Podcasts about hypotensive

This podcast episode focuses on the importance of measuring urine output as a cheap and effective method for monitoring hemodynamics in prolonged field care. The hosts discuss the benefits of using a Foley catheter for urine measurement and emphasize the need for proper sterility during the procedure. They also touch on the topic of hypotensive resuscitation and the challenges of managing patients with low blood pressure in a prolonged field care setting. Takeaways Measuring urine output is a simple and cost-effective way to monitor a patient's hemodynamic status in a prolonged field care setting. A Foley catheter is a reliable tool for measuring urine output and can provide valuable information about a patient's overall health. Proper sterility is important when inserting a Foley catheter to prevent infections. Hypotensive resuscitation is a complex topic that requires further discussion and consideration in the context of prolonged field care. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠ or ⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

We know what to do with the patient who is sick and hypotensive.  But what about the patient who is sick but not hypotensive?  Or the patient who is hypotensive but not sick?References for the papers mentioned in the podcast on use of midodrine in the ED:Puissant et al (2022). Wait, What? Oral Midodrine Instead of Pressors for Septic Shock? Annals of Emergency Medicine;80(4):S94Zada et al (2024). Midodrine in Early Septic Shock. Critical Care Medicine 52(1):S708Lal et al (2021). Oral Midodrine Administration During the First 24 Hours of Sepsis to Reduce the Need of Vasoactive Agents: Placebo-Controlled Feasibility Clinical Trial. Critical Care Explorations 3(5):e0382Additional content and educational resources at ICUedu.org

Have you heard that you're supposed to decrease the dose of your sedative when performing RSI on hypotensive patients? First, avoid the question about why you haven't addressed the hypotension before intubating.. maybe there's a reason. Maybe. But, regardless of why, intubate you will. What about those doses? I've been hearing for years that I should be dropping the dose of sedation prior to RSI. But what evidence are these recommendations based on? We review a paper today that is aimed at providing some evidence on this question. Oh, and I offer a gratuitous plug for the ESO/PCRF Research Forum nerdvanna. Here's the URL for more information: https://www.eso.com/events/research-forum-pcrf/ Citation:Driver BE, Trent SA, Prekker ME, Reardon RF, Brown CA: Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association? Annals of Emergency Medicine. June 2023 (Epub Ahead of Print) Also discussed:Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Winkler W, Yan Y, Kollef MH, Avidan MS, et al.: The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–44.

We're giving you a preview of our Rapid Bombs Podcast this week. Check out our video-format on Youtube as well! Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Cite this podcast as: Briggs, Blake. Episode 182. Hypotensive, but sweet: a deadly combo. July 3rd, 2023. Accessed [date]

Hypotensive patient? Just reflexively give 30 cmL/kg, trend lactates, and broad spec antibiotics right? NOPE. Turns out, the heart could really care less. In fact, it might just decide to kill the patient if you do that. Let's talk about a lesser common cause of shock. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Cite this podcast as: Briggs, Blake; Husain, Iltifat. Episode 174. Cardiogenic Shock. April 30th, 2023. https://www.emboardbombs.com/podcasts/174-cardiogenic-shock-the-heart-doesnt-care-about-your-sepsis-protocol. Accessed [date]

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. It's Fri-YAY. Here is one episode our current premium subscribers are enjoying. We want to give you a taste of what Rapid Bombs is all about. With ITE around the corner for EM residents everywhere, it's time to show you why everyone is using EM Rapid Bombs to prepare for not just the test, but #EMlife.

Dr Stephen Mullen talking about the Hypotensive Trauma Patient. This talk is part of the Paediatric Emergencies 2022 event. To get your CME certificate for listening to this podcast please visit https://www.paediatricemergencies.com/conference/paediatric-emergencies-2022/

