- Weekend Recap - Mac helps lead the Pats to a bounce back win - Picks of the Week -Waiver pick up of the week - Red Sox advance to the ACLS - That was the greatest game I've ever seen! - People's Topic + MORE! ://www.instagram.com/bigredszone/ https://twitter.com/BigRedsZone
In this episode, we talk all things sports rehab with Wesley Wang. Wesley graduated with his Doctor of Physical Therapy from Franklin Pierce University in 2015. He worked for two physician-owned PT facilities after graduating and has been at Healthy Baller, a cash-based PT facility since October 2017. Wesley specializes in treating ACLs and other sports-related injuries. The majority of his demographic includes high school and collegiate level athletes with the occasional pro-level athlete.Wesley also strives to utilize his platform to improve the knowledge and awareness surrounding ACL rehab to decrease high re-tear rates. He designed an ACL Mastermind Group to educate others on how to properly rehab ACLs.@wesleywang.dptSubscribe, download, and firstname.lastname@example.org
Recorded September 20, 2021 | HUGE bounce back week for the boys! Victory Monday was in full effect for Will celebrating wins for the Titans, Raiders, and Washington Football Team. 3x National Champion wrestler and barstool athlete Spencer Lee also stopped by the bus becoming the first collegiate athlete to step foot on the bus. Comp kicks things off by addressing the adversity the boys faced last week but the world quickly realized you can't keep the boys down for long. Then he gives his analysis of the Nebraska Oklahoma game, and how the Huskers were really just a couple of plays away from winning big. Next, the young man with more national championships than ACL's steps onto the bus to share some of his story. (29:00:52) Spencer Lee is one of the most decorated collegiate wrestlers of all time and is competing for his 4th straight national championship this season. He tells us the story about his viral quote "Excuses are for Wusses" and how he was able to win a national championship without either of his ACLs. Next Spencer tells us about his Olympic dreams, wrestling culture at Iowa, how he wants to grow the popularity of the sport and even teases a little bit of MMA and WWE talk. This pod brings everything you could ask for to the table so tell a friend to tell a friend that they need to tune into this weeks episode! ----- EARN YOUR WOLF: Want to be featured on our Instagram Story? Screenshot this episode, tag @bussinwtb, and share it to your Story. The Boys will take care of the rest... ----- SHOP: https://store.barstoolsports.com/collections/bussin-with-the-boys FOLLOW THE BOYS Instagram: https://www.instagram.com/bussinwtb Twitter: https://twitter.com/BussinWTB Facebook: https://www.facebook.com/BussinWTB Website: https://www.bussinwtb.com ----- SUPPORT OUR SPONSORS: Chevy Silverado: The Strongest Most Advanced Silverado Ever Cross Country Mortgage: Go to CrossCountryMortgage.com/Barstool to learn more about your future home buying experience or refinance your current Mortgage. Betterhelp: Go to https://barstool.link/BetterhelpBussin for 10% off your first month. Fightcamp: Get free shipping with a 30 day money-back guarantee at https://barstool.link/FightCampBussin. Georgia Boot: Head over to https://barstool.link/GeorgiaBootsBUSSIN and use code BUSSIN for 20% off Rhoback: Use the code “BUSSIN” on Rhoback.com for a generous 20% off your first order
Jane Strong from Equus effect and John Bourges Jane Strong, SEP, ESMHL Executive Director Co-founder and Lead Facilitator Eponaquest Equine Experiential Learning Instructor PATH, Intl. Equine Specialist in Mental Health and Learning Somatic Experiencing® Practitioner Certified Enneagram Teacher Jane began her lifelong love of horses as a competitive rider. When she left the world of traditional horsemanship behind, she had no idea that horses would ever become an integral part of her life again. It was not until she began to study the principles and practices of natural horsemanship that she came to understand what horses had to teach us about how we come across to others, about being in the moment and how to bring out the best in ourselves. Read More about Jane I've worked in this way with horses for the past 10 years. Because horses engage all of our senses and ask us to be as present as they are, they can help people discover new ways of seeing themselves in relation to others. This work is both serious and fun, energizing and relaxing, easy to understand and deeply meaningful. By teaching us to stay present in the face of change, horses can help us develop our capacity to navigate transitions from one phase of life to another faster than any other mode of experiential learning or treatment I know. They invite the deepest, most honorable part of ourselves to come forward and meet life on life's terms. JS John Bourges Putnam County Currently John Bourges is the Program Coordinator for the PFC Joseph P Dwyer Veteran peer Support program in Putnam County, as well as a Putnam County Coroner. He worked as a Registered Nurse from 2003 to 2018 in the Intensive Care Unit and Emergency Department settings, earning a BSN, CCRN and CEN, as well having been an ACLS, PALS & BLS Instructor. He was deployed to Iraq during Operation Iraqi Freedom (OIF) as an Officer, serving both as an ER and ICU nurse in a combat area of operations. He has twenty years' experience with the New York City Police Department including Patrol, Narcotics and the Detective Bureau. John is also trained in Personal/Dignitary protection (full carry, & H.R. 218). He is on the Board of Directors of the Prevention Council of Putnam, formally NCADD; an advisory member of the Putnam County Suicide Prevention Task Force; on the Advisory Board of The Healing Communities Study (Columbia University); On the Advisory Committee of The NYS Suicide Prevention Coalition “Helping Those Who Help Others” (HTWHO); On the Advisory Committee National Association of Social Workers-NYS ‘Veteran Mental Health Training Initiative', (VMHTI); ‘First Line' Peer to Peer support for Law Enforcement, member/advisor. #JohnBourges #PDSupportGroup #PoliceOfftheCuff ❗❗❗ Check out our website: https://policeoffthecuff.com
John Bourges Putnam County Currently John Bourges is the Program Coordinator for the PFC Joseph P Dwyer Veteran peer Support program in Putnam County, as well as a Putnam County Coroner. He worked as a Registered Nurse from 2003 to 2018 in the Intensive Care Unit and Emergency Department settings, earning a BSN, CCRN and CEN, as well having been an ACLS, PALS & BLS Instructor. He was deployed to Iraq during Operation Iraqi Freedom (OIF) as an Officer, serving both as an ER and ICU nurse in a combat area of operations. He has twenty years' experience with the New York City Police Department including Patrol, Narcotics and the Detective Bureau. John is also trained in Personal/Dignitary protection (full carry, & H.R. 218). He is on the Board of Directors of the Prevention Council of Putnam, formally NCADD; an advisory member of the Putnam County Suicide Prevention Task Force; on the Advisory Board of The Healing Communities Study (Columbia University); On the Advisory Committee of The NYS Suicide Prevention Coalition “Helping Those Who Help Others” (HTWHO); On the Advisory Committee National Association of Social Workers-NYS ‘Veteran Mental Health Training Initiative', (VMHTI); ‘First Line' Peer to Peer support for Law Enforcement, member/advisor. --- Support this podcast: https://anchor.fm/otcpod1/support
Ahead of his fight against Daniel Rodriguez, UFC welterweight Kevin Lee speaks to Submission Radio about his big return, life after his loss to Charles Oliveira, tearing both ACLs, why it was a rib injury that made him question his place in the sport, finding his motivation to return, welterweight and why he has his sights set on Kamaru Usman now that Khabib has retired, his prediction for Kamaru Usman vs. Colby Covington 2, Mike Perry and Belal Muhammad not fighting him, Daniel Rodriguez stepping up and why he takes his fighting background more seriously than an amateur boxing background, not being impressed by Khamzat Chimaev, and more!
Ahead of his fight against Daniel Rodriguez, UFC welterweight Kevin Lee speaks to Submission Radio about his big return, life after his loss to Charles Oliveira, tearing both ACLs, why it was a rib injury that made him question his place in the sport, finding his motivation to return, welterweight and why he has his sights set on Kamaru Usman now that Khabib has retired, his prediction for Kamaru Usman vs. Colby Covington 2, Mike Perry and Belal Muhammad not fighting him, Daniel Rodriguez stepping up and why he takes his fighting background more seriously than an amateur boxing background, not being impressed by Khamzat Chimaev, and more!
En este episodio revisaremos el contenido del Capitulo 3 del ACLS Experto. Un capítulo que se centra en el desempeño de los equipos de reanimación del alto desempeño. Espero que lo disfruten Instagram: https://www.instagram.com/Emergencia24.7podcast
Hola!!! En este episodio revisaremos el contenido del Capitulo 3 del ACLS Experto. Un capítulo que se centra en el desempeño de los equipos de reanimación del alto desempeño. Espero que lo disfruten Instagram: https://www.instagram.com/Emergencia24.7podcast
Some know him as Abarca Fitness, others know him as El Diablo so you already know its a pleasure to have him back in the studio for this weeks podcast. We talk moving to Hoboken, Italy winning the EuroCup, fitness 2.0, tearing our ACLs, fart gate and so much more.
Mouth and Beast dive into the first 3 games of the NBA finals with an NBA Kosher Style 5 piece combo, In part 2, our special MLB Top 10 All Star Break. We bring in former researcher for WFAN and Downtown Sports Intern Corey Davis. He evaluates our researcher Tony Mainville's Top 10. In part 3, we discuss the recent slew of injuries from hyperextensions to torn ACLs with our resident doctor Kate Sneddon of Beach NY Physical Therapy. What is Corey's verdict about our MLB top 10? Who are the best teams at the All Star Break? Does Mouth's prediction have a chance at coming true? Tune in to find out!!!!! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/jonathan-pariente2/message
EP269 - New CEOs at Amazon and Instacart, Other news Breaking News: Instacart has appointed Facebook executive Fidji Simo as its new CEO Amazon News Jeff Bezos steps down Amazon offers it's multi-channel fulfillment (MCF) to Big Commerce customers Other News Shopify Unite 2021 Instagram leans into commerce Nike earnings Warby Parker IPO Episode 269 of the Jason & Scot show was recorded on Thursday July 8, 2021. http://jasonandscot.com Join your hosts Jason "Retailgeek" Goldberg, Chief Commerce Strategy Officer at Publicis, and Scot Wingo, CEO of GetSpiffy and Co-Founder of ChannelAdvisor as they discuss the latest news and trends in the world of e-commerce and digital shopper marketing. Transcript Jason: [0:24] Welcome to the Jason and Scot show this is episode 269 being recorded on Thursday July 8 2021, I'm your host Jason retailgeek Goldberg and as usual I'm here with your co-host Scott Wingo. Scot: [0:40] Hey Jason and welcome back Jason Scott show listeners Jason I hope you had a nice restful July 4th. Jason: [0:49] I had a great July 4th my poor dog that doesn't like fireworks cannot say the same but. Scot: [0:56] I love you tried the Thunder shirt. Jason: [0:58] We've tried all of those homeopathic remedies and we're now on doggies ionx and the last time we talked to our vet like he actually said inadvertently suggested that both the dog and my wife should be on Zan. Scot: [1:11] An unrelated news he's no longer but awesome I'm glad you did well we wanted. Jason: [1:20] Primary care physician exactly. Scot: [1:25] We had some breaking news and pretty exciting and I'm going to kick it over to you because it is your category of grocery. Jason: [1:33] Yeah Scott says that like he doesn't use groceries but the some news from earlier today that instacart announced that they had poached, a senior executive at Facebook and I'm I'm already telling the story wrong but they they've appointed and I'm sure I'm going to butcher her name, fidji Sumo who's a former Facebook executive that is now the CEO of instacart. And the reason this is potentially big news instacart has you know been one of the primary beneficiaries the pandemic, they're they're going gangbusters at the moment there's a lot of speculation that they're about to announce an IPO, and the founder of instacart is now stepping into an executive chairman roll out of the CEO role, and Fiji has actually been at instacart I think for like half a year from Facebook but or, I guess she was on the board of directors and so now she's coming on as a full-time employee. Scot: [2:36] Yeah it was interesting I was watching CNBC as I want to do and they did a breaking news alert and what to a live shot of of her with the apoorva who is the founder and now exec chairman of instacart and they were they were pretty directly asking the IP o– question they had to be kind of coy about it because you don't want to. [2:58] You can't control the timing of that there's another article out from the information that revealed that this seems to be a deeper strategy on the instacart side because they have taken over 60 folks from the Facebook side of things before this this kind of high-profile one and what's interesting about that is the article went on and kind of dug into it and a lot of them come from kind of the korad part of Facebook so you know what what I'm reading between the tea leaves there is you and I have not only talked about this new ad Network on instacart but we had one of the leaders there is a next Amazonian and on the show and yeah I've heard a lot of Buzz around this ad Network getting a lot of play and you can imagine that that would be a really nice thing to start having grow at triple digits post covid-19 as a way to continue to monetize thing so my theory is that this is a concerted effort to really beef up the ad Network part of instacart and add a second leg of monetization the first being consumers paying either extra or a delivery fee for groceries and it's gonna be interesting to see if that you know then maybe that rippled all the way to the top where they said hey would it be great to have someone with a really good ad Network chops in here and thus the addition of the G. Jason: [4:20] Yeah no I think your speculation is probably spot-on you know groceries a tough business to make money like in way instacart isn't really a grocer that are. Multi-sided market place and so it's a little easier to make money but still the best way to make money is with that ad Network and. I feel like more than half my life right now is retail media networks so they are super trendy and the dirty secret is most of them. Are not very high volume yet right like the retailers are investing all this money and collecting ad dollars but they don't actually have. Um enough eyeballs to have real scale and instacart is one of the exceptions to that so so they are a viable place to put your. Your digital ad dollars especially as they get more complicated in the Privacy Wars, so it makes sense that they want Executives that are good at that and I would also argue the instacart. Advertising products could stand for some. Some Evolution and some mature zation and so you know maybe that will be one of her focus is there is two two. Make those products more mature and friendly to advertisers. Scot: [5:34] And it wouldn't be a Jason Scott show without some. Jason: [5:43] Zon news new your margin is there opportunity. Scot: [5:51] Well the news that popped out at me this week and this is kind of a recurring theme that we promised listeners we'd keep track of and this recurring theme I like to call Amazon versus Shopify so you know we started out this year with a lot of kind of back and forth between the two companies on social media there was some talk of Jeff Bezos re-engaging to help the company come up with a Shopify strategy and so we've been watching this one really closely so I thought this news was pretty interesting and I'm curious what you thought about it as well so big Commerce announced that they are partnering with Amazon for mcf which stands for