Podcasts about laryngoscope

Plants are blooming right now – and so are people's allergies. And if it feels like those pesky symptoms are getting worse ... you're probably right. Wednesday, a review published in the journal The Laryngoscope looked at the link between climate change and increasing rates of allergic rhinitis, or hay fever. So today, we turn back to a classic Short Wave episode from Brit Hanson and Maddie Sofia, who spoke to allergy expert Dr. Juanita Mora about some quick tips for managing seasonal allergies.Want more of the science behind your health questions? Send us an email at shortwave@npr.org. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Die Themen in den Wissensnachrichten: +++ Grundeinkommen macht zufriedener +++ Gen Z fällt eher auf Fake News rein +++ Neuer Komet am Morgenhimmel +++**********Weiterführende Quellen zu dieser Folge:Pilotprojekt Grundeinkommen: kein Rückzug vom Arbeitsmarkt, aber bessere mentale Gesundheit, DIW Wochenbericht, 09.04.2025Zusammenfassung der Studie zum Grundeinkommen auf der Vereinsseite, 09.04.2025Profiling misinformation susceptibility, Personality and Individual Differences, Volume 241, Juli 2025Interconnected Disaster Report 2025, United Nations Press Relaese, 09.04.2025How Climate Change Is Impacting Allergic Rhinitis: A Scoping Review, The Laryngoscope, 09.04.2025Alle Quellen findet ihr hier.**********Ihr könnt uns auch auf diesen Kanälen folgen: TikTok und Instagram .

Operating rooms generate up to 30% of a hospital's waste–what can ENT do to change that? In this episode, Dr. Julie Strychowsky, a pediatric otolaryngologist at London Health Sciences Center in Ontario, discusses environmental sustainability in ENT. --- SYNPOSIS The discussion covers the inefficiencies and environmental impacts of current practices, such as the use of nitrous oxide, disposable equipment, and OR waste. Dr. Strychowsky shares insights on transitioning to more sustainable practices, including the use of reusable and multi-use equipment, standardizing procedures, and patient education initiatives like the ‘Bring Your Own Bag' campaign. The doctors highlight the importance of climate change, the carbon footprint of healthcare, and the role of policy and innovation in reducing environmental impact. Finally, they discuss resources for further learning and potential areas for research and development in sustainable healthcare practices. --- TIMESTAMPS 00:00 - Introduction 02:51 - Climate Change and Its Impact on Health 05:07 - Surgical Sustainability: Reducing OR Waste 08:27 - Clinic Waste and Efficiency Improvements 16:12 - Anesthesia Gases and Environmental Impact 23:06 - In-Office Procedures and Telemedicine in ENT 28:58 - Global Efforts & Patient Involvement in Sustainability 37:03 - Policy Changes and Education for Sustainability 39:59 - Future Research and Innovation in ENT 42:26 - Final Thoughts and Mentorship --- RESOURCES Dr. Julie Strychowsky https://www.schulich.uwo.ca/paediatricsurgery/people/faculty/Strychowsky,%20Julie.html Kidane J, Thiel CL, Wang K, Rosen CA, Gandhi S. A Comparison of Environmental Impacts Between Reusable and Disposable Flexible Laryngoscopes. Laryngoscope. 2024 Dec 26. doi: 10.1002/lary.31927. Epub ahead of print. PMID: 39723758. https://pubmed.ncbi.nlm.nih.gov/39723758/ Anderson J, Hu H. Environmental Sustainability: Waste Audit Comparison Operating Room and In-Office Laryngeal Surgery. Laryngoscope. 2024 Feb;134(2):803-806. doi: 10.1002/lary.31005. Epub 2023 Sep 2. PMID: 37658737. https://pubmed.ncbi.nlm.nih.gov/37658737/ Cascade OR playbook https://cascadescanada.ca/

Guest: Kathleen M. Buchheit, MD Guest: Joseph K. Han, MD Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a low quality of life and increased healthcare utilization,1,2 and patients often continue to have severe symptoms despite therapy.​3 Understanding the role of underlying inflammatory pathways and epithelial dysfunction may help inform clinical decision making for these patients.​3,4 In this program, Dr Kathleen Buchheit and Dr Joseph Han share their insights on the pathophysiology of CRSwNP and how unaddressed underlying inflammation may contribute to a variety of challenges for patients. Dr Buchheit is an Assistant Professor of Medicine at Harvard Medical School, specializing in Allergy and Immunology. Dr Han is a Professor of Otolaryngology, the Chief for the Division of Rhinology and Endoscopic Sinus and Skull Base Surgery, and the Chief of the Division of Allergy at Eastern Virginia Medical School in Norfolk, Virginia. References: Mullol J, et al. J Allergy Clin Immunol Pract. 2022;10:1434-1453.e9 Bhattacharyya N, et al. Laryngoscope. 2019;129:1969-1975. van der Veen J, et al. Allergy. 2017;72:282-290. Laidlaw TM, et al. J Allergy Clin Immunol Pract. 2021;9:1133-1141. ©2024 Amgen and AstraZeneca. All rights reserved.US-96000 Last Updated 12/24

Nothing is more satisfying than draining an abscess, right? But when is medical management sufficient or even better? In this episode of the BackTable ENT Podcast, pediatric otolaryngologist Dr. John McClay joins host Dr. Gopi Shah to educate listeners on the diagnosis and management of pediatric retropharyngeal abscess (RPA). --- CHECK OUT OUR SPONSOR PearsonRavitz https://pearsonravitz.com/backtable --- SYNPOSIS First, Dr. McClay reviews the symptoms, pathophysiology, and workup of neck abscesses (including RPA) in children. When evaluating any suspected neck abscess, he uses CT results to evaluate its precise size and location. Then, he addresses the role of surgery in treatment of neck abscesses. While many patients will improve with IV antibiotics alone, he mentions that most abscesses lateral to the carotid sheath and greater than 2 cm in size require surgical drainage. Finally, the conversation shifts to cover important topics including antibiotic selection, the role of steroids, and cost-effective care. --- TIMESTAMPS 00:00 - Introduction 03:34 - Pathophysiology & Presentation of Retropharyngeal Abscess 09:54 - Physical Examination in the Child with Suspected Neck Abscess 17:43 - The Importance of CT Scans 31:40 - Treatment of Neck Abscesses: Antibiotics vs Surgery 37:56 - The Role of Steroids in Abscess Treatment 53:41 - Applying Value-Based Care as a Pediatric Otolaryngologist 55:44 - Recap & Final Pearls --- RESOURCES Dr. McClay's website: https://www.johnmcclaymd.com/pediatric-sinus-center/ Pearson Ravitz https://pearsonravitz.com/ McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg. 2003 Nov;129(11):1207-12. Johnson RF. Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess. Laryngoscope. 2017 Oct;127 Suppl 5:S1-S9.

