Podcast appearances and mentions of natalie may

Join hosts Iain Beardsell and Natalie May at the London Trauma Conference as they welcome Peter Brindley back to the St Emlyn's podcast. In this engaging episode, they delve into the nuances of social media, digital footprints, and the burgeoning influence of artificial intelligence in medicine. Brindley discusses the importance of maintaining an authentic digital presence and addresses the impact of misinformation and disinformation in the digital age. They explore the challenges and opportunities presented by AI in clinical decision-making and share insights on navigating this evolving landscape as healthcare professionals. Tune in for a thought-provoking conversation on staying relevant and responsible in a digitally-driven world. 00:00 Introduction and Welcome 01:40 Understanding Digital Footprint 03:53 Navigating Information and Misinformation 05:41 The Role of AI in Information Search 08:45 AI in Clinical Decision Making 15:28 The Kardashian Index and Social Media Influence 17:39 Conclusion and Final Thoughts

In this episode of the St Emlyn's Podcast, Iain Beardsell and Natalie May speak with Richard Lyon, an emergency doctor and deputy medical director of the air ambulance service at Kent, Surrey, and Sussex. Recorded at the London Trauma Conference 2024 in Kensington, Richard shares experiences and lessons from his talk on five critical cases that shaped him as a clinician and human being.   Discussion topics include the importance of case debriefing, the impact of video recording in clinical practice, overcoming the challenges of self-reflection, and the evolving culture of pre-hospital emergency medicine. Richard emphasizes the significance of supportive and structured debriefing processes and offers insights on integrating video reviews into emergency practices for improved education and reflection.   00:00 Introduction and Guest Welcome 00:37 Richard Lyon's Background and Talk Overview 01:00 The Importance of Case Learning and Debriefing 02:12 Challenges and Strategies in Case Learning 04:24 The Power of Video Recording in Clinical Practice 07:30 Implementing Video Recording: Practical Steps 08:24 Addressing Concerns and Building Trust 12:56 Senior Clinicians and Vulnerability 17:33 Supporting Pre-Hospital Clinicians 20:35 Conclusion and Final Thoughts   The Guest - Richard Lyon   Professor Lyon is an active UK NHS Consultant in Emergency Medicine and Pre-hospital Care in Edinburgh and Deputy Medical Director for Air Ambulance, Kent Surrey & Sussex. A globally recognised leader in pre-hospital and emergency medical care, Prof Lyon works for multiple world class organisations, helping to develop current and future state-of-the art medical devices, systems and concepts aiming to save lives across the globe. A respected clinical leader and senior medical advisor to both governments and global corporations, with a track record of delivering high quality output and success across clinical, academic, research and innovation. Prof Lyon was made a Member of the Most Excellent Order of the British Empire (MBE) by HM The Queen in the 2017 Honours, for Services to Emergency Healthcare, after he established a programme of work on out-of-hospital cardiac arrest for Scotland. Prof Lyon holds a personal Chair of Pre-hospital Emergency Care at the University of Surrey and has an established research portfolio in pre-hospital resuscitation and trauma care, with an extensive publication record. Prof Lyon is a current member of the Faculty of Pre-hospital Care and author of several international guidelines. Prof Lyon is a Physician with the UK International Search & Rescue Team.

In this episode of the St. Emlyn's podcast, hosts Iain Beardsell and Natalie May discuss hyperbaric medicine at the London Trauma Conference with Dr. Jeff Kerrie, an internal medicine physician from Canada. Dr. Kerrie provides insights into dive and hyperbaric medicine, covering the basics of hyperbaric therapy, its applications, and key practices for emergency departments when treating patients with decompression illness. The conversation also touches on misconceptions and unregulated uses of hyperbaric chambers, emphasizing the importance of consulting certified medical professionals. 00:00 Introduction to the Podcast and Guests 00:58 Understanding Hyperbaric Medicine 01:33 Dive Medicine and Decompression Illness 04:15 Emergency Response and Treatment Protocols 07:26 Hyperbaric Chamber Mechanics 10:05 Beyond Dive Medicine: Other Uses of Hyperbaric Therapy 11:43 Challenges and Misuses of Hyperbaric Therapy 12:38 Conclusion and Final Thoughts   The Guest For the last three years, Jeff Kerrie has served as the Island Health Medical Director of Quality, Safety, and Ethics. Dr. Kerrie has a master's degree in clinical bioethics from Clarkson University/Icahn School of Medicine at Mt. Sinai in New York. Over the last six years, Dr. Kerrie helped build the Island Health ethics program, where he has provided ethics consultations and teaching to staff, patients, and families. Dr. Kerrie underwent medical training at the University of Manitoba before completing residency in Internal Medicine at UBC. He practices as a general internist in Victoria, and is an Assistant Clinical Professor with the University of British Columbia and the University of Victoria. Other medical work has included medicine in atypical environments (including dive/hyperbaric medicine, ski patrol, and high altitude environments), obesity medicine, and international health. Dr. Kerrie is also a graduate of the Physician Quality Improvement program at Island Health. In his spare time Dr. Kerrie enjoys aviation, skiing, and SCUBA diving.  

