Nitroglycerin is a medication used to treat chest pain, reduce cardiac workload, and manage acute pulmonary edema. It is also, somewhat inconveniently, an actual explosive.

In this episode of That Paramedic Podcast, we explore how nitroglycerin went from blowing things up to becoming one of the most recognizable medications in emergency medicine. We break down what nitro does to the cardiovascular system, including its effects on preload, afterload, coronary blood flow, and myocardial oxygen demand.

We also discuss common indications, dosing considerations, contraindications, adverse effects, and the clinical situations where nitroglycerin can be extremely helpful or spectacularly unhelpful. Along the way, we examine hypotension, right ventricular infarctions, PDE-5 inhibitors, pulmonary edema, and why giving nitro involves considerably more thought than simply asking whether the patient has chest pain.

It is cardiovascular physiology, explosives, questionable humour, and practical prehospital medicine, all packed into one episode.

DKA is way more than “the sugar is high.”

In this episode of That Paramedic Podcast, we break down diabetic ketoacidosis from the ground up: what causes it, why ketones and acidosis develop, why patients pee out half their circulating volume, and why potassium is the quiet psychopath nobody should ignore.

We also get into Kussmaul respirations, why a DKA patient’s crazy respiratory rate may be the thing keeping them alive, what makes intubation so dangerous, and how Alberta EMS approaches these patients in the prehospital setting.

Plus, we take a trip back to the good old days of medicine when treatment for diabetes included starvation diets, bicarbonate, and a healthy dose of “well… hopefully this works.”

Expect physiology, EMS pearls, dark humour, old-timey medicine, and several reminders not to steal anyone’s emotional-support tachypnea.

Educational only. Follow your local protocols and medical direction.

Your patient is acidotic. Fantastic. Now comes the slightly more important question: why?

In this episode of That Paramedic Podcast, we dive into the wonderfully unpleasant world of respiratory and metabolic acidosis. We break down how the body regulates pH, the roles of the lungs and kidneys, and how to determine whether the problem is caused by too much carbon dioxide, too little bicarbonate, or the human body simply deciding that chemistry is now optional.

We explore the common causes and clinical presentations of both types of acidosis, including respiratory failure, COPD, hypoventilation, shock, sepsis, diabetic ketoacidosis, renal failure, and other situations in which the patient’s internal environment has become medically described as pHucked.

We also discuss compensation, why the respiratory rate matters, how capnography and blood gases can help, and why silencing a patient’s compensatory breathing without understanding what is happening can turn a bad situation into a very short case review.

So take a deep breath, unless you are retaining carbon dioxide, and join us as we attempt to make acid-base balance slightly less confusing and considerably more inappropriate.