Podcasts about ICU

This episode covers renal support in the intensive care unit.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/renalsupport/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

Why are children suddenly presenting with hepatitis of unknown cause? Find out about this and more in today's PV Roundup podcast.

TRIGGER WARNING: murder, drug abuse, opiate use and overdose, domestic abuse Want this episode Ad-Free: Join our Patreon for as little as $3/month and get all episodes Ad-Free! On Monday, March 2, 2020, Steven Nix called his sister-in-law, Brittany Noojin, at work. He nonchalantly told her that her sister had tried to kill herself, and that she should come over. Brittany arrived at her sister's home to find that first responders were stopping resuscitation efforts and pronouncing her 32-year-old sister, Breana Noojin Nix, dead. The autopsy stated that it was an accidental death caused by an overdose of the opiate Fentanyl. Breana's family was stunned. The beautiful, bright, ICU nurse was not a drug user and had never expressed thoughts of suicide. Less than six months later, Breana's husband, Steven, had his ex-girlfriend move into his home and was living comfortably off the money paid to him from Breana's life insurance policy. By this time, the Noojin family knew that Breana's death was not an accident and strongly believed that Steven was behind it. Police, however, supported the ruling of accidental death, forcing the Noojin family to start their own investigation into what was so obviously the MURDER of Breana Noojin Nix. Want access to our first 45 episodes? Grab em here! We've made them available for free to anyone who signs up! Remember, these episodes were recorded when we had no idea what we were doing, so just keep that in mind. The audio isn't the quality we would want to put out now, but the cases are on point! Visit killerqueens.link/og to download and binge all the archived episodes today! Hang with us: Follow Us on Instagram Like Us on Facebook Join our Case Discussion Group on Facebook Get Killer Queens Merch Bonus Episodes Support Our AMAZING Sponsors: Credit Karma: Head to creditkarma.com/loanoffers to see personalized offers. Rothy's: Your new favorite shoes are waiting. Discover the versatile styles you can wear absolutely anywhere and get $20 off your first purchase at rothys.com/QUEENS. Betterhelp: Killer Queens listeners get 10% off their first month at BetterHelp.com/queens. Lumi: Microdose is available nationwide.To learn more about microdosing THC just do a quick search online or go to Microdose.com and use code: QUEENS to get free shipping & 30% off your first order. © 2021 Killer Queens Podcast. All Rights Reserved Audio Production by Wayfare Recording Music provided by Steven Tobi Logo designed by Sloane Williams of The Sophisticated Crayon

Today we are getting behind the mic with Everett Moss, BSN, SRNA, EMT-P. He is a nurse, nurse anesthetist student set to graduate in 2023. Former Atlanta firefighter and EMT turned flight, emergency, ICU and travel nurse who is now a CRNA student. We are going all over today! Everett has captured his social media audience by candidly sharing his journey into nursing. He provides a compelling case for entering the nursing profession and the tremendous opportunities that exist. He is an inspirational male figure attracting more men into the nursing field. Coined THE PARAMURSE on Instagram, Everett sets the stage for a modern-day view of the nurse world. Men make up 9.1% of the nursing workforce nationally and 9% of the Nell H. Woodruff School of Nursing (NHWSN) student body. With the demographics continuing to shift in our country, it is essential that nursing keeps pace with national trends to reflect the diverse populations they serve. Today we want to highlight the importance of Diversity, Equity, & Inclusion!To connect with Everett Moss clickhttps://www.instagram.com/ryannpdatsme/ ( )https://www.instagram.com/the_paramurse/ (HERE) To connect with Tori click https://www.instagram.com/nurse.tori_/ (HERE)  To connect with Sam click https://www.instagram.com/heysamanthaa/ (HERE) To connect with Cellfie Show click https://www.instagram.com/cellfie_podcast/ (HERE) Rate and Review the Show to Claim your Cellfie Swag Bag! https://podcasts.apple.com/us/podcast/the-cellfie-show/id1500843605 (HERE) Check out our Cellfie Show collab sock!!!  https://www.upatdawn.co/collection/cellfie-show-x-up-at-dawn-collab (SHOP UP AT DAWN X CELLFIE SHOW CLICK HERE) https://www.cellfiepodcast.com/ (Cellfie Show ) https://www.cellfiepodcast.com/shop-1 (Cellfie Podcast Merch)  Produced by: Tori + Sam  THIS EPISODE IS BROUGHT TO YOU BY PICMONIC (CODE: CELLFIE save 20%) Picmonic, Inc. is an audiovisual learning platform designed for healthcare students (RN, MD, DO, CNA, LPN, NP, PT etc) It is the study tool of choice for learning thousands of the most difficult to remember and most frequently tested topics, board exam prep and uses questions centered on an evidence-based “learn-review-quiz” format. Quick & effective 2-minute Picmonic videos Connects difficult to remember facts with unforgettable characters Ties the facts together into ridiculously memorable stories Reinforce what you learn and track your progress with thousands of built-in rapid review multiple-choice quizzes. Intelligent spaced-repetition algorithms automatically adjust to your learning needs, so you'll be reminded to review the right information, at the right time - increasing long-term retention. THIS EPISODE IS BROUGHT TO YOU BY CELLFIE STUDIOS  MAXIMIZE YOUR NURSING PROFESSION This 28 page eBook is a digital download that provides you with NURSE PRO TIPS to help you land that dream job! This is a fully loaded guide complete with the strategies to help you master your job application and interview process. We cover all of the juicy details to help you perfect the art of interviewing. https://payhip.com/CellfieStudiosLLC (THE COMPLETE NURSE INTERVIEW GUIDE TO LAND YOUR DREAM JOB! ) 

On this week's episode of Good Nurse Bad Nurse, Nurse Alice joins Tina to discuss the case of an ICU physician who was accused of prescribing colossal doses of painkillers to his patients. The physician's encounter with the law doesn't start there, however, as his past deeds come to the surface. The Good Nurse on this episode is none other than Nurse Alice! Tina commemorates Nurse Alice's contributions to the community.   Got FOMO? Fear not! Don't miss an episode of Good Nurse Bad Nurse! Subscribe on your favorite podcast platform! Please support our podcast by becoming a patron, just visit https://goodnursebadnurse.com/ to learn more! Feeling disconnected? Check out our socials and follow us on Facebook and Instagram. Facebook: Good Nurse Bad Nurse Podcast Instagram: @goodnursebadnurse  Check out our sponsors below! Thank you to our new sponsor HCA Healthcare! If you're a newly graduating nurse, please visit them at https://careers.hcahealthcare.com/pages/hca-healthcare-careers-for-new-graduate-nurses to learn about their nurse residency program! Thank you to Trusted Health for sponsoring this episode. Please go to https://www.trustedhealth.com/gnbn and fill out a profile to help support our podcast and see what opportunities are out there for you! Thank you to our sponsor Samuel Merritt University! If you're interested in getting more information on their MSN and DNP programs and scholarships visit them at fnp.samuelmerritt.edu and show them how much you appreciate them for sponsoring our podcast! Thank you to our sponsor CBD Stat! If you use CBD oils, please try CBD Stat and get 30% off high-quality CBD available at http://www.cbdstat.care/goodnursebadnurse And finally, thank you to our sponsor Eko! Please visit them at https://ekohealth.com and use promo code GNBN for $20 off your purchase of the new Littmann Cardiology IV stethoscope with Eko technology!   Sources https://heavy.com/news/2019/01/william-s-husel/    https://www.cnn.com/2019/12/31/us/husel-lawsuit-fentanyl-deaths/index.html    https://abcnews.go.com/Health/wireStory/prosecutor-discuss-doctor-accused-ordering-fatal-doses-63503134#:~:text=In%20one%20of%20the%20biggest%20cases%20of%20its,care.%20The%20deaths%20occurred%20between%202015%20and%202018.      https://people.com/crime/william-husel-doctor-accused-overdosing-patients-not-guilty/      https://m.youtube.com/watch?v=_x5wblBYc5U&feature=youtu.be   https://m.youtube.com/watch?v=mK_HekPKz5o&feature=youtu.be   https://m.youtube.com/watch?v=2DvXnHCu84g&feature=youtu.be https://m.youtube.com/watch?v=nK8ZvVcbjco&feature=youtu.be

Friends of the Rosary: Yesterday, one of the friends of the Rosary Network, Scherezada Morales Roman, from Orlando, Florida, told us about her youngest sister, Natasha Ramos Roman, 33 years old, who has been diagnosed with stage four cancer, metastatic cancer. She has two little ones, aged 5 and 1. The special intention of today's Rosary is for the recovery of Natasha. Scherezada and Natasha, we feel your pain. We also ask María Blanca to intercede for this lovely family. Fr. Ian, from St. Michael the Archangel Parish, in Greenwich, Connecticut, asked us to direct prayers to Maria Blanca, as we all believe she is with the Communion of Saints. Scherezada and Natasha, please be hopeful. God has always a plan – a good one. We won't understand it immediately; it might even take our whole life. My advice would be to pray and pray and trust in Jesus Christ and His Blessed Mother. Maria Blanca, who had an extremely painful four-week stay at the ICU, told me that God knows what He is doing. Please be hopeful while you embrace the Cross of the Savior. Ave Maria! Jesus, I Trust In You! + Mikel A. | RosaryNetwork.com, New York [ Second Year Anniversary | In the Memory of María Blanca ] • May 16, 2021, Today's Holy Rosary on YouTube — Daily broadcast at 7:30 pm ET

This episode covers cardiovascular support.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/cardiovascularsupport/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

438 I Know Your Tribulation, A Guided Christian Meditation on Revelation 2:9-11 with the Recenter With Christ app  I'm Chaplain Jared and I work as a hospice chaplain and an ICU chaplain. My purpose in making this podcast is to help you find more peace in your life and to be more open for your heart to be changed by the Spirit of God.  By using centuries old form of Christian Meditation named Lectio Divina: Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization. Get into a place where you can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tensing or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate, deflate. Bible verses for Meditation: Revelation 2 NABRE 9 “I know your tribulation and poverty, but you are rich. I know the slander of those who claim to be Jews and are not, but rather are members of the assembly of Satan. 10 Do not be afraid of anything that you are going to suffer. Indeed, the devil will throw some of you into prison, that you may be tested, and you will face an ordeal for ten days. Remain faithful until death, and I will give you the crown of life. 11 “‘“Whoever has ears ought to hear what the Spirit says to the churches. The victor shall not be harmed by the second death.”' ESV “‘I know your tribulation and your poverty (but you are rich) and the slander of those who say that they are Jews and are not, but are a synagogue of Satan. 10 Do not fear what you are about to suffer. Behold, the devil is about to throw some of you into prison, that you may be tested, and for ten days you will have tribulation. Be faithful unto death, and I will give you the crown of life. 11 He who has an ear, let him hear what the Spirit says to the churches. The one who conquers will not be hurt by the second death.' Meditation: God knows the suffering of his people. Just as in this scripture God knew the suffering of his saints in ancient times, so he knows your struggles. He knows how the world will go after good. Yet we can live without fear. Regardless of what the devil does we do not need to fear. Much of our human worries are about things that we cannot control. In this moment give those fears over to the Lord.  God has promised that those who trust in Him, those who come to Him, will be joint heirs with Christ. Regardless of our struggles we can remain faithful. Empowered by God we can do those things we need to do to overcome. We can embrace the peace of God.  The Second death refers to spiritual death, or our separation from God. Those who place their trust in God will not be harmed by the second death. We will overcome this world.    Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Updates:  2 MILLION DOWNLOADS Final Question: What role does the Word have in your life? This week I performed a funeral for a family from Africa. The amount of family that was physically present was not that large but there were many friends who were just as close as family in some ways and their presence and comfort was amazing.  Final Thought:   FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

This is Part 2 of my discussion with Jessica Nathanson on the differences between Unividualism and Nonduality. Now we have tea and biscuits, we really let go into a far reaching conversation, even more full of big ideas than Part 1. (If you haven't listened to Part 1 yet, check out last week's episode!)   These discussions can also be watched as a video on my YouTube channel, beautifully filmed by Rupert Truman, who previously created my WHAT IS LIFE? films.   Then on Sunday 22 May Jessica & I are going to have a discussion with my online community about these ideas. If you're not a member of the ICU, you're welcome to join us for this talk as a guest ... email my PA Jessica@timfreke.com