multi-channel fulfillment and you know I wanted to read this quote so this quote comes from the head of the omni-channel at Bigcommerce Sharon GE GES, and then the code is convenience and fast shipping expectations have become the Holy Grail of the online Shopper with demand forecasting becoming harder to control he G said in a press release Amazon mcf will help our Merchants to better plan purchase fill in a much more efficient way so I thought this was pretty interesting because first of all Amazon multi-channel Fulfillment has had kind of a rocky rocky. [7:05] Road not the ice cream but the you know so Amazon introduced FBA and they kind of introduced this ability to ship to other channels and then they got really rigid with it like then people said well that's good but we want you to ship in a different box and your fees are too high for off Amazon shipments and this that and the other and you know what if we want to use a carrier that you don't really lean into right now like a FedEx or something like that and if so then Amazon you know I don't know well the official stances but it became very hard to use that service in volume because the filament system got full and Amazon kind of prioritized FBA over M CF so mcf had this kind of like up and down Rocky thing so I thought this was interesting because it does seem like to getting more serious about it and then it also you know. [8:00] My theory is if you were going to sit down on a whiteboard come up with 10 to 20 things that can start the Box Shopify in this is one of them and then if you if you think back to the clubhouse we hosted that had Faisal on there he actually kind of said if I was the Amazon I would throw Logistics out on because they'll never figure it out and then I'll use that as a wedge to if I could get all shopify's customers using my Logistics then I could wedge out Shopify so I think that could be part of a you know I don't think this is going to be the Silver Bullet by any means but I think it is one of these silver shotgun pellets that Amazon is going to start firing at Shopify so I found that pretty interesting. How was your day. Jason: [8:43] Yeah I generally agree I'm not confident that it's I'm sure. Competitive factors against Shopify is is one aspect but to be honest it just good business for Amazon. [8:58] Two. It's another service where they get to make a higher percentage of the to the worldwide gmv and all the markets that they're in, um you know because Amazon's already the biggest digital platform in most of the markets they play in that they're shipping the majority of packages for most of these these sellers anyway and so it's just a way to grab the rest of their volume almost every you know the majority of these sellers selling other platforms besides Amazon, the majority of them now have recognized they need to have their own website and so it's kind of foolish of Amazon to I force them to open their own warehouses for those alternative channels or, hire another 3pl so I just think. [9:39] In the same way it made sense for Amazon to rent a WS capacity to others and you know provide some of these other services it's a way to monetize their delivery Network and their fulfillment Network so I think it's super smart. Um I do think Shopify had some aspirations in the 3pl side of things and I assume. Amazon will you know being quite a bit ahead of Shopify you know then making this ubiquitously available will cause some problems for Shopify the one thing that still gives me pause and we give me pause if I were a merchant. Um is that Amazon as you alluded to already has a checkered track record for supporting this service right so, um even if you're just an FBA seller and you put your inventory in FB a Amazon is a notorious for constraining how much of your inventory they'll accept. [10:36] Based on their demand capacity right so there was a lot of Buzz, um leading up to Prime day that a bunch of vendors just couldn't get inventory into FB a because Amazon had dramatically curtailed the amount of inventory that they would keep. Um there and there's all this speculation in the Amazon preferences new skus versus old skus and so a bunch of vendors. Found themselves having to go to other three pll's to sell on Amazon because Amazon just wouldn't accept all of their goods and so if you're going to say oh you know what I'm going to put all my eggs in Amazon's basket and have them ship all of my. I need to be certain that when they get busy when they have holiday Peaks they're not going to, preference their own their own stuff and what's going to sell best on their platform against my needs and at the moment Amazon doesn't have great credibility there so I think they have some reputation. Repair they need to do but assuming they do that like this makes a lot of sense and as you well know. Fragmentation of inventory is super expensive so you know having having some of your inventory and radio or or you know some of these other three pll's and some of your inventory and Amazon totally sucks because, you sell out of one place while you have slow turning inventory in the other place in that car. Scot: [11:57] Yet kind of invites Murphy's Law to come bite you in the butt because the second you send a thousand widget somewhere then you'll need a thousand widgets the other place it always happens that way it's super frustrating. Jason: [12:08] Yeah so I think this is a super appealing service, Amazon has a slight credibility problem that they'll have to overcome and historically they they're pretty good at overcoming those. Scot: [12:17] One last one is I know eBay and Walmart all, you know they got super frustrated that someone would come to eBay to buy something it would show up in an Amazon box so I know that there's been a lot of talk of them either putting up rules or thinking about it or on again off again with rules around that so I think Amazon would have to look at it and also think about the Amazon box and and. Not ship the stuff out and kind of normal Smiley Prime box that everything else comes out and. Jason: [12:49] Yeah no I think that is a TBD and again it's one thing if I'm, indigenous on Amazon and Amazon you know doesn't is super careful about what they let you even put in the Box because they're again trying to disintermediate you from the customer, but if it's my customer if I sold the you on my website and then I'm going to ship you a box and I'm just paying Amazon to ship that box for me. Like I of course want and expect to be able to put my promotional materials in that box and that you know figuring out all of that kind of thing. It is part of the mcf we haven't we haven't seen them as on solve it. As a side note this whole category is just ballooning there was an interesting article in. CNBC last week about how demand for warehouse space is at unprecedented levels and new cities like Columbus and Savannah are emerging as the new shipping hubs because. The traditional ones like Memphis and Kentucky and stuff just don't have have any more space to rent. Scot: [13:55] Carson and then I saw some of the stairs like a next generation of 3pl that's kind of like F ba of vacation / we work on vacation of 3pl like ship hero we've had some of these folks on the show talk about shipping carriers a lot of them are raising hundreds of millions of dollars right now so the VC dollars are flooding into the space to so it's gonna be really interesting to watch the overall fulfillment Wars continue. Jason: [14:21] Yeah and I something we've talked about a few times every week the virtual 3pls right and just you know it's super interesting. Scot: [14:29] And in that vein I put a little LinkedIn post I kind of tied this to fundraising it spiffy but the overall, thing I was trying to get across is. One of the friends of the show Brian Fitzgerald he's one of the internet Analyst at Wells Fargo they did a bricks and clicks day and this was last week and in there they had Rob Williams who's a former Amazon GM of global vendor management and he kind of made this off comment off off-the-cuff comment that I thought was interesting he said Mr Williams emphasized the sheer scale of the Amazon is logistics filled out over the last two years with over a hundred forty million square feet added which is the equivalent to the Distribution Center capacity added by Walmart over the past 50 years so that you and I have remarked several times about how how much infrastructure Amazon is building out and it's just hard to even, compare what they're doing I thought that was an interesting comparison. [15:27] Benedict Evans pointed out that he kind of argued is that a fair comparison because it doesn't count the retail stores I had a clever counter that that I can't remember but you know Amazon has pixels instead of physical space so so it's kind of apples and oranges in a way but yeah the my point in bringing it up with spiffy is I'm out their fundraising all the time and I get this feedback from VCS that say oh wait a minute you have fans and infrastructure yeah we don't invest in any companies that have that and I was want to facetiously say well well you would have missed Amazon because you know they they clearly have if asset heavy is a thing they are the most heavy and assets company out there that that I can think of that doesn't count all the the compute centers that they're building out for AWS but that's a whole nother story and then, there's a famous Jeff Bezos ISM that he has someone asked him this kind of question around this asset heavy thing he said you know one way of thinking about it is if you build a big enough castle that is the moat I guess the question he was asked is you know what's Amazon's competitive, and his answer was we're going to build such a big castle we don't need a moat and that this is this kind of reminded me of that quote as well and I tagged you in this you get the fun benefit of getting all the LinkedIn notifications for people commenting. Jason: [16:51] Yeah I was gonna say you're way more popular LinkedIn than me because that my insight through this is you get like dozens of comments every morning so I get up every morning and I'm like you've got a hundred new notifications and I'm like nice I finally became popular and then it turns out it's all, Scot Wingo levers commenting on your thread. Scot: [17:09] Wait till you live too two things so wait till you're working anniversary that's a always a big day on LinkedIn and then you should put a post up this as I really need an explainer leader explainer video and automated lead generation and I think you'd be very popular. Jason: [17:26] Yeah being slightly facetious I said the notifications are popular the emails I get I get plenty of unsolicited LinkedIn email yeah trying to sell like custodial services to pupusas. Scot: [17:40] Hey some there's a lot of garbage cancer that I imagine you damn thing. Jason: [17:45] Yeah yeah I wouldn't know because the haven't seen enough is very much lately, yeah so that that but that thread is super interesting there's been a lot of good conversations there and I've seen some of your your debates a slight. I don't think this changes the spirit of this at all like Amazon has this huge advantage in logistics it's the biggest advantage and, that it's something that despite the law of large numbers they're still growing and investing way faster than anyone else but Rob's comment was slightly off on Walmart like he what what he meant to say was, in the last two years Amazon has spent as much as Walmart did in their first 50 years not the last 50 years and so it is true, Walmart has dramatically accelerated their spending to not as much as Amazon but much more so than they did in their first 50 years. And / Benedict's point like I do think. These omni-channel retailers are leveraging their stores as a clever part of fulfillment so I to me it's not either or but I do think we're seeing Walmart and Target and Best Buy invest a lot in store fulfillment and in many ways that is working, as a competitive oil to Amazon any other Amazon news caught your attention this week Scott. Scot: [19:07] Well it is we've covered this before but Jeff is stepping Jeff Bezos I should say is stepping down as CEO and they updated some of the company leadership values I didn't see that as big news and a lot of people are you know the headlines are coming out already is this day too and that kind of thing yeah I feel like. Having met a lot of people at Amazon I think the culture has locked in every every both deep and wide there and I think it's going to take at least five years for us to see any kind of change in the culture there so I don't think you'll see them slow down there if people are counting on this to be the moment when they stopped feeling pressure and they can stop worrying about compete with Amazon that would be a mistake. Jason: [19:55] Yeah no I tend to agree I don't think we're going to look back in history and say oh man Jeff Bezos stepping down July 1st 2021 that was the inflection point right. The I would argue it's been day to at Amazon for a while like everything's on a spectrum so. [20:13] Amazon is an amazingly agile company that overcomes a ton of institutional inertia I think it's one of the most impressive things about Amazon despite their enormous size, they have a bunch of politics and institutional inertia and sacred cow syndrome at this point just like everyone else there I mean you know it's a 30 year-old company so you know as much as Jeff Bezos has some great slogans. Like some of that had already said in before Jeff left and you know Amazon is just too big one person like can't. Like be making that day-to-day impact on Amazon that he once did so like clearly his impact is. The culture he created and again I'm with you the company values I think what's interesting is that they changed it all right because, you want these to kind of be pillars that that are not trendy and don't change every year you know based on fads, um and so it is it's interesting that they amended them for the first time in a long while and the way they amended them is that you know to New Missions that Jeff Bezos announced in a shareholder letter right so you know they added. Value around being a better employer and a value around being a better. Ecological. Scot: [21:36] I am concerned about him going off into space that's going to be yeah I kind of questioned the logic on how there's a nonzero chance that doesn't work out. Jason: [21:46] I'll be ya as an investor I like him going in that rocket a lot I care a lot more about that and it makes me a lot more queasy than him stepping down as the CEO. Like there's an argument that his biggest value to Amazon will increase as he like. Stops reading customer service letters and more focuses on big-picture issues as executive chairman and largest shareholder but Rockets are dangerous man. Scot: [22:13] Yeah yeah yeah I'm worried about that but it's going to be exciting as well so we'll see how that goes. Jason: [22:21] Yeah no for sure and then the only other thing that jumped out at me that's a little interesting in this hole. Shuffling of the deck of Executives and things is it. You're starting to see you know those Amazon executives are their Amazon experience is really valuable to other companies so it's not surprising that people are trying to recruit them, I think with Jeff stepping down in a succession plan you know getting implemented, I think it's going to be harder to hang on to some of those other senior Executives so it's going to be interesting to see. If the biggest impact of Jeff stepping down in the long run is less retention from the other s team members and along those lines I notice that Rent the Runway which is getting ready to do. They're their IPO and they you know had some, some challenging leadership Optics grabbed one of the. The senior Executives from the the Amazon supply chain Tony Clark to who is. VP of fulfillment and Amazon to kind of take over Rent the Runway so you know I think those kind of stories could become more common. Scot: [23:40] Yeah yeah there's definitely a lot of poaching going on across the industry is some of these next-generation things are scaling up and looking at going public and need to tap into the. Jason: [23:49] Yeah and the two stories this this week I think people leaving Amazon and