Podcasts about precedex

Scott Schara is the father of Grace Schara, the 19-year-old daughter with Down Syndrome who tested positive for COVID, was hospitalized and treated following the protocols carried out in hospitals across the country. Grace was ushered into eternity on October 13, 2021. Scott is presently engaged in a landmark lawsuit, Schara vs. Ascension Health et al. He warns about the dangers of incentivized healthcare. His work and story have been chronicled in a chapter of the Wall Street Journal bestseller, Rise of the Fourth Reich.--This broadcast is the 5th on this important topic since January 5th of 2022. Scott gave a brief review of the details of Grace's one-week stay in the hospital and the protocols that actually didn't follow the standards that you hear about concerning COVID-19, which typically involve remdesivir and ventilators.--Scott then discusses the lawsuit which is based upon 5 claims- wrongful death, medical malpractice, lack of informed consent, medical battery and a declaratory judgment related to the illegal -do not resuscitate- order. Scott also noted the illegal combination of medicines that Grace was given before her death -Precedex, lorazepam and morphine-.--It would be helpful to hear the earlier programs dealing with this issue. Go to crosstalkamerica.com. At the top of the page click on -Crosstalk-, then -Program Recaps- and in the search box on the right side of the page type in -Grace Schara-.

Scott Schara is the father of Grace Schara, the 19-year-old daughter with Down Syndrome who tested positive for COVID, was hospitalized and treated following the protocols carried out in hospitals across the country. Grace was ushered into eternity on October 13, 2021. Scott is presently engaged in a landmark lawsuit, Schara vs. Ascension Health et al. He warns about the dangers of incentivized healthcare. His work and story have been chronicled in a chapter of the Wall Street Journal bestseller, Rise of the Fourth Reich.--This broadcast is the 5th on this important topic since January 5th of 2022. Scott gave a brief review of the details of Grace's one-week stay in the hospital and the protocols that actually didn't follow the standards that you hear about concerning COVID-19, which typically involve remdesivir and ventilators.--Scott then discusses the lawsuit which is based upon 5 claims- wrongful death, medical malpractice, lack of informed consent, medical battery and a declaratory judgment related to the illegal -do not resuscitate- order. Scott also noted the illegal combination of medicines that Grace was given before her death -Precedex, lorazepam and morphine-.--It would be helpful to hear the earlier programs dealing with this issue. Go to crosstalkamerica.com. At the top of the page click on -Crosstalk-, then -Program Recaps- and in the search box on the right side of the page type in -Grace Schara-.

Scott Schara is the father of Grace Schara, the 19-year-old daughter with Down Syndrome who tested positive for COVID, was hospitalized and treated following the protocols carried out in hospitals across the country. Grace was ushered into eternity on October 13, 2021. Scott is presently engaged in a landmark lawsuit, Schara vs. Ascension Health et al. He warns about the dangers of incentivized healthcare. His work and story have been chronicled in a chapter of the Wall Street Journal bestseller, Rise of the Fourth Reich.This broadcast is the 5th on this important topic since January 5th of 2022. Scott gave a brief review of the details of Grace's one-week stay in the hospital and the protocols that actually didn't follow the standards that you hear about concerning COVID-19, which typically involve remdesivir and ventilators.Scott then discusses the lawsuit which is based upon 5 claims: wrongful death, medical malpractice, lack of informed consent, medical battery and a declaratory judgment related to the illegal "do not resuscitate" order. Scott also noted the illegal combination of medicines that Grace was given before her death (Precedex, lorazepam and morphine).It would be helpful to hear the earlier programs dealing with this issue. Go to crosstalkamerica.com. At the top of the page click on "Crosstalk", then "Program Recaps" and in the search box on the right side of the page type in "Grace Schara".

Scott Schara is the father of Grace Schara, the 19-year-old daughter with Down Syndrome who tested positive for COVID, was hospitalized and treated following the protocols carried out in hospitals across the country. Grace was ushered into eternity on October 13, 2021. Scott is presently engaged in a landmark lawsuit, Schara vs. Ascension Health et al. He warns about the dangers of incentivized healthcare. His work and story have been chronicled in a chapter of the Wall Street Journal bestseller, Rise of the Fourth Reich.--This broadcast is the 5th on this important topic since January 5th of 2022. Scott gave a brief review of the details of Grace's one-week stay in the hospital and the protocols that actually didn't follow the standards that you hear about concerning COVID-19, which typically involve remdesivir and ventilators.--Scott then discusses the lawsuit which is based upon 5 claims- wrongful death, medical malpractice, lack of informed consent, medical battery and a declaratory judgment related to the illegal -do not resuscitate- order. Scott also noted the illegal combination of medicines that Grace was given before her death -Precedex, lorazepam and morphine-.--It would be helpful to hear the earlier programs dealing with this issue. Go to crosstalkamerica.com. At the top of the page click on -Crosstalk-, then -Program Recaps- and in the search box on the right side of the page type in -Grace Schara-.

