Shows
FOAMfrat PodcastPodcast 190 - Intubation Triggers w/ Nicole Hooser"GCS less than 8, intubate." We've all heard it. Many of us were taught it. In this episode of the FOAMfrat Podcast, Tyler and FOAMfrat educator Nicole Hooser examine one of the most repeated airway phrases in EMS and why it may be doing more harm than good. From the origins of the "less than 8" mindset in GCS to the real-world complexity of airway decision-making, this conversation examines what actually matters when deciding whether to take a patient's airway. They discuss: • Why a GCS of 8 is not a magic number • The math behind GCS scoring combinations and why 8 carr...
2026-02-1829 minFOAMfrat PodcastPodcast 185 - Eating Disorders w Hanna ThompsonIn this episode, Tyler sits down with Hanna Thompson to discuss a critical yet often overlooked topic in EMS—eating disorders. Drawing from personal experience and clinical insight, they explore how these conditions present both medically and behaviorally, especially in prehospital and interfacility transport settings. They break down the subtle physical signs that EMS providers can look for—such as Russell's sign, lanugo, unexplained bradycardia, and electrolyte disturbances—and emphasize the importance of sensitive history taking. The conversation also dives into the dangers of refeeding syndrome, slow correction strategies, fluid choice, and the clinical significance of thiamine, magnes...
2025-07-1232 minFOAMfrat PodcastPodcast 184 - Diastolic Augmentation w/ Brian CressIn this episode, Tyler Christifulli sits down with cardiac perfusionist Brian Cress to dig into the physiology of coronary perfusion, the mechanics of the intra-aortic balloon pump (IABP), and the clinical finesse of diastolic augmentation. Whether you're just starting to encounter balloon pumps or want to sharpen your transport strategy, this discussion is packed with visual metaphors, waveform analysis, and real-world pearls.
2025-06-1348 minFOAMfrat PodcastPodcast 183 - Cardiac Ultrasound w/ Dr. WeimersheimerIn this conversation, Dr. Peter Weimersheimer discusses various techniques and tips for performing cardiac ultrasound in emergency medicine. He emphasizes the importance of understanding probe movements such as sliding, fanning, and rocking to optimize cardiac views. The discussion also covers troubleshooting common challenges in cardiac imaging, the critical role of gel in obtaining clear images, and the transition between different cardiac views. Dr. Weimersheimer emphasizes the importance of identifying cardiac pathologies through ultrasound and shares techniques for obtaining the apical four-chamber view. The conversation concludes with insights into the impact of ultrasound on patient care and decision-making in emergency...
2025-05-171h 16FOAMfrat PodcastPodcast 182 - AHORA Spanish Stroke AssessmentStroke assessment tools like BEFAST are crucial for swiftly identifying symptoms and expediting treatment. However, language barriers can hinder prompt care for non-English speakers, particularly in the Hispanic community. Developed through a collaborative effort, AHORA adapts the traditional stroke assessment to be culturally and linguistically appropriate for the Spanish-speaking population. Designing Ahora The need for a specific tool became apparent when traditional tools like BEFAST were found to be ineffective for those who did not speak English. After discarding the complex "Rapido," Banerjee's team crafted Ahora, including Marcia Wilson, MD, and Remley Crowe...
2025-04-2934 minFOAMfrat PodcastPodcast 181 - Discrepancies in Testing & TreatmentDoes medicine have dangerous side effects for women? Are the "normal" values we have set for diagnostics possibly endangering specific populations? In this episode of the FOAMfrat podcast, Tyler sits down with Dr.Alyson McGregor, emergency physician and author of Sex Matters, and Tim Redding, EMS educator and lecturer, to discuss the discrepancies in medical testing, diagnosis, and treatment between male and female patients. Dr. McGregor shares her journey of discovering gender bias in medicine, particularly how women's symptoms are often dismissed or mislabeled as psychiatric in nature. The discussion explores how male-centric research has shaped clinical...
2025-04-1553 min
FOAMfrat PodcastPodcast 180 - MCI Collaboration w/ ATCEMS & Travis County Star FlightIn this episode of the FOAMfrat podcast, join as we discuss mass casualty management with Chief Robert Luckritz of Austin Travis County EMS and Justin Soulier from Travis County Star Flight. Explore the strategies and challenges in mass casualty responses in one of the fastest-growing urban areas in the U.S.
2025-03-1449 min
FOAMfrat PodcastPodcast 179 - Your First 5 Minutes of an MCI w/ Rommie DuckworthJoin Rommie Duckworth and FOAMfrat as we discuss the mental framing and big-picture thought process behind the first five minutes of any mass casualty incident (MCI). Rommie Duckworth, a fire captain and shift commander, is a wealth of knowledge on this topic and speaks globally to prepare emergency responders for these events.
2025-02-0741 minFOAMfrat PodcastPodcast 178 - ECPR Eligibility and Preparation w/ Alec WilcoxIn this episode, Alec Wilcox & I discuss ECPR eligibility & preparation. ECPR, or extracorporeal cardiopulmonary resuscitation, involves taking a patient in cardiac arrest, sucking blood from their venous system, oxygenating it externally, and then pumping it back into their arterial system. This procedure helps maintain blood circulation and oxygen delivery during cardiac arrest, serving as a bridge to further therapy.
2025-01-2141 minFOAMfrat PodcastPodcast 177 - Implementing Ultrasound w/ Allen WolfeThe integration of point-of-care ultrasound (POCUS) is transforming emergency medical services (EMS) by enhancing diagnostic capabilities and improving accuracy in answering important clinical questions. Recently, I had the opportunity to discuss this topic extensively with Allen Wolfe, the Senior Director of Education at Life Link III. A significant challenge in incorporating ultrasound technology within EMS has been overcoming initial barriers to adoption. Many programs, burdened by cost concerns and technological intimidation, have historically relegated ultrasound units to the back shelves. However, as Allen outlined, strategic changes in accessibility and training can dramatically alter this landscape.
2024-12-2946 minFOAMfrat PodcastPodcast 176 - Pediatric TBI Protcol w/ Dr. BanerjeeIn this episode, Dr Banerjee and I discuss a new traumatic brain injury (TBI) protocol his department is trialing for pediatric patients with moderate to severe TBI in collaboration with Arnold Palmer Hospital. This protocol involves administering Keppra and 3% saline in the pre-hospital setting.
2024-12-1029 min
FOAMfrat PodcastPodcast 175 - The Things We Do w/ PulmCCMMatt 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.
2024-11-2656 minFOAMfrat PodcastPodcast 174 - "I Rolled My Ambulance" Interview w/ Kyle RiceIn 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.
2024-10-2745 minFOAMfrat PodcastPodcast 173 - Rethinking Lights & Sirens w/ Jeff Jarvis & Jonathon JenkinsIn 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.
2024-10-0641 minFOAMfrat PodcastPodcast 172- Hamilton T1 Hacks & Strategies w/ Joe HyltonIn 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.
2024-09-171h 00
FOAMfrat PodcastPodcast 171 - Thoracic Dissection Goals w/ Alex GreeneThoracic 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.
2024-08-2624 min
FOAMfrat PodcastPodcast 170 - Finger Thoracostomy w/ Dr. Cynthia Griffin In this conversation, Tyler and Dr. Cynthia Griffin discuss the finger thoracostomy procedure. They cover topics such as when to choose finger thoracostomy over needle decompression, the equipment needed for the procedure, the technique for performing the procedure, and potential complications and tips for success. They also touch on the use of chest tubes and the management of tension physiology. Overall, the conversation provides a comprehensive overview of the finger thoracostomy procedure.
2024-07-0233 minFOAMfrat PodcastPodcast 169 - EVD Transport Logistics w/ Alaina Martini 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...
2024-06-2145 min
FOAMfrat PodcastPodcast 168 - Procedure Preppers (Needle Decompression) w/ Dr. AhoDr. 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...
2024-05-2238 min
FOAMfrat PodcastPodcast 167 - Placenta Previa w- Demi WilkesAn 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.
2024-05-0618 min
FOAMfrat PodcastPodcast 166 - Transcutaneous Pacing & False CaptureThe 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...
2024-04-2551 min
FOAMfrat PodcastPodcast 165 - Should Pressors Have A Max Dose?In this episode we discuss whether the concept of having a "max dose" of your pressor has any evidence or physiological backing. Joining me in this discussion are Dan Rauh, Shane O'Donnell, and Shad Ruby.
2024-02-0250 minFOAMfrat PodcastPodcast 164 - Suicidal Ideation w/ James Boomhower How do you talk to a patient experiencing suicidal ideation? What if you're the one having these thoughts? We're interviewing James Boomhower from Stay Fit 4 Duty in this episode. We discuss suicidal ideation, therapeutic communication, and verbal de-escalation.
2023-11-1832 minFOAMfrat PodcastPodcast 163 - What Can We Learn From A Ketamine Infusion Clinic? w/ Chris CarlstromChris Carlstrom is a flight nurse at Life Link III and also works part-time at a ketamine infusion clinic. We've had some interesting conversations on shift regarding his experiences with ketamine in the clinic versus emergency medicine and I finally was able to get one of these conversations recorded for the podcast. Enjoy Podcast 163 - What Can We Learn From A Ketamine Infusion Clinic? w/ Chris Carlstrom.
2023-10-3018 min2023-09-2931 minFOAMfrat PodcastPodcast 161 - EMT Pharmacology Taking on pharmacology in EMT school is a big hurdle. We wanted to write something that not only explained the basics of the medications but also helped bridge the gap between what EMTs are taught and what paramedics learn when they go back over these medications in paramedic pharmacology. Each chapter discusses how the medications work, why they're given for specific indications, and the logistics of medication administration! We've also included medication profiles, tips and tricks from experienced providers, and flashcards for each medication to help you hone your med knowledge base! In this book...
2023-08-1828 minFOAMfrat PodcastPodcast 160 - Autism Communication w/ Joshua Chan & Matthew Yelton I had the privilege to bring on two passionate fathers of children with Autism to help me better understand how to approach and communicate with a neuro-diverse child. This episode is chock-full of insight, tips, tricks, and logistics of approaching a child in the field with Autism. Josh Chan is a Life Link III flight paramedic/base lead and a Glenwood FD firefighter. Matthew Yelton is a flight paramedic/base lead for Mercy Flight Central and works as a fire captain at Constableville Ambulance Inc.
2023-08-0347 min
FOAMfrat PodcastPodcast 159 - Close Encounters of the Infectious Kind w/ Dr. Hudson GarrettEMS providers encounter various infectious diseases daily and need to know the routes of exposure, risks, and preventive measures to protect themselves and their families. In this episode, We talk with Dr. Hudson Garrett, an infectious disease expert with the medical college of Louisville University, to discuss the practical points of infectious disease for the everyday provider. Want CE for this episode? Sign up for FOAMfrat Studio and access 300+ hours of continuing education for EMS & Nursing. www.foamfrat.com
2023-06-1443 minFOAMfrat PodcastPodcast 158 - RSI Cocktail w/ Heavy Lies The Helmet In this episode, Dan Rauh & Mike Boone from Heavy Lies The Helmet join me to hash out our workflows and drugs of choice for four particular scenarios you may come across. The combative head injury patient that needs to be intubated but has five firefighters holding them down and is actively trying to rip off his collar and IV. The septic hypotensive patient is no longer protecting their airway but also needs resuscitation prior to induction.
2023-04-121h 08FOAMfrat PodcastPodcast 157 - Ventilation & Cardiac Arrest w/ Tom BouthilletMoments after the heart stops the entire circulatory system finally has a chance to bring venous and arterial pressures to equilibrium. Cardiac arrest resuscitation requires the provider to have a strong mental model of physiology and the logistics to carry out a series of interventions crucial to preserving life. This class will serve not as a routine basic life support model, but as a deeper understanding and framework to guide resuscitation during your next cardiac arrest.
2023-03-0346 minFOAMfrat PodcastPodcast 156 - Is using AI cheating? EMS and AI AI will be integrated into everything we do in medicine, perhaps sooner than we think. It will help keep our patients safe, our providers informed, and our communications connected, and change how we think about how we care for patients (if implemented correctly). Systems like ChatGPT are only the beginning, and many companies are already working on or have already integrated with other healthcare specialties. We will see the same integration happen with EMS. While the response to this might be fear of losing our knowledge base, over-automating decision-making, cheating on tests and papers, and the like, w...
2023-02-2533 min
Medic Class Citizen| 38 | Reinventing EMS Con-ED, with Tyler Christifulli & Samuel Ireland (FOAM Frat)Tyler Christifulli and Samuel Ireland are flight paramedics and co-founders of the project, FOAM Frat. Listen as Sam and Tyler discuss the beginning of FOAM Frat as a blog and podcast, and how it evolved to the revolutionary continuing education platform that it is today. Find out more about FOAM Frat by visiting www.foamfrat.com, @foamfrat on Instagram and Facebook, and @FOAMfratStudios on YouTube. www.medicclasscitizen.com
2023-02-201h 07
FOAMfrat PodcastPodcast 155 - Pattern Recognition vs. Autopilot w/ Shaylah MontgomeryIn this episode, Tyler is joined by Shaylah Montgomery to discuss decision-making, human factors, and mental shortcuts utilizing pattern detection. Shaylah is a flight nurse and paramedic for Pafford Air One and a member of the FOAMfrat team.
2023-02-1526 min2023-02-0632 minFOAMfrat PodcastPodcast 153 - Pediatric Arrest w/ Dr. BanerjeeWe just finished re-recording our pediatric arrest class in Studio and decided to play the unedited version of my discussion with Dr. Paul Banerjee. Banerjee is a prolific researcher and medical director in Florida with a particular emphasis on pediatric arrest. Check out the class in Studio for more information on the logistics.
2023-01-1623 minFOAMfrat PodcastPodcast 152 - CISM & Processing w/ Sam HenneSam Henne is the creator of Mind Over Medic and a co-worker of mine at Life Link III. In this episode, we discuss the components of critical incident stress and ways to reduce adrenaline during threat appraisal. Check out www.mindovermedic.com
2022-12-1256 minFOAMfrat PodcastPodcast 151 - Central Line Access for EMS w/ Austin Brook EMS is well-trained in peripheral intravenous as well as intraosseous access. However, central lines remain off-limits for many clinicians in various response areas. If accessing these types of lines is allowed, it's usually permitted when the patient is (nearly) dead. This isn't very surprising since the scope of practice of the EMS clinician usually focuses on emergent treatments. Unless it's learned during a critical care class, little thought is typically given to topics like central, dialysis, and PICC lines in EMS. Why not?
2022-12-0230 minFOAMfrat PodcastPodcast 150 - Slishman TractionHad the opportunity to talk with Dr. Sam Slishman, the inventor of the Slishman traction splint. We had a great conversation on the idea/concept of this splint, who to apply it on, and some additional questions, which we plan on having him back on to discuss.
2022-11-0536 minFOAMfrat PodcastPodcast 149 - P:F vs. A-a & Oxygenation Strategies A-a gradient, a/A ratio, and P: F ratio - are all different views of the same item. These formulas do not have a complete view of oxygenation. Oxygenation is a huge topic, and there are more common values that we use: How well is the patient saturating? Is there dyspnea? How do the lungs sound (auscultation) or look (POCUS)? Where is the patient on the OHCD? What does the ABG show?
2022-10-2128 minFOAMfrat PodcastPodcast 148 - Crashing PE Logistics w/ Shane & BrianI ran some specific decision points when treating the REALLY BAD massiVE pulmonary embolism patient by Shane & Brian from the FOAMfrat Team. This discussion really focuses on the logistics and ideas when you are trying to get the patient from A to B without having to do CPR.
2022-10-0436 min
FOAMfrat PodcastPodcast 147 - NICU Q&A w/ Theresa BowdenTheresa Bowden is a rockstar flight nurse who specializes in NICU transports. In this episode, you will listen in as Theresa explains anything and everything you have ever wondered about NICU interfacility transports. Topics include: Who gets prostaglandin? IO or IV catheter for UVC Cardiac vs. Respiratory Initial Vent Settings Get credit for this class by listening to it in FOAMfrat Studio.
2022-07-1432 minFOAMfrat PodcastPodcast 146 - IVC Assessment w/ Shane O'DonnellDoes IVC assessment have a role in pre-hospital ultrasound? This week we talk to one of the newest members of FOAMfrat, Shane O'Donnell.
2022-05-2226 minFOAMfrat PodcastPodcast 145 - Pediatric Bags Do specialized pediatric jump bags alienate the pediatric population? They typically don't get used as much, and introducing a foreign bag into a low volume population may add to the stress of running a pediatric call anyway. In this episode, Sam & Tyler discuss the case against the pediatric jump bag.
2022-04-1732 min
FOAMfrat PodcastPodcast 144 - VR & EMS EducationThe FOAMfrat podcast is back in 2022 with a discussion on how virtual reality can be used in EMS education. We did our first VR class a few weeks ago and here's what we learned and what we plan to do with it!
2022-02-0326 minFOAMfrat PodcastPodcast 143 - Thyroid Disorders The thyroid is a butterfly-shaped gland. But for some, it can be more like a bullet to the neck. The number of systems that our thyroid helps regulate truly is incredible, and an over or under-active thyroid can cause a whole host of acute and chronic issues. On the one hand, imagine a patient who has a thyroid history and is cold, weak, and has a depressed level of consciousness. Why is this occurring, and what's the diagnosis and treatment? On the other hand, imagine an anxious, hyperpyrexic patient in atrial fibrillation. Both patients have thyroid issues...
2021-12-2347 minFOAMfrat PodcastPodcast 142 - EBM Guide To RSV w/ Natalie May I reached out to @medtwitter asking for help finding a guest to talk about the respiratory syncytial virus (RSV). It may seem weird to be talking about RSV when everyone is thinking about the current pandemic, but I find the virology and mechanism of symptoms of RSV exciting. Twitter did not let me down, my friend Ashley Liebig recommended Natalie May from Sydney, HEMS. Natalie is an EM, and Pediatric-EM trained UK doctor working in Prehospital & Retrieval Medicine in Australia. I was very excited to have a chance to speak with Dr. May regarding RSV & Bronchiolitis and what the current e...
2021-12-1159 minFOAMfrat PodcastPodcast 141 - Adrenal Emergency A young pediatric patient is having nausea and vomiting at school and is said to not be 'staying awake very well.' You discover assessment findings such as hypotension, hypoglycemia, and maybe even peaked T waves on the ECG. You receive information indicating that the child has something called "CAH". Or, perhaps... An older patient is having dizziness upon standing, and persistent hypotension. You note a somewhat jaundiced appearance. They become unconscious in their kitchen while searching for a salty snack, and they appear rather sick. Or... A middle-aged patient has suddenly stopped taking their...
2021-12-0544 minFOAMfrat PodcastPodcast 140 - "We Removed Nitro From Our STEMI Guideline" w/ Matt Schneider In this episode, we talk with Matt Schneider, a Battalion Chief and Paramedic for the Mequon fire department in Ozaukee County. Sam and I had the privilege of sitting in on a guideline update presented by Matt a few weeks ago. One of the guidelines that caught our attention was the decision to remove nitroglycerin from the STEMI guideline. Listen in as Matt describes how their guideline committee arrived at this decision. "Matt's views, comments, and opinions expressed in this segment do not represent the position of his employer(s), or associated agencies/institutions".
2021-11-2750 minFOAMfrat PodcastPodcast 139 - Tracheostomy ManagementNothing is scarier than watching an awake patient struggle to breathe with a trach. Do you have an approach to troubleshoot? Make sure you watch to the end to see our first FOAMfrat reaction video!
2021-11-2137 minFOAMfrat PodcastPodcast 138 - Bad & BougieIn this episode, Tyler & Sam discuss everything you need to know about the Bougie. Traditional use Modified pre-loaded techniques Common pitfalls.
2021-11-1231 minFOAMfrat PodcastPodcast 137 - Glucose (Outer Limits)Welcome to the fourth and final installment of this metabolic panel series, where we're exploring what happens when these lab values hit their limits, or beyond.
2021-10-0638 minFOAMfrat PodcastPodcast 136 - Intranasal Delivery (or not) One of my first calls as a paramedic was to our local ski hill for a 26-year-old guy who crashed into a tree while snowboarding. The ski patrol brought him down to the patrol room and we met them inside. The guy was literally screaming in pain and saying: "just put me out, man!" I could see his leg was obviously deformed below the knee. Now, this dude was covered in gear, and starting an IV was going to take a little while. I looked at my partner and remembered we had just got this new gadget...
2021-09-2420 minFOAMfrat PodcastPodcast 135 - Renal Labs! (Outer Limits) Welcome to the third installment of this metabolic panel series, where we're exploring what happens when these lab values hit their limits, or beyond. Previously we've explored Cations (located here) and Anions (located here), but don't feel like you need to read these in any particular order. These blogs are meant as a reference for you to come back to. There's a lot of information in each, so they might be better absorbed in chunks. I'm writing these as the reference I wish I had when I started learning lab values. This week we're going...
2021-09-1535 minFOAMfrat PodcastPodcast 134 - When Gallbladders Attack w/ Cynthia GriffinWhat does jaundiced skin, right upper quadrant pain, and a fever mean? In this episode, Dr. Cynthia Griffin and I discuss everything gallbladder and biliary colic! Check out the blog post here: https://www.foamfratblog.com/post/when-gall-bladders-attack
2021-09-0920 minFOAMfrat PodcastPodcast 133 - Outer Limits: Anions Welcome to the second installment of this metabolic panel series, where we're exploring what happens when various lab values reach their outer limits (or beyond). Each part in the series can be read on its own, but if you want to start at the beginning, go check out the first blog on cations HERE. This series of blogs and podcasts are meant as a reference for you to come back to. There is a lot of information on each one of the lab values we'll cover, so it might be best to read it in parts. As...
2021-09-0133 minFOAMfrat PodcastPodcast 132 - Reversal Rehearsal "Warfarin"In this episode, Sam and I discuss warfarin's mechanism of action and reversal. Check out the blog for more information! https://www.foamfratblog.com/post/podcast-132-reversal-rehearsal-warfarin
2021-08-2022 minFOAMfrat PodcastPodcast 131- Outer Limits - Cations Lab value interpretation sadly wasn't included in my initial paramedic education. I was absolutely ecstatic to attend a critical care program and learn about lab values - I had always found it very impressive when people could interpret lab values. I wanted to be a lab value wizard too! Unfortunately, in critical care class, our lectures and resources were nothing like what I had hoped for.I hope this series of blogs serve as a resource for those who are eager to learn more about the art of interpreting labs. I wouldn't recommend tackling this whole thing in one...
2021-08-1524 minFOAMfrat PodcastPodcast 130 - Getting To Know The NREMT "Certification Questions"200 comment Facebook post where I asked, "what questions would you like me to ask the NREMT?" These are the questions that seem to be the most popular. 200 comment Facebook post where I asked, \"what questions would you like me to ask the NREMT?\" These are the questions that seem to be the most popular.","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{}}],"entityMap":{},"VERSION":"8.46.0"}"> 1. Besides reciprocity amongst select states, what is the benefit of maintaining your NREMT?
2021-08-0652 minFOAMfrat PodcastPodcast 129 - NoBull Gas Laws (Part Two!)Welcome to round two! We'll be going over fewer laws than last time, but this will round things out nicely! We'll be covering the laws of Fick, Graham, and Dalton/Amagat. Mike Brown joins me again as we look at the clinical application of some lesser-known gas laws.
2021-07-3040 min2021-07-2325 minFOAMfrat PodcastPodcast 127 - Boyle's and Henry's Law! Gas Laws Explained We've been exposed to gas laws our whole life, and we have intuition about what will happen to gas under certain conditions. For example, people notice that the pressure in their tires might become low on a very cold day. Or perhaps you've been at very high altitudes and you've been short of breath. And everyone knows that if you shake a carbonated beverage before opening it you'll be cleaning up a mess very shortly. Each of these observations has been classified into the laws, and we'll be splitting them up between this blog and the next. Stating the...
2021-07-1638 minFOAMfrat PodcastPodcast 126 - ECMO Physiology The concept of taking blood out of the body, oxygenating it, removing the CO2, and then putting back in, fascinates me. A few years ago I admittedly knew very little about extracorporeal membrane oxygenation (ECMO) and its indications. I remember going to a class on ECMO at Life Link III and having questions like: Are we actually pumping blood backward through the body? What happens to the blood in the heart when using ECMO in cardiac arrest (ECPR)?
2021-07-0936 minFOAMfrat PodcastPodcast 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...
2021-07-0233 min
2021-07-0133 minFOAMfrat PodcastPodcast 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...
2021-06-2550 minFOAMfrat PodcastPodcast 123 - The Anion (figurative) GapOk, 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!
2021-06-1922 minFOAMfrat PodcastPodcast 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...
2021-06-1248 min
2021-06-0536 minFOAMfrat PodcastPodcast 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
2021-05-3034 minFOAMfrat PodcastPodcast 119 - Paramedic's Guide To Left Ventricular FunctionIf 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
2021-05-2132 minFOAMfrat PodcastPodcast 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
2021-05-1415 minFOAMfrat PodcastPodcast 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
2021-05-0925 minFOAMfrat PodcastPodcast 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!
2021-04-2835 minFOAMfrat PodcastPodcast 115 - Prolonged Q-T Syndrome w/ Jake GoodYesterday 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.
2021-04-1439 min2021-03-2233 minFOAMfrat PodcastPodcast 113- DON'T stop the insulin! 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.
2021-03-0643 minFOAMfrat PodcastPodcast 112 - When Mental Models #FAIL w/ Tom Grawey & Bryan Selvage 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 piece for FOAMfrat on the "sick v...
2021-02-1049 minFOAMfrat PodcastPodcast 111 - How We Peer Review w/ Eric Bauer & Chris Smetana 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 within the industry. The IA Med team prides itself on meeting the needs of...
2021-01-251h 02FOAMfrat PodcastPodcast 110 - Resus Tempo w/ Keith VelaskiI 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 getting into my g...
2021-01-0453 minFOAMfrat PodcastPodcast 109 - Productivity HacksWe 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
2020-12-2536 minFOAMfrat PodcastPodcast 108 - TBI+MultiSysTrauma w/ Jake GoodIn 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.
2020-12-0922 min2020-11-2741 minFOAMfrat PodcastText-To-Speech: Lara Croft (OB/GYN) and the Cradle of LifeIn 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.
2020-11-1221 minFOAMfrat PodcastPodcast 106 - When Benzos Won't Stop The Seizure 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 refractory to front line treatments.
2020-11-0330 minFOAMfrat PodcastBackStage Pass - My Online Teaching Setup (Tyler)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.
2020-10-3007 minFOAMfrat PodcastPodcast 105 - Logistics of a pediatric arrest w/ Austin QuilletOver 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. Check out "Solving the Pediatric Labyrinth" in the F3 content of the FOAMfrat r...
2020-10-0444 minFOAMfrat PodcastPodcast 104 - Are they resuscitated enough for intubation?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 of that talk and I...
2020-09-2722 min2020-09-2254 minFOAMfrat PodcastPodcast 102: No Agenda w/ Chris Meeks & Jay NanceMy 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.
2020-09-111h 08FOAMfrat PodcastText-To-Speech: The Slow Motion Plane CrashThe 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 new to us. We'll be selecting the blogs that best fi...
2020-08-1922 minFOAMfrat PodcastThe Rapid Sequence Interrogation PodcastA 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 excited to announce the Rapid Sequence Interrogation podcast to the FOAMfrat family! The first episode is being h...
2020-08-0827 min
FOAMfrat PodcastPodcast 101: Extrication Sedation w/ Cliff ReidA 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...
2020-07-2836 min
Critical Care ScenariosEpisode 12: Flight medicine with Tyler Christifulli and Sam Ireland (part 2)Part two of our interfacility transfer from Hell. Tyler Christifulli, FP-C, EMT-P (@christifulli88) and Sam Ireland FP-C, EMT-P (@ireland_sam1) show us how they handle GI bleeding, arrhythmias, shock, cardiac arrest, and more, all from the confines of a helicopter. Listen to Part 1 here. Check out the great educational content from Tyler and Sam over … Continue reading "Episode 12: Flight medicine with Tyler Christifulli and Sam Ireland (part 2)"
2020-07-2643 minCritical Care ScenariosEpisode 11: Flight medicine with Tyler Christifulli and Sam Ireland (part 1)A grueling interfacility transfer gives Tyler Christifulli, FP-C, EMT-P (@christifulli88) and Sam Ireland FP-C, EMT-P (@ireland_sam1) the opportunity to show us how they handle airway management, GI bleeding, mechanical ventilation, cardiac arrest, and more, all from the confines of a helicopter. Check out the great educational content from Tyler and Sam over at FOAMfrat, including … Continue reading "Episode 11: Flight medicine with Tyler Christifulli and Sam Ireland (part 1)"
2020-07-1235 minFOAMfrat PodcastPodcast 100 - Meet FOAMfratTo 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!
2020-06-2154 minFOAMfrat PodcastPodcast 99 - We Tested the Sapphire IV Pump! 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 is currently looking into IV pump solutions, we were happy when QCORE Medical asked us to review the S...
2020-05-2323 minFOAMfrat PodcastPodcast 98 - "Are those really B lines?" w/ Chip LangeChip Lange and I sat down and discussed everything B lines! If you are interested in the basics of lung sliding, detecting pulmonary edema, and differing effusion from consolidation - check out podcast 98!
2020-05-1924 minFOAMfrat PodcastPodcast 97 - Taming The Afterload:Push Dose Nitro w/ Michael PerlmutterIn this episode we talk with Michael Perlmutter (@DitchDoc14) who recently released a poster board for an upcoming paper evaluating the safety and efficacy of push-dose nitroglycerin in EMS for patients experiencing sympathetic induced pulmonary edema. In this episode you will hear us refer to this subset as "SCAPE" patients. This term was coined by Scott Weingart in his very first EMCrit podcast and stands for sympathetic crashing acute pulmonary edema (SCAPE). The safety of this method is extremely beneficial for services that do not have access to an IV pump.
2020-04-2929 minFOAMfrat PodcastPodcast 96 - Vantage Point: RRT w/ Kristin IrelandA few months ago Sam and I started putting together a ventilator module within the FOAMfrat refresher course. Our hopes were to create a "beginners guide" into the world of mechanical ventilation. As we created each lesson we would discuss further points that we felt were essential to include. Two months later and we have a robust approximatley ten hour mechanical ventilation course that takes novice providers through a step by step journey through one of the most intimidating pieces of critical care equipment. Sam mentioned the idea of bringing on his wife who works as a r...
2020-04-2647 minFOAMfrat PodcastPodcast 95 - COVID19 Simulation Experiment & Findings w/ Troy ReihsenSam and I were able to steal Troy Reihsen away for a few minutes to discuss his COVID19 airway simulation package he created with the team at 7Sigma. Troy worked with the Childrens Minnesota hospital to evaluate their technique donning and doffing PPE. Particulate dispersion was evaluated using a blacklight after the simulation. The findings are extremely interesting and valuable to healthcare providers!
2020-03-2826 min