In this episode, Iain Beardsell and Natalie May speak with neurosurgeon Mark Wilson at the London Trauma Conference. Mark provides an in-depth look at the evolution of the GoodSAM app over the past decade. Initially designed to alert off-duty trained individuals to assist in emergencies, particularly for cardiac arrests and impact brain apnoea, the app has grown to include applications in police services, public health during COVID-19, and community volunteer efforts.   It employs advanced technology, such as real-time video guidance and AI, to offer immediate assistance and improve outcomes in medical emergencies and other crises.   Mark's insights shed light on how this innovative platform is saving lives and transforming emergency and public response systems worldwide.   00:00 Introduction and Reunion   00:47 The GoodSAM App: A Decade of Evolution   01:52 GoodSAM's Impact on Cardiac Arrests   02:09 Expanding GoodSAM: Police and Community Involvement   02:35 How GoodSAM Works   05:54 GoodSAM's Role During COVID-19   13:42 The Future of GoodSAM: AI and Community Support   15:04 How to Get Involved with GoodSAM   16:26 Conclusion and Final Thoughts The Guest Mark is a Consultant Neurosurgeon and Pre-Hospital Care Specialist working at both Imperial College (mainly St Mary's Major Trauma Centre) and as an Air Ambulance doctor.  He am a Clinical Professor specialising in Brain Injury at Imperial and Honorary Professor of Pre-Hospital Care (the Gibson Chair) at the Faculty of Pre-Hospital Care, Royal College of Surgeons, Edinburgh.  His specialist areas are acute brain injury (mostly traumatic brain injury) and its very early management. He is co-director of the Imperial Neurotrauma Centre and am co-founder of GoodSAM, a revolutionary platform that alerts doctors, nurses, paramedic and those trained in basic life support to emergencies around them.  Mark have worked extensively overseas (India, Nepal, South Africa, as a GP in Australia, Researcher for NASA and as an expedition doctor on Arctic and Everest expeditions). He also wrote The Medics Guide to Work and Electives Around the World. His research is mainly into the brain in trauma and in hypoxia (using it as an injury model) in humans.

Welcome to our first episode recorded at the London Trauma Conference 2024. In this episode, hosts Iain Beardsell and Natalie May are joined by Matt Hooper from Adelaide to discuss his unique career path, from emergency medicine to pre-hospital and retrieval medicine, intensive care, and more recently, palliative and end-of-life care. The conversation centres around the principles of end-of-life care, particularly in acute and traumatic scenarios, and how these can be integrated with life-saving efforts. Key points include the challenges of shifting focus from survival to quality of death, the importance of recognizing and supporting witnesses and caregivers, and the concept of 'compassionate resuscitation.' Practical tools such as the 'pause' are also explored, aiming to humanize highly charged medical environments and potentially prevent burnout and PTSD among healthcare providers. 00:00 Introduction and Guest Welcome 01:00 Key Messages on Death and Palliative Care 02:12 Challenges in End-of-Life Care 03:20 Improving Quality of Death and Relationships 04:32 Emotional Impact on Care Providers 06:41 Navigating End-of-Life Conversations 12:17 Practical Applications in Intensive Care 16:41 The Pause: A Tool for Reflection 21:58 Conclusion and Final Thoughts The Guest - Matt Hooper Matt is an accomplished intensive care specialist with a diverse background in emergency medicine, prehospital & retrieval medicine, and palliative care. Notable for his leadership in developing critical care service models, he founded South Australia's MedSTAR Emergency Medical Retrieval Service. He has also co-authored a highly regarded case-based text book and held key teaching and examining roles nationally and internationally in prehospital and retrieval medicine. With a strong focus on high-performance teams working within high acuity, high consequence environments, Matt's expertise has also extended to human factors in healthcare, cardiothoracic intensive care, ECMO, and clinical ultrasound. More recently however, he has pivoted towards palliative and end of life care, pursuing a Master's degree at Cardiff University and consulting at Mary Potter Hospice in Adelaide. He is passionate about exploring new and innovative ways to prevent potentially avoidable suffering and enhance end of life outcomes for patients in acute care clinical environments.

In this episode of the St Emlyn's podcast, Iain Beardsell and Natalie May reflect on their experiences at the London Trauma Conference, a four-day event covering various aspects of trauma and pre-hospital care. They discuss key takeaways from sessions on cardiac arrest, including talks on perioperative cardiac arrest and the prognostication of cardiac arrest patients. The episode also delves into wellness in the medical field, featuring insights from senior emergency physician Rod McKenzie and pre-hospital expert Matt Hooper on practical psychosocial care. Additionally, the podcast highlights advancements in trauma care, defibrillation strategies, and the importance of correct pad placement and basic practices. The episode underscores the holistic approach to patient care and the significance of personal well-being for medical professionals. 00:00 Welcome to the St Emlyn's Podcast 00:52 Highlights from the London Trauma Conference 01:13 Cardiac Arrest Symposium Insights 03:53 Prognostication After Cardiac Arrest 06:44 Defibrillation Strategies and Basics 08:29 Wellness and Mental Health in Emergency Medicine 11:10 Palliative Care in Pre-Hospital Settings 12:32 Trauma Conference Highlights and Innovations 16:48 Poster Presentations and Stand-Up Science 17:58 Key Takeaways and Reflections 18:43 Closing Remarks

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The clue to these is very much in the Title – BRUE is a diagnosis in itself. Children often do weird stuff, but they rarely do weird scary stuff. In this talk, Jilly goes talks through how we can define these events as high and low risk and gives us tools to manage these patients (and their parents) Along with colleagues, Jilly has written a guideline for BRUE, the full version of which you can find here Jilly also mentions a flowchart from Peds Cases, which you can find here   There is also this superb blog post from Natalie May on the St Emlyn's website which accompanies this podcast, which goes through some really useful cases. As a Wessex ST7 in Paediatric Emergency Medicine (RCPCH), Jilly Boden currently works in Queen Alexandra Hospital (Portsmouth).  Her specialist interests include acute stabilisation and transfer of the critically ill patient, having spent a year with the 'Southampton & Oxford Retrieval Team' (SORT) and hopes to find a way of combining this with her future PEM career. Jilly has a passion for education, particularly 'PEM to the non-paediatrician', including international teaching of the tri-service military GPs, and being on the national committee to write a new standardised paramedic paediatric curriculum. In her free time (you know, apart from the kids and all that) she works as part of the track medical team for the 'British Motorcycle Racing Club', providing pre-hospital care to high velocity polytrauma patients in the 'golden hour' following collisions often exceeding 120mph. 

