Podcasts on topics relevant to intensive care medicine
Rank #1: Flynn: Fat People in ICU.
Gordon Flynn is an Intensivist and an Anaesthetist from Prince of Wales hospital in Sydney. Here he gives an entertaining and thought provoking talk on the big topic of obesity in ICU. Leave comments below on ICN!
Rank #2: 113. Parr on Post Cardiac Arrest ICU Care.
Michael Parr, director of Liverpool ICU, speaks at BCC4 on ICU care for patients post cardiac arrest.
We believe in the educational merits of Free Open Access Medical education (FOAM), which includes podcasts, blogs, articles on PubMed Central, conferences streamed for free and more. As a result, we would like to encourage others to move beyond quoting podcasts and into the realm of tying “cutting edge” FOAM to the core content. We’ll provide some review and references for listeners to go read. Why, indeed, should we FOAM it alone when FOAM can inspire us to go, read, think, and be excellent?
Rank #1: Episode 7 - Heart Failure.
We review the FOAM from The RAGE podcast (The Resuscitationist's Awesome Guide to Everything), "Episode 4" ,on impact apnea, the right heart and more. Then we discuss the core content related to right ventricular myocardial infarctions and heart failure. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Key Texts: Tintinalli (7e) Chapters 53, 57; Rosen’s (8e) Chapters 78, 81 Thanks for listening! -Jeremy Faust and Lauren Westafer
Rank #2: Episode 21 - Acute Kidney Injury.
This week we review Dr. Josh Farkas's PulmCrit blog posts, Renal microvascular hemodynamics in sepsis: a new paradigm and Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications in which he posits that renal protection in sepsis may prove beneficial for patients. Then, we delve into core content pearls on acute kidney injury using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide) as a guide. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer
Emergency Medicine podcasts based on evidence based medicine focussed on practice in and around the resus room.
Rank #1: Hypothermia.
Rob Fenwick talks to us about this common condition and amongst others throws up a few surprises about the risks of rewarming. Enjoy
Rank #2: Can TXA save lives in head injuries, CRASH-3; Roadside to Resus.
So an incredibly important paper, CRASH-3 has just been published in the Lancet, which looks at the treatment of head injuries with Tranexamic Acid (TXA). TXA has been shown to save lives in trauma patients at the risk of major haemorrhage, with the notable exclusion of those with head injuries, CRASH-2. TXA has been shown to save lives in those with post parts haemorrhage, WOMAN trial. Time to treatment with TXA has been shown to be hugely influential in it's ability to decrease blood loss and save lives. So has TXA now been shown to save lives in head injuries? In this episode we run through the paper and are lucky enough to have an interview with the lead author, Professor Ian Roberts. Have a listen, read the paper and as always we’d love to hear any thoughts or comments you have on the website and via twitter, and take a look at the references below to draw your own conclusions. Enjoy! Simon, Rob & James References The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients.Roberts I. Health Technol Assess. 2013 CRASH-2;The Bottom Line Effectof earlytranexamic acidadministrationon mortality, hysterectomy, and othermorbiditiesin womenwith post-partum haemorrhage(WOMAN): an international, randomised, double-blind, placebo-controlledtrial. WOMANTrialCollaborators.Lancet 2017 WOMAN Trial;The Bottom Line Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients.Gayet-Ageron A. Lancet. 2017 Tranexamic Acid - The Mechanism of Action;Video Tranexamic Acid, Time to Treatment;The Resus Room Does earlier TXA save lives?St Emlyns TXA podcast; PHEMCAST About CRASH-3; LSHTM
The RAGE podcast is the Resuscitationist's Awesome Guide to Everything! RAGE is an audio podcast created by a team of specialist physicians from Australasia and the United States practicing in emergency medicine, intensive care and retrieval/ prehospital medicine. We are Dr Chris Nickson, Dr Cliff Reid, Dr Haney Mallemat, Dr Michaela Cartner and Dr Karel Habig. We bring an irreverent and educational ‘real world’ perspective to current research, core topics and controversies in critical care. RAGE features panel discussions, interviews with guest experts, shout outs and insights from #FOAMcc (FOAM is 'free open-access meducation') and the wider critical care-iverse, not to mention various quirky segments on medical history, trivia and more. Show notes for the podcast, featuring links and resources for further learning, and the podcast's disclaimer can be found at http://ragepodcast.com If you eat, breathe and sleep critical care... and you're awesome, you'll love RAGE :-)
Rank #1: RAGE talks CRM Brindley-style and dasSMACC.
