In this ResusX Podcast episode, Dr. Tarlan Hedayati discusses the ongoing debate surrounding airway management during cardiac arrest, exploring the effectiveness of endotracheal intubation, supraglottic airways, and bag-valve-masks. Drawing from recent studies and meta-analyses, Dr. Hedayati emphasizes the importance of prioritizing CPR and shares insights into selecting the most suitable airway intervention based on the patient's condition and available resources. Tune in to gain a comprehensive understanding of the latest evidence-based practices in cardiac arrest management.

In this episode, Dr. George Willis discusses the critical diagnosis and management of aortic dissection, emphasizing the importance of considering it in patients presenting with chest, back, and abdominal pain. Drawing from a case scenario and clinical experience, Dr. Willis highlights the challenges in diagnosing and managing aortic dissection, particularly when patients deteriorate rapidly. He provides practical insights into using ultrasound for diagnosis, the significance of resuscitation before intubation, and the cautious approach to pericardiocentesis. The episode underscores the necessity of early recognition and intervention to optimize patient outcomes in this high-stakes emergency.

In this podcast episode, Dr. Eddy Gutierrez explores innovative approaches to treating Septic Shock with Hydroxocobalamin and Methylene Blue. Emphasizing the need for unconventional strategies due to high mortality rates with current treatments, he discusses the mechanisms of these medications in addressing the overdrive of the immune system in Sepsis. Methylene Blue, with a history dating back to the 1800s, is highlighted for its role in inhibiting inducible nitric oxide synthase and soluble guanylyl cyclase. The "SHOCKEM - Blue" trial results are discussed, indicating benefits such as faster discontinuation of vasopressors and reduced ICU length of stay. Dr. Gutierrez also delves into Hydroxocobalamin, a vitamin B12 variant, sharing findings from a recent Phase 2 study showing promising catecholamine sparing effects. Despite potential side effects, the cost-effectiveness of these treatments is considered, and ongoing clinical trials suggest a growing interest in exploring these mechanisms for Septic Shock management.

In this episode, Dr. Mohammed Hagahmed discusses the critical management of a patient presenting with suspected pulmonary embolism (PE) and right ventricular failure in the emergency department (ED). Highlighting the importance of optimizing resuscitation before intubation, he emphasizes strategies to address hypotension, optimize preload, and improve myocardial contractility while avoiding systemic hypotension. Dr. Hagahmed shares practical insights on medication choices, ventilatory settings, and the significance of careful patient monitoring, aiming to equip healthcare providers with essential knowledge for managing such high-risk cases effectively.

In this podcast episode, Dr. Salim Rezaie explores the intriguing topic of norepinephrine dosage in critical care, asking "Norepinephrine: How High Can You Go?" After posing the question to the ResusX community, he delves into four retrospective studies and a unique case report, shedding light on the highest recorded doses ranging from 1.4 to 2.91 micrograms per kilogram per minute. With a lack of randomized clinical trials on maximum dosage, Dr. Rezaie discusses survival rates, digit necrosis, and the duration of high doses. Emphasizing the rarity of such instances, he offers insights into assessing patients, suggesting considerations like accurate blood pressure measurement, echocardiography, and source control. Dr. Rezaie encourages critical evaluation during escalating doses, sharing his clinical approach and stressing the importance of recognizing underlying causes. This episode serves as a thought-provoking exploration of norepinephrine limits in critical care, sparking valuable debate and conversation within the medical community.  

In this podcast episode, Dr. Steve Haywood addresses crucial aspects of using a ventilator in emergencies, emphasizing the significance of the PEEP valve. Dr. Haywood underscores the common misuse of PEEP valves, debunking misconceptions and shedding light on their essential role. He guides listeners through the steps of optimizing oxygen delivery, from ensuring proper oxygen connection to highlighting the importance of a Pressure Manometer. Additionally, he advises maintaining continuous monitoring using Waveform End-Tidal CO2, debunking traditional colorimetric indicators. Dr. Haywood's insights provide valuable knowledge for healthcare professionals dealing with acute patient scenarios, offering practical tips for effective ventilator use and patient care.

In this podcast episode, Dr. Rory Spiegel discusses the challenges of breathing, particularly in cases of wet, heavy lungs and increased dead space. The focus shifts to APRV (Airway Pressure Release Ventilation) as a mode of ventilation and its benefits in returning patients to Functional Residual Capacity (FRC). Dr. Spiegel emphasizes the importance of understanding FRC in the context of ARDS (Acute Respiratory Distress Syndrome) and dispels myths surrounding APRV. He delves into the physiological aspects, including the viscoelastic nature of the lung and the impact on dead space. The episode concludes by highlighting the practical goal of maintaining patients at FRC for improved outcomes, touching on aspects like heart function, sedation, and reduced barotrauma.

