Podcast appearances and mentions of ed icu

Marilyn Sherrill and her guests, Dr. Matthew Lyon and Dr. Max Bursey, take a deep look at Augusta University Medical Center's successes and challenges regarding Interhospital transfers.         Guest speakers: Max Bursey, DO Associate Professor, Service Chief Department of Emergency Medicine Medical College of Georgia at Augusta University   Matthew Lyon, MD Associate Dean, Experiential Learning  Director, Center for Ultrasound Education Vice-Chair, Department of Emergency Medicine Medical College of Georgia at Augusta University    Moderator: Marilyn Sherrill, RN, MBA Performance Improvement Program Director Vizient   Show Notes: [01:36] Georgia is unique in that it has a large number of rural hospitals, requiring a large number of interhospital transfers for high acuity cases. [03:50] Telemedicine and ED-based critical care services have aided rural hospital quality of care and decreased the need for transfers. [05:48] These two services have evolved from intervention in the ED only to a holistic program of care for patients in rural hospitals. [07:38] The ED ICU service provides inpatient level care to patients waiting on an ICU bed and “short-stay” ICU patients, and works closely with the telemedicine critical care to prevent and manage transfers. [09:53] Telemedicine interacts with Emtala in ways that allow rural hospitals to admit and keep a broader selection of patients. [11:13] Challenges have included the need for training providers on the use of telemedicine, and training and staffing ICU-level nurses in the ED ICU and in rural hospitals. [13:53] Starting slow and adequately training staff are important best practices. [16:03] Telemedicine isn't going anywhere and should be utilized fully, and included in the work of the ED.   Subscribe Today! Apple Podcasts Amazon Podcasts Spotify Google Podcasts Android Stitcher RSS Feed

On this episode of the Psychology Talk Podcast, Dr. Hoye speaks with Thad CummingsThad is an emergency department nurse as well as the author of Running from Fear and Radical Compassion. He was recently featured in a Business Insider interview on the state of emergency room settings and the polarization that has affected hospital staff and patients. After spending a decade running social enterprises and a non-profit, Thad founded Changing Company, a non-profit where he shares his passion for bringing new conversations to the landscape where all voices are heard, barriers are broken, and the polarization of our communities is diminished.Thad discusses the intersection of his previous work of speaking and presenting workshops on mental health and how that has evolved to meet the levels of burnout and despair he has found working the past two years in the ICU/ER amongst the Covid pandemic. Topics Include:•The severity of the pandemic's effect on health worker's morale•The effect of political polarity in ED/ICU and all hospital staff•Burnout faced by the tsunami of cases with each wave of the Covid•The “no quick fix” to mental health and wellbeing •Thad's previous work as a workshop leader and his current work with hospital staff•Ways to increase mental health through therapy and conversationBusiness Insider's Interview with Thad Cummings: https://www.businessinsider.com/what-its-like-covid-er-nurse-watch-patients-beg-live-2022-1Thad Cumming's Website: https://changingcompany.org/thad-cummingsThe Psychology Talk Podcast is a unique conversation about psychology around the globe. Your hosts Dr. Scott Hoye and licensed clinical professional counselor Kyle Miller talk about psychology with mental health practitioners and experts to keep you informed about issues and trends in the industry. They also tackle mental health trends and issues in their home: Chicago.https://psych-talk.comhttps://www.instagram.com/psychtalkpodcast/https://www.facebook.com/psychtalkpodcast

Tim chats us through what it is like to be a rural doctor in Australia Top 3 Points from this podcast: Know your local teams.  Train with them, support them and practice sim scenarios. Know your equipment.  The Sandpiper clinician is really there to perform a limited suite of meaningful interventions (do the basics, well).  Making sure you know where your equipment is packed and how to use it is vital Be an advocate for change, whether at local level, State or Nationally.  Harness the good news stories from patient outcomes to help generate awareness, support and funding for Sandpiper Australia Resources: Kangaroo island doctor blogging about rural medicine in Australia  https://kidocs.org/  SANDPIPER AUSTRALIA  sandpiperaustralia.org  ACRRM PHEC  https://www.acrrm.org.au/courses/face-to-face/pre-hospital-emergency-care-phec  About Tim: Tim Leeuwenburg is a Rural Generalist on Kangaroo Island, South Australia – he started off as an ED/ICU trainee in Adelaide before realising the heady mix of medicine that an RG encompasses.  For the past twenty years he's been in probate practice on Kangaroo Island, providing primary care, emergency medicine and anesthetic services through clinic and hospital, as well as prehospital care of SA's Rural Emergency Responder Network (RERN)  Now semi-retired, he and partner Trish spend time rehabilitating orphaned wildlife and sea kayaking; Tim still collects pocket money working as a retrieval consultant for the Central Australian Retrieval Service and doing the odd anesthetic locum.  More importantly he now has time to help out as Chair of Sandpiper Australia in the hope that we can overcome the 'tyranny of distance' by establishing rural responder networks across the various States & Territories in Australia. twitter @kangaroobeach