Kit Esuruoso (Bonnie & Clyde / Spring Awakening) co-hosts The West End Frame Show!Andrew and Kit discuss Vardy V Rooney: The Wagatha Christie Trial (Ambassadors Theatre), The Ocean at the End of the Lane (UK Tour, New Wimbledon Theatre) and Generation Games (White Bear Theatre) as well as the latest news about Jon M. Chu's film adaptation of Joseph, We Will Rock You, Stephanie J Block, Oliver! and lots more.Kit is an actor, investor and a dating content creator and coach. He is currently playing Sheriff Schmid and understudying Ted Hinton in the West End production of Bonnie & Clyde at the Garrick Theatre.Just a few of Kit's theatre credits include: Bernardo in West Side Story (Opera National Du Rhin), Otto / understudy Moritz in Spring Awakening (Almeida Theatre), Martin Luther King in Satyagraha (English National Opera),  Justin in Love Letters (Queens Theatre Hornchurch), Big Deal / understudy Riff in West Side Story (Royal Exchange), Craig / understudy Raymond in Tina (Original West End Cast), understudy Joe / Stevedore in Show Boat (West End / Sheffield Crucible) and The Last Days of Troy (Shakespeare's Globe).Kit won Best Actor at the Australian Screen Industry Network Awards for his performance as the title role in Akoni (One Love Films Bondi). He has worked extensively across film, television and radio. Next up, Kit will star in the brand new musical The Land of Might-Have-Been which is running in Buxton and Norwich this July. Follow Kit on Instagram: @kit_is_me  Bonnie & Clyde runs at the Arts Theatre until Saturday 20th May. The Land of Might-Have-Been runs at the Buxton International Festival 7th - 21st July and at the Norwich Theatre 15th - 30th July. Hosted by Andrew Tomlins. @AndrewTomlins32  Thanks for listening! Email: andrew@westendframe.co.uk Visit westendframe.co.uk for more info about our podcasts.  

On this UVA Speaks podcast, Julie Haizlip, M.D., a Clinical Professor of Nursing with a dual appointment in the School of Nursing and the School of Medicine, and Natalie May, an Associate Professor of Research in the School of Nursing at the University of Virginia, explain their research on the concept of mattering and how mattering impacts healthcare providers. Haizlip and May discuss how when we feel that we matter, we make a difference in the lives of others and thus, feel significant in our work. At a time when healthcare providers are reporting a high degree of burnout, the research suggests that creating a culture of mattering can be a protective measure to burnout. They also discuss how the sense of mattering can be fostered for all of us in our daily lives. Transcripts of the audio broadcast can be found here: www.rev.com/transcript-editor/s…loadFrom=SharedLink Julie Haizlip, MD, is a Clinical Professor of Nursing at the School of Nursing and holds a joint appointment as an Associate Professor of Pediatrics in the School of Medicine at the University of Virginia. Based on her experiences working in a collaborative healthcare environment, Haizlip has developed an interest in interprofessional education and practice. She serves as co-director of the UVA Center for ASPIRE (Academic Strategic Partnership for Interprofessional Research and Education) with Dr. Tina Brashers. Natalie May is an Associate Professor of Research at the School of Nursing at the University of Virginia and is a founding member of the UVA Center for Appreciative Practice. Certified as an appreciative inquiry facilitator and lead author of the book Appreciative Inquiry in Healthcare, she enjoys developing appreciative inquiry projects and teaching appreciative practice workshops at UVA and beyond. May is an experienced qualitative researcher with extensive experience in grant writing, program and curriculum development, and program evaluation.

