Podcasts about Extracorporeal

CHEST December 2024, Volume 166, Issue 6 Elias H. Pratt, MD, joins CHEST® Journal Podcast Moderator Alice de Gallo Moraes, MD, to discuss his research exploring whether implementation of different institutional RBC transfusion thresholds for patients receiving venovenous ECMO is associated with changes in RBC use and patient outcomes. DOI: 10.1016/j.chest.2024.05.043   Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine.

ECPR is a treatment option for patients who otherwise would face near-certain death. It involves the use of a machine that temporarily takes over the function of the heart and lung.

Event Objectives:Describe the varying forms of ECLS and understand the introductory nomenclature.Discuss the evolution of ECMO and the early challenges faced by scientists in creating this form of life support.Locate resources for your patients after they have been on ECLS should there be neurodevelopmental concerns.Claim CME Credit Here!

Host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Catherine Beni, MD, PhD, to discuss a study aimed at determining outcomes of extracorporeal CPR (ECPR) in pediatric patients without congenital cardiac disease and identifying associations with in-hospital mortality of factors such as initial arrest rhythm and patient demographics (Beni CE, et al. Pediatr Crit Care Med. 2023 Nov;24:927-935). Catherine Beni, MD, PhD, is a resident physician in the department of surgery at the University of Washington in Seattle, Washington.

Extracorporeal membrane oxygenation, or ECMO, can be a lifesaving technology for patients whose organs have failed. It works, essentially, by performing the functions that a healthy person's lungs and heart would normally do. While using the machine, many recipients of ECMO treatment can walk, talk, even ride a stationary bike, but they can't leave the hospital with the machine, nor can they survive without it. In a recent article in The New Yorker, emergency physician and writer Clayton Dalton described these patients as “caught on a bridge to nowhere.” Marketplace's Lily Jamali spoke to Dalton about the complicated ethics of this technology.

Extracorporeal membrane oxygenation, or ECMO, can be a lifesaving technology for patients whose organs have failed. It works, essentially, by performing the functions that a healthy person's lungs and heart would normally do. While using the machine, many recipients of ECMO treatment can walk, talk, even ride a stationary bike, but they can't leave the hospital with the machine, nor can they survive without it. In a recent article in The New Yorker, emergency physician and writer Clayton Dalton described these patients as “caught on a bridge to nowhere.” Marketplace's Lily Jamali spoke to Dalton about the complicated ethics of this technology.

Extracorporeal membrane oxygenation, or ECMO, can be a lifesaving technology for patients whose organs have failed. It works, essentially, by performing the functions that a healthy person's lungs and heart would normally do. While using the machine, many recipients of ECMO treatment can walk, talk, even ride a stationary bike, but they can't leave the hospital with the machine, nor can they survive without it. In a recent article in The New Yorker, emergency physician and writer Clayton Dalton described these patients as “caught on a bridge to nowhere.” Marketplace's Lily Jamali spoke to Dalton about the complicated ethics of this technology.

Laura & Nicole discuss ECMO!

Send us a Text Message.Dr. Jeffrey DellaVolpe, MD is Medical Director of the Adult Extracorporeal Membrane Oxygenation (ECMO) Program at Methodist Hospital, San Antonio, Texas. He is also the Medical Director of the Cardiovascular Intensive Care Unit at Methodist Healthcare System and the Texas IPS Critical Care Service Line ( https://texasips.com/jeffrey-dellavolpe-md/ ). He also serves as chair of the Joint Society of Critical Care Medicine/Extracorporeal Life Support Organization Task Force and has created a platform for ECMO training and ECMO transport ( https://ecmotransports.com/about/ ).ECMO is a form of extracorporeal life support, providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of oxygen, gas exchange or blood supply (perfusion) to sustain life.Dr. DellaVolpe served as a Flight Surgeon with the 27th Special Operations Wing where he deployed twice in support of Operation Enduring Freedom – Trans Sahara. After completing his fellowship, he was assigned to the San Antonio Military Medical Center where he served as a critical care physician and a member of the 59th Medical Wing Critical Care Air Transport Team and Acute Lung Rescue Team.Dr. DellaVolpe is originally from Newport, RI. After receiving his bachelor's degree at Dartmouth College, he went on to attend medical school at Tulane University School of Medicine. He then completed his residency in Internal Medicine at Tulane Medical Center and his fellowship in Critical Care Medicine at the University of Pittsburgh Medical Center.Dr. DellaVolpe wrote The ECMO Book, published Elsevier Health Sciences, in 2023 ( https://www.us.elsevierhealth.com/the-ecmo-book-9780443111983.html ).#JeffreyDellaVolpe #MedicalDirector #ExtracorporealMembraneOxygenation #ECMO #MethodistHospital #SanAntonio #Texas #Cardiovascular #IntensiveCare #CriticalCare #LifeSupport #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #ViralPodcast  #STEM #Innovation #Technology #Science #ResearchSupport the Show.