The RAGE team talks to Peter Brindley about a new, free crisis resource management book and CRM Brindley-style, and we reflect on the recent dasSMACC conference. The usual stuff is there too: what's bubbling up?, a blast from the past about John Scott Haldane, and some Words of Wisdom from Peter Brindley to finish. Show notes available at: http://ragepodcast.com/rage-talks-crm-brindley-style-dassmacc/
Rank #2: RAGE Session: What's The Sats Target?.
A RAGE session featuring Karel Habig, Cliff Reid, and Chris Nickson: Introduction... kind of (starts 00:00 min) ‘What’s bubbling up?’ (starts 04:48 min) — an ED checklist for cognitive debiasing, are 'cold' platelets ready for primetime, the ART trial and the open lung approach to ventilation using recruitment manoeuvres ‘What's The Sats Target?’ (starts 22:55 min) — the RAGE team discuss what SpO2 targets to aim for, in which patients and diseases, and the tricks and traps of real-world clinical practice. ‘A blast from the past’ by Chris Nickson on ‘Rudolph Virchow’ (starts 52:52 min) ‘Words of Wisdom’ from Cliff Reid (starts 57:10 min)
Meet 'em, greet 'em, treat 'em and street 'em
Rank #1: SGEM#183: Don’t RINSE, Don’t Repeat.
[display_podcast]Date: June 20th, 2017Reference: Bernard et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation 2016.Guest Skeptic: Jay Loosley is a Registered Nurse, and an Advanced Care Paramedic in London. His background includes working as…
Rank #2: SGEM#209: Cephalexin – You Are My Only One for Uncomplicated Cellulitis.
[display_podcast]Date: February 27th, 2018Reference: Moran et al. Effect of Cephalexin plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis – A Randomized Clinical Trial. JAMA May 2017.Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. He also hosts a great…
Rational Evidence-Based Evaluation of Literature
Rank #1: REBEL Cast Ep 54: What the Heck is Pseudo-PEA?.
Background: Pulseless electrical activity (PEA) is an organized electrical activity without a palpable pulse. 1/3 of cardiac arrest cases will be pulseless electrical activity and the... The post REBEL Cast Ep 54: What the Heck is Pseudo-PEA? appeared first on REBEL EM - Emergency Medicine Blog.
Rank #2: REBEL Core Cast 3.0 – Asthma, COPD + PNA.
Take Home Points Single dose oral dexamethasone is an excellent choice for asthma exacerbations. It takes away the compliance issue for patients who have trouble... The post REBEL Core Cast 3.0 – Asthma, COPD + PNA appeared first on REBEL EM - Emergency Medicine Blog.
Core Emergency Medicine
Rank #1: Episode 24.0 – Hepatic Encephalopathy.
This podcast is a brief discussion on hepatic encephalopathy: How it presents, the utility of ammonia levels and what else to look out for. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_24_0_Final_Cut.m4a Download Leave a Comment Tags: Ammonia, AMS, Hepatic Encephalopathy Read More
Rank #2: Episode 20.0 – AVNRT.
On this podcast we review some background on AVNRT and focus on Emergency Department management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_20_0_Final.m4a Download 2 Comments Tags: AVNRT, PSVT, REVERT Trial, Tachydysrhythmias Show Notes AVNRT with Aberrancy vs. VT REBEL EM: SVT with Aberrancy Versus VT Amal Mattu’s ECG Case of the Week: August 26th, 2013 Valsalva Maneuver ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe St. Emlyn’s: JC The REVERT Trial Adenosine in AVNRT Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush Verapamil in AVNRT RAGE Podcast: Rage Session Two ERCast Podcast: How to run a code Appleboam A et al. Postural mdodification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised trial. Lancet 2015. PMID: 26314489 Read More
Making horrible doctors decent and good doctors GREAT at Ultrasound
Rank #1: VTE and Nerve Blocks w/ Cian McDermott.
