Explore every episode of the podcast The World’s Okayest Medic Podcast

Dr. David Rayburn (Medical Director for New Orleans EMS) and Dr. Michael Kling joined the podcast to talk about cold blood product administration and other trauma topics. Listener discretion is advised.

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References: Akhtar, M., Shenasa, M., Jazayeri, M., Caceres, J., & Tchou, P. J. (1988). Wide QRS complex tachycardia: Reappraisal of a common clinical problem. Annals of Internal Medicine, 109(11), 905–912.

Baerman, J. M., Morady, F., DiCarlo, L. A., Jr., & de Buitleir, M. (1987). Differentiation of ventricular tachycardia from supraventricular tachycardia with aberration: Value of the clinical history. Annals of Emergency Medicine, 16(1), 40–43.

Brugada, J., et al. (2020). 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. European Heart Journal, 41(5), 655–720.

Dancy, M., Camm, A. J., & Ward, D. (1985). Misdiagnosis of chronic recurrent ventricular tachycardia. The Lancet, 2(8450), 320–323.

Ohlow, M. A., Beierlein, A., Müller, S., von Korn, H., Geller, J. C., Yu, J., & Lauer, B. (2005). Stabile Tachykardie mit breitem QRS-Komplex in der prähospitalen Notfallmedizin [Stable tachycardia with wide QRS complex in pre-hospital emergency medicine]. Deutsche Medizinische Wochenschrift, 130(47), 2694–2698.

Steinman, R. T., Herrera, C., Schuger, C. D., & Lehmann, M. H. (1989). Wide QRS tachycardia in the conscious adult: Ventricular tachycardia is the most frequent cause. JAMA, 261(7), 1013–1016. Stewart, R. B., Bardy, G. H., & Greene, H. L. (1986). Wide complex tachycardia: Misdiagnosis and outcome after emergent therapy. Annals of Internal Medicine, 104(6), 766–771.

Tchou, P., Young, P., Mahmud, R., Denker, S., Jazayeri, M., & Akhtar, M. (1988). Useful clinical criteria for the diagnosis of ventricular tachycardia. American Journal of Medicine, 84(1), 53–56.

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Reference: Leggatt L, Van Aarsen K, Columbus M, Dukelow A, Lewell M, Davis M, McLeod S. Morbidity and Mortality Associated with Prehospital "Lift-assist" Calls. Prehosp Emerg Care. 2017 Sep-Oct;21(5):556-562.

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References: Almallouhi, E., Al Kasab, S., Nahhas, M., Harvey, J. B., Caudill, J., Turner, N., & Holmstedt, C. A. (2020). Outcomes of interfacility helicopter transportation in acute stroke care. Neurology: Clinical Practice, 10(5), 422–427.

Bartos, J. A., Clare Agdamag, A., Kalra, R., et al. (2023). Supraglottic airway devices are associated with asphyxial physiology after prolonged CPR in patients with refractory Out-of-Hospital cardiac arrest presenting for extracorporeal cardiopulmonary resuscitation. Resuscitation, 186, 109769.

Kashyap, R., Anderson, P. W., Vakil, A., Russi, C. S., & Cartin-Ceba, R. (2016). A retrospective comparison of helicopter transport versus ground transport in patients with severe sepsis and septic shock. International Journal of Emergency Medicine, 9.

Stewart, K., Garwe, T., Oluborode, B., Sarwar, Z., & Albrecht, R. M. (2020). Association of Interfacility Helicopter versus Ground Ambulance Transport and in-Hospital Mortality among Trauma Patients. Prehospital Emergency Care, 25, 620–628.

Wang, H. E., Jaureguibeitia, X., Aramendi, E., et al. (2022). Airway strategy and ventilation rates in the pragmatic airway resuscitation trial. Resuscitation, 176, 80–87.

Listener discretion is advised. Sincere thanks to the Buda FD and Austin-Travis StarFlight for the permission for their staff to come onto the podcast and discuss this case.

