Advanced Critical Transport

Oxygen and blood perform a “dance” in the lungs—when one partner doesn’t show up, oxygenation breaks down.

🫁 Ventilation (V) – air reaching the alveoli
❤️ Perfusion (Q) – blood reaching the alveolar capillaries

When they’re out of balance, we see:
🔻 Low V/Q → pneumonia, airway obstruction, asthma, COPD
🔺 High V/Q → pulmonary embolism

Understanding which side of the equation is failing helps guide the right treatment, and the right outcome.

🩺 BETA BLOCKER OVERDOSE:

What Every Prehospital Provider Should Know

Early recognition, supportive care, and prompt consultation with poison control can make the difference between stabilization and rapid deterioration.

Swipe through for:
⚕️ Key history questions
⚡️ Critical signs & symptoms
💊 Common beta blockers and their toxic effects
🏥 Treatment priorities — from the field to the ICU

Your patient starts to decline after intubation — what’s your next move?
Run through DOPES, the go-to mnemonic for post-intubation troubleshooting:
🔹 Displacement
🔹 Obstruction/Oxygen
🔹 Pneumothorax
🔹 Equipment
🔹 Stacking/Stomach

🚨 SCAPE: Sympathetic Crashing Acute Pulmonary Edema (flash pulmonary edema)

SCAPE is a rapidly progressive and life-threatening emergency often mistaken for classic CHF. Unlike fluid overload, it’s driven by a sympathetic surge and severe hypertension, leaving only a short window for recognition and intervention.

🔎 Key signs: Hypertension, dyspnea, pink frothy sputum, hypoxia, agitation
💊 Treatment focus: High-dose IV nitroglycerin + CPAP/BiPAP

⚡ Why it matters: Patients can deteriorate in minutes without aggressive management.

📘🚑 From Our Orientation Guide to Your Feed
At ACT, we build our training around the realities of transport medicine. This ventilator mode summary comes straight from our new employee orientation guide, the same resource our team uses to prepare for high-acuity transports.

👩‍⚕️👨‍⚕️ Share with colleagues who live and breathe critical care transport.

🍋 When life gives you LEMON…
The LEMON mnemonic helps providers anticipate a difficult airway before the first attempt.
Do you use LEMON in the field?

🚑💨 Severe pediatric respiratory distress OH NO!

Magnesium sulfate is sometimes added as a supportive therapy with albuterol, epi, and steroids. While evidence on its effectiveness is debated, studies show it may reduce hospitalizations with minimal downside.

📊 Dose: 25–75 mg/kg IV (facility-specific)
⚡ Onset: Immediate | ⏱️ Duration: ~30 minutes

👉 What’s the dosing for magnesium sulfate in your protocols? Let us know your experience in the comments.

🚑💉 Blood Thinners in the Prehospital Setting

Patients on anticoagulants or antiplatelets are at a much higher risk of life-threatening bleeding, even from seemingly minor injuries.

For EMS providers, early recognition is critical, especially in cases of:
🔴 Head trauma
🔴 Suspected GI bleed
🔴 Stroke/CVA
🔴 Abdominal aortic aneurysm (AAA)
🔴 Other internal hemorrhage

📌 Knowing the common medications (Eliquis, Xarelto, Plavix, Warfarin, Heparin, etc.) and communicating this information to receiving teams can directly impact patient survival and outcomes.

This week’s ICU spotlight: Blood Thinners for Prehospital Professionals.

👉 Swipe through to review key medications that affect your patient’s clotting cascade

💉 Weekly ICU: Acetylcysteine
In the critical care transport world, we most often encounter acetylcysteine during interfacility transfers—especially when moving patients for pediatric specialty care or organ transplant services after significant acetaminophen overdose.
Understanding the dosing protocols, infusion strategies, and potential side effects is essential for safely managing these patients en route. Even though the medication is typically initiated at the sending facility, transport teams must monitor for adverse reactions, ensure infusion accuracy, and communicate effectively with the receiving team.

📚 This week’s post covers:
✅ Standard & simplified IV regimens
✅ Common side effects & anaphylactoid reactions
✅ Key monitoring considerations during transfer

🧠 Traumatic Brain Injury (TBI)
In the prehospital setting, time is brain. This week’s graphic breaks down the pathophysiology, differential diagnoses, and evidence-based management of TBI so you can recognize and respond faster in the field.

👩‍⚕️ Primary vs. Secondary Injury
📋 Critical Signs of Herniation
⚠️ Pearls on TXA, hyperventilation, and more

💉 TXA administration remains a hot topic in TBI care—let us know your thoughts or local protocols in the comments.

Abdominal Aortic Aneurysm (AAA) is a time-critical emergency that can present subtly—but rupture is often fatal without rapid intervention.

Prehospital providers: early recognition and targeted blood pressure control can make all the difference. Stay sharp, stay prepared.

Looks like withdrawal. Or a seizure. Or an OD. Until it’s not.

Serotonin Syndrome is fast, dangerous, and resembles a lot of other possible diagnoses. This ICU breakdown gives you the tools to spot it early and act fast in the field.

Know your meds. Know your tox. Know your role.