people even Facebook I have to believe it's easier than ever before to peel off Executives from those two companies. Scot: [23:58] Yeah one on Amazon thing I wanted to pick your brain on is assume your Instagram person came out and said hey our new kind of going forward we're no longer a kind of square photo company we have a new Focus area in fact there's for number one creators number two video number 3 shopping and number for messaging I thought that was pretty interesting because we've seen Instagram kind of crank up the amount of activity around shoppable ads and incorporating extending their partnership with Shopify and we've seen shop pay being added all over the place and I thought you know that's pretty interesting what did you make of that. Jason: [24:42] Yeah well so not surprising a those were those are basically. Mark Zuckerberg zwei like priorities from from 2019 f8 so it's not. Totally surprising that they're they've kind of propagated to Instagram at this point it is interesting to me that. You know at least three and maybe four of them are all like cumulatively what I would call Commerce right like you taught you know. [25:10] What big trends am I talking a lot with with clients about it since its creators as micro influencers its video driven Commerce its. Social commerce and the the sleeper is. You know customer service phone lines are going away and they used to sell an awful lot of product on those phone lines and all that is pivoting to the these various chat services and you know you talk to Consumers no one wants to use their phone for voice calls anymore so, so you know Commerce happening via customer service on these messaging services also is a big thing and so, for all those reasons I would say I have a lot more clients that are a lot more interested in piloting things on these social networks and Instagram. Are you we may have the most robust Commerce tool set right at the moment so, makes total sense for them to leaning leaning in I would say the one bomber if you're at Instagram today is that for some good and some irrational reasons The Social Network that has the most Buzz amongst my clients as tick-tock. [26:20] Still smaller I would argue still has less buying intent than Instagram but it's growing much faster and it it gets brought up in a lot more board meeting so I have a lot more panicked. Chief digital officer is calling asking me for advice about Commerce pilots on Tik-Tok than I do Commerce pilots on Instagram at this. Scot: [26:43] Nursery and then do you respond with some of your clever to Funk videos. Jason: [26:48] I do I do I send them all to my Instagram Channel where I talk about Tick-Tock on Instagram. Scot: [26:55] And you do the Renegade. Jason: [26:57] Yeah yeah I've, I was for a while but now the problem is I've like 23 ACLS on my skateboard trying to drink that stupid Ocean Spray so I. I probably need to stop that yeah I tend to be about three or four social networks behind so I've kind of just leaned into YouTube now that it's not cool anymore. Scot: [27:18] Just wrapping up the Friendster account. Jason: [27:21] Oh no I'm hang on at that bad boy. Scot: [27:23] It's coming back I promise. Jason: [27:25] Exactly you guys will all be sorry you abandoned me on MySpace. Scot: [27:30] Another industry news item is Shopify held their kind of virtual unite 2021 conference they announced a bunch of platform enhancements I didn't see anything earth-shattering where they get the most Buzz is they basically said hey if you have an app on our app store we're going to give you the first million dollars free and that was kind of part of there roguish rubbish you know app stores have obviously been in the news a lot with both Apple and Google coming out under Apple versus epic and then Google just got an antitrust filing on this topic so you know date they kind of very cleverly took a kind of a counter PR strategy here which got a lot of Buzz which I thought was pretty clever you know um They never said how much that's going to cost them in revenue and the stock didn't really kind of move around and I thought someone should have asked that question I didn't even ask that question so it must be someone in material or or, people don't care I don't know but I thought that was clever PR but I really didn't get anything much more media out of out of the announcements there. Jason: [28:38] Well so there are few things a I would I would say that one got a lot of Buzz but I would say if that was actually an easy thing for Shopify to offer and it's largely misunderstood, the app store for Google or even way more so the app store for apple is the primary moneymaker it's their primary economic model. [28:59] When we talk about App Store in the context of Shopify it's a B2B app store right so what this is is your, you want to sell your goods on a Shopify store and you need some amenity that isn't built into the native Shopify platform, you need ratings and reviews so you go into the App Store and you buy ratings and reviews from one of the, the 50 vendors that offer a ratings and reviews solution and Shopify used to take a little piece of that initial Revenue. For for that app store right and so now they're saying hey we're not going to take a piece of your first million dollars in Revenue. The so so that's a thing and it makes it a little a little cheaper for small companies to be on that that App Store, the reality is the big companies it's super annoying because they already had access to those customers without the App Store. The App Store is not the only path to get your your product instrumented on Shopify so you kind of it's closer to. Like Google where you can kind of sideload apps and not go through the App Store but the bigger thing is. As a general rule Shopify would tell you not to use the app store and most of the other, initiatives from Shopify were about minimizing the app store because it turns out when you install 50 unvented plugins from small unknown third parties. [30:28] Destroys your stability and performance of your web store and so like. Shopify some of the other things they announced was like a better vetting process of that app store but like in general it's not like sellers are using dozens and dozens of apps and that there's that's a big Revenue stream for Shopify. [30:50] So it the fact that they have a robust app echo system is a competitive Advantage for Shopify against other platforms. So maybe there's more apps available on the Shopify App Store than there are on the Bigcommerce App Store and that might make you pick Shopify and by not charging, rev share on your first million dollars in sales and their App Store that encourages more people to stay on the app store which helps them keep that that little note they have against other platforms so. Maybe more information than anyone wanted on that point but, to me the more interesting thing is I shopify's another one of these amazing companies that I still like to criticize right there doing a bunch of things right, but I still like to highlight that they've got a ton of technical debt and a particular pet peeve of mine has been the the inflexibility of their platform that you kind of like every seller gets kind of homogenized to the same experience because it's kind of hard to get out of the Shopify box, and that that box is not very a very good performer and from a web page load speed thing which is super important to e-commerce success. The Shopify store starts out as mediocre and then if you make some bad decisions mediocre becomes horrific and so I would say that. [32:10] They probably didn't do enough they didn't announce enough in this to make me super excited that they're fixing all those problems but I would say they they owned all of those problems at in their unite 2021 conference and, announced some significant progress in each of those so I think for sure. [32:27] They're they're doing more to allow individual shop owners to change the look and feel and optimize their customer experience in more ways. That are codeless which is you know what most Shopify sites want so I think they made a lot of progress in their in their flexibility on their user experience. They're evolving their product management system in some ways to make it more competitive with Standalone pims and to make it a more useful sort of. Hub for marketplaces so I imagine there's some interested followers it Channel advisor and your competitors in that space that are looking at some of the things they announced it. And then they did make some improvements in their page performance they made a lot of improvements in letting people know what their page performance is they really improve their tools there. Um but they still aren't embracing things that I would say are probably things you want to be embracing in 2021 like Progressive web apps for mobile and things like that so. So I would say they're addressing their technical debt but they did not you know come out and say it's we've wiped it all away. Scot: [33:36] Brickell one of the last things I want to talk about is I saw this and thought of you, United presented several times about different Trends in one of your favorites is the talk about Brands going direct one of my also favorite Trends and you frequently reference Nike as a company that's really focused on this and they had some some interesting news there. Jason: [33:56] Yeah yeah so they had that I want to say in the mid June end of June. They did their their quarterly earnings it's slightly confusing because they're not a calendar fiscal year so. So their Q4 ended May 31st so their quarterly earnings were Q4 whereas a lot of companies on counter years in the same season or doing their kind of what they would call their q1 earnings. I'm sorry Q2 earnings so a they had a really good earnings report. Which is kind of impressive because in general you would have said man shoes and apparel didn't do very well during the pandemic. And you know again comping. [34:42] Kind of what would that be April major March April May of this year versus last year like the basis was really sucky last year so you would expect. Q4 to be up but their fiscal year was way up right so there, so they're they're 2020 fiscal year was up nineteen percent from the previous year which is pretty impressive in the pandemic and what's even more interesting is you look like North America and Nike sales, last quarter we're up 29% versus two years ago so if you're wondering if they've fully recovered from the pandemic and people not wearing shoes yes like they did really well and then digital. You know like a lot of other companies again in the pandemic more of your sales shifted to digital so you expect kind of digital to be up last year which should make the comps this year tough, but they were still up 54% and they're up a hundred and seventy-seven percent from two years ago so so. Like stupendous digital growth. [35:49] And you know you as you alluded to the thing we talked a lot about Nike is in the 1990s Nike was a hundred percent wholesale company and they they so choose to Foot Locker and Footlocker sold them to Consumers, and you know over time they were really one of the first Brands to launch their own retail store Nike Town and it was super controversial at the time. People have obviously gotten used to those initiatives and if you zoom back to like twenty ten fifteen percent of Nikes sales were direct-to-consumer well, in 2017 Nike said hey we're going to get really serious about this direct-to-consumer we think that's the future we're going to fire all of our wholesalers and mainly become a direct-to-consumer company and in fact the numbers were startling, they said they had 40,000 companies that sold Nike shoes and they were looking to diminish that to about 80 companies, and every year we've seen them fire wholesalers this year we saw them say to DSW that you're not going to be selling Nike shoes anymore, so Nikes really practicing what they preach and in 2020. Thirty-five percent of their sales were direct-to-consumer so they are you know making a lot of progress there you know in that that strategy is basically working for them so it's been super interesting to watch and I, I talked with a lot of brands in other categories about the Nike example and it's. [37:12] They have their own platform and echo system with Nike Plus, um that they're they're a leader in social commerce they're doing a bunch of things really well so it's interesting that not shocking that they had a great quarterly earnings and I think their stock had a nice bump as well. [37:31] Speaking of stock there's an IPO that I am eager to get my hands on but I won't be able to right away and I thought maybe you could explain that to our listeners Scott Warby Parker has announced that they have confidentially filed for an IPO and you've already taught me what that means but maybe you could explain it to our listeners. Scot: [37:52] Yes there's back in the Obama Administration there was this jobs act thing that allowed you to file confidentially to do an IPO and the benefit of that is it's when you the old school way you would file for an IPO and then all of your conversations with SEC were public and inside of there there's a little bit of dirty laundry thing that goes on there also. [38:19] It almost fully commits you to the IP o– path at that point so it doesn't give the company the ability to kind of, test and kind of say all right we want to kind of show this you see what's going on here and maybe we decide based on their feedback we don't want to do this process or maybe we do some exploratory conversations with potential shareholders and valuations off and we don't like it we want to pull the IP o– it doesn't give you that opportunity so that's what the confidential filing thing gives you now, when companies so then why would a company announced it so the reason companies now announced that they're doing it is too, if they they don't have to do it the day they file so what they probably did this filed they got good feedback and round one from the SEC and then, they committed to the path and then it's smart at that point kind of prime the pump and tell people you're coming down the path a little bit. [39:14] It still hides your SEC things you still have that small window where they filed before they announced they were doing this to test the waters get feedback from SEC maybe they were a lot of times you're also having what's called a dual path kind of a a program where you're selling the company you're looking at possibly selling the company and an IPO is kind of an alternative so that's that's why it would then be time to to announce it is you're fully committed to the IPO path and it's kind of like when you list a house now a lot of people do it coming soon so it puts a little bit of a coming soon out there to build excitement for the IPO but then also does keep the communications with the SE comp SEC confidential and it does allow you to run a little bit of a decision-making process before you announce the confidential file. Jason: [40:02] Gotcha and so but it is true that at some point that s one becomes public right. Scot: [40:07] Yeah yeah what'll happen is the SEC will say okay this SEC is out of draft mode and it's going to you know once you update it with these things you're good to go and then they'll they'll update it and then it will be kind of a hot live S1 and then that will start the whole thing where they that starts the calendar of after X days you start your road show and then you need to price and then do the type you. Jason: [40:36] Yeah and so I and many others are super eager to get our hands on that as a lot of listeners will know where be Parker was one of the, the first kind of poster child for these like modern digital direct to Consumer Brands and so for the longest time, you know every brand in America was like the sky is falling all these d2c companies are showing up in there doing much better than us and they're getting all the buzz and the two biggest examples were Dollar Shave Club and Warby Parker. And we've never gotten a chance to see the real economics behind our shift Club because they were part of a private acquisition at Unilever and Unilever doesn't have to disclose a lot of there. They're their individual financials because it's not material to