Podcasts about bipap

Contributor: Travis Barlock, MD Educational Pearls: Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation Narrowed bronchioles lead to turbulent airflow → creates the wheezing Crackles (rales) suggest pulmonary edema which is often due to heart failure Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs Diagnosing wheezing due to heart failure (cardiac asthma): Symptoms: orthopnea, paroxysmal nocturnal dyspnea Diagnostic tools: bedside ultrasound Treatment: diuresis and BiPAP for respiratory support Not all wheezing is asthma Consider heart failure in the differential and tailor treatment accordingly References 1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063. 2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Is Upper Airway Resistance Syndrome (UARS) robbing you of your health? In this eye-opening episode, Dr. Sinicropi sits down with Dr. Barry Krakow, author of Life Saving Sleep, to uncover the hidden world of UARS—a stealthy sleep disorder that's often ignored or misdiagnosed. From chronic fatigue to brain fog, anxiety, and metabolic disruptions, UARS wreaks havoc in ways you might not expect. Dr. Krakow explains why standard sleep studies often miss UARS and shares how advanced diagnostic tools, like esophageal pressure monitoring and RERA detection, can make all the difference. He also breaks down why BiPAP therapy may outshine CPAP for UARS patients, offering a more comfortable, effective treatment option. This conversation is packed with actionable insights, including lifestyle tips, treatment innovations, and how to advocate for the care you deserve.

In this episode, we explore the RENOVATE study, comparing high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV or BIPAP) for acute respiratory failure. Discover the pros, cons, and practical takeaways for using HFNC in the ICU and ED. 

Every great resuscitationist needs to understand the fine points of keeping your patients breathing - not only by securing an airway, but also by understanding ongoing ventilation. In this episode, EMRA*Cast host Blythe Fiscella, MD, reviews pearls and pitfalls of NIPPV with critical care expert Colin McCloskey, MD.

In this episode of The Common Sense MD, Dr. Rogers talks with certified respiratory care practitioner Carolyn Graham about the essentials of managing sleep apnea with CPAP machines. Discover practical cleaning tips, effective mask fittings, and the distinctions between central and obstructive sleep apnea. Dr. Rogers shares his experience with the OURA ring and home sleep studies, while Carolyn offers valuable insights into the Berlin Questionnaire and BiPAP benefits. Gain expert advice on compliance, maintenance, and the latest developments in sleep apnea treatment, ensuring better sleep and health outcomes. Tune in! What did you think of this episode of the podcast? Let us know by leaving a review! Connect with Performance Medicine! Check out our new online vitamin store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://performancemedicine.net/shop/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Sign up for our weekly newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://performancemedicine.net/doctors-note-sign-up/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@PMedicine⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@PerformancemedicineTN⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Performance Medicine

You never forget your most embarrassing nursing moment — especially when it happens in the middle of a critical situation. In this episode, Sarah recounts an unforgettable, cringe-worthy blunder during a rapid response call for a COPD patient in respiratory distress. Discover how she managed the patient's COPD exacerbation and advocated for the patient's care despite a lack of urgency from some on the medical team.Sarah also dives into the pathophysiology of COPD and intervention strategies, evaluating the pros and cons of the various oxygen delivery modalities like non-rebreather masks and BiPAP. Curious how an awkward moment turned into a valuable lesson for COPD care? Tune in now!Topics discussed in this episode:The embarrassing BBQ incidentLessons from a COPD patient storyPathophysiology of COPDThe truth about hypoxic driveOxygen therapy and choosing the right delivery method for your patientWhen intubation is the best interventionMentioned in this episode:Rapid Response and Rescue Intro CourseCONNECT

Join us for a fantastic conversation with an expert in the field of neuromuscular disorders, Dr. Kevin Flanigan. Dr. Flanigan is the director of the Center for Gene Therapy at Nationwide Children's Hospitals, which developed the first FDA-approved gene therapy to treat Duchenne Muscular Dystrophy. He teaches us when to include muscular dystrophy in the differential, how BiPAP extends the lives of patients with Duchenne, and what the latest gene replacement therapies have to offer. 

Lynette reached out for help with her daughter Karen and grandchildren Marno and Meane, who suffer from Myotonic Dystrophy. Marno urgently needs a Bipap machine to manage his nighttime breathing issues, while Karen and Meane also require Bipap and Cpap machines. Karen, a single mother and qualified teacher, relies heavily on her parents due to her condition and recent back surgery. The family's financial burden is immense, with Lynette's husband taking a second job to cover food, medical expenses, and therapy costs. Hot Cares

IntroductionWelcome to PICU Doc On Call, a podcast dedicated to current and aspiring pediatric intensivists. I'm Dr. Pradip Kamat from Children's Healthcare of Atlanta/Emory University School of Medicine, and I'm Dr. Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about medical education in the PICU. This podcast focuses on interesting PICU cases and their management in the acute care pediatric setting.Episode OverviewIn today's episode, we are excited to welcome Dr. Karen Zimowski, Assistant Professor of Pediatrics at Emory University School of Medicine and a practicing pediatric hematologist at Children's Healthcare of Atlanta at the Aflac Blood & Cancer Center. Dr. Zimowski specializes in pediatric bleeding and clotting disorders.Case PresentationA 16-year-old female with a complex medical history, including autoimmune thyroiditis and prior cerebral infarcts, was admitted to the PICU with acute chest pain and difficulty breathing. Despite being on low-dose aspirin, her oxygen saturation was 86% on room air. A CT angiography revealed a pulmonary embolism (PE) in the left lower lobe and signs of right heart strain. The patient was hemodynamically stable, and thrombolytic therapy was deferred in favor of anticoagulation. She was placed on BiPAP to improve her respiratory status. Her social history was negative for smoking, illicit drug use, or oral contraceptive use.Key Case PointsDiagnosis: Pulmonary embolism (PE)Hemodynamics: Stable with no right ventricular (RV) strain on echocardiogramManagement Focus: Anticoagulation and consultation with the hematology/thrombosis teamExpert Discussion with Dr. Karen ZimowskiRisk Factors and Epidemiology of VTE in PediatricsPathophysiology: Venous thromboembolism (VTE) in children involves components of Virchow's triad: stasis of blood flow, endothelial injury, and hypercoagulability.Incidence: VTE is rare in the general pediatric population but increases significantly in hospitalized children.Age Distribution: Bimodal peaks in infants and adolescents aged 15-17 years.Risk Factors: Central venous lines, infections, congenital heart disease, cancer, and autoimmune disorders.Clinical Manifestations of DVTSymptoms: Swelling, pain, warmth, and skin discoloration in the affected extremity.Specific Presentations:SVC syndrome from superior vena cava thrombosisAbdominal pain from portal vein thrombosisHematuria from renal vein thrombosisNeurological symptoms...

Contributor: Taylor Lynch, MD Educational Pearls: Opioid Epidemic- quick facts Drug overdoses, primarily driven by opioids, have become the leading cause of accidental death in the U.S. for individuals aged 18-45. In 2021, opioids were involved in nearly 75% of all drug overdose deaths The rise of synthetic opioids like fentanyl, which is much more potent than heroin or prescription opioids, has played a major role in the increase in overdose deaths What is Narcan AKA Naloxone? Competitive opioid antagonist. It sits on the receptor but doesn't activate it. When do we give Narcan? Respiratory rate less than 8-10 breaths per minute Should you check the pupils? An opioid overdose classically presents with pinpoint pupils BUT… Hypercapnia from bradypnea can normalize the pupils Taking other drugs at the same time like cocaine or meth can counteract the pupillary effects Basilar stroke could also cause small pupils, so don't anchor on an opioid overdose How does Narcan affect the body? Relatively safe even if the patient is not experiencing an opioid overdose. So when in doubt, give the Narcan. What if the patient is opioid naive and overdosing? Use a large dose given that this patient is unlikely to withdraw 0.4-2 mg every 3-5 minutes What if the patient is a chronic opioid user Use a smaller dose such as 0.04-0.4 mg to avoid precipitated withdrawal How fast does Narcan work? Given intravenously (IV), onset is 1-2 min Given intranasal (IN), onset is 3-4 min Given intramuscularly (IM), onset is ~6 min Duration of action is 60 mins, with a range of 20-90 minutes How does that compare to the duration of action of common opioids? Heroine lasts 60 min Fentanyl lasts 30-60 min, depending on route Carfentanyl lasts ~5 hrs Methadone lasts 12-24 hrs So we really need to be conscious about redosing How do you monitor someone treated with Narcan? Pay close attention to the end-tidal CO2 to ensure that are ventilating appropriately Be cautious with giving O2 as it might mask hypoventilation Watch the respiratory rate Give Narcan as needed Observe for at least 2-4 hours after the last Narcan dose Larger the dose, longer the observation period Who gets a drip? If they have gotten ~3 doses, time to start the drip Start at 2/3rds last effective wake-up dose Complications Flash pulm edema 0.2-3.6% complication rate Might be from the catecholamine surge from abrupt wake-up Might also be from large inspiratory effort against a partially closed glottis which creates too much negative pressure Treat with BIPAP if awake and intubation if not awake Should you give Narcan in cardiac arrest? Short answer no. During ACLS you take over breathing for the patient and that is pretty much the only way that Narcan can help Just focus on high quality CPR References https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#:~:text=Drug%20overdose%20deaths%20involving%20prescription,of%20deaths%20declined%20to%2014%2C716. Elkattawy, S., Alyacoub, R., Ejikeme, C., Noori, M. A. M., & Remolina, C. (2021). Naloxone induced pulmonary edema. Journal of community hospital internal medicine perspectives, 11(1), 139–142. https://doi.org/10.1080/20009666.2020.1854417 van Lemmen, M., Florian, J., Li, Z., van Velzen, M., van Dorp, E., Niesters, M., Sarton, E., Olofsen, E., van der Schrier, R., Strauss, D. G., & Dahan, A. (2023). Opioid Overdose: Limitations in Naloxone Reversal of Respiratory Depression and Prevention of Cardiac Arrest. Anesthesiology, 139(3), 342–353. https://doi.org/10.1097/ALN.0000000000004622 Yousefifard, M., Vazirizadeh-Mahabadi, M. H., Neishaboori, A. M., Alavi, S. N. R., Amiri, M., Baratloo, A., & Saberian, P. (2019). Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis. Advanced journal of emergency medicine, 4(2), e27. https://doi.org/10.22114/ajem.v0i0.279 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII

Paris Marx is joined by Gil Duran to discuss Balaji Srinivasan's plan to implement “tech Zionism” in San Francisco and the threat posed by Silicon Valley's growing opposition to democracy.Gil Duran is an independent journalist and former editorial page editor for the Sacramento Bee. Tech Won't Save Us offers a critical perspective on tech, its worldview, and wider society with the goal of inspiring people to demand better tech and a better world. Support the show on Patreon.The podcast is made in partnership with The Nation. Production is by Eric Wickham. Transcripts are by Brigitte Pawliw-Fry. Also mentioned in this episode:Gil has written about Balaji's Network State, Garry Tan of Y Combinator, and the plan to build a tech city in Northern California.Paris wrote about Marc Andreessen's Techno-Optimist Manifesto.Peter Thiel no longer feels “freedom and democracy are compatible.”Elon Musk claimed he sent ventilators to hospitals. They received biPAP and CPAP machines.Gil mentioned Quinn Slobodian's “Crack Up Capitalism.”Support the Show.

Are you aware of the existence of sleep apnea and its potential impact on our health? Sleep apnea is indeed dangerous; according to researchers, it may be a potentially serious sleep disorder in which breathing repeatedly stops and starts. In this episode, I discussed sleep apnea and Tirzepatide. I also addressed obstructive sleep apnea, noting its risks linked to obesity, such as interrupted breathing during sleep and various health complications if left untreated. Factors like heart disease and hormonal changes can elevate the risk of developing sleep apnea. Diagnosis involves sleep studies like polysomnography or home tests to assess severity through the Apnea-Hypopnea Index (AHI). Treatment options include CPAP or BiPAP machines to maintain oxygen levels and improve breathing. Alternative therapies like Inspire surgery are available for those intolerant of CPAP. Tune in to learn more about managing sleep apnea and its associated risks! Listen to the latest episode now!   Episode Highlights: Differentiating between obstructive and central sleep apnea Common symptoms indicating the presence of sleep apnea Sleep studies to diagnose sleep apnea Impact of Tirzepatide on reducing AHI levels and aiding in weight loss for individuals with sleep apnea Future implications and research about Tirzepatide Connect with Dr. Alicia Shelly: Website | drshellymd.com Facebook | www.facebook.com/drshellymd Instagram | @drshellymd Linked In | www.linkedin.com/in/drshellymd Twitter | @drshellymd About Dr. Alicia Shelly Dr. Alicia Shelly was raised in Atlanta, GA. She received her Doctorate of Medicine from Case Western Reserve University School of Medicine in Cleveland, OH.  Dr. Shelly has been practicing Primary Care and Obesity medicine since 2014.  In 2017, she became a Diplomat of the American Board of Obesity Medicine. She is the lead physician at the Wellstar Medical Center Douglasville. She started a weekly podcast & Youtube channel entitled Back on Track: Achieving Healthy Weight loss,  where she discusses how to get on track and stay on track with your weight loss journey. She has spoken for numerous local and national organizations, including the Obesity Medicine Association, and the Georgia Chapter of the American Society of Metabolic and Bariatric Surgeons. She has been featured on CNN, Fox 5 News, Bruce St. James Radio show, Upscale magazine, and Shape.com. She was named an honoree of the 2021 Atlanta Business Chronicle's 40 under 40 award. She also is a collaborating author for the, “Made for More: Physician Entrepreneurs who Live Life and Practice Medicine on their own terms''.   Resources: FREE! Discover the 5 Reasons Your Weight-Loss Journey Has Gotten Derailed (And How To Get Back On Track!)

Severe asthma leads to cardiac arrest in today's gripping patient story. Brooklyn, an ER Nurse joins host Sarah Lorenzini to discuss a nightmare case of a young asthmatic patient and her team's desperate fight to stabilize him.Despite various interventions, from albuterol, magnesium, BiPap, ketamine, and more, the patient's condition deteriorated, requiring intubation and ultimately transfer to an ECMO center to save the patient's life. This episode highlights the challenges faced by smaller hospitals with fewer resources and the heroic care this patient received despite so many challenges.Check out part one of our series on caring for the crashing asthmatic!Topics discussed in this episode:Initial treatment of Brooklyn's asthma patientThe patient's escalating condition and challenges in careUnpacking every tool in the asthma treatment toolboxManaging complications from autopeep to pneumothorax to cardiac arrestKey takeaways from this patient caseMentioned in this episode:Rapid Response Academy LinkWanna check out Rapid Response Academy: The Heart and Science of Caring for the Sick? click this link to learn more: https://www.rapidresponseandrescue.com/communityRapid Response and Rescue Intro CourseCONNECT

An outbreak of Legionnaires' disease has sickened 14 people in Grand Rapids and 11 have required hospitalization. The source is the city's water supply. Legionnaires' disease is a serious type of pneumonia caused by inhaling Legionella bacteria found in water. It is deadly, but so far no one in Grand Rapids has died. The Minnesota Department of Health confirmed the first case in April 2023, and since then has been investigating the source. MDH found the only common exposure was the municipal water supply. The city of Grand Rapids is now working the MDH to flush out the bacteria. Julie Kennedy is the Grand Rapids public utilities general manager. She joined Minnesota Now to talk about how the city is working to disinfect its water supply and how to avoid getting sick.The Minnesota Department of Health suggests that to avoid getting sick, people in Grand Rapids to regularly clean devices that use water like sinks, showers, humidifiers, CPAP and BiPAP machines and Netipots.

Contributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA receptors. Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP). Downsides: Hypotension, bradycardia, respiratory depression. What should you do if a patient is getting hypotensive on propofol? Do not stop the propofol. Start pressors. May have to reduce the propofol dose if delay in pressors. Dexmedetomidine (Precedex) Type: Alpha 2 agonist - causes central sedation Uses: Patients are more alert and responsive and therefore can be on BiPAP instead of being intubated. Does not cause respiratory depression. Downsides: Hypotension and Bradycardia. Caution in using this for head injuries, its side effects can mask the Cushing reflex and make it more difficult to spot acute elevations in ICP and uncal herniation. Ketamine Type: NMDA antagonist and dissociative anesthetic, among other mechanisms. Benefits: Quick Onset (but slower than propofol). Does not cause hypotension, but can even increase HR and BP (Thought to potentially cause hypotension if patient is catecholamine-depleted (ie. sepsis, delayed trauma)). Dosing ketamine can be challenging. Typically low doses (0.1-0.3mg/kg (max ~30mg)) can give good pain relief. Higher doses (for intubation/procedural sedation) are generally thought to have a higher risk of dissociation. Downsides: Emergence reactions which include hallucinations, vivid dreams, and agitation. Increased secretions. Benzos Type: GABA agonists. Benefits: Seizure, alcohol withdrawal, agitation due to toxic overdoses.  Push doses are useful because doses can stack. Longer half-life than propofol.   Downsides: Respiratory depression. Longer half-life can make neuro assessments difficult to complete. Etomidate MOA: Displaces endogenous GABA inhibitors. Useful as a one-time dose for quick procedures (cardioversion, intubation). Often drug of choice for intubation since it is thought to have no hemodynamic effects.  Downsides; If used without paralytic - myoclonus. Though to have some adrenal suppression. Fentanyl Type: Opioid analgesic. Not traditional sedative. Benefits: There are many instances in emergency medicine in which sedation can be avoided by prioritizing proper analgesia. Fentanyl can even be used to maintain intubated patients without needing to keep them constantly sedated. Downsides: Respiratory depression. Patients may have tolerance. References Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug;30(4):507-512. doi: 10.1097/ACO.0000000000000487. PMID: 28562388. Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. doi: 10.1007/s40265-015-0419-5. PMID: 26063213. Lundström S, Twycross R, Mihalyo M, Wilcock A. Propofol. J Pain Symptom Manage. 2010 Sep;40(3):466-70. doi: 10.1016/j.jpainsymman.2010.07.001. PMID: 20816571. Matchett G, Gasanova I, Riccio CA, Nasir D, Sunna MC, Bravenec BJ, Azizad O, Farrell B, Minhajuddin A, Stewart JW, Liang LW, Moon TS, Fox PE, Ebeling CG, Smith MN, Trousdale D, Ogunnaike BO; EvK Clinical Trial Collaborators. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022 Jan;48(1):78-91. doi: 10.1007/s00134-021-06577-x. Epub 2021 Dec 14. PMID: 34904190. Mihaljević S, Pavlović M, Reiner K, Ćaćić M. Therapeutic Mechanisms of Ketamine. Psychiatr Danub. 2020 Autumn-Winter;32(3-4):325-333. doi: 10.24869/psyd.2020.325. PMID: 33370729. Nakauchi C, Miyata M, Kamino S, Funato Y, Manabe M, Kojima A, Kawai Y, Uchida H, Fujino M, Boda H. Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatr Int. 2023 Jan-Dec;65(1):e15581. doi: 10.1111/ped.15581. PMID: 37428855. Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMSII  

Has the pendulum swung too far?  Is it time to put the drill down??  Or, drill, baby, drill!  While the number of rib plating cases has exploded the data supporting the practice is less-than-stellar.  On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill bring you up to speed on rib plating. If you haven't already, we recommend you listen to Behind the Knife episode 298, published in May 2020. (https://behindtheknife.org/podcast/big-t-trauma-series-ep-10-rib-fractures/)  This episode covers comprehensive management of rib fractures, including multimodal pain control, regional blocks, pulmonary toilet, BiPAP, etc.   REFERENCES: GUIDELINES EAST PMG Rib Plating (2017): https://www.east.org/education-resources/practice-management-guidelines/details/rib-fractures-open-reduction-and-internal-fixation-of-update-in-process EAST PMG Rib Fracture Non-Surgical Management (2022): https://www.east.org/education-resources/practice-management-guidelines/details/nonsurgical-management-and-analgesia-strategies-for-older-adults-with-multiple-rib-fractures-a-systematic-review-metaanalysis Chest Wall Injury Society Guidelines (2020): https://cwisociety.org/wp-content/uploads/2020/05/CWIS-SSRF-Guideline-01102020.pdf FLAIL/UNSTABLE CHEST Operative vs Nonoperative Treatment of Acute Unstable Chest Wall Injuries: A Randomized Clinical Trial, JAMA 2022: https://jamanetwork.com/journals/jamasurgery/fullarticle/2796556 Prospective randomized controlled trial of operative rib fixation in traumatic flail chest, JACS 2013: https://pubmed.ncbi.nlm.nih.gov/23415550/ Surgical versus conservative treatment of flail chest. Evaluation of the pulmonary status, Interact Cardiovasc Thoracic Surg 2005: https://pubmed.ncbi.nlm.nih.gov/17670487/ Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients, J Trauma 2002: https://pubmed.ncbi.nlm.nih.gov/11956391/ Surgical Rib Fixation of Multiple Rib Fractures and Flail Chest: A Systematic Review and Meta-analysis, J Surg Research 2022: https://pubmed.ncbi.nlm.nih.gov/35390577/ Surgical versus nonsurgical interventions for flail chest, Cochrane Review 2015: https://pubmed.ncbi.nlm.nih.gov/26222250/ NON-FLAIL CHEST Randomized Controlled Trial of Surgical Rib Fixation to Nonoperative Management in Severe Chest Wall Injury, Ann Surgery 2023: https://pubmed.ncbi.nlm.nih.gov/37317861/ Rib fixation in non-ventilator-dependent chest wall injuries: A prospective randomized trial, J Trauma 2022: https://pubmed.ncbi.nlm.nih.gov/35081599/ A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (NONFLAIL), J Trauma 2020: https://pubmed.ncbi.nlm.nih.gov/31804414/ Operative versus nonoperative treatment of multiple simple rib fractures: A systematic review and meta-analysis, Injury 2020: https://pubmed.ncbi.nlm.nih.gov/32650981/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out the rest of the BIG T Trauma episodes here: https://behindtheknife.org/podcast-series/big-t-trauma/

In this episode of "Between Two White Coats" join Dr. Plaster and Nurse Practitioner Amber as they explore the complexities of sleep apnea with special guest Dr. Juan Lacayo. Discover the key differences between obstructive and central sleep apnea, from their causes to symptoms and risk factors. In this conversation, you'll learn about the diagnosis and treatment options, including CPAP and BiPAP machines for obstructive sleep apnea and specialized devices for central sleep apnea. Learn why addressing sleep apnea is crucial for overall health and how it can impact chronic diseases. Don't miss this must-listen episode that could change your perspective on sleep and well-being. Hosted on Acast. See acast.com/privacy for more information.

Indications and contra-indications for common methods of non-invasive ventilation are discussed in quick question-based format with cases as a preparation to the next major episode (i.e. discussion of management options in different types & severities of respiratory failure)

Pediatric CPAP/BiPAP in the pre-hospital world.  Should we be doing it?  if not, why?  MedFlight Radio brings back Chris Newsome (Nationwide Children's Transport Medic) and Rob Glaze (Current MedFlight Medic and Retired from Westerville Fire Department ) to discuss this very topic.    We start by getting a good understanding of CPAP and BiPAP—what it is and how it works then quickly move into our pediatric population.  It is something that can make a difference for us in our pre-hospital or transport environment.  Should EMS and transport teams have it in their pediatric protocol?    Come listen in and find out.        

