Podcasts about Hemodynamics

LBCT: Four-year Hemodynamic Outcomes with An Intra-annular, Self- Expandable Transcatheter Aortic Valve

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED. Hosts: Brian Gilberti, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK Epidemiologic Risk Profiles Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew. Peak demographic manifestation concentrated within the 30–60 age band. High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window. Mineralogical Composition Vectors Calcium oxalate crystals represent the predominant structural matrix. Struvite configurations (magnesium ammonium phosphate matrix) account for 1–2% of cohorts. Struvite stones function explicitly as infection-driven configurations secondary to upper tract proliferation; higher distribution index noted in female cohorts. Etiological & Modifiable Relational Dynamics Profound systemic dehydration or low baseline fluid throughput states. High-sodium diet structures and heavy animal-protein consumption loads. Positive genetic/familial history variables. Relative risk modulation: Each variable independently operates to expand baseline risk by a factor of 2x to 3x. Pathophysiologic Symptom Complexes Acute, sudden-onset, maximum-intensity (10/10) unilateral flank pain. Classic structural radiation vector tracking downward toward the ipsilateral groin/genitourinary dermatomes. Distinctive behavioral marker: Renal colic pacing/writhing behavior with zero antalgic position availability. Concomitant autonomic triggers: Nausea and emesis manifest in 50% of acute presentations. Physical Exam Discordance Metrics Severe subjective distress contrasted with a characteristically soft, completely non-tender abdominal palpation exam. CVA tenderness is completely variable and lacks reliable negative predictive value. Atypical Presentation Classifications Vague, poorly localized abdominal pain presentations occurring in up to 20% of active cases. Isolated lower urinary tract irritative signs including acute frequency or severe urgency. Incidental & Asymptomatic Dynamics Silent intrarenal or ureteral stones found incidentally. Longitudinal tracking demonstrates up to 33.3% of initially asymptomatic cohorts convert to fully symptomatic renal colic within a multi-year tracking window. 2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS Vascular Mimics: AAA rupture/expansion. This is a mandatory exclusion pathway in elderly cohorts presenting with acute flank or back pain. Physical tracking requires active exploration for an expansile, pulsatile abdominal mass. Gynecologic Emergencies: Ruptured ectopic pregnancy. Demands universal screening protocols via rapid beta-hCG testing in all female patients of childbearing potential presenting with lower abdominal/pelvic localization. Infectious Upper Tract Decompensation: Acute uncomplicated pyelonephritis. Differentiated via persistent high spikes, high fevers, systemic shaking chills, and profound pyuria. Genitourinary Structural Crises: Acute testicular torsion. Mandates a thorough, explicit scrotal/testicular structural exam if the flank pain radiates into the scrotum. Gastrointestinal and Adnexal Torsional Confounds: Acute appendicitis variants, acute mesenteric/bowel ischemia, and ovarian torsion syndromes. 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION Urinalysis Interpretation Nuances Microscopic or gross hematuria presents in approximately 66% to 90% of acute cases. Critical Pathological Caveat: Complete absence of hematuria documented in 20% to 33.3% of confirmed, acute obstructing ureteral stones. Diagnostic rule: A pristine urinalysis with zero red blood cells is entirely insufficient to exclude acute ureterolithiasis. Urinary pH as a Composition Clue Consistently low urinary pH parameters (pH < 5.5) point strongly toward a uric acid crystalline composition. Elevated urinary pH parameters (pH > 7.5) indicate the presence of urease-producing microbial pathogens, pointing toward a struvite infection stone. Infectious Screening Metrics Active tracking for marked pyuria, positive leukocyte esterase, and bacterial nitrites to rule out an obstructed, infected upper urinary tract system. BMP Immediate quantification of baseline serum creatinine to establish accurate eGFR values. Targeting detection of post-renal AKI from bilateral obstruction, unilateral obstruction in a single functioning kidney, or severe volume depletion. CBC Evaluation for marked leukocytosis. Physiologic Nuance: Mild-to-moderate white blood cell count elevations frequently represent non-specific stress demargination driven by severe pain and repetitive vomiting. High-grade white blood cell shifts demand immediate exclusion of systemic bacteremia or an infected, obstructed urinary system. Adjunctive Lab Pathways Rapid qualitative urine hCG testing. Reflex urine culture execution whenever urinalysis metrics display significant inflammatory profiles or clinical suspicion of UTI is high. 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION Non-Contrast CT Diagnostics Gold standard; diagnostic sensitivity and specificity parameters exceed 95% for stones >2 mm. Provides precise quantification of stone diameter (mm), exact localization (proximal, mid, or distal ureter), and degree of secondary hydronephrosis. Excellent structural visualization for detecting or ruling out alternate retroperitoneal, vascular, or intra-abdominal pathologies. Contrast-Enhanced CT Protocols Indicated when alternative intra-abdominal surgical pathology is highly suspected over isolated renal colic. Retains diagnostic capability to identify urinary tract stones >3 mm even within contrast-enhanced phases. NCCT Structural Architecture Limitations Standard stone protocol CT scans are executed in a prone position without IV contrast enhancement. It does not opacify the ureteral lumen. Presents a cumulative radiation exposure penalty when utilized serially across recurrent ED presentations. POCUS / Radiology Ultrasound Direct stone visualization capabilities are modest, operating at approximately 50% to 60% sensitivity, and is highly dependent on anatomical positioning at the extreme proximal ureter or the UVJ. Secondary obstruction tracking: Demonstration of hydronephrosis operates at a high sensitivity of approximately 80%. POCUS Clinical Utility Metrics Eliminates ionizing radiation exposure and allows immediate, rapid real-time execution directly at the patient’s bedside. Confirmation of significant hydronephrosis within a classic clinical presentation yields high post-test probability for stone presence while lowering suspicion for vascular catastrophes like a AAA. KUB Radiography Extremely poor overall diagnostic sensitivity, hovering around 57%. Fails to image radiolucent configurations (pure uric acid matrices) or small stones measuring

Show notes at pharmacyjoe.com/episode1136 In this episode, I'll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation.

