Join Eric Bauer and Dr. Mike Lauria as they dissect two challenging critical care transport cases centered on managing respiratory failure in obese and morbidly obese patients. Get ready for a deep dive into advanced physiological concepts, practical tips for troubleshooting ventilator settings, and real-world lessons you can apply to patient care right away. From recognizing unique challenges in the obese population to fine-tuning pressures and understanding how to balance protective ventilation with the realities of chest wall resistance, this episode offers clear, expert-level insights delivered in an approachable way.

Key Takeaways

• Appreciating that obesity significantly reduces functional residual capacity, requiring thoughtful increases in ventilatory pressures.
• Using waveform analysis, plateau pressures, and driving pressures to differentiate between obstructive and restrictive components, especially when chronic illnesses overlap with acute processes.
• Strategic positioning such as ramping or partial proning can be employed to recruit lung volume and improve oxygenation.
• Recognizing that some patients will need alarm limits and inspiratory pressures far beyond standard protocols—especially when chest wall resistance is extremely high.
• Incorporating a systematic approach, including incremental changes and close monitoring, rather than relying on one-size-fits-all protocols.
• Leveraging collaborative practice and direct medical oversight to fine-tune treatment in the face of complex physiology.

The FlightBridgeED Podcast has been your go-to resource for critical care, EMS, and emergency medicine education since 2012. Access this episode and the entire library wherever you get your podcasts or by visiting flightbridgeed.com. While you’re there, you can also explore our award-winning courses that have helped countless professionals master advanced practice concepts.

We invite you to explore our full range of podcast shows, where our network of FlightBridgeED creators and contributors deliver dynamic discussions on everything from critical care to cutting-edge EMS topics. You’ll also find unique blogs, training resources, and opportunities to engage in our growing community. And don’t forget to check out our upcoming courses and see what’s happening at FAST this year.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

In this episode of the FlightBridgeED Podcast, Dr. Michael Lauria and guest Dr. Alex Pfeiffer, a maternal-fetal medicine (MFM) fellow, delve into the critical and complex topic of Placenta Accreta Spectrum Disorder (PAS). With its rapidly evolving complications, this condition demands acute recognition, careful transport coordination, and multidisciplinary care. Together, they unpack the spectrum’s pathophysiology, risk factors, diagnostic strategies, and advanced management protocols essential for critical care and transport teams. Whether you’re a seasoned provider or new to pre-hospital medicine, this episode provides practical knowledge and actionable insights to elevate your clinical practice.

Catch this episode and more wherever you listen to podcasts or on our website at flightbridgeed.com. While there, explore our award-winning courses and other free content in our Culture section to advance your career and expand your critical care expertise.

Takeaways

• Advanced Insight: The importance of understanding PAS as a spectrum, including the implications of invasive placentation on maternal hemorrhage and the role of multidisciplinary teams in patient outcomes.
• Practical Application: Early recognition of PAS through clinical and diagnostic signs, such as Doppler flow abnormalities, hypervascularity, and placental lakes, to facilitate timely and appropriate interventions.
• Foundational Knowledge: Awareness of risk factors like prior cesarean sections, placenta previa, and uterine surgeries that increase the likelihood of PAS and necessitate careful monitoring.

References
1.             Dunbar N, Cooke M, Diab M, Toy P. Transfusion-related acute lung injury after transfusion of maternal blood: a case-control study. Spine (Phila Pa 1976). Nov 1 2010;35(23):E1322-7. doi:10.1097/BRS.0b013e3181e3dad2

2.             Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol. Feb 2011;117(2 Pt 1):331-337. doi:10.1097/AOG.0b013e3182051db2

3.             Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. Bjog. Apr 2009;116(5):648-54. doi:10.1111/j.1471-0528.2008.02037.x

4.             Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol. Sep 2019;221(3):208-218. doi:10.1016/j.ajog.2019.01.233

5.             Murphy EL, Kwaan N, Looney MR, et al. Risk factors and outcomes in transfusion-associated circulatory overload. Am J Med. Apr 2013;126(4):357.e29-38. doi:10.1016/j.amjmed.2012.08.019

6.             Pachtman S, Koenig S, Meirowitz N. Detecting Pulmonary Edema in Obstetric Patients Through Point-of-Care Lung Ultrasonography. Obstet Gynecol. Mar 2017;129(3):525-529. doi:10.1097/aog.0000000000001909

