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 mpiehl@410medical.com

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: peter@handtevy.com

Key Takeaways

1. 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.
2. 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.
3. 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.
4. 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.
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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.

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

1. Understanding ECGs Through Anatomy
   Reid’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.
2. The Importance of Lifelong Learning
   Reid’s journey highlights how continual study and curiosity can lead to advanced clinical insights, inspiring providers to deepen their understanding of medical concepts.
3. Practical Application of ECG Skills
   Reid shares actionable advice from EMS to PA school on applying ECG interpretation skills in high-pressure environments, empowering learners to improve patient care.