Listen to ASCO's Journal of Clinical Oncology essay, “A Labor of Love” by Dr. Rebecca Kowaloff, a Palliative Care Attending at the University of Massachusetts. The essay is followed by an interview with Kowaloff and host Dr. Lidia Schapira. Kowaloff shares how she connects and supports young patients and families at the end of life. TRANSCRIPT Narrator: A Labor of Love, by Rebecca Kowaloff  I had always thought that I gave too much space for death at the bedside of my patients. More than most of my medical colleagues, I seemed to accept its inevitability and had learned to talk about it, to watch it, and to sit with it. I did not cry, even for the patients robbed in their middle age by cancers sucking their life from within, aging them in hyperspeed before my eyes. Why did the weight not feel heavier to me when so many around me seemed unable to carry it? Despite the frailty of his body when we met, caring for Michael showed me my strength. He was a 25-year-old investment banker on Wall Street when he was diagnosed with a rare sarcoma. I wondered what he was doing the moment that first cell divided. Was he working late, handing a $100 tip to a taxi driver as his father said he sometimes did, or practicing with his college soccer team? Was this disease written into his genetic code when he was traveling the world with his family, smiling with missing teeth on a dock in Egypt in the pictures his father showed me? Did his body know it would have only 29 precious years, making him so generous to strangers, so thoughtful of others, and so eager to experience life and travel the world? I am sure he was full of hopes and dreams that shattered at the moment of his diagnosis. Amid the onslaught of emotions at diagnosis and as various chemotherapy regimens failed him, he started a foundation for sarcoma research to leave a legacy of helping children with similar rare tumors.  Outside the hospital, we would almost have been peers as I was less than 10 years older and could imagine the assumptions he would have had about his life would be similar to my own. Suddenly there was no meeting a life partner, no wedding, and no children. There was no career advancement, no retirement trips, and no new hobbies or interests. There are books that will go unread and current events unexperienced. The world which had been expanding at a spectacular pace suddenly contracts to one person's orbit: family, close friends, and what dreams can be realized on a shortened timeline in a perhaps newly limited body. He moved from New York City home to his mother's house, returning, in some ways, to childhood.  His soft-spoken mother listened to my prognostications with grief but not surprise, and my heart ached and eyes welled as I thought how she was watching her baby die. Each night on my drive home, I wept for her. When she saw him walk for the first time, she must have wondered what sports he might play. When he spoke for the first time, she might have wondered what conversations they would have, what speeches he might give, what school plays he might perform, and what songs he might sing. Like me she might have imagined cheering him on in sports, dancing with him at his wedding, and holding his children. She had watched him forge a path onto Wall Street and earn the friendship and respect of teammates on ever more advanced soccer teams. The sadness of her first child leaving home for college had surely receded as he self-actualized into a thoughtful, well-liked, and successful young man. And then came the diagnosis, and she watched all that her son had built slip away, watched him cling to as much normalcy as he could as the sarcoma ate his legs, sank his eyes into his skull, and sucked the color from his still-thick hair.  His father appeared one evening almost a month into his hospital stay with the desperate questions of a parent who has been in such deep denial he had not even told his brothers back home about Michael's illness. In a power suit, he blubbered that he could not live without his son, his "light," and begged me for fantastical treatments to fix him. In a tiny windowless meditation room, I rode the waves of despair with him. I explained over and over why our best efforts were no match for Michael's cancer.  Michael and I were practically peers and yet he entrusted me to lead him into this deep dark forest of the unknown, his final journey. Most times when entering his room I thought he had begun to "transition," his eyes half closed, his skin so pale and translucent, and his body so frail. One morning, I sat next to his bed and gently told him he was not improving, his lungs were failing, and I could not, would not, recommend intubation, which seemed imminent. He protested, asserting from behind an oxygen mask that he felt he was improving. He talked about physical therapy and restarting the treatment that had led him to this hospitalization, that had finally failed as he had always known it eventually would, but which was his last hope. His denial was his last defense. I met him where he was, shared his hope, but held fast to reality, framing the decision not as a choice he had to make, but as a recommendation from a trusted physician and an acceptance of his body's truth. He agreed, do not resuscitate, do not intubate. He thanked me and asked why I was the only honest one on his team. When we entered the room to recommend against a BiPap bridge to nowhere, his father tried to block the painful conversation with his body and his pleas “No, please, I don't want him to hear this!” I sat at Michael's side, completing an arc of love and care with his mother, sister, and nurse, and put into words what he knew and was living. His answer broke us all, “Done.”  This one word, said with surprising strength and finality, felt just as defiant as all his previous optimistic phrases, although it was an acquiescence to reality. To his end, Michael directed his care and made his own decisions, and he made it clear that he was finished with cancer before it finished him. For the first time ever, I sobbed at the bedside. I told Michael I would never forget him and what an honor it had been to care for him. The only response he could muster was, “Likewise,” which will live inside my heart forever.  His mother, pregnant with grief for 4 years since his diagnosis, began her labor of loss, the painful, arduous separation of child from mother. His breathing became more labored, more erratic. Eventually his consciousness shifted beyond the scope of the room. Had his eyes been open, I know I would have seen the look that I have come to identify with those on the precipice of death: Eyes beginning to glaze, one foot in this world, one in the next, looking beyond us. There was no more color to drain from his face, his translucent skin draped across the angles of his frame. Finally, 3 days later, he returned to that from which we all come into being. The pictures at Michael's funeral were interchangeable with my own from my childhood and college years. The lost tooth photos and pictures taken in friends' swimming pools, huge grins on family vacations in the woods, or in front of monuments. I could almost hear the raucous whoops of a soccer team celebrating after a game and could hear the giggles of posing teenage girls with boys jumping exuberantly and mischievously behind them. The red-faced newborn peering over his mother's shoulder and the toddler posing in overalls with his baby sister were similar to pictures of my own son. His childhood snow suit was tacked to the wall next to his college jersey. He was every mother's child. His college soccer coach in the funeral receiving line commented on how hard my work must be. I thought back to weeping at the bedside with his family and nurse. I thought back to Michael's bony hand reaching for mine on the bed as I walked him through a symptom management plan and his reassurance that he trusted me to keep him comfortable. I recalled sitting outside his room with his father as he cycled through despair, gratitude, and nostalgia while looking through the pictures he kept close to his heart in his suit jacket. My heart was full of awe at the unbelievably precious opportunity to enter someone's life and family at such an extraordinarily raw and sacred time. I was full of gratitude to be able to join that journey as a human being, sharing sadness and honesty and, thankfully, hopefully, being able to bring some small measure of comfort. I responded, as usual, “but it's so rewarding.” Driving from the funeral, I thought about his family returning home after the last acquaintance had left the funeral home, with the distractions of planning a service, choosing a casket, and greeting mourners while sharing anecdotes over. Like returning home from the hospital with your first newborn, their lives had irrevocably changed. New parents must adapt to a new presence, a new being in their life. They must make space for it. Michael's family now had to adapt to the absence of a presence. Like a new mother's first discovery of stray burp cloths on the couch and tiny socks stuck in the recesses of the washing machine, they will be caught off guard by his chapstick tube left behind on the coffee table and his half-read book left beside his bed. Caring for Michael showed me that my strength to be present for and bear witness to these difficult deaths is my humanity and my presence. I understand that I do not feel consumed by the heaviness of the work that I do because I distance myself from it, but because I sit with and bear witness to the human experiences, recognizing that doing so is my greatest gift. Becoming a mother changed my practice in a powerful way. I now recognize that every patient is somebody's baby. Many of the mothers who no longer recognize their children once looked at them with an all-consuming maternal love. I return to Michael's bedside in my mind as a way to dip back into my humanity and a grace that is not accessible in everyday life. There are no medications or procedures that will lessen the pain of loss or fear of death, and we in palliative care have only the feeble tools of medicine at our disposal. Michael's story reminds me that in the end, the greatest tool we may have to offer is love. Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of Oncology. I'm your host, Dr. Lidia Shapira, associate Editor for Art of Oncology and a Professor of Medicine at Stanford University. Today we're joined by Dr. Rebecca Kowaloff, Palliative Care Attending at the University of Massachusetts. In this episode, we will be discussing her Art of Oncology article, “A Labor of Love.” At the time of this recording, our guest disclosures will be linked in the transcript.   Rebecca, welcome to our podcast and thank you for joining us today.  Dr. Rebecca Kowaloff: Thank you. I'm excited to be here. Dr. Lidia Schapira: Let me start by asking you a little bit about your process for writing. Are you the kind of physician who writes and has always written, or is the process a difficult emotional experience? Do you write for pleasure, or was this a one-time piece for you? Dr. Rebecca Kowaloff: This is actually a new thing for me, but I think it will become something I do more regularly. I've always enjoyed writing. I was a history major in college. I loved writing papers, but more creative writing is new to me. But since I started my current job and went into full-time palliative care, I've just been struck by some patient stories and found myself sitting on my computer after seeing them, and these stories just poured out. Dr. Lidia Schapira: And when you talk about patient stories, I imagine those are patients that you've cared for, or are you referring to writings from patients, what we generally call illness narratives?  Dr. Rebecca Kowaloff: No, patients that I've cared for.  Dr. Lidia Schapira: And how do you think that understanding the story of a patient can inform the work that we do and how we teach our trainees?  Dr. Rebecca Kowaloff: That's a good question. I think that we sometimes lose a patient's humanity when we're caring for them and their disease and getting caught up in treatment options. And I think remembering that they have a story, that they are an individual and not like any of the other patients who might have had a similar diagnosis, helps us bring back to giving them the best care, but also, I think, brings us back to why we went into medicine. And that's what I try to pass on to trainees that I work with.  Dr. Lidia Schapira: That's so important. So in a way, it's connecting with or rekindling that sense of vocation, and that has to do with being of service, but also being attentive to the humanity, our own as well as that of patients. Dr. Rebecca Kowaloff: Exactly. Dr. Lidia Schapira: Have you recently read any books or stories that you found particularly impactful or that you would want to share with colleagues? Dr. Rebecca Kowaloff: Yes. As I thought back to some of the books that I've particularly enjoyed recently, I think that that sense of story and the story of maybe the common person or I really like historical fiction, so characters that are in textbooks, that are sort of uni-dimensional, being brought into a more three-dimensional arena, are ones that I'm really drawn to. I really liked City of a Thousand Gates by Rebecca Sacks, which looks at the Palestinian-Israeli conflict through multiple lenses and really challenges readers to see multiple perspectives. And I think that's something that I'm really drawn to in the books that I like. Another book that I really enjoyed was called The Five, and it was a look at, actually the five victims of Jack the Ripper, but looked at their lives and who they were as people. Something that I was embarrassed to say I hadn't really thought of before, but I found it fascinating not just to learn about them, but to really think about, they had their own stories, and instead they were caught up in this larger narrative.  Dr. Lidia Schapira: Let's turn our attention to the essay that you beautifully wrote and said and has a title that I think needs to be unpacked a little bit. So let's just start with your choice of title. It mentions ‘labor', and there's a strong theme in the essay of the labor associated with childbirth, but also the labor associated with losing a child. And you bring in your personal experience of motherhood. And then the other important word in the title is ‘love'. And that doesn't often appear in a medical narrative. So tell us a little bit about how you came to put these two words together and present them in the title. Dr. Rebecca Kowaloff: I've always been struck by the way that birth and death mirror each other and that on either end of those is this unknown we come from, wherever we come from, into consciousness, and then we leave into another realm that we always are wondering what's on the other side. So they're both this sort of liminal space between whatever lies beyond and then this life. And then in this particular case, I was really struck by how I was seeing this case, particularly through his mother's eyes, and was able to, I think, really appreciate a level of maternal love that I hadn't before I became a mother myself and what that must have been like for her and feeling it a little bit myself by proxy. And then recognizing that in this particular case, I felt like she had known that this death was coming for a while. The way that pregnancy, you know, that there is a birth coming and then the labor is that separation of the mother and the child. And so I tried to kind of draw that out as well, but I felt like love was what I really felt permeating this case—felt for this patient. Again, sort of that maternal feeling, but also because we were similar in age, a feeling of connection on that level, and that love was really the biggest thing that I could bring to this—that I can't fix death, I can't fix loss, but just being present with love is something I can bring. Dr. Lidia Schapira: I want to go back to that because you use the word love so organically and yet it's been a word that we've been reluctant to use in medicine. I think that there is no question that a mother feels love for her child, but the idea that a palliative care physician or an oncologist feels love for their patient is something that we don't often talk about and yet you're perfectly comfortable with that. So I want to ask you to tell us a little bit more about that because at least in my generation when we were trained, we were cautioned and perhaps even warned not to speak of love when we talked about what we felt for patients. And as a result, I think the medical literature is full of words like caring, but really the sentiment that we're talking about is love. And you very organically and normally basically say it like that and that you brought love to the bedside and that you felt love. Tell us a little bit about that.  Dr. Rebecca Kowaloff: Yeah, I think you're right. We use words like compassion, empathy, caring because love is such a charged word. But I think if we can think of it as love, then it maybe becomes easier because we've all experienced love, I think, and hopefully felt love. It may be, again, give us that renewed sense of purpose to say that I just have to be a human being who feels love and that is something that comes naturally to human beings when we see others in distress or sorrow or whatever it may be. I think that makes maybe this work more accessible, more fulfilling. And I think it is what we feel and we just are afraid to use the word sometimes.  Dr. Lidia Schapira: In this particular case, Rebecca, you also talked about identifying with a patient in so many different ways. You say, we could have been friends. So you talk about him as a peer, as somebody that you felt some feelings of companionship towards, and then you also talk about him as his mother's baby. And I thought that was really a beautiful and very original way of presenting the complexity of the feelings you had. You write in your essay that you normally don't weep or cry at the bedside, but there was something about this particular bedside situation, and Michael in particular, that led you to weep. Can you share a little bit of what that was like for you? Dr. Rebecca Kowaloff: Yeah, I think I had been, as I say in the piece, thinking of this as his mother watching her baby die. And that is, of course, an incredibly emotional concept for any mother. And then when he came to terms with it himself, I think it was tears of relief that he was not accepting, but at least he was acknowledging, but then also in terrible sadness that here, indeed it really was happening and that she was watching that happen. I was glad that that came out, not only for him and his family to see that I was there with them in that emotional space, but it just felt very cathartic to let those tears that I'd been letting out in the car actually come out at the bedside but just also to know that that was possible for me to do. And that just felt very connecting to the patient and their family. Dr. Lidia Schapira: And I imagine it might have even felt freeing for you in the sense that you bring your genuine person to the bedside and that you can allow yourself to connect and express your own emotions without that necessarily distracting them from their sorrow or drawing attention to you or in any way diminishing your expertise in that setting.  Dr. Rebecca Kowaloff: Exactly. In palliative care interactions, I teach my trainees that if the people don't cry that we may not have gotten to the heart of the issue. And so I think tears are a sign that someone is their most naked, vulnerable self and that you know that you're interacting with them without any facade.  Dr. Lidia Schapira: So tell us a little bit about how you, if I can use that word, either calibrate or regulate your emotional response to patients. You get called in to help families in very vulnerable and desperate situations. You use the word sacred. You use the word raw in describing what those situations are like. Tell us a little bit about how you prepare and what it takes to be fully present.  Dr. Rebecca Kowaloff: I think I just walk into each visit knowing that I bring my presence and that that is perhaps what is most required of me, that I have no advice to offer or guidance, but really just being a human being who doesn't look away from suffering is what I'm probably going to bring most to every situation. And that's something that I just know that I can do. And I think that knowing that I can bring that and that I can look at death and illness and I have made it through with patients and that they appreciate that is what keeps me coming back and keeps me able to do that. And as I said at the beginning of the piece, I've always wondered, is it a coldness? Is it a distance? Why is it that I don't weep more often at the bedside? Why is it that I can just keep doing this work and it doesn't wear me down? And I think it's because my perspective on it is that it's so fulfilling and that it is sacred. I describe it as soul-fulfilling work. It's just my soul work. It is almost a transcendent spiritual experience to be able to convene with patients on that level and to be able to bring that level of humanity to the bedside when maybe that is something that they haven't gotten. Dr. Lidia Schapira: I found the description of Michael's father and Michael's mother particularly compelling and how you handled their very different emotional responses to the inevitable passing of their very young and beloved son. Have you stayed in touch with the family?  Dr. Rebecca Kowaloff: I haven't, and I've actually thought about that and wanted to actually share this piece with them. So I'm still deciding. I think I probably will. I actually did connect with a friend of theirs and I didn't tell her I'd written this piece, but I wanted to give them some space. This death only happened very recently, so I wanted to give them some space to process and I didn't want this to become about me or what I got out of it. I really wanted them to have the space to grieve, but I very much would like to reconnect with them. Dr. Lidia Schapira: You share a lot about yourself in this essay and I think that's wonderful. And I'm curious to hear how you use these stories and your personal story when you teach your residents or when you interact with oncology fellows since that's sort of the world that most of our readers know. Dr. Rebecca Kowaloff: I always try to be a person. You look at attendings and they seem like they know exactly what they're doing and they've been doing things forever. And I want my trainees to know what I wish I'd known when I was a trainee, which is everybody at every stage of medicine struggles with feelings of inadequacy, shame, fear, whatever it is, and that those are real and that's part of being a doctor and that having those actually probably makes you a better doctor. So I try to be really vulnerable with my trainees about what I'm going through, how I feel about cases, and then just really stress that what I bring is that humanity and that they can bring that too, and try to remind them to step away a little bit from their sort of medical brain. And that's important, but that what our patients are really going to remember the most, is who we were at their bedside.  Dr. Lidia Schapira: There's an element of authenticity and genuine presence here that I'm picking up through your response to the questions but also in your writing that is, I think, quite exceptional. And that is to really also be able to share and be very open, not only self-aware but share with others that there's a huge amount of emotional labor that's involved in being with people who are so desperately ill. And you downplay your technical skills and give more importance to presence. But I imagine it's a sweet combination of both, am I right? Dr. Rebecca Kowaloff: It really is. Yeah. I was drawn to medicine for the humanistic aspect, and that is what has kept me here and sustained me. But it is wonderful to have a breadth of skills and knowledge to bring to patients that we can be present, but we can also ameliorate symptoms and give them information to help them make decisions. So that's what I find so much joy in palliative care work because that is exactly what we do. We kind of hit all those aspects of patient care. Dr. Lidia Schapira: And I wonder if you use stories in your repertoire when you talk to patients or when you teach your students. Do you sit with patients and tell them the story of another patient that you've cared for? Dr. Rebecca Kowaloff: I actually haven't to this point, other than small snippets of anecdotes, I don't. But it's something that I think could be helpful in the future.  Dr. Lidia Schapira: My last question to you, Rebecca, is what made you not just write the story but decide to publish it? I think there is a big difference between writing for ourselves when we are looking to process an experience and then really exposing our vulnerability and sharing it with colleagues and people that we don't know.  Dr. Rebecca Kowaloff: I think for me, palliative care, there are so many misconceptions that its depressing work, that all we deal with is death. And I call this out in the piece that I spoke to Michael's soccer coach, and he said, it must be such hard work, I forget the exact words. And I thought back to all the things that I felt were really rewarding. And I think a lot of people might look at those aspects and say, that sounds so depressing, and you're dealing with dying young people. So I just really wanted to hopefully convey to the larger oncology community that there is fulfillment and enjoyment and reward and gratification in even the hard work and maybe especially the hard work. And that shying away from it, I think ultimately is self-preserving, but it doesn't lead to the fulfillment that you could feel as a physician and really a healer and that this is really healing work.  Dr. Lidia Schapira: You make the point very clearly in your essay. I think that leaning into that distress and leaning into that sorrow actually fortifies us in a way helps us to get through it. And I would say that it requires some active work and also developing self-compassion, something that palliative care doctors know better than oncologists and we have a lot to learn from you. So thank you for the work that you do. Thank you for sharing your insights with readers of Art of Oncology and JCO. Any final message? Dr. Rebecca Kowaloff: I just hope that the piece touches people in a way they think about palliative care and in a way that they haven't before, and hope it will inspire people to lean into those difficult patient interactions and derive something that they didn't expect to.  Dr. Lidia Schapira: Well, thank you very much. It's been a lovely conversation.  And for our listeners, until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes:  Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio:  Dr. Rebecca Kowaloff is a Palliative Care Attending at the University of Massachusetts.

Contributor: Aaron Lessen MD Educational Pearls: SCAPE (Sympathetic Crashing Acute Pulmonary Edema), formerly known as flash pulmonary edema, is a life-threatening condition due to a sudden sympathetic surge that leads to hypertensive heart failure, pulmonary edema, hypoxia, and respiratory distress.  The initial treatment for SCAPE stabilization is BiPAP to assist with ventilation. Pharmacological treatment for SCAPE is best achieved with high-dose nitroglycerin (HDN), which induces venodilation and redistributes pulmonary edema. Dosing should be high; boluses of HDN are given at doses of 1-2 mg every 3-5 minutes vs. infusions at 200-400 mcg/min then titrating down. HDN leads to reduced intubations, less need for ICU admission, and shortened length of hospital stay in patients with SCAPE. References Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med. 2016;20(12):719-723. doi:10.4103/0972-5229.195710 Paone S, Clarkson L, Sin B, Punnapuzha S. Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. Am J Emerg Med. 2018;36(8):1526.e5-1526.e7. doi:https://doi.org/10.1016/j.ajem.2018.05.013 Stemple K, DeWitt KM, Porter BA, Sheeser M, Blohm E, Bisanzo M. High-dose nitroglycerin infusion for the management of sympathetic crashing acute pulmonary edema (SCAPE): A case series. Am J Emerg Med. 2021;44:262-266. doi:https://doi.org/10.1016/j.ajem.2020.03.062 Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-131. doi:https://doi.org/10.1016/j.ajem.2016.10.038 Summarized by Jorge Chalit, OMS1 | Edited by Meg Joyce & Jorge Chalit, OMS1

When applying a device to deliver noninvasive ventilation (e.g., CPAP or BiPAP) to a patient, many providers forget to pay attention to one of the most critical aspects of using these lifesaving devices: the mask that assists to deliver oxygen at the flow rate set on the device. Read the full article here on EMS Airway.

