Podcasts about medical icu

We are recording Season 3 of the Resilient Birth podcast. Meanwhile we have selected our favorite episodes for you. We hope you'll enjoy this rerun of Dissociation Reframed With Morning Alexander. In this episode Sarah and Justine's guest, Morning Alexander, a birth and postpartum doula and soon to be labor and delivery nurse, surprises us with a quote from Justine that she wrote on the Resilient Birth social media. She shares how Justine helped reframe dissociation for her, shifting the shame she her felt about experiencing dissociation during a traumatic birth experience. Here are links to Justine's words about dissociation as a gift that helped her survive the unbearable and which starts our conversation today. On Facebook: https://www.facebook.com/share/8kAecEYzfxjiki3p/?mibextid=WC7FNe On Instagram: https://www.instagram.com/p/CIga0x-ACQS/?igsh=MWhjYXdlcGRtcWE5ZA== On the Resilient Birth podcast, Justine and Sarah explore the impact of trauma in the perinatal period. Through an inspirational quote that drives the weekly content, Justine and Sarah explore various trauma areas with vulnerability and compassion that support birthing people and birth professionals. Each week, listeners leave with takeaways to utilize in their lives and/or clients. Justine and Sarah hold the stories they share with honor and respect with the hope to impart knowledge, increase understanding, and bear witness to this challenging topic. Sarah is a licensed mental health counselor, educator, and mom of three. She walks with a story of trauma from before and as a result of her perinatal experience. Justine supports survivors of trauma through perinatal coaching and childbirth education. As well as being a mother of three, she holds a Ph.D. on representations of consent and sexual violence. Morning Alexander has been supporting women in the perinatal period for over a decade and have been certified as a birth and postpartum doula for nearly 5 years. She has worked as a nurse tech in the Medical ICU for the past 4 years and is graduating this summer with my BSN and will be working as a labor and delivery nurse, with the ultimate goal of becoming a certified nurse midwife. Morning has a history of childhood trauma that was largely undealt with until after the births of her children. She had a very traumatic birth with her firstborn but it wasn't until years later, as she was diving deeper into birth and trauma training that she came to understand her own experiences. Through her continuing education and years of therapy, she has found not only healing and wholeness but a deep passion for being trauma-informed as a provider and supporting other women in finding healing and empowerment in their births. Learn more about our course called Trauma Informed Fundamentals here: https://resilient-birth.mykajabi.com/traumainformedfundamentals

This CEO Is Fighting Inflammation – Sea Star Medical -$ICU- CEO, Eric Schlorff, Shares Timeless Advice Guest: Eric Schlorff has served as the Chief Executive Officer of SeaStar Medical Ticker: $ICU Website: https://seastarmedical.com/ Sea Star Medical YouTube: / @seastarmed Bio: Since 2019, Eric Schlorff has served as the Chief Executive Officer of SeaStar Medical, responsible for the management, strategy, and operations of the company. He has extensive experience in financial planning and managing large, complex organizations and as well as deep knowledge of SeaStar Medical's business operations, including the scientific basis, regulatory requirements and sales and marketing channels. Prior to joining SeaStar Medical in 2016, Mr. Schlorff spent more than 20 years at Dow Chemical Company, serving in served in multiple role, including Global Director of Alternative Investments for the Dow Chemical Pension Plan, Global Finance Leader for Crop Protection & Seeds at Dow AgroSciences, Global Market Intelligence Leader at Dow AgroSciences, Global Financial Manager of Royalties at Dow Agrosciences, Senior Investment Manager of Alternative Investments at Dow Chemical Company, New Business Development of Pharmaceuticals at Dow Chemical Company, Global Financial Analyst within the New Businesses division at Dow Chemical Company, and Global Financial Analyst within Dow AgroSciences at Dow Chemical Company. Mr. Schlorff has a bachelor's degree in chemistry and biology from Mac Murray College, an M.S. in pharmacology from Southern Illinois University School of Medicine and a master's in business administration from University of Illinois Urbana-Champaign. --- Support this podcast: https://podcasters.spotify.com/pod/show/smartmoneycircle/support

In this episode Sarah and Justine's guest, Morning Alexander, a birth and postpartum doula and soon to be labor and delivery nurse, surprises us with a quote from Justine that she wrote on the Resilient Birth social media. She shares how Justine helped reframe dissociation for her, shifting the shame she her felt about experiencing dissociation during a traumatic birth experience. Here are links to Justine's words about dissociation as a gift that helped her survive the unbearable and which starts our conversation today. On Facebook: https://www.facebook.com/share/8kAecEYzfxjiki3p/?mibextid=WC7FNe On Instagram: https://www.instagram.com/p/CIga0x-ACQS/?igsh=MWhjYXdlcGRtcWE5ZA== On the Resilient Birth podcast, Justine and Sarah explore the impact of trauma in the perinatal period. Through an inspirational quote that drives the weekly content, Justine and Sarah explore various trauma areas with vulnerability and compassion that support birthing people and birth professionals. Each week, listeners leave with takeaways to utilize in their lives and/or clients. Justine and Sarah hold the stories they share with honor and respect with the hope to impart knowledge, increase understanding, and bear witness to this challenging topic. Sarah is a licensed mental health counselor, educator, and mom of three. She walks with a story of trauma from before and as a result of her perinatal experience. Justine supports survivors of trauma through perinatal coaching and childbirth education. As well as being a mother of three, she holds a Ph.D. on representations of consent and sexual violence. Morning Alexander has been supporting women in the perinatal period for over a decade and have been certified as a birth and postpartum doula for nearly 5 years. She has worked as a nurse tech in the Medical ICU for the past 4 years and is graduating this summer with my BSN and will be working as a labor and delivery nurse, with the ultimate goal of becoming a certified nurse midwife. Morning has a history of childhood trauma that was largely undealt with until after the births of her children. She had a very traumatic birth with her firstborn but it wasn't until years later, as she was diving deeper into birth and trauma training that she came to understand her own experiences. Through her continuing education and years of therapy, she has found not only healing and wholeness but a deep passion for being trauma-informed as a provider and supporting other women in finding healing and empowerment in their births. Learn more about our course called Trauma Informed Fundamentals here: https://resilient-birth.mykajabi.com/traumainformedfundamentals

This week's episode of The Metabolic Link features an illuminating conversation between our host Dr. Dominic D'Agostino and Dr. Jonathan Jun, a pulmonary critical care and sleep medicine physician at Johns Hopkins.He is an expert in the diagnosis and treatment of sleep-disordered breathing, and in the care of critically ill patients in the Medical ICU. He is a member of the Sleep Fellowship Program Evaluation and Clinical Competency Committee and provides teaching to medical students and residents at Johns Hopkins.In this episode, we cover:

Welcome to the world of the EMT, a world that in its own way reproduces the complex conditions of an ER—but without the safety net of a large institution. Valerie Creel, a registered nurse and LNC, who also worked for several years as an EMT, shares with you what goes on in an ambulance, both from the perspective of a team member and also the possible malpractice errors that can occur with ambulance transport risks. Although EMTs receive extensive training, Valerie says that only field experience can teach a person what needs to be done. One potential liability incident occurs when someone, having called 911, refuses to get into the ambulance. He may later change his mind and try to sue. Ambulances may get into collisions with other vehicles, another fraught situation. In addition, if all pieces of equipment aren't well secured, other risks occur. LNCs need to be aware that their attorney clients may not provide EMT or ambulance records or that sometimes more than one ambulance becomes involved. Whether the patient is delivered to a hospital that can meet his or her needs may be a liability issue. You will probably get involved in an ambulance-related lawsuit at some point in your LNC career. Valerie's detailed description of what goes on in the world of the EMT provides invaluable information. Learn more about Ambulance Transport Risks - Valerie Creel What kind of training does an EMT get? What levels of service are provided in different ambulances? What kind of hazards are involved in an ambulance ride? What medical liability situations do EMTs face? How do EMTs decide where to take a patient? Listen to our podcasts or watch them using our app, Expert.edu, available at legalnursebusiness.com/expertedu. Get the free transcripts and learn about other ways to subscribe. Go to Legal Nurse Podcasts subscribe options by using this short link: http://LNC.tips/subscribepodcast. https://youtu.be/QXEiezhQHik Announcing LNC Success™ Virtual Conference 9 October 26,27 & 28 Join us for a 3-day virtual event designed for legal nurse consultants just like you LNC Success™ Pat Iyer and Barbara Levin put together THE first Legal Nurse Consulting Virtual Conference in July 2020. They are back with their 8th all-new conference based on what attendees said they'd find most valuable. The LNC Success Conference implementation and networking event is designed for LNCs at any stage in their career. Build your expertise, also attract higher-paying attorney clients, and take your business to the next level. After the LNC Success™ Virtual Conference, you will leave with clarity, confidence, and an effective step-by-step action plan that you can immediately implement in your business. Your Presenter of Ambulance Transport Risks - Valerie Creel Valerie Creel is the owner of Bridge Point Legal Nurse Consulting. She has been an RN since 2013 and has extensive experience with Critical Care. She has been in the intensive care unit (ICU) for the entirety of her nursing career. Valerie has worked with Trauma, Neuro, and Medical ICU patients including providing care through the Covid-19 pandemic. As an ICU nurse, she trained new RNs into the specialty and also worked as a Rapid Response nurse to respond to emergencies and serve as a resource to nurses throughout the hospital. In addition to her nursing experience, she worked as an EMT providing prehospital care in the 911 system of San Mateo County from 2007-2016. She had the opportunity to work with complex trauma and multi-casualty incidents including the Asiana Airline Crash at SFO in 2013. Valerie holds her board certification in Critical Care and earned her Bachelor's Degree from Grand Canyon University with honors. Valerie has been working in the legal nursing field since 2021 and has completed her coursework to specialize in strangulation, gunshot wound evaluation, and more.

