Critical Levels

Hosted by paramedic Zach Cantor, "Critical Levels" is a new podcast dedicated to having critical conversations in paramedicine. "Critical Levels" is a podcast for paramedics, by paramedics, with a Canadian and local bias.

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In Flight Medical Emergencies - Dr. Carvalho 02/28/2026

In Flight Medical Emergencies - Dr. Carvalho In this episode of Critical Levels, Zach sits down with Dr. Anna-Maria Carvalho, a Royal College–certified emergency physician with a subspecialty in aviation medicine, to unpack what really happens when someone asks, “Is there a medical professional on board?” From the physiology of flying at 36,000 feet to the realities of managing cardiac arrest in a cramped aircraft cabin, this episode tackles the fears, logistics, and practical considerations of in-flight medical emergencies—especially for paramedics, nurses, and physicians who may be called upon to help. ✈️ What We Cover 🫁 The Physiology of Flight Why cabin altitude means we’re all mildly hypoxic (normal sats ~92–93%) How hypoxia increases heart rate, blood pressure, and sympathetic tone Why alcohol hits harder in the air Why tomato juice tastes better at altitude The risk of DVTs and who’s most vulnerable Barotrauma, ear pain, and when a perforated eardrum can occur 🚨 In-Flight Medical Emergencies Incidence: ~1 in 600 flights Most common categories: Neurologic Cardiac Respiratory Gastrointestinal The realities of flying with chronic disease Why more emergencies are happening as more people travel 🧰 What’s in the Emergency Medical Kit? AED (separate from the medical kit) Oxygen & Ambu bag Oral airways (intubation equipment varies by airline) IV supplies (limited fluids, but enough for medication administration) Medications: epinephrine, steroids, bronchodilators, benzodiazepines, antipsychotics, glucose agents, and more BP cuff (palpated pressures only—too noisy to auscultate!) Pulse oximeter (remember: 93% can be normal) 📡 Ground-Based Medical Support Most airlines consult 24/7 emergency physicians on the ground Volunteers don’t make diversion decisions—the captain does Diversions involve significant operational and logistical consequences In-flight volunteers are there to assess, stabilize, and communicate 🫀 Cardiac Arrest at 36,000 Feet Move to a bulkhead/galley if possible Call for additional medical volunteers Early AED use CPR until ROSC, exhaustion, or medical futility Diversion decisions are collaborative and situational ⚖️ The Legal Question Good Samaritan protections apply Act within scope No gross negligence or willful misconduct No one has ever been successfully sued for assisting with an in-flight medical emergency You are not responsible for diversion decisions 🕊️ When Death Occurs In Flight Resuscitation attempts may cease when appropriate Diversion is not automatic Flight crew are trained to manage these situations professionally and discreetly 🔑 Key Takeaways You already have the skills. The environment is different—but the fundamentals are the same. Recognizing sick vs. not sick is incredibly valuable. Most in-flight volunteer diagnoses are ultimately confirmed in hospital. About 60% of passengers improve with basic stabilization. You are protected when acting in good faith and within scope. If you’ve ever hesitated to answer that overhead call, this episode may change your perspective. /episode/index/show/criticallevels/id/40262775

The First 60 - Where Every Minute Counts 01/29/2026

AHA Guidelines - Not Godlines: Drs. Cheskes & Drennan 11/29/2025

Waveforms Don't Lie - Danny and Rance (DnR) 10/19/2025

Pearson MCI: Lessons Learned - Darren and Colin 09/26/2025

What's a Paramedic - Dr. Alan Batt 06/29/2025

Neonates - Anthony Iacolucci 05/30/2025

Neonates - Anthony Iacolucci Neonates are one of the most feared patient populations in EMS—and for good reason. In this episode, Zach Cantor talks with Anthony Iacolucci, a pediatric respiratory therapist and paramedic, about how to confidently approach neonatal calls. Anthony introduces NEO SECRETS, a practical acronym covering the top 10 causes of neonatal illness, and offers insight into assessment, common pitfalls, and key treatment considerations. NEO SECRETS Breakdown: • N – Inborn errors of metabolism • E – Electrolyte abnormalities • O – Overdose or toxic exposure • S – Sepsis (the leading cause of neonatal mortality) • E – Endocrine crisis (e.g., hypoglycemia, adrenal insufficiency) • C – Cardiac conditions (cyanotic vs. acyanotic presentations) • R – Recipe or formula mishaps (e.g., dilution errors leading to hyponatremia) • E – Enteric emergencies (e.g., malrotation with volvulus, gastroenteritis) • T – Trauma, including accidental and non-accidental injuries • S – Seizures (often subtle and hard to recognize in neonates) Key Takeaways: • Neonates are not small adults or even small pediatric patients—they are physiologically distinct and highly vulnerable. • Early identification of sepsis, cardiac issues, and metabolic errors can save lives. • Paramedics should rely on strong assessment skills, detailed history-taking, and high suspicion for uncommon causes. • Videos, glucose checks, pre-ductal saturations, and detailed caregiver interviews are essential field tools. • Understanding neonatal physiology, presentation timelines, and risk factors improves both confidence and outcomes. Why Listen: If you’ve ever felt unprepared when faced with a neonatal call, this episode provides a clear, practical, and memorable guide to the top threats to neonates—and how to recognize and respond to them in the field. /episode/index/show/criticallevels/id/36782565