))
"Heavy lies the crown" is a common misquote of "uneasy lies the head that wears a crown" from Shakespeare's Henry IV, Part 2. It refers to the responsibility and insecurity of governing an entire kingdom. Likewise, "heavy lies the helmet" refers to the responsibility we face as critical care transport providers working in an autonomous and often unpredictable environment. Our minds are eased with education that better prepares us for any situation that we may encounter. That is exactly what ...
Myocardial infarctions can present in a variety of ways depending on vessel involvement, timing of pathology, and interpretation of diagnostics (e.g., 12-lead EKG). Unfortunately, not every patient with a myocardial infarction will fit STEMI criteria's paradigm, which has lead to the adoption of a new term: OMI (Occlusion Myocardial Infarction). In…
No matter what level of scope, management of medical and traumatic cardiac arrests is the focus of many clinicians. But what happens after return of spontaneous circulation (ROSC) is achieved? Many do not appreciate the fact that the likeliness of re-arrest is high. How can we avoid return of spontaneous arrest by appropriately treating the patient…
H
Heavy Lies the Helmet
1
Episode 102 - Long and Short of Learning w/Will Wingfield
56:01
56:01
Play later
Play later
Lists
Like
Liked
56:01
The medical industry puts great emphasis on formal education via university and other training programs. Due to financial incentive, these institutions often discourage independent learning despite it usually having a greater impact on patient care quality. For example, paramedics are often non-degree holders, yet they effectively practice medicine…
Whether it's antibiotic-resistant "super bugs" or administration prior to acquiring blood cultures, empirical use of antibiotics is controversial. Should we be administering antibiotics in the prehospital environment for open long bone fractures and/or sepsis? When are antibiotics truly indicated? And is that more important than the timing of the a…
H
Heavy Lies the Helmet
1
Episode 100 - Medical Science Theater 100
55:49
55:49
Play later
Play later
Lists
Like
Liked
55:49
It's not clinical. It's not non-clinical, really. Celebrating our 100th full podcast episode, Bryan and Mike sit down in a Mystery Science Theater 3000 format and make fun of our 1st episodes ever. If you're looking for some light-hearted entertainment including a reflection of how far the platform as come, this is the podcast for you. And one last…
H
Heavy Lies the Helmet
1
Episode 99 - A Survivor's Story w/Jonathan Godfrey and Chris Stevenson
1:03:45
1:03:45
Play later
Play later
Lists
Like
Liked
1:03:45
Based on the Crash and Learn 2022 special feature presentation, we sit down with Jonathan Godfrey and Chris Stevenson to discuss the EMS helicopter crash that had a dramatic effect on both of their lives. Jonathan is the sole survivor of a 3-person crew, and Chris was part of his leadership team at the time of the incident. We carefully examine bot…
Gastrointestinal hemorrhages can present in a variety of ways from a variety of sources. Bleeding esophageal varices, in particular, can be life-threatening. How do we manage these patients? When is it appropriate to establish an advanced airway? Are gastrointestinal tubes contraindicated even though the patient is vomiting? And what do we do when …
Whether it's radio or bedside reporting, communication is a requirement of safely handing off patients. How do we build confidence in our ability to communicate about our patients? How do we develop qualities such as professionalism, accuracy, and conciseness that are essential to our reports? And if we experience interpersonal conflict, how do we …
H
Heavy Lies the Helmet
1
Episode 96 - Airway Management for Airheads w/Dr. Mario Rugna
49:42
49:42
Play later
Play later
Lists
Like
Liked
49:42
Having an appropriate mindset is crucial when it comes to airway management, particularly in a prehospital and/or emergency setting. Whether it's team dynamics or the tools at our disposal, we need to have a different outlook when it comes to addressing the A in ABC's. If you are looking for a comprehensive guide on how to RSI, this is not the epis…
H
Heavy Lies the Helmet
1
Episode 95 - Busted Skulls and Myths
1:02:12
1:02:12
Play later
Play later
Lists
Like
Liked
1:02:12
Traumatic Brain Injury (TBI) is always in the back of our minds when treating polytrauma patients. Unfortunately, the evidence has a controversial history. More and more, we are reminded of how a basic approach is much more important than other therapies that have little evidence to support their effectiveness. In fact, some may even cause harm. Tu…
