The FlightBridgeED Podcast

In Episode 264 of the FlightBridgeED Podcast: MDCAST, Dr. Mike Lauria, Dr. Jeff Jarvis, and trauma anesthesiologist Dr. Chris Stevens return for Part 2 of their deep dive into airway management in profoundly hemodynamically unstable patients. In this episode, the trio explores controversial topics such as the use of pressors in trauma patients, mechanical ventilation in the pre-hospital setting, and the pharmacology of paralytic agents like rocuronium. They also address the highly debated practice of withholding sedatives in certain critically ill patients and emphasize the importance of proper timing when using neuromuscular blockade. This episode provides practical insights for new and seasoned pre-hospital and critical care transport medicine providers, especially when managing CRASH airways and peri-arrest situations. Some Takeaways to Listen For in this Episode:Pressors in Trauma Patients: Dispels the myth that trauma patients shouldn’t receive pressors. Pressors can temporarily stabilize blood pressure while awaiting blood products or other resuscitation efforts.Mechanical Ventilation Post-Intubation: Highlights the importance of gentle, positive-pressure ventilation to avoid worsening hypotension in trauma patients.Rocuronium Use: This episode discusses optimal dosing and the importance of waiting the full 60–90 seconds for the drug to take effect to ensure successful intubation.Withholding Sedation: Explores the controversial practice of omitting sedatives in patients with a GCS of 3 who are completely unresponsive and peri-arrest. This is common in trauma anesthesia but remains debated in pre-hospital and critical care transport settings.

In this thought-provoking episode of the FlightBridgeED Podcast: MDCAST, Dr. Mike Lauria is joined by Dr. Jeff Jarvis and Dr. Chris Stevens to tackle the critical and potentially controversial topic of airway management in hemodynamically unstable patients. The discussion dives into complex scenarios, decision-making challenges, and balancing the benefits of sedation with the risks of compromising a patient’s stability. From discussing medication-assisted intubation to exploring the concept of "crash airway" situations, the episode challenges conventional wisdom and encourages providers to think critically about their approach to airway management. This episode not only raises important questions but also provides valuable insights for both new and seasoned practitioners.Some Takeaways to Listen For in this Episode:Balance Between Sedation and Hemodynamic Stability: It is important to understand how sedative agents like ketamine and etomidate affect blood pressure in critically ill patients. Over-sedation, especially in hemodynamically unstable patients, can lead to adverse outcomes. A nuanced approach to dosing is necessary.Awareness During Intubation: Awareness under paralysis can increase the risk of PTSD and depression. The conversation highlights the importance of avoiding awareness during airway management, especially using longer-lasting paralytics like rocuronium.Resuscitate Before Intubate: Emphasizes the need to stabilize patients, particularly their hemodynamics, before intubation. This can prevent worsening outcomes and cardiac arrest during emergency airway procedures.Decision-Making in Airway Management: Highlights that airway decisions are not black and white. Situational awareness, clinical judgment, and crew confidence are crucial, especially in determining whether to intubate pre-hospital or manage the airway in transit.Use of Supraglottic Airways: In emergencies where intubation is difficult or risky, supraglottic airways are recommended as a temporary measure to ensure oxygenation and ventilation until more definitive care is available.

