FOAMfrat Podcast

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.

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.

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.

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.  

Podcast 186 - Should we throw away our pelvic binders? w/ Dr John Lyng

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.