FOAMfrat Podcast

Thoracic 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.

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.

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 too low can increase the risk of rebleeding. She also discusses the use of hypertonic saline and osmotic therapy to manage increased intracranial pressure. Tyler and Alaina discuss various aspects of managing patients with external ventricular drains (EVDs) during transport in this conversation. They cover topics such as the clamping of EVDs, positioning the patient's head, troubleshooting common issues, and securing the EVD during transport. Alaina provides insights and recommendations based on her experience as a neurocritical care nurse.

Dr. 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 a reliable indicator of successful decompression. The guest introduced the Cap-No-Spot, a device that uses colorimetric indicator paper to detect CO2 and determine if a needle decompression procedure was successful. The device has been shown to have higher sensitivity and specificity than human judgment. The conversation also touches on the importance of proper training and the device's potential applications beyond pneumothorax detection.

An 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.

The 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 the verification of mechanical capture. The speakers explore the use of various methods to confirm mechanical capture, such as feeling for a pulse, using pulse oximetry, and utilizing ultrasound. They also discuss the difficulty of accurately assessing mechanical capture and the potential for false electrical capture. The conversation concludes with a discussion on the transfer of pacing from one device to another and the importance of verifying capture during the process.

Cardiologist Dan Rauh, Anesthesiologist Shane O'Donnell, and Intensivist Shad Ruby discuss the concept of maximum dose for pressors, emphasizing the variability in patient response and the risks of blindly increasing doses. They also touch on unexpected situations in medication administration, the use of calcium in medical treatment, and the high-level education offered by Critical Care Transport Academy.

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.

Chris 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.

This podcast features Shane O'Donnell, an expert in multimodal pain management. The podcast dives into topics such as the importance of pain assessment, patient comfort, and the use of multimodal analgesia. They also discuss the advantages of IV-Tylenol for pain management and the potential use of ultrasound-guided nerve blocks in the pre-hospital setting.