At the SOAP meeting in Montreal, Desiree Chappell and Monty Mythen interview Dr. Marie Louise Meng, Assistant Professor of Anesthesiology at Duke University Department of Anesthesiology and her former cardio-obstetric fellow Liliane Ernst, assistant professor in the Obstetric and Gynecologic Anesthesia section Wake Forest University. The conversation focuses on cardio-obstetric anesthesia, hemodynamics, monitoring, and patient-centered care. Meng describes building multidisciplinary "pregnancy heart teams" to plan management for complex cardiac disease in pregnancy and reduce birth trauma. Ernst discusses research using the Premier database on preexisting atrial fibrillation in pregnancy (about 25 per 100,000 deliveries) and associated management and outcomes. They review cases including mechanical circulatory support with an Impella to prolong pregnancy and highlight knowledge gaps about placental perfusion and pulsatility, including Fontan physiology. Meng outlines individualized hemodynamic monitoring for labor and C-sections, emphasizes recognizing hypertensive instability, and details preeclampsia with severe features, its end-organ criteria, incidence, disparities, postpartum follow-up challenges, and potential use of remote monitoring and noninvasive cardiac output/SVR monitoring to guide therapy. Monty Mythen, founding editor-in-chief of TopMedTalk, is now Senior Vice President, Scientific Liaison, BD Advanced Patient Monitoring. He is also Emeritus Professor of Anaesthesia and Critical Care, University College London, UK. Desirée Chappell, former co-editor-in-chief of TopMedTalk, is now Director of Medical Affairs and Medical Science Liaison, BD Advanced Patient Monitoring. She is also a CRNA at NorthStar Anesthesia, USA. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - EBPOM World Congress 2026

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. Elan Burton, clinical associate professor in the Department of Cardiothoracic Surgery at the Stanford University School of Medicine and Section Chief for Stanford Medicine Affiliates, about distal coronary anastomosis. Chapters  00:00 Intro  01:08 Why CT Surgery?  03:01 Overview & History  05:02 Geometric Planning & Hemodynamics  10:40 Sequential & Composite Configurations  16:23 Y or T Grafts  21:21 Step-by-Step, Suturing  30:37 Endarterectomy  36:37 Intraop Quality Assurance  40:29 Failed Mechanisms & Pitfalls  43:18 Future Trends  45:54 Summary  47:03 Surgery Training Advice  They discuss the history of distal coronary anastomosis, geometric planning, and hemodynamics, as well as sequential grafting and composite configurations, including Y and T grafts. The conversation also covers arteriotomy, suturing techniques, and the continuous parachute method. Additionally, they delve into the traction technique, open direct vision, and intraoperative quality assurance, including pulsatility index. Furthermore, they examine failure mechanisms such as graft kinking and explore future trends. The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Keep an eye out for next month's episode. Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this edition of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, CA, USA, speaks with expert guest Jan Headley, Principal at Consultants in Acute and Critical Care. They explore the use of functional hemodynamics in the postoperative management of cardiothoracic surgical patients. Chapters  00:00 Intro  01:26 Case Study  04:28 Fluid Responsiveness, Dynamic Parameters  07:37 Variability Within Normal Limits  09:34 Determining Responsiveness Efficiently  12:45 No PA-Catheter Patients  15:35 Reassessing Values  17:22 First Step  19:20 No-Fluid Patient  20:27 Stroke Volume Trends  21:13 Key Takeaways  The discussion includes a case study illustrating how functional hemodynamics can guide clinical decisions in this context. They delve into the concepts of fluid management and fluid responsiveness, comparing dynamic parameters and static parameters, and the importance of increasing stroke volume. Key topics also include pulse pressure variation, stroke volume variation, variability, and delta stroke volume. The conversation further covers techniques such as the passive leg raise maneuver and the pulmonary occlusive maneuver. Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don't miss next month's episode! Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In today's conversation, we move beyond the idea of simply recording numbers in the cardiac arrest patient. Instead, we explore how physiological data can be used to guide real-time resuscitation, helping clinicians understand what is happening inside the patient, how interventions are working, and where care should go next. Joining us as the guest to discuss this is Mark Faulkner. Mark is an Advanced Paramedic for Hampshire and Isle of Wight Air Ambulance (HIOWAA), where he provides clinical leadership through his critical care practice. His work spans frontline practice, education, quality improvement, and the development of clinical pathways that shape the delivery of advanced pre-hospital care. This is the reading list associated with the episode:Barreto, A. et al. (2020) ‘Diastolic blood pressure and survival in cardiac arrest', Resuscitation, 155, pp. 1–8.Bernard, S.A. et al. (2024) ‘Physiology-guided resuscitation in cardiac arrest', Journal of Clinical Medicine, 13(12), p. 3527.Brede, J.R. et al. (2019) ‘Prehospital REBOA in cardiac arrest', Resuscitation, 140, pp. 136–143.Butterfield, E. et al. (2024) ‘Prehospital arterial monitoring in cardiac arrest', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1).Kruit, N. et al. (2025) ‘Prehospital ECPR (PRECARE study)', Resuscitation, 188.Nolan, J.P. et al. (2021) ‘European Resuscitation Council Guidelines', Resuscitation, 161, pp. 98–114.Perkins, G.D. et al. (2018) ‘Epinephrine in OHCA', New England Journal of Medicine, 379(8), pp. 711–721.Rubertsson, S. et al. (2014) ‘LINC trial', JAMA, 311(1), pp. 53–61.Sutton, R.M. et al. (2014) ‘Hemodynamic-directed CPR', Resuscitation, 85(3), pp. 397–402.Yannopoulos, D. et al. (2020) ‘Advanced reperfusion strategies', Circulation, 141(10), pp. 784–796.Rees, P. et al. (2023) ‘Prehospital arterial blood pressure monitoring and outcomes in cardiac arrest', Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.Barrett, J. et al. (2023) ‘Diastolic blood pressure and ROSC in OHCA', Resuscitation.VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital CareVitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you're not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.Using AI-driven analytics and patented Pulse Decomposition Analysis, it provides continuous blood pressure alongside advanced haemodynamic parameters such as cardiac output, stroke volume, systemic vascular resistance, and fluid status. The aim is simple but critical: to help clinicians understand not just what the blood pressure is, but why, and whether a patient is fluid responsive or in need of a different intervention.BHA Medical's VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