 | #  | Artist  | Track Title  | 1  | BeBe Winans  | Thank You (M.A.W.12'' Mix)  | 2  | Urban Blues Project & Jay Williams  | Testify (Mousse T.'s Test-A-Dub)  | 3  | unknow artist  | Days Like this  | 4  | Donaeo  | Party Hard (Remix)  | 5  | Natalie May  | Sexy Sexy (All Up On Me)   | 6  | Ron Hall  | the-way-you-love-me-  | 7  | DJ MA1  | Im Right Here (DJ Naughty mix)  | 8  | Gangsta Princess  | Frontline-DJ Manic  | 9  | Black Coffee  | You Turn Me On Ft. Bucie  | 10  | Thommy Davis  | Nightrain(DJ Spen Dub)  | 11  | Perempay N' Dee  | Be Your Girl  | 12  | Invasion Records  | RISING SUN  | 13  | Hardsoul  | Self Religion (Believe In Me) (Hardsoul Reconstruction) Feat Fierce Ruling Diva  | 14  | D Malice  | Gabryelle (Urban Mix)  | 15  | DJ Luck & Shy Cookie  | Troublesome DJ MANIC ACCA  | 16  | D Malice  | Erotic Illusions (Malice_Edit)  | 17  | Supa D & Mr Taffa AMA Remix  | King and Queen (feat. LushKells)  | 18  | Dj Mystery  | Speechless Ft Natalie K  | 19  | Simbad  | SOUL FEVER   | 20  | Unkown  | Track 1 Revisited (Reel to Reel Mix)  | 21  | Jill Scott  | Golden (Wookie Vocal Mix)  | 22  | Manic | Fish go deep vs U Got It Bad  | 23  | Hardhouse Banton  | Sirens  | 24  | Sean Paul & Hard House Banton  | Temperature vs Sirens (The Heatwave Refix)  | 25  | Crazy Cusions  | Bongo Jam (Extended Mix)  | 26  | Hard house banton  | Colonel  | 27  | Fuzzy Logik  | The way you move  | 28  | unknow artist  | QUENTIN HARRIS - NELLY FERTARDO  | 29  | Black Coffee  | SUPERMAN - FEAT BUCIE  | 30  | DJ Kent feat. Malehloka Hlalele  | Falling (DJ Black Coffee Remix)  | 32  | Dennis Ferrer  | How Do I Let Go  | 33  | Ralf GUM feat. Monique Bingham  | Claudette (Ralf GUM Main Mix)  | 34  | Dennis Ferrer  | P 2 Da J  | 35  | Soulsearcher  | Can't Get Enough

I reached out to @medtwitter asking for help finding a guest to talk about the respiratory syncytial virus (RSV). It may seem weird to be talking about RSV when everyone is thinking about the current pandemic, but I find the virology and mechanism of symptoms of RSV exciting.   Twitter did not let me down, my friend Ashley Liebig recommended Natalie May from Sydney, HEMS. Natalie is an EM, and Pediatric-EM trained UK doctor working in Prehospital & Retrieval Medicine in Australia. I was very excited to have a chance to speak with Dr. May regarding RSV & Bronchiolitis and what the current evidence suggests for treatment.

Natalie May talks to critical care helicopter paramedic Libby Hanrahan about prehospital care to ask the all important question: what should we do if we stumble across a prehospital patient? Should we stop? Should we help? And how should we conduct ourselves? Like this content? Join us in person! Visit the website at resuscitology.com to find out more.

Champs black entertainment interviews Natalie who sang sexy sexy with rudimental, Natalie is a successful music artist currently following positive affirmation, Natalie is helping women heal and Rediscover their abilities check out her music

What can Prehospital and Retrieval Medicine teach us about life? Natalie May reflects on lessons learned at Sydney HEMS - from the practical to the philosophical. For more head to: codachange.org/podcasts

Simon Carley, Natalie May, Ash Leibig and Libby Hanrahan discuss how we can take the ideas, inspirations and thoughts from SMACCFORCE and put them into practice. How do we combat the attitude of "that's not how we do it" to open ourselves up to new ideas and processes? For more head to: codachange.org/podcasts

What can Prehospital and Retrieval Medicine teach us about life? Natalie May reflects on lessons learned at Sydney HEMS - from the practical to the philosophical.

2 Night Stay: Stories from the Gilman... Segment 8: Natalie May Dashett Screen Test (1936) ... Gretchen Violetta (vox); Ian Vaughn (vox); Falana Fox (vox); written and produced by Viktor Devonne ... please visit https://2nightstay.wordpress.com/ for transcription and information. This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental. Unless stated, all characters and material is the work and property of Viktor Devonne and White Elephant Burlesque Corp.  Original music "Cherry Blood" used with permission from Miss Cherry Delight.

On this EM Quick Hits podcast we have Natalie May on Kawasaki disease clues to diagnosis, Justin Morgenstern on suturing dog bites: the evidence, Anand Swaminathan on BVM prior to laryngoscopy, Michelle Klaiman on anticraving medications for alcohol use disorder and special guest Howard Ovens on managing ED violence with compassionate care... The post EM Quick Hits 3 – Kawasaki Disease, Suturing Dog Bites, BVM in RSI, Anticraving Meds for Alcohol Misuse, ED Violence appeared first on Emergency Medicine Cases.

On this EM Quick Hits podcast we have Emily Austin on organophosphate poisoning, Arun Sayal on malrotation of metacarpal fractures, Andrew Petrosoniak on pitfalls in abdominal stab wound management, Anand Swaminathan on tranexamic acid for non-massive hemoptysis, and Natalie May on pediatric IV cannulation tips and tricks... The post EM Quick Hits 2 Organophosphate Poisoning, TXA for Hemoptysis, Metacarpal Fracture Rotation, Abdominal Stab Wounds, Pediatric IV Cannulation appeared first on Emergency Medicine Cases.

EM Quick Hits is a brand new EM Cases podcast that contains 5 minute segments chosen from 10 specific topics by 10 different experts and educators. These topics are ones that either are not taught very well in training and/or that physicians tend to be not completely comfortable with. They include toxicology, trauma, ophthalmology, orthopaedics, resuscitation, human factors, addiction and pediatric emergencies. The EM Quick Hits Team is: Emily Austin, Peter Brindley, Chris Hicks, Michelle Klaiman, Anna MacDonald, Natalie May, Justin Morgenstern, Andrew Petrosoniak, Hans Rosenberg, Arun Sayal and Anand Swaminathan... The post EM Quick Hits 1 Massive PE, Gabapentin for Alcohol Withdrawal, Dental Avulsions, Pediatric Eye Exam, Best Resuscitation Fluid appeared first on Emergency Medicine Cases.

