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FlightBridgeED Articles


Klint Kloepping
13 May 2018
It is with a heavy heart that we at FlightBridgeED extend our condolences to the Spirit family.  The news that we have lost a HEMS provider is never easy to hear, especially for co-workers and family members.  In addition, this tragedy has pulsated through the HEMS industry and left us with emptiness in our hearts and leaving us with ques...
Mike Verkest
06 May 2018
Let’s jump right back in…Our patient is pre-oxygenated to an SpO2 value in mid-to-upper 90’s, the drugs go in, no problems identified so far…The HEAVEN criteria we identified in the last post give us a hint of what we have to look forward to.  She has long history of COPD and has some potential airway anatomical issues due to smoke inhalation....
Klint Kloepping
11 April 2018
Recently there has been a lot of discussion around the administration of intravenous fluids for the critical care patient.  It has long been a staple of care for patients in a hypotensive crisis and not many providers have questioned the use of this therapy.  Not only what type of fluids that should be given, but should they be warmed or ...
Tyler Christifulli
04 April 2018
Dr. Dan Davis posed some great questions in response to my last blog/podcast on CVP. Here is my feeble attempt at answering them. Question #1: First, can you fill in the missing puzzle piece: the heart?  How do atrial and right ventricular pressures affect the equation?   In my first post on this topic we stated that a plet...
Bruce Hoffman
28 March 2018
Mixed venous oxygen saturations can help to establish the relationship between oxygen consumption and oxygen delivery.  Understanding the difference between the amount of oxygen being delivered and the amount of oxygen being consumed by the body can lead the clinician to early detection of a soon-to-be-deteriorating patient.  The mixed ve...
Klint Kloepping
13 March 2018
Many years ago a man took his afternoon tea underneath an apple tree.  As he was enjoying this most delicious tea, he was struck on the head by a falling apple.  What does this have to do with trauma?.  This incident gave birth to modern day physics and most importantly to Sir Isaac Newton’s three laws of motion.  The three laws...
Tyler Christifulli
03 March 2018
While this question seems to be splitting hairs, it’s actually an interesting cross section of beliefs. To state a normal CVP is 0-5 mmHg you have to believe that a spontaneously breathing patient can have a perfectly acceptable cardiac output with a CVP of 0. Which also would mean you believe that a CVP does not need to be higher than zero to prov...
Mike Verkest
01 March 2018
Welcome to part 3 of our series on the Adult Burn patient.  As both Tyler Christifulli and Dr. Dan Davis pointed out in the last article, we are in a bit of a pickle.  We have an elderly patient that was rescued from a house fire. She is alert and talking but showing sign of decompensation.  Her oxygen saturations are terrible, she h...
Klint Kloepping
19 February 2018
Critical care transport medicine is designed to take ICU-level care to the patient. Ever emerging technology continues to allow the critical care transport provider to escalate the care and competence delivered to our patients.  One of the least-discussed measurements for the critically ill or injured and intubated patient is the endotracheal ...
Bruce Hoffman
12 February 2018
Yes, this is a medical article; yes, it is relevant to the critical care transport provider and finally, yes, it is definitely worth reading.  Suffice it to say that you’ve already passed the most difficult piece of this article – the title.  With that said, let’s cut to the point.  The ports on a flow-directed pulmonary artery cathe...
Tyler Christifulli
05 February 2018
Imagine you are blowing up a beach ball. As you begin to exhale into the port you notice very little to no external changes in the progress of your efforts. For the first few breaths you are creating what is referred to in physiology as “unstressed volume.” This is a linear volume that is proportional to the compliance of the container. As you...
Mike Verkest
29 January 2018
We started off this second part to the burn case review with a history of what happened and a rapid trauma assessment.  Let’s take the management of this patient one system at a time. Like Klint had mentioned, and what you should know is, we are not moving past the airway until we come up with a plan of action. This patient is at a critical ju...
Eric Bauer
28 January 2018
Strategic AlignmentFlightBridgeED has been dedicated to the mission mindset of bringing you the very best education since the inception of – “The FlightBridgeED Podcast” in 2012. Within this continued framework, FlightBridgeED is consistently trying to find new ways of delivering the highest quality critical care education. It’s with that mindset t...
