Podcasts about ohca

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation.The chance of successful defibrillation decreases every minute that passes.How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes.The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Story at-a-glance Survival rates for cardiac arrest victims go down by 10% with each minute of delay Only 42% of bystanders perform cardiopulmonary resuscitation (CPR) in public settings despite over 350,000 Americans experiencing out-of-hospital cardiac arrests (OHCA) annually Hands-only CPR (100 to 120 compressions per minute, 2 inches deep) is recommended for untrained bystanders, while health care workers should use the 30-to-2 compression-to-breath ratio Immediate actions during cardiac arrest include calling emergency services, locating an automated external defibrillator if available, and beginning CPR promptly without hesitation Heart attacks (arterial blockages affecting blood flow) differ from cardiac arrest (electrical problem causing arrhythmia), though heart attacks sometimes lead to cardiac arrest

The JournalFeed podcast for the week of April 21-25, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:This preplanned subgroup analysis of the TOMAHAWK Trial of patients with ROSC after OHCA found no EKG findings (excluding STEMI) that predicted the presence of coronary artery lesions.Thursday Spoon Feed:In this substudy of the Canadian TIA Score cohort, researchers found score utilization with subsequent MRI imaging could improve the outcome of patients suffering from TIA or stroke, particularly in the medium-risk category, scoring between 4-8 points.

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation.The most common dysrhythmia present during the first few minutes of cardiac arrest.The chance of successful defibrillation decreases every minute that passes.How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Welcome to Episode 44 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 44 of “The 2 View” – The Pitt, Cardiac Arrest in Young People, and Influenza Associated Encephalopathy. Segment 1 – Fraud and Conspiracy and Schemes, Oh My! Florida Physician Assistant Pleads Guilty to a $7.3 Million Health Care Fraud Conspiracy. United States Attorney's Office: District of New Hampshire. United States Department of Justice. Justice.gov. December 3, 2024. https://www.justice.gov/usao-nh/pr/florida-physician-assistant-pleads-guilty-73-million-health-care-fraud-conspiracy Nurse Practitioner Sentenced To Five Years In Prison For $11.2 Million Disability Loan Fraud Scheme. United States Attorney's Office: Sothern District of New York. United States Department of Justice. Justice.gov. February 5, 2025. https://www.justice.gov/usao-sdny/pr/nurse-practitioner-sentenced-five-years-prison-112-million-disability-loan-fraud The Board of Certification for Emergency Nursing. BCEN. February 17, 2023. http://www.bcen.org Segment 2 – Prehospital Tourniquet Application Rittblat M, Gendler S, Tsur N, Radomislensky I, Ziv A, Bodas M. The cost of saving lives: Complications arising from prehospital tourniquet application. WILEY Online Library. Acad Emerg Med. December 16, 2024. https://onlinelibrary.wiley.com/doi/10.1111/acem.15070 The Center for Medical Education. 2 View: Emergency medicine PAs & NPs: 41 - RCVS and CVT, CPR Care Science, Prehospital Tourniquets, Blood Pressure. 2 View: Emergency Medicine PAs & NPs. January 22, 2025. https://2view.fireside.fm/41 Segment 3 – Cardiac Arrest in Young People Chia MYC, Lu QS, Rahman NH, et al. Characteristics and outcomes of young adults who suffered an out-of-hospital cardiac arrest (OHCA). NIH: National Library of Medicine – National Center for Biotechnology Information. PubMed. Resuscitation. February 2017. https://pubmed.ncbi.nlm.nih.gov/27923113/ Parekh S. Teen athlete saved after cardiac arrest speaks out: What to know about lifesaving role of CPR, AEDs in schools. GMA. ABC News. September 6, 2024. https://www.goodmorningamerica.com/wellness/story/teen-athlete-saved-after-cardiac-arrest-speaks-lifesaving-113460919 The Center for Medical Education. 2 View: Emergency medicine PAs & NPs: 42 - Pink Cocaine, Holiday Heart Syndrome, Pertussis, Research Updates, and More! 2 View: Emergency Medicine PAs & NPs. February 12, 2025. https://2view.fireside.fm/42 Tseng Z, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA Network. Jamanetwork.com. February 20, 2025. https://jamanetwork.com/journals/jama/article-abstract/2830678 Segment 4 – Influenza Associated Encephalopathy Fazal A, Reinhart K, Huang S, et al. Reports of Encephalopathy Among Children with Influenza-Associated Mortality - United States, 2010-11 Through 2024-25 Influenza Seasons. CDC: Morbidity and Mortality Weekly Report (MMWR) Morb Mortal Wkly Rep. February 27, 2025. https://www.cdc.gov/mmwr/volumes/74/wr/mm7406a3.htm Surtees R, DeSousa C. Influenza virus associated encephalopathy. NIH: National Library of Medicine – National Center for Biotechnology Information. PMC: PubMed Central. Arch Dis Child. June 2006. https://pmc.ncbi.nlm.nih.gov/articles/PMC2082798/ Segment 5 – The Pitt Max. The Pitt | official trailer | Max. Accessed March 27, 2025. https://www.youtube.com/watch?v=ufR_08V38sQ The Pitt. Max. Accessed March 27, 2025. https://www.max.com/shows/pitt-2024/e6e7bad9-d48d-4434-b334-7c651ffc4bdf Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Ready for the latest insights in prehospital care? The new Prehospital Emergency Care (PEC) Podcast, Episode 148 (Vol 28, Number 6), has dropped! This episode explores vital findings published in the Prehospital Emergency Care Journal, Volume 28, Number 3. We're tackling essential themes for every prehospital clinician: Fluids, Vascular Access, and Resuscitation Strategies. Get the breakdown on significant research, such as the study "Retrospective Comparison of Upper and Lower Extremity Intraosseous Access During Out-of-Hospital Cardiac Arrest Resuscitation" authored by Tanner Smida, Remle Crowe, Jeffrey Jarvis, Taylor Ratcliff, and Mat Goebel. Learn about the nuances of IO access in OHCA! Don't miss this important discussion. Check out PEC Podcast Episode 148 today! Available now on your favorite podcast platform.   As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@aweberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD

Podcast summary of articles from the February 2025 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include ECPR, supraglottic airway devices, environmental factors in out of hospital cardiac arrest, pediatric admissions, Bechet's disease, and auricular hematomas.  Guest speaker is Dr. John Bennison.