In this podcast episode, Dr. Dan Patino delves into the intricacies of awake intubation, a critical procedure in emergency medicine. He highlights the potential risks associated with paralyzing patients, emphasizing how it can worsen acidosis and increase the chances of Peri-Intubation Arrest. Dr. Patino contrasts the standard approach of Rapid Sequence Intubation (RSI) with the scenarios where awake intubation proves essential, shedding light on the characteristics of ideal candidates and the categories of difficult airways. The episode covers crucial steps in preparing for the procedure, including room setup, drying the mouth, and effective topicalization techniques. Dr. Patino provides valuable insights into the use of medications, such as ketamine, and outlines the procedural nuances for both oral and nasal intubation. Listeners gain a comprehensive understanding of awake intubation, its indications, and the meticulous approach required for optimal patient outcomes.  

In this podcast episode, Dr. Shaila Quazi, a seasoned medical professional, shares insights on pacemakers, aiming to simplify the assessment and treatment of patients with these devices. Drawing on her experience as a resident, she emphasizes the importance of reading EKGs or monitors to identify signs of pacemaker failure or the need for a pacemaker. Dr. Quazi breaks down key indicators, such as pauses, lack of response, and abnormal ventricular rates, offering a practical approach for healthcare providers. She delves into scenarios where external pacing might be necessary and discusses the steps involved in transvenous pacing, providing valuable guidance for emergencies. The episode highlights the significance of correlating symptoms, such as chest pain or shortness of breath, with EKG findings and outlines the steps for initiating appropriate interventions, including medications, external pacing, or transvenous pacing when needed.

In this episode, trauma expert Dr. Zaf Qasim engages in a candid and insightful discussion on trauma management with a focus on resuscitation strategies. The conversation covers various aspects, from challenging dogmas in trauma care to addressing specific scenarios like traumatic arrest. Zaf emphasizes the importance of tailoring interventions based on the unique physiology of traumatic arrest, distinguishing it from medical arrest. He delves into the sequence of procedures, advocating for a methodical approach that prioritizes addressing reversible issues. The debate extends to the use of vasopressors in trauma-induced hypotension, with a spotlight on vasopressin as a potential agent. The discussion also touches on crystalloid administration in the absence of immediate blood availability and the role of calcium in trauma resuscitation. Zaf provides insights into the evolving consensus on tranexamic acid (TXA) use, including dosing considerations, and sheds light on the integration of TXA into trauma protocols. The episode concludes with audience questions, exploring topics such as RSI in trauma, including considerations for induction doses, and the role of pericardiocentesis in trauma patients with effusion or tamponade. Overall, the episode offers a valuable blend of evidence-based practices and practical considerations for trauma resuscitation.

In this final installment of the "Airway Hotseat," Dr. Terren Trott guides us through the intricacies of video airway analysis. Discussing cases ranging from inhalation injuries to challenging cardiac arrest intubations, Trott emphasizes the critical decisions and preparations required in emergency scenarios. The importance of a double setup, considerations for patients with potentially burned airways, and the strategic use of tools like bougies for difficult airways are highlighted. The episode delves into specific cases, such as a swollen epiglottis, and debate on intubation techniques. Trott wraps up with insights on troubleshooting tube placement and emphasizes the value of lube in facilitating smoother procedures. This episode offers a comprehensive exploration of airway management complexities, providing valuable lessons for medical professionals and enthusiasts alike.   

In this podcast episode, Dr. Terren Trott conducts a video airway review with three doctors. They discuss the use of video laryngoscopy at the University of Kentucky, emphasizing the importance of recording intubation videos for later asynchronous review. The focus is on challenging airways, with participants analyzing three different cases. Swami shares his approach to managing a soiled airway, advocating for leading with a suction catheter before the laryngoscope. The discussion covers techniques for controlling the tongue, including finger placement and suction catheter use. External Laryngeal Manipulation is highlighted as a valuable tool, offering insights into its application and benefits. The episode concludes with the analysis of a challenging intubation case, addressing issues such as glottic exposure loss, the proximity of the camera, and the potential need for alternative airway approaches during critical situations. The doctors stress the importance of preparedness, a standardized approach, and the role of the bougie in managing difficult airways. The podcast encourages a proactive mindset in airway management and prompts listeners to consider optimizing their techniques for various scenarios.

