Heavy Lies the Helmet

Heavy Lies the Helmet

"Heavy lies the crown" is a common misquote of "uneasy lies the head that wears a crown" from Shakespeare's Henry IV, Part 2. It refers to the responsibility and insecurity of governing an entire kingdom. Likewise, "heavy lies the helmet" refers to the responsibility we face as critical care transport providers working in an autonomous and often unpredictable environment. Our minds are eased with education that better prepares us for any situation that we may encounter. That is exactly what Heavy Lies the Helmet provides. Founded by two brothers, Heavy Lies the Helmet is comprised of industry leaders working in the fields of pre-hospital and inter-hospital critical care and emergency services. We are an accredited podcast, blog, and conference that openly discusses the world of resuscitation and aviation. We highlight caring for critically ill and injured patients in addition to the controversies surrounding their management. Though tailored to the transport environment, our information is applicable to any discipline working in an emergency and/or intensive care setting. We utilize the most recent evidence to provide applicable and accurate education that can assist in improving individual clinical practice and overall program operations. We offer continuing education units to any listener and/or reader interested in obtaining credit for their progressive learning experience. Please visit heavyliesthehelmet.com/ce for more information.

Episodes

April 30, 2022 38 min

Mores lies! But this time, we focus on empirical use of spinal immobilization devices and the harm associated with them. The dogma surrounding this topic is staggering, to say the least. From EMS agencies to Level 1 tertiary centers, cervical collars and long spine boards (LSB) remain a "standard" predicated on a lack of evidence. What evidence DO we have regarding spinal immobilization? And how should we restrict spinal mo...

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Diabetic Ketoacidosis (DKA) is a common metabolic disorder, particularly in the pediatric population. If treated inappropriately, these patients can quickly decompensate to the point of hypovolemic shock, acute respiratory failure, and even cerebral herniation. What are the physiological differences behind DKA verses HHS (Hyperglycemic Hyperosmolar Syndrome)? What are some simple methods to identify DKA in the field? How do we effe...

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March 30, 2022 53 min

There are a lot of "lies"/misunderstandings surrounding appropriate use of paralytics AKA neuromuscular blocking agents (NMBAs). When are these medications truly indicated? How do we appropriately administer them? How do we accurately monitor these patients? And how do we reverse the effects of NMBAs? Tune in to another pharmacologically driven podcast where we draft our EM pharmacist friend, Chase Turner, to discuss.

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March 8, 2022 59 min

The clotting cascade, particularly in the context of anti-coagulation reversal can be complex to understand. Unfortunately, many of our patients are on anti-coagulation agents that require reversal in the presence of life-threatening hemorrhage. How do we choose the most appropriate agent based on which step of the coagulation cascade that it antagonizes? And when is it time to pull the trigger on doing so? In this podcast episode,...

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Which is the lesser evil, opioid or naloxone overdose? To avoid adverse effects, how should we be administering naloxone in the presence of opioid overdose? In this podcast episode, we are joined by Dr. Arne Skulberg, anesthesiologist and lead author, to discuss his recently published RCT comparing intranasal with intramuscular naloxone. We highlight naloxone dose discrepancies and the pitfalls surrounding intravenous administratio...

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An incapacitated pilot scenario is an unfortunate but potential reality of working in rotor and fixed wing EMS. What do you do as medical crew members if your pilot becomes incapacitated? What training and capabilities do you have to revive the pilot and/or get the aircraft on the ground? Do some Controlled Flight Into Terrain (CFIT) incidents actually involve an incapacitated pilot?

In this podcast episode, we are joined by Pilot ...

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Transport of patients with ongoing CPR to the correct treatment center is a high risk but potentially lifesaving intervention. Mechanical CPR (mCPR) devices are recommended to reduce risk and maintain chest compression quality. However, such transports have inherent pitfalls to both patient and provider safety. This is a poorly studied field of our practice and no clear consensus for how this should be done exists. In this podcast ...

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December 16, 2021 56 min

Ventricular Assist Devices (VAD) come in many shapes and sizes. From right to left, extracorporeal to intracorporeal, pulsatile to continuous - It can be confusing. Join us for a podcast episode where Allen Wolfe clarifies the confusion and gives us the maximum amount of knowledge we need to succeed while taking care of these patients.

