Podcasts about Lidocaine

There are defining moments that split your life into before and after. Moments when everything you thought you knew gets stripped away, leaving only what truly matters. For Dr. David Fajgenbaum, that moment came not once, but five times, each bringing him closer to death and, paradoxically, teaching him how to live.This week's episode explores what happens when the system fails you and you refuse to accept failure. When David was diagnosed with Castleman disease at 25, a rare condition where your immune system turns against your own body, traditional medicine reached its limits. But David didn't. Instead of surrendering, he became both patient and researcher, ultimately discovering the treatment that would save not just his life, but potentially thousands of others.In our conversation, David reveals the mindset shifts that kept him fighting when hope felt impossible, how AI is revolutionizing our approach to drug discovery, and why the cure for your condition might already exist in a pharmacy right now. His story challenges everything we think we know about medicine, healing, and what's possible when you refuse to take no for an answer.What struck me most about our conversation wasn't just David's survival story, but how he turned personal crisis into a mission that's reshaping medicine. His ability to stay curious even when doctors said there was nothing left to try, and his belief that the answers we need might already exist, just waiting to be discovered. David showed me that breakthrough thinking isn't always about creating something new, but seeing what's already there differently.About Dr. David Fajgenbaum:Dr. David Fajgenbaum is a physician-scientist, bestselling author of Chasing My Cure, and co-founder of Every Cure, a nonprofit on a mission to unlock the full potential of every approved drug to treat every disease it possibly can. Recently named to TIME's 100 Health list for 2025, he's revolutionising medical research by repurposing existing drugs to treat rare diseases. His TED Talk has inspired millions, and his nonprofit work continues to unlock life-saving treatments hidden in plain sight.Connect with Dr. David Fajgenbaum:Website: https://everycure.orgInstagram: @dfajgenbaumFacebook: David FajgenbaumTwitter: @DavidFajgenbaumBook: Chasing My Cure – Available on AmazonLove,Sarah Ann

Researchers Find the Mechanism Behind Potential AnticancerProperties in LidocaineBy Today's RDH ResearchOriginal article published on Today's RDH: https://www.todaysrdh.com/researchers-find-the-mechanism-behind-potential-anticancer-properties-in-lidocaine/Need CE? Start earning CE credits today at ⁠⁠⁠⁠⁠https://rdh.tv/ce⁠⁠⁠⁠⁠Get daily dental hygiene articles at ⁠⁠⁠⁠⁠https://www.todaysrdh.com⁠⁠⁠⁠⁠ Follow Today's RDH on Facebook: ⁠⁠⁠⁠⁠https://www.facebook.com/TodaysRDH/⁠⁠⁠⁠⁠Follow Kara RDH on Facebook: ⁠⁠⁠⁠⁠https://www.facebook.com/DentalHygieneKaraRDH/⁠⁠⁠⁠⁠Follow Kara RDH on Instagram: ⁠⁠⁠⁠⁠https://www.instagram.com/kara_rdh/

Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient's vital organs and decreasing cerebral damage.Post-arrest goals for O2 saturation, ETCO2, and BP/MAP.Indications for use of an antiarrhythmic after ROSC.Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn Discover medical podcasts with CE at https://conveymed.io

- What OMFS Programs Look For In A Resident- Trust But Verify: The #1 Rule That Could Save Your Dental Career- The Truth About Sedation Safety: Why Dental Assistants Should Be DANCE CertifiedYouTube Link:https://youtu.be/haD0ReGjZRw Podcast Link:https://spotifycreators-web.app.link/e/8PolF4NrxSb Quotes & Wisdom:“Taking a year off was the hardest decision I've ever made—but I don't regret it for a minute.” – Benji“Sometimes you've got to evaluate and say, ‘I need to give 120% to this priority right now.'” – Brendan“Confidence and self-awareness. That's what directors are really looking for.” – Brendan“Pick up the hose and hold it. That taught me to always be doing something, and that stuck with me through everything.” – Benji (on working with his dad)“Nothing is beneath any of us—turning over chairs, cleaning, setting trays—do it all. Especially when no one's watching.” – Brendan“Trust but verify—every single thing.” – Brendan“You don't know where sabotage can come from. It's not always personal, but you need to be ready.” – Brendan“People love to be taught. When you provide structure and knowledge, the whole profession gets safer.” – Benji“Life is life. If you have the time to speak with others, share ideas, and learn from great people—you grow more than you realize.” – BenjiQuestions:06:33 – "How's the CBSE studying going?"08:25 – "Are you going to be working during that time?"08:54 – "What did they say about that?"09:25 – "Did any of them say don't work and solely study for the CBSE?"10:37 – "What about your roommate? What does your roommate do?"11:46 – "Did you see the stats of LECOM? How many students matched into OMFS?"15:50 – "Any interest in head and neck, or fellowship?"18:33 – "How important do you think it is to have a competent anesthesia team?"29:43 – "What would you say program directors are looking for in residents to interview?"Now available on:- Dr. Gallagher's Podcast & YouTube Channel- Dose of Dental Podcast #139- 4.2025#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest.If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm.If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm. An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine.Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach.Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach.Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient's vital organs and decreasing cerebral damage.Post-arrest goals for O2 saturation, ETCO2, and BP/MAP. Indications for use of an antiarrhythmic after ROSC. Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC. Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/*FREE to anyone in the U.S. Save $$ on prescription medications for you and your pets with National Drug Card - https://nationaldrugcard.com/ndc3506 *Indicates affiliate links. I may get paid a small commission if you purchase products or memberships using my link. It doesn't affect the price you pay.Discover medical podcasts with CE at https://conveymed.io

Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest. If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm. If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm. An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code.Objective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cprConnect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/*FREE to anyone in the U.S. Save $$ on prescription medications for you and your pets with National Drug Card - https://nationaldrugcard.com/ndc3506 *Indicates affiliate links. I may get paid a small commission if you purchase products or memberships using my link. It doesn't affect the price you pay.

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for changeReferences: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer:This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/*FREE to anyone in the U.S. Save $$ on prescription medications for you and your pets with National Drug Card - https://nationaldrugcard.com/ndc3506 *Indicates affiliate links. I may get paid a small commission if you purchase products or memberships using my link. It doesn't affect the price you pay.

In this throwback episode Dr. Russell Schafer joins Kevin and Zach to talk about his second love in dentistry...pediatrics!  Key Topics & Discussion Points: Early Childhood Exams (Under 5): Importance of parent/caregiver relationship and communication. Lap-to-lap/Knee-to-knee exam technique. Focus on diet (sugar intake) and sleep (snoring). Identifying early signs of demineralization. Goal: Creating a safe dental home. Older Children (5-6 and up): Expectation of tolerating bitewing and PA radiographs. Addressing parent's anxieties and managing expectations. Importance of behavior management with both child and parent. Interproximal Decay: Varying treatment philosophies (aggressive vs. conservative). Stainless steel crowns vs. composite restorations. When to refer to a pediatric dentist. Pulpotomies: Different techniques and materials (Formocresol, Ferric Sulfate, MTA). Discussion on necrotic pulp and treatment options (extraction). Pulpotomies for diagnosis vs. therapy. Nitrous Oxide: Benefits of nitrous oxide for pediatric patients. Dosage and administration techniques. Anesthesia: Choice of anesthetic (Lidocaine vs. Septocaine). Techniques for minimizing discomfort during injections (e.g., shaking, "cold water" analogy). Importance of adequate anesthesia for procedures. Sealants: Concerns about over-prescription and improper technique. Discussion on the effectiveness of sealants. Alternative approach: Occlusal composites. Silver Diamine Fluoride (SDF): Use of SDF for caries management. SDF as a "time-buying" strategy. When to use SDF vs. restorative treatment. Very Clinical is brought to you by Zirc Dental Products, Inc., your trusted partner in dental efficiency and organization. The Very Clinical Corner segment features Kate Reinert, LDA, an experienced dental professional passionate about helping practices achieve clinical excellence.  Connect with Kate Reinert on LinkedIn: Kate Reinert, LDA  Book a call with Kate: Reserve a Call  Ready to upscale your team? Explore Zirc's solutions today: zirc.com  

Here's another great podcast from early '24. This was a great conversation and finished the year at #9. In this podcast episode, Winston and I delve into the intricate world of pain and its pathways. They explore the nervous system's role in pain transmission, the different types of pain including nociceptive, neuropathic, and nociplastic pain, and the significance of sensitization in chronic pain conditions. The discussion also highlights practical approaches to pain management, including the use of multimodal therapies and the impact of neuroplasticity on pain perception, particularly in cases like phantom limb pain. In this conversation, Dennis discusses the complexities of pain management, emphasizing the importance of understanding the patient's history and the trajectory of their pain. He highlights the shift from opioid reliance to a multimodal approach that includes various analgesics such as acetaminophen, NSAIDs, lidocaine, capsaicin, cannabinoids, and ketamine. Dennis also covers the role of anticonvulsants and antidepressants in managing chronic pain, providing practical recommendations for healthcare practitioners. Takeaways Understanding pain pathways can enhance treatment effectiveness. Pain transmission involves complex processes in the nervous system. There are three main types of pain: nociceptive, neuropathic, and nociplastic. Peripheral and central sensitization play crucial roles in chronic pain. Ketamine is effective in reducing central sensitization. The placebo effect can significantly influence pain management. Recognizing nociplastic pain is essential for proper treatment. Mirror therapy can help alleviate phantom limb pain. Neuroplasticity affects how pain is perceived and treated. A multimodal approach is necessary for effective pain management. History taking is crucial in understanding pain types. The goal of pain management is to improve function and quality of life. Acetaminophen can be as effective as opioids in certain cases. Lidocaine should be used with caution due to potential side effects. Capsaicin is a natural option for neuropathic pain relief. Opioids have significant side effects and should be used carefully. Cannabinoids are gaining popularity but require more research. Ketamine offers a new avenue for pain management. Anticonvulsants can help with neuropathic pain but take time to work. Amitriptyline is a cost-effective option for chronic pain management. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode of The Vet Dental Show, Dr. Brett Beckman, a board-certified veterinary dentist, shares valuable insights into pain management, anesthesia protocols, and best practices in veterinary dentistry. The episode discusses the cautious use of lidocaine in cats, the role of bupivacaine for effective local blocks, and the potential applications of Renia for managing chronic pain in refractory stomatitis cases. Packed with actionable advice, this episode is a must-listen for veterinarians and technicians looking to elevate patient care in their practice.     Podcast Details Host: Dr. Brett Beckman, DVM, FAVD, DAVDC, DAAPM     Key Highlights Topic 1: Lidocaine Use in Cats Question: Should lidocaine be used with caution in cats? Answer: Yes, lidocaine can potentially cause seizures in cats, especially when used as a continuous rate infusion (CRI). Recommendation: Replace lidocaine with bupivacaine for local nerve blocks to ensure longer-lasting analgesia (6-10 hours). Use lidocaine sparingly and with proper discretion. Topic 2: Lidocaine for Intubation Discussion: Historically, lidocaine was applied to the larynx for intubation in cats. Dr. Beckman and his team now prefer using a blunt cannula for safer intubation without the risks associated with lidocaine.     Topic 3: Pain Management for Chronic Cases Case Example: Use of Renia (NK1 antagonist) in refractory stomatitis Mechanism: Blocks Substance P at the postsynaptic membrane to prevent ascending pain signals. Clinical Context: Effective for managing chronic pain when combined with ketamine (NMDA receptor antagonist). Outcome: While Dr. Beckman's team hasn't used it extensively, anecdotal feedback from the veterinary community is positive.     Topic 4: Local Blocks with Bupivacaine Best Practice: Use 0.5% bupivacaine for local nerve blocks in cats and small animals. Dosage: 0.2 mL per foramen ensures safety and efficacy. Rationale: Provides prolonged analgesia compared to lidocaine, minimizing the risk of complications.     Actionable Takeaways Transition to bupivacaine for local nerve blocks to enhance patient comfort and safety. Consider using Renia for managing chronic pain in severe stomatitis cases. Adopt safer intubation techniques, such as using blunt cannulas, to mitigate risks in feline patients. Leverage evidence-based pain management protocols to improve patient outcomes.     Sponsor Mention: This episode is brought to you by the Veterinary Dental Practitioners Program. Learn more and request an invitation at ivdi.org/inv. Closing Note: "I hope you enjoyed this episode filled with actionable items to elevate your dentistry practice. Implement these tips today and see the long-term benefits for your patients and practice!"     If you're ready to take your dentistry skills to the next level, visit ivdi.org/inv to join the Veterinary Dental Practitioners Program!  

