The FlightBridgeED Podcast

Gastropocalypse: Severe GI Bleed in Critical Care Transport Nov 21, 2024

Join Dr. Mike Lauria and guest Dr. Bryce Taylor, an experienced flight physician, as they delve into the complexities of transporting patients with severe gastrointestinal (GI) bleeding. From the nuances of variceal versus non-variceal bleeds to cutting-edge resuscitation strategies and critical airway management, this episode equips providers with the insights they need for optimal care. Discover evidence-based approaches to managing medications, product resuscitation, and the intricacies of using balloon tamponade devices like Minnesota tubes. Whether you're in EMS, critical care, or just stepping into advanced prehospital medicine, this episode has pearls for every provider.

Stream this episode wherever you listen to podcasts, or visit FlightBridgeED.com to explore our award-winning critical care education courses. Your journey to excellence starts here.

TAKEAWAYS

Advanced Insight: The pathophysiological understanding of variceal bleeding highlights elevated portal pressures causing venous backflow into superficial veins of the esophagus and stomach, creating high-risk hemorrhage scenarios.
Clinical Pearls: Intubating a patient with massive hematemesis requires preparedness for anatomical and physiological challenges. Techniques like SALAD (suction-assisted laryngoscopy) and appropriate suction setups are vital.
Foundational Concept: Differentiating upper vs. lower GI bleeds begins with understanding anatomical landmarks like the ligament of Treitz, guiding early diagnosis and management in the field.

MDCAST - Obstetric Critical Care Transport Series - Preterm Labor Nov 14, 2024

In this episode of the FlightBridgeED MDCAST Podcast, Dr. Michael Lauria and Dr. Elizabeth Garchar delve into a vital topic for EMS and critical care: managing preterm labor in transport. They tackle the complexities of diagnosing preterm labor, the nuances of patient risk factors, and the pillars of effective preterm care. Discover how understanding these principles can make a profound difference for both mother and baby, especially when timely, evidence-based intervention is crucial. This is an essential listen for any paramedic, nurse, or medical professional seeking to deepen their knowledge in obstetric critical care and improve their hands-on approach.

Listen on your preferred podcast platform or directly from our website at flightbridgeed.com/fbe-podcast. While you’re there, explore our award-winning courses crafted for your continuing education in critical care and emergency medicine.

Key Takeaways:

Recognize the four pillars of preterm labor management: transport to the appropriate facility, antibiotic administration, antenatal steroids, and magnesium for neuroprotection (before 32 weeks).
To prevent neonatal complications, maintain close monitoring during transport and prioritize fetal head control in the event of precipitous delivery.
Understanding preterm labor risk factors—such as infection, smoking, limited access to care, and history of preterm births—can help guide critical care decisions.
Tocolytic options like calcium channel blockers or beta sympathomimetics are helpful for delaying delivery short-term but require careful consideration of contraindications.
The preterm infant’s immediate needs at birth include delayed cord clamping and potential neonatal resuscitation, underscoring the importance of being prepared for rapid response.

The Bleeding Edge: Finger Thoracostomy in the Field Nov 01, 2024

Join us for another captivating episode of The FlightBridgeED MDCAST as Dr. Michael Lauria explores trauma medicine's most critical and evolving skill: the finger thoracostomy. Featuring special guest Dr. Bryce Taylor, a seasoned emergency physician, and flight medicine fellow currently doing a retrieval medicine fellowship at the University of Wisconsin Med Flight. This episode takes a deep dive into the nuances of trauma-induced tension pneumothorax and the art of rapid chest decompression in the field.

They cover everything from recognizing life-threatening tension physiology to deciding between a needle decompression and a finger thoracostomy and the evolving prehospital protocols that could save lives. Dr. Taylor shares insights on resuscitative ultrasound, operational challenges, and why empirical chest decompression may be the next standard of care for flight and EMS crews. Whether you’re a seasoned critical care provider or new to trauma medicine, this discussion will leave you better equipped to handle the unpredictable.

Available wherever you listen to podcasts or directly on our website, flightbridgeed.com. While there, explore our award-winning courses designed to elevate your critical care knowledge and professional practice.

TAKEAWAYS

Understanding the difference between tension pneumothorax and regular pneumothorax is crucial in trauma care.
Ultrasound can be a valuable tool for identifying pneumothorax in trauma patients.
The choice between needle decompression and finger thoracostomy depends on the clinical scenario and the availability of a sterile environment.
Proper identification of landmarks is essential for successful finger thoracostomy.
Chest tube placement may be appropriate in a controlled environment with access to sterile equipment. Finger thoracostomy is a crucial intervention in the pre-hospital setting for trauma patients with chest injuries and hemodynamic compromise.
Training and education for nurse medics in performing finger thoracostomy are essential for safe and effective implementation.
The safety and efficacy of finger thoracostomy in the pre-hospital setting make it a valuable skill for managing trauma patients in critical care transport.
The decision to perform a finger thoracostomy should be guided by the presence of hemodynamic compromise and the need for timely intervention in trauma patients with chest injuries.
The use of finger thoracostomy as an empiric decompression in polytrauma patients with suspected tension pneumothorax is reasonable and can be performed in parallel with other resuscitative measures.

Hypertensive Disorders in Pregnancy Oct 25, 2024

Welcome to another essential episode of the FlightBridgeED Podcast: MDCAST, where we dive deep into the complexities of critical care and continue our high-risk OB transport conversation. This episode focuses on the often overlooked yet rapidly increasing crisis of hypertensive disorders in pregnancy. Host Dr. Mike Lauria and maternal-fetal medicine specialist Dr. Elizabeth Garchar discuss the full spectrum of hypertensive disorders—from gestational hypertension to the life-threatening condition of eclampsia—and share practical insights on managing these critical patients in prehospital and transport settings.

Starting with foundational definitions of specific disorders like pre-eclampsia vs. eclampsia and HELLP syndrome, they explore the physiological mechanisms driving preeclampsia, the increased mortality rates, and why transport providers are seeing more cases in rural or under-resourced facilities. Learn how to distinguish between different diagnoses, manage acute cases in transit, and navigate treatment protocols with a detailed look at magnesium sulfate's role and the right blood pressure control strategies. This episode brings expert-level insight to providers of all backgrounds, from the basics to the most advanced interventions.

Listen to The FlightBridgeED Podcast anywhere you enjoy podcasts, or find this episode and more podcasts at https://flightbridgeed.com/explore. While there, explore our award-winning courses that empower pre-hospital and critical care transport medicine professionals to build their critical care expertise.

Key Takeaways:

Pathophysiology of Preeclampsia: This condition often arises from placental abnormalities that lead to widespread vascular issues, impacting both the mother and fetus.
Magnesium Sulfate in Management: Magnesium sulfate is vital for preventing eclampsia and should be monitored for toxicity, especially in patients with reduced kidney function.
Identification of Hypertensive Disorders: A blood pressure reading of 160/110 mmHg or greater post-20 weeks' gestation is a significant indicator of hypertensive disorders, warranting immediate medical attention.

References

Sperling JD, Dahlke JS, Huber WJ, Sibai BM. The role of Headache in the classification and management of hypertensive disorders in pregnancy. Obstetrics and Gynecology. 2015; 126:297-302.
Sabai BM. The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): much ado about nothing? Am J of Obstetrics and Gynecology. 1990; 162:311-6.
Steegers EA, von Daselszen P, Duvekot JJ, Pijnenborg R. Pre-Eclampsia. Lancet. 2010; 376:631-44.
Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005; 308:1592-4
von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy. 2003; 22:143-8
Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol. 1998; 179; 1359-75.
Gillon TE, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PloS one. 2014; 9(12): e113715.
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260.

Ventilator Jiu-Jitsu Oct 17, 2024

In this episode of our series on respiratory critical care called Every Breath They Take, Dr. Lauria is joined by EM/Critical Care and Flight Physician Brittney Bernardoni as they discuss how to grapple with optimizing lung protective ventilation in ARDS.

Lung protective ventilation at 6 cc/kg and maintaining plateau pressures of less than 30 cmH2O have been the cornerstones of invasive respiratory support since the findings of the ARMA trial in 2000. In recent years, some interesting new developments have resulted in changes and improvements in lung protective ventilation strategies. With a particular focus on ventilator "jiu-jitsu," this episode explores the intricate adjustments required to optimize patient care during ARDS management. From ventilator modes and plateau pressure to the impact of PEEP, FiO2, and mechanical power, this episode equips listeners with actionable knowledge for mastering the art of ventilation. Whether in the field or the ICU, the nuanced approaches discussed in this episode will enhance your understanding of optimizing respiratory support in critical patients.

Listen to the episode wherever you get your podcasts or directly on our website at https://flightbridgeed.com/explore. While you're there, explore our award-winning courses that have helped thousands of providers clarify and understand the world of critical care transport and pre-hospital medicine.

Takeaways
• Early care in managing respiratory failure in the transport environment is crucial and can significantly impact patient outcomes.
• Lung protective ventilation with low tidal volumes is the foundation of ARDS management.
• The choice of ventilation mode (volume control or pressure control) depends on the clinician's comfort and ability to titrate the settings, but neither has proved superior.
• Permissive hypercapnia is generally well-tolerated in ARDS patients if the pH exceeds 7.15-7.20.
• The initial PEEP setting should be at least eight - several strategies can be used to guide titration.
• High FiO2 levels can be detrimental to ischemic organs, alveolar patency, and the lung tissue itself. Aiming for a FiO2 of less than or equal to 60% is important.
• Set, check, and change parameters to ensure optimal ventilation!
• Driving pressure may be an important factor in patient outcomes.
• Mean airway pressure and inspiratory time can improve oxygenation and minimize lung damage

References
1. Ahn HJ, Park M, Kim JA, et al. Driving pressure guided ventilation. Korean J Anesthesiol. Jun 2020;73(3):194-204. doi:10.4097/kja.20041
2. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. Feb 19 2015;372(8):747-55. doi:10.1056/NEJMsa1410639
3. Azizi BA, Munoz-Acuna R, Suleiman A, et al. Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study. J Intensive Care. Apr 6 2023;11(1):14. doi:10.1186/s40560-023-00662-7
4. Battaglini D, Fazzini B, Silva PL, et al. Challenges in ARDS Definition, Management, and Identification of Effective Personalized Therapies. J Clin Med. Feb 9 2023;12(4)doi:10.3390/jcm12041381
5. Battaglini D, Sottano M, Ball L, Robba C, Rocco PRM, Pelosi P. Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome. J Intensive Med. Jul 2021;1(1):42-51. doi:10.1016/j.jointm.2021.01.003
6. Bellani G, Laffey JG, Pham T, et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med. Jan 1 2017;195(1):67-77. doi:10.1164/rccm.201606-1306OC
7. Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. Jama. Mar 3 2010;303(9):865-73. doi:10.1001/jama.2010.218
8. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. May 4 2000;342(18):1301-8. doi:10.1056/nejm200005043421801
9. Chacko B, Peter JV, Tharyan P, John G, Jeyaseelan L. Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev. Jan 14 2015;1(1):Cd008807. doi:10.1002/14651858.CD008807.pub2
10. Chiumello D, Carlesso E, Cadringher P, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. Aug 15 2008;178(4):346-55. doi:10.1164/rccm.200710-1589OC
11. Fuller BM, Ferguson IT, Mohr NM, et al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Ann Emerg Med. Sep 2017;70(3):406-418.e4. doi:10.1016/j.annemergmed.2017.01.013
12. Gattinoni L, Collino F, Camporota L. Mechanical power: meaning, uses and limitations. Intensive Care Med. Apr 2023;49(4):465-467. doi:10.1007/s00134-023-06991-3
13. Harvey CE, Haas NL, Chen CM, et al. Initiation of a Lung Protective Ventilation Strategy in the Emergency Department: Does an Emergency Department-Based ICU Make a Difference? Crit Care Explor. Feb 2022;4(2):e0632. doi:10.1097/cce.0000000000000632
14. Laffey JG, Bellani G, Pham T, et al. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. Dec 2016;42(12):1865-1876. doi:10.1007/s00134-016-4571-5
15. Maddry JK, Mora AG, Perez CA, et al. Improved Adherence to Best Practice Ventilation Management After Implementation of Clinical Practice Guideline (CPG) for United States Military Critical Care Air Transport Teams (CCATTs). Mil Med. Jan 4 2023;188(1-2):e125-e132. doi:10.1093/milmed/usab474
16. Maddry JK, Mora AG, Savell SC, et al. Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality. J Trauma Acute Care Surg. Jan 2018;84(1):157-164. doi:10.1097/ta.0000000000001607
17. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669
18. Roginski MA, Burney CP, Husson EG, Harper KR, Atchinson PRA, Munson JC. Influence of Critical Care Transport Ventilator Management on Intensive Care Unit Care. Air Med J. Jan-Feb 2022;41(1):96-102. doi:10.1016/j.amj.2021.10.005
19. Sahetya SK, Hager DN, Stephens RS, Needham DM, Brower RG. PEEP Titration to Minimize Driving Pressure in Subjects With ARDS: A Prospective Physiological Study. Respir Care. May 2020;65(5):583-589. doi:10.4187/respcare.07102
20. Yoshida T, Uchiyama A, Fujino Y. The role of spontaneous effort during mechanical ventilation: normal lung versus injured lung. J Intensive Care. 2015;3:18. doi:10.1186/s40560-015-0083-6
21. Zaidi SF, Shaikh A, Khan DA, Surani S, Ratnani I. Driving pressure in mechanical ventilation: A review. World J Crit Care Med. Mar 9 2024;13(1):88385. doi:10.5492/wjccm.v13.i1.88385

Every Breath They Take: REALLY Delivering Lung Protective Ventilation Oct 10, 2024

In this episode of the FlightBridgeED Podcast, part of our "Every Breath They Take" series on respiratory critical care, Dr. Michael Lauria explores whether we truly protect the lungs during mechanical ventilation. While the best evidence suggests keeping tidal volumes at 6 cc/kg and plateau pressures below 30 cm H2O, is that enough? ARDS is a complex lung pathology, and as we unravel its intricacies, there may be more to consider.

Join us as we explore the popular concept of driving pressure and introduce the emerging idea of mechanical power. While plateau pressure remains the gold standard, these additional metrics may provide further guidance for adjusting ventilation strategies and minimizing ventilator-induced lung injury, especially in critical care transport settings. Whether you're new to the field or a seasoned professional, this episode offers valuable insights into advanced respiratory management.

Listen to FlightBridgeED anywhere you get your podcasts, or visit us at flightbridgeed.com/explore. While there, explore our other fantastic, free content and award-winning courses to help you excel in your critical care practice.

TAKEAWAYS

Mechanical ventilation is a double-edged sword. It can maintain oxygenation and ventilation but can also damage the lungs.
Lung protective ventilation prevents ventilator-induced lung injury, especially in acute respiratory distress syndrome (ARDS).
Maintaining a plateau pressure below 30 cmH2O is an essential goal in lung protective ventilation.
Driving pressure, the difference between plateau pressure and PEEP, is a surrogate for transpulmonary pressure and may be a useful parameter to consider in lung protective ventilation.
Keeping driving pressure < 15 cmH2O may be beneficial.
Driving pressure might be helpful in titrating peep and optimizing lung recruitment, as well as in identifying patients who may benefit from smaller tidal volumes, even if the plateau pressure is below 30.
Mechanical power, which represents the energy delivered to the lung over time, is a newer concept that requires further research to determine its role in lung protective ventilation.
Optimizing the ventilatory and inspiratory flow rates (in addition to peep, plateau pressure, and tidal volume) may help reduce mechanical power below 17-22 J/min.

REFERENCES

Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. Feb 19 2015;372(8):747-55. doi:10.1056/NEJMsa1410639
Azizi BA, Munoz-Acuna R, Suleiman A, et al. Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study. J Intensive Care. Apr 6 2023;11(1):14. doi:10.1186/s40560-023-00662-7
Battaglini D, Fazzini B, Silva PL, et al. Challenges in ARDS Definition, Management, and Identification of Effective Personalized Therapies. J Clin Med. Feb 9 2023;12(4)doi:10.3390/jcm12041381
Battaglini D, Sottano M, Ball L, Robba C, Rocco PRM, Pelosi P. Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome. J Intensive Med. Jul 2021;1(1):42-51. doi:10.1016/j.jointm.2021.01.003
Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. Jama. Feb 23 2016;315(8):788-800. doi:10.1001/jama.2016.0291
Bugedo G, Retamal J, Bruhn A. Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? Crit Care. Aug 4 2017;21(1):199. doi:10.1186/s13054-017-1779-x
Chiumello D, Froio S, Mistraletti G, et al. Gas exchange, specific lung elastance and mechanical power in the early and persistent ARDS. J Crit Care. Feb 2020;55:42-47. doi:10.1016/j.jcrc.2019.09.022
Coppola S, Caccioppola A, Froio S, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care. May 24 2020;24(1):246. doi:10.1186/s13054-020-02963-x
Cressoni M, Cadringher P, Chiurazzi C, et al. Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. Jan 15 2014;189(2):149-58. doi:10.1164/rccm.201308-1567OC
Duan J, Wang S, Liu P, et al. Early prediction of noninvasive ventilation failure in COPD patients: derivation, internal validation, and external validation of a simple risk score. Ann Intensive Care. Sep 30 2019;9(1):108. doi:10.1186/s13613-019-0585-9
Gattinoni L, Collino F, Camporota L. Mechanical power: meaning, uses and limitations. Intensive Care Med. Apr 2023;49(4):465-467. doi:10.1007/s00134-023-06991-3
Gattinoni L, Marini JJ, Pesenti A, Quintel M, Mancebo J, Brochard L. The "baby lung" became an adult. Intensive Care Med. May 2016;42(5):663-673. doi:10.1007/s00134-015-4200-8
Gattinoni L, Tonetti T, Quintel M. Regional physiology of ARDS. Crit Care. Dec 28 2017;21(Suppl 3):312. doi:10.1186/s13054-017-1905-9
Goligher EC, Dres M, Patel BK, et al. Lung- and Diaphragm-Protective Ventilation. Am J Respir Crit Care Med. Oct 1 2020;202(7):950-961. doi:10.1164/rccm.202003-0655CP
Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. Nov 29 2016;20(1):384. doi:10.1186/s13054-016-1556-2
Ogbu OC, Martin GS, Murphy DJ. A Few Milliliters of Prevention: Lung-Protective Ventilation Decreases Pulmonary Complications. Crit Care Med. Oct 2015;43(10):2263-4. doi:10.1097/ccm.0000000000001234
Paudel R, Trinkle CA, Waters CM, et al. Mechanical Power: A New Concept in Mechanical Ventilation. Am J Med Sci. Dec 2021;362(6):537-545. doi:10.1016/j.amjms.2021.09.004
Sahetya SK, Hager DN, Stephens RS, Needham DM, Brower RG. PEEP Titration to Minimize Driving Pressure in Subjects With ARDS: A Prospective Physiological Study. Respir Care. May 2020;65(5):583-589. doi:10.4187/respcare.07102
Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. Nov 2018;44(11):1914-1922. doi:10.1007/s00134-018-5375-6
Simonis FD, Binnekade JM, Braber A, et al. PReVENT--protective ventilation in patients without ARDS at start of ventilation: study protocol for a randomized controlled trial. Trials. May 24 2015;16:226. doi:10.1186/s13063-015-0759-1
Tongyoo S, Viarasilpa T, Deawtrakulchai P, Subpinyo S, Suppasilp C, Permpikul C. Comparison of limited driving pressure ventilation and low tidal volume strategies in adults with acute respiratory failure on mechanical ventilation: a randomized controlled trial. Ther Adv Respir Dis. Jan-Dec 2024;18:17534666241249152. doi:10.1177/17534666241249152
van Meenen DMP, Algera AG, Schuijt MTU, et al. Effect of mechanical power on mortality in invasively ventilated ICU patients without the acute respiratory distress syndrome: An analysis of three randomised clinical trials. Eur J Anaesthesiol. Jan 1 2023;40(1):21-28. doi:10.1097/eja.0000000000001778
Wu HP, Chu CM, Chuang LP, et al. The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation. Diagnostics (Basel). Oct 10 2021;11(10)doi:10.3390/diagnostics11101862
Yehya N, Hodgson CL, Amato MBP, et al. Response to Ventilator Adjustments for Predicting Acute Respiratory Distress Syndrome Mortality. Driving Pressure versus Oxygenation. Ann Am Thorac Soc. May 2021;18(5):857-864. doi:10.1513...

Maternal Sepsis Oct 03, 2024

In this compelling episode of the FlightBridgeED Podcast, Dr. Michael Lauria delves into one of the most critical yet underappreciated aspects of emergency and critical care medicine: maternal sepsis and septic shock. As maternal mortality rates rise across the U.S., critical care transport providers are increasingly faced with the challenge of managing septic mothers and post-partum patients. Dr. Lauria, alongside special guest Dr. Elizabeth Garchar, MD, FACOG, an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care, breaks down the latest evidence and best practices for diagnosing and treating septic shock in obstetrical patients.

Explore the pathophysiology of sepsis, the role of cytokine release in organ dysfunction, and the management strategies for ensuring maternal and fetal well-being. Whether you're in pre-hospital care, the ICU, or critical care transport, this episode is packed with insights for all levels of healthcare providers.

Key Takeaways:

Early Sepsis Detection & Organ Impact: Sepsis isn't just about blood pressure. Inflammatory cytokines can cause brain dysfunction (septic encephalopathy), kidney damage, and even septic cardiomyopathy. Be vigilant with these patients.
Unique Obstetric Considerations: Pregnancy causes physiological changes that can mask early sepsis signs. Differentiating between normal pregnancy symptoms and systemic inflammatory response can be challenging but is crucial for survival.
Aggressive Management is Key: Whether it's antibiotics, fluid resuscitation, or early norepinephrine administration, aggressively managing septic obstetric patients can significantly improve outcomes.
Antibiotics First, Always: Ensure that septic patients receive broad-spectrum antibiotics within the first hour. It’s a key factor in preventing further deterioration.
Fluid Responsiveness: Use dynamic assessments to determine fluid responsiveness instead of blindly administering large amounts of fluid.
Pressors are Safe: Norepinephrine is a safe and recommended first-line vasopressor for septic pregnant patients. Don't hesitate to use it.

Listen anywhere you get your podcasts or directly from our website at flightbridgeed.com. While you’re there, be sure to explore our award-winning courses designed to elevate your critical care expertise.

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References

1. Albright CM, Ali TN, Lopes V, Rouse DJ, Anderson BL. The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. Jul 2014;211(1):39 e1-8. doi:10.1016/j.ajog.2014.03.010

2. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. Sep 2012;120(3):689-706. doi:10.1097/AOG.0b013e318263a52d

3. Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. Oct 2013;117(4):944-950. doi:10.1213/ANE.0b013e3182a009c3

4. Chau A, Tsen LC. Fetal optimization during maternal sepsis: relevance and response of the obstetric anesthesiologist. Curr Opin Anaesthesiol. Jun 2014;27(3):259-66. doi:10.1097/ACO.0000000000000077

5. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011-2013. Obstet Gynecol. Aug 2017;130(2):366-373. doi:10.1097/AOG.0000000000002114

6. Dellinger RP, Rhodes A, Evans L, et al. Surviving Sepsis Campaign. Crit Care Med. Apr 1 2023;51(4):431-444. doi:10.1097/CCM.0000000000005804

7. Evans L, Rhodes A, Alhazzani W, et al. Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Crit Care Med. Nov 1 2021;49(11):1974-1982. doi:10.1097/CCM.0000000000005357

8. Fan S-R, Liu P, Yan S-M, Huang L, Liu X-P. New Concept and Management for Sepsis in Pregnancy and the Puerperium. Maternal-Fetal Medicine. 2020;2(4):231-239. doi:10.1097/fm9.0000000000000058

9. Guarino M, Perna B, Cesaro AE, et al. 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department. J Clin Med. Apr 28 2023;12(9)doi:10.3390/jcm12093188

10. Guinn DA, Abel DE, Tomlinson MW. Early goal directed therapy for sepsis during pregnancy. Obstet Gynecol Clin North Am. Sep 2007;34(3):459-79, xi. doi:10.1016/j.ogc.2007.06.009

11. Joseph J, Sinha A, Paech M, Walters BN. Sepsis in pregnancy and early goal-directed therapy. Obstet Med. Sep 2009;2(3):93-9. doi:10.1258/om.2009.090024

12. Knowles SJ, O'Sullivan NP, Meenan AM, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG. Apr 2015;122(5):663-71. doi:10.1111/1471-0528.12892

13. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. Jun 2006;34(6):1589-96. doi:10.1097/01.CCM.0000217961.75225.E9

14. Oud L, Watkins P. Evolving trends in the epidemiology, resource utilization, and outcomes of pregnancy-associated severe sepsis: a population-based cohort study. J Clin Med Res. Jun 2015;7(6):400-16. doi:10.14740/jocmr2118w

15. Plante LA. Management of Sepsis and Septic Shock for the Obstetrician-Gynecologist. Obstet Gynecol Clin North Am. Dec 2016;43(4):659-678. doi:10.1016/j.ogc.2016.07.010

16. Plante LA, Pacheco LD, Louis JM. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol. Apr 2019;220(4):B2-b10. doi:10.1016/j.ajog.2019.01.216

17. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. May 21 2015;372(21):1996-2005. doi:10.1056/NEJMoa1411162

18. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. Jun 2014;2(6):e323-33. doi:10.1016/S2214-109X(14)70227-X

19. Shields A, de Assis V, Halscott T. Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis. Obstet Gynecol. Aug 1 2021;138(2):289-304. doi:10.1097/aog.0000000000004471

20. Snyder CC, Barton JR, Habli M, Sibai BM. Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes. J Matern Fetal Neonatal Med. Mar 2013;26(5):503-6. doi:10.3109/14767058.2012.739221

21. Timezguid N, Das V, Hamdi A, et al. Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission. Int J Obstet Anesth. Jan 2012;21(1):51-5. doi:10.1016/j.ijoa.2011.10.009

22. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. Jun 2010;23(3):249-54. doi:10.1097/QCO.0b013e328339257c

23. Wang T, Liao L, Tang X, Li B, Huang S. Effects of different vasopressors on the contraction of the superior mesenteric artery and uterine artery in rats during late pregnancy. BMC Anesthesiol. Jun 30 2021;21(1):185. doi:10.1186/s12871-021-01395-6

24. Xu S, Shen X, Liu S, Yang J, Wang X. Efficacy and safety of norepinephrine versus phenylephrine for the management of maternal hypotension during cesarean delivery with spinal anesthesia: A systematic review and m...

Maternal and Fetal Physiology in Flight Sep 26, 2024

In this episode of the FlightBridgeED Podcast: MDCAST, Dr. Michael Lauria is joined by Dr. Elizabeth Garchar, MD, FACOG, an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care and is unique in that she flies regularly with our
critical care transport teams as a retrieval OBGYN/MFM. They are also joined by Dr. Alixandria Pfeiffer, an MFM Fellow at the University of Texas in San Antonio. Together, they dive into the complex and underexplored world of obstetric critical care transport. With maternal mortality rates on the rise in the U.S., this episode addresses the vital role critical care transport teams play in improving outcomes for high-risk pregnancies.

The discussion focuses on monitoring pregnant patients during transport, exploring topics such as flight physiology, continuous fetal monitoring (CFM), and the challenges posed by different transport environments. Dr. Pfeiffer shares her groundbreaking research on the feasibility of fetal monitoring during transport and its potential impact on both maternal and fetal outcomes.

