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Education
Science

FOAMfrat Podcast

Updated 7 days ago

Education
Science
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Podcast by Tyler Christifulli & Sam Ireland

Read more

Podcast by Tyler Christifulli & Sam Ireland

iTunes Ratings

116 Ratings
Average Ratings
111
4
0
0
1

CritDude

By Christifulli - Aug 14 2019
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Sam is wicked smart and creative!!

FOAMfrat

By PyroJosh - May 08 2019
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Awesome content very knowledgeable educators keep up the great podcasts

iTunes Ratings

116 Ratings
Average Ratings
111
4
0
0
1

CritDude

By Christifulli - Aug 14 2019
Read more
Sam is wicked smart and creative!!

FOAMfrat

By PyroJosh - May 08 2019
Read more
Awesome content very knowledgeable educators keep up the great podcasts

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Cover image of FOAMfrat Podcast

FOAMfrat Podcast

Updated 7 days ago

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Podcast by Tyler Christifulli & Sam Ireland

Rank #1: Podcast 29 - ResusReady "Must Know Infusions"

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There is just not a whole lot of exposure to infusion mixing and administering in Paramedic school. In this episode I discuss what I think to be the four "must know" infusions in my current setting. High Dose Nitro! It doesn't make sense to break the CPAP seal every time you want to give a spray of nitro. IV nitro is the best way to care for the acute sympathetic pulmonary edema patient. You need quick reduction of afterload.. and you need it now. We do an initial bolus of 400mcg over 2 minutes while an infusion of 100mcg/min is being set up on our IV pump. This has been implemented in our protocols and is not recommended unless you have done the same. A paramedic should definitely have a plan to deliver either epi or norepi in an efficient and safe matter. Our typical concentration for norepinephrine is 4 mg in 250 bag of 0.9% or D5w. This renders a concentration of 16 mcg/ml. If I want to start it off at 5mcg/min, I set my pump to 18.7ml/hr. If I decide I need more inotropic or chronotropic response I can consider epinephrine. We typically mix this as 1000mcg in 500ml (depending on how much fluid you want to give). Ask a new paramedic how he plans to deliver his 150 mg of Amio over 10 minutes! These mental steps just be premeditated and planned before you have a patient in ventricular tachycardia sitting in front of you. We place 250 mg in a 250 bag of D5w. The initial bolus is run in by placing the IV pump at an infusion rate of 900 ml/hr and a volume to be infused of 150ml. This is nice because if you need to start a maintenance Amio drip later you can just set the pump to 60ml/hr (1mg/min). Ketamine intubations are the cats ass right now, which is good! However, it only lasts fifteen to twenty minutes. You need to immediately be thinking of starting a Ketamine drip to prevent your patient from coming down the K continuum to the "disassociated and aware" stage. We throw 500 mg in a 500 bag of 0.9%. This will be ran at whatever the patient weighs in KG's. For example a 120 kg person will receive 1mg/kg/hr or 120 ml/hr. Now go practice!

Aug 24 2017

9mins

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Rank #2: Podcast 66 - LBBB & Ischemia w/ Bryan Winchell

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Bryan Winchell sent me a screen cast he did last year which was FRACKIN AMAZING! He gave me permission to post it on FOAMfrat. I broke it up into two segments. Segment one will look at the conduction abnormalities of a bundle branch block. In part two he gets into case studies of interpreting an MI in the presence of a LBBB using the Smith-Modified Sgarbossa Criteria.

www.foamfrat.com

Dec 03 2018

16mins

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Rank #3: Podcast 32 - Beef Up Your Neuro Exam! with Chip Lange

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"You can't teach an old dog new tricks" is clearly repeated by an elderly man who's family got concerned he was having a stroke when they noticed some gait ataxia. EMS does a quick Cincinnati Stroke Scale and doesn't detect any deficits, 12 lead looks normal, and blood glucose is within normal limits. Should he be evaluated in the emergency room? Should EMS be concerned about a central lesion? Does a negative Cincinnati mean the patient is not having a CVA? Check out the show notes! https://www.foamfrat.com/single-post/2017/10/15/Beef-Up-Your-Neuro-Exam-with-Chip-Lange

Oct 15 2017

20mins

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Rank #4: Podcast 35 - The Push Dose Pressor Bridge

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PDP is the cool kid on the block these days, but it is a bridge to an infusion. 

Jan 13 2018

11mins

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Rank #5: Podcast 74 - Bicarb or Bye-Carb

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Recently I gave a lecture at Arrowhead EMS Conferenceon when to treat metabolic acidosis with sodium bicarbonate. I attempted to record the lecture live and had some AV difficulties that prevented me from being able to. Soooo I re-did an abbreviated version of this talk into a screen-cast.    I think we can all agree that there is never a reason to treat a metabolic acidosis with sodium bicarbonate. So we really are asking:   When do we treat a metabolic acidosis with sodium bicarb?

Feb 09 2019

15mins

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Rank #6: Podcast 43 - Med Math.. Fluid over time!