Episode 93: Hyponatremia treatment.    Catherine and Dr. Saito discuss how to treat hyponatremia in an effective and safe way, especially when the hyponatremia is severe.Introduction: What is sodium?By Hector Arreaza, MD. Read by Alyssa Der Mugrdechian, MD; and Gina Cha, MD.  Sodium is a white metal that does not exist in nature in its free form. In its solid form, it's so soft that you could cut it like butter with a knife. It is the sixth most common element in the earth's crust. Even though sodium only makes up to 0.2% of our body weight, it plays a key role in nerve conduction, muscle contraction, and most importantly regulating water balance. Today we will be talking about low sodium, known as hyponatremia. We will focus on how to treat hyponatremia and will mention some common causes and symptoms. We hope you can learn something from us today.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice.___________________________Hyponatremia treatment.   By Catherine Nguyen, MS4, Ross University School of Medicine. Comments by Steven Saito, MD; and Hector Arreaza, MD.  DEFINITION: Serum sodium concentration impairment in free water excretion > hypoosmolality of serum-Diuretics (thiazides first 1-2 weeks)  -SIADH (Syndrome of inappropriate ADH, I call it the syndrome of EXCESSIVE ADH to help me remember it), caused by common meds.-Heart failure (low cardiac output) & cirrhosis (arterial vasodilation impairment) > decreased tissue perfusion (baroreceptors in carotid sinus senses reduction in pressure) > stimulus of ADH-GI fluid loss (diarrhea, vomiting)-CNS disturbances (stroke, hemorrhage, infections, psychosis, trauma) > increases ADH release-Malignancies > ectopic production of ADH (small cell carcinoma)-Drugs > SSRI, carbamazepine, cyclophosphamide -Potomania > patient drinks large amounts of beer and decreased intake of foods (solids). PRESENTATION:-Asymptomatic-Nausea & malaise earliest findings (125-130)-Headache, lethargy, muscle cramps, confusion/AMS, and eventually seizures, coma, and respiratory arrest (115-120)-Acute hyponatremia encephalopathy may be reversible, but permanent neurologic damage or death can occur. TREATMENT: Clinic: Chronic cases of hyponatremia may require spread-out treatment. Hyponatremia is never normal. -Mild hyponatremia > concentration of 130 to 134 mEq/L: NO treatment with hypertonic saline. Rather, the initial approach includes general measures that are applicable to all hyponatremic patients (i.e., identify and discontinue drugs that could be contributing to hyponatremia; identify and, if possible, reverse the cause of hyponatremia; and limit further intake of water [e.g., fluid restriction, discontinue hypotonic intravenous infusions]. -Moderate hyponatremia > concentration of 120 to 129 mEq/L ASYMPTOMATIC - 50 mL bolus of 3 percent saline (ie, hypertonic saline) to prevent the serum sodium from falling further.SYMPTOMATIC – (call ICU) 100 mL bolus of 3 percent saline, followed, if symptoms persist, with up to two additional 100 mL doses (to a total dose of 300 mL); each bolus is infused over 10 minutes. -Severe hyponatremia > concentration of

This episode covers respiratory support.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/respiratorysupport/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

Crypto crash, Selma Blair's Cranbrook allegations, Andie MacDowell's panic attack, Andy Dick's missing blow, new Hudson's building renderings, a new Bonerline, former UofM president's sweet exit deal, Maz checks in, and Drew finally passes Screech.The Detroit Tigers are still terrible.Naomi Judd committed suicide by shooting herself. Ashley Judd found her body.It's official: BuFu > BooFoo. Jim Bentley tries to take credit, but is called out for being a liar.We learn ALL about Sheriff Rick Singleton- the 'hero' of the Alabama escaped convict case.We have a brand-new Legacy winner! Congrats to _____________!!!Mark Schlissel gets a sweetheart exit deal for stepping down as University of Michigan's President.Matt Damon is getting crap for roping people into crypto. Crypto bros are going broke. El Salvador doubles down because they have no currency. Your 401k is now a 301k.Due to fraudulent purchases, Drew has surpassed Dustin Diamond in Twitter followers. Congrats, Drew!Twitter is fired two top executives... including a guy that was out on paternity leave.Spain is giving women 'menstrual leave' and Drew is jealous.Andie MacDowell had to work with a bunch of guys when Donald Trump got elected and it gave her a panic attack. Now that she has your attention, she wants you to know about her movies that are coming out.Shanna Moakler is posting about "communal d**k". Dennis Quaid once nailed her. Check out Matthew Rondeau's veins right here.More Andy Dick video prior to his arrest. He really wants his missing cocaine.Cameo is losing money and firing staff... but there are still brand-new celebrities that need YOUR money.There are new renderings of what the Hudson's building is going to look like if it's ever built. It's a lot different than the one that was supposed to be done this year.Selma Blair was a drunk at 7 years old and claims the dean at Cranbrook sexually assaulted her.A tip in the Danielle Stislicki case is under scrutiny.If you're looking to get some baby formula, ask the illegal immigrants who have plenty.Tom Mazawey joins the show to preview the NFL schedule release, discuss the crappy Tigers, explain the shenanigans of the Mazawey girls at home, and make excuses for Rich Strike.Christian Yelich got another cycle and Marc poops all over the lucky anomaly.Buy these panties so you can eat infected boxes.Fun with COVID: St. Mary's Polish Country Fair is canceled due to COVID. We hit 1,000,000 deaths. Windsor's ICU infected are almost all fully vaccinated. Amber Heard's team brought up Kate Moss in the Johnny Depp trial and it may backfire on her. Wino Forever.Final Sports Notes: Twitter hates Leah Hextall calling NHL games. Daniella Bruce filled in for a sick Ken Kal earlier in the season. Manon Rhéaume remains smoking hot. Some hottie dropped her top at the Virginia Tech baseball game. The Savannah Bananas are the best baseball team in America.Social media is dumb, but we're on Facebook, Instagram and Twitter (Drew and Mike Show, Marc Fellhauer, Trudi Daniels and BranDon).

A FreshRN VIP asked a question Kati wanted to share with podcast listeners. The VIP currently works in an ICU as a CNA, and curious if it would be wise to work there as a new grad. Listen for Kati's perspective and some Q&A from her Instagram followers. To follow Kati on Instagram, . To sign-up as a VIP, . Music: "Keep My Cool" by Benj Heard.

This week, a barely functional Carter returns to work, Mark and David take a trip down memory lane, Chen has the hots for an ICU nurse, Corday desperately tries to keep a potential organ donor alive, Abby makes a mistake which Benton tries to fix, and the ER is completely overwhelmed by patients.

When a child is terminally ill, parents agonize over how to tell the child about their prognosis, and how to decide when to stop treatment when a cure is no longer possible. Their anguish is fueled by a range of ethical, emotional and spiritual dilemmas, and there is never an easy or an obvious answer. In this episode, we talk with Dr. Steinhorn, an academic pediatrician who practices intensive care and hospice medicine for children.  He led the Judith Nan Joy Integrative Medicine Research Initiative at Lurie Children's Hospital in Chicago from 2002-2010 and founded palliative care programs at major children's hospitals.  He is currently developing children's hospice programs in Washington, DC and San Diego, California.  Dr. Steinhorn has additional training in energy medicine, yoga, meditation, and shamanism, studying with teachers from the Foundation for Shamanic Studies, the Four Winds Society, and Dr. Carl Greer, and has brought shamanic healing approaches to his critical care practice in children's hospitals across the country.   LINKS: To learn more about Dr. Steinhorn's work, click HERE. Watch Dr. Steinhorn and his collaborator Jana Din demonstrate their transpersonal medicine approach  in this nationally broadcast television segment titled "Shamans in the ICU." https://www.youtube.com/watch?v=kBQ7QKmHwAY

This episode covers arterial blood gases.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/arterialbloodgases/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