In this session we will examine the bleeding patient in the tactical and combat environment. We will dig into some of the fundamental education that has changed practice in recent years, we will also look at the sequential approach to bleeding control, second and third generation haemostatics, pharmacological agents, tourniquets, neck zones and injuries, blunt injury and junctional wounds, hypotensive management and finally pain management in the combat arena. We also examine the utility and success of highly interventional skills at or near point of wounding such as REBOA. Finally we will examine Traumatic Cardiac Arrest (TCA) and the utility (or not) of an algorithmic approach to management. To do this, Ed Barnard joins me. Ed is an emergency medicine consultant within Cambridge University hospital and has undergone sub-specialty training in pre-hospital EM, working in more than five EMS systems, educating and mentoring medical students and doctors in training, giving national and international lectures, delivering a national research and clinical innovation meeting, completing a PhD from a top-100 research university, publishing over 30 journal articles, receiving five national-level research awards, and being appointed as a Senior Lecturer for the military. Topics covered: Sequential approach to arresting bleeding Look at second/third/fourth generation haemostatic compounds (celox, quik-clot) Utility of tourniquets (origins, usage and types) Neck zones and wounds Blunt injury and junctional wounds Hypotensive mx - utility of this Critical Hypovolaemia and tx modality Interventions at point of wounding - REBOA TCA management and algorithmic approaches Ed's reflections and perspectives over the past 5 years on bleeding Some of the concepts and evidence that Ed mentions in the episode can be found here: A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526509/ The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry https://militaryhealth.bmj.com/content/164/3/150.abstract Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis https://www.sciencedirect.com/science/article/abs/pii/S030095721630538X Please enjoy this episode with an insightful and engaging guest.

Trade: NormodyneClass: Beta blocker MOA:  Binds with beta1, beta2 and Alpha1 receptors. Inhibits the strength of the hearts contractions, as well as heart rate. This results in decrease in cardiac Oxygen consumption. Indication: ACS, SVT, severe HTNContraindications: Hypotension, Cardiogenic shock, acute pulmonary edema, heart failure, severe bradycardia, Sick sinus syndrome, second or third degree heart block, bronchospasm. Side effects: Usually mild, Hypotensive symptoms, N/V, Bronchospasm, arrhythmia, bradycardia, AV blockDosing: Adult 10mg IV/IO Over 1-2mins may repeat every 10 mins to a max dose of 150mgPedi 0.4-1mg/kg per hour to a max dose of 3mg/kg per hour

In this VETgirl online veterinary continuing education podcast, we interview Dr. Deborah Silverstein, DACVECC, Professor of Critical Care and Dr. Nolan Chalifoux, ECC resident, at University of Pennsylvania PennVet on their recent study "Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012-2019)." Tune in to find out if cats respond to IV fluid resuscitation when hypothermic, hypotensive, and critically ill, and learn more about all things fluid therapy in cats!

The Hypotension Prediction Index is rapidly gaining a well deserved place in the hands of modern perioperative practitioners. Here we look at the history of this tool, why it is needed so badly and how it has developed. Many of the conversations referenced in this piece are worthy of further attention. The clips used are taken from the following TopMedTalk programmes: Live from Boston ASA 2017 – The Elephant In The Room – intraoperative hypotension: https://www.topmedtalk.com/live-from-boston-asa-2017-the-elephant-in-the-room-intraoperative-hypotension/ Intraoperative Hypotension: https://www.topmedtalk.com/intraoperative-hypotension/ ASA 2019 | Perioperative Quality Initiative P.O.Q.I. news https://www.topmedtalk.com/asa-2019-perioperative-quality-initiative-p-o-q-i-news/ ASA 2019 | Hypotension Index: Data drives change https://www.topmedtalk.com/the-hypotension-prediction-index-hpi/ The Roundtable | The Hypotension Prediction Index (HPI) https://www.topmedtalk.com/the-roundtable-the-hypotension-probability-index-hpi/ EBPOM 2018 | Hypotension probability in practice https://www.topmedtalk.com/ebpom-2018-hypotension-probability-in-practice/ Prehab Periop World Congress: Feras Hatib, Simon Davies https://www.topmedtalk.com/prehab-periop-world-congress-feras-hatib-simon-davies/ The Hypotension Prediction Index (HPI) https://www.topmedtalk.com/the-hypotension-prediction-index-hpi/ The picture features TopMedTalk in conversation with Thomas Scheeren, Chair Cardiovascular Dynamics Section at European Society of Intensive Care Medicine (ESICM). TopMedTalk is proud to act as the broadcasting arm of Evidence Based Perioperative Medicine (EBPOM) - our world famous conferences continue to grow in size and scope as the COVID recovery gets underway -, find out more here: www.ebpom.org