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Knowing how to do a quick "fluid over time" calculation is essential in emergency medicine! If this isn't one you already have committed to memory, you're going to wonder how you ever got along without it. 

Apr 15 2018

8mins

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Rank #7: Podcast 54 - Approaching The Shocky Patient In Afib RVR w/ Josh Farkas

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Occasionally we find ourself asking..   Is the hypotension being caused by the rate?   Is the rate compensating for the hypotension?   I reached out to Josh Farkas from PulmCrit (EMcrit)in hopes he would help me come up with an algorithm or mental-flow that could be used to formulate a decision when faced with this situation.   Come listen in on our conversation at www.foamfrat.com

Aug 15 2018

21mins

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Rank #8: Podcast 33 - ApOx, Suctioning, & OOHA Airway Management

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Lately I have received some really good questions and comments based off of my blog I did a few months ago "You're not dead until you have an airway." Here are those comments: "This seems to completely ignore the growing evidence that an airway during arrest is correlated with worse outcomes." The mere presence of an established airway is not the problem with low CPC score or achievement of ROSC. The areas of advanced airway placement that I would speculate contribute to worse outcomes are. 1. Interruption in chest compressions to allow a provider to intubate. 2. Low resources and over ambition with airway as a priority rather than chest compressions and defibrillation. 3. Two hand bagging once an advanced airway is in place (decreased dead space.. increased ITP) A OPA or NPA is an airway ADJUNCT. These should be used as a bridge in the initial stages of cardiac arrest until either an SGA or ETT can be placed. This recent study shows higher complication rates when providers ONLY used airway adjuncts and BVM during cardiac arrest... go figure. http://www.mdedge.com/ecardiologynews/article/150634/arrhythmias-ep/bag-mask-ventilation-cpr-deflates-large-rct According to AHA 2015 Guidelines, continuous chest compressions can only be initiated once an advanced airway is placed. So it would make sense to place an advanced airway in a somewhat timely manner to avoid the need to stop every 30 compressions to deliver ventilations. This doesn't necessarily need to be an ET tube. Check out the blog! https://www.foamfrat.com/single-post/2017/11/03/ApOx-Suction-and-OOHA-Airway-Management

Nov 03 2017

10mins

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Rank #9: Podcast 19 - Tips For The Occasional Intubator Part 1

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Dr. Jeff Jarvis joins me in this three part series on tips to optimize your first pass success with intubation.... but now just for any one, this podcast is for "The Occasional Intubator". Let’s face it, as Paramedics we don’t walk around every shift throwing tubes down everyone’s throat! We have to realize that this is a skill that has the potential to save someone’s life, but also has the potential to take one. There have been rumblings back and forth on whether medics should be allowed to perform a skill they don’t use frequently. These arguments are backed by scenarios where providers have failed intubation, intubated the goose, and never used any quantifiable markers to validate placement….. and the patient died. Can we honestly use this as an argument to take away the skill of endotracheal intubation at the Paramedic level? Let’s address this question with some very reasonable concerns that come up regarding airway management training in Paramedic school. With so much to cover in a short period of time, airway management does not get NEAR the time it deserves in our initial education. We are taught that an RSI is a lighting speed process, we are told to hold our breath and when we need to breathe, it’s time to get out! We are led to believe that we will dip the blade into the hypopharynx and immediately see the cords!! These teachings create a nervous and jittery intubator who isn’t breathing because some clown told him to hold his breath! There competency is validated by their ability to perform five intubations in a nicely lit, controlled environment. Under the heuristics and proper set up of an anesthesiologist. So now you are probably wondering… where are the tips?? This just seems like a dig at formal paramedic education! The first tip is to realize that you are an “occasional intubator”. Don’t let that discourage you though, because you can achieve excellence with this skill, you just need to put all the odds in your favor. Tip 1. Positioning 99% of the time in school you will be intubating mannequin heads that are stuck to a flat board. You will find yourself bending down low and trying to get eye level with the larynx axis. Finger tips turn white as you struggle to lift forward enough to see the cords, while trying to not use the teeth as a fulcrum. There are three axis we need to become familiar with when intubating. The oral, pharyngeal, and laryngeal axis. These can easily be aligned by putting the patient in an ear to sternal notch position. When applied properly, you really only need the laryngoscope to lift the tongue out of the way. This technique in cooperation with airway adjuncts also helps optimize First Pass Ventilation (FPV) with a BVM. The saying “work smarter, not harder” really applies simply to the way you position your patient. Tip 2. Delay Your Sequence Intubation is not a game of speed. Get scene times out of your head for a minute and realize that speed means nothing when you deliver a hypoxic patient in peri-arrest. Delayed Sequence Intubation (DSI) is procedural sedation, with the procedure being pre-oxygenation. If you are intubating a hypoxic patient, you are setting yourself up for failure. Take the time to properly pre-oxygenate & denitrogenate your patient. This usually takes about 3 minutes to perform…. Can you wait that long? It may seem like FOREVER, but trust me it will give you a safety net during intubation. The goal of the peri-intubation period is to have the patient spontaneously breathing as much as possible up until the point of intubation. This prevents excessive bagging, gastric insufflation, and some of the negative effects of BVM ventilation. Most induction agents will depress your respiratory drive such as versed, etomidate, fentanyl, etc. So how do we keep this breathing adequately up until the point of intubation?

