The World’s Okayest Medic Podcast Saturday Coffee Talk (12/13/25)
Dec 14, 2025
Mike discusses a key trial comparing ketamine and etomidate for intubation, revealing the risks of hemodynamic collapse with ketamine. He critiques slow RSI policy adoption in Pennsylvania and underscores the need for better pre-intubation resuscitation strategies. A surprising study highlights the overuse of helicopter transport for trauma patients, driven by profit motives. He tackles the myth of albuterol causing flash pulmonary edema and shares wisdom for new EMTs on managing pressure in emergency situations.
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Public Accusation And Measured Response
- Mike Caroncio recounts being accused on social media of plagiarizing content he created for a training company.
- He documented contracts, invoices, and emails and chose not to publicly re-litigate it unless the accusation resurfaces.
Ketamine vs Etomidate Study — What It Means
- The NEJM randomized trial found no 28-day mortality difference between ketamine and etomidate for RSI.
- The ketamine arm had higher cardiovascular collapse, but the study doesn't change the core message: use a predictable induction drug and resuscitate first.
Resuscitate Before You Intubate
- Do prioritize resuscitating patients before intubation and choose any induction agent you can use reliably.
- Try delayed sequence intubation (DSI) when possible and avoid knee-jerk RSI without optimization.