The Hypotension Prediction Index is rapidly gaining a well deserved place in the hands of modern perioperative practitioners. Here we look at the history of this tool, why it is needed so badly and how it has developed. Many of the conversations referenced in this piece are worthy of further attention. The clips used are taken from the following TopMedTalk programmes: Live from Boston ASA 2017 – The Elephant In The Room – intraoperative hypotension: https://www.topmedtalk.com/live-from-boston-asa-2017-the-elephant-in-the-room-intraoperative-hypotension Intraoperative Hypotension: https://www.topmedtalk.com/intraoperative-hypotension/ ASA 2019 | Perioperative Quality Initiative P.O.Q.I. news https://www.topmedtalk.com/asa-2019-perioperative-quality-initiative-p-o-q-i-news/ ASA 2019 | Hypotension Index: Data drives change https://www.topmedtalk.com/the-hypotension-prediction-index-hpi/ The Roundtable | The Hypotension Prediction Index (HPI) https://www.topmedtalk.com/the-roundtable-the-hypotension-probability-index-hpi/ EBPOM 2018 | Hypotension probability in practice https://www.topmedtalk.com/ebpom-2018-hypotension-probability-in-practice/ Prehab Periop World Congress: Feras Hatib, Simon Davies https://www.topmedtalk.com/prehab-periop-world-congress-feras-hatib-simon-davies/ The Hypotension Prediction Index (HPI) https://www.topmedtalk.com/the-hypotension-prediction-index-hpi/ The picture features TopMedTalk in conversation with Thomas Scheeren, Chair Cardiovascular Dynamics Section at European Society of Intensive Care Medicine (ESICM). TopMedTalk is proud to act as the broadcasting arm of Evidence Based Perioperative Medicine (EBPOM) - our world famous conferences continue to grow in size and scope as the COVID recovery gets underway -, find out more here: www.ebpom.org

The #ProjectSmackdownTeam discusses creating Absite Smackdown! version 3.0 and what to do with a persistently hypotensive trauma patient. Discussion of trauma case starts here: 12:55 Free Absite Review lectures and ebooks here: https://linktr.ee/daily.absite.fact

Patient looking rough? Tachycardic? Hypotensive? Don't know what to do next? Shook? Fear not: Dr. Welsh, a pediatric critical care medicine doctor and Medical Director of the Hasbro Children's Hospital Pediatric Intensive Care Unit at Brown University. Dr. Welsh spends a golden hour with us to teach on the diagnosis, treatment, and management of septic shock, cardiogenic shock, neurogenic shock, adrenal insufficiency, and more! 

In this conversation with Ben Watts we look at the sequential approach to arresting bleeding. We also examine the second/third generation haemostatic compounds (celox, quik-clot), pharmacological agents such as TXA, FFP, FDP, blood, cryoprecipitate. We also examine the utility of tourniquets (origins, usage and types), neck zones and wounds, Blunt injury and junctional wounds, Hypotensive management and Pain management modalities and preferential agents. Ben is a specialist retrieval practitioner/CCP working in Scotland and previously as a CCP in the Thames Valley and before this in South West of England. He also has an extensive history of expedition work in various international locations, I first met Ben whilst working for World Extreme Medicine as a fellow paramedic and he has been a contributor to both WEMcast and to the College of Paramedics podcast. I hope you enjoy this wider ranging conversation as much as we did.