H
Heavy Lies the Helmet
1
Episode 94 - Treat the Heat w/Dr. Justin Hensley
1:13:10
1:13:10
Play later
Play later
Lists
Like
Liked
1:13:10
Heat illness is prevalent around this time of year. And compared to hypothermia, hyperthermia has a lower threshold for danger. From heat cramps to heat stroke, clinicians need to know how to identify and treat each stage appropriately. But what contributes to severe heat illness? How do we treat each stage of illness? And how much time do we have …
H
Heavy Lies the Helmet
1
Episode 93 - Performing Under Pressure w/Dr. Stephen Hearns
49:54
49:54
Play later
Play later
Lists
Like
Liked
49:54
It's no secret that we as emergency and critical care professionals are expected to perform highly in high pressure situations. Unfortunately, none of us are immune to limited cognitive capacity, task saturation/fixation, time pressure, negative team dynamics, and poor communication. How can we mitigate these variables, so that we can continue to e…
H
Heavy Lies the Helmet
1
Episode 92 - Flight Suit Pat Down (Audio Only)
33:25
33:25
Play later
Play later
Lists
Like
Liked
33:25
What should you carry in your flight suit as an American-based HEMS provider? In our opinion, no one can definitively tell you that. But we can attempt to share some ideas based on our personal experiences and training. In this vodcast, Mike shares what he currently carries in his flight suit; from survival gear to medical equipment. Watch the vodc…
H
Heavy Lies the Helmet
1
Episode 91 - Immobi-Lies w/Dr. Mike Hudson
38:40
38:40
Play later
Play later
Lists
Like
Liked
38:40
Mores lies! But this time, we focus on empirical use of spinal immobilization devices and the harm associated with them. The dogma surrounding this topic is staggering, to say the least. From EMS agencies to Level 1 tertiary centers, cervical collars and long spine boards (LSB) remain a "standard" predicated on a lack of evidence. What evidence DO …
Diabetic Ketoacidosis (DKA) is a common metabolic disorder, particularly in the pediatric population. If treated inappropriately, these patients can quickly decompensate to the point of hypovolemic shock, acute respiratory failure, and even cerebral herniation. What are the physiological differences behind DKA verses HHS (Hyperglycemic Hyperosmolar…
There are a lot of "lies"/misunderstandings surrounding appropriate use of paralytics AKA neuromuscular blocking agents (NMBAs). When are these medications truly indicated? How do we appropriately administer them? How do we accurately monitor these patients? And how do we reverse the effects of NMBAs? Tune in to another pharmacologically driven pod…
The clotting cascade, particularly in the context of anti-coagulation reversal can be complex to understand. Unfortunately, many of our patients are on anti-coagulation agents that require reversal in the presence of life-threatening hemorrhage. How do we choose the most appropriate agent based on which step of the coagulation cascade that it antag…
H
Heavy Lies the Helmet
1
Episode 87 - The Lesser Evil Overdose w/Dr. Arne Skulberg
50:52
50:52
Play later
Play later
Lists
Like
Liked
50:52
Which is the lesser evil, opioid or naloxone overdose? To avoid adverse effects, how should we be administering naloxone in the presence of opioid overdose? In this podcast episode, we are joined by Dr. Arne Skulberg, anesthesiologist and lead author, to discuss his recently published RCT comparing intranasal with intramuscular naloxone. We highlig…
H
Heavy Lies the Helmet
1
Episode 86 - Pilot Down But Not Out w/Wade Dunford & Scott Davis
1:16:00
1:16:00
Play later
Play later
Lists
Like
Liked
1:16:00
An incapacitated pilot scenario is an unfortunate but potential reality of working in rotor and fixed wing EMS. What do you do as medical crew members if your pilot becomes incapacitated? What training and capabilities do you have to revive the pilot and/or get the aircraft on the ground? Do some Controlled Flight Into Terrain (CFIT) incidents actu…
H
Heavy Lies the Helmet
1
Episode 85 - A Great First Compression w/Dr. Per Olav Berve
53:37
53:37
Play later
Play later
Lists
Like
Liked
53:37
Transport of patients with ongoing CPR to the correct treatment center is a high risk but potentially lifesaving intervention. Mechanical CPR (mCPR) devices are recommended to reduce risk and maintain chest compression quality. However, such transports have inherent pitfalls to both patient and provider safety. This is a poorly studied field of our…