Emma is joined by Trent and Theresa Tidball to discuss Trent's journey with OSA. Together they discuss: * Trent's symptoms of daytime sleepiness as a teen and doing a sleep study but not following up. * Undergoing a UPPP, tonsillectomy, septoplasty, and turbinate reduction at the same time with an ENT without ever having a sleep study. * Getting a sleep test and diagnosis of obstructive sleep apnea. * Titrating study showing the need for ASV rather than CPAP or BiPAP. * MMA surgery to advance jaws hoping to improve Trent's airway. * Mental health impacts setting in for Trent and Theresa after trying all these treatment options without a positive outcome. * Theresa starting a blog to help process the emotions around coping with Trent's illness. * Trent having a DISE procedure showing his tongue was the main reason for his obstructive apneas * Trent undergoing Hypoglossal Nerve Stimulation surgery and starting to dream again. * Speculating that UPPP surgery had affected the function of Trent's tongue. * Deciding to do a revision MMA surgery with a new surgeon. Connect with Trent and Theresa: Instagram @sleepily_everafter sleepilyeverafterblog.com https://gofund.me/c899511d This episode is sponsored by: BetterHelp⁠⁠ https://www.betterhelp.com/emma⁠⁠ for 10% off your first month of online therapy Sleeplay - click ⁠here⁠ to order CPAPs and CPAP supplies and use code ⁠BEDTIME10⁠ for 10% off. Follow the podcast on Instagram:⁠⁠ @sleepapneastories⁠⁠ Email Emma at ⁠sleepapneastories@gmail.com⁠ ⁠⁠www.sleepapneastories.com⁠⁠ Check out Gary Knight's Story Sharing on Project Sleep's Facebook Live, hosted by Emma - click here to watch! NEW! Support the Podcast! If you would like to support Emma and the 'Sleep Apnea Stories' podcast, you can now contribute monthly. ⁠https://podcasters.spotify.com/pod/show/emma-cooksey⁠ Click "Support this Podcast". Disclaimer: This podcast episode includes people with sleep apnea discussing their experiences of medical procedures and devices.  This is for information purposes only and you should consult with your medical professionals before starting or stopping any medication or treatment. --- Support this podcast: https://podcasters.spotify.com/pod/show/emma-cooksey/support

Fierce Biotech regularly pulls together the industry's top money raisers from the year before. Staff writer Gabrielle Masson and Editor-in-Chief Ayla Ellison discuss a few of the biotechs at the top of the list.  Plus, in this episode, we cover Johnson & Johnson's talc litigation, prison plans for Elizabeth Holmes and more of this week's top headlines.  To learn more about the topics in this episode:  Biotech's top money raisers of 2022 Johnson & Johnson's $8.9B bankruptcy settlement is 'unworkable,' talc plaintiff lawyer says Theranos' Elizabeth Holmes must report to prison this month despite pending appeal, judge rules FDA dubs Abbott's FreeStyle Libre battery issues a Class I recall, spanning 4.2M devices Philips re-recalls 1,200 CPAP, BiPAP machines repaired in far-reaching ventilator probe Activist investor Icahn calls for Illumina CEO to be voted off company board over Grail deal Moderna's mRNA flu shot struggles to prove its worth again in phase 3 trial Sanofi's Provention buyout hit with FTC delay. Will Pfizer's Seagen deal go off as planned? After last year's cuts, Biogen kicks off another round of layoffs The Top Line is produced by senior podcast producer Teresa Carey and managing editor Querida Anderson. The sound engineer is Caleb Hodgson. The stories are by all our “Fierce” journalists. Like and subscribe wherever you listen to your podcasts.See omnystudio.com/listener for privacy information.

Jeff reviews some key changes in 2022 that have enabled Bellomo & Associates to expand its estate planning and elder law services. He also shares a Covid-related health issue that arose during the year along with the positive developments that resulted from that very same challenge.  Looking ahead, Jeff and the team will continue to provide distinctive consultation and educational opportunities for industry professionals and members of the community. These include their popular workshops, boot camps, and this podcast in addition to a new book that's due for publication later this year.   Your host, Jeffrey R. Bellomo, the founder of Bellomo & Associates, is a licensed and certified elder law attorney with a master's degree in taxation and a certificate in estate planning. He explains complex legal and financial topics in easy-to-understand language.   Key Takeaways  00:59 – New space, new team members in 2022 Bellomo & Associates expanded into Lancaster County New office: 2173 Embassy Drive, Lancaster, PA 17603 New community outreach coordinator: Jessica Delp New director of marketing: Roslyn Drotar-Cassidy 03:43 – Covid-19 hits home In January 2022, while traveling with his wife and daughter, Jeff tested positive for Covid-19 Away from home, they rented a house in Florida while Jeff quarantined Back in Pennsylvania, Jeff was diagnosed with sleep apnea, most likely because of Covid or long Covid He is now using a BiPap machine  07:42 – Working from home  Jeff worked from home and was forced to reduce his meeting schedule while he recovered Working from home led to the creation of this podcast, educational videos, and blog posts He also wrote a book titled, “A Fork in the Road,” about modern estate planning—a March/April publication date is expected The other lawyers and team members at the firm really stepped up during the year while Jeff regained his health 09:39 – 2023 will be a busy year Looking for more space in Lancaster Will continue to do weekly and bi-weekly workshops Bootcamps eligible for continuing education credits will be offered for professionals in health care, insurance, counseling, accounting, etc.  Jeff will continue to provide education for the community through his popular speaking engagements Links and Resources Mentioned KBG Injury Law https://resultsyoudeserve.com/ Bellomo & Associates workshops: https://bellomoassociates.com/workshops/  For more information, call us at (717) 845-5390. Connect with Bellomo & Associates on Social Media Twitter: https://twitter.com/bellomoassoc  YouTube:  https://www.youtube.com/user/BellomoAssociates  Facebook: https://www.facebook.com/bellomoassociates  Instagram: https://www.instagram.com/bellomoassociates/   LinkedIn: https://www.linkedin.com/in/bellomoandassociates  Ways to work with Jeff Bellomo Contact Us: https://bellomoassociates.com/contact/  Practice areas: https://bellomoassociates.com/practice-areas/

Emma is joined by Jody Martin, a marine corps veteran and business owner who shares his personal experience of using Lofta home sleep apnea testing. Together they discuss: * The symptoms Jody was experiencing from undiagnosed sleep apnea such as loud snoring and daytime sleepiness. * Jody explains the process he went through to get his BiPAP - from his GP to a respiratory therapist to a sleep study to a DME company. * The problems Jody experienced with his BiPAP machine, including aerophagia filling his stomach with air and developing sores on his nose caused by an ill-fitting mask. * Jody describes abandoning BiPAP therapy with no support to overcome challenges. * Jody explains how his wife discovered Lofta through a facebook ad and considered it "too good to be true" but agreed to try it. * Jody explains how easy the process was from start to finish.  In particular, he shares how quick the turnaround time was and how much better his results were when he had the proper support from someone who really cared. This episode is sponsored by: BetterHelp https://www.betterhelp.com/emma for 10% off your first month of online therapy Follow the podcast on Instagram: @sleepapneastories Email Emma at sleepapneastories@gmail.com www.sleepapneastories.com Disclaimer: this episode of the podcast includes people with sleep apnea discussing their own experiences of medical procedures and devices.  This is for information purposes only and you should consult with your own medical professionals before you start or stop any medication or treatment.

In the first episode of this season I talk about using high dose Nitroglycerine and Bipap for the sympathetic crashing acute pulmonary edema (SCAPE) patients in you ED. Don't take my word for it. Go through the following references and make your own protocol for your department. We have had fantastic results! 1. Paone S, Clarkson L, Sin B, Punnapuzha S. Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. Am J Emerg Med. 2018 Aug;36(8):1526.e5-1526.e7. doi: 10.1016/j.ajem.2018.05.013. Epub 2018 May 10. PMID: 29776826. 2. Mathew R, Kumar A, Sahu A, Wali S, Aggarwal P. High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study. J Emerg Med. 2021 Sep;61(3):271-277. doi: 10.1016/j.jemermed.2021.05.011. Epub 2021 Jun 30. PMID: 34215472. 3.Hsieh YT, Lee TY, Kao JS, Hsu HL, Chong CF. Treating acute hypertensive cardiogenic pulmonary edema with high-dose nitroglycerin. Turk J Emerg Med. 2018 Feb 2;18(1):34-36. doi: 10.1016/j.tjem.2018.01.004. PMID: 29942881; PMCID: PMC6009803. 4. Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, Dunne R, Zalenski R. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007 Aug;50(2):144-52. doi: 10.1016/j.annemergmed.2007.02.022. Epub 2007 May 23. PMID: 17509731. 5.Houseman BS, Martinelli AN, Oliver WD, Devabhakthuni S, Mattu A. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2023 Jan;63:74-78. doi: 10.1016/j.ajem.2022.10.018. Epub 2022 Oct 18. PMID: 36327753.

Eric Contant, sérfræðingur í bráðalækningum, ræðir við okkur um bráða öndunarbilun (e. Respiratory failure). Hvernig er bráðveikur sjúklingur metinn? Hvaða súrefnisgjafaleiðir standa til boða og hvenær skal grípa til ytri öndunarvélar (e. Bipap, cpap)? Þá ræðir Eric við okkur um grunnstillingar ytri öndunarvéla og hvernig hægt sé að breyta þeim svari sjúklingur vélinni illa.  "Dagáll læknanemans" er hlaðvarp fyrir læknanema og annað áhugasamt fólk um hvaðeina sem viðkemur klínik og læknisfræði. Stjórnendur eru Sólveig Bjarnadóttir og Teitur Ari Theodórsson.

Emma is joined by Dr. William Noah, a sleep specialist, and inventor of the V-Com. Together they discuss: * Dr. Noah shares about his background in sleep medicine and running a large sleep center. * Encouraging PAP adherence among patients and how introducing remote monitoring helped to identify patients struggling with their PAP therapy. * Dr. Noah explains IPAP (inspiratory positive airway pressure) and EPAP (expiratory positive airway pressure) and why they matter to the PAP patient experience. * Dr. Noah explains the differences between Ventilators, BiPAP, CPAP and APAP and the financial incentives for DME companies to put patients on BiPAP. * C-Flex and EPR settings and what happens to therapeutic pressure when these are adjusted. * DME switching people to full face masks as a "catch-all" and why that isn't ideal. * How different masks can affect the pressure a patient experiences. * Dr. Noah on inventing the V-Com to reduce IPAP and keep EPAP the same. * Treatment Emergent Central Sleep Apneas and how V-Com can help with that problem. Learn more about the V-Com: https://sleepres.com/ This episode is sponsored by: Airway Management https://tapintosleep.com/ BetterHelp https://www.betterhelp.com/emma for 10% off your first month of online therapy Vivos Therapeutics https://vivos.com/patients/ Follow the podcast on Instagram: @sleepapneastories Email Emma at sleepapneastories@gmail.com www.sleepapneastories.com Disclaimer: this episode of the podcast includes people with sleep apnea discussing their own experiences of medical procedures and devices. This is for information purposes only and you should consult with your own medical professionals before you start or stop any medication or treatment.

After more than a year of respirator recalls, it's probably no surprise that Philips reported lower-than-expected revenues for the third quarter of this year. But that announcement also came with the revelation that the company is now laying off 4,000 workers and planning for even more restructuring. Fierce Medtech's Andrea Park discusses this latest news and digs into the long line of problems that led to this decision. Philips' downward slide started last June, with the recall of CPAP and BiPAP machines used to treat sleep apnea. As of this July, the FDA tallied 168 related deaths, and as of mid-October there were at least 342 pending class action cases against the company. Philips cuts 4,000 jobs, with more restructuring on the way, amid slipping sales and rising costs With FDA decision penciled in for May, GSK powers ahead in RSV race with Pfizer Johnson & Johnson doles out $16.6B to snatch up miniaturized heart pump maker Abiomed Thermo Fisher ties up $2.6B deal for cancer diagnostics maker The Binding Site Alkermes joins Bristol Myers in IL-2 exit with oncology business spinoff Pfizer boosts COVID vaccine projection to $34B on the back of strong Comirnaty haul See omnystudio.com/listener for privacy information.

[S1 E6] Andy Steel, BBA, RRT, RCP, is the Clinical Coordinator for Respiratory Services on the Mount Carmel Saint Ann's campus, here in the Westerville, Ohio area. He still works clinically as a Respiratory Therapist in additional to helping out with the occasional education requests that pop up, because he's a fantastic resource for his area of expertise. In this episode, Andy helps break down what exactly a high-flow nasal cannula (HFNC) is, in addition to helping us compare it to other similar treatment options in the healthcare setting. Listen in on our conversation to learn more about: When does a nasal cannula get bumped up to a "high-flow" classification? Who is a HFNC appropriate for? What is dead space washout? What is Airvo? How does something like Airvo compare to CPAP and BiPAP? Which hospital units are using HFNC/Airvo? And more! Quick Links: Airvo Website Linktree: Links to content mentioned on past episodes Do you have ideas for future guests or topics on this podcast? Maybe you have some thoughts on how to improve the show? If that sounds like you, take a moment to answer the 3 questions on our anonymous feedback survey!Podcast artwork was made with the awesome resources from CanvaMusic for the show was obtained from PixabayEmail the show at hfconversations@gmail.com

We all “know” of the clear respiratory support escalator: air, oxygen, CPAP, BiPAP, Invasive ventilation. But where does High Flow fit in? What parameters should we use to determine when and how to use it? Ram from Imperial/St Mary's in London led the two-armed First ABC trial, the largest and […]

Meet Oki and review bipap basics.

The FDA has given Sarepta Therapeutics the green light for its phase 2 Duchenne muscular dystrophy clinical trial after slapping the biotech with a clinical hold in June. The hold came after a grade 3 adverse event was reported in the midstage trial. Now, only a few months later, the agency has lifted the hold, and we'll discuss why there was a quick turnaround on the hold and what to expect next.  To learn more about topics in this episode:  Sarepta picks up momentum as FDA lifts hold on phase 2 DMD trial  As EU challenge intensifies, Illumina clocks a stateside win in FTC antitrust case over Grail buy  EU blocks Illumina's yearslong quest for Grail  Philips recalls 17M CPAP and BiPAP machine masks due to potential magnet interference  GSK helps SpringWorks double payday from boosted combo deal as it also reels $225M in new funding  BMS-backed Arsenal Bio pulls trigger on $220M series B, touting potential fleet of gene-edited cell therapies  Amylyx's ALS drug faces tough FDA scrutiny ahead of 2nd advisory panel meeting The Top Line is produced by senior multimedia producer Teresa Carey with managing editor Querida Anderson and senior editors Annalee Armstrong, Ben Adams, Conor Hale and Eric Sagonowsky. The sound engineer is Caleb Hodgson. The stories are by all our “Fierce” journalists. Like and subscribe wherever you listen to your podcasts.See omnystudio.com/listener for privacy information.

Hello listener and welcome to episode 130 of the MPR Weekly Dose Podcast. This week we have news of the FDA's vote on an ALS treatment; CPAP and BiPAP device recalls; Orphan Drug designation for a novel CRISPR therapy; Imfinzi gains new approval; and Spevigo is approved for pustular psoriasis flares.