  November was a busy month for the St Emlyn's team with a variety of blogs on conferences, EBM, philosophy and education. Here's the podcast and the links to the blogs mentioned in November.   FeminEM part 2 with Natalie May https://www.stemlynsblog.org/fix18-part-two/    FeminEM part 3 with Natalie May https://www.stemlynsblog.org/fix18-part-three/    Dan Horner on the POLAR trial of hypothermia in brain injury https://www.stemlynsblog.org/jc-hypothermia-in-brain-injury-the-polar-trial-st-emlyns/    Zaf Qasim on whole blood in trauma https://www.stemlynsblog.org/whole-blood-in-trauma-st-emlyns/    Nick Smith on Cognitive Load theory https://www.stemlynsblog.org/education-theories-you-should-know-cognitive-load-theory-st-emlyns/    Claire Bromley on her experience on elective in Cape Town https://www.stemlynsblog.org/south-africa-as-a-medical-student-elective-claire-bromley/    Natalie May on why resuscitation is not sexy https://www.stemlynsblog.org/so-unsexy/    Learning in the social age with Simon Carley https://www.stemlynsblog.org/learning-in-the-social-age-st-emlyns-at-emerge10/    Salim Rezaie on Advanced ACLS - beyonfd the guidelines https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/   

Here's our round up of the best of the blog from October 2018. In Pursuit of Excellence with Natalie May from #stemlynsLIVE https://www.stemlynsblog.org/in-pursuit-of-excellence/ A FeminEM in NY with Natalie May Part 1. https://www.stemlynsblog.org/fix18-part-one/ JC: Cricoid Pressure, Do we still need it? Simon Carley https://www.stemlynsblog.org/jc-cricoid-pressure-and-rsi-do-we-still-need-it-st-emlyns/ Teaching and Learning in Stretched Environments with Simon Carley https://www.stemlynsblog.org/teaching-and-learning-in-stretched-environments-rsm-2018-st-emlyns/ Five free strategies to improve your resuscitations Simon Carley https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/ PTSD and me, EMDR therapy with Rusty Carroll https://www.stemlynsblog.org/ptsd-and-me-part-3-emdr-therapy-st-emlyns/  

What is New York City style resuscitation? Reuben Strayer and Scott Weingart honed their chops in public hospitals in America’s largest city, where patients come from every country, speak every language, and manifest every physiologic derangement on earth. Preferring to ask neither permission nor forgiveness, Reuben and Scott have long challenged emergency medicine and critical care orthodoxy and developed lateral (though sometimes divergent) strategies in their approach to problems that arise in the care of the sometimes unwashed masses who tend to avoid presenting to medical attention until they’ve fallen off the Frank-Starling curve. Topics that may be discussed (or argued) include the use of epinephrine, the use of noninvasive ventilation, the management of recently intubated patients, the use of ketamine as an induction agent with and without a paralytic, and decision-making in badly injured trauma patients. Ad hominem attacks will be defined and probably employed. Though Weingart has a physical and intellectual disadvantage against the bigger, stronger, quicker, younger, and better-looking Strayer, these disparities will be muted by Natalie May’s capable moderation.

Kris dives into the evil of Ketamine that we FOAM’ers seem to forget about. Ketamine may be the wonder drug, but it has a grave limitation that can’t be overlooked. Music: K is Good for You, Natalie May, FOAM RECORDS, @_NMay. Used in a truncated manner. CC BY-NC-SA 4.0 Catch all the conference goodies at: http://cbcemp.proboards.com/thread/73/

Chris Nickson, Natalie May and Simon Carley discuss simulation and educational theory on day 2 of the teaching course.

Our last podcast from the teaching course in Copenhagen #dasTTC. George Wills, Simon Carley, Natalie May, Jesse Spurr and Salim Rezzaie give the faculty perspective. The short version is we think and hope that the delegates learned something, but as a faculty we once again learned loads and met some amazing people. Roll on the next course. (hint they are in San Fransisco and Melbourne). S

Ms. Roberts and Dr. Pescatore discuss hot topics in the June issue, like Dr. Evie Marcolini’s article on how to choose which facility is best for stroke patients and a game-changer from Dr. Natalie May on buckle fractures. They also duke it out over the new Ottawa heart failure scale (Ms. Roberts likes it, but Dr. Pescatore not so much)! Stay tuned to the end for an interview with Dr. Roberts about cardiogenic syncope.

Paediatric major trauma is rare and terrifying. Seriously injured children need good care but a number of factors (the relatively unusual presentations, their size, the way they communicate, their parents..!) make looking after them feel a lot harder than it really is. So what do clinicians really need to know to look after paediatric major trauma? We need to understand differences in physiological responses to injury (and how these can fox our triage assessments), differences in patterns and mechanisms of injury (and how these correspond to the way we diagnose, image and manage injuries in children) and how we can best prepare ourselves to make sure we look after these children well.

The child with the reduced conscious level presents a unique challenge to the Emergency provider - how can we recognise normal sleepiness versus pathology? Natalie May reminds us that, even if it's after bedtime, we have to take the time to wake children up fully as part of our routine assessment. She then explores the common pathologies - 5MF! - we need to consider in children with a reduced conscious level and how we can figure out which one is in front of us.