Send us Fan MailDr. Gabriel Altit and Daniela Villegas from the NeoCardioLab at Montreal join Ben and Rupa to reflect on a packed PAS filled with hemodynamics science — from pulmonary hypertension phenotyping to heart-brain interactions in the golden hour. Dr. Altit makes the case that just as neonatology learned to embrace gentle ventilation, it is time to think about gentle hemodynamics — intervening thoughtfully, recognizing different clinical phenotypes, and knowing when to remove interventions before they carry a price. He also previews early 3D echo data suggesting that a single clip at day 7 to 10 of life may already carry a signature predicting which babies will develop adverse cardiopulmonary outcomes by 36 weeks. Daniela shares her approach to family consent and research recruitment — sitting down, leaving papers behind, connecting families to the history of research that made current NICU care possible, and always giving them space to process before returning for an answer.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

At the 19th World Congress of the Societies of Anaesthesiologists (WCSA 2026) in Marrakesh, TopMedTalk welcomes Desiree Chappell back alongside Kate Leslie to interview Professor Palesa Motshabi-Chakane, Associate Professor and Head of Anaesthesiology at the University of the Witwatersrand and her colleague, Dr Mullai Slave a PhD candidate at University of the Witwatersrand. They discuss a study of 629 women undergoing cesarean section with spinal anesthesia at Chris Hani Baragwanath Hospital, where 23–33% are HIV positive. Using standard monitoring plus BD APM noninvasive continuous hemodynamic monitoring, they compared HIV-positive and HIV-negative patients and found higher hypotension incidence in HIV-positive women (68% vs 64%), with lower heart rate and lower cardiac index over 60 minutes. Additional testing included echocardiography with speckle tracking, pro-BNP, and autonomic assessments, with HIV-positive patients showing stiffer ventricles; Apgar scores did not differ. They discuss replication, multicenter research, and potential machine-learning tools to predict hypotension risk, and describe BD Advanced Patient Monitoring grant support enabling equipment, sensors, staffing, and training (~200 staff) to complete data collection in about six months. Edwards Lifesciences is now known as Becton Dickinson Advanced Patient Monitoring (BD APM). Desiree Chappell, former Co Editor in Chief of TopMedTalk, is now Director, Medical Science Liaison, Medical Affairs, BD Advanced Patient Monitoring. The views expressed on this program are her own and not those of her employers. We mention Adrian Gelb, if you'd like to hear his recent conversation with us go here: https://topmedtalk.libsyn.com/professor-adrian-gelb-on-patient-safety-and-essential-medicines-in-anaesthesia -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/  

Mirza Umair Khalid, MD, Social Media Editor for JACC: Cardiovascular Interventions, and Dr. Volter Rudolph, discuss a recently published original research paper examining the frequency and outcomes of acute hemodynamic instability following tricuspid interventions.

Join us in this episode for a conversation with Aaron Phillips, PhD, scientist and Associate Dean of the Medical School at the University of Calgary. In this conversation we discuss two papers, A neuronal architecture underlying autonomic dysreflexia published in the journal Nature, and An implantable system to restore hemodynamic stability after spinal cord injury published in the journal Nature Medicine. In these papers Dr. Phillips and his team first identify specific neuronal components, and their location, responsible for blood pressure increases due to autonomic dysreflexia. Then an implantable device is demonstrated to help control, via neuromodulation, blood pressure fluctuations in both pre-clinical models and people living with SCI. We invite you to listen in as Dr. Phillips outlines this tour de force in neurologically understanding, and intervening on, hemodynamic instability after SCI.

CardioNerds (Dr. Hamza Patel, Dr. Jenna Skowronski, and Dr. Apoorva Gangavelli) discuss advanced heart failure and LVAD management with Dr. Mark Belkin, Advanced Heart Failure & Transplant Cardiologist, and Dr. Chris Salerno, Cardiothoracic Surgeon. They explore the nuances of right ventricular (RV) physiology, perioperative hemodynamic optimization, long-term complications, sensitization and transplant considerations, and the evolving role of GDMT in LVAD patients.  This episode highlights the delicate interplay between surgical and medical management in achieving optimal outcomes for patients living with durable mechanical circulatory support.Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls “The right ventricle sets the stage.” — LVAD success hinges on RV performance; a struggling RV can turn a perfect LVAD surgery into a perfect storm.  “Watch the ratios.” — A PAPi < 2 and RA:PCWP >0.6 signal high risk for RV failure post-implant; trends and response to optimization matter more than static numbers.  “From hemocompatibility to hemodynamics.” — The LVAD field has moved from fighting pump thrombosis to mastering long-term RV failure and aortic insufficiency.  “Not all antibodies are created equal.” — LVAD-related sensitization often resolves post-transplant, reminding clinicians to interpret PRA trends in context.  “Recovery is possible.” — The RESTAGE-HF trial and emerging SGLT2 data hint at a new era: not just sustaining life with LVADs but restoring native heart function.  Notes Notes drafted by Dr. Hamza Patel. 1. Hemodynamic & Vasoactive Management of the RV  Use norepinephrine and vasopressin for pressor support; consider dobutamine as inotrope of choice.  Consider avoiding early milrinone due to hypotension and reduced coronary perfusion.  Use inhaled NO or epoprostenol selectively; institutional variation depends on cost and supply.  Key hemodynamic markers:  PAPi = (PA systolic – PA diastolic) / RA pressure.  PAPi < 2 → increased RV failure risk.  RA:PCWP ratio ≈ 0.6 normal; ≈ 1 → severe RV dysfunction.  RV reserve—the ability to improve these indices with optimization—is a stronger predictor of outcomes than baseline numbers alone.  NOTE: there is no robust data to guide vasoactive medical decision-making and there is substantial institutional variability in practive.  2. Long-Term LVAD Complications  MOMENTUM 3 trial: HeartMate 3 reduced pump thrombosis (10 → 1 %), stroke (14 → 5%), and GI bleed (77 → 43 %).  Persistent issues: driveline infections, RV failure, and aortic insufficiency.  Driveline care: silver sulfadiazine (Silvadene) cream linked to lower infection rates (Cowher & Kenmore 2025).  Field now focuses on hemodynamic-related adverse events—the next frontier in LVAD outcomes.  Innovation ahead: smaller drivelines and fully implantable LVADs to eliminate infection risk.  3. Sensitization and Transplant Candidacy  LVADs may induce de novo HLA antibodies, complicating transplant matching.  These antibodies tend to be transient and less cytotoxic, often resolving post-transplant.  Sensitization degree varies by device and patient; management strategies are center-dependent.  The field is redefining which antibodies are truly LVAD-induced versus incidental.  4. GDMT & Myocardial Recovery  GDMT data in LVAD patients limited—excluded from major HFrEF trials.  RESTAGE-HF: aggressive GDMT post-LVAD yielded 52% explant rate within 18 months.  SGLT2 inhibitors: emerging evidence of reverse remodeling and reduced LV size (Belkin et al., THT 2025).  GDMT promotes recovery but requires cautious titration to avoid hypotension and RV strain.  5. Future of LVAD Therapy  The fully implantable LVAD remains the goal—wireless energy, no driveline, and fewer infections.  Short-term focus: device miniaturization, improved energy efficiency, and better hemocompatibility.  HeartMate 3 remains gold standard until next-generation systems mature.  References Mehra MR et al. NEJM 2018 — MOMENTUM 3 Final Report.  Takeda K et al. JHLT 2020 — Predictors of RV Failure After LVAD.  Imamura T et al. Circ Heart Fail 2017 — Hemodynamics and RV Adaptation Post-LVAD.  RESTAGE-HF Trial, JHLT 2019.  Cowher J, Kenmore C et al. 2025 — Driveline Care & Infection Outcomes.  Belkin M et al. THT 2025 — SGLT2 Inhibition and Reverse Remodeling Post-LVAD. 

