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🎧 Episode Summary:
In this dynamic episode of the Pre-Hospital Paradigm Podcast, Scott Wildenheim and the full crew—Caleb Ferroni, Ray Pace, and Dr. John Hill—tackle a grab bag of listener-submitted EMS clinical questions. From cardiac chest pain and anaphylaxis to airway burns and medication errors, no topic is off-limits. These questions, sourced from students and field providers, generate thoughtful, experience-driven discussions full of actionable takeaways. Whether you're a new EMT or seasoned paramedic, you’ll find insights worth taking back to the truck.

🧭 Key Topics Covered:

1. Differentiating Cardiac vs. Non-Cardiac Chest Pain

   • Why palpation is not definitive

   • Importance of serial EKGs, trends, and full assessments

   • Ischemia vs. infarction and why treating early matters

2. Epinephrine in Anaphylaxis: Are There Contraindications?

   • No true contraindications in life-threatening anaphylaxis

   • Role of IM epi, Benadryl, steroids, and H2 blockers

   • When symptom relief from nitro isn’t diagnostic of cardiac origin

3. Airway Burns: Management Pearls

   • Early intubation vs. surgical airway preparation

   • Signs to watch: soot, singed hair, stridor

   • Decision-making: tube or knife, and when to switch gears

4. High-Risk Refusals and Documentation

   • Key elements: capacity, complete vitals, risks explained

   • Importance of narrative, witness documentation, and MD consult

   • Using law enforcement for body cam documentation support

5. Status Seizures: After Midazolam, What Next?

   • Re-dosing midazolam, airway management, and ketamine as adjunct

   • Importance of identifying underlying causes (e.g. hypoglycemia)

6. Suspected Sepsis in the Stable Patient

   • Utilizing SIRS criteria and clinical gestalt

   • Role of fluid resuscitation prehospital

   • Why early recognition matters—and when not to jump to antibiotics

7. Dopamine vs. Epinephrine: Vasopressor Use

   • Why epi is preferred in most field situations

   • Dopamine’s decreasing relevance in modern EMS protocols

   • Reminder: norepinephrine is still first-line in hospital settings

8. Pediatric Medication Safety & Dose Calculation

   • Common EMS drug errors: epinephrine and ketamine

   • Benefits of tools like Broselow, Handtevy, OneDose, CertiDose

   • Why repetition and readiness matter in low-frequency, high-risk calls

9. Postictal Seizure Management

   • Supportive care: glucose, airway protection, reassessment

   • Preparation for potential recurrence

10. When to Downgrade ALS to BLS—And When Not To

    • Clinical criteria, resource awareness, and provider judgment

    • Why chest pain, AMS, and abnormal vitals are red flags

11. Glucagon for Beta Blocker OD and Esophageal Impaction

    • Why epinephrine is favored for bradycardia/hypotension

    • Review of research and changing practices around glucagon use

From The Episode