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In this episode of the FlightBridgeED OB Critical Care Transport series, Dr. Mike Lauria is joined by maternal-fetal medicine specialist Dr. Liz Gartner to tackle one of the most commonly missed and dangerous metabolic emergencies in pregnancy: diabetic ketoacidosis (DKA). While DKA is familiar to most clinicians, pregnancy dramatically alters its presentation—often masking it behind symptoms that look indistinguishable from “normal” pregnancy complaints like nausea, vomiting, abdominal pain, fatigue, and polyuria. The conversation breaks down the unique physiology of pregnancy that predisposes patients to DKA at much lower glucose levels than expected. Progressive insulin resistance, hemodilution, increased renal glucose losses, accelerated starvation, and baseline respiratory alkalosis combine to create a perfect storm where euglycemic or near-euglycemic DKA can develop. The result is a high-risk condition that is easy to dismiss unless providers intentionally look for it—especially in patients with type 1 diabetes, type 2 diabetes, or gestational diabetes. From a transport and critical care perspective, the episode emphasizes early recognition, appropriate lab interpretation, and aggressive maternal resuscitation as the cornerstone of treatment. The hosts clarify that management principles remain largely unchanged from non-pregnant patients—fluids first, electrolytes (especially potassium), then insulin—while highlighting pregnancy-specific lab pitfalls and why delivery is not the treatment for DKA. Ultimately, stabilizing the mother is the most effective way to protect the fetus. Key takeaways DKA can look like normal pregnancy: Nausea, vomiting, fatigue, abdominal pain, and polyuria should not be dismissed in pregnant patients with diabetes.Don’t be reassured by a glucose of ~200: Up to 30% of DKA cases in pregnancy are euglycemic.Pregnancy changes the labs: Baseline bicarbonate is lower, and a pH around 7.30 may represent severe acidosis.Beta-hydroxybutyrate is the gold standard for diagnosing ketosis; urine ketones and anion gap alone can miss cases.Fluids and electrolytes come first: Aggressive volume resuscitation and potassium correction are critical before insulin.Resuscitate mom to save baby: Delivery is not indicated for DKA alone and may worsen outcomes.High fetal risk: While maternal mortality is low, fetal mortality remains significant—making early recognition essential.

In this episode of FlightBridgeED, Dr. Mike Lauria is joined by maternal-fetal medicine specialists Dr. Alex Pfeiffer and Dr. Liz Gartner for a practical, transport-focused deep dive into trauma in pregnancy. With maternal morbidity and mortality rising in the U.S. and more obstetric patients requiring transfer from smaller facilities, the team breaks down what changes when you’re managing trauma with two patients sharing one circulation—and how pregnancy can mask shock until both mom and fetus suddenly decompensate. They walk through the pregnancy-specific physiology that matters most in the field: increased blood volume and cardiac output, decreased SVR, and why hypotension is a late sign. You’ll hear why “normal blood pressure doesn’t equal normal perfusion,” how to recognize early compensated shock (including subtle mental-status changes and agitation), and the key resuscitation tweaks that make a major difference—especially oxygenation and ventilation targets that are tighter than what you might accept in non-pregnant trauma patients. The conversation also covers the highest-yield operational pieces for EMS and critical care transport crews: aortocaval compression after ~20 weeks and how to relieve it with left tilt/uterine displacement (even on a backboard), what to do about chest trauma (tube placement one to two interspaces higher), why placental abruption is a clinical diagnosis (and often not seen on imaging), fetal heart tones as a “vital sign,” and how viability changes transport destination decisions. They also address Rh considerations, RhoGAM timing, intimate partner violence screening opportunities during transport, and what crews should understand about perimortem C-section even if it’s not in their scope. Key takeaways Mom first = baby best: Maternal stabilization is fetal resuscitation. Prioritize ABCDs before fetus.After 20 weeks: relieve aortocaval compression with 15–30° left tilt, hip bump, or manual uterine displacement—don’t skip this during resuscitation/transport.Shock can hide: Pregnant patients may lose ~30–40% blood volume before hypotension—watch trends and early signs like tachycardia and altered/anxious behavior.Oxygen/ventilation goals are tighter: Aim SpO₂ ≥ 95%; pregnancy has a lower baseline CO₂—an EtCO₂ around 40 may represent