Key Takeaways:

In obstetric transport, continuous fetal monitoring (CFM) is feasible and can provide critical insights during maternal transport, though it poses unique challenges depending on transport type (flight, ground).
Flight transport often results in a slight decrease in maternal oxygen saturation and systolic blood pressure, suggesting the need for standardized oxygen therapy protocols during transport.
Understanding fetal physiology and monitoring techniques is essential, especially in high-risk pregnancy transports where the health of both mother and baby is at stake.

Whether you're a seasoned critical care provider or just beginning your journey in EMS or critical care transport medicine, this episode delivers insights into the practical realities of OB transport.

Listen now on any podcast platform or directly from our website at flightbridgeed.com. While you're there, explore our highly successful and award-winning courses, designed to elevate your career in critical care medicine. Thank you so much for listening! We couldn't make this podcast without you.

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References

Pfeiffer AF, Munter BT, Munoz J, Ramsey PS, Byrne JJ. Maternal Physiologic Adaptations During Transport. Am J Obstet Gynecol. 2023; 228(1): S259-S260.
Pfeiffer AF, Munoz JL, Neuhoff BK, Boyd AR, Moreno A, Ramsey PS. Fetal Cardiotocographic Monitoring During Maternal Transport. Am J Obstet Gynecol. 2022; 226(1): S609.
Foley MR, Strong, Jr TH, Garite TJ. eds. Obstetric Intensive Care Manual, 5e. McGraw Hill; . Accessed May 24, 2022. https://obgyn.mhmedical.com/content.aspx?bookid=2379&sectionid=185956675

H.R.315 - Improving Access to Maternity Care Act, (2018). Available at: https://www.congress.gov/bill/115th-congress/house-bill/315.

CRASH & BURN: Airway Management in Hemodynamically Unstable Patients - Part 2 Sep 19, 2024

In Episode 264 of the FlightBridgeED Podcast: MDCAST, Dr. Mike Lauria, Dr. Jeff Jarvis, and trauma anesthesiologist Dr. Chris Stevens return for Part 2 of their deep dive into airway management in profoundly hemodynamically unstable patients. In this episode, the trio explores controversial topics such as the use of pressors in trauma patients, mechanical ventilation in the pre-hospital setting, and the pharmacology of paralytic agents like rocuronium. They also address the highly debated practice of withholding sedatives in certain critically ill patients and emphasize the importance of proper timing when using neuromuscular blockade. This episode provides practical insights for new and seasoned pre-hospital and critical care transport medicine providers, especially when managing CRASH airways and peri-arrest situations.

Some Takeaways to Listen For in this Episode:

Pressors in Trauma Patients: Dispels the myth that trauma patients shouldn’t receive pressors. Pressors can temporarily stabilize blood pressure while awaiting blood products or other resuscitation efforts.
Mechanical Ventilation Post-Intubation: Highlights the importance of gentle, positive-pressure ventilation to avoid worsening hypotension in trauma patients.
Rocuronium Use: This episode discusses optimal dosing and the importance of waiting the full 60–90 seconds for the drug to take effect to ensure successful intubation.
Withholding Sedation: Explores the controversial practice of omitting sedatives in patients with a GCS of 3 who are completely unresponsive and peri-arrest. This is common in trauma anesthesia but remains debated in pre-hospital and critical care transport settings.

CRASH & BURN: Airway Management in Hemodynamically Unstable Patients - Part 1 Sep 12, 2024

In this thought-provoking episode of the FlightBridgeED Podcast: MDCAST, Dr. Mike Lauria is joined by Dr. Jeff Jarvis and Dr. Chris Stevens to tackle the critical and potentially controversial topic of airway management in hemodynamically unstable patients. The discussion dives into complex scenarios, decision-making challenges, and balancing the benefits of sedation with the risks of compromising a patient’s stability. From discussing medication-assisted intubation to exploring the concept of "crash airway" situations, the episode challenges conventional wisdom and encourages providers to think critically about their approach to airway management. This episode not only raises important questions but also provides valuable insights for both new and seasoned practitioners.

Some Takeaways to Listen For in this Episode:

Balance Between Sedation and Hemodynamic Stability: It is important to understand how sedative agents like ketamine and etomidate affect blood pressure in critically ill patients. Over-sedation, especially in hemodynamically unstable patients, can lead to adverse outcomes. A nuanced approach to dosing is necessary.
Awareness During Intubation: Awareness under paralysis can increase the risk of PTSD and depression. The conversation highlights the importance of avoiding awareness during airway management, especially using longer-lasting paralytics like rocuronium.
Resuscitate Before Intubate: Emphasizes the need to stabilize patients, particularly their hemodynamics, before intubation. This can prevent worsening outcomes and cardiac arrest during emergency airway procedures.
Decision-Making in Airway Management: Highlights that airway decisions are not black and white. Situational awareness, clinical judgment, and crew confidence are crucial, especially in determining whether to intubate pre-hospital or manage the airway in transit.
Use of Supraglottic Airways: In emergencies where intubation is difficult or risky, supraglottic airways are recommended as a temporary measure to ensure oxygenation and ventilation until more definitive care is available.

PHACTORS: Impacting the "Platinum 10" Post-Intubation Aug 20, 2024

In this engaging and insightful episode of the FlightBridgeED Podcast, Eric Bauer is joined by Dr. Michael Lauria as they delve into the intricacies of post-intubation care and the critical factors that impact patient outcomes during the first 10 minutes after intubation. Building on the well-established concepts of airway management and resuscitation, the discussion introduces the new acronym PHACTORS, which stands for Positive Pressure, Hypoxia, Acidemia, Cardiac Output, Transfer, Ongoing Pharmacology, Resuscitation, and Suction. Eric and Dr. Lauria explore how these elements play a pivotal role in the success or failure of post-intubation management, emphasizing the importance of maintaining vigilance during this critical phase. With practical tips, evidence-based insights, and real-world examples, this episode is a must-listen for anyone involved in pre-hospital critical care.

KEY TAKEAWAYS:

Prioritize Post-Intubation Monitoring: The first 10 minutes after intubation are critical. Continuously monitor for hypotension and hypoxia, even if the initial intubation appears successful.
Transition to Ventilator Early: Whenever possible, transition intubated patients from BVM to a mechanical ventilator as soon as possible to ensure consistent and controlled ventilation, which reduces the risk of over- or under-ventilation.
Use Head-Elevated Positioning: Intubate patients in a head-elevated position (30 degrees) whenever possible to maintain functional residual capacity and reduce the risk of derecruitment and hypoxia.
Suction Regularly: Proactively suction the ET tube and oral cavity to maintain airway patency. This helps prevent complications like ventilator-associated pneumonia and ensures optimal oxygenation.
Be Ready with Push-Dose Pressors: Have push-dose pressors ready during and after intubation, especially in trauma patients or those with borderline hemodynamics, to quickly address any sudden drops in blood pressure.
Assess and Manage Acidosis Individually: Not all acidosis requires aggressive ventilation. Consider the patient's overall condition, and tailor your ventilation strategy based on the specific type and cause of acidosis.
Regular Sedation and Analgesia Dosing: Avoid under-sedation, particularly with long-acting paralytics like rocuronium. Set regular intervals for administering sedation and analgesia to ensure patient comfort and avoid awareness of paralysis.
Proactively Manage Cardiac Output: In patients with compromised cardiac function, focus on optimizing preload, afterload, and contractility. Use fluids, inotropes, and vasopressors as needed to maintain stable hemodynamics.
Secure and Streamline Lines for Transport: Before transferring a patient, ensure all lines are secured and organized to prevent dislodgement or kinking during movement. Keep access points readily available for quick medication administration.
Understand the Impact of Positive Pressure: Transitioning from spontaneous breathing to mechanical ventilation can significantly impact venous return and cardiac output. Be prepared to manage these changes, especially in hemodynamically unstable patients.

Show Notes...

A human, even when paying attention can deliver injurious tidal volume breaths that may go in "easy" but are probably injuring the lungs (Dafilou B, Schwester D, Ruhl N, Marques-Baptista A. It's in the bag: tidal volumes in adult and pediatric bag valve masks. West J Emerg Med. 2020;21(3):722–2021.)
Not only are the volumes too big, but we likely WAY over breath for patients and that can be really, really bad especially after cardiac arrest or in TBI (common reasons patients get intubated...right?) (Dumont TM, Visioni AJ, Rughani AI, Tranmer BI, Crookes B. prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 2010;27(7):1233–41.)
More issues with BVM ventilation that shows it's not consistent
Siegler J, Kroll M, Wojcik S, Moy HP. Can EMS providers provide appropriate tidal volumes in a simulated adult-sized patient with a pediatric-sized bag-valve-mask? Prehosp Emerg Care. 2017;21(1):74–8.
Turki M, Young MP, Wagers SS, Bates JH. Peak pressures during manual ventilation. Respir Care. 2005;50(3):340–4.
Kroll M, Das J, Siegler J. Can altering grip technique and bag size optimize volume delivered with bag-valve-mask by emergency medical service providers? Prehosp Emerg Care. 2019;23(2):210–4.
Mechanical ventilation provides more consistency and automation of a simple task with monitoring parameters (alarms) that can make it safe and effective for paramedics to actually put their brain energy to important clinical decisions and complete other tasks (Weiss SJ, Ernst AA, Jones R, Ong M, Filbrun T, Augustin C, Barnum M, Nick TG. Automatic transport ventilator versus bag valve in the EMS setting: a prospective, randomized trial. South Med J. 2005;98(10):970–6.)
Starting mechanical ventilation and safe ventilator settings in the prehospital setting seems to make ED providers more likley to put in the right settings and continue appropriate lung protective ventilation...at least in ARDS (Stephens RJ, Siegler JE, Fuller BM. Mechanical ventilation in the prehospital and emergency department environment. Respir Care. 2019;64 (5):595–603.)
Here's a really solid position paper from NAEMSP on it that kind of summarizes everything including the specific clinical times when it may be more helpful like cardiac arrest, trauma, etc (Baez, A. A., Qasim, Z., Wilcox, S., Weir, W. B., Loeffler, P., Golden, B. M., … Levy, M. (2022). Prehospital Mechanical Ventilation: An NAEMSP Position Statement and Resource Document. Prehospital Emergency Care, 26(sup1), 88–95. https://doi.org/10.1080/10903127.2021.1994676)

Every Breath They Take: Part 2 Jul 29, 2024

PART 2 of 2

In this episode, Dr. Michael Lauria is joined by several EM/Critical Care and Transport/Retrieval physicians as we discuss the management of acute respiratory distress syndrome (ARDS) in the critical care transport setting. We cover the pathophysiology of ARDS, the criteria for diagnosis, and the basics of lung protective ventilation. We also explore the concept of driving pressure and its role in determining optimal ventilation settings. The conversation highlights the importance of individualizing treatment based on patient characteristics and monitoring parameters such as plateau pressure, driving pressure, and compliance.

Our team provides practical tips for adjusting ventilation settings and emphasizes the need for ongoing assessment and optimization. In the previous episode, we started out with some fundamental concepts of mechanical ventilation: the approach to low tidal volumes in ARDS patients and the use of point-of-care blood gases. We also explored the use of steroids in ARDS, the target oxygen saturation levels, and the use of paralysis in unstable patients. In addition, we touched on controversial topics such as inhaled pulmonary vasodilators in ARDS as well as the application of evidenced-based therapies such as proning in the transport environment (in this episode, part 2). Also, in this part of the conversation, we review the use of alternative ventilator modes, such as APRV, and the indications for ECMO in refractory ARDS. We emphasize the importance of optimizing conventional, evidence-based therapies before considering ECMO and highlight the need for clear guidelines and training when using these advanced interventions. We also discuss the challenges and potential complications associated with ECMO.

Takeaways

ARDS is a syndrome characterized by acute onset, bilateral infiltrates on imaging, and hypoxemia.
The diagnosis of ARDS is based on criteria such as acute onset, infectious or inflammatory etiology, bilateral opacities on imaging, and impaired oxygenation.
Lung protective ventilation aims to minimize lung injury by using low tidal volumes (6-8 ml/kg), maintaining plateau pressures below 30 cmH2O, and keeping FiO2 below 60%.
Driving pressure, the difference between plateau pressure and PEEP, is a marker of lung compliance and can be used to guide ventilation adjustments.
Individualized management is crucial, considering factors such as patient characteristics, response to therapy, and monitoring parameters.
Regular assessment and optimization of ventilation settings are necessary to ensure effective and safe management of ARDS.
Low tidal volumes should be based on the patient's pH and PCO2, with a focus on maintaining a safe pH level. If crews are unable to measure these parameters not decreasing tidal volumes lower than 4 cc/kg is reasonable.
Point-of-care blood gases are essential for monitoring patients on low tidal volumes and making adjustments as needed.
Oxygen saturation targets should be individualized based on the patient's condition and physiology, with a range above 88-92% often considered reasonable. However, this issue is controversial, and occasionally, lower saturations are considered acceptable.
Steroids may be beneficial in ARDS patients, especially those with severe pneumonia, but the timing and dosing should be determined based on the patient's specific situation.
Paralysis can be considered in unstable ARDS patients who cannot tolerate low tidal volumes, but it should be used selectively and in conjunction with deep sedation.
The use of inhaled pulmonary vasodilators in ARDS is controversial, and no significant mortality benefit has been demonstrated. However, they may be considered a salvage therapy in patients on their way to an ECMO center or when other interventions have been exhausted. Inhaled pulmonary vasodilators, such as epoprostenol, can improve oxygenation and pulmonary arterial pressure in patients with ARDS and RV failure.
The use of inhaled pulmonary vasodilators should be based on individual patient characteristics and the availability of resources.
Proning in transport has been shown to be safe and effective. It should be considered for select cases, such as patients with high pulmonary arterial pressure or basilar atelectasis.
Transport teams should be prepared to continue inhaled pulmonary vasodilator therapy if the patient is already receiving it.
ECMO should be considered when conventional therapies have failed, and the patient's condition is reversible and not contraindicated.
ECMO transport requires specialized training, clear guidelines, and ongoing communication with the receiving center.
Alternative ventilator modes, such as APRV, have not shown significant benefit in large trials. Their use is controversial but not unreasonable in certain circumstances. Implementing these settings requires training, education, and clear protocols. Generally speaking, they should be used judiciously and in consultation with the receiving physician.
Optimizing conventional therapies and providing high-quality care can often obviate the need for ECMO.
Transport teams should be proactive in discussing potential ECMO candidates with the receiving physician and considering the appropriateness of ECMO for each patient.

References:

Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-x
Gattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486
Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7
Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669
Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8. doi: 10.1056/NEJM200005043421801.
Grasselli G, Calfee CS, Camporota L, et al; European Society of Intensive Care Medicine Taskforce on ARDS. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023 Jul;49(7):727-759. doi: 10.1007/s00134-023-07050-7.
Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, Bellani G, Brower RG, Burry L, Chen JT, Hodgson C, Hough CL, Lamontagne F, Law A, Papazian L, Pham T, Rubin E, Siuba M, Telias I, Patolia S, Chaudhuri D, Walkey A, Rochwerg B, Fan E. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36. doi: 10.1164/rccm.202311-2011ST.

PREOXI Trial Crossover Episode w/ Dr. Jeff Jarvis Jul 22, 2024

This is a must-listen! What’s the best way to pre-oxygenate our patients prior to intubation? The evidence for this question has been mixed for some time. Dr Jarvis discusses the PREOXI Trial, which directly compares preoxygenation with non-invasive ventilation compared to a face mask to see which provides the best protection against peri-intubation hypoxia. This is an important trial that sheds light on a key component of our bundle of care to make intubation safer.

Citations:

Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, Resnick-Ault D, White HD, Gandotra S, Doerschug KC, et al.: Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. (2024)
Jarvis JL, Gonzales J, Johns D, Sager L: Implementation of a Clinical Bundle to Reduce Out-of-Hospital Peri-intubation Hypoxia. Annals of Emergency Medicine. 2018;72:272–9.
Groombridge C, et al: A prospective, randomised trial of pre-oxygenation strategies available in the pre-hospital environment. Anaesthesia. 2017;72:580–4.
Groombridge C, et al: Assessment of Common Preoxygenation Strategies Outside of the Operating Room Environment. Acad Emerg Med. 2016;March;23(3):342–6.
Baillard C, et al: Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med. 2006;July 15;174(2):171–7.
Ramkumar V, et al: Preoxygenation with 20-degree head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth. 2011;25:189–94.
Pourmand A, et al: Pre-oxygenation: Implications in emergency airway management. American Journal of Emergency Medicine. doi: 10.1016/j.ajem.2017.06.006
Solis A, Baillard C: Effectiveness of preoxygenation using the head-up position and noninvasive ventilation to reduce hypoxaemia during intubation. Ann Fr Anesth Reanim. 2008;June;27(6):490–4.
April MD, Arana A, Reynolds JC, Carlson JN, Davis WT, Schauer SG, Oliver JJ, Summers SM, Long B, Walls RM, et al.: Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Resuscitation. 2021;May;162:403–11.
Trent SA, Driver BE, Prekker ME, Barnes CR, Brewer JM, Doerschug KC, Gaillard JP, Gibbs KW, Ghamande S, Hughes CG, et al.: Defining Successful Intubation on the First Attempt
Using Both Laryngoscope and Endotracheal Tube Insertions: A Secondary Analysis of Clinical Trial Data. Annals of Emergency Medicine. 2023;82(4):S0196064423002135.
Pavlov I, Medrano S, Weingart S: Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. AJEM. 2017;35(8):1184–9.

Every Breath They Take: ARDS Part 1 Jul 04, 2024

PART 1 of 2

In this episode, Dr. Michael Lauria is joined by several EM/Critical Care and Transport/Retrieval physicians as we discuss the management of acute respiratory distress syndrome (ARDS) in the critical care transport setting. We cover the pathophysiology of ARDS, the criteria for diagnosis, and the basics of lung protective ventilation. We also explore the concept of driving pressure and its role in determining optimal ventilation settings. The conversation highlights the importance of individualizing treatment based on patient characteristics and monitoring parameters such as plateau pressure, driving pressure, and compliance.

Our team provides practical tips for adjusting ventilation settings and emphasizes the need for ongoing assessment and optimization. We start out with some fundamental concepts of mechanical ventilation: the approach to low tidal volumes in ARDS patients and the use of point-of-care blood gases. We also explore the use of steroids in ARDS, the target oxygen saturation levels, and the use of paralysis in unstable patients. In addition, we touch on controversial topics such as inhaled pulmonary vasodilators in ARDS as well as the application of evidenced-based therapies such as proning in the transport environment (part 2). In the final part of the conversation, we review the use of alternative ventilator modes, such as APRV, and the indications for ECMO in refractory ARDS. We emphasize the importance of optimizing conventional, evidence-based therapies before considering ECMO and highlight the need for clear guidelines and training when using these advanced interventions. We also discuss the challenges and potential complications associated with ECMO.

Takeaways

ARDS is a syndrome characterized by acute onset, bilateral infiltrates on imaging, and hypoxemia.
The diagnosis of ARDS is based on criteria such as acute onset, infectious or inflammatory etiology, bilateral opacities on imaging, and impaired oxygenation.
Lung protective ventilation aims to minimize lung injury by using low tidal volumes (6-8 ml/kg), maintaining plateau pressures below 30 cmH2O, and keeping FiO2 below 60%.
Driving pressure, the difference between plateau pressure and PEEP, is a marker of lung compliance and can be used to guide ventilation adjustments.
Individualized management is crucial, considering factors such as patient characteristics, response to therapy, and monitoring parameters.
Regular assessment and optimization of ventilation settings are necessary to ensure effective and safe management of ARDS.
Low tidal volumes should be based on the patient's pH and PCO2, with a focus on maintaining a safe pH level. If crews are unable to measure these parameters not decreasing tidal volumes lower than 4 cc/kg is reasonable.
Point-of-care blood gases are essential for monitoring patients on low tidal volumes and making adjustments as needed.
Oxygen saturation targets should be individualized based on the patient's condition and physiology, with a range above 88-92% often considered reasonable. However, this issue is controversial, and occasionally, lower saturations are considered acceptable.
Steroids may be beneficial in ARDS patients, especially those with severe pneumonia, but the timing and dosing should be determined based on the patient's specific situation.
Paralysis can be considered in unstable ARDS patients who cannot tolerate low tidal volumes, but it should be used selectively and in conjunction with deep sedation.
The use of inhaled pulmonary vasodilators in ARDS is controversial, and no significant mortality benefit has been demonstrated. However, they may be considered a salvage therapy in patients on their way to an ECMO center or when other interventions have been exhausted. Inhaled pulmonary vasodilators, such as epoprostenol, can improve oxygenation and pulmonary arterial pressure in patients with ARDS and RV failure.
The use of inhaled pulmonary vasodilators should be based on individual patient characteristics and the availability of resources.
Proning in transport has been shown to be safe and effective. It should be considered for select cases, such as patients with high pulmonary arterial pressure or basilar atelectasis.
Transport teams should be prepared to continue inhaled pulmonary vasodilator therapy if the patient is already receiving it.
ECMO should be considered when conventional therapies have failed, and the patient's condition is reversible and not contraindicated.
ECMO transport requires specialized training, clear guidelines, and ongoing communication with the receiving center.
Alternative ventilator modes, such as APRV, have not shown significant benefit in large trials. Their use is controversial but not unreasonable in certain circumstances. Implementing these settings requires training, education, and clear protocols. Generally speaking, they should be used judiciously and in consultation with the receiving physician.
Optimizing conventional therapies and providing high-quality care can often obviate the need for ECMO.
Transport teams should be proactive in discussing potential ECMO candidates with the receiving physician and considering the appropriateness of ECMO for each patient.

References:

Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-x
Gattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486
Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7
Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669
Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8. doi: 10.1056/NEJM200005043421801.
Grasselli G, Calfee CS, Camporota L, et al; European Society of Intensive Care Medicine Taskforce on ARDS. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023 Jul;49(7):727-759. doi: 10.1007/s00134-023-07050-7.
Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, Bellani G, Brower RG, Burry L, Chen JT, Hodgson C, Hough CL, Lamontagne F, Law A, Papazian L, Pham T, Rubin E, Siuba M, Telias I, Patolia S, Chaudhuri D, Walkey A, Rochwerg B, Fan E. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36. doi: 10.1164/rccm.202311-2011ST.
Matthay MA, Arabi Y, Arroliga AC, Bernard...

Refractory Vasodilatory Septic Shock with Dr. Brittney Bernardoni Jun 18, 2024

In this episode of the FlightBridgeED MDCast, Dr. Mike Lauria and Dr. Brittney Bernardoni discuss the management of refractory hypotension in septic patients. They explore the use of norepinephrine as the initial pressor of choice and the benefits of vasopressin as a second-line agent. They also discuss the use of inotropes, such as epinephrine and dobutamine, and the importance of assessing cardiac function with ultrasound. The conversation provides practical guidance for managing hypotensive septic patients in various clinical settings. In this conversation, the hosts discuss the use of different therapies for refractory shock and sepsis. They cover topics such as pressors, fluid resuscitation, steroids, bicarbonate, calcium, and all levels of therapies. Mike and Britteny provide insight into the evidence-based use of these therapies and offer practical tips for their administration in the hospital and in the critical care transport medicine field. Overall, the conversation provides a comprehensive overview of refractory shock and sepsis management.

Key Takeaways to Pay Attention to During This Discussion

Mean arterial pressure (MAP) is the best number to assess hypotension, with a goal of MAP > 65.
Norepinephrine is the workhorse pressor for septic patients, providing both venous and arterial constriction.
Vasopressin is a valuable second-line agent, especially for patients with right heart dysfunction or acidosis.
There is no maximum dose for norepinephrine, but doses above 2.0 mcg/kg/min may not provide additional benefit.
Ultrasound assessment of cardiac function is crucial in determining the need for inotropes.
Epinephrine is the preferred inotrope due to its increased squeeze and peripheral vasoconstriction.
Dobutamine is not commonly used in vasoplegic shock due to its peripheral vasodilation effects. Pressors such as norepinephrine are the first-line therapy for refractory shock and sepsis.
Steroids, specifically hydrocortisone, can be considered in patients on norepinephrine more than 0.25.
Bicarbonate can be used to increase pH, but caution must be taken to ensure proper ventilation.
Calcium chloride or calcium gluconate can be used to address low calcium levels.
In refractory cases, level three therapies, such as angiotensin 2, methylene blue, and cyanocid, may be considered.

Nightmare Series: The DKA Dilemma with Jean-Francois Couture May 20, 2024

As night falls, a critical medical battle against Diabetic Ketoacidosis (DKA) begins. This formidable foe, hidden within the body's chemistry, pushes patients towards peril. In this thrilling installment of the FlightBridgeED Nightmare Series, EMS providers face a relentless race against time, striving to subdue the devastating effects of DKA before it's too late.

Host Eric Bauer and Jean-Francois Couture, Emergency Physician and Director of Operations at Applications MD, guide us through the intricacies of managing this complex medical emergency. With every passing moment, the tension escalates. Will our EMS warriors decode the mysteries of DKA in time to save their patient? Tune in to discover if they can deliver salvation from the brink of metabolic disaster.

FAST Archives: Oxygenation Assassin May 10, 2024

In this final episode of The FAST Archives miniseries, we're thrilled to present a talk from Chris Meeks. Chris is not just any paramedic and educator; he's a veteran with a knack for making complex medical topics approachable. Today, he's breaking down "Oxygenation Assassin," a deep dive into the world of hypoplastic left heart syndrome—a challenging congenital heart defect.

Chris will walk us through the hemodynamic hurdles of the condition and share essential tips for acute care management. You'll get a solid grasp of the underlying physiology and see how learning about conditions like this - the "small percentage" cases - can drastically improve patient outcomes.

If you enjoy this episode, we invite you to check out the other talks from the FAST Archives miniseries. You can also catch these speakers and more at FAST24 happening June 10 - 12, 2024, in Wilmington, North Carolina. Tickets are still available at FBEFAST.COM. Enjoy the episode and we hope to see you at FAST24.

FAST Archives: Air Rescue During WEF: Special Conditions and Problems May 09, 2024

In this episode of The FAST Archives, we explore a unique challenge in emergency medical planning from Helge Junge, who leads a team specialized in air rescue operations. Helge shares the intricate details of developing a comprehensive care and transport system for the World Economic Forum, held in the challenging and mountainous terrain of the Swiss Alps. The forum's location posed significant logistical and medical challenges, including potential mass casualty scenarios and limited local medical resources.

His talk, "Air Rescue During WEF: Special Conditions and Problems," provides an in-depth analysis of how his team overcame these hurdles to establish a robust emergency response system. The solutions they created ensured attendees' safety and well-being and offered valuable lessons for managing mass casualty incidents (MCI) and rescue operations in austere conditions.

If you enjoy this talk, check out the other talks from the FAST Archives miniseries! We hope you enjoy them!

FAST Archives: A Change of Heart May 08, 2024

In this enlightening episode of The FAST Archives, we feature a compelling talk by Bruce Hoffman titled "A Change of Heart." Bruce, a seasoned critical care nurse and paramedic with a rich background in ICU, ER, trauma, and cardiology, challenges conventional wisdom in the treatment of STEMI patients. Drawing on the latest evidence, he questions the rush to percutaneous coronary intervention (PCI) and whether our current metrics, like door-to-reperfusion times, are truly in the best interest of patient outcomes.

