FOAMfrat Podcast (Tyler Christifulli & Sam Ireland)

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!

In this podcast, we discuss the nuances and strategy of the T1 ventilator with RRT, Joe Hylton. Whether you're a paramedic or a healthcare professional involved in critical care transport, understanding the nuances of this advanced ventilator is essential to safe and effective patient transport.

We break down the pressure-controlled ventilation with volume adaptive options and offer practical guidance on managing obstructive lung conditions like asthma during transport. Plus, we cover essential troubleshooting techniques to help you address common issues when things don’t go as planned.

Taking on pharmacology in EMT school is a big hurdle. We wanted to write something that not only explained the basics of the medications but also helped bridge the gap between what EMTs are taught and what paramedics learn when they go back over these medications in paramedic pharmacology.

Each chapter discusses how the medications work, why they're given for specific indications, and the logistics of medication administration! We've also included medication profiles, tips and tricks from experienced providers, and flashcards for each medication to help you hone your med knowledge base!

In this book, we're coving:

Oxygen

Albuterol and Atrovent Epinephrine

Aspirin Nitroglycerin

Naloxone

Oral Glucose Gel and Glucagon + Flashcards in the back!

This book is for students, EMTs, and paramedics who want an in-depth review of EMT medications! You can download the book for free at foamfrat.com

A young pediatric patient is having nausea and vomiting at school and is said to not be 'staying awake very well.' You discover assessment findings such as hypotension, hypoglycemia, and maybe even peaked T waves on the ECG. You receive information indicating that the child has something called "CAH". Or, perhaps...

An older patient is having dizziness upon standing, and persistent hypotension. You note a somewhat jaundiced appearance. They become unconscious in their kitchen while searching for a salty snack, and they appear rather sick. Or...

A middle-aged patient has suddenly stopped taking their high-dose prednisone for their asthma and is now feeling very weak and cannot stand.

We already know what this episode is about - adrenal insufficiency. However, what if those scenarios up above were in the form of a test question? Or worse yet, a real patient? Would we be aware of what's causing the signs and symptoms, and what the appropriate treatment is? Endocrinology does not get the respect it deserves in EMS, probably due to its low volume - we just do not see that many patients with endocrine emergencies outside of diabetes. Or do we, and we just don't notice?

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.

Nothing is scarier than watching an awake patient struggle to breathe with a trach. Do you have an approach to troubleshoot? Make sure you watch to the end to see our first FOAMfrat reaction video!

In this episode, Sam and I break down the different clinical signs and diagnostics of the dreaded pulmonary embolism. Make sure you check out the show notes at foamfrat.com for references and videos mentioned throughout the episode!

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.

Theresa Bowden is a rockstar flight nurse who specializes in NICU transports. In this episode, you will listen in as Theresa explains anything and everything you have ever wondered about NICU interfacility transports.

Topics include:

• Who gets prostaglandin?
• IO or IV catheter for UVC
• Cardiac vs. Respiratory
• Initial Vent Settings

Get credit for this class by listening to it in FOAMfrat Studio.

A-a gradient, a/A ratio, and P: F ratio - are all different views of the same item. These formulas do not have a complete view of oxygenation. Oxygenation is a huge topic, and there are more common values that we use:

• How well is the patient saturating?

• Is there dyspnea?

• How do the lungs sound (auscultation) or look (POCUS)?

• Where is the patient on the OHCD?

• What does the ABG show?

Sam Henne is the creator of Mind Over Medic and a co-worker of mine at Life Link III. In this episode, we discuss the components of critical incident stress and ways to reduce adrenaline during threat appraisal. Check out www.mindovermedic.com 

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

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

Before the July 4th weekend hits, I wanted to address two main questions whose answers may come in handy on a call you'll run very soon...

1. Should EMS use a burn formula?

2. What's the best way to manage pain for the burn patient?

For a sense of a well-rounded blog on burns, I've included some quick facts about burn care at the end that are unrelated to these questions. Also, Erik Rima (CFRN and former burn center RN) left us his perspective at the end in a peer review. Be sure to check those out before you leave! Alright, on to question number one... should EMS even bother with a burn formula?

Had the opportunity to talk with Dr. Sam Slishman, the inventor of the Slishman traction splint. We had a great conversation on the idea/concept of this splint, who to apply it on, and some additional questions, which we plan on having him back on to discuss. 

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.

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.

Over the years, OHCA in the pediatric population has not much improved like the Adult. Why is this? What are we doing wrong? Well, there is emerging evidence that may change your practice. 

We also know half the battle is the psychological response and communication.

How do we improve? What do we need to do to change these outcomes and find closure? Preparation, psychology of ourselves and others, performance under pressure and tracking data after implementing best practices is just a start. Check out “Solving the Pediatric Labyrinth” in the F3 content of the FOAMfrat refresher to better grasp these concepts and more pearls to change outcomes!

