Podcasts about ecmo

In this episode of *PICU Doc on Call*, Dr. Monica Gray and Dr. Pradip Kamat are joined by fellow Dr. Hope Vancleve to discuss a complex case of a 12-year-old with MRSA septic shock requiring VA ECMO. The conversation covers sepsis-induced myocardial dysfunction, including its pathophysiology, diagnosis, and management. The hosts also explore differential hypoxia, or Harlequin syndrome, a serious VA ECMO complication causing upper body deoxygenation, and discuss monitoring strategies and circuit reconfiguration to prevent cerebral and myocardial ischemia.Show Highlights:Clinical case discussion of a 12-year-old male patient with MRSA septic shock.Complications of sepsis, including sepsis-induced myocardial dysfunction and refractory shock.Management strategies for septic shock, including antibiotic therapy and fluid resuscitation.Use of venoarterial ECMO support in pediatric patients with severe cardiac dysfunction.Pathophysiology of sepsis-induced myocardial dysfunction and its impact on cardiac function.Differential hypoxia (North-South syndrome) in patients on femoral VA ECMO.Diagnostic approaches for sepsis-induced myocardial dysfunction, including echocardiography and biomarkers.Importance of monitoring and managing end-organ function in septic patients.Strategies for addressing differential hypoxia in ECMO patients, including circuit reconfiguration.Discussion of the risks and benefits of various ECMO configurations and management techniques.References:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care ChapterReference 1: Torre DE, Pirri C. Harlequin Syndrome in Venoarterial ECMO and ECPELLA: When ECMO and Native or Impella Circulations Collide - A Comprehensive Review. Rev Cardiovasc Med. 2025 Aug 26;26(8):39992. doi: 10.31083/RCM39992. PMID: 40927093; PMCID: PMC12415751.Reference 2 : Cove ME. Disrupting differential hypoxia in peripheral veno-arterial extracorporeal membrane oxygenation. Crit Care. 2015 Jul 22;19(1):280. doi: 10.1186/s13054-015-0997-3. PMID: 27391473; PMCID: PMC4511033.

Col Valerie Sams, MD is an Air Force trauma surgeon, surgical critical care expert, and the Director of the Center for Sustainment of Trauma and Readiness Skills (C-STARS) at the University of Cincinnati. Her path to the operating room was anything but ordinary.   Before medical school, she served as an Air Force line officer in logistics and fuels, learning how the operational side of the service actually works at the flight line. That bilingual fluency in operations and medicine now shapes how she advocates for resources, leads hospitals, and prepares the military health system for the next fight.    In this conversation, she walks through her two tours as the trauma czar at the Bagram role three hospital straight out of fellowship, where she was responsible not only for clinical excellence but for leading every nurse, emergency medicine physician, and surgeon doing trauma care across the theater. She talks honestly about the weight of that role, especially during her second deployment with junior surgeons on their first downrange experience, the rise in U.S. casualties, the green-on-blue threat, and her work standing up Medic-X as a force multiplier for limited deployed medical crews.     Col Sams makes a powerful case for the strategic importance of military-civilian partnerships like C-STARS, the only Air Force critical care air transport advanced training course, and explains how the Air Force, Army, and Navy are converging through the Joint Trauma System, the Mission Zero Act, and the American College of Surgeons Blue Book to professionalize military-civilian integration. She is direct about the skill sustainment crisis inside military treatment facilities, the shift from 65 percent beneficiary care to 20 percent, the urgency of the Military Unique Curriculum, and the need to train outside-the-tent skills deliberately rather than by accident.   Dr. Sams lays out a clear-eyed vision for large-scale combat operations: faster trauma registry feedback loops, autonomous and decision support tools, closed-loop control ventilation, ECMO projected forward, and a hard end to the wax pencil and TCCC card as battlefield documentation. She closes with what should remain the center of gravity for every military medicine decision — the warfighter — and the conviction that they deserve the best clinical care available anywhere in the country.     Chapters (00:47-05:47) From Fuels Officer to Trauma Surgeon (05:47-12:49) Two Tours as Trauma Czar at Bagram (12:49-24:46) ECMO Forward, C-STARS, and the Skill Sustainment Crisis (24:46-35:42) Joint Military-Civilian Integration and the Military Unique Curriculum (35:42-49:26) LSCO Readiness, Force Multiplication, and Battlefield Technology (49:26-58:30) Female Leadership, Clinical Excellence, and Legacy     Chapter Summaries (00:47-05:47) From Fuels Officer to Trauma Surgeon Col Sams describes her unconventional path from Air Force line officer in logistics and fuels to general surgery and trauma fellowship. She credits her operational background with giving her a bilingual fluency between line and medical worlds that strengthens how she advocates for resources, leads hospital operations, and earns credibility with non-medical commanders.   (05:47-12:49) Two Tours as Trauma Czar at Bagram She unpacks the weight of deploying as the trauma czar at the Bagram Role 3 immediately after her fellowship and the lessons that came from leading mass casualty events, debriefing young teams, and dealing with the green-on-blue threat. She explains the stand-up of Medic-X under Lt Gen Hogg as a deliberate force multiplier for limited deployed medical crews.   (12:49-24:46) ECMO Forward, C-STARS, and the Skill Sustainment Crisis Col Sams details her work projecting ECMO capability into austere environments and around the globe, then explains the mission, history, and structure of the three original C-STARS programs. She is direct about the skill sustainment crisis, with beneficiary care in military treatment facilities dropping from roughly 65 percent to 20 percent over two decades.   (24:46-35:42) Joint Military-Civilian Integration and the Military Unique Curriculum She describes the progress driven by the Mission Zero Act, the Joint Trauma System military-civilian work group, and the American College of Surgeons Blue Book. She makes the case for a robust Military Unique Curriculum that develops both surgical fundamentals and the outside-the-tent skills that today's young military surgeons need before they take their first leadership role downrange.   (35:42-49:26) LSCO Readiness, Force Multiplication, and Battlefield Technology Col Sams turns to large-scale combat operations and the blind spots that the counterinsurgency generation may carry into the next fight. She calls for faster trauma registry feedback, autonomous decision support tools, closed-loop ventilation, ECMO projected forward, and a hard end to the TCCC wax pencil as the primary battlefield documentation tool.   (49:26-58:30) Female Leadership, Clinical Excellence, and Legacy She offers candid advice to young female military surgeons on imposter syndrome, unconscious bias, and the discipline of staying clinically excellent. She closes with the conviction that patient-centered leadership, lifelong learning, and protecting clinical talent are the foundations of how military medicine should remember her work.     Take Home Messages Operational Fluency Strengthens Medical Leadership: Time spent on the line side of the military — understanding logistics, fuels, and how the operational force actually fights — builds credibility with non-medical commanders and sharpens advocacy for resources. Surgeons who speak the operational language sit at the right tables and make better decisions for their teams and their patients.   The Trauma Czar Role Demands Leadership Before Stride: Being responsible for an entire theater of combat casualty care immediately after fellowship is a heavy and unforgiving assignment. Clinical excellence is the floor; the real work is leading nurses, emergency medicine physicians, and surgeons through mass casualty events, debriefs, and the green-on-blue threat with junior teammates who have never deployed before.   Skill Sustainment Requires Military-Civilian Partnership: Military treatment facilities now deliver only a fraction of the beneficiary care they once did, and that volume cannot sustain combat-ready trauma teams. Embedded military-civilian partnerships like C-STARS, supported by the Mission Zero Act and the American College of Surgeons Blue Book, are the realistic path to keep wartime skills sharp.   Outside-the-Tent Skills Must Be Deliberately Trained: Today's young military surgeons need more than technical readiness. They need a deliberate Military Unique Curriculum that develops the non-clinical leadership skills required to run a theater trauma system, manage resources, and lead teams under pressure. Picking those skills up on the fly is no longer good enough.   LSCO Will Not Wait on the Wax Pencil: The next fight will not give the medical force three years to figure out what changed or seven years to update clinical practice guidelines. Force multiplication through MedicX, autonomous decision support tools, closed-loop ventilation, ECMO projected forward, and modern battlefield documentation are non-negotiable investments now, before large-scale combat operations force the lesson.   Col Valerie Sams, MD Biography    Colonel Valerie Sams is the Director of the Center for Sustainment of Trauma and Readiness Skills (CSTARS) Cincinnati and serves as Critical Care Air Transport Team (CCAT) Training cadre. Originally from Georgetown, KY, she was commissioned into the Air Force in 2000, initially serving as a supply and logistics officer, which included a deployment supporting Stabilization Forces in the Balkans.    Transitioning to medicine, she earned her medical degree from St. George's University in 2008. Col Sams completed her General Surgery Residency at the University of Tennessee Medical Center (2013) and a Trauma Critical Care fellowship at Brooke Army Medical Center (2015).    As a trauma surgeon and ECMO physician, Col Sams deployed twice as the Trauma Czar for Bagram Airfield, Afghanistan. Her extensive leadership roles include Trauma Medical Director, Assistant Chief of Trauma and Surgical Critical Care, Ground Surgical Team Pilot Unit Leader, and director of various military trauma research programs.   Episode Keywords WarDocs, military medicine, military trauma surgery, combat casualty care, trauma czar, Bagram role three, Air Force trauma surgeon, C-STARS Cincinnati, critical care air transport, CCATT, Joint Trauma System, military civilian partnership, Mission Zero Act, military unique curriculum, large scale combat operations, LSCO, prolonged casualty care, MedicX, ECMO in combat, battlefield documentation, TCCC card, closed loop ventilation, military medical leadership   Hashtags #MilitaryMedicine, #WarDocs, #CombatCasualtyCare, #TraumaSurgery, #JointTraumaSystem, #LSCOReadiness, #CSTARS, #MilCivPartnership   Honoring the Legacy and Preserving the History of Military Medicine    WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.   Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast  

Hantavirus updates take center stage on this week's Dr. Frita LIVE! as we bring you the latest breaking news on the cruise ship outbreak, rising case counts, reported fatalities, and the woman now fighting for her life on ECMO. We'll explain why exposed passengers were sent to Nebraska's federal quarantine unit, what doctors are watching for, and what this fast-moving story could mean next.Then we are tackling some of the celebrity health news and trending medical headlines we couldn't get to last week. We turn to RFK Jr.'s antidepressant comments and what the science really says about SSRIs, withdrawal, and addiction. We'll also spotlight Damon Wayans' diabetes journey and the vision threat of diabetic macular edema, and separate myth from fact on Trump's recent health checkups.Next, we'll talk through Fresh Prince of Bel-Air star, Tatyana Ali's traumatic birth story that raises more questions about the state of maternal health in our country, and look at what people are calling Ozempic breath.#HealthHappyLifePodcast #DrFrita #DrFritaLIVE! #CelebrityHealthNewsHere are a few helpful resources to help on your journey to wellness:▶️ Subscribe so you will never miss a YouTube video.

Trái tim được hiến từng ngưng đập suốt 15 phút, còn người nhận tim phải chạy ECMO suốt 8 ngày để duy trì sự sống. Thế nhưng sau ca ghép tim tại Bệnh viện Đại học Y Dược TP.HCM, trái tim đã hồi phục mạnh mẽ khiến các bác sĩ cũng bất ngờ.