In this engaging and insightful episode of the FlightBridgeED Podcast, Eric Bauer is joined by Dr. Michael Lauria as they delve into the intricacies of post-intubation care and the critical factors that impact patient outcomes during the first 10 minutes after intubation. Building on the well-established concepts of airway management and resuscitation, the discussion introduces the new acronym PHACTORS, which stands for Positive Pressure, Hypoxia, Acidemia, Cardiac Output, Transfer, Ongoing Pharmacology, Resuscitation, and Suction. Eric and Dr. Lauria explore how these elements play a pivotal role in the success or failure of post-intubation management, emphasizing the importance of maintaining vigilance during this critical phase. With practical tips, evidence-based insights, and real-world examples, this episode is a must-listen for anyone involved in pre-hospital critical care.KEY TAKEAWAYS:Prioritize Post-Intubation Monitoring: The first 10 minutes after intubation are critical. Continuously monitor for hypotension and hypoxia, even if the initial intubation appears successful.Transition to Ventilator Early: Whenever possible, transition intubated patients from BVM to a mechanical ventilator as soon as possible to ensure consistent and controlled ventilation, which reduces the risk of over- or under-ventilation.Use Head-Elevated Positioning: Intubate patients in a head-elevated position (30 degrees) whenever possible to maintain functional residual capacity and reduce the risk of derecruitment and hypoxia.Suction Regularly: Proactively suction the ET tube and oral cavity to maintain airway patency. This helps prevent complications like ventilator-associated pneumonia and ensures optimal oxygenation.Be Ready with Push-Dose Pressors: Have push-dose pressors ready during and after intubation, especially in trauma patients or those with borderline hemodynamics, to quickly address any sudden drops in blood pressure.Assess and Manage Acidosis Individually: Not all acidosis requires aggressive ventilation. Consider the patient's overall condition, and tailor your ventilation strategy based on the specific type and cause of acidosis.Regular Sedation and Analgesia Dosing: Avoid under-sedation, particularly with long-acting paralytics like rocuronium. Set regular intervals for administering sedation and analgesia to ensure patient comfort and avoid awareness of paralysis.Proactively Manage Cardiac Output: In patients with compromised cardiac function, focus on optimizing preload, afterload, and contractility. Use fluids, inotropes, and vasopressors as needed to maintain stable hemodynamics.Secure and Streamline Lines for Transport: Before transferring a patient, ensure all lines are secured and organized to prevent dislodgement or kinking during movement. Keep access points readily available for quick medication administration.Understand the Impact of Positive Pressure: Transitioning from spontaneous breathing to mechanical ventilation can significantly impact venous return and cardiac output. Be prepared to manage these changes, especially in hemodynamically unstable patients.Show Notes...A human, even when paying attention can deliver injurious tidal volume breaths that may go in "easy" but are probably injuring the lungs (Dafilou B, Schwester D, Ruhl N, Marques-Baptista A. It's in the bag: tidal volumes in adult and pediatric bag valve masks. West J Emerg Med. 2020;21(3):722–2021.)Not only are the volumes too big, but we likely WAY over breath for patients and that can be really, really bad especially after cardiac arrest or in TBI (common reasons patients get intubated...right?) (Dumont TM, Visioni AJ, Rughani AI, Tranmer BI, Crookes B. prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 2010;27(7):1233–41.)More issues with BVM ventilation that shows it's not consistentSiegler J, Kroll M, Wojcik S, Moy HP. Can EMS providers provide appropriate tidal volumes in a simulated adult-sized patient with a pediatric-sized bag-valve-mask? Prehosp Emerg Care. 2017;21(1):74–8.Turki M, Young MP, Wagers SS, Bates JH. Peak pressures during manual ventilation. Respir Care. 2005;50(3):340–4.Kroll M, Das J, Siegler J. Can altering grip technique and bag size optimize volume delivered with bag-valve-mask by emergency medical service providers? Prehosp Emerg Care. 2019;23(2):210–4.Mechanical ventilation provides more consistency and automation of a simple task with monitoring parameters (alarms) that can make it safe and effective for paramedics to actually put their brain energy to important clinical decisions and complete other tasks (Weiss SJ, Ernst AA, Jones R, Ong M, Filbrun T, Augustin C, Barnum M, Nick TG. Automatic transport ventilator versus bag valve in the EMS setting: a prospective, randomized trial. South Med J. 2005;98(10):970–6.)Starting mechanical ventilation and safe ventilator settings in the prehospital setting seems to make ED providers more likley to put in the right settings and continue appropriate lung protective ventilation...at least in ARDS (Stephens RJ, Siegler JE, Fuller BM. Mechanical ventilation in the prehospital and emergency department environment. Respir Care. 2019;64 (5):595–603.)Here's a really solid position paper from NAEMSP on it that kind of summarizes everything including the specific clinical times when it may be more helpful like cardiac arrest, trauma, etc (Baez, A. A., Qasim, Z., Wilcox, S., Weir, W. B., Loeffler, P., Golden, B. M., … Levy, M. (2022). Prehospital Mechanical Ventilation: An NAEMSP Position Statement and Resource Document. Prehospital Emergency Care, 26(sup1), 88–95. https://doi.org/10.1080/10903127.2021.1994676)