In this comprehensive guide, let's delve into the science of preventing positional vertigo, offering actionable advice and insights based on the latest research. I explore the risk factors associated with this condition, including the role of vitamin D, bone density, head trauma, and cardiovascular health, to empower individuals and healthcare providers with knowledge to mitigate the risks. Join me as we unravel the complexities behind positional vertigo, emphasizing evidence-based strategies for prevention and management, and ensuring you and your patients remain informed and proactive against this challenging condition. --- Full Lecture on Prevent Vertigo From Coming Back https://youtu.be/f8uq6YXwwOg --- For a deeper understanding, we've attached the research article links discussed in the video below. 1. Chen J, Zhao W, Yue X, Zhang P. Risk Factors for the Occurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Front Neurol. 2020;11:506.dio: 10.3389/fneur.2020.00506 https://pubmed.ncbi.nlm.nih.gov/32655479/ 2. Yu S, Liu F, Cheng Z, Wang Q. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurology. 2014;14:110. Doi: 10.1186/1471-2377-14-110. https://pubmed.ncbi.nlm.nih.gov/24886504/ 3. AlGarni MA, Mirza AA, Althobaiti AA, Al-Nemari HH, Bakhsh LS. Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology. 2018;275(11):2705-2711. Doi: 10.1007/s00405-018-5146-6 https://pubmed.ncbi.nlm.nih.gov/30302575/ 4. Andersson H, Jablonski GE, Nordahl SHG, Nordfalk K, Helseth E, Martens C, Roysland K, Goplen FK. The Laryngoscope. 2021;132(2):443-448. Doi: 10.1002/lary.29851. https://pubmed.ncbi.nlm.nih.gov/34487348/ 5. Liu X, Han K, Zhou M, Wu Y. Association between otolin-1 and benign paroxysmal positional vertigo: A meta-analysis. 2022; Front Neurol. 13:950023. Doi: 10.3389/fneur.2022.950023. https://pubmed.ncbi.nlm.nih.gov/36601298/

Reference: Curry SD, et al. Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma. Laryngoscope. March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children's National Hospital and George Washington University. She is also the director of the Pediatric Otolaryngology […] The post SGEM #429: It's CT Angio, Hi. I'm the Problem. It's Me. For Pediatric Oropharyngeal Trauma first appeared on The Skeptics Guide to Emergency Medicine.

Date: July 21, 2023 Reference: Prekker et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. NEJM 2023 Guest Skeptic: Dr. Jeff Jarvis is the Chief Medical Officer and System Medical Director for the Metropolitan Area EMS Authority in Fort Worth, Texas, also known as MedStar. He is board certified in both Emergency Medicine […] The post SGEM#410: Do You See What I See? Video Laryngoscope for Intubation first appeared on The Skeptics Guide to Emergency Medicine.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 14, 2020 Can you hear that too? You can't? Well, that doesn't mean I'm having auditory hallucinations. It could just be tinnitus, which describes the irritating sound of ringing, buzzing, clicking, or hissing that affects 10% to 20% of the world's population. But is this a ringing in the ears or a ringing in the brain? Produced by James E Siegler. Music courtesy of Andrew Sacco, Jon Watts, Kai Engel, Lovira, Patches, and Kevin McLeod. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Arenberg IK, Countryman LF, Bernstein LH, Shambaugh GE Jr. Van Gogh had Menière's disease and not epilepsy. JAMA 1990;264(4):491-3. PMID 2094236 Crummer RW, Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician 2004;69(1):120-6. PMID 14727828 Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope 1999;109(8):1202-11. PMID 10443820 Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol 2009;5(1):11-9. PMID 19513328 Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol 2013;12(9):920-30. PMID 23948178 Lockwood AH. Tinnitus. Neurol Clin 2005;23(3):893-900, viii. PMID 16026681 Lockwood AH, Salvi RJ, Burkard RF, Galantowicz PJ, Coad ML, Wack DS. Neuroanatomy of tinnitus. Scand Audiol Suppl 1999;51:47-52. PMID 10803913 Mattox DE, Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol 2008;128(4):427-31. PMID 18368578 Palomar García V, Abdulghani Martínez F, Bodet Agustí E, Andreu Mencía L, Palomar Asenjo V. Drug-induced otoxicity: current status. Acta Otolaryngol 2001;121(5):569-72. PMID 11583387 Sullivan M, Katon W, Russo J, Dobie R, Sakai C. A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Arch Intern Med 1993;153(19):2251-9. PMID 8215728  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

Dans cet épisode consacré aux troubles respiratoires du sommeil, Morgane nous parle de l'impact de ces troubles sur la croissance oro-faciale, sur les apprentissages, mais aussi sur la qualité de vie globale du patient. Il sera également question des apnées obstructives du sommeil, du côté délétère de la ventilation buccale, et des indications de chirurgie maxillo-faciale. références bibliographiques citées dans cet épisode: Ribeiro, G. C. A., dos Santos, I. D., Santos, A. C. N., Paranhos, L. R., & César, C. P. H. A. R. (2016). Influence of the breathing pattern on the learning process: a systematic review of literature. Brazilian Journal of Otorhinolaryngology, 82(4), 466 478. https://doi.org/10.1016/j.bjorl.2015.08.026 Camacho, M., Certal, V., Abdullatif, J., Zaghi, S., Ruoff, C. M., Capasso, R., & Kushida, C. A. (2015). Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep, 38(5), 669 675. https://doi.org/10.5665/sleep.4652 Camacho, M., Guilleminault, C., Wei, J. M., Song, S. A., Noller, M. W., Reckley, L. K., … Zaghi, S. (2018). Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology, 275(4), 849 855. https://doi.org/10.1007/s00405-017-4848-5 Guilleminault, C., & Huang, Y. S. (2017). From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Medicine Reviews, 40, 203 214. https://doi.org/10.1016/j.smrv.2017.06.008 Juliano, M. L., Machado, M. A. C., De Carvalho, L. B. C., Zancanella, E., Santos, G. M. S., Do Prado, L. B. F., & Do Prado, G. F. (2009). Polysomnographie findings are associated with cephalometric measurements in mouth-breathing children. Journal of Clinical Sleep Medicine, 5(6), 554 561. Lee, S. H., Choi, J. H., Shin, C., Lee, H. M., Kwon, S. Y., & Lee, S. H. (2007). How does open-mouth breathing influence upper airway anatomy? Laryngoscope, 117(6), 1102 1106. https://doi.org/10.1097/MLG.0b013e318042aef7 Valarelli, L. P., Corradi, A. M. B., Grechi, T. H., Eckeli, A. L., Aragon, D. C., Küpper, D. S., … Valera, F. C. P. (2018). Cephalometric, muscular and swallowing changes in patients with OSAS. Journal of Oral Rehabilitation, 45(9), 692 701. https://doi.org/10.1111/joor.12666 Guilleminault, C., Huang, Y. S., Monteyrol, P. J., Sato, R., Quo, S., & Lin, C. H. (2013). Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Medicine, 14(6), 518 525. https://doi.org/10.1016/j.sleep.2013.01.013 Guilleminault, C., Huseni, S., & Lo, L. (2016). A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Research, 2(3), 00043 02016. https://doi.org/10.1183/23120541.00043-2016 de Felício, C. M., da Silva Dias, F. V., Folha, G. A., de Almeida, L. A., de Souza, J. F., Anselmo-Lima, W. T., … Valera, F. C. P. (2016). Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. International Journal of Pediatric Otorhinolaryngology, 90, 5 11. https://doi.org/10.1016/j.ijporl.2016.08.019

