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 ...
Jun 25, 2021•50 min
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!
Jun 19, 2021•23 min
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 thinkin...
Jun 12, 2021•49 min
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.
Jun 05, 2021•37 min
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
May 30, 2021•34 min
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
May 21, 2021•32 min
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
May 14, 2021•16 min
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
May 09, 2021•26 min
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!
Apr 28, 2021•35 min
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.
Apr 13, 2021•39 min
Yesterday I posted the blog "Ventilation - Playing Defense." The blog addressed the reasons why we don't want to intubate a patient in metabolic acidosis, the correlation between VBG & ABG, and the importance of knowing your ETCO2 to PaCO2 gradient. In part two of this discussion (the podcast), Sam and I invite Bryan Winchell on to discuss the logistics of actually setting up the ventilator and settings that we think are helpful. 1. Optimize volume first and then take advantage of the "no-fl...
Mar 22, 2021•33 min
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 bef...
Mar 06, 2021•44 min
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 ...
Feb 10, 2021•50 min
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 with...
Jan 25, 2021•1 hr 3 min
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...
Jan 04, 2021•54 min
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
Dec 25, 2020•37 min
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.
Dec 09, 2020•23 min
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 ...
Nov 27, 2020•41 min
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.
Nov 12, 2020•21 min
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 refractor...
Nov 03, 2020•31 min
EVERYONE is teaching online now! FOAMfrat teaches live classes five days a week, three times a day, ALL year long! We have ironed out the logistics of zoom room teaching to a science! Here are some tips if you need to give a talk online.
Oct 30, 2020•7 min
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. Chec...
Oct 04, 2020•45 min
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 ...
Sep 27, 2020•23 min
Sep 22, 2020•55 min
My buddy Jay Nance and I went on the Mind Body Medic podcast with absolutely no agenda (I typically don't do those). The conversation was excellent and minimal banter makes it tolerable.
Sep 10, 2020•1 hr 9 min
The whole FOAMfrat team loves listening to audio books. Last week, Austin Quillet pitched the idea of turning our blogs into a audio book style format. So we figured, why not give it a shot? We put this audio blog into a story format with some sound effects and voiceovers to help you visualize yourself on the call (and sometimes provide a little comedy relief). We are always looking for feedback from you guys, so please let us know how we could improve - audio blogs are obviously something brand...
Aug 18, 2020•23 min
A few months ago in our weekly team meeting, Mike Brown(@FireMedicFPC) and Jared Patterson(@OneRadMedic) pitched the idea of starting a podcast that takes questions from clinicias all around the world and answers them in five minutes or less. I initially was skeptical to the idea because of all the EMS podcasts surfacing. What would make this show different? After some thought, We realize this concept is unique in style and allows a certain degree of interaction amongst clinicians. I am super ex...
Aug 08, 2020•28 min
A few weeks ago I posted this scenario on FB . 60 yr male who was in an MVC and is pinned in the driver seat with an obvious closed femur fracture. Firefighters estimate extrication will take 20 minutes. Patient is confused and screaming in pain and asks you to please give him something. He keeps trying to self extricate and is getting in the way of the firefighters tools. Vitals BP- 86/52 HR- 118 SPO2 96% on RA RR 26 You are unable to obtain and IV and firefighters ask you if you are able to gi...
Jul 28, 2020•36 min
To celebrate this landmark podcast we could only think of one guest to facilitate the 100th podcast conversation, our fellow podcaster and close friend, Ginger Locke. Ginger is the host of the very popular Medic Mindset podcast . We asked Ginger to produce this episode in her truly original and unique style she uses with Medic Mindset. Sam, I, and the entire FOAMfrat team - thank you for your support and encouragment throughout the last three years. Celebrate the last 100 and cheers to the next!...
Jun 21, 2020•54 min
FOAMfrat has always believed that infusions can be started quickly, and lead to better patient care. Infusions let you avoid the peaks and valleys of push-dose medication. Infusions also reduce your cognitive load - having to remember to push a medication at timed intervals can easily be forgotten when you’re dealing with multiple issues at once. The last thing anyone wants to do is forget to administer that anesthesia when your patient is paralyzed. For these reasons, and because the industry i...
May 23, 2020•23 min