PART 2 of 2In this episode, Dr. Michael Lauria is joined by several EM/Critical Care and Transport/Retrieval physicians as we discuss the management of acute respiratory distress syndrome (ARDS) in the critical care transport setting. We cover the pathophysiology of ARDS, the criteria for diagnosis, and the basics of lung protective ventilation. We also explore the concept of driving pressure and its role in determining optimal ventilation settings. The conversation highlights the importance of individualizing treatment based on patient characteristics and monitoring parameters such as plateau pressure, driving pressure, and compliance. Our team provides practical tips for adjusting ventilation settings and emphasizes the need for ongoing assessment and optimization. In the previous episode, we started out with some fundamental concepts of mechanical ventilation: the approach to low tidal volumes in ARDS patients and the use of point-of-care blood gases. We also explored the use of steroids in ARDS, the target oxygen saturation levels, and the use of paralysis in unstable patients. In addition, we touched on controversial topics such as inhaled pulmonary vasodilators in ARDS as well as the application of evidenced-based therapies such as proning in the transport environment (in this episode, part 2). Also, in this part of the conversation, we review the use of alternative ventilator modes, such as APRV, and the indications for ECMO in refractory ARDS. We emphasize the importance of optimizing conventional, evidence-based therapies before considering ECMO and highlight the need for clear guidelines and training when using these advanced interventions. We also discuss the challenges and potential complications associated with ECMO. TakeawaysARDS is a syndrome characterized by acute onset, bilateral infiltrates on imaging, and hypoxemia.The diagnosis of ARDS is based on criteria such as acute onset, infectious or inflammatory etiology, bilateral opacities on imaging, and impaired oxygenation.Lung protective ventilation aims to minimize lung injury by using low tidal volumes (6-8 ml/kg), maintaining plateau pressures below 30 cmH2O, and keeping FiO2 below 60%.Driving pressure, the difference between plateau pressure and PEEP, is a marker of lung compliance and can be used to guide ventilation adjustments.Individualized management is crucial, considering factors such as patient characteristics, response to therapy, and monitoring parameters.Regular assessment and optimization of ventilation settings are necessary to ensure effective and safe management of ARDS. Low tidal volumes should be based on the patient's pH and PCO2, with a focus on maintaining a safe pH level.  If crews are unable to measure these parameters not decreasing tidal volumes lower than 4 cc/kg is reasonable.Point-of-care blood gases are essential for monitoring patients on low tidal volumes and making adjustments as needed.Oxygen saturation targets should be individualized based on the patient's condition and physiology, with a range above 88-92% often considered reasonable. However, this issue is controversial, and occasionally, lower saturations are considered acceptable.Steroids may be beneficial in ARDS patients, especially those with severe pneumonia, but the timing and dosing should be determined based on the patient's specific situation.Paralysis can be considered in unstable ARDS patients who cannot tolerate low tidal volumes, but it should be used selectively and in conjunction with deep sedation.The use of inhaled pulmonary vasodilators in ARDS is controversial, and no significant mortality benefit has been demonstrated. However, they may be considered a salvage therapy in patients on their way to an ECMO center or when other interventions have been exhausted. Inhaled pulmonary vasodilators, such as epoprostenol, can improve oxygenation and pulmonary arterial pressure in patients with ARDS and RV failure.The use of inhaled pulmonary vasodilators should be based on individual patient characteristics and the availability of resources.Proning in transport has been shown to be safe and effective.  It should be considered for select cases, such as patients with high pulmonary arterial pressure or basilar atelectasis.Transport teams should be prepared to continue inhaled pulmonary vasodilator therapy if the patient is already receiving it.ECMO should be considered when conventional therapies have failed, and the patient's condition is reversible and not contraindicated.ECMO transport requires specialized training, clear guidelines, and ongoing communication with the receiving center.Alternative ventilator modes, such as APRV, have not shown significant benefit in large trials.  Their use is controversial but not unreasonable in certain circumstances.  Implementing these settings requires training, education, and clear protocols.  Generally speaking, they should be used judiciously and in consultation with the receiving physician.Optimizing conventional therapies and providing high-quality care can often obviate the need for ECMO.Transport teams should be proactive in discussing potential ECMO candidates with the receiving physician and considering the appropriateness of ECMO for each patient.References:Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-xGattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8. doi: 10.1056/NEJM200005043421801.Grasselli G, Calfee CS, Camporota L, et al; European Society of Intensive Care Medicine Taskforce on ARDS. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023 Jul;49(7):727-759. doi: 10.1007/s00134-023-07050-7.Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, Bellani G, Brower RG, Burry L, Chen JT, Hodgson C, Hough CL, Lamontagne F, Law A, Papazian L, Pham T, Rubin E, Siuba M, Telias I, Patolia S, Chaudhuri D, Walkey A, Rochwerg B, Fan E. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36. doi: 10.1164/rccm.202311-2011ST.

Dr. Jeff Jarvis, a medical expert focused on emergency medicine, dives into the findings from the PREOXI Trial, examining the effectiveness of non-invasive ventilation versus traditional face masks for patient pre-oxygenation before intubation. He reveals critical insights on managing peri-intubation hypoxia and discusses the trial's implications for improving patient safety. The conversation also highlights the importance of evidence-based practices in emergency settings and encourages healthcare professionals to adopt effective pre-oxygenation techniques.