Unilever. [41:23] We're all eager to see how big Warby Parker really is and you know I have a hypothesis that that while they seem like a good company and. I'm sure they're going to meaningful sales that they these DDC companies are slightly overhyped and so I think people might be surprised at like what the annual sales run rate is. At where we Parker when when the stuff gets disclosed so I'm. Excited for that and then you know past guest of the show Dan McCarthy like he's having a field day with these s ones because increasingly they're putting. Customer retention data and cohort data in these things and that lets him do why you know the real big brain math. To figure out the the long-term value of these companies and inward to be partners case. They're one of the oldest digital di disease out there so they're going to have a lot of robust cohort so they choose to share some data that will be super interesting. Scot: [42:23] Yeah I don't I don't know how often people change their glasses this that'll be factored. Jason: [42:28] Well part of the Moss so like a lot is annual or at least prescriptions and things like that and part of the word we parked our model is that. It was they would say that like we're so inexpensive that we become more of a fashion accessory and people that would have only owned one pair of glasses will own for pair of glasses and people that would have only bought glasses every three years or buying glasses every year and stuff like that so, it'll be interesting to see how much of that is true. Scot: [42:55] Cope and then kind of a tease for a future trip report you are spreading your wings and find a New York to do some retail business for us what's what what are you going to check out when you're there. Jason: [43:07] Yeah old time listeners will know you know I was on the road every week and we talked about visiting stores every time I got a chance to visit them I haven't gotten to do that in a while. I have done a couple business trips but I do have one for the end of this month in New York and New Jersey and I have reserved a day because there's two significant new store openings that have happened this month. There is a Wizarding World of Harry Potter store, that opened in the Flatiron District in New York I've read a lot about that I got to visit it while it was under construction but this will be my first time seeing it open. And some people will know that I often use Ali Anders Wand Shop at Universal Studios as my example of the best retail experience out there so so Harry Potter has some creds, the Harry Potter team has some creds and Retail it'll be interesting to see what they do in this this Flagship retail space. And then the other company that opened a retail store. [44:12] Arguably for the first time is Google so they've opened a permanent store in New York City and they had a big new cycle where they're like we're opening our first store it's a huge deal, and I would put an Asterix on that because they have done a lot of significant pop-up retail where they like open to store for six months. And I'm not sure that the the permanent store is necessarily going to be wildly different than those pop-ups but I'm eager to see how their their retail shops have evolved and I'll be fun to visit that store. Scot: [44:44] Yeah I think I double dog dare you to walk in the Google Store the megaphone and just say two words OK Google and then run out. Let's see what happens and then at the Harry Potter store I'm excited to hear in a future show you don't have to reveal now if you're not comfortable this a very personal question but what do you put at the core of your wand are you a phoenix feather guy or a unicorn hair or Dragon spit or yeah so it's going to be exciting to get a report on that as well. Jason: [45:17] Yeah well Scott as you well know you don't get to pick that because you do not choose the wand the wand chooses you. Scot: [45:23] Ah man going deep on the HP nods. Jason: [45:26] Yeah but adding a layer of complexity this New York store has some scarcity so there are there is a 1 for example that's only available at the store that's not available through any of the other properties so do you. You pick the one that's the best fit for your innate magic or do you you know pick the one-of-a-kind one that you can only get by visiting the store it's. It's a lot of a lot of. Scot: [45:49] Solid on door for the scarcity and sell it on eBay. Jason: [45:52] Yeah Scott Scott I know exactly what you would do I am selling some stuff on eBay for the first time for so side note for a future show. It turns out it's a normal consumer it's a huge pain in the ass to sell stuff on eBay now which is pretty disappointing. Scot: [46:07] Yeah wait till you ship it in the people some kind of quack Ado has. Jason: [46:10] Don't get paid yeah oh I'm terrified I feel like I've gotten like all this these communications from scammers it's like I would never advise a not sophisticated so or to try to do this like this used to be their primary model. Scot: [46:25] Yeah it's hard. Jason: [46:27] It is a mess. Anyway Scott we did allocate a shorter period of time for the show and I feel like I want to honor that commitment I know it's summer everyone's taking vacation so, we don't want to condemn our listeners to our usual our so I think this is a good place to cut it, if you appreciate shorter shows you can thank us by leaving a review and saying hey we always love the show but we love the shorter one even more. Scot: [46:53] Thanks everybody and until next time… Jason: [46:57] Happy Commercing!
Like many other college athletes, 3x NCAA Champion and 3x Cadet/Junior World Champion has officially started capitalizing on his Name, Image and Likeness. Though, he just wants World & Olympic Gold. Today, the Hawkeye leader joined the podcast once again to talk about what it looks like behind the scenes and what his approach is. We also go back a few months and talk about his "Senior" season, including Big 10's dominance and following up winning NCAA's with no ACLs by having to bow out of the Olympic Trials. This show is brought to you by ATAC! ATAC is a new sophisticated training app, with very cool gaming components, for wrestlers and other high-level athletes, with coaching and technique from stars like Jordan Burroughs, Sarah Hildebrandt, and Reece Humphrey, among others! And, the app is available NOW in the Apple App Store.. Download today! Feel free to tweet us and send us messages with questions and general thoughts! And, be sure to SUBSCRIBE to the podcast and go through the archives to hear more great stories. If you want to support the podcast, be sure to leave a 5-star rating & review on Apple Podcasts, and shop some apparel on BASCHAMANIA.com! For all partnership and sponsorship inquiries, email email@example.com.
We're kicking off Season 3 with a fun game of Would You Rather! As our hosts, Kristen and Maddi both share updates as we head into summer, including some changes as things are slowly changing in hospitals here in Arizona! For those of you that have been with us since Episode 1, to the ones that are listening to their first episode with us today, thank you for being here! We are excited to bring more great conversations, education, and build this community around the amazing career of nursing! Play along with us on this game of would you rather and tag us on Instagram with your favorite ones!! We'd love to see you ask your friends these questions too! 01:15 Our first live, in-person event! 05:00 Work and life updates! 08:15 Summer staffing and students in hospitals. 11:15 Are there still limitations with visitors at your hospital? 14:30 Have you had to do your ACLS? 17:50 Would you rather do admission or discharge? 21:00 Have a long commute and get paid more, or short drive and get paid less? 22:00 Hospice care or psych? 24:50 Would you rather call/go to a stroke alert or rapid response? 26:15 Hospital or Outpatient? 26:40 Would you rather have co-workers love you and manager hate you? Or have your co-workers hate you and your manager love you? 27:40 Slow and boring shift, or busy shift where you don't get to take lunch? 29:30 Would you rather have a rude patient's family or a confused and impulsive patient? 31:00 Spilled urine on your pants or trach sputum on your shirt? 32:00 Donuts vs pizza! 35:30 C-Diff patient or GI bleed? 37:30 THANK YOU for those who have left reviews! ………………………….. Connect with us on Instagram | @lifeinscrubspodcast Follow along with our personal Instagram pages too! Connect with Kristen on Instagram | @thenursekristen Connect with Maddi on Instagram | @nurse.maddi
Em um bate-bola capitaneado pelo Dr. Bruno Valdigem, as principais mudanças recentes em suporte avançado de vida cardíaco (ACLS, do inglês advanced cardiac life support) comentadas e contextualizadas por duas feras no tema: o Dr. Sergio Timerman e o Dr. Daniel Branco Araújo. Escute, relembre e aprenda!
Ben and Vic are joined by Eve Purdy this month to discuss the UK national strategy for simulation, how to prepare for for systems-based simulation (the ‘pre-work phase') , cultural consideration in simulation debriefing, and how simulations in ACLS training may perpetuate gender bias in emergency medicine. We give a shout out to ASPiH, the UK based learned sociality for healthcare simulation, and their conference in November 2021. Ben impresses again with his tun of phrase including the ‘visual haiku', ‘framework mashups' and ‘paragraph of Purdy'. Happy listening and look forward to next month!
(6/4/21) From blurry vision to crooked teeth, ACLs that tear at alarming rates and spines that seem to spend a lifetime falling apart, it’s a curious thing that human beings have beaten the odds as a species. Professor of biology at Lewis-Clark State College in Idaho Dr. Alex Bezzerides’s new book Evolution Gone Wrong: The Curious Reasons Why Our Bodies Work (Or Don't) is a look at the many twists and turns of our ancestral past. Join us for a look at why the body behaves like it does in this installment of Leonard Lopate at Large on WBAI.
Torsades de Pointes (TdP) A type of polymorphic ventricular tachycardia that is inherently unstable and often quickly degrades into ventricular fibrillation. It usually occurs in the setting of a prolonged QT interval, which can either be genetic or acquired. Treatment Defibrillation – per ACLS, ventricular tachycardia with a pulse should receive synchronized cardioversion. But in […]
Dr. Philip Ewell is an Associate Professor of Music Theory at Hunter College of the City University of New York, where he serves as Director of Graduate Studies in the music department. His specialties include Russian music and music theory, Russian opera, modal theory, and critical-race studies. He received the 2019–2020 “Presidential Award for Excellence in Creative Work” at Hunter College, and he is the “Susan McClary and Robert Walser Fellow” of the American Council of Learned Societies for 2020–2021. In August 2020 he received the “Graduate Center Award for Excellence in Mentoring,” which recognized his “ongoing, long-term, commitment to students at all stages of graduate research.” He is also a “Virtual Scholar in Residence” at the University of the Pacific Conservatory of Music for 2020–2021. As a result of his ACLS award, he is currently working on a monograph—to be published by the “Music and Social Justice” series at the University of Michigan Press—combining race and feminist studies with music and music theory. Finally, he is under contract at W.W. Norton to coauthor a new music theory textbook, “The Practicing Music Theorist,” which will be a modernized, reframed, and inclusive textbook based on recent developments in music theory pedagogy.The Question of the Week is, "How can classical music confront its own history of exclusion?" Dr. Ewell and I discuss his experience presenting his paper on race, how classical music and institutions operate through a white racial frame, his advice on how to approach those who do not want to discuss issues in classical music, the inclusive theory textbook he and his colleagues are currently formulating, and his recommendations on those who want to learn more about diversity and equity in classical music. Dr. Ewell's website - http://philipewell.comDr. Ewell's presentation Music Theory and the White Racial Frame - https://vimeo.com/372726003Fact Check - At the end of our conversation, I refer to three recent police shootings and mistakenly called thirteen-year old victim, Adam Toledo, African-American when he is actually Mexican-American. Dr. Ewell corrected me and I wanted to include a fact check note in the show notes to verify this correction. This Season Finale episode of Con Fuoco is dedicated to George Perry Floyd Jr. (October 14, 1973 - May 25, 2020)
In this episode of the Brawn Body Podcast, Dan is joined by Julie (Julianne) Burrill, CSCS, SPT, Cassiah Ray, Mikaela Koenig, SPT, Arianna Camille, Bridgett Finn, CPT, and Emma Lee to discuss experiences and perspectives within Women's sports. This episode marks the LONGEST single-episode of the Brawn Body podcast to date, and focuses on highlighting the many issues within female athletics from the perspectives of the athletes, coaches, and officials who are immersed in the sport. Julie is a 2019 graduate of The University of Scranton's Exercise Science program. She is currently in their DPT program and will graduate in 2022. She played field hockey for 4 years at the collegiate level, and shares a LOT of the same health values, beliefs, and interests as me. Julie is also a strength coach at the University of Scranton, working closely with the school's field hockey team. For more on Julie, you can find her on Instagram @goalsetmindset_jb Cassiah Ray is a current junior at Lebanon Valley College studying Exercise Science. She is also a member of the women's basketball team at her school. Her experience as a female colligate athlete has been a unique one as she tore both of her ACLs nearly 9 months apart from each other in 2019. Mikaela Koenig, SPT provides a unique experience through her interaction with female athletics. Mikaela was a former college basketball player with a career-ending injury which brought her in the other side of athletics; coaching and PIAA officiating. She also is involved in Division lll Athletics through Event Staff Coordination and being an Athletic Office Assistant. Mikaela attended the NCAA Inclusive Excellence Forum in 2017 when she found a passion for female sports. Arianna Camille is a professional dancer, choreographer, and model who has traveled and danced around the world. She has received over a decade of training in dancing and is my go-to expert for ballet, salsa, barre, pilates, and more. Arianna also has an extensive background in mindfulness, pilates, and more, and is currently studying communications. For more on Arianna, you can find her on Instagram @evolvemvmt.co or on her website at https://www.ariannacamille.com/ Bridgett is a former soccer student-athlete from Lebanon Valley College, Vice-Chair of the Division III National Student-Athlete Advisory Committee (SAAC), President of the Middle Atlantic Conferences Student-Athlete Advisory Committee, and President of Lebanon Valley College's Student-Athlete Advisory Committee. She is also an ACSM-CPT, and will be graduating with her Bachelor's in Exercise Science in May 2021! For more on Bridgett, you can find her on Instagram @bridgettfinn_cpt Emma grew up in Sacramento, CA and then went to the University of Washington for Undergrad. She grew up doing gymnastics, participating since age 2 and competing in level 10. She was on the team in her college briefly before becoming the team manager, and later going to finish her Master's in Sport Management. She held multiple different internships, which led her to her current position at DraftKings. --- Send in a voice message: https://anchor.fm/daniel-braun/message Support this podcast: https://anchor.fm/daniel-braun/support
Last year, the American Heart Association (AHA) provided updates to their basic life support (BLS), advanced cardiac life support (ACLS), and pediatric advanced life support (PALS) programs. Mike Sharma is helping again by reviewing some of the key updates and changes to guidelines. We also provide some additional feedback and information to consider with these new guidelines.