On this month's EM Quick Hits podcast: Stephen Freedman on pediatric bloody diarrhea, S-TEC and hemolytic uremic syndrome, Justin Morgenstern on the evidence for IM epinephrine in out of hospital cardiac arrest, Matthew McArther on recognition and ED management of dengue fever, Andrew Petrosoniak on imaging decision making in trauma in older patients, Brit Long & Michael Gotlieb on recognition and management of TTP...Please consider a donation to EM Cases to help ensure continued Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/

New! Download the JournalFeed iPhone app!The JournalFeed podcast for the week of March 3-7, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:Guidelines recommended low molecular weight heparin (LMWH) for most patients with acute pulmonary embolism (PE), but we often choose unfractionated heparin (UFH). Here's why...Friday Spoon Feed:This pre-planned secondary analysis compared OHCA patients who received a single dose of epinephrine to standard ACLS epinephrine dosing and found mixed results in the outcomes of ROSC and survival to hospital discharge. Strap in for this nuanced article summary.

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Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

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Finally, the journal club to rule ALL journal clubs. In this episode of The Poison Lab, we tackle one of the biggest topics in emergency medicine and toxicology: Should naloxone be given during opioid-associated cardiac arrest? With three fantastic studies published in 2024, we're diving into the data and hearing directly from the authors themselves.Join host Ryan Feldman as he interviews Dr. Eric Quinn, Dr. Joshua Lupton, and Dr. David Dillon, some of the minds behind the latest research exploring the role of naloxone in out-of-hospital cardiac arrest (OHCA). With perspectives ranging from clinical outcomes to practical implementation, this episode offers a deep dive into what these studies tell us—and what remains unanswered.But that's not all! Featuring special guests Spencer Oliver and Chris Pfingston from EMS 2020, this roundtable discussion incorporates the real-world insights of prehospital EMS professionals who face these decisions every day. Together, the panel unpacks:Conflicting evidence on naloxone's impact on ROSC and survival.The challenges of interpreting retrospective studies in a high-stakes setting.Ethical dilemmas surrounding randomized trials for naloxone.Practical considerations for paramedics and emergency physicians in the field.Whether you're a toxicologist, EMS professional, or just curious about the intersection of drugs, overdose, and resuscitation, this episode is packed with actionable insights, expert opinions, and engaging discussions.Tune in now to explore the science, controversy, and future directions for naloxone in cardiac arrest care!Studies discussed in the showOutcomes of Out-of-Hospital Cardiac Arrest Patients Who Receive Naloxone in an EMS System with a High Prevalence of Opioid Overdose – Dr. Eric Quinn.Association of Early Naloxone Use with Outcomes in Nonshockable Out-of-Hospital Cardiac Arrest – Dr. Joshua Lupton.Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrest in Northern California – Dr. David Dillon.Studies and guidelines mentioned Editorial by Dr. Lavonas on Dr. Lupton's study AHA 2023 Guidelines for poisoning cardiac arrestAHA 2021 Position statement on opioid overdose out of hospital cardiac arrest Study of opioid overdose death after bystander naloxone training mentioned by ToxoShows mentionedChris and Spencer's excellent EMS showRyan's Interview on Poisoning Cardiac Arrest Guidelines with Dr. Eric LavonasJournal club with Ryan and Dr. Dillon Timestamps and chaptersIntroduction (0:00–12:25)Podcast

