We’re continuing our FAST Replay series, bringing you full sessions recorded live from past FAST conferences as we build toward FAST26: Austin! This episode takes on a topic everyone talks about… but few fully understand: evidence-based medicine. What does it actually mean in EMS?

This session breaks it down in a way that’s practical, honest, and directly applicable to how decisions get made in the field. From the limits of single studies to the importance of real-world context to the evolution of guidelines and what drives them. This is a deeper look at how evidence should (and shouldn’t) shape practice. It also challenges some long-standing habits in medicine, where tradition, opinion, or “how we’ve always done it” have influenced care just as much as actual evidence. If you’ve ever heard “the evidence says…”, this episode might change how you think about that.

This is what FAST sounds like. Real conversations. Real ideas. Live from the room. FAST26 is coming to Austin, Texas this year on May 27-29, 2026. We are co-locating with EMS World Live, giving you 2 HUGE events under 1 roof at the same time! Choose to join one, or the other, or come to both!

👉 Learn more or grab your spot: https://fbefast.com

Enjoy this talk from Eddy Lang! See you in Austin!

Over the next several episodes leading up to FAST26: Austin, we’re bringing you full sessions recorded live from past FAST conferences straight from the session recordings!

This episode features Bruce Hoffman, RN, paramedic, educator, and FlightBridgeED Senior Educator. Bruce is known for pushing beyond the “what” and getting into the why... challenging how we think, how we lead, and how we show up in critical care transport.

If you’ve never experienced FAST, this is a glimpse into what makes it different. It’s not just the content; it’s the people, the conversations, and the environment that stay with you long after the session ends.

FAST26 is coming to Austin this year, co-located with EMS World Live! We're bringing together the FAST experience with a larger EMS community, without losing what makes FAST what it is.

👉 Learn more or grab your spot:
https://fbefast.com

In this episode of the FlightBridgeED OB Critical Care Transport series, Dr. Mike Lauria is joined by maternal-fetal medicine specialist Dr. Liz Gartner to tackle one of the most commonly missed and dangerous metabolic emergencies in pregnancy: diabetic ketoacidosis (DKA). While DKA is familiar to most clinicians, pregnancy dramatically alters its presentation—often masking it behind symptoms that look indistinguishable from “normal” pregnancy complaints like nausea, vomiting, abdominal pain, fatigue, and polyuria.

The conversation breaks down the unique physiology of pregnancy that predisposes patients to DKA at much lower glucose levels than expected. Progressive insulin resistance, hemodilution, increased renal glucose losses, accelerated starvation, and baseline respiratory alkalosis combine to create a perfect storm where euglycemic or near-euglycemic DKA can develop. The result is a high-risk condition that is easy to dismiss unless providers intentionally look for it—especially in patients with type 1 diabetes, type 2 diabetes, or gestational diabetes.

From a transport and critical care perspective, the episode emphasizes early recognition, appropriate lab interpretation, and aggressive maternal resuscitation as the cornerstone of treatment. The hosts clarify that management principles remain largely unchanged from non-pregnant patients—fluids first, electrolytes (especially potassium), then insulin—while highlighting pregnancy-specific lab pitfalls and why delivery is not the treatment for DKA. Ultimately, stabilizing the mother is the most effective way to protect the fetus.

Key takeaways

• DKA can look like normal pregnancy: Nausea, vomiting, fatigue, abdominal pain, and polyuria should not be dismissed in pregnant patients with diabetes.
• Don’t be reassured by a glucose of ~200: Up to 30% of DKA cases in pregnancy are euglycemic.
• Pregnancy changes the labs: Baseline bicarbonate is lower, and a pH around 7.30 may represent severe acidosis.
• Beta-hydroxybutyrate is the gold standard for diagnosing ketosis; urine ketones and anion gap alone can miss cases.
• Fluids and electrolytes come first: Aggressive volume resuscitation and potassium correction are critical before insulin.
• Resuscitate mom to save baby: Delivery is not indicated for DKA alone and may worsen outcomes.
• High fetal risk: While maternal mortality is low, fetal mortality remains significant—making early recognition essential.