Join us in episode 7 as we do our best to talk about everything but the Valero Texas Open. We know the only person who cares about this tournament is Rickie Fowler (and he's probably not going to win). We're just looking forward to the Masters like everyone else.
Contender Series vet and bantamweight vet CeeJay Hamilton joined Riley Kontek to discuss Miesha Tate's return to MMA, Spencer Lee winning the NCAA wrestling tournament on two torn ACLs, why wrestling is the best background for MMA, his #Bellator255 fight vs. Magomed Magomedov and made predictions for Bellator 255.
After helping to save a man's life in the airport, nurse Shelley felt the call to be on a mission. A mission to make sure that whoever wants to learn first aid and CPR can. Along with her husband Chad and three kids, they have turned that experience in the airport into a life change experience for their whole family. Listen in as we talk with Shelly and Chad about starting ACLS Academy, big dreams and how this is impacting their whole family dynamic. Tune into #MWB to learn that and more about working with you spouse/partner not only at home but also at the office!
Run of Show 0:00 - Ollie’s family calls him Bear 0:02 - Going through the rules survey that was sent out 0:49 - Joseph Heinz educates us on ACLs 01:12 - Getting back to the rules we want to see implemented 01:15 - Teams that improved the most from conference to NCAA weekend 01:21 - Questions from friends
A Jam packed episode that really shines in entertainment value towards the last 10 minutes. The front part of this show is jam packed with talk about how GOATed Spencer Lee is for winning a Natty on bad knees, the team winning the title, and breaking down both basketball teams first round wins of the NCAA tournaments. We also talk some about spring break, Deshaun Watson and the potential conspiracy against him, and more!
Sarah Avery is a professional yoga therapist and teacher, founder of Moon Cycle Seed Company, and a physical therapist. Today she shares insight on injury prevention for ankles and ACLs. We talk about some practical tips for ankle strengthening after you've had an injury like a sprained ankle and how to be a proactive athlete in avoiding and training against injury. Contact Sarah here: www.inmotionintegrativept.com Support Ninjababes here: www.patreon.com/ninjababes
Dr. Trent Nessler is the President of Rebound Vitality, Senior Sports Medicine Contributor for SportsEdTV and the founder | developer of the ViPerform AMI™ & ViPerform AMI™ Return to Sport, ACL Play It Safe and Run Safe programs. Trent holds a bachelor's degree in exercise physiology, a master's in physical therapy, and a doctorate with a focus in biomechanics and motor learning. Dr. Nessler has been a sports medicine physical therapist for 23+ years working with athletes at all levels from the pros to weekend warrior. Dr. Nessler is co-developer of a 3D movement assessment (ViPerform AMIä) that is used by 450+ pro teams, colleges and organizations, has been used to assess over 25K athletes in the US and is used in several national research projects. Dr. Nessler is a published researcher and author of a college textbook, speaks internationally on the topic of ACLs and injury prevention and serves as a consultant for professional teams and organizations. As a sport's physical therapist, avid weight lifter (40+ years) and competitive Brazilian Jiu Jitsu purple belt, Dr. Nessler is always looking for ways to apply the latest science to optimize outcomes and enhance athletic performance. In this episode Trent talks about: What drew him to a career in physical therapy. His work around ACL Rehabilitation. The development of his Athletic Movement Index (AMI). His current work with Rebound Vitality and how they are serving the first responder community. Resources discussed: Anatomy and human movement - Nigel Palastanga and Roger Somaes Manual Muscle Testing - Elizabeth Kendall You can stay up to Trent via social media on Instagram @bjjpt_acl_guy and Twitter @ACL_prevention If you are interested in working with Rebound Vitality you can contact them directly at justrebound.com Keep up to date with Monarch Human Performance via our website, Facebook and Instagram pages.
I Have to Kiss Greatness! Drew Gooden (YouTube) joins Agata and Anastasia to discuss basketball news. Drew shares how he learned to love the Magic and what it's like to share his name with the other Drew Gooden. The gang chats Vucevic, Jeremy Lin, metal ACLs, Aaron Gordon's diss track, franchise mode, sucking dicks, the Star Wars prequels, Irish accents, Luka's buzzer beater, and Alex Caruso's balls. Will this episode devolve into an analysis of the Twilight films? Ya just gotta listen to find out!
Dan's back for another medical topic! Today we discuss what to do when your patient codes. What are the MDs responsibilities? What are the RNs responsibilities? We give real life examples of different codes we've participated in, the real world vs ACLS algorithm, and talk about how to mentally prepare for codes. We also take tips and tricks from experienced RNs & MDs about what helps them during codes.... and what annoys them. Topics: Brief overview of ACLS/BLS algorithm Resident roles during codes Nursing roles during codes DNR/DNI RNMD code comments Instagram: @DanielBenhuriMD @RNMDPodcast @TheNocturnalNurse Please subscribe and rate the podcast, that's a free way you can really help us out! Email us your topics or if you'd like to be a guest: RNMDPodcast@gmail.com --- Support this podcast: https://anchor.fm/rnmd/support
Aaron and John talk about Royce Lewis' knee injury, the Twins' first spring training game and the presence of fans at the ballpark, Alex Kirilloff's chances of being on the Opening Day roster, Lewis Thorpe's improved outlook, and why Jake Odorizzi is still unsigned.
In this podcast, Dr. Cole Pueringer, a toxicology fellow with the Minnesota Poison Control System (Hennepin Healthcare), discusses various over-the-counter medications and their toxicological potential. Enjoy the podcast! Objectives: Upon completion of this podcast, participants should be able to: List at least 3 potentially dangerous over-the-counter (OTC) medications. Discuss the basic clinical presentation and management of the following over-the-counter (OTC) medications: acetaminophen, diphenhydramine loperamide, ibuprofen, and dextromethorphan. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at firstname.lastname@example.org. Click on the following link for your CME credit: CME Evaluation: "The Dose Makes the Poison: Over-the-Counter (OTC) Medication" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws. It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Antihistamines: Like so many other over-the-counter medications, the dose of antihistamines makes the poison. Sedation is the most common side effect in antihistamine overdose. Some, like diphenhydramine, are more toxic and have profound anticholinergic effects. Sinus tachycardia is one of the first presentations, but remember the phrases: Tachy as a tie, dry as a bone, mad as a hatter, red as a beet, hot as a hare and blind as a bat. Excitatory toxidromes can be confusing, but urinary retention, impaired bowel motility and the absence of diaphoresis will differentiate anticholinergic toxicity from the other excitatory toxidromes. the higher the dose, the more side effects seen, leading to seizures and cardiac toxicity. Physostigmine is an antidote for anticholinergic toxicity. Delirium is the main indication for physostigmine, but it can also be given to prevent intubation and at times to get a more accurate history from the patient. Physostigmine lowers the seizure threshold, so benzodiazepines are usually given prior administration. Most likely they have already been given to treat undifferentiated delirium and excitation. Of note, physostigmine is not the cure all for the toxidrome because it has a very short half life. In the setting of seizures in overdose, very few anticonvulsants are safe. Benzodiazepines are some of the safer GABAergic agents. GABA is our main CNS inhibitory neurotransmitter, it essentially "tones down the nerves". Propofol and some other GABAergic agents can also help with tachycardia and hyperthermia. In these settings, benzodiazepines are given in very high doses. Diphenhydramine causes sodium channel blockade, subsequently decreasing action potential. lowering calcium in the cells, and causing life threatening myocardial depression. Calcium is given in this circumstance, but the mainstay of treatment is sodium bicarbonate. It works by increasing overall sodium availability and the pH. The more acidotic the patient, the more of the drug becomes unbound and available. At higher pH levels, the sodium channel blockade weakens, and more of the drug becomes protein bound. What about other antihistamines? While overdose of other antihistamines will be uncomfortable, the life threatening seizures and cardiac toxicity is unique to diphenhydramine. Acetaminophen: Acetaminophen is the highest nationally in morbidity and mortality of all drug overdoses. Most often taken on it's own, it's also mixed into many over-the-counter remedies. In the first 24-hours post-ingestion, the symptoms can be minimal. It's metabolized in the liver, and a small portion is metabolized by CIP 2E1, resulting in the toxic metabolite NAPQI. Normally, glutathione will detoxify NAPQI, but in acetaminophen overdose, glutathione stores are depleted and the excess NAPQI creates havoc in the liver. In a reliable historian with an acute ingestion, the Rumack-Matthew nomogram is employed, and will help guide antidote therapy. Serum acetaminophen levels will not be helpful until 4 hours post-ingestion, unless something that slows GI transit time and absorption has been taken as well. N-acetylcysteine or "NAC", is the antidote for Tylenol. If given within eight hours of ingestion it can prevent any liver toxicity. It can also be started any time a serious ingestion is suspected. Keep in mind, delayed-release Tylenol, certain populations, and conditions can obscure the diagnosis and in those settings the Rumack-Matthew nomogram can no longer be used. Chronic alcoholics who have just stopped drinking and malnourished patients are at higher risk of toxicity. Subacute and chronic ingestion is also very common. Essential lab tests include serum acetaminophen levels, ALT and AST, and INR. One would expect any or all of these to be elevated in significant toxicity. If they are, NAC is given intravenously for nearly 24 hours. NAC won't reverse hepatotoxicity that has already occurred, but will prevent more from happening. Dextromethorphan: Dextromethorphan, referred to sometimes as "robotripping" or "robo-frying". Taken in excess causes an individual to become disassociated. It is an NMDA antagonist, like ketamine, LSD and PCP. Expect to see the same clinical signs of serotonin excess, as well as dystonia. Patients can alternate dramatically between vacant blank stares, to incredibly violent outbursts. Patient and staff safety is a crucial element in treating this toxidrome. Rotatory nystagmus, a distinctive rapid "clock ticking" of the eyes is diagnostic of this type of ingestion. Loperamide: When Loperamide, an over-the-counter antidiarrheal, is used in abuse it can lead to death. It acts similar to opioids, slowing down the GI tract but without the central effects, because it is actively expelled from the CNS. In large doses, however, it delivers an opioid-like high. Loperamide can cause respiratory depression, but also persistent arrhythmias. The lethal effects are due to loperamide's potassium channel blocker properties causing profound QT prolongation, sinusoidal waves and can lead to cardiac arrest. Potassium channel blockade is difficult to treat. ACLS drugs, electrolyte normalization like magnesium infusions, and even Narcan can be given, but more than likely these incredibly sick patients will need ECMO. Ibuprofen: Ibuprofen is, overall, a safe drug. Large quantities of the drug have to be taken for toxic effects. If taking over 200mg/kg if Ibuprofen, a patient is likely to have some GI symptoms and possibly an acute kidney injury. treatment would include possible admission for antiemetics and IV fluids. Ibuprofen is metabolized as a propionic acid anion. If ore than 400mg/kg are taken, it will result in an anion gap metabolic acidosis. At over 600mg/kg, a whole constellation of symptoms results: seizures, hypotension, and cardiac shock. These patients are severely ill and may require ECMO for an extended period of time. At this dosage, a 100kg patient would need to take 300 pills. Which leads to the question, "How did they fit that many pills in their stomach?" Activated Charcoal: Finally, a note on activated charcoal. It works great for almost everything, except alcohol ingestion and metals, by binding drugs in the GI tract. Drug absorption is decreased by 60% if given within an hour. It should be avoided if the airway is compromised or if the patient is a risk for seizure. In an intubated patient with recent ingestion, it's given via nasogastric tube. Thank-you for listening.
