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Tragic news from Houston about a friend, mentor, and colleague, Dr David Persse.

Jeff gives a brief update on the podcast. Where it's been what is changing, and what the future holds.  Web site: emslighthouseproject.orgInformation: [email protected] or [email protected]: YouTube.com/@emslighthouseproject

AI is everywhere in popular culture right now. Most of us are confronted with it daily and most of us are either excited or horrified. Is it helpful or harmful? If we are going to use it, how should we? What is the ethical and pragmatic use of AI in research? Drs Remle Crowe and Henry Wang join us to discuss what I think everyone would agree is a rapidly changing technology.  Citations: 1. Lee S, Davis J, Milne K, Shenvi C, Beattie LK, Wegman M, et al. Where Evidence‐Based Medicine Meets AI: Promise, Pitfalls, and Practice. AEM Educ Train. 2026 Jun 21;10(3):e70210. doi:10.1002/aet2.70210 PubMed PMID: 42338624; PubMed Central PMCID: PMC13284287. 2. Milne WK, Fatovich D. The Potential for Artificial Intelligence to Augment Peer Review. Emerg Medicine Australasia. 2026 Apr;38(2):e70243. doi:10.1111/1742-6723.70243 3. The National Desk. ChatGPT Goes Viral for Choosing Global Destruction Over Using Racial Slur [Internet]. 2023 [cited 2026 Jul 12]. Available from: https://thenationaldesk.com/news/americas-news-now/chatgpt-goes-viral-for-choosing-global-destruction-over-using-racial-slur-openai-artificial-intelligence-chat-bot-chatbot-google 4. O’Neil C. Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy. New York, NY: Crown Publishing Group; 2017. 5. McGhee H. The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together. New York: One World; 2021.

Whole blood is the current bright, shiny thing in EMS medicine. It works in the hospital and is what our patients are bleeding out onto the road so it just seems to make sense that we should put back what they’re loosing. But… is it any better than blood components? That’s the question the authors of TOWAR tried to answer. One of those authors, Dr Frank Guyette, joins us for a two episode interview about this trial and about trials in general.  Dr Guyette is an EM and EMS physician, medical director for STATMedEvac, and Professor of Emergency Medicine at University of Pittsburgh. He is also a research leaders with the LITES network, the parent network for the TOWAR trial. We discuss the challenges of conducting large, multi-center randomized controlled trials in episode I, including funding and the ethics of prehospital research. In episode II, we’ll jump into the details of the TOWAR trial itself. Reference:1. Sperry JL, Guyette FX, Cotton BA, et al.: Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage. N Engl J Med. doi: 10.1056/NEJMoa2602167 (Epub ahead of print).

Whole blood is the current bright, shiny thing in EMS medicine. It works in the hospital and is what our patients are bleeding out onto the road so it just seems to make sense that we should put back what they’re loosing. But… is it any better than blood components? That’s the question the authors of TOWAR tried to answer. One of those authors, Dr Frank Guyette, joins us for a two episode interview about this trial and about trials in general.  Dr Guyette is an EM and EMS physician, medical director for STATMedEvac, and Professor of Emergency Medicine at University of Pittsburgh. He is also a research leaders with the LITES network, the parent network for the TOWAR trial. We discuss the challenges of conducting large, multi-center randomized controlled trials in episode I, including funding and the ethics of prehospital research. In episode II, we’ll jump into the details of the TOWAR trial itself. Reference:  1. Sperry JL, Guyette FX, Cotton BA, et al.: Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage. N Engl J Med. doi: 10.1056/NEJMoa2602167 (Epub ahead of print).