Una revisión sistemática y metanálisis reciente publicada en Resuscitation nos ofrece nueva información que impacta directamente en cómo enseñamos y practicamos en entornos prehospitalarios y hospitalarios el acceso vascular intraóseo (IO) versus el intravenoso (IV). ¿Qué significa esto para los protocolos como ACLS, PALS y PHTLS? El Estudio: ¿Qué se Investigó y Por Qué Importa? En entornos de paro cardíaco, el acceso vascular rápido y eficaz es esencial para administrar medicamentos que pueden salvar vidas, como epinefrina y antiarrítmicos. La vía intravenosa (IV) ha sido el estándar de oro, pero puede ser difícil de obtener, especialmente en circunstancias prehospitalarias. Aquí es donde entra la vía intraósea (IO), una técnica que ofrece acceso rápido en huesos largos como la tibia proximal o el húmero proximal. Un reciente metanálisis evaluó la efectividad clínica del acceso IO frente al IV en adultos con paro cardíaco prehospitalario (OHCA). El análisis incluyó tres ensayos clínicos aleatorizados con más de 9,300 pacientes y examinó desenlaces críticos como la supervivencia a 30 días, el retorno de circulación espontánea (ROSC) y los resultados neurológicos. Resultados clave: La vía IO no mejoró la supervivencia a 30 días frente al acceso IV (OR 0.99). Tampoco mostró superioridad en desenlaces neurológicos favorables. El acceso IO tuvo menos probabilidades de lograr ROSC sostenido (OR 0.89). Sin embargo, ofreció tiempos de administración de medicamentos comparables, especialmente útil cuando el acceso IV no es posible. Esto plantea preguntas importantes: ¿Deberíamos priorizar siempre el acceso IV? ¿Qué rol tiene la vía IO en el manejo prehospitalario e intrahospitalario? Conexión con ACLS, PALS y PHTLS Los cursos de ACLS (Advanced Cardiovascular Life Support), PALS (Pediatric Advanced Life Support) y PHTLS (Prehospital Trauma Life Support) son pilares en la educación de profesionales de emergencias. Cada uno aborda el acceso vascular en sus respectivos contextos, pero las recomendaciones del estudio aportan matices que pueden enriquecer nuestra práctica clínica. ACLS: Perspectiva en Adultos ACLS enfatiza la importancia de establecer acceso vascular rápidamente para administrar medicamentos como la epinefrina durante el manejo avanzado del paro cardíaco. La guía de la AHA (American Heart Association) señala que: El acceso IV es preferido debido a su eficacia. Si el acceso IV no puede lograrse en 90 segundos, la vía IO es la mejor alternativa. Correlación con el estudio: Los hallazgos refuerzan la preferencia por el acceso IV, particularmente porque está asociado con mejores tasas de ROSC sostenido. Sin embargo, el IO sigue siendo fundamental en situaciones donde el acceso venoso periférico es difícil o inviable, especialmente en sistemas prehospitalarios con limitaciones de tiempo o recursos. PALS: Niños y Acceso Vascular En PALS, el acceso vascular rápido es igualmente crítico, pero los desafíos técnicos se amplifican en pacientes pediátricos debido al tamaño de las venas y el estado hemodinámico comprometido. Las guías recomiendan: Priorizar el acceso IV, pero no dudar en usar IO si es necesario. Relevancia del estudio: Aunque el metanálisis se centró en adultos, los resultados pueden extrapolarse parcialmente a niños mayores o adolescentes. Esto resalta la importancia de entrenar a los equipos pediátricos en ambas técnicas y asegurar que el acceso IO sea ejecutado con competencia cuando sea necesario. PHTLS: Soporte Vital en Trauma Prehospitalario En el entorno prehospitalario, como lo aborda PHTLS, el acceso vascular rápido puede ser aún más desafiante debido a condiciones como trauma severo, hipovolemia y paro prolongado. Aquí, el acceso IO es una herramienta crítica, particularmente en pacientes con colapso venoso. Impacto en PHTLS: El acceso IO demuestra su utilidad en situaciones de trauma donde el acceso IV no es factible. Por ejemplo, en pacientes con hemorragia masiva, el IO puede ser la única opción viable para administrar fluidos y medicamentos. El estudio subraya que, aunque la vía IV es ideal, la IO sigue siendo una técnica esencial en el arsenal prehospitalario, especialmente cuando cada segundo cuenta. ¿Por qué el acceso IO estuvo asociado a menor RCE? Los autores del metanálisis sugieren varias hipótesis que podrían explicar por qué el acceso intraóseo (IO) mostró una menor probabilidad de retorno de circulación espontánea (ROSC) sostenido en comparación con el acceso intravenoso (IV). Estas teorías están basadas en factores técnicos, fisiológicos y logísticos relacionados con el uso del IO en el contexto del paro cardíaco. A continuación, se detallan los puntos clave mencionados o inferidos: 1. Distribución subóptima de medicamentos Una de las hipótesis principales es que la administración de medicamentos a través de la vía IO puede resultar en una distribución menos eficiente en comparación con el acceso IV. Esto se debe a que los medicamentos administrados por IO deben pasar primero por la médula ósea, lo que podría ralentizar su absorción y disminuye la biodisponibilidad en el sistema circulatorio central. En particular, en el paro cardíaco, donde la perfusión tisular está gravemente comprometida, es posible que la circulación central no sea adecuada para transportar rápidamente los medicamentos desde el sitio IO hacia el corazón y el cerebro​​. 2. Diferencias en las presiones del flujo sanguíneo El acceso IO implica inyectar medicamentos en la médula ósea, donde la presión local puede variar significativamente dependiendo de factores como el sitio de inserción (p. ej., tibia proximal vs. húmero proximal). Si la presión dentro de la médula ósea no es suficiente para permitir un flujo eficiente hacia la circulación central, esto podría comprometer la eficacia de los medicamentos administrados​. 3. Posibles complicaciones técnicas Aunque la tasa de éxito inicial de colocación de IO fue alta (~94%), existe el riesgo de problemas técnicos, como: Mal posicionamiento de la aguja, lo que podría causar infiltración de medicamentos en los tejidos circundantes en lugar de ingresar a la médula ósea. Fallas en la confirmación del flujo libre (un paso crítico para verificar la correcta colocación del dispositivo IO). Interrupciones mecánicas o flujo restringido debido a la posición del paciente o a movimientos durante el transporte​. 4. Diferencias en los sitios de inserción Los estudios incluidos en el metanálisis utilizaron diferentes sitios de inserción para el acceso IO, como el húmero proximal o la tibia proximal. El acceso a través del húmero proximal generalmente proporciona un flujo más rápido hacia el corazón debido a la proximidad anatómica, pero no siempre fue el sitio elegido. Esto podría haber afectado los resultados observados en términos de ROSC sostenido​​. 5. Fisiopatología del paro cardíaco Durante el paro cardíaco, el flujo sanguíneo general está gravemente reducido, lo que limita la capacidad del sistema circulatorio para transportar medicamentos desde el sitio IO hacia los órganos diana, como el corazón y el cerebro. En este contexto, la vía IV, que administra directamente a las venas periféricas, podría ser más efectiva para proporcionar un acceso más directo y rápido​. 6. Impacto del tiempo de colocación y administración Aunque el tiempo de administración fue comparable entre IO e IV en los estudios analizados, cualquier retraso adicional en confirmar la correcta colocación o en administrar medicamentos a través del IO podría haber influido negativamente en la eficacia de los tratamientos, reduciendo las tasas de ROSC sostenido​. Implicaciones para la práctica clínica Los hallazgos resaltan la importancia de: Priorizar el acceso IV siempre que sea posible, dado su mejor desempeño en términos de ROSC sostenido. Entrenar al personal en el uso óptimo de dispositivos IO, incluyendo la elección adecuada del sitio de inserción (p. ej., húmero proximal) y la confirmación del flujo libre. Considerar las limitaciones fisiológicas del acceso IO al administrar medicamentos críticos durante el paro cardíaco. En resumen, la menor probabilidad de ROSC sostenido asociada al acceso IO parece deberse a una combinación de factores técnicos y fisiológicos. A pesar de esto, el acceso IO sigue siendo una herramienta crucial en situaciones donde el acceso IV no es factible o está significativamente retrasado. Fortaleciendo la Educación y el Entrenamiento Una de las lecciones clave de este análisis es la necesidad de entrenar a los equipos médicos en ambas técnicas para garantizar una ejecución precisa y rápida. Tanto ACLS como PHTLS ya incluyen módulos prácticos sobre el acceso IO, pero los resultados del estudio sugieren varias áreas de mejora: Competencia en la Identificación de Sitios IO: La tibia proximal y el húmero proximal fueron los sitios más utilizados en los estudios. Entrenar a los proveedores para seleccionar rápidamente el sitio óptimo según la anatomía del paciente y la situación clínica puede mejorar la eficacia. Minimización de Errores en IO: Aunque la tasa de éxito inicial de colocación IO fue alta en el estudio (~94%), esto no garantiza una administración efectiva de medicamentos. Por lo tanto, el entrenamiento debe incluir estrategias para verificar la colocación correcta y solucionar problemas comunes. Integración de Protocolos Locales: Los sistemas de emergencias médicas deben adaptar las recomendaciones a su contexto. Por ejemplo, en áreas rurales donde el acceso IV puede ser más difícil, la vía IO puede ser priorizada. Simulaciones Realistas: La incorporación de simuladores avanzados en los cursos de ACLS y PHTLS puede ayudar a los equipos a practicar en escenarios que imiten la complejidad de los entornos prehospitalarios e intrahospitalarios. Consideraciones Operacionales para Entornos Prehospitalarios Los sistemas de emergencias médicas varían significativamente en recursos y capacitación. Algunos factores clave para considerar al implementar estas recomendaciones incluyen: Tiempo vs. Eficiencia: En el estudio, el acceso IO tuvo tiempos de administración comparables al IV (~15 minutos). Sin embargo, la efectividad del IO para lograr ROSC sostenido fue menor. Esto resalta la importancia de evaluar cuidadosamente las circunstancias antes de decidir qué vía utilizar. Capacitación Universal: La disponibilidad de dispositivos IO varía entre sistemas. Asegurarse de que todos los equipos prehospitalarios estén capacitados en el uso de dispositivos IO, puede reducir las disparidades en el cuidado. Uso de Checklists: Protocolos estandarizados y listas de verificación pueden garantizar que los pasos críticos, como la confirmación de flujo libre en dispositivos IO, no se pasen por alto. Conclusión El metanálisis confirma que la vía intravenosa sigue siendo la opción preferida para el acceso vascular durante un paro cardíaco, pero destaca el valor del acceso intraóseo en entornos prehospitalarios o cuando el acceso IV no es posible. La integración de estas recomendaciones en cursos como ACLS, PALS y PHTLS refuerza la necesidad de entrenar a los proveedores para manejar con competencia ambas técnicas. Referencias K. Couper, L.W. Andersen, I.R. Drennan, B.E. Grunau, P.J. Kudenchuk, R. Lall, E.J. Lavonas, G.D. Perkins, M.F. Vallentin, A. Granfeldt, On behalf of the International Liaison Committee on Resuscitation Advanced Life Support Task Force, Intraosseous and intravenous vascular access during adult cardiac arrest: a systematic review and meta-ana

