FOAMfrat Podcast

By Tyler Christifulli & Sam IrelandMedicine Health & Fitness

FOAMfrat Podcast episodes

February 19, 2020 Podcast 89 - Approaching Bradycardia (who gets atropine?)
This is a video in the cardiology section of the FOAMfrat Paramedic Refresher. I broke down an evidence based approach to bradycardia. Who gets atropine??
19 min
January 19, 2020 Podcast 88 - The Logistics of a STEMI Transport w/ Andrew Merelman
A few weeks ago Andrew Merelman (@amerelman) and I did part one of our "Routine (N)STEMI Transport" series. In this episode we get down to a granular level to discuss the logistics of:

Which infusions can I turn off until I get to the ambulance/helicopter?

Heparin is typically given as a bolus and then maintenance infusion. The maintenance infusion can be paused while moving the patient to the ambulance/helicopter.

Nitroglycerin is a little bit more nuanced. Even though nitroglycerin has yet to show a mortality benefit, it has been well documented to relieve discomfort.

If patient is on a nitro infusion, MAP's support an acceptable coronary perfusion pressure, and is currently feeling relief from chest discomfort - I will continue this infusion with no interuption.

If patient is on a nitro infusion and is still complaining of chest discomfort that is unrelived by nitro - I will give fentanyl and pause the nitro infusion till we get in the helicopter. This allows me to evaluate the pressures after fentanyl and re-evaluate the dosing for the infusion.

Preparation?

Defib pads placed in the anterior/posterior position.

LUCAS back-plate placed if ominous assessment.

Should we be giving P2Y12 inhibitors in-transport if not provided by the facility?

My shop uses ticagrelor and it is preferred in this region.

What areas should we avoid placing IV's when going to the cath-lab.

Not only should we avoid the right wrist, we should place an additional IV in the left arm if we see the referring EMS or hospital has placed an IV in the right wrist.

Ultrasound and point of care labs to rule out differentials.

These patients come in and get shipped out fast. Typically no imaging or labs has been performed by the time we scoop em up. I like to rule out:

1.Thoracic Aneurysm/ Pericardial Tamponade.

2.H&H for unknown bleed cause type 2 ischemia.

3.Hyperkalemia fooling the ECG.
21 min
December 16, 2019 Podcast 87 - Routine (N)STEMI Transfer w/ Andrew Merelman
Finally got Andrew Merelman (@amerelman) from The Paramedic Practioner Podcast on the show and we discuss:

Social Media ECG interpretatuon vs. real life interpretation

NSTEMI? What does that mean for my transport?

STEMI Equivalents (detailed blog on these by FOAMfratter Jared Patterson here)

Stop points for nitro drip escalations.

This is part one of a two part series. In a few weeks we will post the actual logistics and decisions DURING the transfer. As always, if you have any comments, tricks, or ideas - leave them in the comment section!
30 min
December 08, 2019 Microgram - Is Flow Additive?
The basic question here is: If you add more oxygen delivery devices to a patient, does it increase the overall speed of oxygen delivery? Why does this even matter? Does a NRB at 15 LPM + NC at 15 LPM = 30 LPM of flow?
8 min
November 22, 2019 Podcast 86 - Should I Swap & Intubate?
You jump in the back of an ambulance and see the crew you intercepted with is currently ventilating the patient through a supraglottic airway. Your partner looks at you and says: "should we just swap and intubate?

What factors influence your decision to yank the SGA and perform endotracheal intubation?

Sam & I have a quick discussion and the release a video from the FOAMfrat Paramedic Refresher.

www. foamfrat.com
17 min
October 10, 2019 Podcast 85 - Thoughts On Roc Dosing #TwoVariables
A few days ago I put up a thought experiment blog on generalizing the dose of rocuronium to 100 mg for anyone over the age of 18, and 200 mg if they are in a low flow state. You can find that post here. Here are my thoughts: 1. Based off height not weight. 2. Some the dosing range of Roc is very wide 0.9 to 2 mg/kg 100 would give 1.2 mg/kg for any male up to 6ft 2inches and 2mg/kg for some a male at 5 ft. Both of these are within acceptable dosing recommendations. 3. The argument of commonplace and laziness I can sympathize with- yet I don’t buy it. If anyone has ever watched an anesthesiologist dose medications it is anything but a perfect science. Why? Knowing how the drugs work opens up some freedom. Not recommending free lance dosing-but in some situations we are being pedantic over things that don’t matter. 4.Shock dosed higher? Yes I say double it. 5.We will lose our math skills- this is the caveman fire argument that we saw with direct vs video laryngoscopy. Psh

13 min
October 01, 2019 Podcast 84 - Cold Reads & Ventilation (Part 1)
Whenever discussing ventilator strategies, I feel like the discussion is a bit of a cold read whenever the waveforms are not taken into account. The waveforms tell you what the flow, volume, and pressure are doing over time - and they're extremely helpful in managing a patient. I realize that some of you do not have waveforms on your ventilators. If you don't have waveforms on your ventilator, when you do retrievals from outlying hospitals, examining the waveforms on their ventilator will help you set up a care plan for the transport. If you do have waveforms on your ventilator, you've very fortunate - because they can help you set up a precise strategy to fine-tune your settings.

www.FOAMfrat.com
20 min
September 19, 2019 Podcast 83 - Pressors, Trauma, and Bad Data.. "Response to Eric Bauer"
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
17 min
August 16, 2019 Podcast 82 - Handovers, Delegation, and Critique w/ Cliff Reid
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
34 min
July 19, 2019 **Announcement** @FOAMfrat Paramedic Refresher!!
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
6 min