In Folge 84 haben wir wieder zwei spannende Themen für euch. Im ersten Interview sprechen wir übe die Grundlagen der ECMO (Extra Corporate Membran Oxygenierung). Im zweiten Teil der Folge bekommt ihr einen kleinen Einblick in die ICEM (Internationale Conference on Emergency Medicine) die 2026 in Hamburg stattfinden wird. Wie immer freuen wir uns über Feedback und Rückmeldungen. Liebe Grüsse euer Fasttrack-Team

CardioNerds Drs. Dinu Balanescu, Billy-Joe Mullinax, and Mariana Garcia discuss systemic thrombolysis in pulmonary embolism with expert Dr. Allison Burnett. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Pulmonary embolism is the third leading cause of cardiovascular death in the US, and high-risk PE carries a 30-day mortality risk as high as 30-50%. In this episode, we discuss the indications for systemic thrombolysis, including high-risk PE and cardiac arrest. We addressed how to appropriately select candidates for systemic thrombolysis, balancing the high risk of bleeding. Additionally, we discussed anticoagulation management and timing concurrent with lytic therapy, as well as the importance of multidisciplinary PERT teams.  The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Risk stratification is crucial in acute pulmonary embolism care. Based on the ESC 2019 guidelines, low-risk PE patients are those who are normotensive with no evidence of right ventricular dysfunction. Intermediate risk includes two categories: intermediate-low, with normotensive patients who have a high PE score with negative biomarkers, and intermediate-high risk, which has elevated biomarkers or signs of RV strain. High-risk PE includes hemodynamically unstable patients (SBP

In this episode of Critical Care Time, we tackle one of the most complex and high-stakes corners of critical care: the lung transplant patient in the ICU. From evaluating candidates at the edge of respiratory failure to managing the crashing post-transplant patient, we break down the practical bedside decisions that matter most — including bridge strategies, hemodynamics, immunosuppression, infection, rejection, and the complications that can rapidly spiral if you miss them. Whether you work in a transplant center or occasionally inherit these patients in a general ICU, this episode is built to give you a sharper framework, clearer priorities, and more confidence when the stakes are highest. As is often the case, a heavy lift like this needs some back up and we are grateful to have Dr. Lara Jones, a transplant pulmonologist and her colleague, Dr. Jason Gauthier, a thoracic surgeon on to help us with this one!Thank you to Integration Health for sponsoring this episode. Integration Health is committed to supporting ECMO programs through high-fidelity training, start-up support and dynamic staffing assistance when you need it the most! Check them out at www.Integration.Health! Hosted on Acast. See acast.com/privacy for more information.

In this episode, we explore how REBOA can become an integrated tool for deliberate physiologic support in profound shock. REBOA is a word that immediately commands attention in pre-hospital care. For many teams, it represents the edge of capability, a high-stakes intervention reserved for catastrophic haemorrhage and profound shock.  Many clinicians still think of it primarily as a haemorrhage-control device: inflate fully, plug the leak, and hope for the best. But in profound shock, bleeding is only part of the problem. Coronary perfusion hinges on proximal aortic diastolic pressure, and if the heart isn't being perfused, everything else we do is on borrowed time. Today's guests, Dr Jon Barratt and Dr Halden Hutchinson-Bazely, sit at the cutting edge of this shift in thinking. Jon is a Consultant in Emergency Medicine and Pre-Hospital Emergency Medicine with the British Army and the NHS, serving as Clinical Lead for Research and Clinical Innovation at Yorkshire Air Ambulance and as a MERIT Consultant with West Midlands Ambulance Service. He is a Senior Lecturer with the Academic Department of Military Emergency Medicine and a founding force behind the SPEAR programme, a resuscitation training initiative that leverages ultrasound-guided arterial access and physiologic targets to support patients in deep shock. Jon was also principal investigator for the ERICA-ARREST trial, investigating the use of REBOA to augment coronary perfusion in out-of-hospital cardiac arrest. Hutch is a pre-hospital care doctor at London's Air Ambulance (LAA), specialising in exsanguination, and an intensive care doctor at St Bartholomew's Hospital, specialising in ECMO. He is practising in endovascular resuscitation across the spectrum of the medical and trauma fields. Together with Jon, he is a SPEAR and EVTM faculty member and was an investigator for ERICA-ARREST. He brings a thoughtful and clinically grounded perspective to trauma management, with a focus on practical decision-making in high-pressure environments. His work reflects a commitment to evidence-informed practice and continual learning within acute care systems.You can find more on SPEAR here: https://journals.sagepub.com/doi/10.1177/11297298241242157And here: https://www.eaaa.org.uk/what-we-do/research-and-education/clinical-education/spear 

For two decades, investigative journalist Ethan Gutmann has been researching how the Chinese Communist Party secretly harvests the organs of prisoners of conscience and kills them in the process.He authored the groundbreaking 2014 work “The Slaughter” and, more recently, “The Xinjiang Procedure.”In his latest book, he gathers evidence of how the regime—which has long targeted Falun Gong practitioners for their organs—is now exploiting captive Uyghurs for this same macabre industry.Gutmann traveled to Kazakhstan, Tajikistan, Kyrgyzstan, Uzbekistan, and Turkey to interview dozens of Uyghurs and Kazaks who had managed to escape after being imprisoned in camps in Xinjiang, China, also known as East Turkestan. Many spoke to him at great personal risk to themselves and their loved ones.What they revealed to him was nothing short of horrific.A central witness named “Samal” described working in one of four medical labs located several stories below the concentration camp. One of the clinics—the one she worked in—was used for intestinal removal.“The other three clinics were there to remove organs. You couldn't see them, but occasionally the door would open. You‘d see somebody handling a kidney, a liver, and so forth. Every day that she worked there … there'd be eight or nine bodies. Sometimes it was as many as 20,” Gutmann said.During his research, Gutmann realized a disturbing pattern. Many of those who disappeared in the middle of the night from the camps were typically 28 or 29 years old.He believes the CCP has made this age demographic its primary target for forced organ harvesting.“You are at the peak of your health. At that point, your organs have stopped growing,” Gutmann says.In this episode, he breaks down the devastating evidence he's uncovered—and the failure of Western institutions to address these crimes.The spread of extracorporeal membrane oxygenation (ECMO) technology—which keeps organs oxygenated and viable for many hours—has made the CCP's organ trade even more lucrative than before.“Suddenly,” he told me, “you can pull a lot more organs off a single person and get them to distribute them around. And so the profit margin goes way up on a single human being from $100,000 up to almost a million dollars, if they were selling to foreigners.”Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

La nave Orión de Artemis 2 ameriza en el Pacífico, concluyendo su viaje lunar y preparando futuras misiones tripuladas en 2028. El Hospital 12 de Octubre implementa un programa pionero de transporte ECMO que asiste a niños gravemente enfermos por toda España, salvando vidas y estando ya institucionalizado a nivel nacional. A nivel internacional, Líbano e Israel inician contacto telefónico y acuerdan una reunión en Washington, a pesar de los bombardeos. Benjamín Netanyajú acusa a España de una guerra diplomática. La Fundación ONCE presenta Access Robots, un robot autónomo que guía a personas con discapacidad en espacios públicos, promoviendo su independencia y movilidad. El doctor Darío Fernández subraya la importancia del ejercicio físico para una salud integral, recomendando 150 minutos semanales de actividad aeróbica y de fuerza. Sus beneficios son amplios: cardiovasculares, musculares, óseos y mentales, reduciendo el estrés y mejorando la memoria en todas las edades, incluso en ...

The session starts with a comprehensive review of modalities under the perfusion umbrella, categorizing services ranging from routine cardiopulmonary bypass to specialized support such as venoarterial ECMO for cardiogenic shock or isolated limb perfusion. Speakers discuss regulatory definitions from bodies such as the American Board of Cardiovascular Perfusion (ABCP), emphasizing that these modalities extend beyond the operating room into critical care. Transitioning to surgeon perspectives, the discussion examines qualities valued in perfusionists, such as precise flow management, rapid response to hemodynamic changes, and proactive circuit adjustments. Real-world examples illustrate mismatches between perfusionists' actions and surgeons' expectations, highlighting areas such as air-handling protocols and temperature control during deep hypothermic circulatory arrest. The program then integrates these topics, offering frameworks for perfusionists to self-assess and adapt. Case-based scenarios demonstrate how understanding surgeon preferences enhances outcomes in complex repairs, with emphasis on documentation and post-procedure debriefs to foster continuous improvement.

In this Part 2 or our 2-part EM Cases podcast series on Cardiac Arrest Update, Dr. Sheldon Cheskes and Dr. Rob Simard take us beyond the algorithms and into the real-world decision-making of cardiac arrest care. We answer questions like: Do vasopressin and steroids improve survival or just ROSC? Should we be giving amiodarone earlier—and is lidocaine just as good? When should we use calcium, bicarbonate, or magnesium, and when should we avoid them? What role does ketamine play in CPR-induced consciousness? How should we choose between supraglottic airways and endotracheal intubation? What are the pitfalls of waveform capnography (ETCO2) to help guide CPR quality, detect ROSC, and inform prognosis? What is the role of PoCUS and TEE during cardiac arrest? When should we terminate resuscitation—and how do ETCO2 and POCUS factor into that decision? Should we widen the criteria to consider thrombolytics and who should go to the cath lab, and should we be ordering whole-body CT after ROSC for everyone who isn't going to the cath lab or getting ECMO? And finally, what are the key post-ROSC targets that actually impact neurologic outcomes in cardiac arrest patients? and many more...Please consider a donation to EM Cases to support ongoing high quality Free Open Access Medical Education https://emergencymedicinecases.com/donation/

We discuss this ominous complication of providing local anesthesia. Hosts: Elaine Jonas, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/LAST.mp3 Download Leave a Comment Tags: Critical Care, Toxicology Show Notes I. Pathophysiology & Mechanisms Definition: Systemic toxicity secondary to local anesthetic (LA) via accidental intravascular injection or excessive systemic absorption. Threshold: Occurs when plasma concentration exceeds the safety threshold for cardiac and neural tissue. Agent Profile: Bupivacaine (High Risk) Highly lipophilic with high protein binding. “Fast-on, Slow-off” Kinetics: Strong Na+ channel binding with extremely slow dissociation during diastole. Myocardial Depression: Direct inhibition of Ca2+ release from the sarcoplasmic reticulum, impairing contractility. Low CC:CNS Ratio: The dose required for cardiac collapse is very close to the dose that triggers seizures (narrow safety margin). Contributing Factors: Acidosis/Hypercapnia: Increases the fraction of free drug and promotes ion trapping in the brain/heart; shifts the LA-binding curve toward higher toxicity. Hypoxemia: Exacerbates myocardial depression and lowers seizure threshold. II. Risk Assessment & Prevention Patient-Specific Risk Factors Extremes of Age: Neonates (low α-1-acid glycoprotein) and elderly (reduced clearance). Body Composition: Low muscle mass/frailty (decreased volume of distribution). Organ Dysfunction: Hepatic: Reduced metabolism of amide LAs. Renal: Accumulation of metabolites; risk of metabolic acidosis lowering seizure threshold. Cardiac: Reduced cardiac output slows hepatic delivery/clearance; heart failure patients are more sensitive to Na+ channel blockade. Pregnancy: Increased sensitivity to cardiotoxicity. Procedural Risk Factors Vascularity of Site (Highest to Lowest Risk): Intercostal blocks (highest absorption rate). Caudal/Epidural. Interfascial plane blocks (e.g., TAP block). Psoas compartment/Sciatic. Brachial plexus. Technique: Large volume infiltration, lack of ultrasound, lack of incremental injection. Prevention Mandates Weight-Based Dosing: Lidocaine (Plain): Max 4.5 mg/kg. Lidocaine (with Epi): Max 7 mg/kg. Bupivacaine: Max 2.5–3 mg/kg. Incremental Injection: 3–5 mL aliquots with frequent aspiration. Intravascular Marker: Use Epinephrine (1:200,000) to detect accidental IV placement (HR increase >10 bpmor SBP increase >15 mmHg). III. Clinical Presentation Neurologic Phase (Early to Late) Subjective: Metallic taste, tinnitus, circumoral numbness/tingling. Objective: Visual disturbances, agitation, confusion, tremors. Critical: Generalized tonic-clonic seizures, rapid progression to CNS depression, coma, and apnea. Note: Early phases are often masked in patients receiving midazolam or propofol. Cardiovascular Phase Initial: Hypertension and tachycardia (if epi used) or transient stimulatory phase. Conduction Defects: PR prolongation, QRS widening (classic sign), bundle branch blocks. Dysrhythmias: Bradycardia (most common), VT/VF, PEA, asystole. Contractility: Profound, refractory hypotension and cardiogenic shock. IV. Immediate Management Algorithm Goal: Prevent hypoxia/acidosis and sequester the toxin. 1. Initial Actions Stop Injection: Immediately halt all LA administration. Call for Help: Specify “LAST Protocol” and “Intralipid Kit.” Airway Management: 100% O2​. Hyperventilate slightly if needed to counter respiratory acidosis. Low threshold for intubation (hypoxia/acidosis rapidly worsen LAST). 2. Seizure Control First-line: Benzodiazepines (e.g., Midazolam). Avoid: Propofol if hemodynamically unstable (exacerbates cardiac depression). Neuromuscular Blockers: May be needed for ventilation, but remember they do not stop CNS seizure activity. 3. Lipid Emulsion Therapy 20% Indications: Start at first sign of serious toxicity (airway compromise, seizures, or CV instability). Bolus: 1.5 mL/kg IV over 1 minute. Infusion: 0.25 mL/kg/min immediately following bolus. If Instability Persists: Repeat bolus (up to 2 times). Increase infusion to 0.5 mL/kg/min. Upper Limit: ≈12 mL/kg total dose. 4. Modified ACLS Epinephrine: Use low doses (