Bruce's engaging discussion not only covers cardiac care insights but also includes a curious anecdote about grand pianos and emails, adding a touch of humor and relatability to a deeply technical subject. Join us to explore how these insights could transform STEMI care protocols and improve patient care.

Check out all the talks from the FAST Archives series for more great talks like this one! Interested in seeing these speakers in person? This is your official invitation to come join us for FAST24! We hope to see you there!

FAST Archives: Equity in Emergency Care: What Does That Even Mean? May 07, 2024

In this episode of The FAST Archives, Ritu Sahni explores the essential topic of equity in emergency care. With a background that includes EMS Medical Director roles, emergency medicine, and air ambulance experience, Ritu provides a comprehensive look at what it means to care for entire communities.

In his talk, "Equity in Emergency Care: What Does That Even Mean?", Ritu unpacks the challenges of delivering equitable care in EMS and what it takes to make sure every individual gets the support they need. His insights, drawn from years of experience and his passion for public health, offer valuable guidance for EMS professionals committed to serving their communities.

Tune in to gain a deeper understanding of how we can achieve equity in emergency care and why it's so crucial in our roles as public health providers.

FAST Archives: Parkland May 06, 2024

In this deeply impactful episode of The FAST Archives, we focus on the tragic events of the Parkland school shooting on February 14, 2018, through the lens of Peter Antevy, who served as the EMS Medical Director on the scene that day. With his vast expertise in pre-hospital pediatrics and emergency medicine, Peter offers a detailed and respectful reflection on that tragic day, shedding light on what unfolded, what could have been improved, and the critical importance of being prepared for such events.

The talk also pays tribute to the efforts of Max Schachter, whose son Alex was among the victims. Max has since dedicated himself to preventing future tragedies, and Peter highlights his efforts to make a difference in school safety.

In the show notes, you'll find resources mentioned in the talk and additional materials that have been provided to support responders and communities in preparing for and preventing similar tragedies.

We present this episode in memory of the 17 lives lost and in support of the families and communities affected by the Parkland shooting.

Show notes:
Safe Schools for Alex: https://www.safeschoolsforalex.org/
The Panic App/Rave Mobile Safety: https://www.ravemobilesafety.com/
Pulsara Wristbands: https://www.pulsara.com/why-wristbands/
"We all need to learn 'Stop the Bleed'" Article: https://www.ems1.com/mass-casualty-incidents-mci/articles/fla-medical-director-on-60-minutes-we-all-need-to-learn-stop-the-bleed-bLUgR7O0Lxa9J14S/

Life is like A Rollercoaster
A poem by Alex Schachter

Life is like a roller coaster
It has some ups and downs
Sometimes you can take it slow or very fast
It maybe hard to breath at times
But you have to push yourself and keep going
Your bar is your safety
It’s like your family and friends
You hold on tight and you don’t let go
But sometimes you might throw your hands up
Because your friends and family will always be with you
Just like that bar keeping you safe at all times
It maybe too much for you at times: the twists, the turns, the upside downs
But you get back up
You keep chugging along
Eventually it comes to a stop
You won’t know when or how
But you will know that’ll be time to get off and start anew
Life is like a roller coaster

FAST Archives: Do Any of These Medications Work in Cardiac Arrest? Demystifying the Controversies! May 03, 2024

In this episode of The FAST Archives, William Heuser brings his extensive experience as a clinical critical care pharmacist, clinical toxicologist, and certified Flight Paramedic to demystify the controversial world of resuscitative medicine. In his dynamic talk, "Do Any of These Medications Work in Cardiac Arrest? Demystifying the Controversies!", Will examines the debate surrounding the administration of certain medications during cardiac arrest.

He discusses how these medications impact patient outcomes during resuscitation and offers a clear, evidence-based analysis of their risks and benefits. William’s unique blend of humor, energy, and knowledge makes this talk as entertaining as it is informative. Tune in to gain valuable insights into the evolving field of resuscitative medicine and explore the complexities of pharmacological interventions during cardiac arrest.

Don't forget to check out the other podcasts in the FAST Archives miniseries and join us at FAST24 for more talks like this one, including a brand-new one from Will! We hope to see you there! Enjoy the episode.

FAST Archives: Teaching, Trusting, and Teen Driving May 02, 2024

Welcome back to The FAST Archives! In this episode, Ashley Liebig delivers a compelling talk, "Teaching, Trusting, and Teen Driving," where she explores the nuanced realities of learning, teaching, and belonging. Through her insights into psychological safety, cognitive learning theory, and feedback culture, Ashley opens up how the intricacies of how humans learn and interact... both the good stuff and the things we don't always have a great track record with as an industry. Maslow's hierarchy of needs emphasizes that our basic requirements must be met before we can focus on growth and learning. So grab yourself a snack and tune in to gain valuable knowledge from Ashley’s expertise, as she provides actionable advice that can enhance your approach to education and personal growth.

Civilian Trauma Training: Lessons From Wartime Civilian Training with Kevin Collopy May 01, 2024

In this compelling episode of the FlightBridgeED podcast, recorded at CCTMC24, we dive deep with Kevin Collopy, a distinguished figure in trauma care and awarded Best Research for his poster during the conference's Scientific Assembly. Kevin shares his groundbreaking work with just-in-time prehospital trauma training in Ukraine, a project that has garnered significant attention for its impact and innovation.

Amidst the backdrop of conflict, Kevin, along with a dedicated team of providers and organizations, developed and delivered seven different trauma courses, (including Pre-Hospital Trauma Fundamentals, which he and his team created specifically for this area of need) tailored for Ukrainian communities. These courses aim to mitigate civilian casualties and enhance patient outcomes amid wartime conditions especially when there are a limited number of responders and providers available and civilians are helping other civilians. Throughout the podcast, Kevin unpacks the process of creating these programs, their execution, and the potential future of just-in-time training in other conflict and disaster zones.

Kevin and host, Eric Bauer, also delve into a critical discussion on the undervalued importance of basic trauma skills (such as splinting, tourniquet and wound packing) which, as Kevin's research shows, play a vital role in managing war and disaster scenarios and are often overshadowed by more advanced skills. Tune in to this enlightening episode to understand the pivotal shifts in trauma training and how these lessons from the front lines can reshape our approach to emergency preparedness and response.

FAST Archives: ECPR Across The Twin Cities Apr 30, 2024

In this episode of The FAST Archives, we explore an innovative approach to cardiac arrest treatment with Jason Bartos, a leading figure in the field of cardiology and critical care at the University of Minnesota. Jason delves into the world of extracorporeal cardiopulmonary resuscitation (ECPR), a lifesaving technique that has shown significant promise in improving survival rates among patients who do not respond to conventional ACLS.

Currently, access to ECPR is limited, with only 1.68% of eligible patients receiving this treatment. Jason discusses how his team is working to expand ECPR’s availability in the Twin Cities, detailing the challenges, successes, and potential for replication of their mobile ECMO program in other regions. This talk offers valuable insights into the future of cardiac care and the possibilities of extending high-quality life-saving interventions to a broader population.

Tune in to hear about the transformative efforts being made to increase ECPR access and how these advancements could serve as a blueprint for communities across the nation. If you enjoyed this talk, check out the other episodes of the FAST Archives miniseries! Thank you so much for listening.

FAST Archives: Hey, Katamine... You're Not That Special! Apr 29, 2024

In this episode of The FAST Archives, join one of our favorite Kiwis, Rob Bryant as he takes a critical look at Ketamine, a drug that's as much a star in the medical field as it is a subject of debate. Rob, who has an extensive background in Emergency and Critical Care Medicine, explores the not-so-glamorous side of Ketamine, including its cardiovascular impacts, effects on mental health, and potential long-term damage to the bladder.

Ketamine has long been a celebrated player in emergency and critical care for its versatility and effectiveness. However, like any celebrity, it has its controversies. His talk explores the evidence for and against the use of Ketamine in various settings and circumstances, challenging its pristine reputation and highlighting the importance of cautious and informed use. Whether you're a staunch supporter or a skeptic of Ketamine, this episode offers a balanced view that will enrich your understanding of one of the most talked-about drugs in medicine. Tune in to uncover the complexities of Ketamine through the expert lens of Rob Bryant.

If you enjoyed this podcast, check out the other FAST Archives episodes we've recently released, and don't forget to join us at FAST24! Thank you so much for listening!

FAST Archives: AFE: The 3 B's Apr 26, 2024

This episode from The FAST Archives explores a rare and high-stakes medical emergency: amniotic fluid embolism (AFE). Allison Herman, a seasoned RN with seventeen years of experience across ER, ICU, and helicopter EMS, shares a remarkable case involving this critical obstetrical complication.

Allison, who spent a decade flying with a hospital-based helicopter EMS program in California, has recently returned to the ER as the pediatric emergency care coordinator. Her passion for emergency medicine and high-risk obstetrics shines through as she recounts how her team tackled a challenging AFE case.

During this talk, you'll learn the importance of quick thinking, teamwork, and solid training in navigating unexpected emergencies during childbirth. Alli describes the collaborative efforts that led to a positive patient outcome and provides valuable insights into managing high-risk obstetrical cases.

Whether in emergency medicine, critical care, or simply interested in understanding how EMS teams handle rare and complex scenarios, this episode offers a compelling and educational experience.

If you enjoy this episode, please check out the other FAST Archives episodes that we have recently released. Enjoy the episode!

FAST Archives: Stayin' Alive - Impella Device and Left Ventricular Mechanical Circulatory Support in in Critical Care Transport Apr 24, 2024

Join us for an insightful episode from The FAST Archives, featuring "Stayin' Alive: Impella Device and Left Ventricular Mechanical Circulatory Support in Critical Care Transport," presented by Michael Lauria. A former USAF Pararescueman and Critical Care/Flight Paramedic, Michael is now an EMS and Critical Care Fellow at the University of New Mexico Health Science Center. He brings his extensive experience to this engaging talk on Left Ventricular Assist Devices (LVADs) and their use in critical care transport.

In this episode, Michael dives into the technical aspects of LVADs, including their design, application, and relevance in transport situations. You'll learn about anatomy, physiology, pharmacology, pressure waveforms, and point-of-care ultrasound (POCUS) as they relate to these devices. Michael’s presentation is thorough and engaging, perfect for anyone in critical care or emergency transport.

Whether you're already familiar with LVADs or new to the topic, this episode offers valuable insights and practical knowledge. As these devices become more common in the field, you'll want to be prepared. Tune in to expand your understanding and equip yourself for future transports involving LVADs.

FAST Archives: A Difficult Pill to Swallow: 3 Unforgiveable Sins in Medicine Apr 23, 2024

In this episode from The FAST Archives, we explore the powerful talk, "A Difficult Pill to Swallow: 3 Unforgivable Sins in Medicine." As pressures mount to keep emergency services running smoothly, many first responders are driven to work extra shifts and put their community's needs ahead of their own. But what happens when this "rescuer" mentality seeps into our personal lives?

Kris and Sara Kaull share personal stories and discuss why it's so hard to let go of the high-intensity mindset when we're not on duty. They challenge us to think about the impact this can have on our relationships and overall well-being. As they peel back the layers, they offer insights into building meaningful connections and prioritizing self-care.

Tune in to find out why maintaining balance is crucial for a healthy and fulfilling life. This episode provides a fresh perspective on stepping back from work, embracing a more balanced lifestyle, and rediscovering the things that matter most.

FAST Archives: Paramedics: The Master Multitasker... Right? Apr 22, 2024

In this episode of The FAST Archives miniseries, we're replaying Geoff Murphy's talk from a previous FAST event, "Paramedics: The Master Multitasker... Right?" In this captivating talk, Geoff, from Master Your Medics, delves into the challenge paramedics (as well as nurses, physicians, and other medical professionals) face in multitasking, especially when they're often the most experienced provider.

How well do we juggle life-saving skills while making critical decisions? And is multitasking always in the best interest of our patients? Through a personal story and insightful research, Geoff challenges our assumptions and invites us to consider the potential risks and rewards of multitasking in pre-hospital, critical care, and emergency medicine.

If you're interested in learning more about Geoff Murphy and Master Your Medics, visit https://www.masteryourmedics.com, and if you're interested in joining us at FAST24 for more talks like this, visit https://flightbridgeed.com/fast24. Thanks for listening, and we hope you enjoy this episode!

FAST Archives: The Folk Science of Sepsis Apr 19, 2024

Catch our latest episode with Brian Behn sharing his talk from a previous FAST event entitled, 'The Folk Science of Sepsis.' Brian explores and exposes possible gaps in the understanding of sepsis by EMS and critical care transport providers because of poor/incomplete education about it. He offers essential insights and practical advice to enhance our understanding and management of this deadly condition. Tune in to transform your approach to sepsis treatment and join us at FAST24 in Wilmington, June 10th-12th, for more talks like this one!

FAST Archives: Finding Feedback Apr 19, 2024

Welcome to the second episode of the FAST Archives mini-series! In this episode, we dive into a crucial conversation with Ginger Locke titled "Finding Feedback," where she examines the culture of feedback in EMS and Critical Care Transport. Unlike other professions, feedback in EMS usually comes only after extraordinary events. Ginger proposes a shift towards a continuous feedback loop that fosters growth and learning from every call/situation, not just the emergencies. This talk is a must-listen for anyone in EMS looking to build a more supportive and effective work environment. Join us as we explore practical steps to make feedback a regular part of our daily practice, enhancing personal and team performance.

Please subscribe to The FlightBridgeED Podcast anywhere you listen to podcasts, and don't forget to pass on the knowledge! Share the podcast with friends and co-workers. We couldn't make this podcast without you! Thank you so much for listening! Enjoy the episode.

** Special thanks to Mark Mennie, our wonderful and talented photographer at FAST for the last couple of years!

SHOW NOTES
More information about Finding Feedback at the Medic Mindset website:
https://medicmindset.com/2022/02/08/finding-feedback-uwash-great-rounds-notes/

FAST Archives: Silent Killers in Pediatric Mechanical Ventilation Apr 17, 2024

Welcome to the FlightBridgeED Podcast! We're kicking off this special mini-series, "The FAST Archives," replaying some of our favorite talks from past FAST conferences. These moments made us laugh, think twice, and gave us the tools to be better providers.

First up: Pediatric patients on ventilators... it's a high-stakes game where small changes mean everything. In this essential talk, "Silent Killers in Pediatric Mechanical Ventilation", our very own Eric Bauer takes center stage breaking down the pitfalls to avoid and the strategies that will level up your vent skills for the littlest patients.

Please subscribe to The FlightBridgeED Podcast anywhere you listen to podcasts, and don't forget to pass on the knowledge! Share the podcast with friends and co-workers. We couldn't make this podcast without you! Thank you so much for listening! Enjoy the episode.

** Special thanks to Mark Mennie, our wonderful and talented photographer at FAST for the last couple of years!

Mind Over Medicine: Navigating Cognitive Bias in Emergency Medicine w/ Ashley Bauer Mar 28, 2024

In this gripping episode of "Mind Over Medicine," we dive deep into the critical, often unseen world of cognitive bias in emergency medicine. With the clock ticking and lives in the balance, emergency room professionals make split-second decisions that can mean the difference between life and death. But what happens when the human mind's inherent biases seep into these critical judgments? Join Ashley as she explores the various forms of cognitive bias - from anchoring bias to confirmation bias - that challenge medical professionals in high-stakes environments. "Mind Over Medicine: Navigating Cognitive Bias in Emergency Medicine" is a must-listen for anyone wanting to refine their decision-making processes and examine the complexities of human cognition under pressure. Tune in to uncover the unseen challenges of emergency medicine and the strides being made toward safer, more effective patient care. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more. We appreciate your support over the past 12 years!

Mechanical Ventilation and ARDS in Critical Care Obstetrics Mar 04, 2024

Mechanical Ventilation and ARDS – Podcast Summary and References

This is the sixth of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams as a retrieval OBGYN/MFM and is one of our Assistant Medical Directors for the flight program.

The topic of this podcast is Mechanical Ventilation and ARDS in pregnancy. Although respiratory distress requiring intubation and ARDS in pregnancy is not very common, it is more common than some of the other pathologies we have discussed recently. Mechanical ventilation of the pregnant patient can be intimidating, but rest assured that if you have the capabilities to manage other patients on a vent, you can manage the pregnant patient. Generally speaking solid outcomes data is sparse and, generally speaking, most guidelines recommend vent management of mechanical ventilation in patients with or without ARDS similarly to non-pregnant patients…with a few exceptions. This podcast reviews the basics of ARDS and evidence-based management. It reviews some specific features of obstetric physiology and fetal gas exchange that are important to keep in mind. Finally, we will review what guidance is available and review general recommendations for managing these patients in transport.

For additional learning and a more in-depth review of the evidence check out this talk on gas exchange and mechanical ventilation in critically ill patients by Dr. Allison Lankford (part of the amazing Maryland CC Project lecture series): http://maryland.ccproject.com/2023/05/30/lankford-gas-exchange-and-pulmonary-ventilation-in-the-critically-ill-obstetric-patient/

References

1. Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-x
2. Barrantes JH, Ortoleva J, O'Neil ER, et al. Successful Treatment of Pregnant and Postpartum Women With Severe COVID-19 Associated Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation. Asaio j. Feb 1 2021;67(2):132-136. doi:10.1097/mat.0000000000001357
3. Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol. Oct-Dec 2016;32(4):431-439. doi:10.4103/0970-9185.194779
4. Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. Am J Obstet Gynecol MFM. May 2020;2(2):100106. doi:10.1016/j.ajogmf.2020.100106
5. Campbell LA, Klocke RA. Implications for the pregnant patient. Am J Respir Crit Care Med. Apr 2001;163(5):1051-4. doi:10.1164/ajrccm.163.5.16353
6. Carter AM. Factors affecting gas transfer across the placenta and the oxygen supply to the fetus. J Dev Physiol. Dec 1989;12(6):305-22.
7. Carter AM. Placental Gas Exchange and the Oxygen Supply to the Fetus. Compr Physiol. Jul 1 2015;5(3):1381-403. doi:10.1002/cphy.c140073
8. Cavalcante FML, Fernandes CDS, Rocha LDS, Galindo-Neto NM, Caetano J, Barros LM. Use of the prone position in pregnant women with COVID-19 or other health conditions. Rev Lat Am Enfermagem. 2021;29:e3494. doi:10.1590/1518-8345.5181.3494
9. Cojocaru L, Turan OM, Levine A, et al. Proning modus operandi in pregnancies complicated by acute respiratory distress syndrome secondary to COVID-19. J Matern Fetal Neonatal Med. Dec 2022;35(25):9043-9052. doi:10.1080/14767058.2021.2013464
10. Cole DE, Taylor TL, McCullough DM, Shoff CT, Derdak S. Acute respiratory distress syndrome in pregnancy. Crit Care Med. Oct 2005;33(10 Suppl):S269-78. doi:10.1097/01.ccm.0000182478.14181.da
11. D'Souza R, Ashraf R, Rowe H, et al. Pregnancy and COVID-19: pharmacologic considerations. Ultrasound Obstet Gynecol. Feb 2021;57(2):195-203. doi:10.1002/uog.23116
12. Danish MA. Mechanical Ventilation in Critically Ill Obstetric Patient. Principles of Critical Care in Obstetrics. 2016:133-141:chap Chapter 14.
13. Delyoa-Tomas E M-LT, Lopez-Fermin J, Perez-Nieto OR, et al. Consideration for Mechanical Ventilation in the Critically Ill Obstetric Patient. Crit Care Obst Gyne. 2020;6(10):1-8.
14. Douglass KM, Strobel KM, Richley M, et al. Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series. Am J Perinatol. Jan 2021;38(1):82-87. doi:10.1055/s-0040-1718694
15. Ende H, Varelmann D. Respiratory Considerations Including Airway and Ventilation Issues in Critical Care Obstetric Patients. Obstet Gynecol Clin North Am. Dec 2016;43(4):699-708. doi:10.1016/j.ogc.2016.07.002
16. Gattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486
17. Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7
18. Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884
19. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103
20. Huang C-Y, Tsai Y-L, Lin C-K. The prone position ventilation (PPV) as an approach in pregnancy with acute respiratory distress syndrome (ARDS). Taiwanese Journal of Obstetrics and Gynecology. 2021/05/01/ 2021;60(3):574-576. doi:https://doi.org/10.1016/j.tjog.2021.03.036
21. Khalil M, Butt A, Kseibi E, Althenayan E, Alhazza M, Sallam H. COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State. Membranes (Basel). Jul 17 2021;11(7)doi:10.3390/membranes11070544
22. Kodali BS, Wong MJ, Lankford A, Lee K, Bharadwaj S. Effect of Fetal Delivery on Pao2/Fio2 Ratio During Mechanical Ventilation in Parturients With COVID-19: A Case Series. A A Pract. Jul 1 2022;16(7):e01587. doi:10.1213/xaa.0000000000001587
23. Lam GK, Stafford RE, Thorp J, Moise KJ, Jr., Cairns BA. Inhaled nitric oxide for primary pulmonary hypertension in pregnancy. Obstet Gynecol. Nov 2001;98(5 Pt 2):895-8. doi:10.1016/s0029-7844(01)01549-6
24. Lapinsky SE. Acute respiratory failure in pregnancy. Obstet Med. Sep 2015;8(3):126-32. doi:10.1177/1753495X15589223
25. Lapinsky SE, Posadas-Calleja JG, McCullagh I. Clinical review: Ventilatory strategies for obstetric, brain-injured and obese patients. Crit Care. 2009;13(2):206. doi:10.1186/cc7146
26. Lapinsky SE, Viau-Lapointe J. Mechanical Ventilation and Delivery During Pregnancy. Chest. Mar 2023;163(3):473-474. doi:10.1016/j.chest.2022.10.025
27. Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment. Seminars in Fetal and Neonatal Medicine. 2023;28(1)doi:10.1016/j.siny.2023.101426
28. Linassi F, Campagnolo M, Busato E, Ortolani V, Peta M. Prolonged prone position in pregnant woman with COVID-19 pneumonia. Journal of Anesthesia, Analgesia and Critical Care. 2022/04/12 2022;2(1):16. doi:10.1186/s44158-022-00044-9
29. Lucarelli E, Behn C, Lashley S, Smok D, Benito C, Oyelese Y. Mechanical Ventilation in Pregnancy Due to COVID-19: A Cohort of Three Cases. Am J Perinatol. Aug 2020;37(10):1066-1069. doi:10.1055/s-0040-1713664
30. Magala Ssekandi A, Sserwanja Q, Olal E, Kawuki J, Bashir Adam M. Corticosteroids Use in Pregnant Wom...

Hidden Harms: Refractory Shock in Prehospital Trauma Patients Feb 26, 2024

In this episode, we uncover the enigmatic world of refractory shock in prehospital trauma patients. Shock, often recognized as a critical condition, becomes even more complex when it resists conventional treatment. Join Eric as he discusses resuscitation in vasoplegic patients refractory to fluids and blood products. Tune in to "Hidden Harms" and embark on a journey to unveil the complexities of refractory shock in prehospital trauma patients. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more. We appreciate your support over the past 12 years!

The Nightmare Patient: COPD Induced Respiratory Failure Feb 11, 2024

In this episode, we delve into the complexities surrounding a challenging COPD patient scenario, focusing on treatment considerations and the broader scope of mechanical ventilation management. We underscore essential lessons gleaned from this case, emphasizing the significance of adopting an obstructive approach, the nuanced application of I:E ratio, and the comprehensive management strategies for hypercapnic patients. Join us as we navigate through this intricate medical terrain, shedding light on effective approaches and valuable insights crucial for optimizing patient care in similar scenarios. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more. We appreciate your support over the past 12 years!

MDCast w/ Dr. Michael Lauria - Amniotic Fluid Embolism Dec 22, 2023

This is the fifth of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams as a retrieval OBGYN/MFM and acts as one of our Assistant Medical Directors for the flight program.

The topic of this podcast is Amniotic Fluid Embolism (AFE). Another rare, but devastating disease that can often progress rapidly to cardiac arrest. In this podcast, we go through the epidemiology and definition/diagnosis of the disease. We also go into depth on underlying pathophysiology and the current hypotheses on what causes AFE. Spoiler alert: it’s not as simple as an embolism of amniotic fluid. Then we review the management, specifically focusing on the management of acute right heart failure in the setting of abrupt and pronounced pulmonary hypertension. Finally, Dr. Garchar and I deliver some spaced repetition and go over the management of maternal cardiac arrest, in the likely event that AFE progresses to that point.

References

1. Abenhaim HA, Azoulay L, Kramer MS, Leduc L. Incidence and risk factors of amniotic fluid embolisms: a population-based study on 3 million births in the United States. Am J Obstet Gynecol. Jul 2008;199(1):49 e1-8. doi:10.1016/j.ajog.2007.11.061

2. Aissi James S, Klein T, Lebreton G, et al. Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation. Crit Care. Apr 7 2022;26(1):96. doi:10.1186/s13054-022-03969-3

3. Clark SL, Montz FJ, Phelan JP. Hemodynamic alterations associated with amniotic fluid embolism: a reappraisal. Am J Obstet Gynecol. Mar 1 1985;151(5):617-21. doi:10.1016/0002-9378(85)90150-4

4. Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol. Oct 2016;215(4):408-12. doi:10.1016/j.ajog.2016.06.037

5. Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol. Nov 2009;201(5):445 e1-13. doi:10.1016/j.ajog.2009.04.052

6. Creel-Bulos C, Hassani B, Stentz MJ, et al. Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism-Induced Cardiac Arrest in the First Trimester of Pregnancy: A Case Report. Crit Care Explor. Jul 2020;2(7):e0162. doi:10.1097/CCE.0000000000000162

7. Crissman HP, Loder C, Pancaro C, Bell J. Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis. BMC Pregnancy Childbirth. Jan 3 2020;20(1):9. doi:10.1186/s12884-019-2680-1

8. Durgam S, Sharma M, Dadhwal R, Vakil A, Surani S. The Role of Extra Corporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Case Report and Literature Review. Cureus. Feb 26 2021;13(2):e13566. doi:10.7759/cureus.13566

9. Foley MR ST, Garite TJ. Obstetric Intensive Care Manual. 5th ed. McGraw-Hill Education; 2014.

10. Huybrechts W, Jorens PG, Jacquemyn Y, Colpaert C, Vrints C, Conraads V. Amniotic fluid embolism: a rare cause of acute left-sided heart failure. Acta Cardiol. Dec 2006;61(6):643-9. doi:10.2143/AC.61.6.2017964

11. James CF, Feinglass NG, Menke DM, Grinton SF, Papadimos TJ. Massive amniotic fluid embolism: diagnosis aided by emergency transesophageal echocardiography. Int J Obstet Anesth. Oct 2004;13(4):279-83. doi:10.1016/j.ijoa.2004.03.008

12. Lao TT. Acute respiratory distress and amniotic fluid embolism in pregnancy. Best Pract Res Clin Obstet Gynaecol. Dec 2022;85(Pt A):83-95. doi:10.1016/j.bpobgyn.2022.06.004

13. Lockwood CJ, Bach R, Guha A, Zhou XD, Miller WA, Nemerson Y. Amniotic fluid contains tissue factor, a potent initiator of coagulation. Am J Obstet Gynecol. Nov 1991;165(5 Pt 1):1335-41. doi:10.1016/0002-9378(91)90363-v

14. McDonnell NJ, Chan BO, Frengley RW. Rapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism. Int J Obstet Anesth. Jul 2007;16(3):269-73. doi:10.1016/j.ijoa.2006.10.008

15. Moore J, Baldisseri MR. Amniotic fluid embolism. Crit Care Med. Oct 2005;33(10 Suppl):S279-85. doi:10.1097/01.ccm.0000183158.71311.28

16. Pacheco LD, Clark SL, Klassen M, Hankins GDV. Amniotic fluid embolism: principles of early clinical management. Am J Obstet Gynecol. Jan 2020;222(1):48-52. doi:10.1016/j.ajog.2019.07.036

17. Pacheco LD, Saade GR, Costantine MM, Clark SL, Hankins GD. An update on the use of massive transfusion protocols in obstetrics. Am J Obstet Gynecol. Mar 2016;214(3):340-4. doi:10.1016/j.ajog.2015.08.068

18. Shamshirsaz AA, Clark SL. Amniotic Fluid Embolism. Obstet Gynecol Clin North Am. Dec 2016;43(4):779-790. doi:10.1016/j.ogc.2016.07.001

19. Shechtman M, Ziser A, Markovits R, Rozenberg B. Amniotic fluid embolism: early findings of transesophageal echocardiography. Anesth Analg. Dec 1999;89(6):1456-8. doi:10.1097/00000539-199912000-00025

20. Simard C, Yang S, Koolian M, Shear R, Rudski L, Lipes J. The role of echocardiography in amniotic fluid embolism: a case series and review of the literature. Can J Anaesth. Oct 2021;68(10):1541-1548. Le role de l'echocardiographie dans l'embolie de liquide amniotique : une serie de cas et une revue de la litterature. doi:10.1007/s12630-021-02065-4

21. Society for Maternal-Fetal Medicine . Electronic address pso, Pacheco LD, Saade G, Hankins GD, Clark SL. Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol. Aug 2016;215(2):B16-24. doi:10.1016/j.ajog.2016.03.012

22. Stanten RD, Iverson LI, Daugharty TM, Lovett SM, Terry C, Blumenstock E. Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass. Obstet Gynecol. Sep 2003;102(3):496-8. doi:10.1016/s0029-7844(03)00161-3

23. Sultan P, Seligman K, Carvalho B. Amniotic fluid embolism: update and review. Curr Opin Anaesthesiol. Jun 2016;29(3):288-96. doi:10.1097/ACO.0000000000000328

24. Wu HD, Song ZK, Cao HY, et al. Successful treatment of amniotic fluid embolism complicated by disseminated intravascular coagulation with rivaroxaban: A case report. Medicine (Baltimore). Jan 2020;99(4):e18951. doi:10.1097/md.0000000000018951

MDCast w/ Dr. Michael Lauria - DIC in Pregnancy Nov 28, 2023

Disseminated Intravascular Coagulation

This is the fourth of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport.

