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.

Plateau Pressure (Pplat)

“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 GCS less than 8 mindset to the real-world complexity of airway decision making, this conversation gets into 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.

Osborn waves (also called J waves or camel hump sign) are a distinctive finding on a 12-lead ECG associated with hypothermia. They appear as a positive deflection (hump or notch) at the J point — the junction between the end of the QRS complex and the beginning of the ST segment. They look like an extra "bump" riding on the terminal portion of the QRS, giving it that characteristic camel hump appearance.

Our latest episode of the Foundation series is live now in Studio. Join James Ownbey as he discusses the foundations of COPD pathophysiology and patient treatment.

What is a curare cleft? A curare cleft is a characteristic finding seen on a mechanical ventilator waveform, specifically on the airway pressure-time curve. It appears as a brief dip or notch in the middle of a positive pressure breath waveform. It looks like a small "cleft" or indentation cutting into the inspiratory plateau of the pressure waveform. What causes it? It's caused by a patient making a spontaneous inspiratory effort during a mandatory ventilator breath. When the patient tries to inhale on their own mid-breath, they generate negative pressure that momentarily drops the airway pressure, creating that characteristic notch. The name comes from curare, an old neuromuscular blocking agent. Historically, if a patient was supposed to be paralyzed with curare but a cleft appeared on the waveform, it was a sign that the paralytic was wearing off and the patient was beginning to make respiratory efforts again.