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Published by Mike Boone, Dan Rauh, & Dr. Amanda Humphries
The Heavy Lies the Helmet® Podcast is made by emergency and critical care professionals for clinicians working across the prehospital and hospital environments. Hosted by Mike Boone, Dan Rauh, and Dr. Amanda Humphries, the show takes an honest look at the clinical decisions, challenges, and experiences that come with caring for critically ill and injured patients. We work through complex cases, question assumptions, and explore the things that don't always fit neatly into a protocol or textbook. From clinical practice and teamwork to operations, leadership, stress, and the weight that comes with the job, these conversations are grounded in the realities of high-acuity care. No fluff. No corporate talking points. Just honest conversations for clinicians doing difficult work.
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The agitated patient is one of the most challenging encounters in emergency medicine. They may be yelling, fighting, refusing care, or creating an unsafe environment. But it's important to remember that agitation is not a diagnosis but a symptom. Behavior is a vital sign. In this episode, we challenge the assumption that every combative patient is intoxicated, psychiatric, or simply "difficult." We explore the broad differential diagnosis of agitation, including hypoxia, hypercapnia, hypoglycemia, traumatic brain injury, stroke, sepsis, toxicologic emergencies, and withdrawal states. Listeners will learn a structured approach to identifying life-threatening causes of agitation, recognizing important clinical clues, and balancing patient care, safety, and the need for rapid intervention. From the "frequent flyer" with a hidden medical emergency to the patient who appears intoxicated but is actually deteriorating, this episode reinforces a critical concept: Before we sedate the situation, we must diagnose it. Get CE hours for our podcast episodes HERE ! -------------------------------------------- X @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
FOAMed has revolutionized medical education, but has it also made it easier for bad information to spread? In this podcast episode, we explore the difference between evidence and opinion, what actually defines an expert, and why a large following doesn't necessarily mean someone is right. We'll discuss where expert opinion fits within evidence-based medicine, the role of medical direction and provider oversight, and how cognitive bias and social media can turn repetition into perceived truth. Join us as we discuss how to become a more discerning consumer of medical education and why the most important skill you can develop isn't finding the loudest voice but knowing how to evaluate what you hear. FOAMed isn't the problem. Uncritical consumption is. Get CE hours for our podcast episodes HERE ! -------------------------------------------- X @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Seizures demand fast decisions, but the best answers aren't always simple. In this episode, we sit down with Skyee Edwards, a pharmacist, to break down seizure cessation and prophylaxis in real-world emergencies. We go beyond traditional benzodiazepine-first thinking and explore how current evidence guides escalation to agents like levetiracetam, valproate, and fosphenytoin. Then we step into the evolving edge of care: where ketamine and lacosamide fits in refractory status epilepticus, and when propofol becomes a tool instead of a last resort. We also dig into common pitfalls such as delayed escalation, under-dosing, and not appreciating non-convulsive status. If you manage seizures in any high-acuity environment, this conversation will sharpen your approach from first contact through definitive control. Get CE hours for our podcast episodes HERE ! -------------------------------------------- X @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
In this podcast episode, we dive into the clinical chaos of Infective Endocarditis. It's a disease that can quietly destroy valves before showing its hand. We discuss how it presents, why it matters in transport and critical care environments, and how it can spiral into life-threatening complications like Cardiogenic Shock. Along the way, we touch on early antibiotic considerations and talk through hemodynamic support strategies such as push-dose Epinephrine when things start to fall apart. As always, the goal is connecting physiology to practical decision-making for clinicians who manage sick patients in dynamic environments. Get CE hours for our podcast episodes HERE ! -------------------------------------------- X @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Airway management gets dangerous. In this episode of the podcast, we explore prehospital bronchoscopy—a true bleeding-edge concept—and where it fits in managing airway obstruction before the hospital. We talk mucous plugs, massive hemoptysis, refractory hypoxia, how to address obstructions you can't fix with pressure or bronchodilators, and what to do when bronchoscopy is likely unavailable. This isn't about chasing new tools—it's about physiology, pattern recognition, and knowing when innovation may help. When it comes to considering prehospital bronchoscopy in your system, ask yourself the following: Is this something we need? Can we do the