hypoventilation in pregnancy.Placental abruption is clinical: Uterine tenderness + contractions + vaginal bleeding = high suspicion, even with “normal” ultrasound/CT.Chest tubes go higher: Due to diaphragmatic elevation, place chest tubes 1–2 intercostal spaces higher than usual.Think destination + monitoring: Viability (~23–24 weeks) drives need for OB capability and fetal monitoring; minimum observation discussed as ~4 hours post-trauma for viable gestations.Rh matters, but perfusion matters more: Use O-negative if available for known Rh-negative patients; don’t withhold lifesaving blood when it’s the only option.Transport is a screening opportunity: Consider intimate partner violence and create safe moments to ask when separated from partners.References –  ·         American Academy of Family Physicians. Trauma in Pregnancy: Assessment, Management, and Prevention. Am Fam Physician. 2014;90(10):717–722. ·         Appelbaum RD, Yorkgitis B, Rosen J, Butts CA, To J, Knight AW, Zhang J, Kirsch JM, Levin JH, Riera KM, Kelley KM, Carter KT, Sawhney JS, Mukherjee K, Metz TD, Fiorentino MN, Cantrell S, Sapp A, Potgieter CJ, Kasotakis G, Como JJ, Freeman J. Trauma in pregnancy: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2025 Aug 1;99(2):298-309. ·         SOGC Clinical Practice Guideline. Guidelines for the Management of a Pregnant Trauma Patient. J Obstet Gynaecol Can. 2015;37(6):553–571. ·         Muench MV et al. Physiologic changes of pregnancy relevant to trauma management. Clin Obstet Gynecol. 2007;50(3):601–610. ·         Larson, Nicholas J. et al.Prehospital Management of the Pregnant Trauma Patient. Air Medical Journal, Volume 44, Issue 4, 236 - 241 ·         Mendez-Figueroa, Hector et al. Trauma in pregnancy: an updated systematic review. American Journal of Obstetrics & Gynecology, Volume 209, Issue 1, 1 - 10 ·         Jain V et al. Trauma in pregnancy. Clin Obstet Gynecol. 2015;58(3):613–624. ·         Clark SL et al. Amniotic Fluid Embolism: Diagnosis and Management Update. Am J Obstet Gynecol. 2016;215(2):B16–B24. ·         Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM, Morrison LJ, Katz V, Tsen LC, Daniels K, Halamek LP, Suresh MS, Arafeh J, Gauthier D, Carvalho JC, Druzin M, Carvalho B, Society for Obstetric Anesthesia and Perinatology The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg. 2014 May;118(5):1003-16.  ·         Strong TH, Lowe RA. Perimortem cesarean section. Am J Emerg Med. 1989 Sep;7(5):489-94. ·         Liggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. J Surg Res. 2023 May;285:187-196. ·         Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol. 2019 Dec;134(6):1343-1357. ·         April MD, Long B. Trauma in pregnancy: A narrative review of the current literature. Am J Emerg Med. 2024 Jul;81:53-61.

Episode Description In this powerful and highly practical episode, Eric Bauer is joined by Dr. Scott Weingart for a deep dive into mechanical ventilation strategy, critical thinking in metabolic acidosis, and the nuanced management of obstructive lung disease. You’ll hear honest, experience-driven insights that challenge outdated protocols and provide a real-world framework for decision-making in high-acuity transport and emergency environments. Together, Eric and Scott unpack what matters when setting minute ventilation for acidotic patients, when and why to abandon rigid tidal volume formulas, and how to navigate the delicate dance of airway management without causing more harm than good. You’ll also hear an unfiltered discussion about ventilation in DKA, PEEP misconceptions, and how to safely manage the crashing COPD or asthmatic patient when time and tolerance are in short supply. Key Takeaways Minute ventilation must be tailored to context: “one-size-fits-all” protocols often fail in real-world acidotic patients.A tidal volume of 8–10 mL/kg is not only SAFE, it’s often necessary in early transport, especially when facing deadly acidosis.Not all PEEP is good PEEP! Learn when zero is the right number.In obstructive lung patients, the “expiratory phase” isn’t the whole story. Inspiratory flow rate and sedation play crucial roles.End-tidal CO₂ readings must be interpreted in a clinical context. Chasing normalization can kill.Sometimes the best vent setting… is no vent at all. Preserving spontaneous respiration in compensated DKA may save lives.DON'T default to 100% FiO₂. Understand how oxygen strategy influences alveolar recruitment and long-term outcomes.Listen anywhere you get your podcasts or at flightbridgeed.com. While you're there, explore our award-winning critical care courses, trusted by thousands of providers to prepare for advanced certification exams, or to recertify advanced, national, state, and local certifications and licenses.

