Podcasts about epinephrine

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.If you don't normally monitor patients as part of your job, I suggest two things:1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block.Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Join Dr. Olga Kagan, founder of the Food Allergy Nursing Association (FANA), as she shares insights on revolutionizing food allergy care through nursing innovation, technology, and evidence-based practice. Learn how FANA is empowering nurses to lead transformative change in this critical healthcare subspecialty while improving patient outcomes and quality of life.Discover how nursing leadership is revolutionizing food allergy care through evidence-based practiceLearn strategies for implementing innovative, technology-driven care models in specialty nursingUnderstand the impact of nurse-led research and education on patient outcomes in food allergy managementOlga Kagan, PhD, RN, CIMI, FHIMS, Founder, Food Allergy Nursing Association (FANA)Megan Antonelli, Chief Executive Officer, HealthIMPACT Live

Episode 188: RSV Management and PreventionDr. Sandhu and future Dr. Mohamed summarize the management of RSV and describe how to prevent it with chemoprophylaxis and vaccines. Dr Arreaza adds some comments about RSV vaccines.Written by Abdolhakim Mohamed, MSIV, Ross University School of Medicine. Comments by Ranbir Sandhu, MD, and 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.What is RSV? -The Respiratory syncytial Virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus of the Orthopneumovirus genus within the Pneumoviridae family. -RSV is a major cause of acute respiratory tract infections, particularly bronchiolitis and pneumonia, in infants and young children, and it also significantly affects older adults and immunocompromised individuals. -RSV infections cause an estimated 58,000–80,000 hospitalizations among children younger than 5 years and 60,000–160,000 hospitalizations among adults older than 65 years each year.-RSV is highly contagious and spreads through respiratory droplets and direct contact with contaminated surfaces. The virus typically causes seasonal epidemics, peaking in the winter months in temperate climates and during the rainy season in tropical regions. -Virtually all children are infected with RSV by the age of two, and reinfections can occur throughout life, often with milder symptoms.-Per the 2014 Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis, from the American Academy of Pediatrics, the most common etiology of bronchiolitis is RSV. -About 97% of children are infected with RSV in the first 2 years of life, about 40% will experience lower respiratory tract infection during the initial infection. Other viruses that cause bronchiolitis include human rhinovirus, human metapneumovirus, influenza, adenovirus, coronavirus, and parainfluenza viruses.When is RSV season?-Classically, the highest incidence of infection occurs between December and March in North America. Per CDC, there were typical prepandemic RSV season patterns, but the COVID-19 pandemic disrupted RSV seasonality during 2020–2022. -Before we dive into the seasonality patterns, for context, in order to describe RSV seasonality in the US, data was gathered and analyzed from polymerase chain reaction (PCR) test results reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS) during July 2017–February 2023. -Seasonal RSV epidemics were defined as the weeks during which the percentage of PCR test results that were positive for RSV was ≥3%. Per 2017–2020 data, RSV epidemics in the United States typically follow seasonal patterns, that began in October, peaked in December or January, and ended in April. -However, during 2020–21, the typical winter RSV epidemic did not occur. The 2021–22 season began in May, peaked in July, and ended in January. -The 2022–23 season started (June) and peaked (November) later than the 2021–22 season, but earlier than prepandemic seasons. CDC notes that the timing of the 2022–23 season suggests that seasonal patterns are returning toward those observed in prepandemic years, however, warn that clinicians should be aware that off-season RSV circulation might continue.Treatment of RSVSome key points of the 2014 pediatric guidelines from the American Academy of Pediatrics.-AAP strongly do not recommend beta agonists or steroids for viral associated bronchiolitis because of no significant improved outcomes. “Clinicians should not administer albuterol (or salbutamol) to infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).”-Epinephrine is not recommended for infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).-Nebulized hypertonic saline should not be administered to infants with a diagnosis of bronchiolitis in the emergency department (Evidence Quality: B; Recommendation Strength: Moderate Recommendation), but hypertonic saline may be administered when they are hospitalized (Evidence Quality: B; Recommendation Strength: Weak Recommendation [based on randomized controlled trials with inconsistent findings]).-Chest physiotherapy should not be used in infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Moderate Recommendation).-Antibiotics should not be administered in bronchiolitis unless there is a concomitant bacterial infection, or a strong suspicion of one (Evidence Quality: B; Recommendation Strength: Strong Recommendation).-Oxygen therapy may not be administered if the oxyhemoglobin saturation exceeds 90% in infants and children with a diagnosis of bronchiolitis (Evidence Quality: D; Recommendation Strength: Weak Recommendation [based on low level evidence and reasoning from first principles]).-Clinicians should administer nasogastric or intravenous fluids for infants with a diagnosis of bronchiolitis who cannot maintain hydration orally (Evidence Quality: X; Recommendation Strength: Strong Recommendation).How do we prevent RSV?Infant Immuno-prophylaxis:A clinical trial in 2022 demonstrated that a single injection of nirsevimab (Beyfortus®), administered before the RSV season, protected healthy late-preterm and term infants from RSV-associated lower respiratory tract that required medical treatment. Nirsevimab is a monoclonal antibody to the RSV fusion protein that has an extended half-life.Additionally, on August 3, 2023, the Advisory Committee on Immunization Practices (ACIP) recommended nirsevimab for all infants younger than 8 months who are born during or entering their first RSV season and for infants and children between 8-19 months who are at increased risk for severe RSV disease and are entering their second RSV season. On the basis of pre-COVID-19 pandemic patterns, nirsevimab could be administered in most of the continental United States from October through the end of March.Maternal Vaccination: The CDC recommends the administration of the RSVPreF vaccine to pregnant women between 32 0/7 and 36 6/7 weeks of gestation. This vaccination aims to reduce the risk of RSV-associated lower respiratory tract infection in infants during the first 6 months of life.At this time, if a pregnant woman has already received a maternal RSV vaccine during any previous pregnancy, CDC does not recommend another dose of RSV vaccine during subsequent pregnancies.Older individuals: -Each year in the U.S., it is estimated that between 60,000 and 160,000 older adults are hospitalized and between 6,000 and 10,000 die due to RSV infection-ABRYSVO's approval will help offer older adults protection in the RSV season.-On June 26, 2024, ACIP voted to give these recommendations: all adults older than 75 years and adults between 60–74 years who are at increased risk for severe RSV disease should receive a single dose of RSV vaccine (Abrysvo®).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:Hamid S, Winn A, Parikh R, et al. Seasonality of Respiratory Syncytial Virus — United States, 2017–2023. MMWR Morb Mortal Wkly Rep 2023;72:355–361. DOI: http://dx.doi.org/10.15585/mmwr.mm7214a1Hammitt LL, Dagan R, Yuan Y, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Brooks D, Grenham A, Wählby Hamrén U, Mankad VS, Ren P, Takas T, Abram ME, Leach A, Griffin MP, Villafana T; MELODY Study Group. Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants. N Engl J Med. 2022 Mar 3;386(9):837-846. doi: 10.1056/NEJMoa2110275. PMID: 35235726.Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502. doi: 10.1542/peds.2014-2742. Erratum in: Pediatrics. 2015 Oct;136(4):782. doi: 10.1542/peds.2015-2862. PMID: 25349312.CDC, per their published article Seasonality of Respiratory Syncytial Virus — United States for 2017–2023, in the United StatesWhat U.S. Obstetricians Need to Know About Respiratory Syncytial Virus.Debessai H, Jones JM, Meaney-Delman D, Rasmussen SA. Obstetrics and Gynecology. 2024;143(3):e54-e62. doi:10.1097/AOG.0000000000005492.Maternal Respiratory Syncytial Virus Vaccination and Receipt of Respiratory Syncytial Virus Antibody (Nirsevimab) by Infants Aged

Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.Signs & symptoms that indicate a bradycardic patient is unstable. Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen. Calcium channel blockers and beta blocker medication as treatable causes of bradycardia.The indications and dosage of Atropine.Precautions for Atropine use in patients with second or third degree AV blocks.The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine.The use and dosing of Dopamine and Epinephrine drips.For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Safe Meds VIP - Learn about medication safety and download a free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Send us a textIn this episode, we explore the neurotransmitters that make up the acronym DOSE - Dopamine, Oxytocin, Serotonin, and Epinephrine - and how they affect our daily lives and well-being.Episode Highlights:Dopamine: The Pleasure & Reward NeurotransmitterEvolved to reinforce behaviors that help us survive as individuals and as a speciesModern hijacking through engineered experiences (processed foods, social media, alcohol)The importance of finding healthier sources of dopamine throughout your dayOxytocin: The Connection HormoneCreates bonds between humans that enable our species to thriveMany physicians are likely running low on this "love hormone"Simple ways to increase oxytocin through meaningful connectionSerotonin: The Mood & Wellbeing NeurotransmitterThe mind-gut connection and how our diet affects serotonin productionWhy physicians often end up on SSRIs and whether better self-care could reduce this needImportance of prioritizing sleep, sunlight, exercise, and proper nutritionEpinephrine/Endorphins: The Energy & Excitement ChemicalNot just about fight-or-flight responses but also positive excitementHow many of us over-rely on caffeine for our energy needsBetter sources: exercise, healthy intimacy, adventure, and novel experiencesKey Takeaways:Where do YOU need to adjust your DOSE?Where are you currently getting these neurotransmitters in your life?Are these sources aligned with your health and life goals?What small, intentional changes can you make to create a more balanced neurochemical experience?Resources Mentioned:Email me at megan@healthierforgood.comNote: This episode discusses food and alcohol consumption, which may be triggering for some listeners with histories of disordered eating or addiction.Connect with us:Website: healthierforgood.comEmail: megan@healthierforgood.comInstagram: @meganmelomdIf you enjoyed this episode, please leave a review and share with a colleague who might benefit! Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.Want to contact me directly?Email: megan@healthierforgood.comFollow me on Instagram!@MeganMeloMD