National Sickle Cell Disease (SCD) Awareness Month Part 2 of 2 – September 2022Bria Sharp BSN, RNJoin me this week for part 2 of 2 as Ms. Bria Sharp and I continue our discussion about National Sickle Cell Disease (SCD) Awareness Month. In this episode, you will hear about the intense pain that those with SCD endure and how providers, and others draw conclusions about that pain. More About Ms. Bria Sharp BSN, RN:My name is Bria Sharp. I was born and raised in Memphis. I graduated with my first Bachelor of Science in Biology from Lipscomb University in 2016. Following graduation, I worked as a Mental Health Technician for 2 years. In 2019, I graduated with a Bachelor of Science in Nursing from the University of Tennessee Health Science Center. I have spent the past 3 years working in a Medical ICU. I am currently focusing on classes for the DNP Nurse Anesthesiology Concentration at the University of Tennessee Health Science Center in Memphis. Websites:https://www.sicklecelldisease.org/ https://www.cdc.gov/ncbddd/sicklecell/facts.html https://www.stjude.org/treatment/disease/sickle-cell-disease.html

How do you design care for patients with Long Covid? Will the pandemic lead to a redesign of medical education? Can design principles create safer standards in healthcare? Dr. Lekshmi Santhosh specializes in adult pulmonary and critical care medicine with a focus on medical education. She attends in the Medical ICU, the Neuro ICU, on the Internal Medicine teaching wards, and has a clinic at the Pulmonary Outpatient Faculty Practice at UCSF-Parnassus. She is the founder and Medical Director of the multidisciplinary OPTIMAL Clinic (pOst-covid-19/PosT-Icu MultidisciplinAry cLinic) at UCSF Health. She serves as the Associate Program Director for the Pulmonary and Critical Care Medicine Fellowship and the Assistant Site Director for the Internal Medicine Residency at Parnassus. She also is the Director of the Department of Medicine Grand Rounds. She obtained her Master's in Health Professions Education from UC-Berkeley. Her primary interests in medical education research are related to ICU transitions of care, women in leadership, clinical reasoning, and subspecialty career choice. Episode Mentions: Interview w Lekshmi: What We Do — and, Frustratingly, Don't — Know About Long Covid Article: Long Covid-19 may remain a chronic condition for millions Article: On the Long Road to Understanding Long Covid, This UCSF Initiative Leads Article: Feeling Dismissed? How to Spot ‘Medical Gaslighting' and What to Do About It. Follow Lekshmi: Twitter | LinkedIn Episode Website: https://mailchi.mp/designlabpod/lekshmisanthosh More episode sources & links Sign-up for Design Lab Podcast's Newsletter Previous Episode Newsletters and Shownotes Follow @DesignLabPod on Twitter Instagram LinkedIn Facebook Follow @BonKu on Twitter & Instagram Check out the Health Design Lab Production by Robert Pugliese Edit by Fernando Queiroz Cover Design by Eden Lew Theme song by Emmanuel Houston Indexed in the Library of Congress: ISSN 2833-2032

National Sickle Cell Disease (SCD) Awareness Month – September 2022Bria Sharp BSN, RNJoin me this week for part 1 of 2 of a conversation with Ms. Bria Sharp about National Sickle Cell Disease (SCD) Awareness Month. You'll hear from Bria about common misconceptions, other health issues related to SCD, and how living with SCD affects her life. More About Ms. Bria Sharp BSN, RN:My name is Bria Sharp. I was born and raised in Memphis. I graduated with my first Bachelor of Science in Biology from Lipscomb University in 2016. Following graduation, I worked as a Mental Health Technician for 2 years. In 2019, I graduated with a Bachelor of Science in Nursing at University of Tennessee Health Science Center. I have spent the past 3 years working in a Medical ICU. I am currently focusing on classes for the DNP Nurse Anesthesiology Concentration at University of Tennessee Health Science Center in Memphis. Websites:https://www.sicklecelldisease.org/ https://www.cdc.gov/ncbddd/sicklecell/facts.html https://www.stjude.org/treatment/disease/sickle-cell-disease.html

In this podcast episode, Dr. William Anthony Hawkins, Dr. Charles (CJ) Wilson, and Dr. Michael Long discuss their article, “From Theory to Bedside: Implementation of Fluid Stewardship in a Medical ICU Pharmacy Practice,” with host and AJHP Editor in Chief Dr. Daniel Cobaugh. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Networth Nurse™ Wealth Building Bundle: https://networthnurse.co/wealth-building-bundle/ Code DOCTORNURSE for 10% off Dr. Danielle McCamey, DNP, APRN, ACNP-BC, FCCP is a mentor, nurse motivator, and expert critical care advanced practice clinician. She has nearly 20 years of nursing experience and over a decade as an Acute Nurse Practitioner. Her specialties range from perianesthesia care, palliative, and critical care. Dr. McCamey grew up in a single-parent family home in Northern VA. Inspired by her mother, she became a nurse and received her Bachelor of Science in Nursing from the University of Virginia. She started her nursing career at Georgetown University Hospital in the PACU and Medical ICU. Shortly afterward, she obtained her Master of Science from Georgetown University, specializing in Acute Care Advanced Practice. She then received a Doctorate in Nursing Practice from Georgetown University, where her dissertation focused on the integration of palliative care screening of neurosurgical patients on admissions. Currently, she works as the Chief Advanced Practice Provider of the Preanesthesia Testing Department and Senior Advanced Practice Provider in the Surgical Intensive Care Unit. In addition, she is the co-creator and Chair of the Doctoral Nurses Collaborative, a group that joins DNP and PhD prepared nurses throughout her current healthcare system. The Doctoral Nurses collaborative provides mentorship, scholarship, and elevation of evidence-based practice. Dr. McCamey was inducted as a Fellow in the American College of Chest Physicians back in 2019 and was recently elected as the Vice-Chair of Palliative and End of Life Care Network-where the focus is on education, raising awareness, of palliative and end-of-life care in CHEST and clinical practice. Dr. McCamey is the founder, CEO, and president of DNPs of Color, Inc., a 501c3 nonprofit nursing organization that builds community for nurses of color through networking, mentorship, and advocacy to increase diversity in doctoral studies, clinical practice, and leadership. Her passions are mentoring nurses, DEI, and antiracism in nursing and palliative care in critical care. In her spare time, she enjoys time with family, dancing, traveling, and long rides on her motorcycle. DNPsofColor website: https://www.dnpsofcolor.org/ Dr. McCamey's social media links: https://linktr.ee/drmccamey Doctor Nurse Podcast Links: https://linktr.ee/DoctorNursePodcast Networth Nurse™ Wealth Building Bundle: https://networthnurse.co/wealth-building-bundle/ Code DOCTORNURSE for 10% off