The conversation revolves around a complex trauma case involving a 26-year-old male who suffered severe injuries from a live round during a training exercise. The discussion covers the patient's initial assessment, the challenges faced during his treatment, the surgical interventions performed, and the lessons learned from the case. The speakers emphasize the importance of timely interventions, effective communication, and the need for continuous improvement in emergency medical practices.TakeawaysThe patient was a 26-year-old male with severe injuries.Initial assessment showed signs of shock despite normal blood pressure.CT scans revealed significant internal bleeding.Surgical interventions were complicated by the patient's deteriorating condition.Massive transfusion protocol was activated due to significant blood loss.Lessons learned include the importance of timely blood product administration.Pre-hospital care plays a crucial role in patient outcomes.Effective communication among medical teams is essential.The case highlights the need for continuous training and preparedness.The patient ultimately required extensive rehabilitation after his injuries.Chapters00:00 Introduction to the Case02:52 Patient Arrival and Initial Assessment06:05 CT Scan and Deterioration08:50 Surgical Interventions and Challenges11:58 Massive Transfusion Protocol and Outcomes14:58 Lessons Learned from the Case18:00 Discussion on Pre-Hospital and In-Hospital Care20:48 Final Thoughts and ReflectionsFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠⁠⁠

We explore how to refine and optimize care in the vital minutes following ROSC. Hosts: Jonathan Elmer, MD, MS Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Post-ROSC_care.mp3 Download Leave a Comment Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 I. Phase 1: Stabilization (Minutes 0–10) The “Rearrest” Window & Pathophysiology High-Risk Period: Rearrest rates reach 30% within the first minutes post-ROSC. Shock Incidence: Two-thirds of patients develop profound hypotension/shock as initial resuscitative efforts subside. Catecholamine Washout: Super-physiologic “code-dose” epinephrine (1mg IV) typically wears off within ~3 minutes post-ROSC, leading to predictable hemodynamic collapse. Secondary Injuries: Evaluate for “CPR-induced trauma” (blunt thoracic trauma, rib fractures, pneumothorax, liver/splenic lacerations). Immediate Resuscitative Actions Vascular Access: Transition rapidly from IO to reliable IV access within 1–2 minutes. Prioritize Intraosseous (IO) placement within 5 minutes if IV attempts fail; intra-arrest data suggests no significant difference in early outcomes. Vasoactive “Bridge”: Maintain a “bolus-dose” pressor at the bedside for immediate push-dose titration. Options: Phenylephrine, dilute Epinephrine, or dilute Norepinephrine (titrated to effect rather than rigid dosing). Physician-Specific Task: Arterial Line: Goal: Placement within 5 minutes of ROSC. Preferred Site: Femoral (by landmarks/blind if necessary) for speed; should be a 80 mmHg. The BOX Trial Nuance: While the BOX trial showed no difference between MAP 63 vs. 77, its cohort (Denmark) had exceptionally high survival rates (70% back to work) and short response times, which may not generalize to North American populations with lower shockable rhythm incidence. Permissive Hypertension: If the patient is “self-driving” to higher pressures, do not aggressively lower them, as this may be a physiologic demand for cerebral blood flow. Ventilation and Oxygenation PaCO2 Management: Target: High-normal to slightly hypercarbic (45–55 mmHg). Rationale: Avoid accidental hyperventilation (PaCO2

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826251393909

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826251396933

Welcome to the Atomic Anesthesia podcast hosted by CRNA professor Dr. Rhea Temmermand and Co-Founder Sachi Lord. On this show, you'll hear clear, clinically grounded discussions designed for nurse anesthesia residents and CRNAs who want to feel more confident in complex pharmacology, physiology, and real-world anesthesia decision-making.⚠️ SIGN UP FOR OUR FREE NEWSLETTER: [NEWSLETTER SIGN-UP]Topics included in this episode:Hemodynamic goals and risks during induction in severe aortic stenosis​Limitations and hypotensive effects of propofol in aortic stenosis patients​Pharmacology and potential advantages of cipepofol (ciprofol) as a propofol derivative​Key findings of the JAMA Surgery randomized trial comparing cipepofol vs propofol in severe AS​Practical induction strategies and future implications for managing severe AS patients under anesthesiaARTICLE: Hemodynamic Impact of Cipepofol vs Propofol During Anesthesia Induction in Patients With Severe Aortic Stenosis

The ethics of NRP—current debates, consent, legal/organizational policies, and team communication. Hemodynamic monitoring for the perfusionist—MAP/PPV/SVV, venous oximetry, lactate trends, and practical targets on CPB and ECMO. Learning objectives: Identify the core ethical concerns and guardrails for NRP programs. Build an explicit consent and documentation pathway with the OR/NRP team. Apply a monitoring bundle (flows, pressures, SvO₂, lactate, urine output) to guide decisions. Create checklists for escalation, troubleshooting, and handoff.