I had the opportunity to hang out with Cian McDermott in Dublin for a conference on one of my favorite topics: Venous thromboembolism. This week, we discuss some salient VTE topics as well as our thoughts on ultrasound-guided nerve blocks. Registration for Castlefest 2020, our ultrasound conference in Lexington Ky, is live! Click the following link to learn more. Interested in an online ultrasound fellowship? Click here to find out more.
Rank #2: Day 4 #Castlefest19.
The LAST DAY of Castlefest 2019 was a great one (as were all of the other days). Check out day 4’s summary:Jimmy Fair: Diastology: Consider approaching diastology as binary; does your patient have elevated left atrial pressure or not? If you want a more in-depth summary, watch: Diastology part 1, Diastology part 2 Cardiac arrest: Concentrate on getting windows during your 10 second pulse check, save clips, then interpret the image during compressions. Unless if you have TEE. Then just leave it in there and get continuous monitoring.RUSH: It’s not a law that you have to do every part of the RUSH exam in all your hypotensive patients.Peter Weimersheimer:Pelvic Ultrasound: If you can get the answer with transabdominal US, you don’t necessarily need to go for the endocavitary probeTEE: Why learn this if I get good TTE views during arrest? Answer: Because you often can’t. Also, some tips on how to start a TEE program. Here’s the Link to Annals of Emergency Medicine article on TEE and cardiac arrest (that Mike Mallin was second author on) Claire Heslop: Volume responsiveness is defined as the ability of a patient to increase their cardiac output with fluids. Best way to tell with US: VTI. Although carotid flow time is an up-and-comer. Bendfest 2019 is coming soon! Spots are filling quickly, reserve your spot today! Interested in an online ultrasound fellowship? Go to ultrasoundleadershipacademy.com
#FOAMed based academic emergency medicine from the St.Emlyn's team. #Virchester #MedEd
Rank #1: Problems in Early Pregnancy. Induction podcast with Nat and Iain at St.Emlyn's.
The number of patients seen in each ED with problems relating to early pregnancy in the UK is very variable - some hospitals have rapid referral pathways for patients who know they are pregnant. It's still worth thinking about early pregnancy problems though as all EDs see young women and many of these may not yet know that they are pregnant.Our induction podcast covers our approach to women presenting to the EDNat and Iain :-)
Rank #2: BestBets - Whole-body CT In trauma patients.
This week Simon, Dan and Rick discuss a great BET from Hong Kong. Should we routinely CT our major trauma patients from vertex to symphysis?? We think so, but what's the evidence. Giles and Scott from Hong Kong have written the BET that gives us an answer. Read the BET here http://www.bestbets.org/bets/bet.php?id=1779 and then listen to the podcast. S
A UK Prehospital Emergency Medicine Podcast. This podcast and associated website aims to:- Share knowledge and expertise in the field of prehospital medicine with specific reference to the UK working environment- Make this content relevant to all professional prehospital practitioners
Rank #1: Episode 13: The Ventilator.
https://phemcast.files.wordpress.com/2016/12/vent-final.mp3 Ventilation – a dark art. Difficult to be a master, easy to be average (or terrible)! This is “part 1”, which includes some of the basic (and not very basic) concepts behind ventilation. We recorded over 60 minutes of excellent content with George – we will post more below as soon as it is edited. . Check out Georges powerpoint – its excellent! introduction-to-mechanical-ventilation-11nov2016-podcast
Rank #2: Episode 20: End Tidal Carbon Dioxide.
