FOAMfrat Podcast

Matt Hoffman is the editor-in-chief of PulmCCM, a blog that frequently updates its readers on evidence and best practices in critical care medicine. I have always wondered how our work in the field affects a patient's care downstream. Do pulmonologists ever sigh to themselves and think, "God, I wish paramedics would just start/stop doing ____________?" It turns out that this is not the case, but the discussion was super interesting, and I thank Dr. Hoffman for coming to the show.

In this episode of FOAMfrat, Tyler speaks with paramedic Kyle Rice to discuss a deeply personal and eye-opening experience—rolling his ambulance after running a red light. Kyle shares the lessons he learned about complacency, crew resource management, and the often-overlooked dangers of driving with lights and sirens. Together, they explore how EMS providers can stay vigilant behind the wheel, adopt safer driving practices, and shift their mindset when responding to emergencies. If you're an EMS provider, this episode is a must-listen for understanding the real-life risks of complacency and how to prevent accidents.

In this episode, I sit down with Dr. Jeffrey Jarvis, author of a fascinating paper on the impact of lights and siren (L&S) use in EMS responses. If you're like most of us, when you hear those blaring sirens and see flashing lights, you think, "Wow, someone's really in trouble!" But the truth, according to Dr. Jarvis' study, might surprise you.

In this podcast, we discuss the nuances and strategy of the T1 ventilator with RRT, Joe Hylton. Whether you're a paramedic or a healthcare professional involved in critical care transport, understanding the nuances of this advanced ventilator is essential to safe and effective patient transport.

We break down the pressure-controlled ventilation with volume adaptive options and offer practical guidance on managing obstructive lung conditions like asthma during transport. Plus, we cover essential troubleshooting techniques to help you address common issues when things don't go as planned.

Thoracic dissections are surgical emergencies that require precise temporizing measures until surgery can be performed. In this session, participants will gain critical knowledge on recognizing key symptoms such as ripping back pain and unequal pulses, indicative of thoracic dissections. The discussion will focus on anti-impulse therapy, emphasizing using beta-blockers like esmolol and calcium channel blockers like nicardipine to control blood pressure and prevent further damage. Pain management strategies and the selective use of nitroprusside will also be explored. The class will address the unique challenges of managing blood pressure in prehospital settings, stressing the importance of a well-prepared plan.

Alaina Martini, a flight nurse at Allegheny Life Flight, shares her expertise on transporting patients with external ventricular drains (EVDs). She explains the indications for EVD insertion, such as aneurysmal subarachnoid hemorrhage and obstructive hydrocephalus. Alaina discusses the importance of assessing the color and texture of the cerebrospinal fluid (CSF) to detect changes and potential rebleeding. She also explains the process of inserting the EVD and how it is guided by CT scans to avoid damaging important brain tissue. Alaina emphasizes the need to know if the aneurysm is secure before adjusting the EVD drain level, as opening it too low can increase the risk of rebleeding. She also discusses the use of hypertonic saline and osmotic therapy to manage increased intracranial pressure. Tyler and Alaina discuss various aspects of managing patients with external ventricular drains (EVDs) during transport in this conversation. They cover topics such as the clamping of EVDs, positioning the patient's head, troubleshooting common issues, and securing the EVD during transport. Alaina provides insights and recommendations based on her experience as a neurocritical care nurse.

Dr. John Aho discusses needle decompression and the procedure's indications, techniques, and potential pitfalls. He emphasizes the importance of high clinical suspicion and the limitations of external signs in diagnosing tension pneumothorax. The conversation also covers the choice of needle insertion sites, the use of ultrasound, and the need for proper training and practice.

Dr. Aho provides insights into the anatomical considerations and common mistakes made during needle decompression. He also explores the possibility of instant feedback to confirm successful decompression. The conversation discusses the problem of needle decompression failure rates and the need for a reliable indicator of successful decompression.

The guest introduced the Cap-No-Spot, a device that uses colorimetric indicator paper to detect CO2 and determine if a needle decompression procedure was successful. The device has been shown to have higher sensitivity and specificity than human judgment. The conversation also touches on the importance of proper training and the device's potential applications beyond pneumothorax detection.

An iceberg typically shows only 10% of its mass above water. To appreciate the other 90%, you need to dive deep. That's precisely what we're doing in this series—discovering the deeper knowledge about obstetric topics. These topics can be massive, and much of the information is below the 'surface-level' knowledge that EMS is presented with.

In this episode, Demi Wilkes & I will discuss Placenta Previa and the closely associated Placenta Accrete Spectrum.

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.