The FlightBridgeED Podcast

In this episode of the FlightBridgeED OB Critical Care Transport series, Dr. Mike Lauria is joined by maternal-fetal medicine specialist Dr. Liz Gartner to tackle one of the most commonly missed and dangerous metabolic emergencies in pregnancy: diabetic ketoacidosis (DKA). While DKA is familiar to most clinicians, pregnancy dramatically alters its presentation—often masking it behind symptoms that look indistinguishable from “normal” pregnancy complaints like nausea, vomiting, abdominal pain, fatigue, and polyuria.
The conversation breaks down the unique physiology of pregnancy that predisposes patients to DKA at much lower glucose levels than expected. Progressive insulin resistance, hemodilution, increased renal glucose losses, accelerated starvation, and baseline respiratory alkalosis combine to create a perfect storm where euglycemic or near-euglycemic DKA can develop. The result is a high-risk condition that is easy to dismiss unless providers intentionally look for it—especially in patients with type 1 diabetes, type 2 diabetes, or gestational diabetes.
From a transport and critical care perspective, the episode emphasizes early recognition, appropriate lab interpretation, and aggressive maternal resuscitation as the cornerstone of treatment. The hosts clarify that management principles remain largely unchanged from non-pregnant patients—fluids first, electrolytes (especially potassium), then insulin—while highlighting pregnancy-specific lab pitfalls and why delivery is not the treatment for DKA. Ultimately, stabilizing the mother is the most effective way to protect the fetus.
Key takeaways
DKA can look like normal pregnancy: Nausea, vomiting, fatigue, abdominal pain, and polyuria should not be dismissed in pregnant patients with diabetes.
Don’t be reassured by a glucose of ~200: Up to 30% of DKA cases in pregnancy are euglycemic.
Pregnancy changes the labs: Baseline bicarbonate is lower, and a pH around 7.30 may represent severe acidosis.
Beta-hydroxybutyrate is the gold standard for diagnosing ketosis; urine ketones and anion gap alone can miss cases.
Fluids and electrolytes come first: Aggressive volume resuscitation and potassium correction are critical before insulin.
Resuscitate mom to save baby: Delivery is not indicated for DKA alone and may worsen outcomes.
High fetal risk: While maternal mortality is low, fetal mortality remains significant—making early recognition essential.