Editor's Summary by Preeti Malani, MD, MSJ, and Chris Muth, MD, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from November 23-December 6, 2024.

We've reviewed several papers in the past that suggest there might be an advantage to using IV access compared to IO access for medications in cardiac arrest. Is that really a thing? Wouldn't it be great if we had some randomized controlled trials to help answer the questions?  Funny you should mention RCTs. Dr Jarvis reviews three (THREE!) new RCTs that compare IV to IO access in out of hospital cardiac arrest to try to shed some of that bright light of science on this question!Citations:1. Vallentin MF, Granfeldt A, Klitgaard TL, Mikkelsen S, Folke F, Christensen HC, Povlsen AL, Petersen AH, Winther S, Frilund LW, et al.: Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest. N Engl J Med.2. Smida T, Crowe R, Jarvis J, Ratcliff T, Goebel M: A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. 2024;28(6):1–23.3. Nielsen N: The Way to a Patient's Heart — Vascular Access in Cardiac Arrest. N Engl J Med. doi: 10.1056/NEJMe2412901 (Epub ahead of print).4. Ko Y-C, Lin H-Y, Huang EP-C, Lee A-F, Hsieh M-J, Yang C-W, Lee B-C, Wang Y-C, Yang W-S, Chien Y-C, et al.: Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ. doi: 10.1136/bmj-2024-079878 (Epub ahead of print).5. Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, et al.: Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2016;May 5;374(18):1711–22.6.Daya MR, Leroux BG, Dorian P, Rea TD, Newgard CD, Morrison LJ, Lupton JR, Menegazzi JJ, Ornato JP, Sopko G, et al.: Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation. 2020;January 21;141(3):188–98.7. Nolan JP, Deakin CD, Ji C, Gates S, Rosser A, Lall R, Perkins GD: Intraosseous versus intravenous administration of adrenaline in patients with out-of-hospital cardiac arrest: a secondary analysis of the PARAMEDIC2 placebo-controlled trial. Intensive Care Medicine. doi: 10.1007/s00134-019-05920-7 (Epub ahead of print).

Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient's vital organs and decreasing cerebral damage.Post-arrest goals for O2 saturation, ETCO2, and BP/MAP. Indications for use of an antiarrhythmic after ROSC. Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC. The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC. Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Discover medical podcasts with CE at https://conveymed.io

Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest. If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm. If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm. An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Other Pass ACLS episodes mentioned:Objective Measures of Good CPR at https://passacls.com/bls/objective-measures-of-good-cpr