Ventricular Assist Devices (VAD) come in many shapes and sizes. From right to left, extracorporeal to intracorporeal, pulsatile to continuous - It can be confusing. Join us for a podcast episode where Allen Wolfe clarifies the confusion and gives us the maximum amount of knowledge we need to succeed while taking care of these patients. Get CE hours…
H
Heavy Lies the Helmet
1
Episode 83 - A Few Good Mentors w/Adam Tresidder & Shane Turner
45:00
45:00
Play later
Play later
Lists
Like
Liked
45:00
If "you can't handle the truth", you can't handle a mentor. Mentors come in the form of leaders, educators, guides, and advisors to help you with honest self-reflection in order to improve yourself and your practice. Join us from AMTC21 where we discuss the importance of this arrangement with our close friends and fellow mentors, Adam Tresidder and…
H
Heavy Lies the Helmet
1
Episode 81 - Thyroid Storm Chaser w/Chase Turner
43:51
43:51
Play later
Play later
Lists
Like
Liked
43:51
Thyroid Storm and Thyrotoxicosis are often misdiagnosed due to presenting similarly to many other disease processes. How do we identify this condition? What are the standard treatment options? And how do we treat a patient who is refractory to conventional therapy? Joined by EM pharmacist, Chase Turner, we discuss all things hyperthyroidism in this…
H
Heavy Lies the Helmet
1
Episode 80 - Resus Kung Fu w/Dr. Michael Lauria
54:40
54:40
Play later
Play later
Lists
Like
Liked
54:40
"Kung" means "skillful work" and "Fu" means "time spent". "Resus Kung Fu" refers to the resuscitation skills we acquire over time to become a true master. But how do we achieve mastery of these cognitive abilities and technical skills? And what role does stress inoculation play in training? Join us and Dr. Michael Lauria in this podcast episode whe…
H
Heavy Lies the Helmet
1
Episode 79 - Medicine in the Wild w/David Fifer
1:06:31
1:06:31
Play later
Play later
Lists
Like
Liked
1:06:31
Have you ever been hiking in the woods and wondered what emergency medical services are available in case you got injured? The level of scope varies greatly across the country for wilderness emergency medical and SAR technicians. From first aid to critical care, in this podcast episode, we discuss who is coming, what their capabilities are, and how…
H
Heavy Lies the Helmet
1
Episode 78 - Eating Our Humble Pie (BaSICS Trial)
25:26
25:26
Play later
Play later
Lists
Like
Liked
25:26
Sometimes, we're wrong. And when it comes to normal saline, we might be. Tune in to a breaking news podcast of sorts where we discuss the recently published BaSICS Randomized Clinical Trial, and how it affects our practice in regard to balanced fluid resuscitation. Get CE hours for our podcast episodes HERE! ----------------------------------------…
H
Heavy Lies the Helmet
1
Episode 77 - My First Crush w/Chris Stevenson
44:39
44:39
Play later
Play later
Lists
Like
Liked
44:39
Though the incidents of crush injuries may be low in frequency, major crush injury syndrome is associated with a high mortality rate. In this podcast episode, we sit down with regular guest, Chris Stevenson, to discuss the "why". We highlight the pathophysiology behind re-perfusion injury and pre- and post-treatment options. Get CE hours for our po…
H
Heavy Lies the Helmet
1
Episode 76 - Pressure to Intubate w/Jon Inkrott
48:43
48:43
Play later
Play later
Lists
Like
Liked
48:43
How do you decide between non-invasive and invasive ventilation? If you decide on non-invasive ventilation (NIV), how do you choose between heated high flow nasal cannula (HFNC), C-pap, or Bipap? And what critical decision-making tools do you utilize when escalating to intubation? In this podcast episode, we are joined by Flight Respiratory Therapi…
H
Heavy Lies the Helmet
1
Episode 75 - Door to Balloon and in Between w/Dr. Adam Gottula & Dr. Trevor Skrobut
1:04:37
1:04:37
Play later
Play later
Lists
Like
Liked
1:04:37
Managing Acute Myocardial Infarction (AMI) patients is a concept that many of us learn early on in our careers. Because of that, we can potentially underestimate the importance of our interventions. In this podcast episode, we are joined by Dr. Gottula and Dr. Skrobut to discuss timely management of AMI's, when coronary intervention (PCI) is indica…
H
Heavy Lies the Helmet
1
Episode 74 - These Aren't the Labs You're Looking For
41:55
41:55
Play later
Play later
Lists
Like
Liked
41:55
There are a lot of misconceptions surrounding the meaning of certain lab values and what a positive truly is. Are these numbers as black and white as they are perceived? In this podcast episode, we discuss sensitivity versus specificity, define some of the most common labs and how to avoid tunnel vision when it comes to your clinical interpretation…
H
Heavy Lies the Helmet
1
Episode 73 - Coming in Third w/Dr. Zaf Qasim
57:35