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References: Galvagno SM Jr, Haut ER, Zafar SN, et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012;307(15):1602-1610.

Jarvis JL, Jarvis SE, Kennel J. The association between out-of-hospital drug-assisted airway management approach and intubation first-pass success. Ann Emerg Med. 2025;86(5)

Kashyap R, Anderson PW, Vakil A, Russi CS, Cartin-Ceba R. A retrospective comparison of helicopter transport versus ground transport in patients with severe sepsis and septic shock. International Journal of Emergency Medicine. 2016;9:15.

Orso, D., Flaibani, L., Sisto, U. G., Bonsano, M., Fonda, F., Pangallo, R., & Bove, T. (2025). Survival and cost-effectiveness of helicopter versus ground emergency medical services: A systematic review and meta-analysis with meta-regression and trial sequential analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33, Article 160.

Sanchez, G., Gupta, S., & Johnson, M. E. (2024). Analysis of helicopter air ambulance accidents in the United States from 2010 to 2021. Air Medical Journal, 43(6), 499–507.

Shekhar AC, Blumen IJ. Fatal air medical accidents in the United States (2000–2020). Prehosp Disaster Med. 2023;38(2):264-269. doi:10.1017/S1049023X23000274. Eighty-seven fatal accidents, 239 deaths; 72.4% of deaths on helicopters. NTSB probable-cause reviews.

Listener discretion is advised.

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Listener discretion is advised!!!

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References: Paterson BF, Grammer LC, Greenberger PA. The management of coexisting asthma and cardiac disease. N Engl Reg Allergy Proc. 1987;8(5):309-315.

Pauw EK, Stubblefield WB, Wrenn JO, Brown SK, Cosse MS, Curry ZS, Darcy TP, James TE, Koetter PE, Nicholson CE, Parisi FN, Shepherd LG, Soppet SL, Stocker MD, Walston BM, Self WH, Han JH, Ward MJ. Frequency of cardiotoxicity following intramuscular administration of epinephrine in emergency department patients with anaphylaxis. J Am Coll Emerg Physicians Open. 2024;5(1)

Putland M, Kerr D, Kelly AM. Adverse events associated with the use of intravenous epinephrine in emergency department patients presenting with severe asthma. Ann Emerg Med. 2006;47(6):559-563.

Smith D, Riel J, Tilles I, Kino R, Lis J, Hoffman JR. Intravenous epinephrine in life-threatening asthma. Ann Emerg Med. 2003;41(5):706-711.

Spigner MF, Gussick M, Shah MN. The Estimated Benefit of Lights and Sirens During Ambulance Transport. Prehosp Emerg Care.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED!!!

LISTENER DISCRETION IS ADVISED!!!

Listener discretion is advised!

LISTENER DISCRETION IS ADVISED!!!

LISTENER DISCRETION IS ADVISED!

References: Alam N, Oskam E, et. al. PHANTASi Trial Investigators and the ORCA (Onderzoeks Consortium Acute Geneeskunde) Research Consortium the Netherlands. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med. 2018 Jan;6(1):40-50.

Jouffroy, R., Annane, D., et. al. (2026). A 1-hour resuscitation bundle for prehospital management of septic shock. Critical Care Medicine.

Knack, S. K. S., Scott, N., Driver, B. E., et al. (2024). Early physician gestalt versus usual screening tools for the prediction of sepsis in critically ill emergency patients. Annals of Emergency Medicine.

Kotnarin R, Sirinawee P, Supasaovapak J. Impact of Prehospital Antibiotics on in-Hospital Mortality in Emergency Medical Service Patients with Sepsis. Open Access Emerg Med. 2023 May 26;15:199-206.

Poynter, M. J., Farrugia, A., Kelly, E., & Simpson, P. M. (2023). Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – A systematic review. Paramedicine, 21, 52–65. Scales DC, et. al. Prehospital antibiotics and intravenous fluids for patients with sepsis: protocol for a 2×2 factorial randomised controlled trial. BMJ Open. 2025 May 27;15(5):e104257.