Guest contributor: Lauren Weekes https://phemcast.files.wordpress.com/2017/09/et-06092017-16-24.mp3 What is ETCO2? % or partial pressure of carbon dioxide measured somewhere near the mouth at the end of a normal exhalation (hence end tidal, end of tidal volume breath) To get a measurement the following systems need to be functioning: Metabolically active tissue to produce CO2 Circulation & cardiac output to carry that CO2 to the lungs in blood Transfer of CO2 between the blood and the air in the lung Gas in and out of the lung to excrete the CO2 Brilliant monitor in anaesthesia in that in elective cases, we start off with healthy patients are looking for deviations from the norm- and a normal ETCO2 trace tells you that all those components are functioning. It is still extremely useful in prehospital care, but we just have to remember that an abnormal trace or value may be caused by problems with one or more of those systems i.e circulation, gas exchange, ventilation (rarely tissue metabolism) Much better than pulse oximetry, because of the difference in lag time between clinical change occurring and being able to see it on the monitor- less than 3 seconds for sidestream capnography, compared to up to 90s for pulse oximetry How does ETCO2 relate to arterial CO2? What we’re REALLY interested in is arterial CO2 as this is the clinically significant value in a number of clinical scenarios; for example in the brain-injured patient, we want to keep arterial CO2 values normal as we know that this determines the state of cerebral vasoconstriction or dilation, and thus affects ICP. In non-brain injured patients, high arterial CO2 can lead to a respiratory acidosis, and low pH values are harmful to most body tissues, in particular the clotting cascade (because of its reliance on enzymes, which function best in a narrow range of pH), and cardiac contractility. In healthy people, ETCO2 is usually 0.5-1kPA LOWER than the arterial value. Why is this? CO2 is only found in parts of the lung which participate in gas exchange, i.e are perfused with blood. So the trachea and first few generations of bronchi do not participate in gas exchange and are known as the dead space. They ARE however filling with gas during breaths, and as such gas from this dead space DILUTES the gas containing CO2 that has come predominantly from the alveoli. What we are assuming when we ask ETCO2 to substitute for arterial CO2 is that there is normal matching of ventilation to perfusion occurring in the lungs, so that all the mixed venous CO2 returning to the lungs from respiring tissue can equilibrate with alveolar gas and be eliminated via ventilation What causes a discrepancy between arterial and ETCO2? Artefact Loose connections, not having nasal prongs up nose, dilution with high oxygen flows (partic when using nasal prongs) Failure of venous CO2 to cross to ventilated alveoli Alveolar dead space- alveoli are ventilated but not perfused Classically low cardiac output states, PE, etc Failure of alveolar gas to be transported out of the lungs because alveoli are perfused but not ventilated (shunt): pneumonia and pulmonary edema, pulm haemorrhage (alveoli filled with fluid) tissue trauma: alveolar wall swelling atelectasis: collapse of alveoli from failure to expand, or absorption of the air out of the alveoli without replacing it mucous/vomit plugging Global ventilation failure e.g airway obstruction, hypoventilation esp where tidal volume is very low- dead space is fixed, so as a proportion of each breath it gets higher as tidal volume reduces until there is minimal ALVEOLAR ventilation How do we measure it? Usually by infra-red absorption- CO2 absorbs infra-red light in a manner proportional to its concentration in the sampled gas. Can be measured from a breathing circuit attached to an invasive airway device e.g supraglottic airway or endotracheal tube, or from a number of methods in the spontaneously breathing patient, such as a specific nasal cannula, or a sampling tube attached to an oxygen mask. Important to note that the waveform, and values for ETCO2 are very different in the spontaneously breathing patient, and we’ll come back to that later. Might be measured directly from the breathing circuit (mainstream) or sucked out of the circuit in a sampling tube (sidestream). Might display results as a waveform with a value given for ETCO2, or simply a number (capnometry) although the latter much less useful. Colorimetric devices are available which change colour, based loosely on percentage of gas present. pH related. Occasionally used as an adjunct to waveform What does the waveform mean? The classic waveform that you will see in textbooks come from CO2 measured in the ventilated patient. The graph has time in seconds along the x axis and partial pressure in kPa along the y axis Phase