FOAMfrat Podcast

Prehospital emergency and critical care podcast by Tyler Christifulli & Sam Ireland

Podcast 166 - Transcutaneous Pacing & False Capture 04/25/2024

Podcast 166 - Transcutaneous Pacing & False Capture The conversation is about a paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have electrical capture when they do not. They emphasize the importance of confirming electrical capture before assuming mechanical capture. They also discuss the challenges of pulse palpation and the need for more rigorous research in EMS and ED settings. The conversation discusses the challenges and considerations in transcutaneous pacing, specifically focusing on the verification of mechanical capture. The speakers explore the use of various methods to confirm mechanical capture, such as feeling for a pulse, using pulse oximetry, and utilizing ultrasound. They also discuss the difficulty of accurately assessing mechanical capture and the potential for false electrical capture. The conversation concludes with a discussion on the transfer of pacing from one device to another and the importance of verifying capture during the process. /episode/index/show/foamfrat/id/30978458

Podcast 165 - Should Pressors Have A Max Dose? 02/02/2024

Podcast 165 - Should Pressors Have A Max Dose? In this episode we discuss whether the concept of having a "max dose" of your pressor has any evidence or physiological backing. Joining me in this discussion are Dan Rauh, Shane O'Donnell, and Shad Ruby. /episode/index/show/foamfrat/id/29771878

Podcast 164 - Suicidal Ideation w/ James Boomhower 11/18/2023

Podcast 164 - Suicidal Ideation w/ James Boomhower How do you talk to a patient experiencing suicidal ideation? What if you're the one having these thoughts? We're interviewing James Boomhower from in this episode. We discuss suicidal ideation, therapeutic communication, and verbal de-escalation. /episode/index/show/foamfrat/id/28699388

Podcast 163 - What Can We Learn From A Ketamine Infusion Clinic? w/ Chris Carlstrom 10/30/2023

Podcast 163 - What Can We Learn From A Ketamine Infusion Clinic? w/ Chris Carlstrom Chris Carlstrom is a flight nurse at Life Link III and also works part-time at a ketamine infusion clinic. We’ve had some interesting conversations on shift regarding his experiences with ketamine in the clinic versus emergency medicine and I finally was able to get one of these conversations recorded for the podcast. Enjoy Podcast 163 - What Can We Learn From A Ketamine Infusion Clinic? w/ Chris Carlstrom. /episode/index/show/foamfrat/id/28460195

Podcast 162 - Multimodal Pain Management w/ Shane O' Donnell 09/29/2023

Podcast 162 - Multimodal Pain Management w/ Shane O' Donnell When I became a paramedic, being able to provide pain management was one of the "new interventions" that I looked forward to most. As an EMT, I remember countless times I was without ALS resources and had to watch a patient suffering in pain until we got to the hospital. Trying to obtain any history or perform an assessment on someone writhing in pain can be nearly impossible. As a BLS provider, I would attempt non-pharmacological ways to relieve pain, such as ice packs, warm packs, elevating extremities, and sometimes simply trying to distract them with conversation. While these methods should not be discounted, I will never forget the first time I could provide pain medication to an elderly woman who fell and fractured her hip. I started an IV right there on the floor of the assisted living facility, administered some fentanyl, and comfortably got her to the stretcher. Analgesia did not save this lady's life. Still, it did make her trip to the hospital a little more comfortable and allowed me to obtain an accurate history, including the dizziness and dyspnea she felt before falling. Performing an adequate assessment and obtaining pertinent medical history can be difficult when a patient is experiencing intense pain. For this reason, pain should be managed to a level that allows for comfort & communication. Total pain relief is ideal but may not always be feasible, given hemodynamics and underlying causes. Check out this episode with Tyler & Shane as they discuss multimodal pain management strategies. /episode/index/show/foamfrat/id/28178348

Podcast 161 - EMT Pharmacology 08/18/2023

Podcast 161 - EMT Pharmacology Taking on pharmacology in EMT school is a big hurdle. We wanted to write something that not only explained the basics of the medications but also helped bridge the gap between what EMTs are taught and what paramedics learn when they go back over these medications in paramedic pharmacology. Each chapter discusses how the medications work, why they're given for specific indications, and the logistics of medication administration! We've also included medication profiles, tips and tricks from experienced providers, and flashcards for each medication to help you hone your med knowledge base! In this book, we're coving: Oxygen Albuterol and Atrovent Epinephrine Aspirin Nitroglycerin Naloxone Oral Glucose Gel and Glucagon + Flashcards in the back! This book is for students, EMTs, and paramedics who want an in-depth review of EMT medications! You can download the book for free at foamfrat.com /episode/index/show/foamfrat/id/27790488