The topic of this podcast is Disseminated Intravascular Coagulation (DIC) in the pregnant patient. Although very rare, this disease carries a high morbidity and mortality. The key features are the disease are diffuse and dysregulated coagulation that causes consumption of clotting factors (resulting in a paradoxical coagulopathic state), widespread endothelial damage, and is essentially always the result of some other disease process. In this podcast we go over how critical care transport crews can recognize DIC and identify the underlying process causing it. In addition, Dr. Garchar and I review the management in the transport environment and pearls regarding treating coagulopathy.

In the podcast we give a shout out to a phenomenal OB Critical Care course that is put on by Banner University Medical Center and the Society for Maternal Fetal Medicine. Unfortunately, it’s a little late to sign up for this year’s session (November 2023), but put it on your radar for next year! Here is a link to the brochure and conference content to give you an idea. There is also a healthy component of simulation education. I have no conflict of interest with this course at all…it’s just a phenomenal educational opportunity.

https://s3.amazonaws.com/cdn.smfm.org/media/1807/Brochure-Banner(FINAL).pdf

References

1. Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083

2. Erez O, Novack L, Beer-Weisel R, et al. DIC score in pregnant women--a population based modification of the International Society on Thrombosis and Hemostasis score. PLoS One. 2014;9(4):e93240. doi:10.1371/journal.pone.0093240

3. Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047

4. Foley MR, Strong TH, Garite TJ. Obstetric Intensive Care Manual. 5th ed. McGraw-Hill Education; 2014.

5. Gando S, Nanzaki S, Sasaki S, Kemmotsu O. Significant correlations between tissue factor and thrombin markers in trauma and septic patients with disseminated intravascular coagulation. Thromb Haemost. Jun 1998;79(6):1111-5.

6. Kadikar SK, Divan FJ, Topiwala U, Agasiwala S. Study of pregnancy with disseminated intravascular coagulation. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021;10(11)doi:10.18203/2320-1770.ijrcog20214335

7. Krikun G, Huang ST, Schatz F, Salafia C, Stocco C, Lockwood CJ. Thrombin activation of endometrial endothelial cells: a possible role in intrauterine growth restriction. Thromb Haemost. Feb 2007;97(2):245-53.

8. Levi M, Scully M. How I treat disseminated intravascular coagulation. Blood. Feb 22 2018;131(8):845-854. doi:10.1182/blood-2017-10-804096

9. Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x

10. Papageorgiou C, Jourdi G, Adjambri E, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. Dec 2018;24(9_suppl):8S-28S. doi:10.1177/1076029618806424

11. Rabinovich A, Abdul-Kadir R, Thachil J, Iba T, Othman M, Erez O. DIC in obstetrics: Diagnostic score, highlights in management, and international registry-communication from the DIC and Women's Health SSCs of the International Society of Thrombosis and Haemostasis. J Thromb Haemost. Sep 2019;17(9):1562-1566. doi:10.1111/jth.14523

12. Rattray DD, O'Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. Apr 2012;34(4):341-347. doi:10.1016/S1701-2163(16)35214-8

13. Taylor FB, Jr., Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. Nov 2001;86(5):1327-30.

14. Toffaletti JG, Buckner KA. Use of Earlier-Reported Rotational Thromboelastometry Parameters to Evaluate Clotting Status, Fibrinogen, and Platelet Activities in Postpartum Hemorrhage Compared to Surgery and Intensive Care Patients. Anesth Analg. Mar 2019;128(3):414-423. doi:10.1213/ane.0000000000003499

15. Veronika A L, John V, Xuezhi J. Disseminated Intravascular Coagulation due to Amniotic Fluid Embolism in an Early Molar Pregnancy. Clinical Medical Reviews and Case Reports. 2018;5(1)doi:10.23937/2378-3656/1410199

16. Walker J, Bonavia A. To Clot or Not: HELLP Syndrome and Disseminated Intravascular Coagulation in an Eclamptic Patient with Intrauterine Fetal Demise. Case Rep Anesthesiol. 2020;2020:9642438. doi:10.1155/2020/9642438

17. Zhao Z, Zhang J, Li N, et al. Disseminated intravascular coagulation associated organ failure in obstetric patients admitted to intensive care units: a multicenter study in China. Sci Rep. Aug 12 2021;11(1):16379. doi:10.1038/s41598-021-95841-7

The Influence of Low pH on Efficacy of Critical Care Pharmacology w/ Will Heuser, PharmD Sep 22, 2023

Join Eric and Will Heuser, PharmD, discussing "The Influence of Low pH on Efficacy of Critical Care Pharmacology."

Changes in acid-base balance have a profound influence on many aspects of the action of drugs. This is illustrated by data on the absorption of drugs from the stomach and intestine, changes in the distribution of drugs between plasma and cells, and the effect of changes in pH. Join us as Will breaks down the pathophysiology and decision-making in these low pH states. When do we deploy sodium bicarbonate? Is there a trade-off? How is pharmacology affected by low pH states? This episode is a can't-miss, with the brilliant Will Heuser, PharmD, BCCCP, MS, EMT-P, FP-C. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more. We appreciate your support over the past 11 years!

Contact Info:
Will Heuser, PharmD, BCCCP, MS, EMT-P, FP-C
wheuser@northwell.edu

Big News...New Global Definition for ARDS! Sep 11, 2023

Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high-flow nasal oxygen (HFNO), expanding the use of pulse oximetry in place of arterial blood gases, use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. Join Eric as he dives into the previous ARDS definitions, the pathophysiology around "PseudoARDS," and the new global definition. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more. We appreciate your support over the past 11 years!

New Global Definition for Acute Respiratory Distress Syndrome

MDCast w/Dr. Michael Lauria - Peripartum Cardiomyopathy Sep 08, 2023

This is the third episode of a special podcast series on obstetric critical care. Although I am the sole host of this podcast, the content was reviewed and edited by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport.

The topic of this podcast is peripartum cardiomyopathy. Acquired cardiac conditions in otherwise healthy pregnant patients can be a serious and life-threatening condition. Sometimes, critical care transport crews are called to transport pregnant or recently postpartum females with severe, acquired cardiomyopathy or in frank cardiogenic shock. This podcast reviews the presentation, underlying pathophysiology, and management of this patient population.

References

1. Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. Apr 5 2016;133(14):1397-409. doi:10.1161/CIRCULATIONAHA.115.020491

2. Cherubin S, Peoples T, Gillard J, Lakhal-Littleton S, Kurinczuk JJ, Nair M. Systematic review and meta-analysis of prolactin and iron deficiency in peripartum cardiomyopathy. Open Heart. Oct 2020;7(2)doi:10.1136/openhrt-2020-001430

3. Cooper LT, Mather PJ, Alexis JD, et al. Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and nonperipartum women. J Card Fail. Jan 2012;18(1):28-33. doi:10.1016/j.cardfail.2011.09.009

4. Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. Jan 21 2020;75(2):207-221. doi:10.1016/j.jacc.2019.11.014

5. Dinic V, Markovic D, Savic N, Kutlesic M, Jankovic RJ. Peripartum Cardiomyopathy in Intensive Care Unit: An Update. Front Med (Lausanne). 2015;2:82. doi:10.3389/fmed.2015.00082

6. Djordjevic I, Rahmanian P, Zeriouh M, et al. Treatment of cardiogenic shock in peripartum cardiomyopathy: Case series from a tertiary ECMO center. J Card Surg. Jan 2020;35(1):254-257. doi:10.1111/jocs.14324

7. Elkayam U, Akhter MW, Singh H, et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. Apr 26 2005;111(16):2050-5. doi:10.1161/01.CIR.0000162478.36652.7E

8. Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. Apr 13 2000;342(15):1077-84. doi:10.1056/nejm200004133421502

9. Gorog DA, Vilahur G. Peripartum cardiomyopathy: can the link between prolactin and PAI-1 provide a clue? Cardiovasc Res. Sep 1 2020;116(11):1791-1793. doi:10.1093/cvr/cvaa109

10. Habedank D, Kuhnle Y, Elgeti T, Dudenhausen JW, Haverkamp W, Dietz R. Recovery from peripartum cardiomyopathy after treatment with bromocriptine. Eur J Heart Fail. Nov 2008;10(11):1149-51. doi:10.1016/j.ejheart.2008.09.001

11. Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J. May 7 2015;36(18):1090-7. doi:10.1093/eurheartj/ehv009

12. Hilfiker-Kleiner D, Kaminski K, Podewski E, et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. Feb 9 2007;128(3):589-600. doi:10.1016/j.cell.2006.12.036

13. Iorgoveanu C, Zaghloul A, Ashwath M. Peripartum cardiomyopathy: a review. Heart Fail Rev. Nov 2021;26(6):1287-1296. doi:10.1007/s10741-020-10061-x

14. Kim MJ, Shin MS. Practical management of peripartum cardiomyopathy. Korean J Intern Med. May 2017;32(3):393-403. doi:10.3904/kjim.2016.360

15. Kumar A, Ravi R, Sivakumar RK, et al. Prolactin Inhibition in Peripartum Cardiomyopathy: Systematic Review and Meta-analysis. Curr Probl Cardiol. Feb 2023;48(2):101461. doi:10.1016/j.cpcardiol.2022.101461

16. Maning J, Ebner B, Vincent L, et al. Abstract 15717: Impact of Mechanical Circulatory Support on Outcomes and In-hospital Mortality of Peripartum Cardiomyopathy Patients With Cardiogenic Shock: An Analysis of the Nis Database. Circulation. 2020;142(Suppl_3)doi:10.1161/circ.142.suppl_3.15717

17. Metz TD, Khanna A. Evaluation and Management of Maternal Cardiac Arrhythmias. Obstet Gynecol Clin North Am. Dec 2016;43(4):729-745. doi:10.1016/j.ogc.2016.07.014

18. Sieweke JT, Pfeffer TJ, Berliner D, et al. Cardiogenic shock complicating peripartum cardiomyopathy: Importance of early left ventricular unloading and bromocriptine therapy. Eur Heart J Acute Cardiovasc Care. Mar 2020;9(2):173-182. doi:10.1177/2048872618777876

19. Sliwa K, Blauwet L, Tibazarwa K, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation. Apr 6 2010;121(13):1465-73. doi:10.1161/CIRCULATIONAHA.109.901496

20. Tapaskar N, Tremblay-Gravel M, Khush KK. Contemporary Management of Cardiogenic Shock During Pregnancy. J Card Fail. Feb 2023;29(2):193-209. doi:10.1016/j.cardfail.2022.09.014

21. Triebel J, Clapp C, Martinez de la Escalera G, Bertsch T. Remarks on the Prolactin Hypothesis of Peripartum Cardiomyopathy. Front Endocrinol (Lausanne). 2017;8:77. doi:10.3389/fendo.2017.00077

Warm Fluids In Resuscitation: Current Evidence Aug 25, 2023

In this episode, Eric looks at warm fluids... or lack thereof in resuscitation. We will cover the current evidence around hypothermia in resuscitation secondary to the infusion of cold IV fluids. We discuss current strategies in warming fluids before administration in warm and cold ambient environments and the impact on body systems that ultimately contribute to increased mortality. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more. We appreciate your support over the past 11 years!

MDCast w/ Dr. Michael Lauria - Maternal Cardiac Arrest Aug 13, 2023

This is the second of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport.

The topic of this podcast is maternal cardiac arrest. This is, possibly, one of the most stressful clinical encounters we can have as flight crew. Critical care transport crews are masters of ACLS and resuscitation during cardiac arrest, but what do you do if the patient is pregnant? Often crews have questions: Can we use the same drugs? Do you change the dose of different ACLS drugs? Can you defibrillate a pregnant patient? Do we change hand position for chest compression? In this podcast, Dr. Garchar and I go over the recommendations and guidelines from major organizations and clarify some of these important questions.

References

1. Beckett VA, Knight M, Sharpe P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG. Aug 2017;124(9):1374-1381. doi:10.1111/1471-0528.14521

2. Bennett TA, Katz VL, Zelop CM. Cardiac Arrest and Resuscitation Unique to Pregnancy. Obstet Gynecol Clin North Am. Dec 2016;43(4):809-819. doi:10.1016/j.ogc.2016.07.011

3. Biderman P, Carmi U, Setton E, Fainblut M, Bachar O, Einav S. Maternal Salvage With Extracorporeal Life Support: Lessons Learned in a Single Center. Anesth Analg. Oct 2017;125(4):1275-1280. doi:10.1213/ANE.0000000000002262

4. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. Nov 2012;120(5):1029-36. doi:10.1097/aog.0b013e31826d60c5

5. Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock. Jan 2009;2(1):34-42. doi:10.4103/0974-2700.43586

6. Dijkman A, Huisman CM, Smit M, et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG. Feb 2010;117(3):282-7. doi:10.1111/j.1471-0528.2009.02461.x

7. Ducloy-Bouthors AS, Gonzalez-Estevez M, Constans B, Turbelin A, Barre-Drouard C. Cardiovascular emergencies and cardiac arrest in a pregnant woman. Anaesth Crit Care Pain Med. Oct 2016;35 Suppl 1:S43-S50. doi:10.1016/j.accpm.2016.06.008

8. Einav S, Kaufman N, Sela HY. Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation. Oct 2012;83(10):1191-200. doi:10.1016/j.resuscitation.2012.05.005

9. Enomoto N, Yamashita T, Furuta M, et al. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth. Feb 25 2022;22(1):159. doi:10.1186/s12884-021-04334-y

10. Fischer C, Bonnet MP, Girault A, Le Ray C. Update: Focus in-hospital maternal cardiac arrest. J Gynecol Obstet Hum Reprod. May 2019;48(5):309-314. doi:10.1016/j.jogoh.2019.02.007

11. Fisher N, Eisen LA, Bayya JV, et al. Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training. Am J Obstet Gynecol. Sep 2011;205(3):239 e1-5. doi:10.1016/j.ajog.2011.06.012

12. Ford ND, DeSisto CL, Galang RR, Kuklina EV, Sperling LS, Ko JY. Cardiac Arrest During Delivery Hospitalization : A Cohort Study. Ann Intern Med. Apr 2023;176(4):472-479. doi:10.7326/M22-2750

13. Helviz Y, Einav S. Maternal cardiac arrest. Curr Opin Anaesthesiol. Jun 2019;32(3):298-306. doi:10.1097/ACO.0000000000000719

14. Jeejeebhoy FM, Morrison LJ. Maternal cardiac arrest: a practical and comprehensive review. Emerg Med Int. 2013;2013:274814. doi:10.1155/2013/274814

15. Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. Nov 3 2015;132(18):1747-73. doi:10.1161/CIR.0000000000000300

16. Jeejeebhoy FM, Zelop CM, Windrim R, Carvalho JC, Dorian P, Morrison LJ. Management of cardiac arrest in pregnancy: a systematic review. Resuscitation. Jul 2011;82(7):801-9. doi:10.1016/j.resuscitation.2011.01.028

17. Kikuchi J, Deering S. Cardiac arrest in pregnancy. Semin Perinatol. Feb 2018;42(1):33-38. doi:10.1053/j.semperi.2017.11.007

18. Ko RE, Chung CR, Yang JH, et al. Use of extracorporeal membrane oxygenation in postpartum patients with refractory shock or respiratory failure. Sci Rep. Jan 13 2021;11(1):887. doi:10.1038/s41598-020-80423-w

19. Lipman SS, Daniels KI, Carvalho B, et al. Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises. Am J Obstet Gynecol. Aug 2010;203(2):179 e1-5. doi:10.1016/j.ajog.2010.02.022

20. Mizuno A, Saito A, Shibata A. You can never be too prepared: ECMO for MCA. Am J Obstet Gynecol. Jan 2019;220(1):122-123. doi:10.1016/j.ajog.2018.09.019

21. Naoum EE, Chalupka A, Haft J, et al. Extracorporeal Life Support in Pregnancy: A Systematic Review. J Am Heart Assoc. Jul 7 2020;9(13):e016072. doi:10.1161/JAHA.119.016072

22. Ong J, Zhang JJY, Lorusso R, MacLaren G, Ramanathan K. Extracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports. Int J Obstet Anesth. Aug 2020;43:106-113. doi:10.1016/j.ijoa.2020.04.004

23. Shields AD, Battistelli JD, Kavanagh LB, Thomson BA, Nielsen PE. A modified Delphi approach to determine current treatment advances for the development of a resuscitation program for maternal cardiac arrest. BMC Emerg Med. Aug 26 2022;22(1):149. doi:10.1186/s12873-022-00704-7

24. Sommerkamp SK, Gibson A. Cardiovascular disasters in pregnancy. Emerg Med Clin North Am. Nov 2012;30(4):949-59. doi:10.1016/j.emc.2012.08.007

25. Stokes N, Kikucki J. Management of Cardiac Arrest in the Pregnant Patient. Curr Treat Options Cardiovasc Med. Jun 19 2018;20(7):57. doi:10.1007/s11936-018-0652-9

26. Webster CM, Smith KA, Manuck TA. Extracorporeal membrane oxygenation in pregnant and postpartum women: a ten-year case series. Am J Obstet Gynecol MFM. May 2020;2(2):100108. doi:10.1016/j.ajogmf.2020.100108

27. Wu Y, Luo J, Chen T, et al. Successful ECMO-assisted open chest cardiopulmonary resuscitation in a postpartum patient with delayed amniotic fluid embolism. Eur J Med Res. Feb 3 2022;27(1):19. doi:10.1186/s40001-021-00628-1

28. Zelop C, Einav S, ...

E228: MDCast w/ Dr. Michael Lauria - Severe Postpartum Hemorrhage Jul 03, 2023

This is the first of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a special interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport.

This podcast focuses on severe postpartum hemorrhage. We discuss the epidemiology and risk factors as well as the nuances of diagnosis, specifically how blood loss is actually quantified in this setting. We also go through the importance of point-of-care ultrasound to help identify and manage the causes of postpartum hemorrhage. Then, we transition to the discussion of management, focusing on the medical management of uterine atony, and also go over advanced interventions such as uterine packing, balloon tamponade devices, and REBOA. Finally, Dr. Garchar discusses the indication and procedure for emergent hysterectomy as well as the post-procedure management critical care transport crews may have to perform.

References

Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. Oct 2017;130(4):e168-e186. doi:10.1097/aog.0000000000002351
Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. Int J Gynaecol Obstet. Oct 2010;111(1):32-6. doi:10.1016/j.ijgo.2010.04.036
Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep. Feb 2023;3(1):100135. doi:10.1016/j.xagr.2022.100135
Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand. Apr 2013;92(4):465-7. doi:10.1111/j.1600-0412.2012.01497.x
Bagga R, Jain V, Kalra J, Chopra S, Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. MedGenMed. Feb 13 2004;6(1):50.
Borger van der Burg BLS, van Dongen T, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. Aug 2018;44(4):535-550. doi:10.1007/s00068-018-0959-y
Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. Aug 12 2021;16(1):41. doi:10.1186/s13017-021-00386-9
Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. May 27 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4
Cunningham FG, Nelson DB. Disseminated Intravascular Coagulation Syndromes in Obstetrics. Obstet Gynecol. Nov 2015;126(5):999-1011. doi:10.1097/AOG.0000000000001110
D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada(R) System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices. Sep 2021;18(9):849-853. doi:10.1080/17434440.2021.1962288
Dildy GA, 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. Jun 2002;45(2):330-44. doi:10.1097/00003081-200206000-00005
Dueckelmann AM, Hinkson L, Nonnenmacher A, et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. Sep 2019;240:151-155. doi:10.1016/j.ejogrb.2019.06.003
Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083
Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. Oct 2015;213(4):452-63. doi:10.1016/j.ajog.2015.03.054
Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047
Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. Jul 2017;72(7):853-858. doi:10.1111/anae.13895
Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. Jun 2019;32(3):278-284. doi:10.1097/ACO.0000000000000717
Ji SM, Cho C, Choi G, et al. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul). Jul 31 2020;15(3):314-318. doi:10.17085/apm.19051
Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. Jul 1 2020;7(7):CD013663. doi:10.1002/14651858.CD013663
Kogutt BK, Vaught AJ. Postpartum hemorrhage: Blood product management and massive transfusion. Semin Perinatol. Feb 2019;43(1):44-50. doi:10.1053/j.semperi.2018.11.008
Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x
Liu C, Gao J, Liu J, et al. Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage. Front Med (Lausanne). 2021;8:656422. doi:10.3389/fmed.2021.656422
Lohano R, Haq G, Kazi S, Sheikh S. Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc. Jan 2016;66(1):22-6.
Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. doi:10.1016/0002-9378(93)90082-t
Makin J, Suarez-Rebling DI, Varma Shivkumar P, Tarimo V, Burke TF. Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol. 2018;2018:4952048. doi:10.1155/2018/4952048
Natarajan A, Alaska Pendleton A, Nelson BD, et al. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya. Int J Gynaecol Obstet. Nov 2016;135(2):210-213. doi:10.1016/j.ijgo.2016.05.006
Natarajan A, Kamara J, Ahn R, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. Jul 2016;134(1):83-6. doi:10.1016/j.ijgo.2015.10.026
Okoye HC, Nwagha TU, Ugwu AO, et al. Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci. Mar 2022;22(1):183-190. doi:10.4314/ahs.v22i1.24
Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abno...

E227: MDCast: Calcium Administration in the Severely Injured Trauma Patient - Practical Application w/ Dr. Mike Lauria May 15, 2023

Calcium administration to trauma patients has become a hot topic with the rise of the “Lethal Diamond." While evidence exists regarding the association between hypocalcemia and mortality, it remains unclear whether hypocalcemia is the problem or simply a finding secondary to critical injury. In this podcast, Dr. Lauria reviews the evidence behind calcium administration in trauma and identifies which patients, given the available evidence, might benefit from calcium administration. Don't miss another FlightBridgeED Podcast feature episode of the MDCast! So much good stuff! Please like, subscribe, and leave any questions or comments.

References for the use of Calcium in Severe Trauma

Chanthima P, Yuwapattanawong K, Thamjamrassri T, et al. Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma. Anesth Analg. Jun 1 2021;132(6):1684-1691. doi:10.1213/ANE.0000000000005431
D B. Prehospital administration of calcium in trauma J Paramed Prac. 2022;
DeBot M, Sauaia A, Schaid T, Moore EE. Trauma-induced hypocalcemia. Transfusion. Aug 2022;62 Suppl 1:S274-S280. doi:10.1111/trf.16959
Ditzel RM, Jr., Anderson JL, Eisenhart WJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. Mar 2020;88(3):434-439. doi:10.1097/TA.0000000000002570
Giancarelli A, Birrer KL, Alban RF, Hobbs BP, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. May 1 2016;202(1):182-7. doi:10.1016/j.jss.2015.12.036
Kronstedt S, Roberts N, Ditzel R, et al. Hypocalcemia as a predictor of mortality and transfusion. A scoping review of hypocalcemia in trauma and hemostatic resuscitation. Transfusion. Aug 2022;62 Suppl 1(Suppl 1):S158-S166. doi:10.1111/trf.16965
Leech C, Clarke E. Pre-hospital blood products and calcium replacement protocols in UK critical care services: A survey of current practice. Resusc Plus. Sep 2022;11:100282. doi:10.1016/j.resplu.2022.100282
Messias Hirano Padrao E, Bustos B, Mahesh A, et al. Calcium use during cardiac arrest: A systematic review. Resusc Plus. Dec 2022;12:100315. doi:10.1016/j.resplu.2022.100315
Moore HB, Tessmer MT, Moore EE, et al. Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock. J Trauma Acute Care Surg. May 2020;88(5):588-596. doi:10.1097/TA.0000000000002614
Savioli G, Ceresa IF, Caneva L, Gerosa S, Ricevuti G. Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes. Medicines (Basel). Mar 24 2021;8(4)doi:10.3390/medicines8040016
Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Crit Care. Jun 4 2013;17(3):R106. doi:10.1186/cc12756
Stueven H, Thompson BM, Aprahamian C, Darin JC. Use of calcium in prehospital cardiac arrest. Ann Emerg Med. Mar 1983;12(3):136-9. doi:10.1016/s0196-0644(83)80551-4
Vallentin MF, Granfeldt A, Meilandt C, et al. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. Dec 14 2021;326(22):2268-2276. doi:10.1001/jama.2021.20929
Vallentin MF, Povlsen AL, Granfeldt A, Terkelsen CJ, Andersen LW. Effect of calcium in patients with pulseless electrical activity and electrocardiographic characteristics potentially associated with hyperkalemia and ischemia-sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. Dec 2022;181:150-157. doi:10.1016/j.resuscitation.2022.11.006
Vasudeva M, Mathew JK, Groombridge C, et al. Hypocalcemia in trauma patients: A systematic review. J Trauma Acute Care Surg. Feb 1 2021;90(2):396-402. doi:10.1097/TA.0000000000003027
Vettorello M, Altomare M, Spota A, et al. Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion. J Pers Med. Dec 28 2022;13(1)doi:10.3390/jpm13010063
Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. Mar 2021;41:104-109. doi:10.1016/j.ajem.2020.12.065
Zhang Z, Xu X, Ni H, Deng H. Predictive value of ionized calcium in critically ill patients: an analysis of a large clinical database MIMIC II. PLoS One. 2014;9(4):e95204. doi:10.1371/journal.pone.0095204

E226: MDCast: ASA Overdose Rebuttal & Practical Application w/ Dr. Mike Lauria May 03, 2023

Join FlightBridgeED's new Chief Medical Director, Mike Lauria, as we launch the FlightBridgeED MDCast. Dr. Lauria will hijack these episodes for a new perspective on current topics in critical care medicine. In this episode, Dr. Lauria looks at Eric's previously published podcast [episode 224] on ASA Overdose and gives his insight, practical application, and overall thoughts on these difficult-to-manage patients. Don't miss this episode! So much good stuff! Please like, subscribe, and leave any questions or comments.

