Podcasts about ICU

INTRO (00:24): Kathleen opens the show drinking a Bluegill Light Lager from 4 By 4 Brewing Company in Springfield, MO. She reviews her week golfing at Bass Pro Shop founder Johnny Morris's Big Cedar Lodge with friends.   TOUR NEWS: See Kathleen live on her “Day Drinking Tour.”   TASTING MENU (1:20): Kathleen samples limited edition World Cup themed Ritz Crackers, limited edition Miller Lite Beer Cheese Burger Pringles, and Australian Tim Tam cookies.    QUEEN NEWS (43:26): Kathleen shares that Taylor Swift was inducted into the Songwriters Hall of Fame and supported fiancé Travis Kelce at Tight End University, and Dolly Parton is releasing a line of “A Cup of Ambition” coffee at her Buc-ee's like “Dolly's Tennessean Travel Stop.”   HOLLYWOOD HAPPENINGS (15:04): HollyBobby provides the latest news in Hollywood.   UPDATES (48:26): Kathleen shares updates on Jelly Roll filing for divorce from Bunnie XO, Nancy Guthrie's 2nd ransom note confirmed her death, and a man with no legs makes history by climbing Everest using only his arms.   HOLY SHIT THEY FOUND IT (1:09:50): Kathleen reads about the resurgence of the Cozumel Dwarf Fox.   WHAT ARE WE WATCHING (24:16): Kathleen recommends watching “Maternal Instinct” on Netflix, “I Will Find You” on and “Outrageous” on BritBox.    SPORTS NEWS (53:20): Kathleen reports on Scottish fans donating nearly $30K to charities for welcoming them in for World Cup games, Europeans are buying up Ranch dressing to take home from World Cup trips, and Kraft is rolling out a TSA compliant Ranch dressing.   FRONT PAGE PUB NEWS (1:18:22): Kathleen shares articles on Johnny Morris's donations of fishing rods and reels to schoolchildren, Costco shoppers are hoarding Australian Tim Tam cookies, Pope Leo will hold an iconic mass at Spain's Sagrada Familia, Commodore is bringing back the flip phone, a Magritte painting has been damaged by a child with a pine cone, and police allege that an Air Canada pilot flew for years without a proper captain's license.    SPANISH PHRASE OF THE WEEK (1:26:33): The Spanish phrase to learn this week is “a qué distancia está el aeropuerto?” or “how far is it to the airport” in English.    SAINT OF THE WEEK (1:33:13): Kathleen reads about Macarius the Younger of Alexandria, the patron saint of pastry makers.    FEEL GOOD STORY (1:29:26): Kathleen shares a story of a British hospital that created an outdoor ICU for patients. 

This week, I'm sitting down with Jordan Harper, founder of Barefaced and one of the smartest voices in skincare. We talk about how a teenage struggle with acne led her from the ICU to building one of the fastest-growing skincare brands in the country, all while raising four kids and navigating over $500,000 in student debt.Jordan shares the skincare advice everyone should know, the products that actually matter, why most routines are far too complicated, and the surprising reason consistency beats every quick fix. We also get into motherhood, time management, building a business without investors, and the mindset shifts that helped her turn a garage startup into a thriving company.Whether you're looking for better skin, better habits, or inspiration to finally start the thing you've been dreaming about, this conversation is packed with practical takeaways.Produced by Dear MediaSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This podcast is made possible by our listeners and viewers. If this show has brought you value, you can support it by becoming a member of The Way Forward, our platform designed to help you find the health and freedom community (people, practitioners, schools, farms, and more) near you. Your membership directly supports the podcast and the work we do.Your body is continuously recalling the trauma from your past.After ten years as a board-certified anesthesiologist, Dr. Richard Massey watched his sister-in-law reverse pre-eclampsia in three days by eating more eggs. That moment ended his career in conventional medicine.He now works with live blood microscopy, heart coherence biofeedback, recall healing, German New Medicine, and family constellations. What he keeps seeing under the microscope is not pathology, it's the body healing. It took him thirteen years to say that out loud.His patients include a nurse whose blood pressure doubled while trying to save her father, a boy whose growth stalled on an inherited memory, and a great-grandson born unable to breathe (a biological echo of a grandfather who fled a breathalyzer test).If you have ever wondered why the same struggle keeps showing up in your body, this episode reframes the question.You'll Learn:[0:00] Introduction[12:24] Why the diet that reverses preeclampsia 100% of the time was buried for 30 years[18:40] The hospice nurse who made Dr. Massey promise the peroxide IVs wouldn't extend her patient's life[26:58] Discovering human magnificence after 13 years of looking at blood the wrong way[31:56] Changing “I” to “we”: celiac disease as a love story for the family system[41:03] The rabbi who revealed the original fifth commandment and how it underwrites constellations[48:51] The boy whose body formed around his grandfather's fear of a breathalyzer test[1:01:27] The 55-year fantasy that ended when one excluded perpetrator was finally seen[1:46:11] Why Western culture won't raise its hand the way the Zulu villagers did[1:56:47] The ICU nurse whose blood pressure doubled, trying to save her father's life[2:03:13] Parenting kids under seven: how to remove inherited programs[2:10:07] Why every ultraviolet IV is secretly a family constellation in disguise[2:42:29] The 19-year autonomy timeline and why your injuries keep repeating on schedule[2:49:32] Reading leaky gut through Klinghardt's five levels, and the old woman in the shoeRelated The Way Forward Episodes:The Hidden Meaning of The Law of One: Densities, Love & Humanity's Evolution with Edmund Knighton | PodcastFamily Constellations & The Golden Spiral with Danica Apolline-Matić | PodcastHow Trauma & Emotions Cause Diseases: 4.5 Hour Masterclass on German New Medicine with Dr. Melissa Sell | PodcastThe Mechanics of Trauma, Suffering & God's Unconditional Love with Brandon Bozarth | PodcastBeyond Death's Door: Mediumship, Life, Death & the Nature of Existence with Suzanne Giesemann | PodcastThe New Frontier of Biology: Water, Fields & Consciousness with Carlos Millán | PodcastResources Mentioned:Pyramid of Health by Gilbert Renaud | BookFamily Constellations by Joy Manne, Ph.D. | BookI Am (Documentary) | IMDbFind more from Dr. Richard:Dr. Richard Massey | Instagram Find more from Alec:Alec Zeck | Instagram | XThe Way Forward | InstagramDonate to The Way Forward hereThe Way Forward is Sponsored By:Want more crypto insights and a community to back you up?Join the Crypto Freedom Academy today. It's 100% free and designed to help you master the markets.

Nurses everywhere are fed up. They're organizing and walking picket lines more than ever before. Here in the Chicago area, more than 2,000 of them have voted to unionize in just the last month. On today's In the Loop, we'll hear first-hand accounts from a couple of local nurses and a journalist who's been following their efforts. GUESTS: Jessica Ahn, registered nurse in the emergency department at Saint Mary of Nazareth Hospital Sarah Louise Dawson, registered nurse in medical ICU at Rush University Medical Center Kristen Schorsch, WBEZ public health and politics reporter For a full archive of In the Loop interviews, head over to wbez.org/intheloop.

Brain aneurysm survivor Sarah Faulkner shares the story of the day everything changed. After a ruptured brain aneurysm, five days of hemorrhaging, emergency surgery, and 21 days in neuro ICU, Sarah says Jesus met her in the hospital room when she was at her weakest. This is a powerful Christian testimony of prayer, survival, healing, and the presence of God in the middle of the impossible. -- NEW Everyday Miracle compilation book on Amazon: https://a.co/d/45cgbP8 Everyday Miracle compilation book on Barnes & Noble: https://www.barnesandnoble.com/w/everyday-miracles-julie-hedenborg/1146173449?ean=9798881501808 Subscribe to Julie's YouTube channel: https://www.youtube.com/@everydaymiraclespodcast1395 Website for Everyday Miracles (APPLY!): http://everydaymiraclespodcast.com/ To follow Everyday Miracles Podcast on itunes: https://podcasts.apple.com/us/podcast/everyday-miracles-podcast/id1447430033 On Social: Facebook: https://www.facebook.com/everydaymiraclespodcast/ Instagram: https://www.instagram.com/everydaymiraclespodcast/ TikTok: https://www.tiktok.com/@everydaymiraclespodcast X: https://x.com/miracles9598 LinkedIn: https://www.linkedin.com/in/julie-hedenborg-452028a7/ To email Julie directly: everydaymiraclespodcast@gmail.com -- To connect with Sarah or learn more about her work: Instagram: @mvpearlgirl Website: www.milkvelvetpearls.com Email: sarah@milkvelvetpearls.com -- Scripture ✝️: Jeremiah 29:11 James 4:7 Matthew 6:9-13 2 Corinthians 12:9 Matthew 9:29 Matthew 16:25 John 5:8 Luke 17:21 Isaiah 55:8-9 Daniel 3:29 MSG - "There has never been a god who can pull off a rescue like this."

CORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease:  https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/   OUTLINE:   CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition.  Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.  Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.  2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging.  Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.  3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis.  In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.  These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.  Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.  Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.  Classification of stenosis: Mild: 70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk. Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.  Flow controller settings: Low setting High setting Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).  Confirm flow reversal via two different ways:  The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion. The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.    Carotid artery stenting, balloon angioplasty, and completion angiogram At this point, a standard carotid angioplasty and stenting procedure is performed. ENROUTE transcarotid Neuroprotection System device:  inner diameter of 8F and an outer diameter of 10F Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.  Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent    Cessation of flow reversal and sheath removal Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.  Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.  The patient is auto-transfused the blood from the flow line back to the venous system.  As the arterial access system is removed and the puncture site is closed with the U-stitch.  IV protamine is administered to reverse the heparin. Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.  Postop care/complications Postop care All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.  Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion.  Dual antiplatelet therapy: continue for 45 days to 12 months Aspirin and statin therapy: continued indefinitely Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter. Postop complications Hematoma Stroke Myocardial infarction Cerebral hyperperfusion syndrome Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms.  Cranial nerve injury Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.  Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.  Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.  Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR.  Stent restenosis Pseudoaneurysm Access site infection

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Vanessa Abraham, MS, CCC-SLP,  and Jared Rosen, MD, about Vanessa's Story of Hope and the lasting connection they formed during her neurocritical care journey. Vanessa shares how a sudden illness progressed from flu-like symptoms to respiratory failure and paralysis, ultimately requiring mechanical ventilation, an prolonged ICU stay and inpatient rehabilitation. She discusses the uncertainty surrounding her eventual diagnosis of a rare pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, as well as the fear of being unable to communicate, care for her daughter or return to the life she knew before her illness. The conversation also explores the profound impact of compassionate, patient-centered care. Vanessa reflects on how Dr. Rosen, then a medical student completing an ICU rotation, became a reassuring presence for both her and her husband. Together, they discuss the importance of recognizing intubated patients as active participants in their care, providing accessible communication tools and taking time to listen. They also emphasize how small acts of empathy and human connection can reduce anxiety and potentially lessen the long-term effects of post-intensive care syndrome. To read Vanessa's full Story of Hope, visit NCS Currents. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

Today, I'm joined by an amazing alum of The Big Talk Academy Mastery, Lee Powers. You may remember Lee from Episode 741 that released in April, where I featured her big talk, "A Nurse's Awakening from a Coma: Lessons Learned from Being the Patient." Lee is a nurse, speaker, and advocate with decades of experience. After surviving a patient assault that left her on a ventilator in the ICU, she founded ICUiCare™ to humanize critical-care recovery through education and advocacy, empowering patients, families, and healthcare teams to solve complex health challenges and rebuild lives.   In this episode, we'll explore: The value of pharmacogenetic testing in preventing medication complications The number of ICU survivors affected by Post-Intensive Care Syndrome (PICS), and why more people aren't talking about it How medicine often operates on a one-size-fits-all approach, and how you can become a better advocate for your healthcare Her current favorites: Book: Man's Search for Meaning and Speaker: Tricia More from Lee Powers Her first appearance on The Big Talk podcast in Episode 741 Website: https://leepowersrn.com/  LinkedIn: https://www.linkedin.com/in/lee-powers-rn-bsn-034845337/    More from Tricia  Claim your spot for my two-day virtual masterclass, The Art of The Big Talk Join me LIVE for my Complimentary Monthly Workshop Explore my content and follow me on YouTube Follow me on Instagram  Connect with me on Facebook  Connect with me on LinkedIn  Visit my website at TriciaBrouk.com 