Do we recognize shock early enough? How do we prioritize our interventions? How can we tell whether we’re making our patient better or worse?   World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues.  That’s it.  Our main focus is on improving our patient’s perfusion. Oxygen delivery to the tissues depends on cardiac output, hemoglobin concentration, the oxygen saturation of the hemoglobin you have, and the environmental partial pressure of oxygen. At the bedside, we can measure some of these things, directly or indirectly.  But did you notice that blood pressure is not part of the equation?  The reason for that is that blood pressure is really an indirect proxy for perfusion – it’s not necessary the ultimate goal. The equation here is a formality: DO2 = (cardiac output) x [(hemoglobin concentration) x SaO2 x 1.39] + (PaO2  x 0.003)     Shock CAN be associated with a low blood pressure, but shock is not DEFINED by a low blood pressure.     Compensated Shock: tachycardia with poor perfusion.  A child compensates for low cardiac output with tachycardia and a increase in systemic vascular resistance.     Decompensated Shock: frank hypotension, an ominous, pre-arrest phenomenon.   Shock is multifactorial, but we need to identify a primary cause to prioritize interventions.     How they "COHDe": Cardiogenic, Obstructive, Hypovolemic, and Distributive.   Cardiogenic Shock All will present with tachycardia out of proportion to exam, and sometimes with unexplained belly pain, usually due to hepatic congestion.  The typical scenario in myocarditis is a precipitous decline after what seemed like a run-of-the-mill URI. Cardiogenic shock in children can be from congenital heart disease or from acquired etiologies, such as myocarditis.  Children, like adults, present in cardiogenic shock in any four of the following combinations: warm, cold, wet, or dry. "Warm and Dry" A child with heart failure is “warm and dry” when he has heart failure signs (weight gain, mild hepatomegaly), but has enough forward flow that he has not developed pulmonary venous congestion.  A warm and dry presentation is typically early in the course, and presents with tachycardia only. "Warm and Wet" If he worsens, he becomes “warm and wet” with pulmonary congestion – you’ll hear crackles and see some respiratory distress.  Infants with a “warm and wet” cardiac presentation sometimes show sacral edema – it is their dependent region, equivalent to peripheral edema as we see in adults with right-sided failure. “Warm” patients – both warm and dry and warm and wet -- typically have had a slower onset of their symptoms, and time to compensate partially. Cool patients are much sicker. "Cold and Dry” A patient with poor cardiac output; he is doing everything he can to compensate with increased peripheral vascular resistance, which will only worsen forward flow.  Children who have a “cold and dry” cardiac presentation may have oliguria, and are often very ill appearing, with altered mental status. "Cold and Wet" The sickest of the group, this patient is so clamped down peripherally that it is now hindering forward flow, causing acute congestion, and pulmonary venous back-up.  You will see cool, mottled extremities. Cardiogenic Shock: Act Use point-of-care cardiac ultrasound: Good Squeeze? M-mode to measure fractional shortening of the myocardium or anterior mitral leaflet excursion. Pericardial Effusion? Get ready to aspirate. Ventricle Size? Collapsed, Dilated, Careful with fluids -- patients in cardiogenic shock may need small aliquots, but go quickly to a pressor to support perfusion Pressor of choice: epinephrine, continuous IV infusion: 0.1 to 1 mcg/kg/minute.  Usual adult starting range will end up being 1 to 10 mcg/min. Avoid norepinephrine, as it increases systemic vascular resistance, may affect afterload Just say no to dopamine: increased mortality when compared to epinephrine   Obstructive Shock Mostly one of two entities: pulmonary embolism or cardiac tamponade. Pulmonary embolism in children is uncommon – when children have PE, there is almost always a reason for it – it just does not happen in normal, healthy children without risk factors. Children with PE will either have a major thrombophilic comorbidity, or they are generously sized teenage girls on estrogen therapy. Tamponade -- can be infectious, rheumotologic, oncologic, or traumatic.  It’s seen easily enough on point of care ultrasound.  If there is non-traumatic tamponade physiology, get that spinal needle and get to aspirating. Obstructive Shock: Act Pulmonary embolism (PE) with overt shock: thrombolyse; otherwise controversial.  PE with symptoms: heparin. Tamponade: if any sign of shock, pericardiocentesis, preferentially ultrasound-guided.   Hypovolemic Shock The most common presentation of pediatric shock; look for decreased activity, decreased urine output, absence of tears, dry mucous membranes, sunken fontanelle.  May be due to obvious GI losses or simply poor intake. Rapid reversal of hypovolemic shock: may need multiple sequential boluses of isotonic solutions. Use 10 mL/kg in neonates and young infants, and 20 mL/kg thereafter. Hypovolemic Shock: Act Tip: in infants, use pre-filled sterile flushes to push fluids quickly.  In older children, use a 3-way stop cock in line with your fluids and a 30 mL syringe to "pull" fluids, turn the stop cock, and "push them into the patient. Titrate to signs of perfusion, such as an improvement in mental status, heart rate, capillary refill, and urine output. When concerned about balancing between osmolality, acid-base status, and volume status, volume always wins.  