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

In the patient populations treated by neurologists, central neuropathic pain develops most frequently following spinal cord injury, multiple sclerosis, or stroke. To optimize pain relief, neurologists should have a multimodal and individualized approach to manage central neuropathic pain. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Charles E. Argoff, MD, author of the article “Central Neuropathic Pain,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Argoff is a professor of neurology and vice chair of the department of neurology, director of the Comprehensive Pain Management Center, and director of the Pain Management Fellowship at Albany Medical College in Albany, New York. Additional Resources Read the article: Central Neuropathic Pain 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 Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Charles Argoff, who recently authored an article on central neuropathic pain in the latest issue of Continuum covering pain management. Dr Argoff is a neurologist at Albany Medical College where he's a professor of Neurology, and he serves as vice chair of the Department of Neurology and program director of the Pain Medicine Fellowship Program there. Dr Argoff, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Argoff: I'm Charles Argoff. It's a pleasure to be here and thank you so much for that kind introduction. Dr Jones: I've read your article. Many of our listeners are going to read your article. Wonderful article, extremely helpful. Closes a lot of gaps, I think, that exist in our field about understanding central neuropathic pain, treating central neuropathic pain. You now, Doctor Argoff, you have the attention of a huge audience of mostly neurologists. What's the biggest point you would like to make to them, or the most important practice-changing advice that you would give to them? Dr Argoff: I think it's at least twofold. One is that central neuropathic pain is not as uncommon as you think it might be, and it occurs in a variety of settings that are near and dear to a neurologist's heart, so to speak. And secondly, although we live in an evidence-based world and we want to practice evidence-based medicine - and I'm proud to have formerly been a member of the Quality Standard subcommittee, which I think has changed its name over time. And so, I understand the importance of, you know, treatment based upon evidence - the true definition of evidence-based medicine is using the best available evidence in making decisions about individual patients. And so, I would urge those who are listening that, although there might not be as robust evidence currently as you'd like, please don't not take the time to try to treat the patient in front of you o r at least acknowledge the need for treatment and work with your colleagues to address the significant neuropathic pain associated with that central neurological disorder. Because it can be life-changing in a positive way to make even a dent and to really work with somebody, even though not clear-cut always what's going to work for an individual patient. Dr Jones: Well said. I'm glad you brought that up. So, to put it a different way, absence of evidence is not an excuse for absence of treatment. Right? Dr Argoff: Exactly. And I think that, I hope that we would agree that especially in neurology, what we do is about as far from, ‘Yep, you've got strep throat, here's that antibiotic that's going to work for you and all you have to do is take the medicine.' I mean, most of what we do is nowhere near that.  Dr Jones: It's complicated stuff. And this is a complicated topic. And I'll tell you, I learned a lot reading your article. I think most of us in neurology and medicine, when we hear the term neuropathic pain, it feels roughly synonymous with peripheral generators of that pain, such as diabetic neuropathy or posttraumatic neuralgia. But as you mentioned, there's central mechanisms for pain generation. How is it defined? What is central neuropathic pain? Dr Argoff: It's defined as pain caused by a lesion or disease of the central somatosensory system . Though neuropathic pain in general is pain associated with the lesion of the somatosensory system; and to your point, that can be peripheral, which of course is outside the spinal cord, or brain or central, which is within the spinal cord or brain. And central neuropathic pain is defined specifically as pain caused by a lesion or disease of the central somatosensory system. That's either brain or spinal cord. But there's an interesting follow-up, and I'm going to ask if you could remind me because I know we're talking about definitions now, but I'll just bring something up and we can come back to it. What's interesting about that is that my - whoever 's listening, that's not to say that they're not connected. And in fact, they are very much connected. And there's very new work, which I included in the article, down at Washington University in Saint Louis, that suggests you can actually affect central neuropathic pain by addressing peripheral input to the central nervous system. If you remember Ken Casey at the University of Michigan at the World Pain Congress in Vancouver, British Columbia many years ago, he ended his talk on pain with a limerick, of which the last line was, Remember, there ain't no such thing as pain without a brain. And so that kind of summarizes that. Dr Jones: Well, and it goes both ways too, right? We know that there's some central sensitization that can happen with peripheral generators, right? So we really have to think about the whole circuit. Dr Argoff: Yes. And that's been sometimes the bane of my existence as a colleague of others and a sometimes debater. Is the pain central? Is it peripheral? Well, it's everything. And it's important to know as many of the mechanisms and many of the targets that you could use for treatment so that you can affect the best outcome for your patients. Dr Jones: Yeah, so - and you mentioned in your article what some of the common causes of central neuropathic pain are. What are the big ones in your experience?  Dr Argoff: So, the biggest ones are spinal cord injury-related pain, MS-related pain - and I'd like to come back to a point and just if I do the third one - and central poststroke pain. And what struck me, I think Tim Vollmer published a survey about the incidence, the prevalence of ongoing pain in patients with multiple sclerosis. And it blew my mind several years ago because it was incredibly high. Like in this survey of MS patients who, you never hear about pain, you hear about these modifying treatments, all the wonderful expanses that have been made. I mean, like seventy something percent of people say they have moderate to severe pain. And when you think about how sensory processing occurs, it makes perfect sense that a demyelinating disorder is going to interrupt the flow of information for a person to feel normal.  Dr Jones: Yeah, I think it's a good example of, there are things that we tend to focus on as clinicians where we worry about deficit and function and capacity. But if we're patient-centered and we ask patients what they care about, pain usually moves up higher on the list. And so, I think that's why we, it's maybe underrecognized with some of those central disorders, right? Dr Argoff: I think so, and I and I think you hit the nail on the head that - and we're also trained that way. I tell this to my patients very often so that they are reassured when I examine them and I say, and I tell them that everything looked pretty OK. It's not a medical term, I understand that. Because what we do in a typical neurological exam, even if it's detailed, doesn't really address all the intricacies of the nervous system. So it's really a big picture and sensory processing and especially picking up sensory deficits; you know, we use quantitative sensory testing and research studies and things like that, but bedside testing may not reveal the subtle changes. And when we don't see overt changes, we often think - that can lead someone to think that everything is OK and it's not. Dr Jones: So, when you when you see a patient who you've diagnosed with a central mechanism, so central neuropathic pain, how do you approach the management of those patients, Dr Argoff? Dr Argoff: I always review what treatments and what approaches have been addressed already. And I see if - a handful of time, we actually just submitted a paper for publication regarding this in a group of patients with pelvic pain who had untreated, difficult-to-treat chronic pelvic pain, seen all the urological kinds, gynecological things. Look, we picked up two patients who had unknown MS. So, it's just interesting when it comes down to that level. And we also picked up some patients who had subacute combined degeneration. So that's another central kind of disorder as well. Again, the neurologist in us says to make sure that we have specific diagnosis that underlies the central neuropathic pain. And so interestingly, of course, for somebody with MS - or even though it's uncommon, it could be more than one. Somebody with MS might have a stroke, somebody with MS might have a cord injury due to cervical, you know, joint disc disease. Not to overcomplicate things. Know the lay of the land, know the conditions, know what you're battling and lay out so that you can treat the treatable; you want to treat whatever you can correct? So, for MS you simply want to have the best disease-modifying treatment on board, tolerable and appropriate for that person, and so on. And then you really want to take a history of past treatments - and your treatments can be everything and anything, including behavioral modification, physical rehabilitative approaches, as well as pharmacologic management. That's - as I think I put in my article, we concentrated in the article on pharmacologic management because honestly, that's what most patients are looking for, is ‘what can we, what can you do to help me now, in addition to what I can do myself.' And that's what we typically think of. There are also some more interventional approaches, invasive options, that have developed over time. And of course, those are the ones, some of them, especially in neuromodulation, that we have the least information about, but it appears somewhat promising.  Dr Jones: No, that's exactly what we need to hear. And you also mentioned something that I think is important. This is a common theme throughout the issue because I think it's true for the management of many different types of pain and interdisciplinary approach. In other words, not just honing in on pharmacotherapy or neuromodulation as a one-size-fits-all magic pill, right? So, that - tell us a little bit more about that interdisciplinary approach and how that's important for these patients. Dr Argoff: So, let me back up and give an example. Let's look at Botox for chronic migraine. So, the pre-M studies that led to the approval of Botox for chronic migraine: two treatment sessions versus two random, two placebo session in different patients. The mean headache frequency was, let's say, fifteen to twenty in each group. It was like seventeen, eighteen, something like that. But the mean pain headache day reduction was somewhere between four and five after two treatments compared to a lesser, a lower number in the placebo group. So, if you think about that, that means that you went from nineteen, let's say, to fourteen, thirteen, or twelve. Want to be generous, eleven or ten. But that means that person, everyone 's happy. We use treatment. We have better data than that because the longer you use it, the better it gets in general, but it means that people are still going to be symptomatic. So that drives home in a different painful disorder the importance of yes, treatment can be effective, but it's not the only treatment that a person is going to likely need. And so, I think that's what's so important about multidisciplinary approach. I- we may affect positive changes, reduction in pain intensity with a particular pharmacologic agent, but we don't anticipate it's like taking an antibiotic or a strep throat, not curative. And so, we want to, early on, to explain that logically, methodically, step by step. There are many options for you and we're going to, you know, systematically go through them. And I may need to call in some colleagues to help because I don't do everything. No one does everything, right? But don't feel as if there isn't any hope because there is. If we were to use intraspinal Baclofen for someone who has painful spasticity following a stroke or a spinal cord injury, combining that with physical therapy might give more effect, maybe synergistic. Some targeted muscles, some local muscles may not respond as well to the intraspinal Baclofen, so is that - what can we do? Well, we could use oral agents or we might be able to target that with botulinum toxin, and so on and so forth. So it's limitless, virtually, in what you can do. Dr Jones: There's kind of setting expectations and letting people know that you, you're going to need a lot of different approaches, right? To sort of get them the best possible outcome. Dr Argoff: Yeah, I think that's so important. And of course, no matter what we try to set out, there are going to be individuals - for those of you who are listening, we all know - who expect to be cured yesterday. That might be challenging for us not only to actually complete, but also, it's challenging for some individuals to appreciate that we're with them, we're going to work with them. It'll be a process, but we've got your back. Dr Jones: Great. And you know, this is a question that I get all the time from patients and from other clinicians is, you know, what about cannabinoids? What's the role of cannabinoids for the management of central neuropathic pain? Dr Argoff: First, I'll say that the short answer to that is we don't know. The second part of my response would be, there is new evidence that it might be helpful in the acute treatment of migraine. And I'm happy to say that the editor of this edition of Continuum is the person who developed that evidence, and it's been recently presented at the American Headache Society. But the challenge and the conundrum that we all face is, everywhere within our nervous system where there's pain being processed, there are endocannabinoid receptors. There also happen to be opioid receptors, but that's a separate issue. And the endocannabinoid system, the peripheral or central, you know, CB1, CB2, is very, very important, but we haven't figured out a way of harnessing that knowledge in developing an analgesic, an effective analgesic. And part of that is that there are so many chemical agents that have cannabinoid properties and there are different… the right balance has not yet been found. But even the legalization, the available of medical cannabis, hasn't led to a standardized approach to evaluating if a preparation does help. And that's part of the conundrum. It's like saying, ‘does medicine work?'Well, yeah, sometimes. But which medicine? Which receptor? How do you harness the right ratio between TBD, THC, other active agents, et cetera? And I think maybe as we go forward in the future, we'll be able to do that with - more precise. I mentioned Dr Schuster's study in which he had defined ratios of THC effect and CBD and was able to clearly show effect based upon that. But the average person going into a dispensary doesn't really get that. We don't get to study that. Each person's an NF1  and it's not very helpful to understand how to do that. I would say, as I'm sure you remember, there was a practice parameter that was published probably over a decade ago about using cannabis symptomatically in different neurological disorders. And I believe that it was what they studied or what they reviewed was helpful in MS-related urinary discomfort and spasticity, but not necessarily pain.  Dr Jones: And we're still in the early days of studying it, right? Dr Argoff: Yes.  Dr Jones: That's part of the point, as we got started late and we're still waiting for high-quality evidence. And I guess, if you look at the horizon, Dr Argoff, or the future of management of central neuropathic pain, what's going to be the next big thing?  Dr Argoff: One of the joys of being asked to get involved in a project like this is that inevitably we learn so many new things because, you know, that's when anyone says, oh, you must be an expert, I say, I don't know anything because I'm always learning something new. One of the reasons why I moved to Albany Medical College about seventeen years ago was to be able to further my interest in studying why people benefit from topical analgesics by working with a scientist at Albany Med who studied keratinocyte neurochemistry and its impact on pain transmission. And that's a separate issue, but it indicates my love for the peripheral nervous system. And one of my thoughts historically, that is, what the central nervous system processes is what it processes and it might get input, as you mentioned earlier, from the peripheral nervous system, so that topical agents could be dampening central mechanisms. And lo and behold, as I was doing research for this article, I learned that people doing peripheral nerve blocks - so blocking peripheral input at the into the spinal cord - at Washington University, Simon Guterian and colleagues, demonstrate that they could give prolonged benefit from central pain by blocking peripheral input. And that's wild because certainly the nervous system is a two-way street. It's an understatement. What I really found amazing was that, again, blocking input helped the injured central nervous system to behave better.  Dr Jones: That is kind of cool to think about. And I'll tell you, as editor of the journal, one of the funnest things is getting to learn all about neurology, including pain and including central neuropathic pain, when in the end you're doing all the work, I just get to sit here and enjoy it. And you're a program director of a pain fellowship. What's the pipeline look like? Are neurologists more interested in pain than they used to be?  Dr Argoff: I'm happy for this. We are seeing more and more applicants from neurology into our pain management programs. I would say… I was going to say tragically. If I say tragically, it's because what specialty better understands how to diagnose, figure out, assess, come to a conclusion? You can't have pain without your brain. It's always amazed me that more neurologists weren't interested, and I understand the background and such. Just like in migraine, it's only advances in understanding mechanisms of migraine that allow neuroscientific advances that are leading to great therapeutics - that's happening and increasing in ‘pain.' Today, as program director, we had our fellowship interviews earlier today and three of the nine applicants that we interviewed were neurologists. Last week, I think we interviewed two or three also. That would not have happened five years ago or six years ago. And if you think about it, we can not only diagnose, quote-unquote figure out what's happening, but we now, with pain management training, we can offer people a variety of both invasive and noninvasive options, all while understanding what we're doing with respect to the nervous system in a way that's different than the other specialties that typically go into pain med. And that's such - for me, it's a beautiful experience and something I really enjoy doing. There isn't a neurological condition in the most part that either doesn't have pain associated with it or doesn't have mechanisms that overlap. If you think about epilepsy, and please don't think I'm crazy, but epilepsy is associated with disinhibited hyper-excitatory behavior, just to put it loosely, among certain neurons. That's what pain and neuropathic pain is about too. And you, in fact, we know that several mechanisms since now what medicines are used for both. But what was interesting since, if I may just go back to another point, one of the advances since I brought up the migraine that's very exciting is the whole story about sodium channels. Dr Harouthounian at WashU and his group used lidocaine injection. Lidocaine's a more generalized sodium channel blocker, but some of the newest treatments for treating neuropathic pain. Our NAV specific sodium channel blocker's trying to match up mechanism to treatment. Not exactly the way that we do with migraine, but still a step forward to not just generally treat but really target different neuronal mechanisms. It's an exciting time.  Dr Jones: So, the pipeline is doing better because we're getting better understanding of disease, and hopefully that pulls in more interest because obviously there are big gaps in caring for patients with pain. And again, thank you, Dr Argoff, for an amazing article. Thank you for joining us and thank you for such a fascinating discussion. I enjoyed the article. I read the article, I learned from our conversation today. So, thank you for joining us to talk about central neuropathic pain. Dr Argoff: Thank you for having me. Dr Jones: Again, we've been speaking with Dr Charles Argoff, author of an article on central neuropathic pain in Continuum 's most recent issue on pain management. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Doctor 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 a Text Message (please include your email so we can respond!)We are LIVE at CHEST2024! Thank you to the organizers of the conference for inviting us do a live show and thank you to everyone who came out to listen! We talk about a few articles that were recently published in CHEST - "Prophylactic Minocycline for Delirium in Critically Ill Patients: A Randomized Controlled Trial" published by Dal-Pizzol et al and then "Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of In-Hospital Cardiac Arrest" by Wagner et al.We then touch briefly on some articles being presented later at the conference which we might cover soon (stay tuned)!Minocycline for Delirium (pubmed): https://pubmed.ncbi.nlm.nih.gov/38043911/Minocycline for Delirium (CHEST): https://journal.chestnet.org/article/S0012-3692(23)05833-6/abstractAmio vs Lido (pubmed): https://pubmed.ncbi.nlm.nih.gov/36332663/Amio vs lido (CHEST): https://journal.chestnet.org/article/S0012-3692(22)04039-9/abstractIf you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Welcome back to the St. Emlyn's podcast. This episode covers some of the most important developments in emergency medicine and critical care from July 2024. Whether you're practicing on the frontlines or keeping up with the latest research, this episode has something for you. From coronary risk scoring tools to cutting-edge AI in ECG interpretation, and the management of non-fatal strangulation, it's packed with insightful updates. Here's a breakdown of the key topics: The Manchester Acute Coronary Score (MACS Rule) is a valuable tool for risk-stratifying patients presenting with chest pain in the emergency department (ED). MACS uses both clinical characteristics and biomarkers like troponin to assess a patient's likelihood of experiencing an acute coronary event. A recent systematic review found that the T-MACS model (which uses troponin) has a sensitivity of 96%, making it highly effective at ruling out serious coronary events. Though the specificity is lower, MACS's real strength lies in its ability to drive clinical decisions and patient referrals. This tool is already integrated into the Electronic Patient Record (EPR) in Manchester, where it helps streamline the decision-making process for patients with chest pain. If you're looking for a reliable method to quickly and accurately stratify risk, MACS could be the answer. Artificial intelligence (AI) is revolutionizing healthcare, and its application in ECG interpretation is particularly exciting for emergency medicine. In this episode, Steve Smith joins us to talk about how AI can enhance the detection of occlusive myocardial infarction (OMI)—a concept that might one day replace the traditional ST-elevation and non-ST-elevation classifications. By integrating AI into rapid assessment areas (like pit-stop zones in the ED), clinicians can benefit from real-time ECG analysis. This reduces the burden of interruptions and helps detect subtle abnormalities that might be missed in high-pressure environments. AI-driven ECG tools could dramatically improve patient outcomes, particularly in cases of high-risk cardiac events. Non-fatal strangulation (NFS) is an often underdiagnosed condition in emergency medicine, but it carries significant risks, including carotid artery dissection. A new guideline from the Faculty of Forensic and Legal Medicine emphasizes the importance of detecting these cases and suggests that clinicians use contrast angiography to rule out vascular injuries. Beyond the medical consequences, non-fatal strangulation is also a major indicator of future violence, including homicide. The guideline highlights the ethical challenges clinicians face when deciding whether to involve law enforcement, especially when patient consent is lacking. Safeguarding and appropriate referrals are essential for these high-risk patients. REBOA has been evolving in recent years, and now it's moving from the emergency department into the pre-hospital setting. In the latest advancements, partial REBOA—which allows for some blood flow below the balloon—is being used to resuscitate patients in traumatic cardiac arrest. This partial occlusion technique may be more effective in maintaining coronary perfusion, essentially resuscitating the heart in cases of extreme hemorrhage. Early data from a feasibility study shows promise, with an 18% survival rate in patients who otherwise would have had little chance of survival. REBOA could become a life-saving pre-hospital intervention for trauma patients in the near future. Paediatric eating disorders, particularly anorexia and diabulimia, remain under-recognized in emergency medicine. In this episode, we explore some of the red flags—such as rapid weight loss, bradycardia, and postural hypotension—and why emergency clinicians need to be more attuned to the signs of eating disorders. Of all mental health disorders, anorexia has the highest mortality rate, and in cases of diabulimia, patients intentionally stop taking insulin to induce ketosis and lose weight. Given the severity of these conditions, it's crucial that we recognize them early and respond appropriately, especially when young diabetic patients present with unusual symptoms. The advent of hybrid closed-loop insulin pumps is transforming the care of type 1 diabetes. These pumps act as an artificial pancreas, continuously monitoring blood glucose levels and adjusting insulin delivery automatically. The latest guidelines from NICE recommend these devices for all patients with type 1 diabetes in the UK. However, these pumps come with their own set of challenges, especially in the emergency department, where clinicians need to know how to troubleshoot common problems, such as cannula blockages or starvation ketosis. In this episode, Nicola Trevelyan walks us through the essential steps for managing patients who use these devices. Lidocaine patches have long been used as a low-risk intervention for managing pain in elderly patients with rib fractures, particularly when nerve blocks or NSAIDs aren't viable options. But how effective are they? A recent feasibility study compared lidocaine patches with standard care and found that while the pulmonary complication rate remains high, the patches may offer some benefit for pain relief. While more research is needed, lidocaine patches continue to be a low-harm option that might provide relief in certain patient populations, particularly where other pain management strategies are contraindicated. Button battery ingestion remains one of the most dangerous emergencies in pediatric medicine. Francesca Stedman, a pediatric surgeon, explains the dangers of battery-induced burns, which can occur within hours of ingestion. Time is of the essence in these cases, and quick identification through radiographic imaging followed by rapid removal is critical to prevent long-term damage. Even when batteries are lodged in places like the nose, they can cause significant tissue damage in a short time, making early intervention absolutely vital. That's a wrap for our July 2024 podcast update! From life-saving interventions like REBOA and AI in ECG analysis to the everyday challenges of managing pediatric emergencies and coronary risk, this month's highlights offer a wealth of knowledge for clinicians. Be sure to check out the full blog posts and podcasts for more in-depth discussions on each of these topics. Thanks for listening and stay tuned for more cutting-edge insights from St. Emlyn's!