Being on the caregiver side of complex, rare disease care reveals critical gaps in our healthcare system, even for two physician parents with strong connections. In this powerful follow-up episode of Succeed In Medicine, host Dr. Bradley Block welcomes back Dr. Heather Gatcombe, as she recounts her family's journey: her son's initial metabolic stroke-like episodes at age 7, the five-year path to a definitive mitochondrial disease diagnosis (including a muscle biopsy and eventual identification of a pathogenic variant), sudden heart failure at age 11 during the COVID-19 pandemic, ECMO, LVAD placement, and successful heart transplant. She openly discusses the immense challenges of hospital discharge with an LVAD when no pediatric rehab would accept him, managing tube feeds and alarms at home without adequate home health support, and the frustration of subtle symptoms like throat clearing being overlooked as a sign of heart failure. Dr. Gatcombe also reflects on moments where she felt her family wasn't fully heard, and the lasting impact of those experiences. Throughout the conversation, she shares how this journey has made her a more empathetic and effective clinician, particularly in communicating uncertainty, avoiding premature reassurance, listening to parental intuition, ensuring robust discharge planning with support services, and staying curious even when a diagnosis remains elusive. This episode offers practical lessons for all physicians on improving communication, supporting families through diagnostic uncertainty, preparing patients for safe transitions home, and the power of transparency and advocacy in rare disease care. Three Actionable Takeaways: Communicate uncertainty honestly and compassionately: When the diagnosis isn't clear yet, be transparent about what you know and don't know. Offer guidance on next steps, second opinions, and support resources rather than premature reassurance that may later need to be walked back. Prioritize discharge planning and support services: The transition from hospital to home is one of the most vulnerable periods. Ensure patients and families have home health, equipment (wheelchair, shower chair, etc.), dietician and nurse navigator follow-up, and clear instructions before discharge, especially for medically complex cases. Listen to patients and families as the experts on their own bodies: Parental intuition and lived experience matter. When a child or family member expresses concern, even if it seems outside the norm,  take it seriously, investigate, and avoid dismissing it. Follow up after adverse events when possible to maintain trust. About the Show: Succeed In Medicine covers patient interactions, burnout, career growth, personal finance, and more. If you're tired of dull medical lectures, tune in for real-world lessons we should have learned in med school! About the Guest: Dr. Heather Gatcombe is a board-certified radiation oncologist at Winship Cancer Institute of Emory University and an Assistant Professor at Emory University School of Medicine. She specializes in breast radiation oncology and serves as Vice Chair for Community and Belonging. As the mother of a child with mitochondrial disease who experienced metabolic strokes starting at age 7, progressing to heart failure and transplant, she is deeply committed to raising clinician awareness, reducing diagnostic delays, and advocating for patients and families. She serves on the Board of Trustees and the Scientific and Medical Advisory Board Clinical Training and Education Committee of the United Mitochondrial Disease Foundation (UMDF). Website: https://winshipcancer.emory.edu/profiles/gatcombe-heather.php LinkedIn: https://www.linkedin.com/in/heather-gatcombe-md-3891875 Instagram: https://www.instagram.com/heathergatcombe UMDF: https://umdf.org/about/board-trustees About the Host: Dr. Bradley Block – Dr. Bradley Block is a board-certified otolaryngologist at ENT and Allergy Associates in Garden City, NY. He specializes in adult and pediatric ENT, with interests in sinusitis and obstructive sleep apnea. Dr. Block also hosts Succeed In Medicine podcast, focusing on personal and professional development for physicians Want to be a guest? Email Brad at brad@physiciansguidetodoctoring.com  or visit www.physiciansguidetodoctoring.com to learn more! Socials: @physiciansguidetodoctoring on Facebook @physicianguidetodoctoring on YouTube @physiciansguide on Instagram and Twitter This medical podcast is your physician mentor to fill the gaps in your medical education. We cover physician soft skills, charting, interpersonal skills, doctor finance, doctor mental health, medical decisions, physician parenting, physician executive skills, navigating your doctor career, and medical professional development. This is critical CME for physicians, but without the credits (yet). A proud founding member of the Doctor Podcast Network!Visit www.physiciansguidetodoctoring.com to connect, dive deeper, and keep the conversation going. Let's grow! Disclaimer:This podcast is for informational purposes only and is not a substitute for professional medical, financial, or legal advice. Always consult a qualified professional for personalized guidance. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Join the Johns Hopkins Thoracic Surgery Subspecialty team on this rapid research review revealing how investigative efforts have changed the way we view and use Veno-venous (VV) ECMO therapy in the pre-lung transplant patient population working to avoid ventilator dependence and the associated morbidity while facilitating continued ambulation and preoperative optimization. Hosts:- Dr. Alfred J. Casillan, MD, PhDAttending Thoracic Surgeon Johns Hopkins Hospital - Kyla Rakoczy, MD Johns Hopkins General Surgery ResidentReferences:Awake ECMO as Bridge to Lung Transplantation Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine. 2012;185(7):763–768. PMID: 22268135 Link: https://pubmed.ncbi.nlm.nih.gov/22268135/Predictors of Successful ECMO Bridging Tipograf Y, Salna M, Minko E, Grogan EL, Sonett JR, Bacchetta MD. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Annals of Thoracic Surgery. 2019;107(5):1456–1463. PMID: 30790550 Link: https://pubmed.ncbi.nlm.nih.gov/30790550/Intubation Status and ECMO Bridging Outcomes Zhou AL, Jennings MR, Akbar AF, et al. Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant. Journal of Heart and Lung Transplantation. 2025;44(4):661–669. PMID: 39486773 Link: https://pubmed.ncbi.nlm.nih.gov/39486773/ECMO Duration and Waitlist Mortality Shou BL, Kalra A, Zhou AL, et al. Impact of extracorporeal membrane oxygenation bridging duration on lung transplant outcomes. Annals of Thoracic Surgery. 2024;118(2):496–503. PMID: 38740080 Link: https://pubmed.ncbi.nlm.nih.gov/38740080/Mechanical Ventilation as a Risk Marker Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, et al. Lung transplantation in recipients requiring mechanical ventilation: outcomes and risk factors. Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):114–119. PMID: 19931096 Link: https://pubmed.ncbi.nlm.nih.gov/19931096/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

"A Chaplain's View of the Resurrection" Scripture: John 5:24; Romans 8:1; Ephesians 3:20 Date: Easter Sunday The resurrection isn't just a historical event we celebrate once a year. It's a present reality that meets people in their darkest moments. This Easter, we explored what resurrection power looks like from a chaplain's perspective—not in ancient Jerusalem, but in modern hospital rooms. Three stories. Three encounters with grace. Three demonstrations of resurrection power. First, grace makes us ready to die. A man in his late seventies was admitted with severe circulation issues requiring amputation. For a week, he refused the surgery. Medical teams pleaded. Palliative care tried. Finally, they called the chaplain. When we talked, the real issue emerged—not his leg, but his soul. Thirty years ago, he had been unfaithful to his wife. The guilt had never left. His question: "Can I be forgiven? Am I ready to stand before God like this?" We talked about confession, grace, and the cross of Christ—that there is no sin so deep that His blood does not go deeper still. When we prayed, peace filled the room. Then something sacred happened. He asked his wife to sit down and confessed everything to her. She looked at him and said, "The day you told me—years ago—I decided that I would forgive you. And so… I do." Complete grace. They embraced. And then he turned to me: "You can tell the doctors I don't want the surgery. I'm ready for hospice." He hadn't been refusing because he didn't understand the risks. He wasn't ready to die—not carrying that burden. But now the guilt was gone. Grace had made him ready. Romans 8:1: "Therefore, there is now no condemnation for those who are in Christ Jesus." Second, grace makes us able to live. A young mother went in for a C-section and suffered a catastrophic complication—amniotic fluid embolism. Both she and the baby went into cardiac arrest. After twelve hours of surgery and catastrophic liver bleeding, the doctors said, "There's nothing more we can do." Her husband paced the ICU, praying desperately in Portuguese—the Ave Maria, over and over. Through tears, he even agreed to organ donation: "If she cannot live… let her help someone else live." But the next morning, something impossible happened. Overnight, she stabilized. No new intervention. No explanation. She was placed on ECMO. She kept improving. When her husband spoke to her, her eyes turned toward his voice. He fell to his knees—this time in gratitude. Doctors asked, "Was this… a miracle?" They knew the numbers: less than 1% survival rate. Their answer: "There's no explanation." She went home—to her husband, her family, the daughter she almost never met. Ephesians 3:20: "Now to Him who is able to do immeasurably more than all we ask or imagine." Third, grace secures a life death cannot touch. John, a young man in his early 30s with ALS, suffered cardiac arrest and was not expected to survive. But his best friend shared something remarkable: for six months, Mark had been coming to church, asking questions, wrestling with faith. One day, his best friend sat with him for two hours, opened the Scriptures, and shared the gospel. Mark believed. He wanted to follow Christ. He wanted to be baptized. They picked the date: Easter Sunday. But instead of a baptismal pool, we stood in an ICU. His best friend asked asked, "Can we still do it?" That afternoon, surrounded by family and friends, I baptized Mark. "Baptism is like a wedding ceremony," I explained. "It doesn't create the love it reveals it. God had already poured His love into John's heart." Days later, John died. Through organ donation, four other lives were saved. But John had already crossed over from death to life. John 5:24: "Whoever hears my word and believes him who sent me has eternal life. He does not come into judgment, but has crossed over from death to life." Three rooms. Three stories. One God still writing stories of resurrection power today.

PerfWeb 110 – Day 2 examines clinical indications for extracorporeal membrane oxygenation (ECMO) and available cannulation options, focusing on evidence-based criteria for initiation in adult patients with refractory cardiac or respiratory failure. This session addresses decision-making in high-acuity scenarios where standard therapies fail, providing perfusionists with tools to assess suitability and select appropriate access strategies. By clarifying when ECMO offers benefit versus risk, the content supports safer implementation in programs managing acute decompensations. Learning Objectives: Identify key clinical conditions, such as severe ARDS or cardiogenic shock, where ECMO provides effective temporary support. Differentiate between venoarterial (VA) and venovenous (VV) ECMO configurations based on underlying pathophysiology. Evaluate patient-specific factors influencing ECMO candidacy, including contraindications and prognostic indicators. Describe common cannulation sites and techniques, including peripheral versus central approaches. Apply strategies to mitigate cannulation-related complications like limb ischemia or recirculation. Interpret hemodynamic and gas exchange parameters to guide initial ECMO setup and adjustments.