In this episode, titled "Why You Suck at Vascular Access," the speaker, known as The Vascular Guy, shares insights on improving ultrasound-guided vascular access. Reflecting on personal experiences, he emphasizes the shift from blind procedures to using ultrasound, highlighting it as a game-changer for success rates. The episode covers practical tips, such as the "Gel Tower" technique for pediatric patients, needle entry angles, and the importance of visualizing the catheter in a long view. The host addresses challenges like valve obstruction, offering strategies like bending the needle for better maneuverability. The episode concludes by stressing the significance of understanding ultrasound technology and making informed equipment choices. Listeners are encouraged to enhance their ultrasound skills for more effective vascular access procedures.

In this gripping episode of "A Curious Case" with Dr. Swaminathan and Dr. Hedayati, the hosts delve into a real-life medical case involving a 35-year-old woman with severe postabortion hemorrhage. The patient's critical condition is vividly described, prompting a detailed discussion on managing such emergencies. They emphasized key aspects such as early recognition, vital signs monitoring, and the importance of a collaborative approach. They walk through the use of uterotonic medications, the initiation of a Massive Transfusion Protocol, and the challenges of dealing with limited resources. The episode provides valuable insights into the complexities of postabortion hemorrhage cases, offering practical tips for healthcare professionals faced with these challenging scenarios. 

In this episode of the podcast, Dr. Max Hockstein, an Emergency Physician and Intensivist, delves into the intricacies of End-Tidal Capnography. The discussion covers the terminology surrounding this topic, its significance in understanding Minute Ventilation and Cardiac Output, and the concept of VQ matching in the lungs. Dr. Hockstein explains the working principles of modern End-Tidal measurement, including Non-Dispersive Infrared Absorption, and distinguishes between sidestream and mainstream Capnometry. The episode explores the phases of a Time Capnogram and the utility of End-Tidal in various medical scenarios, from intubation confirmation to resuscitation and preload responsiveness. The episode offers valuable insights into this critical aspect of medical monitoring and leaves listeners eagerly anticipating act two.  

In this episode of End-Tidal Act 2, Dr.Max Hockstein delves into a series of intriguing medical cases by analyzing Capnograms. These waveforms offer a unique window into respiratory and cardiac conditions, presenting challenges such as ventilator dyssynchrony, low cardiac output, and the distinctive Curare Cleft. The discussion covers scenarios like Endotracheal Tube Dislodgement, the Pigtail phase indicating poor compliance, and the classic shark fin appearance denoting obstruction. Max explores counterintuitive insights into Emphysema and highlights the distinctive Capnogram of a Single Lung Transplant. The episode concludes with a fascinating exploration of Cardiogenic Oscillations, where a large heart's pulsations influence lung CO2 levels. The audience gains valuable insights into critical care scenarios, making this episode a must-listen for healthcare professionals and enthusiasts alike.

In this episode, Dr. Mohammed Hagahmed, a faculty physician at the University of Pittsburgh Medical Center, shares a compelling case of a patient named Miss Z, a recent immigrant with COPD. Dr. Hagahmed discusses the challenges of caring for crashing patients, focusing on the critical importance of peri-intubation resuscitation. He delves into factors that can lead to peri-intubation cardiac arrest, such as hypoxemia, hypotension, and high shock index. He also discusses the choice of sedation and paralytic agents, emphasizing the need to ensure appropriate sedation when intubating patients. Dr. Hagahmed provides valuable insights into managing these high-risk scenarios and the latest research findings on the topic.

In this podcast episode, Dr. Evie Marcolini discusses a real case involving a 72-year-old patient who experienced a biking accident. The patient's condition raises important questions about managing blood pressure in neuropatients. Dr. Marcolini emphasizes the significance of tailoring blood pressure goals to the specific condition a patient is suffering from, be it Traumatic Brain Injury or Hemorrhagic Stroke. She underscores the need to maintain Cerebral Perfusion Pressure, highlighting the importance of individualized care based on the patient's health history. The episode also touches on various medical considerations, including the use of medications like fentanyl and the role of hydration in ensuring safe intubation. Ultimately, Dr. Marcolini's message is that thoughtful and well-informed blood pressure management can significantly impact patient outcomes.

In this episode, Dr. Sara Crager discusses the complexities of selecting vasoactive medications, known as "pressors," for patients in shock. She emphasizes the importance of not just memorizing tables but understanding the underlying principles of why, when, and which pressor to use. Dr. Crager points out the limitations of relying solely on evidence-based medicine for such decisions, highlighting the uniqueness of each patient and the importance of considering provider expertise. She explores various factors, including the need for vasoconstriction, vasodilation, increased inotropy, and concerns about side effects like arrhythmias and pulmonary pressures, to guide the thoughtful selection of the most suitable pressor or combination of pressors to improve tissue perfusion in shock patients.

