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The Global Philosopher: Should Borders Matter?. Michael Sandel explores the philosophical justifications made for national borders. Using a pioneering state-of-the-art studio at the Harvard Business School, Professor Sandel is joined by 60 participants from over 30 countries in a truly global digital space. Is there any moral distinction between a political refugee and an economic migrant? If people have the right to exit a country, why not a right to enter? Do nations have the right to protect the affluence of their citizens? And is there such a thing as a 'national identity'? These are just some of the questions addressed by Professor Sandel in this first edition of The Global Philosopher.Audience producer: Louise ColettaProducer: David EdmondsEditor: Richard Knight(Image taken by Rose Lincoln)
#138 — The Edge of Humanity. In this episode of the Making Sense podcast, Sam Harris speaks with Yuval Noah Harari about his new book “21 Lessons for the 21st Century.” They discuss the importance of meditation for his intellectual life, the primacy of stories, the need to revise our fundamental assumptions about human civilization, the threats to liberal democracy, a world without work, universal basic income, the virtues of nationalism, the implications of AI and automation, and other topics. You can support the Making Sense podcast and receive subscriber-only content at SamHarris.org/subscribe.
#107: The Scariest Navy SEAL I've Ever Met...And What He Taught Me. Jocko Willink (@jockowillink) is one of the scariest human beings imaginable. He is a lean 230 pounds. He is a Brazilian jiu-jitsu expert who used to tap out 20 Navy SEALs per workout. He is a legend in the Special Operations world. His eyes look through you more than at you. He rarely does interviews, if ever. But a few weeks ago, Jocko ended up staying at my house and we had a caffeinated mind meld. Here's some background... Jocko enlisted in the Navy after high school and spent 20 years in the SEAL Teams, first as an enlisted SEAL operator and then as a SEAL officer. During his second tour in Iraq, he led SEAL Task Unit Bruiser in the Battle of Ramadi--some of the toughest and sustained combat in the SEAL Teams since Vietnam. Under his leadership, Task Unit Bruiser became the most highly decorated Special Operations Unit of the entire war in Iraq and helped bring stability to Ramadi. Jocko was awarded the Bronze Star and a Silver Star. Upon returning to the United States, Jocko served as the Officer-in-Charge of training for all West Coast SEAL Teams, designing and implementing some of the most challenging and realistic combat training in the world. So why is Jocko opening up? Well, in part, we have mutual friends. Second, he is the co-author of an incredible new book — Extreme Ownership: How U.S. Navy SEALs Lead and Win -- which I've been loving. Trust me. Buy it. This is his first mainstream interview and one you won't want to miss. Show notes and links for this episode can be found at www.fourhourworkweek.com/podcast. This podcast is brought to you by Wealthfront. Wealthfront is a massively disruptive (in a good way) set-it-and-forget-it investing service, led by technologists from places like Apple and world-famous investors. It has exploded in popularity in the last 2 years, and now has more than $2.5B under management. In fact, some of my good investor friends in Silicon Valley have millions of their own money in Wealthfront. Why? Because you can get services previously limited to the ultra-wealthy and only pay pennies on the dollar for them, and it’s all through smarter software instead of retail locations and bloated sales teams Check out wealthfront.com/tim, take their risk assessment quiz, which only takes 2-5 minutes, and they’ll show you—for free–exactly the portfolio they’d put you in. If you want to just take their advice and do it yourself, you can. Or, as I would, you can set it and forget it. Well worth a few minutes: wealthfront.com/tim. Mandatory disclaimer: Wealthfront Inc. is an SEC registered Investment Advisor. Investing in securities involves risks, and there is the possibility of losing money. Past performance is no guarantee of future results. Please visit Wealthfront dot com to read their full disclosure. This podcast is also brought to you by 99Designs, the world’s largest marketplace of graphic designers. Did you know I used 99Designs to rapid prototype the cover for The 4-Hour Body? Here are some of the impressive results. Click this link and get a free $99 upgrade. Give it a test run...