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; and What's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and its treatment with Atropine. ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInOther Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506*Commissions may be earned from the above links.Good luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & Mobitz at https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. John Accarino, an allergist and immunologist at Massachusetts General Hospital and Mass General for Children, on the topic of immunology support for eosinophilic esophagitis (EoE). Dr. Accarino shares his experiences as a person living with food allergies, allergic asthma, peanut allergy, and eosinophilic esophagitis. He tells how his experiences help him in his work with patients. Dr. Accarino shares some education on a variety of allergy mechanisms and the treatments that mitigate them. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron. Ryan introduces co-host Holly Knotowicz.   [1:14] Holly introduces today's topic, immunology support for eosinophilic esophagitis (EoE), and introduces today's guest, Dr. John Accarino, an allergist and immunologist at Massachusetts General Hospital. Holly welcomes Dr. Accarino to Real Talk.   [1:49] Holly notes that Dr. Accarino is her allergist and immunologist.   [2:03] Dr. Accarino works at Massachusetts General Hospital and Mass General for Children. Allergy and Immunology is a field where he can see pediatrics and adults. Originally trained in pediatrics, now Dr. Accarino sees patients of all ages.   [2:23] Dr. Accarino grew up with allergies. He has experienced food allergies since he was young, along with allergic asthma, and some eczema, which he grew out of. Later in life, he was diagnosed with eosinophilic esophagitis. He talks with his patients about his experiences.   [2:47] Dr. Accarino also does research on drug allergies in the context of certain drug interactions that involve eosinophils.    [3:06] When Holly was referred to Dr. Accarino, it was for multiple sclerosis (MS). He told her, “It looks like you have EoE. I have EoE.” It was a huge relief to Holly not to have to explain EoE to her doctor.   [3:41] Some patients start to explain their EoE to Dr. Accarino, and he assures them he understands where they're coming from. Sometimes, he has to be careful not to think everyone has his symptoms, as there is a large spectrum of presentations.   [4:26] Dr. Accarino wasn't diagnosed with EoE until he was in his allergy fellowship, after he suspected it when he had a food impaction at a steakhouse at a graduation party from his pediatric residency. He tried to manage the EoE with lifestyle changes.   [5:39] Dr. Accarino didn't often go to see a doctor during residency, but he realized it was probably a good time to get an endoscopy.   [5:52] Holly shares how she was also diagnosed as a clinical fellow. She was subbing for someone on the GEDP team at Children's Hospital in Colorado. Listening to all the patients, she realized, “This sounds a little bit like me … What is going on?”   [6:23] Even with his medical background, it took Dr. Accarino some time to decide to get the endoscopy and biopsies. You or your doctor have to have a high level of suspicion to realize this isn't just reflux. Food doesn't get stuck in every person's throat.   [7:01] Thinking back, Dr. Accarino remembers an instance as a child when a dry muffin got stuck in his throat. He stayed calm and waited for it to pass. He thought it was normal.   [7:39] He drank a lot of water and chewed his food a lot. Those are markers of potential esophageal inflammation.   [8:20] Different groups have different management strategies for EoE. Dietary management, topical steroids, biologics. A subgroup of people with EoE are responsive to proton pump inhibitors (PPIs). Finding the best management strategy is a work in progress.   [8:53] With pediatric patients, the parents control the diet, and the children eat what is prepared. He notes that with adult patients, sometimes they let foods slip through.   [9:10] If you want to do a single-food elimination diet with dairy, there's a lot of dairy in the American diet. Dr. Accarino tried eliminating dairy and wheat, but he still had persistent eosinophils with dietary elimination.   [9:24] Dr. Accarino then tried PPIs. To know if you have PPI-responsive EoE, you might do twice-daily omeprazole at a significant dose. Have the endoscopy after a few weeks pass and see if the eosinophils are still present in the biopsy.   [9:59] Dr. Accarino did that recently and still has the eosinophils. He plans to talk to his gastroenterologist about considering dupilumab, but he feels that he can mitigate his subjective day-to-day experience of symptoms with dietary elimination and PPIs.    [10:24] If you still have the presence of eosinophils on biopsy, there's still inflammation happening. In the long term, you still have to worry about fibrosis and narrowing.    [10:34] The last treatment Dr. Accarino tried was as a research participant in a study for dissolvable fluticasone. He received either the medication or a placebo; he doesn't know which.   [11:01] To stay in the study, he had to journal and report his symptoms regularly. He didn't have enough symptoms to stay in the study. They were looking for a baseline to see how it changed with either the placebo or the medication.   [11:20] In research, you have to have a baseline to start, and then you want to see improvement, plus or minus. With EoE, it's difficult. You have the biopsy and eosinophils, but there's a large spectrum of symptoms that people may experience.   [12:40] Holly appreciates Dr. Accarino's unique perspective as a doctor with EoE who has experienced various treatments and diets. He understands the concerns of his patients.   [12:43] Dr. Accarino says even taking a twice-daily PPI or other medication is difficult for a lot of people, and that's the most simple of these therapies.   [13:06] Dr. Accarino wants to validate everyone's experience in terms of how difficult it is to treat this disorder, how it may present in different ways, and how there may be a delay in diagnosis.   [13:16] This isn't IgE-mediated immediate food allergy, where you eat a food and may have swelling within minutes; you may have flushing or hives. That's very clear. With EoE, it's a different mechanism; in many cases, there is a delay.   [14:37] Allergy, in general, is under the purview of clinical immunology. Dr. Accarino is allergic to peanuts and has an  IgE-mediated immediate reaction to them. If he eats a peanut, he has symptoms within minutes. He could have anaphylaxis. As a result, he carries an epinephrine auto-injector.   [15:01] If Dr. Accarino has a skin test, it will be positive for peanut. He has IgE antibodies to peanuts. He also has oral allergy syndrome where the body mistakes certain fruits, vegetables, or nuts with certain tree pollens or grass pollens.   [15:23] Oral allergy syndrome is usually a lower-risk condition where it's a less-stable protein that once cooked might not produce any symptoms. If it's raw when you consume it, you may have oral itching, a bit of throat discomfort, or tongue itching. [15:54] Your stomach acid breaks it down so it doesn't get into your bloodstream and you shouldn't have a systemic reaction.   [16:01] If Dr. Accarino eats a peanut, his stomach acid doesn't break down the high-risk, stable peanut protein, it gets into his bloodstream, and he can have a systemic anaphylactic reaction.   [16:20] Chronic EoE symptoms can present with something like a food impaction, or bad reflux or belly pain, and nausea. The reaction may not be immediate. It may be progressive over days or weeks.   [16:38] FIRE is an interesting condition that takes some time to narrow down. It's an immediate response of the esophagus, but we don't think it's histamine-mediated.   [16:56] We don't know, exactly, the mechanism but it's in people with eosinophilic esophagitis. They feel differently, and there would be different specific food triggers.   [17:11]  It took some time to figure out what was going on. Dr. Accarino felt like he had a lump in his throat, then a lump in his chest, nausea, and belly pain. It felt like a slow progression of EoE symptoms, and it was from specific food triggers, in his case.   [17:30] In some of the FIRE literature, they looked at banana and avocado. For Dr. Accarino, it took a couple of exposures to protein bars and milk protein whey isolate, specific to protein bars he had multiple times, until he figured out that was the trigger.   [17:50] Another protein whey isolate that Dr. Accarino scooped as a powder and made into a shake also led to FIRE.   [17:55] It took that event for Dr. Accarino to figure out it wasn't just a flareup of EoE or reflux but some trigger that caused this response that wasn't anaphylaxis but may be due to the recruitment of eosinophils or some immediate process not well understood.   [18:18] FIRE is going to be very hard to research. How would we figure this out? Would we bring someone in and do an endoscopy immediately and see what happens? There's a lot of descriptive data and case series.   [18:32] Dr. Accarino has had experiences when he knew it wasn't an immediate anaphylactic reaction, oral allergy, or reflux. He asked what else it could be in the context of EoE. When he looked at different case series, that's the presentation he had.   [19:17] Dr. Accarino acknowledges that having personal experience with FIRE, oral allergies, and IgE-mediated allergies, on top of EoE, has influenced his work as a medical professional. He can share anecdotes with patients as he explains the available testing.   [19:39] Dr. Accarino says a lot of immunology and allergy is explaining the diagnostic tools and management strategies we have and what we think is going on.   [19:50] The immune system is infinitely complex, and a lot of the practice is making a digestible analogy, not just in the context of allergic conditions but also everything with the immune system. There are so many cells doing so many different things.   [20:04] Dr. Accarino explains false positives in testing. He has positive scratch tests for peanuts, cashews, and almonds, which shows he has IgE for each of them. He is allergic to peanuts, but he can eat cashews and almonds. Those are false positives.    [20:56] When a scratch test is negative for immediate food allergy, it's a powerful predictive tool. But you may get false positives. How positive is it? There might be room for more discussion.   [21:10] There may be more hesitation for people who do large panels of food testing without any history of reacting to any foods.   [21:31] Some people have EoE triggered by milk or wheat but have negative skin tests. That doesn't mean they aren't triggered by these foods. The skin test is an IgE histamine mast cell mechanism, not for eosinophils, which are other immune cells.   [21:58] We go down these steps of thinking about diagnostic triggers and eventually treatment for those immediate symptoms mentioned for EoE.   [22:09] Dr. Accarino doesn't expect FIRE to be responsive to epinephrine. He doesn't have to stabilize the mast cells. It's a chronic disease that's flaring up. You treat it with a chronic type of treatment.   [24:10] Dr. Accarino says that for a doctor, immunology is rewarding, interesting, and complex, but it's intimidating until you get your foothold and see patients and clinical experiences.   [25:14] A lot of medical students and residents are a little fearful of immunology. They might not think about it too much. Dr. Accarino loves to talk about it and think about it. He can't think of anything more complex in terms of systems within our body.   [25:37] Ryan comments on his experiences with IgE-mediated food allergies, some environmental allergies that he has no idea how they work, and EoE, which he believes he has a good grasp on.   [25:55] Ryan imagines that having a physician with a good understanding of the immune system and also personal experience would be helpful for a patient with multiple allergic conditions.   [26:13] Dr. Accarino sees a large overlap of seasonal or year-round environmental allergies and EoE. There are some studies that show that endoscopies on patients with EoE may change at different times of the year if they have underlying seasonal allergies.   [26:33] Some people who have food allergies also have EoE or other eosinophilic disorders. Some discussions with them may be about blood tests that detect eosinophils in the bloodstream versus biopsies of the esophagus, stomach, or colon.   [27:15] It's thinking about what tests are available, what they tell us, and how to use them to predict the next steps, things like dietary changes or for immediate food allergy, considering challenges versus full avoidance. Each test has its pluses and minuses.   [27:35] People like a clear test, and they like an easy fix, but sometimes there's a lot of nuanced conversation of shared decision-making and trying things in a supervised setting.   [27:57] Holly speaks as a patient of the investigative testing Dr. Acarino is doing with her immune system trying to figure it out along with her MS and EoE.   [28:14] Dr. Accarino says the words immune system, immunity, and inflammation are used a lot in talking about foods. Dr. Accarino uses the framework of the immune system trying to help you.   [28:42] Sometimes, instead of making helpful antibodies to things like vaccines or viruses, that give you protection, the immune system makes antibodies that attack a certain organ or your joints.   [29:02] Dr. Accarino thinks of treatments that suppress the immune system in certain ways. Some treatments cool down the populations of many different immune cells. Oral steroids and prednisone are used for many conditions for autoimmune flares.    [29:29] Oral steroids, in the long term, may lead to weight gain, bone density changes, and diabetes. The big push for many diseases is toward non-steroidal biologics to target specific cells that cause disease.   [29:59] For Crohn's disease, a specific monoclonal antibody is used to target TNF-alpha molecules and blocks that inflammation pathway.   [30:14] For EoE, dupilumab, a specifically designed antibody, blocks a specific receptor in a specific pathway so the immune system doesn't have to be shut down and the patient doesn't have the side effects of steroids. It's a targeted therapy.   [30:32] What you see in commercials for injectable medications are large, designed antibodies that, if you took them in a pill form, your stomach acid would break down and digest. So they are injections and infusions that go directly into the bloodstream.   [31:22] Medications that end in -mab are monoclonal antibodies. They are very large molecules that would not be stable in stomach acid.   [32:09] Dr. Accarino talks of eosinophil normal function and aberrant function. IgE-mediated reactions are usually related to mast cells, a type of immune cell that shouldn't be in the bloodstream.   [32:54] Dr. Accarino can do a CBC with differential to see the number of white blood cells and the number of red blood cells. The differential of white blood cells will include neutrophils, lymphocytes, and eosinophils. It shouldn't show mast cells.   [33:19] If you have mast cells in your bloodstream, that's mastocytosis, a different problem. Mast cells live in your skin, in your gut, and around your blood vessels. They're full of granules like histamine and tryptase.   [33:38] Dr. Accarino explains how mast cells release their contents and how he would treat the resulting swelling or itch with an antihistamine or epinephrine. Epinephrine treats systemic reactions and stabilizes the mast cells.   [34:16] Mast cells have many receptors and may be triggered by many things other than IgE. This is a conversation Dr. Accarino has with patients who have chronic hives unrelated to any foods.   [34:29] Some people get hives from non-steroidal anti-inflammatory drugs NSAIDs. Some get hives from vancomycin. Some get hives when the temperature changes, from tight clothing, or from IV contrast. It's not an IgE-mediated mechanism, but it's still mast cells being degranulated.   [35:45] Dr. Accarino says people see hives and they think allergy. But, like EoE, it doesn't involve histamine. There can be hives that aren't related to allergies. This can be idiopathic urticaria or spontaneous urticaria.   [36:04] Sometimes, when switching from a day shift to a night shift, hormonal changes will trigger hives. Sometimes, the stress of having a family member in the hospital will cause hives. An accumulation of triggers can lead to mast cell degranulation.   [36:38] There are many ways that allergy can have different mechanisms and treatments, with different cells involved. There are different molecules that cause symptoms and manifestations.   [36:50] Navigating that and understanding what might be going on can give people a sense of reassurance. The biggest fear is a life-threatening allergic reaction. People will read about fatal anaphylaxis and wonder if it will happen to them with their condition.   [37:16] Sometimes, thinking of the cells involved and the pathways may give a level of reassurance that this may not be the same thing that they read about.   [37:28] Ryan thanks Dr. Accarino for joining us today.   [37:37] Dr. Accarino says it was nice to reflect on things and to go through different scenarios and experiences he has gone through. It was nice to have the opportunity to share them with Ryan, Holly, and all the listeners.   [37:57] For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [38:06] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [38:15] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [38:25] Ryan thanks Dr. Accarino for joining us today for this fun conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. John Accarino, MD, Allergist and Immunologist at Massachusetts General Hospital and Mass General for Children Episode 034: Food-Induced Response and Eosinophilic Esophagitis   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “Allergy and immunology is a field where I can see pediatrics and adults. I was originally trained in pediatrics, but now I see all ages, from infants up until older adults.” — Dr. John Accarino   “Part of the conversation sometimes is trying not to overly bias myself, where I say, ‘Oh, this is my experience.' … Like many diseases, there's a large spectrum of presentations, … different symptoms that people have.” — Dr. John Accarino   “We don't think [Food-Induced Response in Eosinophilic Esophagitis is] histamine-mediated. We don't know exactly the mechanism, but it's in people with eosinophilic esophagitis. They feel differently, and there would be different specific food triggers. It took some time to figure out that was going on.” — Dr. John Accarino   “When a scratch test is negative for immediate food allergy, it's a very powerful predictive tool. But there are times that you may get false positives. How positive is it? There might be room for more discussion.” — Dr. John Accarino   “There are a lot of ways that allergy can have different mechanisms and different treatments, with different cells involved.” — Dr. John Accarino

When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer. When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm. When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm. When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing. Administration of epi via the IO or endotracheal route in the absence of an IV. The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.When do we stop administering epinephrine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInOther Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506*Commissions may be earned from the above links.Good luck with your ACLS class!