PerfWeb 110 – Day 1 focuses on professionalism in managing large perfusion practices and training centers, addressing the unique challenges of high-volume cardiovascular care operations. Speakers examine ethical principles, administrative efficiencies, and educational frameworks that ensure consistent patient safety and team performance amid expanding service lines like extracorporeal membrane oxygenation (ECMO) and complex cardiac surgeries. For perfusion leaders, this content provides tools to align daily operations with professional standards, reducing risks from scaling while promoting long-term program viability. Learning Objectives Define core elements of professionalism in perfusion, including ethical conduct and accountability in high-stakes clinical environments Identify strategies for scaling perfusion services to support increased case volumes without compromising quality or safety Develop protocols for integrating training programs into large practice operations to maintain staff competency Evaluate leadership approaches for managing multidisciplinary teams in busy perfusion centers Apply administrative best practices to handle regulatory compliance, resource allocation, and conflict resolution Assess metrics for measuring professional performance and program success in large-scale perfusion settings

Broadcast from KSQD, Santa Cruz on 3-26-2026: li> Dr. Dawn announces a UCSF study recruiting participants for psilocybin therapy to help patients cope with chronic low back pain, requiring ages 25-70 with failed prior treatments. A caller preparing for bladder stone surgery asks about avoiding a repeat of severe post-anesthesia disorientation. Dr. Dawn recommends pharmacogenomic testing through 3x4 Genetics to identify slow acetylator status and other detoxification enzyme variants that can guide anesthesiologists toward better drug choices. A clinical trial found that 24 minutes of music with binaural beats—where slightly offset audio in each ear generates synchronized brainwaves—significantly reduced anxiety in medicated patients. Dr. Dawn encourages trying this accessible, low-risk intervention. Chronic noise exposure triggers oxidative stress, inflammation, and endothelial dysfunction, increasing cardiovascular disease risk. Data centers and server farms are emerging noise pollution sources, and Dr. Dawn recommends affordable noise-canceling headphones as a health investment. A Crohn's patient in Switzerland reports alarming neurological symptoms including speech arrest with preserved awareness and transient visual disturbances. He is having trouble finding any Functional Medicine trained physician and Dr. Dawn recommends emailing to info@ifm.org. Furthermore, Dr. Dawn suspects possible seizure activity from brain inflammation and recommends pursuing a sleep-deprived EEG and MRI through a neurology referral. MIT researchers discovered Interlectin-2, a protein that both strengthens the mucus barrier by cross-linking mucins and directly traps and kills pathogens like Salmonella and Shigella. Imbalanced levels may contribute to inflammatory bowel disease. Synthetic versions may be an effective treatment for inflammatory bowel disease. A 33-year-old man survived 48 hours without lungs after flu-triggered bacterial pneumonia caused ARDS and multiple organ failure. Surgeons removed both lungs treat septic shock while ECMO (extracorporeal oxygenation)sustained him until a successful double lung transplant. A meta-analysis of 43 studies involving millions of births found no evidence that acetaminophen use during pregnancy increases autism, ADHD, or intellectual disability risk, contradicting recent political claims. Green tea contains about 30% more L-theanine than black tea, with studies showing 200mg daily improves verbal fluency, sleep quality, and reduces anxiety. Decaffeinated green tea retains full theanine content. Pop star Robbie Williams developed scurvy while on GLP-1 weight loss drugs, highlighting that only 2 of 40+ major GLP-1 trials assessed vitamin intake. Dr. Dawn urges anyone on these medications to take a comprehensive multivitamin.

What if a near-death experience was the thing that finally showed you what your life was really for? Tino Dietrich is a visionary entrepreneur, Inc. 500 honoree, and certified Mindvalley coach with a track record of building and scaling global businesses. As the founder and CEO of SNYDER Americas, he is spearheading the U.S. expansion of a premium German-engineered golf ball brand, disrupting the industry with innovation and precision. Tino also leads the Dietrich Institute, a coaching and consulting powerhouse dedicated to empowering high-achieving professionals to master personal growth, build thriving relationships, and leave lasting legacies. A former collegiate golfer at Syracuse University, Tino combines discipline, resilience, and strategic insight to inspire others to overcome adversity and create purpose-driven lives. His upcoming book, a heartfelt tribute to his late mother, explores themes of resilience, legacy, and living with intention.   [00:04:20] Who Is Tino Dietrich? Serial entrepreneur, Inc. 500 honoree, and certified Mindvalley coach based in the U.S. after relocating from Germany 13 years ago Founder and CEO of SNYDER Americas and the Dietrich Institute Coaches entrepreneurs and business owners to become better versions of themselves, with a focus on relationships and family Believes the challenges we face are determined by the choices we make, and that the right people help us make better ones [00:06:40] The ICU Moment That Changed Everything After contracting COVID, Tino's health rapidly deteriorated while his family recovered Was rushed to the emergency room, then the ICU, and placed on an ECMO machine to oxygenate his blood A priest was called to read him his last rites; that was the moment he realized how serious things were In the ICU, he reflected and realized he had been missing his purpose, focused on building companies but not on why He begged for a second chance to make a first impression and got it, returning home days later [00:10:20] Finding Purpose After a Near-Death Experience After surviving COVID, Tino lost 90 pounds and radically reassessed his life Realized his purpose was to coach entrepreneurs and business owners who had been in similar situations Focused his work on relationships, marriage, and family, noting that the divorce rate among entrepreneurs is even higher than the national average His mission: slow down the divorce clock and help people turn their houses into homes Recognized he had been living in a house, not a home, and that his family helped him turn that around [00:18:00] The People Who Shape You: Positive and Negative Tino credits a wide collection of people, not just one, for shaping who he is Learned in the hospital that some people who appear to be friends are not Believes you must understand what you truly want, not what others want for you, before you can see clearly who belongs in your life Is grateful for both the people who helped him and those who did not; both shaped his direction His late mother, a single mom who rose from selling curtains on a market stall in Hamburg to becoming one of the most influential people in the German steel industry in the seventies and eighties, was his greatest inspiration [00:21:00] The Mentor Who Unlocked His Path After college, Tino was introduced to a mentor who had become Chief Marketing Officer for Danone (then BSN), responsible for Eastern European expansion Tino told him he was not a marketing person; the mentor replied that this proved Tino did not yet know what marketing was, and insisted he come work for him Tino worked in marketing for three months, then went on to Colgate Palmolive in Mexico in finance The experience changed his trajectory: he returned to Syracuse and majored in international marketing and management That mentor later became his business partner; Tino credits him with opening his eyes to his own strengths and purpose [00:26:20] Ikigai and the Concept of Purpose Tino connects his near-death clarity to the Japanese concept of ikigai: the intersection of what you are good at, what the world needs, and how you can make it happen Believes everyone has unique talents, but most people never slow down enough to identify them Encourages listeners to dig deeper into ikigai as a framework for living with intention The most important relationship in your life is the one you have with yourself; everything else changes when that one improves   KEY QUOTES "The challenges we face are determined by the choices we make. And the people who helped me through the different phases of my life helped me to make some very good choices." - Tino Dietrich "The most important relationship in your life is the one you have with yourself. If you understand that and you work on that, things will begin to change around you." - Tino Dietrich CONNECT WITH TINO DIETRICH

Contributor: Travis Barlock, MD Educational Pearls: What is an internal jugular catheter (IJ) and when do we use it? IJs are catheters that can be placed in either the left or the right internal jugular vein to provide central venous catheter (CVC) access. CVCs can be placed in other locations other than the internal jugular vein (i.e. subclavian vein or femoral veins). IJs are used when the patient may require long-term venous access or have to receive hyperosmolar solutions (such as solutions with high glucose content for parenteral nutrition); solutions with extreme pHs (9); or vesicant drugs (drugs that can cause tissue necrosis with extravasation). They are not to be confused with EJs (external jugular vein catheters) which can be placed in difficult to peripherally catheterize patients. EJs function similarly to a peripheral IV. The advantage of IJs is their location in larger veins brings them closer to direct access to the heart (i.e. the right internal jugular vein will provide immediate/quicker access to the right atrium to the heart.) What are concerns of using a right internal jugular catheter versus one in the left? The right internal jugular vein provides quick access to the heart via the right atrium, making it ideal in critically ill patients who may require vasopressor support. However it is also the site commonly used for additional cannulation procedures such as hemodialysis, pulmonary artery pressure measurements, extracorporeal membrane oxygenation (ECMO) and transvenous pacemaker placement. These procedures are not uncommon in critically ill patients who also required a CVC for initial hemodynamic support via vasopressors. Gharaibeh et al. found that patients who received a right IJ and hemodialysis had a higher need for re-insertion of the hemodialysis catheter (40% compared to 2.6% in the left IJ group). Furthermore, it was found that with a right IJ, hemodialysis catheters had to be exchanged by a guidewire in 23% of those with a right IJ as opposed to 0.9% in the left IJ group (a guidewire exchange is often considered a salvage technique to try and maintain access). Big Takeaway? If you are able to obtain an IJ on the right, you can likely obtain one on the left, and if considering longitudinal care for your patient, consider obtaining an IJ on the left to allow for future critical access in the right IJ. References Gharaibeh KA, Abdelhafez MO, Guedze KEB, Siddiqi H, Hamadah AM, Verceles AC. Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications. Journal of Critical Care. 2025;87:155011. doi:10.1016/j.jcrc.2024.155011 Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA: A Cancer Journal for Clinicians. 2008;58(6):323-346. doi:10.3322/CA.2008.0015 Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Some stories hit like a jolt of electricity—raw, unfiltered, impossible to forget. Meet James, known as No Limb Jim, who walked into a hospital for mitral valve surgery and woke up months later after 62 days on ECMO, both legs amputated and most fingers gone. What could have ended in silence became a determined rebuild of identity, independence, and purpose driven by faith, family, and a stubborn refusal to accept “you can't” as a verdict.We trace his life before the collapse—freelance cameraman in hurricanes and war zones, disaster airlifts in the Bahamas, a likely brush with West Nile that set the stage for heart failure—and the moment everything changed. James speaks candidly about waking to mummified limbs, searching YouTube for real hope, and launching a channel to show that life after amputation isn't a footnote; it's a new chapter with its own power. He unpacks the hard parts of rehab: being overprotected instead of trained, fighting insurance for a needed knee replacement, and learning transfers the unglamorous way. The turning point arrives behind a steering wheel as he relearns to drive with hand controls, finds dignity in everyday eye‑level conversations, and reclaims the simple freedom to get a burger.We go deep on advocacy and accessibility: why accessible parking abuse undermines independence, how tiered ADA placards could prioritize space for wheelchair users, and what it means to feel truly human in public spaces. James also shares a near‑death experience—moments of blinding peace and a brush with profound darkness—that has since become a lifeline for others on the brink. Through it all runs a through line of resilience: weight loss to be ready for future mobility tech, 3D‑printed tools to keep building, and a family whose bedside faith tipped the odds when medicine nearly quit.If you're navigating disability, caregiving, or any brutal detour you never chose, this conversation offers more than inspiration—it offers a map. Subscribe, share this with someone who needs strength today, and leave a review to help more people find stories that move them forward.

Type of loss: Life limiting diagnosis, Infant lossMore about Sarah's story: Josie's story is one of unimaginable strength, resilience, and love. From a prenatal diagnosis of a congenital heart defect and Down syndrome, to navigating a pregnancy with little support, Sarah opens up about the challenges she faced long before Josie entered the world. Born three months early at just 1 lb 14 oz, doctors warned she likely wouldn't survive—but Josie had other plans.Over the course of six months, Josie defied the odds time and time again. Sarah shares of the three months they spent in a step-down unit, the hope surrounding Josie's heart procedure, and the devastating complications that followed—including blood clots, strokes, infections, and ultimately cardiac arrest. Even after being placed on ECMO and fighting her way off, Josie's body had endured more than most ever will. She passed peacefully in her mother's arms, leaving behind a legacy far greater than her time on earth. Sarah honors Josie through two nonprofits: The Threefold Cord Project, which provides comfort boxes to NICU and pediatric cardiac ICU families, and Josie's Wind Chimes of Hope, which gifts wind chimes to loss families within the Down syndrome community.Learn more about The Threefold Cord Project here.