Nic Naitanui is one of Australia's most recognisable sports stars. The West Coast Eagle has overcome so much adversity across his life to get to where he is. In the past six years alone, the boy from Fiji lost his beloved Mum, played in a losing grand final, did two ACLs and then watched from the sidelines as his teammates won a premiership. All of it drives him every day. As you'll hear in this episode, Nic is a story teller who has always held onto his sense of humour and love of culture.
In this podcast Dr. Demetri Yannopoulos, a interventional cardiologist with M Health Fairview and Interventional Cardiology Researcher Director with the University of Minnesota-Twin Cities, discusses ECPR (ECMO Cardiopulmonary Resuscitation), the recent Arrest Trial and the Mobile ECMO program. Enjoy the podcast! Objectives: Upon completion of this podcast, participants should be able to: Define the importance of time and quality of CPR on outcomes from out-of-hospital cardiac arrest (OHCA). Explain the role of ECPR and ECMO teams in the management of out-of-hospital cardiac arrest (OHCA) refractory cardiac arrest. Review the current state of the art management of cardiac arrest and the reorganization of EMS/hospital response to out-of-hospital cardiac arrest (OHCA). CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at email@example.com. Click on the following link for your CME credit: CME Evaluation: "ECPR (ECMO CPR): The Cardiac Resuscitation Frontier with Dr. Demetri Yannopoulos (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for Continuing Education (CE) and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview and Ridgeview Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws. It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on this presentation. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Demetri Yannopoulos, MD has received honoraria from Helmsley Charitable Trust and the National Institute of Health (NIH) within the past 24 months, as a grant for research studies. Upon an independent review of his presentation, confirms he is following ACCME guidelines, and there is no commercial tie to the named agencies and no impact on his podcast presentation. Ridgeview's Continuing Education Committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Chapter 1: CPR was introduced in the 1960s. At the time, research at John Hopkins was being conducted on pigs in ventricular fibrillation and ventricular tachycardia who required defibrillation. It was noted that when pushing defibrillation paddles against the chest wall, the arterial pressure of the subjects increased. It was concluded that with compression, pulsatile flow was generated. This was essentially the first iteration of closed chest CPR. Over the next 50 years or so, clinicians have been looking for better ways to improve survival outcomes. Key factors include early identification, early CPR, along with obtaining resources and assistance to improve ventilation, perfusion, and defibrillation. Poor predictors of survival for cardiac arrest include CPR for greater than 30 minutes and individuals with coronary artery blockage. With the integration of ECMO, it was found that by bypassing the heart and lungs and essentially taking on their functions, outcomes improved. Dr. Yannopoulos reiterates that CPR for greater than 30 minutes results in poor outcomes, thereby creating a goal to both normalize pressures during this time while also fixing the offending cause, such as a coronary artery occlusion. Around 2015, in the Minnesota metro area, visionary EMS directors implemented an alternative option: If a patient fails three shocks, with ongoing CPR, the patient was transferred to a tertiary care facility with ECMO cannulation capabilities. Once on ECMO, these patients were transferred to the University of MN where they underwent PCI to evaluate for reversible causes such as occluded coronary vessels, PE, etc. Outcomes of this therapy showed 30-40% patient survival, which is a game changing result, thus the need for a randomized control trial, the ARREST Trial. Chapter 2: The ARREST Trial studied a group of patients with out-of-hospital cardiac arrest (OHCA) in ventricular fibrillation, refractory to defibrillation and initial ACLS treatment. This was a randomized control trial where one group was randomized to an ECMO intervention arm, versus a standard ACLS therapy arm. It was a phase 2, single center, open-label, adaptive, safety and efficacy randomized clinical trial. Specific subject criteria included adults aged 18-75 with OHCA, refractory ventricular fibrillation, with no return of spontaneous circulation (ROSC) after three shocks, with an automated cardiopulmonary resuscitation device or LUCAS device and estimated transfer time shorter than 30 minutes. The primary outcome of the trial was survival to hospital discharge. Secondary outcomes included safety, survival and functional assessment at hospital discharge, at 3 months and 6 months after discharge. Results of the ACLS arm showed a 7% survivability, and zero at both three and six months, while the ECMO arm fared better with a 43% survivability. After enrolling 30 patients, the study was terminated at the first pre-planned interim analysis by the National Heart, Lung and Blood Institute after a unanimous recommendation from the Data Safety Monitoring Board, because the posterior probability of ECMO superiority exceeded the prespecified monitoring boundary. Cumulative 6-month survival was significantly better in the early ECMO group compared to the standard ACLS group. No unanticipated serious adverse events were observed. Conclusion: early ECMO-facilitated resuscitation for patients with OHCA and refractory ventricular fibrillation, significantly improved survival to hospital discharge compared with standard ACLS treatment. Chapter 3: The Minnesota Mobile Resuscitation Consortium or MMRC, which was the first program to serve an entire metropolitan area in order to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). This was an observational cohort study that analyzed consecutive patients prospectively enrolled in the MMRC's ECMO-facilitated resuscitation program. Entry criteria were identical to the ARREST Trial, adults 18-75 with an out-of-hospital cardiac arrest in VF or CT with no return of spontaneous circulation post 3 shocks, use of a LUCAS or automated cardiopulmonary resuscitation device, and an estimated transfer time of less 30 minutes. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. CPC 1 results in good cerebral performance: conscious, alert, able to work, that might have some mild neuro or psych deficits. CPC 2 results in moderate cerebral disability; conscious, sufficient cerebral function for independent activities of daily living (ADLS). Secondary endpoints included 3-month functionally favorable survival. Between the period of December 1, 2019 and April 1, 2020, 63 consecutive patients were transported, and of these 58 were treated by the mobile ECMO service. Post EMCO treatment 25 of the 58 or 43% were both discharged from the hospital and alive at 3 months with CPC 1 or 2. This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months. Chapter 4: As the research continues, reaching 25-30% positive outcomes would be adequate to start a viable program. Dr. Yannopoulos speculates that with overall system improvement and refined protocols, that number can be as high as 70-80%, which is an incredible number. The future of ECPR will require a combined effort of the healthcare systems, policy makers, administrators, and communities. With a successful program in the urban and suburban areas, future research can hopefully expand access to more rural populations. Dr. Yannopoulos emphasizes that this is not a hospitalized based program, it relies on the EMS system, and those providers, especially medics, are key to the success of the program. At the time of this interview, the mobile ECMO program was on hold due to COVID, but currently the mobile ECMO program has a pending restart date of March 1st. Thanks for listening.
This session will review the latest evidence for resuscitative hysterotomy (aka perimortem cesearean section), in light of the latest ACLS guidelines. Is there really evidence for the 4 minute rule? How fast do we need to do this? Terrified of this risky procedure? Come learn some practical tips for getting through this as effectively as possible. For more head to: codachange.org/podcasts
When you think of cartilage, you think of Dr. Bert Mandelbaum. Other Fro titles for Dr. Mandelbaum include "Defenders of ACL's" and the "OG and pioneer of orthopedic medical care for soccer in the US." The key discussion points include: -Cedars-Sinai Kerlan-Jobe Institute is now the largest sports medicine fellowship in the world and discussed taking the legacy of Kerlan-Jobe to the next level with research -His mission of concepts, techniques and technology with commitment in fellowship to train leaders through mentorship -Cartilage procedures such as MACI, PACI and BMAC -Orthobiologics and regenerative medicine to establish a path with evidence-based information -We had to talk soccer with the "Defender of ACLs" and discuss the FIFA prevention program with 11 core exercises to help reduce ACL injuries Find out more about Dr. Bert Mandelbaum here. Thank you to our partner OrthoLazer for making this episode of The Ortho Show possible.
The rate of successful resuscitation of patients having a cardiac arrest in the hospital have not improved during the last 40 years that hospital personnel have been relying on ACLS protocols. In this episode I discuss why ACLS fails and what it will take to move forward.
ACLS part 2: let’s talk when we use amiodarone, atropine, verses adenosine...what are the different time frames for each guideline? How long do you have for tPa? Verses door to balloon time? And how do we keep it all straight?! That’s what I’m here for friends! Show note: “99 red balloons” is the song by Nena (a German artist) that I have given you the homework of listening too. As always, none of the information in this podcast is indicated to diagnose or treat. You should always check your current guidelines and only practice within your scope. As I cannot guarantee that when you listen to this recording guidelines and standards are up-to-date, you cannot rely upon this podcast. The purpose of this podcast is to help you learn how to study and think of different ways to remember the things that you need to know.Feel free to reach out to me @DrLaurenAPRN on Instagram for any questions, comments or requests! I’m here for y’all!
Electrical storm has dismal outcomes. It is most frustrating because we know the cause is very likely coronary occlusion (~75%)! We have added esmolol to our tool belt here at MCHD to try and improve refractory VF outcomes. Others are trying early ECMO in this patient population. Prior eCPR studies have all been retrospective. Join the podcast crew as they discuss a recent Lancet article looking at eCPR vs. standard ACLS in refractory VF. Randomized, prospective, and quite amazing. REFERENCES https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32338-2/fulltext
In part 2 of the cardiac arrest series, Dr. Rebecca Gragg, an ER pharmacist at a pediatric trauma center, discusses some key points from the 2020 PALS guidelines.References:Antevy, P. Handtevy method helps providers rapidly calculate pediatric drug dosages. JEMS. 2013; 8 (38). Available at: https://www.jems.com/2013/08/20/handtevy-method-helps-providers-rapidly/Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S469- 523
BrakeSec Sponsored Interview with Nathanael Iversen Questions, comments, and other content goes here: Illumio Nathanael Iversen BDS Podcast Messaging Topic: Overview of development and deployment of micro-segmentation Where does segmentation fit into your security strategy? Micro-segmentation is a preventive measure deployed to create and enforce access at the workload layer. It does not replace identity and access management (IAM), perimeter firewalls, or patching but complements such solutions. Because traditional network segmentation is done with network devices, it only works when the traffic passes through that control point. Micro-segmentation, on the other hand, shifts the enforcement point from the network onto the individual servers and hosts. The means that segmentation policy can be much more granular and can encompass all inbound and outbound traffic, not just the traffic leaving a network zone, VLAN, or environment. Micro-segmentation is a great deterrent for hackers. More organizations are implementing micro-segmentation as an essential part of a defense-in-depth strategy. According to a recent survey of over 300 IT professionals, 45% currently have a segmentation project or are planning one. The keys to a successful micro-segmentation deployment: As with any security control, it’s important to balance the strategy of the business with the need to secure it. There are several key functions and abilities to consider to ensure your deployment goes smoothly: Visibility with application context Scalable architecture Abstracted security policies Granular controls Consistent policy framework across your compute estate Integration with security ecosystem Preventative Cybersecurity There are three broad preventive security actions: First is controlling the ability to reach the device or target service via the network. Clearly, if you cannot even get to the sensitive data or application, then no amount of vulnerabilities will permit compromise. Often terms like firewall, access control lists (ACLs), VLANs, zones, and the like describe these capabilities. This function is generally implemented by the network team or a dedicated network security team. The second broad action available controls the ability to access a device, data or service once you get there. This covers the entire world of credentials, user accounts, permissions, authentication, authorization, tokens, API keys, etc. If you get to the front door of my house and it is locked, you can’t gain access unless you have the right key. The third broad strategy addresses the fact that often malicious behavior exploits some bug or weakness. So, if one can remove vulnerable code, then in many cases, malicious intent can’t be realized. This involves patching, replatforming applications to stronger platforms, doing code reviews, and more. Potential questions: What is micro-segmentation? How long has it been around? Can micro-segmentation be used in conjunction with other cybersecurity tools? Like firewalls? How does micro-segmentation operate in different environments? How does development and deployment differ in the cloud vs. on-prem? What does a successful micro-segmentation deployment look like? Tell us about the common challenges people face in their micro-segmentation projects. What misconceptions do people have about micro-segmentation? What is the difference between having a proactive vs. reactive security strategy? Can you explore the ‘cost’ of preventative cybersecurity in 2020? I.e., how much can your organization save by preventing breaches, vs. paying off ransomware attackers? Or losing customer trust via a public breach? What does micro-segmentation adoption look like as we head into the new year? What is the future of micro-segmentation? Segmentation of database areas? Logs?