In this episode of BackTable ENT, Dr. Ashley Agan and Dr. Seilesh Babu discuss Eustachian tube dysfunction and balloon dilation as a therapeutic option. --- CHECK OUT OUR SPONSOR Acclarent https://www.jnjmedtech.com/en-US/companies/acclarent --- SHOW NOTES First, Dr. Babu provides background on Eustachian tube dysfunction. In kids and adults, Eustachian tube dysfunction can present as a sensation of “ear fullness”, recurrent fluid in the ear, or discomfort with pressure challenges, such as flying or scuba diving. Medical management involves nasal steroids, allergy medications, anti-reflux medications, avoidance of allergens, and doing a modified Valsalva maneuver at home. Additionally, ear tubes and balloon dilation are procedural options. Next, Dr. Babu explains his workup for Eustachian tube dysfunction patients. He takes a thorough patient history and examines the patient's tympanic membrane, nasopharynx, and serous outflow using a flexible scope. He orders an audiogram for all of his patients but notes that tympanograms are not as critical. For patients with discomfort during pressure challenges, he will consider doing a balloon dilation or placing an ear tube. For patients presenting with “ear fullness”, a more in-depth examination must be done through a trial tympanostomy tube or a myringotomy. He also looks for red flags, which indicate Eustachian tube dysfunction may not be the correct etiology for their ear symptoms. These red flags include: aggravation of symptoms upon tube insertion, symptoms of dizziness and vertigo, autophony, and pulsatile tinnitus. Although it is rare, a diagnosis of Patulous Eustachian tube dysfunction must be considered. If the patient does not have these red flags and has had multiple ear tubes without symptom relief, they may be a good candidate for balloon dilation. Dr. Babu then delineates his procedure for a Eustachian tube balloon dilation. He performs this procedure in the OR using the Acclarent AERA Eustachian tube dilation system. He inflates the balloon to achieve a pressure of 12 atm, keeps it dilated for 2 minutes, then removes the instrument. Some procedural pearls he shares are: putting the scope and balloon in at the same time to minimize bleeding in the nasopharynx and guiding the instruments in a lateral direction towards the external ear canal. He usually waits 2-3 weeks before reassessing the patient for recurrent symptoms. Upon discharge, he encourages patients to avoid nose blowing and Valsalva maneuvers, as these actions can cause a pneumothorax or pneumomediastinum. Common postoperative symptoms include minor nose bleeds and the sensation of a sore throat. Dr. Babu usually performs the balloon dilation in conjunction with other OR procedures, such as myringotomies and tympanoplasties, for efficacy. Finally, the doctors discuss the specifics of billing for the Eustachian tube dilation procedure. In recent years, a specific billing code has been assigned for balloon dilation, and insurance companies are beginning to authorize this procedure for a variety of patients. Devices discussed in this podcast are currently available in the US only. Acclarent, Inc. 223616-220810 --- RESOURCES Acclarent: https://www.jnjmedtech.com/en-US/companies/acclarent AERA® Esutachian Tube Balloon Dilation System: https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system Howard, A., Babu, S., Haupert, M., & Thottam, P. J. (2021). Balloon Eustachian Tuboplasty in Pediatric Patients: Is it Safe?. The Laryngoscope, 131(7), 1657–1662. https://doi.org/10.1002/lary.29241

In this episode, I explain anosmia and what you can do to aid in recovery. This episode is sponsored by McNeese Construction. Check out our store at www.se7en.surf where you will find cool items for you, your family, and your pets. To keep this podcast going please feel free to donate at www.paypal.me/yopistudio If you would like to read more on this topic or any other previous topics, you can do so by checking out our blog at https://yopistudio.blogspot.com/ Feel free to see what we are up to by following us at:  https://twitter.com/Dauricee https://www.facebook.com/yopistudio/ https://www.facebook.com/LouisianaEntertainmentAssociation/ To listen to the podcast, watch creative videos and skits go to https://www.youtube.com/channel/UCvn6tns6wKUwz9xZw11_vAQ/videos Interested in projects Daurice has worked on in the movie industry you can check it out at www.IMDb.com under Daurice Cummings. For comments or questions, you can reach us at yopi@post.com To read more about today's topic check out the references below. References: [i] Chem Senses. 2017 Sep; 42(7): 513-523. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5863566/ [ii] Chem Senses. 2017 Sep; 42(7): 513-523. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5863566/ [iii] Chem Senses. 2017 Sep; 42(7): 513-523. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5863566/ [iv] StatPearls, Anosmia September 25, 2021 https://www.ncbi.nlm.nih.gov/books/NBK482152/ [v] StatPearls, Anosmia September 25, 2021 https://www.ncbi.nlm.nih.gov/books/NBK482152/ [vi] StatPearls, Anosmia September 25, 2021 https://www.ncbi.nlm.nih.gov/books/NBK482152/ [vii] Chem Senses. 2017 Sep; 42(7): 513-523. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5863566/ [viii] Chem Senses. 2017 Sep; 42(7): 513-523. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5863566/ [ix] Chem Senses. 2017 Sep; 42(7): 513-523. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5863566/ [x] Chem Senses. 2016 May; 41(4): 293-299. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5006107/ [xi] Int J Mol Sci. 2021 Aug 18;22(16):8912. doi: 10.3390/ijms22168912. https://pubmed.ncbi.nlm.nih.gov/34445619/ [xii] Rhinology 55: 17-26, 2017 https://www.rhinologyjournal.com/Rhinology_issues/manuscript_1517.pdf [xiii] Int J Mol Sci. 2021 Aug; 22(16): 8912. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8396277/ [xiv] Int J Mol Sci. 2021 Aug; 22(16): 8912. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8396277/ [xv] Laryngoscope. 2002 Nov;112(11):2076-80. PMID: 12439184 www.greenmedinfo.com/article/lipoic-acid-may-have-therapeutic-value-treating-smell-dysfunction-following-vi [xvi] Am J Rhinol. 2008 May-Jun;22(3):292-6. PMID: 18588762 www.greenmedinfo.com/article/ginkgo-biloba-may-contribute-restoring-olfactory-loss [xvii] Arch Otolaryngol Head Neck Surg. 2009;135(10):1000-1004. doi:10.1001/archoto.2009.141 https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/410599 [xviii] Avicenna J Phytomed. 2022 Jan-Feb; 12(1): 1-7. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8801216/ [xix] Laryngoscope Investigative Otolaryngology December 25, 2020 https://onlinelibrary.wiley.com/doi/full/10.1002/lio2.513 [xx] Otolaryngol Head Neck Surg. 2015 May;152(5):954-8. doi: 10.1177/0194599815571272. Epub 2015 Feb 24. https://pubmed.ncbi.nlm.nih.gov/25715353/ [xxi] Cureus 13(9): e17829. doi:10.7759/cureus.17829 https://www.cureus.com/articles/68407-turmeric-as-a-possible-treatment-for-covid-19-induced-anosmia-and-ageusia  