In this episode of the FlightBridgeED Podcast, Dr. Mike Lauria welcomes back Dr. Nick George to dissect a topic that’s long overdue for critical discussion: airway management in critical care transport—and whether your background matters. Does being a paramedic or a nurse predict first-pass success rate? Does prior training or clinical experience truly change how well you manage airways in high-stakes situations? Drawing from new research involving over 7,800 intubations at a major HEMS program, Dr. George presents data that challenges long-held assumptions and explores the impact of training, experience, and clinical culture on airway outcomes. From the historical roots of EMS to the realities of modern-day prehospital practice, this episode bridges the past, present, and future of one of the most defining and debated skills in critical care. Whether you're placing tubes daily or just entering the field, this episode delivers real insights for every provider level. Listen anywhere you stream podcasts, or at FlightBridgeED.com. While you're there, explore our award-winning, trusted courses, specifically designed for critical care professionals like you. Key Takeaways Success in airway management isn't about your credentials—it’s about training, experience, and repetition.In a study of 7,812 intubations, there was no statistically significant difference in first-pass or last-pass success between nurses and paramedics.A slight initial gap in first-year performance disappears by year three, suggesting a washout effect driven by experience, not title.Historical models and current cultures (like “owning the airway”) influence skill allocation, sometimes more than evidence.Airway success is more than just getting the tube—metrics like DASH-1A aim to measure outcomes that matter (hypoxia, hypotension), even if imperfect.High-quality, consistent training programs—like annual OR intubations and in-situ simulation—are the real equalizers in skill development.The origin of airway obsession in EMS traces back to Peter Safar, whose daughter’s death from an asthma attack helped spark the creation of modern paramedicine.ReferencesGeorge, Nicholas H et al. “Prehospital Endotracheal Intubation Success Rates for Critical Care Nurses Versus Paramedics.” Prehospital emergency care, 1-7. 23 Jan. 2025, doi:10.1080/10903127.2024.2448246 https://pubmed.ncbi.nlm.nih.gov/39786721/

In this episode of the FlightBridgeED Podcast, Dr. Mike Lauria is joined by Dr. Nick George, a retrieval and EMS physician currently practicing full-time in Darwin, Australia. Together, they break down the often-overwhelming topic of aortic emergencies in a way that’s brilliantly simple, practical, and immediately applicable for all providers—whether you’re in the ICU, on the flight line, or working your way up in emergency medicine. Dr. George introduces a clean mental model—1 tube, 2 major problems, 3 causes—to guide listeners through the classification, diagnosis, and critical transport considerations for aortic dissections and aneurysms. From understanding penetrating ulcers to navigating hypertensive vs hypotensive presentations, this episode dives deep without drowning you in jargon. We also explore the science behind anti-impulse therapy, challenge long-held dogmas about esmolol vs nicardipine, and reveal eye-opening findings from a two-decade analysis of over 1,000 aortic emergency transports. Whether you’re flying patients to tertiary care, working in rural EDs, or prepping for boards, this episode will sharpen your edge. Available anywhere you listen to podcasts or at FlightBridgeED.com. While you’re there, explore our highly successful, award-winning courses trusted by critical care providers around the world. Key Takeaways The aorta can be simplified into “1 tube, 2 problems (tearing or weakening), caused by 3 forces: pressure, pulsatility, and geometry.”Distinguishing between dissection and aneurysm—and whether it’s hypertensive or hypotensive—can guide safe transport decisions, even if you're not making the diagnosis.Dissections may present without pain in up to 30% of cases, underscoring the importance of clinical vigilance and recognizing subtle signs.Classic signs (pulse deficits, BP differentials) are often unreliable. Don’t dismiss vague or mismatched symptoms.Ultrasound, although not definitive, can provide useful data en route—especially in cases of hypotension or ambiguity.Anti-impulse therapy isn't as evidence-backed as we've been taught. Recent studies show nicardipine may be just as effective—and possibly safer—than esmolol.Transport crews must be empowered to advocate for patients when findings don’t line up with the presumed diagnosis.

In this powerful and unfiltered episode, Eric Bauer sits down with Dr. Mark Piehl—pediatric ICU physician, trauma resuscitation expert, and inventor of the LifeFlow device—for a deep conversation that will reshape how you think about blood product administration in trauma care. From pediatric hemorrhagic shock to adult penetrating trauma, from urban EMS to rural ground teams, they unpack the most critical emerging concepts in early resuscitation. You’ll hear eye-opening real-world cases, challenges in implementation, and candid debates about whole blood, plasma vs. PRBCs, and whether saline still has a place. If you’ve ever questioned how fast, how early, or even if we should be administering blood products in the field—this episode is essential listening. Whether you're just getting into critical care or you're a seasoned physician or flight clinician, there’s something here that will challenge you, inspire you, and push your practice forward. 🎧 Available anywhere you get your podcasts—or right now at flightbridgeed.com. While you're there, explore our award-winning critical care and certification prep courses trusted by over 30,000 providers worldwide. Contact Mark Piehl at [email protected] Key Takeaways: Early blood product administration in the field dramatically increases survival—especially in penetrating trauma.Whole blood may be ideal, but component therapy (plasma + PRBCs) is a powerful and proven alternative—even in urban EMS with short transport times.Traumatic arrest is not always the end. With witnessed arrest and early transfusion, survival is possible—even likely in the right cases.Shock index is an underused but powerful indicator for when to trigger blood administration, and its value applies to both adults and pediatrics.Volume matters, but so does composition: PRBCs deliver oxygen, plasma helps heal vessels—both are needed, and timing is everything.Saline isn’t dead—there are valid, lifesaving uses for crystalloids in certain TBI and pediatric cases when blood isn’t available.Implementing a blood program builds better clinical teams. It’s not just about saving lives—it sharpens every aspect of your trauma care.