Depression might be clinically diagnosed as a very specific set of symptoms, but it is often so much more than that. Does your depression cause you to over-function? Does it cause you to under-function? Has your pain ever been invalidated because your symptoms don't look like the stereotypical symptoms of depression? If so, you are not alone! Check out the Light After Trauma website for transcripts, other episodes, Alyssa's guest appearances, and more at: www.lightaftertrauma.com Want to get more great content and interact with the show? Check us out on Instagram: @lightaftertrauma We need your help! We want to continue to make great content that can help countless trauma warriors on their journey to recovery. So, please help us in supporting the podcast by becoming a recurring patron of the show via Patreon: https://www.patreon.com/lightaftertrauma   Transcript: Alyssa Scolari [00:19]: Hello. Hello. Welcome back to the Light After Trauma podcast. I'm your host, Alyssa Scolari, back with a solo episode, after taking a few weeks of doing a guest episode with Rebecca Christensen. It was a two-part series on narcissistic abuse. If you haven't gotten a chance to check it out, it is very good. Go check it out. I was taking a break, mostly because I haven't been feeling that great and physically I'm feeling mostly okay. But emotionally I have not been feeling well at all. April is just not my month. And so I definitely needed a few weeks off. So Rebecca and I had done this two-part episode and I thought now was a perfect time to be able to share it with you all, because it gave me a little bit of a break just to be able to recuperate and try to recover a little bit. And quite honestly, I am still not feeling good, at all. Alyssa Scolari [01:33]: And I think there's a million reasons why. I already know the answer to the why, but the question of how do I get these feelings to go away or to leave? I have yet to answer that because I've been feeling terrible for, I would say at least like a month at this point. I have just been really struggling with depression. And I know that there's a lot going on. Just as an example, this time of year, particularly, is really hard because four years ago was when my mom got really, really sick and she almost died. In fact, we were told that she was going to die and she made it and she survived, but not without months of her being in the hospital and being in ICU and her being up and down and up and down. And one minute she wasn't going to make it. And the next minute she might have a chance. Alyssa Scolari [02:43]: It was an emotional rollercoaster for months. And I can't forget it and I will never forget it. And I think this time of year is when it just hits me the hardest. My body... You Bessel van der Kolk said it best, right? Your body keeps the score. And my body has been reminding me that this time of year, four years ago, was really, really hard. I spent like 24 hours a day, just like praying to every God out there, that my mom would live. And she did. But it's hard because I feel like... I don't want to sound ungrateful because I'm very, very grateful for the circumstances, and I know other people don't have circumstances like that. Other people do lose their parents. So I'm trying not to act like this was the worst thing that ever could have happened. But with that being said, I think that I need to acknowledge that it was very traumatic and it's not even just that. It's a million other things, too, that have been going on and changes in my life and shifts in my relationships that have been really, really hard for me. Alyssa Scolari [04:06]: And I have been depressed. And it's really interesting to hear myself say that because I have always held... I think prior to becoming a therapist, I have always held such a stigma of depression. And I notice that the people around me, the world around us, people hold such a stigma about it. People are so much more likely to say I have OCD or I have anxiety, right? Anxiety is the big one. Anybody will walk up to you and be like, oh, my anxiety. Oh, my anxiety. But very few people will just kind of start talking about their depression. That is largely in part because of the stigma that we place on depression. It's okay to talk about anxiety, but it's not okay to talk about depression. Alyssa Scolari [05:00]: I don't really know why. I could theorize why I think that depression is kind of more serious sounding. And when people think depression, they think suicidal. And when people think suicidal, it makes them very uncomfortable. And therefore, we don't even want to breach that topic. So we're not even talking about it. I think that has a lot to do with it. But ultimately, I don't know for sure. But what I do know is that I even internalized that stigma for a while and had a really hard time talking about my depression. Happy to say, I don't have that hard of a time talking about it anymore. I feel like I've really released that stigma. And so that's what we're talking about today. Alyssa Scolari [05:45]: We are talking about depression. I think we really haven't yet just sat down, me and you, the listener, and had a chat about depression. I've had people on the show that I've talked about depression. Depression has been a theme of almost every episode that we've done, but what does it actually look like? And I think that what has really inspired me lately to share about this topic and to speak on this topic is, I think a lot of the judgements that I have received about my own depression, because if you had a conversation with me, you would have no clue that I was depressed. In fact, you would get the impression of the exact opposite. You would think that I was the happiest person in the world. In fact, people often describe me as being bubbly, which blows my mind, because that is the furthest thing from how I view myself... like bubbly me. Alyssa Scolari [06:53]: Absolutely not. I've often been compared to... I don't know if anybody's going to remember this, but the Powerpuff Girls with Buttercup, Bubbles and Blossom. That was one of my favorite shows growing up. People often compared me to Bubbles, who was like this very adorable little bubbly blonde. She was my favorite when I was growing up. And people often compare me to her and I don't see myself that way at all. So let's just talk for a second about what depression actually is, because contrary to what I think a lot of folks believe, depression is very, very, very different from sadness and in the DSM, which is that book that has all of the mental health diagnoses, it is really classified by multiple symptoms. And those symptoms are not like sadness. Sadness or a sad mood, is not a symptom of depression. That is how different they are... they're not even close. Sad versus depression... completely different things. Alyssa Scolari [08:08]: So some of the symptoms of depression include, a loss of appetite or overeating... so maybe issues with getting in touch with your hunger and fullness cues, or even your hydration cues, your thirst cues. Issues with sleeping... having depleted energy, or maybe being tired all the time, feeling fatigued all the time. Having a low self-esteem, difficulty with concentrating or making decisions. Feelings of hopelessness or despair is another one. The loss of interest and pleasure in a lot of the activities that you used to once find very pleasurable. Problems sleeping... either you can't fall asleep or you wake up throughout the night or you're having nightmares all the time. Perhaps changes in weight. Perhaps not always. We talked about low energy, problems thinking or making decisions, thoughts of guilt or worthlessness. And it can be, again, not always, repeated thoughts of death or suicide or a suicide attempt. Alyssa Scolari [09:20]: So basically there's two different kinds of depression in the DSM. There's major depressive disorder. And then there's different severities of that. So it can be mild, it can be moderate, it can be severe. It can be with psychotic features without psychotic features. Or we're not going to go into that today, because honestly, that's just going to bore you, but major depressive disorder... and that is when you have to have these symptoms, at least five of the symptoms for at least two weeks, then you can classify or qualify for having major depressive disorder. Then there's dysthymia. And dysthymia is also known as persistent depressive disorder. Now, persistent depressive disorder, or PDD, or dysthymia as you'll hear me call it throughout this episode, is less severe than major depressive disorder, but it lasts for much longer. So instead of having to meet five of those symptoms that I listed for PDD, you only have to meet two of those symptoms. Alyssa Scolari [10:31]: So it's certainly a less severe form of depression. But in order to have dysthymia, you have to have felt this way for at least two years with little to no relief. Whereas major depressive disorder is sort of like extremely depressed, noticeable changes, severe changes, but then you come out of it and then maybe you go back into it again, dysthymia is sort of this lower level or like lower grade depression that is just always there. I got to be honest. I don't love this. I really don't love the way the DSM breaks down depression, because honestly, what the fuck? Like, okay, well, what if somebody has both? What if somebody has low level depression all the time, but then it gets really, really bad sometimes. Or there's just so many loose ends with these with the way that depression is listed in the DSM. Alyssa Scolari [11:31]: And I've also almost always seen depression be a part of other mental health disorders. So it's, is this person dysthymic? Do they have PDD or do they have trauma that's taking them years to recover from. And as a result of the trauma, they have depression. Do we keep throwing diagnoses at people and just say, oh, well you have major depressive disorder. Oh, well it's been two years. And now you have PDD... I guess I don't agree with it. I think it's very confusing for folks. And I think it's very confusing even for mental health professionals. But, alas, this is what we're working with here. But I think that it's important to note that this really isn't the be-all end-all for depression. I know I've said this before, but in order to even create these diagnoses, there's no one way to create a diagnosis that's going to be the way for all of eternity. Alyssa Scolari [12:30]: Basically what happens is a bunch of mental health professionals get together in a room and decide what criteria needs to be in place in order to meet... in order to get a diagnosis. So humans are fallible. Therefore, I think that all of these diagnoses in themselves can be fallible. And that's what we're talking about today, because the way that depression is listed in the DSM and the way that therapists are trained to spot depression is very, very stereotypical, which is great, but the majority of people don't operate like this. Maybe not the majority, but many, many, many people do not experience these symptoms, but have depression or don't experience these symptoms outwardly, I should say. Alyssa Scolari [13:28]: So for example, if we can look at Winnie the Pooh for a second... bear with me. Let's take a look at Eeyore. Eeyore is your classic depression. He is depressed, right? Whether he has major depressive disorder or dysthymia... I would say he could probably have both. He perpetually has a low grade level of depression. I think sometimes maybe he feels a little better, especially after he finds his tail. But I would say that he also can suffer from major depressive disorder. I think that he doesn't function as well as the other members of Winnie the Pooh. And I do think that he could meet... I mean, I don't know for sure, but I think that if we talk to Eeyore, if I had him in my office, I think there's a strong possibility that he could have at least five of the symptoms that also would give him a diagnosis of major depressive disorder. Alyssa Scolari [14:36]: When we look at Eeyore, we have no questions about it. We are... Eeyore is depressed, but we can't really look at many people and go, that person is depressed. We just can't. It doesn't work like that. Most people don't walk around acting that way or showing that, and depression has so many different faces. And this is where I tend to get very frustrated because I think that again, as a society, people expect that depression is going to just look like the moping sad person, but it's not. And I have had multiple interactions lately, where, especially in this last month, as I said, I have not been doing well with... my depression has been... it's felt unbearable, to be honest. I don't feel well. And it sucks. And I am doing my best to work through it. And I am engaging in all of the coping skills. Alyssa Scolari [15:42]: I am not isolating myself. I'm trying to go out with friends. I am trying to get outside as much as I can, but at the end of the day, I still feel depressed. I still do. And I am just sort of like trying to ride the wave and wait for it to pass. But because I don't look depressed, my depression doesn't get taken seriously. So let's talk about what depression might look like on me, because, well, basically when we look at depression and anxiety and perhaps a few other mental health disorders, we have people who go into really essentially two different categories. We have chronic overfunctioners and then we have chronic underfunctioners. Alyssa Scolari [16:34]: I am somebody who is an overfunctioner when I am depressed... meaning I will get out of bed. I will brush my teeth. I will do my hair. I will work the entire week. I will extend myself when people need me. If people reach out to me, I will make sure that I respond immediately. I will answer all my emails. I will prepare all my meals. I will eat. I will drink. I will go out with friends. Like I am go, go, go, go, go, go, go. I appear happy. I appear bubbly. I am laughing. I am cracking jokes. I know I shared on my Instagram story... for those of you who follow me, a couple weeks ago, I shared that I had gone out with friends and I went out to meet them for really the first time this... the one person I knew I hadn't seen her in years, but the other people, I didn't know. And that is really, really scary for me. Especially being in a state where I had been feeling really depressed and really vulnerable. Alyssa Scolari [17:40]: I put myself in this situation, which I thought was going to help my depression. And it did. I think that it did, but I went out and I had a good time. Everybody was great. I felt like I was with people who were very similar to me. And I was the life of the party. I was literally the life of the party. I was cracking jokes. I was telling stories. I was laughing. I was engaged. I was making eye contact. I wasn't on my phone at all. I was playing with the animals. I was great. If anybody had been in that room and they had talked to me or they had even watched me, they would say, nope, there's zero risk factor here. What people don't know is that I came home that night and I was getting ready for bed. And I was very much in my head about, oh my God, did they like me? Did I say something stupid? Was I annoying? They probably hate me. I wonder if I'll be invited back. No, I definitely am not going to be invited back. Alyssa Scolari [18:48]: And I had a quick exchange with my husband and he said something to me that I interpreted incorrectly as a result of already being on edge. I sort of thought that he was like upset with me and I lost it. Like had a panic attack that lasted four hours. And look, I know that a lot of people love to say panic attacks only last three to five minutes. That is some bull shit, okay? That is some bullshit. If somebody says that to you, that's because they've never had a panic attack before. Panic attacks do not last for only three to five minutes. I could not breathe for hours. I was hyperventilating. I was sobbing. I was disassociated. I was... I was gone. I was gone. I was in a level of emotional pain that felt absolutely unbearable for me. Alyssa Scolari [19:54]: And as a result of that chronic breakdown, I barely slept. I woke up the next day feeling emotionally hungover. I was exhausted. And when I'm tired, I get even more depressed. So I kind of like lost my weekend to a meltdown that I had merely hours after going out and appearing like everything was absolutely fine. When I am depressed, and when people who are overfunctioners are depressed, you're not going to see us kind of like laying in bed. You're going to see us going and going and going and going until we break. And that is sort of... that is what I do. That is my tendency. And the more depressed I am, the more high energy I'm going to be. Maybe that sounds a little wild, but here's my reasoning behind it. Alyssa Scolari [20:50]: I can't speak for other people, but my reasoning behind it is because the more upset I feel... the more depressed I feel, the more vulnerable I am and I hate being vulnerable. It is really, really terrifying for me. I am working on it, right? The part of this podcast is... this whole episode is me being vulnerable. This is really hard to talk about, but when I'm vulnerable, because I hate it so much, I feel like I need to put on more of a show so that people can't tell that I'm hurting because it almost keeps people at bay, right... because people can't look at me and see my sadness. So they're not going to ask... because I'm like, don't ask me. Please don't look at me. Please don't see through me. I don't want you to see through me and see that I am in agony. I over function. So nobody knows. Alyssa Scolari [21:44]: Outwardly I don't display any of those symptoms, but I come home and I fall apart. And every symptom is there. I know one of the sure-fire ways when I am depressed, is that I stop drinking water. I literally just stop. Like I cannot get in touch with my thirst cues at all. And then my hunger cues go away. And then I feel tired all the time and I stop eating. And it's like... this past Saturday, I don't think I ate a full meal until four o'clock. And that is so unlike me, because I'm usually so good at getting all my meals in. Alyssa Scolari [22:26]: So depression can look like over-functioning. So please do not look at the people around you who appear to have it all together and say, oh, you don't know what it feels like. You don't know what it's like to be depressed... because I've had several people kind of say that to me this past month where, if somebody asks me how I'm doing, and I'm, honestly, I haven't been doing well. Or I said... I had an event to go to where I actually said hey, I don't think I'm going to be able to make it. I'm not really feeling well. And you know, this person was, oh, are you sick? And I was, no, honestly, just emotionally not doing well. Don't think I want to go. I really think I need this night to myself. And this person was... this person is not a close friend of mine, at all. Alyssa Scolari [23:16]: So I didn't really... it's not like this person like knows me really well. And it's not like I really care all that much that this person said this, but it does kind of piss me off... in general, I'm not angry at the person, but just in general, as a society like that, we think this way, because this person was, oh, but you look happy all the time, when I see you. I didn't know you were going through stuff emotionally. And I wanted to be, well, we are all going through stuff emotionally. Have you not been around for the past several years? We are all going through it. What do you mean, I didn't look sad? Oh, I'm sorry. I'm sorry I didn't look sad. And I've just had several little comments like that throughout my life of people being, oh, well you didn't look sad or, oh, well, depression... you never told me you were depressed. First of all, I don't need to tell you. I don't need to tell you. Alyssa Scolari [24:17]: But second of all, I don't care what I look like. I'm telling you my experience. Why are you invalidating it? And so I think the people who have depression, who over-function really struggle with this, as much as we kind of over-function because it's protective for us and we don't want to let people in. We also feel really, really hurt when people invalidate us. Now, listen, I'm not saying that's anybody's problem to fix. I need to be perhaps not so guarded and I need to learn how to tone down my over-functioning and I have... even telling somebody, hey, no, I can't go to this, I need to take care of myself... that is huge for me because in the past I would've been like, go, go, go, go, go. Because I grew up being taught that it is never okay to inconvenience somebody else for your own personal needs. Alyssa Scolari [25:13]: Right? I grew up being taught that all that matters is making other people happy. I grew up being taught that it only matters what you look like to others... doesn't actually matter how you feel. What matters the most is what you look like to others. But some people, when they're depressed, they become underfunctioners. And that is okay. We tend to glorify overfunctioners. And I hate that because overfunctioners, as a result of never letting themselves really feel their feelings and slow down, they tend to develop high blood pressure and high blood pressure is actually considered the silent killer. It is considered the silent killer and studies have found over the years that so many folks with high blood pressure have been able to manage it through stress management. So it is all so linked. So, but here we are glorifying overfunctioners. Alyssa Scolari [26:15]: underfunctioners don't necessarily have the same struggle with the high blood pressure. They might, right? They may, but it's not necessarily a result of them under functioning because your underfunctioners are people who have trouble showering. They have trouble brushing their teeth in the morning. They have trouble eating or drinking, or they will not text anyone back for weeks at a time. They won't show up to anything. They sort of fall off the face of the earth and they struggle with even the most basic things. Simply the act of breathing can feel difficult on the days where the depression is really, really bad. Alyssa Scolari [27:05]: Now there is also a stigma against underfunctioners. And that stigma is that they are lazy. They are flaky. They are dirty, right, especially when we talk about how hygiene can sometimes go, when we're feeling really depressed. So many people turn their nose up to that. Ew, oh God, Ew. How could you not brush your teeth? I don't understand how you could just not brush your teeth and lay in bed all day. Or I don't understand how you could just not wash your sheets for two months. I get infuriated when people say things like this, and honestly, I have been surrounded by people my whole life who are overfunctioners who disparage underfunctioners. How could you let your house get dirty? How could you do this? How could you do that? It's called depression and we need to stop judging it. Alyssa Scolari [28:07]: Now I am not saying that every single person with a filthy home has depression. That's not what I'm saying here, but what I'm saying is these can be signs of depression. If you walk into someone's home for the first time and you notice that it is dirty, that might not be because that person is lazy or doesn't care or wasn't raised right. No, that can be a huge red flag for depression. Somebody's bad breath could be a huge red flag. Maybe it was all they could do just to get to work. So I'm trying to get us to understand that depression doesn't just look like some sad, mopey, Eeyore-like character. Depression can look like the person who comes in with a full face of makeup. You know, they come into work with a full face of makeup and a minty fresh breath, or it can be the person who comes in... they look like they barely put a comb through their hair and their breath reeks. Alyssa Scolari [29:11]: We can't call people names as a result of either. We cannot look at underfunctioners and make judgements on their character when we don't know, because that could be the face of depression. The person with a full face of makeup could be the face of depression. I am the face of depression. I am one of the many faces of depression. I struggle with depression on a regular basis. I have been so tired at times that I haven't been sure how I am going to go on. There are days where I under function as well. They are a little bit more rare for me because my tendency is to over-function, but there have been days where I'm like, I can't get out of this bed. I just can't do it. And therefore, I didn't eat. Therefore, I never got to brush my teeth and you know what? I am no less of a person. It doesn't make me lazy. It doesn't make me gross. It doesn't make me unhygienic. My teeth haven't fallen out. I have not hurt anybody as a result of my under functioning. Alyssa Scolari [30:33]: So there are stereotypes of both, overfunctioning under functioning, major depressive disorder, dysthymia. Whatever you may be struggling with, whatever anybody may be struggling with, it is still excruciating pain. And I want us to remember that the next time we go to cast aspersions on somebody or make judgements. And I want us to remember that the next time that we are in conversations with people, because I, myself am like a victim of being... or not a victim. I'm not a victim. I am a victim of people kind of looking at me and saying, oh, well, you can't be depressed, but I have been wrong before by looking at other people and being like, huh? Why didn't you shower? Like what is going on here? Right. I have judged people by being like, what the heck happened. That can be a face of depression. Alyssa Scolari [31:31]: So this is something for all of us to work on, but this is also something for us to learn about ourselves. Are you an over-functioner? Are you an underfunctioner? What does your depression look like, because what I described coming out of the DSM, that's not all depression can look like. And I think that once we sort of identify for ourselves what it looks like for us, then we are able to catch it much more quickly and can then work to recover from it. It's not always going to look like it does in the textbooks. It's going to look different for each and every one of us. So I think it is really helpful to figure out what it looks like for you. Alyssa Scolari [32:14]: And one way you can do that is by journaling, right? What does my depression look like for me? And you can think of all of the examples that I've just given and you can decide for yourself. And maybe there are things that I've left out. Maybe there are things that I am not aware of myself. Hey, let me know. You know where to find me, and, oh, I don't think I mentioned that at the beginning of this episode, but you can give us a follow over at Light After Trauma on Instagram. Alyssa Scolari [32:42]: And if you are a Patreon member, and you would like, you can certainly request an episode topic. I know a few of you have done so, and I am working on getting to them. When I get an episode topic, I like to do my research on said topic because I don't want to come in just like making stuff up... obviously that's not helpful for anybody, so I like to do my research. So once you request a topic, it is going to take me some time because I want to look into it. I want to read about it. And I want to feel equipped enough to be able to share with you what I've learned, especially if it's not something that I'm familiar with. So just keep that in mind. The Patreon is in the show notes, so you can feel free to go and check that out. Alyssa Scolari [33:29]: And thank you so much for the support as always. If you have not done so already, please feel free to leave a rating or review of the podcast. It helps so much. I hope that everybody's having a good week. I am hoping and I'm praying for a better week on my end. I am just... yeah, I am feeling terrible and I don't have any follow ups... there's no buts after. There's no, oh, I know it's going to get better because... I do know it's going to get better, but it's not helpful for me to kind of say that. Sometimes we just need to be in it. And that's kind of where I am. I just need to be in it. I just need to acknowledge that I am not even a little bit okay, but I am I'm here and I'm doing my best to keep myself moving and enjoying the sunshine and just making the most. But it is what it is for right now until I feel better. Alyssa Scolari [34:35]: So I hope that you are all doing very well. I love you all. I am holding you in the light and I will see you next week. Thanks for listening everyone. For more information, please head over to lightaftertrauma.com or you can also follow us on social media... on Instagram we are @lightaftertrauma and on Twitter it is @lightafterpod. Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks. So please head on over. Again, that's patreon.com/lightaftertrauma. Thank you. And we appreciate your support.