What do you do when a health crisis takes over your business and more importantly - nearly your whole life?Eric Hillestad was 25 years old when his lungs began filling with blood.Doctors eventually placed him on ECMO — the most advanced life support available.Many people don't survive it.Eric did.After weeks in the hospital, he had to relearn how to walk, breathe, and speak. He missed months of his newborn daughter's life. Doctors told his family to prepare for the worst.But Eric's story didn't end there.Today he's a wedding photographer, a father, and a Business Blueprint student who rebuilt his life — and his business — from the ground up.In this episode we talk about:• surviving a near-death medical crisis• rebuilding life and work after trauma• faith in the middle of fear• why his photography now carries a completely different meaning• and how he turned a struggling business into something sustainable for his familyEric's story is raw, powerful, and deeply faith-filled.You're not going to forget this one.⭐️Nathan's Signature Coaching Program:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠THE BUSINESS BLUEPRINT⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⭐️Questions about the Business Blueprint? Email info@nathanchanski.co to chat with Nathan directly.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

In this episode of Fishing Without Bait, Jim welcomes back returning guest Emily — whose recovery journey inspired many listeners in her previous appearance. This time, she shares a new chapter marked not by addiction, but by maternal instinct, fear, and extraordinary courage. Emily describes how she sensed something was wrong with her healthy two-year-old daughter weeks before doctors confirmed it. Despite multiple visits and reassurances that it was “just a virus,” her body told her otherwise. The anxiety built until one terrifying afternoon when her daughter collapsed in her arms. From calling 911, to the helicopter ride to Children's Hospital, to hearing the words “open heart surgery,” Emily walks us through the moment-by-moment unfolding of crisis. She reflects on fear, being unheard, trust in medical professionals, and the power of intuition. This is Part 1 of a deeply moving story about resilience, advocacy, recovery, and the spiritual strength that carried her through. Subscribe on your favorite podcast platform so you don't miss Part 2. Support us on Patreon for ad-free episodes: https://www.patreon.com/c/fishingwithoutbait Pick up Jim's book: Learn to Fish Without Bait https://www.lulu.com/shop/james-ellermeyer-lpc-ma-ncc-lpc/learn-to-fish-without-bait/paperback/product-6n9rd8.html?page=1&pageSize=4

In this episode of Fishing Without Bait, Jim welcomes back returning guest Emily — whose recovery journey inspired many listeners in her previous appearance. This time, she shares a new chapter marked not by addiction, but by maternal instinct, fear, and extraordinary courage. Emily describes how she sensed something was wrong with her healthy two-year-old daughter weeks before doctors confirmed it. Despite multiple visits and reassurances that it was “just a virus,” her body told her otherwise. The anxiety built until one terrifying afternoon when her daughter collapsed in her arms. From calling 911, to the helicopter ride to Children's Hospital, to hearing the words “open heart surgery,” Emily walks us through the moment-by-moment unfolding of crisis. She reflects on fear, being unheard, trust in medical professionals, and the power of intuition. This is Part 1 of a deeply moving story about resilience, advocacy, recovery, and the spiritual strength that carried her through. Subscribe on your favorite podcast platform so you don't miss Part 2. Support us on Patreon for ad-free episodes: https://www.patreon.com/c/fishingwithoutbait Pick up Jim's book: Learn to Fish Without Bait https://www.lulu.com/shop/james-ellermeyer-lpc-ma-ncc-lpc/learn-to-fish-without-bait/paperback/product-6n9rd8.html?page=1&pageSize=4

Out-of-hospital cardiac arrest remains one of the most emotionally complex and ethically challenging events in pre-hospital care. Families can transition from normality to devastating loss within minutes, while clinicians must make rapid, high-stakes decisions that often leave a lasting emotional impact. Traditionally, EMS practice has centred on the moment of “termination of resuscitation”, a clinical decision that often results in abrupt death notifications and limited family involvement. But a growing body of work challenges this model, suggesting that it may unintentionally amplify trauma for both families and providers.In today's episode, we're joined by Dr Darren Braude, Paramedic, Director of the Centre for Prehospital Resuscitation and ECMO, Chief of the Division of Prehospital, Austere and Disaster Medicine. Dr Braude is one of the leading voices behind a powerful reframing: viewing the end of resuscitative efforts not as termination, but as the withdrawal of life support.Borrowing principles from ICU end-of-life care, this approach centres families, promotes clearer communication, and acknowledges that CPR and ventilation are themselves forms of life support. Today, we explore how this model can transform the way EMS navigates death, grief, and humanity in the field. You can read the article this interview is based on here: https://pubmed.ncbi.nlm.nih.gov/40928306/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

Critical illness impacts not only the patient in the bed but also their entire family during and after the ICU. Eli and Cathy Garrison join us to share their young family's course of twists and turns of an amniotic fluid embolism to long-term disability.Check out Cathy's podcast at: Birth Trauma Storieswww.DaytonICUConsulting.com

This inaugural episode of the CardioNerds Pulmonary Embolism (PE) Series explores the evolution of acute PE care. Dr. Ibrahim Zahid, Dr. Dinu Balanescu, and Dr. Billy Joe Mullinax join guest expert Dr. Kenneth Rosenfield to discuss the shifting landscape of PE management. Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality and a frequent diagnostic challenge, often masquerading as myocardial infarction or a benign illness. Over the past decade, PE care has evolved from anticoagulation-only strategies to nuanced, risk-stratified, multidisciplinary management. Modern approaches integrate hemodynamics, biomarkers, and advanced imaging to guide therapy, including catheter-directed interventions and large-bore thrombectomy. The Pulmonary Embolism Response Team (PERT) model addresses historical gaps by coordinating rapid, multispecialty decision-making and standardizing care pathways. The PERT Consortium further advances PE care through education, research, and the world's largest PE registry, while fostering leadership and research opportunities for trainees. Despite advances, long-term outcomes and post-PE syndromes remain important areas for future investigation. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls PE is a “master masquerader”—maintain suspicion for atypical presentations like myocardial infarction, heart failure, flu, or anxiety. Multidisciplinary management mediated through pulmonary embolism response teams improves outcomes and standardizes care. Risk stratification integrates hemodynamics, biomarkers, and imaging. Advanced therapies have expanded beyond anticoagulation. Long‑term follow‑up and post‑PE syndrome need more research. Notes Notes: Notes drafted by Dr. Ibrahim Zahid. 1. How has the clinical approach to PE changed over the past decade? PE is the third leading cause of cardiovascular death and historically under‑recognized. Symptoms mimic MI, HF, asthma, syncope, and more.PE is a silent killer, and it should be recognized more as a cause of spontaneous cardiac arrest. Where life threatening disease like stroke which is owned by neurological specialists and MI is primarily managed by cardiac specialists, PE is an entity without a professional home. The PERT Consortium brings the specialties together for PE care. 2. Ten years ago, a 58-year-old patient with a large bilateral PE, RV dilation, and positive biomarkers might have been managed with anticoagulation and close observation alone. Today, with evolving—but still uneven—data on advanced therapies, PE care feels far more nuanced and highly dependent on where you practice. What are the major gaps in traditional PE management that clinicians should recognize, and what care pathways should they be aware of across different hospital systems? Care has shifted from anticoagulation‑only to multidisciplinary approaches like catheter directed thrombectomy. Risk‑based pathways and the use of CT angiogram has improved early recognition. Risk stratification tools must be used as tools for early recognition of intermediate risk PE. Untreated PE leads to chronic complications like chronic thromboembolic disease and chronic thromboembolic pulmonary hypertension, which requires long term clinic follow up. 3. What is the role of risk stratification tools such as PeSI, sPeSI scores, cardiac biomarkers, and imaging findings in PE, and how do they guide treatment decisions in real world practice? Integrate vitals (blood pressure and heart rate), biomarkers (troponin, pro-BNP), RV/LV ratio assessment, acid‑base status, and scores. Tools include PESI, sPESI, BOVA, HESTIA, FAST, Geneva, NEWS, shock index. Vitals, lactate, acid-base status, and tools like NEWS or shock index track clinical evolution. PESI/sPESI estimate 30-day mortality and help identify low-risk patients who may be candidates for early discharge or outpatient therapy. Clinical judgment matters—scores don't fully capture clot burden, trajectory, or bleeding risk. 4. How was the pulmonary embolism response team created, and since its creation, what evidence or outcome data became available to support the PERT model? Originated after a sentinel case at MGH: A young, pregnant woman in her 30s, who collapsed at home, underwent thrombectomy, and had to be on ECMO for a few days. The case brought cardiology, cardiac surgeons and critical care physicians together for planning and improvement in her health, which was rewarding. Thereby, it was decided to bring specialties involved in PE care together to create a response team. The name of the team, Pulmonary Embolism Response Team (PERT), was coined by Richard Channick in the first meeting. Posters were set up all over the hospital to call a centralized line when an acute PE is recognized A meeting was held to present the concept of putting together a consortium, with development of action items and a PERT database. Enabled rapid multidisciplinary input using early teleconferencing tools. 5. Given concerns about having too many ‘cooks in the kitchen' during the initial PE call—especially with rotating teams—how can institutions reconcile workflow complexity with standardized pathways in a way that meaningfully supports and justifies the added burden on frontline clinicians? Every hospital's PERT is different, catering to their needs and workflow At least two disciplines are needed to make a PERTData is currently being collected to guide further on how the workflow can be standardized Most importantly, the team brings in resources that were not available prior to PERT formation. 6. What are the main goals of the PERT consortium, and how does it support clinicians and institutions involved? To improve care and improve outcomes for patients with PE Expand education, refine algorithms, standardize care with Centers of Excellence. Maintain the largest PE registry for research and outcomes improvement. 7. Beyond global networking, shared learning from successful systems, and the pathway toward Center of Excellence designation, what additional benefits can clinicians and health systems gain by participating in the PERT Consortium? The ability to learn from other systems, the ability to share experiences. Allow people to develop their professional careers like leadership experience, becoming a member of the trainee council Initiate projects and receive funding for your ideas 8. For trainees interested in pulmonary embolism care, how can a trainee be a champion at their institution? Does PERT provide assistance and how can they really contribute meaningfully even before becoming a fellow/attending? Medical students and residents interested in PE should reach out to the consortium and the consortium will hook you up with the correct mentors who can nurture you along. Listen to the podcasts. Participate with your local PERT team PERT wants involvement of people who are social media savvy to help spread the word on PE. Top three take-away points from this episode Acute PE care has advanced and multiple treatment modalities for acute PE including catheter directed therapy, large bore thrombectomy, are becoming standard of care. Multidisciplinary models like PERT improve coordination and outcomes. Trainees play a vital role in advancing PE care through involvement, research, and education References Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. doi: 10.1093/eurheartj/ehz405. PMID: 31504429. https://pubmed.ncbi.nlm.nih.gov/31504429/ Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019 Jun 9;3(3):315-330. doi: 10.1002/rth2.12216. PMID: 31294318; PMCID: PMC6611377. https://pmc.ncbi.nlm.nih.gov/articles/PMC6611377/ Rosenfield K, Bowers TR, Barnett CF, Davis GA, Giri J, Horowitz JM, Huisman MV, Hunt BJ, Keeling B, Kline JA, Klok FA, Konstantinides SV, Lanno MT, Lookstein R, Moriarty JM, Ní Áinle F, Reed JL, Rosovsky RP, Royce SM, Secemsky EA, Sharp ASP, Sista AK, Smith RE, Wells P, Yang J, Whatley EM; Pulmonary Embolism Research Collaborative (PERC) Attendees. Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report From the Pulmonary Embolism Research Collaborative. Circulation. 2024 Oct;150(14):1140-1150. doi: 10.1161/CIRCULATIONAHA.124.067482. Epub 2024 Sep 12. PMID: 39263752; PMCID: PMC11698503. https://pubmed.ncbi.nlm.nih.gov/39263752/ Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism. Vasc Med. 2019 Apr;24(2):103-109. doi: 10.1177/1358863X18824159. Epub 2019 Mar 5. PMID: 30834822. https://pubmed.ncbi.nlm.nih.gov/30834822/ Pandya V, Chandra AA, Scotti A, Assafin M, Schenone AL, Latib A, Slipczuk L, Khaliq A. Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature. J Clin Med. 2024 Jul 8;13(13):3984. doi: 10.3390/jcm13133984. PMID: 38999548; PMCID: PMC11242386. https://pubmed.ncbi.nlm.nih.gov/38999548/ Rivera-Lebron B., McDaniel M., Ahrar K., Alrifai A., Dudzinski D.M., Fanola C., Blais D., Janicke D., Melamed R., Mohrien K., et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin. Appl. Thromb. Hemost. 2019;25:1076029619853037. doi: 10.1177/1076029619853037.https://pubmed.ncbi.nlm.nih.gov/31185730/

Send a textLive from the Neo Conference in Las Vegas, Ben and Daphna sit down with Dr. Zach Anderson from Winnie Palmer Hospital to demystify the integration of Point of Care Ultrasound (POCUS) in the NICU. Moving beyond the intimidation of complex cardiac scans, Zach explains why starting with "pinch points" like vascular access or bladder volume can revolutionize bedside decision-making. From the SAFER protocol to managing the agitated infant on ECMO, this episode explores how POCUS serves as a powerful problem-solving tool that bridges the gap between clinical mystery and immediate intervention.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

ECMO does not succeed because of a single clinician, team, or device. It succeeds because of systems. In this episode of The Emergency Mind Podcast, Dan talks with Christine Stead, CEO of ELSO, about how innovation in ECMO emerges from networks of people, data, organizations, and shared purpose. From the early days of ECMO development to the global response during COVID-19, they explore how systems enable high-risk, high-complexity care to evolve under pressure.

