When to Act: Mastering Vasopressors in 2025

When to Act: Mastering Vasopressors in 2025

Author: Ross Orpet, Paramedic turned EMS Physician October 20, 2025 Duration: 14:14
What do you do when the blood pressure monitor shows a number you don’t like? Most providers hit the button again—but what if it’s real? In this episode, we’re joined by critical care transport specialist James Boomhower from Boston MedFlight, recorded live at the FASTCAN conference in Calgary, to break down modern vasopressor management.   We explore how norepinephrine replaced dopamine as the first-line vasopressor, the evidence behind those changes, and what to do when your patient is on three drips and the pressure still won’t budge. James shares practical, real-world insights from the space between the ED and ICU, where seconds matter and protocols are stress-tested in real time.   Key takeaways include: when to trust your BP reading and act, how to choose and sequence pressors based on evidence and logistics, why norepinephrine reduces arrhythmias and improves outcomes, and when to add adjuncts like steroids, sodium bicarb, or methylene blue. We also explore hidden factors like ventilator settings and underlying causes that can sabotage even the best pharmacology.   Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about our Paramedic Confidence Builder course reach out via email at ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    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: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder📰 Join our bi-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     Guest/Cast/Crew information- Guest- James Boomhower, LMHC-A, FP-C https://www.stayfit4duty.org/    Host- Ross Orpet   Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

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
NEW NAME! The podcast gets a new name, find out what and why... [not-audio_url] [/not-audio_url]

Duration: 3:48
Hello everyone, we have an exciting announcement. Today we are announcing our brand new name: Loud & Clear: EMS Guiding Principles. My name is Ross, and alongside my co-host, Will, we're thrilled to present this fresh ch…
Invisible Scars: The Battle for Mental Health in EMS - PATH4EMS [not-audio_url] [/not-audio_url]

Duration: 37:04
Let's discuss the pressing issue of mental health among first responders, particularly within the EMS community. Will gets vulnerable and shares a personal story of trauma on the job to highlight the urgent need for ment…
Wide Complex Tachycardia: Get Comfortable With Uncertainty [not-audio_url] [/not-audio_url]

Duration: 1:00:02
Learn a systematic approach to management of wide complex tachycardia that doesn't rely on exact rhythm identification or scoring systems with guest Dr. Kevin Butler. By understanding the physiology rather than memorizin…
Trailer - Loud & Clear: EMS Guiding Principles [not-audio_url] [/not-audio_url]

Duration: 2:44
You’ve looked at other paramedic continuing education resources but it’s the same basic material they taught you in school. There’s more you need to know, or you might miss something, someone might get hurt, or worse som…
From Novice to Navigator: Mastering the Art of EMS Field Training [not-audio_url] [/not-audio_url]

Duration: 1:06:34
Joined by Josh, Cody, and Moose from the AlertMedicOne podcast, we explore key principles of good training, leadership, and the importance of making mistakes in a safe learning environment. We discuss strategies to foste…
The Difference Between Equal and Equitable Care [not-audio_url] [/not-audio_url]

Duration: 16:12
Explore the crucial distinction between providing equal care versus equitable care within emergency medical services (EMS). We give you an in-depth discussion with Ritu Sani from The EMS Show podcast, highlighting the im…
Life Over Limb: Field Amputation, Preparing for the Unthinkable [not-audio_url] [/not-audio_url]

Duration: 15:26
Dr. Avery McKenzie interviews Dr. Eric Adler, regional medical director for Flight for Life, about the challenging and rare procedure of field amputations. They discuss the importance of being prepared for the unexpected…