References for Acute Salicylate Intoxication

Anderson RJ, Potts DE, Gabow PA, Rumack BH, Schrier RW. Unrecognized adult salicylate intoxication. Ann Intern Med. Dec 1976;85(6):745-8. doi:10.7326/0003-4819-85-6-745
Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi:10.1080/15563650600907140
Dargan PI, Wallace CI, Jones AL. An evidence-based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. May 2002;19(3):206-9. doi:10.1136/emj.19.3.206
Delaney TM, Helvey JT, Shiffermiller JF. A Case of Salicylate Toxicity Presenting with Acute Focal Neurologic Deficit in a 61-Year-Old Woman with a History of Stroke. Am J Case Rep. Feb 15 2020;21:e920016. doi:10.12659/AJCR.920016
Espírito Santo R, Vaz S, Jalles F, Boto L, Abecasis F. Salicylate Intoxication in an Infant: A Case Report. Drug Saf Case Rep. Nov 27 2017;4(1):23. doi:10.1007/s40800-017-0065-9
Goldberg MA, Barlow CF, Roth LJ. The effects of carbon dioxide on the entry and accumulation of drugs in the central nervous system. J Pharmacol Exp Ther. Mar 1961;131:308-18.
Juurlink DN, Gosselin S, Kielstein JT, et al. Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Ann Emerg Med. Aug 2015;66(2):165-81. doi:10.1016/j.annemergmed.2015.03.031
Kuzak N, Brubacher JR, Kennedy JR. Reversal of salicylate-induced euglycemic delirium with dextrose. Clin Toxicol (Phila). Jun-Aug 2007;45(5):526-9. doi:10.1080/15563650701365800
McCabe DJ, Lu JJ. The association of hemodialysis and survival in intubated salicylate-poisoned patients. Am J Emerg Med. Jun 2017;35(6):899-903. doi:10.1016/j.ajem.2017.04.017
Miyahara JT, Karler R. Effect of salicylate on oxidative phosphorylation and respiration of mitochondrial fragments. Biochem J. Oct 1965;97(1):194-8. doi:10.1042/bj0970194
Oliver TK, Jr., Dyer ME. The prompt treatment of salicylism with sodium bicarbonate. AMA J Dis Child. May 1960;99:553-65. doi:10.1001/archpedi.1960.02070030555001
Oualha M, Dupic L, Bastian C, Bergounioux J, Bodemer C, Lesage F. [Local salicylate transcutaneous absorption: an unrecognized risk of severe intoxication: a case report]. Arch Pediatr. Oct 2012;19(10):1089-92. Application cutanée localisée d'acide salicylique : un risque méconnu d'intoxication : à propos d'un cas. doi:10.1016/j.arcped.2012.07.012
Palmer BF, Clegg DJ. Salicylate Toxicity. N Engl J Med. Jun 25 2020;382(26):2544-2555. doi:10.1056/NEJMra2010852
Penniall R. The effects of salicylic acid on the respiratory activity of mitochondria. Biochim Biophys Acta. Nov 1958;30(2):247-51. doi:10.1016/0006-3002(58)90047-7
Shively RM, Hoffman RS, Manini AF. Acute salicylate poisoning: risk factors for severe outcome. Clin Toxicol (Phila). Mar 2017;55(3):175-180. doi:10.1080/15563650.2016.1271127
Stolbach AI, Hoffman RS, Nelson LS. Mechanical ventilation was associated with acidemia in a case series of salicylate-poisoned patients. Acad Emerg Med. Sep 2008;15(9):866-9. doi:10.1111/j.1553-2712.2008.00205.x
Thurston JH, Pollock PG, Warren SK, Jones EM. Reduced brain glucose with normal plasma glucose in salicylate poisoning. J Clin Invest. Nov 1970;49(11):2139-45. doi:10.1172/JCI106431

E225: The Resuscitative Mindset: Airway Decision Making w/ Kevin Collopy Apr 23, 2023

In this podcast, Eric discusses the art of having a "Resuscitative Mindset" when performing advanced airway management with guest host Kevin Collopy. When is it ok to perform advanced airway management rapidly? Is it ever ok? When do we deploy delayed sequence strategies? Should we always use a "Resuscitative" sequence intubation mindset regardless of our assessment findings? So much good conversation about all things airway and decision-making. Please like, subscribe, and leave any questions or comments.

Contact information for Kevin Collopy

Twitter: @ktcollopy

Email: Kevin.Collopy@novanthealth.org

E224: The Nightmare Patient - ASA Overdose Mar 11, 2023

In this podcast, Eric takes a look at a very difficult case of multifactorial resuscitation within ASA overdose. We dive deep into all things resuscitation and analyze factors that drive our decision-making. This takes the "acidosis rodeo podcast series to another level. Don't miss this episode! So much good stuff! Please like, subscribe, and leave any questions or comments.

E223: Hamilton T1 | When To Use Volume Adaptive w/ Joe Hylton Mar 02, 2023

Eric is joined by Joe Hylton, a respiratory therapist, flight paramedic, and Hamilton RT, as they dive into all things Volume Control [Adaptive], ASV, and Pressure Control (Biphasic) ventilation. There are many misconceptions and questions answered within this information-packed podcast. We use the Hamilton simulator to show the differences between patients and accompanying interactions while in Volume Control [Adaptive] ventilation. We discuss when it's best to use Pressure Control [Biphasic] over Volume Control [Adaptive] and the hazards associated with this common mistake. We dive into the long-discussed debate of Assist Control vs. SIMV. Lastly, we discuss the topic of ASV and the technology around this method/mode of delivery.

This is an audio version only. For the best experience, we highly recommend watching the full video version. Please visit the YouTube link below or the FlightBridgeED channel.

Episode Link: https://youtu.be/nhlll1hI7XU

E222: “Pandemic Immunity Gap?” - Managing Acute Respiratory Compromise in RSV Feb 14, 2023

The "Pandemic Immunity Gap" is likely behind the massive surge in respiratory syncytial virus (RSV), with current CDC data showing a 275% increase from 2020-2021 to 2022-2023. The most vulnerable population is between 0-6 months old, which often raises the stress level for providers across all spectrums. Join Eric for a deep dive into a case study involving a 4-month-old male in acute respiratory compromise. We break down the progression of RSV and its association with bronchiolitis. Dive deep into the current evidence on fluid management, bronchodilators, corticosteroids, NS 0.9%, Hypertonic 3%, racemic epinephrine, HFNC, NiPPV, intubation, and much more.

Recommended flow settings and cannula sizes for high-flow nasal cannula therapy in pediatric patients https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027347/table/t1-kjp-2019-00626/?report=objectonly

Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma: Hosp Pediatr (2017) 7 (7): 403–409. https://doi.org/10.1542/hpeds.2016-0211

Efficacy of 3% hypertonic saline in bronchiolitis: A meta‑analysis, Received May 10, 2018; Accepted August 22, 2018. DOI: 10.3892/etm.2019.7684

Respiratory syncytial virus: diagnosis, prevention and management: Ther Adv Infectious Dis 2019, Vol. 6: 1–9 DOI: 10.1177/2049936119865798

https://journals.sagepub.com/doi/epdf/10.1177/2049936119865798

Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2010;12CD001266.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001266.pub4/full

Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis

https://www.bmj.com/content/342/bmj.d1714

High-dose inhaled corticosteroids’ effect on wheezing in infants after respiratory syncytial virus infection: a randomized, double-blind placebo-controlled trial.

Ermers MJ, Rovers MM, van Woensel JB, Kimpen JL, Bont LJ; RSV Corticosteroid Study Group. High-dose inhaled corticosteroids’ effect on wheezing in infants after respiratory syncytial virus infection: a randomized, double-blind placebo-controlled trial. BMJ. 2009;338:b897.

Heliox inhalation therapy for bronchiolitis in infants

Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2010;4:CD006915.

E221: Culture vs. Risk w/ Miles Dunagan Nov 24, 2022

Join Eric and Miles Dunagan, President of the National Pilots Association at AMTC ELEVATE 2022, to discuss Just Culture, safety, risk, past air medical accidents, and much more. Just culture has become the foundation for organizational learning, transparency, and the overall safety initiative within the industry we all serve. The evaluation of risk is always part of our collective jobs. Whether you are a pilot, a paramedic, or a nurse, we have all experienced risk. Risk is always around us. How can risk be mitigated? It starts with open communication, transparency, each team member feeling like they have a voice and a company culture that drives this message from the top down.

Join us for this information-packed podcast highlighting how Just Culture collides with risk, which drives awareness and good decision-making.

E220: Prehospital Hypertonic Saline Administration After Severe Traumatic Brain Injury w/ Kevin Collopy Nov 10, 2022

In this episode, Eric is joined by Kevin Collopy at Elevate 2022 to discuss his team's recent research on TBI and 3% hypertonic saline. The conversation quickly progressed to overall resuscitation in TBI, with a focus on decision-making in airway management, ICP management, herniation, and the secondary injuries that impact TBI patients. This is a must-listen, with many great discussion points.

Prehospital Hypertonic Saline Administration After Severe Traumatic Brain Injury

https://doi.org/10.1016/j.amj.2022.04.004

Abstract

"A 25-year-old male patient was critically injured in a high-speed motor vehicle collision over an hour from the nearest trauma center. Paramedics diagnosed the patient with a traumatic brain injury and increased intracranial pressure and transported the patient to a predesignated landing zone for helicopter intercept. During transport, paramedics initiated a severe traumatic brain injury protocol which included the administration of 3% hypertonic saline."

E219: American Sirens: Conversations of Origin, Diversity, and Hope with Kevin Hazzard Nov 04, 2022

This episode is a must listen. Join Eric as he sits down with an exclusive interview with American Siren author Kevin Hazzard. Do you know the true origins of emergency medical services? This story highlights the TRUE origins of ems. A story of poverty, hope, diversity, change, success, and the forgotten.

Kevin Hazzard is the author of A 1000 Naked Strangers, a 10-year veteran Paramedic in Atlanta, and current nursing student. In this podcast, we discuss the inspiration for the book, why its a must read, the history of EMS as we know it and the true origins of EMS as told in this story. We discuss the first 24 Paramedics in the United States and how this group paved the way for thousands of pre-hospital providers today.

E218: WHAT IF by Dave Olvera - from FAST22 Las Vegas Oct 20, 2022

As healthcare providers, much of what we struggle with is not what we take with us to the scene (our equipment, medications, and techniques) it's what we take back home with us after we have helped others in the most terrible situations of their lives. We are empathetic creatures, and we share in other people's pain. In addition, we may find ourselves struggling with our terrible situations at work or outside of work. In either case, those traumatic events take a little piece of us with them every time we encounter them.

Dave Olvera shared an incredibly impactful talk at FAST22 detailing his struggles with post-traumatic stress disorder (PTSD) and how he continues to overcome it daily. If there is something that you struggle with, it's important for you to find someone to help you move forward in a healthy way. You don't have to suffer, and you aren't alone. If you need help, FlightBridgeED can connect you with a mental health professional.
If you didn't make it out to FAST22 in Las Vegas, you won't want to miss FAST23! We are returning to Planet Hollywood Resort and Casino in Las Vegas this year, which promises to be bigger and better than last year! Tickets go on sale soon, so be sure to find out more information at FASTSYMPOSIUM.COM. Also, please share this content with your friends and rate and review it wherever you get your podcasts. Thanks so much for listening!

E217: The State of Things: Part 2 Oct 20, 2022

The critical care transport industry is constantly changing, and it can be hard to keep up with the latest news and trends. FlightBridgeED has always been dedicated to providing the best education possible for our students, but we know that we can't do it alone. We need your help to continue to learn and grow as an industry. In this second part of The State of Things series, Eric, Ashley, and Evan sit down for a conversation about the latest news and trends in the critical care transport industry. We have always believed that education should come without labels and that we can all learn from each other as we work together to care for the sick and injured.

E216: Resuscitative Mindset Oct 06, 2022

The FlightbridgeED Podcast has been taken over! Chris Meeks joins us to discuss how the devil is in the details of our RSI procedures! Tune in to learn how applying a high-flow nasal cannula can significantly improve patient outcomes and your workload! Be sure to listen to the end for a huge announcement!

E215: The State of Things: A Debrief Sep 16, 2022

The last few years have been trying for the medical transport industry, making us wonder about the industry's future. In part 1 of this podcast series, Eric, Ashley, and Evan discuss the good and the bad of the trends happening in the industry. If you want some fun listening, just wait until you hear the outtake episode! In the meantime, we hope you learn from and enjoy this very open conversation. Thank you so much for listening! We couldn't make this podcast without the support of our incredible community!

E214: Hangar Talk - Part 3 Aug 09, 2022

In the final Hangar Talk episode, Eric and Evan discuss the concept of Just Culture as part of their survey of the air medical industry. This concept is hugely divisive in the industry and is unlikely to change anytime soon. Just Culture is a large topic, and it has many dimensions. In most organizations, employees must complete mandatory Just Culture training modules. The RaDonda Vaught case captured the healthcare industry's attention after the judge handed down her sentence. How does Just Culture apply to this case? Does it apply? Did it apply? Did someone decide that Just Culture didn't apply in this case, and if so, does that instill a great deal of confidence in you that your next blunder (and you will make blunders... we all do) will also result in bypassing Just Culture and putting you in prison for your job? It will be hard to unpack this concept in a short period of time! Don't forget to like and subscribe wherever you find our podcast. Thanks so much for listening! We couldn't make The FlightBridgeED Podcast without you!

E213: Hangar Talk - Part 2 Aug 01, 2022

Picking up from our last episode, Eric Bauer and Evan Claunch continue their discussion. Getting a job in the air medical industry is exciting, but that shouldn't be your final destination. Critical care medicine is always evolving, and you must stay current with how things are changing in this fast-paced career. In part 2 of Hangar Talk, Eric and Evan reveal some pivotal moments in their careers that may help you as you navigate your way through your own. There are so many great tips and pearls in this episode.

We invite you to listen wherever you get your podcasts, and if you like the content, please don't forget to share it. Thanks so much for listening, and don't forget to listen to episode 3, which is coming soon!

E212: Hangar Talk - Part 1 Jul 19, 2022

A new mini-series from FlightBridgeED! In this episode, Eric Bauer and Evan Claunch tackle a couple of difficult conversations, share some of the milestones they passed as they grew as critical care providers, and lay breadcrumbs for those seeking a path forward toward accomplishing their own goals. Nothing worth doing is simple, and there are always obstacles in our way. Being successful isn't a destination; it's a journey, and determination is the fuel that moves you along your journey. We invite you to listen wherever you get your podcasts, and if you like the content, please don't forget to share it. Thanks so much for listening!

E211: FAST22 Rewind - That One Day Jun 22, 2022

We are starting off the FAST22 Rewind series with one of the most powerful talks we have ever heard. In fact, we are still getting feedback almost two months after the conference about the positive impact this talk had. Mike Verkest pitched the idea of a presentation in which...he never spoke. Symbolically, he would take the stage with tape across his mouth, only to remove it in the last seconds of the talk to encourage others to take the proverbial tape off of their mouths and talk about our shared experiences. You could feel the emotion in the room, hear the tears and experience the permission to feel the way we feel. It was extraordinarily dramatic and culminated with a standing ovation. We are pleased to present to you, "That One Day"!

E210: Deep Dive into Pediatric DKA Apr 21, 2022

Pediatric patients are just tiny adults, right? Isn't that what we have always been taught? It is what was taught, but we flatly reject the concept. Why? Because we have seen the reports and results of that flawed logic and the tragic results that follow. For example, if you treat a pediatric patient with diabetic ketoacidosis (DKA) the same way as you would an adult patient with DKA then you can bet your favorite pair of flight boots that their outcome will suffer. That's what this podcast episode is all about!

Among many concepts, you will learn why it's wrong to bolus your pediatric DKA patients with tons of fluid and why sodium bicarbonate is not your friend in these cases. Also, check out the show notes! These are incredible resources that you can use in your own practice!

Show Notes:

https://f001.backblazeb2.com/file/flightbridgeed-podcast/shownotes/episode210/Bicarb_DKA_Pediatrics.pdf

https://f001.backblazeb2.com/file/flightbridgeed-podcast/shownotes/episode210/DKA-pathway.pdf

https://f001.backblazeb2.com/file/flightbridgeed-podcast/shownotes/episode210/Kupperman+NEJM+2018_Fluids.pdf

https://f001.backblazeb2.com/file/flightbridgeed-podcast/shownotes/episode210/NEJM.pdf

https://f001.backblazeb2.com/file/flightbridgeed-podcast/shownotes/episode210/Neonatal_DKA+case+report.pdf

https://f001.backblazeb2.com/file/flightbridgeed-podcast/shownotes/episode210/peds_protecting+the+brain.pdf

E209: The FlightBridgeED Podcast | Sepsis Syndrome - 2021 Evidence Review Mar 22, 2022

In this episode, Eric breaks down some of the changes that were made to the new sepsis protocols in 2021. Sepsis is one of the most common illnesses that we see in critical care medicine. It's important to understand the many dimensions of sepsis and how to treat it as a critical care provider. A 30-minute transport could make the difference in your patient's outcome; maybe even life, or death. Arm yourself with the latest information and ensure that you are providing the right care for your septic patients.

E208: Evidenced Based 12-LEAD: WALDO can't find his SHIP Feb 25, 2022

In this video podcast, Eric discussed the acronym developed by Jared Patterson, an educator for FOAMfrat. This clever memory aid is used to identify the atypical 12 lead tracings that often go unnoticed or missed. Join us for this information-packed episode on evidence-based 12 lead interpretation. So much good stuff! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E207: Death By Clot: Dissecting Ischemic Stroke Feb 18, 2022

In this video podcast, Eric dives into all things neuro and ischemic stroke pathophysiology. We discuss brain physiology, circulation, common thrombotic and embolic stroke etiology, recognition, assessment, and management based on current evidence-based practice. Don't miss this episode! So much good stuff! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E206: The Metabolic Nightmare: Resuscitation at the Highest Feb 10, 2022

In this video podcast, Eric takes a look at a very difficult case of multifactorial resuscitation with an adult male patient. We dive deep into all things resuscitation and analyze factors that drive our decision-making. This takes the "acidosis rodeo podcast series to another level. Don't miss this episode! So much good stuff! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

Download the Referenced Study Information

E205: Is HEAVEN the New LEMONS: Analyzing Airway Resuscitation Research Feb 04, 2022

In this episode, Eric dives into airway assessment, research, and resuscitation. How do you assess your airway? What methods optimize your ability to predict a difficult airway? How do you anticipate resuscitation factors that impact advanced airway management and your decision-making? This is an information-packed episode. Don't miss it! So much good stuff! Please like, subscribe, and leave a review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E204: The Hypothermia Case Study: Survival Against All Odds Jan 25, 2022

In this episode, Eric dives into an amazing case of survival and breaks down all things hypothermia. We look at the current resuscitation recommendations and evaluate this case, the decision-making, and the ultimate outcome. How should you focus your approach on working with a hypothermia patient with a long downtime? You don't want to miss this episode. So much good stuff! Please like and review your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E203: The Standard of Care Podcast - Cross-over Episode: Reasonable Doubt Nov 17, 2021

In this cross-over podcast, we are joined by our team from the Standard of Care Podcast. On 8/22/2021, a Colorado grand jury handed down a 32-count criminal indictment against the police officers and EMS personnel involved in the incident that led to Elijah McClain’s death. In this episode of The Standard of Care, Nick and Samantha try to untangle what these indictments could mean for the EMS community. We reach out to our resident experts - former prosecutor (now business lawyer) Chris Timmons and defense attorney (and Samantha’s law school classmate) Stephen Coxen – for answers. How do prosecutors even decide to file charges in a case like this? How does a grand jury work? What are the strengths and weaknesses of the prosecution’s case, and how does a criminal defense attorney defend a client against these charges? What can EMTs and paramedics do to protect themselves from potential criminal liability? You don't want to miss this episode. So much good stuff! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E202: Special Episode: IBSC and Advanced Certification Discussion w/ John Clark Nov 11, 2021

In this podcast, Eric and Mike are joined by special guest John Clark, the Chief Operating Officer at the International Board of Specialty Certification - IBSC. We discuss all things related to the FP-C and CCP-C board certifications and answer a lot of listener questions related to why these two board certifications are the standard in critical care medicine for paramedics. You don't want to miss this episode. So much good stuff! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E201: Luminary Series: Mobile ECMO w/ Kyle Driesse Nov 09, 2021

In this podcast, Eric is joined by Mike Verkest and our special guest, Flight Paramedic Kyle Driesse. We discuss the implementation and ongoing performance of the Minnesota mobile extracorporeal cardiopulmonary resuscitation program. This is the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO) facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). Don't miss it! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E200: 200th Episode: Best and Most Downloaded Podcasts of All-Time Review Nov 08, 2021

In this podcast, Eric is joined by Mike Verkest for our 200th episode. It has been an amazing nine years! In this podcast, we review the "Best and Most Downloaded Podcasts of All-Time", as chosen by you the listener. We review any new science and discuss the high points of each podcast. Don't miss it! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E199: Clinical Pearls: Mastering Advanced Hemodynamics Sep 12, 2021

In this video podcast, Eric takes a look at clinical pearls within the realm of advanced hemodynamics and cardiac physiology. He dives into the 1:5 rule and uses simulation from iSimulate, with case studies to illustrate how your hemodynamic numbers can help you in decision-making. This is an information-packed episode, with a focus on current evidence-based practice and treatment guidelines. Don't miss it! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E197: Crossover Episode: Vaccine Straight Talk - Part 1 Sep 07, 2021

Part 1: Bad information abounds. We wanted to get the band back together and give you a no-nonsense, non-political, non-biased easy to understand podcast about the COVID Vaccines (well, the mRNA versions) and talk about safety, efficacy, and everything else you wanted to know. We want you to be able to share this with your non-medical friends and family who may be on the fence when it comes to getting vaccinated. Thanks for continuing to support our podcast! Did you know many of our episodes can also be watched? Be sure to check out the FlightBridgeED channel on YouTube! We appreciate your subscriptions and views! Be sure to leave us a review and rating!

E198: Crossover Episode: Vaccine Straight Talk - Part 2 Sep 07, 2021

Part 2: Bad information abounds. We wanted to get the band back together and give you a no-nonsense, non-political, non-biased easy to understand podcast about the COVID Vaccines (well, the mRNA versions) and talk about safety, efficacy, and everything else you wanted to know. We want you to be able to share this with your non-medical friends and family who may be on the fence when it comes to getting vaccinated. Thanks for continuing to support our podcast! Did you know many of our episodes can also be watched? Be sure to check out the FlightBridgeED channel on YouTube! We appreciate your subscriptions and views! Be sure to leave us a review and rating!

E196: The Lethal Trauma DIAMOND - An Evidence-Based Look at Hypocalcemia Aug 29, 2021

In this video podcast, Eric takes a look at the concept of damage control resuscitation and the new concept of the "Lethal Trauma Diamond". In this podcast we dive into all things trauma resuscitation, focusing on current evidence-based practice as it relates to component therapy (1:1:1), whole blood administration, and the four components of the lethal diamond. We investigate the newest of the four, hypocalcemia, and look at the pathophysiology around ionized calcium and its impact on coagulopathy. This is an information-packed episode, with a focus on current evidence-based practice and treatment guidelines. Don't miss it! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E195: Spinal Cord Injury - DEEP DIVE Aug 22, 2021

Join Eric as he takes a DEEP DIVE into all things Spinal Cord Injury. Spinal cord injuries are catastrophic injuries that can be hard to manage. Each year approximately 17,000 new spinal cord injuries occur in the United States, with trauma from motor vehicle crashes as the leading cause. In this video podcast, we take a look at anatomy and physiology, injury location, and associated presentations for anterior cord, central cord, posterior, and Brown-Sequard syndrome. This is an information-packed episode, with a focus on current evidence-based practice and treatment guidelines. Don't miss it! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E194: Better than the sum of its parts: Whole Blood In Trauma: W/ Dr. Zaffer Qasim Jun 17, 2021

Join Dr. Zaffer Qasim for this video Podcast: "Better than the sum of its parts: Whole Blood In Trauma" This insightful video podcast will take an in-depth look at the evidence surrounding Whole Blood administration and the current practices surrounding trauma resuscitation. Join Dr. Zaffer Qasim for this excellent look at one of the hottest topics in pre-hospital and emergency medicine - Whole Blood!. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E193: "Hail to the Receptor in Chief" w/ Dr. Peter Antevy May 24, 2021

Join Dr. Peter Antevy for this exclusive FAST21 video talk: "Hail to the Receptor in Chief"! This insightful video podcast will take an in-depth look at the evidence surrounding Ketamine and its impact on MDMA receptors. Join Dr. Antevy for this excellent look at one of the hottest topics in pre-hospital and emergency medicine. Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E192: Aim To Be A ZERO! May 03, 2021

In this episode, Eric discusses our impact on our environment and the people around us. How do you come across to others? Are you a (-1), (0) or (+1)? How does this impact your ability to grow in an organization? Join Eric for: "Aim To Be A ZERO! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E191: The Eyes Don’t See…What The Brain Doesn’t Consider!’ Apr 25, 2021

In this episode, Eric takes a look at key elements of differential diagnosis and how being thorough in our approach will often save us from making big mistakes. One of the highest risk areas in prehospital EMS and emergency medicine is cognitive bias. You will not make a diagnosis of the disease that you didn’t include in your differential. Join us for "The Eyes Don't See what the Brain Doesn't Consider"! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E190: The RAGE: 5 Pillars of Mastery Apr 16, 2021

In this episode, Eric takes a look at key elements that will help you be successful in your life, career, or any other pursuits you seek throughout your life. The "Rage: 5 Pillars of Mastery", takes a look at my top five areas of focus to help you be the best version of yourself! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E189: Prehospital Ketamine Use for Rapid Sequence Intubation - RCT Review Apr 12, 2021

In this episode, Eric discusses the current evidence and analysis of the RCT on Ketamine use in RSI as published in the Air Medical Journal. Does this RCT show us anything we didn't already know? How can we optimize a neutral hemodynamic response in our sickest patients? Join us for "Prehospital Ketamine Use for Rapid Sequence Intubation - RCT Review"! Please like and review on your current podcast app, including Spotify, Google Play, iTunes, PodBean, and many more.

E188: Blankets are for Naps, Not Medicine: Metabolic Acidosis - Calculated Discrimination Apr 02, 2021

In this episode, Eric discusses the current evidence, approach and opinions on treating patients in metabolic acidosis w/ partial compensation. How do we determine the correct minute ventilation? Does education cause us to have calculated discrimination for these patients? How do we best approach this type of patient and how often do we really see a patient that needs high minute ventilation? Should education focus more on critical thinking and the identification of these patients? Join us for "Blankets are for Naps, Not Medicine: Metabolic Acidosis - Calculated Discrimination"!