In this podcast episode, Dr. Abhilash Koratala from the Medical College of Wisconsin provides a comprehensive overview of VEXUS (Venous Excess Ultrasound), a valuable tool for assessing a patient's hemodynamics and fluid status at the bedside. Dr. Koratala explains the three key components of evaluating the hemodynamic circuit, which includes Forward Flow, Fluid Responsiveness, and Backward Pressures of the heart. He emphasizes the importance of assessing Systemic Venous Congestion and its impact on organ perfusion, particularly the kidneys. VEXUS combines various ultrasound parameters, including Inferior Vena Cava, Hepatic Vein, Portal Vein, and Intrarenal Vein, to quantify venous congestion and predict the risk of organ injury. The podcast also includes practical insights and case examples of how VEXUS can guide treatment decisions and monitor patient response to therapy.

In this episode, Dr. Laura Duggan, an Associate Professor in the Anesthesia Department in Ottawa, delves into the complexities of traumatic airway management. Dr. Duggan emphasizes the importance of combining opinions and evidence to provide the best patient care. She highlights the challenges of maintaining airway management skills and the shift toward evidence-based decision-making. Dr. Duggan also discusses the risks associated with blunt and penetrating airway trauma, the significance of assessing the mechanism of injury, and the value of visualizing both above and below the glottic entry during intubation. She encourages collaborative efforts between specialties and the use of nasopharyngoscopy for assessing airway trauma while stressing the importance of teamwork in critical situations. Check out ResusX for more from Laura and our other amazing faculty!

In this lively podcast debate from ResusX:ReVolved, Salim Rezaie and Anand Swaminathan tackle the contentious topic of Mechanical versus Manual CPR. Swaminathan, also known as "The Swami," begins by arguing against Mechanical CPR, asserting that there is no compelling high-quality evidence to support its superiority over Manual CPR. He emphasizes the critical importance of high-quality CPR and early defibrillation in achieving good neurologic outcomes in cardiac arrest cases. Swaminathan raises concerns about the obstacles, costs, and training required for Mechanical CPR devices, suggesting that they may not be justified in many settings. He concedes, however, that there might be a role for these devices in scenarios with limited rescuers or prolonged transport times. Rezaie, "The Rebel," counters by acknowledging their shared belief in the significance of compressions and defibrillation but argues that humans often struggle to maintain the quality of compressions. He highlights the potential cognitive offload that Mechanical CPR offers and cites a meta-analysis that found no significant difference in outcomes between Mechanical and Manual CPR. Rezaie also mentions scenarios where Mechanical CPR could be particularly beneficial, such as in ECMO/eCPR cases and scenarios with limited personnel. The debate leaves the audience with plenty to ponder regarding the use of Mechanical CPR devices in cardiac arrest management.

In this captivating podcast episode, Dr. Joe Bellezzo, an ER physician from San Diego, shares their groundbreaking journey of integrating ECMO into their Emergency Department for Refractory Ventricular Fibrillation cases. Beginning with his inaugural case involving a patient named Ralph, the episode explores the transformation of ECMO from a tool designed for surgeons to a life-saving ER procedure. Dr. Bellezzo emphasizes the significance of deliberate movements in critical situations, drawing parallels to motorcycling's "whiskey throttle" concept. The episode also highlights their shift towards a culture of resuscitation excellence, driven by remarkable survival stories, and introduces the concept of "Code Choreography" to optimize resuscitation procedures. Tune in to witness how innovation and dedication have reshaped emergency medical practices, propelling the possibilities of meaningful survival. Don't forget to register for the ResusX:Reset conference, live in Philadelphia or virtual (https://www.resusx.com/Reset)

Join Dr. Terren Trott as he explores the often-overlooked world of "Ventilation in Cardiac Arrest." In this episode, Terren breaks down the guidelines, dives into pathophysiology, and questions the one-size-fits-all approach to ventilation. He discusses the interplay between chest compressions and ventilation, delves into the effects of hypoventilation and hyperventilation, and introduces the concept of Positive Expiratory Pressure. Terren highlights the potential of mechanical ventilation for precise control and patient-centric customization. Tune in for a comprehensive understanding of ventilation strategies during cardiac arrest, empowering healthcare providers for optimized patient outcomes.