Placebo power. The placebo effect demonstrates that the mind-body interaction can be powerful. Placebos can turn on the body’s natural biological processes to relieve a range of conditions, and in the future deception may not even be necessary.
Rank #1: Keys to the Cart: November 14, 2016. Cerebral autoregulation; Cerebral blood flow: temperature effect; Increased ICP: induction agents
Rank #2: Article of the Month - June 2015 - Jean Eloy. Comparison of Plaintiff and Defense Expert Witness Testimony in Malpractice Litigation in Anesthesiology
Rank #1: Neuromuscular Blocking Agents- Free Version. A Brief Review of Neuromuscular Blocking Agents For the Premium Version, Subscribe here AnesthesiaExam Podcast For Board Review and Practice Management Updates TEXT the word ANESTHESIAEXAM to the number 33444 For more information, CME credit and MOCA and Primary Board Prep, For more information, CME credit and MOCA and Primary Anesthesiology Board Prep, Go to AnesthesiaExam.com Basic and Advanced Anesthesia Exam Review, Go to ABAStagedExams.com For CRNA Board Prep, go to CRNABoardPrep.com For the Pediatric Anesthesiology Board Review, Go to PedsAE David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medicaal Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. Copyright © 2015 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author. Skeletal Muscle relaxants Classification Peripherally acting (Neuromuscular blockers) Pre synaptic neuromuscular blocker Inhibit Ach synthesis: triethylacholine – hemicholinium Inhibit Ach release: Mg, aminoglycosides, botulinum toxin Post synaptic neuromuscular blocker Competitive (non depolarizing blockers): d- tubocurarine Gallamine Atracurium Pancuronium Vecuronium Depolarizing blockers: succinylcholine (suxamethonium) Centrally acting skeletal muscle relaxants Baclofen – Diazepam Direct acting skeletal muscle relaxants Dantrolene Mechanism of action Non depolarizing relaxant drugs All neuromuscular blocking agents used in USA except succinylcholine are classifies as non depolarizing agents When small doses of nondepolarizing muscle relaxants are administered, they act predominantly at nicotinic receptor site by competing with acetylcholine The least potent relaxant (eg. Rocuronium) have the fastest onset and the shortest duration of action In large doses, nondepolarizing drugs enter the pore of ion channel to produce a more intense motor blockade. This action further weakens neuromuscular transmission and diminishes the ability of the cholinesterase inhibitor (eg. Neostigmine, edrophonium, pyridostigmine) to antagonize the effect of non depolarizing muscle relaxants. They also block prejunctional sodium channels. As a result of this action, muscle relaxants interfere with the metabolization of acetylcholine at the nerve ending. Both halothane and succinylcholine increase the intensity and duration of action of pancuronium. (1) Depolarizing relaxant drugs Phase I block (depolarizing) Succinylcholine is the only available depolarizing neuromuscular blocking drug. (2) It produces a longer effect at the myoneural junction It reacts with the nicotinic receptor to open the channel and cause depolarization of the motor end plate, and this in turn spreads to the adjacent membranes, causing contractions of muscle motor units. Because succinylcholine is not metabolized at the synapse, the depolarized membranes remain depolarized and unresponsive to subsequent impulses This is called Phase I (depolarizing) block, not reversed by cholinesterase inhibitors Phase II block (desensitizing) With prolonged exposure to succinylcholine, initial end plate depolarization decreases and the membrane become repolarized Despite this repolarization, the membrane cannot be easily depolarized again because it is desensitized The channel block is more important than agonist action at the receptor in phase II of succinylcholine’s neuromuscular blocking action Later in phase II, the characteristics of the blockade are nearly identical to those of a non depolarizing block (ie, a nonsustained twitch response to a titanic stimulus) with possible reversal