Join Christian and Mike as we chat about the causes, impacts and possible treatments regarding Tongue Tie in infants! Felicity Crone's Tongue Tie course (Time Limited special offer) + 10% off if you use the code 2PAEDCHIROS at checkout https://felicity-crone.mykajabi.com/pl/2147530164 Richard Baxters book - Tongue-Tied https://www.amazon.com/Tongue-Tied-String-Impacts-Nursing-Feeding-ebook/dp/B07FC4HZXX/ref=sr_1_1?crid=241MWY6NTG8I0&keywords=richard+baxter+tongue+tie&qid=1642633095&sprefix=richard+baxter+tongu%2Caps%2C229&sr=8-1 ADDITIONAL REFERENCES: Amitai, Y., Shental, H., Atkins-Manelis, L., Koren, G., & Zamir, C. S. (2020). Pre-conceptional folic acid supplementation: A possible cause for the increasing rates of ankyloglossia. Medical Hypotheses, 134. Baxter, R., & Hughes, L. (2018). Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series. International Journal of Clinical Pediatrics, 7(3), 29–35. Baxter, R., Merkel-Walsh, R., Baxter, B. S., Lashley, A., & Rendell, N. R. (2020). Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study. Clinical Pediatrics, 59(9–10), 885–892. Ghaheri, B. A., Cole, M., Fausel, S. C., Chuop, M., & Mace, J. C. (2017). Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study. The Laryngoscope, 127(5), 1217–1223. Golja, M. V., Šmid, A., Kuželički, N. K., Trontelj, J., Geršak, K., & Mlinarič-Raščan, I. (2020). Folate Insufficiency Due to MTHFR Deficiency Is Bypassed by 5-Methyltetrahydrofolate. Journal of Clinical Medicine, 9(9), 1–18. Griffiths, D. M. (2004). Do tongue ties affect breastfeeding? Journal of Human Lactation, 20(4), 409–414. Ingram, J., Copeland, M., Johnson, D., & Emond, A. (2019). The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY). International Breastfeeding Journal, 14(1), 1–5. Ingram, J., Johnson, D., Copeland, M., Churchill, C., Taylor, H., & Emond, A. (2015). The development of a tongue assessment tool to assist with tongue-tie identification. Archives of Disease in Childhood - Fetal and Neonatal Edition, 100(4), F344–F349. Mills, N., Pransky, S. M., Geddes, D. T., & Mirjalili, S. A. (2019). What is a tongue tie? Defining the anatomy of the in-situ lingual frenulum. Clinical Anatomy, 32(6), 749–761. O'Shea, J. E., Foster, J. P., O'Donnell, C. P. F., Breathnach, D., Jacobs, S. E., Todd, D. A., & Davis, P. G. (2017). Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews, 2017(3). Salt, H., Claessen, M., Johnston, T., & Smart, S. (2020). Speech production in young children with tongue-tie. International Journal of Pediatric Otorhinolaryngology, 134, 110035. Schlatter, S. M., Schupp, W., Otten, J. E., Harnisch, S., Kunze, M., Stavropoulou, D., & Hentschel, R. (2019). The role of tongue-tie in breastfeeding problems—A prospective observational study. Acta Paediatrica, 108(12), 2214–2221. Webb, A. N., Hao, W., & Hong, P. (2013). The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. International Journal of Pediatric Otorhinolaryngology, 77(5), 635–646.

Happy August! This month, we review superior semicircular canal dehiscence (SSCD)! Join us! Follow us on instagram @adoseofdizzypodcast References: Gioacchini, F. M., Alicandri‐Ciufelli, M., Kaleci, S., Scarpa, A., Cassandro, E., & Re, M. (2016). Outcomes and complications in superior semicircular canal dehiscence surgery: a systematic review. The Laryngoscope, 126(5), 1218-1224. Lagman, C., Ong, V., Chung, L. K., Elhajjmoussa, L., Fong, C., Wang, A. C., ... & Yang, I. (2017). Pediatric superior semicircular canal dehiscence: illustrative case and systematic review. Journal of Neurosurgery: Pediatrics, 20(2), 196-203. Ward, B. K., Van De Berg, R., Van Rompaey, V., Bisdorff, A., Hullar, T. E., Welgampola, M. S., & Carey, J. P. (2021). Superior semicircular canal dehiscence syndrome: Diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the bárány society. Journal of Vestibular Research, (Preprint), 1-10. Ziylan, F., Kinaci, A., Beynon, A. J., & Kunst, H. P. (2017). A comparison of surgical treatments for superior semicircular canal dehiscence: a systematic review. Otology & Neurotology, 38(1), 1-10. Weber, P, (2017). Vertigo and Disequilibrium: A Practical Guide to Diagnosis and Management. Thieme Publishers, New York, Stuttgart. 2017

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep's Clothing Birnbaumer, Diane MD. A Wolf in Sheep's Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens' missed. Then returns with Wellens' with dynamic T-wave inversion. Dr. Smith's ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We'll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can't wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

In healthcare, small changes in regulations and disruptions in supply chain can have a ripple effect on an industry. On this  Power Supply Vendor Spotlight, we talk with Christian Berling, VP of Sales and Marketing at Heine, about going back to the drawing board to manufacture the industry's only reusable LED laryngoscope handle that can be sterilized without any disassembly with a validated low-level disinfection process. Protect your facility with safe reusable products that have financial and environmental benefits, with no fear of supply chain interruptions. Tune in now to learn more.  Visit bit.ly/heinepromo or e-mail service@heine-na.com to access a Yale study comparing the cost and environmental impact between reusable and disposable laryngoscope systems. Visit www.heine.com to learn more about their diagnostic equipment solutions.  #VendorSpotlight #Laryngoscope #ReusableDevice #MedicalDevice #Inventory #SupplyChain #Heine #SterileProcessing #PowerSupply #SPD #CS #MDR #SPS #Surgery 

In healthcare, small changes in regulations and disruptions in supply chain can have a ripple effect on an industry. On this Beyond Clean Vendor Spotlight, we talk with Christian Berling, VP of Sales and Marketing at Heine, about going back to the drawing board to manufacture the industry's only reusable LED laryngoscope handle that can be sterilized without any disassembly with a validated low-level disinfection process. Protect your facility with safe reusable products that have financial and environmental benefits, with no fear of supply chain interruptions. Tune in now to learn more.  Visit bit.ly/heinepromo or e-mail service@heine-na.com to access a Yale study comparing the cost and environmental impact between reusable and disposable laryngoscope systems. Visit www.heine.com to learn more about their diagnostic equipment solutions.  #VendorSpotlight #Laryngoscope #ReusableDevice #MedicalDevice #Inventory #SupplyChain #Heine #SterileProcessing #BeyondClean #WeFightDirty #SPD #CS #MDR #SPS #Surgery 

Does Wearing Earbuds cause hearing loss? ...what about Bacteria in the ear?The source of this idea seems to be a 1992 study from the medical journal  Laryngoscope in which Itzhak Brook and William Jackson measured bacteria levels found on 20 audio headsets of the type provided on commercial airline flights. At the beginning of the experiment, the typical headset had 60 microorganisms on its surface; after an hour’s use of the headphones by a volunteer, that number went up to 650 – roughly 11, not 700, times more. This could suggest that headphones make germs procreate like crazy, an icky enough image, but the authors say it’s more likely that the heat and humidity created in the user’s ears cause “resident organisms from the deeper skin layers and the sweat and sebaceous glands” to congregate out in the open, which to some might seem far ickier.So we’ve got the general idea that headphones use for an hour = lots more bacteria, but where did that 700-times thing come from? Here we turn to the “Practical Traveler” column in the New York Times of January 3, 1993. Addressing the topic of germs lingering on airplane pillows, headrest covers, and headsets, writer Betsy Wade summarizes the Brook and Jackson report as saying their “research showed a 100- to 700-fold increase in bacteria” on the headset. Now, the Straight Dope staffers and I have turned that study upside down and can’t fathom how Wade got her numbers. Whether they arose from a cryptic reading of the data, a misreading, or a proofreader’s slip, it’s of such that Internet factoids are born.The bigger question is: fine, wearing headphones causes the ears to teem with bacteria; other than grossing us out, does this affect our lives? Unclear. Though they warn of potential risk, Brook and Jackson couldn’t tie the germ increase to actual health trouble; a Malaysian study of 118 phone-support workers who used headsets seven hours a day found that 11 had chronic ear, nose, and throat problems, but in only four cases were those were related to ear infections. Other ear research suggests that pretty much anything you stick in there – stethoscopes, hearing aids, audiological gear – comes out covered in microbes, but those microbes don’t necessarily make anyone particularly sick. So unless you’re prone to getting ear infections – or you’re one of those germ freaks we all know and love – the headphones-bacteria effect may be more curiosity than wake-up call.

Dans cet épisode consacré aux troubles respiratoires du sommeil, Morgane nous parle de l'impact de ces troubles sur la croissance oro-faciale, sur les apprentissages, mais aussi sur la qualité de vie globale du patient. Il sera également question des apnées obstructives du sommeil, du côté délétère de la ventilation buccale, et des indications de chirurgie maxillo-faciale. références bibliographiques citées dans cet épisode: Ribeiro, G. C. A., dos Santos, I. D., Santos, A. C. N., Paranhos, L. R., & César, C. P. H. A. R. (2016). Influence of the breathing pattern on the learning process: a systematic review of literature. Brazilian Journal of Otorhinolaryngology, 82(4), 466 478. https://doi.org/10.1016/j.bjorl.2015.08.026 Camacho, M., Certal, V., Abdullatif, J., Zaghi, S., Ruoff, C. M., Capasso, R., & Kushida, C. A. (2015). Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep, 38(5), 669 675. https://doi.org/10.5665/sleep.4652 Camacho, M., Guilleminault, C., Wei, J. M., Song, S. A., Noller, M. W., Reckley, L. K., … Zaghi, S. (2018). Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology, 275(4), 849 855. https://doi.org/10.1007/s00405-017-4848-5 Guilleminault, C., & Huang, Y. S. (2017). From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. Sleep Medicine Reviews, 40, 203 214. https://doi.org/10.1016/j.smrv.2017.06.008 Juliano, M. L., Machado, M. A. C., De Carvalho, L. B. C., Zancanella, E., Santos, G. M. S., Do Prado, L. B. F., & Do Prado, G. F. (2009). Polysomnographie findings are associated with cephalometric measurements in mouth-breathing children. Journal of Clinical Sleep Medicine, 5(6), 554 561. Lee, S. H., Choi, J. H., Shin, C., Lee, H. M., Kwon, S. Y., & Lee, S. H. (2007). How does open-mouth breathing influence upper airway anatomy? Laryngoscope, 117(6), 1102 1106. https://doi.org/10.1097/MLG.0b013e318042aef7 Valarelli, L. P., Corradi, A. M. B., Grechi, T. H., Eckeli, A. L., Aragon, D. C., Küpper, D. S., … Valera, F. C. P. (2018). Cephalometric, muscular and swallowing changes in patients with OSAS. Journal of Oral Rehabilitation, 45(9), 692 701. https://doi.org/10.1111/joor.12666 Guilleminault, C., Huang, Y. S., Monteyrol, P. J., Sato, R., Quo, S., & Lin, C. H. (2013). Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Medicine, 14(6), 518 525. https://doi.org/10.1016/j.sleep.2013.01.013 Guilleminault, C., Huseni, S., & Lo, L. (2016). A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Research, 2(3), 00043 02016. https://doi.org/10.1183/23120541.00043-2016 de Felício, C. M., da Silva Dias, F. V., Folha, G. A., de Almeida, L. A., de Souza, J. F., Anselmo-Lima, W. T., … Valera, F. C. P. (2016). Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy. International Journal of Pediatric Otorhinolaryngology, 90, 5 11. https://doi.org/10.1016/j.ijporl.2016.08.019

In this episode, we explore the evidence on whether smaller endotracheal tubes are... 1. Less likely to maintain a secure patent airway 2. Less reliable in facilitating positive pressure ventilation 3. Less able to seal the trachea and protect the lungs from aspiration We also discuss the potential harms associated with larger endotracheal tubes.  Our guests are Dr. Shamir Karmali and Dr. Peter Rose from the Department of Anesthesiology at Vancouver General Hospital. Thanks for listening! If you enjoy our content, consider supporting our mission at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Coordes A, Rademacher G, Knopke S, Todt I, Ernst A, Estel B, Seidl RO. Selection and placement of oral ventilation tubes based on tracheal morphometry. Laryngoscope. 2011 Jun;121(6):1225-30. doi: 10.1002/lary.21752. Epub 2011 May 6. PMID: 21557233. Dominelli PB, Ripoll JG, Cross TJ, Baker SE, Wiggins CC, Welch BT, Joyner MJ. Sex differences in large conducting airway anatomy. J Appl Physiol (1985). 2018 Sep 1;125(3):960-965. doi: 10.1152/japplphysiol.00440.2018. Epub 2018 Jul 19. PMID: 30024341; PMCID: PMC6335094. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016 Jun;71(6):706-17. doi: 10.1111/anae.13438. Epub 2016 Mar 28. PMID: 27158989. Ellis SF, Pollak AC, Hanson DG, Jiang JJ. Videolaryngoscopic evaluation of laryngeal intubation injury: incidence and predictive factors. Otolaryngol Head Neck Surg. 1996 Jun;114(6):729-31. doi: 10.1016/s0194-5998(96)70093-1. PMID: 8643294. Fiastro JF, Habib MP, Quan SF. Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest. 1988 Mar;93(3):499-505. doi: 10.1378/chest.93.3.499. PMID: 3277803. Futagawa K, Takasugi Y, Kobayashi T, Morishita S, Okuda T. Role of tube size and intranasal compression of the nasotracheal tube in respiratory pressure loss during nasotracheal intubation: a laboratory study. BMC Anesthesiol. 2017 Oct 17;17(1):141. doi: 10.1186/s12871-017-0432-1. PMID: 29041911; PMCID: PMC5645985. Hu B, Bao R, Wang X, Liu S, Tao T, Xie Q, Yu X, Li J, Bo L, Deng X. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One. 2013 Oct 4;8(10):e74467. doi: 10.1371/journal.pone.0074467. PMID: 24124452; PMCID: PMC3790787. Hwang JY, Park SH, Han SH, Park SJ, Park SK, Kim JH. The effect of tracheal tube size on air leak around the cuffs. Korean J Anesthesiol. 2011 Jul;61(1):24-9. doi: 10.4097/kjae.2011.61.1.24. Epub 2011 Jul 21. PMID: 21860747; PMCID: PMC3155132. Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia. 2020 Nov;75(11):1529-1539. doi: 10.1111/anae.15041. Epub 2020 May 16. PMID: 32415788. Koh KF, Hare JD, Calder I. Small tubes revisited. Anaesthesia. 1998 Jan;53(1):46-50. doi: 10.1111/j.1365-2044.1998.00290.x. PMID: 9505742. Pavlin EG, VanNimwegan D, Hornbein TF. Failure of a high-compliance low-pressure cuff to prevent aspiration. Anesthesiology. 1975 Feb;42(2):216-9. doi: 10.1097/00000542-197502000-00019. PMID: 1115375. Randestad A, Lindholm CE, Fabian P. Dimensions of the cricoid cartilage and the trachea. Laryngoscope. 2000 Nov;110(11):1957-61. doi: 10.1097/00005537-200011000-00036. PMID: 11081618. Shah C, Kollef MH. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med. 2004 Jan;32(1):120-5. doi: 10.1097/01.CCM.0000104205.96219.D6. PMID: 14707569. Stenqvist O, Sonander H, Nilsson K. Small endotracheal tubes: ventilator and intratracheal pressures during controlled ventilation. Br J Anaesth. 1979 Apr;51(4):375-81. doi: 10.1093/bja/51.4.375. PMID: 465261. Tanaka A, Isono S, Ishikawa T, Sato J, Nishino T. Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway. Anesthesiology. 2003 Aug;99(2):252-8. doi: 10.1097/00000542-200308000-00005. PMID: 12883396. Tonnesen AS, Vereen L, Arens JF. Endotracheal tube cuff residual volume and lateral wall pressure in a model trachea. Anesthesiology. 1981 Dec;55(6):680-3. doi: 10.1097/00000542-198155060-00013. PMID: 7305056. Walker EMK, Bell M, Cook TM, Grocott MPW, Moonesinghe SR; Central SNAP-1 Organisation; National Study Groups. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth. 2016 Jun 12;117(6):758-766. doi: 10.1093/bja/aew381. Erratum in: Br J Anaesth. 2017 Sep 1;119(3):552. PMID: 27956674. Wilson AM, Gray DM, Thomas JG. Increases in endotracheal tube resistance are unpredictable relative to duration of intubation. Chest. 2009 Oct;136(4):1006-1013. doi: 10.1378/chest.08-1938. Epub 2009 May 1. PMID: 19411293. Young PJ, Rollinson M, Downward G, Henderson S. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth. 1997 May;78(5):557-62. doi: 10.1093/bja/78.5.557. PMID: 9175972. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital.

Local Legend John Burfitt is raising money for the Blue Ribbon Foundation by walking 16kms from Mildura Police Station to the Redcliffs Police Station on October 8th this year to fund a new Laryngoscope machine for the Mildura Base Public Hospital. If you'd like to donate you find further information here https://www.facebook.com/john.burfitt.9  See omnystudio.com/listener for privacy information.

Co-Host: Erin Forward, MSP, CCC-SLP - In this episode Michelle is joined again by her regular First Bite Co-Host, Erin Forward, MSP CCC-SLP, and they share some recent research in the world of Pediatric Feeding and Swallowing Disorders! Today, Michelle and Erin address 5 different research articles covering everything from laryngomalacia and a supraglottaplasty repair to a systematic weaning protocol of thickened for little ones with a past medical history that includes aspiration. The ladies of First Bite are hitting up some of their favorite journals including “JAMA-Otolaryngology Head & Neck Surgery”, “The Journal of Pediatrics”, and “The Laryngoscope” to name a few! Enjoy the research review and how they build a bridge to real world applications of clinical case studies!

In this episode, we discuss airways with Dr. Rachel Ely, who is doing a rotation with CCEMS as an Assistant Medical Director as part of the military's EMS and Disaster Medicine Fellowship based at Brooke Army Medical Center in San Antonio. Dr. Ely has a background in EMS and actively worked as a paramedic for a few years before and during medical school. Passionate about all things "airway", Dr. Ely outlines some of her "must-dos" for a successful advanced airway while providing insight from her years of experience. Before the call: Visualization and mental rehearsal Physical rehearsal: have a plan, and a backup, and a backup, and practice all of them Location of equipment is key Airway preparation During the call: Pre-oxygenate early. Once you decide they need an advanced airway, give all the oxygen. Resuscitate before you intubate, Laryngoscope as a Murder Weapon (Scott Weingart) Hypotension O2/Hypoxemia pH/acidosis. The apneic period can be deadly in certain patients. Recognizing this is trickier in EMS because you don't have all the data (like blood gases). Fear this in the DKA patient, the septic shock patient, any metabolic acidosis Position the patient: it is worth your time to try do this right. The donut works, sometimes towels/pillows are needed, but just having a FF lift the head off of the floor will give you a 100% better view. Head off stretcher works for some, but may actually make things worse as the angle of oropharynx to glottis becomes more steep (glottis more anterior). Neck flexed, head extended gives optimal alignment

Can you hear that too? You can’t? Well, that doesn’t mean I’m having auditory hallucinations. It could just be tinnitus, which describes the irritating sound of ringing, buzzing, clicking, or hissing that affect 10-20% of the world's population. But is this a ringing in the ears, or a ringing in the brain? ** IF YOU’RE TAKING YOUR NEUROLOGY BOARDS THIS SUMMER, CHECK OUT THE PENN NEUROLOGY BOARD REVIEW COURSE AT https://upenn.cloud-cme.com/default.aspx?P=5&EID=65373. AND FOR A DISCOUNTED RATE ON THE ONLINE OR STREAMING RESOURCES, USE PROMO CODE ‘WAVES2020’. ** Produced by James E. Siegler. Music courtesy of Andrew Sacco, Jon Watts, Kai Engel, Lovira, Patches, and Kevin McLeod. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Arenberg IK, Countryman LF, Bernstein LH and Shambaugh GE, Jr. Van Gogh had Meniere's disease and not epilepsy. JAMA : the journal of the American Medical Association. 1990;264:491-3. Sullivan M, Katon W, Russo J, Dobie R and Sakai C. A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Archives of internal medicine. 1993;153:2251-9. Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope. 1999;109:1202-11. Lockwood AH, Salvi RJ, Burkard RF, Galantowicz PJ, Coad ML and Wack DS. Neuroanatomy of tinnitus. Scand Audiol Suppl. 1999;51:47-52. Palomar Garcia V, Abdulghani Martinez F, Bodet Agusti E, Andreu Mencia L and Palomar Asenjo V. Drug-induced otoxicity: current status. Acta Otolaryngol. 2001;121:569-72. Crummer RW and Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician. 2004;69:120-6. Lockwood AH. Tinnitus. Neurol Clin. 2005;23:893-900, viii. Mattox DE and Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol. 2008;128:427-31. Han BI, Lee HW, Kim TY, Lim JS and Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5:11-9. Langguth B, Kreuzer PM, Kleinjung T and De Ridder D. Tinnitus: causes and clinical management. The Lancet Neurology. 2013;12:920-930.

Bullard

Dr. Julie Wei is an internationally recognized award-winning Pediatric Ear, Nose and Throat Surgeon, speaker, creator of online courses for parents, and author of A Healthier Wei and co-author of Acid Reflux in Children. She currently serves as the Division Chief of Pediatric Otolaryngology – Head and Neck Surgery, and Audiology. Dr. Wei is a Professor of Otolaryngology – Head and Neck Surgery at the University of Central Florida’s College of Medicine and serves as the Chair of Otolaryngology Education. A passionate children’s health advocate, Dr. Wei has been highlighted on TEDx “The Hidden Dangers of the Milk and Cookie Disease” and on The Doctors TV Show teaching audiences about how diet and dietary habits lead to acid reflux, which negatively impact children’s health. She has appeared on various national and local news outlets including Fox News Online. A prominent peer-reviewed author, Dr. Wei’s research has been published in scientific journals including Laryngoscope and the International Journal of Pediatric Otorhinolaryngology. She is currently a board member and contributing author for ENT Today. As a result of her more than 15 years of clinical experience and applied research, Dr. Wei believes that many children suffering from runny noses, allergy symptoms and sore throats are being misdiagnosed and overmedicated. She learned what is not taught in medical and surgical training: diet and dietary habits of children and the adults that feed them are responsible for many of these symptoms. In 2018, Dr. Wei launched the Healthy Kids Movement, a national campaign based on her core commitment to create a paradigm shift in how medical professionals and parents prevent, protect, and restore children’s health. She is singularly focused on sharing her observations and treatment successes with all who care for children, including parents, teachers, physicians and healthcare systems.

We investigate the claim that administering ketorolac (Toradol) increases bleeding and should be avoided in surgeries for which there is concern for bleeding.  Claim 1. Administration of intraoperative ketorolac increases the bleeding time due to platelet inhibition Claim 2. Increased bleeding time translates to higher rate of surgical bleeding Claim 3. The magnitude of bleeding propensity attributable to ketorolac is clinically relevant Our guest today is Dr. Jamie Sparling of the Critical Care Division of the Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Bailey R, Sinha C, Burgess LP. Ketorolac tromethamine and hemorrhage in tonsillectomy: A prospective, randomized, double-blind study. Laryngoscope 1997;107:166–169. Cassinelli EH, Dean CL, Garcia RM, Furey CG, Bohlman HH. Ketorolac use for postoperative pain management fol- lowing lumbar decompression surgery: A prospective, ran- domized, double-blinded, placebo-controlled trial. Spine (Phila Pa 1976) 2008;33:1313–1317. Gobble RM, Hoang HL, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plastic and Reconstructive Surgery 2014; 133(3): 741-755 Singer AJ, Mynster CJ, McMahon BJ. The effect of IM ketoro- lac tromethamine on bleeding time: A prospective, interven- tional, controlled study. Am J Emerg Med. 2003;21:441–443. Strom BL, Berlin JA, Kinman JL, et al. Parenteral ketoro- lac and risk of gastrointestinal and operative site bleed- ing: A postmarketing surveillance study. JAMA 1996;275: 376–382.   --

Researchers from Boston University School of Medicine Department of Dermatology recently published an opinion piece appearing in JAMA Facial Plastic Surgery (August 2018) discussing the phenomenon of “Snapchat Dysmorphia.”  The nonpareil is a 2018 take on the DSM-5 codified mental disorder of Body Dysmorphic Disease (BDD).  Esthetic practitioners should be screening potential injectable patients for BDD and make appropriate referrals when indicated.  In this episode we’ll discuss what BDD is, it’s prevalence, how to recognize it and how to handle a patient suspected of having the disease. Here are some links to articles and the BDD screening form mentioned in the podcast:  Rajanala S, Maymone MBC, Vashi NA. Selfies—Living in the Era of Filtered Photographs. JAMA Facial Plast Surg. Published online August 02, 2018. doi:10.1001/jamafacial.2018.0486 Laryngoscope. 2016 Aug;126(8):1739-45. doi: 10.1002/lary.25963. Epub 2016 May 25. Body Dysmorphic Disorder in aesthetic rhinoplasty: Validating a new screening tool. Lekakis G1, Picavet VA1, Gabriëls L2, Grietens J1, Hellings PW1. https://www.psycom.net/eating-disorders/body-dysmorphic-disorder https://www.aafp.org/afp/2007/1101/p1333.html https://www.cnn.com/2018/08/10/health/snapchat-dysmorphia-cosmetic-surgery-social-media-trend-trnd/index.html BDDQ-AS  BDD screening questionaire - feel free to use in your practice  

Dr Jean-Baptiste Lascarrou discusses the MACMAN trial, comparing video laryngoscopy with direct laryngoscopy in the ICU, at the Critical Care Reviews Meeting 2018, at Titanic, Belfast.

In the past two decades, airway management has been revolutionized by the development of video laryngoscopy, hyperangulated blade geometry, optical stylets, laryngeal masks, and a host of advances in airway pharmacology and technique. The core skill of airway management, however, remains laryngoscopy, whether or not the operator uses a blade with a camera at the end. In this presentation, we break down laryngoscopy into its discrete components and describe best practice technique at each step. We will start by describing common mistakes made in patient positioning; proposing a set of parameters the provider can use to guide positioning that is optimal for laryngoscopy, including the configuration of the patient in the bed, the bed height and head elevation, as well as provider stance. We then move into the effect of laryngoscope grip on operator catecholamine management and describe the optimal laryngoscope grip for emergency airway management. We next confront one of the core principles of RSI, the delay between medication administration and commencement of laryngoscopy, and propose an alternative approach that emphasizes early laryngoscopy with deliberate slowness. We turn our attention to the value of the jaw thrust–as performed by an assistant–during airway management, and then move into a step by step analysis of laryngoscopy as the blade moves into the mouth, down the tongue and ultimately to the glottis. We espouse suction as an underutilized device by emergency providers, and describe the two most important intra-laryngoscopy optimization maneuvers: optimization of the position of the head, and optimization of the position of the larynx. We discuss the value of using the gum elastic bougie for both difficult and routine intubations and describe pitfalls encountered when using the bougie (and how to manage them). We conclude by describing the 3-finger tracheal palpation method of endotracheal tube depth confirmation.

Go to audibletrial.com/TUMS for a free 30-day trial membership and free audiobook! Help Ian interview all 120+ specialties by referring him physicians! Shownotes! Dr. Nicole Maronian Dr. Maronian is the Program Director of Otolaryngology Head and Neck Surgery, as well as the Director of the Voice and Swallowing Center at University Hospitals Cleveland Medical Center. Dr. Maronian completed her undergraduate degree at Allegheny College in 1987; her medical degree at the University of Rochester in 1991, where she also completed an otolaryngology residency in 1998; and then completed a fellowship in Laryngology and Voice Disorders at the University of Washington in 1999, eventually joining the faculty at University Hospitals in 2006. Dr. Maronian’s research interests include neurolaryngology, tracheal disease, and dysphagia. She has published nearly 40 papers in peer-reviewed journals about laryngology and voice disorders and is a reviewer for the journal Laryngoscope. Also a frequent presenter and speaker on laryngeal disease at local, regional and national meetings, Dr. Maronian has been voted Top Doctors in Cleveland by Cleveland Magazine, as well as voted Best Doctors in America by Best Doctors, Inc. Please enjoy with Dr. Nicole Maronian!

  Each video larnygoscope model has its subtle quirks and troubleshooting techniques. The following techniques are useful when intubating with the Glidescope AVL: Consider a deliberately restricted laryngeal view to aid in tube placement. Do this by withdrawing the glidescope slightly. Verathon recommends that the glottic apperature should occupy the "upper 1/3 of the screen". Use the 1-4 step approach as per the Verathon official recommendations: see Verathon Glidescope Technique Video  Look at the mouth to introduce glidescope midline. Look at the screen to "obtain the best glottic view". Look at the mouth to introduce the ET tube. Look at the screen to pass the tube through the chords. Look at the patients mouth when initially inserting the ET tube into the mouth- not at the screen. Practice using VL! Try shifting the entire laryngoscope to the left to allow more room for insertion of the ET tube into the mouth.  When trying to pass the ET tube through the chords, hold the ET tube by the end furthest from the patients mouth. This will give you a longer lever arm. There is also a small grip on the Glidescope rigid stylet for this purpose; this grip can also be used to 'pop the stylet' when needed. Simply flick your thumb up.  Consider withdrawing the stylet 3-5 cm if having difficulty passing the tube through the chords. This will straighten the tip of the tube allowing it to follow the natural curve of the trachea.    For tip #3 I mention that you should be looking at the mouth while introducing the ET tube. During this, it is easier to slide the ET tube underneath the right sided flange that the glidescope has. This concept is illustrated in the Mgrath X blade below where this region is labeled as the "ET Contact Zone".       Thanks to all of our listeners around the world! New Zealand, Pakistan, India, Nepal, UK, Canada and Australia!     References:  Bacon, E. R., Phelan, M. P., & Doyle, D. J. (2015). Tips and Troubleshooting for use of the GlideScope video Laryngoscope for emergency Endotracheal Intubation. The American Journal of Emergency Medicine, 33(9), 1273–1277. doi:10.1016/j.ajem.2015.05.003 GlideScope® Video Laryngoscopes Channel, ©2012 Verathon Inc. 0900-4018-00-86, Retrieved October 28, 2016, from https://www.youtube.com/watch?v=7jb2tbqQ6VQ Carlson, J. N., & Brown, C. A. (2014). Does the use of video Laryngoscopy improve Intubation outcomes? Annals of Emergency Medicine, 64(2), 165–166. doi:10.1016/j.annemergmed.2014.01.032 Duggan, L. V., & Brindley, P. G. (2016). Deliberately restricted laryngeal view with GlideScope® video laryngoscope: Ramifications for airway research and teaching. Can J Anesth/J Can Anesth Canadian Journal of Anesthesia/Journal Canadien D'anesthésie, 63(9), 1102-1102. doi:10.1007/s12630-016-0681-3  

Laryngoscope as a Murder Weapon - Oxygenation Kills Part II

Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I

Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia Show Notes Diabetic Ketoacidosis LITFL: EBM Diabetic Ketoacidosis emDocs: Myths in DKA Management REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis? Hyperkalemia LITFL: Hyperkalaemia Core EM: Hyperkalemia Core EM: Podcast 7.0 Intubation in Severe Metabolic Acidosis EMCrit: Podcast 3 – Laryngoscope as a Murder Weapon Series – Ventilatory Kills – Intubating the Patient with Severe Metabolic Acidosis

Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia Show Notes Diabetic Ketoacidosis LITFL: EBM Diabetic Ketoacidosis emDocs: Myths in DKA Management REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis? Hyperkalemia LITFL: Hyperkalaemia Core EM: Hyperkalemia Core EM: Podcast 7.0 Intubation in Severe Metabolic Acidosis EMCrit: Podcast 3 – Laryngoscope as a Murder Weapon Series – Ventilatory Kills – Intubating the Patient with Severe Metaboli...

Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia Show Notes Diabetic Ketoacidosis LITFL: EBM Diabetic Ketoacidosis emDocs: Myths in DKA Management REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis? Hyperkalemia LITFL: Hyperkalaemia Core EM: Hyperkalemia Core EM: Podcast 7.0 Intubation in Severe Metabolic Acidosis EMCrit: Podcast 3 – Laryngoscope as a Murder Weapon Series – Ventilatory Kills – Intubating the Patient with Severe Metabolic Acidosis Core EM:

This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault.

A lecture from SMACC2013 on how not to kill the shocked patient when intubating