Get ready for a shocking episode of The Human Upgrade with our guest, Adam Gavine, recorded at the 10th Annual Biohacking Conference. You'll learn how the revolutionary Wasabi Method is changing the game in shock wave therapy. You'll also gain understanding on how this innovative approach addresses pain management, boosts longevity, and enhances overall health. The Wasabi Method stimulates tissue regeneration, reduces inflammation, and improves immune function. Adam shares practical applications for this therapy, including its benefits for reproductive health and reversing tissue aging. Whether you're a biohacker, health professional, or wellness enthusiast, this episode is packed with valuable insights and actionable information. Timestamp Highlights: (00:01:14) What is Shock Wave Therapy? (00:04:59) How Adam Got into Shock Wave Therapy (00:08:10) Launching the Wasabi Method (00:11:39) Treating Trigger Points and Knotted Muscles (00:16:46) Applications for Erectile Dysfunction (00:21:34) Reversing Tissue Stiffness and Calcification (00:25:35) Using Wasabi Method for Collagen Production (00:32:29) Cell Membrane Permeability and Nutrient Absorption (00:37:03) Systemic Anti-Inflammatory Effects (00:45:02) Increasing White Blood Cell Count (00:48:12) Scar Tissue Management and Healing (00:54:46) Empowering Individuals in Their Health Journey (01:00:01) Practical Applications and Business Models Sponsors: ARMRA | Head to TryARMRA.com and use code DAVE for 15% off Your first order BEAM Pets | Go to BeamMinearls.com/Dave2024 for 20% off your first order. Resources The Wasabi Method| WasabiMethod.com Follow Wasabi Method on Instagram: @Wasabi_Method Daymond John's Website: https://thesharkhealth.com/ Biohacking Conference: https://www.biohackingconference.com/ Dave's Linktree: https://linktr.ee/daveasprey Dave Asprey's Book ‘Smarter Not Harder' is out now: https://daveasprey.com/books Follow Dave on Instagram: @Dave.Asprey Want to join The Human Upgrade Podcast Live? Join Our Upgrade Collective: https://www.ourupgradecollective.com/ Danger Coffee by Dave Asprey: https://www.instagram.com/dangercoffeeofficial/ Supplements by Dave Asprey: https://shopsuppgradelabs.com/ Own an Upgrade Labs: https://ownanupgradelabs.com/ Studies referenced during the interview: Growth Factors & Angiogenesis Application of extracorporeal shock wave therapy in nervous system diseases - A review Extracorporeal shock wave therapy for treatment of vulvodynia: a prospective, randomized, double-blind, placebo-controlled study The Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Subacute Stroke Patients Efficacy of Extracorporeal Shockwave Therapy on Pain and Function in Myofascial Pain Syndrome IncRNA NEAT1-let 7b-P21 axis mediates the proliferation of neural stem cells cultured in vitro promoted by radial extracorporeal shock waves Effects of the extracorporeal shock wave therapy on the skin: an experimental study Molecular mechanism of action of low-intensity extracorporeal shockwave therapy for regenerating penile and peripheral nerves Comparison of shock wave therapy and US guided for shoulder injection therapy in patients with supraspinatus tendinitis Extracorporeal shock wave treatment in foot and ankle fracture non-unions — A review Treatment for Symptomatic Calcific Tendinopathy of the Shoulder: Ultrasound-Guided Needling Lavage and Extracorporeal Shock Wave Therapy vs Extracorporeal Shock Wave Therapy. A prospective observational study Effect of Low-Intensity Extracorporeal Shock Wave on the Treatment of Erectile Dysfunction: A Systematic Review and Meta-Analysis See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Ayse Akcan Arikan, MD is a dual trained pediatric intensivist and nephrologist and an Associate Professor of Pediatrics with tenure at Baylor College of Medicine. She is the Associate Chief (Research) of the Division of Critical Care Medicine. Dr Arikan is a clinician-scientist whose research focus is on the recognition and management of acute kidney injury in the critically ill, pharmacokinetics in extracorporeal therapies, management of multiple organ failure, as well as sepsis resuscitation and outcomes. Dr Arikan also serves as the Medical Director of the Critical Care Nephrology and Inpatient Dialysis and the Medical Director of the Extracorporeal Liver Support programs at Texas Children's Hospital. She is an international leader in pediatric extracorporeal renal and liver support. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The rationale for using extracorporeal liver support in patients with acute liver failure.The various modalities of extracorporeal liver support and their advantages and disadvantages.An expert's approach to utilization of extracorporeal liver support in patients with acute liver failure.References:Akcan Arikan, Ayse MD1,2; Srivaths, Poyyapakkam MD1; Himes, Ryan W. MD3; Tufan Pekkucuksen, Naile MD1; Lam, Fong MD2; Nguyen, Trung MD2; Miloh, Tamir MD3; Braun, Michael MD1; Goss, John MD4; Desai, Moreshwar S. MD2. Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*. Pediatric Critical Care Medicine 19(7):p e342-e349, July 2018. | DOI: 10.1097/PCC.0000000000001546 Mitzner SR. Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS). Ann Hepatol. 2011 May;10 Suppl 1:S21-8. PMID: 21566251.Support the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Ayse Akcan Arikan, MD is a dual trained pediatric intensivist and nephrologist and an Associate Professor of Pediatrics with tenure at Baylor College of Medicine. She is the Associate Chief (Research) of the Division of Critical Care Medicine. Dr Arikan is a clinician-scientist whose research focus is on the recognition and management of acute kidney injury in the critically ill, pharmacokinetics in extracorporeal therapies, management of multiple organ failure, as well as sepsis resuscitation and outcomes. Dr Arikan also serves as the Medical Director of the Critical Care Nephrology and Inpatient Dialysis and the Medical Director of the Extracorporeal Liver Support programs at Texas Children's Hospital. She is an international leader in pediatric extracorporeal renal and liver support. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The rationale for using extracorporeal liver support in patients with acute liver failure.The various modalities of extracorporeal liver support and their advantages and disadvantages.An expert's approach to utilization of extracorporeal liver support in patients with acute liver failure.References:Akcan Arikan, Ayse MD1,2; Srivaths, Poyyapakkam MD1; Himes, Ryan W. MD3; Tufan Pekkucuksen, Naile MD1; Lam, Fong MD2; Nguyen, Trung MD2; Miloh, Tamir MD3; Braun, Michael MD1; Goss, John MD4; Desai, Moreshwar S. MD2. Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*. Pediatric Critical Care Medicine 19(7):p e342-e349, July 2018. | DOI: 10.1097/PCC.0000000000001546 Mitzner SR. Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS). Ann Hepatol. 2011 May;10 Suppl 1:S21-8. PMID: 21566251.Support the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

ECMO - Extracorporeal Membranous Oxygenation Guest: Philip J. Spencer, M.D. Hosts: Malcolm Bell, M.D. Extracorporeal Membranous Oxygenation is a mechanical life support used for severe heart, lung or heart and lung failure. Over the last decade it has grown massively in use to help us support our most ill patients to destination therapy or recovery.   Topics Discussed: Can you describe some of the history of ECMO to explain how we got to present day use? Please describe some key differences in venoarterial and venovenous ECMO? What makes them different from a technical standpoint and how are they used differently for our patients? There has been some controversy recently as to the use of ECMO and survival. Can you describe where this controversy is coming from and how we think ECMO can really make a difference in survival for patients?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Another new Drat & Drake segment we're calling 'Next Level'. As I discussed before, we try not to have any particular medical jargon for a number of reasons, but when we get the opportunity for some really cool studies with a good friend we can't help but learn some tidbits on niche treatments. Let's learn a few things about dialysis! Dr. Tyler Johnson discusses some applications, obstacles, and limitations to extracorporeal therapies (try saying that 5 times in a row).  At the same time, we discuss a little more about relationships and plants! 

VA-ECMO outcome scores have been previously developed and used extensively for risk adjustment, patient prognostication, and quality control across time and centres. The limitation of such scores is the derivation by using traditional statistical methods which are not capable of covering the complexity of ECMO outcomes. The Extracorporeal Life Support Organization Member Centres have developed a study where they aimed to leverage a large international patient cohort to develop and validate an AI-driven tool for predicting in-hospital mortality of VA-ECMO. The tool was derived entirely from pre-ECMO variables, allowing for mortality prediction immediately after ECMO initiation.To learn more about this study listen to the podcast.

