Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Ross Orpet, Paramedic turned EMS Physician
107 episodes
5 days ago
Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters.
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Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters.
Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
1 hour 19 minutes 29 seconds
5 months ago
The Art of Managing Agitated Patients
Effective agitated patient management requires a fundamental shift from viewing these encounters as behavioral problems to recognizing them as medical emergencies with underlying pathophysiological processes. By systematically addressing safety, identifying root causes, selecting appropriate pharmacological interventions, and maintaining rigorous post-sedation monitoring, EMS providers can dramatically improve outcomes for these challenging patients. Remember: you cannot talk someone out of a hypoglycemic crisis, hypoxic emergency, or sympathomimetic overdose. When verbal de-escalation fails, it's not your failure as a provider—it's an indication that medical intervention is required to address the underlying pathophysiology driving the patient's agitation. The goal isn't just to control behavior—it's to provide definitive medical care that addresses the root cause of the patient's distress while maintaining safety for everyone involved.
Our guest is Patrick Hendley, a practicing paramedic and an expert in agitated patient management. We'll explore the pathophysiology behind agitation and essential strategies for EMS providers faced with these calls. We'll also examine sedation choices, restraint use, and post-sedation care through a lens of real-world EMS principles. Join us as we look at more than just de-escalation, but understanding and acting effectively and ethically to safeguard everyone involved.
Don't forget to check out our sponsor, The Resus Tailor, for custom bag designs tailored to your EMS needs. Reach out to them at theresustailor.com.
00:00 Introduction to Loud and Clear EMS
00:27 Today's Topic: Managing the Agitated Patient
01:00 Guest Introduction: Patrick Henley
02:17 Sponsor Message: The Recess Tailor
03:01 Case Study: Agitated Patient Scenario
06:04 Understanding Agitation and Safety Principles
08:12 Sympathetic Nervous System and Agitation
10:00 Factors Contributing to Agitation
13:02 Drug Influence on Agitation
19:05 Safety Hierarchy in EMS
30:34 Transport Safety and Patient Management
33:07 Treating Underlying Causes of Agitation
39:08 Managing Patient Anxiety with Fentanyl and Oxygen
39:45 Using Ketamine for Pain Control and Sedation
40:25 Addressing Mixed Presentations: Schizophrenia and Substance Use
41:38 Treating Sympathomimetic Overdose and Psychosis
42:56 The Importance of Post-Sedation Monitoring
43:51 Verbal De-escalation and Benzodiazepines
45:00 Using Time as a Tool for Postictal Patients
46:11 Understanding Benzodiazepines and GABA Receptors
47:59 Antipsychotics and Ketamine: When Benzos Aren't Enough
59:17 The Role of Physical Restraints in Patient Management
01:08:43 Effective Handoff and Continuity of Care
01:18:11 Final Thoughts and Core Principles
Resources
The Resus Tailor - https://www.theresustailor.com/
The Art of Managing Agitated Patients Supplemental Blog Post - https://emspodcast.com/the-art-of-managing-agitated-patients/
Gear We Like
Books we recommend -
The Dichotomy of Leadership - https://amzn.to/4fiCAjN
Extreme Ownership - https://amzn.to/3O1FWfa
Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf
Thinking Fast and Slow - https://amzn.to/4fiJG85
A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2
Good Stethoscope - https://amzn.to/3YJJrf2
Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
Notepad for taking notes on calls - https://amzn.to/3Z1X21J
Sunglasses - https://frontline-optics.com/discount/EMSCAST15
Guest/Cast/Crew information-Guest- Patrick HendleyHost- Ross Orpet, Will Berry Catch up with us after the show
Instagram- @emsloudandclear
YouTube- https://www.youtube.com/@EMSLoudandClear
Website- www.emspodcast.com
Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters.
