Foamfrat Podcast

My buddy Bryan Winchell and I sit down and record a conversation about PEEP. We have way more questions than answers, but here's some shop talk on what we are currently doing to optimize PEEP. Check out the full blog and show notes at FOAMfrat.com

If I give this patient a fluid bolus, will it increase cardiac output? What does wall tension have to do with myocardial oxygen demand? In this episode, we will give you a step-by-step guide into assessing LV function utilizing pulse pressure and ultrasound. FOAMfrat is an online library for EMS professionals who are looking to take their knowledge and skills to the next level. www.foamfrat.com

Anne keeps asking "is my baby ok?!" There may be some momentum to just break out the ultrasound and look for a fetal heart rate right now, but you know that taking care of mom means taking care of the baby. In this episode, Cynthia and I discuss the prehospital fetal assessment and how to communicate with mom what you see.   www.foamfrat.com

WPW is an incredibly interesting disease process that can initially cause some trepidation on the part of the clinician due to the perceived nuance of treatment. However, we might just be psyching ourselves out a little bit. Check out Sam & Tyler as they break down the dos and don'ts of WPW management.   www.foamfrat.com

In this episode, Sam and I break down the different clinical signs and diagnostics of the dreaded pulmonary embolism. Make sure you check out the show notes at foamfrat.com for references and videos mentioned throughout the episode!  

Yesterday Sam released a blog on the various flavors of prolonged Q-T syndrome. As a complement to that blog, Sam and Jake sit down and tease out some of the nuances and treatments of this interesting pathology.   

We realized the other day that we have yet to do a podcast on diabetic ketoacidosis (DKA). In this episode, we spend a little bit of time talking about the pathophysiology, but the majority is focused on the logistics of running a DKA transfer. Here are the highlights:   DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN.   DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN.   DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN.   The way you do this safely is by pre-planning! Ask for these things before you leave the hospital:   IV Potassium Liter bag of D5W Bag of lactated ringers Three amps of sodium bicarbonate (if renal failure is suspected)

So, my buddy, Bryan Selvage released a blog a few weeks ago called "The Curious Case of The Brain & The Octopus Trap." This case study caught me off guard because it did not match my mental model of a brain bleed patient. I called Bryan and had a great conversation regarding mental models and how they can either make us look like we have superhuman powers or trip us up.   Bryan started working on a blog to address the perils of mental models at the same time my friend Tom Grawey was writing a piece for FOAMfrat on the "sick versus not sick" assessment. Both of the blogs complimented each other perfectly and I figured we could do a podcast and release both blogs as a package.  

In this podcast, Sam and discuss the evolution of FOAMed peer review with Chris Smetana and Eric Bauer.   Eric is the founder of FlightbridgeED which was one of the first EMS podcasts to surface and quickly became a hit. The FlightbridgeED brand now has grown into one of the industries household names when it comes to providing resources and training for flight clinicians all over the world. You can find their content at FlightbridgeED.com   Chris Smetana is the CEO of IA Med and a known leader within the industry. The IA Med team prides itself on meeting the needs of the industry and collaborating to improve the EMS profession. You can find their content at IAMED.US.   Topics discussed: What is the process from inception to publishing, when it comes to your brands content? Traditional and modified peer review techniques. The art of critique and feedback Reducing noise from social media posts.

I am thrilled to finally get my friend and colleague, Keith Velaski, on the podcast. Keith was my preceptor at LifeLink III and has been a flight clinician for over 25 years. In this episode, we talk about the tempo and mental modeling of resuscitation and flight medicine. This podcast was inspired by my buddy Alex Jones who just started his career in HEMS and sent me this message a few weeks ago. Just got off shift and had saved this in the notes on my phone.  I’m a new flight medic and am still getting into my groove.  If you can decipher this and have any kind of feedback, I’d love your thoughts    Best sequence for assessment Scene and interfacility follow up questions geared towards interfacility Dividing rolls with partners ie do you both receive report, does one take report and the other makes patient contact, or something else? Key labs/imaging based off physical exam findings/chief complaint/HPI What if they haven’t been done/ordered? What’s worth staying at bedside to obtain/initiate? How much is fl

We all want to feel more productive, write a book, or perhaps learn a new skill - but there never feels like enough time. Join Sam and Tyler and they discuss their approach to staying productive while still allowing creative space.   www.foamfrat.com

In this podcast, Tyler, Sam, and Jake discuss managing the patient with multisystem trauma and a suspected TBI. Subscribe to the FOAMfrat podcast for the latest updates in prehospital emergency and critical care.

The primary corrective strategy we must embrace is that assigning blame whether intrinsic or extrinsic, is wasted time and energy. It is not possible to blame and improve at the same time. This is vital for people at all levels to embrace, but particularly in management/leadership. A just culture where people feel empowered to come forward with errors is vital to safe and secure operations. Errors are going to occur, and it is our knowledge of them that allows system and process modification to prevent similar errors moving forward. Think of it like this, if you are a parent meeting your child’s first “boyfriend or girlfriend”, it is your response that often dictates whether you meet the next one or not.

In this story you’ll be playing the role of Lara Croft, an OB/GYN who sees three patients throughout her shift. Your goal is to make the diagnosis for each emergency, and figure out which treatment option is best.

Sometimes seizing patients don't respond to benzodiazepines. In the RAMPART study they found that 18.5% of the midazolam group and 25.8% of the lorazepam group were still seizing upon arrival at the ED.   We know that rapid termination of status epilepticus (SE) is important, but what should EMS do when they are maxing out benzo's, blood pressures are getting soft from all the meds, and the patient is still seizing?!   In this episode we discuss the role of ketamine in SE patients that are refractory to front line treatments.

Over the years, OHCA in the pediatric population has not much improved like the Adult. Why is this? What are we doing wrong? Well, there is emerging evidence that may change your practice.  We also know half the battle is the psychological response and communication. How do we improve? What do we need to do to change these outcomes and find closure? Preparation, psychology of ourselves and others, performance under pressure and tracking data after implementing best practices is just a start. Check out “Solving the Pediatric Labyrinth” in the F3 content of the FOAMfrat refresher to better grasp these concepts and more pearls to change outcomes!

We commonly hear the phrase "resuscitate before you intubate." My question is - how do you know when your patient is resuscitated enough to follow through with intubation? Last weekend I gave a talk at EMSWorld called "The Sound of Silence." At the end of the talk Sam and I had a discussion on how do you know when a patient is resuscitated enough to allow intubation. In true Tyler fashion, I misread how long my talk was suppose to be and had to cut out the ending. This is the discussion portion of that talk and I think you will especially enjoy the ending.