PART 1 of 2In this episode, Dr. Michael Lauria is joined by several EM/Critical Care and Transport/Retrieval physicians as we discuss the management of acute respiratory distress syndrome (ARDS) in the critical care transport setting. We cover the pathophysiology of ARDS, the criteria for diagnosis, and the basics of lung protective ventilation. We also explore the concept of driving pressure and its role in determining optimal ventilation settings. The conversation highlights the importance of individualizing treatment based on patient characteristics and monitoring parameters such as plateau pressure, driving pressure, and compliance. Our team provides practical tips for adjusting ventilation settings and emphasizes the need for ongoing assessment and optimization. We start out with some fundamental concepts of mechanical ventilation: the approach to low tidal volumes in ARDS patients and the use of point-of-care blood gases. We also explore the use of steroids in ARDS, the target oxygen saturation levels, and the use of paralysis in unstable patients. In addition, we touch on controversial topics such as inhaled pulmonary vasodilators in ARDS as well as the application of evidenced-based therapies such as proning in the transport environment (part 2). In the final part of the conversation, we review the use of alternative ventilator modes, such as APRV, and the indications for ECMO in refractory ARDS. We emphasize the importance of optimizing conventional, evidence-based therapies before considering ECMO and highlight the need for clear guidelines and training when using these advanced interventions. We also discuss the challenges and potential complications associated with ECMO. TakeawaysARDS is a syndrome characterized by acute onset, bilateral infiltrates on imaging, and hypoxemia.The diagnosis of ARDS is based on criteria such as acute onset, infectious or inflammatory etiology, bilateral opacities on imaging, and impaired oxygenation.Lung protective ventilation aims to minimize lung injury by using low tidal volumes (6-8 ml/kg), maintaining plateau pressures below 30 cmH2O, and keeping FiO2 below 60%.Driving pressure, the difference between plateau pressure and PEEP, is a marker of lung compliance and can be used to guide ventilation adjustments.Individualized management is crucial, considering factors such as patient characteristics, response to therapy, and monitoring parameters.Regular assessment and optimization of ventilation settings are necessary to ensure effective and safe management of ARDS. Low tidal volumes should be based on the patient's pH and PCO2, with a focus on maintaining a safe pH level.  If crews are unable to measure these parameters not decreasing tidal volumes lower than 4 cc/kg is reasonable.Point-of-care blood gases are essential for monitoring patients on low tidal volumes and making adjustments as needed.Oxygen saturation targets should be individualized based on the patient's condition and physiology, with a range above 88-92% often considered reasonable. However, this issue is controversial, and occasionally, lower saturations are considered acceptable.Steroids may be beneficial in ARDS patients, especially those with severe pneumonia, but the timing and dosing should be determined based on the patient's specific situation.Paralysis can be considered in unstable ARDS patients who cannot tolerate low tidal volumes, but it should be used selectively and in conjunction with deep sedation.The use of inhaled pulmonary vasodilators in ARDS is controversial, and no significant mortality benefit has been demonstrated. However, they may be considered a salvage therapy in patients on their way to an ECMO center or when other interventions have been exhausted. Inhaled pulmonary vasodilators, such as epoprostenol, can improve oxygenation and pulmonary arterial pressure in patients with ARDS and RV failure.The use of inhaled pulmonary vasodilators should be based on individual patient characteristics and the availability of resources.Proning in transport has been shown to be safe and effective.  It should be considered for select cases, such as patients with high pulmonary arterial pressure or basilar atelectasis.Transport teams should be prepared to continue inhaled pulmonary vasodilator therapy if the patient is already receiving it.ECMO should be considered when conventional therapies have failed, and the patient's condition is reversible and not contraindicated.ECMO transport requires specialized training, clear guidelines, and ongoing communication with the receiving center.Alternative ventilator modes, such as APRV, have not shown significant benefit in large trials.  Their use is controversial but not unreasonable in certain circumstances.  Implementing these settings requires training, education, and clear protocols.  Generally speaking, they should be used judiciously and in consultation with the receiving physician.Optimizing conventional therapies and providing high-quality care can often obviate the need for ECMO.Transport teams should be proactive in discussing potential ECMO candidates with the receiving physician and considering the appropriateness of ECMO for each patient.References:Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-xGattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669Acute Respiratory Distress Syndrome Network; Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8. doi: 10.1056/NEJM200005043421801.Grasselli G, Calfee CS, Camporota L, et al; European Society of Intensive Care Medicine Taskforce on ARDS. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023 Jul;49(7):727-759. doi: 10.1007/s00134-023-07050-7.Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, Bellani G, Brower RG, Burry L, Chen JT, Hodgson C, Hough CL, Lamontagne F, Law A, Papazian L, Pham T, Rubin E, Siuba M, Telias I, Patolia S, Chaudhuri D, Walkey A, Rochwerg B, Fan E. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36. doi: 10.1164/rccm.202311-2011ST.Matthay MA, Arabi Y, Arroliga AC, Bernard...