Klint Kloepping
24 January 2018
While central venous pressure (CVP) has been measured for generations within the ED and ICU, the routine use of this modality has been challenged over the past decade.  As transport providers, it is imperative that we understand the risks and benefits of each of the diagnostic and therapeutic interventions we perform.  With regard to CVP,...
Bruce Hoffman
14 January 2018
Since the inception of hemodynamic monitoring, square wave testing, also known as dynamic response testing, continues to intermittently confuse both new and experienced critical care providers.  Square wave testing can have a direct impact on the validity and accuracy of the hemodynamic values which are obtained from the invasive monitoring de...
Tyler Christifulli
30 December 2017
Pre-oxygenation is the process of obtaining a desired oxygen saturation prior to intubation. In this article we will discuss the three different factors that will affect your ability to pre-oxygenate, and the variables that change the rate at which desaturation occurs. In a clean ventilation/perfusion ratio, the oxygen should be able to freely...
Mike Verkest
26 December 2017
This is the first of a 3-part blog that will follow the clinical course of a 68-year-old female who was rescued (in dramatic fashion) from a house fire. In the early hours of a random Tuesday, a fire has started in the attic space of a large house built in the 1970s. At the time of the fire, the house was occupied by 3 adults. Upon arrival of the f...
Klint Kloepping
26 December 2017
The American Heart Association has recently released their guidelines on the new normal for blood pressure.  According to the new guidelines anyone who has a blood pressure that is 130/80 is considered to have Stage one hypertension.  What does this mean?  Does this mean more patients will be placed on daily blood pressure medication...
Bruce Hoffman
05 November 2017
 Anger is one of the great emotional equalizers.  Chances are you’ve felt it; acted on it; regretted it, or even denied it.  It is estimated that one out of every 10 persons’ experience anger and, additionally, have troubling controlling it.  Anger can cause some serious issues, if not channeled in an appropriate and...
Klint Kloepping
30 October 2017
Editors note: The FlightBridgeED Blog team is now performing peer reviews of each article. We encourage you to get invloved as well. At the end of each post, you will find at least 2 peer review commentaries, sometimes in agreement with the article, sometimes not...We want to challenge each other (and you) to bring clincially relevant information t...
Eric Bauer
18 October 2017
  It’s a natural tendency for any person to want to have power or control in their lives.  This doesn’t stop with us in our roles in the work environment. I believe that the feeling of our understanding of a lack of control is a major contributor to ones success and failures.  This type of feeling only adds additiona...
Mike Verkest
17 October 2017
I’ll just start out by saying WORDS MATTER. I’ll follow that up with a warning that this may be a bit of rant.  Simple manners have seemed to have lost their way…Going on my 23rd year in EMS, I’ve been victim and perpetrator of poor manners. As an EMT, going the extra mile on station duties… as a medic, going ab...
Tyler Christifulli
14 October 2017
  Lately I have been studying the way people respond to criticism, correction, and challenged expressions. I can’t help but notice the embedded instinct we all carry to defend our beliefs on concepts that maybe we weren’t even that passionate about to begin with. But when we are challenged, this topic becomes more than just th...
Mike Verkest
07 October 2017
 As I approach the later years of my career, I have had my share of calls. I've seen the things I don’t care to see and I remember things I don't want to remember. In my current role as an EMS Training Officer, I don't face patients every day, but I do face the ones who do. I struggled with this for a long time, as I felt getting "out of...
Bruce Hoffman
18 September 2017
 On a recent flight back to Connecticut, I had the opportunity to reflect a bit on listening.I talk. A lot. It is rare the day that I, or anyone other healthy human, is deprived the gift of speech.  I realized my understanding of essential communication rested in the verbal.Boy, did Mr. Larson (keep reading) have a lesson waiting for me…A...
Klint Kloepping
18 September 2017
 On Friday September 8, 2017, the most unimaginable, yet all too common happened. Imagine getting the phone call saying that there has been a crash.  Immediately there is sheer terror and disbelief followed by panic, anger and sadness.  They have just lost three incredible members of their team and a patient.  They have just exp...
Mike Verkest
03 September 2017
 I recently came across a case file for a novel use of (Resuscitative Endovascular Balloon Occlusion of the Aorta) REBOA in the setting of traumatic cardiac arrest. Typically, REBOA is used for injuries in the pelvis and abdomen. This procedure was born on the battlefield as physicians were looking for a way to get our severely wounded soldier...