Podcast 160 - Autism Communication w/ Joshua Chan & Matthew Yelton 08/03/2023

Podcast 160 - Autism Communication w/ Joshua Chan & Matthew Yelton I had the privilege to bring on two passionate fathers of children with Autism to help me better understand how to approach and communicate with a neuro-diverse child. This episode is chock-full of insight, tips, tricks, and logistics of approaching a child in the field with Autism. Josh Chan is a Life Link III flight paramedic/base lead and a Glenwood FD firefighter. Matthew Yelton is a flight paramedic/base lead for Mercy Flight Central and works as a fire captain at Constableville Ambulance Inc. /episode/index/show/foamfrat/id/27644697

Podcast 159 - Close Encounters of the Infectious Kind w/ Dr. Hudson Garrett 06/14/2023

Podcast 159 - Close Encounters of the Infectious Kind w/ Dr. Hudson Garrett EMS providers encounter various infectious diseases daily and need to know the routes of exposure, risks, and preventive measures to protect themselves and their families. In this episode, We talk with Dr. Hudson Garrett, an infectious disease expert with the medical college of Louisville University, to discuss the practical points of infectious disease for the everyday provider. Want CE for this episode? Sign up for FOAMfrat Studio and access 300+ hours of continuing education for EMS & Nursing. www.foamfrat.com /episode/index/show/foamfrat/id/27143130

Podcast 158 - RSI Cocktail w/ Heavy Lies The Helmet 04/12/2023

Podcast 158 - RSI Cocktail w/ Heavy Lies The Helmet In this episode, Dan Rauh & Mike Boone from Heavy Lies The Helmet join me to hash out our workflows and drugs of choice for four particular scenarios you may come across. The combative head injury patient that needs to be intubated but has five firefighters holding them down and is actively trying to rip off his collar and IV. The septic hypotensive patient is no longer protecting their airway but also needs resuscitation prior to induction. The snoring head bleed with a BP of 220/140 The "almost dead, but needs a tube" population (induction med?) /episode/index/show/foamfrat/id/26523618

Podcast 157 - Ventilation & Cardiac Arrest w/ Tom Bouthillet 03/03/2023

Podcast 157 - Ventilation & Cardiac Arrest w/ Tom Bouthillet Moments after the heart stops the entire circulatory system finally has a chance to bring venous and arterial pressures to equilibrium. Cardiac arrest resuscitation requires the provider to have a strong mental model of physiology and the logistics to carry out a series of interventions crucial to preserving life. This class will serve not as a routine basic life support model, but as a deeper understanding and framework to guide resuscitation during your next cardiac arrest. /episode/index/show/foamfrat/id/26114808

Podcast 156 - Is using AI cheating? EMS and AI 02/25/2023

Podcast 156 - Is using AI cheating? EMS and AI AI will be integrated into everything we do in medicine, perhaps sooner than we think. It will help keep our patients safe, our providers informed, and our communications connected, and change how we think about how we care for patients (if implemented correctly). Systems like ChatGPT are only the beginning, and many companies are already working on or have already integrated with other healthcare specialties. We will see the same integration happen with EMS. While the response to this might be fear of losing our knowledge base, over-automating decision-making, cheating on tests and papers, and the like, we could adopt a very different outlook. We could view this as an opportunity to improve patient safety, offload menial work, automate documentation and communications, and always have an intelligent partner in our pockets we can bounce ideas off of. One day, we'll wonder how we ever lived without it. /episode/index/show/foamfrat/id/26039784

Podcast 155 - Pattern Recognition vs. Autopilot w/ Shaylah Montgomery 02/15/2023

Podcast 155 - Pattern Recognition vs. Autopilot w/ Shaylah Montgomery In this episode, Tyler is joined by Shaylah Montgomery to discuss decision-making, human factors, and mental shortcuts utilizing pattern detection. Shaylah is a flight nurse and paramedic for Pafford Air One and a member of the FOAMfrat team. /episode/index/show/foamfrat/id/25940436

Podcast 154 - ROSC Temp & Sedation w/ Dr. Leon Eydelman 02/06/2023

Podcast 154 - ROSC Temp & Sedation w/ Dr. Leon Eydelman What aspects of temperature-targeted management are most important to EMS, and how should EMS guide sedation for the patient with a return of spontaneous circulation? Check out this interview w/ Dr. Leon Eydelman! The ROSC class referenced in this video can be found in FOAMfrat Studio! Highlights ROSC + FEVER = Bad. Trust a high temperature and question a low one. While most EMS agencies likely do not carry propofol, it is the most commonly used sedation medication in the ED because it washes out quickly and allows for neuro eval. Benzodiazepines are associated with higher rates of ICU delirium and complications. Running levophed to counteract the vasodilation aspect of propofol. Don't have propofol; hemodynamic-dosed ketamine is a good option as well. The sedation dose should be reduced when the shock index is > 0.9. When a patient is in shock, their volume of distribution changes, and peripheral blood flow is reduced. This means more blood is shunted to the brain,, and lower doses of sedation will give the agent therapeutic brain levels. /episode/index/show/foamfrat/id/25849485