It's YOUR time to access information that #BendyBodies need, crave, and deserve. Medical insights, science-based information, inspiring stories, empathy and support, hypermobility hacks, and news you can use. In this episode, YOUR guest is Jill Miller, author of the book 'Body by Breath: The Science and Practice of Physical and Emotional Resilience.'  Jill has 30 years of corrective movement expertise that forges links between the worlds of yoga, massage, athletics, and pain management. Her signature self-care fitness programs, Yoga Tune Up® and The Roll Model® are found at gyms, yoga studios, hospitals, athletic training facilities and corporations worldwide. Jill is the former anatomy columnist for Yoga Journal, has been featured in New York Times, Wall Street Journal, Shape, Women's Health, O, the Today Show, and is a contributing expert on the Oprah Winfrey Network. YOUR host, as always, is Dr. Linda Bluestein, the Hypermobility MD.TakeawaysJill Miller's book 'Body by Breath' is a comprehensive guide to physical and emotional resilience.Bendy bodies should care about fascia because it is the organizing tissue of the entire body and affects mobility and stability.Self-mobilization and self-myofascial release are important for bendy bodies to address tension and enhance proprioception.The five P's of the parasympathetic nervous system (perspective, place, position, pace of breath, and palpation) can help induce relaxation and enhance body awareness.The low back decompression exercise using therapy balls can provide relief and improve proprioception for bendy bodies. Improving core strength and breathing is essential for hypermobile bodies.Understanding zone one, zone two, and zone three breathing can help manage pain, movement, and emotional states.Self-fascial treatments, such as deep gut and rib massage, can improve breathing and alleviate hypertonicity.Extracorporeal shockwave therapy is a non-invasive treatment that can reduce inflammation and alleviate pain.Community support and engagement are crucial for managing hypermobility.High-intensity interval training can improve aerobic capacity and overall well-being for hypermobile individuals.  It is highly recommended to have individual guidance for this.Chapters00:00 Introduction and Background03:01 Inspiration for Writing the Book09:11 Organization of the Book13:30 Why Bendy Bodies Should Care About Fascia15:40 Starting with Limited Budget19:02 Helpful Exercises for Bendy Bodies23:27 Addressing Mixed Picture of Bendiness and Stiffness28:07 The Five P's of the Parasympathetic Nervous System36:14 Low Back Decompression Exercise46:07 Improving Core Strength and Breathing51:41 Understanding Zone One, Zone Two, and Zone Three Breathing57:29 Self-Fascial Treatments for Better Breathing01:00:10 Managing Hypermobility Symptoms01:03:35 Extracorporeal Shockwave Therapy for Acute Pain01:09:10 The Power of Community and High-Intensity Interval TrainingThis important conversation with Jill Miller about using the breath to reduce pain will leave you feeling more knowledgeable and with a better understanding of the contributing factors to suboptimal pain control.  Connect with YOUR Bendy Specialist, Linda Bluestein, MD! Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them.Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/.      YOUR bendy body is our highest priority!Products, organizations, and services mentioned in this episode:www.tuneupfitness.comhttps://thereadystate.com/https://thereadystate.com/product/becoming-a-supple-leopard-2nd-edition/https://fasciaguide.com/experts/carla-stecco/https://jen.health/https://www.tuneupfitness.com/shop/online-course/roll-into-hiithttps://patternpt.com/https://www.youtube.com/@TuneUpFitnesshttps://www.amazon.com/Yoga-Bendy-People-Optimizing-Hypermobility/dp/B0B2TSN3W3/ref

In this episode, YOUR guest is Jill Miller, author of the book 'Body by Breath: The Science and Practice of Physical and Emotional Resilience.'  Jill has 30 years of corrective movement expertise that forges links between the worlds of yoga, massage, athletics, and pain management. Her signature self-care fitness programs, Yoga Tune Up® and The Roll Model® are found at gyms, yoga studios, hospitals, athletic training facilities and corporations worldwide. Jill is the former anatomy columnist for Yoga Journal, has been featured in New York Times, Wall Street Journal, Shape, Women's Health, O, the Today Show, and is a contributing expert on the Oprah Winfrey Network. YOUR host, as always, is Dr. Linda Bluestein, the Hypermobility MD.TakeawaysJill Miller's book 'Body by Breath' is a comprehensive guide to physical and emotional resilience.Bendy bodies should care about fascia because it is the organizing tissue of the entire body and affects mobility and stability.Self-mobilization and self-myofascial release are important for bendy bodies to address tension and enhance proprioception.The five P's of the parasympathetic nervous system (perspective, place, position, pace of breath, and palpation) can help induce relaxation and enhance body awareness.The low back decompression exercise using therapy balls can provide relief and improve proprioception for bendy bodies. Improving core strength and breathing is essential for hypermobile bodies.Understanding zone one, zone two, and zone three breathing can help manage pain, movement, and emotional states.Self-fascial treatments, such as deep gut and rib massage, can improve breathing and alleviate hypertonicity.Extracorporeal shockwave therapy is a non-invasive treatment that can reduce inflammation and alleviate pain.Community support and engagement are crucial for managing hypermobility.High-intensity interval training can improve aerobic capacity and overall well-being for hypermobile individuals.  It is highly recommended to have individual guidance for this.Chapters00:00 Introduction and Background03:01 Inspiration for Writing the Book09:11 Organization of the Book13:30 Why Bendy Bodies Should Care About Fascia15:40 Starting with Limited Budget19:02 Helpful Exercises for Bendy Bodies23:27 Addressing Mixed Picture of Bendiness and Stiffness28:07 The Five P's of the Parasympathetic Nervous System36:14 Low Back Decompression Exercise46:07 Improving Core Strength and Breathing51:41 Understanding Zone One, Zone Two, and Zone Three Breathing57:29 Self-Fascial Treatments for Better Breathing01:00:10 Managing Hypermobility Symptoms01:03:35 Extracorporeal Shockwave Therapy for Acute Pain01:09:10 The Power of Community and High-Intensity Interval TrainingThis important conversation with Jill Miller about using the breath to reduce pain will leave you feeling more knowledgeable and with a better understanding of the contributing factors to suboptimal pain control.  Connect with YOUR Bendy Specialist, Linda Bluestein, MD! Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them.Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/.      YOUR bendy body is our highest priority!Products, organizations, and services mentioned in this episode:www.tuneupfitness.comhttps://thereadystate.com/https://thereadystate.com/product/becoming-a-supple-leopard-2nd-edition/https://fasciaguide.com/experts/carla-stecco/https://jen.health/https://www.tuneupfitness.com/shop/online-course/roll-into-hiithttps://patternpt.com/https://www.youtube.com/@TuneUpFitnesshttps://www.amazon.com/Yoga-Bendy-People-Optimizing-Hypermobility/dp/B0B2TSN3W3/ref