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References: Evans C, Quinlan DO, Engels PT, Sherbino J. Reanimating Patients After Traumatic Cardiac Arrest: A Practical Approach Informed by Best Evidence. Emerg Med Clin North Am. 2018 Feb;36(1):19-40.

Lott, C., Truhlář, A., et al. (2021). European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation, 161, 152-219.

Reuben Strayer’s ATLS Lecture at ResusX: https://youtube.be/OwgYKtB2Kj0?si=4YFkJ4oPB4l3VEGC

Zaf Quasim/Haney Mallemat Critical Care Now Podcast link: https://www.youtube.com/watch?v=HePF-mEtvOc

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References: Cardenas JC, Dong JF, Kozar RA. Injury-induced endotheliopathy: What you need to know. J Trauma Acute Care Surg. 2023 Oct 1;95(4):454-463.

Dietrich M, Hölle T, Lalev LD, Loos M, Schmitt FCF, Fiedler MO, Hackert T, Richter DC, Weigand MA, Fischer D. Plasma Transfusion in Septic Shock-A Secondary Analysis of a Retrospective Single-Center Cohort. J Clin Med. 2022 Jul 27;11(15):4367.

Kuldanek, S. A., Kelher, M., & Silliman, C. C. (2019). Risk factors, management and prevention of transfusion-related acute lung injury: a comprehensive update. Expert Review of Hematology, 12(9), 773–785.

SOARescue EZPLAZ Article: https://www.soarescue.com/handoff/ezplaz-freeze-dried-plasma

Toy, P., Gajic, O., Bacchetti, P., et al. (2012). Transfusion-related acute lung injury: incidence and risk factors. Blood, 119(7), 1757–1767.

Vossoughi, S., Gorlin, J., Kessler, D. A., et al. (2019). Ten years of TRALI mitigation: measuring our progress. Transfusion, 59(8), 2567–2574.

Dr. Greg Shea came onto the podcast to talk about the leadership and organizational lessons learned from the FDNY before, during, and after the 9/11 attacks.

Check out the book he co-authored at https://www.risingfromgroundzero.org/

Unfiltered, no agenda, and no planning. Just Dan and I having a zoom call and recording it...

LISTENER DISCRETION IS ADVISED!!!

LISTENER DISCRETION IS ADVISED!!!

References: Rezaei Zadeh Rukerd M, Shahrbabaki FR, Movahedi M, Honarmand A, Pourzand P, Mirafzal A. Single intravenous dose ondansetron induces QT prolongation in adult emergency department patients: a prospective observational study. Int J Emerg Med. 2024 Apr 2;17(1):49.

Yürük Mısırlıoğlu H, Öztürk İnce E, Akkaş M. The effect of intravenous ondansetron on QT interval in the emergency department. Am J Emerg Med. 2024 Nov;85:7-12.

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Listener discretion is advised! (explicit)

References: McGovern B, Garan H, Ruskin JN. Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome. Ann Intern Med. 1986 Jun;104(6):791-4. doi: 10.7326/0003-4819-104-6-791. PMID: 3706931.

Strasberg B, Sagie A, Rechavia E, Katz A, Ovsyscher IA, Sclarovsky S, Agmon J. Deleterious effects of intravenous verapamil in Wolff-Parkinson-White patients and atrial fibrillation. Cardiovasc Drugs Ther. 1989 Jan;2(6):801-6. doi: 10.1007/BF00133211. PMID: 2488095.

UK Paramedic Assaults: https://collegeofparamedics.co.uk/COP/COP/News/2025/AACE_Calls_For_Further_Interventions.aspx#:~:text=New%20data%20shows%20UK%20ambulance,15%25%20on%20the%20previous%20year.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED!!!