by acetylcholinesterase inhibitors Succinylcholine produce reversible contracture of intrafusal fibers of the muscle spindle and leads to acceleration of the afferent discharge. (3) Another study by Martin Jeevendra and Duriex Marcel E found that: (4) 1. Succinylcholine caused initial activation of the muscle AchR followed by desensitization 2. At clinically relevant concentrations, succinylcholine has no stimulatory or inhibitory interactions with α3β2 (presynaptic) or α3β4 (ganglionic) AchRs 3. High doses of succinylcholine caused inhibition of both α3β2 and α3β4 receptor. Pharmacokinetics of neuromuscular blocking drugs Succinylcholine has the fastest onset of action among all the muscle relaxants. (5) The elimination of succinylcholine appears to follow first order kinetics with linear relationship between intensity of the effect and logarithm of the dose. The rate of recovery is independent of dose for each age group. The rate of recovery is faster in children than in infants; the rate of recovery is faster in infants than in adults. The elimination rate constant for infabts was similar to that of children, but is dissimilar from those of adults. (6) Drug Elimination Clearance (mL/kg/min) Approximate duration of action (minutes) Approximate potency relative to Tubocurarine Atracurium Spontaneous 6.6 20-35 1.5 Cisatracurium Mostly spontaneous 5-6 25-44 1.5 Doxacurium Kidney 2.7 > 35 6 Metocurine Kidney (40%) 1.2 > 35 4 Mivacurium Plasma ChE (Butyrylcholinesterase) 70-95 10-20 4 Tubocurarine Kidney (40%) 2.3-2.4 > 50 1 Pancuronium Kidney (80%) 1.7-1.8 > 35 6 Pipecuronium Kidney (60%) and liver 2.5-3.0 > 35 6 Rocuronium Liver (75-90%) and kidney 2.9 20-35 0.8 Vecuronium Liver (75-90%) and kidney 3-5.3 20-35 6 Succinylcholine Plasma ChE (100%) (Butyrylcholinesterase) >100 < 8 0.4 Soutce: Bertram G. Katzung, Susan B. Masters and Anthony J. Trevor. Basic amd Clinical Pharmacology. 11th Edition. Chapter 27. Skeletal Muscle Rexants. Page 451-465. Pharmacology of Neuromuscular blocking drugs Drug ED95a (mg/kg) Intubating dose (mg/kg) Onset timeb (s) Clinical durationc(min) Succinylcholine 0.3 1.0d 60 10 Benzylisoquinolone Tubocurarine 0.5 0.5-0.6 220 80+ Atracurium 0.23 0.5 110 43 Mivacurium 0.08 0.15-0.2 170 16 Doxacurium 0.025 0.05 250 83 Cisatracurium 0.05 0.1 150 45 Aminosteroids Pancuronium 0.07 0.1 220 75 Vecuronium 0.05 0.1 180 33 Pipecuronium 0.045 0.08 300 95 Rocuronium 0.3 0.6 75 33 Rapacuronium 1.2 1.5
Rank #2: Methemoglobinemia- A Review from AnesthesiaExam.com. Reference DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. Copyright © 2015 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author. Subscribe to our mailing list * indicates required Email Address * Reference https://en.wikipedia.org/wiki/Methemoglobinemia
Rank #1: Tranexamic Acid for all !. Antifibrinolytics had been tried for decades to lower surgical blood loss for cardiac and non cardiac surgery patients. Some were hailed for sometime then demonized and were removed, Aprotinin is a classic example. What about Tranexamic acid? what about using it in off-pump coronary bypass grafting ? Do we know all we need to know to use it routinely ?
Rank #2: Air in/air out, Ventilating normal lung?. Does protective lung ventilation apply to patients with normal lungs?Should use high PEEP, Low tidal volume ? How does mechanical ventilation affect lung injury and and systemic inflammatory response ?If you like to know, tune in!
Rank #1: Epidural Tips and Tricks. Kevin and Shelly go through basics and advanced troubleshooting tips and tricks they've learned doing and teaching epidural placement. Join the Wise Guys for a tour of what works and doesn't work with epidurals.
Rank #2: Paralytics!!!!. Kevin and Shelly do a bit of "role playing" in a listener request for a conventional teaching episode about muscle relaxant/paralytic drugs. Shelly has a "canned" lecture on paralytics routinely given to the residents about how relaxants work and how to approach their use. Kevin plays the "resident" somewhat berated about lack of knowledge about these routine medications. Enjoy the banter!!!
