Heavy Lies the Helmet Episode 130 - Opinion-Based Medicine w/Mike Carunchio
Jun 13, 2025
Mike Carunchio, a medic and host of The World's Okayest Medic Podcast, dives deep into the controversies surrounding opinion-based medicine. He challenges the effectiveness of mobile stroke units in urban settings and questions the necessity of specialized pediatric transport teams. The discussion also tackles fluid management choices, particularly the benefits of lactated Ringer's over saline. Plus, Carunchio sheds light on the complexities of sedation-only intubation and the intricate role social media plays in maintaining EMS credibility.
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Mobile Stroke Units: Hype vs. Reality
- Mobile stroke units often serve more as hospital marketing than life-saving tools in urban areas.
- They increase thrombolytic use without clear mortality benefits, especially where comprehensive stroke centers are accessible.
Reconsider Traumatic Arrest Care
- Avoid epinephrine and chest compressions in traumatic cardiac arrest, as they can worsen bleeding and delay critical interventions.
- Focus on stopping bleeding and relieving tamponade or tension pneumothorax prior to circulation attempts.
Overuse of Pediatric Specialty Teams
- Pediatric specialty transport teams are often overused and deployed for cases manageable by standard ALS providers.
- Develop competency in pediatric care to provide equal quality resuscitation without unnecessary specialist involvement.