The FlightBridgeED Podcast FlightBridgeED

In this episode of the FlightBridgeED MDCast, Dr. Mike Lauria and Dr. Brittany 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 Brittany 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.

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.

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.

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!

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!

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.