In this episode of the PFC Podcast, host Dennis speaks with Eric Bauer from FlightBridge ED about the critical topic of anaphylaxis. They explore the importance of understanding anaphylaxis through real-life scenarios, the initial assessment and response required in emergency situations, and the underlying pathophysiology of allergic reactions. The conversation emphasizes the urgency of treatment protocols, particularly the use of epinephrine, and discusses advanced management strategies for patients experiencing anaphylaxis. This episode serves as an essential guide for emergency medical professionals and anyone interested in critical care. This conversation delves into advanced airway management, IV access, and medication protocols in the context of anaphylaxis treatment. The speakers discuss the importance of proactive decision-making, fluid resuscitation strategies, and the need for careful monitoring and adjustment of treatment. They also touch on Kuhn's syndrome, a condition that can complicate anaphylaxis cases, and emphasize the importance of seeking help when needed in critical care situations.TakeawaysAnaphylaxis is a lower frequency type of call in EMS.Initial assessment should focus on the patient's airway and breathing.Respiratory involvement indicates a more severe allergic reaction.Benadryl is not the first-line treatment for anaphylaxis.Epinephrine should be administered promptly in anaphylactic cases.Timing of treatment is crucial; reactions can escalate quickly.Advanced airway management may be necessary in severe cases.Patient positioning and PEEP can aid in respiratory distress.Understanding the pathophysiology of anaphylaxis is essential for effective treatment.Continuous reassessment is key in managing anaphylactic patients. Advanced airway management is crucial in critical situations.Proactive decision-making is essential in emergency care.Fluid resuscitation strategies must be tailored to the patient's condition.Medication protocols should include timely administration of epinephrine and steroids.Monitoring patient response is vital for adjusting treatment plans.Kuhn's syndrome can mimic myocardial infarction in young patients.It's important to be aware of the potential for rebound responses in anaphylaxis.Healthcare providers should be comfortable adjusting medications as needed.Telemedicine can provide valuable support in critical care situations.Continuous education and self-awareness are key in emergency medicine.Chapters00:00 Introduction to Anaphylaxis and Its Importance02:56 Understanding Anaphylaxis Through a Scenario05:50 Initial Assessment and Response to Anaphylaxis09:07 The Pathophysiology of Anaphylaxis11:51 Timing and Severity of Anaphylactic Reactions15:00 Treatment Protocols for Anaphylaxis18:11 Advanced Management Strategies in Anaphylaxis23:20 Advanced Airway Management in Critical Situations26:04 IV Access and Pressor Administration28:58 Fluid Resuscitation Strategies32:02 Medication Protocols in Anaphylaxis36:03 Monitoring and Adjusting Treatment41:27 Understanding Kuhn's Syndrome45:48 Final Thoughts on Anaphylaxis ManagementThank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this Huberman Lab Essentials episode, I explain how specific hormones influence both energy levels and the immune system and discuss practical tools for increasing energy throughout the day and managing stress. I discuss the mechanism through which cortisol and epinephrine (adrenaline) impact the brain and body and why it's important to regulate their levels, considering factors like time of day or stress levels. I also cover the positive benefits of short-term stress and behavioral protocols to increase energy and enhance stress resilience. Additionally, I explain how to optimize hormone levels through tools like sunlight exposure, meal timing, and supplements such as ashwagandha. Huberman Lab Essentials episodes are approximately 30 minutes long and focus on key science and protocol takeaways from past Huberman Lab episodes. Essentials will be released every Thursday, and our full-length episodes will continue to be released every Monday. Read the full episode show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman BetterHelp: https://betterhelp.com/huberman LMNT: https://drinklmnt.com/huberman Function: https://functionhealth.com/huberman Timestamps 00:00:00 Huberman Lab Essentials; Immunity & Energy 00:01:34 Cortisol, Epinephrine (Adrenaline) 00:03:32 Sponsors: BetterHelp & LMNT 00:06:03 Cortisol & Epinephrine Biology 00:07:50 Timing Cortisol Release, Tool: Morning Sunlight Exposure 00:10:07 Daytime Stress, Learning & Cortisol 00:11:30 Tool: Increase Energy, Ice Baths, Cyclic Breathing, HIIT 00:16:23 Sponsor: AG1 00:17:26 Tool: Building Resilience; Cortisol vs. Epinephrine Effects, Immune System 00:21:29 Brief Stressors & Immune System 00:25:12 Sponsor: Function 00:26:59 Chronic Stress, Cortisol, Hunger & Food Choice 00:29:18 Stress & Gray Hair? 00:29:55 Reduce Cortisol & Supplements, Ashwagandha, Apigenin 00:31:39 Optimizing Cortisol & Epinephrine, Tool: Meals, Circadian Eating, Fasting 00:34:15 Recap & Key Takeaways Disclaimer & Disclosures

In this episode of EpiPod, Sarah and Danielle get hands-on with expired epinephrine auto-injectors, using them to practice on pieces of fruit. They discuss the surprising differences between using expired injectors and the trainers. Plus— how training with these tools can help build crucial muscle memory and boost confidence when it counts the most. They also dive deep into the lesser-known but essential steps to take when administering epinephrine, sharing important tips to ensure effectiveness during an allergic emergency. Tune in for a candid, educational conversation that may just save a life!CONNECT WITH US:Follow EpiPod on⁠⁠ Instagram⁠⁠ and⁠⁠ TikTok⁠⁠To connect with Danielle - click⁠⁠ HERE⁠⁠To connect with Sarah - click⁠⁠ HERE⁠⁠Thank you to Lorissa's Kitchen for sponsoring this EpiSode of EpiPod.CODES + LINKS:Lorissa's Kitchen – Shop⁠⁠ ⁠HERE⁠⁠⁠ with code: EPIPOD for 15% offInchBug – Shop⁠ ⁠HERE⁠⁠ with code: EPIPOD25TelyRx – Order ⁠⁠HERE⁠⁠ with code: EPIPOD for 20% off****A box of 2 epipens is $299.99 – $240 with the code!Well Too Wipes – Shop⁠ ⁠HERE⁠⁠ with code: EPIPOD20 Music by Bryce Cain Band & other various artists

On this month's EM Quick Hits podcast: Stephen Freedman on pediatric bloody diarrhea, S-TEC and hemolytic uremic syndrome, Justin Morgenstern on the evidence for IM epinephrine in out of hospital cardiac arrest, Matthew McArther on recognition and ED management of dengue fever, Andrew Petrosoniak on imaging decision making in trauma in older patients, Brit Long & Michael Gotlieb on recognition and management of TTP...Please consider a donation to EM Cases to help ensure continued Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/