References: Carunchio, M. (July 2020). Atypical Stroke Presentations. EMS World. Available: https://www.hmpgloballearningnetwork.com/site/emsworld/article/1224541/atypical-stroke-presentations

Clawson, J. J., Scott, G., Gardett, I., et al. (2016). Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes. Journal of Stroke and Cerebrovascular Diseases, 25, 2031-2042. Gardett, Olola, Scott, Broadbent, & Clawson. (March 22, 2017). Comparison of EMD Stroke Identification and Paramedic On-Scene Stroke Assessment. Annals of Emergency Dispatch & Response.

Peter Antevy Substack Article on RQI. Available: https://handtevymd.substack.com/p/jalen-brunson-didnt-win-a-championship?r=khz4&utm_campaign=post-expanded-share&utm_medium=post%20viewer&triedRedirect=true

Prehospital Stroke ID Article: Caffarelli M, Wood AJ, Crowe RP, Amorim E, Kamel H, Kim AS, Guterman EL. PMID: 39398987.

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References: My ResusX Talk: http://www.youtube.com/watch?v=ufC2LXtCzUI

Hana Hybasek Dzurikova. (29 Jan 2025). Unmasking Hyperkalemia: Highlighting Critical ECG Changes. Available https://www.powerfulmedical.com/blog/hyperkalemia-ecg-critical-changes/

Listener discretion is advised!!!

Listener discretion is advised!!!

References: Gabayan, G. Z., Gould, M. K., Weiss, R. E., Patel, N., Donkor, K. A., Chiu, V. Y., Yiu, S. C., Jones, J. P., Hoffman, J. R., & Sarkisian, C. A. (2016). Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study. Annals of Emergency Medicine, 68(1), 43–51.e2.

Ganetsky M, Lopez G, Coreanu T, Novack V, Horng S, Shapiro NI, Bauer KA. Risk of Intracranial Hemorrhage in Ground-level Fall With Antiplatelet or Anticoagulant Agents. Acad Emerg Med. 2017 Oct;24(10):1258-1266.

Gokhroo, R. K., Ranwa, B. L., Kishor, K., et al. (2015). Sweating: A Specific Predictor of ST‐Segment Elevation Myocardial Infarction Among the Symptoms of Acute Coronary Syndrome: Sweating In Myocardial Infarction (SWIMI) Study Group. Clinical Cardiology, 39, 90–95.

Knack SKS, Scott N, Driver BE, Prekker ME, Black LP, Hopson C, Maruggi E, Kaus O, Tordsen W, Puskarich MA. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med. 2024 Sep;84(3)

Koo, A. (Oct 29, 2024). Putting Clinical Gestalt to Work in the Emergency Department. Available: https://www.acepnow.com/article/putting-clinical-gestalt-to-work-in-the-emergency-department/5/?singlepage=1

Long, B., Keim, S. M., Gottlieb, M., Carlson, J., Bedolla, J., & Reisdorff, E. J. (2024). Can I Discharge This Adult Patient with Abnormal Vital Signs From the Emergency Department? The Journal of Emergency Medicine, 67(4), e487–e493.

Milner, K. A., Funk, M., Arnold, A., & Vaccarino, V. (2002). Typical symptoms are predictive of acute coronary syndromes in women. American Heart Journal, 143, 283–288.

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References: Buttner & Arlanger. (May 3, 2022). ST depression does not localise. Available: https://litfl.com/st-depression-does-not-localise/

Cannon, J. W., Khan, M. A., Raja, A. S., et al. (2017). Damage control resuscitation in patients with severe traumatic hemorrhage. Journal of Trauma and Acute Care Surgery, 82, 605-617.

Kabra, R., Acharya, S., Kamat, S., & Kumar, S. (2022). ST-Segment Elevation in Lead aVR With Global ST-Segment Depression: Never Neglect Left Main Coronary Artery (LMCA) Occlusion. Cureus.