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..

When trying to train ourselves to perform fine motor function skills under stressful circumstances - we commonly see exercise induced tachycardia utilized as a surrogate for stress induced tachycardia. Are they the same thing? Do tachycardia and stress correlate?

Check out this episode with Mike Brown (@FireMedicFPC).

In this episode, Tyler is joined by Shaylah Montgomery to discuss decision-making, human factors, and mental shortcuts utilizing pattern detection. Shaylah is a flight nurse and paramedic for Pafford Air One and a member of the FOAMfrat team.

The thyroid is a butterfly-shaped gland. But for some, it can be more like a bullet to the neck. The number of systems that our thyroid helps regulate truly is incredible, and an over or under-active thyroid can cause a whole host of acute and chronic issues.

On the one hand, imagine a patient who has a thyroid history and is cold, weak, and has a depressed level of consciousness. Why is this occurring, and what's the diagnosis and treatment? On the other hand, imagine an anxious, hyperpyrexic patient in atrial fibrillation. Both patients have thyroid issues, but why do these patients present so differently?

Let's see what happens when the scales tip either way for a few of the systems that the thyroid helps control!

In this episode, I sit down with Dr. Jeffrey Jarvis, author of a fascinating paper on the impact of lights and siren (L&S) use in EMS responses. If you’re like most of us, when you hear those blaring sirens and see flashing lights, you think, “Wow, someone’s really in trouble!” But the truth, according to Dr. Jarvis’ study, might surprise you.

We've been exposed to gas laws our whole life, and we have intuition about what will happen to gas under certain conditions. For example, people notice that the pressure in their tires might become low on a very cold day. Or perhaps you've been at very high altitudes and you've been short of breath. And everyone knows that if you shake a carbonated beverage before opening it you'll be cleaning up a mess very shortly. Each of these observations has been classified into the laws, and we'll be splitting them up between this blog and the next. Stating the laws is one thing - anyone with google can copy and paste their definitions. However, we have a special interest in these laws as medical professionals because we deal with them on a different level. Sometimes we're manipulating these gas laws on purpose, and other times we're dealing with their side effects. Or perhaps we're just trying to pass our FP-C, CCP-C, or CFRN exam ;)

Let's dive (pun intended) right in!

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.

Finally got Andrew Merelman (@amerelman) from The Paramedic Practioner Podcast on the show and we discuss:

Social Media ECG interpretatuon vs. real life interpretation

NSTEMI? What does that mean for my transport?

STEMI Equivalents (detailed blog on these by FOAMfratter Jared Patterson here)

Stop points for nitro drip escalations.

This is part one of a two part series. In a few weeks we will post the actual logistics and decisions DURING the transfer. As always, if you have any comments, tricks, or ideas - leave them in the comment section!

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.

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!

Last year at WEMSA2019 we had an amazing session that included speakers like Michael Perlmutter, Leon Eidelman, Michael Lauria, and Chip Lange. Each speaker had 20 minutes and the talks were all recorded.

My goal was to put these out A LOT sooner, but the stupid Catalina Mac update prevented me from opening Adobe Audition files. Utilizing an extensive Google search and Russian hacking skills - I was able to access these talks.

This is a 20ish minute talk by friend of the show, flight medic, and current medical student, Michael Perlmutter (@DitchDoc14). Michael is speaking on the application and use of Ketamine "from analgesia to RSI (yes and DSI)."

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.

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.

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.

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

If I give this patient a fluid bolus, will it increase cardiac output? What does wall tension have to do with myocardial oxygen demand? In this episode, we will give you a step-by-step guide into assessing LV function utilizing pulse pressure and ultrasound. FOAMfrat is an online library for EMS professionals who are looking to take their knowledge and skills to the next level. www.foamfrat.com

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

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.

Yesterday Sam released a blog on the various flavors of prolonged Q-T syndrome. As a complement to that blog, Sam and Jake sit down and tease out some of the nuances and treatments of this interesting pathology. 

In this episode of FOAMfrat, Tyler speaks with paramedic Kyle Rice to discuss a deeply personal and eye-opening experience—rolling his ambulance after running a red light. Kyle shares the lessons he learned about complacency, crew resource management, and the often-overlooked dangers of driving with lights and sirens. Together, they explore how EMS providers can stay vigilant behind the wheel, adopt safer driving practices, and shift their mindset when responding to emergencies. If you're an EMS provider, this episode is a must-listen for understanding the real-life risks of complacency and how to prevent accidents.

In this episode we discuss whether the concept of having a "max dose" of your pressor has any evidence or physiological backing. Joining me in this discussion are Dan Rauh, Shane O'Donnell, and Shad Ruby.

I ran some specific decision points when treating the REALLY BAD massiVE pulmonary embolism patient by Shane & Brian from the FOAMfrat Team. This discussion really focuses on the logistics and ideas when you are trying to get the patient from A to B without having to do CPR.