I dagens episode blir vi bedre kjent med spesialfysioterapeut Tiina Andersen i Bergen. I tillegg til å forske på strupen og undervise fysioterapistudenter i lungefysioterapi, jobber Tiina ved Nasjonal kompetansetjeneste for hjemmerespirator ved Haukeland Universitetssjukehus i Bergen. Her følger hun opp pasienter som har behov for langtids mekanisk ventilasjonsstøtte og hostestøtte. I episoden får du lære mer om pasientgruppen, fysioterapeutens rolle, og om de ulike behandlingshjelpemidlene. Tiina forteller også om den spennende forskningen hun driver med, hvor hun ser på hvordan strupen oppfører seg når en bruker BiPAP og hostemaskin.Hvem trenger egentlig hjemmerespirator og hostemaskin – og hvorfor trenger de disse hjelpemidlene?Hvilke ulike typer hjelpemidler fins det – og hvilke når brukes de?  Hva er fysioterapeutens rolle i behandling av pasienter med behov for hjemmerespirator og/eller hostemaskin?Hvorfor er strupen så interessant når vi snakker om hjemmerespirator og hostemaskin?Support the show

Contributor: Dylan Luyten, MD Educational Pearls: Positive End Expiratory Pressure (PEEP) is positive pressure within the lungs and maintained throughout the entire respiratory cycle. It is the pressure preventing alveoli from collapsing at the end of exhalation.  When using a bag valve mask (BVM) to ventilate patients, always attach the PEEP valve to prevent intrathoracic pressure from returning to atmospheric pressure which would allow alveoli collapse.     A BVM with a good seal to patients face and with an attached PEEP valve provides the same support as BiPAP or CPAP.   A generally acceptable PEEP setting is 5 cmH2O.  References Mora Carpio AL, Mora JI. Positive End-Expiratory Pressure. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 27, 2021. Harrison MJ. PEEP and CPAP. Br Med J (Clin Res Ed). 1986;292(6521):643-644. doi:10.1136/bmj.292.6521.643 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Access to video version of lecture, supplemental materials & references at: https://www.icuedu.org/bipap

Emma is joined by Dr. Funke Afolabi-Brown, a board-certified pediatric pulmonologist and sleep medicine physician. Together they discuss: * Signs to watch for in kids that could indicate a sleep problem. * Tonsillectomy and adenoidectomy in kids with obstructed airways. * Dr. Afolabi-Brown's participation in an American Academy of Sleep Medicine task force to explore the safe use of CPAP and BiPAP in kids with Obstructive Sleep Apnea. * Testing kids with suspected obstructive sleep apnea and the importance of selecting an accredited sleep clinic. * Differences between testing adults and children. Find out more about Dr. Afolabi-Brown here: https://www.restfulsleepmd.com/ Instagram: https://www.instagram.com/restfulsleepmd/ This episode is sponsored by Inspire https://www.inspiresleep.com/ Airway Management https://tapintosleep.com/ BetterHelp https://www.betterhelp.com/emma Follow the podcast on Instagram: @sleepapneastories Email Emma at sleepapneastories@gmail.com www.sleepapneastories.com Disclaimer: this episode of the podcast includes people with sleep apnea discussing their own experiences of medical procedures and devices. This is for information purposes only and you should consult with your own medical professionals before you start or stop any medication or treatment.

This is part 2 of 2 on pediatric asthma management. In this episode, Dr. Maready, Ben, Matt, and Will discuss the asthmatic airway management for both invasive and non-invasive modalities. They discuss the use of Hi-Flow, BiPAP, and intubation along with different management and settings associated with each modality. 

