FOAMfrat Podcast

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.

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 that connects to the end of a syringe and lets you inject medication into someone's nose. It was called a mucosal atomizer device (MAD). I pulled up 100 mcg (2 ml) and gave 1 ml per nare. I told the guy that he would be feeling reeeeallll good anytime now. we waited.. and waited..

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 to tackle the renal values on our chemistry panel! Renal physiology can be more than a little intimidating, but you're going to totally understand these labs by the time we're done! Because this renal section is a little different than the other sections, I'm going to start us off with a little refresher on the nephron, using a couple of illustrations.

What 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

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 I mentioned in the last blog, I'm writing these as the reference that I wish I had when I started learning to interpret lab values. In this portion of the series we'll be discussing anions - the negative changes in the serum. We'll be starting off with chloride, which accounts for the majority of the negative charge in our blood!

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

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 sitting ;) We'll be starting with the positive charges (cations) in this blog, then handling the other parts of the basic metabolic panel in weeks to come (negative charges, renal, and glucose).       Before we get started, I want to get us in the right headspace for learning about lab values. This stuff is kind of dense, and there are a lot of different conditions that will cause lab values to reach their outer limits, or beyond. While I'll present a lot of information for each lab value abnormality, the theory of what's going on is far more important. Once you understand the theory of why a problem occurs, you can find a formula, calculator, or treatment guideline to get you the rest of the way.       Now let's what happens when cations reach their outer limits!

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?   2. If I let my NREMT lapse, or never even got my NR, what is the process in order for me to get it back?   3. The hour requirements are broken down into general categories (i.e. trauma, cardiology, etc.), are the subcategories mandatory or suggested?   4. Do you ever see the instructor-led hour requirements coming back?

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.

In this episode, Tyler interviews Tom Bouthillet and Dr. Stephen Smith on who exactly should get a right-sided ECG. Do not delay transport to PCI to grab a right-sided ECG. If you do decide to perform a right-sided ECG, it should not be for the decision on whether or not to give nitro. If time permits, it may be helpful and confirm your suspicions of RV involvement. Isolates RV infarcts are extremely rare. In EMT school, I was taught how to assist a patient taking their own nitroglycerin if they developed chest pain. I had to make sure they weren't on any phosphodiesterase inhibitors, grab a blood pressure, and make sure they took the right dose. We would obtain a 12 lead, but I had no clue what I was looking at, and my decision to give nitro was not based on any specific ECG finding.   Fast-forward to paramedic school, and I am taught to ALWAYS perform a 12 lead before giving nitroglycerin. Why? Wellll If they had an inferior wall MI, nitroglycerin was a hard stop. Every time the student would give nitro before obtaining a 12 lead in simulation, their patients would code...Every. Time.   I thought this was weird because patients were prescribed nitroglycerin if they developed chest pain at home. They were certainly not performing a 12 lead on themselves prior to doing this. So what was the fear?   The Fear EMS is full of cautionary tales (as my buddy Brian Behn points out in this blog). The fear of administering nitroglycerin to a patient with an inferior wall MI is the possibility of plummeting the blood pressure if there is right ventricular (RV) involvement.   Because the RV is preload dependent, dropping preload with nitroglycerin could cause hypotension. This is probably a good place to say that the LV is preload dependent too, but the LV preload is dependent on the RV preload. So if you wipe out the RV, the LV follows.   I believe the fear of nitro is probably healthy, but not for JUST inferior wall MIs. The benefit of sublingual nitro has yet to be proven (as Dr. Smith points out in the interview) and on top of that, a study published in Prehospital Emergency Care in 2015 found that hypotension occurred post-NTG in 38/466 inferior STEMIs and 30/339 non-inferior STEMIs, 8.2% vs. 8.9%, p = 0.73. That means it makes literally no difference where the MI is.