A few weeks ago Andrew Merelman (@amerelman) and I did part one of our "Routine (N)STEMI Transport" series. In this episode we get down to a granular level to discuss the logistics of:

Which infusions can I turn off until I get to the ambulance/helicopter?

Heparin is typically given as a bolus and then maintenance infusion. The maintenance infusion can be paused while moving the patient to the ambulance/helicopter.

Nitroglycerin is a little bit more nuanced. Even though nitroglycerin has yet to show a mortality benefit, it has been well documented to relieve discomfort.

If patient is on a nitro infusion, MAP's support an acceptable coronary perfusion pressure, and is currently feeling relief from chest discomfort - I will continue this infusion with no interuption.

If patient is on a nitro infusion and is still complaining of chest discomfort that is unrelived by nitro - I will give fentanyl and pause the nitro infusion till we get in the helicopter. This allows me to evaluate the pressures after fentanyl and re-evaluate the dosing for the infusion.

Preparation?

Defib pads placed in the anterior/posterior position.

LUCAS back-plate placed if ominous assessment.

Should we be giving P2Y12 inhibitors in-transport if not provided by the facility?

My shop uses ticagrelor and it is preferred in this region. 

What areas should we avoid placing IV's when going to the cath-lab.

Not only should we avoid the right wrist, we should place an additional IV in the left arm if we see the referring EMS or hospital has placed an IV in the right wrist.

Ultrasound and point of care labs to rule out differentials.

These patients come in and get shipped out fast. Typically no imaging or labs has been performed by the time we scoop em up. I like to rule out:

1.Thoracic Aneurysm/ Pericardial Tamponade.

2.H&H for unknown bleed cause type 2 ischemia.

3.Hyperkalemia fooling the ECG.

We just finished re-recording our pediatric arrest class in Studio and decided to play the unedited version of my discussion with Dr. Paul Banerjee. Banerjee is a prolific researcher and medical director in Florida with a particular emphasis on pediatric arrest. Check out the class in Studio for more information on the logistics.

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!

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.

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.

I had the privilege to bring on two passionate fathers of children with Autism to help me better understand how to approach and communicate with a neuro-diverse child. This episode is chock-full of insight, tips, tricks, and logistics of approaching a child in the field with Autism. Josh Chan is a Life Link III flight paramedic/base lead and a Glenwood FD firefighter. Matthew Yelton is a flight paramedic/base lead for Mercy Flight Central and works as a fire captain at Constableville Ambulance Inc.

In this episode, Tyler & Sam discuss everything you need to know about the Bougie.

Traditional use

Modified pre-loaded techniques

Common pitfalls.

AI will be integrated into everything we do in medicine, perhaps sooner than we think. It will help keep our patients safe, our providers informed, and our communications connected, and change how we think about how we care for patients (if implemented correctly). 

Systems like ChatGPT are only the beginning, and many companies are already working on or have already integrated with other healthcare specialties. We will see the same integration happen with EMS. While the response to this might be fear of losing our knowledge base, over-automating decision-making, cheating on tests and papers, and the like, we could adopt a very different outlook. We could view this as an opportunity to improve patient safety, offload menial work, automate documentation and communications, and always have an intelligent partner in our pockets we can bounce ideas off of. 

One day, we'll wonder how we ever lived without it.

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.

EMS providers encounter various infectious diseases daily and need to know the routes of exposure, risks, and preventive measures to protect themselves and their families. In this episode, We talk with Dr. Hudson Garrett, an infectious disease expert with the medical college of Louisville University, to discuss the practical points of infectious disease for the everyday provider.

Want CE for this episode? Sign up for FOAMfrat Studio and access 300+ hours of continuing education for EMS & Nursing. 

www.foamfrat.com

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!

Moments after the heart stops the entire circulatory system finally has a chance to bring venous and arterial pressures to equilibrium. Cardiac arrest resuscitation requires the provider to have a strong mental model of physiology and the logistics to carry out a series of interventions crucial to preserving life. This class will serve not as a routine basic life support model, but as a deeper understanding and framework to guide resuscitation during your next cardiac arrest.

My buddy Jay Nance and I went on the Mind Body Medic podcast with absolutely no agenda (I typically don't do those). The conversation was excellent and minimal banter makes it tolerable. 

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

We commonly hear the phrase "resuscitate before you intubate." My question is - how do you know when your patient is resuscitated enough to follow through with intubation?

Last weekend I gave a talk at EMSWorld called "The Sound of Silence." At the end of the talk Sam and I had a discussion on how do you know when a patient is resuscitated enough to allow intubation. In true Tyler fashion, I misread how long my talk was suppose to be and had to cut out the ending. This is the discussion portion of that talk and I think you will especially enjoy the ending.