80 mmHg","type":"unordered-list-item","depth":0,"inlineStyleRanges":[{"offset":0,"length":36,"style":"ITALIC"}],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"56arn","text":"Both recommendations received a Grade 1C recommendation, meaning it was a recommended practice. However, this was a recommended practice for each respective clinical presentation, not with both etiologies present at the same time (Spahn, et al., 2019). What the literature has suggested from numerous pre-hospital and in-hospital studies is that reduced or restricted fluid administration in trauma was shown to be less harmful overall than large volume resuscitation (Carrick, et al., 2016). For patients presenting with both insults, it is necessary to accommodate both management strategies.","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"8omnf","text":"","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"ddm55","text":"TBI insult and subsequent management should take priority over the hypotensive approach for hemorrhage as any single episode of hypotension increases the mortality to nearly 50%. ","type":"unstyled","depth":0,"inlineStyleRanges":[{"offset":0,"length":178,"style":"ITALIC"}],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"76a2f","text":"","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"6f7l3","text":"To accommodate both, the MAP should be kept near 80 mmHg with limited fluid resuscitation to achieve that status. Secondarily, patients with TBI and hemorrhagic shock were also found to have worsening coagulopathy compared to those with TBI and hemorrhagic shock alone (Galvagno, et al., 2017). Furthering the premise that maintaining a fluid restriction resuscitation along with a MAP at or just above 80 mmHg in a patient with both insults is theoretically the best way to manage these patients. This is a field of medicine that does require future studies for best practice advice. ","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"fqgup","text":"","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{}},{"key":"4qjjn","text":"In this podcast, I sit down with Tyler & Sam to discuss TBI + Multisystem trauma management. ","type":"unstyled","depth":0,"inlineStyleRanges":[{"offset":0,"length":93,"style":"{"FG":"#000000"}"},{"offset":0,"length":93,"style":"BOLD"}],"entityRanges":[],"data":{}}],"entityMap":{}}"> It was a quiet afternoon in Bentonville, Arkansas. 8 pm and you hear dispatch crackle over the radio and summon your station to respond for a motor vehicle accident at SW Regional and SW I street. Multiple reports of persons ejected”. As you arrive on the scene, you note two teenage patients ejected 50-75 feet from where the accident occurred. It appears they were traveling at a high rate of speed through a red light and were struck by another vehicle. You approach a motionless patient lying prone on the pavement, you note obvious head trauma, and presume multi-system trauma given the mechanism of injury. Your first blood pressure reveals a MAP of 55 and the pelvis is unstable.   While we know aiming for a normal blood pressure in the presence of non-compressible hemorrhage is likely not ideal, a primary concern for this patient is that permissive hypotension may compromise cerebral perfusion pressure (CPP) and put the patient at further risk of a secondary brain injury.   A single episode of hypotension in the TBI patient nearly doubled their mortality (Spahn, et al., 2019).   The clinical conundrum most emergency medical providers face is having to manage both injuries and the repercussions of both management strategies.   The European Guidelines on Management of Major Bleeding and Coagulopathy following Trauma: Fifth Edition published the following recommendations: For hemorrhagic shock: Hypotensive fluid resuscitation with a goal of a systolic blood pressure between 80-90 mmHg (MAP of 50-60 mmHg) without evidence of brain injury For TBI: Maintain a MAP of > 80 mmHg Both recommendations received a Grade 1C recommendation, meaning it was a recommended practice. However, this was a recommended practice for each respective clinical presentation, not with both etiologies present at the same time (Spahn, et al., 2019). What the literature has suggested from numerous pre-hospital and in-hospital studies is that reduced or restricted fluid administration in trauma was shown to be less harmful overall than large volume resuscitation (Carrick, et al., 2016). For patients presenting with both insults, it is necessary to accommodate both management strategies.   TBI insult and subsequent management should take priority over the hypotensive approach for hemorrhage as any single episode of hypotension increases the mortality to nearly 50%.   To accommodate both, the MAP should be kept near 80 mmHg with limited fluid resuscitation to achieve that status. Secondarily, patients with TBI and hemorrhagic shock were also found to have worsening coagulopathy compared to those with TBI and hemorrhagic shock alone (Galvagno, et al., 2017). Furthering the premise that maintaining a fluid restriction resuscitation along with a MAP at or just above 80 mmHg in a patient with both insults is theoretically the best way to manage these patients. This is a field of medicine that does require future studies for best practice advice.   In this podcast, I sit down with Tyler & Sam to discuss TBI + Multisystem trauma management.

Bradycardic? Hypotensive? Keep the agent discussed in this week's episode in mind when reviewing your patient's medication list.References:Rains J, Kesterson J. Ocular timolol as the causative agent for symptomatic bradycardia in an 89-year-old female. Am J Emerg Med. 2020; Article in PressAbbas SA, Hamadani SM, Ahmad U, et al. Ophthalmic timolol and hospitalization for symptomatic bradycardia and syncope: a case series. Cureus. 2020; 12(3): e7270Wang Z, Denys I, Chen F, et al. Complete atrioventricular block due to timolol eye drops: a case report and literature review. BMC Pharmacology and Toxicology. 2019; 20: 73

In this Turbo Dose, Matt and Joe discuss a structured approach to the hypotensive patient covering assessment, management and key causes

Magnesium is hypotensive, a natural blood thinner and allows structural flexibility for the blood cells passage in the arteries.For Transdermal Magnesium in Glass bottles "Zechstein Inside®" or for our free health tips, books or podcasts come check us out at : theheartoftradition.comFor 10% off try the promo code : HEART10