May 13 2017

20mins

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Rank #10: Podcast 49 - Shocking Asystole w/ Swami

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We sit back and laugh at the Hollywood physicians that shock asystole.. but what if they are on to something? In this episode Swami and I discuss occult ventricular fibrillation and the evidence to possibly support shocking the flat liners.

www.foamfrat.com

Jun 13 2018

13mins

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Rank #11: Podcast 79 - Too Sick To Transport w/ Vahe Enders

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A few weeks ago Brian Behn (The Brian Behn) put out a blog on FOAMfratraising the question "When is a patient too sick to transport?"   This question sparked a TON of good conversation on social media with a very diverse population of opinions.     "As long as crew safety is addressed, then we should make every effort to get this pt to definitive care. Declining a transport due to "instability" when the pt is 100% going to die at the sending, does a huge disservice to your pt. "     "Given the picture painted, after all my checks and additional resuscitation efforts I'll make my decision. 3 hours by ground through the mountains and the patient is still peri arrest with zero likelihood of intact neurologic outcome? Nope. I don't put my ass on the line for futility."     Knowing Flight Paramedic, Vahe Enders (@calldaburd), spoke on this in the past (ECHO2017). I asked him to come on the show and continue this conversation.

Jun 01 2019

36mins

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Rank #12: Podcast 12 -Your Mother On A Vent Part 1

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Imagine you had to set up the ventilator setting for your first love.. your mom! Are you up to the task? If not, why should anyone else trust you with their family? Sam Ireland puts ventilator management into perspective in this powerful lecture at the 2015 Lifestar Critical Care Conference.

Mar 06 2017

21mins

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Rank #13: Microgram - Humeral Head IO Placement w/ Annie Feavel

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In this Microgram my friend Annie Feavel does a spectacular job teaching the process and technique for dropping a humeral head IO. 

Aug 06 2018

6mins

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Rank #14: Podcast 11 - Flavors of Obstruction

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Why do we classify all obstruction patients into the same vent settings?! The mechanisms behind the obstruction is vastly different, and subsequently some of the vent settings will be as well. In this podcast I create two subcategories of the "obstructive" approach, and discuss how the pathophysiology behind the illness is the key to understanding when to apply PEEP.

Mar 03 2017

13mins

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Rank #15: Podcast 80 - Right Ventricularly Speaking w/ Brendan Riordan

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Sam and I ran into Brendan Riordan (@concernecus) at Camp ECHO a few months ago in West Virginia. We had a fantastic conversation out in the lobby of the conference center on all the right ventricle! In this podcast we address questions like:

How can we differentiate sepsis from pulmonary embolism (PE)?

Does extrinsic application of PEEP reflect in CVP?

Does a dilated RV in arrest always mean PE? (I know I'll charge my phone!)

Does extrinsic application of PEEP reflect in CVP?

www.foamfrat.com 

Jun 25 2019

47mins

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Rank #16: Podcast 46 - Is it time to ditch ACLS? W/ Dan Davis MD

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Today I had the pleasure of speaking with Dan Davis, MD. He tells me about his Advanced Resusitation Training (ART) program, as well as the success it's had in clinical evaluations. It is time to ditch ACLS?

May 12 2018

20mins

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Rank #17: Podcast 39 - A Stubborn Old Mule Named Hypoxia w/ Brad Garmon

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My buddy Brad Garmon (@1stArrivingClin) and I sat down and discussed the different options for a patient in refractory hypoxia. Brad has a mental flow chart that he uses when trying to improve oxygenation in the vented and spontaneous breathing patient. I had him externalize this flow chart and talk about it on the FOAMfrat Podcast!

Feb 20 2018

37mins

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Rank #18: Podcast 47 - NPPV Tips with Josh Dillman

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Two Complaints I Commonly Hear With NPPV 1. I can't get the &%$% mask to seal! 2. This thing blows through oxygen like a Ukrainian sea turtle!   In this episode I chat with Josh Dillman who is one of my favorite Respiratory Therapist and a gigantic ventilator nerd (sorry Bauer). We discuss how to properly fit a non invasive mask and factors that contribute to rapid 02 consumption in NPPV. Now check out the podcast!   www.foamfrat.com

May 24 2018

14mins

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Rank #19: Podcast 76 - The Airway Gauntlet w/ Dr.Pickett

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Is there any benefit to reap from the obligatory "airway gauntlet" day of medic school. Remember this day? Intubating patients upside down, in the dark, and wedged by the toilet. Dr. Pickett believes so, and here is why.  

Mar 11 2019

19mins

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Rank #20: Podcast 53 - Let’s Learn Chest X-Rays w/ Cynthia Griffin

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I want to get better at reading chest films! So I asked the lovely Cynthia Griffin to put together some videos to help me out. She did, and it’s friggin fantastic! Enjoy!

Aug 05 2018

12mins

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