Lee, G.-K., Hsieh, Y.-P., Hsu, S.-W., Lan, S.-J., & Soni, K. (2019). Value of ST‐segment change in lead aVR in diagnosing left main disease in Non‐ST‐elevation acute coronary syndrome—A meta‐analysis. Annals of Noninvasive Electrocardiology, 24.

Morrison, C. A., Carrick, M. M., Norman, M. A., et al. (2011). Hypotensive Resuscitation Strategy Reduces Transfusion Requirements and Severe Postoperative Coagulopathy in Trauma Patients With Hemorrhagic Shock: Preliminary Results of a Randomized Controlled Trial. Journal of Trauma: Injury, Infection & Critical Care, 70, 652-663.

Rossaint, R., Afshari, A., Bouillon, B., et al. (2023). The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Critical Care, 27.

Tamura, A. (2014). Significance of lead aVR in acute coronary syndrome. World Journal of Cardiology, 6(7), 630.

Uthamalingam, S., Zheng, H., Leavitt, M., Pomerantsev, E., Ahmado, I., Gurm, G. S., & Gewirtz, H. (2011). Exercise-Induced ST-Segment Elevation in ECG Lead aVR Is a Useful Indicator of Significant Left Main or Ostial LAD Coronary Artery Stenosis. JACC: Cardiovascular Imaging, 4, 176–186.

Weymouth, W., Long, B., Koyfman, A., & Winckler, C. (2019). Whole Blood in Trauma: A Review for Emergency Clinicians. The Journal of Emergency Medicine, 56, 491-498.

Wang, A., Singh, V., Duan, Y., Su, X., Su, H., Zhang, M., & Cao, Y. (2020). Prognostic implications of ST‐segment elevation in lead aVR in patients with acute coronary syndrome: A meta‐analysis. Annals of Noninvasive Electrocardiology, 26.

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References:

Hair Tourniquet: PMID: 29092968

ACEP. (2025). A Worthy Investment: What Every EM Resident Needs to Know About Reimbursement in 2025. Available: https://www.acep.org/administration/reimbursement/what-every-graduating-resident-needs-to-know-about-reimbursement

Dan Magdziarz. (Jan 5, 2021). High-Yield RVU Generation in Emergency Medicine. Emergency Physicians Monthly. Available: https://epmonthly.com/article/high-yield-rvu-generation-in-emergency-medicine/

John Proctor. Gauging Emergency Physician Productivity: Are RVUs the Answer? Available: https://www.acep.org/imports/clinical-and-practice-management/resources/reimbursement-imported/gauging-emergency-physician-productivity-are-rvus-the-answerEmer

Listener discretion is advised!

References: ACEP. (2025). A Worthy Investment: What Every EM Resident Needs to Know About Reimbursement in 2025. Available: https://www.acep.org/administration/reimbursement/what-every-graduating-resident-needs-to-know-about-reimbursement

Dan Magdziarz. (Jan 5, 2021). High-Yield RVU Generation in Emergency Medicine. Emergency Physicians Monthly. Available: https://epmonthly.com/article/high-yield-rvu-generation-in-emergency-medicine/

John Proctor. Gauging Emergency Physician Productivity: Are RVUs the Answer? Available: https://www.acep.org/imports/clinical-and-practice-management/resources/reimbursement-imported/gauging-emergency-physician-productivity-are-rvus-the-answerEmer

Listener discretion is advised.

Dr. Rugna's Article: https://assets-che.mkt.dynamics.com/82359f7e-b7af-4cc1-a9fe-c8a35b467194/digitalassets/standaloneforms/7a39198e-7127-f011-8c4d-0022480cd54d#div_id

Listener discretion is advised. Language. Adult themes.

References: Anand Swaminathan, "Clinical Conundrum: Should We Always Treat Fever in Patients with Sepsis?", REBEL EM blog, December 17, 2024. Available at: https://rebelem.com/clinical-conundrum-should-we-always-treat-fever-in-patients-with-sepsis/.