This episode covers the intensive care unit.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/icu/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

436 My Family is Whoever Does the Will of The Father, A Guided Christian Meditation on Matthew 12:46-50 with the Recenter With Christ app I'm Chaplain Jared and I work as a hospice chaplain and an ICU chaplain. My purpose in making this podcast is to help you find more peace in your life and to be more open for your heart to be changed by the Spirit of God. By using centuries old form of Christian Meditation named Lectio Divina: Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization. Get into a place where you can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tensing or unrelaxing. If you feel comfortable to do so, I invite you to close your eyes. Guided Relaxation / Guided Meditation: Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate, deflate. Bible verses for Meditation: Matthew 12 NIV 46 While Jesus was still talking to the crowd, his mother and brothers stood outside, wanting to speak to him. 47 Someone told him, “Your mother and brothers are standing outside, wanting to speak to you.” 48 He replied to him, “Who is my mother, and who are my brothers?” 49 Pointing to his disciples, he said, “Here are my mother and my brothers. 50 For whoever does the will of my Father in heaven is my brother and sister and mother.” NASB 46 While He was still speaking to the crowds, behold, His mother and brothers were standing outside, seeking to speak to Him. 47 Someone said to Him, “Look, Your mother and Your brothers are standing outside, seeking to speak to You.” 48 But Jesus replied to the one who was telling Him and said, “Who is My mother, and who are My brothers?” 49 And extending His hand toward His disciples, He said, “Behold: My mother and My brothers! 50 For whoever does the will of My Father who is in heaven, he is My brother, and sister, and mother.” Meditation: This scripture has always been interesting and in some ways confusing to me. On its face it makes complete sense that Jesus prioritizes those who are obedient. He is teaching a fundamental point that God does not play favorites. In that sense, it is incredibly compelling as a way of changing our priorities and removing our human biases. It invites us to feel like even if we are not on the inside track or some special group, that God still loves us. On the other hand I find it confusing because of the many ways that Jesus speaks so highly of his mother and looks to ensure that she is cared for even at the Cross. The mighty Jehovah himself is the one that proclaimed honoring father and mother as one of the top ten rules, making the list of ten commandments. Additionally scripture does not shy away from showing the importance of Jesus's mother in the narrative. These two priorities seem to be at odds with each other. I also find it an interesting ballance in my own life. Personally, my family is extremely important to me. My mother is a special woman that I will forever be grateful for. I appreciate her goodness, kindness, and example in so many ways. In the words of Abraham Lincoln, All that I am or hope to be I owe to my angel mother. She raised me as a single mother and I owe her the world. Additionally I consider the role of my wife and her motherly influence on our children, and it is so profoundly meaningful to me. I prefer her to all others. Yet I also recognize that loving others is the second great commandment. Luckily these are not mutually exclusive commands and we can honor God by loving and honoring his children. Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Updates: 2 MILLION DOWNLOADS Final Question: What role does the Word have in your life? This week I performed a funeral for a family from Africa. The amount of family that was physically present was not that large but there were many friends who were just as close as family in some ways and their presence and comfort was amazing. Final Thought: FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod    

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kama and I'm Rahul Damania, a third-year PICU fellow. I'm Kate Phelps, a second-year PICU fellow and we are all coming to you from Children's Healthcare of Atlanta, Emory University School of Medicine, joining Pradip and Rahul today. Welcome to our episode, where will be discussing rhabdomyolysis and associated acute kidney injury in the ICU. Rahul: Here's the case, a 7-year-old female presents to the ED with three days of fever, poor PO, and diffuse myalgia. In the ED, her vital signs are T 39.1C, HR 139, BP 82/44, RR 32. She is pale and diaphoretic, complaining weakly about how much her legs hurt. Her parents note that she has not been peeing very well since yesterday, and when she does pee it is “very concentrated, almost brown.” She's also been spending all her time on the couch and has asked to be carried to the bathroom when she does need to go. An IV is placed by the emergency room team, and she is given a fluid bolus, acetaminophen, and initial labs are drawn (CMP, CBC, RSV/Flu swab) before she is admitted to the PICU. In the PICU, her fever is better and her vitals have improved to T 37.7, HR 119, BP 115/70, and RR 25. Her respiratory swab has just resulted positive for Influenza A. Further labs are sent, including creatine kinase (CK), coagulation studies, and a urinalysis. Labs are notable for K 3.9, Bicarb 22, BUN 15, Cr 0.8, and CK 5768 IU/L. Her urinalysis is notable for 1 WBC, 2 RBC, +3 blood, negative nitrites, and leukocyte esterase. Kate: To summarize key elements from this case, this patient has: Influenza A, as evidenced by her respiratory swab, as well as her clinical prodrome. She has diffuse myalgias, as well as fevers, diaphoresis, and hypotension. Labs are most notable for elevated creatinine and elevated creatine kinase, as well as an abnormal urinalysis. All of which brings up a concern for rhabdomyolysis and myoglobin-induced acute kidney injury. Before we get into this episode — let's create a mental framework for this episode — we will dissect our case by highlighting key H&P components, visit a differential diagnosis, pivot to speaking about pathophysiology, and finally, speak about management! Rahul: Let's transition into some history and physical exam components of this case. The classic presentation of rhabdomyolysis is myalgias, muscle weakness, and tea-colored urine, all of which our patient has. Decreased urinary output can also accompany, a variety of reasons, but most notably if the patient has myoglobin-induced acute kidney injury. In our patient, poor PO is also probably contributing to her decrease in urine output. Red flag signs or symptoms will include anuria, hypotension, and altered mental status (which is rare but may indicate severe acidemia and deterioration) Pradip: As we think about our case, what other disease processes might be in our differential? As we dive in a bit more, we'll come up with ways to distinguish between rhabdo and other things! Viral myositis - inflammation in the muscles in the setting of a viral illness, which can definitely happen with influenza and other common viruses Some other things which may cause reddish-brown urine, including hematuria, hemoglobinuria, porphyria, some specific foods or drugs (like rifampin, beets, food coloring — even ibuprofen) We also have to investigate a bit more to convince ourselves that our patient's AKI is due to rhabdomyolysis, as it could be from dehydration, sepsis, NSAIDS, etc. Kate: Let's dive further into rhabdomyolysis! Rhabdomyolysis affects over 25,000 adults and children every year. While toxins (including prescription drugs, alcohol, and illicit drugs) and trauma are two common causes of rhabdo in adults (and teens), infections, especially viruses, are the most common cause in young children. Influenza, EBV, and CMV are three most commonly reported. What's the pathophysiology of...

