The World’s Okayest Medic Podcast

Listener discretion is advised. Dr. Rugna's Article: https://assets-che.mkt.dynamics.com/82359f7e-b7af-4cc1-a9fe-c8a35b467194/digitalassets/standaloneforms/7a39198e-7127-f011-8c4d-0022480cd54d#div_id

Listener discretion is advised. Language. Adult themes. References: Anand Swaminathan, "Clinical Conundrum: Should We Always Treat Fever in Patients with Sepsis?", REBEL EM blog, December 17, 2024. Available at: https://rebelem.com/clinical-conundrum-should-we-always-treat-fever-in-patients-with-sepsis/. Jibril F, Sharaby S, Mohamed A, Wilby KJ. Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making. Can J Hosp Pharm. 2015 May-Jun;68(3) Scott Weingart, MD FCCM. EMCrit 132 – MoTR – Toughness Part I with Michael Lauria. EMCrit Blog. Published on September 6, 2014. Accessed on May 8th 2026. Available at [https://emcrit.org/emcrit/toughness-michael-lauria-i/ ].

Listener discretion is advised.

Listener discretion is advised: language, adult themes Reference: Boland, Hokanson, et. al. (2016). Prehospital lactate measurement by EMS in patients meeting sepsis criteria. Western J. EM (17)5.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED. Sensitive themes. Language. References: Rautaharju PM, Park L, Rautaharju FS, Crow R. A standardized procedure for locating and documenting ECG chest electrode positions: consideration of the effect of breast tissue on ECG amplitudes in women. J Electrocardiol. 1998 Jan;31(1):17-29.

Bill Berlin is a flight nurse and serves in the USAF. His daughter is currently battling Leukemia and Bill was kind enough to come on to the podcast to talk about what this journey has taught him about being a health care provider. Listener discretion is advised.

Listener discretion is advised. References: Cook CE, Thigpen CA. Five good reasons to be disappointed with randomized trials. J Man Manip Ther. 2019 May;27(2):63-65. doi: 10.1080/10669817.2019.1589697. Epub 2019 Mar 14. PMID: 30935322 Fernainy P, Cohen AA, Murray E, Losina E, Lamontagne F, Sourial N. Rethinking the pros and cons of randomized controlled trials and observational studies in the era of big data and advanced methods: a panel discussion. BMC Proc. 2024 Jan 18;18(Suppl 2):1. doi: 10.1186/s12919-023-00285-8. Erratum in: BMC Proc. 2024 Aug 16;18(1):16. doi: 10.1186/s12919-024-00299-w. PMID: 38233894 Ramchurn TP, Nundy S. Randomised clinical trials in surgery: are we at a crossroads? Ann Med Surg (Lond). 2023 Nov 7;86(1):3-6. doi: 10.1097/MS9.0000000000001457. PMID: 38222736

Listener discretion is advised. Sensitive language and themes.

LISTENER DISCRETION IS ADVISED. Language. Sensitive themes. Study Citation: Vattipally VN, Ran KR, Myneni S, Jo J, Margolis A, Nasr IW, Robinson S, Cohen AR, Azad TD. Emergency Medical Services Time on Scene Associated with Reduced Dead-on-Arrival Status Among Pediatric Patients with Severe Traumatic Brain Injury. Prehosp Emerg Care. 2026 Jan 21:1-9. doi: 10.1080/10903127.2025.2605648. Epub ahead of print. PMID: 41418045.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED! ADULT THEMES. LANGUAGE. References: Smith, J. E., Cardigan, R., Sanderson, E., Silsby, L., Rourke, C., Barnard, E. B. G., Basham, P., Antonacci, G., Charlewood, R., Dallas, N., Davies, J., Goodwin, E., Hawton, A., Hudson, C., Lucas, J., Keen, K., Lyon, R. M., & Nolan, B. (2026). Prehospital whole blood in traumatic hemorrhage — a randomized controlled trial. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa2516043 Dr. Antevy's Discussion Thread on LinkedIN: https://www.linkedin.com/posts/peter-antevy-md-faems-a9b11726_the-swift-trial-just-published-in-nejm-group-activity-7440071242285625344-1HZP?utm_source=share&utm_medium=member_desktop&rcm=ACoAAF6Ls6YBtNzvNfxmvsyVNOMy6QNK6Bc_pj4

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. Japanese Airway Study: Kubo A, Kunitatsu K, Nakashima T, Horitani R, Kajimoto Y, Inoue S, Hironishi M. Association between endotracheal intubation and outcomes of nonshockable out-of-hospital cardiac arrest in Japan. BMC Emerg Med. 2025 Sep 24;25(1):185. doi: 10.1186/s12873-025-01341-6. PMID: 40993541; PMCID: PMC12462024.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. References: Varney J, Motawea KR, Mostafa MR, AbdelQadir YH, Aboelenein M, Kandil OA, Ibrahim N, Hashim HT, Murry K, Jackson G, Shah J, Boury M, Awad AK, Patel P, Awad DM, Rozan SS, Talat NE. Efficacy of heads-up CPR compared to supine CPR positions: Systematic review and meta-analysis. Health Sci Rep. 2022 May 24;5 Norii T, Lukas G, Samantaray A, Yabuki M, Olasveengen TM, Bray JE; International Liaison Committee on Resuscitation ILCOR Basic Life Support Task Force. Effects of head-up CPR on survival and neurological outcomes: A systematic review. Resusc Plus. 2025 Jun 16 Kim DW, Choi JK, Won SH, Yun YJ, Jo YH, Park SM, Lee DK, Jang DH. A new variant position of head-up CPR may be associated with improvement in the measurements of cranial near-infrared spectroscopy suggestive of an increase in cerebral blood flow in non-traumatic out-of-hospital cardiac arrest patients: A prospective interventional pilot study. Resuscitation. Huang CC, Chen KC, Lin ZY, Chou YH, Chen WL, Lee TH, Lin KT, Hsieh PY, Chen CH, Chou CC, Lin YR. The effect of the head-up position on cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2021 Oct 30;25(1):376. Swaminathan, A., Mohan, M. (2023). Heads Up! Data Dredging Coming Through: Heads Up Cardiopulmonary Resuscitation Does Not Improve Outcomes. February 2023 Annals of Emergency Medicine Journal Club