In this episode, Dr. Corey Slovis dives into the contentious realm of cardiac arrest management, discussing the use of various drugs including epinephrine, bicarbonate, and calcium. As an expert in emergency medicine, he explores the complexities surrounding these interventions, shedding light on what works and what doesn't in the critical context of cardiac resuscitation. Dr. Slovis emphasizes the importance of securing the ABCs—airway, breathing, and cardiovascular stability—while providing insightful commentary on the recommended dosages and timing of epinephrine administration. He highlights the pivotal role of shockable and non-shockable rhythms in determining the efficacy of epinephrine, drawing from both historical studies and recent double-blind placebo-controlled trials. The host explores the nuanced relationship between epinephrine and neurologic outcomes, addressing the intricate balance between survival and functional quality of life. Dr. Slovis delves into the controversial topics of bicarbonate and calcium use during cardiac arrest, discussing studies that challenge their effectiveness and present potential risks. He advocates for judicious use of these agents and provides practical insights for recognizing scenarios where their administration might be warranted. Throughout the episode, Dr. Slovis engages listeners with his comprehensive review of the literature, critical analysis of evidence, and candid observations on the current state of resuscitative practices. He wraps up the discussion by outlining key takeaways for clinicians, emphasizing the importance of making informed decisions based on the available evidence and patient needs. This episode offers a thought-provoking exploration of the ever-evolving landscape of cardiac arrest management, inviting listeners to rethink established practices and consider the implications for patient outcomes.

In this podcast episode, Dr. Amal Mattu from the University of Maryland School of Medicine discusses the critical importance of interpreting Post-Arrest 12-lead Electrocardiograms (ECGs) in Acute Care Medicine. Hosted by Haney Mallemat, the episode features a fictional case of a patient with chest pain progressing to cardiac arrest in the Emergency Department. Dr. Mattu emphasizes the significance of distinguishing between ST-segment elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (ACS) when analyzing post-arrest ECGs. Recent literature suggests that patients without ST-segment elevation might not need immediate catheterization, allowing for potential delayed catheterization. The discussion delves into the intricacies of interpreting dysrhythmias, particularly wide complex tachycardias that can mimic ventricular tachycardia (V-tach). Dr. Mattu advises caution in diagnosing V-tach when the rate falls below 120-130 bpm or the QRS complex exceeds 200 ms. He highlights real cases where patients faced adverse outcomes due to incorrect diagnosis and inappropriate treatment with sodium channel-blocking anti-arrhythmic agents. Throughout the episode, Dr. Mattu underscores the need for evidence-based decisions and careful consideration when interpreting post-arrest ECGs to ensure optimal patient care.

In this podcast episode, Dr. Evie Marcolini addresses the management of elevated Intra Cranial Pressure (ICP) in diverse medical scenarios, particularly in emergency departments. She emphasizes understanding the mechanisms and effective treatments for conditions like Traumatic Brain Injury (TBI), Intracerebral Hemorrhage, and Subarachnoid Hemorrhage. Dr. Marcolini outlines a tiered approach to managing ICP, starting with simple measures such as elevating the head of the bed, administering Fentanyl for analgesia, and employing Osmotic Therapy with Mannitol or Hypertonic Saline. She delves into more invasive options like Ventriculostomy and Inodilators for severe cases while cautioning against therapeutic hypothermia. Overall, the episode provides valuable insights into ICP management strategies, encouraging healthcare professionals to consider the specific mechanisms of each case.

This week's ResusX:Podcast features Dr. Colin McCloskey, an EM Intensivist, provides valuable insights on identifying and managing Cardiogenic Shock. This life-threatening condition has a 50% in-hospital mortality rate. He highlights the importance of differentiating it from other shocks, emphasizing key signs such as low systolic blood pressure, narrow pulse pressure, and cool extremities. Echocardiography and bedside physical examination play a crucial role in confirming the diagnosis. Dr. McCloskey discusses resuscitation, starting with inopressors to defend MAP, with norepinephrine as the first-line choice. Inotropic medications like dobutamine or milrinone may be used if needed to improve cardiac output and coronary perfusion pressure. Mechanical circulatory support devices can be considered when inotropes are insufficient, and a multidisciplinary approach involving heart failure cardiologists, cardiac surgeons, and CT intensivists is crucial for optimal management. Early diagnosis, appropriate medical care, and collaboration among healthcare professionals are highlighted as essential factors in effectively managing Cardiogenic Shock and improving patient outcomes. Don't forget to subscribe to this channel for more critical care and emergency medicine content.