INTRODUCTION: Anna, pronouns anything respectful, is a Chicago-born social entrepreneur who builds streaming platforms which center & celebrate BIPOC & QTPOC creatives. Media has always been her passion and in 2009 she turned that passion into a reality when she founded E3 Radio, an online radio station playing Queer music & reporting on Queer news with an intersectional lens. Most recently, she founded The Qube, a curated app of music & podcasts by BIPOC & QTPOC creatives. Anna is determined to ride media into its next era by utilizing digital media streams to tell the stories and play the music that deserves to be heard.  Learn more about her work here. In no particular order I'm also a daughter, wife, sister, and friend who loves cooking and running. Favorite Quote: “First they ignore you, then they laugh at you, then they fight you, then you win.” –Gandhi Did you know? Anna has been in love with Robin Roberts all her life. Interviewing her would be the ultimate experience. Media Coverage ABC 7 Pride Coveragehttps://abc7.ws/3BGSAZz  Choose Your Struggle https://open.spotify.com/episode/5VaUCZRfUCxUNzdfmAibuV?si=Wqu7M0knQmWZYyJ_Ahmleg&nd=1 191: Learn How To Do Queer Radio Right with Anna DeShawn, Founder of E3 Radiohttps://podcasts.apple.com/us/podcast/191-learn-how-to-do-queer-radio-right-anna-deshawn/id1189319336?i=1000521261587  Trindi Media Podcasthttps://podcasts.bcast.fm/e/mn4wvyq8 Park Careers Podcasthttps://anchor.fm/icparkcareerspodcast/episodes/Episode-9--Anna-DeShawn-IC07-e10l4bp/a-a5haqne   INCLUDED IN THIS EPISODE (But not limited to): ·      Exposure To The Qube App·      Celebration Of BIPOC & QTPOC Creatives·      Why It's Good To Be Complete BEFORE You Enter A Relationship·      Why Mental Health Therapy Is SOOO Damn Good For You·      The Variety Of Mental Health Options Available To You·       A Warning Against Being Addicted To Church·      A Warning About Biblical Interpretation·      Politics & Religion = YUCK!·      Why Being Non – Straight Is Not A Damn Choice! CONNECT WITH ANNA: Website & Radio: https://www.AnnaDeShawn.comTikTok: https://tiktok.com/@annadeshawn Facebook: https://facebook.com/annadeshawnInstagram: https://instagram.com/annadeshawn  Twitter: https://twitter.com/annadeshawn  E3 Radio: https://e3radio.fmThe Qube: https://theqube.app   ANNA'S RECOMMENDATIONS: ·      EyeWear: https://thekayakollection.com·      VDOM: https://thevdom.com/the-vdom/ CONNECT WITH DE'VANNON: Website: https://www.SexDrugsAndJesus.comYouTube: https://bit.ly/3daTqCMFacebook: https://www.facebook.com/SexDrugsAndJesus/Instagram: https://www.instagram.com/sexdrugsandjesuspodcast/Twitter: https://twitter.com/TabooTopixLinkedIn: https://www.linkedin.com/in/devannonEmail: DeVannon@SexDrugsAndJesus.com  DE'VANNON'S RECOMMENDATIONS: ·      Pray Away Documentary (NETFLIX)o  https://www.netflix.com/title/81040370o  TRAILER: https://www.youtube.com/watch?v=tk_CqGVfxEs ·      Upwork: https://www.upwork.com·      FreeUp: https://freeup.net·      Disabled American Veterans (DAV): https://www.dav.org·      American Legion: https://www.legion.org  INTERESTED IN PODCASTING OR BEING A GUEST?: ·      PodMatch is awesome! This application streamlines the process of finding guests for your show and also helps you find shows to be a guest on. The PodMatch Community is a part of this and that is where you can ask questions and get help from an entire network of people so that you save both money and time on your podcasting journey.https://podmatch.com/signup/devannon  TRANSCRIPT: [00:00:00]You're listening to the sex drugs and Jesus podcast, where we discuss whatever the fuck we want to! And yes, we can put sex and drugs and Jesus all in the same bed and still be all right at the end of the day. My name is De'Vannon and I'll be interviewing guests from every corner of this world as we dig into topics that are too risqué for the morning show, as we strive to help you understand what's really going on in your life.There is nothing off the table and we've got a lot to talk about. So let's dive right into this episode.De'Vannon: What's up. What's up. What's up everyone. I'm so happy to have you with me again. One more week. I hope everyone is fucking fantastic. Happy Cinco de Mayo. Today we have a spotlight on black indigenous people of color and queer trans people of color as well. Anna de Shawn has created the cube app, which is a safe space for creative people of color of various ideas.We dish on religion, sex [00:01:00] self-acceptance mental health and so much more. And I throw some shade at Lakewood church over in Houston, Texas, because of the way they dehumanize people behind the scenes. Take a listen to my people.Anna. Good girl, girl. How the fuck is you doing the day? That's what I need to know. Anna: I'm amazing that I'm here with you period. De'Vannon: Looking at you, trying to gain me up, see energy. Like that is the reason why sometimes contemplate letting a lesbian fuck me in the ass because y'all have got that. Yeah. The game was on point.The words on point y'all is I am a survivor. I'm like, oh, almost y'all I'm just like Emile come in there. And I'm like a good low to come in my ass. Okay. Anna: We don't get that. We don't got that. We got a lot of other things, but we got a lot of other. De'Vannon: Although they [00:02:00] have those buildings. Now you can put something like different juices or whatever in them, and then it'll squirt it into whatever hole you want.So Anna: mommy, my homemade is actually creating this really amazing strap. It's her, her business is called V Dom. Y'all should check it out. V D O M she was on television recently for a pitch competition. Like it's like mechanical, so it's not hard all the time. So you hit a button, it gets hard on the, on the whim.It's like from an app. So you don't gotta go. And like, yo it's legit stuff. It's good De'Vannon: stuff. So it's a Dick, a plastic Dick that get, that can give, go from levels of softness to hard, Anna: but the press of a button. De'Vannon: I ain't seen that before. Hmm. Next level I found real. It, it okay. Also Anna de Shawn is a bad bitch.She. It's the [00:03:00] greater of an app called the cube. She hosts the radio station and everything like that. And she considered herself to also be a social entrepreneur as an initial. We're going to be talking about what the cube is, how this benefits the LGBTQ plus community, the alphabet mafia, as I like to call us, because we will fuck a bitch up if we have to, we don't want to, but sometimes y'all just make us pull the will Smith on a bitch and just Anna: necessary.Okay. Sometimes it's necessary.De'Vannon: I don't think he should have done it, but I'm not here to judge him. I feel suck his Dick right now and buy tickets to his movie. But I, we, we, we will not be slapping everybody on Smith. Anna: I don't know what he was thinking. I think actually, I think he thought it was recorded. I think he forgot. It was like. I mean, there's so De'Vannon: many of them things, it's just like he's sitting at his [00:04:00] kitchen table.Anna: I think he forgot it was left. I think he thought they were going to be able to enter that up. De'Vannon: So we'll be talking about what the cube is. It's a new thing specific for our community and people of color and things like that to help help us with podcasts and getting our creative arts and media out there.And then we're going to talk about Anna's history. She has a lot of history with the church and church Bo shit, and there's so much bullshit and the church is unreal. And so what do you got to say about your own history? Tell us about you got the run Anna: down to the quick rundown, quick rundown south side of Chicago, born and raised.I consider myself a social entrepreneur who. Platforms digital platforms that celebrate and center black, brown and queer folks of color. I, I love my [00:05:00] people and I love the power that media has to actually create some change, some meaningful change to humanize people's stories and experiences. And I think that we have the power to shift that, you know, if we tap into it and since 2009, I've been interviewing black queer folks to raise awareness around our stories out of Chicago.And I've always been into media. Let's be clear, Robin Roberts is everything to me. Okay. I want it to grow up and be just like her on ESPN or doing some play by play announcing. But it became very clear that people don't look like me on television. They're not masculine the center. Prokes a report in the 10 o'clock news.Okay. But radio allowed for me to speak to folks without folks having to see me. And that is a very powerful thing. And I realized I really loved it. So I got into radio. Which of course leads you into podcasting. And then I just saw the same things that were happening in traditional media. What's happening in podcasts.I'm like, where are my black people at? Where am I brown people at? Where am I queer [00:06:00]folks of color at? Like, why is it that when I go to apple and Spotify and all these places, like I can't find my people and I wanted to change that. De'Vannon: Well, it is a noteworthy thing you're doing. And I can tell you have sense enough to understand that this is something that's takes time.You know, this is, this is a long-term dedicated process. Does it? Don't take, you know, a long, long time to, to see, come to fruition. Hopefully you see it in your generation, but you know, you know, these things take time. So I appreciate that. You're laying this foundation here, you know, for generations to come, you know, I can see it in a, in a hundred years, you know, you know, when you did that and gone somebody is going to have a very successful.Show you know, public broadcast and everything like that. You gonna be like, we want to thank him to Sean for the work that we did back in 2009 to make this day [00:07:00] possible for me in 3050 or whatever the Anna: case. That's unbelievable. Let me tell you. But I do say this, that I do see the radio station and what we're building with the cube as being far bigger than myself, I feel like, and I think we connect can connect on this on a spiritual level.Like we're here because we're called to do something. And when I think when you tap into your call, it is bigger than you because you're just a vessel for the work and you've been given some gifts and you, and you've been called to use them. And so I feel like I'm called to use these gifts in this way.Everything about me says I'm about systematic changes about changes that can affect masses amount of people. That's what I'm called to do. Some folks is called to be in the streets activating, you know, some folks has called to do one-on-one work and change people's lives one by one by one. And I feel like I've been called to change folks' lives through media and a massive amount of [00:08:00] ways.And so I'm excited about what the cube is going to be to the world of podcasting. I'm excited what it's going to be for discoverability. Today 43% of people listening to podcasts actually identify as people of color and there's no place that is serving those folks. And the discoverability of those folks.There's so many people like you creating amazing content, raw content, authentic content, quality content, and more people need to know, you know what I'm saying about sex drugs and Jesus. Come on. De'Vannon: Okay. We don't want to go down that rabbit hole is a tight, deep hole and trust me may have gotten stuck in it.Anna: I love you. De'Vannon: So I love you too, baby. So one of my favorite things about you. So we're going to talk about Anna for a little bit and get into her personal story, which tells us a lot about why she's doing what she's doing. And then we're going to get very granular and talk very specifically about what the cube [00:09:00] is, where you can find it.Who's who was this for a podcast. As people want to go on shows what sort of content you can find there and all of that. So when I was reading through your bio and everything like that, and researching you as I do, I found that your pronouns, you don't have like, he, she, they. You know, whatever you said, anything respectful.And I admire the open-mindedness of that and the flexibility of that, it reminds me a lot of myself because when people ask me who I am, sometimes I like to refer them to the Torah, you know, to the, to the oh, Hebrew scripture when when Moses was first called by God. And he had his slippers off on the side of the mountain and God was in the burning Bush.And Moses was like, God, who is you? Who are you? He was trying to put God in a box and figure out how shall I, what can, what can, how can I associate you with what I already know? Okay. And God told him, bitch, I am that I am. [00:10:00] And that's all there is to it. Anna: Yes. Is that a quote description? That is, I am what I am and that's really it.Right. Because the point of even. The initiatives around using someone's proper pronouns is about respect. It is about honoring someone's identity, right? And for me, depending on what space I'm in child, ain't no telling what the pronouns is going to be. If I, with my boys, it's just, it is whatever. Right.And then I'm in society and people see me a certain way. And then that's that all I'm saying is with respect to who I am. So anything respectful is what resonates most with me, De'Vannon: right? Because it's in the tone of voice in the spirit behind the words. So you can be like, what a bitch and mean it would love.And you can be like, oh, Hey girl, Amina, what all the painting is and violent as that you could contrive. And when you hate that bitch, and you're like, Hey girl, you [00:11:00] know, that was not really in the word, but isn't the heart behind it. More than anything.Anna: Absolutely cause the shade is real. You can notice the shade.Okay. De'Vannon: At all. Oops. Plaque.Anna: You don't have it, but I see it. Okay. Y'all got it. But I see it. De'Vannon: I keep one in my glove compartment, just in my car, just in case I needed somewhere. And I got several in the house. Anna: So does my wife, Lord, all the De'Vannon: things, speaking of that. Yeah. And your bio, it says you are a daughter, a wife, a sister, and a friend who loves cooking and running.What I wanted to know from you about the wife. How did it feel? I want to know how did it feel to be married? Did you have any struggles and things like that? I don't meet a whole lot of married women. I don't. So talk to me about that whole process. Anna: Yeah, we just celebrated our five-year wedding [00:12:00] anniversary.We've been together for nine years. Just like when I met her, my momma loved there. Okay. And I don't like the ideas of, or the statements around, like someone completes me. I was done and completed, but she just adds so much to my life. She's just such a sweet and kind person. And she just fit right in with my family.It was like she had always been there. Everybody embraced her and, and I love her. So she's my best friend. She is the ultimate diva. Okay. She is the most high film woman I have ever dated in my life. But she balances me out and I just love her to pieces. De'Vannon: Yeah. Opposites attract like that. I learned that when I was in my hitting the therapy class, I was training to be a licensed hypnotist, which I am, you know, there's all kinds of signs [00:13:00]behind why quiet, conservative people attract more outgoing people, you know, and vice versa.If you too much alike, you tend to repel each other, you know, to put it simply my boyfriend's the same way. He's quiet. Fucking there. Okay in there, I'm the ones linking from the poles and the chandelier's and hitting the splits. And even now with all of that, you know, showing up, you know, shutting the shit down and everything, and he couldn't even talk.He would, he's not necessarily the most comfortable talking to people in public. You know, when I walk in the bitch, I own the room. Oh, his y'all's belongs to me until I leave this bitch. Anna: Okay. And let me tell you, so I turn it on when a microphone is in front of me, but other than that, I don't have to say a word to anybody.Okay. Yes, my wife is the same way. She walked into a room, she's a stylist. She just takes up space. Okay. Take some space. You came misled. And she also sells, I wear all right. [00:14:00] So the Kia collection.com. So she sells customer. I wear. And so every time she walked into a room, somebody taken something off her face off her risk, won't something.And she is, she's the life of a party.Oh, yeah. The K a collection.com. K a K a Y a K O L L E C T I O N. So the K a collection.com. De'Vannon: Okay. So then I'm like, Hey, yo, collection.com. All right. I'll drop that shit in the show notes, but show ya. I also heard what you said about how you were complete before you met her. This is something I concur with.None of this. This person completes me. I'm lost without you. I can't. Oh that you better know who you are before you get into a relationship with somebody. And a lot of that has to do with just theory, spirituality and shit like that. I think so many relationships in between. People lose [00:15:00] sight of their own individual identity in the whole process.And if you're not in tune with who you are, you're not going to be able to truly cater to that other person. You know, you gotta be whole firstAnna: a hundred percent and let's also be clear. We all been broken, right? So I ain't coming up here. Like I walked, I woke up like this therapy saved my life. Right.Therapy saved my life. We've all had tough and challenging relationships that have taken you all types of places that you never thought you would go. Then at some point you have to like, do some self reflection. Like, is it me? Maybe it's me. And you got to own that. You have to own that. Otherwise you'll continue to date the same person over and over again in a different body with a different sign and all types of stuff.And that was my reality. I had realized that I was dating the same person over and over again. I'm like, what is wrong? And so quickly checked myself into therapy and it saved my life. And so when my wife came into my [00:16:00] life, I didn't need completing. At that point, I was very clear about who I was and who I am.And she was just like the perfect fit into, into my life. So now we have our life with our puppy and grateful. De'Vannon: So when you say you checked yourself into therapy, are you being general in that saying you started seeing a therapist, did you check into a residential. Anna: I'll say it in general. Like I went to start, I started seeing a therapist and I've seen a few over my life and actually it's just about to start seeing a new one.And I think there'll be, is one of these things where you can choose to be in it for a really long time with the same person, but sometimes you even grow out of your therapist. And so sometimes you have to shift and sometimes you don't need it anymore and sometimes you gotta restart it because life would be doing a lot of living.And we just went through what, two years of an airborne panic. And if you listen into this, that means you survived it too. And [00:17:00] so none of us are the same as we were in 2019. There's no way you're the same person. So I think that there's there's seasons. And so I'm in a season where I got a lot going on.So I'm about to go see another therapist and it's just, if you've never done it, it's just a refreshing opportunity to talk to someone who is not fully engaged in your life, but can offer an outside an outside viewpoint that is often not, it's not critical, it's not judging. Right. You find somebody that works with you that you can vibe with, and you'll find yourself lighter after leaving.They're clearer, maybe about something you're struggling with. And for me, it was, it saved my life. De'Vannon: What kind of therapist? A licensed clinical social worker, a Anna: licensed clinical social worker and a black woman. De'Vannon: I find the LCSW to be [00:18:00] more like down to earth, then send like a psychologist, cause an LCSW is not prescribing medication.So they're actually the only way they can help you is through the words and the talking and the exercises and the practices. They, they, they give you to take home. I see an LCSW. I see a licensed marriage and family therapist together with my boyfriend together for, I don't know, 2, 3, 4 years, some shit I don't keep up with the damn time.You have to ask him I'm bad with birthdays and just general time, because I, I view things more eternal. You know, I don't believe in time constraints. It always has existed and always will in a way. And so And then I see my hypnotherapists individually and I love hypnotherapy because of how focused it is and how it gets into the subconscious and how you rip out what you don't want.You speak back to your open, vulnerable mind, which you do want. And so I particularly use that to help me stay off of [00:19:00] drugs. And so all. So that is our plug for mental health, because we know that it's something that's lacking in both the color community and in the gay community. It is not a straight a strike to your pride.If you want to go talk to somebody about getting help, there's many different types of therapists. That's why I asked her that if you go to one therapist and they're a fucking piece of shit, then fuck that hell you go to somebody else. Maybe you need a different type of therapy. There's all sorts of new age, metaphysical shit out there, getting the therapy Stella constellations all kinds of mind, body, soul meditation, shit.If you don't want to do traditional therapist, you can therapy. You can do the shit off his own. Now there's all kinds of shit. So whatever it is you think mental health is if you have a bad taste in your mouth about it I asked you to revisit it and take a second look at it. Because again, I said, we all had been fucked.You know, and so you need help to get unfucked up and to get an objective perspective. So you [00:20:00] don't keep getting fucked up relationships and sabotaging yourself. So just humble yourself down and go get some help, baby. And look, no one has to know, these therapists are bound by confidentiality, so it's not like they can go put it on social media that you were in treatment, or they would get their license taken and probably go to jail.So it's a secret, nobody. Nobody nobody has to Anna: know that's right. And may is mental health awareness month. So there is so much information out here right now in promoting and making awareness, you know, mental health awareness, I think this month. So you just one Google search. De'Vannon: Just one Google search away.So a quote that you had it says is your favorite pro. You said at first they ignore you. Then they laugh at you. Then they fight you, then you win. And that was by Gandhi. Tell me what this quote means to you.[00:21:00]Anna: And that you can't be waiting for people to validate who you are or validate your idea or validate what you call to do. It is not about that. You know, people gonna go along for the ride, you have to be clear about what you want to do. And I think that along the way, you're going to encounter different people.You know, I'm building a business. I don't come from a whole lot. I come from a whole lot of love. And so, but we got a lot of things and a lot of people, I talked to a lot of asks and the requests, I take a lot of leaps of faith. I have to keep practicing my faith muscle and building up my face muscle and what it means to take risks.And along the way, I'm going to run into people that don't agree with me, who don't believe what I'm in, what I'm doing, who don't see a market for it, who don't see a need for it. And honestly, like when we make it, that's when everybody want to be down. So for me, that quote by Gandhi just resonates a lot with what it means to be on the journey.And not, and for me, it's [00:22:00] not caring so much about the destination because to your point, like, I feel like things just will continue to be, but it's about enjoying the journey. And that quote reminds me that it's a journey that is not just going to be one thing or another thing. It's all of things, De'Vannon: all of them each and every last one of them.I love the friction that comes along. When w when people would try to repel us, though, I believe it helps to meet tourists. And it helps to refine us like when a moth or a butterfly. It's trying to crawl a lot of that Chrysalis after they'd been a caterpillar, you know, that struggle helps to release the, you know, the blood flow in whatever juices are in their little furry bodies to expand their wings.You know, that that struggle is needed. They can not become what they are to be without the problems. And, you know, and so I'm thankful for all the Karens for all the church, people who told us we had to get out, you know, and, and everything like that. For [00:23:00] the people who told us since we were black, we can't, we can't stay there.And stuff like that. When I read that, I thought about how I got kicked out of Lakewood church in Houston, Texas for not being straight, you know, but eventually I'm going to get the victory over them. Cause you know, I've been there when they kicked me out. This was like 2008, 2009. And I just finished my book and I went into great detail about how I felt about all of that.It took me over 10 years, but I finally clapped. I finally clapped the back. And so I will win. Yes, Anna: you are winning. You are winning. You've already won. The victory is yours. You're already, De'Vannon: they may in an amen. Okay. So then I'm just curious about, what do you think some of the top issues are facing just the lesbian community today?Hmm. [00:24:00] And why are you thinking about that? I noticed some of your top lives being moments when I was researching you. I would agree with queen Latifa from set it off. Anna: Yes, honey. That is number one of all time. You know what? I would argue anybody down and say that ain't the number one black lesbian moment in film, because.She was studied out in and go, okay, let dances. It was everything. Okay. It's a freaking classic acquaint. Lindsey foot is number one and she ain't even have to be out she out now, but she ain't going to have to be out. She is out to us anyway. So that was actually a really fun video to do. And I'll probably do another one because so many people rode in some of their favorite black lesbian moments that I had not even thought about again, or that people didn't tell me about because I asked my friends.So for example Lena commented, Lena [00:25:00] wave comments. And then she was like, what about when Tasha was on, came out on the L word? And I was like, dang, that was a pivotal moment because L where had been so white up until that point and it Tasha show up and just wreck the crew. And I was just like, Hey you.Right. So I'll probably do another video. But I think, I think for lesbians, some of the major challenges is still representation. And I think there is a lot of invisibility happening with lesbians. So there's a, there's a podcast called cruising, which on this podcast and but there's a podcast called cruising and they have like three lesbians going across the country and they are going to all of the last lesbian bars.And so there's 60,000 bars across the country and there's only 25 lesbian bars, 25 lesbian owned bars across the whole country. And so they did a whole podcast traveling around the country and visiting these bars. [00:26:00] So I think that there is a great need for visibility of lesbians. Not only in media, but just in life in general, you know?And I think lesbians often can kind of get lost in the south. So similar to how people feel like there's some invincibility with, by bisexuals in the community right now, I think, you know, a lot of trans folks get a lot of press because there is a political onslaught happening from right wing conservatives politically.And it doesn't mention, you know, gay folks or lesbian folks or bisexual folks it's specifically mentioned trans folks, you know, and I think that there's some, there's a definitely a sector of lesbians who feel like they have been left behind often also because we use the word queer these days and no one really uses the word lesbian.So I know that there's some lesbians out there that just feel like they've been left [00:27:00]somewhere in the eighties and. I think it's a, I think it's a challenge for them in that respect with all that being said, if one of our alphabet mafia is as you put it, okay, it's being attacked. Then we all being attacked.If we all don't have freedom, then none of us have freedom. So I think that some of what I hear as lesbian concerns, you know, aren't really concerns at all. I think it is fear. And I think that when our trans fam is experiencing right now, what they are experiencing right now affects every single last one of us.De'Vannon: So when you say someone says there's a lesbian concern and it's not really a concern, it sounds like you're speaking about hate and ignorance. Anna: Well, it might be a problem for them. It's not a problem for me. I think [00:28:00] that. I think it's just people being who they are.And I think that there, I think that people evolve and I think that terms evolve. And so I think there are people who are lesbians, who identify with a very strict definition of what it means to be a lesbian. I think there's people who identify with the very strict definition of what it means to be, get men who love men and women who love women.Like these are various particular definitions like that is it. And that is all right. That we're coming upon a time. I felt like we were living in a time where there is sexual fluidity and so forth, and I can speak for myself and I statements are so helpful in these moments. It's like I came out as a lesbian, but at the end of the day today, I identify as queer because child, I love a lot of things.Okay. And it's not just, it's not just women or assists women. Okay. It's just not. And so I needed an expansive word. I needed an expansive definition outside of [00:29:00] lesbian to identify with. So I think that I think oftentimes people get. And what they always known or anything like or stuff like that.But at the end of the day, things evolve, people evolve terms, evolve, communities evolve. And I also think that if there is one major issue affecting lesbians today, it is just continues to be a lack of representation and visibility, especially for masculine scent and lesbians. I mean, fam lesbians, they, their level of Ms.Visibility is a whole nother story, right? I've I've had films. Tell me, like, I intentionally date, you know, masculine of center women. So people know that I am a lesbian. I don't want you to think I'm straight, you know? And for masculine of center women, there is a, there is an appearance that out you, when you walk out the house.So you know, [00:30:00] visibility on a grander scale is still not there, even though there's a different level of acceptance. I believe four lesbians than there are even for gay men. I think gay men have a whole other struggle that around masculinity, especially in this country, that it's just really different than the lesbian experience.I've talked about. A friend I grew up with a gay guy who was very flamboyant, right? We was cool. He had to come to school with a knife right in his shoe. He never left home without a knife. And underneath the sole of his shoe, that was not my story. I never felt unsafe. He always felt unsafe. And I think at the core of it, I mean, there's so much to be said around the differences between a male identified experience and a woman identified experience within the LGBTQ community.De'Vannon: Let's talk about these experiences in the church. So in researching you, there is some Lutheran Baptist. History [00:31:00] here. Talk to us about how you grew up in cherish. Anna: Ah, man, my mama and my daddy met at church. So my dad has been a teacher for 40 years and he was teaching at teaching at a private Lutheran school where my mom had enrolled my sister.So my sister is 17 years older than me. And so my mom rolled my sister there and then they started a love affair in which they had to keep on, on the low, because the teachers weren't supposed to be thanking the parents, the parents were supposed to be dating the teacher's child, but in a way,and let me tell you, 40 years later, they still at the same church. Okay. So. They landed at a black Lutheran church on the south side of Chicago. And so that's where I grew up, but my dad's side of the family started a missionary Baptist church also on the south side of Chicago. So I would often have two Easter speeches.Okay. I, we would often end up going to two different churches on Sundays. Cause my family was at that church, [00:32:00] my uncles, my aunts, my grandma. I mean, everybody was that Christian Love missionary Baptist church. Right. And so we would, you know, time's always different to, with black church. So Lutherans start at a bright and early 10:00 AM.Okay. And we was done in 60 minutes, strong, maybe 75 on communion. Sunday Baptist church was just getting started about 11 and praise and worship. 