Sep 25, 2026 · 46 min · 10 segments
Josh and Cody unpack this clinical practice theory of Audacity. Cody posted a few months, this topic and here is what he said in the post. Audacity is having the balls to make a decision, when you…
I might've talked about this in the past, but a couple of years ago, I ran a call where I had a patient that was having an inferior wall MI.
He was profoundly diaphoretic, borderline altered, extremely weak with a blood pressure of 60
over 40.
Heart rate was still, I think, if I remember correctly, it was in the 50s and 60s at the time.
So, you know, not the worst heart rate, not something that I think we need to pace at the time.
It's more of a pressure issue.
And as we moved out to the unit, I luckily had a second medic there with me that day and we were discussing what's our next steps.
And he goes, do you want to do fluids? And I sat there for, you know, we'll say, you know, five, 10 seconds in my mind decided, do we want to do fluids? Fluids would be the quote unquote safe approach.
It's what the protocolized approach would be.
But I also knew that this patient was profoundly hypotensive, profoundly shocky, and he's got an MI going on.
He's got multiple factors going on, but what is going to kill this person first? It's going to be his pressure.
He's going to tank.
He's going to code.
And then we're in a whole new algorithm working on scene until we figure out what's going to go from there.
So I said, no, we're going to do an epi drip.
At the time, that's what we had.
My agency now has LevaFed or Epi, which would have been the choice if we had it.
But Epi was what we have.
And we needed to get that pressure up and maintaining so we could deliver a patient to the ER that could end up getting catheterized and treated.
Now, when I arrived at the ER, did I catch some flack from the receiving physician that I didn't do a liter of fluids first?
Yeah.
But I also knew that on scene, I had a patient that, once again, was profoundly hypotensive, was almost peri-arrest, and fluids were not going to be the lifesaver on scene like pressers were.
Was there risk involved? Yes.
Was there benefit involved? Yes, and it was more.
But you have to think about the risks with some things we're going to do.
I might've talked about this in the past, but a couple of years ago, I ran a call where I had a patient that was having an inferior wall MI.
He was profoundly diaphoretic, borderline altered, extremely weak with a blood pressure of 60
over 40.
Heart rate was still, I think, if I remember correctly, it was in the 50s and 60s at the time.
So, you know, not the worst heart rate, not something that I think we need to pace at the time.
It's more of a pressure issue.
And as we moved out to the unit, I luckily had a second medic there with me that day and we were discussing what's our next steps.
And he goes, do you want to do fluids? And I sat there for, you know, we'll say, you know, five, 10 seconds in my mind decided, do we want to do fluids? Fluids would be the quote unquote safe approach.
It's what the protocolized approach would be.
But I also knew that this patient was profoundly hypotensive, profoundly shocky, and he's got an MI going on.
He's got multiple factors going on, but what is going to kill this person first? It's going to be his pressure.
He's going to tank.
He's going to code.
And then we're in a whole new algorithm working on scene until we figure out what's going to go from there.
So I said, no, we're going to do an epi drip.
At the time, that's what we had.
My agency now has LevaFed or Epi, which would have been the choice if we had it.
But Epi was what we have.
And we needed to get that pressure up and maintaining so we could deliver a patient to the ER that could end up getting catheterized and treated.
Now, when I arrived at the ER, did I catch some flack from the receiving physician that I didn't do a liter of fluids first?
Yeah.
But I also knew that on scene, I had a patient that, once again, was profoundly hypotensive, was almost peri-arrest, and fluids were not going to be the lifesaver on scene like pressers were.
Was there risk involved? Yes.
Was there benefit involved? Yes, and it was more.
But you have to think about the risks with some things we're going to do.
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