Dr. Rory Spiegel, an EM Critical Care physician, discusses post-arrest care and the optimal blood pressure for patients who have been resuscitated from cardiac arrest. Previous retrospective studies suggested that higher MAPs were associated with better outcomes, but these findings were confounded by the overall health status of the patients. Dr. Spiegel highlights three recent small randomized control trials that compared lower and slightly higher MAP targets but found no significant difference in outcomes. He emphasizes a recently published large randomized trial that investigated blood pressure targets in comatose survivors of cardiac arrest. Dr. Spiegel questions the effectiveness of identifying an ideal MAP for specific patient populations, citing previous studies in sepsis and other conditions that have failed to determine an optimal blood pressure target. He explains that MAP, although commonly used as a surrogate for perfusion, does not accurately represent micro-hemodynamics. Different organs have varying resistance, affecting their perfusion, and disease states can further complicate the relationship between macro-circulation and microcirculation. Overall, Dr. Spiegel suggests that while MAP is frequently measured and easily accessible, it may not be the best indicator of perfusion. He highlights the need to consider micro-hemodynamics and individual organ perfusion in each patient's management.    

In this YouTube video, critical care and emergency medicine expert Dr. Sarah Sarah Crager introduces a new way of thinking about shock and challenges the traditional categorization of shock into four types: distributive, cardiogenic, hypovolemic, and obstructive. She highlights the limitations of this classification system and emphasizes the importance of considering shock precipitants and shock physiology as distinct entities. Dr. Crager introduces the "tank, pipes, pump" model as an alternative approach to understanding shock. The key takeaway is that shock is not solely about hypotension but rather hypoperfusion. Blood pressure and tissue perfusion are not always closely linked, and microcirculatory dysfunction can have significant implications for patient outcomes independent of macrocirculatory parameters. Dr. Crager emphasizes the importance of considering tissue perfusion and microcirculation, rather than solely focusing on blood pressure and forward pressures.

In this podcast episode, Laura Duggan, an associate professor at the University of Ottawa, discusses the topic of awake intubation. She emphasizes the importance of awake techniques in cases of blunt and penetrating airway trauma and explains that while penetrating airway trauma can often be managed post-induction, there are instances where an awake approach is necessary. Duggan shares her personal approach to awake intubation, drawing from her 20 years of experience in anesthesia and emergency medicine. She highlights the need for evidence-based decision-making and procedural skills, emphasizing the importance of staying updated with current techniques and involving other specialists when dealing with complex airways. The podcast addresses the question of why awake intubation is still necessary despite the availability of video laryngoscopy (VL). Duggan presents research showing that even with the widespread use of VL, awake intubations still occur in approximately 1% of cases. She explains that anatomically difficult airways and physiologically challenging cases are the main reasons for opting for awake intubation. Throughout the episode, Duggan discusses various challenging airway scenarios, including burn patients, post-cervical spine fusion bleed, Ludwig's angina, and patients with physiological difficulties like pneumonia or pulmonary embolism. She highlights the importance of maintaining the patient's own spontaneous or negative pressure ventilation in such cases and the need for a team approach involving the patient. The podcast also covers key aspects of awake intubation, such as the use of glycopyrrolate for drying up secretions, the avoidance of sedation, the importance of well-maintained equipment, and the technique of topicalization using atomization and paste for effective anesthesia. Duggan emphasizes the significance of using the right concentration of lidocaine and provides practical tips for applying topical anesthesia. In conclusion, the podcast episode provides valuable insights into awake intubation, its indications, and its techniques. It emphasizes the need for continued learning and collaboration in managing difficult airway cases, ultimately aiming for successful outcomes and patient comfort.   ✨Sign up here for the incredible cardiac arrest conference, ResusX:ROSC Conference happening July 11 & 12, 2023. https://www.resusx.com/resusx-rosc

