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.

Where do you place the tourniquet?

Infants can develop elevated levels of methemoglobin, a form of hemoglobin that can’t carry oxygen. The result is a slate-blue color that doesn’t improve with supplemental oxygen. Instead of obvious respiratory distress, these babies often show up with nonspecific clues like fussiness, poor feeding, or unusual fatigue. One of the big triggers is nitrate exposure, especially when formula is mixed with contaminated well water. Certain medications and rare enzyme deficiencies can do it too. If you see persistent cyanosis with clear lungs, a normal cardiac exam, and an SpO2 that won’t budge, think methemoglobinemia. Early recognition and treatment with methylene blue can be lifesaving. Always keep blue baby syndrome on the radar.

Carbon Monoxide (CO) Poisoning

Neurological Trauma is now live in FOAMfrat Studio! This class reviews the anatomy and physiology behind traumatic brain and spinal cord injuries and breaks down the mechanisms, clinical patterns and secondary insults that influence patient outcomes. Participants will work through recognition of epidural, subdural, subarachnoid and diffuse axonal injuries, along with skull fracture patterns and key signs of rising intracranial pressure. The session also covers spinal cord injury syndromes, neurogenic shock, ventilatory compromise and the principles of preventing secondary injury. Management strategies focus on airway protection, oxygenation, ventilation targets, cerebral perfusion, hemorrhage control and seizure prevention. Flight considerations, including altitude effects and destination selection, round out the material to support safe and informed care during transport. Sign up for FOAMfrat Studio to access this course and so much more! Individual and corporate plans are available. Learn more at https://bit.ly/4qaiRZr

Bougie removal 😱

Bloodlines—a FOAMfrat documentary produced by Bryony Gilbey—follows the San Antonio Fire Department as they embark on the journey of launching a whole blood program. This film explores the critical impact of whole blood on patient outcomes, along with the medical training and logistics required to implement this life-saving resource.

Can the RV handle it?