For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm. For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive. Epinephrine administration. Placement of an advanced airway. Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions. When we should discontinue resuscitation efforts and call the code.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms. The use of epinephrine for severe anaphylaxis and unstable bradycardia. Review epinephrine's effects on blood vessels and bronchioles. Why epinephrine is helpful for patients with anaphylaxis. Using an epi drip for unstable bradycardia. Epinephrine administration during cardiac arrest. Starting and epinephrine or Dopamine drip for patients that have ROSC. Review the effects of Dopamine based on mcg/kg/min dosing. Monitoring the patient and titrating epi or Dopamine drips to prevent harm. For more information on ACLS medications, check out the pod resource page at passacls.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Wayne Shreffler, Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital. Dr. Shreffler is also an investigator at The Center for Immunology and Inflammatory Disease and The Food Allergy Science Initiative. His research is focused on understanding how adaptive immunity to dietary antigens is both naturally regulated and modulated by therapy in the context of food allergy. This interview covers the results of a research paper on The Intersection of Food Allergy and Eosinophilic Esophagitis, co-authored by Dr. Shreffler. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron. Ryan introduces co-host, Holly Knotowicz.   [1:15] Holly introduces today's topic, the intersection of food allergy and eosinophilic esophagitis.   [1:26] Holly introduces today's guest, Dr. Wayne Shreffler, Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital and an investigator at The Center for Immunology and Inflammatory Disease and The Food Allergy Science Initiative.   [1:43] Dr. Shreffler's research is focused on understanding how adaptive immunity to dietary antigens is both naturally regulated and modulated by therapy in the context of food allergy.   [1:54] Holly welcomes Dr. Shreffler to Real Talk. When Holly moved to Maine, she sent her patients to Dr. Shreffler at Mass General.   [2:25] Dr. Shreffler trained in New York on a Ph.D. track. He was interested in parasitic diseases and the Th2 immune response. Jane Curtis, a program director at Albert Einstein College of Medicine, encouraged him to consider MD/PhD programs. He did.   [3:31] Jane Curtis connected him to Hugh Sampson, who was working with others to help understand the clinical prevalence of food allergy and allergens.   [3:51] As a pediatric resident, Dr. Shreffler had seen the burden of allergic disease, caring for kids in the Bronx with asthma. His interest in Th2 immunity, the clear and compelling unmet clinical need, and the problem of food allergy guided his career.   [4:31] Dr. Shreffler's wife has food allergies and they were concerned for their children. Fortunately, neither of them developed food allergies.   [5:21] Dr. Shreffler thinks the food allergy field has a lot of people who gravitate toward it for personal reasons.   [5:53] Food allergy is an adverse response to food that is immune-mediated. There is still uncertainty about this but Dr. Shreffler believes that a large percentage of patients with EoE have some triggers that are food antigens.   [6:27] The broad definition of food allergy would include things like food protein-induced enterocolitis syndrome (FPIES).   [6:47] The way we use the term food allergy in the clinic, there are two forms: IgE-mediated allergies and non-IgE-mediated allergies, including EoE.   [7:40] Some patients have food-triggered eczema, some have FPIES.   [8:04] In 2024, Dr. Shreffler and Dr. Caitlin Burk released a paper that looked at the triggers of EoE, particularly the intersection of IgE-mediated food allergy and EoE.   [8:41] Dr. Caitlin Burk joined the group as they were publishing papers on IG food allergy and EoE. It was a moment where things unexpectedly came together.   [9:17] Adaptive immunity to food proteins comes from antibodies that cause milk allergy, egg allergy, peanut allergy, or multiple allergies. The IgE has specificity.   [9:40] T cells also are specific to proteins. They express a host of receptors that recognize almost anything the immune system might encounter. They have a long memory like B-cells.   [10:09] The overlap in these two threads of research was regarding a population of T cells that are important for mediating chronic inflammation at epithelial sites, including the gut.   [10:36] These T cells have been described in the airways in asthma, in the skin in eczema, and the GI tract. Researchers years ago had also described them as being associated with IgE food allergy. People with IgE food allergies avoid allergens.   [11:13] T cells, being associated with chronic allergic inflammation, now being associated with food allergies which are not having chronic exposures to the allergen, was interesting and surprising.   [11:30] Dr. Shreffler and his group found the T cell subset in patients who don't do well with Oral Immunotherapy (OIT) and patients who have EoE with immediate symptoms.   [12:01] Dr. Shreffler notes differences. There are immediate symptoms of IgE food allergy. There is a subset of patients with EoE who have immediate symptoms that are not fully understood. Maybe IgE plays a role there.   [12:28] There are different mechanisms for how symptoms are caused and so different ways of making a diagnosis. A food allergy with an IgE antibody can be measured through skin tests and blood tests. This can help identify which foods are the trigger.   [12:57] This common T cell subset that we see in EoE and food allergy, helps to explain why IgE alone is not always a very specific marker for identifying people who will have immediate reactions when they're exposed to the food.   [13:17] For patients who react at low levels, it's not just that they have more or better IgE but they also have an expansion of these T cells that are common between EoE and other chronic forms of allergy and IgE food allergy.   [13:41] There's a lot to learn that might be relevant for patients about this T cell subset.   [14:23] These T cells are a specific subset of the group of Th2 T cells, which are a subset of all CD4 T cells. Some CD4 T cells are important for responding to viruses and tumors. Others are important for responding to outside allergens.   [15:01] In an allergy or a parasite infection, Th2 T cells are important. There is a subset of T cells that is driven by repetitive and chronic exposure to the triggering protein, antigen, or allergen.   [15:47] Most antigens are proteins that trigger an immune response. An antigen that elicits an allergic response is an allergen. [16:30] A food trigger is a protein antigen that is an allergen. In IgE, food allergies, milk, and eggs are prevalent triggers early in life. For reasons not well understood, a lot of people outgrow them. In older patients, peanut and tree nut allergies are prevalent.   [17:01] In EoE, milk is one of the most common dietary triggers into adulthood. Some patients with IgE allergy to milk can tolerate it if it's well cooked. Patients with EoE are less likely to be able to get away with regular and ongoing exposure to milk protein.   [17:54] Milk, eggs, and nuts are common triggers in both conditions. There can also be rare food allergy triggers. That's part of the early evidence that the adaptive immune response was likely to be involved. It can be so specific for some people to rare things.   [18:20] Hallmarks of something being immune-mediated are that it is reproducibly demonstrable as a trigger. It's going to be long-lived. It's going to be generally relatively small amounts. The immune system is good at detecting small exposures.   [19:07] EoE is tricky because there's not that clear and easy temporal association between an offending allergen exposure for most people and their symptoms. People don't associate the symptoms with the triggers.   [20:14] A history of having blood in the stools can be milk-allergen-driven and was associated with a diagnosis of EoE in those kids when they're older.   [20:26] There are a lot of commonalities in the allergens but it's not always obvious clinically.   [22:40] A challenge in diagnosing EoE is that providers have to be on guard against their biases. They have to give a patient good advice. In EoE there is no test to identify triggers, except rigorous introduction, elimination, reintroduction, and endoscopies.   [24:18] For some of Dr, Shreffler's patients, it becomes less important to know their dietary triggers. They gravitate toward an approved form of treatment that may, if successful, allow them to have a more normal diet because of effective medication.   [24:50] Dr. Shreffler thinks there are other triggers, including pollens. There is evidence of seasonality of active EoE in patients shown to have allergic sensitization to pollens. That's indirect evidence. If the body is making IgE, it's likely making other responses.   [25:32] There are questions about how large the population of patients is who have EoE that may be more intrinsically than extrinsically driven because of genetic variations.   [25:54] Dr. Shreffler believes that EoE in some patients is allergen-driven and in some patients EoE is food-driven. Food is a trigger for the majority of pediatric patients and a large percentage of adult patients but not necessarily the exclusive trigger.   [27:04] If a patient is motivated to learn what dietary triggers may be at play, Dr. Shreffler often makes assessments outside of pollen season for allergens to which the patient has demonstrated positivity.   [28:09] Looking at the epidemiology, both EoE and food allergy are atopic disorders. You see an increased prevalence of asthma, hay fever, eczema, and even allergic proctocolitis in infancy. You see an enrichment of one disorder to another.   [28:29] The overlap of food allergy to EoE is stronger than you might expect. About 30 to 40% of patients with EoE will also have IgE food allergy. A higher rate will have IgE positivity, whether or not that food is a trigger of immediate symptoms.   [28:48] Patients with food allergies are about four times more likely to have EoE than the general population. That's a stronger association than the risk of eczema or other atopic conditions to EoE.   [30:09] There are differences between IgE food allergy and EoE. The presence of IgE gives a useful tool for identifying the food trigger in food allergy, but not in EoE. Identifying rare triggers in EoE patients is done by clinical observation.   [31:46] Epinephrine and antihistamines are not useful in treating EoE. Blocking IgE with Omalizumab has not been effective in trials in treating EoE. PPIs, topical steroids, and dupilumab are helpful for many EoE patients.   [32:38] Dupilumab has been evaluated a bit in food allergy in combination with OIT, and there was no statistically significant benefit from dupilumab in food allergy.   [33:25] A group in Pennsylvania has been evaluating epicutaneous immunotherapy as a modality to treat EoE. It's also being evaluated for IgE food allergy. Dr. Shreffler thinks it's something to keep an eye on.   [33:40] The oral route for immunotherapy can drive EoE for patients. As they become less sensitive from an immediate reactivity viewpoint, a significant percentage of patients develop GI symptoms. This has also been observed with sublingual therapy.   [34:14] Iatrogenic EoE, caused by the treatment, may resolve on the cessation of the immunotherapy treatment.   [36:25] Dr. Shreffler says in some cases, the shared decision is a decision where he has a strong evidence-based opinion. In some cases, there's a lot more room for a range of clinical decisions that could be equally supported by what we know right now.   [36:57] We've said that EoE is a contraindication for OIT. There is a shift happening. Dr. Shreffler sits with families and has a conversation about restricting diet or trying chronic therapy and keeping an ad-lib diet.   [37:38] What about doing the same thing by treating the immediate-type food allergy with chronic allergen exposure and then ameliorating the effects of EoE if it emerges, with another therapy? A hundred providers would have a diversity of responses.   [38:19] When there is a history of EoE in a family, Dr. Shreffler advocates for getting a baseline scope. It becomes an important “ground zero.”   [38:28] The goal is to have less invasive ways to monitor these conditions.   [39:32] Chronic inflammation, which is the hallmark of EoE, is well-targeted by therapies like PPIs and steroids. Steroids don't help with IgE-related food allergies. They're not effective at blocking the IgE-driven immediate response.   [41:13] Until recently, IgE food allergy has only been managed with avoidance. We have some other tools now. Xolair is not effective in EoE but is effective in two-thirds to three-quarters of patients with immediate-type food allergies for preventing anaphylaxis.   [41:45] Dr. Shreffler refers to an upcoming study on the effectiveness of Xolair in treating people with food allergies. Those who were able to tolerate a minimum amount were allowed to begin consuming allergen. We'll get insight into how those patients did.   [43:08] Food-induced immediate response of the esophagus (FIRE) is immediate discomfort with exposure to some allergens. Dr. Shreffler explains it. Data supports that these patients are experiencing an IgE-mediated but local response to those triggers.   [44:59] If FIRE is IgE-mediated, it may be that Xolair would help suppress it in these patients. It's worth looking at Xolair for this subset of EoE patients.   [45:20] Ryan invites any listeners who want to learn more about FIRE to check out episode #34 with Dr. Nirmala Gonsalvez.   [45:37] In the paper, Dr. Shreffler wrote about what he hopes will be the practical usefulness of the finding, the intersection between IgE food allergy and EoE.   [45:56] A subset of Th2 T cells express a protein called GPR15. It appears to be a marker for the subset of cells that are playing a role in the EoE.   [46:36] Caitlin Burk's work now is looking at their activation status in active disease and post-diet elimination and remission. She is developing a data set that is leading us toward the possibility of focusing on that cell subset and techniques to adopt in clinics.   [47:12] She is also working out more advanced techniques to look at the receptors. Dr. David Hill at CHOP is working on similar research. This research has the potential to lead to the development of better tests for EoE.   [47:44] Holly tells Dr. Shreffler this has been such an informative episode with so many tidbits of things to help patients advocate for themselves. Holly thanks him for sharing all of that.   [48:12] Dr. Shreffler is trying to see what can be utilized from their research to make non-invasive tests to identify food allergen triggers for patients so they don't have to go through so many endoscopies. He sees it as a huge unmet need.   [48:31] Ryan thanks Dr. Shreffler for joining us. For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [48:41] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [48:50] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [49:00] Ryan thanks Dr. Shreffler for joining us today for this interesting conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. Wayne Shreffler, MD, Ph.D., Chief of Pediatric Allergy and Immunology and Co-Director of The Food Allergy Center at Massachusetts General Hospital “Triggers for eosinophilic esophagitis (EoE): The intersection of food allergy and EoE” Dr. Caitlin Burk Dr. David A. Hill   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “This fascinating problem of food allergy: why does the immune system do that for some people — recognize what should be nutritive and innocuous sources of energy as an immunological trigger? ” — Dr. Wayne Shreffler   “A food allergy; because there is this IgE antibody, we can do skin tests. We can measure that in the blood. It's a useful marker for helping to identify which foods are the trigger.” — Dr. Wayne Shreffler   “EoE is tricky because there's not that clear and easy temporal association between an offending allergen exposure for most people and their symptoms. People don't associate the symptoms with the triggers.” — Dr. Wayne Shreffler   “Everything is shared decision-making. In some cases, it's a shared decision where I have a strong evidence-based opinion. In some cases, there's a lot more room for a range of clinical decisions that could be equally justified.” — Dr. Wayne Shreffler   “Steroids don't help with IgE-related food allergy. They're not effective at blocking that IgE-driven immediate response.” — Dr. Wayne Shreffler   “I'm trying to see what we can utilize from our research to make non-invasive tests to identify food allergen triggers for patients so they don't have to go through so many endoscopies. I think that's a huge unmet need.” — Dr. Wayne Shreffler  

