From Algorithms to Acidosis

ERcast: Clinical Perspectives Podcast Preview

Jun 2, 2026
1 Chapter
53 min

AI is rapidly expanding across medicine, with a growing impact in the prehospital setting. EM physician and former paramedic John Casey joins Andy Little to break down how EMS teams are beginning to use AI—and what it means for emergency care. Then, we discuss aspirin toxicity - a time-sensitive diagnosis where early recognition is key. Mastering its acid-base disturbances and knowing when to alkalinize can prevent rapid deterioration and help avoid common management pitfalls.

Chapters

Salicylate toxicity is a pH-driven poisoning where tachypnea, a mixed respiratory alkalosis with metabolic acidosis, and a misleadingly modest first level can precede rapid deterioration. Prehospital AI is already reshaping EMS dispatch, triage, and destination decisions, but only works safely with human oversight and protocol-level guardrails. Salicylate Toxicity Essentials Classic acid-base pattern: Early salicylate poisoning causes a primary respiratory alkalosis, then evolves into a mixed respiratory alkalosis and metabolic acidosis that should immediately raise suspicion. Chronic toxicity red flags: Older adults with confusion, tachypnea, or vague decline after medication changes can have chronic salicylate toxicity, which is often missed and can be deadlier than an acute ingestion. Misleading single drug level: One salicylate level is not enough because delayed absorption and tissue redistribution can make an initially modest result falsely reassuring; that serial trend is central in the chapter. Alkalinization as core therapy: Sodium bicarbonate is the first-line treatment because alkalemia keeps salicylate ionized, limits CNS penetration, and enhances elimination, with potassium repletion as a nonoptional partner. High-risk airway physiology: Intubation is dangerous because these patients rely on high minute ventilation to buffer acidemia; even brief peri-intubation hypoventilation can precipitate abrupt clinical worsening. We get into the airway nuances in the episode. Early dialysis triggers: Pulmonary edema, renal failure, worsening mental status, severe acidosis, or failure to improve with bicarbonate should move dialysis up early rather than waiting for a crash. AI in EMS Operations Dynamic dispatch optimization: AI is already being used to stage ambulances from real-time and historical demand data, improving response times and matching crews to where call volume is likely to surge. Enhanced dispatch triage: Call-center AI can analyze voice tone and background audio to flag cardiac arrest sooner and suggest stroke earlier, helping identify critical illness before EMS reaches the scene. Field decision support: Prehospital AI can assist with protocol lookups, medication questions, and destination planning, especially in rural systems or long transports where decision support is thin. We walk through the practical use cases in the episode. Trauma destination prediction: AI trauma triage models have outperformed human judgment in predicting which injured patients need a trauma center versus a community hospital, a meaningful signal for future EMS workflows. Bias and confabulation risks: AI can misread incomplete prehospital data or amplify existing disparities such as zip-code bias, so unchecked recommendations can create new safety problems instead of solving old ones. Human oversight governance: Safe adoption starts with low-risk pilots such as dispatch support or protocol review and keeps clinicians responsible for overruling bad output under clear governance.

Faculty

Geoffrey Comp, DO, FACEP
Dr. Comp is an Associate Program Director for the Creighton University / Valleywise Health Emergency Medicine Residency Program in Phoenix. A clinician-educator at heart, Geoff spends his time mentoring the next generation of Emergency Medicine residents and advocating for better ways to teach and learn medicine. His professional world revolves around wilderness medicine, clinician wellness, and finding innovative ways to bridge the gap between theory and the bedside. When he isn’t in the ED or the classroom, you’ll likely find him combining his love for medicine with his passion for the outdoors, always looking for a new trail to explore or a new way to collaborate with fellow clinicians.
Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
Anne Steckowych, APRN
Emergency medicine is in Anne’s blood; her father has been an Emergency Medicine physician for the last 30 years. After earning her nursing degree from the University of New Hampshire (UNH) in 2018, Anne worked as an EMT at her local fire department, gaining practical experience that prepared her for five years as a nurse in the emergency department. She eventually returned to UNH to become an NP and has spent the last 8 years in the same ED, building relationships with a clinical team dedicated to providing the best possible patient care. Outside of the hospital, she’s usually skiing, hiking, or running in the New Hampshire hills. ERcast is her first podcast, and she’s thrilled to be part of the Hippo team.
Brett Murray, MD
Dr. Murray is an Emergency Medicine physician practicing at a busy community trauma center. After attending Boston University School of Medicine, he completed his residency training at Brown University / Rhode Island Hospital, where he also served as Chief Resident from 2020 – 2021. His clinical interests center on medical education, performance science, and Emergency Medical Services.
Shirley Shao, MD
John Casey, DO