Get ready for a transformative episode of the FlightBridgeED Podcast, where host Eric Bauer teams up with EMS trailblazer Dr. Peter Antevy to dive into the life-saving world of pre-hospital hemorrhage control and blood product administration. Discover how whole blood is reshaping trauma care, doubling survival rates for patients bleeding out from trauma, OB emergencies, or medical crises. Dr. Antevy shares hard-won lessons from Palm Beach County, revealing the vital signs that trigger transfusions, the logistics of launching a blood program, and why resuscitating before intubating is a game-changer. From a child saved on I-95 to a police officer revived after a ricochet wound, these gripping stories bring the science to life. Plus, peek into the future with spray-dried plasma and TBI protocols that could redefine EMS. Whether you’re a seasoned critical care provider or just starting your journey, this episode will ignite your passion for saving lives. Listen anywhere you enjoy podcasts or at flightbridgeed.com, where you can also explore our award-winning courses to fuel your growth in critical care medicine. AS PROMISED, HERE IS DR. ANTEVY'S EMAIL ADDRESS IF YOU WANT TO REACH OUT: [email protected] Key Takeaways Whole blood administration in pre-hospital trauma care achieves a ~90% 24-hour survival rate for non-arrest patients with massive hemorrhage, using criteria like systolic BP 70, heart rate ≥110, or end-tidal CO2 25, emphasizing the need for precise patient selection and rapid intervention within 35 minutes of injury.Prioritizing resuscitation over intubation prevents peri-intubation cardiac arrest in hypotensive trauma patients, as shown by a tenfold reduction in intubation rates in New Orleans’ advanced resuscitative care bundle, highlighting the importance of restoring perfusion first.Plasma or packed red blood cells can be effective alternatives when whole blood isn’t available, but providers must manage citrate-induced hypocalcemia (e.g., with calcium chloride) and use tools like the LifeFlow infuser for rapid transfusion.Networking and advocacy are critical for EMS innovation: connecting with resources like San Antonio’s summits or the SPARC Academy can help overcome barriers to implementing blood programs, empowering providers to drive change in their communities.

In this episode of the FlightBridgeED Podcast, Dr. Michael Lauria sits down with Dr. Bryce Taylor—flight physician, trauma educator, and surgical critical care expert—for a deep dive into one of the most visually shocking and physiologically demanding scenarios in transport medicine: the patient with an open abdomen. From trauma-based damage control laparotomies to the high-stakes management of abdominal compartment syndrome, this episode unpacks the pathophysiology, decision-making, and transport logistics for these fragile patients. Whether you're facing hemostatic chaos, rising pressures, or metabolic unraveling, you'll gain insight into recognizing, stabilizing, and safely transporting these complex cases. You'll learn not just how to manage the wound—but how to manage the why behind the wound. Get this episode wherever you listen to podcasts—or listen directly at flightbridgeed.com. While you're there, explore our award-winning, nationally recognized courses in critical care and emergency medicine. No pressure. Just professional growth. Key Takeaways: Surgical damage control isn’t about definitive repair—it's about temporizing a dying patient. Understanding what was done (packing, foams, drains) matters less than knowing why it was done.Open abdomens are dramatic but misleading. The real threat is usually hidden: bleeding, inflammatory storms, obstructive shock, or silently rising compartment pressures.A vacuum dressing isn't just a dressing—it’s part of the resuscitation strategy. Ensuring it's functioning correctly could mean the difference between success and multi-organ failure.Watch the urine output. Sudden drops are a red flag. It’s your non-invasive window into renal perfusion, evolving abdominal pressures, and even early septic deterioration.Fluid is a drug. Over-resuscitating these patients doesn’t just cause swelling—it can prevent surgical closure, increase infections, and result in months of additional recovery or death.

What if the biggest mistake you’re making with your COPD vent patients isn’t in what you’re doing—but in how fast you’re doing it? In this episode, Eric Bauer takes us deep into the nuances of ventilating a COPD patient in acute respiratory failure. Through a complex case breakdown, Eric challenges conventional thinking around rate, tidal volume, and ventilator pressures, offering critical insights into the obstructive approach. You’ll hear the step-by-step evolution of ventilator management from a real-world interfacility transfer of a hypercapnic, non-compliant COPD patient. Discover why high respiratory rates can be catastrophic, how static compliance and RCexp should influence your strategy, and what “minute ventilation” really means in obstructive physiology. This is more than a case review—it's a clinical recalibration. Key Takeaways: Ventilator strategy must match the pathophysiology—blindly applying high respiratory rates in COPD can worsen outcomes by truncating inspiratory time and impairing ventilation.Minute ventilation is king. Tidal volume and rate must be adjusted not for numbers but to optimize both inspiratory and expiratory phases—especially in patients with increased resistance.Understand the math behind I:E ratios. Your ventilator isn’t a magic box—if you don’t understand how to calculate cycle times, you’ll miss what’s happening with your patient.Static compliance is dynamic. Don’t trust low numbers blindly—evaluate whether your lung is being adequately filled before calling compliance “low.”Auto-PEEP and high-pressure alarms can silently sabotage your tidal volumes if you don't actively adjust them to meet the demands of inspiratory resistance.