In this episode of the FlightBridgeED MDCast, Dr. Mike Lauria and Dr. Brittney Bernardoni discuss the management of refractory hypotension in septic patients. They explore the use of norepinephrine as the initial pressor of choice and the benefits of vasopressin as a second-line agent. They also discuss the use of inotropes, such as epinephrine and dobutamine, and the importance of assessing cardiac function with ultrasound. The conversation provides practical guidance for managing hypotensive septic patients in various clinical settings. In this conversation, the hosts discuss the use of different therapies for refractory shock and sepsis. They cover topics such as pressors, fluid resuscitation, steroids, bicarbonate, calcium, and all levels of therapies. Mike and Britteny provide insight into the evidence-based use of these therapies and offer practical tips for their administration in the hospital and in the critical care transport medicine field. Overall, the conversation provides a comprehensive overview of refractory shock and sepsis management.Key Takeaways to Pay Attention to During This DiscussionMean arterial pressure (MAP) is the best number to assess hypotension, with a goal of MAP > 65.Norepinephrine is the workhorse pressor for septic patients, providing both venous and arterial constriction.Vasopressin is a valuable second-line agent, especially for patients with right heart dysfunction or acidosis.There is no maximum dose for norepinephrine, but doses above 2.0 mcg/kg/min may not provide additional benefit.Ultrasound assessment of cardiac function is crucial in determining the need for inotropes.Epinephrine is the preferred inotrope due to its increased squeeze and peripheral vasoconstriction.Dobutamine is not commonly used in vasoplegic shock due to its peripheral vasodilation effects. Pressors such as norepinephrine are the first-line therapy for refractory shock and sepsis.Steroids, specifically hydrocortisone, can be considered in patients on norepinephrine more than 0.25.Bicarbonate can be used to increase pH, but caution must be taken to ensure proper ventilation.Calcium chloride or calcium gluconate can be used to address low calcium levels.In refractory cases, level three therapies, such as angiotensin 2, methylene blue, and cyanocid, may be considered.

As night falls, a critical medical battle against Diabetic Ketoacidosis (DKA) begins. This formidable foe, hidden within the body's chemistry, pushes patients towards peril. In this thrilling installment of the FlightBridgeED Nightmare Series, EMS providers face a relentless race against time, striving to subdue the devastating effects of DKA before it's too late.Host Eric Bauer and Jean-Francois Couture, Emergency Physician and Director of Operations at Applications MD, guide us through the intricacies of managing this complex medical emergency. With every passing moment, the tension escalates. Will our EMS warriors decode the mysteries of DKA in time to save their patient? Tune in to discover if they can deliver salvation from the brink of metabolic disaster.

In this final episode of The FAST Archives miniseries, we're thrilled to present a talk from Chris Meeks. Chris is not just any paramedic and educator; he's a veteran with a knack for making complex medical topics approachable. Today, he's breaking down "Oxygenation Assassin," a deep dive into the world of hypoplastic left heart syndrome—a challenging congenital heart defect.Chris will walk us through the hemodynamic hurdles of the condition and share essential tips for acute care management. You'll get a solid grasp of the underlying physiology and see how learning about conditions like this - the "small percentage" cases - can drastically improve patient outcomes.If you enjoy this episode, we invite you to check out the other talks from the FAST Archives miniseries. You can also catch these speakers and more at FAST24 happening June 10 - 12, 2024, in Wilmington, North Carolina. Tickets are still available at FBEFAST.COM. Enjoy the episode and we hope to see you at FAST24.

In this episode of The FAST Archives, we explore a unique challenge in emergency medical planning from Helge Junge, who leads a team specialized in air rescue operations. Helge shares the intricate details of developing a comprehensive care and transport system for the World Economic Forum, held in the challenging and mountainous terrain of the Swiss Alps. The forum's location posed significant logistical and medical challenges, including potential mass casualty scenarios and limited local medical resources.His talk, "Air Rescue During WEF: Special Conditions and Problems," provides an in-depth analysis of how his team overcame these hurdles to establish a robust emergency response system. The solutions they created ensured attendees' safety and well-being and offered valuable lessons for managing mass casualty incidents (MCI) and rescue operations in austere conditions.If you enjoy this talk, check out the other talks from the FAST Archives miniseries! We hope you enjoy them!