This episode of The Freke Show is a discussion between myself and Jessica Nathanson, exploring the important differences between Unividualism and Non-duality. We discuss why we need to move on from self-denying spirituality and celebrate our individuality as the foundation from which to awaken to oneness. The conversation can also be watched on my YouTube channel. It has been beautifully filmed by Rupert Truman, who previously created my WHAT IS LIFE? films.   PART 2 is coming soon! Then on Sunday 22 May Jessica and I are going to have a discussion with my online community about these ideas. If you're not a member of the ICU, you're welcome to join us for this talk as a guest, email my PA Jessica@timfreke.com

There's power in children's songs and power in prayers. And there's relief in feeling surrounded by medical expertise and community support, especially when Louise thought Archer would start in rehab, but they found themselves back in another ICU anxious about new complications of Archer's Spinal Cord Injury. There were southern angels by Archer's bedside and by Louise and Billy's side, too.  Come listen to who they were and join Louise in Season 3: Episode 3: For Real for some surprises from another lifetime.    In this episode, you'll hear interview excerpts from:   Mary McCune Dillon, Louise's college friend from UVA and one of the Atlanta Angels, speaks about the prep and organization that went into caring for the Senft family's arrival at a temporary home away from home. They also talk about how a mutual college friend in Charleston, SC, ignited the formation of the Atlanta Angels and re-connections from another lifetime.    If you're interested in taking part in our 10 minute listener survey, you may fill it out here: https://forms.gle/zGd8uXXLTCpm9qCEA   Our theme music is by Victoria Vox. Sound effects from this episode are from freesound.org.   Music in this episode is:   Close to You by The Carpenters   Emotional Piano Improvisation by Alexander Nakarada Link: https://filmmusic.io/song/6199-emotional-piano-improvisation License: https://filmmusic.io/standard-license   Peppers Theme by Kevin MacLeod Link: https://incompetech.filmmusic.io/song/4998-peppers-theme License: https://filmmusic.io/standard-license   Horizon Flare by Alexander Nakarada Link: https://filmmusic.io/song/4837-horizon-flare License: https://filmmusic.io/standard-license   Blink of an Eye Podcast is sponsored by I C THAT — The Integrative Center for Trauma Healing, Advocacy and Transformation: a non-profit created as a national resource to help change the way we respond to Spinal Cord Injury to include trauma healing approaches for families and medical teams across the U.S.  I C THAT provides a national team of SCI specialized doctors for expert opinions in the first hours of crisis, a Multidisciplinary Family Support & Navigation Team for SCI families lead by SCI families for the first 30 days of crisis, and a National Resource Library of trauma informed responses for the first hours and days after injury specialized for families, friends and SCI medical staff. I C THAT also offers a Registry of Medically Unexpected SCI Recoveries.  I C THAT will host the inaugural conference The Science of Trauma: Hope for Trauma Healing October 6, 2022.  To donate and find out more, visit www.ICTHAT.org.   To find out more about Archer, Louise, and this podcast, visit the websites blinkofaneyepodcast.com, BaltimoreMediation.com and BeingRelational.com. Follow us on Instagram and Facebook @blinkofaneyepodcast. Our Twitter is @blinkofaneyepod. Make sure to subscribe wherever you get your podcasts.   You can become a member of our Patreon community and see extra Blink of an Eye content and bonus episodes at: www.patreon.com/blinkofaneyepodcast.    To see some of Archer's artwork, check out www.slimeyard.com.    #hopeforeverything   #obtaineverything

This episode covers the pathophysiology and management of acute and chronic pain.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/painmanagement/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

How salvation is more like the morgue than the ICU. Who unites us more important than what divides us.

On this episode, “Follow Your Dreams w/Ariana Evans”…. It started with a dream but she thought nursing was her the journey she was meant to be on. That's until she hit the record button and from there her purpose was made clear. Check out this amazing story of the ICU nurse who had no idea she was meant to do film making. Make sure you tune in and don't forget to like, comment and subscribe to our youtube channel. Have a drink and let's talk about it sis.

The pandemic that never ends is still disrupting our daily lives and killing many, many people no matter how tired of it we are. Darren Markland is an ICU doctor at the Royal Alexandra Hospital in Edmonton, Alberta, Canada, and has been in the trenches since the pandemic started. His twitter account, @drdagly, has swelled to more than 55,000 followers since he began recounting raw, broken-down stories of patients he has treated. He joins Sorry, I'm Sad to talk about the state of the pandemic, how he has managed his own mental and physical wellbeing during the last two years and where he finds hope. Support the show

Avery Thatcher is a former ICU RN who noticed the majority of the reasons people found themselves in the ICU were because of illnesses and diseases linked to chronic stress. She decided to get out of the reactive side of medicine and now helps people prevent burnout and reverse the negative health effects of stress. She believes in the importance of real, raw and vulnerable conversations to normalize our human experience and remind us that we're not alone in our struggles. Https://becomingavery.com Https://intstagram.com/becomingavery  

This episode covers common procedures in anaesthetics.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/procedures/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

One of our favorite ladies is with us today! Ryann P is an ICU travel nurse, TikTok creator, advocate, social media girlie, and truly one of our favorite people. Ryann is one of the leading influences in the TikTok social media world with 208K followers, 9.2M likes, where she brings daily ins and outs of her life. She shares her personal lifestyle, educates new nurses, provides tips for practice, and gives the realness of what it means to be a modern-day nurse. Ryann brings a truly authentic presence online.  She has her bachelor's in Spanish as well as Nursing and recently obtained her critical care registered nurse certification. She's been working in healthcare since she was 18 years old and has been working as a nurse for the past four years. Her specialty is ICU nursing but she has also worked in the emergency room, Medical-Surgical, and Telemetry units. Ryann frequently uses her TikTok platform with 200k followers to discuss issues in nursing as well as offer self-care tips to current and aspiring nurses. In her free time, she loves to travel, dance, and spend time with friends and family. Moreover, she is a true advocate with positive messages, and tangible ways to make a difference in our complex healthcare world by engaging in thought-provoking conversations. She is a mover and shaker, someone we are thrilled to have on today. We hope you enjoy this episode!  To connect with Ryann P clickhttps://www.instagram.com/ryannpdatsme/ ( HERE) To connect with Tori click https://www.instagram.com/nurse.tori_/ (HERE)  To connect with Sam click https://www.instagram.com/heysamanthaa/ (HERE) To connect with Cellfie Show click https://www.instagram.com/cellfie_podcast/ (HERE) Rate and Review the Show to Claim your Cellfie Swag Bag! https://podcasts.apple.com/us/podcast/the-cellfie-show/id1500843605 (HERE) Check out our Cellfie Show collab sock!!!  https://www.upatdawn.co/collection/cellfie-show-x-up-at-dawn-collab (SHOP UP AT DAWN X CELLFIE SHOW CLICK HERE) https://www.cellfiepodcast.com/ (Cellfie Show ) https://www.cellfiepodcast.com/shop-1 (Cellfie Podcast Merch)  Produced by: Tori + Sam  THIS EPISODE IS BROUGHT TO YOU BY PICMONIC (CODE: CELLFIE save 20%) Picmonic, Inc. is an audiovisual learning platform designed for healthcare students (RN, MD, DO, CNA, LPN, NP, PT etc) It is the study tool of choice for learning thousands of the most difficult to remember and most frequently tested topics, board exam prep and uses questions centered on an evidence-based “learn-review-quiz” format. Quick & effective 2-minute Picmonic videos Connects difficult to remember facts with unforgettable characters Ties the facts together into ridiculously memorable stories Reinforce what you learn and track your progress with thousands of built-in rapid review multiple-choice quizzes. Intelligent spaced-repetition algorithms automatically adjust to your learning needs, so you'll be reminded to review the right information, at the right time - increasing long-term retention. https://www.picmonic.com/viphookup/nursetori (CLICK HERE)

195 - Scott Schara joins the podcast to tell the story of his daughter Grace. She was admitted to the hospital in October 2021 and was killed after being given lethal doses of Precedex, Lorazepam & Morphine to "treat Covid." This is the inside story of what happens to patients in the hospital under government protocols. Topics of discussion include: -The light that fills Grace's spirit and is still shining on the world -Grace's hospital experience and how she was targeted by doctors for having Down syndrome -The financial incentives of standard government protocols for treating Covid-How Grace was a victim of government-funded eugenics targeting the disabled and elderly -Remaining grounded in faith during times of darkness Please consider donating:GiveSendGoOurAmazingGrace.netConnect with Evan:Subscribe on Substackevanmcdermod.orgWork With Me:Tarot ReadingsAnimal Spirit ReadingsShadow Work ConsultationsHomeschool Curriculum SupportTeaching/Tutoring ServicesMasculinity CoachingSupport my work directly:Donations: PayPal | Venmo | CryptoThe Fifth Dimension ShopSocial Media:InstagramTelegramTwitterYoutubeIf you like the show, please subscribe & leave us a Review :)Theme Music:Highland Song by Alexander Nakarada | https://www.serpentsoundstudios.comMusic promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0)https://creativecommons.org/licenses/by/4.0/Support the show (https://www.paypal.com/paypalme/evanmcdermod)

Hello and welcome to Beauty and the Biz where we talk about the business side of cosmetic surgery, and how Brock Ridenour, MD decided to take the plunge and start over at 45 by going into private practice. On this Beauty and the Biz podcast, my guest is Dr. Brock Ridenour, board-certified facial cosmetic surgeon running a very successful private practice in St. Louis, MO. However, before private practice, he was director of the division of facial plastic surgery at the prestigious Washington University in St. Louis for more than a decade, so we'll talk more about that. Dr. Ridenour has authored several book chapters and articles and is a member of numerous professional medical organizations, as well as frequent national and international speaker on facial cosmetic surgery and rhinoplasty. He works with several industry pharma companies and vendors of laser devices and is a strong supporter of many charitable causes throughout St. Louis. We talked about… What finally pushed him to private practice His challenges and regrets and, The many lessons he learned along the way   Visit Dr. Ridenour's website at: https://www.ridenourplasticsurgery.com   Enjoy and I look forward to your feedback –

This episode covers other types of anaesthesia (other than general anaesthesia).Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/otheranaesthesia/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

434 Behold the Blood of the Covenant, A Guided Christian Meditation on Exodus 24:4-8 with the Recenter With Christ app  I'm Chaplain Jared and I work as a hospice chaplain and an ICU chaplain. My purpose in making this podcast is to help you find more peace in your life and to be more open for your heart to be changed by the Spirit of God.  By using centuries old form of Christian Meditation named Lectio Divina: Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization. Get into a place where you can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tensing or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate, deflate. Bible verses for Meditation: ESV 4 And Moses wrote down all the words of the Lord. He rose early in the morning and built an altar at the foot of the mountain, and twelve pillars, according to the twelve tribes of Israel. 5 And he sent young men of the people of Israel, who offered burnt offerings and sacrificed peace offerings of oxen to the Lord. 6 And Moses took half of the blood and put it in basins, and half of the blood he threw against the altar. 7 Then he took the Book of the Covenant and read it in the hearing of the people. And they said, “All that the Lord has spoken we will do, and we will be obedient.” 8 And Moses took the blood and threw it on the people and said, “Behold the blood of the covenant that the Lord has made with you in accordance with all these words.” NIV  4 Moses then wrote down everything the LORD had said. He got up early the next morning and built an altar at the foot of the mountain and set up twelve stone pillars representing the twelve tribes of Israel. 5 Then he sent young Israelite men, and they offered burnt offerings and sacrificed young bulls as fellowship offerings to the LORD. 6 Moses took half of the blood and put it in bowls, and the other half he splashed against the altar. 7 Then he took the Book of the Covenant and read it to the people. They responded, “We will do everything the LORD has said; we will obey.” 8 Moses then took the blood, sprinkled it on the people and said, “This is the blood of the covenant that the LORD has made with you in accordance with all these words.” Meditation: Here Moses had already received the Ten Commandments and that is what he was presenting to the people. This represented a covenant or a testament between the law of God and the people. The people willingly agreed to follow the Law of God. They had been delivered from Egypt by the hand of God, quite obviously by the miracles of God and here God had laid out His rules. Yet even in the midst of what appears to be a straightforward promise there was sacrifice offered and the blood of that sacrifice was sprinkled on the people in the middle of this covenant or as some translations call it, testament.  To our modern sensibilities it may seem an unexpected aspect of this kind of promise that a sacrifice and blood would be involved. Why was a sacrifice needed? Why the blood? Perhaps we could look to Leviticus where it lays out the different kinds of sacrifices and what the purpose of those sacrifices but they were to redeem fallen people in the face of an all powerful and perfect God. It is important to recognize the symbolism for all these sacrifices. The book of Hebrews points out that the sacrifices were a symbol of Christ. Similarly, the blood that was sprinkled on them was a symbol of the coming blood of Christ.  Hebrews also points out that the old covenant or testament was incomplete without the New Testament or Covenant. The New Covenant or New Testament. Jesus says that the Covenant is played out in the last supper. Christ's plan all along has been fulfilled and now we stand as the beneficiaries of a covenant we don't deserve because God knew that we need his grace in our human weakness.  We remember Christ, we honor the covenant that he made with us, that he would redeem us if we believe in him and pick up our Cross and follow him.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Updates:  2 MILLION DOWNLOADS Final Question: What role does the Word have in your life? Final Thought:   FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod  