The podcast explains how exercise or fasting raises epinephrine levels in the blood. Epinephrine then stimulates beta-adrenergic receptors in fat tissue, boosting the breakdown of stored triglycerides. This activation initiates a cascade, increasing cyclic AMP and activating protein kinase A. Protein kinase A then triggers hormone-sensitive lipase, leading to the breakdown of triglycerides into fatty acids and glycerol. These products are subsequently released into the bloodstream and can provide tissues with an alternative (fatty acids) source of energy to glucose.

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/*FREE to anyone in the U.S. Save $$ on prescription medications for you and your pets with National Drug Card - https://nationaldrugcard.com/ndc3506 *Indicates affiliate links. I may get paid a small commission if you purchase products or memberships using my link. It doesn't affect the price you pay.Practice ECGs at Dialed Medics: https://dialedmedics.com/

Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.Signs & symptoms that indicate a bradycardic patient is unstable. Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen. Calcium channel blockers and beta blocker medication as treatable causes of bradycardia. The indications and dosage of Atropine. Precautions for Atropine use in patients with second or third degree AV blocks. The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine. The use and dosing of Dopamine and Epinephrine drips. For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as:What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II.Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!The Curious Clinicians Podcast: History of Doctor Wenckebach & Mobitz at https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics at https://dialedmedics.com/

Using your auto-injector is NOT like pulling the pin on a grenade! In this episode, we share our experiences with anaphylaxis and how we let fear cloud our understanding of the relief brought by proper treatment, including epinephrine. Anaphylaxis can be scary, but it doesn't have to be. Preparation is key. We discuss the steps we take and the tools we have in place for when a reaction hits. Join us for an open conversation on preparing for the worst case scenario. To learn more about allergy & anaphylaxis emergency plans visit FAACT:https://www.foodallergyawareness.org/food-allergy-and-anaphylaxis/what-is-anaphylaxis/allergy-and-anaphylaxis-emergency-plans/

When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer. When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm. When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm.Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing. Administration of epi via the IO or endotracheal route in the absence of an IV.The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.When do we stop administering epinephrine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

The biology that gives us Autism allows us to be comfortable within ourselves.Our biology orients the Autistic towards our internal state. This is more comfortable for the Autistic in comparison to the outside world. In this episode, we cover brain regions, networks, and internal calculators. All humans use these biological calculators. However, based on the living organisms unique structure of brain regions and networks (connections), it is easy to understand why people are different.Epinephrine & Glia https://www.sciencedirect.com/science/article/pii/S009286741930621XOther Resources: Autism and Adaptive Responses https://youtu.be/Zj3_e6ZjCGkAutism and Default Mode Network https://youtu.be/9CqyH4woB34Autism and Salience Network https://youtu.be/9ZbTztb3al8Autism and B.3 https://youtu.be/Ov_Bw--zzrQ00:00 - Introduction00:42 - Biology and Autistic Comfort03:05 - Salience Network Explanation05:06 - Attention Management in Autism08:35 - Default Mode Network in Autism09:47 - Introducing Internal Calculators & Neuromodulators; Neuroplasticity10:52 - Biological Responses in Autistic Behavior14:02 - Effort and Energy: The Role of Internal Calculators; Calculator for Effort vs. Outcome17:07 - Social Interaction and Energy Use20:23 - Dopamine and Internal Calculators; Reward Prediction Error as an Internal Calculator25:18 - Internal Calculators and Societal Norms; Impact of Social Expectations on Internal Calculators; NeuroplasticityX: https://x.com/rps47586Hopp: https://www.hopp.bio/fromthespectrumYT: https://www.youtube.com/channel/UCGxEzLKXkjppo3nqmpXpzuATikTok: (I don't love it) https://www.tiktok.com/@fromthespectrumpodcastemail: info.fromthespectrum@gmail.com

In this Huberman Lab Essentials episode, I explain how neuroplasticity allows the brain to continue to adapt and change throughout life, particularly through focused attention and active engagement in learning. I explain how neuroplasticity differs in children and adults, highlighting the key neurochemicals required for adult learning. I explain science-supported protocols to boost alertness and improve attention, including techniques like visual focus and goal accountability. I also discuss how sleep, along with practices such as non-sleep deep rest (NSDR) and naps, support the brain to enhance learning.  Huberman Lab Essentials are short episodes (approximately 30 minutes) focused on essential science and protocol takeaways from past Huberman Lab episodes. Essentials will be released every Thursday, and our full-length episodes will still be released every Monday. Read the full show notes at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman David: https://davidprotein.com/huberman LMNT: https://drinklmnt.com/huberman More Huberman Lab Huberman Lab Premium: https://go.hubermanlab.com/premium Huberman Lab Merch: https://go.hubermanlab.com/merch Timestamps 00:00:00 Huberman Lab Essentials; Neuroplasticity 00:03:27 Sponsor: David 00:04:43 New Neurons; Sensory Information, Brain & Customized Map 00:07:40 Recognition, Awareness of Behaviors 00:09:58 Sponsor: AG1 00:11:06 Attention & Neuroplasticity 00:15:40 Epinephrine, Acetylcholine & Nervous System Change 00:18:20 Improve Alertness, Epinephrine, Tool: Accountability  00:20:39 Improve Attention, Acetylcholine, Nicotine 00:23:09 Sponsor: LMNT 00:24:26 Tool: Visual Focus & Mental Focus 00:29:54 Tool: Ultradian Cycles, Anchoring Attention 00:31:00 Sleep & Neuroplasticity; NSDR, Naps 00:33:34 Recap & Key Takeaways 00:36:38 Zero-Cost Support, YouTube, Spotify & Apple Follow & Reviews, Recommendations, Sponsors Disclaimer & Disclosures

