi there! Welcome to the ParaIntensivist Podcast. This episode is here to lay down some ground rules.

Maybe you’ve Googled. Maybe you’ve searched. Maybe you’ve asked your friends. Scratched your butt a little. You know, researched. Couldn’t figure out what a paraintensivist is? I know why not.

Paraintensivist is a word that I made up. Got it? Good. Okay. Great.

So let’s define that term, shall we?

Para-: Kind of.
Intensivist: ICU doctor.

A paraintensivist is someone who operates in the world of intensive or critical care medicine, but is not a physician (or mid-level provider). That still leaves a lot of people out there–ICU nurses, flight nurses, respiratory therapists, EMTs, ICU techs, and, like me, critical care paramedics.

And that term is something you can own. I stake no claim to the Paraintensivist nomenclature. Much like the term resuscitationist, it’s yours to own. It doesn’t come with one title or one certification. It’s not exclusive to nurses, or to medics or RTs. So walk into a party and hold your head high, and when people ask you what you do, tell them you care for the sickest patients on the planet. Tell them you’re a paraintensivist. Be proud. Own it.

Sure, there are a million podcasts out there for ER and ICU docs. I can name a dozen great ones, like EmCrit, and Taming the SRU, and ERCast, and PEM-ED, and RAGE, and Life in the Fast Lane. Holy cow, you guys. There’s so much great stuff out there!

But not all of it is geared towards us, the grunts, the people actually getting our mitts dirty and get it done. So this podcast is for us, the how-tos, the tips-n-tricks. It’s also aimed at people who want to be us when they grow up, like EMTs who dream of flying, or CNAs who work part-time while they’re in school.

So this podcast is gonna have 4 different subsections to it, mostly because I like pigs. Ready? We’re going to have:

  • The ParaIntensivist’s Guide to Pathophysiology (PIG-PP)
  • The ParaIntensivist’s Guide to Intensive & Critical Care (PIG-icc, like what happens when a pig throws up).
  • The ParaIntensivist’s Guide to EMS (PIG-ems)
  • The ParaIntensivist’s Guide to Pediatrics (PIG-peds)

This blog is gonna be COVERED in piglets. No, I’m not sorry.

And the cool part? The cool part is that you got in on the ground floor! That means that the comments you leave here and now will shape this podcast going forward! You get to help pick the content, the topics, the format, everything! It’s all open to feedback and I’m excited to hear what you have to say!

So drop it all in the comments, people. Are you excited? Anxious? Love pigs? (Love bacon?) What do you want from this podcast going forward? What topics are you itching to learn more about and haven’t yet?

Posted in Blog Entries
4 comments on “What the Hell is a ParaIntensivist, Anyway?
  1. paramedrusty says:

    Samantha-thanks for the work. Agree with the need for your niche.
    Would like to hear your thoughts from US on next generation of prehospital investigations in critical care: lactate, ultrasound…..
    Keep them coming, and stay safe out there!
    Rusty x

    • Hi Rusty! Thanks for the feedback! These are two topics I’m really enthusiastic about (prehospital labs and POCUS), and they will definitely become episodes (series?) at some point in the future!

      I was just listening to a SMACC podcast about sepsis & lactate on the drive home from work, actually, so your question is well-timed. I think that there are other lab values that would be much more useful for guiding pre/inter-hospital care–ABG/VBG, electrolytes, etc. Much more useful for guiding ventilation and therapy of electrolyte disorders (is that renal patient ACTUALLY hyperkalemic?), which is more actionable. Lactate is a much more non-specific marker, although I can see values > 4.0 being used to guide patients down a stronger prehospital approach to suspected sepsis. I think in general we need to better understand what lactate actually means before we start extrapolating its information to the field.

      As for Prehospital POCUS, it’s a tool I very much wish I had. FAST is useful, RUSH even more useful. Then there’s looking at cardiac function during arrest, U/S of the legs for suspected DVT/PE, and of course guiding pericardiocentesis or thoracostomy. Cardiac wall & valve function. Pulmonary hypertension / RV dilation by looking for “D”ing of the septal wall. Looking at bone structure to determine if a bone has a subtle/non-deforming fracture. Or, hell, just using the damn thing for IV access, or as a stethoscope and get a good clean look at pulmonary function. POCUS seems as magical as the acronym makes it sound.

      In terms of deployment, as cost and size/weight/cost come down, I forsee POCUS becoming an EMS reality for high-level systems, especially those with long transport times. I think in bigger systems with shorter transport times (think LA / NY / Seattle / …) it may not ever make the cost/benefit ratio, considering the amount of training it might require, but it’s definitely in the future of EMS.

      Sadly, neither service I work for has either of these available in the pre/interhospital setting. I actively avoid listening to Matt & Mike’s Ultrasound Podcast to avoid the jealous rages I’m sure I would enter if I did. And if you’re interested there was a really good lecture by Dr Faizan Arshad, available at http://katch.me/emscritcare/v/20b3318f-f994-3017-b346-a983323c67ab — if only we could see the screen!

      What about you, Rusty? Do(es) your service(s) use POCUS? Are you as excited by the potential of the tools as I am, or do you have your reservations about its prehospital function? Have any even BETTER videos to share to make me jealous?

      Stay safe out there!! ~Sam

  2. Marc August says:

    Absolutely love the piglets! (and the podcasts)