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Tyler Christifulli
25 February 2020
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 extensi...
Tyler Christifulli
20 February 2020
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?How do Zebras go from nearly being attacked by a lion to grazing again?? Check out...
Tyler Christifulli
19 February 2020
I put together an annotated algorithm based on evidence and logical reasoning for approaching bradycardia. In reality, we probably spend too much time trying to determine what kind of block we see. Here is my approach to bradycardia. The algorithm has nothing to do with the block degree.For everyone that is about to comment " YOU WOULD GIVE AT...
Tyler Christifulli
18 January 2020
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 an anecdotal granular level and discuss: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...
Tyler Christifulli
16 December 2019
Finally got Andrew Merelman (@amerelman) from The Paramedic Practioner Podcast on the show and we discuss:Social Media ECG interpretation 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....
Sam Ireland
08 December 2019
I posed the above poll on Twitter to see what people thought. The reservoir answer, while the most popular, was actually a distractor item - that option doesn't actually have anything to do with liter flow / speed. The basic question here is: If you add more devices to a patient, does it increase the overall speed of oxygen deliver? Why does this e...
Tyler Christifulli
22 November 2019
You jump in the back of an ambulance and see the crew you intercepted with is currently ventilating the patient through a supraglottic airway (SGA). Your partner looks at you and says: "should we just swap and intubate?What factors influence your decision to yank the SGA and perform endotracheal intubation? Here is a decision tree I made to he...
FOAMfrat
10 October 2019
A few days ago I put up a thought experiment blog on generalizing the dose of rocuronium to 100 mg for anyone over the age of 18 years old. You can find that post here.  Here are my thoughts:  ...
FOAMfrat
01 October 2019
The Dreaded Cold ReadDoes anyone ever send you a cold read? A cold read is when you get a piece of information, but really no context. An example of this would be the ECG or lab panel that you get sent you with the predictable question: "What would you do?" This is a difficult question to answer, because the person is generally asking you to m...
FOAMfrat
19 September 2019
Recently I was asked to come in and speak to a critical care paramedic class on the topic of hemodynamics - not monitoring them, just the dynamics. I have often imagined the ideal way to teach a class on hemodynamics would be to build a simplified plumbing system of the body. This would consist of: 1. Hand Pump2. Large flexible/compliant&...
FOAMfrat
16 August 2019
  This month we had the privilege to chat with Cliff Reid (@cliffreid)- a Retrieval Physician with Sydney HEMS. Dr. Reid has an extensive history in HEMS and emergency/critical care medicine. I wanted to pick his brain on a variety of topics such as: Receiving a report from the crew you are intercepting with....
FOAMfrat
18 July 2019
 Sam and I sit down and and chat with our new friend @ChillaPharmD about : -Intubating the hypotensive patient.-Her perspective on the push dose pressor craze.-Long term sedation strategies....
FOAMfrat
14 July 2019
You will have to forgive me as this piece will not do intersectionality enough justice. I acknowledge whole-heartedly the complexities that come with being of a different race, sexual orientation, ability, etc, but this has the potential to turn into a dissertation if I delve too deeply. I humbly welcome opinions and perspectives that further open ...
FOAMfrat
25 June 2019
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 a dilated RV in arrest always mean PE? (I ...
FOAMfrat
31 May 2019
A few weeks ago Brian Behn (The Brian Behn) put out a blog on FOAMfrat raising 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. De...
FOAMfrat
22 May 2019
I was listening to Eric give a lecture during his ventilator pre-conference workshop. I forget the exact context, but he mentioned that lactate was a normal product of glycolysis. While lactate can be produced through glycolysis, this statement somewhat shook my understanding of how and why lactate is produced. I approached him later and asked him ...
FOAMfrat
27 March 2019
Let's have a little chat about static and dynamic tube confirmation.I organized a few graphs to show my current thought process.When you combine that concept with this..I believe we reach the best dynamic ETT monitoring system.Stuff not covered in the podcast:Can I use ultrasound?Are you currently doing it? No, only because I honestly need more pra...
FOAMfrat
11 March 2019
The Airway Gauntlet!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.Dr. Pickett is an awesome dude with a commendable proactive approach to improving system performance in EMS.He...
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