I (inspiratory baseline) reflects inspired gas, which is normally devoid of carbon dioxide. Phase II (expiratory upstroke) is the transition between dead space and alveolar gas from the respiratory bronchioles and alveoli. Phase III is the alveolar plateau, when largely homogenous gas from the alveoli empties. This is the most accurate reflection of arterial co2 Phase 0 is the inspiratory downstroke, the beginning of the next inspiration In the spontaneously breathing patient, there is not usually a plateau phase, which makes interpretation of ETCO2 values more difficult EVIDENCE ETT placement All major anaesthetic organisations mandate the use of ETCO2 to confirm ETT placement Good evidence that the trace is not completely flat even in cardiac arrest- Silvestri Ann Emerg Med 2005 Should seen >7 waveforms to exclude oesophageal (Orinato 1993) Cardiac arrest- general 2010 & 2015 ERC guidelines recommend use of waveform capnography Not new- 1978 paper Kalenda in Resuscitation described the use of capnogram as a guide to CPR efficacy Predicting ROSC Grmec 2003 & 2011 in Critical Care ETCO2 of >2.4kpa after 20min predictive of rosc , <1.3 = no ROSC Alwens 2001 used cut off 10mmHg Systematic review in 2013 Resuscitation used cut off of 1.3kPa but this wasn’t 100% sensitive across all studies Concerns also raised by Norwegian paper in Resuscitation again 2011 showing a number of confounding factors made interpretation of etco2 problematic inc rhythm, bystander CPR, cause of arrest CPR quality As noted in 1978, ETCO2 drops off when chest compressions become ineffective. Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J. trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). In a study of 191 blunt trauma patients, only 5% of patients with an end-tidal CO2 determination of 3.25 kPa survived to discharge PRACTICAL USE When should we use ETCO2 monitoring in the prehospital setting? Mandatory if intubating (RSI, cardiac arrest) Mandatory if performing procedural sedation where consciousness impaired Highly recommended in cardiac arrest Highly recommended in all critically ill patients In cardiac arrest: Attach to circuit/ BVM at soonest available opportunity Use it to confirm intubation (if using) Use it as a guide: If ETCO2 has been steady during CPR but then begins to fall, consider changing rescuer As corroborating evidence around decision making- if there has been no ROSC after 20min of full ALS protocol and ETCO2 remains below 1.3kPA, you are highly unlikely to resuscitate that patient If there is a sudden increase in ETCO2- well done, you’ve achieved ROSC (even if you can’t yet feel a pulse- in fact, maybe you needn’t do a pulse check if you’ve got ETCO2) Optimise ventilation post ROSC as you are now dealing with a head-injured patient. In the critically ill patient: If I can only have one monitor on an entrapped patient, I’d pick capnography You will learn more quickly than any other method when your patient is deteriorating- e.g in blood loss, ETC02 will gradually fall. In the head injured patient who’s coning, you’ll see apnoeas and gradually rising ETCO2. In the heart failure patient who’s about to arrest, you’ll see their ETCO2 fall precipitously almost before anything else. In the comatose patient, you’ll be able to see that their airway is obstructed on the capnography a full 30 to 60s before their sats drop (by which point you’re already a long way down the oxygen dissociation curve). You can also see when your treatment is working- if you give a patient in septic shock some fluid and improve their CO, you’ll see a rise in ETC02 You can confirm adequacy of respiratory function in the fitting or post-ictal patient when all other methods fail PITFALLS Device failure- lines blocking, batteries running out, pump failure. Test by blowing Over-interpreting the accuracy of non-invasive capnography Those lovely graphs showing curare clefts, rebreathing, bronchospasm etc you see on lots of different websites and in textbooks? They are almost all referring to capnography in the intubated and ventilated patient, who has a constant tidal volume. Numbers are often wildly inaccurate in the critically unwell population, and there may be an ET-arterial gradient of 10kPA. What CAN you tell from it? 1. Ventilation is occurring (accurate RR) 2. There is a cardiac output 3. You can interpret trends ie a gradual rise or fall in CO2, in the given clinical context 4. Very low is bad whichever way you look at it Sometimes a low ETCO2 value is due to hyperventilation (because as we all remember, arterial CO2 concentration is almost linearly related to alveolar minute ventilation) BUT it may be hypoventilation with increased proportion of dead space ventilation compared to alveolar ventilation Not using capnography The more you use it, the more familiar with various