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Urgent Care RAP show. Earn CME on your commute while getting the latest practice-changing urgent care information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/UCRAPPOD Ilene Claudius, MD, Matthieu DeClerck, MD, Lisa Patel, MD, and Mizuho Morrison, DO walk us through the classification of burns in pediatric patients and how this affects management. Criteria and referral to a burn center is discussed as well as the treatment of burns for outpatient vs. inpatient management. Pearls: When calculating the total body surface area burned, only include areas of partial or full thickness injury.  A good burn area estimation tool is that a child’s hand is ~1% of their total BSA.  Any partial and/or full thickness burn involving >15% of the total BSA requires immediate burn center referral. Topical antibiotic ointment is now preferred over silver sulfadiazine for superficial partial thickness burns. All full thickness burns and partial thickness burns to the hands, face, genitals, or over joints should be seen within several days by a pediatric burn specialist.  When considering burns in children, it is useful to classify them into 3 categories: life threatening, common, and negligible burns. Superficial burns (ie: those with erythema only) are of no clinical consequence.  When using a burn formula to calculate the total body surface area (BSA) involved, only the areas of partial and full thickness areas of burn count (ie: with blistering and/or loss of skin).  Partial thickness burns involve the papillary (superficial partial) or reticular (deep partial) layers of the dermis. These are generally very painful. Full thickness burns involve any tissue below the dermis (e.g. fat, muscle, bone etc). These are commonly less painful because the nerves have been destroyed. Overestimation of burned surface area is common, especially in children. Most pediatric burns have a small area of partial thickness surrounded by extensive superficial burn.   A common pitfall is to count the entire area of injury in the estimate of the percent of total BSA burned.  When estimating the percent of total BSA affected in children, the “rule of 9’s” (commonly used in adults) does not work because the proportional anatomy of children is different. The Lund Browder Chart (see references) is useful for estimating total BSA burned in children.  1% of a child’s BSA is also roughly the size of the palm and fingers on one of their hands.  Serious burns may require immediate burn center referral or outpatient follow-up depending on anatomic areas affected and the percent of total BSA burned. Burns involving >15% of the total BSA require immediate burn center referral because of the risk of significant fluid losses.  Lactated Ringer’s is preferred over Normal Saline because of the risk of acidosis. In an ED/ICU setting, fluid management is guided by monitoring urine output.  If possible, it is reasonable to begin IV fluids from UC while arranging an emergent burn center referral.  Heat loss and risk of hypothermia can be significant for children with large burns and covering children with a warm, dry sheet can help mitigate this while arranging transfer. Burns are very painful, so the liberal use of topical and oral analgesia for severe burns is critical. Smaller areas partial thickness burns involving the hands, face, genitals, or extending over a joint or complete circumference of an extremity can cause serious cosmetic and functional impairment and are best managed with close burn center follow-up.  All full thickness burns will require non-urgent burn center follow-up (ie: within several days) because skin grafting will usually be required to allow for healing. Recommended topical wound/burn care depends on the depth of the burn. Superficial burns require no wound care but aloe products or Vaseline™ can soothe discomfort.  Superficial partial thickness burns with intact blisters seem to become infected less often and heal faster if the blister is drained and debrided, but this remains controversial. It is appropriate to NOT debride blisters that are thick walled or

Present by Joshua Sawyer, a medical student at the Alabama College of Osteopathic Medicine and the AAEM/RSA Medical Student Council Southern Regional Representative and Adam Kessler, DO, an Associate Professor in the Department of Emergency Medicine and Anesthesiology Critical Care at the University of Alabama-Birmingham, where he developed an ED-ICU and an Emergency Critical Care consult service. He also serves on the Therapeutic Hypothermia Service, Quality Variance, and Critical Care Committee. Intro music by Akashic Records, Key to Success - Discover the Possibility from the album Corporate Presentation - Key to Success, powered by JAMENDO.

In this episode, Joshua Sawyer, a medical student at the Alabama College of Osteopathic Medicine and the AAEM/RSA Medical Student Council Southern Regional Representative, speaks with Dr. Adam Kessler, an Associate Professor in the Department of Emergency Medicine and Anesthesiology Critical Care at the University of Alabama-Birmingham, where he developed an ED-ICU and an Emergency Critical Care consult service. He also serves on the Therapeutic Hypothermia Service, Quality Variance, and Critical Care Committee.