57:35
Play later
Play later
Lists
Like
Liked
57:35
Taking care of the High Risk OB patient is outside the comfort zone of many of us. The third trimester, specifically, presents unique challenges both pregnancy-related and otherwise. Why are normal physiologic changes related to pregnancy ABNORMAL in the third trimester? How do we determine if the pregnant patient is sick or not sick? And how do yo…
H
Heavy Lies the Helmet
1
Episode 72 - The Business of Medicine w/Chris Smetana
1:04:06
1:04:06
Play later
Play later
Lists
Like
Liked
1:04:06
Has administration ever made a decision that you didn't agree with and/or understand? Of course! As much as we don't like to admit it, the medical industry is a business. For that reason, finances play a significant factor in decision-making. How do we maintain balance between profit and patient care? How do we bridge the gap between leadership and…
H
Heavy Lies the Helmet
1
Episode 71 – Chicken, Starfish & Cat Scans (Audio Only)
55:42
55:42
Play later
Play later
Lists
Like
Liked
55:42
Due to the popularity of Episode 68 - X-Ray Vision, we've decided to extend our radiology series and focus on computerized tomography (CT) scans. Head CT scans, specifically, are often viewed by emergency and transport clinicians when patients require tertiary neurovascular services. Tune in to another visually-guided episode as we discuss this ext…
H
Heavy Lies the Helmet
1
Episode 71 - Chicken, Starfish & Cat Scans
55:45
55:45
Play later
Play later
Lists
Like
Liked
55:45
Due to the popularity of Episode 68 - X-Ray Vision, we've decided to extend our radiology series and focus on computerized tomography (CT) scans. Head CT scans, specifically, are often viewed by emergency and transport clinicians when patients require tertiary neurovascular services. Tune in to another visually-guided episode as we discuss this ext…
H
Heavy Lies the Helmet
1
Episode 70 - A Mind-Blowing Case Study (Presentation)
25:56
25:56
Play later
Play later
Lists
Like
Liked
25:56
Some clinicians may have a tendency to neglect performing a thorough neurological exam in a comatose patient. And when a neuro patient requires an advanced airway, some clinicians may not be mindful of cerebral perfusion pressure and how to optimize it effectively. In this podcast episode, we provide you with the recording of Bryan's presentation f…
H
Heavy Lies the Helmet
1
Episode 69 - Resisting Traumatic Arrest w/Dr. Amanda Humphries
1:06:53
1:06:53
Play later
Play later
Lists
Like
Liked
1:06:53
Pre-hospital resuscitation of the traumatic arrest patient is controversial, to say the least. Some evidence has shown our efforts to be futile. But are the studies skewed by inappropriate management and our resistance to act? When do we intervene, and when do we not? And how can we help improve these poor mortality rates? Join us as we discuss thi…
Though we are not Radiologists, we constantly find ourselves needing to interpret basic chest x-rays. Whether it's ETT placement or ARDS identification, it is important to know what you're looking at. Join us for a visually-assisted podcast episode where our very own Intensivist and Medical Director, Dan Rauh, helps break down this seemingly overwh…
Though we are not Radiologists, we constantly find ourselves needing to interpret basic chest x-rays. Whether it's ETT placement or ARDS identification, it is important to know what you're looking at. Join us for a visually-assisted podcast episode where our very own Intensivist and Medical Director, Dan Rauh, helps break down this seemingly overwh…
H
Heavy Lies the Helmet
1
Episode 67 - The Calm After the Storm
1:13:27
1:13:27
Play later
Play later
Lists
Like
Liked
1:13:27
Recently, Central America was devastated by back-to-back Category 4 tropical storms including Hurricane Eta and Lota. As a Guatemalan resident, our very own Chris 'Razor' Sharpe was in the thick of it. Tune in to this podcast episode where we discuss the SAR and relief work he was a part of during that dire time. We highlight mission preparation, p…
Non-Convulsive Seizures (NCS) or Non-Convulsive Status Epilepticus (NCSE) is defined as cerebral ictal activity without obvious clinical signs. Altered mental status is usually the only notable deficit, so it's important to know how to identify and treat this life-threatening disorder. Tune in to find out how through a casual discussion and real-li…
H
Heavy Lies the Helmet
1
Episode 65 - One Hiring to Rule Them All (Graduation Presentation)
16:34
16:34
Play later
Play later
Lists
Like
Liked
16:34