Join Eric Bauer and Dr. Mike Lauria as they dissect two challenging critical care transport cases centered on managing respiratory failure in obese and morbidly obese patients. Get ready for a deep dive into advanced physiological concepts, practical tips for troubleshooting ventilator settings, and real-world lessons you can apply to patient care right away. From recognizing unique challenges in the obese population to fine-tuning pressures and understanding how to balance protective ventilation with the realities of chest wall resistance, this episode offers clear, expert-level insights delivered in an approachable way. Key Takeaways Appreciating that obesity significantly reduces functional residual capacity, requiring thoughtful increases in ventilatory pressures.Using waveform analysis, plateau pressures, and driving pressures to differentiate between obstructive and restrictive components, especially when chronic illnesses overlap with acute processes.Strategic positioning such as ramping or partial proning can be employed to recruit lung volume and improve oxygenation.Recognizing that some patients will need alarm limits and inspiratory pressures far beyond standard protocols—especially when chest wall resistance is extremely high.Incorporating a systematic approach, including incremental changes and close monitoring, rather than relying on one-size-fits-all protocols.Leveraging collaborative practice and direct medical oversight to fine-tune treatment in the face of complex physiology.The FlightBridgeED Podcast has been your go-to resource for critical care, EMS, and emergency medicine education since 2012. Access this episode and the entire library wherever you get your podcasts or by visiting flightbridgeed.com. While you’re there, you can also explore our award-winning courses that have helped countless professionals master advanced practice concepts. We invite you to explore our full range of podcast shows, where our network of FlightBridgeED creators and contributors deliver dynamic discussions on everything from critical care to cutting-edge EMS topics. You’ll also find unique blogs, training resources, and opportunities to engage in our growing community. And don’t forget to check out our upcoming courses and see what’s happening at FAST this year.

In this episode of the FlightBridgeED Podcast, Dr. Michael Lauria and guest Dr. Alex Pfeiffer, a maternal-fetal medicine (MFM) fellow, delve into the critical and complex topic of Placenta Accreta Spectrum Disorder (PAS). With its rapidly evolving complications, this condition demands acute recognition, careful transport coordination, and multidisciplinary care. Together, they unpack the spectrum’s pathophysiology, risk factors, diagnostic strategies, and advanced management protocols essential for critical care and transport teams. Whether you’re a seasoned provider or new to pre-hospital medicine, this episode provides practical knowledge and actionable insights to elevate your clinical practice. Catch this episode and more wherever you listen to podcasts or on our website at flightbridgeed.com. While there, explore our award-winning courses and other free content in our Culture section to advance your career and expand your critical care expertise. Takeaways Advanced Insight: The importance of understanding PAS as a spectrum, including the implications of invasive placentation on maternal hemorrhage and the role of multidisciplinary teams in patient outcomes.Practical Application: Early recognition of PAS through clinical and diagnostic signs, such as Doppler flow abnormalities, hypervascularity, and placental lakes, to facilitate timely and appropriate interventions.Foundational Knowledge: Awareness of risk factors like prior cesarean sections, placenta previa, and uterine surgeries that increase the likelihood of PAS and necessitate careful monitoring.References1.             Dunbar N, Cooke M, Diab M, Toy P. Transfusion-related acute lung injury after transfusion of maternal blood: a case-control study. Spine (Phila Pa 1976). Nov 1 2010;35(23):E1322-7. doi:10.1097/BRS.0b013e3181e3dad2 2.             Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol. Feb 2011;117(2 Pt 1):331-337. doi:10.1097/AOG.0b013e3182051db2 3.             Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. Bjog. Apr 2009;116(5):648-54. doi:10.1111/j.1471-0528.2008.02037.x 4.             Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol. Sep 2019;221(3):208-218. doi:10.1016/j.ajog.2019.01.233 5.             Murphy EL, Kwaan N, Looney MR, et al. Risk factors and outcomes in transfusion-associated circulatory overload. Am J Med. Apr 2013;126(4):357.e29-38. doi:10.1016/j.amjmed.2012.08.019 6.             