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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The World’s Okayest Medic Podcast is a podcast for all EMS providers. Whether you’re an EMT, paramedic, nurse; work in a 911 response setting or critical care transport; and are a novice or experienced clinician, this podcast is for you.
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Listener discretion is advised.By Mike Carunchio
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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. Jake Potter from Scope Education and Josh Cooke from The Alert Medic One Podcast joined me for an agendaless discussion.By Mike Carunchio
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Listener discretion is advised. Thank you to Dr. Haney Mallemat and my partner Cameron for coming on to discuss a high-risk/low-frequency case.By Mike Carunchio
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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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Listener discretion is advised.By Mike Carunchio
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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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Listener discretion is advised. We will address three topics on this episode: Burnout: "I hate my patients." Managers who don't handle a low performing employee "I don't feel accepted by my new team."By Mike Carunchio
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LISTENER DISCRETION IS ADVISED.By Mike Carunchio
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Episode 130 - Opinion-Based Medicine w/Mike Carunchio
1:10:08
1:10:08
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1:10:08Though 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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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised!By Mike Carunchio
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Episode 129 - Little Lung Problems w/Nate Brown
1:07:36
1:07:36
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1:07:36Wet 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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Jake Potter: Sedation, Agitation, and Rabbit-holes
56:15
56:15
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56:15Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised. You all know him and love him: Mustafa Sidik from The Alert Medic One Podcast joined me for a discussion about...well, a lot of things.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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Episode 128 - Keeping Trauma Close to the Chest
55:14
55:14
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55:14'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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Listener discretion is advised.By Mike Carunchio
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LISTENER DISCRETION IS ADVISED. Dr. Stephen Wood, host of the "Tac Medic Whiskey Podcast" joined us again! We talk about a wide-range of topics from politics (the EMS kind, not national), blood, airway, degrees, trauma...By Mike Carunchio
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Listener discretion is advised.By Mike Carunchio
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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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More Listener Questions with Nurse Gwenny and Wes Nelson
57:45
57:45
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57:45LISTENER DISCRETION IS ADVISED.By Mike Carunchio
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Episode 126 - Certification Versus Qualification
50:47
50:47
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50:47Do 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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Listener discretion is advised. Thanks to Adam from "Dialed Medics" for coming onto the podcast and talking about EMS education. Follow them on social media @dialedmedics.By Mike Carunchio
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Episode 125 - Breaking the Case: The Point of Ultrasound
45:05
45:05
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45:05Previously, 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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Episode 124 - Canine Care w/George Tarver III
56:54
56:54
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56:54Humans 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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Chris Wright: Lessons in Trauma from Ukraine
50:02
50:02
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50:02Listener discretion is advised. Chris Wright is a flight paramedic who spent a few months working as a medic in the Ukranian conflict. He came on to talk about tourniquet conversion but we ended up going into all kinds of trauma lessons he learned from his time.By Mike Carunchio
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Episode 123 - To Treat or Not to Treat: Hypertension
1:00:03
1:00:03
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1:00:03It 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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Episode 122 - Stay Positive When Preoxygenating (PREOXI Trial)
1:01:23
1:01:23
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1:01:23The 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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Listener discretion is advised. EMS training guru Rick Maricle came onto talk about the regional blood program in Southern Texas and to talk unscripted about prehospital blood.By Mike Carunchio