Tyler Christifulli
03 September 2017
A 52 Year old male presents to the emergency department with 6/10 substernal chest pain that started two hours ago. Patient has already taken NTG X 3 and 324 mg ASA. Patient states he was sitting in his chair when the pain started.Vitals BP 90/40HR 54 Sinus RhythmSp02 97%...
Klint Kloepping
25 August 2017
                      It is 2017 and we are on the brink of some really exciting things in the field of Emergency Medical Services.  The care is arguably more advanced than ever and to see field providers and medical directors really getting on board with evidence based medicine has b...
Bruce Hoffman
04 August 2017
I recently had an experience with a co-worker who seemed “off”; distracted; consumed by something other than what he was supposed to be doing.  In typical fashion, I bit, queried and then listened.  He unpacked several latent issues that had been bothering him – some about his work, others about his personal life and sti...
Klint Kloepping
21 July 2017
Crew Resource Management (CRM) is something that many of us have heard about and practiced at one point or another in our careers.  Where did this idea of CRM come from and how can it be applied to the modern air medical industry?  In the 1970’s, there was a big push to reduce contributing elements that resulted in aviation mishaps;...
Bruce Hoffman
07 July 2017
Peter Klein, the founding director of the Global Reporting Centre, recently published an article via The Globe and Mail about teaching (1).  He reminisces on his early days as a student and hearing the expression “those who can’t do, teach and those who can’t teach, teach gym”.  He quotes Mr. Woody Allen, a charact...
Mike Verkest
02 July 2017
 Hey Guys, I thought I would share a facinating case report I came across while researching REBOA and trying to udate a talk on Trauma...vertical shear to be specific. Take a look at this amazing story of a 28 year old female who survived a 300 ft fall while climbing a rock face. https://sjtrem.biomedcentral.com/articles/10.1186/1757...
Tyler Christifulli
01 July 2017
One thing we can be sure of throughout the changes of advanced cardiac life support (ACLS), is that chest compressions have remained relatively consistent in recommendation and level of evidence from the American Heart Association (AHA). Besides some clarification in 2015 on the maximum frequency of chest compressions per minute 1, the science behi...
Mike Verkest
28 June 2017
 I had the opportunity to talk about a horrendous call with some co-workers. The situation was described by a deputy chief as "one of the most complex and difficult extrications I have ever seen in my 35-year career"The operators were experienced. Very experienced. They have the technology and equipment to get people out of the most unthinkabl...
Klint Kloepping
19 June 2017
Airway management is a skill which many prehospital practitioners pride themselves.  Hours of practice, preparation, and lab time go into managing the airway.  One aspect of airway management that is focused on less often is the pediatric airway.  It is talked about and yes, maybe even practiced on, but what about the actual patient ...
Bruce Hoffman
11 June 2017
I don’t know that there is anything that gives me an insta-aneurysm more than the casual educational cliché “yea – that’s the way we teach it in here, but when you’re out there, its totally different”.  Pardon me, but…really?!  Statements like that belong nowhere, and I mean NO WHERE near ...
Tyler Christifulli
03 June 2017
The other day I was laid up sick in bed and listening to the soundtrack of my house. It included little feet running, cartoons playing, and of course babies crying. Besides realizing my wife was Wonder Woman, I noticed that she could almost immediately tell what the baby needed by its cry. I thought to myself, "My wife has become a master of little...
Mike Verkest
26 May 2017
This is Part III of Lessons learned from Extreme Ownership Muster 002 held In NYC in early May 2017.So far, we have covered the general concepts of the muster and the first of the 4 laws of combat. The first law, what Jocko and Leif call “Cover and Move” is translated loosely to removing silos and building relationships.  I hope yo...
Klint Kloepping
17 May 2017
In emergency and prehospital medicine we often find that we are extremely driven to be perfect.  The job we do, the things we see, are things most people would never even fathom.  Most of us are hard on ourselves and want to get it right each and every time.  Seeking perfection is always good, but how well do we evaluate and admit ou...
