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Another must-listen! How many times have we seen seizure patients who continue to seize, and providers in the field and in the hospitals give 2.5mg Versed, or 1mg Ativan, then another similar dose, struggle to find IV's, put all their faith in Keppra, Valproic Acid, etc, and wonder why the patient continues to seize? In this episode, we are going to look at all of this and more, including why the national guidelines for critical care neuro push for an up-front 10mg IM dose of benzo, and to forgo messing around for IV's? We will also look at why as time goes on, benzodiazepines actually become LESS effective and cause a paradoxical worsening of seizures as time goes on, and Ketamine becomes the best option. Keppra? Valproic Acid? Don't even get me started...

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It feels like we have revived a topic from last season, and I have absolutely done so for good reason. In this episode I present multiple reasons why, if you are not already a fan of Lidocaine, you may want to listen and possibly change your practice. I am willing to be there will be some things in here about the two medications you may not have even heard of before, and that goes for the physicians and mid-level providers too! Dump the benches on both sides of this ring and let's watch these two meds throw fists. Who will come out on top, based on cutting-edge evidence?

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This episode is sure to ignite some fiery debate, and this is the intention. Regardless of which alphabet-soup canned trauma course you subscribe to, the National Association of EMS Physicians (civilian and military) Trauma Compendium has released a landmark review of 4,000+ studies, papers, cases, and reviews covering the use of rigid cervical collars and backboards....sorry to be that guy, but for those still in favor, including you, Level 1 Trauma Centers, I would strongly urge you to take a look. Maybe it's truly time to re-write the guidelines. Link is below to the review/analysis:

https://doi.org/10.1080/10903127.2025.2541258

Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of Literature. Millin et al, 07 MAY 2025. 

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For those who didn't check out the LVAD episode from way back in 2024 during season 1, here is a little refresher and some newer information to help get you up to speed. For those who have never heard of an LVAD before, or a VAD in general, tune in and find out what these are all about! We will cover some treatment and evaluation tips and some trouble-shooting ideas in case you ever have to care for a patient with a VAD!

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Quite frequently we hear medical staff confusing lactic acidosis and lactate. It may seem that it is the same, but these are quite different, especially on the molecular level. Where does each one come from, which one(s) are we actually testing for and when, and what do their levels mean for our patients? This episode looks at all of this and more. 

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If you interpret ECG's, you have probably at least heard of Sgarbossa criteria for Left Bundle Branch Blocks (LBBBs) and ventricular-paced rhythms. Maybe you have heard of Smith Modification Criteria, or Modified Sgarbossa. But have you heard of the Barcelona criteria? Join me and discover what this is all about and how much further it pushes the specificity and sensitivity of the Sgarbossa and Modification criteria, especially in ventricular paced rhythms, which can be especially challenging to diagnose OMI's hiding under their layers. 

We will also discuss why many times, EMS tries to activate a STEMI/OMI alert and cath lab personnel may shoot it down. What gives? Let's find out!

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I've said it before, and I will say it again. The world of ECG's is full of so much more than just ST-elevations and depressions related to MI's. Today's topic looks at another must-know finding that while rare, is a dead giveaway that your patient will soon be, well, just join me and find out the rest!!

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Similar to the P/F Ratio, we can use the A-a gradient to help us understand more about the pathophysiology affecting our respiratory patients, how we can tweak our treatment pathways, and more. This isn't your high school algebra class, and is something you can use on your ventilated and even non mechanically-ventilated patients. 

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Back by request, this is a brief overview of some of the more common, and one not-so-common, vasoactive and inotropic agents we see in our patients. Remember when treating patient's hypotension, besides figuring out the cause, don't forget positioning, pH drops, fluid status, alpha, beta, Vaso, and AGII receptors in your treatment plan if needed. 

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What is the anion gap in the comprehensive metabolic panel? What does that number mean, and why do we care about "closing the gap" in many of our patients? Join me as we look at the anion gap, as well as the osmolar gap and how understanding these will help with your differential diagnosis'.