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826251347539

In patients with heart failure, remote hemodynamic monitoring can identify health changes long before symptoms appear, contributing to slower disease progression, improved patient outcomes, and reduced rehospitalizations. Learn more about current and future technology that can support better patient health, and the role of nurses in patient education and monitoring. Guests: Linda Park, PhD, MS, FNP-BC, FAAN, FAHA, FPCNA, and Eryn Bryant, MSN, APRN-CNP, FPCNA.PCNA Heart Failure Tools: https://pcna.net/health-topics/heart-failure/Tele-HF study: https://www.jacc.org/doi/10.1016/j.jchf.2015.07.017 CHAMPION Trial (CMEMs after CRT): Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction https://www.acc.org/latest-in-cardiology/clinical-trials/2015/12/29/12/44/championJournal of American College of Cardiology paper, Remote Monitoring and Heart Failure Scientific Statement: https://www.jacc.org/doi/10.1016/j.jacc.2023.04.010 European Society of Cardiology consensus statement: https://doi.org/10.1093/eurheartjsupp/suae116BMAD trial: BMAD Trial: Wearable Remote Monitor Reduces Hospital Readmission Risk in HF Patients - American College of Cardiology: https://www.acc.org/Latest-in-Cardiology/Articles/2023/03/01/22/45/mon-830am-bmad-acc-2023 GUIDE-HF trial (CMEMS, Lancet): Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial - The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01754-2/abstractESCAPE trial (using RHC / pulm art pressures to guide therapy during ADHF: Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial - PubMed: https://pubmed.ncbi.nlm.nih.gov/16204662/MONITOR-HF trial (improved QOL and functional status w/ CMEMs): Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial - The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00923-6/abstract MONITOR-HF: Pulmonary artery pressure monitoring in chronic heart failure: effects across clinically relevant subgroups in the MONITOR-HF trial | European Heart Journal | Oxford Academic: https://academic.oup.com/eurheartj/article/45/32/2954/7668040MONITOR-HF (summary in ACC): Remote Hemodynamic Monitoring of Pulmonary Artery Pressures in Patients With Chronic Heart Failure - American College of Cardiology: https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2023/07/18/17/21/monitor-hfHeartLogic: HeartLogic Multisensor Algorithm Identifies Patients During Periods of Significantly Increased Risk of Heart Failure Events: https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.117.004669SCALE-HF-1 Trial (bodyport scale to predict worsening HF trends): Use of a Cardiac Scale to Predict Heart Failure Events: Design of SCALE-HF 1 | Circulation: Heart Failure: https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.122.010012See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Ever wondered how PICU teams make those critical calls about blood pressure and vasoactive meds? On this episode, Dr. Monica Gray and Dr. Pradip Kamat dive into the real-world questions that come up during pediatric intensive care rounds. They break down the pros and cons of arterial line versus non-invasive cuff measurements, talk through blood pressure targets for tough cases like sepsis and brain injury, and share practical tips for weaning kids off vasoactive drugs. With a focus on the latest guidelines and research, Monica and Pradip offer actionable advice to help you fine-tune hemodynamic management for your sickest patients. Tune in!Show Highlights:Relationship between blood pressure and cardiac output in pediatric patientsComparison of arterial line (invasive) versus non-invasive cuff measurements for blood pressure monitoring in the PICUBlood pressure targets for critical illnesses such as sepsis, traumatic brain injury, and respiratory failure in childrenStrategies for weaning vasoactive medications in critically ill pediatric patientsImportance of accurate blood pressure measurement and monitoring in the PICUDiscussion of organ autoregulation and its impact on blood pressure managementClinical assessment and individualized care in setting blood pressure goalsRecommendations for initial vasoactive agents in pediatric septic shockChallenges and considerations in vasoactive medication selection and weaningNeed for further research on pediatric vasoactive medication management strategiesReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 110. Alder M et al. Pediatric Sepsis. Pages 1293-1309.Rogers Textbook of Pediatric Critical Care Medicine. Chapter 88. Fitzgerald J et al. Bacterial Sepsis.Pages 1469-1485.Reference 1 Weiss S. Vasoactive Selection for Pediatric Septic Shock-Where to begin. JAMA Network Open, 2025;8(4):e254726.Reference 2 Schlapbach LJ, Watson RS, Sorce LR, Argent AC, Menon K, Hall MW, Akech S, Albers DJ, Alpern ER, Balamuth F, Bembea M, Biban P, Carrol ED, Chiotos K, Chisti MJ, DeWitt PE, Evans I, Flauzino de Oliveira C, Horvat CM, Inwald D, Ishimine P, Jaramillo-Bustamante JC, Levin M, Lodha R, Martin B, Nadel S, Nakagawa S, Peters MJ, Randolph AG, Ranjit S, Rebull MN, Russell S, Scott HF, de Souza DC, Tissieres P, Weiss SL, Wiens MO, Wynn JL, Kissoon N, Zimmerman JJ, Sanchez-Pinto LN, Bennett TD; Society of Critical Care Medicine Pediatric Sepsis Definition Task Force. International Consensus Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27;331(8):665-674.

Born at 21 0/7 weeks' gestation, Nash Keen is recognized as the youngest infant ever to survive. In this powerful follow-up to Episode 74, where his mother, Mollie, shared their family's journey, listeners now hear from two of the neonatologists who cared for Nash at the University of Iowa's Stead Family Children's Hospital—Dr. Patrick McNamara and Dr. Amy Stanford.The conversation explores what first inspired them to pursue neonatology, how the culture and belief within the walls of the NICU at the University of Iowa shape outcomes, and why their “small baby” program has become a model of consistency, teamwork, and hope. They reflect on the challenges Nash faced in his earliest days, the role of hemodynamics in guiding his care, and the profound meaning of seeing babies like Nash go home after months of critical illness.This episode is a tribute not only to Nash and his courageous family but also to the dedicated NICU teams whose relentless commitment continues to redefine what's possible for the tiniest and most fragile infants.Dr. Brown's Medical: https://www.drbrownsmedical.com  The Infant-Driven Feeding™ (IDF) Program: https://www.infantdrivenfeeding.com/ Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/  NICU Mama Hats: https://empoweringnicuparents.com/hats/  NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/  Newborn Holiday Cards: https://empoweringnicuparents.com/shop/  Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/  Episode 75 Show Notes: https://empoweringnicuparents.com/episode75  Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/ Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparents  Pinterest Page: https://pin.it/36MJjmHThank you for listening to the Empowering NICU Parents Podcast. Be sure to subscribe and leave us a review—it helps other families find us. We're grateful to be part of this incredible community. Visit www.empoweringnicuparents.com for resources and support.