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In this episode, we discuss the challenges involved in the management of an obese patient admitted to intensive care after OHCA.  

Date: November 10, 2024 Reference: Couper et al. The Paramedic 3 Trial: A randomized clinical trial of drug route in out-of-hospital cardiac arrest. October 31, 2024 NEJM Access to the SGEM Podcast episode at this LINK. Guest Skeptic: Missy Carter is a PA currently practicing in critical care after having attended the University of Washington’s […] The post SGEM#462: Spooky Scary Access – IV or IO for OHCA first appeared on The Skeptics Guide to Emergency Medicine.

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

Contributor: Aaron Lessen MD Educational Pearls: Can opioids cause cardiac arrest? Opioids can cause respiratory suppression and the subsequent low oxygen levels can lead to arrhythmias and eventually cardiac arrest. In 2023, 17% of out-of-hospital cardiac arrests (OHCA) were attributable to opioids. Given that this is a rising cause of cardiac arrest, should we just treat all cardiac arrest with naloxone (Narcan)? Naloxone is correlated with an increased chance of return of spontaneous circulation (ROSC) Additionally, a wide variety of individuals can be exposed to opioids and therefore opioid overdose should be considered in all cases of OHCA But does naloxone improve neurologic outcomes? Yes, naloxone, especially when given early on in the resuscitation can improve neuro outcomes What is the dose? 2-4 mg IN/IV depending on access. High suspicion for opioid overdose consider going with an even higher dose such as 4-8 mg IN/IV References Orkin, A. M., & Dezfulian, C. (2024). Recognizing the fastest growing cause of out-of-hospital cardiac arrest. Resuscitation, 198, 110206. https://doi.org/10.1016/j.resuscitation.2024.110206 Quinn, E., & Du Pont, D. (2024). Naloxone administration in out-of-hospital cardiac arrest: What's next?. Resuscitation, 201, 110307. https://doi.org/10.1016/j.resuscitation.2024.110307 Saybolt, M. D., Alter, S. M., Dos Santos, F., Calello, D. P., Rynn, K. O., Nelson, D. A., & Merlin, M. A. (2010). Naloxone in cardiac arrest with suspected opioid overdoses. Resuscitation, 81(1), 42–46. https://doi.org/10.1016/j.resuscitation.2009.09.016 Wampler D. A. (2024). Naloxone in Out-of-Hospital Cardiac Arrest-More Than Just Opioid Reversal. JAMA network open, 7(8), e2429131. https://doi.org/10.1001/jamanetworkopen.2024.29131 Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce MS1 & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of 80% or more.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Back in episode 80 we discussed a feasibility study out of Salt Lake City that showed IM epi resulted in 3-minute faster administration in cardiac arrest. It was underpowered to show survival, however. Fortunately, the great folks in Salt Lake City is back with a larger bite at the statistical apple. Dr Jarvis discusses the background around what we know about epinephrine in cardiac arrest (briefly, for once), walks us through this new study, and puts it in context of modern clinical practice. Citations.1. Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST: Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024;August;201:110266.2. Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, et al.: A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018;August 23;379(8):711–21.3. Okubo M, Komukai S, Callaway CW, Izawa J: Association of Timing of Epinephrine Administration With Outcomes in Adults With Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2021;August 10;4(8):e2120176.4. Hubble MW, Tyson C: Impact of Early Vasopressor Administration on Neurological Outcomes after Prolonged Out-of-Hospital Cardiac Arrest. Prehosp Disaster Med. 2017;June;32(3):297–304.5.  Pugh AE, Stoecklein HH, Tonna JE, Hoareau GL, Johnson MA, Youngquist ST: Intramuscular adrenaline for out-of-hospital cardiac arrest is associated with faster drug delivery: A feasibility study. Resuscitation Plus. 2021;September;7:100142.