In 1992, 23-year-old Michael Hunter was found deceased in his northwest Raleigh apartment. When police take a closer look, they realize a lethal injection of Lidocaine caused his death, and his roommate, medical student Joseph Mannino, admits to injecting him with antihistamines to ease migraine symptoms. But the investigation reveals a motive for murder within a contentious love triangle. We also take a look at the hit-and-run death of Ruth Buchanan in 1989 and how the Charlotte-Mecklenburg Police recently solved it. Renee's Digital Course on Podcasting: https://www.wow-womenonwriting.com/classroom/ReneeRoberson_Podcasting.php Skincare by SkinxErin: https://shopxerin.com/collections/fit-rocker-chick-skin Use code MISSINGCAROLINAS10 for 10 percent off your order

Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient's vital organs and decreasing cerebral damage.Post-arrest goals for O2 saturation, ETCO2, and BP/MAP. Indications for use of an antiarrhythmic after ROSC. Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC.The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC.Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest. If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm. If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm. An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!Other Pass ACLS episodes mentionedObjective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cpr

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Use of the chemical compound to search for pain origin.

On this episode of the Real Life Pharmacology podcast, I continue my coverage with the Top 200 Drugs Podcast. Here's the list of medications we will cover. Lorazepam (Ativan) is a benzodiazepine well known for its anxiolytic and anti-seizure properties. Phenazopyridine (Pyridium) is a urinary analgesic that can change the color of the urine to a reddish/orange color as one of its adverse effects. Hydroxychloroquine (Plaquenil) is a DMARD used in rheumatoid arthritis and Lupus. One highly testable and unique nugget to remember is that it can cause retinopathy. Lidocaine patch (Lidoderm) is used topically to help with various types of pain including neuropathy and postherpetic neuralgia. Diclofenac (Cataflam) is an NSAID used as an analgesic and anti-inflammatory. It can increase the risk of GI bleed, edema, renal failure, and thrombosis.

Events of the day leads to thoughts of events of the past – with a little Lidocaine thrown in for good measure.

With the handful of local anesthetics at our fingertips, we seem to reach for Lidocaine and Articaine the most. Is one of these better than the other?  Tom Viola answers this fast fact! Be sure to check out what Tom Viola is up to by visiting Tomviola.com or email him - Tom@Tomviola.com

With the handful of local anesthetics at our fingertips, we seem to reach for Lidocaine and Articaine the most. Is one of these better than the other?  Tom Viola answers this fast fact! Be sure to check out what Tom Viola is up to by visiting Tomviola.com or email him - Tom@Tomviola.com

Being the team leader during a cardiac arrest is challenging. Using an algorithm helps by standardizing & prioritizing our interventions using an If/Then methodology. Review of BLS steps for determining if rescue breathing or CPR is needed and use of an AED for patients in cardiac arrest. If the patient is in a non-shockable rhythm on the ECG such as PEA or asystole, we will go down the right side of the Adult Cardiac Arrest Algorithm. If the patient is in a shockable rhythm on the ECG such as V-Fib or V-Tach, we will go down the left side of the Adult Cardiac Arrest Algorithm. An example of a code's flow for shockable rhythms when an antiarrhythmic such as Amiodarone or Lidocaine is administered. We will follow the algorithm until the patient has ROSC or we call the code.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Other Pass ACLS episodes mentionedObjective Measures of Good CPR https://passacls.com/bls/objective-measures-of-good-cpr

Welcome to FractureLine: the official weekly news feed from the Chest Wall Injury Society, where we will listen to all the bottom-line CWIS updates, shout-outs, fun facts, and weekly banter! This week's episode welcomes some FractureLine favorites and friends! We talk with SarahAnn, Dr. White, Dr. Bauman, and Dr. Faliks. First, we bust some myths about medicine and the human body that SarahAnn has been plagued by! Then, we talk about recent research on the front of Lidocaine patches! Finally, this week is Case Review, so be sure to tune in! The amount of info here is mind-numbing! **To end this episode (post-credits), we will hear the reflections of a CWIS Giant, Dr. Fred Pieracci (Denver Health, Denver, CO), from CWISummit 2024**

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Let's take a journey through the history of personal lubricants, from ancient remedies to modern options. Today we explore the different types of lubricants, their ingredients, and when to use them. Discover the pros and cons of water-based, oil-based, and silicone-based lubricants. Learn about the importance of choosing body-safe ingredients., and what ingredients are best to avoid. Whether you're young or older, lubrication can enhance sexual pleasure and reduce discomfort. Dive into the world of lubricants and find the perfect one for you. Key moments in this episode are: 00:21 History of lubricants 01:34 Water-based lubricants 01:54 Glycerin and osmolality of water-based lubes 03:38 Pros and cons of water-based lube 04:20 Parabens in water-based lubes 04:37 Capsasian in water-based lubes 04:56 Lidocaine or benzocain in water-based lubes 05:18 Oil-based lubricants 05:44 Pros and cons of oil-based lube 07:39 Silicone-based lubricants 08:39 Pros and cons of silicone-based lubes 09:04 Body-safe silicones 09:39 Testing your lube if you're sensitive 10:08 Hydroxycellulose in lubricants 10:24 Is lube safe in pregnancy? 11:01 Is lube safe when trying to conceive? 11:34 Are flavored lubes safe? Body-safe silicones we discussed in this podcast: Cyclomethicone Cyclopentasiloxane Dimethicone Dimethicone Crosspolymer Dimethiconol Phenyl trimethicone Follow us! Instagram @foundationskristinjacksonmd Website https://www.foundationsfl.com/ FB facebook.com/advancedurogynecology Loved this episode? Share with a friend.

Unlock the essential strategies for ensuring patient safety during anesthesia in the prone position! On this episode, host Alli Bechtel welcomes Taizoon Dhoon, an associate professor at the University of California, Irvine, who shares his expertise from his recent article in the APSF newsletter. Dhoon sheds light on the often-overlooked risks of prone positioning, detailing the physiological changes and positioning injuries that can arise. This discussion is a treasure trove of knowledge for anesthesia professionals, aiming to elevate patient care practices and enhance collaborative efforts among medical teams.Our journey begins with an in-depth review of recommended practices and preoperative considerations, emphasizing the critical role of thorough exams, patient history evaluations, and cardiac assessments. Discover the actionable steps you can take to improve safety, from pre-surgical planning to additional monitoring during procedures. Whether you're an experienced anesthetist or new to the field, this episode provides the insights and tools you need to navigate the complexities of prone positioning with confidence and precision. Tune in and empower your practice with expert advice and practical recommendations.We are covering two bonus articles to discuss concerns with the Perifix® L.O.R. syringe (B-Braun, Melsungen, Germany) that is used with the loss of resistance (LOR) technique to confirm the epidural space, and we are diving into the literature. Our literature review summary takes you through the 2023 article, "Comparison of the hemodynamic effects o opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial."For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/207-patient-safety-during-prone-positioning/© 2024, The Anesthesia Patient Safety Foundation

Lidocaine is so safe - but it's now "over the counter" in a 4% concentration.  But companies are putting as much as 10% lidocaine in products and selling them online.  The FDA just issued warning letters to 6 companies that are selling illegal lidocaine products.  On today's show, we talk about the dangers of lidocaine and the dangers of hyaluronidase.  We also discuss when filler is too much and when it is time to perform a facelift instead of more filler.  

