Episode 23: Epi - Volume vs Tone

This episode features Medical Director Dr. Jonathan Apfelbaum and EMS Lieutenant Dusty King as they unpack when epi helps, when it adds nothing, and when it can actually work against your patient. Using real cases, they revisit alpha and beta receptor effects, walk through why there is no evidence-based role for epi in classic traumatic arrest, and contrast that with scenarios like neurogenic shock, tamponade, tension pneumothorax, and peri-RSI hypotension where carefully titrated push-dose epi can be appropriate. Along the way they review the MARCH algorithm, prehospital blood, TXA and calcium, ultrasound findings that clarify shock type, and those “medical vs trauma” MVCs where a cardiac event or PE causes the crash. The discussion blends fundamentals with nuance to give EMS providers practical tools to decide when the problem is volume, when it’s tone, and how to let physiology, not habit, drive the decision to reach for epi.