Anaphylaxis + Asthma: When Standard Anaphylaxis Treatment May Not Be Enough (AMAX4 Explained)

Anaphylaxis + Asthma: When Standard Anaphylaxis Treatment May Not Be Enough (AMAX4 Explained)

Author: Ross Orpet, Paramedic turned EMS Physician December 17, 2025 Duration: 19:03
This episode tells the tragic story of Max McKenzie, a teenager with asthma who died from anaphylaxis despite receiving "standard care." His death led his father, Dr. Ben McKenzie, to develop the AMAX4 algorithm. Educator and critical care transport nurse/paramedic Bruce Hoffman breaks down the algorithm and explains why the combination of anaphylaxis and asthma can be lethal, why IM epinephrine may not be enough, and why this is the time to be aggressive. But this isn't simply about memorizing another algorithm. It's about developing the operational confidence to recognize when standard approaches may fail and override your impulse to "try the book answer one more time." You'll learn to identify time-critical scenarios, build red-flag combination awareness, and make high-stakes decisions without second-guessing yourself.  Want to systematically build this decision-making confidence? Discover The Loud & Clear Fellowship at emspodcast.com/program —where we teach the operational skills your school didn't.   Guest/Cast/Crew information-Guest- Bruce Hoffman, Associate Professor, Critical Care RN and ParamedicHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J   Want to stay ahead of the top 1% in EMS and build real confidence in the field?👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Stepping out of the classroom and into the rig is where the real learning begins, but that transition often leaves even seasoned providers with a lingering doubt. Loud & Clear: EMS Guiding Principles addresses that gap directly, moving past the basic protocols to explore the foundational reasoning that makes for excellent prehospital care. Hosted by Ross Orpet, a paramedic who now practices as an EMS physician, this podcast digs into the "why" behind the algorithms. It’s built on the understanding that no textbook can possibly cover every unique scenario you’ll encounter on the road. Instead of just listing steps, each episode examines the core principles that guide critical decisions when the situation doesn't fit a neat checklist. You’ll hear discussions that bridge the gap between field experience and medical rationale, focusing on the adaptive thinking required for complex emergencies. This is advanced continuing education designed for paramedics, EMTs, and all prehospital providers who feel that standard training was just the beginning. The conversations in this series aim to solidify your clinical judgment, helping you build confidence through comprehension. By tuning in, you gain access to a deeper level of professional development, where the objective is to think clearer and act more decisively, no matter how many days you have on the job. This podcast serves as a vital resource for those committed to mastering their craft beyond the basics.
Author: Language: English Episodes: 100

Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Podcast Episodes
Pediatric Sepsis with Dr. Peter Antevy [not-audio_url] [/not-audio_url]

Duration: 32:50
Pediatric sepsis is easy to miss because the first hour often looks ordinary. Kids compensate, until they don't. In this episode, Will Berry talks with Dr. Peter Antevy about the case that still bothers him and why fluid…
How to Build Procedural Skills - That Actually Stick [not-audio_url] [/not-audio_url]

Duration: 1:37:52
Most EMS skills training creates an illusion of competence. You drill a procedure, check a box, and move on. But what does the research actually show about competency and retention? Dr. Jason Hine (EM physician, SimKit f…
How to Fail Better in EMS: A Framework for Growth [not-audio_url] [/not-audio_url]

Duration: 16:18
Stephanie Suzadail's favorite word is "fail." She'll tell you why and how we should embrace it. In this episode she walks through the difference between failure that builds you and failure that breaks you. Why Sisyphus i…
Great Mentors Shape Better Clinicians [not-audio_url] [/not-audio_url]

Duration: 19:33
Don't Be A Field Training Officer Be A Field Training Mentor. Field training is about more than teaching skills, it shapes culture, standards, and the kind of clinician someone becomes. In this episode, Ross sits down wi…
Frozen Fingers, Time Is Tissue: The Prehospital Approach to Frostbite [not-audio_url] [/not-audio_url]

Duration: 1:00:06
Frostbite is more dangerous than it looks and easier to make worse than you think. In this episode, Ross and Will sit down with Dr. Greg Doctor, a wilderness medicine specialist and emergency physician practicing in the…
Wired to Fail: The Science of Human Error in EMS [not-audio_url] [/not-audio_url]

Duration: 11:17
What if the mistake wasn't your fault... but it's still your responsibility? That's the tension Shay Montgomery sits with every time she talks about the day she flew to a scene without the drug bag. Shay is a flight nurs…