The EEG Show

The topic of this episode is “Role of EEG in Pediatric Emergency Department” To explore this topic further, I invited Dr. Manish Shah Professor of Pediatrics at Baylor College of Medicine and Attending Physician in the Texas Children's Hospital Emergency Center in Houston.  Dr. Shah is passionate about improving pediatric prehospital and hospital-based emergency care on local, statewide and national levels through advocacy, education, and research. As a former appointed member of the U.S. Department of Transportation's National Emergency Medical Services Advisory Committee (NEMSAC) from 2015-2017 and a past chair of the Emergency Medical Services (EMS) subcommittee for the American Academy of Pediatrics Section of Emergency Medicine from 2011-2014, he has collaborated with stakeholders to enhance awareness of issues of national significance in pediatric prehospital care.  He has collaborated with colleagues across the United States to develop an online EMS educational resource for physicians, co-create the curriculum and educational research for the Pediatric Simulation Training of Emergency Prehospital Providers (PediSTEPPs) program at Texas Children's Hospital, and develop an EMS training curriculum for the Botswana Ministry of Health.  In addition, Dr. Shah has lectured at the National Association of EMS Physicians (NAEMSP) and Emergency Medical Services for Children (EMSC) Annual Meetings to promote understanding of the special needs of children in the prehospital environment. Dr. Shah is currently the Principal Investigator for the Pediatric Dose Optimization for Seizures in Emergency Medical Services (PediDOSE) study, which has been funded by the National Institute of Neurological Disorders and Stroke (NINDS) and is being conducted in the Pediatric Emergency Care Applied Research Network (PECARN). This podcast is brought to you by Ceribell Inc. To learn more, visit ceribell.com  

The topic of this episode is “Seizure Detection with Artificial Intelligence (AI) enabled EEG” To explore this topic further, I invited Dr. James Quinn, Professor of Emergency Medicine at Stanford University Medical Center.  Dr. Quinn's primary focus is emergency care research with previous experience running large multi-center trials. His work has been published in over one hundred manuscripts.  Dr. Quinn is currently focused on the use of machine learning and artificial intelligence algorithms to augment physician decision making and personalizing the care of patients.  In this interview, Dr. Quinn shares whether physicians should worry about the rise of Artificial Intelligence (AI) or celebrate it, the impact of AI enabled EEG on patient care, the downside of AI-enabled EEG, and much more. This episode is brought you to you by Ceribell Inc. To learn more, visit us at ceribell.com

Our guest for this episode is Dr. DaiWai Olson, Professor in the Department of Neurology and Neurosurgery at University of Texas Southwestern.  Dr. Olson began his nursing career in Iowa and obtained his PhD at the University of North Carolina. He worked as a staff nurse from 1986 to 2018.  He was an assistant professor at Duke University until 2012 when he relocated to work at the University of Texas Southwestern where he is now the first nurse to be promoted to full professor. Dr. Olson's work is focused on developing a more comprehensive understanding of how nursing care contributes to patient outcomes following acquired brain injury.  In this endeavor, he has published over 300 manuscripts, 16 book chapters, and 150 scientific abstracts.  He is the Editor-in-Chief for the Journal of Neuroscience Nursing and the co-chair of the Curing Coma Campaign.  

Our guest today is Dr. Prasanthi Govindarajan, Associate Professor of Emergency Medicine and practicing emergency physician at Stanford University Medical Center in Palo Alto, California. Dr. Govindarajan is a health services researcher with expertise in acute neurological conditions, emergency medical services and healthcare systems.  The goals of her research are to improve access to specialized centers for acute stroke care through early detection of stroke in the prehospital setting.  Most recently, Dr. Govindarajan served as the lead principal investigator for BEST-ED, a Ceribell sponsored research study evaluating the diagnostic or therapeutic benefit of EEG use in an acute care setting. Dr. Govindarajan completed her medical school training in India, emergency medicine residency at Boston Medical Center, Boston, and a fellowship in emergency medical services and prehospital care at University of California, San Diego. Please join me in welcoming Dr. Govindarajan on The EEG Show. Visit www.ceribell.com to learn more about Ceribell Rapid Response EEG.  Caution: Federal (US) law restricts this device to sale by or on the order of a physician. Refer to the Ceribell Pocket EEG Device Operator Manual and Labeling for Indications, Contraindications, Warnings, Precautions and Instructions for use.  