training to support it? Get CE hours for our podcast episodes HERE ! -------------------------------------------- X @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Mechanical ventilation doesn't have to feel like wizardry. In this podcast episode, we strip it back to what really matters—simple mental models, clean decision-making, and an approach that works whether you're in the back of a helicopter, a tight ambulance box, or a chaotic ED bay. We walk through the foundational concepts and the "why" behind each knob you touch. Then we zoom in on the Hamilton T1, the vent many of us love, hate, and still rely on every single shift. We cover what the T1 gets right, where people get tripped up, and how to let the machine work with you instead of against you. If you've ever wished mechanical ventilation felt less like memorizing settings and more like understanding physiology in motion, this episode will tighten up your practice and give you tools you can use on your very next flight or transport. Get CE hours for our podcast episodes HERE ! -------------------------------------------- X @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Mechanical ventilation doesn't have to feel like wizardry. In this podcast episode, we strip it back to what really matters—simple mental models, clean decision-making, and an approach that works whether you're in the back of a helicopter, a tight ambulance box, or a chaotic ED bay. We walk through the foundational concepts and the "why" behind each knob you touch. Then we zoom in on the Hamilton T1, the vent many of us love, hate, and still rely on every single shift. We cover what the T1 gets right, where people get tripped up, and how to let the machine work with you instead of against you. If you've ever wished mechanical ventilation felt less like memorizing settings and more like understanding physiology in motion, this episode will tighten up your practice and give you tools you can use on your very next flight or transport. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Tracheostomies are increasingly common in both prehospital and critical care transport settings, but they come with unique challenges. In this podcast episode, we break down short-term and long-term complications you may encounter, and how to troubleshoot them in high-stakes environments. From occlusions and dislodgements to bleeding, we'll cover practical strategies to keep these vulnerable patients safe. Whether you're new to airway management or a seasoned clinician, this discussion will sharpen your approach to one of the most intimidating airways you'll encounter. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
What happens when resources are limited, transport is delayed, or you're forced to manage a critically ill patient far beyond the typical flight window? In this podcast episode, Dr. Tim Hurtado and Brett Weiner help us dive into the challenges and realities of prolonged field care in air medical transport. We'll explore clinical considerations, crew dynamics, and decision-making strategies that can help you maintain high-quality care when time isn't on your side. We're also excited to announce our new in-person course. This immersive training opportunity is designed to push you beyond the textbook and prepare you for the complexities of prolonged care in austere or transport environments. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Tranexamic Acid (TXA) is a lot like hot sauce: People put it on everything — especially for apparent or suspected acute blood loss. In this podcast episode, we dive into a drug that's been both praised and questioned in trauma and prehospital care. We break down what TXA is, how it works, and the evidence behind its use. From CRASH-2 to CRASH-3, we explore the key studies, the controversies, and the real-world implications. Whether you're administering TXA in the back of a rig or evaluating its role in your protocols, this episode helps you make sense of when, why, and how TXA might—or might not—stop the bleeding. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Though evidence dictates much of what we do as emergency medical providers, some areas remain open to debate: How are we justifying stroke ambulances, CCT speciality teams, AHA guidelines, and our choice of crystalloids? How are we justifying what professionals are allowed to post on social media? And do we agree with the currently accepted norms? Who better to join us in this discussion than Mike Carunchio of The World's Okayest Medic Podcast . Diving into these and other controversial topics, we see if our two platforms can come to a consensus in a randomized, uncontrolled conversation. *Strong opinions were involved in this production. If something challenges your perspective, good—that's the point. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Wet or dry. Air in or out. Reactive or obstructive. The possibilities may seem endless when treating the pediatric patient with undifferentiated respiratory distress. It is confounded by the fact that pediatrics are outside the comfort zone of many novice critical care transport providers. In this podcast episode, neonatal/pediatric specialist Nate Brown eases your worries with concise and effective means of diagnostics and intervention. Primarily, we cover croup, bronchiolitis, and asthma disease processes. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