Contributor: Aaron Lessen MD Educational Pearls: What is Carbamazepine (Tegretol)? Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, epilepsy, and neuropathic pain. It functions primarily by blocking sodium channels which can prevent repetitive action potential firing. What are the symptoms of an overdose? Common initial signs include diminished conscious state, nystagmus, ataxia, hyperreflexia, CNS depression, dystonia, and tachycardia Severe toxicity can cause seizures, respiratory depression, decreased myocardial contractility, pulmonary edema, hypotension, and dysrhythmias. How is an overdose treated? An overdose is treated with large doses of activated charcoal and correction of electrolyte disturbances. Be ready to intubate given the potential for respiratory depression. Carbamazepine is moderately dialyzable and dialysis is recommended in severe overdoses. Additional educational pearl: Individuals in correctional facilities can occasionally self-administer medications which means that medication overdose should still be on the differential for any of these individuals. References Epilepsies in children, Young People and adults: NICE guideline [NG217]. National Institute for Health and Care Excellence. (2022, April 27). https://www.nice.org.uk/guidance/ng217  Ghannoum M, Yates C, Galvao TF, Sowinski KM, Vo TH, Coogan A, Gosselin S, Lavergne V, Nolin TD, Hoffman RS; EXTRIP workgroup. Extracorporeal treatment for carbamazepine poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2014 Dec;52(10):993-1004. doi: 10.3109/15563650.2014.973572. Epub 2014 Oct 30. PMID: 25355482; PMCID: PMC4782683. Seymour JF. Carbamazepine overdose. Features of 33 cases. Drug Saf. 1993 Jan;8(1):81-8. doi: 10.2165/00002018-199308010-00010. PMID: 8471190. Spiller HA. Management of carbamazepine overdose. Pediatr Emerg Care. 2001 Dec;17(6):452-6. doi: 10.1097/00006565-200112000-00015. PMID: 11753195. Tran NT, Pralong D, Secrétan AD, Renaud A, Mary G, Nicholas A, Mouton E, Rubio C, Dubost C, Meach F, Bréchet-Bachmann AC, Wolff H. Access to treatment in prison: an inventory of medication preparation and distribution approaches. F1000Res. 2020 May 13;9:357. doi: 10.12688/f1000research.23640.3. PMID: 33123347; PMCID: PMC7570324. Summarized by Jeffrey Olson, MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

One of the biggest questions in ECPR right now is how do we organize our system to provide ECPR in an effective and streamlined approach?  Nichole Bosson and her army of ECPR enthusiasts have successfully implemented a multi-hospital ECPR receiving center program in Los Angeles.  In this episode, Zack talks with Dr. Bosson about how they started, what they learned, and where they are going. A little about Dr. Bosson She is the Assistant Medical Director at the Los Angeles County EMS Agency. She is an Associate Clinical Professor at David Geffen School of Medicine at UCLA and faculty and EMS fellowship director in the Department of Emergency Medicine at Harbor-UCLA. Here is the link to her paper Bosson N, Kazan C, Sanko S, Abramson T, Eckstein M, Eisner D, Geiderman J, Ghurabi W, Gudzenko V, Mehra A, Torbati S, Uner A, Gausche-Hill M, Shavelle D. Implementation of a regional extracorporeal membrane oxygenation program for refractory ventricular fibrillation out-of-hospital cardiac arrest. Resuscitation. 2023 Jun;187:109711. doi: 10.1016/j.resuscitation.2023.109711. Epub 2023 Jan 30. PMID: 36720300. And here is Jason Bartos' editorial Bartos JA, Yannopoulos D. Starting an Extracorporeal cardiopulmonary resuscitation Program: Success is in the details. Resuscitation. 2023 Jun;187:109792. doi: 10.1016/j.resuscitation.2023.109792. Epub 2023 Apr 10. PMID: 37044354.

On this episode of the Back Story Podcast host Dr. J. Ricky Singh, MD is joined by Dr. Jennifer Soo Hoo, MD to discuss the topic of  Extracorporeal Shockwave Therapy (ESWT)We talk about my own experience as a patient undergoing this therapy,  which is used in a variety of clinical applications including the management of musculoskeletal conditions. In this conversation, he addresses the following topics and questions about shockwave therapy:· What is ESWT?· The origins of shockwave therapy use and some of its additional applications· Describing the process of shockwave therapy and its effects· Some of the factors to consider when performing ESWT, especially to clinicians who have never used this treatment option before· Understanding the different types of shockwave therapy and how they can be used to treat injuries· What types of providers can administer ESWT, and what are the recommended treatment protocols for medical teams?· What are some of the medical conditions that are best treated by ESWT, in both the lower and upper extremities?Additional ResourcesTo learn more about Dr. Soo Hoo or schedule a consultation please click HERE

Pemiarsa,JIka dulu penderita batu ginjal harus menjalani operasi besar untuk mengambil batu ginjal, saat ini telah ada metode yang mudah untuk tindakan batu ginjal.Extracorporeal shock wave lithotripsy (ESWL) adalah prosedur untuk mengatasi penyakit batu ginjal dengan menggunakan gelombang kejut. Dengan ESWL, batu ginjal dapat dibuang tanpa melalui prosedur bedah.ESWL dilakukan dengan memfokuskan gelombang kejut di sekitar ginjal, untuk menghancurkan batu ginjal menjadi pecahan yang lebih kecil. Batu ginjal yang telah hancur kemudian akan keluar bersama urine.Apa yang Pemiarsa perlu ketahui mengenai ESWL? Temukan jawabannya dalam Bincang Sehat bersama tim dari @rskb_annur. Bincang Sehat juga dapat diikuti melalui www.retjobuntungfm.com#radio #radioshow #retjobuntung #retjobuntungfm #radiotalkshow #talkshow #talkshow

Apologies for being MIA for a month now. Been busy! But am back and in this episode talk about calcium channel blocker toxicity. The physiology behind it, a little pharmacology and then the treatment. Busting some myths and reinforcing the need for proactive emergency medicine evidence based treatment. You can check out these papers and do more research for yourselves too - 1. Wightman RSHRA. Cardiologic Principles II: Hemodynamics. In: Nelson LS, Howland MA, Lewin NA, et al, editors. Goldfrank's toxicologic emergencies. 11th Edition. New York City, NY: McGraw Hill; 2019. p. 260–7 2. Levine M, Brent. Beta-Receptor Antagonists. In: Brent J, Burkhart K, Daragan P, et al, editors. Critical care toxicology. New York City, NY: Mosby; 2017. p. 771–86. Wallukat G. The beta-adrenergic receptors. Herz 2002;27(7):683–90. 4. Ranniger C, Roche C. Are one or two dangerous? Calcium channel blocker exposure in toddlers. J Emerg Med 2007;33(2):145–54 5. Gummin DD, Mowry JB, Beuhler MC, et al. 2019 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol 2020;58(12):1360–541. 6. Holger JS, Engebretsen KM, Obetz CL, et al. A comparison of vasopressin and glucagon in beta-blocker induced toxicity. Clin Toxicol 2006;44(1):45–51 7. Jang DH, Donovan S, Nelson LS, et al. Efficacy of methylene blue in an experimental model of calcium channel blocker-induced shock. Ann Emerg Med 2015;65(4):410–5. 8. Laes JR, Williams DM, Cole JB. Improvement in hemodynamics after methylene blue administration in drug-induced vasodilatory shock: a case report. J Med Toxicol 2015;11(4):460–3. 9. Wang GS, Levitan R, Wiegand TJ, et al. Extracorporeal membrane oxygenation (ECMO) for severe toxicological exposures: review of the toxicology investigators consortium (ToxIC). J Med Toxicol 2016;12(1):95–9 10. Hayes BD, Gosselin S, Calello DP, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin Toxicol 2016;54(5):365–404 11. American College of Medical Toxicology. ACMT position statement: guidance for the use of intravenous lipid emulsion. J Med Toxicol 2017;13(1):124–5. 12. Kerns W 2nd. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am. 2007 May;25(2):309-31; abstract viii. doi: 10.1016/j.emc.2007.02.001. PMID: 17482022. 13. Cole JB, Arens AM. Cardiotoxic Medication Poisoning. Emerg Med Clin North Am. 2022 May;40(2):395-416. doi: 10.1016/j.emc.2022.01.014. Epub 2022 Apr 5. PMID: 35461630.

