The EMS Lighthouse Project

Remember when we learned interruptions in compressions take a long time to recover blood pressure from? And how, to avoid these, we should do continuous compressions to avoid them. And ventilations aren’t all that important. Right? Right? Well, about that. Maybe the stories of the importance of continuous compressions were greatly exaggerated. Join Dr. Jarvis as he discusses the literature that le...

What’s the best way to pre-oxygenate our patients prior to intubation? The evidence for this question has been mixed for some time. Dr Jarvis discusses the PREOXI Trial, which directly compares preoxygenation with non-invasive ventilation compared to a face mask to see which provides the best protection against peri-intubation hypoxia. This is an important trial that sheds light on a key component...

There is evidence that clinician experience with intubation is associated with improved success rates and evidence that missed intubation attempts are associated with worse survival, at least in cardiac arrest. The recent Airway EBG paper recommends EMS agencies with low intubation proficiency should use SGAs instead of intubation in cardiac arrest. This all begs the question of whether agencies w...

Description:  Let’s say you were looking for a safe and effective BLS option for analgesia. Something other than oral acetaminophen or ibuprofen. You want the Green Whistle (methoxyflurane), but you can’t get the Green Whistle (thanks, FDA!). How about sub-dissociative ketamine by nebulizer? Sounds great, but you’re worried about your colleagues getting stoned, right? Admit it, you are. Fortunatel...

What value does EtCO2 have when predicting survival from cardiac arrest? We all know a sharp spike in EtCO2 is associated with ROSC, but what about persistently elevated levels? What does this mean for decision-making regarding the termination of resuscitation?   Join Drs. Jeff Jarvis, Remle Crowe, and Heidi Abraham for the first episode of “Between Two Nerds,” a subgenre of the EMS Lighthouse Pro...

The debate about which drug to use for sedation before RSI will... not… die. Advocates for both ketamine and etomidate approach the argument with near-religious zeal. There have been studies. We’ve even covered some here. We need a systematic review and meta-analysis, preferably using an analysis that recognizes this likely isn’t a black-and-white question. That’s where our friend Bayes comes in....

Atrial Fibrillation with rapid ventricular response is a common cause of EMS activations and ED visits. It is associated with chest discomfort, palpitations, and hypotension. Treatment is aimed at either rhythm or rate control, with rate control being the most common first-line approach. EMS has the potential to treat this condition with medications such as diltiazem, metoprolol, or amiodarone. Fo...

Dr. Jarvis is joined by OG co-host Mike Verkest and Dr. Brent Myers from NAEMSP 2024. We discuss an intriguing concept in cardiac arrest… giving the initial dose of epinephrine IM instead of starting an IV or IO. They discuss a 2021 paper that compared this approach to standard dosing in a feasibility study done in Salt Lake City. Those authors released some additional data from this study… this t...

EMS History is full of interventions we've rapidly adopted, often at great expense and with disruption of existing processes, that later turned out to, how should I say this..... not work. Want examples? MAST and high-volume crystalloids in trauma. Mechanical compression devices, high-dose epinephrine, indiscriminate calcium administration in cardiac arrest. Do I even need to mention backboards? T...

What would you say if I told you that Black patients were less likely to receive pain medication compared with white patients? My guess is you’d either question the methods, assume it isn’t possible, or ask why. Regardless of what your answer is, you’re going to want to listen to this episode. Mikey V returns to co-host a live episode from the ESO PCRF research forum, where we interview Drs. Remle...

Have you heard that you’re supposed to decrease the dose of your sedative when performing RSI on hypotensive patients? First, avoid asking why you haven’t addressed the hypotension before intubating.. maybe there’s a reason. Maybe. But, regardless of why, intubate you will. What about those doses? I’ve been hearing for years that I should be dropping the dose of sedation before RSI. But what evide...

Y’all know I have thoughts on epinephrine in cardiac arrest. Perhaps you might have heard me say epinephrine “saves the heart at the expense of the brain.” I’ve also said I don’t have an issue with any epinephrine in arrest, just how we give it currently, and have wondered if less epi might do the trick. We reviewed the One and Done paper recently published from North Carolina that looks at this q...

We’ve spoken a lot recently about intubation First-Pass Success, including the definition. We’ve also discussed different papers about the impact the type of laryngoscope, video or direct, has on first-pass success. A new paper compares video vs. direct laryngoscopy directly. Join us to discuss the DEVICE trial.   Citations:  1) Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngosc...