Show # 270 - Coffee with Rich | Mallory is the co-owner of Michigan Civil Defense and a Krav Maga Black Belt Show # 270 - Coffee with Rich | Mallory is the co-owner of Michigan Civil Defense and a Krav Maga Black Belt On today's Coffee with Rich, we will be joined by Mallory Brake. Mallory is the co-owner of Michigan Civil Defense, a community organization that focuses on transforming civilians into trained and engaged citizens. Michigan Civil Defense offers training in self-defense, emergency first aid, and community preparedness. Mallory is a Black Belt in Krav Maga and a Level 2 Certified Instructor. Krav Maga is a military self-defense and fighting system developed for the Israel Defense Forces (IDF) and Israeli security forces derived from a combination of techniques sourced from Boxing, Wrestling, Judo, Aikido, and Karate. Mallory is the first and only female Krav Maga Black Belt in Michigan. She has been training Krav Maga for 10 years and instructing for 6. Her pride and passion for teaching is empowering women to take responsibility for their own self-protection. Mallory is a certified USCCA firearms instructor. She was the Honor Guard at the American Warrior Society's Firearm Instructor Development Course 3-21. Mallory is a certified American Heart Association Instructor for Basic Life Support, CPR, First Aid, AED and a Stop the Bleed Instructor. Mallory has also been a Registered Nurse for 12 years. She is a bachelor's prepared RN from Bellarmine University in Louisville Kentucky, and she has a certification in Critical Care nursing. Mallory worked in the Intensive Care at Henry Ford Hospital, a level one trauma center, in downtown Detroit for the past twelve years. While there she also worked as a Unit Educator for the Medical ICU. Mallory's unit is run by Pulmonologists, and therefore was the COVID ICU during the current pandemic. During her limited down time, Mallory loves being with her family – who made her the woman she is today. She also trains, trains, and trains some more. Coffee with Rich Youtube Channel: https://www.youtube.com/user/rhodieusmc/videos American Warrior Show: https://americanwarriorshow.com/index.html SWAG: https://shop.americanwarriorsociety.com/ American Warrior Society please visit: https://americanwarriorsociety.com/  

In this episode, I sit down with Sumita Khatri, MD, director of the Asthma Center at Cleveland Clinic, to discuss unconscious bias, advocating for immigrant physicians, overcoming imposter syndrome and balancing work and family life. Brought to you by Amgen and AstraZeneca. Intro :15 About Khatri :39 The interview 1:12 You have so many hats you wear … how do you do justice to this? 2:49 Is there a strategy to working with and instructing fellows? 4:25 You are a strong ally and a strong advocate for both immigrant physicians or foreign graduates … and you're a role model to women in medicine. How did you manage to do that? 7:29 Do you have any advice for people who are aware of the unconscious bias between male and female physicians and who want to do more? 13:30 How did you manage raising triplets while balancing your career? 17:00 In your own words, describe your journey 21:02 Is there a solution to that level of anxiety when it comes to fellows finding a good job? 25:47 What did you do to be more disciplined about work and personal life? How did you make it more personalized? 28:23 Do you have any specific experiences from med school and residency that have always stayed with you? 30:00 How do you get over your impostor syndrome? How do you get over your fears? 33:57 How do you handle your successes and failures? 35:36 You're a full professor and you started a leadership program for women … how did that start? 39:23 You are also involved with advocacy and you're a part of the leadership at the American Lung Association. How did that happen? 42:25 As an advocate, as a leader, as a clinician, as a teacher, as a researcher, how do you do justice to family time? 44:09 You love traveling. What have been some of your favorite places to travel to? 49:01 Some of Khatri's favorite books 50:29 Final words of advice for the listeners 53:28 Thank you so much for joining today 53:46 Sumita Khatri, MD, MS, is a professor of medicine at Cleveland Clinic Lerner College of Medicine/Case Western Reserve University School of Medicine and an adult pulmonary and ICU physician with a specialized focus in asthma patient care and clinical research. Khatri is also the director of the Asthma Center at Cleveland Clinic and cares for patients in the Medical ICU. We'd love to hear from you! Send your comments/questions to Dr. Bhardwaj at podcast@healio.com. Follow us on Twitter @HealioPulm @abhi_bhardwaj99. Disclosures: Bhardwaj and Khatri report no relevant financial disclosures.

Ms. Brennan Warren, BSN, CRRT shares the rollercoaster of emotions that many nurses and those who work in healthcare go through during this Covid-19 pandemic. She is saddened about the heartbreaking loneliness that her patients go through during their hospitalization. She says the key is the importance of working together with the Rapid Response Team during Code Blue which is extremely important during the “organized chaos” to help a patient. She talks about her resiliency by using her spirituality during challenging shifts. She decompresses by being mindful of the quality time with her family! She is very grateful for the hugs and love she receives from them. Thank you!

Aisha McMillan is a Registered Nurse and has a Master of Science in Nursing. She has worked in the Medical-surgical; Cardiac ICU, Medical ICU, Surgical ICU, public health, school health, as well as a lead nurse in an infusion and much more. Aisha has over 23 years of work experience within the nursing field. She is also a nurse instructor, helping others to begin their nursing career. Aisha provides important insights and tips on the etiquette in the nursing field as well as the importance of keeping a balanced work and home life. She offers inspirational testimonies which she had experienced throughout her career and personal life. If anyone is thinking about entering the nursing field or is already in this field this is a must listen to radio talk show

Introducing the newest Clinical series: Unit on the Brink: Voices from the COVID Frontline. This multi-part series delves deep into the stories behind the health care workers at University Hospital as they hold the line against the COVID-19 pandemic. Their stories offer a snapshot of the virus bearing down on one state, one group of healers, one Medical ICU. Reported by Stephen Dark, listen as these medical professionals stand united in their sense of a calling even as they risk their lives against an invisible threat.

Kevin O'Keeffe, Hilary Charles, and Cathy Vasquez are all licensed social workers at Albany Medical Center. They shared their experience about being medical social workers during the COVID-19 pandemic and discuss the importance of the social work profession. Social Workers are Essential Workers.  Bios: Kevin O'Keeffe is a LMSW who graduated with his MSW in 2015 from U-Albany. He has been working at Albany Medical Center since August 2017. He has experience in providing Social Work interventions on Medical/Surgery Floors, and in the Emergency Room. He is currently the social worker on the Medical ICU, where he works with the Critical Care Team to provide families and patients support & guidance during a critical time in their lives.Hilary Charles is an LMSW who graduated with her MSW in 2015 from Arizona State University. She has been working at Albany Medical Center since August 2018 initially assisting any unit that needed support and in May 2019 working on the Infectious Disease Unit. She has experience working with various populations across the lifespan.  In her role as the Infectious Disease Medical Social Worker, Hilary assists patients by connecting them to resources within their communities and provides social and emotional support to patients and their families.Cathy Vasquez is a LMSW who graduated with her MSW in 2017 from CUNY Hunter College in NYC. She has been working at Albany Medical Center since May 2018. She began as a medical social worker working in the outpatient pediatric hematology office and then switched over to the inpatient side of the healthcare field. She has experience in providing Social Work interventions on Medical/Surgery Floors on the Pediatric and Adult units. She is currently the social worker on the Medical Unit, where she works with the Interdisciplinary Team to provide families and patients support & guidance through safe discharge planning.

Did you know that your gut microbiome starts in your mouth? We’re told that the key to good oral health is to follow the recommendations set out by the ADA, but is this the best way? Trina Felber, the creator of Primal Life Organics, joins me today to discuss natural oral health. About Trina Felber Born in 1968, the second of five daughters in Toledo, Ohio, Trina grew up amongst a house full of skin and beauty products. As a youth, Trina was always health conscious and science-driven. In 1992 Trina obtained her RN diploma from St. Vincent Medical Center in Toledo, Ohio. Over the next decade, she worked as a Registered Nurse in specialty areas including Burn ICU, Neuro ICU, Medical ICU, and Surgical ICU. Trina spent a year as a traveling nurse before committing to furthering her education. Trina studied and obtained her BSN in 2004 from The University of Akron. She continued her studies and received her Masters of Science in Nursing with a specialty in Nurse Anesthesia in 2007. In 2010, Trina was introduced to Crossfit and the Paleo lifestyle by her husband, box owner Josh Felber. True to her “Type A” personality, Trina researched and perfected her Paleo lifestyle. She and her husband easily adapted to the Paleo diet and raise their three young children Paleo.  Living proof that Paleo equals health, Trina takes the Paleo world beyond the diet and applies it to the food for the skin. After all, to truly reap the benefits, all aspects - including skincare, must be as nutrient-dense as possible. Trina is committed to providing nutrient-dense, 100% Paleo Skin-Food that is made from fresh, organic ingredients.   Each Creation is extensively researched for specific skin types and conditions. No product is made until it is ordered ensuring the freshest, most nutrient-dense Paleo Skin-Food is delivered. Trina continues to work as a Certified Registered Nurse Anesthetist, as well as Paleo Advocate, Educator, and Skincare Expert. On this episode of The Girlfriend Doctor, Trina shares how the dental products recommended by the ADA might actually be creating more disease in your mouth than they’re solving. When these products contain triclosan, SLS, fluoride, and other harsh chemicals, they disrupt your mouth’s natural pH balance. Trina explains how your mouth, specifically your saliva, is the first line of defense against infections, diseases, and harmful bacteria that exists in our modern world. This is especially prevalent in our American soil is lacking so many of the vitamins and minerals due to factory farming and harmful chemical treatments. By changing your dental products to natural, chemical-free ones, Trina says that you can help create a more alkaline environment for your mouth. An alkaline mouth has a direct impact on your gut health and microbiome.  Trina gives us the information we need to make informed choices about the dental products we choose. She tells us what the problem with most ADA recommended dental products is. And finally, Trina gives us a definite answer to why we should be scraping our tongue every day. How confident are you in your dental hygiene? Do you scrape your tongue every day? As always, you can ask me anything and let me hear your thoughts in the comments on the episode page. If you have questions, email team@drannacabeca.com. In This Episode: Where a good, healthy microbiome starts How dental products could be creating more disease in your mouth How American soil is impacting our overall health, starting with our dental hygiene What happens when your mouth is an alkaline environment What the problem with most dental products is Why it’s so important to scrape your tongue Quotes: “One of the best ways that you can protect yourself is by keeping your mouth healthy. But if you’re using harsh ingredients or triclosan, SLS, or even fluoride, inside your mouth and body, you’re destroying your body’s first line of defense against all bacteria and all bad viruses.” (5:59) “I think that the ADA really has us all brainwashed into believing that we are supposed to brush our teeth to clean them when in reality, your saliva is meant to do that as you eat.” (10:03) “I know a lot of people that have not gotten the flu or a cold since they switched their oral care products because it’s such a drastic change when you use what’s good for you and something that allows your saliva, your body’s natural way to defend you, to actually work the way it’s supposed to. It’s a powerful thing.” (21:43) Resources Mentioned Buy Mighty Maca Plus Get the 21 Day Oral Detox Kit Buy the LED Teeth Whitener Buy Natural Hand Protectors Buy The Gemstone Face Collection Find Trina Felber and Primal Life Organics Online Find Primal Life organics on Facebook | Twitter | YouTube | Pinterest | Instagram   Check out the full episode page Find Dr. Anna Online Follow Dr. Anna on Facebook | Instagram | Twitter