Listener discretion is advised. References: Decorticate and Decerebrate Posturing. (Dec 18, 2025). David Goldemund. “Stroke Manual.” Available: https://www.stroke-manual.com/decorticate-and-decerebrate-posturing/ Schmutzhard, E. (2019). Central breathing disturbances in stroke. J. Neuro Sciences, 405 suppl. Torres AC, Bebarta VS, April MD, Maddry JK, Herson PS, Sciorilli JV, Rossi YI, Dos Reis Schevz R, da Silva DBP, Lee J, Gallani F, Maegele M. Is ketamine safe for traumatic brain injury? A systematic review and meta-analysis. J Crit Care. 2026 Feb;91:155347.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listner discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. References: Bona & Friedman. (Apr 3, 2018). Ambulance Lights and Sirens Should Only Be Used When the Benefit Outweighs the Risks. Available: https://https://www.acepnow.com/article/ambulance-lights-and-sirens-should-only-be-used-when-the-benefit-outweighs-the-risks/ NTSB Preliminary Report: Available: https://verticalavi.org/wp-content/uploads/2026/01/Report_ERA26FA035_201974_1_21_2026-12_05_27-AM.pdf PMID 30648537, 20845321, 11339726 Zavadasky, M. (June 2, 2025). Culture shift: Reducing lights and siren vehicle operation. Available: https://www.ems1.com/safe-transport-point-b/articles/culture-shift-reducing-lights-and-siren-vehicle-operation-XDonsygscixIghQT/

Sal Cortez has over forty years of experience as a paramedic and LEO. He has responded to two major active shooter incidents, worked as a flight medic, served on the California Governor's protection detail, and now runs TEMS training at the International School of Tactical Medicine. Listener discretion is advised.

Listener discretion is advised. References: PMID 12776641, 29463461

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. CORRECTION: I mentioned that Precedex is an alpha antagonist. I misspoke and meant to say that it is an "agonist." References: Ehrman-Dupre R, Kaigh C, Salzman M, Haroz R, Peterson LK, Schmidt R. Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report. J Addict Med. 2022 Sep-Oct 01;16(5):595-598. doi: 10.1097/ADM.0000000000000955. Epub 2022 Jan 11. PMID: 35020700. London KS, Huo S, Murphy L, Warrick-Stone T, Goodstein D, Montesi M, Carter M, Butt S, Alexander K, Satz W, Tasillo A, Xu L, Arora M, Casey E, McKeever R, Lowenstein M, Durney P, Hart B, Perrone J. Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA. J Addict Med. 2025 Aug 1. doi: 10.1097/ADM.0000000000001560. Epub ahead of print. PMID: 40747932. Reel B, Maani CV. Dexmedetomidine. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/

Listener discretion is advised. References: Casey, J., Seitz, K., et al. (2025). Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. NEJM. Available: https://www.nejm.org/doi/full/10.1056/NEJMoa2511420?query=featured_home Farkas. (Dec 10, 2025). PulmCrit: Hot take on RSI trial of ketamine vs etomidate. Available: https://emcrit.org/pulmcrit/rsitrial/ Srivatsa S, Chawla M, Hernandez M, et al. Helicopter transport of trauma patients continues to be overutilized: a call for universal transport criterion. Am Surg. Published online September 13, 2025:31348251378910. doi:10.1177/00031348251378910.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED. Kim YG, Choi YY, Han KD, Min K, Choi HY, Shim J, Choi JI, Kim YH. Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias. Sci Rep. 2021 Sep 13;11(1):18111. doi: 10.1038/s41598-021-97335-y. PMID: 34518592 Ren J, Yang Y, Zhu J, Wu S, Wang J, Zhang H, Shao X. The use of intravenous amiodarone in patients with atrial fibrillation and Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 2021 Jan;44(1):35-43. doi: 10.1111/pace.14113. Epub 2020 Dec 9. PMID: 33118640.

Listener discretion is advised.

Listener discretion is advised. Greenhaw, R. & Jamali, M. (2021). Medical Helicopter Accident Review: Causes and Contributing Factors. Available: https://libraryonline.erau.edu/online-full-text/faa-aviation-medicine-reports/AM21-19.pdf Hinkelbein J, Schwalbe M, Genzwuerker HV. Helicopter emergency medical services accident rates in different international air rescue systems. Open Access Emerg Med. 2010;2:45-49. Millin MG, Innes JC, King GD, Abo BN, Kelly SM, Knoles CL, Vezzetti R, White CC 4th, Yee A, Gallagher JM. Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature. Prehosp Emerg Care. 2025 Aug 7:1-13.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised. Thank you to Mike Damkot for coming onto the podcast. Check him out on his podcast "EMS On the Mountain."

Listener discretion is advised.