When it comes to diet, water, medicine, awareness, nature immersion, movement, hormesis, community, and ancestral technologies, not many folks know quite as much as my guest on today's show: Arthur Haines. Arthur is a Maine hunting and recreation guide, forager, ancestral skills mentor, author, public speaker, and botanical researcher. He grew up in the western mountains of Maine, a rural area that was home to swift streams known for their trout fishing. He spent most of his childhood in the Sandy River Valley hiking, tracking, and foraging. Arthur now runs the Delta Institute of Natural History in Canton, Maine, where he teaches human ecology, focusing on the values of foraging, wildcrafting medicine, and primitive living skills. His series of YouTube videos has inspired thousands of people interested in foraging wild edible and medicinal plants. Arthur recently authored a very big book that I thoroughly enjoyed, entitled “”. This guide is a comprehensive work on nature connection and rewilding, detailing how to incorporate ancestral practices into modern living. During our discussion, you'll discover: -The criteria by which humans have become "domesticated"...7:38 Altered temperament -- milder than in the natural state Cows originated from aurochs (now extinct), which were very fierce Altered social hierarchy (establish that humans are in authority) Our ancestors lived a more egalitarian lifestyle than we do today Altered diet  Diet today is far different, oftentimes poorer in quality The ability to breed in captivity Humans consider pregnancy/giving birth to be an ailment 99% are institutionalized; take moms out of their most comfortable habitat Arthur maintains that humans display all of the above traits of domesticated animals -How fit were our hunter/gatherer ancestors...14:00 Very active lifestyle out of necessity, depending on resource density (still exist in N. America) estimated to travel over a million acre home range over the course of a year What we travel on foot today is a fraction of that 10k steps a day would be close to the average of hunter/gatherers (5-10 miles per day) Arthur does not engage in any type of self-quantification Draw weight of bows among our ancestors: The more energy required to bend the bow, the more energy can be imparted to the arrow Most bows today are ~50 lb. draw Bows of hunter/gatherers were much higher; ~70 lb. The highest recorded were over 130 lbs. -The calorie consumption and burn of our ancestors, contrasted with the modern office worker...23:40 Recent studies have conflicting results; some say it's the same, others say it's far less today Humans tend to be bigger today than in ancestral times; results in more calorie expenditure Hunter/gatherers spent far more calories moving Calorie expenditure today due to complexity of the food Diversity of movement in ancestral times is lost in the modern gym or fitness center -Arthur's personal fitness or movement routine...29:40 Lots of walking; humans are meant to walk with episodes of running Paddling or carrying canoes Grains are milled by hand "Active lifestyle with bouts of athleticism" Brazilian jiu jitsu 1-2 times per week High Intensity Repetitive Training, HIRT (was mentioned in ) Moving a killed animal over terrain "True cross fit" training can be found in everyday life, particularly in hunting -How indigenous diets fit within the context of the modern ketogenic or carnivore diets...42:00 Be aware of biological norms 97% of our time on the earth has been as hunter/gatherers Homo sapiens have been shown to be as old as 315,000 years Domesticated human diet for just a short time Wild plants were a huge component of their diets (~60%) Ancestors were not in ketosis on a regular basis Low carb diet is a "new" diet It is efficacious in treating things like epilepsy, not so much as a weight-loss strategy -Arthur's thoughts on the carnivore diet as a sustainable lifestyle choice...51:48 No group of people in history have ever been pure vegetarians Some have eaten mostly meat due to necessity Plants can't be grown due to climate/terrain, etc. However, they would gather plants in large quantities when available Large proportion of Vitamin C would come from plants Diet can be an actual therapy; drugs just cover the symptoms Plants can help us fight off the deleterious aspects of nature (sun exposure, toxins in the air, etc. -How the variety of species of plants that we currently consume compares to what our ancestors would have eaten...1:00:40 Plants are edible for a finite amount of time in the wild; a natural protective mechanism as a result Hypotensive and hypertensive compounds in the same plant; certain suites of plants win out depending on the person Average # of plants consumed by American diet is 30, Many of them are only one species; ex. collards, Brussels sprouts, cauliflower, kale, are the brassica oleracea species No real diversity in the diet  have been documented to ingest 40+ different plant foods; more than the average American diet Over 100 foods in warmer climates -How the micronutrient or vitamin content in modern produce compares to wild plants...1:05:00 Stark contrast between wild and cultivated Minerals Vitamins Sometimes up to 100x more than what we find in the store Small berries have more skin; large berries are counterproductive Dillution effect: Individual fruits end up with lower mineral content than what's found in the wild Are backyard gardens wild or cultivated plants? Difference in genetics of most cultivated species Lettuce has been tampered with; it's more bitter in the wild Difference between organic and conventional (sprayed) produce When we tend plants, they don't need to work as hard to protect themselves Seedless grapes don't have nearly the same nutritional value More fiber in wild foods than in cultivated "Minimally modified plant foods" means eating closer to the wild What about grains? What is making the grains we consume today bad for us? Evidence of grain consumption up to 105,000 years ago Stone ovens that are 30,000 years old Diversify, properly prepare, choose the right type of grains -Ancestral skills Arthur believes fully re-wilded modern humans should have...1:22:15 Hunter/gatherer is not a viable goal The entire goal is sovereignty: to lose  our dependence on industrial society Begin with recovering your health: diet, movement, exposure to toxins, etc. Don't worry about how much or how little you know Primitive living schools are becoming more common (avoid the prepper schools) -And much more Resources from this episode: -Book: - - - - - - - Episode Sponsors: -: Join us on our 5-Day Meditation Challenge from 15-19 July! Ben Greenfield Fitness listeners receive a 10% discount off their entire order at Kion when you use discount code: BGF10. -: A new take on an ancient secret: Pain-soothing herbs, incredible antioxidants, and phytonutrients all in one delicious, soothing “Golden Milk” nighttime tea! Receive a 20% discount on your entire order when you use discount code: BENG20. -: You can be sure that I researched all the saunas before I bought mine and Clearlight was the one that stood out from all the rest because of their EMF and ELF Shielding and their Lifetime Warranty. Use discount code: BENGREENFIELD to get $500 off your sauna and a free bonus gift! -: Quality is our Gimmick isn’t just our slogan, it’s a commitment we honor with every stitch we sew. 100% money back guarantee. Get 10% off your order, PLUS free shipping on any order over $99 when you use discount code: BENG. Do you have questions, comments or feedback for Arthur or me? Leave your comments below and one of us will reply!  

