FOAMfrat Podcast

I reached out to @medtwitter asking for help finding a guest to talk about the respiratory syncytial virus (RSV). It may seem weird to be talking about RSV when everyone is thinking about the current pandemic, but I find the virology and mechanism of symptoms of RSV exciting. Twitter did not let me down, my friend Ashley Liebig recommended Natalie May from Sydney, HEMS. Natalie is an EM, and Pediatric-EM trained UK doctor working in Prehospital & Retrieval Medicine in Australia. I was very excited to have a chance to speak with Dr. May regarding RSV & Bronchiolitis and what the current evidence suggests for treatment.

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?

In this episode, we talk with Matt Schneider, a Battalion Chief and Paramedic for the Mequon fire department in Ozaukee County. Sam and I had the privilege of sitting in on a guideline update presented by Matt a few weeks ago. One of the guidelines that caught our attention was the decision to remove nitroglycerin from the STEMI guideline. Listen in as Matt describes how their guideline committee arrived at this decision. "Matt's views, comments, and opinions expressed in this segment do not represent the position of his employer(s), or associated agencies/institutions".

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, Tyler & Sam discuss everything you need to know about the Bougie. Traditional use Modified pre-loaded techniques Common pitfalls.

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.

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..

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.

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

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!

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

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!

200 comment Facebook post where I asked, \"what questions would you like me to ask the NREMT?\" These are the questions that seem to be the most popular.","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{}}],"entityMap":{},"VERSION":"8.46.0"}"> In this episode, I interview NREMT's Chief Certification Officer, Mark Terry, and Certification Manager, Megan Hollern. I really enjoyed this conversation and felt it cleared up many misconceptions and confusion surrounding initial certification and certification renewal. After carefully going through a >200 comment Facebook post where I asked, "what questions would you like me to ask the NREMT?" These are the questions that seem to be the most popular. 200 comment Facebook post where I asked, \"what questions would you like me to ask the NREMT?\" These are the questions that seem to be the most popular.","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{}}],"entityMap":{},"VERSION":"8.46.0"}"> 200 comment Facebook post where I asked, \"what questions would you like me to ask the NREMT?\" These are the questions that seem to be the most popular.","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{}}],"entityMap":{},"VERSION":"8.46.0"}"> 1. Besides reciprocity amongst select states, what is the benefit of maintaining your NREMT? 2. If I let my NREMT lapse, or never even got my NR, what is the process in order for me to get it back? 3. The hour requirements are broken down into general categories (i.e. trauma, cardiology, etc.), are the subcategories mandatory or suggested? 4. Do you ever see the instructor-led hour requirements coming back?

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.

In this episode, Tyler interviews Tom Bouthillet and Dr. Stephen Smith on who exactly should get a right-sided ECG. Do not delay transport to PCI to grab a right-sided ECG. If you do decide to perform a right-sided ECG, it should not be for the decision on whether or not to give nitro. If time permits, it may be helpful and confirm your suspicions of RV involvement. Isolates RV infarcts are extremely rare. In EMT school, I was taught how to assist a patient taking their own nitroglycerin if they developed chest pain. I had to make sure they weren't on any phosphodiesterase inhibitors, grab a blood pressure, and make sure they took the right dose. We would obtain a 12 lead, but I had no clue what I was looking at, and my decision to give nitro was not based on any specific ECG finding. Fast-forward to paramedic school, and I am taught to ALWAYS perform a 12 lead before giving nitroglycerin. Why? Wellll If they had an inferior wall MI, nitroglycerin was a hard stop. Every time the student would give nitro before obtaining a 12 lead in simulation, their patients would code...Every. Time. I thought this was weird because patients were prescribed nitroglycerin if they developed chest pain at home. They were certainly not performing a 12 lead on themselves prior to doing this. So what was the fear? The Fear EMS is full of cautionary tales (as my buddy Brian Behn points out in this blog). The fear of administering nitroglycerin to a patient with an inferior wall MI is the possibility of plummeting the blood pressure if there is right ventricular (RV) involvement. Because the RV is preload dependent, dropping preload with nitroglycerin could cause hypotension. This is probably a good place to say that the LV is preload dependent too, but the LV preload is dependent on the RV preload. So if you wipe out the RV, the LV follows. I believe the fear of nitro is probably healthy, but not for JUST inferior wall MIs. The benefit of sublingual nitro has yet to be proven (as Dr. Smith points out in the interview) and on top of that, a study published in Prehospital Emergency Care in 2015 found that hypotension occurred post-NTG in 38/466 inferior STEMIs and 30/339 non-inferior STEMIs, 8.2% vs. 8.9%, p = 0.73. That means it makes literally no difference where the MI is.

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!

The concept of taking blood out of the body, oxygenating it, removing the CO2, and then putting back in, fascinates me. A few years ago I admittedly knew very little about extracorporeal membrane oxygenation (ECMO) and its indications. I remember going to a class on ECMO at Life Link III and having questions like: Are we actually pumping blood backward through the body? What happens to the blood in the heart when using ECMO in cardiac arrest (ECPR)? What kind of vent settings should I use? I am by no means an expert on ECMO, in fact, I have only been on a handful of ECMO transports, but the concept fascinates me and I thought a blog breaking down a few concepts of ECMO physiology would be beneficial.