Our topic today is one that is near and dear to every CDH parent's heart — innovation in CDH care, ventilation strategies, and reducing the need for ECMO. Dr Suneetha Desiraju joins us to explain the strategies she employs at Johns Hopkins Baltimore and the wonderful outcomes she is seeing.If you've had a child on ECMO, then you know all too well the fear, the weight, and the heartbreak that can come with it. So any advancement that helps lessen the need for ECMO is something worth talking about.

In this episode, Alec Wilding is joined by Nikki Hewitt, a clinician who has been among the first Paramedics in the United Kingdom to deliver pre-hospital ECMO as part of London's Air Ambulance (LAA), Endovascular Cardiac Arrest Team, known as ECAT. This represents one of the most significant steps forward in resuscitation science within the pre-hospital environment, and Nikki has been at the centre of that evolution.During the conversation, Nikki guides us through the evidence base underpinning ECPR, exploring what we currently know, what remains uncertain, and how ongoing research continues to shape clinical decision-making. She also takes us inside the operational structure of the ECAT model, how the team was established, what it takes to deliver ECMO in the field, and the training, skill sets, and logistics required to make it viable outside the hospital walls.Nikki also shares her perspective on where ECPR is heading: The challenges, the opportunities, and what the future of advanced pre-hospital cardiac arrest care may look like as technology, capability, and evidence continue to advance. It is a fascinating area of practice, and Nikki brings frontline insight, experience, and clarity to a topic that is reshaping the conversation around survivability in cardiac arrest.This Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

Do you think your hospital should allow unilateral DNR orders? Under what circumstances? Through what process?  Do you think that when you obtain the assent of a family to not code their loved one, that assent DNR should be counted as a unilateral DNR order? Should we document unilateral DNR and the rationale? Why for DNR, when we don't document unilateral dialysis not offered, or unilateral no ECMO offered?  Is the assent of a family member to a statement that we will not code their loved one a nudge, and is the assent approach ethical? Reasonable people will disagree, as we do on this podcast. Our guests today are Gina Piscitello, Erin DeMartino, and Will Parker, authors of a terrific viewpoint in JAMA about the need to address inadequate documentation of unilateral DNR orders.  You might recall Gina was a guest on our lively podcast about slow codes, and we pick up where that podcast left off. We highlight the many clinical, practical, and ethical issues at stake, including Gina's finding that during Covid, 3% of critically ill patients receiving pressors had a DNR order. Black patients and those who spoke Spanish had higher rates of unilateral DNR.  That variation should trouble those in favor of unilateral DNR orders.  We talk about variation Gina found at the state and health system level, and what exactly is concerning, the variation itself, or the lack of thought and care that went into some of these policies. Are you a heartbreaker? Dream Maker? Love taker? Don't you mess around with me. (song hint) -Alex  

When air meets uncertainty, judgment matters most. We dig into the evolving landscape of airway management where video laryngoscopy, supraglottic devices, and even ECMO promise better outcomes, yet cognitive errors and non‑OR settings still account for many of the most devastating events. Drawing on recent studies, malpractice claims, and national audits, we map the pressure points that turn a difficult intubation into a crisis and show how to defuse them with clearer plans, tighter teamwork, and sharper skills.We start with three high‑yield rules that change outcomes fast: cap the number of attempts, anticipate physiologic crashes, and switch early to rescue strategies. From there, we unpack the INTUBE findings on hypoxemia and cardiovascular instability, plus data showing how repeated attempts compound failure. Video laryngoscopy gets a balanced look: why it lifts first‑pass success across ED and ICU intubations, and how overreliance can silently erode direct laryngoscopy and awake fiberoptic competence. Expect practical strategies to preserve breadth: intentional DL reps, awake FOI workshops, and shared mental models that define time limits and bailout triggers.We also tackle unsettled ground. Aspiration risk reduction remains murky; cricoid pressure under general anesthesia has not delivered clear benefits, and robust trials comparing asleep rapid‑sequence to awake, topicalized methods in high‑risk patients are missing. We offer a decision lens to tailor approach by anatomy, physiology, and available expertise. For extreme airways—think massive goiter or tracheal compression—we explore where ECMO fits: preemptive, standby, or rescue. You'll hear how activation criteria, cannulation readiness, and interprofessional rehearsal turn a complex tool into a safety net rather than a new hazard.By the end, you'll have a cleaner playbook: plan A–D that you can execute under stress, a review of device trade‑offs, and concrete ways to reduce cognitive traps that drive harm. If this conversation sharpens your next airway, share it with a colleague, subscribe for future episodes, and leave a quick review to help others find the show.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/294-from-video-laryngoscopy-to-ecmo-what-keeps-airway-management-safe/© 2026, The Anesthesia Patient Safety Foundation

In this episode, Dr. Sergio Zanotti discusses a structured approach to ECMO emergencies, focusing on recognizing cardiac arrest, organizing the team response, and early ECMO troubleshooting to support key life-saving interventions. He is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trustin the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine, with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support Additional resources: British societies guideline on the management of emergencies in patients on extracorporeal membrane oxygenation. Waqas Akhtar, et al. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/41051555/ UK multisociety consensus statement on the emergency and resuscitation of patients with left-sided Impella support. Waqas Akhtar, et al. BMJ Journals 2026: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896 Books mentioned in this episode: His Dark Materials Series: The Golden Compass; The Subtle Knife; The Amber Spyglass: https://bit.ly/4cmSXgB

When a patient's heart or lungs fail, ECMO (Extracorporeal Membrane Oxygenation) technology can keep them alive—but only if the team operating it works flawlessly under pressure. In this episode, Thomas Preston draws on over 30 years of experience in cardiopulmonary care to reveal what it takes to manage these life-sustaining systems.This Teamcast episode covers the specialized roles within ECMO teams, the critical relationship between perfusionists and other medical staff, and strategies for navigating crisis moments when seconds matter. Thomas discusses how trust, constant vigilance, and ongoing training form the foundation of successful outcomes in some of medicine's most intense situations. If you value this discussion, the best way to support our work and stay up to date on future episodes is to subscribe and leave us a quick rating or review. It helps us reach more people who need to hear these conversations.

Folks this right here is a JAM PACKED episode of CCT goodness for you guys to enjoy! In this show for the ages we take a deep dive into the world of Mechanical Circulatory Support (MCS) and Cardiopulmonary Critical Care with one of the best in the biz, Dr. Bindu Akkanti! We will go through several fictional patients illustrating use cases, pitfalls and pearls of tools such as the balloon pump, ECMO and the microaxial flow devices used in ICUs all over the globe to help care for the sickest of the sick. If these tools ring a bell or if you are just interested in how we optimize care for these types of patients, give us a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

Send us a textVivek Paul is a highly skilled Cardiac Perfusionist with a strong academic and clinical background in cardiovascular perfusion science. He completed his Bachelor's degree in Cardiac Perfusion Technology from the prestigious Narayana Hrudayalaya Institute of Cardiac Sciences. His professional journey has equipped him with extensive hands-on experience in conducting cardiopulmonary bypass for both adult and pediatric cardiac procedures, including minimally invasive cardiac surgeries. He is confident in operating a wide range of heart–lung machines and extracorporeal life support systems such as IABP and ECMO.Vivek is the Founder of the Global Perfusion Community, a fast-growing professional network of perfusionists with over 15,000 followers across Instagram and LinkedIn, dedicated to education, collaboration, and career growth in perfusion technology. In addition to his clinical expertise, he is also an accomplished author of several perfusion-focused books, including Perfusion Emergency & Problems and the Quick Review ECMO Handbook, reflecting his deep commitment to continuous learning and knowledge sharing.He is passionate about mentoring students and junior perfusionists and actively contributes to the profession through leadership roles. Vivek serves as an Executive Committee Member of the Indian Society of Extracorporeal Technology (ISECT) and the Association of Clinical Perfusionists in Maharashtra, India, where he works toward improving education standards, professional development, and patient safety in cardiac perfusion practice.Learn about career options from the people doing it

In this episode of The Birth Trauma Mama Podcast, Kayleigh sits down with Derek Grassley, RN CEN, CFRN, CCRN, NRP, FP-C WP-C - a flight nurse and ECMO specialist, to break down what ECMO is, when it's used, and why it can be life-saving for critically ill pregnant and postpartum patients.This powerful conversation pulls back the curtain on critical care, emergency transport, and the realities of caring for patients at the edge of survival.

衝突 chōngtú – conflict關門 guānmén – to close a door力道 lìdào – force; strength愛惜班上的公務 àixí bānshàng de gōngwù – to take care of class property愛惜 àixí – to cherish; to take care of日常 rìcháng – daily; everyday乾哥 gāngē – sworn older brother口角衝突 kǒujiǎo chōngtú – verbal dispute演變 yǎnbiàn – to develop; to evolve肢體衝突 zhītǐ chōngtú – physical conflict事先藏好 shìxiān cánghǎo – hidden in advance彈簧刀 tánhuángdāo – switchblade連刺多刀 lián cì duō dāo – to stab repeatedly頸部 jǐngbù – neck胸部 xiōngbù – chest中刀 zhòngdāo – to be stabbed大量失血 dàliàng shīxiě – heavy blood loss失去意識 shīqù yìshì – to lose consciousness救護人員 jiùhù rényuán – emergency medical personnel到場 dàochǎng – to arrive at the scene呼吸 hūxī – breathing心跳 xīntiào – heartbeat被緊急送往 bèi jǐnjí sòngwǎng – to be urgently sent to葉克膜 yèkèmó – ECMO (extracorporeal membrane oxygenation)遺憾 yíhàn – regret; sadly宣告不治 xuāngào búzhì – officially pronounced dead殺人未遂 shārén wèisuì – attempted murder正式起訴殺人罪 zhèngshì qǐsù shārén zuì – formally charged with murder遭到羈押禁見 zāodào jīyā jìnjiàn – detained and held incommunicado一審判決出爐 yìshěn pànjué chūlú – first-instance verdict announced被關起來 bèi guān qǐlái – to be imprisoned檢方 jiǎnfāng – prosecutors法院 fǎyuàn – court判得太輕 pàn de tài qīng – sentence judged too lenient提出上訴 tíchū shàngsù – to file an appeal二審 èrshěn – second trial; second instance被害學生的家屬 bèihài xuéshēng de jiāshǔ – family of the victimized student判決結果 pànjué jiéguǒ – verdict result司法制度 sīfǎ zhìdù – judicial system過度保護 guòdù bǎohù – excessive protection加害者 jiāhàizhě – perpetrator未成年 wèichéngnián – minor; underage深仇大恨 shēn chóu dà hèn – deep hatred or vendetta假釋 jiǎshì – parole檢視 jiǎnshì – to review; to re-examineFollow me on Instagram: fangfang.chineselearning !