Did you know that your gut microbiome starts in your mouth? We're told that the key to good oral health is to follow the recommendations set out by the ADA, but is this the best way? Trina Felber, the creator of Primal Life Organics, joins me today to discuss natural oral health. About Trina Felber Born in 1968, the second of five daughters in Toledo, Ohio, Trina grew up amongst a house full of skin and beauty products. As a youth, Trina was always health conscious and science-driven. In 1992 Trina obtained her RN diploma from St. Vincent Medical Center in Toledo, Ohio. Over the next decade, she worked as a Registered Nurse in specialty areas including Burn ICU, Neuro ICU, Medical ICU, and Surgical ICU. Trina spent a year as a traveling nurse before committing to furthering her education. Trina studied and obtained her BSN in 2004 from The University of Akron. She continued her studies and received her Masters of Science in Nursing with a specialty in Nurse Anesthesia in 2007. In 2010, Trina was introduced to Crossfit and the Paleo lifestyle by her husband, box owner Josh Felber. True to her “Type A” personality, Trina researched and perfected her Paleo lifestyle. She and her husband easily adapted to the Paleo diet and raise their three young children Paleo.  Living proof that Paleo equals health, Trina takes the Paleo world beyond the diet and applies it to the food for the skin. After all, to truly reap the benefits, all aspects - including skincare, must be as nutrient-dense as possible. Trina is committed to providing nutrient-dense, 100% Paleo Skin-Food that is made from fresh, organic ingredients.   Each Creation is extensively researched for specific skin types and conditions. No product is made until it is ordered ensuring the freshest, most nutrient-dense Paleo Skin-Food is delivered. Trina continues to work as a Certified Registered Nurse Anesthetist, as well as Paleo Advocate, Educator, and Skincare Expert. On this episode of The Girlfriend Doctor, Trina shares how the dental products recommended by the ADA might actually be creating more disease in your mouth than they're solving. When these products contain triclosan, SLS, fluoride, and other harsh chemicals, they disrupt your mouth's natural pH balance. Trina explains how your mouth, specifically your saliva, is the first line of defense against infections, diseases, and harmful bacteria that exists in our modern world. This is especially prevalent in our American soil is lacking so many of the vitamins and minerals due to factory farming and harmful chemical treatments. By changing your dental products to natural, chemical-free ones, Trina says that you can help create a more alkaline environment for your mouth. An alkaline mouth has a direct impact on your gut health and microbiome.  Trina gives us the information we need to make informed choices about the dental products we choose. She tells us what the problem with most ADA recommended dental products is. And finally, Trina gives us a definite answer to why we should be scraping our tongue every day. How confident are you in your dental hygiene? Do you scrape your tongue every day? As always, you can ask me anything and let me hear your thoughts in the comments on the episode page. If you have questions, email team@drannacabeca.com. In This Episode: Where a good, healthy microbiome starts How dental products could be creating more disease in your mouth How American soil is impacting our overall health, starting with our dental hygiene What happens when your mouth is an alkaline environment What the problem with most dental products is Why it's so important to scrape your tongue Quotes: “One of the best ways that you can protect yourself is by keeping your mouth healthy. But if you're using harsh ingredients or triclosan, SLS, or even fluoride, inside your mouth and body, you're destroying your body's first line of defense against all bacteria and all bad viruses.” (5:59) “I think that the ADA really has us all brainwashed into believing that we are supposed to brush our teeth to clean them when in reality, your saliva is meant to do that as you eat.” (10:03) “I know a lot of people that have not gotten the flu or a cold since they switched their oral care products because it's such a drastic change when you use what's good for you and something that allows your saliva, your body's natural way to defend you, to actually work the way it's supposed to. It's a powerful thing.” (21:43) Resources Mentioned Buy Mighty Maca Plus Get the 21 Day Oral Detox Kit Buy the LED Teeth Whitener Buy Natural Hand Protectors Buy The Gemstone Face Collection Find Trina Felber and Primal Life Organics Online Find Primal Life organics on Facebook | Twitter | YouTube | Pinterest | Instagram   Check out the full episode page Find Dr. Anna Online Follow Dr. Anna on Facebook | Instagram | Twitter

Life for Doctors/Healthcare Professionals in New York with Dr. Lina Miyakawa, Pulmonary & Critical Care physician and Deputy Medical ICU Director at Mount Sinai Beth Israel

In many parts of the world the COVID-19 pandemic is overburdening Intensive Care Units with huge numbers of critically unwell patients, many of whom are dying. Whilst China, Italy, Spain, France, Germany and the UK have been crisis-ridden over the last few months, one of the most inundated parts of the world right now is the USA and especially the state of New York. In this episode you will hear the firsthand experience of a New York City ICU nurse where things are extremely intense and overwhelming. Simone Hannah-Clark is a critical care nurse in the Medical ICU at the Mount Sinai hospital in Manhattan. Originally a New Zealander, she worked in both New Zealand and Australia before moving to the USA 15 years ago. Simone recently penned an engrossing New York Times opinion piece entitled “An ICU Nurse’s Coronavirus Diary”. In this podcast she delves deeper into her recent reality as a nurse caring for ICU patients with COVID-19. She recounts stories of the hard work, the sense of duty, the intricacies of personal protective equipment, the inspiring camaraderie, her revived passion for her job, and above all the heartbreaking emotion of dying patients with absent relatives. Nurses around the globe are doing extremely arduous jobs and risking their own health as they care for thousands of seriously ill people with COVID-19. They are the true linchpins of the ICU. As you’ll glean in this episode, Simone is a perfect example of the compassion, professionalism and humanity that is so essential in the world right now. Thanks for listening to this conversation with Simone Hannah-Clark.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The show aims to focus on the human aspects of what happens at the Intensive Care Unit bedside. Conversations with thought-provoking guests should hopefully help you to bring your best self to work as an intensive care clinician.   --------------------   Links related to Simone Hannah-Clark Simone Hannah-Clark on Twitter Opinion piece in New York Times “An ICU Nurse’s Coronavirus Diary” (by Simone Hannah-Clark)   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media

In this episode, Reesh chops it up with Gargi Mehta, who is a critical care physician assistant as well as Manager of the Medical ICU & Acute Medicine Advance Practice Providers at one of the largest hospitals in New York City. They talk about how COVID-19 patients wind up in the ICU, some common patterns being seen with younger patients infected with COVID-19, "the invisible 50" in the hospital that we don't hear about in the media, and how healthcare providers in the epicenter of this pandemic are dealing with the overwhelming nature of what they're experiencing on a daily basis. To the healthcare professionals on the frontline that are probably either getting off of a shift or getting ready for their next, thank you for all that you do! Hit up Gargi with any questions you have about her experience and/or about the value of Advanced Practice Providers in the hospital: gargihmehta@gmail.com Slide in our DMs and gives us your two cents: MRx Facebook MRx Instagram MRx Twitter #CarpeDM --- Send in a voice message: https://anchor.fm/medicineremixed/message

On the first episode of the podcast we have Rheanne as a guest! She has 10 years of nursing experience and is now practicing in a Medical ICU and as a Simulation Specialist at a nursing school. Rheanne started with her ADN and is now completing a her Masters in Nursing Education. We talked about her experience of growing as nurse with starting as a home health nurse to her current position. We also discuss having set backs like failing classes, and giving tips how to make good impressions during clinical rotations.