In this podcast episode, Dr. Scott Weingart discusses the role of the trauma team leader in emergency medicine and the importance of training residents in this role. He highlights that emergency medicine residents should be the ones learning to lead trauma teams, rather than general surgery residents, as general surgeons often have limited involvement in trauma cases. Scott and his colleague Chris Hicks have created a taxonomy of the skills and knowledge required for a trauma team leader, which they discuss in detail throughout the episode. The episode covers various aspects of being a trauma team leader, starting with the "zero point survey" where the team ensures safety, equipment availability, and team cohesion before the patient arrives. The trauma team leader stands at the foot of the bed to have control over the room and focuses on creating a calm and quiet environment. They emphasize the use of closed-loop communication and regular sit-reps to keep everyone informed and open to suggestions. The trauma team leader also assigns someone else to maintain awareness during procedures, using the concept of "eyes on, eyes off." The podcast delves into the role of the podium nurse as a partner to the trauma team leader, discussing their responsibilities such as running pre-briefings, coordinating tasks and equipment, and managing certain aspects like finger stick and tetanus. The trauma team leader is advised to stay out of procedures and assign others to take charge while maintaining situational control. The primary survey is explained, highlighting the key components: airway, breathing, circulation, disability, and environmental factors. Scott introduces the concept of "exsanguination" as an additional consideration in the primary survey. The podcast explores the need for advanced airway management and emphasizes the importance of using checklists and considering different intubation techniques based on the patient's condition. Monitoring is discussed, including the use of saturation, end-tidal CO2, and arterial lines. The podcast suggests considering temperature monitoring with a temperature foley catheter if available. The episode also covers assessing and managing hypotensive or malperfused patients, focusing on finding the source of bleeding through various assessments and imaging techniques. The podcast addresses chest decompression, emphasizing the trauma team leader's role in requesting the necessary equipment and ensuring the procedure is performed correctly. It also touches on establishing vascular access, the use of blood transfusions and tranexamic acid, and the importance of using appropriate transfusion devices. The episode highlights the significance of maintaining adequate calcium levels and suggests considering viscoelastic testing for guidance. The role of sedation and balancing blood pressure is discussed, with the aim of achieving a high-flow, low-pressure state. The podcast suggests using fentanyl or ketamine for sedation, considering paralysis if necessary. The importance of laboratory tests and the potential use of TEG and ROTEM for assessing coagulation status are also mentioned. Lastly, the podcast emphasizes the need to stabilize pelvic or femur injuries, discussing the use of binders or splints depending on the situation. Overall, the episode provides valuable insights into the responsibilities and considerations of a trauma team leader in emergency medicine, emphasizing the importance of training and equipping residents with the necessary skills for this role.

In this video, Dr. Steve Haywood discusses crucial preparations and considerations before initiating intubation in critical care and emergency medicine settings. He emphasizes the importance of being aware of potential complications and taking necessary steps to prevent adverse outcomes. Dr. Haywood introduces a mnemonic, SOAP P-ME-E, to guide the pre-intubation checklist. The mnemonic includes the following key elements: suction, oxygenation, airway equipment, pharmacology, positioning, monitor setup, emergency backup plan, and end-tidal CO2 monitoring. Dr. Haywood highlights the gravity of every intubation having the potential for adverse events, stressing that even successful intubations can lead to death. He explains the risks associated with post-intubation cardiac arrest and the high mortality rates associated with such events. The discussion delves into the selection of induction agents, particularly Ketamine, highlighting its advantages over other agents while acknowledging its potential complications. The importance of proper positioning, monitoring, and emergency backup plans, including video laryngoscopy and bougie usage, are also emphasized. This informative video provides critical insights and practical tips for healthcare professionals involved in intubation procedures, with the ultimate goal of enhancing patient safety and optimizing outcomes. Remember to like and subscribe to our channel for more valuable content on critical care and emergency medicine!

Register HERE for the ResusX:ROSC conference!  In this video, Sara Crager discusses the management of Unstable A-Fib (Atrial Fibrillation). She highlights the importance of distinguishing between primary and secondary causes of instability before considering immediate cardioversion. Sara emphasizes that not all patients with A-Fib and low blood pressure require immediate intervention. Factors such as fluid status, electrolyte levels, and sympathetic activity should be evaluated to determine the underlying cause of instability. Sara advocates for a comprehensive approach that goes beyond the choice between beta blockers and calcium channel blockers. She introduces seven key questions to guide the management of Unstable A-Fib, including primary versus secondary causes, rate versus rhythm issues, the necessity of immediate cardioversion, electrolyte correction, fluid status assessment, and the use of appropriate medications. Sara suggests considering Amiodarone as a go-to option for rate and rhythm control in unstable A-Fib cases, while also addressing blood pressure support with medications like phenylephrine or vasopressin. Overall, this video provides valuable insights and strategies for effectively managing Unstable A-Fib. Check out https://www.resusx.com for education on resuscitation

In this ResusX video Dr. Rory Spiegel discusses the use of phenobarbital for treating alcohol withdrawal. He explains the physiology of alcohol withdrawal, which involves an imbalance between excitatory and inhibitory neurotransmitters in the brain, mainly glutamate and GABA, leading to symptoms like tachycardia, seizures, and agitation. Traditionally, benzodiazepines, which work by augmenting the effects of GABA, have been used for treating alcohol withdrawal. They require the presence of GABA in the system to work effectively. Rory prefers a symptom-triggered approach for treatment, which means the severity of the disease state determines the medication dosage. This approach has been found to be more effective and less likely to lead to complications compared to a fixed dosing approach. He critiques lorazepam, a commonly used medication for alcohol withdrawal, for its short half-life and the need for constant re-dosing, which necessitates intensive monitoring and an ICU stay. Dr. Spiegel suggests phenobarbital as a superior option due to its predictability in dosage and effect, wide therapeutic effect, safety, and long half-life that allows for a built-in taper. This makes the monitoring process simpler and reduces the need for ICU stays.        