Ketamine and trauma are the topics for this months papers. The three papers we cover are really important for all of us involved in the care of critically unwell patients. Hypotensive resuscitation in the context of trauma has been an evolving area of practice in the treatment of our acute trauma victims. A paper published in SJTREM this month meta-analyses the data that exists out there on the topic and looks to give us an idea of the benefits and potential risks associated with such an approach, the paper is available here and is well worth a full read. Morphine has been a mainstay of the treatment of acute severe pain in the Emergency Department for decades, but as the popularity of ketamine grows we take a look at another meta-analysis, this time comparing the efficacy of ketamine versus morphine in this setting and group of patients. And lastly, if you have ever had a patient become severely agitated with ketamine sedation, you'll be keen to avoid that happening again! The last paper we look at is a randomised control trial looking at the potential benefits of using either midazolam or haloperidol to achieve that. We hope you find the podcast useful, as ever please go and take a look at the papers yourself and we'd love to hear any thought or comments you have either rat the bottom of the page, or via twitter @TheResusRoom. Enjoy! Simon & Rob References Risks and benefits of hypotensive resuscitation in patientswith traumatic hemorrhagic shock: a meta-analysis. Owattanapanich N. Scand J Trauma Resusc Emerg Med.2018  A Systematic Review and Meta-analysisof Ketamine as an Alternativeto Opioids for Acute Pain in the Emergency Department. Karlow N. Acad Emerg Med.2018 Premedication With Midazolamor Haloperidolt o Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double Blind Clinical Trial. Akhlaghi N. Ann Emerg Med.2019  St Emlyns; JC: Should we premedicate for ketamine sedation?  

Exsanguination and brain injury are the leading causes of death after major trauma. During the last decades, significant progress has been made in the fight against haemorrhage. Nevertheless, the window of opportunity is still small, and the golden hour of shock more fiction than fact. Hence, the majority of trauma patients is still lost on the street and during the first hour after hospital admission. Moreover, trauma is an increasing epidemiologic burden worldwide. Pre-hospital emergency care plays an essential role when distances are long and immediate damage control is key. Since evidence of established interventions (i.e. fluid resuscitation or vasopressor use) is spare, we summarized currently available trauma care guidelines, and elaborated a best practice advice for massive bleeding comprising a five-step approach: First identification, on-going monitoring and appropriate notification of the receiving hospital. Second, control of haemorrhage by tourniquets and pelvic splints; and advanced interventions, such as emergency resuscitative thoracotomy and resuscitative endovascular balloon occlusion. Third, target controlled fluid resuscitation within the concept of hypotensive resuscitation in order to prevent hypovolemic cardiac arrest during the pre-hospital phase. Fourth, pharmacologic interventions employing vasopressor drugs and medication for coagulation management. Fifth, avoiding mistakes in anesthetized and ventilated patients with critical intravascular volume status, as well as means to counteract inadvertent hypothermia. Finally, a minimum data set allowing retrospective analysis and system comparison is needed. In conclusion, code red protocols are key in order to reduce pre-hospital care to the max and to pave the way to major trauma care. Current concepts of trauma care with a strong focus on the C-ABC (Circulation-Airway-Breathing-Circulation) approach, hypotensive resuscitation, haemostatic resuscitation and damage control surgery improve survival after major trauma.