Podcast 153 - Pediatric Arrest w/ Dr. Banerjee 01/16/2023

Podcast 153 - Pediatric Arrest w/ Dr. Banerjee We just finished re-recording our pediatric arrest class in Studio and decided to play the unedited version of my discussion with Dr. Paul Banerjee. Banerjee is a prolific researcher and medical director in Florida with a particular emphasis on pediatric arrest. Check out the class in Studio for more information on the logistics. /episode/index/show/foamfrat/id/25625214

Podcast 152 - CISM & Processing w/ Sam Henne 12/12/2022

Podcast 152 - CISM & Processing w/ Sam Henne Sam Henne is the creator of Mind Over Medic and a co-worker of mine at Life Link III. In this episode, we discuss the components of critical incident stress and ways to reduce adrenaline during threat appraisal. Check out /episode/index/show/foamfrat/id/25305309

Podcast 151 - Central Line Access for EMS w/ Austin Brook 12/02/2022

Podcast 151 - Central Line Access for EMS w/ Austin Brook EMS is well-trained in peripheral intravenous as well as intraosseous access. However, central lines remain off-limits for many clinicians in various response areas. If accessing these types of lines is allowed, it’s usually permitted when the patient is (nearly) dead. This isn’t very surprising since the scope of practice of the EMS clinician usually focuses on emergent treatments. Unless it’s learned during a critical care class, little thought is typically given to topics like central, dialysis, and PICC lines in EMS. Why not? /episode/index/show/foamfrat/id/25195665

Podcast 150 - Slishman Traction 11/05/2022

Podcast 150 - Slishman Traction Had the opportunity to talk with Dr. Sam Slishman, the inventor of the Slishman traction splint. We had a great conversation on the idea/concept of this splint, who to apply it on, and some additional questions, which we plan on having him back on to discuss. /episode/index/show/foamfrat/id/24915939

Podcast 149 - P:F vs. A-a & Oxygenation Strategies 10/21/2022

Podcast 149 - P:F vs. A-a & Oxygenation Strategies A-a gradient, a/A ratio, and P: F ratio - are all different views of the same item. These formulas do not have a complete view of oxygenation. Oxygenation is a huge topic, and there are more common values that we use: How well is the patient saturating? Is there dyspnea? How do the lungs sound (auscultation) or look (POCUS)? Where is the patient on the OHCD? What does the ABG show? /episode/index/show/foamfrat/id/24759342

Podcast 148 - Crashing PE Logistics w/ Shane & Brian 10/04/2022

Podcast 148 - Crashing PE Logistics w/ Shane & Brian I ran some specific decision points when treating the REALLY BAD massiVE pulmonary embolism patient by Shane & Brian from the FOAMfrat Team. This discussion really focuses on the logistics and ideas when you are trying to get the patient from A to B without having to do CPR. /episode/index/show/foamfrat/id/24582987

Podcast 147 - NICU Q&A w/ Theresa Bowden 07/14/2022

Podcast 147 - NICU Q&A w/ Theresa Bowden Theresa Bowden is a rockstar flight nurse who specializes in NICU transports. In this episode, you will listen in as Theresa explains anything and everything you have ever wondered about NICU interfacility transports. Topics include: Who gets prostaglandin? IO or IV catheter for UVC Cardiac vs. Respiratory Initial Vent Settings Get credit for this class by listening to it in FOAMfrat Studio. /episode/index/show/foamfrat/id/23742911

Podcast 146 - IVC Assessment w/ Shane O'Donnell 05/22/2022

Podcast 146 - IVC Assessment w/ Shane O'Donnell Does IVC assessment have a role in pre-hospital ultrasound? This week we talk to one of the newest members of FOAMfrat, Shane O'Donnell. /episode/index/show/foamfrat/id/23189003

Podcast 145 - Pediatric Bags 04/17/2022

Podcast 145 - Pediatric Bags Do specialized pediatric jump bags alienate the pediatric population? They typically don’t get used as much, and introducing a foreign bag into a low volume population may add to the stress of running a pediatric call anyway. In this episode, Sam & Tyler discuss the case against the pediatric jump bag. /episode/index/show/foamfrat/id/22814408