Join Dr. Jeff Jarvis for part II of his interview with podcase friend and frequent contributor, now-Dr Tanner Smida where we discuss his defense of his PhD. Dr Smida discusses four papers that inform cardiac arrest resuscitation, as well as lessons he learned about conducting well-designed observational studies.  Although his dissertation was built around only 4 papers, here is Dr Smida’s entire bibliography: 1.        Smida T, Willson C, Salerno J, Weiss L, Salcido DD. Can you get there from here? An analysis of walkability among PulsePoint CPR alert dispatches. Resuscitation. 2020 Mar 1;148:135-139.  2.        Patterson PD, Weiss LS, Weaver MD, Salcido DD, Opitz SE, Okerman TS, Smida TT, Martin SE, Guyette FX, Martin-Gill C, Callaway CW. Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial. Trials. 2021 Mar 16;22(1):212.  3.        Smida T, Koller AC, Menegazzi JJ, Salcido DD. Early cytotoxic lymphocyte localization to the brain following resuscitation in a porcine model of asphyxial cardiac arrest: A pilot study. Resusc Plus. 2021 Apr 28;6:100125.  4.        Smida T, Salerno J, Weiss L, Martin-Gill C, Salcido DD. PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area. Resuscitation. 2022 Jan;170:36-43.  5.        Smida T, Menegazzi JJ, Crowe RP, Weiss LS, Salcido DD. Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Sep 30;180:99-107.  6.        Smida T, Menegazzi JJ, Crowe RP, Bardes J, Scheidler JF, Salcido DD. Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Dec;181:28-36.  7.        Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Feb 13:1-7.  8.        Smida T, Menegazzi J, Scheidler J, Martin PS, Salcido D, Bardes J; CARES Surveillance Group. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023 Apr 28:109812.  9.        Smida T, Price BS, Scheidler J, Crowe R, Wilson A, Bardes J. Stay and play or load and go? The association of on-scene advanced life support interventions with return of spontaneous circulation following traumatic cardiac arrest. Eur J Trauma Emerg Surg. 2023 May 10.  10.  Smida T, Menegazzi JJ, Crowe RP, Salcido D, Martin PS, Scheidler J, James Bardes. The Association of Combined Prehospital Hypotension and Hypoxia With Outcomes Following Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Jul 26:1-9.  11.  Smida T, Menegazzi JJ, Crowe RP, Salcido DD, Bardes J, Myers B. The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2023 Sep 26:1-7.  12.  Smida T, Bonasso P, Bardes J, Price BS, Seifarth F, Gurien L, Maxson R, Letton R. Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients. J Trauma Acute Care Surg. 2024 Jan 26.  13.  Suchko S, Smida T, Crowe RP, Menegazzi JJ, Scheidler JF, Shukis M, Martin PS, Bardes JM, Salcido DD. The association of clinical, treatment, and demographic characteristics with rearrest in a national dataset. Resuscitation. 2024 Mar;196:110135.  14.  Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M. A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehosp Emerg Care. 2024 Feb 28:1-23.  15.  Smida T, Crowe RP, Martin PS, Scheidler JF, Shukis M, Price BS, Bardes JM. A retrospective, multi-agency ‘target trial emulation’ for the comparison of post-resuscitation epinephrine to norepinephrine.  Resuscitation.  2024 April 16.  Smida T, Crowe RP, Merrill PW, Scheidler JF. A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data. Air Med J. 2024 May-Jun;43(3):259-261.  17.  Niemann B, Zarfoss E, Victory J, Smida T, Petros K, Sestito M, Bardes J. Evaluation of Oral Vasoactive Medications to Maintain Mean Arterial Pressure in Spinal Cord Injury. J Surg Res. 2024 Aug 12;302:339-346.  18.  Smida T, Price BS, Mizener A, Crowe RP, Bardes JM. Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2024 Aug 15:1-8.  19.  Smida T, Voges L, Crowe R, Scheidler J, Bardes J. Prehospital Transcutaneous Cardiac Pacing in the United States: Treatment Epidemiology, Predictors of Treatment Failure, and Associated Outcomes. Prehosp Emerg Care. 2024 Sep 4:1-8.  20.  Smida T, Dayal S, Bardes J, Scheidler J. Association of Prehospital Rearrest With Outcome Following Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Observational Studies. Prehosp Emerg Care. 2024 Oct 18:1-9.  21.  Smida T, Cheskes S, Crowe R, Price BS, Scheidler J, Shukis M, Martin PS, Bardes J. The association between initial defibrillation dose and outcomes following adult out-of-hospital cardiac arrest resuscitation: A retrospective, multi-agency study. Resuscitation. 2025 Jan 23:110507.  22.  Smida T, Crowe R, Price BS, Scheidler J, Martin PS, Shukis M, Bardes J. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025 Jan 23:110515.  23.  Nordstrom NK, Smida T, Bardes JM, Brown C, Wilson A. A contemporary analysis of prehospital crystalloid resuscitation after trauma. Injury. 2025 Jul 15:112614. 24.  Kimbrell JM, Kreinbrook JA, Stebel J, Smida T, Shekhar AC, Rodriguez D, Mara A, Mullen J, Miele A, Vega J. Delays to chest compressions and defibrillation after prehospital rearrest. Am J Emerg Med. 2025 Dec;98:118-123.  25.  Smida T, Kimbrell JM, Kreinbrook JA, Gan GH, Odom W, Bouthillet T, Walsh B, Shukis M, Scheidler J, Martin PS, Moskowitz A, Counts CR, Bardes J. The prevalence of sustained electrical capture during prehospital transcutaneous pacing: a multicenter observational study. Resuscitation. 2025 Dec 22:110934.  26.  Smida T, Harvey W, Bonasso P, Price BS, Martin PS, Bardes J. The ability of statewide prehospital pediatric blood transfusion protocols to predict early in-hospital blood product administration: A National Trauma Data Bank analysis. J Trauma Acute Care Surg. 2026 Jan 20.  27.  Smida T, Handyside R, Crowe R, McDonald A, Scheidler J, Bardes J. Factors associated with successful intravenous access in the prehospital setting. Prehosp Emerg Care. 2026 Feb 25:1-12. 28.  Smida T, Handyside R, Crowe R, Merrill PW, Scheidler J, Bardes J. A retrospective comparison of plunger-type and band-type mechanical chest compression devices for prehospital resuscitation. Prehosp Emerg Care. 2026 Feb 25:1-12.  29.  Kreinbrook JA, Kimbrell JM, Gan GH, Odom W, Shukis M, Bardes J, Smida ...

