FOAMfrat Podcast

By Tyler Christifulli & Sam IrelandMedicine Health & Fitness

FOAMfrat Podcast episodes

July 02, 2021Podcast 125 - For Those Who Play With Fire
Before the July 4th weekend hits, I wanted to address two main questions whose answers may come in handy on a call you'll run very soon...

Should EMS use a burn formula?

What's the best way to manage pain for the burn patient?

For a sense of a well-rounded blog on burns, I've included some quick facts about burn care at the end that are unrelated to these questions. Also, Erik Rima (CFRN and former burn center RN) left us his perspective at the end in a peer review. Be sure to check those out before you leave! Alright, on to question number one... should EMS even bother with a burn formula?
34 min
June 25, 2021 Podcast 124 - Arterial Line Placement in Critical Care Transport w/ Michael Lauria
Invasive arterial blood pressure (IABP) monitoring techniques have enjoyed a rich history of use throughout the mid-to-late 20th century in the peri-operative setting and are now a standard of care intensive care units. While there are a variety of IABP monitoring options, one of the most common techniques is percutaneous radial arterial catheterization. Although monitoring of radial arterial lines is a widely accepted skill in the critical care transport (CCT) world, placement by CCT providers is less common. Concerns over safety and logistical management have contributed to the perceived difficulty in arterial lines; however, this article aims to demonstrate that arterial lines can be placed safely and effectively in the pre-hospital setting. www.foamfrat.com
51 min
June 19, 2021 Podcast 123 - The Anion (figurative) Gap
Ok, here's the thing.. there really is no anion gap. We pretend there is because the things we routinely measure leave something to be desired on the anion side. Sam put out a killer blog and this is a follow-up conversation. Enjoy!
23 min
June 12, 2021 Podcast 122 - Ultrasound-Guided Pacing w/ Leon Eydelman
Traditionally transcutaneous pacing involves a paramedic placing pads anterior/posterior (preferred), and turning up the milliamps until electrical capture is obtained. Electrical capture is obtained when a pacing spike is followed by a wide complex. The clinician will then try to palpate a pulse to confirm mechanical capture. Because the contractions of the pectoral muscles can tug on the muscles of the neck as well, AHA recommends palpating a femoral pulse versus a carotid (3) to avoid thinking you feel a pulse (false mechanical capture). Not only are events of false capture common, but there are even situations in which the paramedic swears they feel a pulse and observes the patient becoming more alert, and they never had mechanical capture.

I believe most of us are using SPO2 pleth wave to confirm mechanical capture versus the subjectivity of palpating a pulse, but even patients with a pulse can have poor pleth wave readings. I believe ultrasound-guided pacing is ideal and should become mainstream. I typically find I can get a parasternal long view on ultrasound with the pads placed as illustrated below. However, there are other views if your pad sweet spot is obstructing where you wanna put the probe.

This is nothing profound and is definitely not a new concept in emergency medicine. It is however a new concept for paramedics and another feather in the cap of prehospital ultrasound. This is a conversation between myself and Dr. Eydelman discussing this topic. Enjoy!
49 min
June 05, 2021 Podcast 121- The Curve & Airway Management
A few months ago Sam published a blog on the oxyhemoglobin dissociation curve. If you haven't checked it out I highly recommend reading that before listening to us discuss what this curve teaches us about airway management.
37 min
May 30, 2021 Podcast 120 - The Mystery of Optimal PEEP
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
35 min
May 21, 2021 Podcast 119 - Paramedic's Guide To Left Ventricular Function
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
33 min
May 14, 2021 Podcast 118 - Obstetric Ultrasound w/ Cynthia Griffin
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
16 min
May 09, 2021 Podcast 117 - Jumping The Gun - WPW and Adenosine?
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
26 min
April 28, 2021 Podcast 116 - Pulmonary Embolism (Clinical Signs)
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!

36 min