Carl Shanholtz, MD, Professor of Medicine in the Division of Pulmonary and Critical Care and Director of the Medical ICU at the University of Maryland presents the multi-departmental critical care curriculum lecture on ARDS.

Ms Vollman is a Critical Care Clinical Nurse Specialist, Educator and Consultant. She has published & lectured nationally and internationally on a variety of topics including critical care, pulmonary medicine, sepsis. From 1989 to 2003 she functioned in the role of Clinical Nurse Specialist for the Medical ICU’s at Henry Ford Hospital in Detroit Michigan. Currently, her company, ADVANCING NURSING LLC, is focused on creating empowered work environments for nurses through the acquisition of greater skills and knowledge. In 2004, Kathleen was inducted into the College of Critical Care Medicine in 2009 she was inducted into the American Academy of Nurses. In 2012, Ms Vollman was appointed to serve as an honorary ambassador to the World Federation of Critical Care Nurses.

Chronic obstructive pulmonary disease, or COPD, has skyrocketed over the past 35 years. Dr. Matthew Schreiber discusses what it means for D.C., and how you can be as healthy as possible if you have the disease.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking to Dr. Matthew Schreiber, associate director of the Medical ICU and an attending physician in Pulmonary Disease/Critical Care Medicine at MedStar Washington Hospital Center. Welcome, Dr. Schreiber. Dr. Schreiber: Well, thank you for having me. Host: Today we’re talking about a September 2017 report that showed that the number of Americans who died from chronic respiratory diseases, particularly chronic obstructive pulmonary disease known as COPD, skyrocketed over the past 35 years. In 2014, 53 people out of every 100,000 died of a chronic respiratory illness, up from 41 in 1980, a 31% spike. 85% of those deaths were from COPD, which is now the third leading cause of death in the U.S. Dr. Schreiber, how does Washington, DC compare to the national rates of chronic respiratory diseases and COPD? Dr. Schreiber: Well, Washington DC, if you were to just look at it as a city, it’s doing great. The CDC and the NIH did a report starting in 2011 that talks about state by state, how much COPD is there, and I think when you’re talking about chronic respiratory diseases, COPD is really kinda the marker for what you’re talking about. There are a ton of different things that are chronic diseases in the lung, but the biggest bulk of them is going to be COPD, and even if someone had asthma their whole life, they can later have COPD, because of the chronic nature of that destructive disease.  Coming back to what you asked, DC is ranking in with only 4.6% of its residents having COPD and that’s actually pretty darned good, if you look at our neighboring states. It’s 5.9% in MD; 6.1% in VA; and 8.9% in WV. If you dive into the data a little bit deeper though, DC is a tale of two cities. There are a number of things that the CDC and the NIH found had associations with being diagnosed with COPD, and what they found was that in Washington, you had 2.1% of white respondents saying they had COPD, but up to 6.7% in the African American population, and they didn’t report on other ethnic backgrounds. So, 4.6 sounds awfully nice, it’s at the low end of the national levels, but then when you start breaking that down, there are definitely some groups in our district who are suffering from this condition, uh, at higher than average levels for the nation. If you look at people who are unable to work, and this might be because of their lung disease, but, of course, being unemployed can have any number of reasons—19.9% of folks that were unable to work reported being diagnosed with COPD. If you had less than a high school education, 9.6%. Nearly 1 out of 10 people with less than a high school education had been diagnosed with COPD, and age was a big factor. If you looked at folks 18-44, it’s down to 2.2%, but once you’re over 75, almost 10. So, even though you could say we’re doing great, being at the low end of the national level, we’ve got some work to do. Host: Why would there be such disparity between the education and the types of work that people are doing? Is there some kind of a cause environmentally? Dr. Schreiber: COPD is a condition that no one can say they know absolutely what causes it. There’s a number of theories behind it. What I can tell you is COPD is exactly what the name says. It’s chronic, so once you have it, you have it. It doesn’t get cured, it doesn’t go away, it might not progress very fast, but you have it, and it’s all about obstruction. The ‘O’ in the name says the whole thing. People with COPD have trouble moving the air in and out of their chest. And so, if you can’t move the air out, and you’re trying to do some activity or exercise, the faster you’re breathing, the more air that you’re breathing in that you can’t then get out, and you get short of breath. And it’s pulmonary disease, lung disease. So, if you look at it as a pure aspect like that, this could be caused by inhaling something that can damage your lungs over and over again. Cigarettes are the model example for that, and in truth, this seems like common knowledge to a lot of people now, it’s new. We didn’t have studies that showed cigarettes caused things like lung cancer until the 1950s. And we didn’t have a surgeon general’s warning about the damages of smoking until the 1960s and 70s, so progress has been made. But you’ve got a lot of history in the United States with tobacco use and tobacco exposure, and a lot of science going into cigarettes since the early 1900s, that have done its job, so to speak, on getting people to use cigarettes, and the consequences of that use, that we’re only now seeing. When you think about other types of inhaled irritants, different jobs can cause different problems. I ask in my clinic all the time, ‘What kind of work have you done through your whole life?’ And people will focus on the things they might have enjoyed or liked and then I always come back, ‘Did you ever do anything that was around smoke, around fires, around a lot of chemicals, around inhaled irritants where you had to wear a mask, or maybe wish you had worn a mask?’ And people will think about what they did earlier in their life. And the lungs are remarkable things. We have “extra,” so to speak, that when you look at the lifelong duration of how much lung function you have and when it would have to get low enough to cause symptoms, we’re all, for the most part, born with enough lung and develop enough into our late teens early twenties that we can all fortunately die of something else before our lungs become an issue. But when you have these exposures or even some people who just have genetics that predisposes their lungs to dropping off function faster than the average person, when you get to later in life, you start to have this obstruction and then these symptoms, and that’s where people come in and we make this diagnosis. Host: What can a person do to reduce their risk for COPD? Dr. Schreiber: Quit smoking. That’s clearly from a research based standpoint, the thing that can have the greatest impact on reducing your risk. If you have a strong family history, you know, ‘both my parents and one of my brothers has been diagnosed with COPD.’ If that’s your story, you can talk to your professionals in your clinics and your primary care, uh, centers to say, ‘Is there anything that I should be tested for because it seems like everyone in my family is getting COPD or getting it at a young age,’ or ‘I have a non-smoker in my family who’s been told they have COPD.’ They’re a deficiency; something called alpha-1 antitrypsin. Incredibly rare disease, but important enough because of how it gets passed along in families that it’s something you can consider having testing for if it seems like there’s a higher than average risk for COPD in your family. Um, if you are in a career path or a job that gives you a lot of, what we call occupational lung exposure - you’re around something where you’re just breathing in things that seem to irritate you all the time, or, you know, in the back of your head, you’re just saying ‘Gosh, I’m breathing a lot of this stuff,’ it’s…it’s worth it to come talk to your primary care physician or if you have a pulmonologist you can see otherwise, to talk about your risks and being tested. The American Academy of Family Practitioners recommends that anyone who has ever smoked, meaning 100 cigarettes in their life, so the, ‘Well, I only have a cigarette or two if I’m out on the weekends at the bar,’ well that only takes two years of weekends before you’ve had a hundred cigarettes. Host: That’s five packs. Dr. Schreiber: There ya go! And a cough should be tested because we want to catch people early in COPD so we can both manage their symptoms and encourage them to make lifestyle changes that will hopefully not let the disease progress. Host: So, you talked about some disparities in education and across the work force. Who’s most at risk for developing chronic respiratory diseases and COPD? Dr. Schreiber: The research shows that far and away the most at risk are still going to be the smokers. Now the question is, who becomes the smokers? There are a number of scholars that have looked into the impacts of tobacco on public health. So, they point out that there’s a disproportionate, meaning a lot more than you’d expect, of advertising for tobacco