Join Dr. Jeff Jarvis as he interviews podcase friend and frequent contributor, now-Dr Tanner Smida for the first of a two-part interview where we discuss his defense of his PhD. Dr Smida discusses four papers that inform cardiac arrest resuscitation, as well as lessons he learned about conducting well-designed observational studies.  Although his dissertation was built around only 4 papers, here is Dr Smida’s entire bibliography: 1.        Smida T, Willson C, Salerno J, Weiss L, Salcido DD. Can you get there from here? An analysis of walkability among PulsePoint CPR alert dispatches. Resuscitation. 2020 Mar 1;148:135-139. doi: 10.1016/j.resuscitation.2019.12.038. Epub 2020 Jan 18. PMID: 31962177. 2.        Patterson PD, Weiss LS, Weaver MD, Salcido DD, Opitz SE, Okerman TS, Smida TT, Martin SE, Guyette FX, Martin-Gill C, Callaway CW. Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial. Trials. 2021 Mar 16;22(1):212. doi: 10.1186/s13063-021-05161-4. PMID: 33726840; PMCID: PMC7962082. 3.        Smida T, Koller AC, Menegazzi JJ, Salcido DD. Early cytotoxic lymphocyte localization to the brain following resuscitation in a porcine model of asphyxial cardiac arrest: A pilot study. Resusc Plus. 2021 Apr 28;6:100125. doi: 10.1016/j.resplu.2021.100125. PMID: 34223383; PMCID: PMC8244478. 4.        Smida T, Salerno J, Weiss L, Martin-Gill C, Salcido DD. PulsePoint dispatch associated patient characteristics and prehospital outcomes in a mid-sized metropolitan area. Resuscitation. 2022 Jan;170:36-43. doi: 10.1016/j.resuscitation.2021.11.007. Epub 2021 Nov 11. PMID: 34774964. 5.        Smida T, Menegazzi JJ, Crowe RP, Weiss LS, Salcido DD. Association of prehospital hypotension depth and dose with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Sep 30;180:99-107. doi: 10.1016/j.resuscitation.2022.09.018. Epub ahead of print. PMID: 36191809. 6.        Smida T, Menegazzi JJ, Crowe RP, Bardes J, Scheidler JF, Salcido DD. Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest. Resuscitation. 2022 Dec;181:28-36. doi: 10.1016/j.resuscitation.2022.10.011. Epub 2022 Oct 19. PMID: 36272616. 7.        Smida T, Menegazzi J, Crowe R, Scheidler J, Salcido D, Bardes J. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Feb 13:1-7. doi: 10.1080/10903127.2023.2169422. Epub ahead of print. PMID: 36652451. 8.        Smida T, Menegazzi J, Scheidler J, Martin PS, Salcido D, Bardes J; CARES Surveillance Group. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023 Apr 28:109812. doi: 10.1016/j.resuscitation.2023.109812. Epub ahead of print. PMID: 37120129. 9.        Smida T, Price BS, Scheidler J, Crowe R, Wilson A, Bardes J. Stay and play or load and go? The association of on-scene advanced life support interventions with return of spontaneous circulation following traumatic cardiac arrest. Eur J Trauma Emerg Surg. 2023 May 10. doi: 10.1007/s00068-023-02279-9. Epub ahead of print. PMID: 37162554. 10.  Smida T, Menegazzi JJ, Crowe RP, Salcido D, Martin PS, Scheidler J, James Bardes. The Association of Combined Prehospital Hypotension and Hypoxia With Outcomes Following Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2023 Jul 26:1-9. doi: 10.1080/10903127.2023.2238820. Epub ahead of print. PMID: 37494278. 11.  