'Tis the season for trauma. (If there truly is a season.) Chest trauma, specifically, can vary in subtlety and severity, primarily due to the presence of multiple vital organs and vessels. In this podcast, we discuss these potentials while focusing on those injuries that are associated with the highest mortality rate. We also discuss why you should think twice before intervening. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: Heavy Lies the Helmet's content is for educational purposes only and does not constitute medical advice. Always follow local guidelines and consult qualified professionals before applying any information. The hosts and guests are not responsible for errors, omissions, or outcomes. Views expressed are their own and do not reflect their employers or affiliates. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Does your patient have high blood pressure? Are they seizing or showing other signs of a neurological disorder? It could be PRES! Unfortunately, Posterior Reversible Encephalopathy Syndrome (PRES) is difficult to diagnose unless you are aware of its existence. In this podcast episode, we discuss this infrequent condition and how can you appropriately diagnose and treat it. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Do certifications accurately reflect an individual's qualifications? This is an ongoing argument depending on what side of the exam you are on. How much value should we on that piece of paper? And, regardless, how do we work towards obtaining and maintaining qualifications? In this podcast episode, we discuss it all including Dunning-Kruger Effect and Hierachy of Competence. We also delve into teaching strategies that can help newcomers gain their confidence after achieving whatever got them there in the first place. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Previously, we recorded a podcast episode about the utility surrounding Point of Care Ultrasound (POCUS). In this episode, we apply that knowledge to specific case scenarios as a continuation of our "Breaking the Case" series. We also ask the question, is POCUS really all it's cracked up to be, or should we be re-thinking our approach, particularly in the prehospital setting? Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Humans are easy. That's why we are able to do what we do as prehospital providers. But what happens when your patient is a canine? These working dogs are highly regarded by their handlers and require care just like anyone else that may be ill or injured. Considering that, are you equipped to care for them? If not, how can you successfully start and maintain a K9 program at your agency? Tune in to another podcast to discuss this unique topic, but this time, we are joined by HLTH team member Rick Maricle and his colleague George Tarver III. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
It can be difficult to determine whether you should treat undifferentiated hypertension or not. Many clinicians are distracted the number rather than focusing on the patient in front of them. Asymptomatic hypertension, in particular, is often benign. In fact, treating asymptomatic hypertension in a patient who a primary medical history of hypertension can harm them. In this podcast, we discuss these adverse effects related to blood pressure physiology, acute versus chronic hypertension, and how you can determine whether anti-hypertensives or other forms of therapy are indicated. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
The principles of preoxygenation and passive oxygenation should be familiar to any experienced intubator. Best practice recommends the use of a nasal cannula in conjunction with either a non-rebreather mask or bag-valve mask (BVM) to prevent hypoxemia during the apneic phase of Rapid Sequence Intubation (RSI). In the PREOXI Trial, the authors pushed this concept further, questioning whether non-invasive positive pressure ventilation (NIPPV) might be more effective than these formally mentioned adjuncts. In this podcast, we dive into the strengths and weaknesses of the trial and explore whether its findings are truly practice-changing. We might even disagree along the way… (We also provide a rebuttal to some of the feedback we received on our previous podcast episode .) Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
Not all cardiac arrests are created equal. Whether the presenting rhythm is asystole, ventricular fibrillation, or PEA, these patients require tailored interventions beyond "blanket" protocol and ACLS/PALS algorithms. When refractory to conventional therapy, the pulseless V-Tach/V-Fib patient, in particular, requires critical thinking "outside the box" in order to gain ROSC (Return of Spontaneous Circulation) and preserve neurological outcomes. What are some of the measures we can consider when presented with these refractory patients? We answer that question in this podcast episode. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyliesthehelmet Instagram @ heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. -------------------------------------------- Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com
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Observed September 16, 2026. Cached outside the daily freshness window; the positions keep the date they were taken on.
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