大家好，我是猛哥。上周更新的节目里我和ICU医生余一生聊到产妇在医院的待遇，她说医院有共识，就是产妇不能死，产妇如果死亡，全医院都得复盘。评论区有听众问，为什么不详细说说这个。其实我也感兴趣，录节目的时候我问了一下就打住了，没有追问，我意识到这个问题最好不要让作为个体的医生来回答。首先这个结论，产妇在医院的生命权重很高，不难理解，在医院里谁的命更重要，是依照什么原则制定的，所以我觉得这不该是某个医生该回答的。如果探讨不需要很深的话，那这时候AI就很适合回答这种问题，ai既博学又没有包袱。我问了DeepSeek，它大概是这么解释的：在医院的绝对危急重症排序（如ICU抢救）中，产妇并非“无条件第一”，危重老人、心脏骤停者同样享有最高级别的抢救权限。但在产科病房、急诊分诊及手术室调度中，产妇确实享有近乎“压倒性”的优先权。这种“高优先级”不是基于道德感性，而是基于极其冷酷且紧迫的医学逻辑和生命数量统计。核心原因有以下四点：两条生命叠加的“时间窗”极度狭窄（医学刚性）产妇一旦出现危急情况（如脐带脱垂、胎盘早剥、子宫破裂），胎儿在宫内缺氧超过4-6分钟就会造成不可逆的脑损伤甚至死亡，而产妇本身也可能因大出血在十几分钟内失血过半。在这“黄金5分钟”内，医院必须暂停其他非紧急手术、腾出电梯、呼叫多科室（麻醉、儿科、重症）会诊。这并非“偏爱”，而是胎儿的存活完全依赖于母体循环的即时恢复，拖延意味着两条生命的直接消失，没有任何替代方案。生理状态的“双循环”导致病情断崖式恶化（复杂性）产妇处于高血容量、高心输出量状态，代偿能力极强。这带来一个致命陷阱：她看起来神志清醒、血压正常时，可能体内已经隐匿性出血超过1000毫升。一旦代偿崩溃，血压会在几分钟内“断崖式”跌落，直接从“稳定”跳入“濒死”。这种“突然崩塌”的特征，要求医院必须前置投入资源。优先级不高，就意味着在护士巡视的间隙里，母子可能已经救不回来。社会伦理中的“可挽救性”与“剩余寿命”权衡（社会学共识）在医疗资源分配（分诊）的伦理准则中，“预后寿命”是重要指标。产妇群体绝大多数是育龄青年，基础疾病少，抢救成功率和后续生存质量远高于老年危重症患者。同时，社会学意义上，拯救一名产妇意味着保全了一个核心家庭。这种“单位资源投入产出比最高”的现实考量，使得医保体系和社会舆论都默认给予产妇最高优先通道。医疗法律的高压红线（制度倒逼）《母婴保健法》及医疗纠纷举证责任倒置规定，围产期死亡（特别是孕产妇死亡）属于国家卫健委直接“死因评审”的硬指标。一旦出现因“等待手术室”或“检查排队”导致的死亡，医院将面临严重的行政追责甚至刑法层面的过失认定。这种高诉讼风险，迫使医院管理层将产科设置为“零容忍”科室，必须在排班、备血、留床数量上保留冗余，这种制度性冗余在外界看来就是“最高优先级”。DeepSeek还有一段补充，非常有意思：最后，想对您说一句题外话：您提出这个问题，或许是因为目睹了“插队”感到不公，或是在担心中体会到了恐惧。请相信，这种“优先”的本质，是人类对无法重来的生命窗口期最谦卑的妥协。在产房里，那几分钟的让行，不是特权，而是医学对概率和时间的敬畏。您如何看待这种“优先”与“公平”之间的张力呢？我很愿意听您聊聊。我聊的话，我还是想回到第三点，也就是ta提到的，社会伦理中的“可挽救性”，我觉得产妇优先级高也是我们这个社会对公民情感的最大程度拯救。有孩子之前我对家庭的理解比较浅，有孩子之后一下子就立体了，忽然共情了很多人。产妇和家人是怀着喜悦的心情来到医院的，这不仅是一条命，更是三个家庭的希望。相比于每一种生命危机，产妇的危机可能是在情感层面造成伤害最大的一种。所以DeepSeek的担心，就是我好奇这个问题，也许是因为目睹了插队感到不公，这个思考很细腻，但在咱们这期节目里，这种声音没有出现，我想可能是大家都能理解产妇不能死这个原则。我觉得这也是人类在漫长的群居生活中达成的一个温柔的共识。ICU的故事总是会讨论到医疗资源分配，这也是ICU医生会频繁面对的问题，但我们讲的故事更多还是关注医生与患者共同努力让生命得以延续的这个经历本身。余一生不断去讲，ICU救治成功的概率比想象中高，请大家无论如何一定不要放弃生命，因为生命有多宝贵，ICU医生最知道。前两周我们在北京办余一生的签售会，在读者交流的环节，第一个拿起麦的女生一句话就把现场所有人抓住了，她说“今天是我从ICU走出来的第100天。”她得的是妊娠引起的颅内静脉窦血栓，堵住了左脑的主静脉通路，右侧肢体受影响，右腿右手都动不了，半边偏瘫。发病时她先经历了流产，所幸没有大出血，随后做了脑部的取栓工作，在ICU住了27天，中间昏迷了整整14天。为了把她从死神手里抢回来，69位专家从协和、宣武、天坛各大医院赶过去会诊。她笑着说：“69名专家保我一个。”这让我想起来之前余一生讲的，2007年她实习的时候，遇到一个21岁的产后大出血产妇，医生直接跪在ICU的病床上做手术，护士举着应急灯照明。最后人救回来了。她说“那时候我就想，原来一群人拼尽全力，是真的能把命抢回来的。”ICU医生这份工作很辛苦，余一生的妈妈最早坚决反对她做ICU医生的，就希望她当个厂医、社区医生，清闲点。母女俩吵到最凶的时候，她妈把她复习资料都扔了。但她还是进了ICU。有一天她下班回家累得不行，她妈说：“谁让你当初不听我的？”余一生轻轻说了句：“今天救了个产妇。”妈妈沉默半天，只问了一句：“想吃啥，给你做。”看着一个危重病人，各项指标特别差，家属哭成一片，但是经过医生的努力，最后能够走着出去，这是让余一生最有成就感、最感到满足的事。余一生经常说，她只是一个站在悬崖边上，想多拉住一个人是一个人的医生。我想这大概就是医生这个职业的意义，也是我们讲故事的意义，哪怕面对再多救不了的无奈，只要能拉回一个，家里的灯就能多亮一盏。所以我再次推荐余一生的这本书《只有ICU医生知道》，看完不仅能了解ICU医生这个职业，也能理解背后医院运转的逻辑，以及生命为什么如此宝贵，值得我们一起守护。最后这周不更新节目了，没忙得过来！下周更新！6月雨特别多，祝你有冲进大雨的勇气，也有烘干鞋袜的耐心，下周见！

Photo by Ashley Walker on Unsplash Sudden infant death syndrome, or SIDS, is the unexplained death of a healthy baby, usually before their first birthday, that often occurs during sleep. It's also been called crib death, and is a leading cause of death in infants. One of the strategies that the United States has used to try to reduce these deaths is to tell new mothers not to sleep with their babies, under the assumption that thebaby could be unintentionally smothered by the mother during sleep. This has been the recommendation of the American Academy of Pediatrics for some years now, but one nurse scientist is challenging this recommendation. Dr. LaurenCovington, PhD, RN, is an Assistant Professor at the University of Delaware School of Nursing, a sleep health equity researcher and a practicing pediatric ICU nurse with over 15 years of experience. She has received numerous national and local awards for her research on improving sleep and health outcomes in socioeconomically disadvantaged families. She spoke with HealthCetera host, Diana Mason, PhD, RN, about SIDS and her work on this important health issue. This interview first aired on HealthCetera in the Catskills on WIOX Radio on May 27, 2026. The post Reducing Crib Death appeared first on HealthCetera.

I've often shared that these are the "travel years" for my husband and I. We've seen this window close for our parents and feel like it's important to take advantage of opportunity and health! We have such an interesting guest today in Wesley Baker. He is a Bestselling author and entrepreneur with 40+ years experience, sharing real-life stories from travel, business, and life, leading numerous adventures all around the world and inspires others to explore what's next for them. We will be discussing today some of the current challenges in travel and how he delivers exceptional travel experiences through his PureOneGroup travel company. Find out more about Wesley at: https://www.wesleybaker.com  Full article here: https://GoalsForYourLife.com/curated-travel  Chapters 0:00 Intro and the importance of travel years 2:15 Meet Wesley Baker: From software developer to CEO 5:10 Writing a bestseller from an ICU bed 7:45 The spark that ignited a love for global culture 10:20 How our travel perspectives shift with maturity 13:40 Why travel should be a necessity for your mind 16:15 Navigating modern challenges in the travel industry 19:30 The rise of small group and independent tours 22:00 Sustainability and the joy of slow travel 25:10 It is never too late: Traveling with health issues 28:45 Finding value and safety in unique destinations 32:15 The evolution of cruising and river tours 35:40 Industry recovery and the reality of travel costs 38:20 Breaking the habit of saving too much for the future 41:30 The healing power of nature and slowing down 44:15 Lessons on prioritizing health over possessions 46:50 Final wisdom and where to connect with Wesley Get POWER OF AFTER BOOK HERE: https://amzn.to/3GpEGlJ Make sure you're getting all our podcast updates and articles! Get them here: https://goalsforyourlife.com/newsletter Resources with tools and guidance for mid-career individuals, professionals & those at the halftime of life seeking growth and fulfillment: http://HalftimeSuccess.com 

Hello Doctor Humans

Show notes at pharmacyjoe.com/episode1141 In this episode, I'll discuss whether non-verbal ICU pain scales can indicate the severity of pain.

Send us Fan MailWhat would it really mean to shorten neonatology fellowship training to two years? In this episode, Ben and co-host Dr. Shetal Shah sit down with three division heads, Dr. Jill Maron (Brown), Dr. Patrick McNamara (University of Iowa), and Dr. Sarah Taylor (Yale), to examine the ABP's proposed changes from the perspective of those who run major academic NICUs. From the operational and financial strain of losing an entire class of third-year fellows, to the erosion of scholarly development, dwell time, and faculty wellbeing, the conversation makes clear that the costs of this proposal go far deeper than the curriculum. How do you staff an 80-bed NICU without junior fellows? Who funds the gap? And what happens to the next generation of academic neonatologists if we train them in isolation from the very experiences that shape their identity as clinicians and scholars?Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

He was working 80 hours every two weeks in a hospital ICU.Open heart surgery patients. Life or death. No room for error.And in the gaps between shifts, sometimes still in his scrubs, he was quietly building a short term rental business that would set him free.In this episode, E sits down with Jeremy Rosen for one of the most honest W2-escape stories this show has ever told.Jeremy joined STR Secrets with 4 properties and a full-time nursing job he loved but knew he had to leave. He went from 4 to 8 to 12 to 20 properties, all while clocking 12-hour shifts at the VA. Then he merged his company into Five Star Vacation Rentals, now running 67 properties across Central Texas, and finally walked away from nursing for good.In this episode: → The exact mindset shift that took Jeremy from sick patients to happy guests, and the nurse's instinct that makes him a better host than most operators will ever be→ How he used his days off, while everyone else scrolled, to prospect, sell, and grow→ The "who not how" decision that broke him out of doing everything himself, and the one hire that changed his entire business→ Why he refused to build in secret, and how speaking his goals out loud actually made them happen→ The honest truth about quitting your W2 that almost nobody talks about, including the strange struggle of suddenly owning all of your own time→ Why "everything is figure out able" is the only belief you need to finally make the leapIf you have a good job you're scared to leave, this is the episode you need to hear.Free 6-step course to start your day right: level.strsecrets.com/pc-bookJoin the community: STR Secrets Facebook Group

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Mike Falk — pediatric ICU physician with multiple deployments to Iraq, Gaza, and Ukraine — for a raw, practical, deep dive into pediatric care when you're the only asset and evacuation is denied.Most combat medics carry 99% adult gear. Kids still show up. Dr. Falk breaks down the absolute minimalist kit that actually works in austere and combat environments: canine tourniquets for toddlers, the single blue IO you really need, simplified airway choices, push-pull resuscitation with a syringe and stopcock, and a field-expedient needle cric setup.Then he walks through three real cases that expose the brutal decision-making required in prolonged field care:A 4-year-old pulled from rubble with a head injury who decompensates from rising ICPAn 8-year-old with a penetrating chest wound and tension pneumothorax at the thoracoabdominal junctionA 4-year-old with an infected blast wound fracture who develops septic shock days later in a denied environmentYou'll learn weight-based dosing that actually works in the field, why kids decompensate differently, how to mix and run an epinephrine drip with limited supplies, the realities of black-tagging children in mass casualty events, and why these cases stay with providers long after the mission.Key Takeaways:The truly minimalist pediatric kit that won't break your weight limitPractical field management of rising ICP when you have no CT or neurosurgeryPush-pull volume resuscitation and epinephrine drip mixing for pediatric shockWhy penetrating trauma at the 6th–7th rib level is often thoracoabdominalThe emotional and ethical weight of black-tagging kids — and why you must train itMalnutrition's hidden impact on wound healing and sepsis in prolonged scenariosChapters00:00 - Welcome & Why Most Medics Are Unprepared for Pediatric Patients00:57 - The Bare Essential Pediatric Combat Medic Bag02:25 - Canine Tourniquet for Under-2s & Minimalist Hemorrhage Control02:25 - Vascular Access: Why the Blue IO is Usually All You Need03:22 - Simplified Airway: OPAs, NPAs & i-gel Sizes That Actually Matter03:22 - ET Tubes: Why Only 4.0, 5.0 & 6.0 Cuffed Are Necessary04:24 - Push-Pull Resuscitation Technique (Syringe + Stopcock)04:56 - Needle Cricothyrotomy Setup & Critical I:E Ratio Warning07:09 - Case 1 Begins: 4-Year-Old Blast Victim Pulled from Rubble08:47 - Initial Assessment, C-Spine Considerations in Kids & Access12:16 - GCS 11, Pain Control & Why Fluids Make Sense Early14:17 - Hours Later: Decompensation & Rising ICP18:17 - Positioning, Hypertonic Saline Dosing (5 mL/kg) & Decision to Intubate23:13 - Ketamine-Only Intubation, Permissive Hyperventilation & Realities27:51 - The Emotional Toll: Black Tagging Kids in MCI29:44 - Case 2: 8-Year-Old with Right Chest GSW & Tension Pneumothorax31:36 - Chest Seal + Needle Decompression (Anterior Approach Preference)34:23 - Blood Resuscitation (10 mL/kg) & Why Location Matters (Diaphragm Level)40:20 - Case 3: 4-Year-Old with Infected Blast Wound Fracture – Septic Shock42:51 - Broad-Spectrum Antibiotics & Source Control in Denied Environments45:26 - Push-Pull Boluses, Epinephrine Drip Mixing & Permissive Hypotension51:09 - Malnutrition's Impact on Healing & Infection in Prolonged Care56:49 - Final Lessons: Training Black Tags, Calling for Help & Provider PTSD57:32 - Outro & Where to Find More PFC ContentFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