7.             Padilla CR, Shamshirsaz A. Critical care in obstetrics. Best Pract Res Clin Anaesthesiol. May 2022;36(1):209-225. doi:10.1016/j.bpa.2022.02.001

8.             Padilla CR, Shamshirsaz AA, Easter SR, et al. Critical Care in Placenta Accreta Spectrum Disorders-A Call to Action. Am J Perinatol. Jul 2023;40(9):988-995. doi:10.1055/s-0043-1761638

9.             Panigrahi AK, Yeaton-Massey A, Bakhtary S, et al. A Standardized Approach for Transfusion Medicine Support in Patients With Morbidly Adherent Placenta. Anesth Analg. Aug 2017;125(2):603-608. doi:10.1213/ane.0000000000002050

10.          Pegu B, Thiagaraju C, Nayak D, Subbaiah M. Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstet Gynecol Sci. May 2021;64(3):239-247. doi:10.5468/ogs.20345

11.          Roubinian N. TACO and TRALI: biology, risk factors, and prevention strategies. Hematology Am Soc Hematol Educ Program. Nov 30 2018;2018(1):585-594. doi:10.1182/asheducation-2018.1.585

12.          Sawada M, Matsuzaki S, Mimura K, Kumasawa K, Endo M, Kimura T. Successful conservative management of placenta percreta: Investigation by serial magnetic resonance imaging of the clinical course and a literature review. J Obstet Gynaecol Res. Dec 2016;42(12):1858-1863. doi:10.1111/jog.13121

13.          Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet. Mar 2018;140(3):291-298. doi:10.1002/ijgo.12410

14.          Shamshirsaz AA, Fox KA, Erfani H, et al. Coagulopathy in surgical management of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol. Jun 2019;237:126-130. doi:10.1016/j.ejogrb.2019.04.026

15.          Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. Jun 2015;42(2):381-402. doi:10.1016/j.ogc.2015.01.014

16.          Simonazzi G, Bisulli M, Saccone G, Moro E, Marshall A, Berghella V. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand. Jan 2016;95(1):28-37. doi:10.1111/aogs.12798

17.          Tadayon M, Javadifar N, Dastoorpoor M, Shahbazian N. Frequency, Risk Factors, and Pregnancy Outcomes in Cases with Placenta Accreta Spectrum Disorder: A Case-Control Study. J Reprod Infertil. Oct-Dec 2022;23(4):279-287. doi:10.18502/jri.v23i4.10814

18.          Tinari S, Buca D, Cali G, et al. Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound Obstet Gynecol. Jun 2021;57(6):903-909. doi:10.1002/uog.22183

19.          Toy P, Gajic O, Bacchetti P, et al. Transfusion-related acute lung injury: incidence and risk factors. Blood. Feb 16 2012;119(7):1757-67. doi:10.1182/blood-2011-08-370932

20.          Toy P, Popovsky MA, Abraham E, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. Apr 2005;33(4):721-6. doi:10.1097/01.ccm.0000159849.94750.51

21.          Warshak CR, Ramos GA, Eskander R, et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. Jan 2010;115(1):65-69. doi:10.1097/AOG.0b013e3181c4f12a

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

...

Explore the fascinating world of 12-lead ECG interpretation with a special guest, Reid Gilbert-Vass, PA-C, creator of "ECG Lectures with Reid" on YouTube. Reid discusses his journey from Marine Corps logistics to EMS and ultimately becoming a PA specializing in cardiology. Learn his structured, anatomy-driven approach to ECG interpretation, designed to help clinicians at all levels—from beginners to seasoned critical care professionals—develop a deeper understanding of cardiac physiology and electrophysiology.

Join the FlightBridgeED Podcast: MDCAST host, Michael Lauria, as they discuss Reed's innovative teaching methods, his passion for lifelong learning, and how his work transforms how clinicians approach ECGs. Don’t miss the practical insights and compelling stories that make this episode a must-listen for anyone in pre-hospital, emergency, or critical care medicine.

Listen to the FlightBridgeED Podcast wherever you get your podcasts or at flightbridgeed.com/fbe-podcast. You should also check out ECG Lectures with Reid on YouTube @ECGwithReid. Thank you so much for listening! We couldn't make this podcast with you.

Takeaways

1. Understanding ECGs Through Anatomy
   Reid’s step-by-step anatomical approach to ECG interpretation emphasizes the flow of electricity through the heart, helping clinicians localize issues and correlate findings with physiology.
2. The Importance of Lifelong Learning
   Reid’s journey highlights how continual study and curiosity can lead to advanced clinical insights, inspiring providers to deepen their understanding of medical concepts.
3. Practical Application of ECG Skills
   Reid shares actionable advice from EMS to PA school on applying ECG interpretation skills in high-pressure environments, empowering learners to improve patient care.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

In this episode of the FlightBridgeED Podcast, Dr. Michael Lauria dives deep into the art and science of non-invasive positive pressure ventilation (NIPPV), exploring how to optimize CPAP and BiPAP for critically ill patients. Discover advanced techniques to fine-tune ventilator settings, evaluate effectiveness, and reduce mortality and morbidity in COPD, CHF, and other conditions. Learn how to align ventilatory support with patient pathophysiology and understand the tools that predict success or failure in non-invasive ventilation.

Whether you're a seasoned critical care provider or just starting to explore advanced practice concepts, this episode offers valuable insights to elevate your understanding of respiratory management.

Listen anywhere you get your podcasts or directly on our website at flightbridgeed.com/fbe-podcast. While there, explore our award-winning courses and resources designed to empower healthcare professionals.

Takeaways

1. Advanced Insight: Using effective PEEP and pressure support in BiPAP can dramatically reduce breathing work and improve outcomes for COPD and CHF patients.
2. Practical Guidance: Titrating CPAP and BiPAP requires continuous evaluation of patient response and adjusting settings like pressure support, PEEP, rise time, and expiratory trigger.
3. Foundational Knowledge: Understanding when and why to choose non-invasive ventilation based on patient pathophysiology is critical for improving care quality.

References
1.             Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. Ann Transl Med. Sep 2018;6(18):355. doi:10.21037/atm.2018.04.39

2.             Berbenetz N, Wang Y, Brown J, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. Apr 5 2019;4(4):Cd005351. doi:10.1002/14651858.CD005351.pub4

3.             Carrillo A, Lopez A, Carrillo L, et al. Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients. J Crit Care. Dec 2020;60:152-158. doi:10.1016/j.jcrc.2020.08.008

4.             Chong CY, Bustam A, Noor Azhar M, Abdul Latif AK, Ismail R, Poh K. Evaluation of HACOR scale as a predictor of non-invasive ventilation failure in acute cardiogenic pulmonary oedema patients: A prospective observational study. Am J Emerg Med. May 2024;79:19-24. doi:10.1016/j.ajem.2024.01.044

5.             Coleman JM, 3rd, Wolfe LF, Kalhan R. Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. Sep 2019;16(9):1091-1098. doi:10.1513/AnnalsATS.201810-657CME

6.             Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. Dec 2002;28(12):1701-7. doi:10.1007/s00134-002-1478-0

7.             D'Andrea A, Martone F, Liccardo B, et al. Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study. Echocardiography. Aug 2016;33(8):1144-55. doi:10.1111/echo.13225

8.             Duan J, Chen L, Liu X, et al. An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study. Crit Care. Jul 3 2022;26(1):196. doi:10.1186/s13054-022-04060-7

9.             Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med. Feb 2017;43(2):192-199. doi:10.1007/s00134-016-4601-3

10.          Duan J, Yang J, Jiang L, et al. Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure. Ann Intensive Care. Dec 5 2022;12(1):110. doi:10.1186/s13613-022-01085-7

11.          Esnault P, Cardinale M, Hraiech S, et al. High Respiratory Drive and Excessive Respiratory Efforts Predict Relapse of Respiratory Failure in Critically Ill Patients with COVID-19. Am J Respir Crit Care Med. Oct 15 2020;202(8):1173-1178. doi:10.1164/rccm.202005-1582LE

12.          Ferreyro BL, De Jong A, Grieco DL. How to use facemask noninvasive ventilation. Intensive Care Med. May 27 2024;doi:10.1007/s00134-024-07471-y

13.          Giovannini I, Chiarla C, Boldrini G, Terzi R. Quantitative assessment of changes in blood CO2 tension mediated by the Haldane effect. Journal of Applied Physiology. 1999;87(2):862-866. doi:10.1152/jappl.1999.87.2.862

14.          Ho KM, Wong K. A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Crit Care. 2006;10(2):R49. doi:10.1186/cc4861

15.          Klocke RA. Mechanism and kinetics of the Haldane effect in human erythrocytes. Journal of Applied Physiology. 1973;35(5):673-681. doi:10.1152/jappl.1973.35.5.673

16.          Leatherman J. Mechanical ventilation for severe asthma. Chest. Jun 2015;147(6):1671-1680. doi:10.1378/chest.14-1733

17.          Lenique F, Habis M, Lofaso F, Dubois-Randé JL, Harf A, Brochard L. Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med. Feb 1997;155(2):500-5. doi:10.1164/ajrccm.155.2.9032185

18.          Martin JG, Shore S, Engel LA. Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis. Nov 1982;126(5):812-7. doi:10.1164/arrd.1982.126.5.812

19.          Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med. Dec 15 2003;168(12):1432-7. doi:10.1164/rccm.200211-1270OC

20.          Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Jul 13 2017;7(7):Cd004104. doi:10.1002/14651858.CD004104.pub4

21.          Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet. Apr 8 2006;367(9517):1155-63. doi:10.1016/s0140-6736(06)68506-1

22.          Rittayamai N, Pravarnpat C, Srilam W, Bunyarid S, Chierakul N. Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study. J Thorac...

In this episode of the FlightBridgeED Podcast: MDCAST, we continue our OB Critical Care Series, focusing on airway management in critically ill obstetric patients. Hosted by Dr. Michael Lauria and featuring special guest Dr. Emily McQuaid-Hanson, Director of OB Anesthesia at the University of New Mexico, this episode delivers essential insights into managing one of the most intimidating and dynamic challenges in pre-hospital and critical care transport medicine.

Join us as we discuss modern advancements in airway safety, the physiological challenges of gravid patients, and the critical techniques and tools for managing obstetric airways effectively. Dr. McQuaid-Hanson shares invaluable strategies for pre-oxygenation, intubation, medication selection, and post-intubation care, along with a reminder to approach every airway with preparation and respect—without fear.

Whether new to pre-hospital medicine or a seasoned critical care professional, wherever you are on your journey, this episode offers actionable insights and pearls of wisdom.

Listen to this podcast on your favorite platform or visit flightbridgeed.com/fbe-podcast. While you're there, explore our award-winning courses and check out our website's Culture section, which offers free content like this podcast, blogs, YouTube videos, TikTok creators, and more! Enjoy, and thank you for being part of the FlightBridgeED community!

Takeaways

1. Advanced Insights: Modern airway equipment like video laryngoscopes and better preparation have made obstetric airway management comparable in difficulty to other critical care populations, emphasizing preparation and respect for physiological challenges.
2. Clinical Strategies: Proper positioning, effective pre-oxygenation techniques, and having a well-thought-out plan with appropriate tools are key to successful airway management in obstetric patients.
3. Foundational Knowledge: Awareness of the physiological changes during pregnancy—such as reduced functional residual capacity and increased aspiration risk—helps providers anticipate and mitigate challenges during airway management.

References
1.        Aziz MF, Kim D, Mako J, Hand K, Brambrink AM. A retrospective study of the performance of video laryngoscopy in an obstetric unit. Anesth Analg. 2012 Oct;115(4):904-6.

2.        Ahuja P, Jain D, Bhardwaj N, Jain K, Gainder S, Kang M. Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study. Int J Obstet Anesth. 2018 Feb;33:17-22.

3.        Bryson PC, Abode K, Zdanski CJ. Emergent airway management in the labor and delivery suite. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:83-6.

4.        Šklebar I, Habek D, Berić S, Goranović T. AIRWAY MANAGEMENT GUIDELINES IN OBSTETRICS. Acta Clin Croat. 2023 Apr;62(Suppl1):85-90. 

5.        Dongare PA, Nataraj MS. Anaesthetic management of obstetric emergencies. Indian J Anaesth. 2018 Sep;62(9):704-709.

6.        Djabatey EA, Barclay PM. Difficult and failed intubation in 3430 obstetric general anaesthetics. Anaesthesia. 2009 Nov;64(11):1168-71.

