The FlightBridgeED Podcast

Kari Young, an experienced paramedic renowned for frontline airway and critical-care insights, joins to unpack a rapid hypoxic spiral case. They walk through assessment clues, the COPD vs CHF dilemma, tough triggers for intubation, and the resuscitative vs rapid RSI debate. Expect frank discussion of post-intubation crashes, ventilation strategy choices, and defending on-scene resuscitation.

Kari Young, an advanced practice paramedic and educator, guides a clinical case review of a very sick dialysis patient. They unpack multiple overlapping problems and the scene challenges, airway and resuscitation choices, and how cognitive bias can derail diagnosis. Short, sharp lessons on managing complex prehospital critical care.

Post-ROSC transport demands sharp priorities: stabilize the heart, uncover the arrest’s cause, protect the brain, and anticipate re-arrest. Explore airway decisions, vasopressors, repeat ECGs, ultrasound, ventilation, sedation, and neurologic exams, plus the ALIVE-12 checklist for moving fragile patients safely toward definitive care.

A deceptively stable patient with pulmonary edema may already be sliding toward cardiogenic shock. This discussion explores recognizing early left-heart failure in transport, using ultrasound and clinical signs, and supporting the failing ventricle with nitroglycerin, CPAP or BiPAP, diuresis, and dobutamine. It also covers coaching anxious patients through noninvasive ventilation and responding when deterioration becomes unmistakable.

A deep dive into why cardiogenic shock still carries high mortality and how changing patient populations drive rising cases. The SCAI A–E framework is highlighted as a tool to spot severity early. Practical transport-focused topics include MAP support, oxygenation strategies, volume and inotrope decisions, optimizing mechanical support, and the logistics of fast, safe transfers to specialized centers.

A focused dive into why the right ventricle is uniquely vulnerable to sudden pressure rises and how that can trigger a rapid hemodynamic collapse. The conversation highlights the classic “RV spiral of death,” bedside clues like CT and echo signs, and a practical five-step resuscitation framework. Specific strategies include blood pressure support, careful preload management, reducing pulmonary afterload, and targeted therapies such as inhaled vasodilators and selective inotropes.

This week’s FAST Replay is a double feature! Two talks that tackle high-stakes medicine from completely different angles, but with the same underlying theme: thinking differently when the usual approach isn’t enough. First up, Brittany Bernardoni takes us into the rapidly evolving world of Extracorporeal Cardiopulmonary Resuscitation (ECPR). From the limitations of conventional CPR to the growing use of ECMO in cardiac arrest, this session explores what may become the next major leap forward in resuscitation care. Brittany walks through the physiology, patient selection, timing, and the real-world programs already bringing ECPR directly to patients in the field. Then, Elizabeth Garcher dives into one of the most intimidating areas in prehospital and critical care medicine: pregnancy-related emergencies. This talk focuses on “errors of omission.”  The treatments clinicians hesitate to give because of fear of harming the baby, even when delaying care, can seriously harm both patients. From airway changes and hypertensive emergencies to eclampsia, DKA, blood products, and seizure management, this session is packed with practical pearls and critical reminders for managing pregnant patients in the field. Two completely different topics. Two incredibly practical talks. One common thread: understanding the physiology well enough to act decisively when it matters most.

We’re continuing our FAST Replay series, bringing you full sessions recorded live from past FAST conferences as we build toward FAST26: Austin. This episode features Jeff Jarvis and covers a wide range of topics that directly address how we practice in EMS. From trauma care to airway to cardiac arrest, this session walks through current position statements and evolving recommendations, including: •  Blood product use in trauma  •  How to approach traumatic (circulatory) arrest  •  Pneumothorax and chest decompression decisions  •  Postpartum hemorrhage and hypertension management  •  Airway timing and first-pass success  •  And where some of our long-standing practices don’t hold up to the evidence  More than anything, this talk highlights a core idea: not everything we do in EMS is built on strong evidence, and we need to be willing to question and refine our approach as new data emerge. FAST26 is coming to Austin this year on May 27 - 29, 2026. We are co-locating with EMS World Live, bringing together the entire EMS community with FAST26: Austin and EMS World Live Austin, giving you the very best of every possible aspect from basics to critical care to administration! 👉 Learn more or grab your spot at https://fbefast.com

A deep dive into pulmonary arterial hypertension in the critically ill and why right ventricular failure drives rapid collapse. Clear explanations of how PAH differs from other pulmonary hypertension and the five WHO groups. Practical warnings about stopping continuous prostacyclin therapy during transport or ICU care. Tactical tips on supporting the failing right ventricle while avoiding fluids and correcting oxygenation and CO2.

This episode reviews the newly released 2026 pulmonary embolism guidelines with an emphasis on what matters most for critical care and transport clinicians: identifying the sickest PE patients early and recognizing how quickly they can deteriorate. Dr. Michael Lauria stresses that although pulmonary embolism is common, the subset with hemodynamic instability carries very high mortality and often requires transfer for advanced therapies such as ECMO, catheter-based intervention, or surgery.  A major focus is the new classification system, which replaces the older “massive” and “submassive” terminology with categories A through E. Instead of emphasizing clot size, the new framework centers on clinical severity, especially hypotension, end-organ hypoperfusion, and progression toward cardiopulmonary failure. The episode also highlights that severe PE is fundamentally a problem of right ventricular failure: as pulmonary vascular resistance rises, the RV dilates, perfusion worsens, LV filling drops, and the patient can spiral into shock.  Management is therefore framed around supporting the failing RV while moving toward definitive reperfusion. The speaker recommends maintaining perfusion pressure, avoiding aggressive fluids, optimizing oxygenation, reducing RV afterload, and using inotropic support when needed, while also warning that intubation and positive pressure can worsen hemodynamics in these patients. For the sickest patients, especially category D and E PE, systemic thrombolysis is presented as the main reperfusion option available in many settings, though it remains underused and carries meaningful bleeding risk, including intracranial hemorrhage.  Key points •  The episode centers on the new 2026 PE guidelines and their practical relevance for emergency, ICU, and transport care.  •  The old “massive/submassive” terms are replaced by categories A through E, with D and E representing the highest-risk patients.  •  Severe PE is dangerous primarily because of right ventricular failure and shock, not just hypoxia.  •  Initial treatment focuses on supporting the RV: maintain MAP, avoid excess fluids, improve oxygenation, reduce RV afterload, and add inotropy when needed.  • Systemic thrombolysis is a key reperfusion therapy for the sickest patients, but it is underused and has significant bleeding risks.