What does it really take to build a successful ECMO program? On MedAxiom HeartTalk, host Melanie Lawson, MS, speaks with John Mehall, MD, president of Integration Health and senior vice president of Heart & Vascular Partners, about the expanding role of ECMO in cardiac care. Dr. Mehall discusses rising utilization, improved survival outcomes, economic benefits for hospitals, and the critical importance of physician leadership, training, and institutional support to sustain effective ECMO programs.

In this essential episode of the Prolonged Field Care (PFC) Podcast, host Dennis sits down with CRNA Kevin to dive deep into one of the most overlooked yet critical issues in trauma care: Hypothermia prevention and management. Even in warm environments, trauma patients can rapidly become hypothermic—leading to coagulopathy, increased bleeding, wound infections, and worse outcomes. Dennis and Kevin break down the science, real-world lessons from deployments, and practical strategies for austere and prolonged field care settings.Whether you're a medic, provider, or anyone involved in combat casualty care, this episode will change how you approach keeping patients warm under fire or in remote locations.Episode Highlights:The four main mechanisms of heat loss: radiation (40-60% of total loss), convection, conduction, and evaporation—and how to counter each one effectively.Why even healthy patients cool rapidly under anesthesia, and why trauma patients in the field are at much higher risk.Practical tips for austere environments: using tents, inflatable structures, insulation from the ground, wool blankets, and body heat to raise ambient temperature.Common mistakes that actively cool patients: wet clothing, cold airways (LMAs/ventilation), uncovered exposure, and cold blood/fluid administration.Best bang-for-buck interventions: covering the head, minimizing exposure, drying the patient, using HME filters, and insulating from the ground.Real deployed experiences: keeping trauma bays warm, pre-warming gear, using camping pads on litters, and limitations of Ready-Heat and HPMKs at altitude or in extreme cold.Advanced rewarming techniques (when available): fluid warming, bladder lavage, peritoneal lavage, and ECMO.Temperature monitoring challenges in the field: esophageal, nasopharyngeal, rectal, Foley, and forehead strips—plus how to interpret trends.Chapters:00:00 – Introduction & Why Hypothermia Matters in Trauma Care02:30 – Heat Loss in Anesthesia: Vasodilation and the First-Hour Temperature Drop04:50 – Mechanisms of Heat Loss: Radiation, Convection, Conduction, Evaporation07:10 – OR Strategies: Room Temperature, Head Covering, Fluid Warming, Bear Huggers09:29 – Environmental Control in the Field: Raising Ambient Temperature & Reducing Wind11:52 – Using Tents and Structures to Trap Body Heat14:14 – Insulation from the Ground: Litters, Wool Blankets, Camping Pads, Air Mattresses17:53 – Preventing Conduction & Pressure Sores with Padding19:56 – Avoid Actively Cooling Patients: Cold LMAs, Unheated Ventilation, Wet Clothing22:21 – Heat Moisture Exchangers (HME) & Humidified Gas26:40 – Blood Resuscitation: Cold Fluids vs. Hypovolemia—What Kills First?31:17 – Team-Based Rewarming: Minimize Exposure, Pre-Warm Gear, Dry HPMKs35:22 – Limitations of Battery-Powered Warmers & Bear Huggers in Austere Settings40:04 – Prevention First: Insulate, Cover, Dry—Then Active Rewarming Works Better42:24 – Downstream Effects of Hypothermia: Lethal Triad & Wound Infections44:51 – Aggressive Rewarming Options: Chest Tubes, Gastric/Bladder Lavage, ECMO47:15 – Temperature Monitoring in the Field: Probes, Strips, and Trend InterpretationFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠

Episode 210: Heat Stroke BasicsWritten by Jacob Dunn, MS4, American University of the Caribbean. Edits and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. Definition:Heat stroke represents the most severe form of heat-related illness, characterized by a core body temperature exceeding 40°C (104°F) accompanied by central nervous system (CNS) dysfunction. Arreaza: Key element is the body temperature and altered mental status. Jacob: This life-threatening condition arises from the body's failure to dissipate heat effectively, often in the context of excessive environmental heat load or strenuous physical activity. Arreaza: You mentioned, it is a spectrum. What is the difference between heat exhaustion and heat stroke? Jacob: Unlike milder heat illnesses such as heat exhaustion, heat stroke involves multisystem organ dysfunction driven by direct thermal injury, systemic inflammation, and cytokine release. You can think of it as the body's thermostat breaking under extreme stress — leading to rapid, cascading failures if not addressed immediately. Arreaza: Tell us what you found out about the pathophysiology of heat stroke?Jacob: Pathophysiology: Under normal conditions, the body keeps its core temperature tightly controlled through sweating, vasodilation of skin blood vessels, and behavioral responses like seeking shade or drinking water. But in extreme heat or prolonged exertion, those mechanisms get overwhelmed.Once core temperature rises above about 40°C (104°F), the hypothalamus—the brain's thermostat—can't keep up. The body shifts from controlled thermoregulation to uncontrolled, passive heating. Heat stroke isn't just someone getting too hot—it's a full-blown failure of the body's heat-regulating system. Arreaza: So, it's interesting. the cell functions get affected at this point, several dangerous processes start happening at the same time.Jacob: Yes: Cellular Heat InjuryHigh temperatures disrupt proteins, enzymes, and cell membranes. Mitochondria start to fail, ATP production drops, and cells become leaky. This leads to direct tissue injury in vital organs like the brain, liver, kidneys, and heart.Arreaza: Yikes. Cytokines play a big role in the pathophysiology of heat stroke too. Jacob: Systemic Inflammatory ResponseHeat damages the gut barrier, allowing endotoxins to enter the bloodstream. This triggers a massive cytokine release—similar to sepsis. The result is widespread inflammation, endothelial injury, and microvascular collapse.Arreaza: What other systems are affected?Coagulation AbnormalitiesEndothelial damage activates the clotting cascade. Patients may develop a DIC-like picture: microthrombi forming in some areas while clotting factors get consumed in others. This contributes to organ dysfunction and bleeding.Circulatory CollapseAs the body shunts blood to the skin for cooling, perfusion to vital organs drops. Combine that with dehydration from sweating and fluid loss, and you get hypotension, decreased cardiac output, and worsening ischemia.Arreaza: And one of the key features is neurologic dysfunction.Jacob: Neurologic DysfunctionThe brain is extremely sensitive to heat. Encephalopathy, confusion, seizures, and coma occur because neurons malfunction at high temperatures. This is why altered mental status is the hallmark of true heat stroke.Arreaza: Cell injury, inflammation, coagulopathy, circulatory collapse and neurologic dysfunction. Jacob: Ultimately, heat stroke is a multisystem catastrophic event—a combination of thermal injury, inflammatory storm, coagulopathy, and circulatory collapse. Without rapid cooling and aggressive supportive care, these processes spiral into irreversible organ failure.Background and Types:Arreaza: Heat stroke is part of a spectrum of heat-related disorders—it is a true medical emergency. Mortality rate reaches 30%, even with optimal treatment. This mortality correlates directly with the duration of core hyperthermia. I'm reminded of the first time I heard about heat stroke in a baby who was left inside a car in the summer 2005. Jacob: There are two primary types: -nonexertional (classic) heat stroke, which develops insidiously over days and predominantly affects vulnerable populations like children, the elderly, and those with chronic illnesses during heat waves; -exertional heat stroke, which strikes rapidly in young, otherwise healthy individuals, often during intense exercise in hot, humid conditions. Arreaza: In our community, farm workers are especially at risk of heat stroke, but any person living in the Central Valley is basically at risk.Jacob: Risk factors amplify vulnerability across both types, including dehydration, cardiovascular disease, medications that impair sweating (e.g., anticholinergics), and acclimatization deficits. Notably, anhidrosis (lack of sweating) is common but not required for diagnosis. Hot, dry skin can signal the shift from heat exhaustion to stroke. Arreaza: What other conditions look like heat stroke?Differential Diagnosis:Jacob: Presenting with altered mental status and hyperthermia, heat stroke demands a broad differential to avoid missing mimics. -Environmental: heat exhaustion, syncope, or cramps. -Infectious etiologies like sepsis or meningitis must be ruled out. -Endocrine emergencies such as thyroid storm, pheochromocytoma, or diabetic ketoacidosis (DKA) can overlap. -Neurologic insults include cerebrovascular accident (CVA), hypothalamic lesions (bleeding or infarct), or status epilepticus. -Toxicologic culprits are plentiful—sympathomimetic or anticholinergic toxidromes, salicylate poisoning, serotonin syndrome, malignant hyperthermia, neuroleptic malignant syndrome (NMS), or even alcohol/benzodiazepine withdrawal. When it comes to differentials, it is always best to cast a wide net and think about what we could be missing if this is not heat stroke. Arreaza: Let's say we have a patient with hyperthermia and we have to assess him in the ER. What should we do to diagnose it?Jacob: Workup:Diagnosis is primarily clinical, hinging on documented hyperthermia (>40°C) plus CNS changes (e.g., confusion, delirium, seizures, coma) in a hot environment. Arreaza: No single lab confirms it, but targeted testing allows us to detect complications and rule out alternative diagnosis. Jacob: -Start with ECG to assess for dysrhythmias or ischemic changes (sinus tachycardia is classic; ST depressions or T-wave inversions may hint at myocardial strain). -Labs include complete blood count (CBC), comprehensive metabolic panel (electrolytes, renal function, liver enzymes), glucose, arterial blood gas, lactate (elevated in shock), coagulation studies (for disseminated intravascular coagulation, or DIC), creatine kinase (CK) and myoglobin (for rhabdomyolysis), and urinalysis. Toxicology screen if history suggests. Arreaza: I can imagine doing all this while trying to cool down the patient. What about imaging?-Imaging: chest X-ray for pulmonary issues, non-contrast head CT if neurologic concerns suggest edema or bleed (consider lumbar puncture if infection suspected). It is important to note that continuous core temperature monitoring—via rectal, esophageal, or bladder probe—is essential, not just peripheral skin checks. Arreaza: TreatmentManagement:Time is tissue here—initiate cooling en route, if possible, as delays skyrocket morbidity. ABCs first: secure airway (intubate if needed, favoring rocuronium over succinylcholine to avoid hyperkalemia risk), support breathing, and stabilize circulation. -Remove the patient from the heat source, strip clothing, and launch aggressive cooling to target 38-39°C (102-102°F) before halting to prevent rebound hypothermia. -For exertional cases, ice-water immersion reigns supreme—it's the fastest method, with immersion in cold water resulting in near-100% survival if started within 30 minutes. -Nonexertional benefits from evaporative cooling: mist with tepid water (15-25°C) plus fans for convective airflow. -Adjuncts include ice packs to neck, axillae, and groin; -room-temperature IV fluids (avoid cold initially to prevent shivering); -refractory cases, invasive options like peritoneal lavage, endovascular cooling catheters, or even ECMO. -Fluid resuscitation with lactated Ringer's or normal saline (250-500 mL boluses) protects kidneys and counters rhabdomyolysis—aim for urine output of 2-3 mL/kg/hour. Arreaza: What about medications?Jacob: Benzodiazepines (e.g., lorazepam) control agitation, seizures, or shivering; propofol or fentanyl if intubated. Avoid antipyretics like acetaminophen. For intubation, etomidate or ketamine as induction agents. Hypotension often resolves with cooling and fluids; if not, use dopamine or dobutamine over norepinephrine to avoid vasoconstriction. Jacob: What IV fluid is recommended/best for patients with heat stroke?Both lactated Ringer's solution and normal saline are recommended as initial IV fluids for rehydration, but balanced crystalloids such as LR are increasingly favored due to their lower risk of hyperchloremic metabolic acidosis and AKI. However, direct evidence comparing the two specifically in the setting of heat stroke is limited. Arreaza: Are cold IV fluids better/preferred over room temperature fluids?Cold IV fluids are recommended as an adjunctive therapy to help lower core temperature in heat stroke, but they should not delay or replace primary cooling methods such as cold-water immersion. Cold IV fluids can decrease core temperature more rapidly than room temperature fluids. For example, 30mL/kg bolus of chilled isotonic fluids at 4 degrees Celsius over 30 minutes can decrease core temperature by about 1 degree Celsius, compared to 0.5 degree Celsius with room temperature fluids. Arreaza: Getting cold IV sounds uncomfortable but necessary for those patients. Our favorite topic.Screening and Prevention:-Heat stroke prevention focuses on public health and individual awareness rather than routine testing. -High-risk groups—elderly, children, athletes, laborers, or those on impairing meds—should acclimatize gradually (7-14 days), hydrate preemptively (electrolyte solutions over plain water), and monitor temperature in exertional settings. -Communities during heat waves need cooling centers and alerts. -For clinicians, educate patients with CVD or obesity about early signs like dizziness or nausea. -No formal "screening" exists, but vigilance in EDs during summer surges saves lives. -Arreaza: I think awareness is a key element in prevention, so education of the public through traditional media like TV, and even social media can contribute to the prevention of this catastrophic condition.Jacob: Ya so heat stroke is something that should be on every physician's radar in the central valley especially in the summer time given the hot temperatures. Rapid recognition is key. Arreaza: Thanks, Jacob for this topic, and until next time, this is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! References:Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31. PMID: 26525947. https://pubmed.ncbi.nlm.nih.gov/26525947/.Platt, M. A., & LoVecchio, F. (n.d.). Nonexertional classic heat stroke in adults. In UpToDate. Retrieved September 7, 2025, from https://www.uptodate.com/contents/nonexertional-classic-heat-stroke-in-adults. (Key addition: Emphasizes insidious onset in at-risk populations and the role of urban heat islands in exacerbating classic cases.) Heat Stroke. WikEM. Retrieved December 3, 2025, from https://wikem.org/wiki/Heat_stroke. (Key additions: Details on cooling rates for immersion therapy, confirmation that anhidrosis is not diagnostic, and fluid titration to urine output for rhabdomyolysis prevention.)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