Commentary by Dr. Sean Pinney

Commentary by Dr. Valentin Fuster

In this week's View, Dr. Eagle discusses the ACC Expert Consensus Documents on comprehensive multidisciplinary care for the patient with cardiac amyloidosis, then looks at findings from the SPRINT Trial on the effect of intensive blood pressure control on troponin and natriuretic peptide levels. Finally, Dr. Eagle explores early extracorporeal CPR for refractory out-of-hospital cardiac arrest compared to traditional CPR.   Subscribe to Eagle's Eye View  

All published abstracts can be found here AbstractsCategory 1: Amlodipine VasoplegiaAbstract 1: Vasodilation in patients with calcium channel blocker poisoning treated with high dose insulin: a comparison of amlodipine versus non-dihydropyridinesStudy of HDI on propranolol poisoned pigsStudy of Minnesota HDI protocolAbstract 2: Amlodipine anxiety: a 10-year review of amlodipine associated fatalitiesAbstract 3: Extracorporeal membrane oxygenation utilization for vasoplegic shock due to pediatric toxic ingestionsData of ECMO in poisoningCategory 2: XylazineAbstract 4: “Tranq dope” opioid overdose: clinical outcomes for emergency department patients with illicit opioid overdose adulterated with xylazineCategory 3: Case Reports with Terrifying Clinical ImplicationsAbstract 5: Recovery after poly-drug overdose despite blood flow imaging demonstrating no brain perfusionAbstract 6: Challenges in diagnosing an environmental cause of recurrent methemoglobinemiaAbstract 7: Acute thiamine deficiency as a complication of insulin euglycemic therapy for an amlodipine overdoseCategory 4: Comparative evidence, Prognostication, and TriageAbstract 8: Utility of pre four-hour iron concentration in predicting toxicologyAbstract 9: Andexanet alfa vs 4-factor prothrombin complex concentrate for intracranial hemorrhage at a level I trauma hospitalCategory 5: Rapid ReviewAbstract 10: Fentanyl and fentanyl analogue exposure among emergency personnel and first responders: a systematic reviewAbstract 11: Significance of falsely low creatinine values in diagnosing massive acetaminophen ingestionAbstract 12: Large dose intentional ciprofloxacin ingestion associated with false-positive urine immunoassay for oxycodone and fentanylAbstract 13: Don't make it a double?: a 20- year review of supratherapeutic amlodipine ingestions while on chronic therapyAbstract 14: Evaluation of pediatric lisdexamfetamine exposures reported to a statewide poison control systemAbstract 15: An assessment of the reliability of stated quantity in acute acetaminophen overdoses reported to a regional poison center

In this episode, we discuss the utility of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) for the temporary management of biventricular failure and cardiogenic shock requiring full cardiopulmonary support. Here, we define the types of ECMO and describe the unique physiology of this mechanical circulatory support platform, as well as review the potential complications and management strategies. Most notably, we highlight indications for and contraindications to the use of VA-ECMO and review the importance of patient selection.  Lastly, we discuss de-escalation and de-cannulation strategies for patients on VA-ECMO as a bridge to recovery. Join Dr. Amit Goyal (CardioNerds Cofounder and FIT at Cleveland Clinic), Dr. Yoav Karpenshif (Series Co-chair and FIT at University of Pennsylvania), and Dr. Megan Burke (Episode FIT Lead and FIT at University of Pennsylvania) as they learn about how to care for some of our sickest patients from Dr. Ann Gage, interventional and critical care cardiologist at Centennial Heart. At the beginning of the episode, enjoy a message from the very first CardioNerds Scholar, Dr. Katie Vaughan (Chief Resident and soon Cardiology Fellow at BIDMC). Episode notes were developed by Dr. Megan Burke. Audio editing by CardioNerds Academy Intern, Hirsh Elhence. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Biventricular Failure and the Use of VA-ECMO Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of temporary mechanical circulatory support that can do the work of both the heart and lungs. The ECMO circuit is a narcissist, i.e. cannulas are named in reference to the circuit and not the patient (“inflow” vs “outflow”). The decision to utilize ECMO should be made by a multidisciplinary shock team and patient selection is KEY! ECMO physiology rule #1: VA-ECMO increases LV afterload Patients on VA-ECMO should be monitored with a PA catheter and an arterial line in the right arm Show notes - Biventricular Failure and the Use of VA-ECMO Notes drafted by Dr. Megan Burke. 1. What is ECMO and what are the different types? Extracorporeal membrane oxygenation (ECMO) is a temporary form of mechanical life support that comes in two flavors: veno-arterial, or “VA” and veno-venous, or “VV.”  VV-ECMO supports extracorporeal gas exchange in the setting of acute respiratory failure VA-ECMO provides full circulatory support in addition to gas exchange, doing the work of both the heart and lungs.  2. What are the components and “anatomy” of the VA-ECMO circuit? The circuit is made up of the following major components: Venous (inflow) cannula Centrifugal Pump Oxygenator (also responsible for CO2 removal) Arterial (outflow) cannula The cannulas are named in reference to the ECMO circuit, not the patient. Dr. Gage suggests that we think of the ECMO circuit (and mechanical circulatory support in general) as narcissistic, i.e. flow is always in reference to the device. Gas exchange happens in the oxygenator. In the oxygenator blood flows through thin filaments that allow for diffusion of oxygen and carbon dioxide. Gas flows in the opposite direction of blood flow to maximize diffusion through the countercurrent effect. Oxygenation is determined by rate of blood flow through the oxygenator and FiO2 delivered. Carbon dioxide removal is determined by rate of countercurrent gas flow,

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief of JAMA, the Journal of the American Medical Association, for the November 8, 2022, issue.