E187: ECMO in out of hospital cardiac arrest with Dr. Dimitri Yannopoulos Feb 03, 2021

In this episode, Mike Verkest joins Eric and Dr. Dimitri Yannopoulos to discuss the role of ECMO in out-of-hospital cardiac arrest. Dr. Yannopoulos’s research involves cardiopulmonary resuscitation, hypothermia, and myocardial salvage during acute coronary syndromes. He is considered an authority in cardiorespiratory interactions and hypothermia during CPR. His work in the laboratories of Dr. Keith Lurie (at the University of Minnesota) and Dr. Henry Halperin (at Johns Hopkins University) has helped change current CPR practices. We will discuss the ARREST trial and learn about the trials he is blazing in cardiac arrest care.

E186: Implementing Helmet-based Ventilation in the COVID-19 Era Sep 29, 2020

This is a special edition podcast that was recorded from a live broadcast on September 24th, 2020 featuring Sea-Long Medical Industries and their partnership with Life Link III. This discussion will cover the unique collaboration that all started with a news story on ABC Nightly News. Hear how the relationship formed and how Life Link III took on the task of implementing this nontraditional, yet groundbreaking treatment modality for COVID-19.

E185: The Asthma Nightmare Case Jul 21, 2020

You are called for an 18-year-old male who was intubated at a community hospital. That is probably the best thing they could have done. Listen to Eric as he describes the challenge of this patient and the associated ventilator strategies. Join the conversation! Download, subscribe, listen, and share this podcast. Don’t forget to subscribe wherever you get your podcasts!

E184: Does Glucose Predict Hypotension? Jul 14, 2020

Eric discusses a recent paper on the predictive values of POC Glucose and its relationship to hypotension in the adult trauma patient. Join the conversation! Download, subscribe, listen, and share this podcast. Don’t forget to subscribe wherever you get your podcasts.

E183: The FlightBridgeED Podcast - Episode 183 - PEDS with COVID May 25, 2020

Ashley Bauer continues her COVID conversation, with a focus on the pediatric population. The number of cases involving children and changes in symptoms have sparked a worldwide discussion as to what to do with these cases. Join the conversation! Download, subscribe, listen and share this podcast. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks so much for listening!

E182: Special Episode: The Nightmare Patient - COVID-19 Case Study Apr 19, 2020

In this special episode, Ashley has kicked Eric out of the podcast studio and has gone solo. Join Ashley Bauer as she hosts the podcast and takes you through a Nightmare case study of a COVID-19 positive patient. She breaks down the initial presentation and moves through diagnostic studies, including labs, chest x-ray findings, and much more! This is a can't miss episode! We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks so much for listening!

E181: Advanced Hemodynamics: Tips and Tricks... Looking Past The Numbers Apr 07, 2020

Join Mike Verkest, Eric Bauer, and Bruce Hoffman as we discuss all things Advanced Hemodynamics. This topic can be complex and is often not used enough to get proficient. Join us as we discuss "tips and tricks" and answer your common questions. We finish with a look at the application and how to make the correct pharmacology decision based on the hemodynamic numbers you are seeing. Download, rate, and review wherever you get your podcasts. Reviews help us stay high on the chart where your friends and co-workers can find us. If you love our free podcast, help us spread the word!

E180: The Oxylator w/ Dr. Jim DuCanto Apr 06, 2020

As we continue through this COVID-19 pandemic, mechanical ventilation and the available equipment needed to manage these intubated patients are dwindling fast. Join Dr. DuCanto as he introduces the Oxylator as a tool to manage intubated patients who need mechanical ventilation support. The device is simple to use and may be a great option in this COVID-19 fight. Download, rate, and review wherever you get your podcasts. Reviews help us stay high on the chart where your friends and co-workers can find us. If you love our free podcast, help us spread the word!

E179: COVID-19 Part 1 - Disease Evolution: Pathophysiology Mar 22, 2020

We have not seen anything like this... I would dare to say the COVID-19 pandemic will live in our memories for a lifetime. As the world watches, healthcare providers around the world are dealing with patients that have mild to severe symptom morphology. This podcast goes into the disease escalation and how the sickest patients end up in acute respiratory failure. Join me in part 1 of 2 in the COVID-19 series as we identify the disease evolution and look at the specific pathophysiology associated with the secondary effects seen with COVID-19 patients. Download, rate, and review wherever you get your podcasts. Reviews help us stay high on the chart where your friends and co-workers can find us. If you love our free podcast, help us spread the word!

E178: Retro Release "Acidosis Rodeo" - Part 1 Mar 16, 2020

This is a retro release from the highly downloaded series on Acid-Base Balance. If you missed these episodes, need to brush up on concepts or just love all things Acid Base Balance listen and sharpen your skills. In this first of a three-part series, Eric Bauer unpacks a difficult critical care case scenario and begins to explain how we can better identify pH balance disturbances in our patients. Learn how to identify acidosis even without blood gasses, how to protect your patients from further sliding into a worsening state, and much more. Download, rate, and review wherever you get your podcasts. Reviews help us stay high on the chart where your friends and co-workers can find us. If you love our free podcast, help us spread the word!

E177: Big News!! - VIPER Study Review Feb 18, 2020

Push dose pressor administration in the pre-hospital and air medical industry is becoming a more standard guideline. However, there is very little evidence of its application in our environment. The Vasopressor Intravenous Push to Enhance Resuscitation (VIPER) study takes a prospective observational look at Phenylephrine and Vasopressin in non-trauma and trauma patients in the air medical environment. Listen and find out more. Download, rate, and review wherever you get our podcast. Remember that reviews help us stay high on the charts where your friends and colleagues can find us. If you love our podcasts, please help us out and spread the word online and in the streets. Thanks for listening!

E176: Retro Release: The Endocrine Nightmare w/ Guest Ashley Bauer Feb 11, 2020

This was one of the most popular and most downloaded podcasts we have ever done. Endocrine is often an unpopular subject and can bring forth many complex topics. Join guest Ashley Bauer in this retro release and dive into this great podcast. In this episode of The FlightBridgeED Podcast, Eric is joined by his lovely wife, Ashley Bauer as they dissect several complicated patient care scenarios. These cases are lab value intense and each value is explained clearly and applied to the patient so that you can easily understand what they mean for your next critically ill patient. Download, rate, and review wherever you get our podcast. Remember that reviews help us stay high on the charts where your friends and colleagues can find us. If you love our podcasts, please help us out and spread the word online and in the streets. Thanks for listening!

E175: The Best of The Best - 2019 Rewind! Dec 24, 2019

In this episode of The FlightBridgeED Podcast, Eric is joined by Mike Verkest to review the top 5 most downloaded podcasts from 2019. It was an incredible year, and 2020 is shining just as bright! Download, rate, and review wherever you get your podcasts. The FBE family of podcasts is now available on TuneIn! Get the app now and listen to your favorite podcast and more! Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E174: The Nightmare Series - The Herniating Ischemic Stroke Patient Dec 10, 2019

In this episode, we explore another critical Nightmare Series Patient. We explore the complex world of ischemic stroke and the pathophysiology of herniation. Eric is joined by his good friend Flight Nurse Rahkeem Francis in the discussion of all things neuro and how to handle a herniating ischemic stroke patient within the transport realm. Don't miss this excellent case and overview of the herniating ischemic stroke patient. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E173: Congenital Heart Defects: Part 3 Dec 03, 2019

In this episode, we dive into Congenital Heart Defects Part 3 of 3. In this podcast, we will review tricuspid atresia and hypoplastic left heart. Despite these patients often being transported by NICU teams, there are cases of congenital heart defects that have been undiagnosed and something you may encounter on-scene fights that decompensate once the PDA has closed. This places the care in the pre-hospital provider's hands and brings forth a high-stress case that can be overwhelming for most. Couple this with the high quantity of questions seen on all advanced certification exams and it is a must that we review these congenital heart defects. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E172: Congenital Heart Defects: Part 2 Nov 25, 2019

In this episode, we dive into Congenital Heart Defects Part 2 of 3. In this podcast, we will review truncus arteriosus and Tetralogy of Fallot. Despite these patients often being transported by NICU teams, there are cases of congenital heart defects that have been undiagnosed and something you may encounter on-scene fights that decompensate once the PDA has closed. This places the care in the pre-hospital provider's hands and brings forth a high-stress case that can be overwhelming for most. Couple this with the high quantity of questions seen on all advanced certification exams and it is a must that we review these congenital heart defects. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E171: Congenital Heart Defects: Part 1 Nov 18, 2019

In this episode, we dive into Congenital Heart Defects Part 1 of 3. In this podcast, we will review Coarctation of the Aorta and Transposition of the Great Vessels. Despite these patients often being transported by NICU teams, there are cases of Coarctation of the Aorta infants that have been undiagnosed that you may encounter on-scene fights that decompensate once the PDA has closed. This places the care in the pre-hospital provider's hands and brings forth a high-stress case that can be overwhelming for most. Couple this with the high quantity of questions seen on all advanced certification exams and it is a must that we review these congenital heart defects. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening! Thanks for listening!

E170: The Nightmare Series Patient - The Decompensating Infant Nov 12, 2019

In this episode, we dive into another Nightmare Series Patient Case of the decompensating infant. Join Eric as he discusses neonatal to full-term infant resuscitation based on current standards by NRP, PALS, STABLE, and Pediatric Fundamentals of Critical Care Support (PFCCS). This is a great case that highlights key factors in neonatal and infant resuscitation. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E169: Statistical Analysis: AVERT Vasopressin Trial Sep 23, 2019

Throughout the course of modern medicine, old methods fall as new ones emerge safer, more reliable, better for patient outcomes, and more. Sims et al., Says this: "Resuscitation strategies that decrease the need for transfusions without increasing complications, therefore, would represent a clinically important innovation". Research is deep and results are shared throughout the world. One of the fastest-growing, most industry-related sections of medicine today is that of resuscitation. In this episode of The FlightBridgeED Podcast, the team of Dr. Jeff Jarvis and Mike Verkest from the highly-rated EMS LightHouse Project Podcast dissect the actual study from a statistical analysis standpoint. Is the data as good as it seems? Is it statistically significant? Is there a place for vasopressin administration early in the resuscitation phase within the realm of trauma-induced massive hemorrhage? Join them and find out! Don’t forget to rate and especially review wherever you got your podcasts. These reviews are especially key to keeping us high on the charts where your friends and colleagues can find us. Thank you for listening.

E168: Vasopressors In Trauma? - "The FOAMfrat Blog Response"! Sep 16, 2019

The debate regarding vasopressor use in trauma has been going on for years. FOAMfrat recently released a blog article called. "Levophed Assisted Transfusion". In this article written by Tyler, he lays out his thoughts on this subject and advocates for vasopressor administration in the early resuscitation phase with patients suffering from multi-system trauma and associated TBI. This podcast is a rebuttal podcast on that article and the current evidence. Are vasopressors in trauma warranted? Is there clinical evidence? I say... Join me in this review and find out my stance! These reviews are especially key to keeping us high on the charts where your friends and colleagues can find us. Thank you for listening.

E167: Vasopressin - AVERT Trial Results... Wow! Sep 06, 2019

Throughout the course of modern medicine, old methods fall as new ones emerge safer, more reliable, better for patient outcomes, and more. Sims et al., say this: "Resuscitation strategies that decrease the need for transfusions without increasing complications, therefore, would represent a clinically important innovation". Research is deep and results are shared throughout the world. One of the fastest-growing, most industry-related sections of medicine today is that of resuscitation. In this episode of The FlightBridgeED Podcast, Eric presents the newly published research just released on the AVERT Trial. Remember we introduced this abstract in a podcast called "Vasopressin The Master Medication - September 17, 2017. Well... the evidence is out! This is groundbreaking stuff in trauma resuscitation, don't miss it! Don’t forget to rate and especially review wherever you got your podcasts. These reviews are especially key to keeping us high on the charts where your friends and colleagues can find us. Thank you for listening.

E166: FlightBridgeED-Episode 166 | A Little Help? Aug 09, 2019

In this episode, I ask for your support in my submission for the open board position within the IAFCCP Association. Thank you for all your support! Remember that reviews are key to helping keep us stay high on the charts and where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E165: FlightBridgeED-Episode 165 | The Nightmare Series Patient - ASA Overdose Aug 03, 2019

In this episode, we explore another critical Nightmare Series Patient. We explore the complex world of ASA overdose and the wide-ranging pathophysiology we have to migrate through. ASA overdose is one of the more complex presentations and will challenge the most experienced providers Remember that reviews are key to help keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E164: FlightBridgeED-Episode 164 | The World of OZmolality Jul 17, 2019

In this episode, we explore the world of OZ... OZmolality, urine specific gravity, and the disease processes of SIADH and diabetes insipidus. These are important concepts for advanced certification exam preparation and overall patient application. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E163: FAST19 Rewind - "Breaking the Lethal Culture of Mental Health" Jul 08, 2019

WOW! FAST19 was so amazing. So inspiring! If you missed FAST19.. Don't worry, FAST20 will be - May 18-20, 2020 in Murfreesboro, TN. This is the second of a few releases from FAST19. This was a moving talk by our own Daniel Mills from the 911 BuddyCheck Project. You don't want to miss this! Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E162: Critical Care Round Table - Listener Q|A Answered Jun 11, 2019

In this episode, we dive into the many emails I receive and attempt to answer hot-topic clinical questions. Join me in this dynamic episode as we discuss all things critical care. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E161: The Nightmare Series Patient: Undifferentiated Overdose Jun 03, 2019

In this episode, we dive into another Nightmare Series Patient Case of the Undifferentiated Overdose. Join Ashley, Mike, and Eric during our recent visit to the National Teaching Institute Critical Care Nursing Conference. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E160: The EMS Lighthouse Project - Making Sense Of Epi in Cardiac Arrest May 18, 2019

This is a plug and introduction to all the FBE listeners to our newest podcast. The EMS Lighthouse Project Podcast exists to foster knowledge translation from peer-reviewed scientific journals to the street. Join Mike Verkest and Dr. Jeff Jarvis as they shine the bright light of science on EMS practice in an informative and fun way as they look deep into the research on epi in cardiac arrest. Does it help? Are there better outcomes? How do patients do based on neurological outcomes? Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E159: FAST19 Rewind - RVAD vs. Air Embolus | A Lesson in CRM w/ Bruce Hoffman May 12, 2019

WOW! FAST19 was so amazing. So inspiring! If you missed FAST19.. Don't worry, FAST20 will be - May 18-20, 2020 in Murfreesboro, TN. This is the first of a few releases from FAST19. This was a very popular talk by our own Bruce Hoffman as he perfectly goes through the case-based study called - RVAD vs. Air Embolus | A Lesson in CRM. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E158: FAST18 Rewind - "When Things Get Wicked"! w/ Ginger Locke May 04, 2019

FAST18 was Epic! If you missed FAST18... Don't worry, FAST19 is in three days - May 6-8, 2019 in Murfreesboro, TN. This is the fifth and final release of FAST18. Join the 2019 Keynote opening speaker, Ginger Locke for this thought-provoking talk - "When Things Get Wicked"! Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E157: The Nightmare Series - Cardiac Catastrophe Apr 29, 2019

We are back to the horrors associated with "The Nightmare Patient". The crew is tenuously attempting to rip the patient out of death’s mouth and bring him back from the roaring mouth of oblivion. Will the patient be saved? In this episode, we dive into the cardiac catastrophe. Take a journey as we discuss treatment pearls associated with atypical presentations, with a focus on Wellen's syndrome and papillary muscle rupture of the mitral valve and associated treatment PEARLS. Join me on the tough topic and take a journey with me as we explore our thinking methodology. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E156: Black or White? Or Fifty Shades of Gray? “Cook Book Medicine Vs. Objective-Thinking. Apr 24, 2019

The transition from a more rigid protocol into a more guideline-based thought process can be overwhelming. Many of us can be very black-and-white with our thinking. This can be dangerous! We all need to have the "Fifty Shades Of Gray" mindset. This podcast is meant to challenge the black-and-white thinking many of us struggle with. Join me on the tough topic and take a journey with me as we explore our thinking methodology. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E155: TXA in Traumatic Brain Injury - The ROC Study Results Are In!! Apr 16, 2019

In this episode of The FlightBridgeED Podcast, Mike Verkest discusses the results of the Resuscitation Outcomes Consortium (ROC) TXA study in traumatic brain injuries. This was a double-blinded study that resulted from data derived from the Crash-2 and MATTERs studies on TXA in hemorrhage. Join Mike as he recaps the results. Hot off the press!! Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E154: The Second Fracture! Mar 06, 2019

In this episode, Eric is joined by Ashley Bauer as they look at the concept of the "Second Fracture". We can oftentimes become hyper-focused on a specific complaint, to then completely miss the true problem. Join us as we explore three different cases that highlight this concept. Don't miss this important lesson in medicine... The Second Fracture! Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E153: Combatting Atelectasis - Dissecting Physiologic Shunt Mar 01, 2019

In this episode of The FlightBridgeED Podcast, Eric breaks down atelectasis and physiologic shunting seen in the standard hypoxic patient. It is essential to understand the physiology and pathophysiology of these difficult patients. Join him in part 1 of 2 of this podcast series. Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E152: The Best of the Best - 2018 Rewind Jan 28, 2019

In this episode of The FlightBridgeED Podcast, Eric is joined by Mike Verkest to review the top 5 most downloaded podcasts from 2018. It was an incredible year, and 2019 is shining just as bright! Download, rate, and review wherever you get your podcasts. The FBE family of podcasts is now available on TuneIn! Get the app now and listen to your favorite podcast and more! Remember that reviews are key to helping keep us high on the charts where your friends and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E151: Know Your Labs! - Diagnosing DKA using Beta-Hydroxybutyrate Jan 09, 2019

Diabetic ketoacidosis patients can be very sick and challenging. There are multiple diagnostic indicators used in diagnosing and treating DKA patients. One standard test used is the urine and/or serum ketone test. This can be inaccurate and does not always give the provider the true story when evaluating an improving or declining clinical picture. However, the earliest ketone body formed during fatty acid breakdown is beta-hydroxybutyrate. This isn't a new lab, but a lab that has become more available in the emergency department. Join me for this quick podcast on this great tool assisting in the overall diagnosis of the diabetic ketoacidosis patient. You don't want to miss this one! Last, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E150: The Silent Killers in Pediatric Mechanical Ventilation - Part 2 Jan 01, 2019

Mechanical ventilation in the pediatric population brings forth different areas of concern. Couple this with an already stressful patient population and these types of calls can be highly stressful. Join us in part 2 of 2 as Tyler Christifulli hosts w/ guest Bryan Winchell, as they discuss the "Silent Killers related to pediatric mechanical ventilation, with an application to the Hamilton T1 ventilator. You don't want to miss this one! Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E149: The Silent Killers in Pediatric Mechanical Ventilation Dec 27, 2018

Mechanical ventilation in the pediatric population brings forth different areas of concern. Couple this with an already stressful patient population and these types of calls can be highly stressful. Join us in the last podcast for 2018 where we dive into the "Silent Killer" in Pediatric mechanical ventilation. This will be part 1 of 2 podcasts on this highly requested topic. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E148: Soft Vs. Hard is the Question? W/ Dr. Mike Hudson Dec 09, 2018

Join us at AMTC 2018 for a discussion that has been a hot topic around the United States for the past few years. Dr. Mike Hudson, medical director for Classic Air Medical in Utah, joins us. He is one of just a few medical directors in the United States taking a stance on this hot topic. Are we close to following in the footsteps of our brothers across the pond? Join us to find out more about "Soft Vs. Hard is the Question?" Lastly, we couldn’t make this podcast without you. Please rate and review wherever you download the podcast. Thanks for listening!

E147: Did Someone Say...Push Dose Pressor? "The New KID On The Block!" Nov 11, 2018

Using push dose pressors has become common practice in pre-hospital and critical care environments. We have seen many companies adopt protocols that guide the use of medications such as Epinephrine and Phenylephrine as the go-to medications in the setting of Rapid Sequence Intubation, with associated hemodynamic compromise. However, are these the best medications? We know that both Epinephrine and Phenylephrine come with many potential side effects. Is there a better option? Join us to find out more about "The New KID On The Block." Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E146: The Steps To Becoming A FLIGHT NURSE w/Kelly Miller Nov 03, 2018

This is our second in a series of two unique podcasts that takes a look at the road to becoming a Flight Nurse. I'm joined with Kelly Miller, Regional Clinical Manager for the Midwest Region of Air Methods Corporation. We have received numerous podcast requests on the topic of: "What is the best way to achieve the position of "Flight Nurse". Kelly comes with a diverse experience level as a nurse in the ED, ICU and flight nurse in the HEMS industry, with his current role as a Regional Clinical Manager. Take a journey with us as we dive into the best way to obtain a flight position and be prepared for these challenging clinical positions. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E145: The Nightmare Scenario - "Managing The Unimaginable" Oct 27, 2018

We have all sat back and thought about the worst scenarios possible. We train on different patient presentations and take great care in understanding our job as a whole. But...Do we take the same time and preparation in our crew resource management skills? How would you respond in different flight-related emergencies with your patient, partner, pilot, or aircraft? Sit back and get ready for the Nightmare Scenario - Managing The Unimaginable. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E144: Big News..The Best Tool In Medicine! Oct 17, 2018

What is the best tool we have? It is easy to get excited about intubation, chest tubes, or even surgical airways. What saves lives? What tool out of all our procedures and equipment is the best? In the episode, we discuss how to have optimal performance and ways to build on this amazing tool! We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E143: The Mental Reset - "OODA Loop!" Oct 14, 2018

Join us for a special "hijacked episode" of the podcast. This is a much-needed topic of conversation. The "OODA Loop" process has been discussed in-depth concerning cognitive and performance psychology. However, we often find ourselves task-saturated, tunnel-visioned and stuck in a faulty loop of repetitive error. In the episode, we discuss five tips to train and prepare for optimal performance, troubleshooting, and the mental reset. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E142: FOAMfrat "Transfusion Confusion" RESPONSE! Sep 27, 2018

If you didn't listen to the recent podcast put out by Tyler Christifulli and FOAMfrat called "Trigger Happy Transfusion Confusion" please download and listen via the FOAMfrat podcast feed. Tyler does a great job and provides out-of-the-box thinking on the hot topic of PRBC administration in the transport environment. This "Response" podcast is based on my commentary, overall thoughts on the topic, additional topic points to consider, and an overall review of the data related to PRBCs, FFP, and the recently published PAMPer trial. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E141: Is Ketamine a Safer RSI Medication in Pre-hospital Transport Environment? Maybe Not! Sep 19, 2018

From the authors of David Olvera, FP-C, and Daniel Davis M.D. The abstract introduction: Rapid sequence intubation (RSI) is associated with several complications that can increase morbidity and mortality. Among RSI agents used to blunt awareness of the procedure and produce amnesia, ketamine is unique in its classification as a dissociative agent rather than a CNS depressant. Thus, ketamine should have a lower risk of peri-RSI hypotension due to the minimal sympatholysis as compared to other agents. The main goal of this analysis was to explore the incidence of hypotension and/or cardiopulmonary arrest in patients receiving ketamine versus other agents during RSI. We hypothesized that ketamine would be associated with a lower risk of hemodynamic complications, particularly after adjusting for co-variables reflecting patient acuity. In addition, we anticipated that an increased prevalence of ketamine use would be associated with a decreasing incidence of peri-RSI hypotension and/or arrest. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E140: FAST18 Rewind: "Fit For Duty"? w/ James Boomhower Aug 21, 2018

FAST18 was Epic! If you missed FAST18... Don't worry, FAST19 is right around the corner - May 6-8, 2019 in Murfreesboro, TN. This is the fourth release of many FAST18 Rewinds that will be released throughout the next year, leading up to FAST19. This talk is a groundbreaking look into our mental ability to be ready for duty. This was one of my favorite talks and something everyone must hear! I promise you this will knock you down and pick you back up! Join James Boomhower a Flight Paramedic from Boston MedFlight with his talk "Fit For Duty"! We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E139: FOAMfrat Re..Butt..AL - "Response Required"! Jul 28, 2018

In this episode, Eric responds to the latest podcast by FOAMfrat and Tyler Christifulli, titled "Response Required"! This is a must-listen and a full Re..butt..AL based on the podcast we published a few weeks back called: "The 5 Hottest Questions In Mechanical Ventilation w/ Mike Herman". Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E138: Debunking the Continuing Controversy with Ketamine in Traumatic Brain Injury Jul 21, 2018

In this episode, Eric discusses the continuing controversy surrounding the use of Ketamine in the TBI patient. Does Ketamine cause an increase in ICP after administration? Join us for a look at the available literature and review this controversial topic. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E137: The 5 Hottest Questions In Mechanical Ventilation w/ Mike Herman Jul 13, 2018

In this episode, Eric is joined by his buddy Mike Herman for a down-and-dirty question-and-answer blitz on mechanical ventilation. We dive into the hottest subjects in mechanical ventilation, where I attempt to answer five questions that are common in pre-hospital critical care. You don't want to miss this episode!! Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

Download Advanced reperfusion strategies for patients with out-ofhospital cardiac arrest and refractory ventricular fibrillation
(ARREST): a phase 2, single centre, open-label, randomised controlled trial paper

Download The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes

E136: FAST18 Rewind - Traumatic Arrest | Dissecting Critical Thinking w/Sam Ireland Jun 30, 2018

FAST18 was Epic! If you missed FAST18... Don't worry, FAST19 has been planned and booked for May 6-8, 2019 in Murfreesboro, TN. This is the third of many FAST18 Rewinds that will be released throughout the next year, leading up to FAST19. Don't miss this talk on the critical thinking involved in Traumatic Arrest. Join Sam Ireland from our FOAMfrat brothers and sista! Sam is a phenomenal speaker and will make you think differently about the Traumatic Arrest patient. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E135: High Dose Nitro in Hypertensive Left Ventricular Failure Jun 08, 2018

High-dose nitro has become a hot topic as of late. In the podcast, I'm joined by Chris Meeks, a Flight Paramedic and the host of the Mind Body Medic Podcast. Chris and I sit down and discuss the physiology of left systolic and diastolic ventricular failure and how to approach a patient who is in severe overload due to high systemic vascular resistance. The newest literature is guiding high push dose nitro, with doses of 1-3mg IV push given every couple minutes. Join us for the discussion, and look into physiology and application in the pre-hospital ground and helicopter environments. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E134: The Steps To Becoming A Flight Paramedic w/Evan Claunch May 23, 2018

This is a unique podcast that takes a look at the road to becoming a Flight Paramedic. I'm joined by the original co-founder of FlightBridgeED-Evan Claunch. We have received numerous podcast requests on the topic of: "What is the best way to achieve the position of Flight Paramedic". What better way to honor Evan as he moves into a new career and leaves the HEMS industry behind than to have this discussion with him? Evan and I discuss the best ways to achieve these tough-to-find positions. Take a journey with us as we dive into the best way to obtain a flight position and be prepared for these challenging clinical positions. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E133: Surviving Sepsis 2018 Update - Literature Review May 14, 2018

Hot Off the Press! In this podcast, we dive into the 2018 Surviving Sepsis Update and look at the new recommendations, evaluate the evidence, and take a look at how this does or does not fit with other high-level evidence. We dive into the fluid debate, with a focus on Normal Saline vs. Lactated Ringers, whether 30mL/kg is based on the best evidence, whether fluid should be given based on true body weight or ideal body weight, and lastly, the hot topic of EtCO2 guided fluid resuscitation when coupled with passive leg raising. This is always a hot topic! Take a journey with me on this often disagreed subject! Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E132: The Nightmare Patient - Tylenol Toxicity May 05, 2018

We are back to the horrors associated with "The Nightmare Patient". The flight crew is tenuously attempting to rip the patient out of death’s mouth and bring him back from the roaring mouth of oblivion. Will she be saved? How will her care be rendered? In this episode, Bruce Hoffman joins Eric for a look at the complexities associated with Tylenol toxicity. We look specifically at the physiology, associated labs, the four phases of toxicity, and associated treatment PEARLS. Don't miss this podcast. This is a highly tested subject on all advanced certification exams and can be a difficult patient to manage in general. Lastly, we couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E131: FAST18 Rewind - A Paradigm Shift In Pediatrics w/ Dr. Peter Antevy Apr 29, 2018

FAST18 was Epic! If you missed FAST18... Don't worry, FAST19 has been planned and booked for May 6-8, 2019 in Murfreesboro, TN. This is the second of many FAST18 Rewinds that will be released throughout the next year, leading up to FAST19. This talk is a groundbreaking look into pediatric resuscitation by a true visionary. Join Dr. Peter Antevy with his talk "A Paradigm Shift In Pediatrics. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E130: Dissecting "TIME CONSTANT" - Optimizing Alveolar Filling and Emptying Apr 23, 2018

This podcast is going to dive into the topic of TIME CONSTANT. Have you ever wondered how we truly determine the exhalation time for our ventilator patients? Time Constant is the concept that guides our care and determines the time needed for proper alveolar filling or emptying. We couple this podcast with a downloadable worksheet for practice that can be found in the show notes on the FlightBridgeED website under this podcast. The worksheet gives calculation examples, practice questions, and answers to check your work. I promise this podcast will challenge you, bring insight into problems you've encountered in the transport environment, and ultimately give you new tools that will make you better as a clinician. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E128: ARDS vs. Pseudo ARDS Literature Review Apr 15, 2018

This podcast is going to dive into the hot topic of ARDS or lack thereof. I’ve been so excited to review this article and was blown away by its depth and science-based discussion. In this amazing article by Pulmcrit and Josh Farkas, the topic of ARDS is examined with a focus on the Berlin Definition of ARDS, pathophysiology, iatrogenic injury, and the new theory called “pseudoARDS”. In this episode, we explore the old thought process in ARDS, with a focus on diagnosis, physiology, theory, and overall treatment approach. We then examine the science and take a look at the newer thoughts on “pseudoARDS”. We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks for listening!