Pachtman S, Koenig S, Meirowitz N. Detecting Pulmonary Edema in Obstetric Patients Through Point-of-Care Lung Ultrasonography. Obstet Gynecol. Mar 2017;129(3):525-529. doi:10.1097/aog.0000000000001909 7.             Padilla CR, Shamshirsaz A. Critical care in obstetrics. Best Pract Res Clin Anaesthesiol. May 2022;36(1):209-225. doi:10.1016/j.bpa.2022.02.001 8.             Padilla CR, Shamshirsaz AA, Easter SR, et al. Critical Care in Placenta Accreta Spectrum Disorders-A Call to Action. Am J Perinatol. Jul 2023;40(9):988-995. doi:10.1055/s-0043-1761638 9.             Panigrahi AK, Yeaton-Massey A, Bakhtary S, et al. A Standardized Approach for Transfusion Medicine Support in Patients With Morbidly Adherent Placenta. Anesth Analg. Aug 2017;125(2):603-608. doi:10.1213/ane.0000000000002050 10.          Pegu B, Thiagaraju C, Nayak D, Subbaiah M. Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstet Gynecol Sci. May 2021;64(3):239-247. doi:10.5468/ogs.20345 11.          Roubinian N. TACO and TRALI: biology, risk factors, and prevention strategies. Hematology Am Soc Hematol Educ Program. Nov 30 2018;2018(1):585-594. doi:10.1182/asheducation-2018.1.585 12.          Sawada M, Matsuzaki S, Mimura K, Kumasawa K, Endo M, Kimura T. Successful conservative management of placenta percreta: Investigation by serial magnetic resonance imaging of the clinical course and a literature review. J Obstet Gynaecol Res. Dec 2016;42(12):1858-1863. doi:10.1111/jog.13121 13.          Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet. Mar 2018;140(3):291-298. doi:10.1002/ijgo.12410 14.          Shamshirsaz AA, Fox KA, Erfani H, et al. Coagulopathy in surgical management of placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol. Jun 2019;237:126-130. doi:10.1016/j.ejogrb.2019.04.026 15.          Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. Jun 2015;42(2):381-402. doi:10.1016/j.ogc.2015.01.014 16.          Simonazzi G, Bisulli M, Saccone G, Moro E, Marshall A, Berghella V. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand. Jan 2016;95(1):28-37. doi:10.1111/aogs.12798 17.          Tadayon M, Javadifar N, Dastoorpoor M, Shahbazian N. Frequency, Risk Factors, and Pregnancy Outcomes in Cases with Placenta Accreta Spectrum Disorder: A Case-Control Study. J Reprod Infertil. Oct-Dec 2022;23(4):279-287. doi:10.18502/jri.v23i4.10814 18.          Tinari S, Buca D, Cali G, et al. Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound Obstet Gynecol. Jun 2021;57(6):903-909. doi:10.1002/uog.22183 19.          Toy P, Gajic O, Bacchetti P, et al. Transfusion-related acute lung injury: incidence and risk factors. Blood. Feb 16 2012;119(7):1757-67. doi:10.1182/blood-2011-08-370932 20.          Toy P, Popovsky MA, Abraham E, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. Apr 2005;33(4):721-6. doi:10.1097/01.ccm.0000159849.94750.51 21.          Warshak CR, Ramos GA, Eskander R, et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. Jan 2010;115(1):65-69. doi:10.1097/AOG.0b013e3181c4f12a

Explore the fascinating world of 12-lead ECG interpretation with a special guest, Reid Gilbert-Vass, PA-C, creator of "ECG Lectures with Reid" on YouTube. Reid discusses his journey from Marine Corps logistics to EMS and ultimately becoming a PA specializing in cardiology. Learn his structured, anatomy-driven approach to ECG interpretation, designed to help clinicians at all levels—from beginners to seasoned critical care professionals—develop a deeper understanding of cardiac physiology and electrophysiology. Join the FlightBridgeED Podcast: MDCAST host, Michael Lauria, as they discuss Reed's innovative teaching methods, his passion for lifelong learning, and how his work transforms how clinicians approach ECGs. Don’t miss the practical insights and compelling stories that make this episode a must-listen for anyone in pre-hospital, emergency, or critical care medicine. Listen to the FlightBridgeED Podcast wherever you get your podcasts or at flightbridgeed.com/fbe-podcast. You should also check out ECG Lectures with Reid on YouTube @ECGwithReid. Thank you so much for listening! We couldn't make this podcast with you.Takeaways Understanding ECGs Through AnatomyReid’s step-by-step anatomical approach to ECG interpretation emphasizes the flow of electricity through the heart, helping clinicians localize issues and correlate findings with physiology.The Importance of Lifelong LearningReid’s journey highlights how continual study and curiosity can lead to advanced clinical insights, inspiring providers to deepen their understanding of medical concepts.Practical Application of ECG SkillsReid shares actionable advice from EMS to PA school on applying ECG interpretation skills in high-pressure environments, empowering learners to improve patient care.