Smida T, Menegazzi JJ, Crowe RP, Salcido DD, Bardes J, Myers B. The Association of Prehospital End-Tidal Carbon Dioxide with Survival Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2023 Sep 26:1-7. doi: 10.1080/10903127.2023.2262566. Epub ahead of print. PMID: 37751228. 12.  Smida T, Bonasso P, Bardes J, Price BS, Seifarth F, Gurien L, Maxson R, Letton R. Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients. J Trauma Acute Care Surg. 2024 Jan 26. doi: 10.1097/TA.0000000000004258. Epub ahead of print. PMID: 38273438. 13.  Suchko S, Smida T, Crowe RP, Menegazzi JJ, Scheidler JF, Shukis M, Martin PS, Bardes JM, Salcido DD. The association of clinical, treatment, and demographic characteristics with rearrest in a national dataset. Resuscitation. 2024 Mar;196:110135. doi: 10.1016/j.resuscitation.2024.110135. Epub 2024 Feb 7. PMID: 38331343. 14.  Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M. A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehosp Emerg Care. 2024 Feb 28:1-23. doi: 10.1080/10903127.2024.2321285. Epub ahead of print. PMID: 38416867. 15.  Smida T, Crowe RP, Martin PS, Scheidler JF, Shukis M, Price BS, Bardes JM. A retrospective, multi-agency ‘target trial emulation’ for the comparison of post-resuscitation epinephrine to norepinephrine.  Resuscitation.  2024 April; doi: 10.1016/j.resuscitation.2024.110201. Epub ahead of print. 16.  Smida T, Crowe RP, Merrill PW, Scheidler JF. A Simpler Method for Choosing Adult i-gel Size: An Evaluation of Real-World Prehospital Data. Air Med J. 2024 May-Jun;43(3):259-261. doi: 10.1016/j.amj.2024.03.011. Epub 2024 Apr 5. PMID: 38821710. 17.  Niemann B, Zarfoss E, Victory J, Smida T, Petros K, Sestito M, Bardes J. Evaluation of Oral Vasoactive Medications to Maintain Mean Arterial Pressure in Spinal Cord Injury. J Surg Res. 2024 Aug 12;302:339-346. doi: 10.1016/j.jss.2024.07.059. Epub ahead of print. PMID: 39137515. 18.  Smida T, Price BS, Mizener A, Crowe RP, Bardes JM. Prehospital Post-Resuscitation Vital Sign Phenotypes are Associated with Outcomes Following Out-of-Hospital Cardiac Arrest. Prehosp Emerg Care. 2024 Aug 15:1-8. doi: 10.1080/10903127.2024.2386445. Epub ahead of print. PMID: 39088816. 19.  Smida T, Voges L, Crowe R, Scheidler J, Bardes J. Prehospital Transcutaneous Cardiac Pacing in the United States: Treatment Epidemiology, Predictors of Treatment Failure, and Associated Outcomes. Prehosp Emerg Care. 2024 Sep 4:1-8. doi: 10.1080/10903127.2024.2393768. Epub ahead of print. PMID: 39150824. 20.  Smida T, Dayal S, Bardes J, Scheidler J. Association of Prehospital Rearrest With Outcome Following Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis of Observational Studies. Prehosp Emerg Care. 2024 Oct 18:1-9. doi: 10.1080/10903127.2024.2408628. Epub ahead of print. PMID: 39321386. 21.  Smida T, Cheskes S, Crowe R, Price BS, Scheidler J, Shukis M, Martin PS, Bardes J. The association between initial defibrillation dose and outcomes following adult out-of-hospital cardiac arrest resuscitation: A retrospective, multi-agency study. Resuscitation. 2025 Jan 23:110507. doi: 10.1016/j.resuscitation.2025.110507. Epub ahead of print. PMID: 39855423. 22.  Smida T, Crowe R, Price BS, Scheidler J, Martin PS, Shukis M, Bardes J. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025 Jan 23:110515. doi: 10.1016/j.resuscitation.2025.110515. Epub ahead of print. PMID: 39863130. 23.  Nordstrom NK, Smida T, Bardes JM, Brown C, Wilson A. A contemporary analysis of pr...

