Introduction

• My first experience with a cardiac arrest as a new EMT → exhilarating, confirmed calling to emergency medicine.
• Early struggles: dropped out of college, lacked discipline, but EMT training provided a direction and purpose.
• Spent years balancing work as EMT/paramedic with school → long path to becoming a PA.
• Lessons from emergency medicine shaped clinical skills and mindset.
• Concept of standards:
  • Standards = benchmarks, measurable expectations, non-negotiable habits.
  • Different from principles (general truths) → standards are concrete, either met or not.
  • Standards build consistency, resilience, and preparation.
• Personal struggles: binge eating, lack of discipline, repeated failures to meet daily goals.
• Turning point: completing 75 Hard program → developed discipline, consistency, higher personal standards.
• Standards spill over into clinical performance, family life, and personal growth.
• Emphasizes locus of control:
  • Focus on what you can control, not external factors.
  • Even in chaotic emergency medicine, there are controllable elements.
• Warns that neglected habits eventually become emergent problems (health, mindset, life).
• Family story: father’s heart attack → personal wake-up call about health and discipline.
• Core message: Raising standards in personal life and medicine leads to thriving, not just surviving.
• Purpose: help others raise their own standards without taking 16 years to learn the lessons.

Chapter 1: Do Not Seek to Diagnose

• Case study: elderly woman with shortness of breath and chest pain.
  • No pulmonary embolism, but fluid in lungs and around heart → problem found, but no definitive diagnosis yet.
  • Highlight: in the ED, the goal is to rule out life-threatening conditions, not always find the exact cause.
• Key principle: Diagnosis is often less important than identifying and stabilizing dangerous conditions.
• Emergency medicine limits:
  • Not every test or long-term treatment available.
  • Focus on acute, life-threatening issues; leave underlying cause to specialists.
• Patients often expect answers and certainty, but ED care is about safety and ruling out the worst cases.
• Overdiagnosis problems:
  • Incidental findings (lung nodules, brain aneurysms, ultrasound anomalies) → create stress, anxiety, or unnecessary proce

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

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