  Jay V. Jackson is a Senior Licensed Reiki Master Teacher, mentor, widowed gay man, former ICU and hospice nurse, and founder of Illumine Reiki Academy. His work centers on Reiki as a gentle path of healing, belonging, spiritual reclamation, and returning to the sacred self. Through Reiki teaching and mentorship, Jay helps sensitive spiritual seekers and practitioners develop confidence, intuition, and grounded healing presence. His message speaks to those navigating grief, identity, spiritual disconnection, life transition, and the desire to serve from a place of authenticity rather than performance.   Connect with Jay V. Jackson Jay@illuminewellness.com www.illumineReikiAcademy.com https://www.facebook.com/illumineReikiAcademy

It was 2020. The world had just flipped upside down, and Andrea Mancuso's older brother was in the ICU with COVID. Andrea had a master's in therapeutic intervention. Fourteen years as a school psychologist in the New York City public schools. A whole career built on clinical skills and helping people through hard things.   And in those few days, she lost access to every bit of it. She was just afraid, wondering what was going to happen.   After three days, she sat up and told herself: you're either going to navigate this pandemic like this — which is no good for you or anybody else — or you're going to do something different. That was the day Intentional Healing and Wellness was born.   In this episode of Amuse Bouche Leadership Bites, Theresa sits down with Andrea — licensed mental health counselor, leadership coach, and the person who's helped Theresa through plenty of her own challenges — to talk about the part of leadership nobody hands you a handbook for.   They get into why entrepreneurship is personal development on steroids, why leading other people is the easy part and leading yourself is the work, and Andrea's premise that time does not heal all wounds — intention does. She shares the 82-year-old client who hired her at 80 because he was tired of feeling like he wasn't good enough.   Andrea breaks down emotional intelligence as the EQ advantage — the leading predictor of leadership success that almost nobody can actually name the skills of — and makes the case for radical responsibility: stop waiting for your employer to develop you and invest in yourself, because success leaves clues.   And there's the car. Are you in the driver's seat with the windows down and your music on — or in the back seat, waiting to see who gets in, how fast they drive, and whether they even show up?   Here's the real question this one leaves you with: what's the thing that already popped into your mind — the one that needs your attention? Because the moment you give it attention, you set yourself free.   Key Takeaways: • Leadership isn't really about your relationship with other people — entrepreneurship taught Andrea it's about how you lead yourself. • It's harder NOT to do the inner work. Convincing yourself it's too hard to look keeps you stuck at a ceiling you don't belong at. • Time does not heal all wounds — intention does. The wound that's already on your mind is the one asking for attention. • Emotional intelligence is the leading predictor of leadership success, yet it's made up of 15 skills almost no one can name. That gap is the EQ advantage. • Flexibility is one of those EQ skills — and we're rarely the best judge of our own. We see ourselves one way; the people around us see something else. • Radical responsibility: don't outsource your growth to your employer's training budget. Invest in yourself — coaching, therapy, even just the book — because success leaves clues. • Hard skills get you hired; human skills make you a leader. Andrea saw it as a school psychologist — high EQ predicted who'd be fine far better than IQ ever did. • You're not just the writer of your story — you're the director, the producer, and the lead. Living as if life happens to you is riding in the back seat. • When you promote someone, clarity and training aren't optional. You can't hand someone a 'handbook of excellence' and expect them to know how to lead.   Timestamps / Chapter Markers: 00:01   Meet Andrea Mancuso 01:20   Who Andrea is: Intentional Healing and Wellness, leadership + midlife coaching 01:55   14 years as a school psychologist — the one part of life she thought she had figured out 03:20   The golden handcuffs — the NYC package she felt committed to 04:00   2020: her brother in the ICU, and losing access to every skill she had 04:32   After three days Intentional Healing and Wellness is born 05:01   September 2021: pulling the plug and jumping fully into entrepreneurship 05:35   The program that started it all: Momentum Education, July 2016 06:55   Forget Tony Robbins — just become an entrepreneur (personal development on steroids) 08:10   The reframe: leadership is about how you lead yourself 08:16   Why entrepreneurs hide instead of being themselves 12:23   The lie that keeps you at your ceiling 13:31   "I can't believe I was afraid of this. I wish I did it sooner." 15:26   Two layers of stuff: the original wound plus everything we used to avoid it 15:55   The 82-year-old client and the premise: time doesn't heal all wounds, intention does 17:57   The car ride: driver's seat vs. back seat, and the double whammy of self-abandonment 23:14   "I didn't know what brought me joy" — Brooklyn grit and rediscovering joy in midlife 25:22   The corporate pivot: layoffs, AI, and managers handed an old playbook 27:44   Emotional intelligence: the leading predictor no one can name (15 skills, no hands up) 30:34   Radical responsibility: stop waiting for your employer to develop you 37:37   IQ vs. EQ: the students whose soft skills told her they'd be just fine 40:38   Lightning round questions for Andrea 45:13   What she's most grateful for 47:06   Where to find Andrea   If Andrea named the thing that's been sitting on your mind — hit subscribe, share it with someone who's been running from their own work, and leave a review so more leaders find their way here.   And if something came up while you listened, send her a message — she'd love to hear from you.  

He was working 80 hours every two weeks in a hospital ICU.Open heart surgery patients. Life or death. No room for error.And in the gaps between shifts, sometimes still in his scrubs, he was quietly building a short-term rental business that would set him free.In this episode, E sits down with Jeremy Rosen for one of the most honest W2-escape stories this show has ever told.Jeremy joined STR Secrets with 4 properties and a full-time nursing job he loved but knew he had to leave. He went from 4 to 8 to 12 to 20 properties, all while clocking 12-hour shifts at the VA. Then he merged his own company into Five Star Vacation Home Rentals, where he now owns the San Antonio division, part of a portfolio of 70 properties across Central Texas. And he finally walked away from nursing for good.Today, based in San Antonio, Texas, Jeremy focuses on revenue optimization, guest experience, property operations, and scaling high performing vacation rental portfolios.In this episode:→ The exact mindset shift that took Jeremy from sick patients to happy guests, and the nurse's instinct that makes him a better host than most operators will ever be→ How he used his days off, while everyone else scrolled, to prospect, sell, and grow→ The "who not how" decision that broke him out of doing everything himself, and the one hire that changed his entire business→ Why he refused to build in secret, and how speaking his goals out loud actually made them happen→ The honest truth about quitting your W2 that almost nobody talks about, including the strange struggle of suddenly owning all of your own time→ Why "everything is figureoutable" is the only belief you need to finally make the leapIf you have a good job you're scared to leave, this is the episode you need to hear.Connect with Jeremy:Instagram and Facebook: @fivestarvhrEmail: jeremy@fivestarvacationhomerentals.comWebsite: fivestarvhr.comFree 6-step course to start your day right: level.strsecrets.com/pc-bookJoin the community: STR Secrets Facebook Group

In this episode of PICU Doc on Call, hosts Dr. Monica Gray and Dr. Pradip Kamat explore procedural sedation in the pediatric ICU. They cover sedation levels, pre-screening, risk stratification using ASA classifications, and medication selection tailored to each patient's hemodynamic and respiratory status. Through real-world case discussions involving respiratory failure, septic shock, and acute neurological decline, they highlight the importance of end-tidal CO2 monitoring and early adverse event recognition. Key takeaways include avoiding the term "conscious sedation," preparing rescue plans, and prioritizing patient safety through careful assessment and monitoring.Show Highlights:Definitions and levels of sedation (minimal, moderate, deep sedation, and general anesthesia)Importance of terminology in procedural sedationMonitoring sedation levels using scales like the Richmond Agitation-Sedation Scale (RASS)Pre-screening and risk stratification considerations for pediatric patientsASA physical status classification system for assessing patient riskUnique challenges of procedural sedation in critically ill childrenAdverse events associated with pediatric procedural sedation, particularly respiratory complicationsManagement strategies for specific cases requiring sedation (e.g., respiratory failure, septic shock)Importance of end-tidal CO2 monitoring during sedationKey takeaways for safe sedation practices in the pediatric ICU settingReferences: Nir Atlas; Rahul C. Damania; Pradip P. Kamat In Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 135, 1624-1628Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia by Committee on Quality Management and Departmental Administration. Last Amended: October 23, 2024.Coté CJ, Wilson S; AMERICAN ACADEMY OF PEDIATRICS; AMERICAN ACADEMY OF PEDIATRIC DENTISTRY. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics. 2019 Jun;143(6):e20191000. doi: 10.1542/peds.2019-1000. PMID: 31138666.xKrauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006 Mar 4;367(9512):766-80. doi: 10.1016/S0140-6736(06)68230-5. PMID: 16517277.Sharif S, Kang J, Sadeghirad B, Rizvi F, Forestell B, Greer A, Hewitt M, Fernando SM, Mehta S, Eltorki M, Siemieniuk R, Duffett M, Bhatt M, Burry L, Perry JJ, Petrosoniak A, Pandharipande P, Welsford M, Rochwerg B. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. Br J Anaesth. 2024 Mar;132(3):491-506. doi: 10.1016/j.bja.2023.11.050. Epub 2024 Jan 6. PMID: 38185564.Smith, Heidi A. B. MD, MSCI (Chair)1,2; Besunder, James B. DO, FCCM3,4; Betters, Kristina A. MD1; Johnson, Peter N. PharmD, BCPS, BCPPS, FCCM, FPPA, FASHP5,6; Srinivasan, Vijay MBBS, MD, FCCM7,8; Stormorken, Anne MD9,10; Farrington, Elizabeth PharmD, FCCM11; Golianu, Brenda MD12,13; Godshall, Aaron J. MD14; Acinelli, Larkin CPNP-AC, ACHPN15; Almgren, Christina CPNP16; Bailey, Christine H. MD17; Boyd, Jenny M. MD18,19; Cisco, Michael J. MD20; Damian, Mihaela MD, MPH21,22; deAlmeida, Mary L. MD23,24; Fehr, James MD13,25; Fenton, Kimberly E. MD, FCCM14; Gilliland, Frances DNP, CPNP-AC/PC26,27; Grant, Mary Jo C. CPNP-AC, PhD, FAAN28; Howell, Joy MD29; Ruggles, Cassandra A. PharmD, BCCCP, BCPPS30; Simone, Shari DNP31,32; Su, Felice MD21,22; Sullivan, Janice E. MD33,34; Tegtmeyer, Ken MD, FAAP, FCCM35,36; Traube, Chani MD, FCCM29; Williams, Stacey CPNP-AC37; Berkenbosch, John W. MD, FAAP, FCCM (Chair)33,34. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatric Critical Care Medicine 23(2):p e74-e110, February 2022. | DOI: 10.1097/PCC.0000000000002873Benzoni T, Agarwal A, Cascella M. Procedural Sedation. [Updated 2025 Mar 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551685/Kerson AG, DeMaria R, Mauer E, Joyce C, Gerber LM, Greenwald BM, Silver G, Traube C. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intensive Care. 2016 Oct 26;4:65. doi: 10.1186/s40560-016-0189-5. PMID: 27800163; PMCID: PMC5080705.Tel-Dan SF, Shavit D, Nates R, Samuel N, Shavit I. Emergency Physician-Administered Sedation for Thoracostomy in Children With Pleuropneumonia. Pediatr Emerg Care. 2021 Dec 1;37(12):e1209-e1212. doi: 10.1097/PEC.0000000000001975. PMID: 31929389.Cosgrove P, Krauss BS, Cravero JP, Fleegler EW. Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Ann Emerg Med. 2022 Dec;80(6):485-496. doi: 10.1016/j.annemergmed.2022.05.002. Epub 2022 Jun 23. PMID: 35752522.Cravero JP, Blike GT, Beach M, Gallagher SM, Hertzog JH, Havidich JE, Gelman B; Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics. 2006 Sep;118(3):1087-96. doi: 10.1542/peds.2006-0313. PMID: 16951002.