In this episode, we explore something that you will really only see in the ICU (aside from the OR) which is arterial lines. We go in-depth on why we use arterial lines, how it is inserted, and how to manage them. Arterial lines can be intimidating to new grads, so I hope you can gain some confidence from this episode. If you are interested in any cheat sheets or enamel pins! https://www.etsy.com/shop/NurseDose --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Mores lies! But this time, we focus on empirical use of spinal immobilization devices and the harm associated with them. The dogma surrounding this topic is staggering, to say the least. From EMS agencies to Level 1 tertiary centers, cervical collars and long spine boards (LSB) remain a "standard" predicated on a lack of evidence. What evidence DO we have regarding spinal immobilization? And how should we restrict spinal movement of polytrauma patients based on that evidence? Tune in to another eye-opening podcast episode where we are joined by air medical director, Dr. Mike Hudson, who has been leading the way in U.S. spinal motion restriction (SMR) techniques. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet YouTube /heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com Creative Commons Attribution 3.0 Unported License https://creativecommons.org/licenses/by/3.0/deed.en_US

Happy Friday Friends!My next guest has shared her story in the medical field juggling being a mother. I love her openness and her vulnerability about witnessing some very hard cases being in the Neonatal ICU. Please welcome PREMIERE guest Dr. Susan Landers. Susan has 34 years of experience in the neonatal intensive care unit (NICU). She practiced in academic medicine (on faculty of two medical schools) and in private practice. She found her work in the demanding environment of the NICU rewarding & managed to postpone burnout until the end of her career. She and her physician husband raised three children (now all young adults) while they both practiced medicine full time. She recently wrote a memoir called "So Many Babies: My life Balancing a Busy Medical Career and Motherhood." Susan enjoys recounting some of her best, and worst, experiences of being a working mother, and how she managed to stay resilient. She shares with other working mothers many things she learned along her journey as a busy mother and successful doctor.She attended medical school at the Medical University of South Carolina in Charleston and completed her pediatrics residency at University of Texas Southwestern Medical School and Parkland Hospital in Dallas. She completed her neonatology fellowship at Texas Children's Hospital and Baylor College of Medicine in Houston. She has special expertise in breastfeeding medicine, and human donor breastmilk banking. She previously worked for the American Academy of Pediatrics as a leader in the Section on Breastfeeding Medicine. She currently is retired and lives in Austin, Tx.https://www.linkedin.com/in/susan-landersmd/https://www.instagram.com/drsusanlanders/https://www.facebook.com/drsusanlandershttps://twitter.com/susanlandersmdhttps://susanlandersmd.comSupport for Label Free Podcast is brought to you by ​MANSCAPED™​, who is the best in men's below-the-waist grooming.  ​ @MANSCAPED offers precision-engineered tools for your family jewels. They obsess over their technology developments to provide you the best tools for your grooming experience. MANSCAPED is trusted by over 2 million men worldwide! We have an exclusive offer for my listeners - 20% off + free shipping with the code: LabelFree20 at   https://www.manscaped.com​ As always thank you for the support, to contact me directly follow the link below: https://www.labelfreepodcast.com​ Stay Healthy, Stay Ready- Deanna Marie Kuempel #ad​​ #sponsor​ #publishedauthor #neonatal #ICU

一场事发蹊跷的车祸，推导出一套完整的商业模型。 纳斯达克滚烫的欲望，敲响了ICU病房里的丧钟，被商业奇迹强行扯断的心电图，变成了石景山的耶路撒冷。 既然事已至此，我们就干脆聊点高兴的。 Shownotes: 01:33 一场事发蹊跷的车祸 22:00 大家还是兵分五路，各自去民间招商引资吧 25:30 香港圣玛丽医院ICU病房里的五个丧钟 30:30 北京的朋友假期可以去看看一冰的摄影展 35:10 末日囤货私人清单 60:53 北京黑洞：石景山 68:58 三叔的厨房：灯笼椒之恋 72:03 三叔囤了几个NFT 77:42 商业模式越来越完善了 82:25 ICU里的心电图与纳斯达克上市丧钟 88:28 石景山：人类的耶路撒冷 95:36 希望身处困境的朋友能够尽量开心一些 Songlist: JAGATARA - 裸の王様 JAGATARA - もうがまんできない

This episode covers general anaesthesia.Written notes can be found at https://zerotofinals.com/surgery/anaesthetics/generalanaesthesia/ or in the anaesthetics and ICU section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

Dr. Steve Hodak and his guest, Dr. Leopoldo Segal, discuss current therapeutics and our ability to treat severe cases in the ICU. They also discuss promising new research into ACE2 inhibitors and what the findings can mean for the future of treating and preventing severe virus infection.

Today's guest is Linsey Rhyne - an ICU nurse turned website designer + branding expert. In this episode Chelsea and Linsey talk about:+ the best time to start a website as a business owner+ website MUST-HAVES and what to avoid+ what branding is and why you need it+ and SO much more!Be part of the first ever Ahai energy healing circle, hosted on May 4th 2022 at 5pm - join HERE!Miss out on The Expansion Pact?! Or want ongoing access to the videos? You can grab access to the videos HERE.Join the waitlist for 1:1 mentorship HERE - applications are currently *OPEN*Special savings with Chelsea10% off any CLEARSTEM products with code CHELSEA