30 minutes. And so by the time we get that, we still at the beginning of the service, so it would a lot more shouting to go. So it was definitely two very different religious experiences growing up too, which I think just kinda tells a lot about my life in general.The dichotomies. I'll be one place at one moment and be in total different place in the moment. Another moment, you know, I could be at some highfalutin place one moment, and then I could be in the projects the next moment. All of it [00:33:00] made sense to me for where I was in my life. But church church was a good time.De'Vannon: So you're a preacher's kid. You, you, you say that would explain why you are freaking, you call yourself queer into all things. You have them PKS. I'm pretty freaky deaky. Anna: We get into some things, we get into some things and they'll see it. My dad. So he's a deacon, but at the end of the day, he could preach anywhere and he does preach all the time.And. He just for Lutherans, you got a lot of rules, regulations. And so he never went back to get that final piece, but he has his master's in divinity and all this stuff. So, yeah. Child, Sundays, Wednesdays, Saturdays, and church. De'Vannon: Yeah, that's awesome. That's how I was growing up. Pentecostal Wednesday, you know, Bible ban this night, delivering service this night and the other service [00:34:00] that night when I was at Lakewood, I was there four nights a week, choir practice, Tuesday night, Wednesday night, kids worship leading and teaching Saturday night kids, life choir, Sunday choir.I think, I think we get like addicted to church before we realized we are Anna: Church is a big part, right? If you grew up in the church, it's a big part of your identity. It's your community, it's your family and my home church where my parents still go is home. They have always loved me, always embracing me.I've never been anything that I'm not there, but I have my own thoughts around religion and religious organization. So joining the Missouri Senate is not an option for me because they don't see me as a whole person. So for me, it goes beyond the church. It's about the religious organization, right. [00:35:00] But it defined so much.And that's why when queer folks get rejected from church, It is incredibly impactful and can really damage and cause harm because the first couple of places you learn how to love is at home and at church. And that's often times the two places you spend the most time. And so when one, or both turn their back on you as a human being, you are not the same person you were before.It can, it, it leads you down a path that it, it destroys you period. Point blank. It destroys you, you know, and a lot of my work over the years has been around dismantling that and telling the truth about it. That Jesus never said one thing about gay people, not one, Jesus never said it. Now. I just, these clapper scriptures and everything else, I mean, The Bible is meant to be interpreted.It's meant to be [00:36:00] understood. It's meant to be put into context and the way folks have picked and chosen what they want to and who they want to damn to Hale is, is the most unlocked ungodlike thing they can absolutely ever do. And back in the day, I did this project with this organization called church, was in a church where we did a video 30 day release them to do video every 30 days called my God is not a bully to just emphasize that point that God is not bullying anybody.It's the people in the pulpit that are, and their lack of interpretation of scripture and in context of strip scripture. So The church means a lot to me actually is part of the Q we are releasing our own content as part of the queue and to, and one of our podcasts first podcast is called second Sunday.And I cannot wait for y'all to hear this podcast [00:37:00] because it's talking about the intersections of being black queer and in the church. And we had the opportunity to interview a lot of black queer theologians, lay people musicians for this podcast and the things that they share a child, it's just, it humanizes an experience that gets polarized a lot.And I hope I hope folks can get seen through this work. De'Vannon: Yeah. I was at a graduate at the Houston graduate school of theology and he of course, Euston, Texas, but I was going to get a master's of divinity as well. When you said that it, it popped out my ears, but I, I left that bitch. I broke up, I broke up and that bitch, when the, when the law professor said that, that they like to control people in church.And so that was like, well, I didn't come here to dominate motherfuckers, so I'll be going now. And so let me get more, I want to get more granular [00:38:00] with your per perspective. Cause I watched that video. One of the, one of the God is not a bully and I agree with what you're saying and it's at the epicenter of my message to people.I preach spiritual independence and people getting close to God on their own without a church or with one. But if you're going to have a church, remember that it's second to God. And so You bring up. Okay. So you're talking about like how the people are using the scripture to throw shade at people who are unlike them.It, how. Scriptural interpretation is very subjective and it is, everybody can read the Bible and come out of it with what they want. It's clearly not an easy to understand book because if it was simple to interpret, then you wouldn't need a thousand different translations of it. And so, I mean, And so since people are indoctrinated in such a young age, you know, at churches, you, you understand you go there to learn, but critical thinking about what the preacher is saying is not what's taught to you.And [00:39:00] so you're accepting whatever is being said. And by the time you're old enough to know any difference, you've got all of these issues to sort out, and then you feel conflicted about it because you've been told never to disagree with a preacher or a church, but now you like the shit don't make sense though.And so, so we add an out here to tell you that you will not burn up and go to hell for not being straight and to all the straight people. And I mean that loosely, because you never know what the hell people not doing behind closed doors. I didn't fuck so many straight married men and my day is unreal.And so you know, just, just know that while they're trying to use these scriptures over here to condemn you to hell since they want to be so strict about that. The, the Bible and everything. You know, the Bible speaks against getting divorced for any reason, other than infidelity. It speaks against interracial couples and stuff like that, stuff that we're all totally cool with.Now, them people in church got 50,000 divorces. [00:40:00] It all kinds of reasons and all kinds of mixed, mixed racial shit's going on. And I'm cool with all of it. But my whole point is this. If you're going to be such a hard ass about one part, you need to be a hard ass about the whole fucking thing. I don't want to see you eating nothing that divided the hoof.I don't want you getting down with the pig or nothing like that. If you going to be that much of a, of a bitch about it, then follow the whole fucking thing from end to end and not just a P a few slices of. Anna: And that's what they do, right? Those Christians like them, so-called Christians cause they not Christian some so called Christians.You know, they use, they use it for whatever they feel like they want to use it for. And they cause a lot of freaking harm and they're causing harm right now. And now it's entered the political round, you know? And we need more folks like you, we need more projects. I tell queer folks and LGBTQ young people that you'll still love that God still loves you.That your relationship with God is far more important [00:41:00] than whatever this preacher is saying from a pulpit. I also think critical thought is so incredibly important when you understand that there are books missing from the Bible, right? When you understand that, that what you're reading is not the entire Canon, like what are we doing here?People, what are we doing here? And also think it's easy to make God this very angry damning person and being. That was not what God taught at all. That's not what God taught at all. De'Vannon: He's not, he's a God of mercy and grace forgiveness, long suffering, slow to anger, quick, the mercy, quick, the compassion.That's what the scripture say. He's not like man, you know, quick to judge and clobber you and what you speak of about getting kicked out from churches and how it changes you. It's it's, it's what I call being dehumanized. It makes you feel like you're less than a person. And when a church tells you, you have to go.Not because of [00:42:00] something you've done with church has never supposed to tell anyone to go, no matter what, you know, Jesus accepted murderers and everybody. So for a terrace would be like, you can't go because of who you love, which is what Lakewood church did to me. You know, you can't. There, you know, you, that, that, that, that sent me on a downward spiral that ultimately led me into drugs and to drug dealing and to getting hepatitis B and HIV, my choice to do what I do, do what I did, but they certainly would've sparked the set that shit in motion and fuck them.Fuck you wake with church in on repeat, if we can dub stuff, that shit, then the video you also said. You, you made a comparison about how, okay. Say like procreation, one of the arguments people use against the non straight community is that God hates what you're doing because when you have sex, you can't, and there's no kid that's gonna come of it.[00:43:00]And then you were like, okay, well they're straight couples that God has prevented them from having children's. It was that because he hates them too. You know, it's not a, you can't apply that sort of a rubric evenly. You can't do it. And then you were also saying, you said something very interesting to me.You said that you wouldn't choose another burden and you were like, I'm already blessed. That's hard enough as it is. Do I really want. Add queer to it and all the problems that come along in this life, in that statement, you're rebutting the stupid shit. Like I heard Joyce Meyer and whoever the fuck else say that, where they think it's a choice, you know, like, like we just, oh, well we'll think we'll be gay today, you know, or some or some stupid shit like that as that is the most overly simplistic, dumb ass shit.These supposedly educated people Anna: say 100%. And I think that that's at the core of it. And I was talking to somebody recently whose child just came out to [00:44:00] them a year or so ago. And I was just like, you know, We have to start the conversation at choice with choice, because if you believe what I'm doing is a choice, then we're not going to get very far because at the heart of homophobia, is this idea that you can change.Hence why conversion therapy, right. Has been such a popular way for Christians to change people because you don't think it's a choice because you think it's a choice. But in fact, it's not. In fact, I grew up when my mama put me in bowls and matching ruffle socks. Okay. And doing everything in her power to make, to, to raise a feminine girl.And in fact, I was who I was from the moment I had any say over it. It's just not who I was. And I was very clear about that from a very young age. I was very clear that I was [00:45:00] athletic. Does that make me gay? No, but I was also very clear. I liked wearing my dad's shirts and my dad and I had the same initials and he gets his shirts embroidered with his initials on them.And I wanted to wear his shirts. I was not going to wear my mother's dresses. I didn't want nothing to do with heels. I didn't want to do a pantyhose. It's just, it just wasn't who I was and it's not who I am. And so I think all of these conversations around homophobia and transphobia and hate come around, the idea that who we are is a choice and who we are is not a choice in the same ways who they are, you know innately is not a choice.De'Vannon: That do be facts though, because if there was, they're going to apply that logic, the us, and it has to go in reverse. And I like you when I was two, three years old, I was already playing with Kendall. I was trying to see what was up under his shorts and shit like that. So, but if, but if there's a choice, then when did they kick to be straight?And [00:46:00] then if that's the case, are they confessing that they had homosexual desire at some point, you know, the way they tell it, they'd been straight from the beginning. So if that's the case, you know, it's uneven, but it's like anything else from your favorite food to your favorite color? Life is a thing of discovery.We do not get to put ourselves together like a doll or a made out of Play-Doh. You don't get to go. My favorite color is going to be green. My favorite dish is going to be lobster. My favorite state, I think I'll go with Kentucky. My favorite shoes, I think van sounds nice. You know, you, you get exposed to shit and then you pay attention to what keeps standing out to you.And what keeps drawing you in and then you go, oh, it seems like I'm into the color green or, oh, I think I really, really liked these fucking vans. They represent me. Well, you discover who you are, the beginnings of who you are, is shaped. And when you're in your mother's womb everywhere, she goes, the things she says, the people she talks to, the thing she thinks read, exposes [00:47:00] that child to everything, you cannot separate the two.So you're predisposed to so much before you're even born. So for them fuckers to be like, well, you chose to be gay. I goes again, signs and all logic. And they're just stupid as hell. Anna: Pretty much, pretty much. And what's really unfortunate is, is that I, I see that there can be a differentiation. So let me give you an example.Like you can believe that being queer is wrong, right? You can believe. But that should not equate to me not having the rights as a citizen, within a country that I pay taxes in, if that makes sense. So for me, politics shapes society. So you can think being gay is wrong, but that doesn't mean you have the right to limit my rights, [00:48:00] to control who I love control.If I can get married control, if I can get medical care control with books, I read you not have that type of control in my life. Just because you don't agree with who I am. I don't agree with you being a white, racist, homophobic transphobic person. Right. Right. But I ain't trying to write legislation to kill off your human existence.Right. Because that is exactly the fact of the matter is that what's happening across the country right now is killing. Trans youth, the numbers the suicide hotlines, like the Trevor project, they are outrageous right now, right? People are trying to leave states where they have had homes and families and a legacy because their children can't get the medical care they need.Because now politicians are saying that parents don't know what's best for their own children. How dare you? Just because you don't believe in who I am. [00:49:00] And I think it's just so incredibly contradictory because they don't want anyone telling them who they are or what they should be doing. You know,De'Vannon: if it's any consolation, these people are the hypocrites of our day. You had them in Jesus's time. I agree with what you said earlier, how the Bible is not complete. Some people will say everything you need to know about life it's in the Bible. That's bullshit. It's a general. It's a general guide to help get you close enough to God.So you can talk to him for yourself and then he can fix you and instruct you the rest of the way. But everything is not in there, but these, these Republicans and evangelicals and everything, these are today's hypocrites. Every generation has to have them. There's not going to come a time in this earth until probably the millennial kingdom when Jesus Christ reigns here again, but even, well, I'm not going to say that because even then there's going to be people who don't believe in him in the earth.And so there's always going to be those people who are contradictory, these people [00:50:00] are like how solid the apostle is before you became Paul. The thing is if God doesn't open somebody's eyes to their hypocrisy, then they won't see if you don't up in their ears to hear truth. They won't hear, they won't believe and be converted.Every generation has to have the people who are going to be citizens of hell bound to go to hell. Because if they have humility and love in their heart, they would go to heaven and they would be rugged. You people not going to accidentally end up in hell, you have to be like Pharaoh or somebody and just hardheaded ignoring the signs, not hearing what the people under you are trying to say, not hearing the voice of the people.That's how far was he just would not hear logic and reason because he was so set in his ways and what he wanted to want other people to do. Now, Paul Saul took his ass to the Sanhedrin saying Hedron was a religious council of the day. I think it's like 70 something. My fathers who control shit. It's no [00:51:00] different than legislation.The day, a whole group of motherfuckers who control. You say, I look this Jesus person and come here with his bullshit and these people trying to act like him and we can't be having none of this. So give me some power, some letters and shit. So then go arrest. They asses and beat them and fuck with them and shit beat this Jesus out of the acids.Cause this ain't right. It's on rip up our moral fabric. And this is going to tear our society down because of how they believe. And the Sanhedrin was like, go on, play a gong. Now his way to Damascus Jesus intercepted his bitch ass. And it was like, ah, ah, ah, ah, what you doing? You need to stop this shit because I did not send you scripturally speaking.He said, Saul saw, why, why are you persecuting me? It's hard for you to kick against the pricks. And so what do we have here? Somebody who said those people over there, I don't like what they doing. So let me in and enact laws to change them. And the Lord said, I don't want [00:52:00] you to do that. That, that is the what the whole beginning of that, that part of the book of acts is about Jesus Christ.Being against using the law to co Eris people to behave differently. It was right there yet. When those people, the people of our day, the hypocrites, the Republicans, evangelicals, if they even read they dusty ass Bibles, I don't see how they can. And when they read the Bible, they, they read it to find not what's wrong with other people.They are right there. But when they killed Steve and I'm going to say this and shut the hell up, but this is a hot button for both of us when they killed even the one who said to me, the first martyr, he read the religious people for Phil, and he told them, you motherfuckers are the same people who kill the prophets and everything like that.While you sitting up here trying to judge me that he, it was a whole long chapter in acts. And then they stoned him to death and everything like that. So these things must be so, Anna: and I think so, [00:53:00] Chad, you just said so much, there's so much to say. I think, I think at the heart of it also is that the theology, like your own spiritual connection to God is, can be so expansive.So the, to your point, right, the Bible is one thing. But then, right. Christians will tell you that all these, you shouldn't even explore these other religions. They can't give you nothing. Like, no, you can't get nothing out of nothing out of these, none of these other spaces. And I think to myself, like I thought God created everything.I thought God created everything. And if God created everything and God is in everything. And and I find myself having a very expansive worldview about God and my beliefs, like, so. Growing up. You're taught that if someone commits suicide, they go into hell. [00:54:00] And then now I was thinking, and then as I grew up, I was like, why would God send anybody to hell for committing suicide?And where does it say that in the Bible? And it doesn't right. We're just fed these. We fed these things out of fear to control you to not commit suicide, but who in the world told you that? When I think about the, the, the, the preachers and spiritual teachings that like folks around the world, anyone who doesn't call Jesus by name as their Lord and savior is going to go to hell, how is that possible?When there's people in the other countries, in the world who don't even know who Jesus is. So you're telling me that this God of love is going to send somebody who had an opportunity to get to know who, who Jesus was. That doesn't make any sense to me. And I think that. When for me, because of my sexual identity, it caused me to have to question a whole hell of a lot of stuff.Definitions of [00:55:00] what heaven heaven is, definitions of what hail is, definitions of who's going, and who's not, you begin to question all of it. And for me, when it boils down, I love it. When my mom says this to people about me. When she would tell me this all the time, she'd be like, have you read your 10 commandments recently?I don't see nothing in there about God, about gay people, you know? But I see a whole lot of other stuff that applies to you. Hello. So my mom, you know, she got to the point where she was empowered enough to, you know, stand up and say something and speak out about that. And I think that we need more people to do just that.Cause they ain't gonna say it to me. They gonna say it to their friend who they think agreed with them, you know? So. I just think we have a long way to go to the, understand what it means to, to embody and to embody a godlike existence, because it has so much [00:56:00] more to do with love and choice than anything else.De'Vannon: I was like you a very well said girl. I was like you very confused and conflicted about myself because of what the church said. They only gave me peace with learning, how to read the scripture for myself. I went back to the original Greek Hebrew and Aramaic the original, the Bible and discovered it for myself, what I want people to do, because any translation you read king James, a message or whatever, the living Bible, those are all other people's translations.That's not the actual original language. Instead, if you want the true truth, then you got to go back to the source. You got to go back to the original languages of the net and you get. Somebody else's version Anna: that end. You have to I think you gotta find your own practice. So you have to find what that practice looks like for you.Especially when you feel disconnected from church, because church was a practice Sunday, Saturday, Wednesday, however many times a [00:57:00] week, that was a practice. So as if you feel yourself pulling away from that, that you have to figure out what your practice look like. And so today, like my practice looks like me being in my prayer corner in the mornings, but my affirmation books with my journals, with my candle, with my music, with pictures of my family, like for me growing up, like it is being grounded in quiet and close to God in those moments.And that's my, that's my practice today. And I feel closer to God than I ever have. I see signs all the time. I think numerology is real. Like if something profound happens, I'm like, what time is it? I think, I think there's so many ways to connect with God. And when you choose to close yourself off to all the possibilities and all the possibilities of who God is, you will miss her.You going to miss, you're going to miss her. You gonna miss her. That's it.[00:58:00]De'Vannon: Let me see here. So we wanted to talk about the cube. As we begin to wrap it up, I'm going to read your favorite quote by Shirley Chisholm believes you better than she was the first black woman to put in a bid to be a presidential nominated back in the seventies and her eyeglass, a tiny her frame game was on point yes and date match for the gods date.And she said, if they don't give you a seat at the table, bring a folding chair. You go on to say in your it says in your, in your, in your website, you know, we bought our folding chairs and there hasn't been any equity to be found at those tables. It's time for us to build our own tables and our own chairs to this space and model the change we want to see in the world of podcasting.Anna: Yes. All of that. So I love Shirley chill. I love [00:59:00] everything. She's still fought. She she's made a lot of things possible and she had to bring her folding chair. Okay. She had to, they weren't inviting her to no tables. She had to bring a folding chair, but because of the work that she did and in fact that we can stand on the shoulders of so many other incredible, incredible people of history from Ella baker to Angela Davis, to Coretta Scott King, Utah, I mean, Elaine brown, I can go on and on.We can build our own tables. We don't have to wait on anyone to do anything for us. Should apple be more inclusive? Yes. Should Spotify be more inclusive? Yes, they should. But it is not about what they should do because capitalism rules this country. So if it's not, if it doesn't make money, it doesn't make sense in so many ways in that world, but we have an opportunity to do something different.[01:00:00]And I think we have an opportunity to shape, especially the podcasting space, because I feel like it's still very much so a new medium, I believe it's coming into its own after 20 years. And that's why I like new it's like, so it's such a funny thing to say because it's been 20 years, but for so many people, they are just really getting into what it could mean to listen to a podcast.And we can shape what we want this world to see. And I wanted to see more diverse. I want to see more people like me and I wasn't finding them. And so the cube will be that there'll be the one and only curated destination of music and podcasts by BiPAP and QT POC folks. And the music is powered by our radio station.Ethan. Which plays queer music and reports on queer news and high rotation specifically at the intersections of race and sexuality. So there's so many queer artists out here doing their thing, and you don't hear about them. [01:01:00] There's so many of them making good music. I got one of my favorite inspirational artists is a black queer woman who was on Sunday.Best Maya be you know, her, you know, like they deserve a space to be. And then there's like, dope podcasts is like, you whole deserve to be seen who to serve more visibility, more amplification of your work. And I think we can do it. And matter of fact, I know we can do it. We are doing it. And I think we can do it really, really well.So it's going to be an app or in development. My goal. My hope is that we are dropping beta in July and totally out to the public. By September of this year, we've accepted 94 podcasts into the app. We've got a team of folks listening to every single piece of podcast content, because we want the best pod-casters inside of our app.I want the best because there's a lot of poor Lee produced podcasts in the market. People who [01:02:00] sound like they got the iPhone on top of the roof on a fourth bottle of wine. Okay. And you know, that's okay. That's okay. You can do that. You got something to say and you better go say it. Okay. But they don't have to be what's in my ears.It doesn't have to be what's inside this app. I want it to have to be where the best reside and that's what resonates with me. And that's what we're building. De'Vannon: Yeah. I was listening to somebody, his podcasts earlier, who's trying to come on my show and be a guest. And I was like, God, I can't hear what you're saying.You sound muffled. Yes. Out there. So I thank you for your compliments. Just all the sex, drugs and jingles podcast has been accepted into the cube. So our clients, our quality is on point enough for these standards. And so. I'm going to read it a little bit further. So it says the cube is majority owned by a black queer woman and co-founded by three black LGBTQ persons.The cube will be a centralized [01:03:00] destination for discovery of BiPAP and QT pop music and podcasts. Tell us what the BiPAP and QT pox Anna: fans. Absolutely BiPAP is black indigenous people of color. And I choose to say BiPAP because I leave with my blackness. And so I choose to say black indigenous people of color.And then I choose to identify queer trans people of color specifically, even though we inside the BiPAP, we in there. But I think it's important for queer folks to know that I'm talking about that, that this platform is also for them, that I want to be able to center and amplify their work as well. And so that's why I, I include QT POC into the narrative now is my marketing team happy about that?No. Okay. It's a lot of words. It's a lot of acronyms people don't know what the heck I'm talking about, but the people, the people who know know. Right. And so, you know, at the end of the day I'm in this accelerator right now with Google, which is [01:04:00] really dope. It's the Google for startups like founders academy.And one of the mentors was like, I need five words, five words to describe your business. You should be able to describe your business in five words. And I was like, God, dang it. And so I came up with discover, discover the best bi-pod podcast. Right. If I had to describe it in five words, discover the best BiPAP podcast is what I came up with.And so that's what it all means. At the end of the day. It's about discovery. You will, will be able to listen to these podcasts inside of the app. And I hope people would choose to do that as well. There's an opportunity for Uproxx to tip their creators from within the app and that money would go straight to those creators.And I'm excited about that. The moment we get enough users, we'll be able to roll out an ad revenue sharing program, right? So we could put more money into creatives pockets who do want to make money from advertising. And, you know, I think we just continue to build this platform in this [01:05:00] space for folks to discover some of the amazing ways that black, brown, and queer folks of color show up in the world.And I think podcasting is a space that people are choosing to share their experiences with the world the same way you share yours. You know? I think there's a, there's a, I know there's a lot of people doing that and you just can't find them. De'Vannon: Up until now, because now Anna: you got the keyDe'Vannon: cue, baby. Yeah.All right. So just any last words you have for the world, any community, whatever you want to say, you can say, what the fuck you feel? Anna: I love it. I love, I can say whatever the fuck I feel.I feel like we're in. I feel like we're in a moment right now. So I, I feel like we've survived a pandemic and it feels like the world is restarting in some ways. [01:06:00] And I feel like we've got an opportunity here to change the way. We do media and podcasting has a way, has an opportunity to show folks how to do media collaboration.Right? I think we can show what it means to be a community inside of a media industry. I think podcasting has an opportunity to do it differently than what and how things have been done in the past. And so I hope that I, I hope that I can be part of that change. There are so many amazing people in this space doing amazing work, our partners.And my hope is that I can amplify them as well. So when we talk about the black podcast association, when I think about the women of color association, when I think about the

You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress. Initial Vitals Temp 99.9 HR 110 RR 22 BP 122/82 O2 82% on BiPAP 10/5 100%FiO2 Critical Actions Correctly interpret CXR #1 (multifocal PNA) Correctly interpret CXR #2 (bilateral PNTX) Treat with Oseltamivir […]

In this lean and mean episode, we cover the outrageously broad topic of respiratory acidosis. Come listen to help structure your approach to Won't Breathe, Can't Breathe, and Breathing Won't Work.  If you remeber nothing else, its that hypercapnia does not always mean BIPAP

This is part B of our Episode 8 on Sleep Studies.  If you haven't listen to Part A please go back and listen for some really great gems on sleep studies.  Part B has juicy stuff too such as:What the heck are all those wires attached to us during an in lab sleep studyBrainwaves which help determine stages of sleepAttachment by the eyes to determine onset of Rapid Eye Movement (REM)Another attachment on the jaw to detect jaw movement and  or bruxism (grinding of the jaw)Legs-to determine periodic leg movementsMonitor breathing with a thermal airflow sensor in the noseEKG patches to monitor heart rate and rhythmPulse oximeter to determine level of oxygen in the blood systemHow a patient can get assistance to relax during an in lab sleep studyWhy is the sleep technician watching and listening to patients during an in lab sleep study?What are some tips to make a home sleep study effective?What is the optimal number of hours necessary for an in lab studyIn lab sleep studies can sometimes look like a hotel roomThe GOOP in our hair is yuck! Why is it necessary and best way to get it out.What's with a home sleep study and then the need to get an in lab sleep studyCPAP, BiPAP, Auto PAP, ASV explained- The various types of machines explainedPatient tip on getting your CPAP machine quicker from Durable Medical Equipment companies (Is it insurance that is holding things up or a slow DME company)Having problems paying for your CPAP or sleep study-Investigate this early using this tip we discussWhy getting your sleep study report is crucial (Even if you are told you don't have sleep apnea) to following up with key questions for your doctorWhat are the circumstances when I would get another sleep study the following yearThis episode has tons of great information for those wondering about sleep studies!In our next episode (Episode 9) we are moving back around to discuss sleep apnea from a social perspective and we are going to explore:Why are we afraid to be diagnosed with sleep apnea?  Is the solution worse than not knowing?  

Der Klinisch Relevant Podcast liefert Ärztinnen und Ärzten, sowie Angehörigen der Pflegeberufe und medizinischer Fachberufe wie Physiotherapie, Ergotherapie und Logopädie kostenlose und unabhängige medizinische Fortbildungsinhalte, die Du jederzeit und überall anhören kannst.

Today we'll be covering Glycogen Storage Disorders, going along with this month's theme, Metabolic Disorders. If you haven't listened to our podcast before, each week we have a case-based discussion about a medical topic to help you study for the pediatric medicine board exam. Episodes are released every weekend, and the case is then reviewed and reinforced on social media throughout the week.   Follow the podcast on social media: Facebook- @portablepeds (www.facebook.com/portablepeds) Twitter- @portablepeds (www.twitter.com/portablepeds)   We'd love to hear from you via email at portablepeds@gmail.com!   Also, feel free to visit our website, www.portablepeds.com, for more content.   Today's Case:   A 2 month old male infant born at 39 weeks gestation via SVD as a home birth presents to the ED for respiratory distress. Pt is tachypneic and tachycardic with global retractions, head bobbing, and grunting. Pt was placed on BiPAP, and a chest X-ray was then obtained, which showed marked cardiomegaly. Subsequent EKG showed left ventricular hypertrophy. On further examination, pt was also noted to have hepatomegaly, macroglossia, and hypotonia. What enzyme is likely deficient in this patient?   Glucose-6-Phosphatase  Acid Alpha-Glucosidase Glycogen Debranching Enzyme Myophosphorylase Phosphofructokinase   We would like to give an enormous thank you to Zack Goldmann for designing this podcast's logo and accompanying artwork. You can find more of his work at www.zackgoldmann.com.   The intro and outro of this podcast is a public domain song obtained from scottholmesmusic.com.   Intro/Outro- Hotshot by Scott Holmes   Disclaimer: This podcast is intended for healthcare professionals. The information presented is for general educational purposes only and should NOT be used as professional medical advice or for the diagnosis or treatment of medical conditions.   The views and opinions expressed do not represent the views and opinions of our employer or any affiliated institution. Expressed opinions are based on specific facts, under certain conditions, and subject to certain assumptions and should not be used or relied upon for any other purpose, including, but not limited to, the diagnosis or treatment of medical conditions or in any legal proceeding. Full terms and conditions can be found at portablepeds.com.   Thanks for listening! As always, please Rate and Review this podcast on Apple Podcasts, Facebook, or your favorite podcasting platform. Also, Subscribe to get all the latest episodes, and Share this episode with someone you think would enjoy it! Hope to see you real soon!

As the COVID-19 pandemic continues, clinicians are learning more about the impact of the disease on the body, particularly in the lungs, and it's shaping the way hospitals need to think about treating these patients – specifically with regard to what type of breath support to use.In this episode in our Coronavirus Special Edition Series, Dr. Bill Croft, Ed.D, Ph.D., RRT, RCP, Executive Director of the North Carolina Respiratory Care Board, discusses the unique physiology of the COVID-19 lung, the pros and cons of BiPAP versus mechanical ventilators, and a more refined, incremental treatment path for breath support in COVID-19 patients.For more on the use of invasive BiPAP as a potential alternative to mechanical ventilation, listen to our previous episode, Surviving the Ventilator Shortage. And to learn more about the Syneos Health Ventilator Initiative, visit www.COVID-biPAPinfo.com. Stay tuned for more installments of the Coronavirus Special Edition Series, which explores, from an operational standpoint, the impact of COVID-19 on the biopharma industry, the challenges for rapid R&D in an outbreak environment, and the opportunities to leverage technology and innovation to address these critical issues. Additional materials and insights can also be found in our COVID-19 Resource Center.If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision making and investment. You can find it all at insightshub.health.Like what you're hearing?  Be sure to rate and review us!  We want to hear from you!  If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com. * This episode was recorded on 4/23/2020.

A critical shortage of mechanical ventilators is anticipated in many countries, including the United States, because of the ongoing COVID-19 pandemic. A potential emergency solution would be the use of bi-level positive airway pressure (BiPAP). BiPAP may be used in the hospital setting with appropriate precautions for intubated COVID-19 patients experiencing Acute Respiratory Distress Syndrome (ARDS). Use of invasive BiPAP on an emergency basis may delay or obviate the need for mechanical ventilation in appropriate COVID-19 patients.In this episode for physicians on the front lines treating patients with COVID-19, Keith Robinson, MD, a critical care pulmonologist at Syneos Health, discusses how, when, and in which patients, the use of BiPAP can potentially be used in place of mechanical ventilators. For more information on this solution, download the full white paper. And to learn more about the Syneos Health Ventilator Initiative, visit www.COVID-BiPAPinfo.com.Stay tuned for more installments of the Coronavirus Special Edition Series, which will explore, from an operational standpoint, the impact of COVID-19 on the biopharma industry, the challenges for rapid R&D in an outbreak environment, and the opportunities to leverage technology and innovation to address these critical issues. Additional materials and insights can also be found in our COVID-19 Resource Center.If you want access to more future-focused, actionable insights to help biopharmaceutical companies better execute and succeed in a constantly evolving environment, visit the Syneos Health Insights Hub. The perspectives you'll find there are driven by dynamic research and crafted by subject matter experts focused on real answers to help guide decision making and investment. You can find it all at insightshub.health.Like what you're hearing? Be sure to rate and review us!  We want to hear from you! If there's a topic you'd like us to cover on a future episode, contact us at podcast@syneoshealth.com. * This episode was recorded on 3/22/2020.

In this episode I cover Non-Invasive Ventilation (NIV).If you want to follow along with written notes on non-invasive ventilation go to https://zerotofinals.com/niv or find the respiratory section in the Zero to Finals medicine book.This episode covers the non-invasive ventilation. We talk about BiPAP and CPAP, what they involve, how they work and when to use them. The audio in the episode was expertly edited by Harry Watchman.