Rank #1: Episode 66: Neuromuscular Blockers. In this episode, episode 66, I go through an overview of neuromuscular blockers including how they work, how to use them, and what their adverse effects are. Happy New Year! Outline by Brian Park: NMB Outline References: Miller’s Anesthesia 7th edition: Chapter 29: Pharmacology of Muscle Relaxants and Their Antagonists. Naguib M and Lien C. Rocuronium vs succinylcholine for rapid sequence induction intubation. https://www.ncbi.nlm.nih.gov/pubmed/26512948 Neuromuscular blockade: what was, is and will be: https://www.ncbi.nlm.nih.gov/pubmed/25622380 Reversal of neuromuscular block: https://www.ncbi.nlm.nih.gov/pubmed/19468024
Rank #2: Episode 10: IV Induction Agents. In this episode I review the common IV agents used in anesthesia excluding opioids. I cover Propofol, Barbiturates, Benzodiazepines, Ketamine, Etomidate and Dexmedetomidine. NOTE: There is an error in the audio recording regarding the dosing units for dexmedetomidine. I say on the podcast that the dosing units are mcg/kg/min which is INCORRECT. The correct dosing units are mcg/kg/HOUR. I have corrected this in the accompanying slides. Thanks to Melanie Browder for picking this up! Good luck to the recent graduates taking their written board exam on July 29th! Slides to go along with the podcast are here: IV induction agents slides
Rank #1: Podcast on Hypoxic Breathing, Rocuronium, and Reversal. Moderator: James P. Rathmell, M.D. Participants: Albert Dahan, M.D., Ph.D. and Jaideep J. Pandit, M.A., B.M.B.Ch, D.Phil, F.R.C.A., D.M. Articles Discussed: Reversal of a Partial Neuromuscular Block and the Ventilatory Response to Hypoxia: A Randomized Controlled Trial in Healthy Volunteers Reversing Neuromuscular Blockade: Not Just the Diaphragm, but Carotid Body Function Too Transcript
Rank #2: September 2019 Editor-in-Chief Podcast. Creator: Evan D. Kharasch, M.D., Ph.D.. Anesthesiology September 2019, Volume 131, Issue 3 Overview of September issue original studies. Transcript
Rank #1: #39 – Succinylcholine Overview – Michael Mielniczek, BSN, SRNA. In this episode, I had the privilege of chatting with Michael Mielniczek, BSN, SRNA on an overview of succinylcholine. At the time of this recording, Michael was a second year Student Registered Nurse Anesthetist at the University of Scranton and…Read more ›
Rank #2: #12 – Preparing for Nurse Anesthesia School – Mason McDowell, DNAP, CRNA and Kara Michalov, MSN, CRNA. If you’re a critical care nurse and you’re thinking about applying for anesthesia school, this show is for you! Jon talks with Mason McDowell, DNAP, CRNA & Kara Michalov, MSN, CRNA about how best to prepare for getting into nurse anesthesia…Read more ›
Rank #1: MIND-USA. Assoc Prof Timothy Girard presents the MIND-USA trial, comparing haloperidol, ziprasidone and placebo in critically ill mechanically ventilated patients with delirium, at the Critical Care Reviews Meeting 2019, in Titanic, Belfast.
Rank #2: John Hinds Trauma Lecture 2018. Dr Sophie Wallace (Perth, Western Australia) delivers the annual honorary John Hinds Trauma Lecture at the Critical Care Reviews Meeting 2018, in Titanic, Belfast.
Rank #1: SCCM Pod-VCCR6 Vasopressor Selection in Septic Shock. Sean P. Kane, PharmD, BCPS, speaks with Scott T. Benken, PharmD, BCPS-AQ Cardiology about vasopressor selection in septic shock. In the episode, each vasopressor agent is discussed individually regarding its receptor profile, adverse effect profile, and the comparative clinical evidence supporting its use in this patient population.