In this episode of FlightBridgeED, Dr. Mike Lauria is joined by maternal-fetal medicine specialists Dr. Alex Pfeiffer and Dr. Liz Gartner for a practical, transport-focused deep dive into trauma in pregnancy. With maternal morbidity and mortality rising in the U.S. and more obstetric patients requiring transfer from smaller facilities, the team breaks down what changes when you’re managing trauma with two patients sharing one circulation—and how pregnancy can mask shock until both mom and fetus suddenly decompensate.
They walk through the pregnancy-specific physiology that matters most in the field: increased blood volume and cardiac output, decreased SVR, and why hypotension is a late sign. You’ll hear why “normal blood pressure doesn’t equal normal perfusion,” how to recognize early compensated shock (including subtle mental-status changes and agitation), and the key resuscitation tweaks that make a major difference—especially oxygenation and ventilation targets that are tighter than what you might accept in non-pregnant trauma patients.
The conversation also covers the highest-yield operational pieces for EMS and critical care transport crews: aortocaval compression after ~20 weeks and how to relieve it with left tilt/uterine displacement (even on a backboard), what to do about chest trauma (tube placement one to two interspaces higher), why placental abruption is a clinical diagnosis (and often not seen on imaging), fetal heart tones as a “vital sign,” and how viability changes transport destination decisions. They also address Rh considerations, RhoGAM timing, intimate partner violence screening opportunities during transport, and what crews should understand about perimortem C-section even if it’s not in their scope.
Key takeaways
Mom first = baby best: Maternal stabilization is fetal resuscitation. Prioritize ABCDs before fetus.
After 20 weeks: relieve aortocaval compression with 15–30° left tilt, hip bump, or manual uterine displacement—don’t skip this during resuscitation/transport.
Shock can hide: Pregnant patients may lose ~30–40% blood volume before hypotension—watch trends and early signs like tachycardia and altered/anxious behavior.
Oxygen/ventilation goals are tighter: Aim SpO₂ ≥ 95%; pregnancy has a lower baseline CO₂—an EtCO₂ around 40 may represent hypoventilation in pregnancy.
Placental abruption is clinical: Uterine tenderness + contractions + vaginal bleeding = high suspicion, even with “normal” ultrasound/CT.
Chest tubes go higher: Due to diaphragmatic elevation, place chest tubes 1–2 intercostal spaces higher than usual.
Think destination + monitoring: Viability (~23–24 weeks) drives need for OB capability and fetal monitoring; minimum observation discussed as ~4 hours post-trauma for viable gestations.
Rh matters, but perfusion matters more: Use O-negative if available for known Rh-negative patients; don’t withhold lifesaving blood when it’s the only option.
Transport is a screening opportunity: Consider intimate partner violence and create safe moments to ask when separated from partners.
References – 
·         American Academy of Family Physicians. Trauma in Pregnancy: Assessment, Management, and Prevention. Am Fam Physician. 2014;90(10):717–722.
·         Appelbaum RD, Yorkgitis B, Rosen J, Butts CA, To J, Knight AW, Zhang J, Kirsch JM, Levin JH, Riera KM, Kelley KM, Carter KT, Sawhney JS, Mukherjee K, Metz TD, Fiorentino MN, Cantrell S, Sapp A, Potgieter CJ, Kasotakis G, Como JJ, Freeman J. Trauma in pregnancy: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2025 Aug 1;99(2):298-309.
·         SOGC Clinical Practice Guideline. Guidelines for the Management of a Pregnant Trauma Patient. J Obstet Gynaecol Can. 2015;37(6):553–571.
·         Muench MV et al. Physiologic changes of pregnancy relevant to trauma management. Clin Obstet Gynecol. 2007;50(3):601–610.
·         Larson, Nicholas J. et al.Prehospital Management of the Pregnant Trauma Patient. Air Medical Journal, Volume 44, Issue 4, 236 - 241
·         Mendez-Figueroa, Hector et al. Trauma in pregnancy: an updated systematic review. American Journal of Obstetrics & Gynecology, Volume 209, Issue 1, 1 - 10
·         Jain V et al. Trauma in pregnancy. Clin Obstet Gynecol. 2015;58(3):613–624.
·         Clark SL et al. Amniotic Fluid Embolism: Diagnosis and Management Update. Am J Obstet Gynecol. 2016;215(2):B16–B24.
·         Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM, Morrison LJ, Katz V, Tsen LC, Daniels K, Halamek LP, Suresh MS, Arafeh J, Gauthier D, Carvalho JC, Druzin M, Carvalho B, Society for Obstetric Anesthesia and Perinatology The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg. 2014 May;118(5):1003-16. 
·         Strong TH, Lowe RA. Perimortem cesarean section. Am J Emerg Med. 1989 Sep;7(5):489-94.
·         Liggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. J Surg Res. 2023 May;285:187-196.
·         Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol. 2019 Dec;134(6):1343-1357.
·         April MD, Long B. Trauma in pregnancy: A narrative review of the current literature. Am J Emerg Med. 2024 Jul;81:53-61.

Episode Description
In this powerful and highly practical episode, Eric Bauer is joined by Dr. Scott Weingart for a deep dive into mechanical ventilation strategy, critical thinking in metabolic acidosis, and the nuanced management of obstructive lung disease. You’ll hear honest, experience-driven insights that challenge outdated protocols and provide a real-world framework for decision-making in high-acuity transport and emergency environments.
Together, Eric and Scott unpack what matters when setting minute ventilation for acidotic patients, when and why to abandon rigid tidal volume formulas, and how to navigate the delicate dance of airway management without causing more harm than good. You’ll also hear an unfiltered discussion about ventilation in DKA, PEEP misconceptions, and how to safely manage the crashing COPD or asthmatic patient when time and tolerance are in short supply.
Key Takeaways
Minute ventilation must be tailored to context: “one-size-fits-all” protocols often fail in real-world acidotic patients.
A tidal volume of 8–10 mL/kg is not only SAFE, it’s often necessary in early transport, especially when facing deadly acidosis.
Not all PEEP is good PEEP! Learn when zero is the right number.
In obstructive lung patients, the “expiratory phase” isn’t the whole story. Inspiratory flow rate and sedation play crucial roles.
End-tidal CO₂ readings must be interpreted in a clinical context. Chasing normalization can kill.
Sometimes the best vent setting… is no vent at all. Preserving spontaneous respiration in compensated DKA may save lives.
DON'T default to 100% FiO₂. Understand how oxygen strategy influences alveolar recruitment and long-term outcomes.
Listen anywhere you get your podcasts or at flightbridgeed.com. While you're there, explore our award-winning critical care courses, trusted by thousands of providers to prepare for advanced certification exams, or to recertify advanced, national, state, and local certifications and licenses.