E127: FAST18 Rewind - "My Worst Day"! Mar 30, 2018

FAST18 was Epic! If you missed FAST18... Don't worry, FAST19 has been planned and booked for May 6-8, 2019 in Murfreesboro, TN. This is the first of many FAST18 Rewinds that will be released throughout the next year, leading up to FAST19. This talk is my keynote talk that ended day 1. Join me in reflection and listen to "My Worst Day!"

E126: REBOA with special Guest Dr. Bryan C. Morse Mar 22, 2018

In this episode of The FlightBridgeED Podcast, Eric invites Dr. Bryan C. Morse to discuss REBOA. REBOA is a minimally invasive procedure in which a balloon is inserted into the aorta to control bleeding. This buys time for the patient to receive the surgical care that they require and saves their life. Join us for this episode and share it with your colleagues! We couldn’t make this podcast without you. Please rate, and review wherever you download the podcast. Thanks so much for listening!

E125: Zero to Flow Mar 06, 2018

In this episode of The FlightBridgeED Podcast, we take a look at CVP and what it means to modern critical care practice. There are a lot of misconceptions about the correct ranges, what it tells us, and so much more. You won’t want to miss this incredibly informative podcast to get you on the road from Zero to Flow! If you love The FlightBridgeED Podcast, rate, and review wherever you get your podcasts. Thanks for listening!

E124: FAST18 Discussion with Ashley Liebig Feb 28, 2018

FAST18 is almost here, and we couldn’t be more excited! As the clock counts down until the doors open, we are beginning to get a clear understanding of what an incredible gathering of brilliant educators and speakers is going to be in the same building at the same time. With that in mind, Eric has invited Ashley Liebig onto the show for a quick chat about what everyone can expect! If you haven’t made up your mind about attending, you still have a short window to purchase your tickets. This could be your chance to breathe new life into your career, or keep the fire burning! Hop in on this conversation and tap into the buzz surrounding this event! FlightBridgeED is dedicated to our community of friends and family from around the world! This is your chance to get connected, earn some continuing education hours, and learn from some of the most talented educators in the FOAMed community! Thanks for listening!

E123: Top 5 Podcasts of 2017 Jan 30, 2018

In this episode of The FlightBridgeED Podcast, Eric is joined by a curio collection of some of the most brilliant minds in the pre-hospital critical care industry to review the top 5 most downloaded podcasts from 2017. It was an incredible year and 2018 is shining just as bright! Download, rate, and review wherever you get your podcasts. The FBE family of podcasts is now available on TuneIn! Get the app now and listen to your favorite podcast and more! Remember that reviews are key to help keep us high on the charts where your friends, and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E122: The Silent Killer in RSI Jan 04, 2018

In this episode of The FlightBridgeED Podcast, Eric takes a few minutes to delve into an intriguing aspect of the paralytics we carry out on every flight. As the old quote goes, everything is a poison in the right amount, it is perhaps worth applying this, in a manner of speaking, to the pharmacokinetics of the paralytics we give our patients. Are some of these medications doing more harm than we realize? What are the potential problems with the tried-and-true medications we are comfortable with, and that have a long history with providers? Learn how you can bring the cutting edge of medicine to your paralytic toolbox in this episode! Download, rate, and review wherever you get your podcasts. The FBE family of podcasts is now available on TuneIn! Get the app now and listen to your favorite podcast and more! Remember that reviews are key to help keep us high on the charts where your friends, and family can find us. We couldn’t make this podcast without you. Thanks for listening!

E121: Pharmacokinetics, Pharmacodynamics, and Plasma Protein Binding Dec 19, 2017

Have you ever wondered what happens to that medicine you so easily flush down the IV line of your patient, or in that capsule your patient swallows? We so often take for granted that an incredibly complex, and amazing chain of processes must take place to move the medicine we give to the exact spot where it’s needed. Join Eric Bauer as he peels back the mysterious layers of medication absorption and distribution. As always, this really difficult subject gets broken down into easily understood analogies, and concepts that build knowledge on top of knowledge. The best part… it’s all free! Download, subscribe, rate, and review wherever you get your podcast from. Did you learn a lot from this podcast? Help us keep this podcast, and more high on the charts so your friends and colleagues can find us easily! Give us a quick review and let the world know how much you like our stuff! Thanks for listening!

E120: HEAVEN the new LEMONS Nov 10, 2017

In this episode of The FlightBridgED Podcast, Eric and Dave Olvera carve out some time while they are on the road to talk about airway management preparation strategies. Dave has invested many years of his professional career investigating, and researching, among other important projects, how to best optimize intubation success. For as long as I can remember, we have used difficult airway predictors in our field practice, such as LEMON(S), to help prepare for eventualities when placing an endotracheal tube. Dave and his colleagues have determined that those predictors are great, but may not be as applicable to field intubations. With mountains of research at hand the HEAVEN criteria was created, along with best-practice strategies for increasing intubation success in an ever-changing environment. Join us for this episode as Eric and Dave discuss HEAVEN criteria and more! Download, rate, and review wherever you get your podcast. Each review is so important to our success. Your reviews on iTunes, Google Play Music, Stitcher, or other platforms help to make us a recommended podcast so we are more visible, and easily discovered. If you believe in the value of what FlightBridgeED brings in this podcast, please take a few minutes and write a short review. We couldn’t make this podcast without you!

E119: Fallacy or Fact? Oct 30, 2017

In this episode of The FlightBridgED Podcast, Eric Bauer, Mike Verkest, and Tyler Christifulli gather around to discuss some of the industry's current patient care fallacies… and facts! When we learn new concepts, we often find ourselves joining the bandwagon, or joining the misfits. Not all concepts are grounded in fact, and those that are grounded in fact should have their source evaluated before taking it as gospel. In our exciting age of free, open access to think, discuss, and discover it’s also important to learn responsibly! Join the guys as they take on some of the largest elephants in the room in this episode of The FlightBridgeED Podcast. Download, rate, and review wherever you get your podcast. Remember that reviews are key to keeping us high on the charts where your friends and colleagues can find us easily. We couldn’t make this podcast without you! Thanks so much for listening.

E118: 48 Hour Survival Challenge Oct 23, 2017

While safety in, and around the aircraft is of paramount importance it is also equally important to train for what happens when safety turns into survival. We have all attended survival training in some form, or fashion. How was your experience? If you’re like most, you unfortunately get run through a quick day of training just to check the box. In the face of life, and death there is certainly a box waiting for you to check, but why not choose to survive? You are choosing life when you demand serious, quality survival training. Join us in this episode as we talk with Chief Flight Nurse, Deb Witte, and Chief Flight Paramedic, Nathan Morreale, from AirMed at the University of Utah Health to talk about a program they developed to teach, test, and overcome in an emergency survival situation. Download, rate, and review wherever you get your podcasts. Remember reviews are key to keeping us high on the charts so your friends and colleagues can find us. Thank you for listening to The FlightBridgeED Podcast.

E117: The 3 P's of ETCO2 Oct 16, 2017

We have all been trained to make the numbers “normal” for so many years, that it seems so unnatural to leave a number alone. It’s like a terrible itch that we have to scratch, and we feel satisfaction when we finally optimize our patient’s ETCO2 by shoving it right back to 40 mmHg. We take off our work boots, and strap on our favorite running shoes as we run headlong chasing numbers into oblivion. What if we told you that what you are doing could be considered… murder? Maybe the patient is already dead… Join Eric in this episode of The FlightBridgeED Podcast as we learn how to troubleshoot an out-of-sorts ETCO2 with the 3 P’s of ETCO2. Download, rate, and review wherever you get your podcasts! Remember that reviews are the key to our future success and the intelligence of your peers by keeping us high on the charts where people can find us more easily. We love making this podcast, and we thank you, our listeners, so much for being the reason we get to come to work!

E116: Nightmare Series: Burn Management Oct 09, 2017

A spark of twisted smoke and fire ignites into a blazing inferno of charring flame. Amid the flickering light, a man suffers in the terrifying grip of heat and hellish pain. The flight crew is tenuously attempting to rip the patient out of death’s mouth and bring him back from the roaring mouth of oblivion. Will he be saved? How will his care be rendered? Are the old ways the best ways? Join us for the death-defying answer in this Nightmare Series episode of The FlightBridgeED Podcast.

E115: IABP Pearls: Mechanical vs Chemical Balloon Oct 02, 2017

Intra-aortic Balloon Pump Counterpulsation therapy is a miracle of modern science that has roots going to the 1960’s. We have come a long way since those days and now, although not a high-volume request, flight crews are regularly transporting patients with these lifesaving devices in place. Because this service is not a high-volume request, it’s very important to ensure you understand how an IABP works, what the numbers mean, and how you can help and hinder mechanical function through the use of medications. Did you know that by giving a medication you believe could help stabilize your patient’s blood pressure, you may be potentiating the deficit the patient’s weak, and fragile heart is already experiencing? Download and join us as Eric Bauer takes us through the IABP Pearls. If you love what you are hearing from us, please take a moment and review our show on iTunes, Stitcher, Google Play Music, or wherever you get your podcasts. Your review could mean the difference in others like you hearing this information, or not. Be a part of building the future of pre-hospital, critical care, and emergency medicine!

E114: Vasopressin: The Master Medication Sep 18, 2017

Throughout modern medicine, old methods fall as new ones emerge safer, more reliable, better for patient outcomes, and more. Research is deep and results are shared throughout the world. One of the fastest growing, most industry-related sections of medicine today is that of resuscitation. In this episode of The FlightBridgeED Podcast, Eric presents his argument for crowning Vasopressin as King of the pressers. He even goes so far as to suggest using it in trauma! With plenty of evidence at his back for you to enjoy, please join us for the latest episode of the podcast! Don’t forget to rate and especially review wherever you got your podcasts. These reviews are especially key to keeping us high on the charts where your friends and colleagues can find us. Thank you for listening.

E113: Acidosis Rodeo: G.O.L.D.M.A.R.K. (part 3 of 3) Sep 05, 2017

In this episode of The FlightBridgeED Podcast, we circle the wagons back around to the Acidosis Rodeo ranch and catch part 3 of this series. As medicine changes, so do our acronyms. Come join us as Eric unpacks the details of G.O.L.D.M.A.R.K. Don’t forget to rate and review wherever you get your podcasts. Reviews help keep us high on the charts so your colleagues and friends can find us. Thanks so much for listening!

E112: Suspension Trauma: Hanging Harness Syndrome Aug 21, 2017

In this episode of The FlightBridgeED Podcast, we take a look at a phenomenon associated with harnesses. OSHA requires them for safety, and some of our jobs use them as tools for saving the lives of victims of circumstance, but what happens when something goes wrong? Sure they save you from the nasty business of falling to your death, but is there a hidden danger that most of us are not aware of? Join Eric Bauer as he explores the reality of hanging harness syndrome. If you enjoy our podcasts, please take a few minutes to rate, and especially review wherever you found our podcast. Reviews help keep us high on the charts so your friends and colleagues can find us. Thank you so much for listening!

E111: Oxygen Extraction Aug 07, 2017

We all know that the first thing you need to do when treating a patient is throw on a non-rebreather mask, right? What happens when that’s not doing the trick? How can we leverage the gas laws to our patient’s advantage? Join us for all this and more in this episode of The FlightBridgeED Podcast with Eric Bauer. Download, rate, and review wherever you get your podcasts. Reviews are critical to keeping us visible and viable so we can keep making the great, free content you love to hear, and we love to make! Thanks for listening!

E110: Neonatal Undifferentiated Collapse Jul 08, 2017

In this blood-chilling episode of The FlightBridgeED Podcast, Eric is joined by a friend to help him cast a light on the dark corner of an otherwise happy little home. A curse has befallen a completely helpless little one. It will take more than the light of their flashlights to scare away this nightmare. Which path should they choose? Where does the river of death spring? Are you up to the challenge of solving these cases? Join us to hear the terrifying conclusion and test your wits against our heroes in this Nightmare Series Podcast episode. Download, rate, and especially review wherever you get your podcasts. We wouldn’t want you to go through this nightmare alone…

E109: Undifferentiated Cardiac Collapse Jun 21, 2017

In this episode of The FlightBridgeED Podcast, a mysterious presence lingers in the long shadows of the unknown. Its identity is cloaked by confusion, and with malice aforethought, the hideous villain winds its long, cold fingers around the heart of its victim. Will he survive? Who can name the twisted entity and diagnose this nightmare? You won't want to miss the conclusion of Undifferentiated Cardiac Collapse. Don't forget to rate and review wherever you get your podcast. Remember that reviews help us stay high on the charts so your friends and colleagues can find us. Thanks so much for listening!

E108: ASV - Dissecting the Evidence Jun 05, 2017

In this episode of The FlightBridgeED Podcast, we take a look at a new mode of ventilation found on some transport ventilators made by Hamilton. Adaptive Support Ventilation (ASV) has been touted as a completely hands-off mode in a “set-it-and-forget-it” sort of way. You won’t believe what a recent study uncovered about this mode! Download, rate, and review wherever you get your podcast. Remember, reviews help keep us high on the charts where your friends and colleagues can find us. If you love our podcast, help us out! It only takes a couple of minutes and your review might light the fire of knowledge for someone else! Thanks for listening!

E107: The Endocrine Nightmare May 29, 2017

In critical care medicine, lab values are a standard tool for determining a patient’s course of care, but they are often misunderstood. In this episode of The FlightBridgeED Podcast, Eric is joined by his lovely wife, Ashley Bauer as they dissect several complicated patient care scenarios. These cases are lab value intense and each value is explained clearly and applied to the patient so that you can easily understand what they mean for your next critically ill patient. Download, rate, and review wherever you get our podcast. Remember that reviews help us stay high on the charts where your friends and colleagues can find us. If you love our podcasts, please help us out and spread the word online and in the streets. Thanks for listening!

E106: Patient BVM Advocacy with Tyler Christifulli of the Lifestar Podcast May 16, 2017

In this episode of The FlightBridgeED Podcast, Eric is joined by Tyler Christifulli from the Lifestar podcast to talk about the ongoing debate over using pediatric BVMs for our adult patients. Regardless of what side of the argument you’re on, you won’t want to miss this episode! Download, subscribe, rate, and review from wherever you get our podcast! Thanks for listening!

FAST18 Announcement May 15, 2017

We are proud to announce the launch of our biggest event yet! On March 20 and 21, 2018 you will want to join us for the first-ever FlightBridgeED Air and Surface Transport Symposium in Nashville, Tennessee! World-class speakers, vendors, of course, the FlightBridgeED Team will be in attendance, and much, much more! Go to our website now to register! Join the revolution!

E105: Blankets are for Naps, Not Medicine: Is a 6 mL/kg Tidal Volume for Everyone? May 08, 2017

Medicine is an ever-evolving practice of learning from mistakes, conquering diseases, and seeing the needs of a unique individual who is desperate for a cure. It would be nice to be able to throw the same things at everyone and get the same results, but if we do that we forget the of the individual and the uniqueness of their body. In this episode, we discuss the trend of “blanket medicine,” and how it specifically relates to the once king of tidal volumes, 6 mL/kg. If you love our podcast, don’t forget to rate and especially review wherever you get your podcasts.

E104: Adult or Pediatric BVM May 01, 2017

In this episode of the podcast, Eric explains and offers insight into an old argument that has recently been given a spotlight by industry professionals. Are adult bag valve masks a dangerous tool? Should we be using pediatric equipment for adults? Join the conversation with our community on FaceBook and Twitter! Don't forget to rate, and review our podcast from wherever you get your podcasts. Taking the time to write a review helps keep our podcast high on the charts so it can easily be found by everyone. If you love the podcast, you can give back to us by reviewing the content we make on iTunes, Google Play Music, Stitcher, or any other podcast platform. Thanks for listening!

E103: Overcoming the Need for Speed Apr 03, 2017

In this special episode of The FlightBridgeED Podcast, join Eric Bauer, Mike Verkest, Ryan Wyatt, and Dave Olvera at the ECHO conference for an incredible meeting of the minds for what could be considered an industry-changing, best practice for airway management. These powerhouses of the pre-hospital world are shattering old paradigms and raising the bar of quality patient care. You won’t want to miss it! Don’t forget to download, rate, and review from wherever you get our podcast. Remember, reviews help keep us high on the charts so your friends and colleagues can find us more easily. Help us drive the future of pre-hospital, critical care, and emergency medicine.

E102: Acidosis Rodeo - Part 2 Mar 20, 2017

Part 2 of 3 in the Acidosis Rodeo is a continuation of our previous case study. In this episode, Eric dives into DKA and HHNK from differential diagnosis to lab values. This episode will link up with part 3 to give you an incredibly in-depth picture of acidosis and how you can put this information into use in your practice. Don’t forget to rate and review wherever you get your podcasts from. Rating, and especially reviews help us stay high on the charts so that your friends and co-workers can find us more easily. We believe in our mission to bring high-level critical care education to the masses. If you believe in us as much as we believe in you, take a couple of minutes and give us a review! We will be forever grateful!

E101: Damage Control Resuscitation - Part 2 of 2 Mar 01, 2017

In this episode of The FlightBridgeED Podcast, Eric is joined, once again, by Rahkeem Francis for part 2 in this series entitled “Damage Control Resuscitation.” Covered in this episode are the topics of blood, vasopressin, the lethal trauma triad, and more! Download, rate, and review from wherever you get our podcast. Remember that reviews matter so much because they help our podcast stay high on the charts so our industry peers can find us. Help us change the face of pre-hospital, critical care, and emergency medicine!

E100: The FlightBridgeED Podcast's 100th Episode Feb 13, 2017

In this special 100th episode of The FlightBridgeED Podcast, Eric is joined by Mike for a look back over the journey thus far. Filled with stories, some laughs, and even a little crying, you won’t want to miss this incredible milestone episode! As downloads climb, and review courses fill we want you to know one very important thing… FlightBridgeED is still dedicated to you! Congratulations to you, our community of friends and family, for the success of FlightBridgeED over the years! This one is dedicated to all of you. Download, rate, and don’t forget to review the podcast wherever you get it. Reviews help us stay high on the charts so your friends and co-workers can find us. If you love what you hear, let us know!

E99: Damage Control Resuscitation - Part 1 of 2 Jan 22, 2017

In this episode of The FlightBridgeED Podcast, Eric is joined by Flight Nurse, and Paramedic Rahkeem Francis to unpack the first of a 2 part series covering “Damage Control Resuscitation.” In the pre-hospital field, we have always held our airway skills in high regard, but is airway king? Could there be a better focus for our skills of which airway is but a small piece? This one simple shift in paradigms could change the way you practice pre-hospital and emergency medicine forever. Download, rate, and review from wherever you get our podcast. Remember that reviews matter so much because they help our podcast stay high on the charts so our industry peers can find us. Help us change the face of pre-hospital, critical care, and emergency medicine!

E98: The Neuroglobin Scavenger Jan 16, 2017

In this episode of The FlightBridgeED Podcast, after some incredible results in a recent research study, there could finally be a cure for, the often difficult-to-treat, CO poisoning. Join Eric Bauer and Mike Verkest as they discuss this mutated protein that is promising for this common complaint. Don't forget to rate, and review. Help keep us high on the charts so your friends and co-workers can find us.

E97: EMSPOCUS with Branden Miesemer Dec 29, 2016

In this episode of The FlightBridgeED Podcast, Eric catches up with our good friend and ultrasound guru Branden Miesemer of EMSPOCUS at AMTC. Recorded right from the convention floor, the guys discuss just what is EMSPOCUS and how it is being used in the pre-hospital world. Download, rate, review and subscribe from wherever you get your podcasts!

E96: Acidosis Rodeo - Part 1 Dec 09, 2016

In this first episode of a three-part series, Eric Bauer unpacks a difficult critical care case scenario and begins to explain how we can better identify pH balance disturbances in our patients. Learn how to identify acidosis even without blood gasses, how to protect your patients from further sliding into a worsening state, and much more. Download, rate, and review wherever you get your podcasts. Reviews help us stay high on the chart where your friends and co-workers can find us. If you love our free podcast, help us spread the word!

E95: Ventilator Rewind - Application Part 2 Nov 21, 2016

Eric continues our update of ventilator application in part 2 of this series. Discover the proper use of I:E ratios and I-time, a breakdown of manipulating PIPs and pPlats, and much more! Download, subscribe, and rate wherever you get our podcast! Don’t forget to check out the brand new Ventilator Management: A Pre-hospital Perspective (2nd Edition) book available now!

E94: Driving Pressure Nov 14, 2016

In this episode of The FlightBridgeED Podcast, Eric presents a key concept in reducing mortality in ARDS that is being used in the ICU. Does it have application in the air medical world? Download, rate, and review from wherever you get our podcast! Help us stay high on the charts so intelligent folks like yourself can better find us!

E93: Ventilator Pearls - Recruitment Maneuvers Oct 31, 2016

Have you ever had a hypoxic patient on a ventilator that you just couldn’t get to oxygenate properly? Spinning dials can be frustrating for you and deadly for your patients. In this episode, we present a practical, and logical application of transport ventilation for optimizing oxygenation. Help keep this podcast and podcasts like it high on the charts so people can find us! Rate us wherever you download, or subscribe to our podcast!

E92: Ventilator Rewind - Application Part 1 Oct 25, 2016

As we approach the 4th anniversary of FlightBridgeED, Eric takes some time to reflect on one of the earliest and most popular podcast series we produced - Ventilator Management. It has always been one of our company goals to help clarify the mysteries of ventilator management in pre-hospital medicine. In this retrospective glance mixed with new strategy and science, you will refresh and renew your understanding of cellular respiration and ventilator management. Download, subscribe, and rate wherever you get our podcast! Don’t forget to check out the brand new Ventilator Management: A Pre-hospital Perspective (2nd Edition) book available now at FlightBridgeED.com.

EMS World Expo Announcement Oct 04, 2016

Join us for the NAEMT EMS World Expo in New Orleans and for a limited time, pick up the brand new 2nd edition of Ventilator Management: A Pre-Hospital Perspective for a special price!

E91: Refractory Hypoxia - Dissecting Rise Time vs. I-time Sep 09, 2016

When it comes to ventilator management, and critically ill patients it can sometimes get a little scary. Have you ever had a patient on a ventilator who starts declining only to pull them off and go back to that good old BVM? Why does the magical BVM work and not the ventilator? Join us for this episode to find out! Download, subscribe, rate, and review wherever you get your podcast goodness!

E90: Evaluating the Shock Index Sep 08, 2016

Join Eric for a quick explanation of the shock index and how it applies to your practice in this Teachable Moment Mini Episode of the FlightBridgeED Podcast.

E89: The Ketamine Response Aug 21, 2016

When it comes to RSI in the pre-hospital setting, Ketamine is our new best friend. There are many more benefits to using this medication within several subgroups of patients for RSI than our old standby, etomidate. We have read the accolades and positives in several studies, and trials, but what are the negatives? Are there any negatives? Could Ketamine be the perfect drug? Is it all just hype? Join the podcast as Eric discusses a new study and you will not believe what it says about your new favorite drug. Download, listen, rate, and review! Help FlightBridgeED keep our podcasts at the top of the charts so your friends and colleagues can find us!

E88: How to Read a Clinical Trial Paper Jul 25, 2016

In this episode of The FlightBridgeED Podcast, Eric unpacks the often complicated subject of clinical trials. We all want to know the latest and greatest treatments, and best practices so we can apply them to our clinical practice. To know that, we have to see what’s going on in the realm of research medicine. Clinical trial papers have a lot to offer, but how do we know the information we are reading is accurate and appropriate for us? Join us for this episode to learn more! Help keep us high on the charts so your friends and co-workers can find our podcast! Download, rate, and comment wherever you get your podcasts!

E87: Damage Control RSI Jul 11, 2016

In this episode of The FlightBridgeED Podcast, Eric introduces Damage Control RSI. While some of the concepts discussed are not necessarily new concepts, this package of best practice procedures, tips and tricks, and more will streamline your advanced airway practices. This podcast covers procedures, medications, and critical care concepts that you can begin using right away. Download this podcast from your favorite source and help us stay high on the charts so more people can find us. If you enjoy these podcasts, take a second to rate and review our podcast on iTunes, Google Play Music, Stitcher, or anywhere you find us. It really does make a big difference!

E86: Yellow Jacket Attack - A Nightmare Series Podcast Jun 18, 2016

Their dagger-like stingers drip with venom as they seek a victim to cut down in the wake of their horrific swarm. There is no time to waste as the poison courses through the veins of the patient. Each breath could be the last, and seconds become precious as the yellow and black reapers swing the death stroke. Will you save her? Don’t miss a moment of this spine-tingling Nightmare Series Podcast, Yellow Jacket Attack!

FBE Public Service Announcement Jun 06, 2016

FlightBridgeED Public Service Announcement - The new website has been released! Take a listen then go to www.flightbridgeed.com and sign up! Registration is FREE and the benefits are incredible!