Extracorporeal Cardiopulmonary Resuscitation (ECPR) with Dr. Lakshmi RamanObjectives:By the end of listening to this episode, learners should be able to:Define ECPR.Understand the rationale for ECPR in cardiopulmonary arrest in children.Recognize aspects of high-quality ECPR.Understand the patient selection, context and setting that is most appropriate for pediatric ECPR.Recognize when it is appropriate to activate the ECPR team after pediatric cardiac arrest.Understand the rationale of choosing the location of cannulation (i.e., peripheral vs. central).About our guest: Dr. Lakshmi Raman is a Professor of Pediatrics at UT Southwestern and a pediatric intensivist at Children's Medical Center Dallas. She serves as the Medical Director of the Extracorporeal Membrane Oxygenation (ECMO) program at CMC. She is active in ELSO and serves as the Chair of Publications. She also co-authored the 2021 ELSO Pediatric ECPR guidelines.References:Guerguerian, Anne-Marie; Sano, Minako; Todd, Mark; Honjo, Osami; Alexander, Peta; Raman, Lakshmi. Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines. ASAIO Journal: March 2021 - Volume 67 - Issue 3 - p 229-237doi: 10.1097/MAT.0000000000001345 How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

On this episode of the AMSSM Sports Medcast (T: @TheAMSSM) host Dr. Jacob Wessels, MD is joined by Dr. Adam Tenforde, MD to discuss the topic of Exercise for Extracorporeal Shockwave Therapy (ESWT) in Musculoskeletal Medicine. Dr. Tenforde recently published a research about best practices for ESWT, which is used in a variety of clinical applications including the management of musculoskeletal conditions. In this conversation, he addresses the following topics and questions about shockwave therapy: · What is ESWT? · The origins of shockwave therapy use and some of its additional applications · Describing the process of shockwave therapy and its effects · Some of the factors to consider when performing ESWT, especially to clinicians who have never used this treatment option before · Understanding the different types of shockwave therapy and how they can be used to treat injuries · What types of providers can administer ESWT, and what are the recommended treatment protocols for medical teams? · What is the reimbursement status of shockwave therapy for providers? · What are some of the medical conditions that are best treated by ESWT, in both the lower and upper extremities? Additional Resources Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM&R 2022 May;14(5):611-619. doi: 10.1002/pmrj.12790. https://doi.org/10.1002/pmrj.12790 Bone stress injuries. Nat Rev Dis Primers. 2022 Apr 28;8(1):26. doi: 10.1038/s41572-022-00352-y. PMID: 3548413 A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel). 2021 Nov 24;11(12):1287. doi: 10.3390/life11121287.

On this episode of the AMSSM Sports Medcast, host Dr. Jacob Wessels, MD is joined by Dr. Adam Tenforde, MD to discuss the topic of Extracorporeal Shockwave Therapy (ESWT) in Musculoskeletal Medicine.   Dr. Tenforde recently published research about best practices for ESWT, which is used in a variety of clinical applications including the management of musculoskeletal conditions. In this conversation, he addresses the following topics and questions about shockwave therapy: What is ESWT? The origins of shockwave therapy use and some of its additional applications Describing the process of shockwave therapy and its effects Some of the factors to consider when performing ESWT, especially to clinicians who have never used this treatment option before Understanding the different types of shockwave therapy and how they can be used to treat injuries What types of providers can administer ESWT, and what are the recommended treatment protocols for medical teams? What is the reimbursement status of shockwave therapy for providers? What are some of the medical conditions that are best treated by ESWT, in both the lower and upper extremities?   Additional Resources Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM&R 2022 May;14(5):611-619. doi: 10.1002/pmrj.12790. https://doi.org/10.1002/pmrj.12790 Bone stress injuries. Nat Rev Dis Primers. 2022 Apr 28;8(1):26. doi: 10.1038/s41572-022-00352-y. PMID: 3548413 A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel). 2021 Nov 24;11(12):1287. doi: 10.3390/life11121287.

In this episode of the Spectrum of Health podcast, Dr. Christine sits down with Dr. Yoshi Rahm to discuss Extracorporeal blood oxygenation and ozonation (EBOO) treatment. Dr. Yoshi explains the treatment of EBOO, what ailments can be healed by this treatment, and how it can be used to boost the immune system. Dr. Yoshi Rahm is a board-certified osteopathic family physician with separate board certifications in Integrative and Holistic Medicine. Much of his life's pursuits stem from growing up far outside a small Northern California town. His simple upbringing, which included living without electricity, TV, or phone, gave him an early appreciation for healthy living. The suffering of unwell family members was a big driver for Dr. Yoshi to pursue healing by becoming a family physician. After residency at Glendale Adventist Medical, Dr. Rahm became an Attending Physician teaching at the same residency program and founded Oasis Family Medicine.   Listen in to learn more about: {00:43} What is EBOO, and how is it different from other ozone therapies {03:38} The patient experience during EBOO treatment {19:41} How EBOO helps with environmental toxins {30:25} The benefits of Ocean Minerals and hydrogen water To get the full show notes - www.dr.christineschaffner.com/Episode158

Article discussed in this episode:Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis

小額贊助支持本節目： https://open.firstory.me/user/ck4fgb04n698h0804wzdkaycj 簡介： 體外震波治療 Extracorporeal shockwave therapy (ESWT) 為許多肌肉骨骼疾病提供了一種非侵入性的治療選擇。在人醫和獸醫領域已經證明對於手術治療反應不佳的慢性重複性損傷來說是有幫助的。 在ESWT 在馬運動醫學已被廣泛使用，隨後才應用到狗病患。 EWST 應用的肌肉骨骼疾病範圍很廣，從促進骨癒合、肌腱疾病和骨關節炎。隨著研究證據的發表，更多患有肌肉骨骼疾病的小動物病患可能從 ESWT 得到幫助。 臨床重點提示：進行震波療程，至少需要2次的震波治療，每次治療可以間隔2至3週。保持震波電極探頭垂直於目標的組織，以獲得最大的效果。剃除毛髮並使用超音波凝膠來提高震波的穿透力。避免在肺部或大血管區域使用震波。 重點整理：體外震波治療(Extracorporeal shockwave therapy, ESWT) 為多種肌肉骨骼疾病，提供了一種安全、非侵入性的治療方法。體外震波治療的儀器，在各種治療方案中無法進行比較。電動液壓式體外震波儀的最大證據，是改善骨癒合。擴散式震波療法，似乎有利於骨關節炎的治療。 留言告訴我你對這一集的想法： https://open.firstory.me/user/ck4fgb04n698h0804wzdkaycj/comments 留言告訴我你對這一集的想法： https://open.firstory.me/user/ck4fgb04n698h0804wzdkaycj/comments Powered by Firstory Hosting

Audible Article by Abraham J. Matar and Ram Subramanian

Commentary by Drs. Mladen Vidovich, Thomas Meredith, and Maurizio Taramasso

MedFlight Radio takes the show on the road to the Regional Tertiary Center of The Ohio State University Medical Center to talk about ECMO. We sit down with Dr. Amar Bhatt and Dr. Travis Sharkey to get the lowdown on this topic.  Learn about the most cutting edge and complex technology out on the market the pushes the envelope in cardiac and respiratory resuscitation.   What is ECMO? Are there different types of ECMO? Who gets it and who doesn't, and why? How do you manage it, and what are the most common complications? What is the future of ECMO? All of these questions get answered and many more in this month's episode.    

Tammy Sparacino, CCP reviews the latest peer-reviewed publication on the effects of ECMO on the brain.

ECMO usage, the number of patients being considered for ECMO therapy and the number of ECMO platforms has exploded during the last two years. Joe will explore the number of reported ECMO cases and their outcomes, his own experience with managing a large ECMO population experience and discuss the direction he sees ECMO as a therapeutic modality is going in the future. Hosted by Joe Basha, CCP.