Get CE hours for our podcast episodes HERE!

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If "you can't handle the truth", you can't handle a mentor. Mentors come in the form of leaders, educators, guides, and advisors to help you with honest self-reflection in order to improve yourself and your practice. Join us from AMTC21 where we discuss the importance of this arrangement with our close friends and fellow mentors, Adam Tresidder and Shane Turner.

Get CE hours for our podcast episodes HERE!

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Thyroid Storm and Thyrotoxicosis are often misdiagnosed due to presenting similarly to many other disease processes. How do we identify this condition? What are the standard treatment options? And how do we treat a patient who is refractory to conventional therapy? Joined by EM pharmacist, Chase Turner, we discuss all things hyperthyroidism in this podcast episode.

Get CE hours for our podcast episodes HERE!

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"Kung" means "skillful work" and "Fu" means "time spent". "Resus Kung Fu" refers to the resuscitation skills we acquire over time to become a true master. But how do we achieve mastery of these cognitive abilities and technical skills? And what role does stress inoculation play in training? Join us and Dr. Michael Lauria in this podcast episode where we answer these questions.

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Have you ever been hiking in the woods and wondered what emergency medical services are available in case you got injured? The level of scope varies greatly across the country for wilderness emergency medical and SAR technicians. From first aid to critical care, in this podcast episode, we discuss who is coming, what their capabilities are, and how David Fifer is trying to change that model.

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Sometimes, we're wrong. And when it comes to normal saline, we might be.

Tune in to a breaking news podcast of sorts where we discuss the recently published BaSICS Randomized Clinical Trial, and how it affects our practice in regard to balanced fluid resuscitation.

Get CE hours for our podcast episodes HERE!

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Though the incidents of crush injuries may be low in frequency, major crush injury syndrome is associated with a high mortality rate. In this podcast episode, we sit down with regular guest, Chris Stevenson, to discuss the "why". We highlight the pathophysiology behind re-perfusion injury and pre- and post-treatment options.

Get CE hours for our podcast episodes HERE!

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How do you decide between non-invasive and invasive ventilation? If you decide on non-invasive ventilation (NIV), how do you choose between heated high flow nasal cannula (HFNC), C-pap, or Bipap? And what critical decision-making tools do you utilize when escalating to intubation? In this podcast episode, we are joined by Flight Respiratory Therapist, Jon Inkrott, to answer those questions and more.

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Managing Acute Myocardial Infarction (AMI) patients is a concept that many of us learn early on in our careers. Because of that, we can potentially underestimate the importance of our interventions.

In this podcast episode, we are joined by Dr. Gottula and Dr. Skrobut to discuss timely management of AMI's, when coronary intervention (PCI) is indicated, and what medications we should consider to achieve maximal medical managemen...

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There are a lot of misconceptions surrounding the meaning of certain lab values and what a positive truly is. Are these numbers as black and white as they are perceived? In this podcast episode, we discuss sensitivity versus specificity, define some of the most common labs and how to avoid tunnel vision when it comes to your clinical interpretation.

Get CE hours for our podcast episodes HERE!

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Taking care of the High Risk OB patient is outside the comfort zone of many of us. The third trimester, specifically, presents unique challenges both pregnancy-related and otherwise. Why are normal physiologic changes related to pregnancy ABNORMAL in the third trimester? How do we determine if the pregnant patient is sick or not sick? And how do you change your treatment based on these findings?

Tune in as we sit down with Dr. Zaf ...

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Has administration ever made a decision that you didn't agree with and/or understand? Of course! As much as we don't like to admit it, the medical industry is a business. For that reason, finances play a significant factor in decision-making. How do we maintain balance between profit and patient care? How do we bridge the gap between leadership and staff members?

Tune in to this brutally honest episode where we sit down wit...

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Due to the popularity of Episode 68 - X-Ray Vision, we've decided to extend our radiology series and focus on computerized tomography (CT) scans. Head CT scans, specifically, are often viewed by emergency and transport clinicians when patients require tertiary neurovascular services. Tune in to another visually-guided episode as we discuss this extremely important topic, providing ways to easily interpret the various forms of i...

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