Acquiring a job in flight medicine is only the beginning. In this presentation to the 2020 Flight Crew Academy graduating class, Mike discusses three archetypes of new hires. He highlights positive and negative behaviors, systematically addressing incompetence, and how to ultimately get off orientation successfully. --------------------------------…
H
Heavy Lies the Helmet
1
Episode 64 - Trapped Inside: Obstructive Lung Diseases (ASTNA Webinar)
1:01:08
1:01:08
Play later
Play later
Lists
Like
Liked
1:01:08
With the upcoming respiratory season, many of us will be caring for an increased number of pediatric and adult patients with pulmonary disease processes. Obstructive physiology, specifically, can result in an increased strain of resources to effectively care for this critically ill population. In this webinar, Mike, Bryan, and Jordan focus on statu…
H
Heavy Lies the Helmet
1
Episode 63 - Flight Medicine Rules w/Chris Stevenson
58:30
58:30
Play later
Play later
Lists
Like
Liked
58:30
Chris Stevenson is back for a third go-round, so I think that makes him a regular guest on the show. This time, he came at us with a non-clinical topic that peeked our interest... Likely over the years, we find ourselves giving or receiving advice related to flight medicine. As our years of experience have accumulated, so has the length of our rule…
H
Heavy Lies the Helmet
1
Episode 62 - Fast Rhythms, Furious Management w/Dr. Salim Rezaie (Bonus Feature)
1:17:54
1:17:54
Play later
Play later
Lists
Like
Liked
1:17:54
Due to 'The Big C', ECHO Yacht Club was cancelled... but life goes on, and so does our podcast. We decided to turn lemons into lemonade and have our friend and emergency medicine powerhouse Dr. Sal Rezaie join us for a discussion based on what-would-have-been our Yacht Club presentation. Everyone carries a card that says they know how to manage tac…
H
Heavy Lies the Helmet
1
Episode 61 - Down Under Dynamics w/Dr. Cliff Reid
1:04:46
1:04:46
Play later
Play later
Lists
Like
Liked
1:04:46
Whether it's in regard to scope of practice, clinical judgment, or professional communication, transport is a very dynamic environment. We had the privilege of welcoming the infamous Dr. Cliff Reid to the show to discuss his and Sydney HEMS' approach to all of these areas. Tune in and learn how to be a high level transport provider from one of the …
H
Heavy Lies the Helmet
1
Episode 60 - Save Your Life w/Randy Mains (Part 2)
42:46
42:46
Play later
Play later
Lists
Like
Liked
42:46
This could quite possibly be one of our most important podcast episodes to date featuring one of the most interesting persons in our industry. What is the opposite of complacency? And how do you know if you are? In this podcast episode, we are joined by Randy Mains, pilot and safety expert, to discuss all things Crew Resource Management (CRM) and t…
H
Heavy Lies the Helmet
1
Episode 59 - Save Your Life w/Randy Mains (Part 1)
47:05
47:05
Play later
Play later
Lists
Like
Liked
47:05
This could quite possibly be one of our most important podcast episodes to date featuring one of the most interesting persons in our industry. What is complacency? And how do you know if you are? In this podcast episode, we are joined by Randy Mains, pilot and safety expert, to discuss all things Crew Resource Management (CRM) and the human factors…
H
Heavy Lies the Helmet
1
Episode 58 - Going With the Flow (Presentation)
21:31
21:31
Play later
Play later
Lists
Like
Liked
21:31
High flow nasal cannula is an increasingly popular modality for Acute Respiratory Distress and Failure. Previously, we saw it used mostly in the pediatric population. But as time has went on, especially with the COVID-19 outbreak, this has become an effective means of O2 delivery in all patient groups. With its increased frequency of use, it is onl…
H
Heavy Lies the Helmet
1
Episode 57 - Weight and Calculate w/Lynn Lamkin
51:10
51:10
Play later
Play later
Lists
Like
Liked
51:10
How do you calculate your drug dosages? What do you base it on? In this podcast episode, we are joined by Lynn Lamkin, EM pharmacist, to discuss weight based versus non-weight based drug dosages. We also breakdown when true body weight (TBW), ideal body weight (IBW), lean body weight (LBW) or adjusted body weight (ABW) is a more appropriate option.…
H
Heavy Lies the Helmet
1
Episode 56 - Where There's Smoke, There's Injury w/Chris Stevenson & Dr. Michael Feldman
42:00
42:00
Play later
Play later
Lists
Like
Liked
42:00
You asked. We answered. In a follow-up to our burn resuscitation podcast episode, we are joined by Chris Stevenson and his burn center Medical Director, Dr. Mike Feldman, to discuss inhalation injuries. Tune in as we discuss the mechanism surrounding inhalation injuries and how to treat them affectively based on anatomical location and poison type.…