In this special Rated Rx interview, Robbie sits down with Dr. Zack Meade, an anesthesiologist and major social media presence known for breaking down medical misinformation and educating patients online. They talk about why he started posting, how his content evolved from awkward early videos to confident patient-focused education, and why online medicine feels completely different from practicing in person. Zack opens up about the realities of online backlash, the communities that react the strongest, and the ground rules he follows to stay professional while still being funny. He also shares stories about hospital policies, case report controversies, naturopathic claims, wellness scams, and the strange world of “designer ECMO” at med spas. The conversation closes with the biggest lesson he learned from the comment section: patients need more time, more patience, and more understanding than most clinicians realize. This podcast is intended for entertainment and informational purposes only. https://www.facebook.com/people/The-Rated-Rx-Podcast/61574813907982/ https://www.youtube.com/@RatedRxPodcast https://www.facebook.com/DrZackMD https://www.youtube.com/@TheWhiteCoatCouple

Blogpost asociado  https://ecctrainings.com/te-atreverias-a-dar-tromboliticos-prehospitalarios-para-embolia-pulmonar-lo-que-revela-el-nuevo-estudio-y-como-prepararte-con-acls/" Referencia del estudio original: Harjola, J., Holmström, P., Sane, M., Hartikainen, J., & Harjola, V.-P. (2025). Prehospital fibrinolysis in high-risk pulmonary embolism – Observational data on clinical picture and outcome. Prehospital Emergency Care, 29(7), 1–8. https://doi.org/10.1080/10903127.2025.2582671 Recordatorio rápido: embolia pulmonar de alto riesgo Definición sencilla: EP de alto riesgo / masiva → se manifiesta como shock obstructivo o paro cardiaco. Fisiopatología en pocas palabras: Trombo grande en circulación pulmonar → aumento de poscarga del ventrículo derecho → falla del VD → colapso hemodinámico. Por qué es tan letal: Deterioro muy rápido, ventana terapéutica corta. Frecuentemente se presenta como paro fuera del hospital. Conectar con ACLS: La EP masiva está dentro de las "T" (tromboembolismo) en las causas reversibles del paro. Las guías ACLS contemplan el uso de trombolíticos cuando se sospecha fuertemente EP como causa del paro. ¿Cómo se ve clínicamente un paciente con EP de alto riesgo? Disnea súbita, dolor torácico, síncope, hipotensión, antecedentes de riesgo trombótico. Resumen del estudio de Harjola et al. Objetivo principal del estudio Explorar supervivencia y complicaciones hemorrágicas del uso de trombolíticos prehospitalarios para embolia pulmonar de alto riesgo. Diseño Datos de EMS del área metropolitana de Helsinki + hospital universitario. Periodo aproximado: 2007–2019. Inclusión: Pacientes con EP de alto riesgo sospechada clínicamente. Tratados con fibrinolisis intravenosa prehospitalaria. Diagnóstico de EP confirmado posteriormente por imagen o autopsia. Grupo comparador: Pacientes con EP de alto riesgo que no recibieron fibrinólisis prehospitalaria. Resultados clave Total de pacientes con EP de alto riesgo: 60. Grupo con trombolíticos prehospitalarios para embolia pulmonar: n = 23. 44% mujeres. Edad media: alrededor de 57 años. 74% se presentaron en paro cardiaco. 26% en shock obstructivo. Mortalidad: Mortalidad prehospitalaria aproximada: 35%. Mortalidad intrahospitalaria: alrededor de 27% de los que llegaron vivos. Mortalidad total combinada: cerca de 52%. Todas las muertes en este grupo fueron en pacientes que llegaron en paro cardiaco. Complicaciones: 2 pacientes con sangrado mayor. Ningún sangrado fatal. Supervivencia a 12 meses: Los pacientes trombolizados que salieron vivos del hospital seguían vivos a los 12 meses. Grupo sin trombolisis prehospitalaria: n = 37. Más añosos (edad media cercana a 72 años). Mayor proporción de paro cardiaco. Mortalidad a 12 meses más alta (≈ 76%, tendencia, p alrededor de 0.06). Comentario para desarrollar: Es un estudio observacional, con n pequeño, no podemos concluir causalidad, pero sí hay "señales" interesantes de posible beneficio. ¿Qué nos dice realmente este estudio? Mensajes principales La EP de alto riesgo fuera del hospital tiene una mortalidad muy alta aun con intervenciones agresivas. En este contexto crítico, los trombolíticos prehospitalarios para embolia pulmonar: Parecen relativamente seguros (pocas hemorragias mayores, ninguna fatal). Podrían ofrecer un beneficio en supervivencia, especialmente en pacientes seleccionados. Limitaciones para mencionar Serie de casos; no es ensayo aleatorizado. Número pequeño de pacientes trombolizados. Posible sesgo de selección: Pacientes más jóvenes y potencialmente con menos comorbilidades recibieron trombólisis. No responde preguntas como: Detalle exacto del protocolo. Diferencias entre equipos. Tiempos exactos desde el colapso hasta la trombólisis. Idea clave: No es un "permiso" para trombolizar a todo el mundo, pero sí una invitación seria a considerar que, en EP de alto riesgo, la inacción también tiene un costo muy alto. El reto práctico: decidir trombolisis en el campo Barreras en la vida real Diagnóstico presuntivo sin imagen: Dependemos de clínica, antecedentes, ECG, quizás eco focal. Miedo al sangrado: Especialmente hemorragia intracraneal. Falta de protocolos claros: Muchos sistemas de EMS no contemplan todavía trombolíticos prehospitalarios para embolia pulmonar. Falta de entrenamiento específico: No todos se sienten cómodos con indicaciones, contraindicaciones, dosis. Cómo ayuda ACLS aquí ACLS bien aprendido: Te obliga a pensar en H y T, no solo en adrenalina y ciclos. Te muestra dónde se colocan los trombolíticos prehospitalarios para embolia pulmonar dentro del algoritmo. Te entrena para liderar un equipo y tomar decisiones bajo presión. Conectar con los cursos de ECCtrainings: En nuestros ACLS discutimos escenarios de paro por EP masiva. Practicamos cómo tomar la decisión de administrar o no trombolítico. Simulamos la comunicación con el hospital receptor después de trombólisis. Caso clínico narrado Propuesta de caso Varón de 48 años. Disnea súbita, dolor torácico, antecedente de inmovilidad o TVP reciente. Hipotenso, taquicárdico, saturación baja, signos de shock. En la ambulancia entra en PEA. El equipo evalúa H y T → EP masiva muy probable. Protocolo local permite trombolíticos prehospitalarios para embolia pulmonar: Se administra el medicamento durante la RCP. Después de varios ciclos recupera pulso. Llega vivo al hospital, se confirma EP por imagen y sobrevive. Puntos a resaltar Valor de: reconocer el patrón clínico, tener protocolos, estar entrenado en ACLS. Conectar con la serie de Helsinki: "Son justamente este tipo de pacientes los que aparecen en la serie: altísimo riesgo, pero con posibilidad real de supervivencia si somos agresivos." Cómo prepararte tú y tu sistema Pasos sugeridos para líderes, educadores y clínicos de EMS Revisar la evidencia Usar este estudio como punto de partida para la discusión sobre trombolíticos prehospitalarios para embolia pulmonar. Evaluar la realidad local ¿Disponibilidad del medicamento? ¿Quién puede prescribir y administrar? ¿Qué soporte hospitalario hay (UCI, hemodinamia, ECMO)? Desarrollar protocolos claros Criterios de inclusión y exclusión. Algoritmo que integre ACLS y trombólisis. Entrenamiento formal No basta con escribir el protocolo; hay que entrenarlo en simulación. Cursos ACLS con escenarios específicos de EP. Simulaciones y revisión de casos Simulacros periódicos con roles definidos. Morbimortalidad / debriefing de casos reales o simulados. Comunidad: seguir la conversación en ECCnetwork ECCnetwork: Comunidad en línea para profesionales de emergencias, cuidado crítico, medicina táctica, etc. Espacios para discutir artículos, casos, protocolos, dudas. Invitar a que compartan: ¿Su sistema consideraría trombolíticos prehospitalarios para embolia pulmonar? ¿Qué barreras ven? ¿Experiencias que puedan comentar? Recursos adicionales y blogpost Recordar el blogpost: URL:

ECMO is the topic of this week's episode of Pediheart. We speak with Assistant Professor of Pediatrics and cardiac critical care specialist at Northwell Health, Dr. Ivana Capin about a recent ELSO database study she conducted to assess outcomes in single ventricle patients who were treated with ECMO prior to single ventricle palliation. What factors were associated with worse overall outcomes? Can this therapy be used to stabilize the HLHS patient with an intact atrial septum? Why have outcomes for this high risk patient group not appreciably improved in the recent decade? How can these data improve prognostic clarity when speaking with families in this difficult situation.Also joining us briefly is Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, Dr. Scott Aydin to discuss his co-author and mentor, Dr. George Ofori-Amanfo as we approach the 4th anniversary of his untimely and tragic passing. DOI: 10.1017/S1047951125001386

What happens when life depends on perfect coordination between human and machine? In this episode, Thomas Preston — a veteran ECMO expert and executive leader at Integration Health — joins us to explore the high-stakes world of ECMO (extracorporeal membrane oxygenation) and the complex teamwork it demands.

In this 320th episdode I welcome Drs. Essandoh and Cody back to the show to discuss the latest data and guidelines around the use of the Impella device and how it compares to IABP and ECMO.Our Sponsors:* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Factor and use my code accrac50off for a great deal: https://www.factor75.com* Check out Truelearn: https://tinyurl.com/ACCRACTL* Check out Uncommon Goods: https://uncommongoods.com/ACCRACAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy