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FOAMfrat Podcast: Daily Summaries Delivered
by Tyler Christifulli & Sam Ireland
Prehospital emergency and critical care podcast by Tyler Christifulli & Sam Ireland
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The most recent episodes — sign up to get AI-powered summaries of each one.
- 3 weeks ago58 min
Podcast 194 - Resus Architecture w/ Adam LaChapelle
What if the way you pack your gear could actually make you better at resuscitation? In this episode of the FOAMfrat Podcast, Tyler sits down with Adam LaChapelle from The Resus Tailor to talk about resuscitation architecture: designing bags, equipment, and workflows around how clinicians perform under pressure. They break down the small details that can have a big impact on scene: where equipment lives, how kits should be organized, why standardization matters, how to reduce unnecessary cognitive load, and how to build airway and medication setups that follow the natural sequence of a procedure. The conversation gets into BVM and suction placement, RSI kits, medication organization, pediatric equipment, cric kits, cardiac arrest loadouts, and even the debate over where the zippers should be when you close your bag. The goal isn't to buy a fancy new bag. It's to ask a better question: *Does the way we organize our equipment make it easier or harder to take care of a critically ill patient?* Adam also gives us a look at the DECENT airway simulator and discusses how better training equipment can help clinicians develop more realistic airway skills. Whether you're designing an entire EMS system or just reorganizing the jump bag on your truck, this episode will probably make you look at your equipment a little differently.
- Jun 14, 202650 min
Podcast 193 - Airway Recording Program w/ Dr. Brookeman & John Winstead
The Future of Airway Quality Improvement: Learning from Every Intubation In this episode of the FOAMfrat Podcast, Dr. Harrison Brookeman sits down with John Winstead, Captain of the EMS Specialist Program at Fairfax County Fire and Rescue, to discuss how video laryngoscopy recordings are changing the way we evaluate, teach, and improve airway management. From building a sustainable airway recording program to creating a culture of objective feedback, they share practical lessons learned from reviewing hundreds of real-world intubations. The conversation explores first-pass success, the importance of suction and preparation, team-based airway management, and how video review can transform both individual performance and system-wide practice. As airway procedures become increasingly rare but remain critically important, the question is no longer "Did we get the tube?" It is "How can we get better every single time?" Tune in for a forward-looking discussion on the future of airway education, quality improvement, and the role technology may play in making prehospital airway management safer and more effective.
- Apr 22, 202642 min
Podcast 192 - Salicylate Toxicity Management w/ Dr. Brookeman & Nicholas Henchal
In this episode, flight paramedic Nicholas Henchal and EMS physician Dr. Harrison Brookeman break down salicylate toxicity from the ground up. What started as a casual conversation at the crew table turns into a deep dive into one of the most misunderstood overdoses in EMS and critical care. They walk through the full spectrum of aspirin toxicity, from subtle prehospital clues to advanced hospital management. You'll hear how patients can appear relatively stable early on, why respiratory alkalosis precedes metabolic acidosis, and how the situation can spiral once the electron transport chain is disrupted. The conversation also delves into real-world decision-making: when to suspect it, when not to intubate, how to manage ventilation if you have to, and why treatments like bicarbonate, glucose, and even dialysis play a critical role. There's also a strong discussion of the dangers of missing this diagnosis and how quickly things can go downhill if the underlying physiology isn't understood. Link to interactive Anion Gap Tool: https://claude.ai/artifacts/latest/d3b744cf-5a1b-4bb7-88bc-4f74fd97ec16 FOAMfrat.com
- Mar 7, 202649 min
Podcast 191 - Sepsis Update w/ Kevin Collopy
What does sepsis management look like for EMS? Tyler and Kevin Collopy break down the current state of sepsis care, including EMS recognition, hospital sepsis bundles, fluid strategies, vasopressor use, lactate trends, and the debate around prehospital antibiotics. The conversation focuses on practical decision-making and why identifying septic shock early can change outcomes long before the patient reaches the hospital.