Mike Verkest
17 May 2017
 In my last entry, I mentioned the laws of combat.  Again, the laws seem to make no sense when you try to apply them to Fire/EMS/HEMS…the concepts are simple, but not easy.No SilosTeamworkIf one fails, we all failBuilding RelationshipsJocko and Leif told a story about the multi-disciplinary teams involved in the fight for Ramadi. Y...
Mike Verkest
06 May 2017
Over the last few days, I had the opportunity to learn about the laws of combat. At first blush, The laws of combat seemingly have no place in Fire/EMS/HEMS..... or do they? Echelon Front, a company founded by Retired U.S Navy SEALs Leif Babin and Jocko Willink recently held Muster 002 in New York City. The Muster had attendees from 12 countries an...
Klint Kloepping
20 March 2017
  It happens more often than not.  We get into a routine and forget the most basic part of our job, communication.  In HEMS we work with a lot of the same people, however, once in a while we may work with someone different.  At that particular point in time our communication will be vitally important.  Communication wi...
Eric Bauer
24 February 2017
 Leadership PursuitsLeadership is the basis for all things we do in life. Whether at home with your children or during your career, leadership skills need to be established early on and continuously developed. Our pursuits to become the best leader possible should never stop. The focus starts with understanding your relevance and the experienc...
Eric Bauer
22 February 2017
 It’s a natural tendency for any person to want to have power or control in their lives.  This doesn’t stop with us in our roles in the work environment. I believe our own awareness of our lack of control is a major contributor to ones success or failures.  This type of feeling only adds additional stressors in our lives, but also af...
Bruce Hoffman
22 February 2017
  I recently listened to a five-minute-ish Ted Talk given by Ric Elias on the “3 things I learned while my plane crashed”.  If you haven’t had the pleasure of listening to it, just click here and engage!  I won’t spoil the storyline of his talk, but there were a few key points that I can easily recall; each one relevant to quest...
Klint Kloepping
12 February 2017
    Any professional actor, actress, or performer will tell you the most important part of their job is the dress rehearsal.  It makes sense…right?  They go, in full costume garb, and perform as if there’s a full audience, with one major exception – there are no paying customers watching!  They do this to perfect,...
Klint Kloepping
27 August 2016
   Extracorporeal Membrane Oxygenation has been around for a long time. The utility of this modality has widely been used in children for a long time, and is slowly becoming a standard of critical care for the acutely ill adult.  Many critical care transport programs safely and efficiently move ECMO patients on a regular basis w...
Klint Kloepping
03 June 2016
  A big part of many EMS system’s medical guidelines is their STEMI protocol. This may be common place in today’s culture, but this was not always the case.  STEMI protocols have been around for a long time, but in the early 2000’s the emergency and critical care medical communities saw their role dramatically increase in popularity ...
Bruce Hoffman
03 June 2016
  A few weeks ago while I was in a notable healthcare facility, I overheard a provider say “I’m so sick and tired of hearing that “it’s all about the patient”.  Not trying to create a scene I casually glanced over at the individual, locked eyes with her for a hot second, and then continued on my way.  Not being one to mince my w...
Klint Kloepping
09 March 2016
 As medical professionals we tend to respond to a lot of different and often difficult situations.  The way we’ve trained our minds and our emotions to deal with the situation is to get the job done.  It is safe to say that we become emotionally closed off to what is going on around us in order to complete the mission.  Fantasti...
Bruce Hoffman
28 February 2016
  I can remember, with distinct clarity, the first few calls that I was involved with during my paramedic internship.  Specifically, I can recall hearing the phrase “now you get to see how we really treat patients”.  I remember being confused and not quite sure what to do.  On one hand I had just completed one of the most i...
Eric Bauer
25 February 2016
  Subdural Bleed - NewNote:  The Blue arrow showing newer bleeding based on the white-ligher area.  The RED arrow is showing the shift past midline called a subfalcine herniation.   ...
Eric Bauer
19 February 2016
 Scottsville, KY -- (ReleaseWire) -- 02/19/2016 --The educational team at FlightBridgeED is proud to announce the third year anniversary of the highly successful and globally recognized podcast that has become the go to source for pre-hospital critical care providers working in the helicopter and ground based emergency medical services industr...
Klint Kloepping
15 February 2016
 One of my favorite subjects to teach, train, or talk about is airway management.  There are so many different ways to perform airway management and each scenario has its own special needs.  It is safe to say that I have been a believer in and doer of one particular way for the last three or more years.  It is called the D-Grip....