Show notes at pharmacyjoe.com/episode1062. In this episode, I’ll discuss hemodynamic changes after using a dexmedetomidine loading dose in ED patients. The post 1062: Hemodynamic changes after using a dexmedetomidine loading dose in ED patients appeared first on Pharmacy Joe.

Born at just 21 0/7 weeks and weighing only 285 grams, Nash Keen entered the world with odds that were essentially nonexistent. Yet from his very first breath, he showed a will to live that defied every expectation.Refusing to give up on their son, Mollie Keen and her husband, Randall, made a life-changing decision to transfer to University of Iowa Stead Family Children's Hospital—where an extraordinary team, rooted in a steadfast belief and culture of giving infants at his gestation a chance at life, stood ready to fight alongside them.What followed was nothing short of remarkable. Against relentless setbacks, fragile moments, and months of intensive care, Nash's determination only grew stronger. Mollie watched in awe as her tiny son—born smaller than a can of soda—met every challenge with quiet, unwavering strength. Today, Nash has been officially recognized by Guinness World Records as the most premature baby to survive.In this special episode for NICU Awareness Month, Nicole Nyberg sits down with Mollie as she shares their family's extraordinary journey—the heartbreak that came before, the terrifying and traumatic moments in the NICU, the small but mighty victories, and the resilience that continues to inspire everyone who meets him. This is more than a story about survival—it's a powerful testament to hope, love, and the belief that even the smallest beginnings can rise into something extraordinary.Dr. Brown's Medical: https://www.drbrownsmedical.com  The Infant-Driven Feeding™ (IDF) Program: https://www.infantdrivenfeeding.com/ Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/  NICU Mama Hats: https://empoweringnicuparents.com/hats/  NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/  Newborn Holiday Cards: https://empoweringnicuparents.com/shop/  Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/  Episode 74 Show Notes: https://empoweringnicuparents.com/episode74  Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/  Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparents  Pinterest Page: https://pin.it/36MJjmH

Dr. Kenneth Ellenbogen, Deputy Editor of JACC Clinical Electrophysiology discusses Pressure-Volume Analysis Demonstrates Short and Long-Term Hemodynamic Effects of Atrioventricular Interval Modulation Therapy in Hypertension.

Send us a textThis week we have a physiology heavy hitter - we review cardiac hemodynamics and how to translate those principles into the use and application of PA catheters. Written by: Dr. Paul Mundra (Internal Medicine Resident) Reviewed by: Dr. Craig Ainsworth (Cardio-Intensivist) & Dr. Hugh Traquair (General Internist) Don't forget to use code FIGSCA for 20% off your first purchase! Support the show

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241297119

Long-term Hemodynamic Performance And Clinical Outcomes In Small And Large Aortic Annuli Patients With Severe Aortic Stenosis

New Insights from the DanGer Shock Trial!

The conversation revolves around a complex trauma case involving a 26-year-old male who suffered severe injuries from a live round during a training exercise. The discussion covers the patient's initial assessment, the challenges faced during his treatment, the surgical interventions performed, and the lessons learned from the case. The speakers emphasize the importance of timely interventions, effective communication, and the need for continuous improvement in emergency medical practices.TakeawaysThe patient was a 26-year-old male with severe injuries.Initial assessment showed signs of shock despite normal blood pressure.CT scans revealed significant internal bleeding.Surgical interventions were complicated by the patient's deteriorating condition.Massive transfusion protocol was activated due to significant blood loss.Lessons learned include the importance of timely blood product administration.Pre-hospital care plays a crucial role in patient outcomes.Effective communication among medical teams is essential.The case highlights the need for continuous training and preparedness.The patient ultimately required extensive rehabilitation after his injuries.Chapters00:00 Introduction to the Case02:52 Patient Arrival and Initial Assessment06:05 CT Scan and Deterioration08:50 Surgical Interventions and Challenges11:58 Massive Transfusion Protocol and Outcomes14:58 Lessons Learned from the Case18:00 Discussion on Pre-Hospital and In-Hospital Care20:48 Final Thoughts and ReflectionsThank 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

Guest: Dr. Adrianne Rahde Bischoff Clinical Assistant Professor of Pediatrics-Neonatology Neonatal Hemodynamics Specialist University of Iowa, Stead Childrens Hospital   CEU objectives for this episode: Describe two differences between a TNE (Targeted Neonatal Echo) performed by NICU staff and a Cardiac Ultrasound performed by an Echo Tech Explain at least one way that hemodynamic measurements obtained during a TNE might change the clinical management of a baby in the NICU List two or more treatment options for a PDA This episode is eligible for CEUs. Visit https://handtohold.org/resources/podcasts/nicu-heroes/ to complete the questionnaire. It is the sole responsibility of the individual to verify if this credit is valid and eligible for use in your State and/or for your discipline for licensure or certification renewal.  