products in poor neighborhoods. Their arguments that things like menthol cigarettes are targeted at particular socioeconomic or racial backgrounds and advertising has been done in a way to actually target different groups. Now, these are all theories. I…I can’t overtly say there’s proof, but, I think if you walk around a neighborhood that may be lower on the socioeconomic scale, and walk around a very affluent neighborhood, you will notice there are more billboards in some than others, that there are more advertisements on your corner store for cigarettes than in others, and in fact, this has gotten to the point where laws had to be passed about advertising cigarettes in certain proximities to schools and daycares, because of how it seems that there’s not only this risk of socioeconomics and education having to do with developing COPD and as a proxy of that, maybe using tobacco products, but also the way that marketing is being applied because of how those populations are vulnerable when more people may have this condition and smoking and you add fuel to the fire. So, it is a bigger question of social structure than I think I could ever answer, but there are a lot of people very interested in why these disparities are there. Host: If a person has smoked in the past and they quit, maybe they quit ten years ago, or they used to work in a chemical plant or a place where they’re exposed to smoke, is there anything particular that they can do to either be screened or to reduce the effects of that damage? Dr. Schreiber: Being screened, absolutely. The only way to diagnose COPD is with something called spirometry. It’s a breathing test. It’s looking for that obstruction. We have someone basically blow into a tube connected to a small computer, and we see how much air came out and how much came out in the very first second.  Because someone with COPD, they can get all the air out, they just can’t do it quickly, and if I asked you to blow out for the six seconds it takes for that test and you have normal lungs, it’s hard.  Like at the end you’re really trying to push out that last bit. People that have obstructions, I’ve read results from these tests and they’re still breathing out at 13, 14, 15 seconds because that’s how long it takes to get the air out because of the slowness of it. You can’t diagnose COPD with a cat scan, an x-ray, a stethoscope, a physical exam, a history – unfortunately, that still happens all the time. In the NIH/CDC data talking about COPD in all these different states, DC for example - three out of ten people reported never having had spirometry, yet were given a diagnosis of COPD. I would bet they probably have it based on the symptoms they had, but there are other things that could be going on and getting tested with spirometry, which can be done in the clinic, you don’t necessarily have to get what we call full pulmonary function tests which are done in the hospital, um, not as an admitted patient, but just in…in our hospital facilities, to get some of that answered. And a number of primary care clinics can do spirometry in the office. Um, we can do it in our pulmonary clinic, if that’s all the information we need. Or we can send people for additional testing with full pulmonary function tests. What can somebody do to slow the effects? That’s the tough part. There was a…a landmark study that gets talked about all the time in healthcare where a group of researchers developed a diagram showing the natural history of what happens to lungs. It’s called the Fletcher Peto Curve. And, what they showed is that for a person with no lung disease, we have our best lungs at about 20-25 years old. And then it’s literally all downhill from there. For somebody who has vulnerable lungs and has that bit of damage happening from smoking or whatever their particular cause is, if they can get away from that or quit smoking or get rid of that damaging effect, their lungs never grow back. The lungs aren’t like skin and muscle and bones. You kinda have what you have after the age of 25, but the rate of decline slows down. And so, you ask…started off this conversation saying, ‘Where is this large uptick in COPD coming from?’ It’s coming from us finally recognizing what’s been going in a lot of people for probably the last twenty or thirty years. If you look at that Fletcher Peto graph and you say, ‘Well ok, if a 50-yr. old quits smoking at age 50, they might not get bad enough lungs to have symptoms until they’re 75.’ It doesn’t mean they didn’t have COPD at 50, just wasn’t causing them disability where they actually might have gone in and gotten tested for it.  If you have someone who’s 73 and maybe has no symptoms because they’re one of those people that you’ve met that smoked their whole lives and did fine, then in 2 years later they start having lung problems, they had COPD all along. It’s just they got so close to that symptom marker that now, you know, a year after they quit, they’re on oxygen or can’t go up the three steps to go in their house, and in truth, that’s the scary thing. I don’t understand the response sometimes from patients but they’ll say something like, ‘Well, I’m not worried because this family member, uh, did well with this or did well with that, and so I’m not worried about smoking.’ But it’s not about necessarily the death with COPD, it’s the disability.  Losing your independence and…and I’ve met people in my clinic who literally get short of breath eating. Taking a shower leaves them winded, and that’s the kind of life changing event that is so horrible about COPD, that it takes away your freedom. And, people surveyed in DC talking about how COPD has affected them, almost 2/3 said they have some kind of exercise limitation because of breathing, and that’s why we need people to get checked early, to hopefully get them to either start medication to prevent flare-ups and exacerbations or maintain their symptoms under control, or to make lifestyle changes that might slow the progression. Host: How do you go about addressing that risk with your patients? Dr. Schreiber: I spend a lot of the time counseling smoking cessation, and encouraging activity, referring people to something called Pulmonary Rehabilitation, which is different from just physical therapy because they’ll have respiratory therapists and people that are trained on ways you can manage your breathing a little bit better and how to push your limits but not get exhausted, to still make progress. We talk about nutrition, and keeping people physically fit and being preventative, like getting vaccinations where they’re appropriate. Um, so there’s a lot of things when someone has COPD that we can offer them or counsel them to try to keep them as healthy as possible. Medications have been shown to help when you have COPD. And, it’s an interesting split to me and…and I say this to my patients in the clinic all the time - you wouldn’t wait until you’re having a heart attack or a stroke to start taking your blood pressure medicine, even though you feel fine. For some reason with inhalers people say, ‘Well, I’m breathing ok so why am I taking this inhaler every day?’ But these are preventive medicines, and if I can stop you from having a flare-up this year, which then will affect your lung function next year, that’s a win.  And so, the things that we prescribe in the pulmonary clinic are not always just to make you feel better, they’re also to prevent you from falling apart in some way, because nature is still going to cause those lungs to decline a bit, but if I can NOT have you in an urgent care or hospital with something that’s gonna make it decline even faster, to then keep you independent and doing things, even though you quote ‘feel like you’re breathing ok,’ then I’m doing my job. Taking a pill for folks just seems to be simpler than using an inhaler, and granted, there’s a lot more coordination going on with using an inhaler, and a lot of people use them wrong, and there’s no point in medicating the back of your throat when we need it to get it down into your lungs.  But, it’s another task in the day that takes a few more seconds than just swallowing something with water and, you know, it’s something that I think when you look at a patient and they’re using an inhaler, there might be social or, you know, other biases where you look at them and say, ‘Oh, you’re doing that, as compared to just discretely swallowing a pill with a glass of water.’ And so, I think a lot goes into it. Um, it also comes back to that idea of ‘well why am I taking this medicine if it’s not making me feel better?’ And, with the way that our society, uh, has a healthy and appropriate fear of heart disease and strokes and diabetes and hypertension, um, medications for those, I think, are something people buy into and I don’t think we’re there yet with breathing disorders to say, ‘This is something that you really should do and here are the risks and here are the dangers and here’s why.’  I think, in some ways, that’s a…a blessing, that this is a new enough common disease, so to speak, that we’ve only been dealing with this for forty or fifty years, um, that people don’t have a hundred years of being afraid of heart attacks and strokes the way that, uh, they don’t necessarily have that fear with COPD, but it means we’ve got a lot of catching up to do really quickly. Host: Thank you for joining us today, Dr. Schreiber. Dr. Schreiber: No, it’s been my pleasure. Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