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... Should EMS use a burn formula? 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?

Invasive arterial blood pressure (IABP) monitoring techniques have enjoyed a rich history of use throughout the mid-to-late 20th century in the peri-operative setting and are now a standard of care intensive care units. While there are a variety of IABP monitoring options, one of the most common techniques is percutaneous radial arterial catheterization. Although monitoring of radial arterial lines is a widely accepted skill in the critical care transport (CCT) world, placement by CCT providers is less common. Concerns over safety and logistical management have contributed to the perceived difficulty in arterial lines; however, this article aims to demonstrate that arterial lines can be placed safely and effectively in the pre-hospital setting. www.foamfrat.com

Ok, here's the thing.. there really is no anion gap. We pretend there is because the things we routinely measure leave something to be desired on the anion side. Sam put out a killer blog and this is a follow-up conversation. Enjoy!

Traditionally transcutaneous pacing involves a paramedic placing pads anterior/posterior (preferred), and turning up the milliamps until electrical capture is obtained. Electrical capture is obtained when a pacing spike is followed by a wide complex. The clinician will then try to palpate a pulse to confirm mechanical capture. Because the contractions of the pectoral muscles can tug on the muscles of the neck as well, AHA recommends palpating a femoral pulse versus a carotid (3) to avoid thinking you feel a pulse (false mechanical capture). Not only are events of false capture common, but there are even situations in which the paramedic swears they feel a pulse and observes the patient becoming more alert, and they never had mechanical capture. I believe most of us are using SPO2 pleth wave to confirm mechanical capture versus the subjectivity of palpating a pulse, but even patients with a pulse can have poor pleth wave readings. I believe ultrasound-guided pacing is ideal and should become mainstream. I typically find I can get a parasternal long view on ultrasound with the pads placed as illustrated below. However, there are other views if your pad sweet spot is obstructing where you wanna put the probe. This is nothing profound and is definitely not a new concept in emergency medicine. It is however a new concept for paramedics and another feather in the cap of prehospital ultrasound. This is a conversation between myself and Dr. Eydelman discussing this topic. Enjoy!

A few months ago Sam published a blog on the oxyhemoglobin dissociation curve. If you haven't checked it out I highly recommend reading that before listening to us discuss what this curve teaches us about airway management.

My buddy Bryan Winchell and I sit down and record a conversation about PEEP. We have way more questions than answers, but here's some shop talk on what we are currently doing to optimize PEEP. Check out the full blog and show notes at FOAMfrat.com

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

Anne keeps asking "is my baby ok?!" There may be some momentum to just break out the ultrasound and look for a fetal heart rate right now, but you know that taking care of mom means taking care of the baby. In this episode, Cynthia and I discuss the prehospital fetal assessment and how to communicate with mom what you see. www.foamfrat.com

WPW is an incredibly interesting disease process that can initially cause some trepidation on the part of the clinician due to the perceived nuance of treatment. However, we might just be psyching ourselves out a little bit. Check out Sam & Tyler as they break down the dos and don'ts of WPW management. www.foamfrat.com

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!

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.

Yesterday I posted the blog "Ventilation - Playing Defense." The blog addressed the reasons why we don't want to intubate a patient in metabolic acidosis, the correlation between VBG & ABG, and the importance of knowing your ETCO2 to PaCO2 gradient. In part two of this discussion (the podcast), Sam and I invite Bryan Winchell on to discuss the logistics of actually setting up the ventilator and settings that we think are helpful. 1. Optimize volume first and then take advantage of the "no-flow" zone to add in breaths. 2. The width of your flow waveform will tell you whether or not more inspiratory time will = more volume. 3.These patients typically don't need a ton of PEEP because they are spending such a short time exhaling (due to the fast rate). PEEP of zero is probably ok because the pressure will likely never truly get to zero. If a PEEP of zero gives you visceral pain, 3-5 mmHg is a good spot to start.

We realized the other day that we have yet to do a podcast on diabetic ketoacidosis (DKA). In this episode, we spend a little bit of time talking about the pathophysiology, but the majority is focused on the logistics of running a DKA transfer. Here are the highlights: DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN. DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN. DO EVERYTHING YOU CAN TO AVOID STOPPING THE INSULIN. The way you do this safely is by pre-planning! Ask for these things before you leave the hospital: IV Potassium Liter bag of D5W Bag of lactated ringers Three amps of sodium bicarbonate (if renal failure is suspected) If I add weak acids (ketones) into the anion side, the body will dump bicarbonate to maintain electrical neutrality. The only way to get the bicarbonate to return to normal is to get rid of the ketones. I got rid of all my ketones but my bicarb has not returned to normal!! Why?! You gave too much chloride which is now hogging all the anion space. The kidneys aren't working properly and you need to give sodium bicarbonate.

