The World’s Okayest Medic Podcast Saturday Coffee Talk (12/20/25)
Dec 20, 2025
The host reflects on the year's podcast journey and thanks supporters, touching on his upcoming speaking engagements. A deep dive into capnography reveals its strengths in monitoring ventilation, despite some surprising pitfalls. Concerns about rising drug adulterants like medetomidine replacing xylazine in fentanyl highlight significant withdrawal issues, prompting a warning for EMS about life-threatening situations. The episode wraps with a chilling personal experience involving a confused patient during transport.
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Capnography's Primary Value Is Ventilation
- Mike Caroncio concluded non-invasive ETCO2 is mainly useful to confirm ventilation, not to diagnose respiratory disease severity.
- He found its readings often misleading in sick respiratory patients due to dead space and dilution effects.
Capnography Saved a High-Risk Sedation Run
- Mike described a ketamine chemical restraint call where nasal ETCO2 helped monitor breathing after sedation and avoided a bad outcome.
- He emphasized capnography reassured the crew during a high-risk, combative patient who later required additional sedatives.
ETCO2 Rose With Blood In Hemorrhagic Shock
- Mike described a gunshot patient in decompensated hemorrhagic shock whose ETCO2 rose markedly after a unit of whole blood.
- He used that rise as physiologic confirmation of improved cardiac output during transport.