ICU delirium is a state of agitation or confusion that can affect as many as 80 percent of patients who are admitted to the intensive care unit. Dr. Matthew Schreiber explains this condition and how we reduce the risk for our patients.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking to Dr. Matthew Schreiber, associate director of the Medical ICU and an attending physician in Pulmonary Disease/Critical Care Medicine at MedStar Washington Hospital Center.  Welcome, Dr. Schreiber. Dr. Matthew Schreiber: Thank you for having me. Host: Today we’re talking about ICU delirium, a sudden and intense confusion that can include hallucinations, delusions, and paranoia. So, Dr. Schreiber, what can cause ICU delirium? Dr. Schreiber: What can cause it is really the focus of a lot of research right now and the list of things is very, very long. We know that medications have an association with delirium.  Some of the things that historically have been used in the ICU to help treat a patient also have risks that are now being identified, like delirium.  Additionally, the ICU as an environment itself can lend to having delirium because imagine in your normal job, or your normal life, with a newborn child or something else, if you become sleep deprived, the next day you’re a little bit foggy and a little bit less focused, and imagine dealing with night after night of a twenty-four-hour lights on, beeping environment where things are happening because they need to happen to treat somebody. After days of that, it also impacts a patient’s mental status and can lead to delirium.  On top of that, delirium is really a very specific disease.  It’s not dementia, it’s not pain, it’s not agitation -- those things might look really similar, but what delirium is, is it’s an end organ failure, meaning the brain, in response to other things going on.  And we don’t have a model to say A causes B, but we know delirium happens based on a diagnostic criteria—a series of questions and kind of a test, if you will, to say if someone’s delirious or not. But we can’t necessarily chalk it up to ‘if we could just do this one thing we’d be able to get rid of it.’  It’s a…it’s a sign of a disease, but it is its own condition and its own disease and its own thing on its own. Host: That’s fascinating. So, the brain can actually die from overstimulation? Dr. Schreiber: It’s interesting that you put it that way, ‘cause that’s somewhat of what’s being shown in some research.  If you parallel this to something like sepsis. Sepsis is the whole body responding to an infection in one place.  So, lots of people get urinary tract infections, but some people, their body’s inflammation and that’s the body’s response to it, they end up septic from that same urinary tract infection.  The brain sees all the same blood as everywhere else in the body, so even though somebody might have low blood pressure or troubles breathing because of an infection down in their lower extremities or again, that urine, the lungs were an innocent victim. Here the brain is an innocent victim to whatever the illness is because of all the things circulating around in the body causing end organ damage.  To come back to what you said about the brain dying, there actually are some studies coming out of Vanderbilt where they’ve done MRIs on people who were diagnosed as having delirium during an ICU stay. Six months later the brain actually looks different when compared to people who were just as sick but for whatever reason their body didn’t end up having delirium, so something physical is happening there. Host: So, we’re talking visual, and auditory and physiological symptoms. What would be some of the indications that a person has delirium as opposed to another condition? Dr. Schreiber: So, it’s important to point out that those kinds of things you brought up are what a lot of people think of when they think of delirium, but delirium really is more nuanced than that.  It’s got a couple of clinical tests that can be done at the bed side to help make the diagnosis, but they’re all consistent in what they are.  Delirium is a condition that waxes and wanes, meaning it comes and goes.  Dementia is something that comes on and gradually happens over years and doesn’t necessarily just get better.  Delirium is something that can be there at 6 AM, and gone at noon and back again at 7 PM and gone at 2 AM and so the ongoing fluctuations like that are a key component. The second part is inattention.  The patient just can’t maintain focus.  And so, we test that by seeing if they can just do something that we’re asking them to do, uh, ten times.  You know, some of them being in the affirmative, meaning do it, and some of them not, meaning we say something and they’re not supposed to do it, but if they can’t maintain focus for those, that’s inattention, and that’s the second component. And the last part is disorganized thinking.  You might just call it confusion.  But the way that we test for this when it comes to disorganized thinking is we ask questions to a patient that really should have no question of what’s right and wrong. Things like, is ice cream cold? Is a mouse bigger than a giraffe?  Can you hit a nail with a hammer?  And when somebody has delirium, questions like that still become difficult for them to answer even though they sound like something anyone should be able to get right. Really, it’s hard to tell without actually doing the test.  There are people who can be completely oriented, can tell you the date, where they are, their name and be delirious.  And there are people who can be disoriented or have dementia or have changes in their ability to respond because of a stroke and not be delirious.  So, it really does come back to those key things of waxing and waning mental status, so it’s changing throughout the day, inattention, and disorganized thinking. Host: So, it sounds like different populations of people, different conditions for which they’re hospitalized in the ICU, can cause varying levels of delirium symptoms.  Is there a particular risk factor an individual might have that would make, say me as opposed to you, more susceptible? Dr. Schreiber: That has been shown. So, the older a person gets, the more likely they are to have delirium. The more ill the person is when they first come into the hospital, the more likely they are to have delirium. People that have a history of dependencies on different chemical substances, whether it’s things like alcohol or illicit drugs or even prescription medications, are more likely to have delirium. Whether if any one of those things is the absolute risk or not, hard to say. But it’s something we really should be looking for in every patient.  It’s also important to say this is not just an ICU thing.  It’s where a lot of it happens, in fact eight out of 10 people who end up on a breathing machine will have delirium at some point in their hospital stay. But half the people who never end up on a breathing machine can still be that way, and even just regular admissions to the hospital, what we call the medical/surgical floors or wards—up to a quarter of those people will have delirium during their stay, at some point. Host: So, this is a fairly common thing.  How many cases would you estimate that you see at MedStar Washington Hospital Center in a year? Dr. Schreiber: Hundreds. I think the better way to put it is how many people every day do we see having delirium?  We…we make it part of our rounds.  It’s something that the nurses do every single shift, is do a test - we call it a Cam ICU, confusion and agitation method in the ICU, to look at that series of questions. Has their mental status changed? We ask people, to basically squeeze my hand or blink your eyes or stick out your tongue.  Whatever they can do when I say the letter A, and then I spell out ‘save a heart,’ and heart is spelled wrong, it’s s a v e  a  h a a r t, and if they get more than two of those wrong, then we move on to disorganized thinking and ask them those simple yes, no questions, and can they follow a command. And if they can’t follow two separate commands and answer questions without more than two errors altogether, that’s delirium.  We check every patient in the ICU every single day, and when we find it, then that can actually change our plan of care.  Do we need to be more aggressive getting rid of a sedative?  Do we need to change that to something else, even if it, you know, we’re not sure it’s going to be as effective to help maintain a level of comfort. Or, is it a sign that something’s going wrong?  You know, when a patient’s in the hospital and has a fever, everyone says “oh, we need to figure out why that patient has a fever.”  If someone was normal yesterday and delirious today, that’s another sign that the brain is raising a red flag maybe something’s going on and that might be the first sign of an infection or a complication. Host: Is this something that patients have ever brought up in themselves and say, you know, “doctor, I just don’t feel right?” Or is this something that family members can also watch out for? Or caregivers? What’s their role? Dr. Schreiber: The patient’s usually not aware because it’s affecting their brain and so that level of noticing ‘hey, I’m different’ is one of the risk factors of the condition.  Family see it, they just not necessarily know what to call it. Why is my loved one not themselves?  Why did they act like they didn’t know who I was?  And the worry is, is this dementia? Is this permanent? Is—have they had a stroke? Is there something going on?  Is it any number of things?  They don’t necessarily come up and say, ‘I think my loved one’s delirious.’  But when we get those kind of questions, like ‘she was talking out of her mind this morning’ or ‘she couldn’t remember something I said to her fifteen minutes ago’ or something like that, those are red flags to that disorganized thinking. Host: Is there anything that a patient or a family member can do to decrease the risk for delirium? Dr. Schreiber: Absolutely. Being a familiar face, being able to redirect, being able to anchor that patient in what’s going on and help them stay focused, has been shown to help.  Having things like the whiteboards in our rooms that have today’s date and today’s nurse and today’s information, help reorient the patient.  Having things on the television in the room that have current, redirecting kind of issues.  Not necessarily dramatic things you might see on the news, but things that let people know of what’s going on now have been shown to help. And also, letting people get the rest they need.  You know, we do have an open ICU that allows visiting hours around the clock. But our goal is to let patients sleep at night and stay awake during the day. During the day, we try to be aggressive with pushing things forward as much as the patient can do and so family members can help by being encouraging for that. Helping keep the patient’s spirits up and when the patient’s saying things like “I just don’t know if I can do physical therapy today,” to ask them, “Are you sure?  How about a little, but can we help you?  Can we cheer you on?” You know, this is really gonna help you out by staying purposeful and active and moving forward because early mobilization and activity’s also been shown to reduce delirium. Host: Interesting. So, walking or getting up and participating in PT? Dr. Schreiber: Absolutely, and not just with the physical therapist. One of the things that we’ve been doing here for almost two years now in the medical ICUs is rolling out a bundle of things to help control, manage, and prevent delirium. This is called the ABCDEF bundle. It stands for assessing and addressing pain, because that’s important. When a patient is ‘quote un quote’ agitated, maybe it’s because they’re hurting, and if we can control that pain syndrome instead of just using something like a sedative, or an antipsychotic or something to calm them down, you might actually get two birds with that one stone, and reduce their risk, and help that issue. The B is for both the spontaneous awakening and breathing trial. So, people that are on a vent—mechanical ventilation, a breathing machine for life support - to every single day see, can they breathe on their own?  