N Engl J Med 1996;334:1349-1355Background Before 1990, the prevailing idea held that the negative inotropy of beta-blockers would harm patients with impaired systolic function. Yet part of the progression of systolic heart failure involved over stimulation of the sympathetic nervous system. Norepinephrine can exert adverse effects on the circulation, both directly and indirectly. Smaller trials of beta-blockers in systolic heart failure found trends for benefit with beta-blockers, however, a mortality benefit had not yet been proven. The U.S. Carvedilol Heart Failure Study aimed to study mortality in patients with heart failure with a reduced ejection fraction.Cardiology Trial's Substack remains free of industry ads because of your support. Thank you. Please consider becoming a free or paid subscriber.Patients The study enrolled 1094 patients with chronic heart failure symptoms for at least 3 months, LVEF ≤ 0.35%, at least 2 months of treatment with diuretics and an angiotensin-converting enzyme (ACE) inhibitor (if tolerated). Treatment with digoxin, hydralazine, or nitrates was permitted but not required.Exclusion criteria were extensive and important to understand. These included any recent major cardiac events or surgery within the previous 3 months, uncorrected valvular disease, active myocarditis, sustained VT or higher degrees of AV block not controlled by pacing, systolic blood pressure of more than 160 or less than 85 mm Hg or diastolic blood pressure of more than 100 mm Hg, clinically significant kidney or liver disease or use of calcium-channel blockers, adrenergic agonists/antagonists, or class IC/III antiarrhythmic agents. Patients receiving β-adrenergic agonists or antagonists (presumably for another indication) were not enrolled.Baseline Characteristics The results of this and other beta-blocker trials in heart failure will be clear. One of the most important points for translating this evidence to patients will be the baseline characteristics. It is vital to understand who these patients were.The mean age was 58 years and approximately 76% were male. Most patients had mild to moderate heart failure, with 53% in NYHA Class II, 44% in Class III, and only 3% in Class IV. The etiology of heart failure was nearly evenly split between coronary artery disease (47%) and nonischemic cardiomyopathy (53%). Patients had significantly impaired cardiac function with a mean LVEF of 0.23. The mean six-minute walk distance ranged from 386 to 390 meters. Hemodynamic parameters were relatively stable, with mean systolic blood pressure of 116 mmHg, and mean heart rate of 83-84 beats per minute. Most patients were receiving standard heart failure therapy at baseline, including digitalis (90-91%), loop diuretics (95%), and ACE inhibitors (95%), while approximately one-third (32%) were on direct-acting vasodilators.Trial Procedures Patients were assessed for eligibility during a 3-week screening period during which exercise capacity was assessed with a 6-minute walk test. Notable was that these were outpatients able to complete a 6-minute walk test. Enrollment was stratified to one of four treatment protocols on the basis of the patients' performance on the exercise test: patients able to walk between 426 and 550 m when tested were assigned to the mild-heart-failure protocol; those able to walk between 150 and 425 m were assigned either to the moderate-heart-failure protocol or to a dose-ranging protocol, depending on the location of the study center; and those able to walk only less than 150 m were assigned to the severe-heart-failure protocol.After this base-line testing, all patients received 6.25mg of carvedilol twice daily for two weeks in an open-label run-in period. Those who tolerated this initial dose were then randomized to receive either placebo (n=398) or carvedilol (n=696) on a double-blind basis, in addition to their usual medications.The allocation ratio (carvedilol:placebo) was 2:1 in the mild and severe heart failure protocols and 1:1 in the moderate heart failure protocol. The dose was gradually increased to target levels of 25-50mg twice daily over 2-10 weeks, followed by maintenance therapy for an additional 6 months (12 months for mild heart failure).Endpoints At the time of trial planning, the original intent was safety. That is, to show that carvedilol did not increase mortality. The original intent was to enroll 1100 patients. As smaller trials on beta-blockers were published, the statistical plan included the possibility of beta-blocker benefit. The trialists therefore planned two sided statistical analysis.Cumulative survival curves were constructed as time-to-first-event plots by Kaplan–Meier survivorship methods and differences between the curves were tested for significance by the log-rank statistic with use of a Cox proportional-hazards regression model (which included the protocol as a covariate).Results Median follow-up was only 6.5 months due to early termination for benefit. The patients mean total daily dose of carvedilol was 45±27 mg. Overall mortality was 7.8% in the placebo group vs. 3.2% in carvedilol group. The relative risk reduction from carvedilol vs placebo was 65% (95% CI, 39-80%; p

Returning for a second study this month, the JHLT Digital Media Editors invite first author Charlotte Van Edom to discuss the paper, “Apixaban plasma levels in patients with HeartMate 3 support.” As a cardiologist in training and a PhD candidate at the University Hospitals Leuven in Belgium, Van Edom's work focuses on hemocompatibility and mechanical circulatory support, covering both short-term and long-term support. The episode explores: The evolution of the use and understanding of direct oral anticoagulants (DOACs) during LVAD support, including the increased focus on Factor Xa inhibitors Encouraging findings from the study and what clinical practices might need to change if introducing apixaban Additional studies exploring DOACs in LVAD patients For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Treat or research pulmonary vascular diseases? Check out the first April episode for a study on sotatercept in PAH patients. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

Commentary by Dr. Jian'an Wang.

Philippe Rola, intensivist, master of the VEXUS scan, and founder of the Hospitalist and Resuscitationist conference, shares his recent model of four hemodynamic interfaces to describe the entire circulatory system. Register for the H&R conference (May 22-23 2025) here with the discount code provided in the show. (No, we're not sponsored, just a cool event.) … Continue reading "Lightning rounds 51: Hemodynamic interfaces with Philippe Rola"

Drs. Gerard Slobogean, Conor Kleweno, Jon Eastman, and Josh Parry discuss the highlights from this 2024 OTA Annual Meeting symposium. Live from the 2024 OTA Annual Meeting. For additional educational resources visit OTA.org

Abdullah Al-Abcha, MD, social media editor of JACC: Cardiovascular Interventions, and Thomas Pilgrim, MD, MSc, discuss a recently published manuscript reporting the incidence, predictors, and clinical outcomes hemodynamic valve deterioration after transcatheter aortic valve replacement.