Topics: The important role topical patches play in prescription pain management   Key Messages:   Pharmacists play a vital role in supporting patients seeking acute, non-opioid pain relief, and their proactive engagement can ensure personalized and effective pain management solutions.  Clinically proven, medicated patches deliver pain relief directly to the site of pain where it is needed most.   One effective prescription-strength option to consider is YARAL Pharma's Diclofenac Epolamine Topical Patch 1.3%.  This option may be covered by the patient's insurance; therefore, patients can access prescription-strength relief while minimizing out-of-pocket costs compared to over-the-counter alternatives.  Product Attributes:   Diclofenac epolamine topical system 1.3%: a nonsteroidal anti-inflammatory drug (NSAID) indicated for the topical treatment of acute pain due to minor strains, sprains, and contusions in adults and pediatric patients 6 years and older.   Accessible and Affordable  The Authorized Generic of the Flector® (diclofenac epolamine) topical system 1.3%. Patients receive a product identical to the brand, at an affordable price.  Targeted Topical Acute Pain Relief  Low systemic exposure. For a wide variety of patients and pain sites  Fast-acting  Significant pain relief within 4 hours after first application. Sustained pain reduction for 7 days with twice-a-day application  Long Lasting  Delivers NSAID power for 12 hours    Lidocaine Patch 5%: Treatment to help relieve pain associated with post-herpetic neuralgia, a complication from shingles, causing a burning painful skin rash.  Fast Acting  Medicated  Numbing Prescription Relief  Odor Free    Guardrails:    While both Lidocaine Patch 5% and Diclofenac Epolamine Topical System 1.3% may be used for pain, the approved indications differ, therefore we cannot say that diclofenac can be used as an alternative to or substitute for lidocaine, or that Lidocaine Patch 5% (FDA approved only for shingles complications) can be used as an alternative to or substitute for other FDA-approved indications for lidocaine pain-relief products.  We will need to stay on label for each product regarding indication, ISI, etc. and cannot make claims specific to YARAL's products.  Diclofenac Epolamine Topical System 1.3%  Diclofenac Epolamine Topical System 1.3% - YARAL Pharma Inc.  diclofenac-PI-8-29-23.pdf (yaralpharma.com)    Lidocaine Patch 5%  Lidocaine Patch 5% - YARAL Pharma Inc.  PI_Lidocaine-13851.pdf (yaralpharma.com)  Ensure products are not positioned for chronic pain.  We cannot make comparisons that YARAL's products can be used as an alternative to opioids because the indications for use and safety profiles are different, and there is no head-to-head study at this time directly comparing the safety/efficacy of YARAL's products to opioids for YARAL's FDA-approved uses.  We cannot make comparative claims to OTC pain relief products or suggest alternatives because the safety profiles differ and the approved indications for use may differ across various products.  Must focus only on monadic (non-comparative) claims for YARAL's products.  Must include fair balance with safety information, including the «major statement« of risks for products discussed.    Questions/Topics:  Introduction:  Can you share a bit about your background and experience in pain management as a pharmacist?  How did you become interested in non-opioid pain management?  Can you speak about the evolution of pain management?   Movement toward topical pain treatment options  How topical patches play a role in pain management  Topical Pain Management:  Could you explain why topical delivery of pain medications is an important option for patients/physicians to consider?  Touch lightly on available options (OTC, prescription)  Make expressly clear that OTCs and Rx drugs are not interchangeable, as the approved uses and the safety profiles differ significantly. Patients must always talk to their doctor about their pain management options.  Identify patient populations most likely to benefit  Long-term care community (reduction in frequency of administration)  What role can pharmacists play in educating patients about topical pain management?  What makes Diclofenac Epolamine Topical Patch 1.3% an option for acute pain relief for minor strains and sprains in adults and children over 6?   How do YARAL Pharma's topical patches for acute pain management benefit the patient's experience?  As an example, let us take YARAL Pharma's product Diclofenac Epolamine Topical System 1.3% - a nonsteroidal anti-inflammatory drug (NSAID) indicated for the topical treatment of acute pain due to minor strains, sprains, and contusions in adults and pediatric patients 6 years and older.   As an authorized generic of IBSA USA's Flector, Diclofenac Epolamine Topical System 1.3% offers patients a non-opioid, topical treatment backed by more than 30 years of clinical experience.   This prescription, medicated patch delivers pain relief directly to the site of pain where it is needed most.   The prescription patches are mess-free, offer localized absorption of active ingredients, and are not habit-forming.  These topical patches provide controlled release of medication, maintaining optimal concentration and reducing the need for frequent administration.  Patches for topical use can release a medicinal product in a controlled manner over periods of up to 12 hours, offering many advantages over oral administration.   Current State of the Topical Patch Market:   What do you feel is driving the explosive growth in the use of topical pain management options?  Future Developments:  Are there any upcoming developments or innovations in pain management that listeners should be aware of?    Major Statements   Diclofenac Epolamine Topical System 1.3%    Diclofenac Epolamine Topical System 1.3% is a nonsteroidal anti-inflammatory drug (NSAID) used for treating acute pain from minor strains, sprains, and bruises in adults and children aged 6 and older.     Serious side effects may include increased risk of cardiovascular and gastrointestinal (GI) events. NSAIDs can raise the risk of heart attack, stroke, gastrointestinal bleeding, ulceration, and perforation of the stomach and intestines, which can be fatal. The risk for serious cardiovascular events may occur early in treatment and may increase with duration of use. Elderly patients and those with a history of peptic ulcer disease or GI bleeding are at higher risk for serious GI events.    Do not use in patients who are allergic to diclofenac or any of its ingredients, or have a history of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Do not use in the setting of coronary artery bypass graft surgery. Avoid use on broken skin. Discontinue immediately if signs of hypersensitivity occur.      Patients should be informed about the warning signs and symptoms of liver problems. Discontinue use if abnormal liver tests persist or worsen or if signs of liver disease develop. Avoid using Diclofenac Epolamine Topical System 1.3% in patients with severe heart failure unless the benefits are expected to outweigh the risks.    The most common side effects include itching, nausea, and headache. Patients should stop use, and consult their doctor, at the first sign of skin rash or other signs of sensitivity.    Patients should ask their doctor if Diclofenac Epolamine Topical System 1.3% is right for them. For more information and Full Prescribing Information including Boxed Warning and Important Safety Information, visit www.yaralpharma.com.    Lidocaine Patch 5%    Lidocaine Patch 5% is indicated for relief of pain associated with post-herpetic neuralgia, a common complication of shingles. It should only be applied to intact skin.    Lidocaine patch 5% is contraindicated in patients with a known history of sensitivity to local anesthetics of the amide type, or to any other component of the product.     Cases of methemoglobinemia, a rare blood disorder that affects how red blood cells deliver oxygen throughout the body, have been reported in association with local anesthetic use. It is important for patients to store and dispose of Lidocaine Patch 5% out of the reach of children, pets and others. Applying Lidocaine Patch 5% to larger areas or for longer than the recommended wearing time could result in increased absorption of lidocaine and high blood concentrations, leading to serious adverse effects. Patients should avoid contact with water, such as bathing, swimming, or showering.    Reactions may occur at the site of application. These reactions are generally mild and resolve within a few minutes to hours. Allergic and severe allergic reactions associated with lidocaine, although rare, can occur.     Patients with severe hepatic disease are at greater risk of developing toxic blood concentrations of lidocaine because of their inability to metabolize lidocaine normally. Advise patients to discontinue use immediately and seek immediate medical attention if the following signs or symptoms occur pale, gray, or blue-colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.       Patients should ask their doctor if Lidocaine Patch 5% is right for them. For more information, including Full Prescribing Information and Important Safety Information, visit www.yaralpharma.co  

This week, managing type 1 diabetes into your 70s is a bit of uncharted waters.. While thankfully more and more people are living long with T1D, that wasn't always the case. I'm taking to Dianne Mattiace who is in her early 70s and was diagnosed as an adult, 30 years ago. She was the first person in the US to use the Eversense CGM when it was approved in 2018 and she's still using it today. She answers your questions about this implantable CGM, why she's stayed with it and what else she does to manage in retirement and beyond.   This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. More about Eversense here Our previous episodes about Eversense here  Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode Transcription:  Stacey Simms  0:00   Diane Matisse. Thanks so much for joining me. Welcome to Diabetes Connections. It's great to talk to you. Dianne Mattisse  0:04   Thank you so much for having me. Yeah, let's Stacey Simms  0:07   jump right in. Let's start with your diagnosis story, because you were initially misdiagnosed, right? Take me through what happened? Yes, Dianne Mattisse  0:15   I was 40 years old. And my family history was type two diabetes. And they actually, as soon as you say that to a physician, and it was a general practitioner, it was not an endocrinologist, they automatically just put that label on me and said, you know, you're another type two in your family. It went on for about three months. And I actually was in the honeymoon phase, which now was not even recognized back then. But I, it was at the time where you're making enough insulin to keep you from going into DKA into ketoacidosis end up in a hospital, but not enough to make you feel well, so my blood sugar's were still rising, the medication they had me on wasn't working. And finally, after, I think about three or four months, well, during that time, I saw an endocrinologist. And he also was doing a lot of testing, even the C peptide, which is now a diagnosis tool wasn't able to be done where I lived, they had to send it out to a lab in Atlanta. So once that was kind of established, he admitted me, and started me on insulin and, you know, multiple injections per day, Stacey Simms  1:35   why did you What led you to actually seek out an endocrinologist? Dianne Mattisse  1:39   I was not feeling great with the general doctor treating me and I just kept getting worse and worse. And I was taking oral medications, they weren't all these designer meds that they have now for type twos. Back then it was couple pills. So I was I would call them increase the pills. And as I was increasing the pills over the three or four months, so was my blood sugar increasing, and I kept losing weight. And I'm thinking, well, this is a great diet I'm on I was eating better. But my blood sugar's were going into the three hundreds. So finally, I had been in the medical field before that, actually, it was in the medical field at the time, I was a controller for a nursing home company, but it didn't really have access to a lab or anything like that. I was actually the Regional Controller. And I was on the financial side, right? So I actually went to a lab got my blood sugar taken. I didn't even think to buy a meat or anything like that, which I should have, but I did not. And I kept seeing my blood sugar's go up and up and up. And so I finally just on my own said, I'm gonna go to an endocrinologist. And as soon as I went, he told me, I think you're a type two. And type one, I think you are type one, misdiagnosed as a type two. And let's do some testing. He started he did the C peptide, sent it out, did a bunch of other tests. I have no no recollection. Now, it's been 33 years of what else he did. But over that weekend, so that was like a Friday over that weekend, I just be compensated more I started getting muscle cramps, I called him and he said, go to the hospital Monday morning, seven o'clock and bring a bag you're being admitted. So I did. And he said, I was really on the brink of going into diabetic ketoacidosis. So it was really, really just, you know, it's good that I went to the hospital that morning and got on insulin, I think but I think a lot of people when they're diagnosed after 40 or 35, I just talked to somebody the other day who was diagnosed at like 55. And I think the older you get, the less they even think it just automatically think you're a type two. Yeah, yeah, Stacey Simms  3:58   it's something like half of all cases of Type one are occurring and people over the age of 20. But as you say, once you're over 20, many doctors don't know that it could be type one. I hear a lot of stories of Pupil misdiagnoses type two who have type one of a lot of people who have lotta, you know, latent autoimmune diabetes in adults. I don't hear a lot of these stories happening in the late 1990s. Or prior to that time period. Did you ever talk to your endocrinologist? Like, I don't want to say he was cutting edge because it was pretty obvious you were suffering, right at that point. But it is interesting that this was 33 years ago, and somebody finally got it right. Dianne Mattisse  4:41   I think I was just so sick. By the time I actually went to see him and I had lost about 40 pounds. By that point. He looked at the amount of medication oral meds that I was on, and I think it had been about a period of three months and I kind of was keeping track of the blood sugars on a piano And a little notebook back then, that we had. And he looked at that and said, you know, you're you're decompensating, you're not doing well on any of these meds, the amount of weight I had lost. And I was young, younger. So I wasn't. I mean, I was losing muscle mass, but it wasn't as noticeable if I had been 60 or 70 years old. And he said, You're losing muscle mass. And you're just feeling so bad. I mean, I remember going on a trip with my husband. And we went to the Statue of Liberty at that point. It was you were able to go up the stairs and go into the statue. Yeah, well, we actually went with some family members. And this is before I actually was on insulin about a month before. And I remember going up three steps, and turning around and telling my husband, I can't do this. Oh, wow. And we had always, I had always been going to the gym be doing aerobics. Back then more of a runner than walking. Walking is more popular. Now. Of course, you know, less on the joints and everything. But I was a runner back then I was into aerobics. I was very athletic skier and, you know, snow ski or water skier. And he looked at me and said, What do you mean? And I said, I can't do it. I'm out of breath on step number three, I need to turn around. So that kind of pushed me to figure out. And now when I look back at those pictures of what I look like, I'm like, I actually looked very, very sick. I mean, that weight for me was not a normal weight ever in my life. Maybe when I was 10. Stacey Simms  6:45   For a lot of weight, I Dianne Mattisse  6:48   think I weighed 103. And I mean, I think I weighed more than that. Honestly, in fourth grade. Yeah. Stacey Simms  6:53   Wow. Especially for somebody athletic. That's really tiny. Right? Right. Um, Dianne Mattisse  6:59   you know what it is? It's it's denial. Oh, because nobody in my family. I mean, my family thought I look great. You're, you're on a diet, you're doing great, everything's good. But they didn't know how I was really feeling you know, health wise, I felt horrible. And weak and, and constantly thirsty, and constantly urinating and, you know, in the bathroom all the time and starving me, you actually are starving your body. And it's just the worst, it was a thirst. When I describe it to people, it was a thirst that no matter how much you drank, you could never make it go away. It was just something that was there all the time. So I mean, it was very, I was very lucky to find the right endocrinologist that, like you said, was a little bit of ahead of time, and kind of just said, You're a type one. You're not a type two, there's just no way and immediately hospitalized me and got me on track. So Stacey Simms  8:00   I'm imagining that you did go home with a meter this time. Do you mind taking us through your technology journey because we're here to talk about you know what, you're one of the first people to use the ever since Dianne Mattisse  8:12   I was first I was the first person implanted in the United States with the ever since and my doctor who is in Opelika, Alabama was the for about Columbus, Georgia. And he has an office in OPA Leica. He was the first person to be sort of the first physician to be certified. Wow, the technology. Let me tell you technology now. I always say this if you have to have a disease and a chronic disease. I'm so happy now that I have all of the help and see GMs I had actually left the hospital with a meter. And it was like, I think he had to wait two minutes for it to actually read. You know, your drop of blood. It had to be a much bigger drop of blood and all that. My doctor at the time would not there were pumps, but they were obviously much larger. And the CGM, the first CGM that I had was I had to go to the hospital and have it put on and I wore it it was a big box and I had to wear it for seven days. Then go back to the hospital. They would take the recording out they would review and and print everything, send it to my endocrinologist and then I had to go back to the endocrinologist for a report. So it only took a week of my life and of course, like anybody else I was sure that I was doing everything right and trying to have good read, you know a good recording done. So I would get a good report when I went there. Now I had changed my my original endocrinologist had a family tragedy with his son, so I had to change endocrinologist. And I thought I had a really good endocrinologist. But for some reason, she didn't really push me with the CGM. So I really pushed that. And I have been on all of them. I've been on all of the 10 to 14 day ones I've been on. Like I said, the original one that had to wear for seven days. And honestly, the last one, not the last few years before I went on, ever since I did not, they didn't get along with my body. I mean, I had too many alarms. I had too many failures. I had skinny rotations, I had just inaccuracies. And I finally said to myself, I'm not being compliant because of it. So I just started doing more meter checks. And I tried to manage my diabetes, which I could not I mean, to be honest, I was thinking I was compliant when I when I moved to Alabama and got with my physician now, my endocrinologist. I was not I was not being compliant, because I didn't have a CGM. So I mean, it's almost impossible to stick your finger every five minutes. I was gonna say do Stacey Simms  11:19   you think the right word is compliant, though? I mean, you were trying, right? It's not like you were in your like, I hit that non compliant page. I Dianne Mattisse  11:27   was right. You're right. I was trying. But now that I look back, I'm like, I should have. Well, there was nothing like ever since before I got it. So it was funny thing. My husband heard about it. I actually moved to Alabama a year earlier than my husband he was working down there want to do is finish his job for another year. And so I moved to Alabama, because we bought a house on the spur of the moment. We're on a visit up here. And so yeah, we weren't it wasn't a plan. It was not a plan. We just did it. So when I came up here, I did not have a physician here. I didn't even have a primary. But I did have a pump and I needed to get my supplies. So I I actually called there's only two endocrinologist in Auburn, Alabama. And that's about a half hour from where I live. So one of them wanted me to have a referral. But I didn't even have a primary yet. So I called the other one. Because I needed to get my insulin and my supplies. And they gave me an appointment. And it was funny. I went in on a Thursday to see Dr. Baliga. And he looked at me and said, This is my you know, I'm a new patient started talking to me about the ever since. Have you ever seen it? Have you ever heard about it? And I said, you know, it's funny. My husband saw something on the news about it a few months ago, and he mentioned it to me, but I hadn't seen anything else about it. So he started telling me about it that it was something that was placed under the skin. You wore it for at that time, it was 90 days now it's 180 days. And I said well, let's let's do it today, because he made it sound so wonderful that you wouldn't have to be doing, you know, I would know something every five minutes, I would know if you know and I was familiar with other products that gave you arrows, whether you're going up whether you're going down so you can kind of fix things as you're going along. I didn't have that right now. When I went to see him so I'm like, Ah, it sounds great. He goes well wait, we we haven't got he was at the FDA had certified it. He was certified, but they had to bring the team from Atlanta at the time. So he says but we can do a Tuesday. And I'm like, Okay, I can't wait. I mean, I was so excited. So I had it placed on Tuesday four days after I saw him and I'm now on number 24th sensor and it has been actually so life changing for me i One of the main reasons I was so anxious and happy to hear about something like that is because I was having severe low blood sugars at night and nothing not to wake me up. I mean I My husband actually would call me every morning at 839 o'clock to make sure I had made it through the night that I was still alive. So it was a horrible really way to live and I was having multiple sometimes multiple low blood sugars during the day and or blood glucose during the day. And then I would treat them and then I would go up and down you know so it was it was just up and down cycle and you don't feel well with that at I don't anyway most people don't because you you know you now you have to fix this and you know hope that it fixes that. So once the I got on ever since that disappeared, basically disappeared from my life, I maybe have one, low blood sugar, maybe once every two months now, I have a very, very low percentage less than 1%, every 90 days. So it's amazing to me how technology has changed my life and made me feel like I can actually live kind of like a normal life. I need it. And I also was never really addicted to looking at my phone all the time, like a lot of younger people do. And you know, I don't do a lot of selfies and but now, I mean, I do sit at the table and have my phone there because I want to see what's going on. And if I'm out to dinner, I put it there. And I want to see if it's going down, is it going up? And it gives me that you know that that safety net of, I'm not going to go high, and I'm not going to go low. Do you mind if I ask Stacey Simms  15:57   what other technology you're using because the CGM alone isn't going to prevent lows. Dianne Mattisse  16:02   I have an insulin pump. I don't have the loops. I don't use that because I have the CGM that I 100% believe in and, and love it. I do have a meter. And I do have to calibrate the Eversense once a day, which to me, gives me that feeling of security and safety that I am getting good numbers throughout the day. And if something's really off, you know if it feels like it's off, I will check with my meter. But I use the meter a lot less to be honest, I you know, I really trust you ever since. And I mean, it's been it's proven to me because many times the meter and the ever since will have exactly the same number, or within a few a few numbers. And that makes me feel so much better. Right. Stacey Simms  16:53   But you use you use a pump. That's just I wouldn't call it a dumb pump. But you don't use an automated system. I Dianne Mattisse  16:59   don't use the loop. I don't use the automated system. It has the capability. Okay, but but I don't I just that's not an important factor for me, right? Stacey Simms  17:10   I mean, I'm just trying to be clear for folks that you know, we're listening, you know what you're using in right with, I mean, my son, it's funny to look at technology because he was diagnosed in 2006. So we went, you know, shots and meter, and then DME pump and meter for forever. And then CGM pump your meter to calibrate like you say, and now in 2020, he went closed loop. So he's got a pump that communicates with the CGM. So it's just wild to see how it all works. All right, all the questions people have about ever since tell us about the insertion and the removal, because a lot of that makes a lot of people uncomfortable to think about. Dianne Mattisse  17:49   Right, right. I think the placement of the ever sense has, I think a lot of people think about it as a surgery and as this and that, it really is such a tiny little, maybe just a tiny little incision, not even as big as your pinky fingernail. And they actually, you know, they numb you, of course, and then they put the little the little sensor right under the skin. I mean, you can actually kind of feel it through the skin, you know, which is helpful when you're placing the transmitter. And it doesn't. I mean, honestly, it doesn't hurt at all, I'd rather have that done and then have my teeth cleaned, to be honest. I mean, it's it's really that simple. And I've had, like I said, I'm on number 24. And it's really nothing the removal is the same thing. It takes maybe the insertion the longest part of the insertion or the placement is getting the Lidocaine to numb the area, you know, they actually do it in a very sterile way comes with a big sterile cape. And you know, you're laying on the table and they clean the area very well. I've never had an infection I've never had any what I would call any bleeding I mean it might bleed a little tiny bit, but they cover it with steri strips, there's no stitching, there's no you know, there's nothing like you have to go back and have surgery looked at it or anything like that there's no stitches or anything like that. So the removal my physician has always used an ultrasound for removal. So I think that has become very popular because I belong some a lot of these pages that people talk about it and I can actually feel mine because it really is right under the skin and but I think the ultrasound kind of helps them know exactly where the end is. Because listen, there's you're putting it under the skin, it could move a little bit it could you know turn or whatever, right so I've never really had any issues. I mean, you hear horror stories from people who have never even had it, which really is quite annoying, because I think it's just like slamming a restaurant, if you've never eaten there, you know, just and I think the greatest thing is that we have a choice. Now, it might not be for everyone. But it is something that for people who get these severe irritations or allergies to certain products, you know, with some of the 10, the 14, ones, 14, day 10 to 14 day CGMS. And also, I think a lot of people worry about getting it knocked off. And the cost of it, were this the transmitter, which where you were on the outside, if it comes off, you know, you just stick a new adhesive on it and stick it back on. The other great thing is, you know, we live by a lake and we have a boat. And if I want to go swimming, I take my transmitter off, I get into the water. And I don't have to worry about anything, I don't have like a permanent thing going into my body a permanent or fish going in, you know, which always kind of bothered me going into a pool or going into a lake or something like that. This is once that heals up after a couple of days, there's nothing really on the outside plus it you know, the great thing about ever since also is it uses a different kind of technology. It's not the same technology as other CGMS use. So I believe and this is personally my opinion, I believe that it's much more accurate because of the type of technology that they're using. It's very advanced, Stacey Simms  21:47   you being the way the sensor reads. Yes, the way the sensor reads. And you said you had a lot of irritation from the other CGM. You don't have any irritation with the adhesive that the transmitter sticks Dianne Mattisse  21:59   on at all. None at all. None at all. The little adhesive ups the little adhesive that we put on the back of the transmitter is very very skin friendly. Very skin friendly i and I'm fair and I have blue fair skin blue wise, so I have had pretty severe irritations with other CGM said I had to move them around and try different things and try different products under it. Also products to keep them on, which haven't had to do that either. You know, this kind of stays on? And I don't really think about it. I mean, I think more about checking my phone now than I do thinking about having the sensor. So tell me again, Stacey Simms  22:47   this is your 24th Yes, sir. How long will this one stay in? Dianne Mattisse  22:54   Six months, not? Well, it stays now up to 180 days or up to six months. beginning it was up to three months. And I do know that the FDA is working on the approval for the what 365 Day, which we're all looking forward to that. What I mean, I love going to my doctor so I'm like, you know, I we always kid around. So you know, we have to stop meeting like this. But yes, I mean, it's a it's going to be quite awesome for a lot of people to get it for one year because I do go to my doctor every three months to get prescriptions for the other supplies I need and insulin and things like that. But some people only go to see their endocrinologist or their primary doctor only once a year to manage your diabetes. Stacey Simms  23:49   In the six months, I'm just trying to you know, I'm trying to picture that you think that all the different the CGM changes that would happen within six months. Have you had any issues any reason to go back to your endo and say take a look at this get out the ultrasound machine or is it smooth sailing for you? Dianne Mattisse  24:05   I haven't had any issues for several years. I mean, we're going on six years this July that I've had it the greatest thing is which I've never used the most recent products I'm not sure but but the ever since has an online or on your phone whole picture of what's going on. So I'll tell you how long you're you know how much time you're in. It will tell you exactly the percentage time and range and it also will tell you seven days, 14 days, 30 days, 60 days, 90 days so you can actually see and it will also tell you what your estimated A1C will be it will tell you what percentage is low you're in the low area what percentage you're in high so it gives you all kinds of information. The greatest thing is my doctor has that information also. So if I make a call to him, and I say, you know, I'm not doing well, something's not right, I can't get the sugars down and, and it's not the pump I, you know, I've moved it, I've changed insulin, all that thing, all those things, then he will go on there and say this is what you need to do. But this is what we need to change around, you know, because it's all based on the insulin that you're getting and the activity. It's nothing really I don't feel to do with the CGM. Right? So with the sensor, so I haven't ever had to call him and say, I think it's a sensor. I think most of the time, it's just been the amount of insulin. Or maybe I'm sick. You know, maybe if I have an illness that's not, you know, I had or I made a couple months ago, I had take a steroid shot my wrist. And that just blew me out of the water. So I called him and he was like, Okay, this is what we need to do for two days, you know, so the CGM? No, I mean, I find no fault with that. I mean, I think if the built in protection there is if your meter reading when you put in your calibration in the morning, which I do mine in the morning, you can kind of set it up to do whenever, but I always want to do it first thing in the morning, because I want to know where I'm starting anyway, my day, is it going to be good, bad or ugly that day? So I put my calibration number in there. And if it's, let's say it's off, it's off by 30 or 40 points, you know, you, the sensor itself will tell you something's not right. And it will actually ask you to do another calibration in another hour or so. So, to me, it's, it's kind of a safety check. So that I don't worry about it going off, and being kind of crazy on its own. Because, you know, if something like that happens, and I'm sure with technology, everything has, you know, kinks in it. They you would call the customer service, they have great customer service. And they can actually do a lot with Reese not resetting it actually totally, but figuring out if it really is the sensor really is you. I've had to do a reset on the sensor maybe? Stacey Simms  27:20   Sure. Um, I'm curious, you had mentioned you're in some groups, and I'm sure you know, people who also were there ever since and a lot of people who are interested in it. What's the first question people ask you about it? Like diabetes people? Dianne Mattisse  27:35   How about how is the insertion? How is the placement? Does it hurt? Does it scar does it? How is the surgery? You know, they all like to think it's surgery and everything? Because listen, when you're thinking about that you're thinking about, I don't know, maybe they're thinking of a transplant or something. But it's a very simple thing. And there's a lot of other medical procedures now that use these placements under the skin. There's hormonal ones. I know there's a testosterone one, I think there's an there's one for birth control now. So it's it's, you know, very upfront technology that's being used a lot in medical treatment. So it's not anything, you know, that people should be afraid of. I mean, this is an advanced, very advanced product, I think, and simple life is so much simpler with this, you know, just, I mean, once every six months now you go in, I mean, you're it's 15 minutes, and you know, I mean, the 10 minutes, I'm waiting for the Lidocaine to work. That's, that's the biggest thing. Stacey Simms  28:44   Do you have scoring? Do you have a scar on other very Dianne Mattisse  28:46   fair, like I said before, and I don't scar and usually the FDA requires that they switch arm to arm every six months. So like, they'll do the left arm and then they do the right arm. So in that meantime, I can't even like when I go back to have the removal. If if the sensor has already expired, like but I usually try to go a couple days before. If it's expired, of course, it's not going to have a reading. And then, you know, I have to really figure out where it is because I don't see the scar anymore. There is actually I think it's so tiny that it heals up. I mean, you're supposed to leave the bandaging and everything on instructions or five days. Usually, it's healed up in about two or three days completely healed. You can't even really see anything. So I mean, some people would scar I would imagine, but I mean, I think you have that's the trade off or having a totally accurate CGM. That's easier. That's less expensive than things that are failing and you have to replace all the time I mean, for me, it's, it was never I never thought twice about that. I may be by my age, I have a lot of scars anyway, from falling, and it's like, you know, I'm not worried about having perfect skin anymore. So, but no, actually, because I'm fair. I, I did think about that, but but only for about two seconds. Stacey Simms  30:25   Well, you know, and if you don't mind, um, you know, I'd love to talk about aging with type one. I mean, you know, it's different. Life is different from 20 to 50. Certainly, you've mentioned like, you don't run so much anymore, you know, so I don't want to make a whole Pash of like we all know we're getting older. For lucky, we know we're getting older as like, but you know, years and years ago, people weren't living past 50 type 1 diabetes, let alone 70. And I have listeners in their 80s. And we know people in their 90s with type one. So it's a pretty wild. So I Dianne Mattisse  30:58   73. It's changed 73. My A1C is 6.6. I'm so proud of that. Because when I first got the Eversense inserted, it was in the mid nines or a little bit higher. It wasn't 10, but it was in the night. So I've made tremendous strides in getting it down being healthier. And I'm just very proud of that. Because you know, I would like to be in the fives but I, you know, I'm fine. My physician is fine with it being in the sixes, getting rid of the low blood sugars was a huge thing for me because many, many people die in the middle of the night from having a low blood sugar. And that still happens to people and really with CGM and all these choices, it shouldn't happen. And the fact that the CGM gives me this vibration, I know all anywhere, anytime, if I'm out eating, if I'm in bed sleeping, I know I'm going to get a vibration that's going to tell me what's going on. So that has really helped me be happier in my life. I think I worked 25 years in health care as administrator and then 25 years is real estate. Now I'm retired but I do a lot. I have a charity I'm treasurer for up here in Alabama, that does art. We provide art classes and projects for kids in the schools here, elementary schools and some high schools. I have a little word working business with my sister here, we make maps of the lake and we sell to all the little stores around here and everything. And I keep very busy, I also do a transaction. I'm a transaction broker for my son who's a broker in Florida. So I do a lot of paperwork online for him. So I keep very busy. But the fact that I'm getting older, you know, and I know people will say this, you talk to anybody old, your mind is still young, you still look you know, when you look in the mirror, you go Who is that old lady, but when you when you when you feel good, and I feel so much better with a normal blood sugar. I don't feel like I'm that age, you know, I mean, I I enjoy traveling, I traveled to Florida quite a bit because of a lot of relatives and friends still down there having been there for a long living there my entire life basically. And I feel comfortable traveling by myself, which is a huge thing. Because I can tell you 10 years ago, I did not I mean, I always wanted to have my husband or my son or somebody with me. So that getting old and having diabetes. And I've been very lucky because I don't have any side effects. I don't have any complications from having diabetes for so long. I mean, on one hand, I was very lucky, I didn't have to go through puberty or childbearing. So I got it when all that was done, had my children and everything. But on the other hand, you know, 33 years when I think back 33 years is a long time to be dealing with a chronic disease 24/7 And I don't think anybody really understands that it is a full time job. It is something that is with you 24/7 You cannot forget about it even for a day. I mean, it's dangerous if you think you can, but you just can't. But getting older. I just like to I'm so excited to see all the things that have have come from diabetic technology, all the opportunities that we have now. I love being part of the ever since group of people because honestly I never knew anybody growing up, you know, during when I was diagnosed at 40 I never knew another type one. I felt very isolated and kind of depressed about it because I'm like, even in my family, they didn't really acknowledge it because Nobody had the knowledge about it, they knew a lot about type twos and you should lose weight, eat better and exercise, but they didn't really know much about why I was a type one or how I was managing it or how encompassing it was to your life. So I think just having better communities, among us is has helped tremendously for me. And the ever since has just been, like I said, before, life changing for me, no matter what age I would have gotten it, I think it's just the best product because it's the easiest product to use. And I've used them all, I mean, you can't name one that I haven't used and, and I've gone through the progression from when they had to put it on the hospital until the very newest ones. And nothing really, my body didn't like them for whatever reason. But getting old is great. I just look at it and go, I have friends from first grade still, that I see when I go down. And I'm like, you know, and they, you know, most of my close friends know when everything and they, they are very supportive, but they don't really understand it. So now that I understand it better. I'm okay with that. I mean, I think age has just made me feel like, Hey, I am so lucky to be here and feel as good as I do can be as active as I want to be. No, I don't run anymore, and I don't ski anymore. I last skied when I was 65 And I'm like, hey, that's it. I'm done. I'm not doing that anymore. I you know, I got away without ever having a broken bone or anything. Or last time we went, you know, I went with a bunch of younger girls and, and family, bunch of family. And and I'm like, Hey, I'm skiing is good as he's 40 year olds, but I'm not risking it anymore. Yeah. Stacey Simms  36:45   So I meant to ask Do you know is ever since covered by Medicare? I can look that. Yes, I Dianne Mattisse  36:49   did. Absolutely. Now the first couple years, it was not. And my husband I made that decision to pay out of pocket. But yes, it is covered now. That's great. Yes, right. covered. And it covers the insertion and the removal for the physician also, which I think some of the other insurances don't but but yeah, that was not the deciding factor for me. I mean, we paid out of pocket, and and we just knew it was going to be the best thing for me. Stacey Simms  37:18   Good to know, though. I mean, it's really interesting, again, with a lot of my older listeners, you know, and as we are so excited that people with type one are living to Medicare year and beyond, right, it's really important to look at these things. It is it's a deciding factor for a lot of people. Yes. Okay, before I let you go, Diane, how did you get hooked up as an ambassador? I mean, it makes sense. You're the very first patient in America. So I guess it's kind of a dumb question that everybody wants to speak out, you know, right? Dianne Mattisse  37:42   Well, I never Well, okay. So like I said, I never really was in a group of people, I didn't really even have anybody. You know, nobody in my family, nobody to talk to. So the team came from Atlanta, when I had my first insertion, placement, they'd like you to lose placement. So when I had my first placement, the team from Atlanta came, and that was six years ago, this July. So the person who is head of the sales now I believe, she was on that team, and she came in, and we kind of hit it off. And then I think it went on for about, I think six months later, they decided to get a group together, and call them the patient ambassadors. And that's when that is before a Sensia actually got began, began to be involved in the marketing. So that was when Sen. psionics was doing it. So this person picked eight or nine people. And we still have, I believe, four or five of the original ambassadors, and now it's more demographically varied. You know, we have young, I obviously, I'm the older person, you know, but it is good, because I think it's, you know, it shows that it's for everyone. I mean, there's not an age barrier. And there's not a weight barrier. There's not any kind of barrier, except you have to be a type one and you have to want this device. And it's just but that's how are we got hooked up and we kind of it kind of slacked off a little bit when we became the marketing went over to a Sensia. And they had that agreement with a Sensia. And then they picked four or five of the original people and and you know, we're still very close, we have our own little group chats and things like that. So and it's good because now I know if I have a question or if they have a question we can get with each other. It's it that is the greatest thing. I think younger people or anybody now, Facebook has pages, you know, people like you who are spreading the word. I mean, if there had been This, I think I would have felt so much better. I mean it I'm almost getting teary here. But I think I would have felt so much more inclusive, then than I felt for many, many, many years. So I think that you're doing a wonderful thing by spreading the word and helping people and sharing. And I think you know, somebody like your son, who's 19 is going to have a whole different experience with this than I did. And, you know, because you just by 40, you've gone through all those teenage angst and everything but and I was done having children everything, but then it's like, what the heck now? i What is this, you know, coming on, and I was healthy at that time. And I'm like, What did I ever do? Never did drugs, never smoked. Never, you know, there wasn't all the information about immune system, autoimmune and it runs in my family. We have so much autoimmune disease, but not type one. Yeah. So but the patient ambassador, it's a greatest group, we have a blast when we get together. That's awesome. Well, Stacey Simms  41:10   doing the show is truly a privilege for me, you know, getting to talk to people like you and learning so much. I really appreciate it. Diane, thank you so much for joining me. I hope we connect again soon. So Dianne Mattisse  41:21   and I hope you are very good at that editing.  

Join us as we review recent practice-changing articles on E-cigarettes for smoking cessation, Gabapentin and COPD exacerbations, lidocaine patches for mechanical neck pain, Cdiff risk by antibiotic type, and “dosing by clicks” for GLP1 agonists. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), and Matt Watto (@doctorwatto). Claim CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! |Mailing List | Contact | CME! Credits Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Matthew Watto MD, FACP Reviewer: Rahul Ganatra MD, MPH Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Introduction and disclaimer E-cigarettes for smoking cessation Gabapentinoids and COPD exacerbations Topical lidocaine for neck pain Association between specific antibiotics and C. diff infection Shortage of GLP-1 agonists and “dosing by clicks” Sponsor: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts. Sponsor: Freed  You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. 

Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient's vital organs and decreasing cerebral damage.Post-arrest goals for O2 saturation, ETCO2, and BP/MAP. Indications for use of an antiarrhythmic after ROSC. Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC. The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC. Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

We revisited with an old friend of the podcast: Dr. Josef Rauschecker. He was our first ever guest – go back and listen to that episode! – who came up with the famous 'gating' theory of tinnitus. Josef's gating theory poses that while neural ‘noise' may arise in the ear and lower brain regions due to hearing loss, this noise is typically cancelled out further up the auditory pathway. For most people at least, but not for those experiencing tinnitus.We speak to Josef in person at his office in Georgetown University about how his theory has evolved, his views on psychological treatments for tinnitus, why animal studies for tinnitus often fail, and how we can quickly get new tinnitus medications to market.(00:00) Introduction(02:23) Explaining the 'gating' theory(06:55) Tinnitus disorder(09:31) Recent insights from MRI studies(12:06) Psychological treatments for tinnitus(15:49) Animal models to cure tinnitus(21:04) Speeding up new treatments(27:08) Lidocaine cures tinnitus?(30:18) New funding opportunitiesBecome a Tinnitus Talk Podcast Patron at https://moretinnitustalk.com for bonus content, video interviews, Ask an Expert series, and more!

In this episode: what not to bring in an MRI and two people who broke the rules and paid the price. Can Lidocaine, a common anesthetic, help cure some cancers? The research is very positive. Plus, Matthew Perry's autopsy named Ketamine as a contributing factor in his death. How does Ketamine, which is used for depression and pain management, turn deadly? And lastly, are in-home laser and light therapy devices safe? We'll find out.What Not to Take Into an MRI, Are In-Home Laser Treatments Safe and the surprising benefit of Lidocaine.

In this episode: what not to bring in an MRI and two people who broke the rules and paid the price. Can Lidocaine, a common anesthetic, help cure some cancers? The research is very positive. Plus, Matthew Perry's autopsy named Ketamine as a contributing factor in his death. How does Ketamine, which is used for depression and pain management, turn deadly? And lastly, are in-home laser and light therapy devices safe? We'll find out.See omnystudio.com/listener for privacy information.

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In the world of anesthesia, Articaine is a product riddled with controversy. Whilst recent studies have proved that Articaine is relatively safe to use, many are still skeptical due to the previous narrative that Articaine has a higher chance of causing paralysis than Lidocaine and other anesthetics. So today, we sit down with Oral and Maxillofacial Surgeon, Dr. Ben Hechler, to get to the bottom of Articaine's safety by unpacking a few studies that were published in the last five years.  Our first study denotes that on an absolute scale, Articaine is not riskier to use than Lidocaine, and Dr. Ben explains why he agrees wholeheartedly. We also discuss anesthetic efficiency and discover that, once again, there is little to separate Articaine and Lidocaine. To end, both our host and guest detail how they use Articaine in their practices and Dr. Ben explains why every oral surgeon should be embracing Articaine instead of running away from it.Key Points From This Episode:Why we've chosen to speak about Articaine and we dive into our first case study. Dr. Ben explains what he likes about the study in question.How there's no definitive proof that Articaine causes paralysis more than Lidocaine. The second article that we discuss explores anesthetic efficiency. How Articaine is slightly more effective than Lidocaine (within certain parameters).The way Doctors Ben and Grant use Articaine in their practices. Why Articaine should be embraced by all oral surgeons. Links Mentioned in Today's Episode:Dr. Ben Hechler on LinkedIn — https://www.linkedin.com/in/ben-hechler/   ‘Does the Use of Articaine Increase the Risk of Hypesthesia in Lower Third Molar Surgery? A Systematic Review and Meta-Analysis' — https://pubmed.ncbi.nlm.nih.gov/32976834/  ‘Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review' — https://pubmed.ncbi.nlm.nih.gov/30267700/ KLS Martin — https://www.klsmartin.com/en/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Our primary focus immediately following return of spontaneous circulation (ROSC) is aimed at ensuring adequate perfusion of the patient's vital organs and decreasing cerebral damage.Post-arrest goals for O2 saturation, ETCO2, and BP/MAP. Indications for use of an antiarrhythmic after ROSC. Determining which antiarrhythmic to use post cardiac arrest. Administration of Amiodarone or Lidocaine to control ventricular ectopy after ROSC. The use of Amiodarone post arrest if no antiarrhythmics were administered prior to obtaining ROSC. Links to other medical podcasts that cover antiarrhythmics and other ACLS-related topics are on the Pod Resource page at PassACLS.com.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back via PayPal Good luck with your ACLS class!

In the Adult Cardiac Arrest algorithm, we should administer an antiarrhythmic medication to patients in V-Fib or pulseless ventricular tachycardia approximately two minutes after the first dose of epinephrine.The two first-line ACLS antiarrhythmics that are generally used are Amiodarone and Lidocaine. Review of Lidocaine dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Review of Amiodarone dosing and administration to patients in persistent V-Fib or pulseless V-Tach. Use of antiarrhythmic infusions post-cardiac arrest to suppress ventricular ectopy. Amiodarone use & dosing for stable patients in V-Tach with a pulse.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Mixing ILK with lidocaine/epinephrine for AA - Highlights from the IDS - Isotretinoin for rosacea - Leukotriene receptor antagonists for chronic urticaria - Jak inhibitors for HS - Check out our video content on YouTube: ⁠Dermasphere Podcast - YouTube⁠ - and VuMedi!: https://www.vumedi.com/channel/dermasphere/ The University of Utah's Dermatology ECHO: ⁠⁠https://physicians.utah.edu/echo/dermatology-primarycare - ⁠⁠Connect with us! - Web: ⁠https://dermaspherepodcast.com/⁠ - Twitter: @DermaspherePC - Instagram: dermaspherepodcast - Facebook: https://www.facebook.com/DermaspherePodcast/ - Check out Luke and Michelle's other podcast, SkinCast! ⁠https://healthcare.utah.edu/dermatology/skincast/⁠ Luke and Michelle report no significant conflicts of interest… BUT check out our friends at: - ⁠Kikoxp.com ⁠(a social platform for doctors to share knowledge) - ⁠https://www.levelex.com/games/top-derm⁠ (A free dermatology game to learn more dermatology!)