And, if they’re really sick, they’re going to declare that they can’t because they’ll breathe fast, and you can tell within a minute. But maybe they can, because if they can breathe on their own on that machine with some settings being changed, maybe they’re ready for that to come off and you get rid of another risk factor for delirium. The awakening trial is not just saying, let’s turn down any pain or sedative medications to see where we can get the patient awake and comfortable, but literally every single day to push stop on those machines and see if the patient needs it.  That’s been studied, and by always trying to adjust to just enough for the patient what they need was considered standard of care. By doing that but also once a day pushing pause on the machines, cut the number of days of continuous medications like that, cut the number of days on the vent, shortened the ICU stay, and did nothing to raise mortality or patient harm, and so the fear of ‘Well, I can’t push stop on this medicines that going through this IV pump, the patient will hurt themselves,’ never has actually been shown. In fact, continuing it longer seems to be what hurts people. The C is the choice in those medications.  Things called benzodiazepines.  At home, people might know this as Xanax, is one of those examples. Ativan is another example. That family of medicines has the most research behind it to lead to delirium than anything else we know. In fact, one study showed a direct relationship of the dose that you get of medicines in this family to having delirium within a day, and it doesn’t seem like much but relatively low doses ended up having a hundred percent of people having delirium that day, so we try to avoid those whenever we can.  Sometimes they’re needed. We use benzodiazepines when someone is seizing. We use them when someone’s in alcohol withdrawal.  But, a lot of times you can find something else.  The D is for delirium. To check it, because if you don’t look for it, you’re not going to find it. And that’s that test we call a Cam ICU.  The E is early mobilization activity, which might be physical therapy, but our nurses are fantastic. You know, we can sit somebody on the edge of the bed, let them use those core muscles to dangle their feet. We can move people to a chair because the sitting position uses different muscles than laying in bed, and we walk people. And we walk people.  You know, we get a physical therapist, a nurse, another nurse to help, if needed, and even if someone is still on a ventilator, still on a breathing machine, still on life support, we can walk them in the unit if they’re able, but we won’t know if we don’t check to see what they can do. And the F is family engagement and involvement.  Because it is important for family members to help us help that patient in a way that we can’t. As much as I might like my patients, I will never be that familiar face that they’ve known for years and years and years, at least I hope that I’m never that face. And that’s something we can’t reproduce. And so, we do try to invite families to rounds every day. If they can’t be there, we try to call them every day, and we really do try to encourage that engagement with the patient to help them move along. Host: Is there a risk for untreated delirium, or if somebody has it, can it resolve on its own? Dr. Schreiber: Most of the time patients, as they get better clinically, as whatever got them sick in the first place gets better, they’ll start to improve.  There are long term risks here though.  Being delirious on its own, even when you, what we call, adjust for other things, meaning you’re doing statistics to say how much does this cause that or associate with that, and you say ‘well, I’m going to take two people who are just as sick and one’s delirious and one’s not, how does, how does this outcome change,’ delirium’s been shown to increase mortality at six months. If it’s its own process being on its own, it’s more likely to kill you, which is why it’s so important to try to prevent it with those other things like getting out of bed, and less days on the vent and less sedation.  I mentioned the MRI studies a little bit earlier, that there’s something physically different happening in the brain and so, long term, patients that have had delirium tend to have more cognitive issues and functional issues and it can be something simple like more often saying ‘I was going to tell you something. I just can’t remember what that was’, but it can be life changing if now they can’t go back to work.  And icudelirium.org is a fantastic website for both patients and practicing clinicians and family members and everyone else to see testimonials from patients and caregivers and hospital professionals all talking about the long-term outcomes of this condition. It can be life altering and the worst part is, if no one was ever able to say ‘hey, you had this while you’re in the hospital’ because there are plenty of places that don’t check for it every day. Even in our institution, I can’t tell you that every single unit, every single nurse, every single day, checks for this. Then they go home and wonder ‘why am I different?’  And we have a long way to go to help support people at the back end of their illness, at the back end of the ICU after they’ve left, to try to give them every opportunity to get back to being themselves. Host: That’s really a lovely statement, I think, because yeah, I mean it’s traumatic enough being in the hospital, let alone being in the ICU after a traumatic event.  Is there a certain subset, say accident victims or surgery, you know, people that had complications with surgery, that you see delirium in more often or a certain age group? Dr. Schreiber: The older you are, the more likely you are to become delirious.  As far as the disease itself, I think the literature is just not there yet from the research.  It has been shown in burn ICUs, cardiac ICUs, surgical ICUs, medical ICUs, it doesn’t discriminate.  What we do know is it happens far more often if you are on a breathing machine, and that’s probably a mix of both - that means you’re sicker because if you’re on a form of life support to help you breathe, that’s pretty bad.  But also, what does oxygen do to you and your brain?  If you’ve ever been unfortunate enough to have a family member in a neonatal ICU or if you’ve ever worked near one of those, you know that they, as…as early and aggressively as possible, try to have that baby off of oxygen because of how it can affect your eyes and other things.  We always try to use it as little as possible but it has things that cause inflammation, it’s one of the effects, so could the vent itself do some of this?  We don’t know. The research isn’t there yet.  People who are septic -  there’s some studies that say there might be more delirium in that because of the way the whole body can become inflamed, including the brain, when the body is dealing with an infection and becoming septic.  But if there is one disease to do it, I don’t think we have that answer yet. Host: Have you ever seen a very severe case of delirium turn around and what was that process like? Dr. Schreiber: I have. I, I can distinctly remember a patient who, you’d walk past the room and looked like a normal guy.  Sitting in the chair awake, watching tv, and then you’d talk to him, and you’d hear from the nurse, ‘Well, overnight we had to, you know, give him something because he was agitated, or we had to calm him down,’ you know, even if it wasn’t with the medicines. So, right there you have waxing and waning mental status. And then you’d ask questions and he would give answers that just seemed a little off, and so you’d take the next step and ask him to squeeze your fingers when you say the letter a for all those letters, and get that wrong, and then ask him these disorganized think questions and get that wrong. And then something would come out and he, he was scared because that’s what he saw and that’s what he believed was going on, and you would never know this if you didn’t ask the right questions because he would talk to you like everything’s fine, until you got into what he was perceiving and seeing. And, you know, he acted like he was actually handling it ok, and it’s not a big deal but then you realize he’s delirious and that visual hallucination was one of the things his delirium was manifesting. He ended up doing well.  He left the hospital. I saw him in the clinic months later and he was trying to go back to work.  He ran his own business and said he was having some trouble doing the books, so to speak, but for as close as he came to death with what brought him in, it was a remarkable improvement, just not all the way to as good as you wish you could get if you survived a life-threatening illness. Host: Thank you for joining us today, Dr. Schreiber. Dr. Schreiber: Oh, it’s been my pleasure! Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Eric M. Stone, CEO & Co-Founder, Velano Vascular Eric M. Stone is the Chief Executive Officer and co-founder of Velano Vascular. A patient advocate and serial healthcare entrepreneur, Stone currently serves as National Trustee and a Committee Chair of the Crohn's and Colitis Foundation of America (CCFA). Prior to Velano, he served as Vice President of Sales and Marketing for Molecular Health, and earlier in his career launched a series of pioneering interventional cardiology devices for Abbott while based in Brussels, Belgium and California. Stone was a founding member of Model N's (NYSE: MODN) Life Sciences division, where he led marketing and business development. Stone began his career in Marketing with Trilogy Software, and has since co-founded social sector programs at Harvard and Wharton. He served for a decade on Harvard University's Alumni Association (HAA) Board of Directors. Stone is a Director of Vigilant Biosciences and an Advisor to multiple healthcare upstarts. Stone received an MBA from The Wharton School, a Master's from Harvard University, and a BA from the University of Pennsylvania. He lives with his wife and daughter in San Francisco. Pitou Devgon, CMO & Co-Founder, Velano Vascular Pitou Devgon is a physician entrepreneur, co-founder and Chief Medical Officer of Velano Vascular and the inventor of Velano Vascular's patented vascular device technology.Prior to co-founding Velano Vascular, Pitou spent several years in venture capital at Safeguard Scientifics, focused on medical devices, diagnostics and healthcare IT investing. Pitou was instrumental in closing several notable investments at the firm and held board or advisory roles at Crescendo Biosciences and Ben Franklin Technology Partners.During his medical training and business school he had valuable experiences in a variety of roles, including technology transfer and patent review at UPenn and a summer associate position in marketing at Medtronic. Pitou caught his entrepreneurial spirit while still in college as a dot-com entrepreneur in the collegiate web portal space by founding and directing the Student Information Network, which became Sinapse Consulting.In addition to his ongoing staff physician appointment in the Medical ICU at the Philadelphia VA Medical Center Pitou regularly guest lectures at UPenn and the Wharton School on topics of entrepreneurship and healthcare investing.Pitou holds a BA in biological psychology from the College of William & Mary, an MD from Eastern Virginia Medical School (EVMS) and an MBA from the Wharton School of the University of Pennsylvania.

  The 3 P's to PT Excellence w. Kyle Ridgeway Dr. Kyle Ridgeway, PT, DPT, is a senior physical therapist in the Medical ICU at the University of Colorado Hospital. I had him on the show to pick his brain on working with a frail population. This is a very helpful conversation for those of us wanting to challenge our patients in a thoughtful manner. Lots of gems in this one! -------------------- If you like what you hear, consider Joining the Senior Rehab Project to get access to: Monthly Mastermind Meetup Newsletter Private FB Group *For links & the other podcasts in the Senior Rehab Project, go to http://SeniorRehabProject.com

Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients

William Meadow, MD, PhD, is the lead author of an article published in the March Critical Care Medicine titled: Power and limitations of daily prognostications of death in the medical ICU