Vea la parte 1 aquí. Taquicardias El algoritmo de taquicardias de la actualización 2020 de ACLS es, en esencia, el mismo algoritmo anterior. Aunque no hay cambios en las recomendaciones, el algoritmo aclara algunas situaciones, y complica otras. Existen diferentes tipos de desfibriladores bifásicos que pueden administrar diferentes niveles de energía logrando el mismo resultado. Aunque 100 J sean un punto común de partida para la cardioversión sincronizada de la mayoría de las arritmias, algunas tecnologías específicas pueden lograr lo mismo con menos energía. Un aspecto relevante a recordar es que: El beneficio de cardiovertir una arritmia hemodinámicamente inestable es mayor que el potencial daño al músculo cardiaco, aún con niveles altos de energía. Si no convierte, aumente la energía para la segunda dosis. Algunas arritmias son notables porque NO convierten con dosis bajas de energía. Por ejemplo, es relativamente común tener que cardiovertir una fibrilación atrial con niveles altos. Si se comenzara inadvertidamente con una dosis baja, simplemente se aumenta la energía en una descarga subsiguiente. El algoritmo anterior reflejaba esto diciendo que la primera descarga debía ser entre 120 J y 200 J bifásicos (que equivalen a 360 J monofásicos). El algoritmo nuevo no hace esta aclaración o distinción debido a la variación que puede haber entre una marca de equipo y otro. Por ejemplo, puede ver aquí el protocolo de desfibrilación de ZOLL. Este otro documento habla de las diferencias entre la energía bifásica y la bifásica truncada. Por otro lado, el otro cambio que el algoritmo tiene es precisamente diciendo lo mismo que acabo de mencionar. El algoritmo tiene un nuevo segmento que dice qué hacer cuando la cardioversión no funciona. Si la cardioversión no funciona, ¡aumenta la dosis de energía! En adición, sugiere identificar la causa de la taquicardia y/o añadir un antiarrítimico al manejo. Sonografía durante el paro cardiaco En este episodio previo del ECCpodcast hablamos sobre el rol de la sonografía para entender lo que ocurre con el paciente en paro cardiaco. Es importante señalar que el rol de la sonografía en este momento no es el pronosticar el éxito del intento de reanimación y/o decidir que se debe detener la reanimación basado en ausencia de signos alentadores a través de la sonografía (ausencia de movimiento de la pared ventricular, etc.). El rol de la sonografía en este momento debe ser en ayudarnos a entender la causa del paro cardiaco e identificar qué acciones pueden tener la mayor oportunidad de éxito. Situaciones especiales: intoxicación con opioides La intoxicación con opioides provoca depresión respiratoria. La depresión respiratoria puede ser desde leve hasta provocar apnea. Aunque la naloxona (IN, IM o IV) es el antídoto a la intoxicación con opioides, lo primero que debe ser obvio es la necesidad de mantener la vía aérea abierta y una ventilación adecuada. No ignore la posibilidad de que el paciente esté en paro cardiaco por otra razón. Puede ver el algoritmo de paro cardiaco por intoxicación con opioides aquí. Situaciones especiales: Paro cardiaco en mujeres embarazadas Vea el algoritmo de cuidado a mujeres embarazadas en paro cardiaco aquí. Debido a que las pacientes embarazadas son más propensas a sufrir hipoxia, se debe priorizar la oxigenación y el manejo de la vía aérea durante la reanimación del paro cardíaco. (Clase de Recomendación: 1, Nivel de Evidencia: C-LD) Debido a la posible interferencia con la reanimación materna, no se debe llevar a cabo el monitoreo fetal durante el paro cardíaco en embarazadas. (Clase de Recomendación: 1, Nivel de Evidencia: C-EO) Recomendamos un manejo específico de la temperatura para embarazadas que permanecen en estado comatoso después de la reanimación del paro cardíaco. (Clase de Recomendación: 1, Nivel de Evidencia: C-EO) Durante el manejo específico de la temperatura de la paciente embarazada, se recomienda supervisar continuamente al feto para detectar bradicardia como una posible complicación, y se debe realizar una consulta obstétrica y neonatal. (Clase de Recomendación: 1, Nivel de Evidencia: C-EO) Cuidado médico pos-paro Vea el algoritmo de cuidado posparo aquí. El algoritmo de las guías 2015 presentaba cuatro aspectos importantes. Los cuatro elementos importantes que el paciente posparo necesita son: Mantener una oxigenación adecuada Mantener una perfusión adecuada Corregir la causa (en adultos, sospechar el SCA) Proteger el cerebro Esta lista no es exhaustiva. El curso PALS provee una lista de cotejo mucho más detallada que incluye otros aspectos a considerar. Cuidado médico pos-paro: Mantenerlo vivo El algoritmo muestra dos pasos iniciales muy importantes: mantener una ventilación y circulación adecuada. Estos dos pasos se enseñan secuencialmente pero se hacen simultáneamente. La frecuencia respiratoria debe ser lo suficiente para mantener un PaCO2 entre 35 mmHg y 45 mmHg y una oxigenación entre 92% a 98%. Anteriormente la recomendación era simplemente mantener la saturación sobre 94%. El monitorear los niveles de CO2 puede ser importante en pacientes que tengan presión intracranial elevada ya que la circulación cerebral responde a los niveles de CO2. Si el PaCO2 disminuye de 35 mmHg, ocurre vasoconstricción en la circulación cerebral. Vice versa, cuando los niveles de CO2 aumentan sobre 45 mmHg, ocurre vasodilatación en la circulación cerebral. Bajo condiciones normales, el cuerpo humano puede autorregular el flujo sanguíneo para mantener una presión intracranial aceptable. En pacientes cuyo problema incluya un problema de aumento en la presión intracranial, previo al cuidado definitivo, es importante proteger al cerebro de una lesión secundaria si los niveles de CO2 cambian y la circulación cerebral se disminuye o aumenta inapropiadamente. Colocación temprana del tubo endotraqueal Primum non nocere. Primero, no cause más daño. La intubación endotraqueal y ventilación mecánica en pacientes posparo es común. A no ser que el paciente recupere consciencia inmediatamente ocurra el retorno de circulación espontánea, el paciente posparo está inconsciente y por lo tanto no puede confiársele proteger su propia vía aérea. También pudiera ser que recupere pulso, pero no recupere respiración inmediatamente y requiera ser ventilado. La causa del paro cardiaco pudiera incluir alguna etiología que trastoque el equilibrio ácido-base y la ventilación del CO2 excesivo pudiera ser esencial para corregir la acidosis. Sin embargo, en otros episodios del ECCpodcast hemos discutido la importancia de cómo prevenir el paro cardiaco peri-intubación. El paciente en paro cardiaco puede estar hipoxémico, hipotenso y acidótico. Cada uno de estos tres factores pueden provocar hipotensión y/o un colapso circulatorio inmediatamente antes, durante o después de la intubación endotraqueal. Entonces, primero resucite y oxigene el paciente... luego lo intuba. Eso nos lleva al siguiente punto, corregir la hipotensión, lo cual pudiera ser necesario realizar concurrentemente mientras se prepara al paciente y al personal para la intubación. La presión arterial sistólica mínima debe ser 90 mmHg (presión arterial media de 65 mmHg). Es importante considerar mejorar la precarga para subir la presión, pero debemos dejar de pensar solamente en los fluidos como herramienta para mejorar la presión. Es necesario tener una cantidad adecuada de fluidos. Si la causa de la hipotensión es hipovolemia, el administrar fluidos puede ser útil. Sin embargo, si la causa no es hipovolemia, darle más fluido no debe ser la única estrategia. En este caso, el uso temprano de vasopresores puede ser útil. En este otro episodio del ECCpodcast se discute el uso de vasopresores en bolo para el manejo de hipotensión temporal, por ejemplo, secundaria al manejo de la vía aérea en un paciente susceptible. Cuidado médico pos-paro: Neuropronóstico Se teoriza que una de las posibles causas de malos resultados por paro cardiaco pudiera ser el retirar el cuidado médico demasiado temprano. A veces puede ser que algunos cerebros simplemente necesiten más tiempo. La actualización 2020 de ACLS provee una referencia más tangible de qué herramientas pueden servir para evaluar el paciente que tuvo un insulto cerebral anóxico y está comatoso posterior al retorno de circulación espontánea. Como parte de la evaluación en la unidad de cuidados intensivos. es importante medir inmediatamente el nivel de glucosa, electrolitos, y considerar los medicamentos de sedación, anestesia o bloqueo neuromuscular que pueden alterar el nivel de consciencia posterior al retorno de circulación espontánea, pero esto ya es valorado en el cuidado posparo en toda unidad de cuidados intensivos. La actualización 2020 de ACLS hacen referencia al uso de pruebas multimodales solamente luego de las primeras 72 horas posterior al retorno de circulación espontánea. Rehabilitación y recuperación Recomendamos que los sobrevivientes de un paro cardíaco tengan una evaluación y un tratamiento de rehabilitación multimodales para trastornos físicos, neurológicos, cardiopulmonares y cognitivos antes del alta hospitalaria. (Clase de Recomendación: I, Nivel de Evidencia: C-LD) Recomendamos que los sobrevivientes de un paro cardíaco y sus cuidadores reciban una planificación del alta integral y multidisciplinaria que incluya recomendaciones de tratamiento médico y de rehabilitación y las expectativas de regreso a la actividad / trabajo. (Clase de Recomendación: I, Nivel de Evidencia: C-LD) Recomendamos realizar una evaluación estructurada de la ansiedad, la depresión, el estrés postraumático y la fatiga de los sobrevivientes de paro cardíaco y sus cuidadores. (Clase de Recomendación: I, Nivel de Evidencia: B-NR) Los pacientes necesitan apoyo para entender la causa por la cual tuvieron el evento, y cómo prevenir una nueva ocurrencia. Esto puede inclusive incluir apoyo para el regreso a actividad niveles normales pre-evento. Debido a la importancia que tiene la rehabilitación y recuperación, la AHA ha añadido un eslabón más a la icónica "cadena de sobrevivencia" que ilustra los elementos en el sistema de cuidado para el éxito del paciente con paro cardiaco. Debriefing para los respondedores Pueden ser beneficiosos los debriefings y las derivaciones para dar apoyo emocional a reanimadores legos, proveedores de SEM y trabajadores de la salud hospitalarios después de un paro cardíaco. (Clase de Recomendación: IIb, Nivel de Evidencia: C-LD) Conclusión de la actualización 2020 de ACLS La siguiente infográfica ayuda a resumir algunos de los aspectos claves de la actualización. La actualización 2020 de ACLS provee cambios importantes en el manejo del paciente. El adiestramiento completo, prácticas frecuentes y retroalimentación efectiva salva vidas. Referencias Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM; on behalf of the Adult Basic and Advanced Life Support Writing Group. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(suppl 2):S366–S468. doi: 10.1161/CIR.0000000000000916 Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, et al: on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141:e139–e596. doi: 10.1161/CIR.0000000000000757