CRITICAL CARE, MEDICINE, & ED PHYSICIAN LEADERSHIP COVID CONFERENCE 7-15-20   ICU physician consultation process 6 hour + ED ICU holds should consider ICU consult ICU Consult - put in consult to the critical care or call them and ask for a consult PCU borderline patients - narrowed fio2 >50%, >RR rate, comorbid conditions - employing consultation with pulmonary or ID, ICU downgrades watch very carefully Increase severity of patients going to PCU - 10% ICU conversion rate observed    should we start the Covid power plan? Probably start to help identify care needs in the ED   should we have full ICU admit orders Probably to start identifying care needs of patient   should we initiate the ICU vent power plan  Very labor intensive plan   should we initiate the sedation and vasoactive agents ICU power plan Basic sedation order sets    Does the ED power plans differ much from the ICU power plans for Vents, vasoactive, etc?  Similar order sets, will review with critical care physicians    Should prone in the ED possible or should be avoided Very labor intensive process, difficult to perform in the ICU   Will nurses follow the orders and tasks Nursing / physician leadership task force to work and help implement ICU admit hold orders   Fluid Resuscitation treat the symptom, give normal resuscitative fluid bolus as clinically indicated.  Treat shock with resuscitation   10.Medications / Novel Therapies Anticoagulation - prophylaxis initially Ketamine and paralysis- for dysonchrony / refractory hypoxemia  Antibiotics - CAP / HCAP based on classification (nursing home, etc.) Plasma - not for ED ICU holds, long wait list.   Steroids -  best benefit from literature is later presentation, doesnt have to be in the ED Remdesivir  - shortage of this medication, dosage can wait until ICU admission  Hyrdoxychlorquine - questionable utility, not recommended Tocilizumab - cytokine storm presentation patients that are ventilated may benefit.  Will be prescribed by critical care or ID   11. Capacity    Hospital very full    Expanding ICU units to alternative locations (NICU, PCU)    ICU Capacity very tight - each transfer being reviewed based on needs    ICU ECMO at south full - no additional capacity     Ventilators - some strategic changes in vent types based on location, RT and ICU       updated.  Plenty of vent

Podcast summary of articles from the April 2020 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include ECG findings in Pericarditis vs. STEMI, Baclofen toxicity, POCUS for hip pain, Erector Spinae Plane Blocks, Diabetic Ketoacidosis in an ED/ICU setting and board review on Measles.  Guest speaker is Dr. Ryan Yavorksy.

Dr. Scott Weingart is our go to international expert in critical care.  He is an ED/ICU doctor in New York.  In this podcast we talk about what's happening on the ground, how to protect yourself as a provider, and how to prevent your family from being exposed because of your job.

Do ED ICUs save lives? Probably. The paper in question is by Gunnerson et al and can be found here.Scott Weingart's work on ED ICUs can be found here.

In this episode of Critical Matters, we explore the role of the intensivist in the management of patients with ventricular assist devices. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac & Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Summary of information presented during the episode kindly provided by Dr. John Greenwood: https://bit.ly/2MJdfSa HeartWare Waveforms App for iPad: https://apple.co/2NpyQEr Articles Mentioned In This Episode: Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68: https://bit.ly/2MKr3M6 Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153: https://bit.ly/2NoreC4

In this episode of Critical Matters, we explore the role of the intensivist in the postoperative care of the cardiac surgical patient. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac and Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care: https://www.ncbi.nlm.nih.gov/pubmed/25962078 Postoperative Critical Care of the Adult Cardiac Surgical Patient: Part II: Procedure-Specific Considerations, Management of Complications, and Quality Improvement: https://www.ncbi.nlm.nih.gov/pubmed/26136101 Critical Care Perspectives in Emergency Medicine – a monthly CME podcast on resuscitation and critical care-related issues that can present to the ED https://www.criticalcareinem.com/ Critical Care Project – a multi-institutional website designed to be a multidisciplinary educational resource on topics in critical care. http://ccproject.com/ Books Mentioned in This Episode: How to Win Friends & Influence People: https://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034/ref=sr_1_3?ie=UTF8&qid=1521825606&sr=8-3&keywords=dale+carnegie The Last Lecture: https://www.amazon.com/Last-Lecture-Pausch-Randy-Hardcover/dp/B011MCWCDW/ref=sr_1_2?ie=UTF8&qid=1521826496&sr=8-2&keywords=the+last+lecture In the first of two episodes, we discuss general postoperative care, common complications, and the intensivist-cardiac surgeon relationship.

Burns Part I - Fluid Management

Today we are visited by Dr. Rory Spiegel. The man behind EM Nerd and the most recent winner of the EMRA Educator and FOAMer of the year! Dr. Spiegel is most recently completing his Resuscitation Fellowship at Stony Brook University Medical Center where every day activities focus on two things: the creation of an ED-ICU model AND reviewing/critiquing scientific papers. Today he will be doing his best to concentrate his brilliance into a 45 minute presentation. I have heard a ton of lectures on EBM, but never before has one made so much sense in such a short period of time!

