FOAMfrat Podcast

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 give the patient something IM to calm him down through the extrication process.  Do your guidelines discuss extrication sedation? What drug and dose? The comments were very interesting and I wanted to get someone well respected in the HEMS and prehospital environment on the show to give their thoughts. Dr. Cliff Reid is a seasoned retrieval physician who works for Sydney HEMS in Australia. This is his second time on FOAMfrat and we always have a great discussion. I think you will enjoy!

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!

 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 Sapphire IV pump. How did it go? 

Chip 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!

In 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.

A 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 respiratory therapist. His vision was to round out the course with a long-term perspective on mechnical ventilation. We found this interview with Kristin Ireland very informative and hope that it sheds a little more light on what goes on after we drop off a patient, or before we pick them up. Topics discussed include: What's up with the ED crash settings we always find patients on? What do critical care transport teams do that drive you nuts? What should we absolutley ask the RT before we leave with an intubated patient? Weaning & Extubation

Sam 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!

In this episode Sam and I talk with Leon Eydelman (@ECMOeydelman) who is an intensivist from Illinois. Dr. Eydelman discusses how his team is currently handling the surge of patients with COVID19. Discussion topics include: Isolation from an ICU vantage point. Proning vs. ECMO Antiviral therapy and steroid use Coinfection and efficacy of azithromycin and antibiotics. Information is as accurate as 3/22/2020

Recent conversations with our friend and beloved medical student, Tom Latosek, have been very mentally stimulating surroundind the current pandemic. I recorded one of these conversations and felt the topics covered were stimulating and extremely beneficial for EMS providers in these dynamic times. In this episode Sam and I speak with Tom regarding: 1.The science behind virus particles and how they hijack specific cells to replicate. 2.How antivirals work. 3.Basic Epidemiology 4.Protective PPE Nuances. Let us know what you think and please leave us a review on iTunes.

My friend Brian King recently finished the Speaker's Atlas course. For his capstone project he recorded an amazing video on the bleeding trach. Watch his use of animations, engaging graphics, and vocal modulation! If you are like me, you are thankful that a bleeding trach is a rare encounter. After all you are staring into a black hole with blood coming from a unknown source. But there is one cause of tracheostomy bleeding that should give you nightmares and that’s bleeding from a tracheoinnominate artery fistula.