Eric Bauer
02 February 2016
 H.R. 4365, the Protecting Patient Access to Emergency Medications Act of 2016 Background ...
Bruce Hoffman
28 January 2016
 There has been a recent upsurge in the numbers and personality types of private and commercial social media platforms.  These include, but are not limited to blogs, twitter handles, podcasts and facebook pages.  Simultaneously exciting and scary, these (at times) bold and controversial domains can be the breeding ground for the good...
Eric Bauer
23 January 2016
 It is with a heavy heart that currently one of our own is lying in an ICU, fighting for his life in Louisville, KY.  John Malcomson is a friend and collegue to many!  We can' t find the words to describe the heavy hearts we all share.  John & his wife Bekki have dedicated their lives to serving others. John as a Firefighter...
Klint Kloepping
20 January 2016
 Hopefully we have all survived the holidays, had a chance to digest our holiday food and part one of this series on sepsis.  The next item to review is clinical care in sepsis management.  The main player in this is the Surviving Sepsis Campaign (1).  This campaign is aimed at clinical care of sepsis patients and has been aroun...
Bruce Hoffman
13 January 2016
   An autopsy, also known as medical obduction, is a surgical procedure used to perform a thorough and comprehensive examination of a dead body.  This is done to determine the cause and mechanism of death and to evaluate the presence of any disease or injury.  As part of my continuing medical education, I have participated ...
Klint Kloepping
06 January 2016
  There is so much buzz in the world of Emergency and Critical Care transport medicine about the use of prehospital ultrasound technology.  This technology has become more affordable and more widely available and the clinicians in these areas of practice are ready to have this tool at their disposal.  The biggest question I hear...
Eric Bauer
05 January 2016
    If you have listened to the Second shift podcast, you know we like our movies and TV shows….I am always down for a great distraction and I think, if you have the time, there is nothing better than a good movie or an episode of “this old house” (right, Dr. Antevy?)  Even though it didn’t make my top 5, I think one of my ...
Bruce Hoffman
30 December 2015
Have you ever worked with someone who thinks they are always right?  I know I have.  They think they are right…about everything…all of the time.  As a life long (so far) student, I have embraced the blended emotions associated with learning – unimaginable joy and labored challenge.  Whether it is hearing new ideas, cre...
Klint Kloepping
23 December 2015
Perhaps it’s only me, but it seems that the “new” critical care buzz word of the quarter is sepsis; and honestly, why wouldn’t it be?  Sepsis is killing more and more patients and, to date, we have not figured out the magic bullet to proper sepsis therapy and treatment.  Since 2002, the Surviving Sepsis Campaign, has been working to devel...
Bruce Hoffman
16 December 2015
  Here may be another reason why you should.I’m not sure about you, but when I went to school to become a paramedic (and a nurse for that matter), one thing I never really understood was heart sounds, or heart tones, depending on who taught you.  My attempt at learning such resorted to scouring textbooks, journals, online editorials,...
Klint Kloepping
09 December 2015
SMACC Dublin registration is less than a week away. Ahead of SMACC Dublin I am getting a lot of questions from friends and colleagues about what FOAM is. My first reaction is that I cannot believe people in society and especially in medicine do not know what FOAM is. For those who do not know FOAM is Free Open Access Medical Education also known as...
Bruce Hoffman
01 December 2015
  Provocative title, I know, but it may be time for a gross reality check.  I know I was; and boy, was I glad for the experience; I think the question has heightened my awareness to the integral role that honesty has in our profession.  The following is not meant to be punitive, derogatory or malicious, but rather the musings of...
Evan Claunch
24 November 2015
 All of us have that one thing we always go to when we work. No matter where you work or what you do, you have that one favorite device. Every practitioner has that one tool they use all the time. For years and years the one tool that has been used in the Intensive Care Unit has been advanced hemodynamic monitoring. The use of such lines has d...
Bruce Hoffman
17 November 2015
  Dr. Carol Dweck is internationally renowned for her inspiring work in the field of motivation.  Her book, Mindset, has generated lots of interest particularly in the area of "growth mindset".  Teachers from around the world have capitalized, expanded and interpreted her work through catchy slogans, creative bulletin boards and...