For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm. For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive. Epinephrine administration. Placement of an advanced airway. Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions. When we should discontinue resuscitation efforts and call the code.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Has a PCP provided feedback that your patient should NOT have epinephrine in the local anesthesia? It's a complicated issue as epi does so much to improve the efficacy of the anesthetic agents but also helps manage patient pain. In this episode, Tom Viola discusses the ins and outs of using epinephrine and maybe how medical providers get it wrong every now and again... Be sure to reach out to him if you have any questions by emailing TomViola@tomviola.com, visit his website TomViola.com or check out his social media - @pharmacologydeclassified

Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms. The use of epinephrine for severe anaphylaxis and unstable bradycardia. Review epinephrine's effects on blood vessels and bronchioles. Why epinephrine is helpful for patients with anaphylaxis. Using an epi drip for unstable bradycardia. Epinephrine administration during cardiac arrest. Starting and epinephrine or Dopamine drip for patients that have ROSC.Review the effects of Dopamine based on mcg/kg/min dosing.Monitoring the patient and titrating epi or Dopamine drips to prevent harm. For more information on ACLS medications, check out the pod resource page at passacls.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Has a PCP provided feedback that your patient should NOT have epinephrine in the local anesthesia? It's a complicated issue as epi does so much to improve the efficacy of the anesthetic agents but also helps manage patient pain. In this episode, Tom Viola discusses the ins and outs of using epinephrine and maybe how medical providers get it wrong every now and again... Be sure to reach out to him if you have any questions by emailing TomViola@tomviola.com, visit his website TomViola.com or check out his social media - @pharmacologydeclassified

Learn about innovative methods for epinephrine administration and improve patient outcomes. Credit available for this activity expires: 12/05/25 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/innovations-and-breakthroughs-epinephrine-delivery-2024a1000loh?ecd=bdc_podcast_libsyn_mscpedu

keywords   perioperative emergencies, cardiac events, daylight savings, medical emergencies, simulation training, allergic reactions, patient management, anesthesia, emergency preparedness, healthcare training   summary   In this conversation, Dr. Serv Wahan and Dr. Peter pfeiffer discuss various aspects of perioperative emergencies, including the prevalence of cardiac and respiratory issues during surgeries, the impact of daylight savings time on cardiac events, and real-life experiences with medical emergencies. He emphasizes the importance of having proper training and equipment, such as AEDs, in medical settings. The discussion also covers the management of hypotension and hypertension in patients, allergic reactions, and the significance of simulation training for emergency preparedness. Overall, the conversation highlights the critical nature of being prepared for medical emergencies in both dental and medical practices.   takeaways Perioperative emergencies are relatively rare but can be serious. Daylight savings time can increase the risk of cardiac events. Real-life experiences in emergencies highlight the need for preparedness. AEDs are essential in any medical or dental office. Training and simulation improve emergency response skills. Managing blood pressure in patients requires careful consideration. Allergic reactions can escalate quickly and require immediate action. Epinephrine is crucial for treating anaphylaxis. Experience and training are vital in handling emergencies. Emergencies can happen to anyone, regardless of experience. titles Navigating Perioperative Emergencies The Hidden Dangers of Daylight Savings Sound Bites "Daylight savings time causes heart attacks." "AEDs save lives. That's a thing." "You need this. Nobody could find an AED." "You have to have reps, right?"   Chapters   00:00 Understanding Perioperative Emergencies 03:03 The Impact of Daylight Savings on Cardiac Events 05:55 Real-Life Emergency Experiences in Medical Settings 09:13 Managing Hypotension and Hypertension in Patients 12:06 Addressing Allergic Reactions and Anaphylaxis 14:57 The Importance of Simulation Training for Emergencies 19:11 The Role of Experience in Emergency Situations

After six doses of epinephrine, it may be too late for the CPR patient. Emergency physicians Dr. Zachary Boivin and Dr. Trent She, both from Connecticut, discussed their recent study entitled "Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation."1 This research sought to determine if there is a ceiling to the effective use of Epinephrine during resuscitation. Peter Antevy, MD, who created the Handtevy System, a software-based pediatric resuscitation method and bag system is also an EMS Physician for Palm Beach County (FL) Fire Rescue and he made a post on LinkedIn advocating for abolishing Epinephrine in shockable rhythm protocols. He posts about how his protocol does not follow standard AHA guidelines at Palm Beach County Fire Rescue and their plan for ventricular fibrillation is to use esmolol, but no Epinephrine. References Boivin, Z., Duignan, K. M., Doko, D., Pugliese, N., & She, T. (2023). Epinephrine in Cardiac Arrest: Identifying a Potential Limit for Resuscitation. Western Journal of Emergency Medicine, 24(6), 1025.

Exploring Neffy Nasal Spray: A Needle-Free Epinephrine Option Managing anaphylaxis just became easier with Neffy, the FDA-approved nasal spray for epinephrine. This innovative, needle-free option is transforming emergency allergy care. Dr. Autumn Burnette joins Dr. Payel Gupta and Kortney to discuss how Neffy works, who it's best suited for, and its potential impact on anaphylaxis treatment. With her expertise in allergy and immunology, Dr. Burnette addresses common concerns about Neffy's effectiveness, highlights its benefits, and shares practical details like cost, shelf life, and heat sensitivity. What We Cover in our Episode About Neffy Nasal Spray Delivery System A Game-Changer for Anaphylaxis: Discover how Neffy offers a needle-free option for delivering life-saving epinephrine during severe allergic reactions. Patient Benefits of Neffy: Learn how its ease of use and accessibility can make anaphylaxis management less daunting for patients. Addressing Skepticism About Neffy: Dr. Burnette explains how studies validate Neffy's effectiveness and addresses questions about trusting a nasal spray for emergencies. Practical Tips for Neffy Use: Get insights on cost, insurance coverage, shelf life, and whether Neffy works with nasal congestion or nose jobs! Expanding Treatment Options: Explore why having more options like Neffy is exciting for patients and healthcare providers alike. More resources about Anaphylaxis and Neffy:  Neffy: https://www.neffy.com/ Anaphylaxis: https://allergyasthmanetwork.org/anaphylaxis/ Epinephrine: https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/ Made in partnership with The Allergy & Asthma Network. Thanks to ARS Pharma for sponsoring today's episode. While they support the show, all opinions are our own, and sponsorship doesn't influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement. This podcast is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for any medical concerns.  

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things:Find a system for ECG interpretation that works well for you; andPractice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block. Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Practice ECGs at Dialed Medics: https://dialedmedics.com/

Curious About Neffy, the New Nasal Epinephrine Spray? We're diving into everything you need to know about Neffy, the new FDA-approved nasal spray for epinephrine. This groundbreaking, needle-free option provides an easy way to manage anaphylaxis in emergencies. Dr. Sakina Bajowala joins Dr. Gupta and Kortney to explore Neffy's unique nasal delivery system, what distinguishes it from traditional auto-injectors, and the science behind its development. With her expertise in allergy and asthma care, Dr. Bajowala walks us through Neffy's FDA approval journey, the technology that powers the nasal spray, and how it's changing the landscape of allergy treatment. What We Cover in Our Episode on Neffy Nasal Spray: Why Neffy Nasal Spray is Unique: Dr. Bajowala explains why nasal epinephrine is an innovative choice for anaphylaxis treatment and when it may be preferable to injectables. FDA Approval for Neffy: We discuss the rigorous testing behind Neffy's FDA approval, including studies conducted with actual patients post-approval. Intravail Technology in Neffy Nasal Spray: Learn about the advanced technology enabling rapid, effective absorption through the nasal passages for timely intervention. Considerations for Using Neffy Nasal Spray: We explore practical aspects of Neffy's use, from nasal congestion to potential side effects. Neffy Dosing and Side Effects: Dr. Bajowala provides insights on dosing, including when a second dose may be recommended. Helpful links: Neffy: https://www.neffy.com/ Anaphylaxis: https://allergyasthmanetwork.org/anaphylaxis/ Epinephrine: https://allergyasthmanetwork.org/anaphylaxis/what-is-epinephrine/ This podcast is made in partnership with The Allergy & Asthma Network. Thanks to ARS Pharma for sponsoring today's episode. While they support the show, all opinions are our own, and sponsorship doesn't influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.

Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.Signs & symptoms that indicate a bradycardic patient is unstable. Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen. Calcium channel blockers and beta blocker medication as treatable causes of bradycardia. The indications and dosage of Atropine. Precautions for Atropine use in patients with second or third degree AV blocks. The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine. The use and dosing of Dopamine and Epinephrine drips. For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (150); Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and its treatment with Atropine. ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & Mobitzhttps://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics:https://dialedmedics.com/

When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer. When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm. When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm.When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm. Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing. Administration of epi via the IO or endotracheal route in the absence of an IV. The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest. When do we stop administering epinephrine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm. For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive. Epinephrine administration.Placement of an advanced airway. Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions. When we should discontinue resuscitation efforts and call the code.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

In this EpiSode, Danielle & Sarah breakdown their top tips for safely carrying epinephrine auto-injectors. They discuss everything from how they remember to refill their prescriptions on time to how they keep them in that ever-so-small temperature range & what to do with those expired epis. Plus -- learn from the mistakes they've made! (You'll never believe where Danielle used to keep her epis before she knew better ;)) CONNECT WITH US: Follow EpiPod on⁠⁠ Instagram⁠⁠ and⁠⁠ TikTok⁠⁠ To connect with Danielle - click⁠⁠ HERE⁠⁠ To connect with Sarah - click⁠⁠ HERE⁠⁠ Thank you to Pulse Power for sponsoring the Q&A portion of EpiPod! Things we mentioned this EpiSode: - The Spokin app for setting epi reminders - Epi reminder door hangers DISCOUNT CODES + LINKS: Lorissa's Kitchen – Shop⁠⁠ ⁠HERE⁠⁠⁠ with code: EPIPOD for 15% off InchBug – Shop⁠ ⁠HERE⁠⁠ with code: EPIPOD25 TelyRx – Order ⁠⁠HERE⁠⁠ with code: EPIPOD for 20% off ****A box of 2 epipens is $299.99 – $240 with the code! Our peanut clean-up wipes: Well Too Wipes – Shop⁠ ⁠HERE⁠⁠ with code: EPIPOD20 

Epinephrine and Dopamine are adrenergic agonist used in several ACLS algorithms. The use of epinephrine for severe anaphylaxis and unstable bradycardia. Review epinephrine's effects on blood vessels and bronchioles. Why epinephrine is helpful for patients with anaphylaxis. Using an epi drip for unstable bradycardia. Epinephrine administration during cardiac arrest. Starting and epinephrine or Dopamine drip for patients that have ROSC. Review the effects of Dopamine based on mcg/kg/min dosing. Monitoring the patient and titrating epi or Dopamine drips to prevent harm. For more information on ACLS medications, check out the pod resource page at passacls.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Back in episode 80 we discussed a feasibility study out of Salt Lake City that showed IM epi resulted in 3-minute faster administration in cardiac arrest. It was underpowered to show survival, however. Fortunately, the great folks in Salt Lake City is back with a larger bite at the statistical apple. Dr Jarvis discusses the background around what we know about epinephrine in cardiac arrest (briefly, for once), walks us through this new study, and puts it in context of modern clinical practice. Citations.1. Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST: Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024;August;201:110266.2. Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, et al.: A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018;August 23;379(8):711–21.3. Okubo M, Komukai S, Callaway CW, Izawa J: Association of Timing of Epinephrine Administration With Outcomes in Adults With Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2021;August 10;4(8):e2120176.4. Hubble MW, Tyson C: Impact of Early Vasopressor Administration on Neurological Outcomes after Prolonged Out-of-Hospital Cardiac Arrest. Prehosp Disaster Med. 2017;June;32(3):297–304.5.  Pugh AE, Stoecklein HH, Tonna JE, Hoareau GL, Johnson MA, Youngquist ST: Intramuscular adrenaline for out-of-hospital cardiac arrest is associated with faster drug delivery: A feasibility study. Resuscitation Plus. 2021;September;7:100142.

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!Practice ECGs at Dialed Medics: https://dialedmedics.com/

Patients with a heart rate less than 60 are bradycardic. Some people can have a resting heart rate in the 40s without any compromise. For others, a heart rate of 50 or less could signify the need for immediate intervention and warrants additional assessment.Signs & symptoms that indicate a bradycardic patient is unstable.Monitoring oxygen saturation with pulse oximetry and indications for administration of oxygen. Calcium channel blockers and beta blocker medication as treatable causes of bradycardia. The indications and dosage of Atropine. Precautions for Atropine use in patients with second or third degree AV blocks.The use of transcutaneous pacing (TCP) for unstable bradycardic patients refractory to Atropine. The use and dosing of Dopamine and Epinephrine drips. For additional information about causes and treatment of bradycardia, check out the pod resources page at PassACLS.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach).Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block.Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & Mobitz: https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics: https://dialedmedics.com/

Can a nasal spray treat anaphylaxis? Find out about this and more in today's PeerDirect Medical News Podcast.

Anaphylaxis specialist Jay Lieberman, MD, FAAAAI, tells us everything we need to know about the first FDA approved epinephrine nasal spray to treat type 1 allergic reactions and anaphylaxis. 

When working to resuscitate a patient in sudden cardiac arrest, Epinephrine is the first IV medication we administer. When we give the first dose of epinephrine depends on whether the patient is in a shockable or non-shockable rhythm. When to give the first dose of epinephrine and its frequency for patients in asystole or PEA following the right side of the Adult Cardiac Arrest algorithm. When to give the first dose of epi and its frequency for patients in V-Fib or pulseless V-Tach following the left side of the Adult Cardiac Arrest algorithm. Example chronology of events for a scenario where a patient is found unresponsive with only gasping/agonal breathing. Administration of epi via the IO or endotracheal route in the absence of an IV. The maximum cumulative dose of epinephrine that can be administered to patients in cardiac arrest.When do we stop administering epinephrine.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

For apneic patients without a carotid pulse or patients with only gasping/agonal respirations, we will follow the Adult Cardiac Arrest algorithm. For pulseless patients that the AED doesn't advise a shock, the patient's ECG shows asystole, or a non-perfusing organized rhythm (PEA), we will follow the right side of the Adult Cardiac Arrest algorithm.Initial steps are aimed at delivery of high-quality CPR to keep the brain and vital organs alive. Epinephrine administration.Placement of an advanced airway.Considering possible reversible H & T causes of cardiac arrest including three common causes of PEA and their emergent interventions. When we should discontinue resuscitation efforts and call the code.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

This is the third and final episode of the series focused on basic anesthetic drugs. In this episode, we will explore vasopressors and inotropes.  After listening to this episode, you will be able to: 1. Outline the role of vasopressors 2. List the 5 main vasopressors used in the OR and their indications 3. Describe the mechanism of action for Phenylephrine, Ephedrine, Norepinephrine, Epinephrine, and Vasopressin  

Contributor: Travis Barlock MD Educational Pearls: Recent study assessed outcomes after ROSC with epinephrine vs. norepinephrine Observational multicenter study from 2011-2018 285 patients received epineprhine and 481 received norepinephrine Epinephrine was associated with an increase in all-cause mortality (primary outcome) Odds ratio 2.6; 95%CI 1.4-4.7; P = 0.002 Higher cardiovascular mortality (secondary outcome) Higher proportion of unfavorable neurological outcome (secondary outcome) Norepinephrine is the vasopressor of choice in post-cardiac arrest care References Bougouin W, Slimani K, Renaudier M, et al. Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022;48(3):300-310. doi:10.1007/s00134-021-06608-7 Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit  

In this episode of The Root Cause Medicine Podcast, Dr. Chip Watkins talks to us about neurotransmitters, what they are, what their functions are, the different types, and potential issues related to neurotransmitters. They dive into: 1. What is a neurotransmitter? 2. GABA deficiency symptoms 3. What are the main neurotransmitters? 4. How does the body make neurotransmitters? 5. Neurotransmitters and gut health Dr. Chip Watkins has over twenty years of experience in private practice, teaching, and corporate medicine. He uses mind-body medicine in his practice and nutritional approaches to care and has an understanding of traditional Chinese medicine, Ayurvedic medicine, and bioenergetics. Dr. Watkins is the President of NCHealthSPAN, Regional Medical Director at Community Care of NC, and Chief Medical Officer at Sanesco International. He is also a Member of the American Academy of Family Physicians and a past president and Chairman of the Board of the North Carolina Academy of Family Physicians.