7.        McKeen DM, George RB, O'Connell CM, Allen VM, Yazer M, Wilson M, Phu TC. Difficult and failed intubation: Incident rates and maternal, obstetrical, and anesthetic predictors. Can J Anaesth. 2011 Jun;58(6):514-24.

8.        Hannig KE, Hauritz RW, Jessen C, Herzog J, Grejs AM, Kristensen MS. Managing Known Difficult Airways in Obstetric Patients Using a Flexible Bronchoscope and IRRIS: A Case-Illustrated Guide for Nonexpert Anesthesiologists, without Surgical Backup. Case Rep Anesthesiol. 2021 Oct 8;2021:6778805.

9.        Preston R, Jee R. Obstetric airway management. Int Anesthesiol Clin. 2014 Spring;52(2):1-28.

10.  Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC; Obstetric Anaesthetists' Association; Difficult Airway Society. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015 Nov;70(11):1286-306.

11.  Goldszmidt E. Principles and practices of obstetric airway management. Anesthesiol Clin. 2008 Mar;26(1):109-25, vii.

12.  Kurdi MS, Rajagopal V, Sangineni KS, Thalaiappan M, Grewal A, Gupta S. Recent advances in obstetric anaesthesia and critical care. Indian J Anaesth. 2023 Jan;67(1):19-26.

13.  Ende H, Varelmann D. Respiratory Considerations Including Airway and Ventilation Issues in Critical Care Obstetric Patients. Obstet Gynecol Clin North Am. 2016 Dec;43(4):699-708.

14.  Mhyre JM, Healy D. The unanticipated difficult intubation in obstetrics. Anesth Analg. 2011 Mar;112(3):648-52.

15.  Stopar Pintarič T. Videolaryngoscopy as a primary intubation modality in obstetrics: A narrative review of current evidence. Biomol Biomed. 2023 Nov 3;23(6):949-955.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

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

1. 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.
2. 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.
3. 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.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

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:

1. Recognize the four pillars of preterm labor management: transport to the appropriate facility, antibiotic administration, antenatal steroids, and magnesium for neuroprotection (before 32 weeks).
2. To prevent neonatal complications, maintain close monitoring during transport and prioritize fetal head control in the event of precipitous delivery.
3. Understanding preterm labor risk factors—such as infection, smoking, limited access to care, and history of preterm births—can help guide critical care decisions.
4. Tocolytic options like calcium channel blockers or beta sympathomimetics are helpful for delaying delivery short-term but require careful consideration of contraindications.
5. 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.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

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.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

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:

1. Pathophysiology of Preeclampsia: This condition often arises from placental abnormalities that lead to widespread vascular issues, impacting both the mother and fetus.
2. Magnesium Sulfate in Management: Magnesium sulfate is vital for preventing eclampsia and should be monitored for toxicity, especially in patients with reduced kidney function.
3. 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

1. 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. 
2. 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.
3. Steegers EA, von Daselszen P, Duvekot JJ, Pijnenborg R.  Pre-Eclampsia.  Lancet. 2010; 376:631-44.
4. Redman CW, Sargent IL.  Latest advances in understanding preeclampsia.  Science. 2005; 308:1592-4
5. von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia.  Hypertens Pregnancy. 2003; 22:143-8
6. Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts.  Am J Obstet Gynecol. 1998; 179; 1359-75. 
7. 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.
8. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260.

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.

🚀 New for 2025: The Creator Festival – Featuring “Burnt Ones,” a spicy take on Hot Ones, where top EMS creators tackle scorching hot wings while answering the most challenging questions in the industry. Expect live demos, interactive exhibits, and big-name influencers sharing their insight in a way you won’t find anywhere else.

Plus, a killer vendor experience, special guests, catered lunches, and after-hours events that make networking effortless and enjoyable. FAST25 is where it all happens.

📍 Central Bank Center | Lexington, KY
🏨 Hilton Lexington/Downtown (special rates available!)
🎟️ Tickets are limited—grab yours now: flightbridgeed.com/fast25

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

FAST25 | May 19-21, 2025 | Lexington, KY

🔥 FAST25 is back—bigger, bolder, and hotter than ever! 🔥

This isn’t just another conference—a high-energy, immersive experience for pre-hospital and critical care transport pros. Expert-led sessions, hands-on workshops, and unfiltered discussions will take your practice to the next level.