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The search for a suitable replacement for Succinylcholine has been ongoing for decades...a non-depolarizing agent that has the same onset and duration times as Succinylcholine, but without all the nasty side effects...wouldn't that be wonderful? Especially if it was reversible??? Enter Gantacurium...well...it almost entered anyways. A bit of stage fright? Not so much. Join me on this episode as we discuss what this is and why it disappeared before it really ever appeared, and what comes next!

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Nitrous? Sure...but it comes with a host of issues. Methoxyflurane? Wasn't that banned in the US by the FDA? It was...but it's making a comeback globally and stands poised to change inhaled analgesia for good. Want to know more? Join me in this episode as we take a ride on the Green Whistle!

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This is never an easy topic to discuss, but we are going to tackle it today. Whether you are EMS/pre-hospital or in the hospital, you are unfortunately involved in some of the most dangerous professions in our country today. Instances of violence, both verbal and physical, are rising. And that is just what is actually reported. What can we do to strengthen ourselves, the job sites, and our training, to protect ourselves, and what recourse and legal protections do we have? Tune in to find out.

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These are the voyages of the Starship AHA. And this episode is going to go where few have actually dared to go before...a path through space unencumbered by the numbingly binding dogma that is ACLS in cardiac resuscitation. 

Let me be clear. This is not an attack on the AHA. I am an instructor in every discipline the AHA offers, and am affiliate faculty for the AHA. That being said, the ACLS guidelines are recommendations that are meant to cater to the non-resuscitation personnel in the healthcare world, those who are not yet at the point where they can apply critical thinking outside of the ACLS algorithms. Every cardiac arrest is different, and a blanket approach cannot be applied to every patient. So what should those in EMS and Emergency/Critical Care Medicine who ARE resuscitation experts do? Do we also blindly follow the algorithms? Or do we apply critical thinking and maneuver our way around and between the guidelines? Join me for what is most likely going to be a spicy episode discussing Epinephrine, hypothermic arrests, trauma arrests, POCUS and PEA, and more. 

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Sliding scale insulin is often used in the hospital, especially in-patient. However, there is a multitude of issues that comes with it for our hyperglycemic patients, with the primary issue being that SSI is more of a knee-jerk reaction than a proactive treatment. Doing something because we have always done it that way is not something I enjoy hearing. This episode lays out all of the compelling science-backed reasons why SSI should NOT be the weapon of choice for hyperglycemic patients especially in-patient, whether NPO or not...change my mind? Let's see after you listen in!

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There once was an anticoagulant agent named tPA...hold up, this isn't a fairytale and this story doesn't cover tPA or TNK! Those are different stories for different days. 

Does every stroke patient we encounter need to be anticoagulated? Or should we not be so quick to pull that trigger? If you are going to give a stroke patient anticoagulants, which types of strokes should it be? What are the three main subsets that really need it? With that question comes another bigger question, which anticoagulant agents are most appropriate for these types of strokes? Join me on this episode as we discuss fractionated vs unfractionated Heparin, DOAC's, and Coumadin's roles in the stroke patients. 

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We know beta blockers are a staple treatment in outpatient CHF/HFpEF and stable HFrEF patients. However, what is it about the nature of beta blockers that makes them potent killers in the decompensated HFrEF patient? Why do we routinely mix up the two variations of Metoprolol and why is the common Metoprolol Tartate considered the Metoprolol Mistake in HFrEF patients? Listen in to find out!

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With this case review (fictional) and dive into the pharmacology behind Dobutamine, by the end of this episode you should hopefully have a firm understanding of what it is, what it does, how it can be helpful to our patients, but also how it can harm them. I will also spend some time talking about Dobutamine in transport and how squeeze should never be the sole treatment. This concept does hold credence for in-hospital as well, but is subject to provider judgement. 

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How do we prevent "death-by-induction?" How do you appropriately resuscitate a patient before intubation? Have you heard of the Shock Index before? Or are you aware that there is a difference between systolic shock index and diastolic shock index? In this episode we will explore all of this and more, and put significant emphasis on the diastolic shock index as the most reliable indicator of whether this patient will decompensate during/after the intubation attempt. 

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In the absence of whole blood, if I had to choose between PRBC's or plasma in the prehospital environment for the bleeding patient with coagulopathy, and didn't get to carry both, I would choose (freeze-dried) plasma as the product to carry. Why is this? What reasoning is there to support this?

In trauma, our concern is not just the oxygen carrying capacity in resuscitation. It is also to fix the trauma-induced coagulopathy, the endothelial glycocalyx damage, and more. PRBC's make these worse by diluting the concentration of clotting factors in favor of adding O2-carrying capacity. Plasma gives us back the ability to clot and more. 

Join me in this episode as I present the evidence that would support these claims.