La Actualización 2020 de ACLS la American Heart Association son la entrega más reciente de la evaluación de la ciencia y recomendación de tratamientos en atención cardiovascular de emergencia. La actualización 2020 de ACLS de Advanced Cardiovascular Life Support, o Soporte Vital Cardiovascular Avanzado, provee las recomendaciones de atención médica de emergencia para víctimas que sufren un paro cardiorrespiratorio. A continuación haremos un resumen de los aspectos más destacados de esta entrega de recomendaciones nuevas. Note que esto no es el contenido completo del curso de ACLS, o de las otras recomendaciones importantes hechas en años recientes. Si usted no ha tomado un adiestramiento de ACLS (Soporte Vital Cardiovascular Avanzado), puede ver nuestro calendario e inscribirse aquí. Algunas de las recomendaciones en la actualización 2020 de ACLS no necesariamente son recomendaciones nuevas, sino una revalorización de la evidencia o de las recomendaciones basadas en nuevos artículos. Por lo tanto, es posible que algunos textos sean similares a los anteriores. Hay que mejorar la implementación La fórmula Utstein de sobrevivencia dice que: Guías basadas en evidencia + educación + implementación = sobrevivencia De nada vale tener la mejor evidencia y buenas recomendaciones si el personal no las conoce. Pero, de nada vale conocerlas, si no se implementan. Tenemos evidencia de intervenciones que funcionan, y tenemos sospechas de que algunas terapias pueden funcionar, pero no pueden descartarse hasta que se implementan. No podemos decir que una intervención fracasa hasta que se implementa correctamente. Aquí es donde estamos viendo oportunidades de mejora. Por ejemplo, sabemos que el tiempo es cerebro. Cuando una persona sufre muerte súbita, los testigos deben iniciar la RCP de inmediato. Sin embargo, no lo hacen. RCP temprana por testigos Según las estadísticas provistas por la AHA, en los EEUU, solamente un 39.2% de los pacientes en paro cardiaco reciben RCP por parte de un testigo, y solamente un 11.9% usa un desfibrilador externo automático (AED, por sus siglas en inglés). Los testigos tienen que comenzar a realizar RCP antes de que llegue el personal del servicio de emergencias médicas y otros rescatistas. "Recomendamos que los reanimadores legos inicien RCP para tratar un presunto paro cardíaco porque el riesgo de daño al paciente es bajo si este no sufre un paro cardiaco." (Clase de Recomendación: 1, Nivel de Evidencia: C-LD) Retroalimentación en tiempo real No es suficiente hacer lo correcto... hay que hacerlo correctamente. Es un juego de palabras pero tiene un significado. Todos sabemos que hay que realizar buena RCP. Si nos preguntan, ¡todos afirmamos que hacemos buena RCP! Sin embargo, la realidad es otra. Si usted es un instructor de RCP, y usted usa un dispositivo que mida la calidad de la RCP, usted sabe a lo que me refiero. La mayoría de las personas no dan buenas compresiones cardiacas. Sin embargo, con algunas correcciones leves, son capaces de hacerlo correctamente... y mantenerlo correctamente. Pero, luego ocurre otro fenómeno... el cansancio físico, y la calidad de las compresiones vuelve a sufrir. Aunque el compresor está dando un buen esfuerzo, ese buen esfuerzo cada vez logra menos calidad. Aquí es donde el dispositivo de retroalimentación provee una última oportunidad de motivar al compresor a mejorar el esfuerzo. Los reanimadores deben intercambiar posiciones cada 2 minutos para evitar la fatiga. Puede resultar razonable utilizar dispositivos de retroalimentación audiovisuales durante la RCP para la optimización en tiempo real del rendimiento de la RCP. (Clase de Recomendación 2b, Nivel de Evidencia: B-R) Puede ser razonable utilizar parámetros fisiológicos como la presión arterial o el ETCO2, cuando sea posible, para controlar y optimizar la calidad de la RCP. (Clase de Recomendación: 2b, Nivel de Evidencia: C-LD) Acceso IV versus IO En este momento, IV es preferible a IO. Central sería ideal, pero toma tiempo y las interrupciones son significativas. Sabemos que IV es igualmente efectivo. Sabemos que IO funciona, pero la revisión de literatura no permite hacer un análisis definitivo porque la data es inconclusa o los estudios han tenido limitaciones. En este momento, IV es preferible a IO. Más adelante esto pudiera cambiar según se estudien los diferentes sitios de administración (tibia versus húmero, por ejemplo) Es razonable que los profesionales de la salud intenten primero establecer el acceso IV para la administración de medicamentos en los casos de paro cardíaco. (Clase de Recomendación: 2b, Nivel de Evidencia: B-NR) Se puede considerar el acceso IO si los intentos de acceso IV no se realizan correctamente o no son factibles. (Clase de Recomendación: 2b, Nivel de Evidencia: B-NR) Adrenalina (epinefrina) en paro cardiaco No hay cambios en el algoritmo de paro cardiaco. El uso de adrenalina en paro cardiaco ha sido un tema de debate por diversos estudios que han demostrado que los pacientes que reciben adrenalina cuando están en paro cardiaco tienen mayor retorno de circulación espontánea, especialmente si se usa en la etapa temprana del paro cardiaco. El algoritmo tiene dos nuevos iconos para recordar que la intervención inicial más importante en el paro cardiaco con ritmo desfibrilable es realizar la desfibrilación mientras que en el ritmo no-desfibrilable puede ser administrar adrenalina. Con respecto al momento de la administración, en caso de un paro cardíaco con ritmo no desfibrilable, resulta razonable administrar la adrenalina tan pronto como sea posible. (Clase de Recomendación: 2a, Nivel de Evidencia: C-LD) Con respecto al momento de la administración, en caso de un paro cardíaco con un ritmo desfibrilable, pudiera ser razonable administrar la adrenalina después de que los primeros intentos de desfibrilación hayan fallado. (Clase de Recomendación: 2b, Nivel de Evidencia: C-LD) La traducción de la recomendación al español menciona incorrectamente ambos con la frase "es razonable". Sin embargo, en la versión en inglés hace la distinción que la primera "es razonable" (it is reasonable) pero la segunda "pudiera ser razonable" (it may be reasonable). Esto es importante en vista de la diferencia en la clase de recomendación. En este previo episodio del ECCpodcast discutimos el rol de la epinefrina en el manejo del paciente en paro cardiaco fuera del hospital en vista del estudio PARAMEDIC2. Desfibrilación en secuencia doble Ahora que estamos dando mejores compresiones, y estamos manteniendo la perfusión al miocardio por más tiempo, los pacientes duran en fibrilación ventricular más tiempo. Aunque muchos pacientes convierten en la primera o la segunda desfibrilación, otros pudieran no convertir a pesar de que se les está dando la máxima energía disponible y se está manteniendo una excelente perfusión coronaria. Ante esta situación, se han planteado varias posible soluciones. Una es la de desfibrilar con más energía. Lamentablemente esto no se puede hacer con los equipos que tenemos hoy día porque lo más alto que llega es a 360 J. Pero, alternativamente, se ha estudiado la posibilidad de usar 2 equipos a la misma vez, resultando en dos descargas simultáneas, o dos descargas realizadas casi simultáneas (con una fracción de segundo de diferencia entre una y otra... de ahí el nombre en secuencia doble en vez de simultánea). El objetivo es lograr terminar la tormenta eléctrica que está ocurriendo durante la arritmia. La terapia con desfibrilación en secuencia doble puede lograr esto en teoría de dos formas diferentes: Puede ser que la dosis de energía más alta sea lo que el paciente necesita Puede ser que la colocación del segundo set de electrodos (usualmente antero-posterior, es decir, en el centro del pecho y en la espalda) sea lo que el paciente necesita. Los estudios en este momento no han dado una respuesta conclusa a esta intervención, y existe la posibilidad de que simplemente sea una variación en la colocación de los parches lo que hace la diferencia. No se ha establecido la utilidad de la desfibrilación secuencial doble para tratar un ritmo desfibrilable refractario. (Clase de Recomendación: 2b, Nivel de Evidencia: C-LD) Bradicardias: ajustes de dosis en atropina y en dopamina La AHA tiene diversos concilios, que a su vez publican diferentes recomendaciones. Por ejemplo, hay recomendaciones específicas sobre el manejo de síndromes coronarios agudos, accidente cerebrovascular isquémico, taquicardias supraventriculares, fibrilación atrial, taquicardias ventriculares, bradicardia, y otros temas en específico. En lo que respecta a atención cardiovascular de emergencia, la AHA busca mantener la consistencia y no redundar esfuerzo o publicar recomendaciones diferentes. Las guías de bradicardia del 2018 hacen referencia a 0.5 mg a 1 mg de atropina en bradicardias sintomáticas. El manejo del paciente con bradicardia sintomática consiste en determinar qué está causando la bradicardia y tratar la causa (por ejemplo, hipoxia). Mientras se identifica la causa, en pacientes con signos de compromiso hemodinámico, es razonable usar atropina. Aunque la atropina puede aumentar la frecuencia cardiaca, no siempre va a ser efectiva, especialmente cuando no atiende la causa de la bradicardia o en algunos tipos de problemas específicos de conducción del corazón. Por lo tanto, no debemos basar el manejo del paciente exclusivamente en el uso de atropina. La actualización 2020 de ACLS realiza dos ajustes en el algoritmo de bradicardia con pulso pero no ofrece un trasfondo de por qué. Sin embargo, cuando vemos el cambio, realmente no es muy diferente. Atropina 1 mg en vez de 0.5 mg. La atropina se puede repetir cada 3-5 minutos hasta un máximo de 3 mg. La infusión de dopamina es de 5-20 mcg/kg/min en vez de 2-20 mcg/kg/min. La dosis de dopamina se titula usualmente cada 5 minutos hasta lograr la respuesta deseada. El efecto deseado en este contexto es la estimulación de los receptores beta y alfa. La dopamina puede estimular tres receptores dependiendo de la dosis: 1-5 mcg/kg/min - receptores dopaminérgicos 5-10 mcg/kg/min - receptores beta 10-20 mcg/kg/min - receptores alfa El punto de inflexión donde cambia el efecto no es exacto o preciso. En algunos pacientes ocurre en dosis más bajas, y en otros ocurre en dosis más altas. Es importante ajustarlo.
Ever thought in detail about how people die? I suppose that for most this morbid subject is not dwelled upon, but for 40 years it has been a big part of my job. Experience has taught me that people die in many ways. And this is a problem since most medical personnel are trained to understand one model of the dying process and it is one that they are unlikely to often encounter. On this podcast I outline a different scheme for understanding this process that will finally allow caregivers to progress beyond ACLS.
In part 1 of the cardiac arrest series, we review some key recommendations and clinical pearls from the 2020 adult BLS and ACLS guidelines. References: Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142: S366-S468Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19. Circulation. 2020; 141 (25): e933- 943Velissaris D, Karamouzos V, Pierrakos C, et al. Use of sodium bicarbonate in cardiac arrest: current guidelines and literature review. J Clin Med Res. 2016; 8 (4): 277-283Murchison C. Sodium bicarbonate therapy does not work in cardiac arrest. Updated November 5, 2018. Accessed December 1, 2020. http://www.emdocs.net/sodium-bicarbonate-therapy-does-not-work-in-cardiac-arrest/
Intuition: it’s really simple, and it’s really hard. It is, like most things, a practice. The voice of our intuition is always there, but we listen selectively. Buffy weaves stories of torn ACLs, blue necklaces, and a dangerous hot springs encounter, which will have you both holding your breath and breathing more deeply afterward.This week, get quiet enough to hear yourself. Get low enough to the ground to prioritize listening for what’s next. The thing is, we usually know what to do, but we don’t usually slow down enough to listen. Your body is likely talking to you already.She references Doe Zantamata in this episode.
Brian answers your Tuesday mailbag questions. 49ers get MRI confirmation that both Nick Bosa and Solomon Thomas will miss the remainder of 2020 with torn ACLs. Jimmy Garoppolo's high ankle sprain is less severe than feared.. The team signed free agent Ziggy Ansah to bolster the defensive line. Support Us By Supporting Our Sponsors! Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKEDON,” and you’ll get $10 off your first order. MyBookie INVEST IN YOUR INTUITION. USE PROMO CODE LOCKEDON AND DOUBLE YOUR FIRST DEPOSIT. NEW PLAYERS GET UP TO $1,000 IN FREE PLAY - DESIGNED TO ADD MORE EXCITEMENT TO THE SPORTS YOU LOVE AND THE GAMES YOU BET. YOUR WINNING SEASON BEGINS TODAY...ONLY AT MYBOOKIE! NFL Game Pass This season, get football on your time with NFL Game Pass. See all the action from every game with full game replays.Go to nfl.com/gamepass to start your free trial today. Keeps If you’re ready to take action and prevent hair loss, go to Keeps.com/lockedonnfl to receive your first month of treatment for free. Learn more about your ad choices. Visit megaphone.fm/adchoices
Supposed NFC contenders fell to 0-2, star players look to be out for the year with major injuries, and Week 2 might as well be Week 2020 for the NFL. Teams fear Saquon Barkley and Nick Bosa tore their ACLs, while the Vikings and Eagles take the collar through two weeks. Peter Bukowski brings on the local experts to take on the biggest stories of Week 2. Spoiler Alert: Expect pain. Learn more about your ad choices. Visit megaphone.fm/adchoices