So, my buddy, Bryan Selvage released a blog a few weeks ago called "The Curious Case of The Brain & The Octopus Trap." This case study caught me off guard because it did not match my mental model of a brain bleed patient. I called Bryan and had a great conversation regarding mental models and how they can either make us look like we have superhuman powers or trip us up. Bryan started working on a blog to address the perils of mental models at the same time my friend Tom Grawey was writing a piece for FOAMfrat on the "sick versus not sick" assessment. Both of the blogs complimented each other perfectly and I figured we could do a podcast and release both blogs as a package. I loved the discussion and feel this will likely lead to more podcasts/blogs down the road. Would love to hear what some of my friends like Cliff Reid, Mike Brown, and Michael Lauria have to say on this topic. Now let's get to the podcast!

In this podcast, Sam and discuss the evolution of FOAMed peer review with Chris Smetana and Eric Bauer. Eric is the founder of FlightbridgeED which was one of the first EMS podcasts to surface and quickly became a hit. The FlightbridgeED brand now has grown into one of the industries household names when it comes to providing resources and training for flight clinicians all over the world. You can find their content at FlightbridgeED.com Chris Smetana is the CEO of IA Med and a known leader within the industry. The IA Med team prides itself on meeting the needs of the industry and collaborating to improve the EMS profession. You can find their content at IAMED.US. Topics discussed: What is the process from inception to publishing, when it comes to your brands content? Traditional and modified peer review techniques. The art of critique and feedback Reducing noise from social media posts.

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!

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

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.

The primary corrective strategy we must embrace is that assigning blame whether intrinsic or extrinsic, is wasted time and energy. It is not possible to blame and improve at the same time. This is vital for people at all levels to embrace, but particularly in management/leadership. A just culture where people feel empowered to come forward with errors is vital to safe and secure operations. Errors are going to occur, and it is our knowledge of them that allows system and process modification to prevent similar errors moving forward. Think of it like this, if you are a parent meeting your child's first "boyfriend or girlfriend", it is your response that often dictates whether you meet the next one or not.

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.

Sometimes seizing patients don't respond to benzodiazepines. In the RAMPART study they found that 18.5% of the midazolam group and 25.8% of the lorazepam group were still seizing upon arrival at the ED. We know that rapid termination of status epilepticus (SE) is important, but what should EMS do when they are maxing out benzo's, blood pressures are getting soft from all the meds, and the patient is still seizing?! In this episode we discuss the role of ketamine in SE patients that are refractory to front line treatments.

EVERYONE is teaching online now! FOAMfrat teaches live classes five days a week, three times a day, ALL year long! We have ironed out the logistics of zoom room teaching to a science! Here are some tips if you need to give a talk online.

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!

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.

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.

The whole FOAMfrat team loves listening to audio books. Last week, Austin Quillet pitched the idea of turning our blogs into a audio book style format. So we figured, why not give it a shot? We put this audio blog into a story format with some sound effects and voiceovers to help you visualize yourself on the call (and sometimes provide a little comedy relief). We are always looking for feedback from you guys, so please let us know how we could improve - audio blogs are obviously something brand new to us. We'll be selecting the blogs that best fit the format for audio blogs, and then you'll see them show up on the same feed and the main podcast. As we continue to find new ways to tell our stories we really appreciate all of the support that you, the listeners and readers, provide. Thanks for your support! We look forward to hearing what you think! - The FOAMfrat Team

A few months ago in our weekly team meeting, Mike Brown(@FireMedicFPC) and Jared Patterson(@OneRadMedic) pitched the idea of starting a podcast that takes questions from clinicias all around the world and answers them in five minutes or less. I initially was skeptical to the idea because of all the EMS podcasts surfacing. What would make this show different? After some thought, We realize this concept is unique in style and allows a certain degree of interaction amongst clinicians. I am super excited to announce the Rapid Sequence Interrogation podcast to the FOAMfrat family! The first episode is being hosted on both the RSI Podcast and the FOAMfrat Podcast. You should see the podcast appearing in iTunes shortly under the name The RSI Podcast. Please subscribe and let us know what you think! Mike & Jared would love you to start sending questions to [email protected]. #YouCreateTheShow

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 You are unable to obtain and IV and firefighters ask you if you are able to give the patient something IM to calm him down through the extrication process. Do your guidelines discuss extrication sedation? What drug and dose? The comments were very interesting and I wanted to get someone well respected in the HEMS and prehospital environment on the show to give their thoughts. Dr. Cliff Reid is a seasoned retrieval physician who works for Sydney HEMS in Australia. This is his second time on FOAMfrat and we always have a great discussion. I think you will enjoy!

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!

FOAMfrat has always believed that infusions can be started quickly, and lead to better patient care. Infusions let you avoid the peaks and valleys of push-dose medication. Infusions also reduce your cognitive load - having to remember to push a medication at timed intervals can easily be forgotten when you're dealing with multiple issues at once. The last thing anyone wants to do is forget to administer that anesthesia when your patient is paralyzed. For these reasons, and because the industry is currently looking into IV pump solutions, we were happy when QCORE Medical asked us to review the Sapphire IV pump. How did it go?

Chip Lange and I sat down and discussed everything B lines! If you are interested in the basics of lung sliding, detecting pulmonary edema, and differing effusion from consolidation - check out podcast 98!

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.