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Podcast by Tyler Christifulli & Sam Ireland

FOAMfrat Podcast Tyler Christifulli & Sam Ireland

    • Wissenschaft

Podcast by Tyler Christifulli & Sam Ireland

    Podcast 91 - Ketamine "Analgesia to RSI" w/ Michael Perlmutter

    Podcast 91 - Ketamine "Analgesia to RSI" w/ Michael Perlmutter

    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)."

    • 20 Min.
    Podcast 90 - Why Zebras Don't Get Ulcers w/ Mike Brown

    Podcast 90 - Why Zebras Don't Get Ulcers w/ Mike Brown

    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).

    • 34 Min.
    • video
    Podcast 89 - Approaching Bradycardia (who gets atropine?)

    Podcast 89 - Approaching Bradycardia (who gets atropine?)

    This is a video in the cardiology section of the FOAMfrat Paramedic Refresher. I broke down an evidence based approach to bradycardia. Who gets atropine??

    • 18 Min.
    Podcast 88 - The Logistics of a STEMI Transport w/ Andrew Merelman

    Podcast 88 - The Logistics of a STEMI Transport w/ Andrew Merelman

    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.

    • 20 Min.
    Podcast 87 - Routine (N)STEMI Transfer w/ Andrew Merelman

    Podcast 87 - Routine (N)STEMI Transfer w/ Andrew Merelman

    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!

    • 29 Min.
    • video
    Microgram - Is Flow Additive?

    Microgram - Is Flow Additive?

    The basic question here is: If you add more oxygen delivery devices to a patient, does it increase the overall speed of oxygen delivery? Why does this even matter? Does a NRB at 15 LPM + NC at 15 LPM = 30 LPM of flow?

    • 7 Min.

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