- Feb 18, 202629 min
Podcast 190 - Intubation Triggers w/ Nicole Hooser
"GCS less than 8, intubate." We've all heard it. Many of us were taught it. In this episode of the FOAMfrat Podcast, Tyler and FOAMfrat educator Nicole Hooser examine one of the most repeated airway phrases in EMS and why it may be doing more harm than good. From the origins of the "less than 8" mindset in GCS to the real-world complexity of airway decision-making, this conversation examines what actually matters when deciding whether to take a patient's airway. They discuss: • Why a GCS of 8 is not a magic number • The math behind GCS scoring combinations and why 8 carries so much variability • Airway protection versus airway reflexes • Resuscitation before intubation • The momentum problem once an RSI has been initiated • When hesitation is appropriate • When decisive action is necessary • Flight-specific pressures and transport considerations • Sedation versus full RSI • Reversible causes of altered mental status you cannot miss Nicole shares real-world flight cases, including moments of disagreement with partners and the professional growth that follows those cases. The episode also explores how experience, bias, fear, and pattern recognition shape airway decisions. If you've ever wondered whether you truly needed to intubate a patient, this episode challenges reflexive thinking and reinforces a more deliberate approach. Guest: Nicole Hooser Listen in and weigh in on the discussion.
- Jan 19, 202650 min
Podcast 189 - APRV & Volumetric CO2 w/ Joe Hylton
In this episode of the FOAMfrat Podcast, we sit down with Joe Hylton, one of the go-to ventilator educators in critical care transport, to break down APRV in a way that actually makes sense. We move beyond surface level explanations and get into how APRV really works, why it is so effective for ARDS and severe hypoxemia, and how volumetric capnography can give you real-time physiologic feedback when titrating mean airway pressure and PEEP. This is not a "set it and forget it" APRV discussion. We dig into the mechanics, the physiology, and the bedside decision making that matters in transport and critical care environments. Topics covered in this episode: • How APRV differs from conventional pressure control ventilation • Why mean airway pressure is the real driver of recruitment • Using flow curves and time constants instead of guesswork • Volumetric CO₂ vs end-tidal CO₂ and why the difference matters • Identifying optimal recruitment and overdistension in real time • How VĊO₂ trends can guide PEEP and pressure adjustments • APRV pitfalls, misconceptions, and when paralysis may still make sense • Practical APRV setup on Hamilton ventilators for transport teams If APRV has ever felt like ventilator voodoo, this episode pulls the curtain back and ties the mechanical settings to what is actually happening at the alveolar and capillary level. Joe brings deep experience from working with Hamilton Medical systems, and the discussion is framed through real-world transport and ICU decision making, including insights relevant to teams like Life Link III and other critical care programs. This episode is ideal for: • Flight paramedics and critical care transport clinicians • ICU nurses and respiratory therapists • Medical directors and educators • Anyone who wants to understand APRV beyond memorized settings 🎧 Listen, learn, and rethink how you approach lung recruitment. Subscribe for more high-yield critical care and EMS education from FOAMfrat.
- Dec 11, 202543 min
Podcast 188 - Sodium Nitrite Ingestion & Methemoglobinemia w/ Dr. Brookeman
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.
- Aug 21, 202557 min
Podcast 187 - Dynamic PEEP? | Ventilation Strategies for Metabolic Acidosis w/ Melody Bishop, RRT
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? In this podcast, I discuss my thought process with respiratory therapist extraordinare, Melody Bishop @melodybishop_rt. She helps surface some definitions and distinctions to terms like air-trapping, Set PEEP, & auto-PEEP while we discuss ventilation strategies in metabolic acidosis. The blog below was what I had sent her before the podcast to get all my thoughts & illustrations down in writing. As always, please follow your local guidelines, and I hope you enjoy listening to the conversation.
About FOAMfrat Podcast
Prehospital emergency and critical care podcast by Tyler Christifulli & Sam Ireland
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