Send us a textNeste episódio, trazemos um compilado de estudos recentes que abordam avanços e desafios no manejo hemodinâmico dos recém-nascidos, um tema essencial para neonatologistas e cardiologistas pediátricos. Nosso objetivo é fornecer informação acessível e atualizada para profissionais da área que falam a língua portuguesa. Vamos aos artigos selecionados:"Changes in Patent Ductus Arteriosus Management and Outcomes in Infants Born at 26 to 28 Weeks' Gestation", por Kaluarachchi DC et al. https://www.jpeds.com/article/S0022-3476(24)00559-6/abstract Este estudo analisa mudanças recentes na abordagem do tratamento do persistência do canal arterial (PCA) em prematuros de 26 a 28 semanas e seus impactos nos desfechos clínicos. "Hemodynamic assessment by neonatologist using echocardiography: Primary provider versus consultation model", por Shahab Noori et al. https://www.nature.com/articles/s41390-024-03248-7 Este artigo compara a avaliação hemodinâmica realizada diretamente pelo neonatologista com o modelo tradicional de consulta cardiológica. "Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations", por Oster ME et al. https://publications.aap.org/pediatrics/article/155/1/e2024069667/200337/Newborn-Screening-for-Critical-Congenital-Heart A Academia Americana de Pediatria apresenta um novo algoritmo para a triagem de cardiopatias congênitas críticas em recém-nascidos. "Vasopressin as adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension in term newborns", por Santelices F et al. https://www.nature.com/articles/s41372-024-02015-0#citeas Este estudo investiga o uso da vasopressina como terapia adjuvante na hipertensão pulmonar associada à hipotensão sistêmica refratária em recém-nascidos a termo. Queremos saber sua opinião! Se este episódio foi útil para você, avalie nosso programa na sua plataforma de streaming favorita e compartilhe com colegas interessados na neonatologia. Sua participação nos ajuda a continuar trazendo conteúdo relevante e acessível para a comunidade.Prepare-se para um evento imperdível em Neonatologia! De 3 a 5 de abril, Gramado/RS recebe o IX Encontro Internacional de Neonatologia e o VII Simpósio Interdisciplinar de Atenção ao Prematuro. Inscreva-se agora: evento.fundmed.org.br/encontroneonatologia2025Até o próximo episódio! Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Lembrando que o Podcast está no Instagram, @incubadora.podcast, onde a gente posta as figuras e tabelas de alguns artigos. Se estiver gostando do nosso Podcast, por favor dedique um pouquinho do seu tempo para deixar sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. Isso é importante para a gente poder continuar produzindo os episódios. O nosso objetivo é democratizar a informação. Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.org

Send us a textHemodynamic assessment by neonatologist using echocardiography: Primary provider versus consultation model.Noori S, Ramanathan R, Lakshminrusimha S, Singh Y.Pediatr Res. 2024 May 22. doi: 10.1038/s41390-024-03248-7. Online ahead of print.PMID: 38778230As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

TopMedTalk at The American Society of Anesthesiologists (ASA)'s annual general meeting; Anesthesiology 2024. We're bringing you a series of podcasts from the conference. Make sure you check our podcast feed and are subscribed to TopMedTalk, as we are currently releasing episodes more often than usual to accommodate high demand. This piece provides much needed focus on the topic of pediatrics and hemodynamics. Is it true to say that children are completely different to adults? What information do we need and what should the considerations around this topic really be? Presented by Desiree Chappell and Mike Grocott with their guests Dwight Bailey, Chief, Division of Pediatric Critical Care Medicine at Atrium Health, Levine Children's Hospital and Jonathan Tan, Vice Chair of Analytics and Clinical Effectiveness, Department of Anesthesiology Critical Care Medicine, Assistant Professor of Clinical Anesthesiology and Spatial Sciences, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Spatial Sciences Institute of the University of Southern California

Send us a textBen and Daphna welcome back Dr. Srirupa Gopal, who returns to The Incubator podcast with exciting updates. Now an Assistant Professor of Neonatology at SSM Health Cardinal Glennon Children's Hospital, Dr. Gopal shares insights from her CHNC workshop on hemodynamic-based strategies in neonatal care and her perspective on evolving medication approaches. Additionally, Dr. Gopal introduces her new role within The Incubator team, leading a special series featuring neonatal fellows discussing their research projects. Tune in to learn how this initiative aims to foster international collaboration and bring neonatal research to a global audience.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Answering emails and questions. Books: The Man Who Broke Capitalism by Gelles, The Ethnic Cleansing of Palestine by Pappe

Send us a Text Message.In this episode of "The Incubator" at NeoHeart 2024, hosts Ben and Daphna interview Dr. Phil Levy from Boston Children's Hospital.Dr. Levy discusses his experience preparing for a year-in-review presentation on 18 months of neonatal hemodynamics research. He highlights the work of Dr. Reagan Geisinger and her trainees, emphasizing their contributions to various aspects of neonatal hemodynamics, including:Hemodynamic screening programs and their impact on outcomesPDA management strategies across different gestational agesThe use of inhaled nitric oxide in preterm infantsEstablishing normal values for cardiac function in premature babiesHemodynamic changes during therapeutic hypothermiaDr. Levy also mentions the updated 2024 guidelines for Targeted Neonatal Echocardiography and Point of Care Ultrasound, highlighting their comprehensive approach to teaching, education, and training.The conversation touches on recent trends in PDA management, including a decrease in surgical ligations and an increase in device closures. Dr. Levy discusses new guidelines on the timing of PDA interventions, emphasizing the importance of a multidisciplinary approach.Finally, Dr. Levy shares information about an upcoming addition to NRP training that will include modules on resuscitating babies with congenital heart disease, highlighting the growing collaboration between neonatology and cardiology. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a Text Message.In this episode of "The Incubator" at NeoHeart 2024, hosts Ben and Daphna interview Dr. Lauren Ruoss from Winnie Palmer Hospital and Dr. Catalina Bazacliu from the University of Florida.Dr. Ruoss discusses her role in bridging cardiac-focused care and targeted neonatal echo. She highlights her upcoming session on when cardiac POCUS (Point-of-Care Ultrasound) may aid in neonatal care, emphasizing the nuances and training required for cardiac POCUS compared to other applications like lung ultrasound. Dr. Ruoss also shares successes from her program, including improved physiological discussions and management of acute pulmonary hypertension in term infants.Dr. Bazacliu shares her motivation for attending NeoHeart, citing her goal to stay current with literature and eventually start a hemodynamic program at the University of Florida. The conversation emphasizes the welcoming nature of the conference for professionals at various stages in their hemodynamics journey.The hosts and guests discuss the collaborative nature of the neonatal hemodynamics community, highlighting resources like Gabriel Altit's curriculum and monthly case reviews. They stress the importance of ongoing learning and the need for more training programs in this field.The episode underscores the evolving nature of neonatal hemodynamics and the value of conferences like NeoHeart in fostering knowledge exchange and professional growth. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Show notes at pharmacyjoe.com/episode936. In this episode, I'll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. The post 936: Why does ketamine for RSI sometimes cause post-induction hemodynamic instability? appeared first on Pharmacy Joe.