1.The 1st line agent for an exsanguinating patient is and always will be blood.   2.There may be circumstances in which MSFP needs to be adjusted in order to compensate for changes we cause through the process of intubation and PPV.   3. The only reason we have literature showing pressors associated with an increase in mortality in trauma is because this intervention is performed on a daily basis in emergency departments and operating rooms. We need a well designed study that reports dosing regimens, a control arm, and patients randomly allocated.    https://www.foamfrat.com/single-post/2019/09/19/If-I-Taught-Hemodynamics-Response-To-EricNaysayerBauer

This month we had the privilege to chat with Cliff Reid (@cliffreid)- a Retrieval Physician with Sydney HEMS. Dr. Reid has an extensive history in HEMS and emergency/critical care medicine. I wanted to pick his brain on a variety of topics such as:   Receiving a report from the crew you are intercepting with. As you and your partner enter the back of the ambulance of the crew you are intercepting with, there is a tendency for one person to begin talking to your partner while the other speaks to you. This can create an inefficient communication pattern that leaves gaps in the handover.    Delegating tasks on scene. Sometimes a specific skill needs to be executed, and that intervention falls within the scope of practice of the crew you are intercepting with. Do you let them perform it, knowing that they didn't recognize or were intimidated to perform the skill prior to your assessment? Do you use this as a teaching opportunity?   Creating a constructive culture of peer review. Nothing can be more uncomfortable than giving your partner or colleagues feedback after a mission. Dr. Reid discusses his approach to this necessary interaction in which he calls "Coffee & Cases".   All this plus a lesson on the endangered wangaroo.   https://www.foamfrat.com/single-post/2019/08/16/Podcast-82---Handovers-Delegation-and-Critique-w-Cliff-Reid

FOAMfrat is very excited to announce our online paramedic refreshers!   It is our goal to make learning enjoyable, so we have taken a different approach to this online refresher.   What makes it different?    Bite-size We all know that we have short attention spans, this is why we have organized our modules into bite-size pieces that you can spend ~5-20 minutes on, and chip away at the hours you need to refresh your license. Even though our CEU is counted in hours, we know that we learn in minutes.    No death by bullets In the same way that we have always made videos without boring bullet points, we use illustrations and animations to drive the points home.    Multiple learning methods We are using a mix of podcasts, blogs, and new videos to deliver content. This mixed approach allows you to earn hours no matter where you are. It is with particular excitement that our paramedic refresher will also include a podcast / blog subscription! This means that when we put out a new piece of content, you can claim CEU hours for it!    Canvas Thanks to FlightBridgeED, we are using their canvas learning platform to deliver the content. One of the cool things about Canvas is that there is a learners app you can download (free app) and get all of our content on a mobile device! FlightBridgeED has also given us the ability to certify all of our content with CAPCE!   www.FOAMfrat.com

Sam and I sit down and and chat with our new friend @ChillaPharmD about :   -Intubating the hypotensive patient. -Her perspective on the push dose pressor craze. -Long term sedation strategies. -The ONE thing that EMS does that drives her CRAZY!!   @ChillaPharmD is a board certified critical care pharmacist in California!

Sam and I ran into Brendan Riordan (@concernecus) at Camp ECHO a few months ago in West Virginia. We had a fantastic conversation out in the lobby of the conference center on all the right ventricle! In this podcast we address questions like:

How can we differentiate sepsis from pulmonary embolism (PE)?

Does extrinsic application of PEEP reflect in CVP?

Does a dilated RV in arrest always mean PE? (I know I'll charge my phone!)

Does extrinsic application of PEEP reflect in CVP?

www.foamfrat.com 

A few weeks ago Brian Behn (The Brian Behn) put out a blog on FOAMfratraising the question "When is a patient too sick to transport?"   This question sparked a TON of good conversation on social media with a very diverse population of opinions.     "As long as crew safety is addressed, then we should make every effort to get this pt to definitive care. Declining a transport due to "instability" when the pt is 100% going to die at the sending, does a huge disservice to your pt. "     "Given the picture painted, after all my checks and additional resuscitation efforts I'll make my decision. 3 hours by ground through the mountains and the patient is still peri arrest with zero likelihood of intact neurologic outcome? Nope. I don't put my ass on the line for futility."     Knowing Flight Paramedic, Vahe Enders (@calldaburd), spoke on this in the past (ECHO2017). I asked him to come on the show and continue this conversation.