The JournalFeed podcast for the week of Sept 2-6, 2024.JournalFeed wants your feedback!! Tap here for a brief survey!! (

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation (VF).The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

This week on Inside EMS, our cohosts discuss a recent study out of UC Davis Health that highlights the benefits of using naloxone in opioid-associated out-of-hospital cardiac arrest response. Chris and Kelly discuss the results and debate how this knowledge could impact OHCA protocols. Top quotes “If you look at the … survival of hospital discharge, the number needed to treat was 26. So 1 in 26 patients you would do this to has a chance of surviving the hospital discharge. That's pretty compelling. It's going to change my practice.” — Kelly Grayson “It's obviously needed information considering how bad the opioid overdose epidemic is in the United States. The numbers are compelling – the fact that this affects so many of our out-of-hospital cardiac arrests and that this actually shows pretty strong evidence of improved outcome.” — Kelly Grayson “We think about over the past 20 years, and now with fentanyl being part of that process, we're starting to see a lot more [drug-related cardiac arrests] and there's an urgent need for this evidence that allows us to now figure out if Narcan can make a difference in OHCAs.” — Chris Cebollero This episode of Inside EMS is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

The PEC podcast team covers the Prehospital Emergency Care Journal Volume 28 Number 3...Kind of.  As the PEC Journal grows, the PEC podcast team is breaking up Volume 28 Number 3 to allow for more discussion.  In this episode we cover the Out of Hospital Cardiac Arrest section. We talk about engaging manuscripts in this journal like: COVID-19 Testing Among Out-of-Hospital Cardiac Arrest Patients: Implications for Public Health & Prehospital Administration of Norepinephrine and Epinephrine for Shock after Resuscitation from Cardiac Arrest Click here to download it today! As always THANK YOU for listening. Hawnwan Philip Moy MD (@pecpodcast) Scott Goldberg MD, MPH (@EMS_Boston) Jeremiah Escajeda MD, MPH (@jerescajeda) Joelle Donofrio-Odmann DO (@PEMems) Maia Dorsett MD PhD (@maiadorsett) Lekshmi Kumar MD, MPH(@Gradymed1) Greg Muller DO (@DrMuller_DO) Ariana Weber MD (@weberMD4) Rebecca Cash PhD (@CashRebeccaE) Michael Kim MD (@michaelkim_md) Rachel Stemerman PhD (@steminformatics) Nikolai Arendovich MD Elijah Robinson MD

For more on this topic check out Dr. Jeff Nusbaum's talk here.

Commentary by Dr. Candice Silversides

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't.Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach.Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

The JournalFeed podcast for the week of May 27-31, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:A retrospective study of 60 patients who received a fixed-dose ketamine of 250 mg by EMS observed that 6 were intubated in the ED. There was no association between weight-based dose of ketamine and risk for intubation.Thursday Spoon Feed:In a large retrospective review of patients with out-of-hospital-cardiac-arrest (OHCA) there was a very small, and probably clinically insignificant, association with favorable neurological outcome and survival in those who underwent early as opposed to late advanced airway management.

Background: The holy grail of outcomes in OHCA is survival with good neurologic outcome.  The only interventions proven to increase this outcome are high quality CPR and defibrillation in shockable rhythms.  Ventilation is also an important component of resuscitation in OHCA.  Excess minute ventilation can adversely affect hemodynamics due to increased intrathoracic pressure (i.e. decreased ... Read more The post REBEL Cast Ep126: Should We Not Be Recommending Small Adult BVMs in OHCA? appeared first on REBEL EM - Emergency Medicine Blog.

This week I am talking to Dr. Deborah King about her Near Death Experience.BioI am an advanced practice registered nurse (clinical nurse specialist) with a Ph.D. in Clinical Psychology. Clinical practice and education have been my passion for over four decades. I have tried to integrate spirituality into my practice of holistic caring and teaching---although my traditional training often fell short in providing me with the tools needed to do so.  I experienced many "unexplained" but very real, powerful encounters with the spiritual realm during my years of work as a nurse and psychotherapist in critical care, hospice, mental health, grief, trauma, and behavioral medicine.  However, a powerful near-death experience (NDE) of my own brought spiritual insight and lessons that I could have never learned in all of my years of clinical experience---or in any textbook or degree program. It changed my life, and deeply transformed me both personally and professionally.On December 15, 2008, while newly grieving the loss of my father, I experienced a sudden cardiac arrest (SCA) while at home, just a few hours after visiting his gravesite for the first time since his death.  I did not have a "heart attack," had no interruptions of blood flow to my heart or muscle damage, and had no traditional risk factors for such an event. My heart simply stopped.  An out-of-hospital cardiac arrest (OHCA) like the one I experienced is fatal about 90% of the time;  survival after treatment to hospital discharge occurs only about 10% of the time, often with resulting neurological and functional impairment. Brokenhearted, grieving, and emotionally and physically exhausted from a life of caregiving and poor self-care, I experienced a complete energetic depletion that almost took my physical life, while, at the same time, renewed my life spiritually in ways I never could have anticipated.My NDE occurred sometime during my cardiac arrest and resulting coma. During my NDE, I experienced life as pure consciousness, out of my physical body, in the presence of the most all-encompassing love I have ever known.  God, the source energy of all that is, was ever-present, guiding me through a life review, sharing messages about our innate identity as souls, our mission as loving beings of compassion and light---and my own spiritual mission. With "no medical explanation," I awoke from the coma, and miraculously returned to my body and earthly life after surviving what the medical team told my family was not medically possible---with a very clear sense of mission about the work I needed to do.  Intuitive gifts, deep spiritual transformation, and clear insight and vision emerged to fuel me on my journey and provide the tools needed to fulfill my new mission.https://www.drdebking.com/https://www.pastliveshypnosis.co.uk/https://www.patreon.com/ourparanormalafterlifeBecome a supporter of this podcast: https://www.spreaker.com/podcast/our-paranormal-afterlife-finding-proof-of-life-after-death--5220623/support.

為了提高到院前急救存活率，急診室醫師陳治圩費盡心力創設「聽見AED」平台，召喚民眾當神救援，在救護車抵達前，搶先啟動緊急救護流程，充分掌握黃金救命時間。 留言告訴我你對這一集的想法： https://open.firstory.me/user/ckc4r732e4rnp0918dz051gs5/comments Powered by Firstory Hosting

The JournalFeed podcast for the week of April 15-19, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:In subgroup analysis, there may be more successful ROSC in patients with upper extremity IO access compared to lower extremity access in OHCA, but these results should be adopted with caution.Thursday Spoon Feed:Targeted ETCO2 ≥20 mm Hg during pediatric resuscitation was associated with higher rate of survival in patients with in-hospital cardiac arrest.

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast Brit Long interviews Zachary Aust on the use of a mental model in post ROSC patients. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Can the addition of high-dose methylprednisolone to the treatment of out-of-hospital cardiac arrest make a meaningful difference? In this post-hoc analysis of a placebo-controlled randomized control trial comparing high-dose methylprednisolone versus placebo in out-of-hospital cardiac arrest (OHCA), the authors aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.