In this episode of the FlightBridgeED Podcast, Dr. Michael Lauria dives deep into the art and science of non-invasive positive pressure ventilation (NIPPV), exploring how to optimize CPAP and BiPAP for critically ill patients. Discover advanced techniques to fine-tune ventilator settings, evaluate effectiveness, and reduce mortality and morbidity in COPD, CHF, and other conditions. Learn how to align ventilatory support with patient pathophysiology and understand the tools that predict success or failure in non-invasive ventilation. Whether you're a seasoned critical care provider or just starting to explore advanced practice concepts, this episode offers valuable insights to elevate your understanding of respiratory management. Listen anywhere you get your podcasts or directly on our website at flightbridgeed.com/fbe-podcast. While there, explore our award-winning courses and resources designed to empower healthcare professionals. Takeaways Advanced Insight: Using effective PEEP and pressure support in BiPAP can dramatically reduce breathing work and improve outcomes for COPD and CHF patients.Practical Guidance: Titrating CPAP and BiPAP requires continuous evaluation of patient response and adjusting settings like pressure support, PEEP, rise time, and expiratory trigger.Foundational Knowledge: Understanding when and why to choose non-invasive ventilation based on patient pathophysiology is critical for improving care quality.References1.             Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. Ann Transl Med. Sep 2018;6(18):355. doi:10.21037/atm.2018.04.39 2.             Berbenetz N, Wang Y, Brown J, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. Apr 5 2019;4(4):Cd005351. doi:10.1002/14651858.CD005351.pub4 3.             Carrillo A, Lopez A, Carrillo L, et al. Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients. J Crit Care. Dec 2020;60:152-158. doi:10.1016/j.jcrc.2020.08.008 4.             Chong CY, Bustam A, Noor Azhar M, Abdul Latif AK, Ismail R, Poh K. Evaluation of HACOR scale as a predictor of non-invasive ventilation failure in acute cardiogenic pulmonary oedema patients: A prospective observational study. Am J Emerg Med. May 2024;79:19-24. doi:10.1016/j.ajem.2024.01.044 5.             Coleman JM, 3rd, Wolfe LF, Kalhan R. Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. Sep 2019;16(9):1091-1098. doi:10.1513/AnnalsATS.201810-657CME 6.             Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. Dec 2002;28(12):1701-7. doi:10.1007/s00134-002-1478-0 7.             D'Andrea A, Martone F, Liccardo B, et al. Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study. Echocardiography. Aug 2016;33(8):1144-55. doi:10.1111/echo.13225 8.             Duan J, Chen L, Liu X, et al. An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study. Crit Care. Jul 3 2022;26(1):196. doi:10.1186/s13054-022-04060-7 9.             Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med. Feb 2017;43(2):192-199. doi:10.1007/s00134-016-4601-3 10.          Duan J, Yang J, Jiang L, et al. Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure. Ann Intensive Care. Dec 5 2022;12(1):110. doi:10.1186/s13613-022-01085-7 11.          Esnault P, Cardinale M, Hraiech S, et al. High Respiratory Drive and Excessive Respiratory Efforts Predict Relapse of Respiratory Failure in Critically Ill Patients with COVID-19. Am J Respir Crit Care Med. Oct 15 2020;202(8):1173-1178. doi:10.1164/rccm.202005-1582LE 12.          Ferreyro BL, De Jong A, Grieco DL. How to use facemask noninvasive ventilation. Intensive Care Med. May 27 2024;doi:10.1007/s00134-024-07471-y 13.          Giovannini I, Chiarla C, Boldrini G, Terzi R. Quantitative assessment of changes in blood CO2 tension mediated by the Haldane effect. Journal of Applied Physiology. 1999;87(2):862-866. doi:10.1152/jappl.1999.87.2.862 14.          Ho KM, Wong K. A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Crit Care. 2006;10(2):R49. doi:10.1186/cc4861 15.          Klocke RA. Mechanism and kinetics of the Haldane effect in human erythrocytes. Journal of Applied Physiology. 1973;35(5):673-681. doi:10.1152/jappl.1973.35.5.673 16.          Leatherman J. Mechanical ventilation for severe asthma. Chest. Jun 2015;147(6):1671-1680. doi:10.1378/chest.14-1733 17.          Lenique F, Habis M, Lofaso F, Dubois-Randé JL, Harf A, Brochard L. Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med. Feb 1997;155(2):500-5. doi:10.1164/ajrccm.155.2.9032185 18.          Martin JG, Shore S, Engel LA. Effect of continuous positive airway pressure on respiratory mechanics and pattern of breathing in induced asthma. Am Rev Respir Dis. Nov 1982;126(5):812-7. doi:10.1164/arrd.1982.126.5.812 19.          Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med. Dec 15 2003;168(12):1432-7. doi:10.1164/rccm.200211-1270OC 20.          Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. Jul 13 2017;7(7):Cd004104. doi:10.1002/14651858.CD004104.pub4 21.          Peter JV, Moran JL, Phillips-Hughes J, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet. Apr 8 2006;367(9517):1155-63. doi:10.1016/s0140-6736(06)68506-1 22.          Rittayamai N, Pravarnpat C, Srilam W, Bunyarid S, Chierakul N. Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study. J Thorac...