Scott Schara is the father of Grace Schara, the 19-year-old daughter with Down Syndrome who tested positive for COVID, was hospitalized and treated following the protocols carried out in hospitals across the country. Grace was ushered into eternity on October 13, 2021. Scott is presently engaged in a landmark lawsuit, Schara vs. Ascension Health et al. He warns about the dangers of incentivized healthcare. His work and story have been chronicled in a chapter of the Wall Street Journal bestseller, Rise of the Fourth Reich.--This broadcast is the 5th on this important topic since January 5th of 2022. Scott gave a brief review of the details of Grace's one-week stay in the hospital and the protocols that actually didn't follow the standards that you hear about concerning COVID-19, which typically involve remdesivir and ventilators.--Scott then discusses the lawsuit which is based upon 5 claims- wrongful death, medical malpractice, lack of informed consent, medical battery and a declaratory judgment related to the illegal -do not resuscitate- order. Scott also noted the illegal combination of medicines that Grace was given before her death -Precedex, lorazepam and morphine-.--It would be helpful to hear the earlier programs dealing with this issue. Go to crosstalkamerica.com. At the top of the page click on -Crosstalk-, then -Program Recaps- and in the search box on the right side of the page type in -Grace Schara-.

Scott Schara is the father of Grace Schara, the 19-year-old daughter with Down Syndrome who tested positive for COVID, was hospitalized and treated following the protocols carried out in hospitals across the country. Grace was ushered into eternity on October 13, 2021. Scott is presently engaged in a landmark lawsuit, Schara vs. Ascension Health et al. He warns about the dangers of incentivized healthcare. His work and story have been chronicled in a chapter of the Wall Street Journal bestseller, Rise of the Fourth Reich.This broadcast is the 5th on this important topic since January 5th of 2022. Scott gave a brief review of the details of Grace's one-week stay in the hospital and the protocols that actually didn't follow the standards that you hear about concerning COVID-19, which typically involve remdesivir and ventilators.Scott then discusses the lawsuit which is based upon 5 claims: wrongful death, medical malpractice, lack of informed consent, medical battery and a declaratory judgment related to the illegal "do not resuscitate" order. Scott also noted the illegal combination of medicines that Grace was given before her death (Precedex, lorazepam and morphine).It would be helpful to hear the earlier programs dealing with this issue. Go to crosstalkamerica.com. At the top of the page click on "Crosstalk", then "Program Recaps" and in the search box on the right side of the page type in "Grace Schara".

We sit down with Scott Schara, the father of Grace Schara, who died in a hospital with a condition she was fighting alongside with. On Oct. 13, 2021, at 7:27 pm, beautiful Grace Schara—an inquisitive young woman with Down-Syndrome—died a tragic and preventable death at a Wisconsin hospital. Rather than using treatments proven to combat COVID-19, Ascension's St. Elizabeth's Hospital followed the U.S. government's ineffective COVID-19 treatment protocols, for which they reap significant financial rewards. On the final day of Grace's life, as her doctor assured her parents she was doing well, Dr. Gavin Shokar also “unilaterally labeled Grace a DNR and ordered a lethal combination of IV sedatives and narcotics”—a fatal combination of the drugs Precedex, Lorazepam, and Morphine—which were administered over an incredibly short period of time. Notably, all three drugs are manufactured by mRNA “vaccine” maker and pharmaceutical giant Pfizer.Who Was Grace Schara?Grace Schara was full of love. Properly describing the magical impact Grace had on every life she touched—especially her mom, dad, and sister—would require more space than this. Her family and all those who knew and loved Grace were clearly blessed to have her in their lives for 19 years. Besides bringing an incredible amount of joy everywhere she went, Grace could read and write, drive a car, ride a horse, play the violin, and drive her riding lawnmower, and so much more. Truly, Grace loved absolutely everything about the life she was living. UncoverDC spoke at length with Scott Schara, Grace's father, about the tragic and immoral circumstances leading up to his daughter's death. Describing Grace, Scott recently wrote:“Grace was our bright, beautiful, fun-loving 19-year-old daughter with Down Syndrome. Her precious life was taken from us at St. Elizabeth's Hospital in Appleton, Wisconsin, on Oct. 13, 2021. She was an angel who loved her Lord and Savior, Jesus. Everyone knew Grace. I was known only as ‘Grace's dad.' She had a sense of her Heavenly Father that very few people ever have. She called me her ‘Earthly dad.' Who does that?” Our Amazing Grace's Newsletter https://ouramazinggrace.substack.com/ Be sure to check out Scott Schara's website with a lot of information we had discussed on the show today https://www.ouramazinggrace.net/home Deprograming with Graces Dad Podcast https://www.ouramazinggrace.net/blog/deprogramming?Pad=1 https://www.amazon.com/Americas-Political-Warfare-Modern-Civil/dp/B0BRLYKJJR/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr= --- Send in a voice message: https://podcasters.spotify.com/pod/show/savagedunfiltered/message