In this episode, Dr. Colin McCloskey, an EM Intensivist from University of Hospitals Cleveland, talks about transvenous and epicardial pacers, and explains how to place a transvenous pacer. He emphasizes that transvenous pacing is a high acuity low opportunity event that requires deliberate practice to achieve competence. McCloskey outlines the common indications and contraindications for transvenous pacing and stresses the importance of knowing the location of the kit and the contents of the kit before attempting to place a transvenous pacer. He also provides step-by-step instructions on how to place a transvenous pacer, including the use of a sterile sheath, the connection to the pacer box, and how to achieve mechanical capture. McCloskey discusses potential pitfalls and offers solutions to overcome them. Overall, he emphasizes that transvenous pacing is a simple procedure that is within the skill set of healthcare providers.

Welcome to another episode of the ResusX:FOAMed! Today, we have a special and personal story from Dr. Mike Winters about an anaphylaxis case that hits close to home. Mike shares the experience of when his son Hayden had a severe anaphylactic reaction after eating an oatmeal raisin cliff bar. This incident fueled Mike's passion for understanding, recognizing, and treating anaphylaxis. In this episode, we discuss the definition, clinical features, and latest guideline updates on anaphylaxis. We also delve into the various clinical formulas, pathophysiology, and the importance of treating anaphylaxis as a distributive, hypovolemic, and cardiogenic form of shock. Join us as we explore the critical goals of anaphylaxis treatment, including the administration of oxygen, intravenous fluids, and epinephrine. We'll also discuss second-line medications and their role in anaphylaxis management. Lastly, we'll touch upon the discharge and follow-up care of patients who have experienced an anaphylactic reaction. Don't miss this gripping and informative episode that can help you better manage and treat anaphylaxis in your clinical practice. #AnaphylaxisAwareness #EmergencyMedicine #AnaphylacticShock #EpinephrineTreatment #ResuscitationTips #AllergicReactions #AnaphylaxisManagement #LifeSavingTips #AnaphylaxisEducation #EmergencyResponse #AllergyEmergencies

Discover the Power of the Cognitive Pause During Resuscitation with Dr. Anand Swaminathan! In this ResusX:FOAM episode, Anand shares invaluable insights and life-saving techniques about the crucial role of cognitive pause in resuscitation and critical care. 1. The Science of Cognitive Pause with Dr. Anand Swaminathan - Why It Matters 2. Cognitive Pause in Resuscitation: Maximizing Success 3. The Role of Cognitive Pause in Critical Care Decision-making 4. Real-life Cases: Cognitive Pause in Action 5. Expert Tips from Dr. Swaminathan: Mastering Cognitive Pause for Better Outcomes Watch the YouTube video here.

Chest pain can be a concerning chief complaint in a standard patient, but chest pain in pregnancy can be down right frightening. The differential diagnosis ranges from benign to life threatening. Thankfully we have Dr. Tarlan Hedayati to take us through the threatening possibilities as well as a practical approach to the workup of these patients. She'll discuss spontaneous coronary artery dissection (S.C.A.D.), pulmonary embolism, aortic dissection and more. This lecture was recorded from the ResusX:ReVolved conference in 2022. Signup for our weekly newsletter so you never miss any education from us: https://www.resusx.com/newsletter

In this first episode, Dr. Scott Weingart talks about how arterial lines are used to help people who are in cardiac arrest. He talks about how important it is to keep an eye on blood pressure all the time and how arterial lines can give more accurate and reliable readings than non-invasive methods. Dr. Weingart also talks about the benefits and risks of putting arterial lines in people who are in cardiac arrest and how to do it. He says that putting in and taking care of arterial lines requires proper training and experience. Throughout the episode, Dr. Weingart talks about his own experiences and thoughts as an emergency doctor and critical care specialist. This gives listeners important information about how arterial lines can be used to help when managing a code. This episode is a must-listen for anyone who cares for patients in cardiac arrest. The insights and practical tips shared by Dr. Weingart are sure to be valuable for clinicians at all levels of experience. For more on ResusX, check out the website www.ResusX.com