Jibril F, Sharaby S, Mohamed A, Wilby KJ. Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making. Can J Hosp Pharm. 2015 May-Jun;68(3)

Scott Weingart, MD FCCM. EMCrit 132 – MoTR – Toughness Part I with Michael Lauria. EMCrit Blog. Published on September 6, 2014. Accessed on May 8th 2026. Available at [https://emcrit.org/emcrit/toughness-michael-lauria-i/ ].

Listener discretion is advised.

Listener discretion is advised: language, adult themes

Reference: Boland, Hokanson, et. al. (2016). Prehospital lactate measurement by EMS in patients meeting sepsis criteria. Western J. EM (17)5.

Listener discretion is advised.

Listener discretion is advised.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED. Sensitive themes. Language.

References: Rautaharju PM, Park L, Rautaharju FS, Crow R. A standardized procedure for locating and documenting ECG chest electrode positions: consideration of the effect of breast tissue on ECG amplitudes in women. J Electrocardiol. 1998 Jan;31(1):17-29.

Bill Berlin is a flight nurse and serves in the USAF. His daughter is currently battling Leukemia and Bill was kind enough to come on to the podcast to talk about what this journey has taught him about being a health care provider.

Listener discretion is advised.

Listener discretion is advised.

References: Cook CE, Thigpen CA. Five good reasons to be disappointed with randomized trials. J Man Manip Ther. 2019 May;27(2):63-65. doi: 10.1080/10669817.2019.1589697. Epub 2019 Mar 14. PMID: 30935322

Fernainy P, Cohen AA, Murray E, Losina E, Lamontagne F, Sourial N. Rethinking the pros and cons of randomized controlled trials and observational studies in the era of big data and advanced methods: a panel discussion. BMC Proc. 2024 Jan 18;18(Suppl 2):1. doi: 10.1186/s12919-023-00285-8. Erratum in: BMC Proc. 2024 Aug 16;18(1):16. doi: 10.1186/s12919-024-00299-w. PMID: 38233894

Ramchurn TP, Nundy S. Randomised clinical trials in surgery: are we at a crossroads? Ann Med Surg (Lond). 2023 Nov 7;86(1):3-6. doi: 10.1097/MS9.0000000000001457. PMID: 38222736

Listener discretion is advised. Sensitive language and themes.

LISTENER DISCRETION IS ADVISED. Language. Sensitive themes.

Study Citation: Vattipally VN, Ran KR, Myneni S, Jo J, Margolis A, Nasr IW, Robinson S, Cohen AR, Azad TD. Emergency Medical Services Time on Scene Associated with Reduced Dead-on-Arrival Status Among Pediatric Patients with Severe Traumatic Brain Injury. Prehosp Emerg Care. 2026 Jan 21:1-9. doi: 10.1080/10903127.2025.2605648. Epub ahead of print. PMID: 41418045.

Listener discretion is advised.

LISTENER DISCRETION IS ADVISED! ADULT THEMES. LANGUAGE.

References: Smith, J. E., Cardigan, R., Sanderson, E., Silsby, L., Rourke, C., Barnard, E. B. G., Basham, P., Antonacci, G., Charlewood, R., Dallas, N., Davies, J., Goodwin, E., Hawton, A., Hudson, C., Lucas, J., Keen, K., Lyon, R. M., & Nolan, B. (2026). Prehospital whole blood in traumatic hemorrhage — a randomized controlled trial. The New England Journal of Medicine. https://doi.org/10.1056/nejmoa2516043

Dr. Antevy's Discussion Thread on LinkedIN: https://www.linkedin.com/posts/peter-antevy-md-faems-a9b11726_the-swift-trial-just-published-in-nejm-group-activity-7440071242285625344-1HZP?utm_source=share&utm_medium=member_desktop&rcm=ACoAAF6Ls6YBtNzvNfxmvsyVNOMy6QNK6Bc_pj4

Listener discretion is advised.

Listener discretion is advised.