Rank #2: SCCM Pod-VCCR1 Treatment Approaches for ACE Inhibitor-Induced Angioedema. Sean P. Kane, PharmD, BCPS, speaks with Craig Cocchio, PharmD, BCPS, about angiotensin-converting enzyme (ACE) inhibitor-induced angioedema. In the episode, a variety of treatment approaches for ACE inhibitor-induced angioedema are discussed, including fresh frozen plasma, ecallantide, icatibant, and conventional therapies for undifferentiated angioedema.
Rank #1: Oxygenation & PEEP. A discussion of ventilation, oxygenation, and the role of PEEP.
Rank #2: Metabolic Acidosis in the ICU. A common problem in the ill or injured patient is a metabolic acidosis. In this episode we will review the common etiology of a metabolic acidosis as well as some lesser known causes.
Rank #1: CCP Podcast 119: Sepsis management- has anything changed?. The post CCP Podcast 119: Sepsis management- has anything changed? appeared first on Critical Care Practitioner.
Rank #2: CCP Podcast 028: James DuCanto Talks Intubation. I love the world of social media. It was through the medium of Twitter that I was able to connect with James DuCanto (@jducanto)who is an anesthesiologist at Aurora Health Care in Wisconsin. Gavin Denton (@DentonGavin) and I picked his brains about some of the pitfalls in intubation especially for those not so experienced but […] The post CCP Podcast 028: James DuCanto Talks Intubation appeared first on Critical Care Practitioner.
Rank #1: Acute Liver Failure PK. Danielle discusses the intensive care management of acute liver failure, including future directions for treating this devastating condition. This was also recorded at the ICN NSW meeting in the Pecha Kucha format of 20 slides, 20 s per slide, so it's waffle-free and well rehearsed! Go to www.intensivecarenetwork.com for more!
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.
Rank #1: Non-Invasive Positive Pressure . David Farcy, MD FAAEM FCCM, Chairman of Emergency Medicine at Mount Sinai Medical in Miami Beach, Florida, speaks with Todd Slesinger, MD FAAEM, Program Director, Emergency Medicine Residency at Aventura Hospital in Florida about non-invasive positive pressure, the types of delivery, and specific disease processes it may help. Intro music by NICOCO, "Quiberon," from the album "Nicoco," powered by JAMENDO.
Rank #2: CMS Sepsis Core Measures: 2017 Update . David Farcy, MD FAAEM FCCM, Chairman of the Department of Emergency Medicine at Mount Sinai Medical Center - Miami Beach and President-Elect of AAEM, speaks with Tiffany Osborn, MD MPH FACEP, Professor of Emergency Medicine and Acute and Critical Care Surgery at Barnes-Jewish Hospital. Drs. Farcy and Osborn discuss the recent update of the Surviving Sepsis Campaign and its application in patient treatment. Discussion points include: upcoming changes, lactate clearance, and Vitamin C. Intro music by NICOCO, "Quiberon," from the album "Nicoco," powered by JAMENDO.
Rank #1: Severe Burns by Andrew Udy. An overview of severe burns from the perspective of intensive care management by Associate Professor Andrew Udy. The target audience is Intensive Care Registrars. Show notes are available at: http://intensiveblog.com/severe-burns-andrew-udy/
Rank #2: The History Of The Alfred ICU by David Tuxen. Professor David Tuxen provides his unique and entertaining perspective on the history of the Alfred ICU.
Rank #1: Shah: Mechanical Ventilation, Focusing on the basics. Today we welcome back Dr. Nirav Shah, program director for the Pulmonary and Critical Care Fellowship program at the University of Maryland Medical Center. Today Dr. Shah takes us back to the basics of ventilator use. Even the experts in the audience will find tips and tricks to take back to the ICU in order to improve patient care. And for all the budding intensivists out there, this is a talk you cannot miss!!
Rank #2: Cardiogenic Shock, When the Pump Fails. Today we are fortunate to have Dr. Sammy Zakaria, Assistant Director of the Johns Hopkins Bayview Cardiac Intensive Care Unit and overall cardiac critical care guru. He will discuss his take on the basics of cardiogenic shock and cardiopulmonary resuscitation. Over the next 60 minutes you will learn not only ...