The World’s Okayest Medic Podcast

Listener discretion is advised. References: Bona & Friedman. (Apr 3, 2018). Ambulance Lights and Sirens Should Only Be Used When the Benefit Outweighs the Risks. Available: https://https://www.acepnow.com/article/ambulance-lights-and-sirens-should-only-be-used-when-the-benefit-outweighs-the-risks/ NTSB Preliminary Report: Available: https://verticalavi.org/wp-content/uploads/2026/01/Report_ERA26FA035_201974_1_21_2026-12_05_27-AM.pdf PMID 30648537, 20845321, 11339726 Zavadasky, M. (June 2, 2025). Culture shift: Reducing lights and siren vehicle operation. Available: https://www.ems1.com/safe-transport-point-b/articles/culture-shift-reducing-lights-and-siren-vehicle-operation-XDonsygscixIghQT/

Sal Cortez has over forty years of experience as a paramedic and LEO. He has responded to two major active shooter incidents, worked as a flight medic, served on the California Governor's protection detail, and now runs TEMS training at the International School of Tactical Medicine. Listener discretion is advised.

Listener discretion is advised. References: PMID 12776641, 29463461

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. CORRECTION: I mentioned that Precedex is an alpha antagonist. I misspoke and meant to say that it is an "agonist." References: Ehrman-Dupre R, Kaigh C, Salzman M, Haroz R, Peterson LK, Schmidt R. Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report. J Addict Med. 2022 Sep-Oct 01;16(5):595-598. doi: 10.1097/ADM.0000000000000955. Epub 2022 Jan 11. PMID: 35020700. London KS, Huo S, Murphy L, Warrick-Stone T, Goodstein D, Montesi M, Carter M, Butt S, Alexander K, Satz W, Tasillo A, Xu L, Arora M, Casey E, McKeever R, Lowenstein M, Durney P, Hart B, Perrone J. Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA. J Addict Med. 2025 Aug 1. doi: 10.1097/ADM.0000000000001560. Epub ahead of print. PMID: 40747932. Reel B, Maani CV. Dexmedetomidine. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/

Listener discretion is advised. References: Casey, J., Seitz, K., et al. (2025). Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. NEJM. Available: https://www.nejm.org/doi/full/10.1056/NEJMoa2511420?query=featured_home Farkas. (Dec 10, 2025). PulmCrit: Hot take on RSI trial of ketamine vs etomidate. Available: https://emcrit.org/pulmcrit/rsitrial/ Srivatsa S, Chawla M, Hernandez M, et al. Helicopter transport of trauma patients continues to be overutilized: a call for universal transport criterion. Am Surg. Published online September 13, 2025:31348251378910. doi:10.1177/00031348251378910.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED. Kim YG, Choi YY, Han KD, Min K, Choi HY, Shim J, Choi JI, Kim YH. Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias. Sci Rep. 2021 Sep 13;11(1):18111. doi: 10.1038/s41598-021-97335-y. PMID: 34518592 Ren J, Yang Y, Zhu J, Wu S, Wang J, Zhang H, Shao X. The use of intravenous amiodarone in patients with atrial fibrillation and Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 2021 Jan;44(1):35-43. doi: 10.1111/pace.14113. Epub 2020 Dec 9. PMID: 33118640.

Listener discretion is advised.

Listener discretion is advised. Greenhaw, R. & Jamali, M. (2021). Medical Helicopter Accident Review: Causes and Contributing Factors. Available: https://libraryonline.erau.edu/online-full-text/faa-aviation-medicine-reports/AM21-19.pdf Hinkelbein J, Schwalbe M, Genzwuerker HV. Helicopter emergency medical services accident rates in different international air rescue systems. Open Access Emerg Med. 2010;2:45-49. Millin MG, Innes JC, King GD, Abo BN, Kelly SM, Knoles CL, Vezzetti R, White CC 4th, Yee A, Gallagher JM. Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature. Prehosp Emerg Care. 2025 Aug 7:1-13.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. Thank you to Mike Damkot for coming onto the podcast. Check him out on his podcast "EMS On the Mountain."

Listener discretion is advised.

Listener discretion is advised. Thank you to Pulmonologist Nick Ghionni and host of the EmCrit Podcast, Dr. Scott Weingart for coming onto the podcast and talking about approaches to the assessment and management of the often vague and really sick patient with respiratory distress.

Listener discretion is advised.

Listener discretion is advised. DOSE VF Trial: PMID 36342151 PARAMEDIC: PMID 25467566 Heads Up CPR: PMID 39442790.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. References: Christine Witten. Airway Jedi Blog. Available: https://airwayjedi.com/2019/01/24/etco2-valuable-vital-sign-perfusion/ Dubin A, Murias G, Estenssoro E, Canales H, Sottile P, Badie J, Barán M, Rossi S, Laporte M, Pálizas F, Giampieri J, Mediavilla D, Vacca E, Botta D. End-tidal CO2 pressure determinants during hemorrhagic shock. Intensive Care Med. 2000 Nov;26(11):1619-23. doi: 10.1007/s001340000669. PMID: 11193267. Öztürk Örmeci G, Yiğit Ö, Eray O. Utility of ETCO2 to predict hemorrhagic shock in multiple trauma patients. Turk J Med Sci. 2022 Feb;52(1):206-215. doi: 10.3906/sag-2103-206. Epub 2022 Feb 22. PMID: 36161601; PMCID: PMC10734833. Wahba RW, Tessler MJ, Béïque F, Kleiman SJ. Changes in PCO2 with acute changes in cardiac index. Can J Anaesth. 1996 Mar;43(3):243-5. doi: 10.1007/BF03011742. PMID: 8829863 Warner KJ, Cuschieri J, Garland B, Carlbom D, Baker D, Copass MK, Jurkovich GJ, Bulger EM. The utility of early end-tidal capnography in monitoring ventilation status after severe injury. J Trauma. 2009 Jan;66(1):26-3

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

@pulmtoilet Dr. Nick Ghionni comes onto dispel some of the thoughts on SCAPE and high-dose nitroglycerin. Listener discretion is advised.