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Jesse Bobrowski is a Vice President and Partner of Business Development at Calvert Home Mortgage Investment based in Calgary, Alberta. In this episode we talked about: Jesse's  Bio & Background Lending in Real Estate- BRRRR Strategy Hard Money Lenders VS Private Lenders Underwriting Deals Interest Rates and Inflation Resources and Lessons Learned Useful links: Book: The Five Dysfunctions of a Team: A Leadership Fable https://chmic.ca https://www.instagram.com/calverthomemortgage_/?hl=en Transcriptions: Jesse  (0s): Welcome to the working capital real estate podcast. My name is Jesper galley. And on this show, we discuss all things real estate with investors and experts in a variety of industries that impact real estate. Whether you're looking at your first investment or raising your first fund, join me and let's build that portfolio one square foot at a time.   Jesse  (23s): Ladies and gentlemen, my name's Jessica galley, and you're listening to working capital their real estate podcast. My special guest today is a another Jesse Jesse . Jesse is the vice president and partner of business development at Calvert home mortgage. We're going to talk today about burst strategies, home mortgages, anything to do with lending. We're going to go into a little bit of Jessie's background and kind of shoot from the hip. So hope you enjoy it, Jesse. How are you doing today?   Jesse B (50s): I'm doing great, Jesse. Thanks for having me along and hello to all your wonderful listeners.   Jesse  (56s): Yeah, thanks for coming on. We were just chatting right before the show. It's a little sunnier here in Toronto. You are joining us from a little bit further west, and you're saying that you, you guys, you guys are snowing right now.   Jesse B (1m 10s): We are actually, it's sunny. Now we sold for the last 24 hours. So yeah, we got about half a foot of snow on the ground,   Jesse  (1m 18s): Right on. So that's out in Calgary. So I think I'm not sure if we've chatted about this, the audience that we have. I always like to say it's a, it's a podcast by a Canadian for all real estate investors, because I think 60% of our listeners are in the us 40% in Canada. So maybe those in the Midwest are getting a little bit of snow as well, this time of year. But for listeners, as we do with all our guests, perhaps you can give us a little bit of a background about how you got into real estate, that journey for you and, and where you're at today and what you're doing.   Jesse B (1m 53s): Yeah, sure. I'd love to give the listener some insight into how I got here. So 16 years ago, I finished my university career. I went to a school in Ontario. I'm from Ontario, actually thunder bay, born and raised and, and finished my, my university career with a degree honors, spatular, commerce, finance, and marketing, and being from thunder bay.   There's not much opportunity for somebody to work in the finance industry. So I was looking for other places to go. This is back in 2007. I had friends in Toronto that had left on our bay. I had friends in, in Calgary and some friends in Vancouver. I grew up fishing, hunting, skiing, sledding, outdoor stuff. And everybody who was in Calgary was not only doing really well professionally, but they were enjoying the outdoors.   So it was an easy fit. I moved to Calgary, worked for a very short period of time as a proprietary trader. And during university, I bar tended at a, at a, at a, at a restaurant and I loved it. So when I moved to Calgary young professional right away, I got a bartending gig, great way to meet people, not a bad way to earn some money and also a great way to meet females at the time.   So, so got into that. And through that, there were these regular clients that came in and I got to know them and they were, they ran a syndicated mortgage lending company. And as I got to know them, they got to know me and about what I did. And, and soon I started doing some consulting work for them and learning about the business. I was super interested in this, this lending business. And this is just when the subprime mortgage crisis started to started to bubble up in the states.   So I was like, Hey, there's, what's going on here. And I very quickly learned that it's a, it's a very transparent way to do business if you're doing it right. It's very, it's, it's, it's very straightforward in terms of you're putting a mortgage on a property. That's your security. So the consulting started being working, part-time working full-time fast, forward eight years. I am looking to become a partner with these people that we couldn't agree to terms on the partnership, unfortunately, or fortunately now, and through that eight years, I met my current partners here because they were very present in the industry.   I they're, they're very thoughtful word business, business owners, and we got to talking and sure enough, I started working for them. And fast forward, six years I'm partner, we're, we're scaling this company in a very meaningful way, helping many, many borrowers and shareholders lending on a short term, real estate, residential throughout Alberta and Ontario.   Jesse  (5m 16s): That's great. And it's, it's great to have you on, because we talk a lot about the traditional lending aspect of real estate, you know, your standard, what you think of as a mortgage or pretty, I guess, typical debt that you'd have on properties. And I think it would a lot of people, more people that get into our industry and more people that have been involved in an owner's field for a longer period of time, realize that there's another aspect of lending on the private side that we don't see very often. So at Calvert, can you talk a little bit about what exactly the team does there, is it focused on private?   Do you do, do you do it all? W what kind of stuff do you typically work? When,   Jesse B (5m 52s): So we are a mortgage investment corporation. We are a lender, that's all do we don't broker deals. We, we go out and we educate the market on here's the solutions that we're providing, and our solutions are very narrowly focused on people that buy, renovate, sell, or buy renovate, and refinance residential properties. Banks don't want that business. It's not profitable for them in the short term.   Not many of our industry members slash competitors want that business for very similar reasons. We've taken time to understand what real estate investors are missing in terms of service, product type, and have created products specifically to cater to them. So all we do is have that narrow focus, really try to kick ass for the borrowers by providing them the service and solutions that they need.   So a lot of times what they'll do is they'll buy a rundown house, renovate it, get it on the market. They'll buy a rundown under performing multiunit property, use our money, renovate it, get rents up, refinance it with a nice conventional loan and build a rental portfolio that way we're in it, just to provide those short-term solutions. And it has, it has been very popular for the market.   We're, we're, we're, we're solving a real problem.   Jesse  (7m 33s): So let's kick off the kind of overview of the burst strategy for those that don't know. Maybe you could just give a high level of what the burst strategy is and what you typically see from the investor side, when, you know, when they're typically engaging you or when they should be engaging you and maybe, you know, talk a little bit about the best practices when it comes to finding debt for these types of, of buying flips or by rent rehab, refinance, repeat, I think I may be not in the right order, but yeah, if you could chat a little bit about that, I think the listeners would get a lot of value.   Jesse B (8m 7s): Sure. So, so there's really, yeah. There's two strategies. We'll focus on Burr. So one is buy, renovate, sell. We do a kind of that. We just, we just define that as flipping and then the other is buy renovate, rent, refinance, repeat. So what they're doing there is, again, they're identifying, we're just, we're just residential. And we like, we, we typically do four doors or less, but we're getting into learning more about really successful practitioners who are into the higher unit stuff.   And we're happy to help them when it makes sense, but what they do is they go out to the market and they identify, again, usually it's properties that are, they haven't been touched in a long time. They've been poorly managed. And in turn, there is a good opportunity to add some, add some renovation touches to increase the value, but also increase the quality of tenant and the quality of rent. So they're using our money because typically these properties are in such disarray that the banks don't even want them.   But also because they're in Sasha's rate, even if the banks do them, they're usually able to increase the value, you know, 20, 30, sometimes 40%. And it makes sense to use are more expensive that for four or 5, 6, 7, 8, 9 months. And then when the project is complete, when they've increased the rents, when they've done their renovations, they can go to a bank lender, especially with the new cm. There's a, there's a CMAC product now and insure product that is specifically for this multifamily residential stuff, where it opens a lot more options on the refinance side.   So they're able to go and, and typically get 80% loan to value. So buying something for 600, you increase the value to, to, by putting in, let's say 150 grand to a mill. Now you're 600 plus one 50, you're exiting with 80%. So 800 grand putting money back into your jeans and being able to do the next project and the project after that. So that works really well for the real estate investor, who wants to build a portfolio and build doors.   It's a lot easier said than done because building a portfolio and building doors takes really great. The business acumen, the devil's in the details always. So the administrative processes is, is critical who you're using as property managers, all that stuff comes into play. But for those that are, that are, that are executing on this strategy, they really like what we're offering in terms of allowing them to get in, do what they need to do, and also get in with little friction.   So, because we know this so well, when we see part of my language of piece of shit house, we're like, oh, show us, show us the show us the, the budget. And then we have, we're unique that we have our own internal evaluators. We hire appraisers that work for us that do the, do the value as complete. And they do that in real time, usually same day. So we're able to provide a real effort, this experience on that ad and say, yeah, here's your end value.   Here's the profit you're making. And because you're making this profit, we want to support you. So we're very, we're lower docs, but because we really understand the business, we're not saying, oh, what's going on with, with this flooring? What about how is somebody ever going to live here? No, we did it. Thanks for the budget. We know what you're doing. We may ask some clarifying questions, but typically, because we're real estate investors ourselves, I've been doing this for literally 30 years and billions of dollars and thousands of mortgages. We've seen it all and we have the expertise to help the borrower.   Jesse  (12m 13s): Fair enough. So I just want to unpack a little bit about that. So for, for any listeners in the U S CMHC Canadian mortgage housing corporation, you're Fannie Mae, Freddie Mac would be your agency debt, very similar to what we use here. Now, I guess the 80% LTV on a lot of these, I guess it's like a lot of what we do now. It's really the, the, the loan to value. Oftentimes isn't the limiting factor these days, that's usually the debt service coverage, right? Yeah. So I'm curious the, well, number one, I, I question question about the product that you're mentioning, are you mentioning short-term debt and then you eventually do long-term with CMHC or is the short term product with agency debt?   Jesse B (12m 54s): No, so we're so, so the short-term product is Calvert's money. We're lending that the exit with, with, with, with a CMHC approved lender yes. Is the borrower goes and figures that out. And typically they figure it out through a really strong mortgage broker. Like that's, when we're doing the loan, that's already part of the plan we've reviewed, we've done our analysis on, and by the way, we have a Burr analyzer. That's about to be released to the market where we've done our analysis on the debt service coverage, where we're, we're clear on what the rent should be.   And in turn, the boar is really clear on provided. I execute, provided I do this. I'm going to hit what's needed for the exit. And that's really important for Burr, like a lot of, a lot of new or less sophisticated borrowers will say, yeah, I'm going to burn it. Okay. Explain us the exit. Hey, you know, it doesn't debt service, you know, your credit is really poor. You're not a great covenant. I don't think you're bankable. And, and they haven't thought of this.   So again, because of our experience, we're asking every question and making sure that they can exit. So sometimes what they think is a Burr will say, no, you should really plan on this being a flip and, and run your numbers is if it's a flip and maybe you get, maybe you prove us wrong and you can Brit, but make sure that this is a viable project with your most likely scenario.   Jesse  (14m 26s): Yeah, no, that makes sense. And for, I think most listeners would know, but just for the DSCR debt service coverage ratio, that would be your net operating income over your divided, by the, the amount you have to pay to service your debt. So if you have $120,000 NOI, a hundred thousand dollars, your annual mortgage payments, you got a 1.2 is the, typically the way lenders will look at that. So I guess one of the distinctions that we've people on the show before that our hard money lenders, you hear the terms hard money lender, private lender, kind of thrown, thrown around and in conjunction with each other.   Can you distinguish if at all, between hard money lenders and private lenders?   Jesse B (15m 8s): Yeah. So the way that we're, we're a mortgage investment corporation. So we operate a fund. And within that fund, we have certain rules that we have to adhere to through securities regulators, through the various real estate regulators, through tax, through our auditors, through our board of directors, we borrow money from banks, they put rules on us. So we're a very structured lender.   We like to refer to ourselves as an alternative mortgage lender. So by alternative, there would be in terms of, in terms of, I usually go by size, there would be, there would be your tier one banks. Then there would be your, your model lines of credit unions. And those are all lending money out at prime minus right now. And then you have your B lenders. The lenders are like your, your whole Mack, your home equity banks, your, your home trusts.   And they're basically sending on a prime plus. And then there's alternative lenders. That's where we would fit in where, where we're, we're still structured. Well-governed companies that have to adhere to that governance. And then there's true privates. There's true hard money lenders that are, that are lending their own money, that, that can make their own rules.   Jesse  (16m 33s): This is the uncle that does lending that it seems to work from home. You don't really know what he does   Jesse B (16m 38s): Exactly, exactly. Or like there's some, you know, some family offices that let's say the families that are worth 500 mill, they've taken a hundred mill. And they said, we're going to lend this money out on our own. And they do whatever they want. Yeah. So that would be, to me, that's the distinction of, of alternative versus private. So true, private, hard money. All we don't need docs, we'll just look at the property and lend on it. Usually that's more expensive. Usually that comes with big renewal fees and big fees.   We're, we're more of, of, of, of a, of a alternative lender just below B. So that's kind of the distinction and yes, a lot of your listeners in the states, they refer to it as hard money lenders. We, we have a lot of flexibility that a hard money lender does, but we're more consistent. The money's always there. We get here to what we say. We have, you know, we have a 40 person organization that is behind all of this Making decision from my couch.   Jesse  (17m 42s): Yeah. That makes sense. I think the connotation with heart is that, you know, you're meeting on a park bench and somebody is handing you a duffel bag of cash, which is not the case. I mean, typically, but definitely with, with your company, it sounds like it is more of a structured kind of investment. Now I want to talk about the state of the market, because I think it's pretty topical right now where interest rates are at inflation rates, some of the latest hikes, but before we get there, when somebody is coming to you to do flips or to do a burst strategy, what would you say to them to make sure that they are, they are following the right guidelines to make the process as seamless as possible.   And to be able to get to identify properties that are going to work with, with a team like yours.   Jesse B (18m 26s): So the, the primary, the primary piece of advice I give general is, is own the process. This is your, this is a business you're putting your money at risk. It's amazing how many, how few people understand the comparables have asked their realtor, you know, are you just cherry pick like, like really know their numbers really know their budget, really know who they're dealing with in terms of lawyers, realtors, mortgage, brokers, us as a lender, like this is an entrepreneurial endeavor.   And to be a successful entrepreneur, you need to put your, your, your mind, heart and soul into it. And you can't just watch HGTV, call a realtor, slap a deal together. And it works out now in fairness, the, the, the, the craziness that has been the Ontario and BC market, a lot of people, this has worked for them for years, being from Alberta, where we see prices, you know, peaks and valleys every six years, basically the professionals are in it for years and years and years, the speculators are out.   So at some point in time, and we'll get into, you know, kind of what, what, what we're predicting for the market. At some point in time, there will be prices will go down how meaningful they go down, we'll find out. But, but the overall piece of advice that I have is own the process. Understand your numbers, come prepared, understand who your, who you're partnering with, and you don't have to know it all right off the bat. Like you, you still have to take action, but as you're taking action, continue to learn.   