  Is the care you deliver to critically ill patients in your ED the same as the care delivered in your ICU? And if not, why not?Consider the challenges facing the delivery of excellent care in the ED, and be inspired to make changes at your hospital to improve your system. Learn ten strategies for optimizing the care of critically ill patients in your ED. References:1. Learn more about ED-ICU’s at Scott Weingart’s excellent site http://www.emcrit.org2. Consider a resuscitation fellowship like this one: http://www.resuscitationinstitute.org/index.cfm/education/resuscitation-fellowship1/3. There are zillions of articles about the benefits of simulation and training, here is a link to just one, if you only want to dip your toe in the water: http://qualitysafety.bmj.com/content/19/Suppl_2/i34.full4. Audit and feedback around quality outcomes are a potential strategy. Read more about the pros and cons from the World Health Organization here: http://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/2010/using-audit-and-feedback-to-health-professionals-to-improve-the-quality-and-safety-of-health-care

Jim Miner discusses the fine points of ED/ICU procedural sedation

There is a really smart anesthesiologist out there called Nicholas Chrimes. He along with his mate Peter Fritz invented the Vortex Approach to Airway Management. He also runs a blog called Clinical CrEd. He did a post advocating the Mapleson B Circuit as the Ultimate Preox Device What is the Mapleson B? The Mapleson circuits were used for anesthetics in the good old days. At least in the US, we have move to bigger, and arguably better designs for our operative patients. Many would have thought this device would have been consigned to the trash heap, but seemingly not. from anesthesia 2000 My Recommended Approaches I recommend two approaches to preox: standard and shunt physiology strategies. I outlines these strategies in the paper Rich Levitan and I wrote. Standard: NRB @ >=15 lpm and NC @ 10-15 lpm for 3 minutes Shunt Physio: Choose 1 BVM with PEEP Valve & NC @ 10-15 lpm NIPPV Ventilator with NIPPV Mask or BVM Mask & NC @ 10-15 lpm Nick makes a number of arguments as to the superiority of the Mapleson circuit over these standard techniques. His points are excellent, but I disagree with pretty much all of them--I think it becomes a question of perspective. Automatic Checking Yes, using the same device for reox and preox makes sure the reox device is there and hooked up, but this for me is an inadequate argument to dispense with NRB/NC set-up. Multiple BVM Masks We don't have these readily available in any ED or ICU I've worked in. We have neonate, peds, and adult. Our masks also are not inflatable. PEEP PEEP is good, Mapleson may or may not be a good way to provide this for the reasons I've mentioned in the wee, but a BVM with a PEEP valve or a vent are at least as good. ApOx Mapleson may provide this better than BVM, but not as well as a NC, which should be on during any intubation. ETCO2 No advantage of Mapleson Low resistance Maybe this matters, as soon as you put on the PEEP, I can't imagine this difference persisting Room Air Entrainment Release your seal for even one breath and you have blown denitrogenation. Always, always use a strapped system if possible=NRB/NC, NIV mask, or BVM mask with OR straps. Troubleshooting Leaks This is the real area in which Nick and I differ. Nick makes the point that a good seal in preox guarantees a good seal in reox--this may be true, but it is unimportant. What I care about is does a bad, one-handed seal in preox mean I won't be able to reox with the BVM--this is entirely untrue. If I did to an awake patient what I will do to them when asleep and desaturating, they would, quite rightfully, punch me in the face. Anesthesiologists should use Mapleson B/C; ED/ICU should only use BVM +/- PEEP Valve with two hands and oral airway and a rocking triple maneuver (that no pt should experience if they are conscious) otherwise they should be NIV mask with straps or (BVM mask with straps). This is the same reason I tell my residents to just train with Macintosh blades. Primary and secondary leaks are the main thrust of Nick's love for the old-timey circuits. But all of us have appreciated this easily by squeezing the bag-valve-mask: Easy-squeezy or Hard Squeezy ETCO2 with a monitor you can see Is he holding or squeezing? I can feel compliance with a BVM if I squeezed it, but I don't unless the pt needs it during reox. But are they squeezing the Mapleson? If they are, they may be doing damage. This study (Anesthesiology 2014;120:326) talks about the myths of Gentle Facemask Ventilation: >15 cmH20 may be entraining gas into the stomach via the LES (in some patients, even 10 cmH20 may be a problem) UES will withstand at least 20 cmH20 until NMB at which point again 15 seems to be the number (The latter is why we don't bag during apnea unless we have to) Two hands ALWAYS on the mask Recently, I spent 2 weeks intubating 10-15 patients per day. One hand mask skills got better and better--all for naught.