It can be difficult to determine whether you should treat undifferentiated hypertension or not. Many clinicians are distracted the number rather than focusing on the patient in front of them. Asymptomatic hypertension, in particular, is often benign. In fact, treating asymptomatic hypertension in a patient who a primary medical history of hypertension can harm them. In this podcast, we discuss these adverse effects related to blood pressure physiology, acute versus chronic hypertension, and...

The principles of preoxygenation and passive oxygenation should be familiar to any experienced intubator. Best practice recommends the use of a nasal cannula in conjunction with either a non-rebreather mask or bag-valve mask (BVM) to prevent hypoxemia during the apneic phase of Rapid Sequence Intubation (RSI). In the PREOXI Trial, the authors pushed this concept further, questioning whether non-invasive positive pressure ventilation (NIPPV) might be more effective than these formally...

Not all cardiac arrests are created equal. Whether the presenting rhythm is asystole, ventricular fibrillation, or PEA, these patients require tailored interventions beyond "blanket" protocol and ACLS/PALS algorithms. When refractory to conventional therapy, the pulseless V-Tach/V-Fib patient, in particular, requires critical thinking "outside the box" in order to gain ROSC (Return of Spontaneous Circulation) and preserve neurological outcomes. What are some of the measures we can consider...

Interfacility transfers are not always indicated at the time and place of which they are being requested. Whether it's referring provider misinformation or a lack of advocacy by the transport agency, these transfers can result in unnecessary risk for crew members and patients. Specifically, weather conditions, time of day, crew fatigue, and other important factors are not always considered when blindly accepting these transfers. As the transport specialists, how can we ensure that we are...

Antidiuretic hormone (ADH) plays an essential part in the body's osmotic/fluid balance, sodium homeostasis, and blood pressure regulation. This hormone is synthesized in the hypothalamus and released from the posterior pituitary gland. In conditions such as Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH), there is a lack of synthesis or over-production of this hormone which results in negative downstream effects. At the request of a podcast listener, we have decided to...

Angioedema is defined by upper airway swelling secondary to an immune response. The trigger and subsequent physiological response are how we categorize it. In this podcast, we discuss how to diagnose and treat both types: IgE/Histamine-mediated and Bradykinin-mediated. We also touch on how to address the difficult airway that may or may not lead to intubation. All in all, do not fear angioedema but respect it. Get CE hours for our podcast episodes HERE! ...

When discussing methylene blue, management and treatment of methaemoglobinaemia is usually the first indication mentioned. But in this podcast, we challenge you to increase the size of your lense and focus on its benefits in other states (e.g., septic shock). Of course, we could not do this alone, so we invited a Flight Paramedic, Pharmacist, Toxicologist, and Professor to join us. And fortunately for us, they are all the same person. Tune in as Will Heuser helps us discuss the...

Though we have delved into foreign HEMS systems in the past (See Episode 61 – Down Under Dynamics w/Dr. Cliff Reid), we have not dedicated an entire series to it. Having now rubbed shoulders with many clinicians and operators around the world, it is evident that these conversations need to take place on a regular basis. Why? Because operating in a vacuum can lead to bad decision making. Our new "Around the World" series attempts to mitigate this by interviewing prehospital and intrahospital...

"Self-loading baggage" is a derogatory term often used by pilots to describe lazy or disengaged medical crew members in the air medical industry. Whether intentional or not, this behavior sets a bad precedent for those of us that want to embrace aviation cross-training and be able to assist the pilot effectively. In this podcast episode, we are joined by pilots Miles Dunagan and Brett Reeder to discuss how pilots and clinicians alike can be a cohesive team before, during, and after the...

The Russo-Ukrainian War is an ongoing international conflict between Russia and Ukraine. At times such as these, medical training is essential and sometimes required of laypersons. International Medical Corps partnered with the Harvard Humanitarian Initiative (HHI) to provide comprehensive emergency and trauma care training to healthcare workers, public safety professionals, and the Ukrainian community. Course Coordinator Kevin Collopy and Instructor Brock Jenkins, live from AMTC23, join us...

B.R.A.S.H. Syndrome is a phenomenon with a constellation of Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia requiring identification and management in the prehospital and transport setting. In this podcast episode, live from AMTC23, we discuss the pathophysiology of BRASH Syndrome, highlighting the synergy between its components, as well as relevant pharmacotherapy and treatment considerations. Get CE hours for our podcast episodes HERE! ...

Dan presented the talk “Metabolic Acidosis: The Eye Can Only See What the Mind Can Comprehend” at AMTC23. In this recording, he teaches you how to identify the prevalence of acid-base disorders including triple disturbances, how to calculate anion gap and determine the etiology of the gap, and how to identify adequacy of compensation for a primary metabolic acidosis. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook...

As a critical care clinician, do you consider yourself well-versed in comfort care? Do you consider yourself well-rehearsed in having the discussions leading up to the patient's or family's decision to implement it? This concept may be outside your comfort zone, especially if you work in emergency medicine. But the fact of the matter is, from the prehospital environment all the way to the ICU, we are provided many opportunities for implementation of this type of care plan. Join us for a...

Atrial fibrillation, particularly A-Fib with RVR (Rapid Ventricular Response), is often an emergency requiring emergent intervention beyond ACLS and its associated algorithms. Identification of A-Fib can be challenging in itself, much less trying to determine what intervention(s) are indicated. This includes chemical and/or electrical cardioversion. So where do we start? And where should we end up? Dan and Mike will let you know in this podcast episode. Get CE hours for our podcast episodes ...

Continuing our "10 Things" series, we focus our attention on gastroenterology. GE/GI goes well beyond colorectal. From bleeding esophageal varices to pancreatitis to liver failure, these patients require specific diagnostics and interventions to improve their mortality and morbidity. Join us for a "pearl packed" episode where we discuss practical steps you can take to improve your care of this specialized patient population. Get CE hours for our podcast episodes HERE! ...

Pediatric Emergency Medicine (PEM) is a sub-speciality that many clinicians find intimidating. Are pediatric patients truly unique or are they simply "little adults"? In this podcast episode, we are joined by Dr. Dominique Diggs, board certified PEM physician, to demystify pediatric emergency care with 10 tips that will help you the next time you care for this patient population. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet ...

Vascular emergencies refer to any time-sensitive condition where perfusion is prevented secondary to bleeding or occlusion of a vessel. These can include, but is not limited to, the superior mesenteric artery (SMA) and aorta. And depending on the severity of the aneurysm or embolism/thrombus, downstream ischemia can significantly impact a patient's quality of life. How do we identify these conditions? When are they classified as a true emergency? And how do we treat patients with the notion...

Reviewing case studies with trusted colleagues can be extremely beneficial. Not only does it provide a moment of reflection on actions taken, but it also provides different approaches that may be applicable to future scenarios. Occasionally we like to challenge each other, and this episode is no exception. Tune in as Amanda, Dan, and Mike present three real case studies and see if they would approach the same patient differently. We start from "bread and butter" to the complex critically...

Have you ever handed off to an ER doctor, and you felt they were displeased with your care? Have you ever received an order from an ER doctor, and you didn't quite understand why? In this podcast episode, we continue our "10 Things" series with a focus on the emergency department. Our very own Dr. Amanda Humphries, Emergency Physician and Assistant Professor of Emergency Medicine and Emergency Medical Services,  leads the discussion. Get CE hours for our podcast episodes HERE! ...

Myocardial infarctions can present in a variety of ways depending on vessel involvement, timing of pathology, and interpretation of diagnostics (e.g., 12-lead EKG). Unfortunately, not every patient with a myocardial infarction will fit STEMI criteria's paradigm, which has lead to the adoption of a new term: OMI (Occlusion Myocardial Infarction). In this podcast episode, we are joined by our very own Nick Zuber to discuss his recent OMI and why he's able to sit down and talk with us today. ...

No matter what level of scope, management of medical and traumatic cardiac arrests is the focus of many clinicians. But what happens after return of spontaneous circulation (ROSC) is achieved? Many do not appreciate the fact that the likeliness of re-arrest is high. How can we avoid return of spontaneous arrest by appropriately treating the patient during the peri-arrest phase and subsequently improving quality of life? Tune in to another nugget-filled podcast episode where the team discusses...

The medical industry puts great emphasis on formal education via university and other training programs. Due to financial incentive, these institutions often discourage independent learning despite it usually having a greater impact on patient care quality. For example, paramedics are often non-degree holders, yet they effectively practice medicine on a daily basis as a result of learning via unconventional methods (e.g., podcasts). How much actual value is in formal education? Do we need a...

Whether it's antibiotic-resistant "super bugs" or administration prior to acquiring blood cultures, empirical use of antibiotics is controversial. Should we be administering antibiotics in the prehospital environment for open long bone fractures and/or sepsis? When are antibiotics truly indicated? And is that more important than the timing of the antibiotic itself? This podcast is not only "Antibiotics 101", but we also address these important issues. Get CE hours for our podcast...

It's not clinical. It's not non-clinical, really. Celebrating our 100th full podcast episode, Bryan and Mike sit down in a Mystery Science Theater 3000 format and make fun of our 1st episodes ever. If you're looking for some light-hearted entertainment including a reflection of how far the platform as come, this is the podcast for you. And one last thing... THANK YOU FOR 5 YEARS! Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet ...