FOAMfrat Podcast

Latest Episodes:

Podcast 114 - Vent Strategies & Metabolic Acidosis w/ Bryan Winchell Mar 22, 2021

Show notes

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-flow" zone to add in breaths. 2. The width of your flow waveform will tell you whether or not more inspiratory time will = more volume. 3.These patients typically don't need a ton of PEEP because they are spending such a short time exhaling (due to the fast rate). PEEP of zero is probably ok because the pressure will likely never truly get to zero. If a PEEP of zero gives you visceral pain, 3-5 mmHg is a good spot to start.

Podcast 113- DON'T stop the insulin! Mar 06, 2021

Show notes

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 before you leave the hospital:

IV Potassium
Liter bag of D5W
Bag of lactated ringers
Three amps of sodium bicarbonate (if renal failure is suspected)

If I add weak acids (ketones) into the anion side, the body will dump bicarbonate to maintain electrical neutrality. The only way to get the bicarbonate to return to normal is to get rid of the ketones. I got rid of all my ketones but my bicarb has not returned to normal!! Why?!

You gave too much chloride which is now hogging all the anion space.
The kidneys aren't working properly and you need to give sodium bicarbonate.

Podcast 112 - When Mental Models #FAIL w/ Tom Grawey & Bryan Selvage Feb 10, 2021

Show notes

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 versus not sick" assessment. Both of the blogs complimented each other perfectly and I figured we could do a podcast and release both blogs as a package. I loved the discussion and feel this will likely lead to more podcasts/blogs down the road. Would love to hear what some of my friends like Cliff Reid, Mike Brown, and Michael Lauria have to say on this topic. Now let's get to the podcast!

Podcast 111 - How We Peer Review w/ Eric Bauer & Chris Smetana Jan 25, 2021

Show notes

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 the industry and collaborating to improve the EMS profession. You can find their content at IAMED.US. Topics discussed:

What is the process from inception to publishing, when it comes to your brands content?
Traditional and modified peer review techniques.
The art of critique and feedback
Reducing noise from social media posts.

Podcast 110 - Resus Tempo w/ Keith Velaski Jan 04, 2021

Show notes

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 getting into my groove. If you can decipher this and have any kind of feedback, I'd love your thoughts

Best sequence for assessment

Scene and interfacility follow up questions geared towards interfacility

Dividing rolls with partners

ie do you both receive report, does one take report and the other makes patient contact, or something else?

Key labs/imaging based off physical exam findings/chief complaint/HPI

What if they haven't been done/ordered?

What's worth staying at bedside to obtain/initiate?

How much is flight time a consideration if at all?

How much emphasis do you put on-scene times?

Not sure how intelligible this is, just 2am thoughts jotted into my notes on shift.

Alex, this podcast is for you!

Podcast 109 - Productivity Hacks Dec 25, 2020

Show notes

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

Podcast 108 - TBI+MultiSysTrauma w/ Jake Good Dec 09, 2020

Show notes

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.

Podcast 107: Exposing Errors of High Caliber Performance Nov 27, 2020

Show notes

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 prevent similar errors moving forward. Think of it like this, if you are a parent meeting your child's first "boyfriend or girlfriend", it is your response that often dictates whether you meet the next one or not.

Text-To-Speech: Lara Croft (OB/GYN) and the Cradle of Life Nov 12, 2020

Show notes

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.

Podcast 106 - When Benzos Won't Stop The Seizure Nov 03, 2020

Show notes

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.

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