The JournalFeed podcast for the week of March 11-15, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Thursday Spoon Feed:This updated meta-analysis re-demonstrated a benefit for extracorporeal cardiopulmonary resuscitation (ECPR) in reducing overall in-hospital cardiac arrest (IHCA) mortality and improving neurological outcomes after cardiac arrest but also demonstrated a new significant reduction in out of hospital cardiac arrest (OHCA) mortality with ECPR.Source:Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis. Crit Care. 2024 Feb 21;28(1):57. doi: 10.1186/s13054-024-04830-5.Friday Spoon Feed:A Bayesian meta-analysis found an 83.2% probability that ketamine lowers mortality compared to etomidate in critically ill patients undergoing intubation.Source:Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis. Crit Care. 2024 Feb 17.

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

The JournalFeed podcast for the week of Feb 12-16, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:In out-of-hospital cardiac arrest (OHCA), patients presenting with refractory ventricular fibrillation (RVF), receiving short interval (

The JournalFeed podcast for the week of Jan 29 – Feb 2, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.Friday Spoon Feed:Tidal volume (TV) delivered is hard to control during cardiac arrest, and evidence has shown that over-ventilation can be detrimental in physiological parameters integral to cardiac arrest survival. Small bags were thus integrated into a single EMS system to help combat over-ventilation. Paradoxically, large bags had a greater likelihood of return of spontaneous circulation (ROSC) in out of hospital cardiac arrests (OHCA).

MCHD's POCUS program has definitely involved both forward progress and lessons learned. In this episode, we'll discuss some of the reasons POCUS can be a game changer in the prehospital setting. However, unintended consequences do exist. We've begun to make the move to utilizing carotid ultrasound in OHCA, and we'll tell you exactly why. REFERENCES 1. Badra K, Coutin A, Simard R, Pinto R, Lee JS, Chenkin J. The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound. Resuscitation. 2019 Jun;139:17-23. 2. Kang SY, Jo IJ, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Shin TG, Kim K, Shim JS, Yoon H. Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation. Resuscitation. 2022 Oct;179:206-213. 3. Clattenburg EJ, Wroe P, Brown S, Gardner K, Losonczy L, Singh A, Nagdev A. Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study. Resuscitation. 2018 Jan;122:65-68. 4. Clattenburg EJ, Wroe PC, Gardner K, Schultz C, Gelber J, Singh A, Nagdev A. Implementation of the Cardiac Arrest Sonographic Assessment (CASA) protocol for patients with cardiac arrest is associated with shorter CPR pulse checks. Resuscitation. 2018 Oct;131:69-73. 5. Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I. Competence of health professionals to check the carotid pulse. Resuscitation. 1998 Jun;37(3):173-5. 6. Zengin S, Gümüşboğa H, Sabak M, Eren ŞH, Altunbas G, Al B. Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients. Resuscitation. 2018 Dec;133:59-64.