I had such a fun time chatting on the phone with Dan about medicine.  Total recorded time was 2 hours that I had to edit down to this current episode.  His story from childhood to how he became one of the administrators for a surgical group in one of the biggest hospital systems in California is enriching.  He is a true inspiration.  Thanks Dan! Physician Assistant Stats:* Physician Assistants practice medicine on teams with physicians and other healthcare workers. They examine, diagnose, and treat patients autonomously and as part of a team in all various specialties of medicine.   2017 Median Pay: $104,860 per year ($50.41 per hour)   Educational Degree: Masters Degree   Number of US jobs in 2016:106,200   10 Year Job Outlook: 37% growth, much faster then avg.     *Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physician Assistants, (visited August 5, 2018).     Terms Covered in Episode Navy A School   Corpsman - Enlisted medical specialist   Lipoma - Overgrowth of adipose tissue (fat) creating a benign tumor often located between skin and muscle layer.   Eugene Stead Jr. MD   CT Surgery - Cardiothoracic surgery deals with issues of the thorax, generally the heart and lungs.   Trauma Surgery - Surgical field dealing with acute traumatic injuries such as falls, motor vehicle crashes, gunshots, blunt and penetrating injuries, etc.   ICU (Intensive Care Unit, Critical Care Unit, or Intensive Therapy/Treatment Unit) - Part of the hospital with the sickest patients requiring the most intervention from both staff and equipment.  May consist of intubated, sedated, and ventilated patients.   Call - To be available on your “off time” for phone calls, patient visits, surgeries, emergencies, etc that varies by job.   Open Surgery - Traditional way of surgery going through the layers of the body to operate.   Endoscopic Surgery - Surgery utilizing cameras, smaller openings and temporary ports in the body to pass through instruments in a tight space allowing for less pain and quicker recovery.   Vein Harvest - Generally endoscopic removal of a vein to replace a coronary artery (cardiac bypass)   Bypass - Surgical procedure to restore blood flow to the heart after an obstruction occurs.   Cardiac Graft   BP (Blood Pressure) - Force of blood against the arterial walls.   Recovery - Phase after surgery when anesthesia is wearing off and patient is being monitored before being sent home with family or admitted to the hospital.   Punch Biopsy - Small round biopsy (cut) taken to identify the cause of abnormal tissue.   Hernia - Bulging of an organ (intestines) through an abnormal opening.   ENT Surgery - Ear, Nose, and Throat.  Various procedures involving the head.   MBA - Masters of Business   UCSF Neuroscience   Medicare - Government provided healthcare insurance to those over 65, young people with disabilities, and people with end stage renal disease.   401k - Retirement plan.   Western Governors University   Bedside Manner - approach or attitude towards a patient.   Neurosurgery - Surgery dealing with the Nervous System (brain and spine).   Trauma LVL 1 Center - Hospital able to provide total care for every aspect of injury.  Large facility with all types of staff including Residents.   Cerebral Stenosis - When artery inside the brain that becomes blocked by plaque or disease.   TPA (Tissue Plasminogen Activator) - Protein involved in the breakdown of blood clots.   Aneurysm - Ballooned and weaker area of an artery.   CVA (Cerebral Vascular Assault) - Stroke.  Damage to the brain from a loss of blood flow.   Ischemic CVA - loss of blood flow from a blockage.   Hemorrhagic CVA - loss of blood flow from a blockage a ruptured aneurysm.   Elective Surgery - Nonemergent scheduled surgery   Discectomy - Surgical removal of whole or part of a intervertebral disc.   Fusions - Surgery to join two or more vertebrae together.  Done for fractures, deformities, instabilities, slipped vertebrae, or herniated disk.   ACDF (Anterior Cervical Discectomy & Fusion) - Discectomy of the cervical spine (neck) with fusion to decompress the spinal cord and nerve roots of the cervical spine.   Neuroaxis (Neuraxis) - Central Nervous System   Tumor - Abnormal growth of cells   Resection - to surgically remove   Spine Stabilization - Surgery to stabilize the spine with more flexible materials then traditional fusion.   Angio - technique used to visualize inside blood vessels.   MRI (Magnetic Resonance Image) - Medical Imaging using magnets to see deep layers of the body.   Space Occupying Lesion - abnormal mass in the brain usually due to cancer, but may be abscess (infection) or hematoma (blood).   Glioblastoma - Rare very aggressive and fatal cancer of the brain or spine.   Code Yellow - Phrase used over PA system of hospital when Trauma Patient is coming to the ER.  To alert the hospital to assemble the Trauma Team and support staff to receive the patient.   Hypotensive - lower then normal blood pressure.   Chest Tube - tube placed in the chest cavity to evacuate blood, pus, or air.   Central Line - Larger then an traditional IV placed into a main vein of the body. Thoracotomy - Opening into the chest wall.   Finochietto (Rib Spreader) - Used to get a better window/view into the chest cavity the pushes the ribs aside.   Pericardial massage - Manually pumping the heart with a hand in the chest cavity.   Each and every episode of Maybe Medical is for educational purposes only, not to be taken as medical advice.  The opinions of those involved are of their own and not representative of their employer.

