In this episode of the FOAMfrat Podcast, Dr. Harrison Brookeman joins the discussion to examine methemoglobinemia and the emerging prehospital threat of sodium nitrite ingestion. Often viewed as a rare toxicology concept, this condition is appearing more frequently and can progress rapidly with devastating consequences if it is not recognized early.

The episode focuses on what matters most to EMS clinicians in the field: the physiology of methemoglobinemia, why these patients appear profoundly hypoxic despite adequate ventilation, and the classic clue: a pulse oximetry reading that remains fixed around 85 percent regardless of oxygen delivery. The conversation also addresses iatrogenic causes such as benzocaine exposure, expected mental status changes, and why oxygen alone does not correct the problem.

Emphasis is placed on prehospital decision-making, including early involvement with poison control, transport destination considerations, and the importance of ensuring these patients are taken to the right facility the first time. This episode is intended to sharpen recognition, improve pattern awareness, and prepare providers for a call that does not follow typical respiratory failure patterns.

A little over a year ago, I made a short reel discussing ventilating a patient in a severe metabolic acidosis. In the video, I mentioned that minimal to no PEEP might be appropriate. Not because the patient doesn't need PEEP, but because the shortened cycle time at higher respiratory rates can unintentionally generate dynamic PEEP on its own. But what if it was intentional? What if the presence of a wider pressure when the ventilator switches into exhalation would cause the air to exit more rapidly?

Pelvic binders have long been considered a standard intervention in the management of suspected pelvic fractures in the prehospital setting. However, recent guidance from the National Association of EMS Physicians (NAEMSP) challenges some of the long-standing assumptions surrounding their use. In a recent FOAMfrat podcast episode, I spoke with Dr. John Lyng, editor-in-chief of the NAEMSP Trauma Compendium, to explore the evidence and rationale behind their newly released position statement on pelvic fracture management.

In this episode, Tyler sits down with Hanna Thompson to discuss a critical yet often overlooked topic in EMS—eating disorders. Drawing from personal experience and clinical insight, they explore how these conditions present both medically and behaviorally, especially in prehospital and interfacility transport settings.

They break down the subtle physical signs that EMS providers can look for—such as Russell's sign, lanugo, unexplained bradycardia, and electrolyte disturbances—and emphasize the importance of sensitive history taking. The conversation also dives into the dangers of refeeding syndrome, slow correction strategies, fluid choice, and the clinical significance of thiamine, magnesium, and phosphate replacement.

What You'll Learn:

• How eating disorders can manifest in EMS calls

• Why you may be treating the consequences, not the disorder itself

• Red flags like bradycardia, lanugo, and Russell's sign

• How to handle refeeding syndrome safely

• Why dextrose, fluids, and electrolyte replacement should be approached cautiously

• The connection between electrolyte shifts and seizures or arrhythmias

Key Takeaway: Patients with eating disorders are medically and psychologically fragile. In EMS, we often encounter them through the effects of the disorder—not the diagnosis itself. Recognizing subtle clues and avoiding aggressive interventions could save a life.

Resources Mentioned:

• Hannah's blog on EMS considerations in eating disorders

• Data on post-COVID spikes in eating disorder incidence

• Guidelines for electrolyte correction and refeeding syndrome

Disclaimer: This podcast is for educational purposes only and not a substitute for clinical protocols or medical direction. Always consult your agency's guidelines and medical control.

In this episode, Tyler Christifulli sits down with cardiac perfusionist Brian Cress to dig into the physiology of coronary perfusion, the mechanics of the intra-aortic balloon pump (IABP), and the clinical finesse of diastolic augmentation. Whether you're just starting to encounter balloon pumps or want to sharpen your transport strategy, this discussion is packed with visual metaphors, waveform analysis, and real-world pearls.

In this conversation, Dr. Peter Weimersheimer discusses various techniques and tips for performing cardiac ultrasound in emergency medicine. He emphasizes the importance of understanding probe movements such as sliding, fanning, and rocking to optimize cardiac views. The discussion also covers troubleshooting common challenges in cardiac imaging, the critical role of gel in obtaining clear images, and the transition between different cardiac views. Dr. Weimersheimer emphasizes the importance of identifying cardiac pathologies through ultrasound and shares techniques for obtaining the apical four-chamber view. The conversation concludes with insights into the impact of ultrasound on patient care and decision-making in emergency situations. In this conversation, Dr. Peter Weimersheimer shares his expertise on cardiac ultrasound techniques, with a focus on the apical four-chamber view and the importance of understanding ventricular shape and function. He discusses practical tips for navigating ultrasound views in critical situations, optimizing imaging techniques, and utilizing patient physiology to enhance imaging quality. The conversation also covers the interpretation of right ventricular size in cardiac arrest and differentiating between the inferior vena cava (IVC) and aorta during ultrasound imaging.

Stroke assessment tools like BEFAST are crucial for swiftly identifying symptoms and expediting treatment. However, language barriers can hinder prompt care for non-English speakers, particularly in the Hispanic community. Developed through a collaborative effort, AHORA adapts the traditional stroke assessment to be culturally and linguistically appropriate for the Spanish-speaking population.

Designing Ahora

The need for a specific tool became apparent when traditional tools like BEFAST were found to be ineffective for those who did not speak English. After discarding the complex "Rapido," Banerjee's team crafted Ahora, including Marcia Wilson, MD, and Remley Crowe, PhD. This tool was made to mirror BEFAST but is simplified for practical use within the Spanish-speaking population.

Does medicine have dangerous side effects for women? Are the "normal" values we have set for diagnostics possibly endangering specific populations? In this episode of the FOAMfrat podcast, Tyler sits down with Dr.Alyson McGregor, emergency physician and author of Sex Matters, and Tim Redding, EMS educator and lecturer, to discuss the discrepancies in medical testing, diagnosis, and treatment between male and female patients.

Dr. McGregor shares her journey of discovering gender bias in medicine, particularly how women's symptoms are often dismissed or mislabeled as psychiatric in nature. The discussion explores how male-centric research has shaped clinical guidelines, leading to underdiagnosis and undertreatment of women across a wide range of conditions—from heart attacks to strokes and even pain management.

In this episode of the FOAMfrat podcast, join as we discuss mass casualty management with Chief Robert Luckritz of Austin Travis County EMS and Justin Soulier from Travis County Star Flight. Explore the strategies and challenges in mass casualty responses in one of the fastest-growing urban areas in the U.S.

Join Rommie Duckworth and FOAMfrat as we discuss the mental framing and big-picture thought process behind the first five minutes of any mass casualty incident (MCI). Rommie Duckworth, a fire captain and shift commander, is a wealth of knowledge on this topic and speaks globally to prepare emergency responders for these events.

In this episode, Alec Wilcox & I discuss ECPR eligibility & preparation. ECPR, or extracorporeal cardiopulmonary resuscitation, involves taking a patient in cardiac arrest, sucking blood from their venous system, oxygenating it externally, and then pumping it back into their arterial system. This procedure helps maintain blood circulation and oxygen delivery during cardiac arrest, serving as a bridge to further therapy.