Heavy Lies the Helmet

Hypertonic saline and mannitol are staples in the management of elevated intracranial pressure, but how well do we understand their mechanisms, and what does the evidence actually support? Are we improving patient outcomes, or simply improving a number? In this episode, we break down the physiology of osmotherapy, compare hypertonic saline and mannitol, and explore their role in traumatic brain injury and other neurologic emergencies. We'll examine the research, discuss prehospital considerations, and review practical interventions to optimize cerebral perfusion. We'll challenge common assumptions, highlight the limitations of the available evidence, and discuss what it means for clinical practice. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com   Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

End-of-life care is part of EMS, but many systems aren't prepared to provide it well. In this episode, we explore how prehospital teams can integrate palliative care into their practice, recognize when the goal should shift from prolonging life to providing comfort, and build systems that support patients and families during some of their most difficult moments. We discuss practical approaches to caring for patients at the end of life, the role of EMS in honoring goals of care, and what it takes to develop a system that supports clinicians rather than simply transporting patients to the next level of care. And then there is the part we don't always talk about: what happens when the patient is someone you know? A colleague. A friend. A family member. Maybe even the person who works beside you every shift. This episode takes a practical and deeply human look at end-of-life care in the prehospital environment, and how we can be better prepared for the calls that stay with us long after the shift ends. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

The agitated patient is one of the most challenging encounters in emergency medicine. They may be yelling, fighting, refusing care, or creating an unsafe environment. But it's important to remember that agitation is not a diagnosis but a symptom. Behavior is a vital sign. In this episode, we challenge the assumption that every combative patient is intoxicated, psychiatric, or simply "difficult." We explore the broad differential diagnosis of agitation, including hypoxia, hypercapnia, hypoglycemia, traumatic brain injury, stroke, sepsis, toxicologic emergencies, and withdrawal states. Listeners will learn a structured approach to identifying life-threatening causes of agitation, recognizing important clinical clues, and balancing patient care, safety, and the need for rapid intervention. From the "frequent flyer" with a hidden medical emergency to the patient who appears intoxicated but is actually deteriorating, this episode reinforces a critical concept: Before we sedate the situation, we must diagnose it. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

FOAMed has revolutionized medical education, but has it also made it easier for bad information to spread? In this podcast episode, we explore the difference between evidence and opinion, what actually defines an expert, and why a large following doesn't necessarily mean someone is right. We'll discuss where expert opinion fits within evidence-based medicine, the role of medical direction and provider oversight, and how cognitive bias and social media can turn repetition into perceived truth. Join us as we discuss how to become a more discerning consumer of medical education and why the most important skill you can develop isn't finding the loudest voice but knowing how to evaluate what you hear. FOAMed isn't the problem. Uncritical consumption is. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

Seizures demand fast decisions, but the best answers aren't always simple. In this episode, we sit down with Skyee Edwards, a pharmacist, to break down seizure cessation and prophylaxis in real-world emergencies. We go beyond traditional benzodiazepine-first thinking and explore how current evidence guides escalation to agents like levetiracetam, valproate, and fosphenytoin. Then we step into the evolving edge of care: where ketamine and lacosamide fits in refractory status epilepticus, and when propofol becomes a tool instead of a last resort. We also dig into common pitfalls such as delayed escalation, under-dosing, and not appreciating non-convulsive status. If you manage seizures in any high-acuity environment, this conversation will sharpen your approach from first contact through definitive control. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

In this podcast episode, we dive into the clinical chaos of Infective Endocarditis. It's a disease that can quietly destroy valves before showing its hand. We discuss how it presents, why it matters in transport and critical care environments, and how it can spiral into life-threatening complications like Cardiogenic Shock. Along the way, we touch on early antibiotic considerations and talk through hemodynamic support strategies such as push-dose Epinephrine when things start to fall apart. As always, the goal is connecting physiology to practical decision-making for clinicians who manage sick patients in dynamic environments. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

Airway management gets dangerous. In this episode of the podcast, we explore prehospital bronchoscopy—a true bleeding-edge concept—and where it fits in managing airway obstruction before the hospital. We talk mucous plugs, massive hemoptysis, refractory hypoxia, how to address obstructions you can't fix with pressure or bronchodilators, and what to do when bronchoscopy is likely unavailable. This isn't about chasing new tools—it's about physiology, pattern recognition, and knowing when innovation may help. When it comes to considering prehospital bronchoscopy in your system, ask yourself the following: Is this something we need? Can we do the training to support it? Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

Mechanical ventilation doesn't have to feel like wizardry. In this podcast episode, we strip it back to what really matters—simple mental models, clean decision-making, and an approach that works whether you're in the back of a helicopter, a tight ambulance box, or a chaotic ED bay. We walk through the foundational concepts and the "why" behind each knob you touch. Then we zoom in on the Hamilton T1, the vent many of us love, hate, and still rely on every single shift. We cover what the T1 gets right, where people get tripped up, and how to let the machine work with you instead of against you. If you've ever wished mechanical ventilation felt less like memorizing settings and more like understanding physiology in motion, this episode will tighten up your practice and give you tools you can use on your very next flight or transport. Get CE hours for our podcast episodes HERE! -------------------------------------------- X @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

Mechanical ventilation doesn't have to feel like wizardry. In this podcast episode, we strip it back to what really matters—simple mental models, clean decision-making, and an approach that works whether you're in the back of a helicopter, a tight ambulance box, or a chaotic ED bay. We walk through the foundational concepts and the "why" behind each knob you touch. Then we zoom in on the Hamilton T1, the vent many of us love, hate, and still rely on every single shift. We cover what the T1 gets right, where people get tripped up, and how to let the machine work with you instead of against you. If you've ever wished mechanical ventilation felt less like memorizing settings and more like understanding physiology in motion, this episode will tighten up your practice and give you tools you can use on your very next flight or transport. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

Tracheostomies are increasingly common in both prehospital and critical care transport settings, but they come with unique challenges. In this podcast episode, we break down short-term and long-term complications you may encounter, and how to troubleshoot them in high-stakes environments. From occlusions and dislodgements to bleeding, we'll cover practical strategies to keep these vulnerable patients safe. Whether you're new to airway management or a seasoned clinician, this discussion will sharpen your approach to one of the most intimidating airways you'll encounter. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email [email protected] Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com