This is a special version of the EMS Lighthouse, live from Ashland, OR. We are joined by Mike Verkest and Dr Ritu Sahni from The EMS Show, and Jimmy Apple from The EMS Avenger at the State of Jefferson Conference in Southern Oregon. We had a blast and covered a to of ground. I hope y'all enjoy!

Dr Remle Crowe returns to the podcast to discuss three new papers with Dr Jarvis: Two papers on epinephrine in cardiact arrest (including one on trauma!) and one on pulse oximetry in hypoxemic patients with darker skin. We might nerd out a bit on methodology, tacos, and have a few book recommendations. Citations:  Martin DS, Doidge JC, Gould D, et al.: The impact of skin tone on performance of pulse oximeters used by NHS England COVID Oximetry @home scheme: measurement and diagnostic accuracy study. BMJ. 2026;January 14;392Witt CE, Shatz DV, Robinson BRH, et al.: Epinephrine in Prehospital Traumatic Cardiac Arrest—Life Saving or False Hope? Prehospital Emergency Care. 2026;January 2;30(1):153–61.Lilien EJ, Ashburn NP, George TS, et al.: Single Dose Epinephrine Protocol Is Associated With Improved Survival of Older Adults With Out‐Of‐Hospital Cardiac Arrest. Academic Emergency Medicine. 2025Perez CP: Invisible Women: Data Bias in a World Designed for Men. New York, NY, Abrams Press, 2019.O’Neil C: Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy. New York, NY, Crown Publishing Group, 2017. • 6. Perkins GD, Ji C, Deakin CD, et al.: A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018;August 23;379(8):711–21.

We were all taught succinylcholine is contraindicated in hyperkalemia because it can cause potassium release, exacerbating the problem. But does it? Does it really? Dr. Jarvis discusses a recent paper that seems to compare mortality within 24 hours of RSI in hyperkalemic patients between those intubated with succ or rocuronium. And then we discuss methods.. including the Table 1 Fallacy.  Citations: 1.     Simmer PE, Perza M, Cho YD, et al.: Hyperkalemic emergency department patients intubated with rocuronium or succinylcholine: Retrospective study of clinical outcomes. The American Journal of Emergency Medicine. 2026; February;100:154–64. 2.     Cole JB, Knack SKS, Driver BE: The value of P-values in “Table 1.” The American Journal of Emergency Medicine. 2026; February;100:182–6. 3.     Pappal RD, Roberts BW, Mohr NM, et al.: The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–44. 4.     ‘Rick & Jerry’ Pass the Baton | Emergency Physicians Monthly. Available at https://epmonthly.com/article/rick-jerry-pass-the-baton/. Accessed January 25, 2026.

You've read about how this groundbreaking trial on ketamine vs etomidate for RSI "Changes Everything!" on the socials. Or perhaps "it's horribly biased and unnecessary... we're already knew all this!".  Why? Well.. social media. Listen in as Dr Jarvis discusses not just this trial, but what the evidence landscape was before it was released. Why was it done, how was it done, what does it show, and how can we integrate it into our practice? Citations:1. Casey JD, Seitz KP, Driver BE, et al. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. N Engl J Med. Published online December 9, 2025.2. Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374(9686):293-300. 3. Matchett G, Gasanova I, Riccio CA, et al. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022;48(1):78-91. 4. Koroki T, Kotani Y, Yaguchi T, et al. Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis. Crit Care. 2024;28(1):48. 5. Yeh RW, Valsdottir LR, Yeh MW, et al. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. BMJ. 2018;363:k5094. doi:10.1136/bmj.k5094

Right on the heels of the release of the 2025 AHA guidelines, including one on preferentially using IVs over IOs, comes two RCTs in the same edition of NEJM that compare intial attempts with IVs to IOs in out of hospital cardiac arrest. Dr Jarvis discusses these two papers while answer a listeners question, and tries to put this, and early epinephrine, into context. And he might throw in some commentary about the AHA's recommendations on mCPR and Heads Up CPR. Citations:1. Couper K, Ji C, Deakin CD, et al. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025;392(4):336-348. doi:10.1056/NEJMoa24077802. Vallentin MF, Granfeldt A, Klitgaard TL, et al. Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med. 2025;392(4):349-360. doi:10.1056/NEJMoa2407616

