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We have all probably encountered the hypoxic patient who did not improve with oxygen. Why might that have been? Did you stop at that moment and consider which of the four types of hypoxia they may be suffering from? Or whether this was a ventilation and oxygenation problem? A perfusion problem? Multiple of the above? Is there some way we could tell in the moment where exactly the problem was? 

What about the relationship between EtCO2 and PaCO2? When is EtCO2 unreliable? And finally, what is the relationship between SpO2 and PaO2? Find out all of this and more in this episode! 

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Hang on...didn't I just spend almost an entire episode talking about how we should not delay getting OMI and "NSTEMI" patients to the cath lab??? Now what is this about delaying catheterization??? Join me and find out about this potential game-changer and the DTU-STEMI trial.

Credit for some of this presentation goes to Bruce Hoffman, RN/CCRN, Baystate Medical Center in Springfield. Thank you Bruce!

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STEMI and NSTEMI have been the unchallenged terminology for too long. However, unlike the modern culture of just simply changing things to see them changed, the push across interventional cardiology to change "STEMI" and "NSTEMI" to OMI and NOMI is driven out of the understanding that:

a) Traditional STEMI criteria just flat out miss too many occlusions, and

b) Traditional NSTEMI criteria and dogma leads us to put NSTEMI patients lower on the totem pole, leading to delays in PCI and irreparable damage...

Join me and take a look at the new OMI criteria, OMI diagnostic algorithm, and really take a deep dive into how we are in need of better care of our NSTEMI patients!

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Coming soon to a valley near you!

What: 2025 Mt. Washington Valley Emergency Medicine Conference

When: Saturday, June 14th and Sunday June 15th

Where: Grand Summit Hotel at Attitash (Bartlett)

Open to all area EMS and hospital emergency medicine/critical care staff. Join us on the 14th for awesome optional pre-conference workshops (extra fees may be associated) and on June 15th for the General Conference Assembly where you can earn continuing education/contact hours for EMS and nursing, learn some new and interesting topics, participate in an awards ceremony, and more! Oh, did I mention your Day 2 General Assembly ticket cost covers some pretty amazing food, with breakfast and lunch catered by the resort???

Check out the website for more information at:

https://2025MWVEMConference.com

*Please note, this conference is not sponsored by MaineHealth, and while I have done everything I can to keep costs for you as low as possible, I can't cover this all myself. Day 2 entry tickets are $100/person, which covers breakfast, lunch, the Day 2 conference, continuing education, site fees, surprises in store, and more.

Don't wait too long, the conference is capped at 200 persons for attendance, and pre-conference workshops also have max attendee caps. See you there!!!!

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...Which is the better of them all? Alkalosis, or Acidosis? We know both can be incredibly challenging to treat, but what about the theory that athletes are intentionally making themselves alkalotic to see improved health benefits? How can there be benefits to it if shallow-water blackouts are related to the induced alkalosis? It all seems contradictory, but join me as we dissect these two sides of the acid-base balance, and see if there is more to this than just being a fad.

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Sound like a cryptic title? So too can ECG's seem cryptic...however, if you approach them all with a standardized approach, apply rules of cardiology, the world opens up and much more is possible with them than just ST-elevations and depressions...care to join me and find out?

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Taking a deeper dive after our Cardiogenic Shock episode, we will look at Dobutamine and Milrinone more in-depth, compare the two, and see which one is more beneficial at specific times. 

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If you have taken any type of 12-Lead ECG training, you have probably heard of a condition known as LVH, or left ventricular hypertrophy. It is possible that you also heard there is no way to diagnose an Occlusion Myocardial Infarction (OMI/STEMI) if LVH is present. What is LVH exactly, how does it affect our patients, and what tools can we use to evaluate if LVH is hiding an MI?

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Considered one of the more challenging types of shock to treat, Cardiogenic shock can present in different ways in different patients, and each patient may require a different treatment modality depending on cause, physiologic differences, etc. Do you reach for the Norepi? Epi? Milrinone? Dobutamine? Some fluids? Or maybe something mechanical in nature? Let's find out!

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Ok, because we touched on Sodium Bicarb in the last episode, I felt it made sense to not only re-visit this topic, but to also look at ways to reduce the negative effects of the hypertonicity with dilution in D5W, when to consider diluting and when to just full-send the 8.4% IV bolus, and a few other situations to consider administration of IV sodium bicarb that have nothing to do with cardiac arrest or acidosis.