E85: REBOA - with Dr. Zaffer Qasim May 20, 2016

In this episode of The FlightBridgeED Podcast, we are joined by Dr. Zaffer Qasim to discuss the history, application, and data of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) for a variety of reasons including aortic aneurysm, trauma, and so much more. You won't believe what these things can do, and you might be carrying them in the field sooner than you think!

E84: 28 Month-Old Collapse Apr 25, 2016

In this episode of The FlightBridgeED Podcast, the swirling mists of secrecy cover a young life with an esoteric mystery diagnosis. As we shine our flashlights into the vast, gloomy corners of discovery our sure-footed pathway leads to a maze of deception, misdirection, and confusion. A diagnosis is within reach, and a treatment just beyond our outstretched, wriggling fingers as we claw ever closer to the truth. Our adventure awaits as we wander in this nightmare series podcast we call the 28 Month-Old Collapse. Download, share, rate, and subscribe!

E83: Find Your Greatness - Find what inspires you and do it more! Apr 18, 2016

In this episode of The FlightBridgeED Podcast Eric chooses to move off the well-worn path for a moment, motivating us to breathe more passion into what inspires and ignites our mind. We live in an incredible era of information and discovery. Dare to dream!

E82: 50 Foot Fall From Radio Tower Mar 24, 2016

A tedious and trembling silhouette ascends a precarious perch into a tower thrust high in the skies. A moment's mistake forces the twisted hand of fate as our patient succumbs to the fierce pull of gravity. Plunging to the cold ground, unable to move, and fearfully close to the end it's up to you to fight the hollow heart of death in this episode of The FlightBridgeED Podcast.

E81: Push-Dose Pressors: Literature Review and Update Mar 14, 2016

A follow-up to our previous push-dose pressor podcast. Even though there is substantial evidence for push-dose pressors in certain situations, the air medical industry as a whole has yet to embrace them. We need to be responsible in our care and with our knowledge and work hand-in-hand with our medical directors and with our patient care protocols. Having said this, it is also up to us to shape the care we give by influencing the folks who make decisions in our institutions. Join Eric as he discusses push-dose pressors and their future in our practice.

E80: TBI: Understanding Current Therapies - part 2 Mar 09, 2016

After laying the foundations in the previous podcast, we dive below the dura mater in part 2 of the TBI series and take a look at subarachnoid, intraventricular, and intracerebral (parenchymal) hemorrhages as well as specific treatments for each.

E79: IABP: Therapy Overview & Pearls with Kelly Miller Mar 01, 2016

In this episode of The FlightBridgeED Podcast Eric is joined by Kelly Miller, Regional Clinical Manager for Air Methods, Inc., to demystify the technical and physiologic application of the intra-aortic balloon pump (IABP). These devices have come a long way throughout their lives, and in the wake of their continued development lives have been saved and outcomes have been improved. We as providers must constantly refresh on the operation and application of the IABP since they are a low-volume niche of our transport population. Join us as we unpack the ballon pump, and get the industry professional tips and tricks you need to succeed.

E78: TBI: Understanding Current Therapies - part 1 Feb 26, 2016

In this episode of The FlightBridgeED Podcast, Eric begins part 1 of a series of podcasts regarding traumatic brain injury, with an in-depth examination of anatomy and physiology, the Monro-Kellie Hypothesis, and signs and symptoms of some common neurological injuries. Don’t miss a single episode of this incredible series! Subscribe, or download right now!

One of the Most Important Podcast We Have Ever Made Feb 09, 2016

We generally never mix these two very unique podcasts, but this podcast is quite possibly the most important podcast we have ever published. A pillar of our practice is under fire and we need everyone's help. Back in the 70's there were several laws written regarding the use and distribution of controlled substances. Unfortunately for us, back in the 70's EMS looked very different. In fact, it was so different that there were never any laws written specifically to direct the function of EMS within those laws. We have been operating for years under a sort of combined mishmash of laws. Recently, the DEA and other members of the US government have been investigating how we operate and you won't believe what they have determined. There is hope for our profession, but it starts with each of us doing our part. Listen to this podcast, contact your representative, and encourage them to rally to our side. Failure with this matter means rapid access to lifesaving medication will go away for our patients, and the pre-hospital industry will be turned upside down. Download this podcast, listen, distribute, share, and get the word out to your friends, family, co-workers, medical directors, and anyone who will listen. We have to band together for the sake of our patients and our profession.

E77: Lactate: Myths & Evidence Reivew Feb 05, 2016

In this episode of The FlightBridgeED Podcast, Eric picks up his magnifying glass and takes a close look at serum lactate. Is there enough evidence to support it, or is it snake oil? Join us as we uncover the evidence together.

E76: BiPAP: Do you understand absolute versus additive Jan 13, 2016

In this episode of The FlightBridgED Podcast, BiPAP is nothing new for us, but do we understand the correct way to set up our transport ventilators to deliver the correct pressures? Maybe. Maybe not! Join Eric as he explains the difference between absolute and additive pressures.

E75: Changing Airway Management Culture: Using the HEAVEN Criteria, VL and Decision Making with Dave Olvera Dec 14, 2015

In this episode of The FlightBridgeED Podcast, special guest Dave Olvera joins Eric on the show to bring our community some incredible facts, figures, and real-world applications of powerful, research-based advanced airway management best practice techniques. With years of evidence and statistics, this podcast will challenge you to critically analyze your airway skills and why it is that we perform the way that we do. You won't want to miss it! Join us for Changing Airway Management Culture: Using HEAVEN Criteria, VL & Decision Making with Dave Olvera.

E74: Approaching Aristotle Dec 07, 2015

In this ground-breaking episode, special guest Michael Lauria joins Eric Bauer to present one of the most astoundingly captivating concepts that you won't want to miss. Join us for Approaching Aristotle: Making Critical Care Education Brain-Friendly.

E73: Absorption Atelectasis: Are We Missing This Important Concept Nov 29, 2015

In this episode of The FlightBridgeED Podcast, Eric shines a revealing light on the detrimental effects of nitrogen washout on our patient's alveoli and what that could mean for their treatment long term. More oxygen is always better, right? Join us for this insightful discussion as we reveal the truths behind absorption atelectasis.

E72: Trending Topics: Ketamine and Paralytics - Dissecting the Research Nov 16, 2015

In this episode of the FlightBridgeED podcast, Eric pulls together the evidence for the traditional drugs we push during RSI, for sedation and paralytics. Join us for an incredibly thought-provoking discussion that will challenge your foundational knowledge of these medications and further your clinical expertise.

E71: Long Acting Paralysis: Treatment and Paralysis Oct 26, 2015

In this episode of The FlightBridgeED Podcast, Eric addresses an e-mail from listener and critical care provider Ryan Wyatt of Tuscon, Arizona regarding the use of paralytics in our practice.

E70: The Traumatic Airway: A Nightmare Series Podcast Oct 05, 2015

In this episode of The FlightBridgeED Podcast, a nightmare creeps from the tattered remains of a beaten and bruised patient. The wrenching grasp of death casts a long, dark shadow over the flight team as a crucial decision means life or death. What will happen? Will the patient survive? Join us for the mesmerizing tale of The Traumatic Airway.

E69: Inferior Wall MI: Debakey I Tear Sep 23, 2015

In this episode of The FlightBridgeED Podcast, a patient's life perches precariously atop a critical decision. What terrifying malady stands behind this horrific situation? Could it be the gripping, wrenching grasp of a myocardial infarction, or could this be the result of an even more devious fiend? Then again, it could be door number 3…

E68: Sodium Bicarbinate Treatment in Acidosis - An Update to a Long-term Debate Sep 07, 2015

In this episode of The FlightBridgeED Podcast, Eric discusses the issue of sodium bicarb treatment in acid-base disorders through the lens of new evidence and the overall metabolic state of the patient. As paradigms in treatment shift, all of our patients benefit. Join us for this episode of the podcast.

E67: NIPPV Hypoxemic vs Hypercapnic Strategies Aug 30, 2015

In this episode of The FlightBridgeED Podcast, Eric outlines the application guidelines and strategies for effective non-invasive positive pressure ventilation. Sometimes putting down the blade, and picking up the mask is an essential step in revolutionary patient care.

Ventilator Management Book Pre-Release Sale Aug 20, 2015

Pre-order this exciting new book from Eric Bauer and FlightBridgeED Ventilator Management: A Pre-Hospital Perspective, written in a conversational style that is in-depth, easy to understand, and practical in application is sure to be a go-to resource for your practice. Check out this short introduction of the book from the author himself, and go online to pre-order now for a discounted price.

E66: Ventilator Management - Ventilation Failure: Auto-PEEP Strategies Aug 13, 2015

In this episode of The FlightBridgeED Podcast, Eric clarifies and defines the role of Auto-PEEP. This often neglected measurement has big implications for our patients and adjustments should be made, but with caution and in small increments. Join us as we explore Ventilator Management - Ventilation Failure: Auto-PEEP Strategies.

E65: Inodilators: Dobutamine & Milrinone Aug 03, 2015

In this episode of The FlightBridgeED Podcast, we continue our conversation about hemodynamic pharmacology started in our previous podcast titled Pure Vasopressors. Today’s conversation focuses on left ventricular dysfunction and how inodilators such as dobutamine, and milrinone are used.

E64: In-Flight Delivery: A Nightmare Series Podcast Jul 27, 2015

In this episode of The FlightBridgeED Podcast, like a creature stepping forth from another dimension, an unexpected delivery catches the bewildered flight crew off guard in a dizzying rush to get on the ground. Join Eric as he presents the thrilling case of the In-Flight Delivery.

E63: Fluidology 201: Plasmalyte, Normosol, Dextran, and Albumin Jul 20, 2015

In this episode of The FlightBridgeED Podcast, Eric takes a suggestion from our community and dives into the "other" fluids. While these fluids aren't our normal go-to solutions, they all have a place in the great field of "Fluidology." Join us as we explore plasmalyte, normosol, and dextran.

E62: Ketamine 2.0: Debunking the Myths with Dr. Mike Abernethy Jul 13, 2015

In this podcast we dive further into our exploration of Ketamine - a great medication, but one with lots of misconceptions. Join Eric and very special guest, Dr. Mike Abernethy (@FLTDOC1), Med Flight Chief Physician at the University of Wisconsin, as they debunk the myths on this episode of The FlightBridgeED Podcast.

E61: LVADS - An Interview with ASTNA President Allen Wolfe Jul 06, 2015

In this episode of The FlightBridgeED Podcast, Eric talks with ASTNA President Allen Wolfe.

SecondShift Advertisement Jul 02, 2015

SecondShift, a new podcast from FlightBridgeED with Eric Bauer and Mike Verkest. This podcast covers a lot of the current issues and trends in the Helicopter EMS, pre-hospital, critical care, and emergency medical care industry. As a bonus, or maybe a consolation, you also get to hear these guys yack on about stuff like sports, talk trash about some former co-workers, and maybe even what flavor their socks smell like! Yup... doesn't get much better than this! Join us for the lighter side of FlightBridgeED in our new podcast production, SecondShift. You'll (probably) be glad you did! Don't worry though, The FlightBridgeED Podcast isn't going anywhere! Subscribe and tell us what you think!

E60: Pediatric Drowning: A Nightmare Series Podcast Jun 15, 2015

In this episode of The FlightBridgeED Podcast, an unthinkable horror glides through dark waters with a terrible appetite for fresh, tender flesh. Join Eric Bauer, and Mike Verkest as they peel back reality to expose this nameless evil in this nightmare series podcast, Pediatric Drowning.

E59: Fluidology 101 Jun 01, 2015

In this episode of The FlightBridgeED Podcast, Eric rides the waves of knowledge as he sheds light on the various fluids we use in our practice. Join us as we learn together!

E58: TXA in TBI: ROC Trial with Mike Verkest May 25, 2015

In this episode of The FlightBridgeED Podcast, Eric Bauer and special guest Michael Verkest discuss TXA in traumatic brain injuries. Join us for the first interview podcast from FlightBridgeED as we learn from these two incredibly talented educators.

E57: Rx Special Feature: Ketamine May 19, 2015

In this episode of The FlightBridgeED Podcast, Eric takes some time to unpack this week's spotlight medication, Ketamine. This medication has been around for quite some time now, but it is only recently seeing routine use in some geographic areas in the pre-hospital critical care field. Join us as we take an in-depth look at Ketamine.

E56: Pure Vasopressors Apr 27, 2015

In this episode of The FlightBridgeED Podcast, Eric covers neo-synephrine, and vasopressin as they are used in the pre-hospital and critical care clinical environments. He also discusses the research regarding methylene blue as a vasopressor.

E55: Pulmonary Collapse Apr 09, 2015

In this episode of The FlightBridgeED Podcast, a mysterious traveler from the deep south winds his way into town. Why is he there? Who is he? As he moves in and out of the shadows, the evidence of his malicious intent becomes apparent as his terrible hands clutch and tear the tender flesh of his victim until there is no use to struggle against him. Will our patient find salvation? Join your host, Eric Bauer, as he uncovers the mystery of the Pulmonary Collapse - A Nightmare Series Podcast.

E54: Passive Oxygenation: What Do The Studies Say? Mar 23, 2015

In this episode of The FlightBridgeED Podcast, we take an in-depth look at the concept of passive oxygenation and camp out in the literature and studies regarding it. Join us for the podcast and discover together how to apply the concept of passive oxygenation to your practice!

E53: Ventilator Associated Pneumonia Mar 13, 2015

In this episode of The FlightBridgeED Podcast, below the tempest-driven surface of the deep and plunging into the murky, gray depths, a struggling soul descends to join the silence of fate. Join us to discover the horrifying fate and as death wraps its icy hand around the lungs of our patient. What is this terror? Find out in this nightmare series podcast episode, Ventilator Associated Pneumonia.

E52: Get Rid of Dopamine in EMS Mar 02, 2015

In this episode of The FlightBridgeED Podcast, dopamine comes under fire in the pre-hospital setting. Is this old-school medication finished? Join us as we investigate the issues surrounding why we should Get Rid of Dopamine in EMS.

E51: 3 Amazing Concepts Feb 23, 2015

In this episode of The FlightBridgeED Podcast, Eric draws the map to some interesting and controversial new research. What is REBOA? Do you need that cervical collar? Does dopamine deserve to be ditched? Join us for this and the next three episodes for the complete dialogue in this series of three Amazing Concepts!

E50: Hypoxic Status Seizure Feb 16, 2015

Claustrophobic and dark hallways surround our patients as they hysterically shake and fly to free themselves from the ever-tightening grasp of a hypoxic straightjacket. There are worse things than death, and as time fights against the minds of the providers, the insane realization that this critical patient may very well be toeing the edge of oblivion sets in. Join your host, Eric Bauer, as he walks with you down the terrifying corridors of the newest Nightmare Series podcast... The Hypoxic Status Seizure.

A Nightmare Series Podcast

E49: Update 2015 - BIG NEWS! Feb 02, 2015

Come and taste what's been cooking in the FlightBridgeED kitchen for 2015! During this podcast, Eric talks about a few things that are in the works, made possible by the suggestions we have collected from our community! We are proud to roll out the new FlightBridgeED YouTube channel with 13 brand-new videos for you to enjoy right now. Check it out now...

E48: The Post-Arrest Nightmare Jan 26, 2015

In this episode of The FlightBridgeED Podcast, THE DEAD WALK... join us to learn more about this terrifying episode and discover the perilous struggle of one lone patient against overwhelming odds in an upside-down world.

E47: Ventilator Strategy: Hypotension Jan 12, 2015

In this episode of The FlightBridgeED Podcast, Eric unpacks and examines a new ventilator strategy for hypotensive trauma patients. This strategy involves reducing intrathoracic pressure and optimizing gas exchange. Join us via MP3 download or Enhanced podcast.

E46: Neo-Sticks: Push Dose Pressors in RSI Dec 05, 2014

In this episode of the FlightBridgeED Podcast, we discuss how to use push dose pressors to offset the effects caused by sedation and paralysis on hemodynamically unstable patients requiring RSI.

E45: The Oxyhemoglobin Dissociation Curve: A Resuscitation Paradigm Aug 08, 2014

In this episode of The FlightBridgeED Podcast, Eric helps us develop the concept of the oxyhemoglobin dissociation curve, left and right shifts, and other important principles of oxygen delivery at the tissue level. Although this is a difficult subject, it’s incredibly relevant and enlightening, and it has real applications for our patients. Join us as we study the Oxyhemoglobin Dissociation Curve - A Resuscitation Paradigm.

E44: The Subarachnoid Bleed May 22, 2014

In this episode of The FlightBridgeED Podcast, creeping and crawling, silently weaving a web of destruction, a small, venomous disease unleashes its deadly bite on an unsuspecting woman. Join Eric and the flight crew as they pull down the webs of confusion and unravel the secrets of The Subarachnoid Bleed.

E43: Takotsubo Apical Ballooning Syndrome May 07, 2014

In this episode of The FlightBridgeED Podcast, terror from the deep rises from the blackest abyss to wrap its tentacles around an innocent woman who has lost everything. The flight crew struggles to comprehend the twisted and strange horror but presses on in search of escape. Join us to discover the ending and what happens to our suffering victim. - A Nightmare Series Podcast -

E42: The Nightmare Patient: Advanced Hemodynamic Case Study Apr 14, 2014

In this episode of The FlightBridgeED Podcast, a patient comes precariously close to disaster as a microscopic fiend unleashes its fury on an unsuspecting patient. Seeking out this horrible monster will take skill as the crew follows the clues found in strange, cryptic waveforms. Join the podcast as we seek answers and unravel the mystery of advanced hemodynamics.

E41: The Nightmare Patient - Neonatal Respiratory Arrest Mar 17, 2014

In this episode of The FlightBridgeED Podcast, a looming shadow is cast over an innocent crib as an unseen hand holds the fate of a tiny child in its icy grasp. Will disease prevail? Join us... maybe you can be the hero!

E40: FlightBridgeED Early 2014 Update Mar 01, 2014

In this episode of The FlightBridgeED Podcast, Eric discusses new product roll-outs and a few plans for the future! Thanks, and congratulations to the FlightBridgeED community on moving into our 2nd year of learning together!

E39: Sedation = Delirium: A Recipe for Disaster Feb 03, 2014

In this episode of The FlightBridgeED Podcast, we pick up a conversation we began in a previous podcast (Forget the PARALYSIS and Treat the PAIN). Now, we will discuss the need for choosing appropriate medications and correctly managing their dosing to improve patient outcomes in critical care environments.

E38: The Nightmare Patient: IABP Cardiac Arrest Jan 11, 2014

In this episode of The FlightBridgeED Podcast, a perfect storm is rising over a terribly complicated case. Juggling a multitude of therapies and way behind, the flight team must fight to keep their heads above water. Find out what happens as the flight team and patient struggle for survival!

E37: aVR - The Forgotten Lead Dec 16, 2013

In this episode of The FlightBridgeED Podcast we discuss aVR as a diagnostic 12-lead tool and apply this to a patient case study. Find out more about this EKG misfit.

E36: The Nightmare Patient: Left Main Dominant Nov 18, 2013

In this episode of The FlightBridgeED Podcast, a cardiac patient with a genetic anomaly is in a precarious battle for life against a deadly attacking disease. Conventional wisdom may not be the best medicine, and the flight crew has a choice to make. Will they fend off certain doom, or is there a second chance waiting for the victim? Find out now!

E35: Pediatric Asthma: The New Approach Nov 04, 2013

In this episode of The FlightBridgeED Podcast, traditional asthma treatments come under scrutiny as evidence-based medicine demonstrates a better way!

E34: Identifying Horsepower - Huh? Oct 21, 2013

Seriously? What does horsepower have to do with critical care medicine? Who comes up with this stuff???

E33: The Nightmare Patient 2: ARDS Oct 07, 2013

In this episode of The FlightBridgeED Podcast, a patient struggles to breathe as illness grips them tightly by the throat. Death looms close by watching... waiting. Make your stand and save the patient's life!

E32: The Lethal Trauma Triad Sep 23, 2013

In this episode of The FlightBridgeED Podcast, we take some time to look at 3 very cricual elements of trauma management that lead to successful patient outcomes. These critical findings are based on years of research, but some are commonly overlooked at astoundingly high rates. Join in and discover the Lethal Trauma Triad.

E31: Case Study: The Nightmare Patient Sep 10, 2013

In this episode of The FlightBridgeED Podcast, evil lurks around every corner as we dissect the flesh from a terrifying case study. Is there no way out for this patient? Do they face certain death? You may be this helpless victim's only hope, but the clock is ticking, and one mistake could lead to disaster...

E30: Forget the Paralysis and Treat the Pain! Aug 26, 2013

In this episode of The FlightBridgeED Podcast, we discuss the need for good pain management when dealing with intubated patients. We further deal with a frustrating, old mindset that seems to be lingering in which paralysis overshadows adequate sedation and analgesia practices.

E29: Pressure Regulated Volume Control - What Is It? Aug 12, 2013

In this episode of The FlightBridgeED Podcast, we discuss the PRVC mode of ventilation in depth. While not a new mode of ventilation, it has seen more frequent use in the transport environment especially for pediatric patients.

E28: Oxygenation vs Ventilation: How Do We Fix The Problem? Jul 29, 2013

In this episode of The FlightBridgeED Podcast we discuss oxygenation and ventilation. These important concepts are cornerstone principles in properly managing patients on the ventilator, and understanding respiratory function.

E27: Manipulating Gas Laws in Critical Care Medicine Jul 15, 2013

In this episode of The FlightBridgeED Podcast, we discuss five gas laws related to flight physiology and investigate their effects on patient disease processes and treatment. These concepts are especially important for those interested in pursuing a career in the HEMS industry or for those preparing for advanced certification courses.

E26: Remembering Our Fallen Brothers Jun 14, 2013

In this podcast, we briefly discuss the recent tragedy of AEL 109 and the importance of safety. No matter what you do, there is always a very real danger of injury or death in the HEMS industry. Your most important job is returning home to friends and family after each mission.

E25: Cardiac Pharmacology and Vasopressors May 20, 2013

In this episode of The FlightBridgeED Podcast, we survey cardiac pharmacology as it relates to beta blockers and vasopressors.

E24: Sepsis - A Pre-Hospital Approach May 06, 2013

In this episode of The FlightBridgeED Podcast, we take a look at sepsis and septic shock, discussing criteria, stages, outcomes, and treatment strategies.

E23: ETCO2 - Cardiac Output and Intubation Concepts Apr 22, 2013

In this episode of The FlightBridgeED Podcast, we examine ETCO2 and its role in cardiac output and intubation confirmation.

E22: Tranexamic Acid and Trauma Resuscitation Apr 08, 2013

In this episode of The FlightBridgeED Podcast, we discuss DIC (Disseminated Intravascular Coagulation) related to trauma resuscitation and Tranexamic Acid (TXA). This relatively new medication has shown incredible promise through the Crash 2 study conducted in the UK.

E21: DKA - A How to Approach Apr 01, 2013

In this episode of The FlightBridgeED Podcast, we discuss Diabetic Ketoacidosis and use a scenario to demonstrate physiological indicators and treatment methods for managing these critically ill patients.

E20: PIP vs pPlat Mar 25, 2013

PIP and pPlat are vital to effective ventilator management. These two values go hand-in-hand but are often misunderstood and often neglected. In this episode, we will discuss PIP and pPlat in depth and how they relate to your ventilator patients.

E19: FlightBridgeED Update and Thank You Mar 18, 2013

We are changing pace a little this week and just taking some time to recognize the efforts of our community and their contribution to the success and continued development of our endeavors. From all of us to you, thank you!

E18: Dominating Acid-Base Balance - Part 3 Mar 11, 2013

In this third and final installment of the Dominating Acid-Base Balance series, we discuss Winter's Formula and strategies for affecting a change in patient pH based on what we have learned from this series.

E17: Dominating Acid-Base Balance - Part 2 Mar 05, 2013

In part 2 of this two-part series, we discuss strong and weak acids, what fills the anion gap, and how sodium chloride, CO2, Sodium Bicarbonate, and potassium affect acid base.

E16: Dominating Acid-Base Balance - Part 1 Feb 25, 2013

Part 1 of this 3-episode series lays the foundation of Dominating Acid-Base Balance. It will include a philosophical and clinical exploration of pH, PaCO2, HCO3, base deficits, and how acid-base affects critical systems in the body.

E15: Traumatic Arrest: What Are We Treating? Feb 18, 2013

In this episode of The FlightBridgeED Podcast, we discuss ethical and practical aspects of traumatic arrest resuscitative practices.

E14: Pressure Control: PRVC Modes of Ventilation Feb 11, 2013

In this episode, Eric clearly explains the importance and implementation of pressure-controlled ventilation modes. These modes are generally less understood than volume-controlled modes; however, they are vitally important to lung protection and improved patient outcomes. Along with theory, this podcast incorporates an in-depth and easy-to-understand "How-To" guide for PRVC modes of ventilation.

E13: Sedation and Pain Management Feb 04, 2013

Good sedation and pain management are essential to managing the intubated patient. In this podcast, Eric Bauer explores why this is so vital and discusses industry standards for getting it done right.

E12: Trauma Management: Fluid Resuscitation and Permissive Hypotension Jan 28, 2013

Eric Bauer discusses hypovolemic shock, permissive hypotension techniques, and theory, and how fluid affects oxygenation.

E11: Cardiac Arrest: Intubation or BVM? Jan 21, 2013

New ACLS standards regard quality CPR above advanced airway placement. Are they right?

E10: 12-Lead: LBBB and Sgarbossa Criteria Jan 17, 2013

This is part 2 of a two-part series covering 12-lead ECG interpretation, focusing on LBBB and Sgarbossa criteria.

E9: 12-Lead: A Fundamental Approach Jan 16, 2013

This is part 1 of a 2-part series covering 12-lead ECG fundamentals.

E8: The Platinum 10 Jan 15, 2013

Eric Bauer discusses the importance of the first "Platinum 10" minutes and its key relationship to the "Golden Hour."

E7: Ventilator Management In The EMS World - Part 3 Dec 19, 2012

In this three-part education series, Eric presents ventilator management approaches and strategies for different patient presentations. We also apply the pathophysiology we learned in parts 1 and 2, bringing it all together to form an easy-to-understand strategy for ventilator management.

E6: Ventilator Management In The EMS World - Part 2 Dec 16, 2012

In this 3 part education series, Eric Bauer discusses ventilator management in the critical care environment and the different ventilation modes.

E5: Ventilator Management In The EMS World - Part 1 Dec 12, 2012

In this three-part education series, Eric Bauer discusses ventilator management in the critical care environment. We look closely at cellular respiration and the different terminology related to ventilator management.

E4: RSI: Doing It Right! - Part 2 Nov 24, 2012

In this two-part series, Eric discusses RSI and all aspects of related drug pharmacology, providing insight into implementation in the critical care setting.

E3: RSI: Doing It Right! - Part 1 Nov 12, 2012

In this two-part series, Eric discusses RSI and all aspects of related drug pharmacology, providing insight into implementation in the critical care setting.

E2: Cellular Respiration Nov 08, 2012

Eric Bauer explains everything about oxygenation. We examine cellular respiration and diffusion, ventilation/perfusion, shunt, VQ mismatches, and the Fick principle.

E1: Introduction Nov 01, 2012

Eric Bauer introduces himself and The FlightBridgeED Podcast. In this first episode, he briefly describes this educational podcast series and the origins of FlightBridgeED.

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