In this episode of the FlightBridgeED Podcast, Dr. Mike Lauria welcomes back Dr. Nick George to dissect a topic that’s long overdue for critical discussion: airway management in critical care transport—and whether your background matters.
Does being a paramedic or a nurse predict first-pass success rate? Does prior training or clinical experience truly change how well you manage airways in high-stakes situations?
Drawing from new research involving over 7,800 intubations at a major HEMS program, Dr. George presents data that challenges long-held assumptions and explores the impact of training, experience, and clinical culture on airway outcomes. From the historical roots of EMS to the realities of modern-day prehospital practice, this episode bridges the past, present, and future of one of the most defining and debated skills in critical care.
Whether you're placing tubes daily or just entering the field, this episode delivers real insights for every provider level.
Listen anywhere you stream podcasts, or at FlightBridgeED.com. While you're there, explore our award-winning, trusted courses, specifically designed for critical care professionals like you.
Key Takeaways
Success in airway management isn't about your credentials—it’s about training, experience, and repetition.
In a study of 7,812 intubations, there was no statistically significant difference in first-pass or last-pass success between nurses and paramedics.
A slight initial gap in first-year performance disappears by year three, suggesting a washout effect driven by experience, not title.
Historical models and current cultures (like “owning the airway”) influence skill allocation, sometimes more than evidence.
Airway success is more than just getting the tube—metrics like DASH-1A aim to measure outcomes that matter (hypoxia, hypotension), even if imperfect.
High-quality, consistent training programs—like annual OR intubations and in-situ simulation—are the real equalizers in skill development.
The origin of airway obsession in EMS traces back to Peter Safar, whose daughter’s death from an asthma attack helped spark the creation of modern paramedicine.
References
George, Nicholas H et al. “Prehospital Endotracheal Intubation Success Rates for Critical Care Nurses Versus Paramedics.” Prehospital emergency care, 1-7. 23 Jan. 2025, doi:10.1080/10903127.2024.2448246
https://pubmed.ncbi.nlm.nih.gov/39786721/

In this episode of the FlightBridgeED Podcast, Dr. Mike Lauria is joined by Dr. Nick George, a retrieval and EMS physician currently practicing full-time in Darwin, Australia. Together, they break down the often-overwhelming topic of aortic emergencies in a way that’s brilliantly simple, practical, and immediately applicable for all providers—whether you’re in the ICU, on the flight line, or working your way up in emergency medicine.
Dr. George introduces a clean mental model—1 tube, 2 major problems, 3 causes—to guide listeners through the classification, diagnosis, and critical transport considerations for aortic dissections and aneurysms. From understanding penetrating ulcers to navigating hypertensive vs hypotensive presentations, this episode dives deep without drowning you in jargon.
We also explore the science behind anti-impulse therapy, challenge long-held dogmas about esmolol vs nicardipine, and reveal eye-opening findings from a two-decade analysis of over 1,000 aortic emergency transports. Whether you’re flying patients to tertiary care, working in rural EDs, or prepping for boards, this episode will sharpen your edge.
Available anywhere you listen to podcasts or at FlightBridgeED.com. While you’re there, explore our highly successful, award-winning courses trusted by critical care providers around the world.
Key Takeaways
The aorta can be simplified into “1 tube, 2 problems (tearing or weakening), caused by 3 forces: pressure, pulsatility, and geometry.”
Distinguishing between dissection and aneurysm—and whether it’s hypertensive or hypotensive—can guide safe transport decisions, even if you're not making the diagnosis.
Dissections may present without pain in up to 30% of cases, underscoring the importance of clinical vigilance and recognizing subtle signs.
Classic signs (pulse deficits, BP differentials) are often unreliable. Don’t dismiss vague or mismatched symptoms.
Ultrasound, although not definitive, can provide useful data en route—especially in cases of hypotension or ambiguity.
Anti-impulse therapy isn't as evidence-backed as we've been taught. Recent studies show nicardipine may be just as effective—and possibly safer—than esmolol.
Transport crews must be empowered to advocate for patients when findings don’t line up with the presumed diagnosis.