ACOG, the American College of Obstetricians and Gynecologists, recently published EMS guidelines for treatment of hypertension in pregnancy/pre-eclampsia, eclampsia, and postpartum hemorrhage. Drs. Jenna White and Christopher Zahn join Dr Jarvis to discuss the science behind these recommendations as well as how to implement them into our practice.  Citations: 1. https://www.acog.org/programs/obstetric-emergencies-in-nonobstetric-settings 2. Vuncannon, D. M.; Platner, M. H.; Boulet, S. L. Timely Treatment of Severe Hypertension and Risk of Severe Maternal Morbidity at an Urban Hospital. American Journal of Obstetrics & Gynecology MFM 2023, 5 (2), 100809. https://doi.org/10.1016/j.ajogmf.2022.100809. 3. Gupta, M.; Greene, N.; Kilpatrick, S. J. Timely Treatment of Severe Maternal Hypertension and Reduction in Severe Maternal Morbidity. Pregnancy Hypertension 2018, 14, 55–58. https://doi.org/10.1016/j.preghy.2018.07.010.

You use ketamine. I use ketamine. We all use ketamine. But… how safe it is, really? A new study out of Toronto suggests 30% of patients who receive ketamine have adverse events, a rate higher than seen in the ED. What are we to make of this? I bring Dr Remle Crowe on to discuss… Citations: 1.     Kwong JL, Verbeek PR, Leong YC, Turner L, Huiskamp M, Drennan IR, Francom S, Ropp S, Cheskes S: Paramedic use of ketamine for severe agitation and violence. Can J Emerg Med. doi: 10.1007/s43678-025-00963-w (Epub ahead of print). 2.     Fernandez AR, Bourn SS, Crowe RP, Bronsky ES, Scheppke KA, Antevy P, Myers JB: Out-of-Hospital Ketamine: Indications for Use, Patient Outcomes, and Associated Mortality. Annals of Emergency Medicine. 2021;78(1):123–31. 3.     Brown LH, Crowe RP, Pepe PE, Miller ML, Watanabe BL, Kordik SS, Wampler DA, Page DI, Fernandez AR, Bourn SS, et al.: Adverse events following emergent prehospital sedation of patients with behavioral emergencies: A retrospective cohort study. The Lancet Regional Health - Americas. 2022;May;9:100183.

We've covered pre-oxygenation strategies and intubation alot on this podcast, mayber more than anyting else. We covered the definition of FPS in E74, the DEVICE trial on DL vs VL in E75, and the PREOXI trial of NIV vs Mask Pre-oxygenation in E86. Now we have another Preoxygenation paper, this one that reports no difference between preoxygenation with BVM and face mask. WTAF? Better listen, because it turns out words matter, definitions are... definitional, and we absolutely MUST read more than just the abstract.   Citations: 1.     Gottlieb M, Alexander R, Love AK: Comparison of Preoxygenation Strategies for Intubation of Critically Ill Patients. Annals of Emergency Medicine. doi: 10.1016/j.annemergmed.2025.06.621 (Epub ahead of print). 2.     Chou CD, Palakshappa JA, Haynie H, Garcia K, Long D, Gibbs KW, White HD, Ghamande S, Dagan A, Stempek S, et al.: Association of Two Preoxygenation Approaches With Hypoxemia During Tracheal Intubation: A Secondary Analysis. Annals of Emergency Medicine. doi: 10.1016/j.annemergmed.2025.06.003 (Epub ahead of print). 3.     Pitre T, Liu W, Zeraatkar D, Casey JD, Dionne JC, Gibbs KW, Ginde AA, Needham-Nethercott N, Rice TW, Semler MW, et al.: Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials. The Lancet Respiratory Medicine. 2025;July;13(7):585–96. 4.     Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, Resnick-Ault D, White HD, Gandotra S, Doerschug KC, et al.: Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. doi: 10.1056/NEJMoa2313680 (Epub ahead of print). 5.     Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, et al.: Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023;June 16;389(5):418–29. 6.     Trent SA, Kaji AH, Carlson JN, McCormick T, Haukoos JS, Brown CA, National EARI: Video Laryngoscopy is Associated With First-Pass Success in Emergency Department Intubations for Trauma Patients: A Propensity Score Matched Analysis of the National Emergency Airway Registry. Ann Emerg Med. doi: 10.1016/j.annemergmed.2021.07.115 (Epub ahead of print).