Our kidneys are smarter than we are, but they need to be perfused first.   Distributive Shock The most common cause of distributive shock is sepsis, followed by anaphylactic, toxicologic, adrenal, and neurogenic causes.  Septic shock is multifactorial, with hypovolemic, cardiogenic, and distributive components. Children with sepsis come in two varieties: warm shock and cold shock. Distributive Shock: Act Warm shock is due to peripheral vascular dilation, and is best treated with norepinephrine. Cold shock is due to a child’s extreme vasoconstriction in an attempt to compensate.  Cold shock is the most common presentation in pediatric septic shock, and is treated with epinephrine. Early antibiotics are crucial, and culture everything that seems appropriate.   Shock: A Practical Approach   "How FAST you FILL the PUMP and SQUEEZE" Sometimes things are not so cut-and-dried.  We'll use a practical approach to diagnose and intervene simultaneously. Look at 4 key players in shock: heart rate, volume status, contractility, and systemic vascular resistance. How FAST you FILL the PUMP and SQUEEZE First, we look at heart rate -- how FAST? Look at the heart rate – is it sinus?  Could this be a supraventricular tachycardia that does not allow for enough diastolic filling, leading to poor cardiac output?  If so, use 1 J/kg to synchronize cardiovert.  Conversely, is the heart rate too slow – even if the stroke volume is sufficient, if there is severe bradycardia, then cardiac output  -- which is in liters/min – is decreased.  Chemically pace with atropine, 0.01 mg/kg up to 0.5 mg, or use transcutaneous pacing. If the heart rate is what is causing the shock, address that first. Next, we look at volume status. How FAST you FILL the PUMP and SQUEEZE Look to FILL the tank if necessary.  Does the patient appear volume depleted?  Try a standard bolus – if this improves his status, you are on the right track. Now, we look at contractility. How FAST you FILL the PUMP and SQUEEZE Is there a problem with the PUMP?  That is, with contractility?  Is this in an infarction, an infection, a poisoning?  Look for signs of cardiac congestion on physical exam.  Put the probe on the patient’s chest, and look for effusion.  Look to see if there is mild, moderate, or severe decrease in cardiac contractility.  If this is cardiogenic shock – a problem with the pump itself -- begin pressors. And finally, we look to the peripheral vascular resistance. How FAST you FILL the PUMP and SQUEEZE Is there a problem with systemic vascular resistance – the SQUEEZE? Look for signs of changes in temperature – is the patient flushed?  Is this an infectious etiology?  Are there neurogenic or anaphylactic concerns?  After assessing the heart rate, optimizing volume status, evaluating contractility, is the cause of the shock peripheral vasodilation?  If so, treat the cause – perhaps this is a distributive problem due to anaphylaxis.  Treat with epinephrine. The diagnosis of exclusion in trauma is neurogenic shock.  Perhaps this is warm shock, both are supported with norepinephrine.  All of these affect systemic vascular resistance – and the shock won’t be reversed until you optimize the peripheral squeeze.   Summary The four take-home points in the approach to shock in children To prioritize your innterventions, remember how patients COHDe: Cardiogenic, Obstructive, Hypovolemic, and Distributive. Your patient's shock may be multifactorial, but mentally prioritize what you think is the MAIN case of the shock, and deal with that first. To treat shock, remember: How FAST You FILL The PUMP and SQUEEZE: Look at the heart rate – how FAST.  Look at the volume status – the FILL.  Assess cardiac contractility – the PUMP, and evaluate the peripheral vascular tone – the SQUEEZE. In pediatric sepsis, the most common type is cold shock – use epinephrine (adrenaline) to get that heart to increase the cardiac output. In adolescents and adults, they more often present in warm shock, use norepinephrine (noradrenaline) for its peripheral squeeze to counteract this distributive type of shock. Rapid-fire word association: Epinephrine for cardiogenic shock Intervention for obstructive shock Fluids for hypovolemic shock Norepinephrine for distributive shock References Agha BS, Sturm JJ, Simon HK, Hirsh DA. Pulmonary embolism in the pediatric emergency department. Pediatrics. 2013 Oct;132(4):663-7. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013; 41:580-637. Jaff MR et al. for the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; Apr 26;123(16):1788-830. Levy B et al. Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study. Crit Care Med. 2011; 39:450. Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care. 2013; 17:R246. Osman D, Ridel C, Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med. 2007; 35:64-8. Ventura AM, Shieh HH, Bousso A, Góes PF, de Cássia F O Fernandes I, de Souza DC, Paulo RL, Chagas F, Gilio AE. Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Crit Care Med. 2015;43(11):2292-302. This post and podcast are dedicated to Natalie May, MBChB, MPHe, MCEM, FCEM for her collaborative spirit, expertise, and her super-charged support of #FOAMed.  You make a difference.  Thank you. Undifferentiated Shock Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