Acute heart failure (AHF) is defined as rapid onset of new or worsening signs and symptoms of heart failure. It represents a life-threatening condition requiring treatment for fluid overload and hemodynamic compromise. Presentation may be initial diagnosis with symptoms and signs of AHF or acute decompensation of pre-existing cardiomyopathy. Hemodynamic instability results from disorders of the myocardium, valves, conduction system or pericardium, in isolation or combination. Potentially treatable causes, e.g. acute coronary syndromes, must be diagnosed and managed early for restoration of function.   Physiological changes associated with AHF result in reduced cardiac output and end-organ hypoperfusion. Once potentially treatable causes are managed, stratification of patients by clinical presentation guides further therapeutic intervention. AHF patients can be categorized as either ‘wet’ or ‘dry’ by clinical fluid status assessment, and either ‘cold’ or ‘warm’ according to perfusion status. In combination, these features identify four patient groups (‘warm-wet’, ‘warm-dry’, ‘cold-dry’, ‘cold-wet’) that guide therapy and facilitate prognostication. ‘Warm-dry’ patients rarely require intensive care for AHF treatment but may benefit from escalation of oral therapeutic regimen. Patients who examine as ‘cold-dry’ may benefit from fluid challenge, and/or inotropic agent infusion. ‘Warm-wet’ patients present with predominantly congestive or hypertensive symptoms which benefit from diuresis and vasodilatation. Patients who present ‘wet-cold’ with normal blood pressure (SBP >90) may benefit from vasodilators and diuretics, with inotropic agents for refractory symptoms. Hypotensive ‘wet-cold’ patients (classic cardiogenic shock) require inotropy with or without vasopressor agents, effective diuresis and early consideration of mechanical circulatory support (MCS).  Definitive therapies for AHF depend on underlying cause, and may include coronary artery intervention, valve repair, rhythm control to restore atrio-ventricular synchrony or management of pericardial tamponade. Patients with severe AHF not responsive to standard therapies should be considered for temporary MCS while candidacy for more durable option is explored by the multi-disciplinary team.  

In this VETgirl online veterinary continuing education podcast, we review the significance of lactate levels in hypotensive cats in the ICU. Can lactate be a prognostic factor for survival?

In this VETgirl online veterinary continuing education podcast, we review the significance of lactate levels in hypotensive cats in the ICU. Can lactate be a prognostic factor for survival?

Patients with TBI (traumatic brain injury) often have concomitant systemic injuries that complicate the management of the TBI. How does the practitioner balance the needs of the hypotensive resuscitation with CPP? How does ICP affect emergent operative needs? Thoracic injuries complicate cerebral oxygenation - are there effective management strategies? Where is the best place to care for these patients?

In this episode, we discuss an interesting study which was recently published in the Journal of Trauma and Acute Care Surgery (see link below) with the study’s lead author, Dr. Matthew Carrick, and the senior author, Dr. Kenneth Mattox.  Drs. Carrick and Mattox describe the extension of the hypotensive resuscitation paradigm beyond the trauma bay and into the operating room, as well as some details about how they were able to accomplish this prospective, randomized trial with exception from informed consent.  In characteristic form, Dr. Mattox also challenges the audience to take on more areas of untested dogma — what he calls the “sacred cows” of patient care — and to make an impact in clinical science research. Article ReferencedCarrick MM, Morrison CA, Tapia NM, Leonard J, Suliburk JW, Norman MA, Welsh FJ, Scott BG, Liscum KR, Raty SR, Wall MJ Jr, Mattox KL. Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective clinical trial. J Trauma Acute Care Surg. 2016 Jun;80(6):886-96.http://www.ncbi.nlm.nih.gov/pubmed/27015578

Now it’s time to bust out some clinical content and talk resuscitation.  You can start today!  You don’t need fancy equipment or tools.  Just reach down and grab something, use a Foley and you’re there…and as a special bonus, you get a little intro on hypotensive resuscitation and why it may not be all that for the long haul…Drs. Phil Mason and Chris Burns are interviewed by Justin.