patterns you will become Stick it on everyone –it causes no harm. See what happens when you give a decent dose of morphine: slows respiratory rate but breaths are normal volume You get reduced alveolar MINUTE ventilation but normal alveolar TIDAL ventilation Therefore what you see at ETCO2 is reasonably representative of arterial concentration because the same number of alveoli are ventilated and have opportunity to equilibrate with the blood CO2 This is unlike when a patient is making low tidal volume breaths, because then you’re largely ventilating dead space, and a much smaller number of alveoli are ventilated and thus equilibrium cannot occur between blood and gas Demonstration traces: From: Capnography Outside the Operating Rooms, Anesthes. 2013;118(1):192-201. doi:10.1097/ALN.0b013e318278c8b6 A Prolonged phase II, increased α angle, and steeper phase III suggest bronchospasm or airway obstruction. B Expiratory valve malfunction resulting in elevation of the baseline, and the angle between the alveolar plateau and the downstroke of inspiration is increased from 90°. This is due to rebreathing of expiratory gases from the expiratory limb during inspiration. C Inspiratory valve malfunction resulting in rebreathing of expired gases from inspiratory limb during inspiration (reference 5 for details). D Capnogram with normal phase II but with increased slope of phase III. This capnogram is observed in pregnant subjects under general anesthesia (normal physiologic variant and details in reference 9). E Curare cleft: Patient is attempting to breathe during partial muscle paralysis. Surgical movements on the chest and abdomen can also result in the curare cleft. F Baseline is elevated as a result of carbon dioxide rebreathing. G Esophageal intubation resulting in the gastric washout of residual carbon dioxide and subsequent carbon dioxide will be zero. H Spontaneously breathing carbon dioxide waveforms where phase III is not well delineated. I Dual capnogram in one lung transplantation patient. The first peak in phase III is from the transplanted normal lung, whereas the second peak is from the native disease lung. A variation of dual capnogram (steeple sign capnogram – dotted line) is seen if there is a leak around the sidestream sensor port at the monitor. This is because of the dilution of expired PCO2with atmospheric air. J Malignant hyperpyrexia where carbon dioxide is raising gradually with zero baseline suggesting increased carbon dioxide production with carbon dioxide absorption by the soda lime. K Classic ripple effect during the expiratory pause showing cardiogenic oscillations. These occur as a result of to-and-for movement of expired gases at the sensor due to motion of the heartbeat during expiratory pause when respiratory frequency of mechanical ventilation is low. Ripple effect like wave forms also occur when forward flow of fresh gases from a source during expiratory pause intermingles with expiratory gases at the sensor. L Sudden raise of baseline and the end-tidal PCO2(PETCO2) due to contamination of the sensor with secretions or water vapor. Gradual rise of baseline and PETCO2occurs when soda lime is exhausted. M Intermittent mechanical ventilation (IMV) breaths in the midst of spontaneously breathing patient. A comparison of the height of spontaneous breaths compared to the mechanical breaths is useful to assess spontaneous ventilation during weaning process. N Cardiopulmonary resuscitation: capnogram showing positive waveforms during each compression suggesting effective cardiac compression generating pulmonary blood. O Capnogram showing rebreathing during inspiration. This is normal in rebreathing circuits such as Mapleson D or Bain circuit. Useful links: https://lifeinthefastlane.com/ccc/capnography-waveform-interpretation/ http://www.capnography.com/new/index.php?option=com_content&view=article&id=131&Itemid=993
This podcast account features all of the audio clips from the Academic Life in Emergency Medicine (ALiEM) educational blog site. http://www.ALiEM.com
Rank #1: 60 Sec Soapbox Episode 10: Patrick Bafuma - Single Dose IV Antibiotics.
60 Sec Soapbox Episode 10: Patrick Bafuma - Single Dose IV Antibiotics by The ALiEM Team
Rank #2: EM Match Advice- Acing your EM Rotation.
Hosted by Dr. Michael Gisondi, he reviews tips on acing the EM rotation as a senior medical student. He also interviews panelists: Dr. Lainie Yarris, and Dr. Maria Moreira, and Dr. Jan Schoenberger, and Dr. Michelle Lin. https://www.aliem.com/2014/em-match-advice-em-rotation-eras-competitive/Podcast editor: David Yang
This podcast is designed to inspire intensive care clinicians to become the very best they can be at delivering care to their critically ill patients.
Rank #1: Episode 3: Rinaldo Bellomo - Compassionate care combined with continuous enquiry.
