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Heavy Lies the Helmet

Mike Boone, Dan Rauh, & Dr. Amanda Humphries

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The Heavy Lies the Helmet® Podcast is by critical care professionals, for critical care professionals. Hosted by Mike Boone, Dan Rauh, and Dr. Amanda Humphries, we dive deep into the realities of emergency and critical care medicine. Our conversations are raw, honest, and practical — cutting through the noise to focus on real-world challenges, clinical decision-making, and the human side of high-acuity care. Whether we’re unpacking complex patient scenarios, discussing the nuances of teamwor ...
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LISTENER DISCRETION IS ADVISED. References: Buxton. Sustained Monomorphic VT: Clinical Manifestations, Diagnosis, and Evaluation. Up-to-Date. Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J. 2023;23(1):1-13. doi:10.1016/j.i…
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What happens when resources are limited, transport is delayed, or you’re forced to manage a critically ill patient far beyond the typical flight window? In this podcast episode, Dr. Tim Hurtado and Brett Weiner help us dive into the challenges and realities of prolonged field care in air medical transport. We’ll explore clinical considerations, cre…
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Listener discretion is advised. References:Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020 Jun;32(3):647-666. doi: 10.1007/s…
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Listener discretion is advised. Reference:Tsukube, T., Okita, Y. (2017). Cardiac tamponade due to aortic dissection: clinical picture and treatment with focus on pericardiocentesis. E-Journal of Cardiology Practice. European Society of Cardiology. Available: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Cardiac-tampon…
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Tranexamic Acid (TXA) is a lot like hot sauce: People put it on everything — especially for apparent or suspected acute blood loss. In this podcast episode, we dive into a drug that’s been both praised and questioned in trauma and prehospital care. We break down what TXA is, how it works, and the evidence behind its use. From CRASH-2 to CRASH-3, we…
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LISTENER DISCRETION IS ADVISED. More thoughts on OBLearning 12-leadsParalytic choicesALS for AMS Cash RE, Kaimal AJ, Samuels-Kalow ME, Boggs KM, Swanton MF, Camargo CA Jr. Epidemiology of Emergency Medical Services-Attended out-of-Hospital Deliveries and Complications in the United States. Prehosp Emerg Care. 2024;28(7):890-897. Dexter F, Epstein R…
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Though evidence dictates much of what we do as emergency medical providers, some areas remain open to debate: How are we justifying stroke ambulances, CCT speciality teams, AHA guidelines, and our choice of crystalloids? How are we justifying what professionals are allowed to post on social media? And do we agree with the currently accepted norms? …
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Wet or dry. Air in or out. Reactive or obstructive. The possibilities may seem endless when treating the pediatric patient with undifferentiated respiratory distress. It is confounded by the fact that pediatrics are outside the comfort zone of many novice critical care transport providers. In this podcast episode, neonatal/pediatric specialist Nate…
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'Tis the season for trauma. (If there truly is a season.) Chest trauma, specifically, can vary in subtlety and severity, primarily due to the presence of multiple vital organs and vessels. In this podcast, we discuss these potentials while focusing on those injuries that are associated with the highest mortality rate. We also discuss why you should…
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Does your patient have high blood pressure? Are they seizing or showing other signs of a neurological disorder? It could be PRES! Unfortunately, Posterior Reversible Encephalopathy Syndrome (PRES) is difficult to diagnose unless you are aware of its existence. In this podcast episode, we discuss this infrequent condition and how can you appropriate…
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Do certifications accurately reflect an individual's qualifications? This is an ongoing argument depending on what side of the exam you are on. How much value should we on that piece of paper? And, regardless, how do we work towards obtaining and maintaining qualifications? In this podcast episode, we discuss it all including Dunning-Kruger Effect …
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Previously, we recorded a podcast episode about the utility surrounding Point of Care Ultrasound (POCUS). In this episode, we apply that knowledge to specific case scenarios as a continuation of our "Breaking the Case" series. We also ask the question, is POCUS really all it's cracked up to be, or should we be re-thinking our approach, particularly…
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Humans are easy. That's why we are able to do what we do as prehospital providers. But what happens when your patient is a canine? These working dogs are highly regarded by their handlers and require care just like anyone else that may be ill or injured. Considering that, are you equipped to care for them? If not, how can you successfully start and…
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It can be difficult to determine whether you should treat undifferentiated hypertension or not. Many clinicians are distracted the number rather than focusing on the patient in front of them. Asymptomatic hypertension, in particular, is often benign. In fact, treating asymptomatic hypertension in a patient who a primary medical history of hypertens…
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The principles of preoxygenation and passive oxygenation should be familiar to any experienced intubator. Best practice recommends the use of a nasal cannula in conjunction with either a non-rebreather mask or bag-valve mask (BVM) to prevent hypoxemia during the apneic phase of Rapid Sequence Intubation (RSI). In the PREOXI Trial, the authors pushe…
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Not all cardiac arrests are created equal. Whether the presenting rhythm is asystole, ventricular fibrillation, or PEA, these patients require tailored interventions beyond "blanket" protocol and ACLS/PALS algorithms. When refractory to conventional therapy, the pulseless V-Tach/V-Fib patient, in particular, requires critical thinking "outside the …
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