Don't just say, oh, my realtor has gotten this, like, learn from your realtor, learn from your mortgage broker, learn from your lender, learn from your contractor. Because the more of that I'll call it institutional knowledge. You can build the more successful you'll be the most successful clients that we are fortunate enough to work with. Are those people that know everything. They may, they may never swung a hammer, but they know every single cost. They know their measurements inside and out. They probably don't have a law degree, but they can challenge their lawyer and me on certain closets.   Those are the people that are going to kick ass.   Jesse  (20m 51s): Awesome. So in terms of the, the actual distinction between, you mentioned it before a four unit and below five and five unit and above, which we typically classify, even though it's residential, multi, residential, or commercial, when somebody's looking to underwrite, or when somebody is coming to you to underwrite the deal, you mentioned the fact that you have flexibility. Does that mean that you guys are going to be more open on those smaller deals to look at the asset specific rather than just the individual? Because I know one of the challenges or one of the, put it put another way.   One of the benefits of doing apartment buildings, which is what my partners and I do, is that it really is less about us. And it's more about the asset. And if you can make the numbers work on the asset, you can get approvals and debt much easier. Whereas if it's single family houses or two, three units at a certain point, people seem to tap out in terms of the amount of debt they get. So how does that underwriting process look like for you? If it is more individual specific, more asset or a blend of the two,   Jesse B (21m 53s): When we're underwriting a flipper bird deal, the bulk of our underwriting is based off of profitability. If they're bringing us a profitable deal and they can, they can execute on that profitable deal. We're likely in, so we're not digging, we're not relying on the covenant. So if it's in a, if it's, if it's a good property in, in, in, in, in a location that we want to do business in which basically is any urban center or surrounding area, and they're making money and they show us that, like, let's say, let's just use a quick example.   Let's say, they're bringing us about a property that they're purchasing for 500 grand and their renovation is 50. And when it's done, it's worth six 50, and they're going to, they're going to be able to ex execute their renovations in a 60 day time period. So they're making money. We want him, we can do that deal, you know, Cheerio with as little as $20,000 down so we can lend them four 80 plus the feeds. It's always a 2% fee and, and 2% and four 80 is what is that $909,600.   So we can lend them 480,000 plus the 9,600. So essentially $490,000 on a $500,000 purchase. Let's say that let's say two to cover the renovation costs. Plus our payments is going to be around 75 grand for the, for the duration of the loan. They need to show us that they have 75 grand, 75 grand could be cash lines of credit credit cards, show us that you have the money. And based off that, we're in.   Hmm. You could, you could show, you can show almost, you can show a zero in a way you can, you can have,   Jesse  (23m 42s): We receive notice of assessment for those, for those wondering yeah.   Jesse B (23m 46s): Income, you can choose zero tax return.   Jesse  (23m 49s): Okay. Yeah,   Jesse B (23m 51s): You can have relative, like if you're totally delinquent on credit and you've never paid a bill, we're not, we don't want to do business with you, but if you have bruised credit, like what we define as Bruce credit is credit below 600, as long as there's rationale. And it's not like you're, you have $200,000 worth of outstanding credit consumer debt that that is maxed out. We probably want it. We're going to want to avoid that. But Bruce credit, we're fine to deal with. So we're underwriting the project. Each deal that we look at is an individual business opportunity.   And as long as you can prove to us that you have the cash to do it and it's profitable. And the means to do it. Like if you, if, when we look at your budget, we have some questions. Who's doing the work I am. Okay. What's your experience with it looks like you're doing cabinetry. What's your experience with cabinetry? I haven't been, well, you might want to think about hiring that out. So as long as you prove to us, and again, we have a lot of expertise in this that you can execute we're in.   Jesse  (24m 50s): Got it. So let's move a little bit to the macro picture right now. Interest rates have gone up over the last, last few months over this. I mean, since, since the beginning of the year in Canada, in the states, we're starting to see buyers actually start making decisions for a long time. They weren't really impacting their decisions, which is kind of amazing for, for quite some time. How are you looking at the market right now in terms of a risk standpoint?   And also, do you see this, you know, put you on the spot with the crystal ball, what do you see for the future as it pertains to the lending industry?   Jesse B (25m 30s): So we see interest rates, firstly, continuing to rise. We have, we have an inflation problem that we had it two years or a year and a half ago, but we were, a lot of people were insisting. It was transitory. All inflation is transitory. It just depends on when and what measures need to be taken. Is it, is it transitory within a year or do we have a ten-year issue? So anyhow, we think rate, we, I believe rates will continue to increase probably another 50 bips next month, at least what the market's pricing in.   And then 25 basis points thereafter for the foreseeable future that increase will impact affordability. A lot of people are already stretched with their debt, with their debt servicing that will in turn impact the market. Some people may bow to the market, which is not a bad thing because right now the, for the most part Canadian real estate is too hot. It's not sustainable. So will prices go down, maybe, especially in some markets where there already is affordability issues.   Like we're seeing a lot of, a lot of markets in Ontario where, where you have relatively low wage wages versus the price of the homes. So there's already an affordability issue there. We don't think they'll go down in a big way. And the big stop gap to that is Canadians, want single family, residential housing. And right now there just isn't sufficient supply to, to make up for that demand.   You have 400,000 immigrants coming into Canada for the next every year for the next five years. Canada does really good job at bringing in economic immigrants. So people that have capital and are ready to hit the ground running with employment, most immigrants value real estate, most immigrants want single family housing. So we're where I believe we have a supply issue that is always, is at least for the foreseeable issue is just going to really backstop a big slide in real estate values.   So what, what I anticipate at least as a bit of a reset, you know, we won't see massive appreciation. We might see slight downward pressure, but what I love in terms of how Calvert has been in business for so long, we've S we've essentially only been lending in, in Ontario for two years prior to that, it was only Alberta. And in Alberta, we've managed through those peaks and valleys. So up into 2021, we had a, a market going down 2, 3, 4, 5% a year, every year for five years.   So we're ready to we're, we're ready to manage through it and help our clients manage through it and with what our clients do in terms of flipping single family, residential housing stock. We believe that when the market turns, there'll be more opportunities for our buyer right now, it's hard for them to find really good value because you have a mom and pop buyer, which typically they don't want anything to do with a piece of shit house. Now they're saying, ah, you know, why don't we buy this? We could do our own renovations in a, in a, in a balanced market where you have three months supply, which I don't know when the last time many Ontario markets have seen that your buyer's not going to buy that stuff.   Yup. So we, we anticipate slowdown of, of, of real estate appreciation, maybe even, maybe even in some markets, a bit of a downturn, but we believe that that fundamental supply issue will backstop a big downturn.   Jesse  (29m 22s): Fair enough. And yeah, I think similar outlook on, on my end as well. I think we've, we've had a really good run for a long time in real estate. And you know, the idea of appreciation 15, 20, 20 5% annually is just, yeah, not a sustainable, not a sustainable business. So I think our reset for a lot of investors would be welcome with open arms and especially from an affordability point of view. But I think really the crux of it, I completely agree with you on the supply side.   And it kind of just frustrates me on the policy level that we try so many things and we don't look at the supply side that if you want affordable housing, you need supply. That's just the bottom line you have to, you can't, you can't restrict supply, but yeah, I mean, we'll see how things go. I, you know, from, from the investor, that's looking to, you know, potentially work with short-term debt. Is there anything that you would advise on that end when it comes to the idea of making sure that when you do exit that short-term debt say it's 12 months at 10 months at whatever it is that you're making sure that you're going to be able to get permanent permanent capital permanent debt for the project that you're working on?   Jesse B (30m 34s): Yeah, certainly no, certainly engage your bankers if you have bankers, but even if you have bankers engage in amaz engage a mortgage broker who has done this because they know all the bankers. So you'll want to make sure from the onset that, you know, yes, this is refinanceable, here's, who's likely to do it. Here's what the cost is likely to be. And we build that. And again, we talk about the Burr analyzer that we're going to be launching.   We're going, that's going to be a tool that you can use to take to your banks, preemptively like the right banks and the right brokers are clamoring for your business. So go out and find them, align yourself with them, give them the plan and in turn, create an extremely high likelihood that, that exits there. You cannot, we won't allow you to go into a project and not make sure it's there. You may, you know, especially the newer people may not be prepared to do that extra step and that extra homework, but it's, it's a requirement.   So align yourself with the right professionals, bankers, mortgage brokers. And as they're doing the work for you, learn from them, what does the B what is the bank looking for? Why is this particular issue with this property posing an issue? Is it zoning? Is it how many units is it location? You know, cause they're, every bank looks at these deals differently and, and sees they're the w the, the, the warts and the rainbows differently. So take time and understand what, what they're looking for, because then that'll influence the next project.   Could you go into,   Jesse  (32m 14s): Got it. All right. We will put links up where people can reach it. And I'll just ask you in a second, but before we do, we have four questions. We ask every guest before we, we get off. So kind of rapid fire here.   Jesse B (32m 27s): Sounds good.   Jesse  (32m 28s): Okay. What's something that, you know, now in your career, it could be a mortgages real estate and business that you wish you knew when you started in the business.   Jesse B (32m 38s): I, now that success is the combination of work ethic and time. And before I was just hoping it was purely work ethic, but man, does it take a lot of time to learn stack those wins, stack those relationships, bring the best people and knowledge around you to succeed. So time plus work ethic, not just work ethic.   Jesse  (33m 7s): Perfect. What's a resource or book that you find yourself recently recommending to a, to others.   Jesse B (33m 15s): So as we're scaling this, this business, a lot of, a lot of organizational management matters is where I'm focused on leadership, mentorship, coaching five dysfunctions of a team that I read a few months ago has been amazing. Lensioni is the author's last name. He's done a few really good organizational business books. So if you're, if you're a leader, it can relate to personal matters.   Relationships, team matters, relationships, mentorship stuff. So five dysfunctions of a team is what I've been recommending a lot lately. And it's mostly because of where I'm at professionally, the things I'm going through,   Jesse  (34m 0s): What would you tell a young individual that's trying to get into our business, and that can be on the mortgage side or just the real estate investing business in general,   Jesse B (34m 12s): Anything in the real estate industry is just putting yourself in positions to succeed. You're not going to hit the home run day one. You're probably going to be an admin, an analyst, a cold caller, whatever it takes, but make sure you're surrounding yourself. Make sure you're entering an organization or surrounding yourself with somebody that you believe in trust. And, and you've researched. Don't just jump into bed with antibody, be selective, but also be willing to, as they say you Chet, like if, if you're going to work for the best, they probably don't have a, the, the, the, a super high paying big responsibility job for you.   You got to prove that you deserve those opportunities.   Jesse  (35m 1s): Hey, at 33, I'm still eating shit today. And a new title should be a, vice-president cool to call her. Cause at the end of the day, it's, we're still doing outreach. We're still connecting whether you want to buy, find off market deals. That call is typically not lined up, lined up for you. So that's great advice. Last question. First car, make and model   Jesse B (35m 21s): First car making model. I had a, again, thunder bay, you know, kinda rednecky town. I had a shed silver auto halftime keen 88, 2 wheel drive tires to this thing was a death trap. And we would lay, we w w we were in the middle of nowhere. So the nearest, the nearest big city to us with Minneapolis St. Paul, I remember bombing down in, in snow storms when I was 17 years old with my buddies with just enough money to get down and scalp a ticket to the Minnesota Vikings game.   And like, they're telling me to go faster and I'm like, guys, if I go faster, we're going to fly up the road with this Pete. Like this thing was a death trap and 500, or I guess it would be 600 kilometers there. 600 kilometers back somehow we made it   Jesse  (36m 8s): Awesome. Yeah. That is just a large piece of steel. What would you w we have a lot of colleagues that are in thunder bay. What would be the, the American equivalent of thunder bay?   Jesse B (36m 20s): Yeah. American equivalent of thunder bay. It's like, I don't know what, what, what town of plenary is a population of 120,000? The nearest cities to that is to St. Marie to the east, which is 800 kilometers. So, so for Americans, that's 600 miles. Then the apples St. Paul to the south, which is 400 miles Winnipeg to the west, which is 600 miles.   Like in terms of geography, there's nothing similar.   Jesse  (36m 54s): Yeah. I mean, culturally, I feel like a, I don't know if there'd be something in, in, in Michigan or if it would be, I don't know. It's like, it's kind of a mix of different, different cultures in thunder bay, but it's definitely,   Jesse B (37m 7s): Yeah. We spent a lot of time. So down. So south at thunder bay, there's a Duluth aloof Minnesota. Now Duluth is kind of a, for the American listeners. Duluth is a more refined prettier version of thunder bay. So imagine more blue color, less picturesque version. That's the underbanked.   Jesse  (37m 31s): Yeah. You know, miss soda. That makes sense. If Fargo was filmed in Canada, which maybe, maybe it was thunder bay would probably be a good, a good spot.   Jesse B (37m 39s): Yeah. Yeah. Fargo is a really good equivalent.   Jesse  (37m 42s): All right. Well, for people to reach out or connect with you, Jesse what's, where can we send them? We'll put the, we'll put everything we talked about in the show notes in any of the links, but yeah. Just let the listeners know and we'll put that up there.   Jesse B (37m 54s): Yeah. So we have a great website with, with all the tools that, that a real estate investor would need in terms of, for flip and Britain Burr financing@chmic.ca. So Calvert, Google cower, home mortgage take you to our website. My contact information is there. I'm happy to, to discuss anything. I have an amazing team of underwriters and business development, people that can, that can point you in whatever direction needed. We also have a really great Instagram account ICU due to Jessie.   I follow you personally, but our Instagram account is just to provide knowledge to real estate investors. So we're doing tips for flips economic reports. We're, we're releasing tools. We've just written. We've just wrote a white paper on the, on the benefits to the, the macro economy on real estate investing. So please follow us on Instagram at Calvert home mortgage.   Jesse  (38m 51s): My guest today has been Jesse Jesse. Thanks for being part of working capital.   Jesse B (38m 57s): Thank you.   Jesse  (39m 5s): Thank you so much for listening to working capital the real estate podcast. I'm your host, Jesse, for galley. If you liked the episode, head on to iTunes and leave us a five star review and share on social media, it really helps us out. If you have any questions, feel free to reach out to me on Instagram, Jesse for galley, F R a G a L E, have a good one take care.  

Dr. Haney Mallemat, a triple-boarded critical care physician and Editor-in-Chief at criticalcarenow.com, joins us to discuss all things vasopressor related. During the interview, Dr. Mallemat mentions the Arginine Vasopressin During the Early Resuscitation of Traumatic Shock (AVERTShock) trial. You can find a summary of that study here, and deployedmedicine.com has a good video discussing the trial as well.Dr. Mallemat also mentions a study describing a "central line-less" ICU while discussing the safety of vasopressin administration through peripheral IVs. You can find that study here:Cardenas-Garcia, J., Schaub, K. F., Belchikov, Y. G., Narasimhan, M., Koenig, S. J., & Mayo, P. H. (2015). Safety of peripheral intravenous administration of vasoactive medication. Journal of hospital medicine, 10(9), 581–585. https://doi.org/10.1002/jhm.2394