Podcast 144 - VR & EMS Education 02/03/2022

Podcast 144 - VR & EMS Education The FOAMfrat podcast is back in 2022 with a discussion on how virtual reality can be used in EMS education. We did our first VR class a few weeks ago and here's what we learned and what we plan to do with it! /episode/index/show/foamfrat/id/22011131

Podcast 143 - Thyroid Disorders 12/23/2021

Podcast 143 - Thyroid Disorders The thyroid is a -shaped gland. But for some, it can be more like a bullet to the neck. The number of systems that our thyroid helps regulate truly is incredible, and an over or under-active thyroid can cause a whole host of acute and chronic issues. On the one hand, imagine a patient who has a thyroid history and is cold, weak, and has a depressed level of consciousness. Why is this occurring, and what's the diagnosis and treatment? On the other hand, imagine an anxious, hyperpyrexic patient in atrial fibrillation. Both patients have thyroid issues, but why do these patients present so differently? Let's see what happens when the scales tip either way for a few of the systems that the thyroid helps control! /episode/index/show/foamfrat/id/21586355

Podcast 142 - EBM Guide To RSV w/ Natalie May 12/11/2021

Podcast 142 - EBM Guide To RSV w/ Natalie May I reached out to @medtwitter asking for help finding a guest to talk about the respiratory syncytial virus (RSV). It may seem weird to be talking about RSV when everyone is thinking about the current pandemic, but I find the virology and mechanism of symptoms of RSV exciting. Twitter did not let me down, my friend Ashley Liebig recommended Natalie May from Sydney, HEMS. Natalie is an EM, and Pediatric-EM trained UK doctor working in Prehospital & Retrieval Medicine in Australia. I was very excited to have a chance to speak with Dr. May regarding RSV & Bronchiolitis and what the current evidence suggests for treatment. /episode/index/show/foamfrat/id/21452051

Podcast 141 - Adrenal Emergency 12/04/2021

Podcast 141 - Adrenal Emergency A young pediatric patient is having nausea and vomiting at school and is said to not be 'staying awake very well.' You discover assessment findings such as hypotension, hypoglycemia, and maybe even peaked T waves on the ECG. You receive information indicating that the child has something called "CAH". Or, perhaps... An older patient is having dizziness upon standing, and persistent hypotension. You note a somewhat jaundiced appearance. They become unconscious in their kitchen while searching for a salty snack, and they appear rather sick. Or... A middle-aged patient has suddenly stopped taking their high-dose prednisone for their asthma and is now feeling very weak and cannot stand. We already know what this episode is about - adrenal insufficiency. However, what if those scenarios up above were in the form of a test question? Or worse yet, a real patient? Would we be aware of what's causing the signs and symptoms, and what the appropriate treatment is? Endocrinology does not get the respect it deserves in EMS, probably due to its low volume - we just do not see that many patients with endocrine emergencies outside of diabetes. Or do we, and we just don't notice? /episode/index/show/foamfrat/id/21379517

Podcast 140 - "We Removed Nitro From Our STEMI Guideline" w/ Matt Schneider 11/27/2021

Podcast 140 - "We Removed Nitro From Our STEMI Guideline" w/ Matt Schneider In this episode, we talk with Matt Schneider, a Battalion Chief and Paramedic for the Mequon fire department in Ozaukee County. Sam and I had the privilege of sitting in on a guideline update presented by Matt a few weeks ago. One of the guidelines that caught our attention was the decision to remove nitroglycerin from the STEMI guideline. Listen in as Matt describes how their guideline committee arrived at this decision. "Matt's views, comments, and opinions expressed in this segment do not represent the position of his employer(s), or associated agencies/institutions". /episode/index/show/foamfrat/id/21296402

Podcast 139 - Tracheostomy Management 11/21/2021

Podcast 139 - Tracheostomy Management Nothing is scarier than watching an awake patient struggle to breathe with a trach. Do you have an approach to troubleshoot? Make sure you watch to the end to see our first FOAMfrat reaction video! /episode/index/show/foamfrat/id/21232280

Podcast 138 - Bad & Bougie 11/12/2021

Podcast 138 - Bad & Bougie In this episode, Tyler & Sam discuss everything you need to know about the Bougie. Traditional use Modified pre-loaded techniques Common pitfalls. /episode/index/show/foamfrat/id/21148247

Podcast 137 - Glucose (Outer Limits) 10/06/2021

Podcast 137 - Glucose (Outer Limits) Welcome to the fourth and final installment of this metabolic panel series, where we're exploring what happens when these lab values hit their limits, or beyond. /episode/index/show/foamfrat/id/20727686

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