Iain Beardsell and Natalie May talk you through a wise and safe approach to the child with moderate shortness of breath. Listen and learn from the St.Emlyn's team.

This week we review Dr. Natalie May's brilliant post on the St. Emlyn's blog, "When Sick Means Sick: Emesemantics and Vomiting in Kids"  in which she dissects emesis descriptors such as bilious, projectile, and coffee-ground. Then, we delve into core content on Neonatal Jaundice and Intussusception. Key Texts: Tintinalli (7e) Chapters 111, 124 ; Rosen's (8e) Chapter 172 As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

Breathless patients are a challenge in the ED. Shortness of breath can be a frightening presenting complaint for both patients and doctors. As always, think about the possible life threatening causes and actively rule them out. For breathless patients think especially about: Pneumonia Asthma/COPD Pulmonary Embolism Acute left ventricular failure Pneumothorax   Breathless Patients PodcastIn this podcast Iain and Simon discuss their approach to breathless patients in the ED which we hope will provide you with a good starting point.  For those of you who are more visual learners here is the video recorded a few years ago for SEMEP featuring our very own Iain Beardsell. http://vimeo.com/35310564   Take Home PointsOxygen should be used in the patient with shortness of breath and the patient monitored closely. Hypoxia kills Always rule out life threatening causes first These patients are sick - do not be afraid to ask advice from a senior colleague early Look for clues - you don't have to wait until the penultimate page of the story to solve the mystery. What have you learned about breathless patients? Oxygen - or no oxygen?? Oxygen administration is rarely a problem in the immediate and acute setting - and can save lives. So yes, when you first approach a patient who is short of breath, get that oxygen on while you make your assessment then think about the finer points of respiratory failure afterwards.  Where do I begin? A focused history, including asking the patient about previous conditions and whether they know what's going on! And then - initial assessment and examination including vital signs (especially respiratory rate), looking for clues as to the underlying cause of their breathlessness, remembering the five common causes.  What treatments might be useful? A small fluid bolus might help and carries relatively little risk; think about the need for nebulised bronchodilators for patients with asthma or COPD, and remember that antibiotics given early to patients with sepsis save lives. If the patient has pain we should definitely treat that too. Which investigations might help me find out more? A chest x-ray is often useful in patients who are short of breath; your ED seniors might be able to use bedside ultrasound to further ascertain the underlying pathology, so get help early! ECGs are often useful in these patients Blood gases can also provide lots of useful information - think carefully about whether you need arterial gases and if so, please use local anaesthetic. If nothing makes sense - get a blood sugar, remembering that metabolic disease may cause an acidosis, presenting with an increased respiratory rate (although not often true dyspnoea). And GET SENIOR HELP (including getting your seniors to assess you for those all-important workplace-based assessments; definitely start those early) Other resourcesChest RadiographsOne of the key investigations in patients with shortness of breath is the humble chest radiograph. There are some phenomenal FOAM resources for interpretation of CXRs (along with other XRs) at Radiology Masterclass. Well worth bookmarking for your ED shifts (but do ask a senior if you're unsure). Chest X-Ray Anatomy  -  Chest X-Ray Abnormalities  -  Chest X-Ray Systematic Approach Blood GasesThink! Do you really need an ABG? If the answer is yes, please use local anaesthetic! Your patients will thank you... Further Reading on Shortness of BreathThe Flipped EM Classroom - Shortness of Breath (with further links). Natalie May  

How does our approach to the paediatric patient and their family help or hinder us in critical care? Natalie May reveals all.

In this podcast we join Paediatric specialist Dr Natalie May and discuss childhood illness and the difference between meningitis and meningococcal meningitis.

Jellybean #5; Natalie May of St Emlyns at SMACC by Doug Lynch @TheTopEnd

Check out this firing show as im joined by 'Old Skool' host and MC 'Depeo' as he revisits his Dejavu Fm roots, and bubbles on this set quite nicely. On this show you'll also hear a world exclusive remix I did for Mistaken Identity for their vocal track 'Everything' being aired for the very first time, so that's more than one reason to take a listen..press play..!! This Podcast Features Material From The Likes Of Funkystepz, Mistaken Identity, Carnao Beats, DJ Seany B, Swindle, Natalie May, Derico, Aroop Roy, Shay & Sinista, Murdz 86, Mr Solo, Apple, Funk E Truce, DJ Whitecoat, Jae Elle, Deloopz, Jook 10, Mellow Bee, Sunday Roast, Tinyman, L.R. Groove, Bassboy And Of Course My Self; ‘Smoove Kriminal’. Remember To Search ‘Smoove Kriminal’ On iTunes And Subscribe To The Free Podcast. Tracklisting: For U – Funkystepz Feat. Lily McKenzie Love Strong – Carnao Feat. Kadey James Tell Me Would Ya – DJ Seany B Feat. Tonia (Smoove Kriminal Special) Had It - Swindle Feat. Natalie May The Remedy – Derico (Instrumental Mix) No More - Swindle Feat. Nadia Suliman (Smoove Kriminal Special) Underpurpled – Swede:art (Aroop Roy Remix) Musiek - Shay & Sinista You Will Get Air Pie - Murdz 86 / 86 Baby Riddim - DJ Whitecoat Feat Jae Elle Megatron – Jook 10 Tick Tock – Mellow Bee (VIP Mix) Spells Of Yoruba – Gel Abril (DJ Seany B Re-Edit) Mistaken Identity Feat. B.Dett - Everything (Smoove Kriminals 'Distant Sunset' Remix) (Exclusive) The Journey - Mistaken Identity Vibrate - Deloopz Occurance - Smoove Kriminal Badd Habits - Sunday Roast Come Through - Smoove Kriminal (Exclusive) Apple & Funk E Truce - Distant Relative Digi-Tek 2 – Smoove Kriminal (V.I.P. Mix) Dilemma - Beneath In My Zones - Mr Solo Feel Happy - Sunday Roast The Beginning - Jook 10 Fuse Bomb - Matt IQ Broken - Mr Solo Creeper V.2 - Swing Ting Beat Of Zen - Damu Mr Niagy - Sunday Roast Robot Wars - Mistaken Identity Blank - L.R. Groove Bipolar - Tinyman Drip Remix - Marcus Nasty & Bassboy Afrobass - Mr Solo Spanish Chick - Mr Turbo / Apex Level Recordings Other Links: Previous Shows/Podcasts: http://vulive.co.uk/author/smoovekriminal/ www.smoovekriminal.com www.soundcloud.com/smoovekriminal www.myspace.com/smoovekriminal www.facebook.com/smoovekriminal www.twitter.com/smoovekriminal Playing The Best In UK House & UK Funky Every Friday Evening (18:00-20:00) GMT Time.