Klint Kloepping
11 November 2015
In the prehospital and retrieval medicine field there is always the push to put as much of the hospital out there as possible.  Scott Weingart calls it maximally invasive care everywhere.  This is not without certain hurdles and those of us involved in the work on the PHARM know this all too well.  One aspect of medicine that is ofte...
Bruce Hoffman
04 November 2015
I’m not sure about you, but I love learning (and teaching) with the use of metaphors.  They help me associate difficult subjects with something that I interact with on a more regular basis.  For example, when I first learned about the autonomic nervous system and its effects on the heart, it was bulky and complex, making it difficult to u...
Eric Bauer
22 October 2015
   I wanted to take the time and answer a few listener questions.  Based on an email I received from a very good and passionate critical care provider, I wanted to discuss the treatment and administration of long-acting neuromuscular blocking agents.  As FlightBridgeED has grown to the platform it is now, we have thousands ...
Klint Kloepping
20 October 2015
                   No matter what you do or where you go everything is driven by time.  Our shifts at the airport, emergency department, operating theater, and even our hobbies are based on time.  Whether we want to admit it or not, a clock is the thing the rules us all.  Those t...
Bruce Hoffman
22 August 2015
   With the onslaught of data, research, evidence based practice there seems to be one thing that WE are not addressing; and by WE I mean healthcare providers - nurse, paramedic, emergency medical technician, respiratory therapist, physician or medical assistant.  Are WE connecting with each other?  I know that we are connected ...
Eric Bauer
03 July 2015
 The FlightBridgeED family would like to honor Dr. John Hinds @DocJohnHinds after he lost his life doing what he loved.  It's very surreal to have just heard his lectures and insight at SmaccUS.  This is a great example of why you live life every day to the fullest and strive to leave a legacy that will be carried on by others.  ...
Klint Kloepping
04 June 2015
  The title catches you off guard right?! A paramedic who is claiming to be a clinician! It may outrage some and may even make some smile. Think about it for a second, are we as instructors creating a culture of technicians or clinicians? I understand that the T in EMT-P stands for technician. However, in this ever changing healthcare cli...
Mike Verkest
14 May 2015
    Hello everyone!  I'd be remiss if I didn't take few minutes to introduce myself! My name is Mike Verkest and I amcurrently an education consultant for FlightBridgeEd team and the EMS training officer for AMRMultnomah County (Portland) , Oregon. My EMS career started as a volunteer in rural Southern Oregonwhere I pr...
Eric Bauer
12 March 2015
  History Providers work hard to provide the very best care possible. However, often times, despite the excellent care we provide, our patients die due to other secondary events and disease processes.  Secondary issues such as inflammatory responses, ventilator lung injury (VLI), acute respiratory distress syndrome (ARDS), dissemina...
Eric Bauer
03 March 2015
  In this podcast, we take a look at the ever changing world of EMS and how the critical care arena is playing into the decision to carry specific medications. Dopamine has always been the staple inopressor medication for all EMS ambulances.  We’ve always had access to this medication, but limited access to other excellent vasopresso...
Eric Bauer
15 February 2015
   Case Study: The Nightmare Patient – Hypoxic Status Seizure...
Evan Claunch
15 February 2015
  Multiplying The Genius In Others ...
Eric Bauer
09 February 2015
                                                                              In this weeks podcast we are going to take a look at something we haven’...
Eric Bauer
03 February 2015
 Dead space is something we need to always look at and calculate when dealing with our ventilator patients.  We can calculate dead space in 2 different ways.1. 1 mL/pound of ideal body weight (neonates, pediatrics, small adults)...
Eric Bauer
03 February 2015
   Understanding how to positively make changes with our patients suffering from refractory hypoxia is essential in the prehospital and emergency medicine realm. From the start of our clinical training, we were taught to apply oxygen to all of our patients. As we’ve progressed through the education process and broadened our careers, ...
Eric Bauer
03 February 2015
 The Oxyhemoglobin Dissociation Curve can be confusing... However, it's an essential aspect to understanding oxygen physiology in critical care. Think of it as a "Manual for Dating". In a healthy relationship you have a good date, really like that person, but don't mind dropping them off after an evening out because you know you'll see th...

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