Commentary by Dr. Valentin Fuster

Because COVID-19 can create a status of systemic inflammation, which can affect multiple organs, including the kidneys, the adjuvant therapy of blood purification has gained some recognition. Host Pamela Peeke is joined by Javier Neyra to discuss clinical cases and the use of extracorporeal blood purification in COVID-19 patients.

Editor's Summary by Linda Brubaker, MD, Associate Editor of JAMA, the Journal of the American Medical Association, for the February 1, 2022, issue.

Episode 80: Oral Meds for COVID-19. The US department of human health and services recently launched the COVID19 Therapeutics Locator website to allow providers find locations where they can send prescriptions for Paxlovid and Molnupiravir. Find the COVID19 therapeutics locator online: https://arcg.is/iuuW50Yasmin and Arti discuss oral medications under emergency use authorization for COVID-19: Paxlovid and Molnupiravir. Introduction: Meds for COVID-19.  By Hector Arreaza, MD.  For the last 2 years, humanity has faced the challenge to find an effective way to fight COVID-19. This pressing charge has not been free of obstacles. It has been hindered by politics, misinformation, greed, jealousy, and many other not-so positive human traits. For me, living through the pandemic has been somewhat frustrating and shaming. Stupidity, vulgarity, and mediocrity are a few of the attributes that have flourished during the last 2 years all around us. But not everything about the pandemic has been negative. Many talented people with good intentions have engaged in serious research and have made tremendous contributions to science and humanity. Vaccines have been developed using cutting-edge technology and their efficacy has been very positive so far. Many medications have been tried to fight COVID-19 since the beginning. Some clinicians have tried to repurpose old medications in their honest desires to fight COVID-19. Examples include ACE inhibitors, statins, azithromycin, hydroxychloroquine, and chloroquine, which have not proven to be effective against this virus so far. Ivermectin, for example, has been very controversial since the beginning of the pandemic. Ivermectin is not approved by the FDA for the treatment of COVID-19. Until today, the National Institutes of Health do not have enough data to recommend for or against using ivermectin for COVID-19. “Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.” Ivermectin is still being used by some clinicians in the United States based on personal experience and opinions.At this time, remdesivir (brand name Veklury®) is the only medication approved by the FDA to treat COVID-19. IV remdesivir won full FDA approval in October 2020 for hospitalized patients, and its use has been expanded a couple days ago to include use in non-hospitalized high-risk patients. The NIH recommends against IL-6 inhibitors, such as tocilizumab or sarilumab, in COVID-19 patients who are not in the ICU. At this moment, there is not enough data for the NIH to make a recommendation for patients who are in the ICU. Baricitinib is an oral medication used to treat rheumatoid arthritis authorized in November 2020 to be used in combination with remdesivir for the treatment of COVID-19 in certain hospitalized children and adults who require supplemental oxygen, mechanical ventilation, or Extracorporeal membrane oxygenation (ECMO). Baricitinib is now authorized to be used without remdesivir against COVID-19 in hospitalized patients. We cannot forget the use of dexamethasone in hospitalized patients requiring oxygen.Today we want to give you a little taste of two oral medications: Paxlovid® and molnupiravir. You will listen to two brave medical students presenting what they have found about these medications. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. Paxlovid®.   By Yasmin Fazli, MS3, Ross University School of Medicine.  What is it?Paxlovid® is the first oral treatment for mild-to-moderate coronavirus disease (COVID-19) in patients over 12 years-old to be issued by the FDA. The FDA issued an emergency use authorization (EUA) on December 22, 2021. It is made up of two different medications: nirmatrelvir and ritonavir. Nirmatrelvir is a protease inhibitor while ritonavir helps decrease the breakdown of nirmatrelvir.  The combination authorized is nirmatrelvir 300 mg plus ritonavir 100 mg. You may remember ritonavir use in combination with other antiretrovirals for the treatment of HIV/AIDS. At the end of the 2021, Pfizer announced that results from a trial comparing between Paxlovid® versus a placebo revealed that Paxlovid® reduced proportion of mortality and morbidity by 88% compared to placebo after a 5-day course. When and how to prescribe it?To use Paxlovid® some criteria must be met by the patient. First, a positive result of COVID-19 viral testing, second, the patient must be at high risk for illness progression to a more severe state, including hospitalization and death; and third, the patient must be 12 years or older.  Paxlovid® should be started as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. It is to be taken by mouth 2 times a day for 5 days straight with or without food. You take 3 pills twice a day. It is not authorized for more than 5 days.  It is not authorized for the pre-exposure or post-exposure prevention of COVID-19. It's not meant to be a replacement for the vaccine.  Side effects?Possible side effects of Paxlovid® include dysgeusia (altered or impaired sense of taste), diarrhea, increased blood pressure, and myalgia (muscle aches). Nirmatrelvir and ritonavir, which comprise Paxlovid®, also interact with other medications, which may lead to serious or life-threatening adverse reactions.  It's contraindicated in patients taking medications that are dependent on CYP3A metabolism for clearance, for example, warfarin, amiodarone, clozapine, midazolam, sildenafil (for pulmonary hypertension), etc. A list of these medications has been reviewed by the FDA and you can find it online.  Liver problems have occurred in patients receiving ritonavir. Therefore, caution should be exercised when administering Paxlovid® to patients with pre-existing liver diseases, liver enzyme abnormalities, or hepatitis. Furthermore, Paxlovid® is not recommended for patients with severe kidney problems, and if they do use it, the dose should be adjusted.Because nirmatrelvir is co-administered with ritonavir, there may be a risk of HIV-1 developing resistance to HIV protease inhibitors in individuals with uncontrolled or undiagnosed HIV-1 infection. As for pregnancy or lactation, there currently is no data available for it to understand any potential effects on miscarriages, birth defects, or maternal and fetal outcomes. Considering all of this, please review your patients' list of medications and supplements and medical history prior to initiating Paxlovid®.Concerns?Due to its limited clinical data availability, other adverse effects that have not been reported may also occur while using Paxlovid® on top of the side effect list we are aware of. Ritonavir is a well-known medication, but nirmatrelvir is brand new.  Another concern is its limited availability. So even though it has shown positive results, it is not widely available yet, which leads to having to prioritize certain populations such as the unvaccinated patients. This may prove to be a moral and ethical concern.  Effectiveness?There is no long-term data on Paxlovid® yet; however, from what we do know, it is proving to be effective more than placebo by almost 90% which shows much promise. It works against current or previous variants of COVID-19.  EPIC-HR is the randomized, double-blind, 2-arm study done to prove Paxlovid®. It included 2246 patients with laboratory-confirmed SARS-CoV-2 infection, mild to moderate symptoms, and at least one comorbidity with increased risk of developing severe illness from COVID-19. Patients were randomly assigned 1:1 to receive either Paxlovid or placebo orally every 12 hours for 5 days. Results: Paxlovid significantly reduced the risk of COVID-19-related hospitalization or death from any cause by 89% (within 3 days of symptom onset) compared with placebo. Through day 28, 0.7% (5/697) of patients in the Paxlovid® arm were hospitalized compared with 6.5% (44/682) of those in the placebo arm. The study also showed that nobody died taking Paxlovid® while 12 people died taking placebo. These are promising results and Pfizer will be announcing more information on the effectiveness as time passes by.  Pricing?The original pricing was announced to be $530.00; however, it's been added that it'll be at no cost to the people in the United States.  Molnupiravir.   By Arti Patel, MS3, Ross University School of Medicine.  1. What is molnupiravir? Molnupiravir is an antiviral medication that can be used to treat COVID-19. Molnupiravir is a nucleoside analog that inhibits viral replication. The active drug of molnupiravir (N-hydroxycytidine) tricks the RNA polymerase enzyme into incorporating the drug instead of uridine or cytidine. Nucleobases continue to get added to the RNA chain and eventually the new RNA molecule has accumulated enough errors that the virus cannot replicate further.    2. When and how to prescribe it? Molnupiravir is available for Emergency Use Authorization for “mild to moderate COVID-19 disease in adults with positive results of direct viral testing who are at risk of developing severe COVID-19, including hospitalization or death or those in whom alternative COVID-19 treatment options approved by the FDA are not accessible or clinically appropriate.”  FDA provided EUA status on December 23, 2021. It should be taken as soon as COVID-19 is diagnosed, and within 5 days of symptom onset. It is not to be used as a method to prevent COVID-19 disease. Not for prophylaxis.  Benefits of treatment have not been seen after hospitalization, so administration of molnupiravir in patients hospitalized due to COVID-19 is not recommended. Adults above the age of 18 should take 800 mg orally every 12 hours for 5 days, with or without food. Use for longer than 5 days has not been studied.  3. Side effects? Most common adverse effects are diarrhea, nausea, and vomiting.  4. Concerns? Pediatric patients: Molnupiravir may not be used in patients under the age of 18 due to effects on bone and cartilage growth. Studies in rats with repeated doses of molnupiravir showed bone and cartilage toxicity.  Pregnancy: Fetal toxicity was observed when given to pregnant individuals in animal reproduction studies. Risk of adverse maternal or fetal outcomes or birth defects have not been studied in humans as of now. Use of molnupiravir in pregnant individuals may be considered once the prescribing physician has assessed the potential risks and benefits. Prior to initiating treatment of molnupiravir, if clinically indicated, assess whether a patient is pregnant. If a patient is having irregular menstrual cycles, first day last menstrual period is unknown, or patient is not using an effective method of contraception, a pregnancy test is advised.  Females of childbearing age are advised to use an effective method of contraception while under treatment of molnupiravir and for 4 days after the final dose. Effects of molnupiravir on sperm are not known, thus effective contraception must be used while under treatment of molnupiravir and for 3 months after the last dose.  Additionally, breastfeeding is not recommended during treatment and for 4 days after the last dose.  5. Effectiveness? Although molnupiravir is not substitute in patients for whom COVID-19 vaccination and booster are recommended, it can be used for treatment of non-hospitalized patients with COVID-19 who have a high risk of progression to severe disease.  In, MOVe-OUT, a randomized, double-blind, placebo-controlled clinical trial, almost 7% of about 700 individuals who received molnupiravir were hospitalized compared to almost 10% of 700 individuals who received the placebo. During the follow up period, one person who received molnupiravir died compared to 9 people who received the placebo. The safety and effectiveness of molnupiravir continues to be studied.  Availability and pricing?Not available in pharmacies yet, and preliminary pricing for a 5-day course of molnupiravir was about $700. Conclusion of episode:Now we conclude our episode number 80 “Oral Meds for COVID-19.” We hope you got enough information about these two medications: Pax-lovid and Mol-nu-pira-vir. Remember that they are authorized (not approved yet) by the FDA for the treatment of COVID-19. They are both oral medications, taken twice a day for 5 days. Their use in pregnant patients is not recommended yet. Paxlovid can be used in patients older than 12 years old, and molnupiravir in patients older than 18 years old. We'll keep learning together about these medications in the future. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Arti Patel and Yasmin Fazli. Audio edition: Suraj Amrutia. See you next week! _____________________References:F.D.A. Approves Remdesivir for Patients Not Hospitalized, The New York Times, nytimes.com, January, 21, 2022, https://www.nytimes.com/2022/01/21/world/remdesivir-fda-approval-expanded-covid.html. “Frequently Asked Questions on the Emergency Use Authorization for Paxlovid for Treatment of COVID-19”, U.S. Food and Drug, December 22, 2021, https://www.fda.gov/media/155052/download. Accessed on Jan 24, 2022. “Pfizer Receives U.S. FDA Emergency Use Authorization for Novel COVID-19 Oral Antiviral Treatment,” pfizer.com, December 22, 2021. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-receives-us-fda-emergency-use-authorization-novel.  Ahmad, B., Batool, M., Ain, Q. U., Kim, M. S., & Choi, S. (2021). Exploring the Binding Mechanism of PF-07321332 SARS-CoV-2 Protease Inhibitor through Molecular Dynamics and Binding Free Energy Simulations. International journal of molecular sciences, 22(17), 9124. https://doi.org/10.3390/ijms22179124 Coronavirus (COVID-19) Update: FDA Authorizes Additional Oral Antiviral for Treatment of COVID-19 in Certain Adults, fda.gov, December 23, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-oral-antiviral-treatment-covid-19-certain. Accessed on January 24, 2022. Fact Sheet for Healthcare Providers: Emergency Use Authorization for Molnupiravir, fad.gov, December 23, 2021, https://www.fda.gov/media/155054/download, accessed on January 24, 2022. 