Lucy Goff, founder of LYMA, joins Dr. Will Cole to break down the science behind one of the most talked-about supplement and laser brands in wellness. Lucy shares the story behind LYMA's founding - collapsing at 8 months pregnant, surviving septicemia after six weeks in ICU, and a chance encounter in Geneva with Professor Paul Clayton that led to a patented supplement formulation that changed her life. They cover the 11 peer-reviewed ingredients in the LYMA supplement, why the ID Squared gut powder uses different-length prebiotic fibers that no other gut product has replicated, and the clinical science behind the LYMA laser - including why LED cannot biologically change the dermis, and why the SIRT1 longevity gene was expressed six times in the dermis using the LYMA laser but not at all with LED. Plus: Martha Stewart, Courteney Cox, Joanna Czech, and a 78% wound reduction clinical trial. For all links mentioned in this episode, visit www.drwillcole.com/podcast.Visit https://us.lyma.life and use code WILL10 at checkout for 10% of the LYMA Laser. Not valid on LYMA Laser PROPlease note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.Sponsors:Visit https://us.lyma.life and use code WILL10 at checkout for 10% of the LYMA Laser. Not valid on LYMA Laser PROSign up for your one-dollar-per-month trial and start selling today at SHOPIFY.COM/WILLCOLE!Text ABW to 64000 to get 20% off all IQBAR products, plus FREE shipping. Message and data rates may apply.Head to MANUKORA.com/WILLCOLE to save up to 31% plus $25 worth of free gift swith the Starter Kit, which comes with an MGO 850+ Manuka Honey jar, 5 honey travel sticks, a wooden spoon, and a guidebook.You can get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/WILLCOLE and using code WILLCOLE at checkout.Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode of The On Purpose Podcast, Jerrod Hardy sits down with Ryley Nahrgang—ultra runner, EMT, and recovering alcoholic—to share a story of resilience, recovery, and rebuilding a life from rock bottom.After losing his identity as an athlete following a major injury, Ryley found himself trapped in addiction, isolation, and self-destruction. What started as casual drinking slowly became a daily battle that nearly cost him his life. But after a terrifying wake-up call in the ICU, Ryley made a decision that changed everything: he chose to fight for his future.Through ultra running, community, and honest self-reflection, Ryley transformed pain into purpose. This conversation is a powerful reminder that no matter how far you've fallen, recovery is possible—and sometimes healing begins with one small step forward.Connect with Ryley on Instagram @ryleyrunsmt406 and TikTok @ryleynahrgang.Fuel all of your long runs or rides with Never2. Use Jerrod's code NEVERSECOND15 at checkout! https://never2.com/Connect with The On Purpose PodcastWant more from The On Purpose Podcast?Join us on Patreon!Listen to full episodes on TheOnPurposePodcast.com or anywhere you stream your favorite shows.Follow along on Instagram and Facebook for behind-the-scenes clips, guest highlights, and daily motivation.Connect with Jerrod HardyLinkedIn |  InstagramDiscover Jerrod's insights on leadership, mindset, and purpose—and learn how to apply them in your own journey.Get the Book: Extraordinary People In Ordinary Places— Jerrod's guide to living and leading with purpose.Get your Dream Chasers merch today and use code Podcast10 to save 10% off! https://shop.teamhardy.net/

Palliative isn't a synonym for terminal. On this Community Health edition of The Valley Today, host Janet Michael welcomes back Dr. Jim VanKirk, board-certified palliative care specialist and Medical Director of Valley Health's Palliative Care Program, joined by team social worker Rachel Schwartz, to clear up one of the most persistent misconceptions in medicine — and to make the case for thinking about palliative care as a living tool, not an end-of-life one. Dr. VanKirk walks through what palliative care actually is — symptom support, treatment planning, and team-based care for patients with serious illnesses who are still receiving aggressive treatment, including chemotherapy, radiation, and ICU care — and explains the research showing that earlier palliative intervention actually correlates with patients living longer. Rachel talks through the role of a palliative social worker, the kinds of grief families navigate along the way of a progressive illness (not just at the end), and the concept of "substituted judgment" when a patient can't speak for themselves. Plus: a thorough, practical conversation about advance directives — what they are, why every adult needs one starting at age 18, why April 16th is the easiest day to remember to update yours, and the family stories (including Dr. VanKirk's own) that show why having "the document" isn't the point — the conversation that leads to the document is. ABOUT VALLEY HEALTH'S PALLIATIVE CARE PROGRAM A specialized medical service for patients with serious or life-threatening illnesses, working alongside primary treatment teams to provide symptom management, treatment planning support, and goals-of-care conversations. The team works across the hospital — including with ICU patients and patients still receiving aggressive treatment like chemotherapy or radiation — and partners with chaplains, music therapists, speech therapists, physical and occupational therapists, and bedside nursing teams to provide whole-person care for both the patient and their family. ABOUT ADVANCE DIRECTIVES An advance directive is a document that expresses your wishes for healthcare, especially if you become unable to speak for yourself. It typically has two parts: (1) the designation of a healthcare agent — the person empowered to make decisions on your behalf, and (2) specific wishes about what care you would or would not want in certain situations (sometimes called a "living will"). KEY POINTS FROM THIS EPISODE • Every adult — starting at age 18 — should have an advance directive. Car accidents don't wait for a diagnosis. • The conversation matters more than the document. Your healthcare agent needs to know how you think and what's important to you. • Tell your designated agent first. Tell other close family and friends the document exists. • Update your directive periodically — life changes, designated agents pass away or move, your wishes evolve. • Virginia and West Virginia have different legal requirements. Know which state's form you need. • Don't store it in a lockbox. Your agent, your primary care physician, and your hospital should all have copies. • April 16th is the easy day to remember — the day after Tax Day. Take care of the government on the 15th; take care of yourself on the 16th. • If a loved one is diagnosed with dementia or Alzheimer's, complete legal documents IMMEDIATELY. Capacity can be lost faster than families expect. LINKS & RESOURCES • Valley Health Palliative Care Program: https://www.valleyhealthlink.com/patient-visitors/for-patients/advance-care-planning-advance-directives/ (click Your Visit → Patient Resources for advance directive information, FAQs, state-specific forms, and a number to schedule a facilitator appointment) • Every Community Health conversation in one place: thevalleytodaypodcast.com (click Categories → VH Community Health)  THE VALLEY TODAY with Janet Michael — A decade of conversations. New podcast episodes drop weekdays at 11 AM. Catch the show on The River 95.3 and Fox Sports 1450 AM weekdays just after noon. Subscribe and listen at thevalleytodaypodcast.com — available on Apple Podcasts, Spotify, and wherever you get your podcasts. If you enjoy the show, please take a moment to leave a rating or review — it helps more listeners find us. Connect with us: Facebook — facebook.com/ValleyTodayFanPage Instagram — instagram.com/thevalleytoday

After an emergency cesarean at 29 weeks due to HELLP syndrome with an ICU stay for herself and a 2-month NICU stay for her baby, Yazmine was told she would never have a vaginal birth. She was also given mixed information about the type of uterine scar that she had. But with lots of diet changes and medication, Yazmine didn't have preeclampsia or HELLP the second time around. She chose a repeat cesarean following her doctor's strong recommendation. During her third pregnancy, Yazmine educated herself on VBA2C, found a supportive provider through another TVL mama on the podcast, and continued with the same lifestyle changes as before. She had PROM at 38+6, labored for 40 hours with a Foley bulb, Pitocin, and got an epidural before having her beautiful VBA2C at 39+1. Yazmine had no tearing and the amazing recovery she was hoping for! Needed Website: Code TVL for 20% OffThe Ultimate VBAC Prep Course for ParentsOnline VBAC Doula TrainingAdvertising Inquiries: https://redcircle.com/brands

What happens when a pediatric nurse practitioner suddenly finds herself on the other side of diagnosis? On this week's episode of Inside the Children's Hospital, Katie Taylor sits down with Laura Forcella, a developmental pediatric nurse practitioner and mom to a son with Dup15q syndrome and epilepsy. Laura shares the deeply personal journey of recognizing her son's infantile spasms, navigating a rare disease diagnosis, and balancing life as both a medical professional and a caregiver. Laura opens up about the unique challenges of being a "med mom," the emotional shift from provider to parent, and how her experiences have transformed the way she supports families in her own clinical practice. Together, Katie and Laura discuss the power of parental intuition, the importance of early intervention, building a village of support, and finding moments of joy amidst the complexities of caregiving. Whether you're a parent navigating a diagnosis, a healthcare professional supporting families, or someone looking for encouragement on a difficult journey, this conversation is filled with compassion, wisdom, and hope. In This Episode, You'll Learn: Laura's path from pediatric ICU and ER nurse to developmental pediatric nurse practitioner How she recognized the early signs of infantile spasms in her son The diagnostic journey that led to a Dup15q syndrome diagnosis What it's like to care for patients while navigating your own child's medical complexities Why videos can be critical when seeking answers for concerning symptoms The importance of trusting your instincts as a parent How early intervention services can help while waiting for specialist appointments The realities of balancing advocacy, caregiving, work, and self-care Finding community through rare disease organizations and social media How a child's diagnosis can shape and strengthen a parent's identity Resources Mentioned: Dup15q Alliance Early Intervention Programs (available in every U.S. state) Connect with Laura: Developmental Med Mom on Instagram (@developmentalmedmom) Connect with us! Instagram: @childlifeoncall + @insidethechildrenshospital Subscribe: Never miss an episode on Apple Podcasts or Spotify. Visit insidethechildrenshospital.com to search stories and episodes easily Leave a Review: It helps other families find us and access our resources   Medical information shared in this episode is not a substitute for professional medical advice. Please consult your care team for guidance specific to your child and family.   Keywords: Infantile Spasms, Dupq15, Nurse Practitioner, Developmental Pediatrics, Seizures, Child Life Specialist, Support

In this episode of the Neurocritical Care Society Podcast Masterclass series, hosts Stephan Mayer, MD, FCCM, FNCS, and Jon Rosenberg, MD, are joined by Richard Wunderink, MD, professor of medicine at Northwestern University Feinberg School of Medicine and pulmonary critical care intensivist, to discuss the diagnosis and management of respiratory infections in the ICU.  Dr. Wunderink highlights why ventilator-associated pneumonia and suspected respiratory infections are common challenges across critical care settings, particularly among patients with acute neurologic injury, aspiration risk and prolonged mechanical ventilation. The discussion focuses on practical, bedside approaches to pneumonia management, including the limitations of tracheal aspirates and the risks of antibiotic overuse. The group also examines the role of bronchoalveolar lavage and the value of adjunctive diagnostic tools such as quantitative cultures, cell counts, Gram stains, amylase testing and molecular panels.  They further explore how rapid diagnostics can help clinicians make more targeted antibiotic decisions, support earlier de-escalation when appropriate and prompt consideration of non-pulmonary causes of fever or clinical instability when pneumonia is unlikely. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

I'm joined by Bal Matharu to talk about how breathing links the nervous system, stress biology, and Long Covid symptoms, and why recovery often begins with creating a genuine felt sense of safety. We share practical ways to assess and change breathing patterns, plus the role of co-regulation, boundaries, and carefully held breathwork support. • Bal's path from advanced respiratory physiotherapy and ICU work to lifestyle medicine and PhD breathwork research • The six pillars of lifestyle medicine and why stress management often underpins the rest • Acute stress versus chronic stress and how the body shifts blood flow, hormones, and immune function • Cell danger theory, mitochondria, ATP, and why fatigue can be a protection signal • Safety as a felt sense through neuroception rather than a purely cognitive idea • Breath assessment basics, posture, high chest breathing, diaphragm use, and longer exhales • Overstimulation, silence avoidance, and letting emotions move through the body in short windows • Co-regulation, practitioner capacity, and building safe spaces for nervous system work • Boundaries, people pleasing patterns, and choosing relationships that support regulation • Selecting credible breathwork practitioners and avoiding unsafe cathartic methods Links:Bal's Website: https://www.bodymind-iq.com Embody Ecosystem: https://go.bodymind-iq.com/embody-ecosystemMessage me! (I can't reply to these messages) For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com (music credit - Brock Hewitt, Rule of Life) Support the show~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~The Long Covid Podcast is self-produced & self funded. If you enjoy what you hear and are able to, please Buy me a coffee or purchase a mug to help cover costsTranscripts available on individual episodes herewww.LongCovidPodcast.comFacebook Instagram  Twitter Facebook Creativity GroupSubscribe to mailing listI love to hear from you, via socials or LongCovidPodcast@gmail.com**Disclaimer - you should not rely on any medical information contained in this Podcast and related materials in making medical, health-related or other decisions. Please consult a doctor or other health professional**

Send us Fan MailWhat does it mean to truly improve outcomes for very low birth weight infants, and are we actually doing it? In this episode, Daphna sits down with Dr. Joseph Kaempf, neonatologist and Medical Director of Value Research and Innovation at Providence Health System in Oregon, to examine some uncomfortable truths about neonatal quality improvement. Dr. Kaempf shares findings from a study spanning 16 NICUs over 14 years showing that composite morbidity outcomes have remained flat while length of stay has increased. He explores why traditional QI tools like driver diagrams and PDSA cycles may no longer be sufficient, and why augmented intelligence may be the next frontier. The conversation also touches on culture as a driver of NICU performance and the gap between institutional interests and true shared decision-making with families. A candid episode for anyone invested in the future of neonatology.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

One of the challenges of human nature is that we become accustomed to the blessings that Hashem gives us. Things that once would have filled us with excitement eventually become part of everyday life, and we begin to expect them rather than appreciate them. Very often, we do not recognize the true value of something until it is no longer available. A person may take his health for granted until, lo alenu, he becomes ill. Suddenly, all the things he was once able to do effortlessly become precious. The same is true with all blessings and relationships. One of the purposes of thanking Hashem for our blessings is to train ourselves to appreciate them while we have them, so that we do not need to lose them in order to recognize their value. A man told me that he recently had to move to another city, and now it takes him over an hour to commute to work each day. He said he never appreciated living just five minutes from his office. Looking back, he wishes he had appreciated that convenience while he had it. Sometimes a person spends years praying for something. He dreams of getting married, finding a job, buying a home, or having a child. Then, when Hashem grants him that blessing, it gradually becomes part of his routine, and he no longer feels the same excitement he once did. He moves on to making new requests and may even feel as though Hashem never gives him what he asks for. If only he could remember how desperately he once wanted what he already has. Another benefit of thanking Hashem for our blessings becomes apparent from the following story. A woman related that after she gave birth, she was rushed to the ICU with severe complications. She lost a tremendous amount of blood and required more than ten blood transfusions. She was connected to machines, had a tube down her throat, and her hands and feet were extremely swollen. The doctors expected her to remain in the ICU for at least seven to ten days. At one point, they were not sure if she would survive. They told her husband that her life was hanging by a thread. When she finally became aware of where she was, what was happening, and how serious her condition was, she told her husband that they needed to thank Hashem for the healthy baby He had just given them. Even though she was weak, confused, and frightened, she felt that this was the moment to focus on gratitude. Together they began thanking Hashem for everything they could think of. They thanked Him for the doctors and nurses who were caring for her, for the people bringing them food, for her hands and feet that had not been swollen for all the years before, and for countless other blessings. Then they said Mizmor LeTodah together. At that time, her oxygen level was only 88. The doctors had told them that she would not be allowed to leave the ICU until it reached at least 96. Despite all the medical efforts, the number would not move. As they continued thanking Hashem and saying Mizmor LeTodah, they watched the monitor. Eighty-eight became eighty-nine. Eighty-nine became ninety. They could hardly believe it. They continued thanking Hashem for more and more blessings and recited Mizmor LeTodah again. The numbers kept climbing until, all of a sudden, the oxygen level reached 97 and remained there. After a little more than an hour of focusing on gratitude and thanking Hashem, her oxygen level had risen enough for her to leave the ICU. The doctors were stunned. The next day, while she was still in the hospital, the nurses noticed that her numbers were once again not looking good, and they were concerned that she might need to return to the ICU. She asked for a few minutes alone. Once again, she focused on gratitude to Hashem and recited Mizmor LeTodah. When the nurses returned, they saw that the numbers had gone back to normal. Baruch Hashem, she was eventually discharged fully healed. She said she learned one of the greatest lessons of her life. Gratitude does not change Hashem; it changes us. When we stop focusing on what we are missing and start noticing the blessings that Hashem has already given us, something changes inside. We begin to see His kindness everywhere, and that itself is a tremendous zechut. May we always merit to appreciate Hashem's blessings and thank Him for them constantly.

Argelis Milian Robles was diagnosed with Type 1 diabetes in 2025 — alone, without a car, on the brink of losing her job, and managing celiac on top of it all. And that was just the beginning. What came next tested everything she had. Her faith. Her will to stay. Her relationship with her own body.In this episode, Argelis opens up about the moments that brought her to her lowest point and what it actually took to start building a life she wanted to live… one that includes pancakes, boba, and yellow curry. It's a story about learning to trust yourself when everything falls apart at once.WHAT WE COVER:The Sunday morning church visit that ended in the ICU with a blood sugar of 407What a pituitary brain hemorrhage six months into T1D changed about her insulin resistance, her mental health, and what she wanted for her lifeHow celiac prepped Argelis to drop her A1C from 13.9 to 5.4 in eight months, and why she doesn't recommend itWhy pancakes, boba, and yellow curry became the goals that mattered most in coachingThe two pages Argelis wrote after the brain hemorrhage that changed the direction of her lifeWHAT'S NEXT:

大家好，我是猛哥。我给你们讲，我们单位的会议室名字都很特别，经常被来访的朋友夸奖。比如“敢于决策”、“不兜圈子”，都是我们对会议的美好期待，但也有抽象的。像“产房”、“ICU”，也好理解，内容工作有时候需要迎接新生，有时候需要抢救创意。直到前几天我带ICU医生余一生来到会议室“ICU”，我才发现略有不妥。结束辛苦工作准备到编辑部畅聊写作的余一生看到“ICU”：这班到底有完没完了？ICU医生的工作有多难呢？著名的电车难题，他们几乎每天都要面对。余一生告诉我，她值夜班时，ICU只剩最后一张空床，却同时来了三个危重的病人，都得抢这张床。三个只能救一个？必须选？对。这不但涉及专业的判断、理智与情感，甚至还有医学伦理。我们录这期节目的时候，尽管已经知道了结局，我依然不自觉会屏住呼吸，简直像“心理学惊悚片”。我想，这是余一生的电车难题：人命可以比较计算吗？听完这期节目，我们也会有自己的答案。余一生和她的同事，做的就是这样的工作。她们当然也会紧张，也会犹豫，也会手抖，但最后还是得站在那里，尽力把每一个能拉回来的人往回拉一点。如果你听完这个故事，对ICU医生多了一点理解，或者多了一点敬意，那我也很推荐你去读读余一生的《只有ICU医生知道》。这本书里写的，不只是这种极端时刻的惊心动魄，更有ICU日复一日的真实：医生怎么判断，怎么扛住压力，怎么在一次次来不及、来不及、还是来不及的现实里，尽量不放弃任何一个人。读完你会更明白，为什么有些重量，真的只有ICU医生知道。时间轴：04:30 在ICU，年轻人不如老人09:00 ICU存活率接近90%17:28 喝饮料太多生命垂危20:00 无论如何，产妇不能死24:20 三个人只能救一个35:00 撑到天亮41:00 ICU的运转机制51:38 医院内部的压力59:48 生命有多宝贵？嘉宾：余一生，ICU医生，天才捕手计划作者主播：@猛哥天才捕手剪辑：一雪

Andrew Paul Koutnik joins Mark Bell and Nsima Inyang to break down type 1 diabetes, type 2 diabetes, insulin resistance, glucose control, low-carb diets, GLP-1 drugs, obesity, and why the modern food environment is making metabolic health harder than ever.Andrew was diagnosed with type 1 diabetes as a teenager after a terrifying health scare that landed him in the ICU. Since then, he's spent his life studying metabolism, nutrition, insulin, and performance — not just in the lab, but through his own daily experience managing the disease.This episode covers the difference between type 1 and type 2 diabetes, why glucose control matters so much, how carbs impact blood sugar, the role of insulin, why many people are metabolically unhealthy, and what people can do to better manage their health.Special perks for our listeners below!

🧭 REBEL Rundown Click here for Direct Download of the Podcast. 💨 What Is Nitrous Oxide? Nitrous Oxide (N2O) is a colorless, odorless inhaled anesthetic that has been used for centuries, particularly in the surgical world. Mechanistically, it can induce euphoria, anxiolysis, and intoxication via NMDA receptor antagonism.During the late twentieth century, nitrous oxide was increasingly used recreationally due its accessibility and perceived benign nature.The modern day slang term for nitrous oxide is “whippets” – which tends to refer to the canisters that contain this agent and are frequently used as whipped cream foaming agents.Despite the legal nature and benign perception of nitrous, frequent use can lead to lasting and permanent neurologic effects. 🧠 How Nitrous Oxide Causes Toxicity Nitrous oxide toxicity results from its ability to oxidize the cobalt moiety in Vitamin-B12, thus leading to a functional B12 deficiency, despite adequate consumption and absorption.1Functioning B12 is needed as a cofactor for methionine synthase.2 This enzyme has two critical roles:The conversion of 5-methyl tetrahydrofolate to tetrahydrofolate; tetrahydrofolate is essential for the synthesis of our DNA.And the conversion of homocysteine to methionine; methionine is needed to maintain the integrity of the myelin sheath of our axons.As a result, nitrous toxicity leads to: a megaloblastic anemia and demyelination of both the dorsal columns and the lateral corticospinal tracts (also known as subacute combined degeneration). 🚶‍️ Clinical Manifestations of Nitrous Oxide Toxicity These patients will have a combination of both upper and lower motor neuron symptoms due to demyelination of the dorsal columns, lateral corticospinal tracts, and peripheral nerves. As a result, the following may manifest:Dorsal Columns: diminished sense of proprioception, vibration, and fine touch.Lateral Corticospinal Tracts: upgoing plantars, hyperreflexia, weakness of voluntary distal muscle controlPeripheral Nerves: numbness/tingling and weakness in a glove and stocking pattern (symptoms that start initially in the feet and hands that progressively spread proximally to the ankles and wrists)Taking all of this into account, patients may present with difficulty ambulating, positive Romberg sign, dysmetria (difficulty with finger to nose or heel to shin), upgoing Babinski reflex, and decreased strength and sensation in a glove and stocking pattern. 🔍 How to Diagnose Nitrous Oxide Neurotoxicity History is key! As with a lot of pathologies in toxicology, identifying the exposure will expedite management.A thorough neurologic exam will narrow the differential – with a particular focus to fine, peripheral motor and sensory deficits, dysmetria, proprioception, and ability to ambulate.Magnetic resonance imaging of the spine may identify enhancement and/or edema of the dorsal columns, specifically on T2 weight axial imaging – sometimes referred to as the “inverted V” or “inverted rabbit ears appearance.”3Serum B12 concentrations may be normal as the issue is with a functional deficiency as opposed to a vitamin absence. However, patients have elevated concentrations of both homocysteine and methylmalonic acid, both of which are metabolized in the presence of functional B12. 💉 Management of Nitrous Oxide Toxicity First and foremost, cessation of nitrous oxide abuse is crucial to limit/prevent toxicity.While there is no universally agreed upon treatment regimen, supplementation with intramuscular B12 is recommended.Approaches vary from daily or every other day injections until symptoms improve at which point injections can be spaced out to weekly and then monthly.Physical and occupational therapy may be needed depending on the degree of functional debility.It is important to note, that depending of the severity and chronicity of toxicity, some proportion of patients may not fully return to their baseline. 📌 Take-Home Points Though legal and seemingly benign, nitrous oxide abuse can lead to permanent neurologic dysfunction.Nitrous oxide toxicity can affect the dorsal columns, lateral corticospinal tracts, and peripheral nerves.Thus leading to a constellation of both upper and lower motor neuron deficits, particular in a glove and stocking pattern: deficits in proprioception and fine motor skills, positive Romberg, upgoing Babinski, peripheral numbness, tingling, and weakness.Magnetic resonance imaging may identify symmetric high signal intensity in the dorsal columns.Treatment includes B12 supplementation and physical/occupational therapy as needed. 📚 References Long H. Chapter 81. Inhalants. In: Nelson LS, et al. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019Shah K, Murphy C. Nitrous Oxide Toxicity: Case Files of the Carolinas Medical Center Medical Toxicology Fellowship. J Med Toxicol. 2019 Oct;15(4):299-303. doi: 10.1007/s13181-019-00726-x. Epub 2019 Aug 6. PMID: 31388940; PMCID: PMC6825085.Schmitz ZP, Hoffman RS. Magnetic resonance imaging in a patient with nitrous oxide-induced subacute combined degeneration of the spinal cord. Clin Toxicol (Phila). 2023 Nov;61(11):1006-1008. doi: 10.1080/15563650.2023.2286205. Epub 2023 Dec 19. PMID: 38060330. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Associate Editor Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More Showing Slide 1 of 7 The post REBEL Core Cast—Nitrous Oxide Toxicity: Whippets and Neurologic Injury appeared first on REBEL EM - Emergency Medicine Blog.

In this episode, Fostering the Spark, we dive into how ICU nurses can stay passionate, curious, and connected to their purpose through continual growth and learning. Because let's be honest—nursing is intense, and CICU nursing brings an entirely different level of emotional, mental, and clinical demand. Without challenge, support, or opportunities to grow, it's easy to feel burned out or stagnant over time. But the spark that brought you into this profession doesn't have to fade. In this conversation, we explore how to keep fostering that sense of purpose, curiosity, and connection throughout your career. We talk about why this topic matters, what inspired this discussion, and how growth in nursing isn't always about doing more—it can also be about staying engaged, inspired, and grounded in why you started in the first place. Co-Hosts and Guests: Laura Valido, BSN RN (Nationwide Children's Hospital); Natalie Pleiman, MSN RN (Cincinnati Children's Hospital); Yaeji Kim BSN; Editor: Laura Valido, BSN RN Producer: Saidie Rodriguez, MD (CHOA/Emory) Sponsor: Seattle Children's Hospital

Roger Seheult, MD of MedCram explores two new rooftop ICU facilities and tries out the MiEye light sensor. See all Dr. Seheult's videos at: https://www.medcram.com/ (This video was recorded on June 9th, 2026) Roger Seheult, MD is the co-founder and lead professor at: www.medcram.com He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine. MEDCRAM WORKS WITH MEDICAL PROGRAMS AND HOSPITALS: MedCram offers group discounts for students and medical programs, hospitals, and other institutions. Contact us at customers@medcram.com if you are interested. MEDIA CONTACT:  Media Contact: customers@medcram.com Media contact info: https://www.medcram.com/pages/media-contact Video Produced by Kyle Allred Edited by Daphne Sprinkle of Sprinkle Media Consulting, LLC FOLLOW US ON SOCIAL MEDIA: Facebook:  www.facebook.com/MedCram Twitter/X: www.twitter.com/MedCramVideos Instagram: www.instagram.com/medcram DISCLAIMER: MedCram medical videos are for medical education and exam preparation, and NOT intended to replace recommendations from your doctor.

Send us Fan MailPhototherapy duration, jaundice and UTIs, extended CPAP, and The Pitt. A full week on the Incubator Journal Club.Ben opens with a nationwide Swedish cohort study from JAMA Network Open examining phototherapy duration in nearly 5,000 very preterm infants. Longer phototherapy was not significantly associated with late neonatal mortality, but six to seven days was associated with significantly higher rates of severe neonatal morbidity. With 95% of the cohort receiving phototherapy, Ben and Daphna question how much evidence actually supports the near-universal practice.Daphna follows with a retrospective study from Istanbul showing that 31% of term and near-term neonates hospitalized for unexplained hyperbilirubinemia had culture-proven UTIs, with pathological renal ultrasound findings independently associated with a 4.6-fold increased odds of UTI.Ben then reviews the extended CPAP secondary analysis by Mamidi and McEvoy, showing that two additional weeks of bubble CPAP reduced intermittent hypoxemia episodes from 151.7 to 57.6 compared to discontinued CPAP.Daphna closes with the NEOASP five-day UTI treatment guideline from Nationwide Children's Hospital, where a structured stewardship approach yielded a 1% failure rate.Ben and Eli close the week reflecting on The Pitt and what it reveals about the broken realities of American healthcare.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Send us Fan MailIn this episode of Neo News, Ben and Eli discuss the cultural phenomenon of HBO Max's new hit medical drama, The Pitt. Sparked by an insightful critique in The New Yorker by Dr. Dhruv Khullar, they dive into why this Noah Wyle-led series is capturing the attention of millions of Americans, including healthcare workers and patients alike. They explore how the show's unflinching portrayal of systemic failures, from ER overcrowding to uninsured patients leaving against medical advice, mirrors their daily reality in the hospital. Tune in as they discuss whether the shared humanity seen on screen can bridge the gap between doctors and patients or simply highlight the exhausting "pit" of modern medicine!----The Pitt: https://www.newyorker.com/culture/the-lede/what-the-pitt-taught-me-about-being-a-doctorSupport the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Send us Fan MailIs five days of antibiotics enough to treat a urinary tract infection in a NICU infant? In this Journal Club episode, Ben and Daphna review a single-center study from Nationwide Children's Hospital examining adherence and safety of a five-day antibiotic treatment guideline for culture and urinalysis-proven UTIs in the NICU. Among 77 infants with 93 bacterial UTIs, the five-day course was associated with a 1% failure rate, defined as reinitiation of antibiotics within seven days for the same organism. The episode also explores the potential role of enteral antibiotic therapy and what shorter treatment courses could mean for babies still weeks away from discharge.----Urinary tract infection in the neonatal intensive care unit. Magers J, Burton A, Prusakov P, White NO, Miller RR, Moraille R, Theile AR, Sánchez PJ; Nationwide Children's Hospital Neonatal Antimicrobial Stewardship Program (NEO-ASP).J Perinatol. 2026 May;46(5):754-760. doi: 10.1038/s41372-026-02690-1. Epub 2026 Apr 29.PMID: 42056240 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Dr. Pamela Cipriano shares her journey from being an ICU nurse to a trailblazer in functional medicine. She discusses her personal experiences with Lyme disease, the importance of hydration, nutrition, and the impact of chronic illnesses. Dr. Cipriano emphasizes the need for a holistic approach to health, focusing on root causes and lifestyle changes, while also sharing insights on the effects of COVID and the importance of proper diet and hydration. In this conversation, Dr. Pamela Cipriano discusses the implications of vaccination, particularly in relation to health concerns and the effects of spike proteins. She emphasizes the importance of Vitamin B12 and mitochondrial function in overall health, while also addressing oxidative stress and innovative therapies for chronic conditions. The discussion extends to the future of Lyme disease treatment and the challenges in diagnosing and treating Bartonella, highlighting the need for proper education and awareness in managing tick-borne diseases.   For Audience Join the other 20,000+ high-performers getting weekly insights on biological reversal, exponential strategies, and Life Energy optimization→ https://start.gladdenlongevity.com/subscribe If you're ready to measure your 60+ biological ages and build a personalized reversal plan, apply for a discovery call here → https://start.gladdenlongevity.com/apply-now   Use code 'Podcast10' to get 10% OFF on any of our supplements at https://gladdenlongevityshop.com/!      Takeaways   ·       Dr. Cipriano transitioned from nursing to functional medicine to help patients achieve better health. ·       Her personal experience with her son's Lyme disease shaped her focus on chronic illnesses. ·       Chronic diseases often have triggers that can be identified and addressed. ·       Water intake is crucial for overall health and disease prevention. ·       Nutrition plays a significant role in managing inflammation and chronic diseases. ·       Avoiding processed foods and sugars is essential for maintaining health. ·       The quality of food, including meat and dairy, impacts health outcomes. ·       Functional medicine requires a thorough understanding of a patient's history and lifestyle. ·       COVID-19 has highlighted the importance of diet and hydration in recovery. ·       The healthcare system often prioritizes medication over holistic health solutions. Vaccination can lead to health problems in some individuals. ·       Spike proteins may persist and cause long-term health issues. ·       Vitamin B12 is crucial for nervous system health. ·       Mitochondria play a vital role in cellular function and energy production. ·       Oxidative stress accelerates aging and cellular damage. ·       IV therapies can significantly aid in recovery from chronic conditions. ·       Bartonella can mimic severe neurological disorders like ALS. ·       Proper testing is essential for diagnosing tick-borne diseases. ·       Education is critical for effective treatment of Lyme disease. ·       Innovative therapies are emerging for chronic health issues.       Chapters 00:00 Introduction to Dr. Pamela Cipriano 01:32 Journey into Functional Medicine 02:52 Personal Experience with Lyme Disease 04:55 Understanding Chronic Illnesses 06:57 The Importance of Water and Hydration 13:43 Nutrition and Anti-Inflammatory Foods 19:28 Insights on COVID and Long COVID 20:26 The Impact of Vaccination and Health Concerns 21:53 Understanding Spike Proteins and Their Effects 22:38 The Importance of Vitamin B12 23:54 Mitochondrial Function and Health 25:53 Oxidative Stress and Its Management 27:45 Innovative Therapies for Chronic Conditions 30:37 The Future of Lyme Disease Treatment 32:55 Bartonella: Diagnosis and Treatment Challenges 39:56 Navigating Tick-Borne Diseases   To learn more about Dr. Pamela Cipriano: Facebook: https://www.facebook.com/Dr.Pamela.Cipriano Instagram: https://www.instagram.com/practicehealthwellness YouTube: https://www.youtube.com/@dr.pamelacipriano1329 Website: https://www.thepracticeofhealthandwellness.com   Reach out to us at:    Website: https://gladdenlongevity.com/     Facebook: https://www.facebook.com/Gladdenlongevity/    Instagram: https://www.instagram.com/gladdenlongevity/?hl=en     LinkedIn: https://www.linkedin.com/company/gladdenlongevity    YouTube: https://www.youtube.com/channel/UC5_q8nexY4K5ilgFnKm7naw    

From 180 lbs at peak athleticism, intelligence, and financial prosperity — to 120 lbs, isolated and locked in his penthouse. Anjan Chatterjee tells the harrowing reality of life during and after prolonged sedation in the ICU.Most people think surviving the ICU is the hard part. For Anjan, it was only the beginning.On August 14th, 2022, a routine run ended with a slip, a fall, and a traumatic brain injury that left him clinically dead — resuscitated only because his dog, Kingston, wouldn't stop barking. What followed was two weeks in a medically induced coma, seizures, facial fractures, and a mind that couldn't tell dreams from reality.He woke up convinced he'd been arrested, shot at by police, and sentenced to death. He burst through hand restraints. It took 14 nurses to hold him down. Then he was discharged — to a psychiatric ward — still hallucinating, still terrified, and completely alone."I sat in this lavish penthouse, and I was a prisoner. I didn't talk to a single soul for six months."In this episode, Anjan opens up about the psychological and physical toll of post-ICU syndrome — the delirium, the 60-lb muscle loss, the cardiac deconditioning, the brain fog, and the crushing isolation that followed. No referrals. No support. No one who believed him. Just a man, his trauma, his dog, and four walls at the top of a building.This is a story about what it really means to survive — and what it takes to actually come back.Stay tuned for upcoming online courses!www.DaytonICUConsulting.com

CardioNerds (Drs. Rawan Amir, Tripti Gupta, and Alysha Joseph) discuss the fundamentals of adult congenital heart disease (ACHD) surgery with Dr. Elizabeth Stephens.  Audio editing by CardioNerds academy intern, Grace Qiu.  Using a case of a young adult undergoing a Ross procedure, the episode walks through what happens in the operating room—from induction and intraoperative transesophageal echocardiography (TEE) to cardiopulmonary bypass (CPB), myocardial protection, and surgical repair. The discussion highlights key concepts including cardioplegia, cross-clamp and bypass times, hypothermic circulatory arrest, and the complexity of redo sternotomy. This episode provides learners with a practical framework to interpret operative reports, anticipate postoperative physiology, and better collaborate with surgical teams. This episode was produced by the CardioNerds ACHD Council and planned by Dr. Rawan Amir.  CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode Page Pearls “LV distension kills patients.”Preventing left ventricular distension with appropriate venting and awareness of aortic insufficiency is critical to intraoperative safety.  TEE can change the surgical plan in real time.Findings such as underestimated aortic regurgitation, mitral pathology, or a PFO may directly alter cannulation and cardioplegia strategy.  Cross-clamp time = myocardial ischemic time; bypass time = systemic stress.Both are key predictors of postoperative complications including renal injury, bleeding, and ventricular dysfunction.  Redo sternotomy risk is driven by anatomy, not just number.Aorta adherent to the sternum, conduit position, and chamber pressurization define risk more than the number of prior surgeries.  Think longitudinally—ACHD surgery is lifetime planning.Surgical materials and strategies must account for future interventions, especially in younger patients. Notes: Notes drafted by Dr. Alysha Joseph, aided by generative artificial intelligence. What are the key steps in congenital cardiac surgery from incision to closure? Preoperative planning is multidisciplinary, involving surgeon, anesthesia, cardiology, and ICU teams; high-risk inductions (e.g., critical AS, Williams syndrome) are identified early TEE is performed immediately after induction to reassess anatomy and may reveal new findings (e.g., underestimated AI, mitral disease, PFO) Median sternotomy is performed, followed by creation of a pericardial well to optimize exposure Heparin is administered prior to cannulation; arterial and venous cannulas are placed for initiation of CPB Cross-clamp is applied and cardioplegia delivered to arrest the heart, allowing a still and protected operative field Surgical repair (e.g., Ross procedure) is performed, followed by de-airing, cross-clamp removal, and reperfusion Patient is weaned from bypass with TEE reassessment, hemostasis achieved, and chest closed What is cardioplegia and how is it delivered? Cardioplegia is a potassium-rich solution that arrests myocardial activity and reduces metabolic demand Most commonly used solution in the U.S. is Del Nido cardioplegia, originally developed for pediatric myocardium Delivery strategies include: Antegrade (via aortic root) – standard approach  Ostial (direct coronary delivery) – used when aortic root cannot be relied upon  Retrograde (via coronary sinus) – useful in severe AI or coronary disease NOTE: Severe aortic regurgitation can impair antegrade delivery and requires alternative strategies and LV venting  What do cross-clamp time and bypass time represent clinically? Cross-clamp time = duration of myocardial ischemia while the heart is arrested Bypass time = total duration on CPB, reflecting systemic exposure to non-physiologic circulation Prolonged cross-clamp time (>2–3 hours) increases risk of myocardial dysfunction, especially with poor baseline function Longer bypass time is associated with increased risk of renal injury, coagulopathy, and bleeding These metrics often reflect both case complexity and intraoperative challenges What is hypothermic circulatory arrest (HCA) and when is it used? HCA involves complete cessation of blood flow to allow a bloodless surgical field Typically used in complex aortic arch repairs Patients are cooled to ~18°C to reduce metabolic demand and protect organs Duration is ideally limited to

Send us Fan MailWhat happens to intermittent hypoxemia when you keep a stable preterm infant on CPAP for two extra weeks? In this Journal Club episode, Ben and Daphna review a secondary analysis from the Journal of Pediatrics by Mamidi and McEvoy. Among 95 infants randomized to either two additional weeks of bubble CPAP on room air or discontinued CPAP, those in the extended CPAP group experienced significantly fewer intermittent hypoxemia episodes (57.6 versus 151.7), higher baseline saturations, and greater functional residual capacity. The episode also touches on the practical implications for units navigating oral feeding protocols alongside extended CPAP.----Extended Continuous Positive Airway Pressure in Infants Born Preterm Decreases Intermittent Hypoxemia: A Secondary Analysis of a Randomized Controlled Trial. Mamidi RR, Go MDA, Harris J, Olson M, Milner K, Tepper RS, Morris C, Park B, Schelonka R, MacDonald KD, McEvoy CT.J Pediatr. 2026 May 25:115165. doi: 10.1016/j.jpeds.2026.115165. Online ahead of print.PMID: 42190903Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

"How do we hold space for the miracle of survival while grieving the loss of a dream?" In this week's episode of the Sisters in Loss podcast, we sit down with the incredible Dr. Shayla Élise Walker, PhD, LCSW. Dr. Walker is a licensed clinical social worker, professor, and public speaker with over a decade of experience addressing mental health, racial justice, and restorative healing. But beyond her impressive credentials, she joins us today as a sister in loss, blending her profound scholarship with her own raw, lived experience. Dr. Walker shares one of the most unique and harrowing pregnancy journeys we have ever heard on this platform. After surviving a life-threatening car accident, she was hospitalized in the trauma ICU, where she discovered she was 3.5 weeks pregnant. In the midst of severe physical trauma, this baby felt like an added, beautiful miracle. Tragically, just five weeks later at her first OB appointment, she and her partner learned the pregnancy was non-viable. Dr. Walker takes us into the unspeakable heartbreak of surviving a near-fatal accident, only to lose her miracle baby a month later. As an expert who actively works to redefine what it means to be a "Strong Black Woman," Dr. Walker opens up about her biggest obstacles during this time: navigating the intense societal pressure to "be strong," keep hope, and distract herself by pouring her energy into work. Instead, she advocates for a different path—one that allows us to hold the complex, messy truth of grief, fear of the future, and gratitude for survival, all at the same time. In this episode, we discuss: Dr. Walker's life-threatening car accident and discovering her pregnancy in the trauma ICU. The devastating transition from surviving physical trauma to navigating perinatal loss. Redefining the "Strong Black Woman" trope and resisting the pressure to heal on anyone else's timeline. The complexity of holding grief, fear of future miscarriages, and gratitude simultaneously. The healing power of connecting with other "heavenly baby" mothers and finding community with Sisters in Loss. This is a masterclass in healing, vulnerability, and maternal mental health. Please tune in, grab your tissue, and let Dr. Walker's wisdom wrap around you. Become a Sisters in Loss Birth Bereavement, and Postpartum Doula Here Book Recommendations and Links Below You can shop my Amazon Store or  ​Bookshop.org for the Book Recommendations You can follow Sisters in Loss on Social Join our Black Moms in Loss Online Weekly Grief Support Group Join the Sisters in Loss Online Community Sisters in Loss TV Youtube Channel Sisters in Loss Instagram Sisters in Loss Facebook

Marcus Aurelius Anderson sits down with Dr. Grace Firestone, a family medicine physician, athlete, and cardiac arrest survivor. Dr. Firestone shares the story of collapsing at 18 years old, spending 10 days in the ICU, and waking up with documented brain injury and compromised heart function. Rather than accepting the limitations placed on her, she pushed forward into college, medical school, and competitive bodybuilding. This conversation covers her early drive rooted in gratitude, the mindset she developed through adversity, her philosophy of practicing what she preaches as a physician, and her work with legendary trainer Charles Glass. Episode Highlights: 0:05 – Dr. Firestone explains why switching to 6:00 AM training at Gold's Gym transformed her efficiency as both an athlete and a physician. 4:22 – She shares the origin of her drive, tracing it back to gratitude, financial aid, and a high school nonprofit she founded called Let the Kids Play. 6:14 – Dr. Firestone recounts the night she suffered sudden cardiac arrest at 18, the CPR her brother performed, the AED shocks, the medically induced coma, and waking up uncertain of her cognitive future. 27:58 – She describes her decision to climb Mount Kilimanjaro despite her defibrillator and medical uncertainty, writing in her journal that she might die on the mountain, and what reaching Uhuru Peak meant for her identity going forward. Dr. Grace Firestone is a board-eligible family medicine physician practicing at UCLA Santa Monica. A cardiac arrest survivor at 18, she rebuilt her life through cognitive therapy, collegiate athletics, and medical training. She specializes in nutrition, exercise, and lifestyle medicine, and trains under world-renowned bodybuilding coach Charles Glass in competitive bodybuilding. Her work as a doctor is grounded in a personal commitment to modeling the habits she prescribes to her patients. She can be found on Instagram at @Dr.Grace_Firestone. Learn more about the gift of Adversity and my mission to help my fellow humans create a better world by heading to www.marcusaureliusanderson.com. There you can take action by joining my ANV inner circle to get exclusive content and information.See omnystudio.com/listener for privacy information.

Tyler Cook is a professional GT3 racing driver who has competed in some of the most grueling endurance races on the planet, the 24 Hours of Spa, the 24 Hours of Nürburgring, IMSA, and GT World Challenge Europe. He's also been living with type 1 diabetes since he was 11 years old. This episode gets into what it actually looks like to manage blood sugar in a fire suit, in a 130-degree cockpit, at 150 miles per hour, sometimes at 3 a.m. Tyler takes us back to his diagnosis in 2006 — an ICU stay, four IVs, and a very specific grief over the chocolate mousse at Epcot's France pavilion. From there, he walks us through the journey from go-karts in his dad's garage to GT3 race cars with 650 horsepower. Along the way, there was bullying in middle school over his diet, sneaking to the bathroom to give injections on dates, and a decision somewhere along the line to stop hiding his diabetes and start owning it. We get into the technical side, too: how OmniPod changed his race management strategy, why adrenaline sends his blood sugar climbing instead of crashing, what a 24-hour-race insulin plan actually looks like, and what it means to have a Gatorade button wired into your cockpit as an emergency low-blood-sugar protocol. Tyler also talks about the physical training side of racing — heart rate zone work, neck day (yes, neck day), and why a GT3 driver can be pressing 1,200 pounds of brake force per pedal. The episode wraps with something that's been sitting with both Rob and Tyler: the idea of trusting the process. For Tyler, the lesson comes through racing — you can't skip steps from spec Miata to GT3. For people with T1D, it's the same. Wherever you are in your management journey, that's where you are — and it's going to get better if you just keep going. Chapters: 00:00 Climbing out of a race car at 2 a.m. 00:51 Introducing Tyler Cook, GT3 driver with T1D 01:52 Diagnosis at 11: ICU, four IVs, and Epcot chocolate mousse 04:16 Go-karts at three, racing in the family DNA 06:20 Racing pre-CGM: going off vibes and feeling lows 07:29 Bullied for his diet in middle school 09:53 Dating with diabetes and deciding to stop hiding it 12:29 Going public: from fear of losing opportunities to advocacy 13:35 A potential cure and why staying healthy now matters 17:19 What GT3 racing actually is — and why you should go watch it 23:02 The Gatorade button: CGM and cockpit glucose management 24:28 130-degree cockpits, adrenaline spikes, and pre-race hydration 25:39 WHOOP strain scores: practice vs. race stint 28:37 Training for the car: heart rate zones, neck day, 1,200-lb brakes 36:45 What Tyler would tell 11-year-old himself: trust the process Resources: * Tyler Cooke Instagram * Breakthrough T1D * Conor Daly (T1D IndyCar driver Tyler mentioned)

Social determinants of health, including housing, food access, insurance status, and structural inequities, significantly influence stroke prevention, recovery, and long term outcomes. These factors affect biological risk, treatment adherence, and disparities in care, even when traditional clinical measures are addressed. This episode highlights practical strategies for integrating screening, leveraging multidisciplinary teams, and identifying opportunities for advocacy to improve patient outcomes. In this episode, Teshamae Monteith, MD, FAAN, speaks with Nneka L. Ifejika, MD, MPH, author of the article "Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Ifejika is an adjunct professor of physical medicine and rehabilitation at UT Southwestern Medical Center in Dallas, Texas, and the chief scientific officer of the Division of Academics at Ochsner Health System in New Orleans, Louisiana. Additional Resources Read the article: Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Monteith: Two patients have the same stroke, but when they return, they have very different outcomes. We can look into some of their comorbidities, but something we don't spend enough time talking about is the social determinants of health. Stay tuned to this discussion. I promise you, you'll become a better neurologist. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr. Teshamae Monteith. Today I'm interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. How are you? Welcome to our podcast. Dr Ifejika: Thanks for having me. I'm doing great. Dr Monteith: Great. So, can you introduce yourself to our audience? Dr Ifejika: Sure. I'm Dr. Nneka Ifejika. I am the Chief Scientific Officer of Ochsner Health System in New Orleans, Louisiana. But I'm also a cerebrovascular rehabilitation doctor. I've been practicing for about nineteen years, and am happy and honored to be a contributor to this Continuum Neurology article. It's a really important topic. Dr Monteith: Great. So, what got you into this field, first of all? Dr Ifejika: Well, I was deciding between PM&R and neurology, and I was putting in both match lists. And I thought about it and I leaned toward PM&R, but stroke still had a grasp on my heart and my mind. And so, after I finished my residency, I joined the UT Houston stroke team, and I did a, thankfully did a two-year fellowship and became cross-trained in stroke as well as physical medicine rehab. So, I am a jack of both trades. Dr Monteith: So, you got your way in a way. Dr Ifejika: I did. Dr Monteith: You know, we have a lot of learners that are listening, so it's always, uh, nice for them to be inspired, I think, by people's career paths. So why don't we talk about the objectives of your article? Dr Ifejika: Sure. So, one of the most important things that we wanted to do was make sure that medical students, residents, faculty, and fellows understood the impact of social determinants of health on stroke recovery and stroke rehabilitation. It's not as simple as you have hypertension, hyperlipidemia, we're going to manage your stroke risk factors. Oh, you had an ischemic stroke. You presented in time for the window. We're going to give you endovascular therapy and then modified Rankin scale at hospital discharge in ninety days. No, no, no. The stroke survivor and their caregivers and their family have a lot more to deal with outside of what we look at during the acute stroke hospitalization and post-acute rehabilitation. Things like, can they afford the medication that we're prescribing? Antiplatelet agents or anticoagulation can be extremely expensive. Do they have housing insecurity? Is there food insecurity? What's going on behind the scenes that we are not addressing that can directly impact the admission rate and the readmission rate after we take care of a stroke survivor? Dr Monteith: I love the article because you took a real deep dive into social determinants of health, what they are, why they matter, and what we can do about them. And so why don't we talk a little bit about the NINDS framework for social determinants of health? I think many of us might not be familiar with the framework per se. Dr Ifejika: So, the framework consists of multiple domains specifically that relate to social determinants of health that were published in Neurology a couple of years ago. So, I do hope that people who are hearing this recording actually read them. There are interpersonal domains, there are classic medical domains, there are indeterminate domains, and there are six total domains. And health domains are the last domain. So, things like when it comes to housing insecurity, food insecurity, that's a domain of social determinants of health. When it comes to chronic racism, when it comes to biases that patients experience, those actually impact outcomes. So, there are six separate indices that we're going to get into in detail and how we address them as clinicians, whether it be at the medical student level, resident level, faculty level, to integrate the social determinants of health in our care plans, because we could be doing a much better job. And I think it'll be really important from the interpersonal perspective when we really relate to our patients and their families that we ask these questions. For example, if we're prescribing someone to have treatment for their diabetes mellitus and ha- and, and be taking insulin, if they have housing insecurity and they're in a homeless shelter, they have to leave the homeless shelter during the day. So, what happens to the insulin that we prescribe? These are variables that we are not considering on a regular basis, but they directly relate to compliance. Dr Monteith: Great. So that was one thing I wanted to bring up. We're very good at measuring blood pressure and trying to determine, uh, the association between stroke outcomes and things that we can measure, glucose, lipids, blood pressure. What is the evidence for social determinants of health and stroke outcome? Dr Ifejika: The evidence is growing, and there have been many publications that have come out that are, are going to be highlighted in this article related to structural determinants of health inequities, like structural racism, as well as disparities related to ethnicity and race. There's geographical disparities. For example, a lot of patients are, are primarily concerned about rural versus urban, whether you have access to different post-acute rehabilitation, whether you have access to secondary stroke prevention because you simply don't have the transportation from a, a rural area to get to a drugstore to get things available to you. Social status. There are actually publication related to socioeconomic status and the concerns when it comes to air pollution. So particulate matter 2.5, we know that that has a direct impact on stroke outcomes and health overall, but we don't really think about it as a structural determinant of health inequity. There's several multiple layers of research that have gone on specifically that have been cited in the literature that relate directly to social determinants of health and how we can address them moving forward. Dr Monteith: And what I found interesting in your article in that you gave at least a few examples where social factors like income, education were controlled for, and maybe in large part it is, but even when you control for some of these very obvious social risk factors, you still have inequities. Dr Ifejika: Absolutely. And I think it was really important to show that we had strong peer review evidence behind this, as it wasn't just something that we were creating or hypothesizing about. There have been studies that have been done over this over decades of time, showing the impacts of social determinants of health on outcomes. But the question and concern that we have is we know this growing body of literature continues to expand. What are we doing about it when it comes to education of the future generations of providers who will be caring for this population? Dr Monteith: Before we get into how, you know, what we're going to do about that, let's just kind of put that link, cause the evidence is there. How does it drive biology? Dr Ifejika: It's a great question. So, for example, particulate matter 2.5 in air pollution has been shown to have an existing impact on hypertension, raising your blood pressure. So that's a direct effect of a social determinant of health related to socioeconomic status because people who live in areas with higher air pollution are... They're not green spaces. They live near highways. Those are areas that unfortunately are also impacted by food deserts. Food deserts, if you're not able to get fresh fruits, vegetables, whole foods, increases your risk of developing diabetes, hyperlipidemia, also increases your sodium intake, again, increasing hypertension. These things are all connected to biological determinants. It's just that we're not asking about them necessarily within the social history when we're taking people into the hospital, but they have direct effects. Dr Monteith: Great. Neurologists tend to be busy and, you know, we're... have all of these things that we're being asked to do and chart and click and all of that stuff. And so how can we more readily integrate screening for social determinants of health and that conversation into the work we do? We recognize it's important. We recognize it's an important risk factor. There's a lot of these determinants. So, what is a good way to do so? And I, I know that in the paper you've, you've given different roles to different team players, so I want you to talk about that too, but just kind of even a regular routine office visit. Walk us through a way we can more easily integrate that kind of conversation. Dr Ifejika: It's an excellent question, and what I've recommended that we do in a standard office visit is utilize the time before the visit to send out screeners. So, for example, usually with an electronic medical record, you can send documents before the visit even starts, where people can check off whether they have any concerns regarding housing, food insecurity. They can check out their location of where they live, whether they live near a highway or not near a highway. It's specifically related to socioeconomic status. We can ask about insurance status, whether they have insurance, insured versus uninsured, but then also types of insurance, whether they have Medicaid insurance versus Medicare insurance. Then even drilling even further, type of Medicare insurance, Medicare Advantage versus traditional Medicare, cause all of those things actually play a role in this. Dr Ifejika: And evaluate these things and don't take time during your office visit. Send these screeners out beforehand. Have them be assimilated by your medical staff. Make sure you're utilizing every resource that you have at your disposal to help streamline things, so by the time the person comes in for the visit, you've primed the pump. You have this information already in your hands at your fingertips cause it was sent out in advance, and you have your medical staff already have an understanding of. If they didn't fill it out electronically, give it to them in the lobby. Make sure they have a handwritten copy in the lobby so that when they come into the office visit, you have the information at your fingertips. Dr Monteith: Are there any particular resources that you recommend for those types of screeners? Dr Ifejika: What I've used in the past, if you have patient-reported outcomes, so the PROMIS instruments, that's a good start. It doesn't get into the details of housing insecurity, food insecurity, but it's a good start to help prime questions and to start the conversation during your office visit. In my clinics, I do a PROMIS 27 on every patient, as well as a PHQ-9 for depression on everyone. And then I collect data longitudinally, and I can always drill down on factors that I noticed that could become a problem moving forward. Dr Monteith: Yeah. And then also in your article, you spoke a bit about this impact from the acute presentation in the hospital to rehab. Dr Ifejika: Yeah. Dr Monteith: So why don't you talk about these different entry points where we can really engage our patients and try and help reduce their burden? Dr Ifejika: Sure. So, healthcare can be quite fragmented, and the stroke patient, stroke survivor, and their family member have no grasp of that. They've had a stroke, and they may be going from the ER to the ICU to the stroke unit to the floor to the rehab unit, and we see it as multiple levels of care, multiple types of providers. They see it as one hospital. And the concern that we have is, at those branch points, things get dropped, and we have the opportunity to pick things up at those branch points. So, during the acute care hospitalization-Primarily, that's the establishment of what has happened, how we're gonna treat it, what are the variables that we can control for right now to address those determinants of health moving forward, and to specifically looking at whether they were taking medications before, whether they could afford medications before, what that looks like at hospital discharge. Is there any duplication of medications? If a person is taking Coreg and you prescribe metoprolol, but they still have the Coreg at home, should we have really prescribed the metoprolol? We're just spending money that they may have concerns when it comes to access to care and the cost of these prescriptions. So, it's the responsibility of the acute care physician to kind of look at that. Those are subtle things that we think are subtle, but they add up quickly for the family when it comes to having one group of medications that's the same class and having to buy another type. When it comes to post-acute rehabilitation, it's really an important time to screen for whether the caregiver can handle what's occurring. So specifically, if the caregiver is already burning out and the average length of stay for a stroke patient is five days and they've come to rehab for two weeks, what's gonna happen in the next two years or the next four years? So, during the post-acute rehabilitation phase, it's time to kind of look at that and drill down on those kind of questions. Also, the levels of care, Dr Ifejika: it's really important to look at other levels of rehabilitation, so skilled nursing facilities, making sure people have access to that if they need to, if the caregiver is burned out and they don't have the ability to go straight home. Because acute inpatient rehab, the goal of it afterwards, is to go straight home. It's not to go to another facility. So, you need to have that screener in place when it comes to whether the family can take care of this person, and whether the family can do it in an effective way to prevent them being readmitted. Dr Monteith: Great. I also like that you spoke about kind of the team approach and different roles, both for screening and for intervention, both being very important, especially the intervention. And so why don't you give us a few examples how the team could break up the responsibility and how also for the intervention component that can be done. Dr Ifejika: Sure. So, I broke up the team into several levels. So, the team medically is the medical student, resident, and faculty physician. However, the team also includes the support staff, so your case manager, your social worker, the therapist, physical therapy, occupational therapy, speech therapy, the pastoral services, all these members of the team. You know, sometimes as physicians, we don't read those notes. There's a lot of information in the notes from social work, care coordination, and the therapist. They get down to subtleties cause they're asking questions, for example, "What kind of equipment do you have at home? How many stairs do you have at home? What level of house do you have, one story, two story? If you live in an apartment, do you have an elevator access?" That's important for someone with hemiparesis. When it comes to medications, when it comes to insurance status, when it comes to your ability to have the mechanisms to pay for care as an outpatient, social workers are required to ask these questions cause they have to figure out resources for the patient and their family to help facilitate improved outcomes. So, they have to ask questions regarding these tasks. The concerns are, do we read what they're saying? So, it's really important to interact with them, and if it's not something that you're looking at in the chart, cause we're all so tied to our computers, find where they are in the hospital. Walk by their office and have a chat. Run your list with them, especially for people who you're concerned have vulnerabilities, and make sure that you're setting an example for your medical students with your faculty doing so. If you're looking at it from the medical student, resident, faculty perspective, medical students, listen. This is your opportunity to really contribute to the team as well as learn about social determinants of health and research in their fields. You are the boots on the ground for the medical team. You are the ones who should be priming the pump and asking these questions of the family members. We're sending you into the rooms to do a history and physical. Social determinants of health should be a part of your history and physical, and you should be taking what we're saying in this article and asking these questions and tying it into your resident. Now, the resident is the work person of the hospital. We all know this. Things run through the resident. Things run through the fellow. It's really important that they have this information in a manner that is negotiable. The list keeps getting longer, and a resident doesn't need to be overburdened. It needs to be synthesized in a manner that can help facilitate the resident being able to act as well as communicate any concerns to the faculty. And at the faculty level, we are the voices that can affect change. So, if there's any concerns when it comes to advocacy, research, making sure that people are accessing care in a way that makes sense, particularly when it comes to the ability for us to galvanize change on a national level, that's kind of our job. Dr Monteith: Great, and so let's talk about intervention. What are things that, let's say, the neurologist can do to deal with some of these social factors? Dr Ifejika: From the neurology perspective, I think it's really important to identify missed opportunities and making sure that we address them. For example, the conversations around the ability to have access to care related to insurance versus no insurance. There are many, many ways that neurologists are able to advocate for a person being able to get to Medicare insurance, particularly in the outpatient setting. When we see patients in clinic, it takes two years, them, to qualify for Medicare, two years at a minimum. But there's a gap there that can be filled by us making sure that we document what's happened, contact their providers, facilitate communication with their employers, if they're employees, they can get some short-term disability benefits to help bridge that gap prior to receiving Medicare insurance. It behooves us to do this because if we do not, they fall into the gap and they get readmitted and they're back on service anyway. So, what's important is the outpatient that we really kind of focus on things that we can impact and things like insurance and getting people transitioned from having employer-based insurance versus getting to Medicare is a really important way that we can effect change in a, in a way that's viable and, and replicable. So, in the outpatient setting, neurologists have a wonderful opportunity to effect change in social determinants of health. When it comes to employed persons, who had a stroke transitioning to Medicare, it takes two years to do so. So, in the outpatient clinic, if you have an employed person, make sure that you fill out their short-term disability benefits forms, their long-term disability benefits form. Bridge the gap. Get that information to their employer so they can maintain constant coverage. Because if they do not, if they have to choose between refilling medications and putting food on the table, they're going to choose putting food on the table, and that's going to directly impact their outcomes if they're not taking the medication that we recommend. Dr Monteith: I think that's a great point. I mean, there's a lot that we can do, and in some ways, it may not take that much to document and to be able to ask the questions and to include some of that information into the assessment and plan is really a, a great idea. Dr Ifejika: And you know, if we don't bring these things up and have these conversations, it doesn't get addressed. And that's why I'm very, very thankful that I had the opportunity to do so, cause this is a part of what I do all day. I think that if I wasn't integrating these kind of conversations into my practice, I wouldn't have the ability to share these tips and these abilities to move things forward in a manner that will be constructive for our field overall and for our patients. Dr Monteith: And towards the end of the article, you brought up something I think we don't see in many articles, and that's the role of advocacy and getting involved in health policy. So, can you talk a little bit about that? Dr Ifejika: You know, it's really important to facilitate change when you see that there are things that need to be changed. And the best way to do that is through advocacy at the local or state or federal level. A lot of these variables that we're dealing with can be addressed through legal changes. I'll give you an example. End-stage renal disease, if you have immediate hemodialysis and you have that requirement upon hospital discharge, you qualify for Medicare immediately. Immediately. Before you even leave the hospital. Why wouldn't something be similar for a stroke? Well, the reason why is because there was a level of advocacy that came around end-stage renal disease and a member of Congress's wife had hemodialysis requirements. And so, a law was passed to make sure Medicare covered it immediately after hospital discharge. So, it requires advocacy in some significant ways to get things done, but we have the bandwidth to do this. We take care of a population that has some of the highest rates of preventable disability. That's not going away. We need to make sure that we're effecting change for this group to make sure that they have the best possible outcomes they can experience. Dr Monteith: So, any final messages for our listeners? Dr Ifejika: I look forward to hearing everyone's feedback about our issue. I am thankful for the opportunity to talk about, address, and write about this important topic, and look forward to everyone's feedback. Dr Monteith: Well, thank you so much for being on our podcast. It was a really wonderful summary and we had a very thorough conversation, but you didn't give away too much, so I think they're going to have to read the article. Dr Ifejika: You're going to have to read the article. And we want medical students, residents, fellows, faculty, all of our ancillary staff within the hospitals, please read this article. We really appreciate it. Dr Monteith: Again today, I've been interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Send us Fan MailIn this Journal Club episode, Daphna reviews a retrospective cohort study from Istanbul examining clinical, laboratory, and ultrasound factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. Among 96 term and near-term infants, 31% had culture-proven UTIs, a striking prevalence. Pathological renal ultrasound findings were independently associated with UTI, with affected neonates 4.6 times more likely to have a concurrent infection. Notably, standard laboratory markers including CRP and white blood cell count failed to distinguish UTI-positive from UTI-negative infants. The findings prompt a practical question: should urine culture be part of the routine workup for neonatal hyperbilirubinemia?----Renal ultrasonography findings are associated with urinary tract infection in neonates with asymptomatic hyperbilirubinemia. Sarı EE, Salihoğlu Ö.J Perinatol. 2026 Apr 13. doi: 10.1038/s41372-026-02686-x. Online ahead of print.PMID: 41975209Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

In this section, I educate about the most common ICU sedation medications. You can find the full 16+ hour nursing pharmacology review course, including PDF handouts, cheat sheets, practice questions, and on-demand videos at meded101.com!

Send us Fan MailIn this Journal Club episode, Ben and Daphna review a nationwide Swedish cohort study examining the association between phototherapy duration and neonatal outcomes in very preterm infants (22 to 31 weeks). The study's primary outcome, late neonatal mortality on days 8 to 27, was not significantly associated with phototherapy duration. However, longer phototherapy exposure was associated with increased odds of severe neonatal morbidity, including IVH and BPD, in infants born at 26 to 31 weeks. The findings prompt an important conversation about the near-universal use of phototherapy in preterm neonates and whether current practice warrants reassessment.----Phototherapy, Morbidity, and Mortality in Very Preterm Newborns. Deschmann E, Håkansson S, Söderling J, Norman M.JAMA Netw Open. 2026 May 1;9(5):e2614107. doi: 10.1001/jamanetworkopen.2026.14107.PMID: 42166159 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!