In this episode Prof Rinaldo Bellomo from the Austin Hospital in Melbourne, Australia describes how he has always had an enquiring mind and how he judges himself with respect to his ability to be caring, compassionate, competent, communicative and collegial, both professionally and personally. He discusses topics such as: how an experience as a 5th medical student sparked his interest in intensive care medicine; how intensive care has become more safe as technological advancements have occurred; how he seeks feedback from colleagues; how to give feedback and how it needs to be helpful in nature; what his daily routine is; how being at the bedside is so important to excellent clinical care; how experience has helped him deal with stress more easily but makes fatigue a bigger issue; how doing research is the basis of his stress management program; what his out of work pursuits are and how he'd love to have a 30 hour day. He carefully describes the process he uses in his end of life family conversations and astutely points out that end of life care can never be rushed. The interview concludes with Rinaldo's hope that he be known for his continuous desire to ask "how do we know that we know this" at the patient's bedside (which has no doubt fuelled his enormously successful research career) and precisely what he thinks all doctors could do to help them become more humble. This is an outstanding conversation about compassionate clinical care with one of the best intensive care researchers in the world who is also one of the great mentors of our time. This podcast was created to help and inspire intensive care clinicians to improve the care we give to our patients by providing interesting and thought-provoking conversations with highly respected and experienced clinicians. In each episode, Andrew Davies, an intensivist in Melbourne, Australia, speaks with a guest for the purpose of hearing their perspectives on the habits and behaviours that they believe are the most important for improving the outcomes of our patients. Things like bringing our best selves to work each day, optimal communication, coping with stress and preventing burn out, working well in a team, and interacting with patient’s families and the many other health professionals we deal with on a daily basis. The podcast is less about the drugs, devices and procedures that can be administered and more about the habits, behaviours and philosophies that can help intensive care clinicians to master the craft of intensive care.
Rank #2: Episode 45: Scott Weingart - Useful mental strategies of a thoughtful ED intensivist and hugely influential podcaster.
Today’s guest is Scott Weingart, the pioneer podcaster in the intensive care field through his EMCrit podcast. Scott is an ED Intensivist from New York, where he is Chief of the Division of Emergency Critical Care at Stony Brook Hospital and a Professor of Emergency Medicine at Stony Brook Medicine. Scott has devoted his career to bringing "Upstairs Care, Downstairs" (ie. bringing ICU care down to the ED - where it needs to be). He loves his job taking care of the sickest patients, innovating new ways to do it better, and then teaching these concepts to his residents. Of course, none of that is nearly as much fun as playing with his son, Mace. Scott is best known for talking to himself about Resuscitation and Critical Care on the EMCrit podcast, which has been downloaded over 20 million times. EMCrit is also a hugely valuable blog and educational resource. In this conversation Scott talks about: How he trained to be where he is now as an ED intensivist What inspired his mission to improve critical care prior to ICU admission How he got into podcasting The benefit of putting his views out into the online community How podcasting and new media can allow the “small to be seen” The automatic peer review built in to his podcasting The value he’s had from SMACC conferences and the FOAM movement His obsession to improve What a day in his life is like How his martial arts experience spurned his meditation practice What his minimal effective dose of meditation is His thoughts and use of negative visualisation and mental rehearsal The value of errors in improving ourselves The need to be care- rather than people-orientated in resuscitation How his communication is changing over time The use of dramatic pauses to spur knowledge translation and learning His advice on reading And some of his favourite books and podcasts Scott is a deep-thinking man, very focused on understanding and practicing well considered and patient-oriented care particularly at the resuscitation end of intensive or critical care medicine, and is very good with spoken language. Please enjoy listening to Scott Weingart. Andrew Davies -------------------- About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. I hope you’ll glean insights to help you improve as a healthcare professional and as a human being so you can make a truly valuable contribution to your patient’s lives. -------------------- Links to people, organisations and other resources mentioned: Scott Weingart Scott Weingart on Twitter: @emcrit EMCrit podcast & website Liz Crowe Essay: The Thousand True Fans (by Kevin Kelly) Seth Godin SMACC Talk by Scott Weingart “The Path to Insanity” Talk by Scott Weingart “Kettlebells for the Brain” Mastering Intensive Care podcast - Episode 21 with Martin Bromiley Book “House of God” (by Samuel Shem) Cliff Reid Chris Hicks Sara Gray Mastering Intensive Care podcast – Episode 13 with Sara Gray Book “A Confederacy of Dunces” (by John Kennedy Toole) Book “Catch 22” (by Joseph Heller) 99% Invisible podcast Radiolab podcast The Flop House podcast Mastering Intensive Care podcast – episode 44 with Geoff Toogood Crazy Socks 4 Docs New Normal Project podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Email Andrew Davies
Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation
Rank #1: EMCrit 259 – Cardiogenic Shock — The Next Level & Mechanical Circulatory Support with Jenelle Badulak.
Taking Cardiogenic Shock Management to the next level...