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LISTENER DISCRETION IS ADVISED Gauer, R. (2017). Severe Asymptomatic Hypertension: Evaluation and Treatment. Am Family Physician. 95(8). Oras, et. Al. (2019). Elevated BP in the ED. Hypertension 75(1). Yaphe, J, Atzema, C, Helman, A. Hypertensive Emergencies. Emergency Medicine Cases. February, 2014.…
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Episode 121 - Outside the Box: Cardiac Arrest Management
46:51
46:51
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46:51Not 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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Episode 120 - Sorry, We Are Closed: Interfacility Transfers w/Austin Wingate
1:04:17
1:04:17
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1:04:17Interfacility transfers are not always indicated at the time and place of which they are being requested. Whether it's referring provider misinformation or a lack of advocacy by the transport agency, these transfers can result in unnecessary risk for crew members and patients. Specifically, weather conditions, time of day, crew fatigue, and other i…
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Episode 119 - Losses and Gains: Antidiuretic Hormone
43:50
43:50
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43:50Antidiuretic hormone (ADH) plays an essential part in the body's osmotic/fluid balance, sodium homeostasis, and blood pressure regulation. This hormone is synthesized in the hypothalamus and released from the posterior pituitary gland. In conditions such as Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH), there is a lack of synthe…
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Episode 118 - Trigger Warning: Angioedema
46:54
46:54
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46:54Angioedema is defined by upper airway swelling secondary to an immune response. The trigger and subsequent physiological response are how we categorize it. In this podcast, we discuss how to diagnose and treat both types: IgE/Histamine-mediated and Bradykinin-mediated. We also touch on how to address the difficult airway that may or may not lead to…
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Episode 117 - Dye or Die: Methylene Blue w/Will Heuser
50:56
50:56
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50:56When discussing methylene blue, management and treatment of methaemoglobinaemia is usually the first indication mentioned. But in this podcast, we challenge you to increase the size of your lense and focus on its benefits in other states (e.g., septic shock). Of course, we could not do this alone, so we invited a Flight Paramedic, Pharmacist, Toxic…
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Episode 116 - Around the World: HEMS in México w/Daniel Peñaflor
58:23
58:23
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58:23Though we have delved into foreign HEMS systems in the past (See Episode 61 – Down Under Dynamics w/Dr. Cliff Reid), we have not dedicated an entire series to it. Having now rubbed shoulders with many clinicians and operators around the world, it is evident that these conversations need to take place on a regular basis. Why? Because operating in a …
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Episode 115 - Me, My Self-Loading Baggage, and I w/Miles Dunagan and Brett Reeder
1:06:59
1:06:59
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1:06:59"Self-loading baggage" is a derogatory term often used by pilots to describe lazy or disengaged medical crew members in the air medical industry. Whether intentional or not, this behavior sets a bad precedent for those of us that want to embrace aviation cross-training and be able to assist the pilot effectively. In this podcast episode, we are joi…
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Episode 114 - You Train Ukraine w/Kevin Collopy and Brock Jenkins
37:09
37:09
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37:09The Russo-Ukrainian War is an ongoing international conflict between Russia and Ukraine. At times such as these, medical training is essential and sometimes required of laypersons. International Medical Corps partnered with the Harvard Humanitarian Initiative (HHI) to provide comprehensive emergency and trauma care training to healthcare workers, p…
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Episode 113 - Being B.R.A.S.H. When Treating Bradycardia w/Dr. Kate Connelly and Jake Miller
30:45
30:45
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30:45B.R.A.S.H. Syndrome is a phenomenon with a constellation of Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia requiring identification and management in the prehospital and transport setting. In this podcast episode, live from AMTC23, we discuss the pathophysiology of BRASH Syndrome, highlighting the synergy between its compone…
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Episode 112 – Acid Base Trifecta (Presentation)
56:03
56:03
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56:03Dan presented the talk “Metabolic Acidosis: The Eye Can Only See What the Mind Can Comprehend” at AMTC23. In this recording, he teaches you how to identify the prevalence of acid-base disorders including triple disturbances, how to calculate anion gap and determine the etiology of the gap, and how to identify adequacy of compensation for a primary …
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Episode 111 - Critical Comfort Care w/Brianna Fields
47:52
47:52
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47:52As a critical care clinician, do you consider yourself well-versed in comfort care? Do you consider yourself well-rehearsed in having the discussions leading up to the patient's or family's decision to implement it? This concept may be outside your comfort zone, especially if you work in emergency medicine. But the fact of the matter is, from the p…
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