一、【20240128人間菩提】轉念行善勤造福 天災人禍一直一直在發生，一旦戰爭發生，到底這個戰爭多久才能平穩下來？眾生共業，眾生若是業力大，爭鬥的氣就升高起來。所以我們要戒慎，要注意一念心，不是只有老百姓注意這念心，期待這掌握權者發大心、造福天下的人民，不爭、不鬥，造福人間，這樣天下就平安，生機就會很旺。 佛陀告訴我們，人間、一念心，一念心可造天堂，但是一念心也可陷入地獄。佛陀來人間說法，讓人人的心接觸到佛法，能夠了解如何來保護大地、如何來造福生機，人人互愛，彼此行在菩薩道上，這都是佛陀的教育。 慈濟人平時開口動舌無不都是勸人好，也是帶動人人行菩薩道，開口動舌無不都是功德；無不都是勸人做好事，這叫做功德。「功」，功就是我們要動作，這叫做功；「德」，「得者，德也」，這就是功德。隨時舉手動足、開口動舌無不都是造福德。所以盤點自己，是不是時時都有在造福德？有做，就有算；沒有做，算不進去，所以請大家時時多用心。 二、醫療之愛 1.中醫腫瘤莊佳穎主任 頑固性胃淋巴瘤跨海求醫中西結合救人救心創奇蹟 胃部淋巴癌 -（緣起）給莊醫師：猶記在去年七月，偶然間從「大愛學漢醫」視頻中，初次認識莊醫師。也透過您的電視教學，瞭解了我們中醫治療的能力與功效。之後，我毅然決然的決定，趁著十二月的大學教授放寒假一個月，在范博士陪同專程搭機返台，直奔台中慈濟！ 中醫怎麼看淋巴癌 淋巴系統是身體免疫系統中的一環，身體裡許多地方都充滿著淋巴組織，它像樹枝般的網絡遍布全身，當淋巴組織內的淋巴球細胞，在分化及成熟的過程中，發生惡性變化而增生，就會形成淋巴瘤。《黃帝內經》提到「寒熱瘰癧在於頸腋者…」淋巴癌是痰、濕、毒、瘀集成的「痰核」「積聚」 中醫怎麼治療淋巴癌 年紀大、操勞過度、想東想西，腸胃不好，痰火上擾、脾腎兩虛、心肝有火，健脾、溫腎、化痰、解毒，半夏白朮天麻湯 合 七寶美髯丹，淋巴瘤在不同區域用不同的藥物治療：胸肋、腹部位置淋巴結：肝經胃經的梔子、香附、蒼朮、半夏、白朮，頸部位置淋巴結：牡蠣、玄參、浙貝母、夏枯草，兩大行李箱的藥材上飛機。 胃部淋巴癌 -（日常飲食叮嚀） 淋巴癌與痰濕相關，所以不要吃甜食、油膩、高熱量、含糖飲料、酒精等會助長痰濕的食物。 可以吃四神湯或喝薏仁漿健脾、散結、化痰濕，五穀雜糧，加入梔子煮飯加強治療胃部淋巴癌消散。 胃部淋巴癌 -（終獲痊癒）12-8-2023 在MD Anderson 第四次胃鏡檢查，切片52處 結果全都沒有Lymphoma 了，太令我們振奮了！！！美國醫療界的朋友，都難以置信不已！ 短短的十八個月內我的胃腫瘤，在您奇蹟般的精湛醫技，仁心仁術治療下完全消失！這也讓我們在美國的醫療團隊（包括全美及世界第一流的MD Anderson醫生們）感到訝異和讚嘆：我們共同完成了這個不可能的任務！ 感謝函~每次走訪台中慈濟，從進門接受大愛志工親切問候，加上離開前走訪藥劑師團隊。我們深深的感受到那種無私的奉獻，真誠的溫暖的熱情、關懷及效率。這些也都是「大愛精神」最佳的表率！我們深深感受到：上人的大愛及感召！在此特別感恩感謝一路上給予我們協助及鼓勵我們的慈濟人。包括：黃師兄、熊師兄、仁珍師姊、家欣師姊、李典錕醫生，及所有曾經有幸相遇的慈濟人！再次感恩　謝○○ 敬上 發心回饋一念起 報告好消息，我們今天已經初步拜託休斯頓的慈濟將「大愛學漢醫」翻譯上英文註解，尤其莊佳穎醫生的講座，這樣就更能推廣慈濟和中醫英文的解說。 我們已在Fidelity 設立了休斯頓慈濟帳戶第一款約新台幣一百萬元，希望這是個新的「開始」如有任何建議，希望賜告先生和我！感恩 2.大腸直腸外科邱建銘主任 痙攣之苦 40歲女性，體重40公斤，11歲起到澳洲求學，長期緊張或有壓力時就腹痛，漸漸演變成嚴重腹脹、排便困難，肛門緊縮、疼痛，需定期施打肉毒桿菌毒素。至少要兩天灌一次腸，每次灌腸都會肛門深部劇痛，不吃瀉藥則完全無法排便，一吃瀉藥則腹部劇痛、甚至暈厥。 診斷：腸道痙攣(colon spasm) 常因長期精神及情緒壓力導致，常見症狀：腹痛、便秘、胃脹氣、突然強烈便意感、腹瀉、大便裡有黏液，焦慮 腸胃道症狀 更焦慮腸胃症狀更嚴重 無限惡性循環。大便要從大腸的頭走到尾，要經過重重關卡（痙攣） 平常腹脹、腹痛、便秘想解解不出來，吃瀉藥 勉強有大便，但是會痛到昏倒，吃解痙劑 疼痛稍緩，腹脹便秘更嚴重，不是只有大腸會痙攣，小腸跟直腸還有肛門一樣會痙攣。經過與患者跟家屬反覆討論後先解決大便無法出來的問題，要縮短她的大腸，預先告知：切完還是一樣會腹痛，傳統微創便秘手術，小腸接直腸，切太多 這位患者拉得會比一般人更兇 會崩潰，切太少 便秘可能不會改善 一樣會崩潰，不能切太多也不能切太少。 手術只是第一階段的治療，術前、術後不斷地對患者講解腦神經和腸胃道生理互動的機制，腸胃道要適當放鬆才能正常運作，我們是用情緒跟自己的腸道互動，不能想要用意志力去控制自己的腸道，要懂得讓自己的腸子「安心」，術後腹脹改善，會不定時自行排便不需要用軟便劑，還是會不定時腹痛及肛門痙攣，患者回澳洲後一直保持密切聯絡。 病人的回饋~這三年在澳洲看了多數的專科醫師，跑過n次的ER，也做過了無數的檢查，到了最後3-6個月，根本無法正常生活……回到台灣的那一個月也跑了6次的ER，看了6個專科醫師，每個都指向colostomy bag(造口)，在我想放棄生命的時候，很幸運地被轉介給你，是你讓我有了希望……做了手術之後，你不斷地照顧我，對我來說，你不只是我的醫生，還是我的導師，是賜予我生命的摯友…… 多年便秘手術後的心得~~邱醫生您好，想祝你和你的家人聖誕節快樂，去年的這個時候，我才剛開完刀不久，還很不穩定，後來過了聖誕節又回慈濟醫院，今年能在家跟家人過聖誕節，很開心，雖然不是100%，還是要服藥 regular Buscopan & MgO，但比前幾年好多了，感謝您讓我能 function不像在醫病人，像在收學生，教學相長，有教無類，要勇敢承擔起病人身體上跟精神上的最後一道防線，跟病人的互動過程中，磨練自己安病人心、也安自己心的能力。 3.護理之家賴筱婷督導 光是陪伴就是一種療癒 堂山阿公85歲，111年11月15入住護理之家，入住原因：住民獨居於宜蘭，親戚送餐發現退化明顯，經常問重複問題、找不到東西、忘記吃過東西或藥物，曾經外出後找不到路回家，故入住機構。換了環境每天永無止境的找不到房間、找不到廁所……不同層次的指引(黃色的底圖、黑色的標，最容易辨識)-能找到房間，引導能找到馬桶，能走到活動區，習慣環境後，訓練認知，拼圖、走迷宮，但不喜歡阿公說…這些都不重要，人生中最重要的兩件事是~交女朋友、賭博，直到有一天傍晚…他們的相遇……天竺鼠與阿公 你吃什麼?你要吃菜嗎?還是你吃水果? 你應該是吃香蕉，我去幫你找看看有沒有水果…… 光是陪伴就是一種療癒，幫他找家、把天竺鼠帶到護理站，˙ 阿公說:你怎麼又出現了，你的主人呢?小麥草餵養天竺鼠，慢慢適應環境後，活動參與意願提升!每個月用鼓掌的雙手一起做環保!透過寵物接觸，讓失智長輩撫平不安、焦慮情緒!期許照護能延緩長輩退化速度，讓家人安心上班! 4.心臟血管中心謝世榮主任 當無常之火閃現 死亡開始敲門 65歲男性病患過去健康情形良好，112年8月3日傍晚有背部疼痛情形，且突然失去意識，故由救護車送至本院急診。18:40 發病，救護車上急救壓胸 CPR 20 分鐘，(猝死院外死亡 OHCA)19:19 到急診，無脈搏、無血壓、無意識，緊急氣管內插管，繼續急救，19:29 恢復心跳血壓，19:39 無脈搏、無血壓，繼續急救，19:43 繼續急救中，心室顫動，給予心臟電撃，19:46 恢復心跳血壓… 急診做心臟超音波檢查：心包積液、心包填充 ，2023-08-03電腦斷層掃描：急性A型主動脈剝離症合併心包積血。主動脈壁的三層構造~內層(薄)中層(厚，有彈性 )外層(堅韌) 主動脈剝離:容易導致灌注不良症候群，任何器官都可能發生急性缺血性壞死及功能衰竭，如腦中風、癱瘓、心肌梗塞、腸壞死、腎衰竭、下肢缺血。手術治療很順利，傷口復原很好，生命保住了，可是… 65歲男性，本院單位主管，過去健康情形良好，運動健將；有點高血壓但沒吃藥控制。112年9月某日部科晨會後，走路回辦公室，突然虛弱無力，臉色蒼白，胸悶冒冷汗，由辦公室同仁送至急診就醫，疑似急性心肌梗塞，但心電圖檢查及抽血檢查都不符合急性心肌梗塞特徵，電腦斷層掃描：急性A型主動脈剝離症 無 心包積血，電腦斷層掃描：急性A型主動脈剝離症，急性A型主動脈剝離症:立即安排緊急手術，電腦斷層掃描檢查後，開始有失憶現象，答非所問。右下肢股動脈已沒有脈搏。病情變化很快。手術治療很順利，在團隊合作下，經過六個多小時，手術順利完成，術中術後沒有發生重大疾病，或手術併發症！住院兩星期，出院，體能慢慢恢復。目前回院正常上班。在因緣巧合及良好的團隊合作治療下，得到比較好的結果。