What even is FPS? There's been a long-running argument about the definition of FPS. By argument, I mean mostly established in the literature, with some people not liking it. FPS is successful ET passage through the cords within 1 attempt at laryngoscopy or when the blade passes the teeth. That definition worked well when we were using direct laryngoscopy, where the hard part of intubation was visu...

A new study describes the utility of post-mortem CT panscans in patients who died either in the field or in the ED to identify mortal and potentially mortal injuries. This paper has a couple of surprising findings that can help EMS focus our efforts on caring for these patients.  Citations:  1. Levin JH, Pecoraro A, Ochs V, Meagher A, Steenburg SD, Hammer PM. Characterization of fatal blunt injuri...

DSI (delayed sequence intubation) has been proposed as an alternative to RSI (rapid sequence intubation) for patients who can't tolerate interventions needed to properly pre-oxygenate patients. But does it work? There have been several observational studies (blatant bias acknowledgment: I wrote one of them!) suggesting it is safe and effective, but no randomized trials. Well, now we have one. Join...

In episode 69, we interviewed Tanner Smida about his very interesting paper using the ESO dataset. It looked at the association between survival from out-of-hospital cardiac arrest and the type of SGA used (iGel vs. KingLT). He found 36% higher odds of survival with iGel.  The ink was barely dry on that paper before he published a follow-up paper looking at the same association but with a differen...

Man, did we have fun recording this one? I found myself in a hotel room in Ashland, Oregon, with Drs. Ed Racht, Maia Dorsett, and Ritu Sahni talking about Sepsis. We decided this would make for a great crossover episode with The EMS Show, minus our buddy Mikey V. Anytime I get together with this group of friends, I always have fun. We discuss a new sepsis trial, the OG sepsis paper, Dr. River's Ea...

The cage match you've all been waiting for! iGel vs King LT in cardiac arrest. Which is associated with higher survival? Airways-2 was an RCT of iGel vs. ETI in OHCA and found no difference. PART was an RCT of King LT vs. ETI in OHCA and found a slight difference favoring King LT. How about those patients just getting an SGA? How does the iGel compare to King LT? Dr. Jarvis interviews the amazing...

Remember AIRWAYS-2, the British RCT comparing iGel to ETI in adults with cardiac arrest? Have you wondered if those results would hold up in a different prehospital population? Wonder no more! Dr. Jarvis reviews the SAVE Trial, another RCT of adult, non-traumatic cardiac arrest, comparing iGel to ETI in Taiwan.  Citation: Lee AF, Chien YC, Lee BC, et al. Effect of Placement of a Supraglottic Airwa...

If one is good, two must be better, right? If it applies to cookies and ice cream, why not defibrillators? That’s the question the DOSED-VF trial set out to answer. We’ve covered this topic in episodes 12 and 27, including going over the pilot trial of DOSED-VF. But now the full meal deal is available. And you may have heard it was stopped early because… well, you’d best listen to find out.   As a...

Dr. Crowe returns to the EMS Lighthouse Project Podcast from our “vacation” in Mexico to discuss the impact of variations between pulse oximetry and blood gas values across races.   Citations: Sudat SEK, Wesson P, Rhoads KF, et al. Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course. Am J Epidemiol . Published online September 2022:kwac...

National guidelines for the management of seizures recommend midazolam 10 mg IM as first-line therapy. The big question is how often EMS follows this guideline or how well that guideline matches up to real-world use. Dr. Jarvis makes a road trip to ESO headquarters to discuss this paper using the ESO research dataset with newly minted Texan Mike Verkest and special guest Dr. Remle Crowe. As we get...

First, there was Episode 31: TXA for Epistaxis (the Zahed RCT from Tehran), then Episode 40: TXA for Epistaxis, Part Deux (the NoPAC trial), and now Episode 64: TXA for Epistaxis, Part Trois, another Iranian RCT.  So, we have conflicting evidence, all from RCTs, about whether TXA works for epistaxis. Dr. Jarvis reviews the prior trials and then provides a more detailed analysis of the new evidence...

COVID sucks, no doubt about it. Vaccination has been a game changer for how we live through the pandemic, but we still need therapeutics for those breakthrough cases and the unvaccinated amongst us. Paxlovid is a novel anti-viral agent that showed promise in an initial industry-sponsored trial among unvaccinated patients with the delta strain. But does it hold up in the real world where vaccinatio...