Rank #2: EMCrit #235 – Cardiac Arrest Science with Zack Shinar.
Cardiac Arrest Science
Resuscitationist-Initiated Extracorporeal Life Support
Rank #1: EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way.
We do an EDECMO ECPR course each year called REANIMATE. REANIMATE5 blew away all previous iterations. One of the main reasons was our guest of honor, Demetris Yannopoulos from the University of Minnesota. Demetris has organized Minneapolis into arguably the most impressive ECPR city in the world. We were lucky enough to be able to film his Sharp Hospital Grand Rounds. This lecture was mind-blowing and made us so jealous. We think you will love it.Tickets are on Sale for REANIMATE6 REANIMATEconference.com Additional Info/Resources EDECMO 36 – Zack interviews Demetris EDECMO Crash Episode – Microdissection of Demetris' ECPR Techniques JAHA Publication on ECPR Results The post EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way appeared first on ED ECMO.
Rank #2: EDECMO 45: ECMO in Sepsis.
In this episode, Zack talks with Heidi Dalton about ECMO use in Sepsis. This is another controversial area with pediatric literature showing strong results while the adult results have been less impressive. Heidi has been a key figure in both adult and pediatric ECMO. She is the former chair of the yearly ELSO conference. She is a professor at both George Washington University and Virginia Commonwealth University. Her background is in pediatric critical care. She currently works at INOVA in Virginia where she is the director of adult and pediatric ECMO. Sepsis has been thought to be a contraindication to ECMO use secondary to the pro-inflammatory nature of ECMO and potential to harbor infection. Recent research is certainly controversial with adult studies showing low survival in septic shock and sepsis as a cause of arrest. As with much of ECMO literature, the problem is with the denominator – What is the expected survival of these patients? The follow up question becomes what effort is prudent for these low survival rates? The sepsis cohort tend to be younger and potential for long term survival is high. The question remains should we be utilizing ECMO for sepsis?1–9References1.Maclaren G, Butt W, Best D, Donath S, Taylor A. Extracorporeal membrane oxygenation for refractory septic shock in children: one institution’s experience. Pediatr Crit Care Med. 2007;8(5):447-451. [PubMed]2.Datzmann T, Träger K. Extracorporeal membrane oxygenation and cytokine adsorption. J. 2018;10(S5):S653-S660. doi:10.21037/jtd.2017.10.1283.Perdue SM, Poore BJ, Babu AN, Stribling WK. Successful use of extracorporeal membrane oxygenation support in severe septic shock with associated acute cardiomyopathy. J. 2018;33(1):50-52. doi:10.1111/jocs.135084.von Bahr V, Hultman J, Eksborg S, Frenckner B, Kalzén H. Long-Term Survival in Adults Treated With Extracorporeal Membrane Oxygenation for Respiratory Failure and Sepsis*. C. 2017;45(2):164-170. doi:10.1097/ccm.00000000000020785.Millar J, Fanning J, McDonald C, McAuley D, Fraser J. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care. 2016;20(1):387. [PubMed]6.Choi M, Ha S, Kim H, Park S, Han S, Lee S. The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Underwent Extracorporeal Membrane Oxygenation for Septic Shock. Ann Thorac Surg. 2017;103(4):1246-1253. [PubMed]7.Tramm R, Ilic D, Davies A, Pellegrino V, Romero L, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev. 2015;1:CD010381. [PubMed]8.Park T, Yang J, Jeon K, et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg. 2015;47(2):e68-74. [PubMed]9.Sharma A, Weerwind P, Maessen J. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2014;147(4):1441-1442. [PubMed]The post EDECMO 45: ECMO in Sepsis appeared first on ED ECMO.
The Critical Care Reviews Podcast discusses the biggest critical care trials, either planned or in progress, with their chief investigators. It's hosted by Rob Mac Sweeney, an intensivist in Belfast, Northern Ireland.
Rank #1: How I Manage Fluids with John Myburgh.
John Myburgh (Sydney) describes how he manages IV fluids at the Critical Care Reviews Meeting 2017, in Titanic, Belfast.
Rank #2: How I Manage.....Antibiotics.
Mervyn Singer (London) describes how he manages antibiotics at the Critical Care Reviews Meeting 2017, in Titanic, Belfast.