Speaker 1: Welcome to the EEG Show, where you'll learn about the importance of EEG in the assessment of patients with various neurological conditions and the new research findings that are defining a new path for the utilization of EEG and the current practice of medicine. Kunal Sampat: Hello, friends. My name is Kunal Sampat. I'm your host at the EEG Show. I'm also the director of clinical operations at Ceribell. I'm excited to interview our guest today, Dr. John Stern. Dr. Stern is a professor in the department of neurology, director of epilepsy clinical program, and director of the epilepsy residency training program at UCLA. His activities encompass a range of diagnostic and treatment modalities from seizures and epilepsy. He has authored the book Atlas of EEG patterns and served as a co-editor for the book Atlas for Video EEG Monitoring. I invited Dr. Stern to share with us the current state of EEG technologists staffing, given the pandemic crisis. Dr. Stern, welcome to the show. John Stern: Thank you. Glad to be here. Kunal Sampat: What changes, if any, have you seen or experienced in EEG technology staffing during COVID-19? John Stern: We haven't changed our EEG staffing during COVID-19, and we haven't because of plans that we put into place in planning for the anticipated surge. Our staffing is 24/7 for EEG technologists. But our concern in planning for the surge and our concern still is technologists' exposure to infection, or technologists being quarantined and not available in the pool of technologists for us, or not having sufficient number of technologists because of increased number of patients who require continuous EEG. So we've not changed our staffing by changing our protocols for continuous EEG and limiting technologists' exposure to patients who potentially have COVID in using the neurologist who already is engaged in care of that patient to obtain the first continuous EEG. And that's with Ceribell. Kunal Sampat: So has the usage of conventional EEG and/or spot EEG increased, decreased, or stayed flat during the pandemic? John Stern: Our use of Ceribell has increased during the pandemic because of the utilization in situations where we may just go straight to a continuous EEG. The patients who require super steady EEG with Ceribell will still get it. But there's situations where we will want to hold back on the use of the larger devices and use Ceribell first as a way of increasing our ability to provide continuous EEG. In other words, if the use of a large device is on a patient who is later found to have COVID, that device requires downtime for cleaning, for sanitization. That, and Ceribell device is much more quickly cleaned and back up for use for another patient. Kunal Sampat: I see. Is there a concern about the EEG technologists' frequent or prolonged exposure to potentially infectious patients? And if so, how do you think hospitals are currently addressing this? John Stern: So we certainly are concerned about any staff member of the hospital being exposed to the coronavirus, for their safety and as well as the system being able to provide care for patients. And so minimizing the exposure of the EEG technologists is one of the benefits of use of the Ceribell device. We're not increasing the exposure for anyone else, we are shifting the number of... We're decreasing the number of staff members who are seeing the patient by having the neurologist who is already seeing the patient obtain the initial EEG using Ceribell. Kunal Sampat: I see. John Stern: The Ceribell device has provided an ability to increase our EEG capacity in the hospital. And not by purchasing more equipment, but by realizing that the Ceribell device can substitute for a larger EEG machine and allow us to have a greater number of patients on continuous EEG than we did before. If the Ceribell device is only for screening, then the patients may then go on to continuous EEG or may not. And that allows for faster response. But the Ceribell device can remain in place for longer than just screening and then allow us to have a greater number of patients being evaluated. And that was part of our concern in anticipation of the surge, however, remains a benefit of our use of the Ceribell device. Kunal Sampat: How about any non-Ceribell-related strategies that you've implemented at your institution? John Stern: Oh, I see. Yeah, I'm looking at the protocol that we drafted and it's all really all about Ceribell. Kunal Sampat: Okay. I see. John Stern: And so our protocol has to do with when do we get a routine EEG and when not because of concern of exposure. I can share our protocol if that's helpful. Kunal Sampat: Sure. John Stern: Our protocol for continuous EEG changed in the context of the pandemic with an interest in providing the best care for the largest number of patients, but also minimizing the risk to the hospital staff. And so we have a bifurcation in the protocol now where patients who have other tested negative for COVID or show no signs or symptoms of COVID will go through the process as usual. And that is if a consulting team requires a continuous EEG for the patient, the G lab provides that as usual. But if a patient has signs or symptoms of COVID or has tested positive, and if they're showing signs symptoms that then presumably they're being evaluated and it's unknown if they have COVID, then the primary team consults neurology. The idea is that such patients would typically warrant a neurology consultation and the neurologist would evaluate whether that patient requires a continuous EEG, and the neurologist would provide the Ceribell device as a way of beginning of the process continuous EEG and thereby limit the exposure of other hospital staff to a patient who potentially has COVID.             The continuous EEG would continue, either with Ceribell or switching over, depending upon the patient's situation. But the use of this protocol has expanded our capacity because it has increased the number of available EEG units for us and decreased the downtime of units when they are offline for cleaning after use for patients who either has COVID or potentially has COVID. Kunal Sampat: Thank you, Dr. Stern, for your time today. This was great. John Stern: Thank you. Speaker 1: Thank you for joining us today on the EEG Show. This podcast was brought to you by Ceribell. 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