Post-ROSC Care and Pacing: Prove the Perfusion

Post-ROSC Care and Pacing: Prove the Perfusion

Author: Ross Orpet, Paramedic turned EMS Physician August 31, 2026 Duration: 1:06:06
Getting a pulse back feels like a win. Seeing pacer spikes and something that resembles a pulse feels reassuring. But in both situations, the monitor can make you feel better before the patient actually is.Geoff Murphy of Master Your Medics breaks down the fragile minutes after return of spontaneous circulation. He explains why hypotension deserves immediate attention, how falling end-tidal CO2 can warn that cardiac output is deteriorating, and when fluids can serve as a short bridge to vasopressors.Then, paramedic Jacob Miller challenges some of the assumptions clinicians learn about transcutaneous pacing. He discusses pad placement, pacing current, ultrasound, pharmacologic support, and why clinicians need to keep reassessing even after they think they have capture.In this episode, you’ll learn: Why an initially normal blood pressure after ROSC can be falsely reassuring How skeletal muscle contraction during pacing can create ECG artifact and a false sense of mechanical capture What can improve your chances of capturing a patient when transcutaneous pacing is needed Why practicing the pacer during routine monitor checks can make a rare, high-stress call much easier to manage Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Interested in ABLS Now? Our listeners get 10% off with code LOUD26POD. Jacob’s Resources:Article with images of false vs true electrical capture: Kimbrell J, Kreinbrook J, Poke D, et al. False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024;28(7):928-936. doi: 10.1080/10903127.2024.2321287   Link to Scott Weingart's EMCrit podcast episode discussing false positive SpO2 signal without actual capture:  https://emcrit.org/emcrit/tcp-pulse-ox-fail/   Jacobs website with handout version of my slides:  https://jacobmilleracnp.com/slides/   Guests:Geoff Murphy, Founder and Lead Educator of Master Your Medics Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP

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: 50

Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Podcast Episodes
The First 60 Seconds After ROSC: How To Prevent Re-Arrest [not-audio_url] [/not-audio_url]

Duration: 35:52
The First 60 Seconds After ROSC: How To Prevent Re-Arrest How do you improve your resuscitation systems beyond the ACLS algorithm? Will talks with Ian Blanchard, Senior Scientist for Alberta’s provincial EMS system about…
Burn Care in EMS: What Actually Matters in the First 15 Minutes [not-audio_url] [/not-audio_url]

Duration: 1:02:04
Burn patients can create a disproportionate amount of anxiety. The calls are uncommon, the injuries can be visually overwhelming, and it is easy to get distracted by the burn itself.Ross and Will talk with Mark Johnston,…
Heat Stroke: Recognition, Cooling, and Transport Decisions [not-audio_url] [/not-audio_url]

Duration: 47:32
What differentiates heat stroke from heat exhaustion? Once central nervous system dysfunction appears, every minute spent at an elevated core temperature increases the risk of permanent neurologic injury or death.Ross an…
The Three Building Blocks of Trust in EMS [not-audio_url] [/not-audio_url]

Duration: 1:08:37
Trust is the architecture behind every patient interaction you run. Dr. Cory Scheer, author of Closing the Trust Gap, has identified three evidence-based building blocks of trust: competency, problem-solving, and care fo…
The Skill Is Not The Hard Part [not-audio_url] [/not-audio_url]

Duration: 29:33
The hardest part of a bad call is rarely the algorithm. In two different interviews I explore some human traps of running an EMS call. I talk with Danny and Rance from DNR Prehospital Education about a choking arrest, a…