Listener discretion is advised. Topics: Inappropriate OB Transfers Situational Awareness Organizational Standards and Lazy People

Listener discretion is advised. Dr. Steve Wood and Paramedic Ryan Mueller come on to debrief the New England Whole Blood Summit and talk about all things prehospital blood (and politics.....blood politics...not world politics)...

The audio is not studio-crisp beautiful. This was the first outdoor podcast I've ever recorded. Thanks to the crew for Heavy Lies the Helmet for coming onto the show and debriefing the Crash and Learn Conference. Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. @medicmagill and @ordinaryopsmedic come on to the podcast and discuss a topic I know absolutely nothing about: community paramedicine.

Listener discretion is advised. Rambling about a range of topics: Nobody cares that you work in the big city Clipboards, tablets, charting in front of the patient Video laryngoscopy The vallecula Stupid supervisors Dealing with stupid supervisors Needle decompression

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED. References: Buxton. Sustained Monomorphic VT: Clinical Manifestations, Diagnosis, and Evaluation. Up-to-Date. Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J. 2023;23(1):1-13. doi:10.1016/j.ipej.2022.11.002 Kashou AH, Evenson CM, Noseworthy PA, et al. Differentiating wide complex tachycardias: A historical perspective. Indian Heart J. 2021;73(1):7-13. doi:10.1016/j.ihj.2020.09.006 Salim Rezaie, "SVT With Aberrancy Versus VT", REBEL EM blog, November 22, 2013. Available at: https://rebelem.com/svt-aberrancy-versus-vt/. Steinman RT, Herrera C, Schuger CD, Lehmann MH. Wide QRS tachycardia in the conscious adult. Ventricular tachycardia is the most frequent cause. JAMA. 1989 Feb 17;261(7):1013-6. PMID: 2915409. Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias. Curr Cardiol Rev. 2014 Aug;10(3):262-76. doi: 10.2174/1573403x10666140514103309. PMID: 24827795; PMCID: PMC4040878.

LISTENER DISCRETION IS ADVISED.

Listener discretion is advised.

Listener discretion is advised. References: Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020 Jun;32(3):647-666. doi: 10.1007/s12028-020-00959-7. PMID: 32227294; PMCID: PMC7272487. Desai A, Damani R. Hyperosmolar therapy: A century of treating cerebral edema. Clin Neurol Neurosurg. 2021 Jul;206:106704. doi: 10.1016/j.clineuro.2021.106704. Epub 2021 May 20. PMID: 34045110. Mount CA, Das JM. Cerebral Perfusion Pressure. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537271/ Susanto M, Riantri I. Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review. Medeni Med J. 2022 Jun 23;37(2):203-211. doi: 10.4274/MMJ.galenos.2022.75725. PMID: 35735001; PMCID: PMC9234368.

Listener discretion is advised. Jake Potter from Scope Education and Josh Cooke from The Alert Medic One Podcast joined me for an agendaless discussion.

Listener discretion is advised. Thank you to Dr. Haney Mallemat and my partner Cameron for coming on to discuss a high-risk/low-frequency case.

Listener discretion is advised. Reference: Tsukube, T., Okita, Y. (2017). Cardiac tamponade due to aortic dissection: clinical picture and treatment with focus on pericardiocentesis. E-Journal of Cardiology Practice. European Society of Cardiology. Available: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Cardiac-tamponade-due-to-aortic-dissection-clinical-picture-and-treatment-with-focus-on-pericardiocentesis

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED. More thoughts on OB Learning 12-leads Paralytic choices ALS for AMS Cash RE, Kaimal AJ, Samuels-Kalow ME, Boggs KM, Swanton MF, Camargo CA Jr. Epidemiology of Emergency Medical Services-Attended out-of-Hospital Deliveries and Complications in the United States. Prehosp Emerg Care. 2024;28(7):890-897. Dexter F, Epstein RH, Wachtel RE, Rosenberg H. Estimate of the relative risk of succinylcholine for triggering malignant hyperthermia. Anesth Analg. 2013 Jan;116(1):118-22. Nunnally ME, O'Connor MF, Kordylewski H, Westlake B, Dutton RP. The incidence and risk factors for perioperative cardiac arrest observed in the national anesthesia clinical outcomes registry. Anesth Analg. 2015 Feb;120(2):364-70.

Listener discretion is advised. We will address three topics on this episode: Burnout: "I hate my patients." Managers who don't handle a low performing employee "I don't feel accepted by my new team."

LISTENER DISCRETION IS ADVISED.

Listener discretion is advised.

Listener discretion is advised.