In this episode of the FlightBridgeED Podcast: MDCAST, we continue our OB Critical Care Series, focusing on airway management in critically ill obstetric patients. Hosted by Dr. Michael Lauria and featuring special guest Dr. Emily McQuaid-Hanson, Director of OB Anesthesia at the University of New Mexico, this episode delivers essential insights into managing one of the most intimidating and dynamic challenges in pre-hospital and critical care transport medicine. Join us as we discuss modern advancements in airway safety, the physiological challenges of gravid patients, and the critical techniques and tools for managing obstetric airways effectively. Dr. McQuaid-Hanson shares invaluable strategies for pre-oxygenation, intubation, medication selection, and post-intubation care, along with a reminder to approach every airway with preparation and respect—without fear. Whether new to pre-hospital medicine or a seasoned critical care professional, wherever you are on your journey, this episode offers actionable insights and pearls of wisdom. Listen to this podcast on your favorite platform or visit flightbridgeed.com/fbe-podcast. While you're there, explore our award-winning courses and check out our website's Culture section, which offers free content like this podcast, blogs, YouTube videos, TikTok creators, and more! Enjoy, and thank you for being part of the FlightBridgeED community! Takeaways Advanced Insights: Modern airway equipment like video laryngoscopes and better preparation have made obstetric airway management comparable in difficulty to other critical care populations, emphasizing preparation and respect for physiological challenges.Clinical Strategies: Proper positioning, effective pre-oxygenation techniques, and having a well-thought-out plan with appropriate tools are key to successful airway management in obstetric patients.Foundational Knowledge: Awareness of the physiological changes during pregnancy—such as reduced functional residual capacity and increased aspiration risk—helps providers anticipate and mitigate challenges during airway management.References1.        Aziz MF, Kim D, Mako J, Hand K, Brambrink AM. A retrospective study of the performance of video laryngoscopy in an obstetric unit. Anesth Analg. 2012 Oct;115(4):904-6. 2.        Ahuja P, Jain D, Bhardwaj N, Jain K, Gainder S, Kang M. Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study. Int J Obstet Anesth. 2018 Feb;33:17-22. 3.        Bryson PC, Abode K, Zdanski CJ. Emergent airway management in the labor and delivery suite. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:83-6. 4.        Šklebar I, Habek D, Berić S, Goranović T. AIRWAY MANAGEMENT GUIDELINES IN OBSTETRICS. Acta Clin Croat. 2023 Apr;62(Suppl1):85-90.  5.        Dongare PA, Nataraj MS. Anaesthetic management of obstetric emergencies. Indian J Anaesth. 2018 Sep;62(9):704-709. 6.        Djabatey EA, Barclay PM. Difficult and failed intubation in 3430 obstetric general anaesthetics. Anaesthesia. 2009 Nov;64(11):1168-71. 7.        McKeen DM, George RB, O'Connell CM, Allen VM, Yazer M, Wilson M, Phu TC. Difficult and failed intubation: Incident rates and maternal, obstetrical, and anesthetic predictors. Can J Anaesth. 2011 Jun;58(6):514-24. 8.        Hannig KE, Hauritz RW, Jessen C, Herzog J, Grejs AM, Kristensen MS. Managing Known Difficult Airways in Obstetric Patients Using a Flexible Bronchoscope and IRRIS: A Case-Illustrated Guide for Nonexpert Anesthesiologists, without Surgical Backup. Case Rep Anesthesiol. 2021 Oct 8;2021:6778805. 9.        Preston R, Jee R. Obstetric airway management. Int Anesthesiol Clin. 2014 Spring;52(2):1-28. 10.  Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC; Obstetric Anaesthetists' Association; Difficult Airway Society. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015 Nov;70(11):1286-306. 11.  Goldszmidt E. Principles and practices of obstetric airway management. Anesthesiol Clin. 2008 Mar;26(1):109-25, vii. 12.  Kurdi MS, Rajagopal V, Sangineni KS, Thalaiappan M, Grewal A, Gupta S. Recent advances in obstetric anaesthesia and critical care. Indian J Anaesth. 2023 Jan;67(1):19-26. 13.  Ende H, Varelmann D. Respiratory Considerations Including Airway and Ventilation Issues in Critical Care Obstetric Patients. Obstet Gynecol Clin North Am. 2016 Dec;43(4):699-708. 14.  Mhyre JM, Healy D. The unanticipated difficult intubation in obstetrics. Anesth Analg. 2011 Mar;112(3):648-52. 15.  Stopar Pintarič T. Videolaryngoscopy as a primary intubation modality in obstetrics: A narrative review of current evidence. Biomol Biomed. 2023 Nov 3;23(6):949-955.

Join Dr. Mike Lauria and guest Dr. Bryce Taylor, an experienced flight physician, as they delve into the complexities of transporting patients with severe gastrointestinal (GI) bleeding. From the nuances of variceal versus non-variceal bleeds to cutting-edge resuscitation strategies and critical airway management, this episode equips providers with the insights they need for optimal care. Discover evidence-based approaches to managing medications, product resuscitation, and the intricacies of using balloon tamponade devices like Minnesota tubes. Whether you're in EMS, critical care, or just stepping into advanced prehospital medicine, this episode has pearls for every provider. Stream this episode wherever you listen to podcasts, or visit FlightBridgeED.com to explore our award-winning critical care education courses. Your journey to excellence starts here. TAKEAWAYS Advanced Insight: The pathophysiological understanding of variceal bleeding highlights elevated portal pressures causing venous backflow into superficial veins of the esophagus and stomach, creating high-risk hemorrhage scenarios.Clinical Pearls: Intubating a patient with massive hematemesis requires preparedness for anatomical and physiological challenges. Techniques like SALAD (suction-assisted laryngoscopy) and appropriate suction setups are vital.Foundational Concept: Differentiating upper vs. lower GI bleeds begins with understanding anatomical landmarks like the ligament of Treitz, guiding early diagnosis and management in the field.