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The JournalFeed podcast for the week of Dec 18-22, 2023.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:For the majority of out-of-hospital cardiac arrest (OHCA) patients undergoing standard (30:2 compressions:breaths) cardiopulmonary resuscitation (CPR) prior to definitive airway placement, bag-valve mask (BVM) ventilations did not achieve adequate lung volumes most of the time. Receiving adequate BVM ventilations >50% of the time was associated with significantly higher rates of return of spontaneous circulation (ROSC) and survival.Friday Spoon Feed:This was a stratified analysis of patients according to vulnerability to complications from COVID-19; it showed clinical benefit in most extremely vulnerable groups, but less benefit for healthier patients, even over age 70.

靜思小語『一雙手健全卻不肯做事的人，等於沒手的人。』 志工只有一隻手 或是身有重病到院前停止心跳，但 等到身體好一些，把握時間機會出門做環保、做志工鍛鍊身體來作福。來聽聽這一群環保志工們，到了享福的年紀，或許有些遭遇困難，但有更多是在付出造福的同時，感受到人生的幸福美好。來聽聽嘉玲製作的 證嚴法師的幸福心法，這一站，幸福! 分集名稱：這一站，幸福! 李玉寅師姊:我截肢，只能用一隻手做環保。 師父:慈濟人無我相，只有用心去付出，發揮愛的力量。只要有心，比兩隻手的力量更大。 陳建基師兄:我OHCA兩次，但現在已能趴趴走，我會回去做，你們大家等我! 師父:無常是佛法中的真理，擋不住，要看自己的因緣福報。福報要靠自己，做來盾。 ================= 【心示代 Ep.85】夏威夷野火遭遇，感嘆人心無明一把火為何燒不盡？Ft.靜思精舍 德渙師父

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous, high-quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Why bystander CPR is important for out-of-hospital cardiac arrest (OHCA) outcomes. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

The JournalFeed podcast for the week of Sept 4 - 8, 2023.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Tuesday Spoon Feed:In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Try this checklist!Wednesday Spoon Feed:In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. ST segment elevation, or even an isoelectric ST segment, in these leads is abnormal and should make us concerned for ischemia. See below.

Two factors to cardiac arrest survivability that have been clearly shown to make the biggest difference is continuous high quality CPR and early defibrillation. The most common dysrhythmia present during the first few minutes of cardiac arrest is ventricular fibrillation. The chance of successful defibrillation decreases every minute that passes. How our chance of successfully defibrillating a patient into a perfusing rhythm significantly changes when good CPR is delivered vs when it isn't. Examples of in-hospital and out-of-hospital cardiac arrest (OHCA) outcomes when CPR is performed until defibrillation vs defibrillation without CPR. The role of the CPR coach. Five tips to aid us in limiting CPR interruptions to less than 10 seconds so we can maintain a chest compression fraction (CCF) of at least 80%.Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Last year, state lawmakers in Oklahoma passed SB 1369, the Oklahoma Healthcare Transparency Initiative Act. The legislation requires all healthcare providers to enter patient records into an online database. Set to go into effect on July 1st, the measure specifically requires providers to quote “submit health and dental claims data, unique identifiers, and geographic and demographic information for covered individuals to the Oklahoma Healthcare Transparency Initiative”. In advance of implementation, mental health care providers in Oklahoma are raising concerns about patient privacy and confidentiality. We spoke with  Sabrina  DeQuasie, a  therapist in Oklahoma. We reached out to the Oklahoma Health Care Authority, Oklahoma's Medicaid Agency. This is their statement below.    OHCA Invites Continued Feedback Regarding OKSHINE/HIE   Oklahoma City, OK – SB1369, passed in the 2022 legislative session, requires OHCA to set up a separate office, the Office of the State Coordinator for Health Information Exchange, with responsibility to oversee a statewide health information exchange with patient data from all healthcare providers. The proposed rules for the program were first introduced in September and have gone through two rounds of public comments, resulting in more than 300 comments. These comments, along with input from the public and dozens of stakeholder engagement meetings, are guiding and informing the implementation process. OHCA is grateful for the feedback of Oklahoma patients and providers.   The opportunity to utilize the HIE is significant, with potential to reduce adverse drug events, redundant testing, and promote a culture of improved collaboration among different healthcare providers, resulting in a more streamlined, holistic health care approach for Oklahomans. The agency understands the importance of privacy considerations in this effort and is working to ensure best practices and appropriate privacy safeguards, including all legal and licensure requirements under HIPAA and other applicable state and federal laws.   The proposed rules allow temporary exemptions based on size, technological capability or financial hardship. OHCA is actively engaging with providers to discuss exemption criteria for specific provider types regarding transmission of data restrictions, with a particular focus on behavioral health, and are expecting to revise the proposed rules to apply exemptions based on provider type.   After the passage of SB 1369, the rule proposal is the first step in a thorough process to develop regulations that will achieve the desired benefits for Oklahoma's citizens, serving the needs of providers and patients alike. To ensure your concerns are addressed, OHCA invites you to be a part of the conversation. Please send your feedback through the new comments feature on oklahoma.gov/ohca/okshine. This page will be updated with new information as it becomes available.