Attempts at improving cardiac arrest outcomes have increasingly included extracorporeal techniques to re-establish circulation. In particular, the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest is called extracorporeal cardiopulmonary resuscitation (ECPR). However, there is much debate about the impact of ECPR use on survival and neurological and functional recovery in adults suffering cardiac arrest. These issues have been evaluated in a systematic review conducted by Dr Abrams et al. Listen to the following podcast to hear more about which patients are most likely to benefit from EPCR, required resources and relevant ethic issues on using EPCR. Original article: https://pubmed.ncbi.nlm.nih.gov/34505911/ (Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications) Speakers: Darryl ABRAMS. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York (USA). Laura BORGSTEDT. Department of Anesthesiology, Klinikum rechts der Isar, Technical University of Munich, Munich (DE).

Extracorporeal Oxygenation and Coronavirus Disease 2019 Epidemic: Is the Membrane Fail-Safe to Cross-Contamination? Presented by Joe Basha, CCP.

Veno Venous Extracorporeal Membrane Oxygenation in a Multiple Trauma Patient. Presented by Tammy Sparacino, CCP.

This webcast will be a comparative analysis of conventional heparin-versus bivalirudin-based systemic anticoagulation in adult and pediatric patients supported on extracorporeal membrane oxygenation (ECMO).

Margaret M. Parker, MD, MCCM, and Luregn Schlapbach, MD, FCICM, review a survey of international practice on prevention, diagnosis, and treatment of infections on extracorporeal life support in adults and children published in Pediatric Critical Care Medicine