Dr. Dallen Mills from Peak View Anesthesia joins us once again to cast a wide net over the topic of anesthesia as we discuss beta blockers, ketamine, kidney failure, and a whole lot more! The last time he was here, Dr. Mills walked us through the ins and outs of Precedex. Today, he answers some follow-up questions by explaining how long you can use a Precedex solution after it's been diluted. Our guest goes on to describe his treatment plan for post-surgery combatant patients, his thoughts on using beta blockers with ketamine, how he uses nitrous oxide as an adjunct to sedation, and how he approaches sedating patients who have kidney complications. To end, Dr. Mills thoroughly examines everything related to taking medication before surgery. Tune in for all this and more!Key Points From This Episode:Dr. Dallen Mills explains the shelf life of a diluted Precedex solution. His go-to treatment for patients who wake up agitated from surgery. What he thinks about routinely using beta blockers with ketamine. How he deals with increased secretions of ketamine. The way Dr. Mills uses nitrous oxide in his daily operations. His protocol for treating patients with kidney failures and those on dialysis. Everything you need to know about taking medication prior to sedation. Links Mentioned in Today's Episode:Dr. Dallen Mill on LinkedIn — https://www.linkedin.com/in/dallen-mill-055338/ Peak View Anesthesia — https://www.pvanesthesia.com/  ‘The Pros and Cons of Precedex and Remifentanil, Plus a Dive into an Innovative Non-Pharmaceutical Approach (with Dr. Dallen Mill, MD Anesthesiologist)' — https://www.buzzsprout.com/1404670/14398433-the-pros-and-cons-of-precedex-and-remifentanil-plus-a-dive-into-an-innovative-non-pharmaceutical-approach-with-dr-dallen-mill-md-anesthesiologist.mp3 KLS Martin — https://www.klsmartin.com/en/   KLS Martin 35% Discount Code — StuckiFavs  Dr. Stucki's KLS Martin Instrument List & Instruction Video — https://www.klsmartin.com/dr-stucki-instruments Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059 

There is no such thing as a perfect anesthetic, but there are some that are pretty close. In today's episode, we welcome Board-Certified MD Anesthesiologist, Dr. Dallen Mill, to discuss the pros and cons of our favored anesthetics and one non-pharmaceutical option that is as simple as it is effective. We open with Precedex, how it works, and how we can better understand its effects by brushing up on our knowledge of the autonomic nervous system. Then, we explore the side effects of Precedex, assess its onset rate, and discuss its other uses before diving into Remifentanil, its fast-working properties, warning signs to remember, and how to use the drug safely. After a brief interlude on the value of doing close case reviews, we end by examining one non-pharmaceutical technique that will calm your child in preparation for their surgery. And be sure to listen in to learn how playing hockey has improved Dr. Mill's life as a surgeon!Key Points From This Episode:Dr. Mill's professional training, history, and his current practice setup. Preferred alternative medications for implant and third molar cases. Understanding how Precedex works with a refresher on the autonomic nervous system.     Some side effects to consider when taking Precedex, and assessing its onset rate. Other ways to use Precedex.An introduction to the lightning-quick Remifentanil and why it's so short-acting.  Remifentanil warnings and how to use the drug safely. An interlude on the value of close case reviews. Taking a closer look at Precedex and Remifentanil doses. A non-pharmaceutical technique that is worth exploring. How hockey has improved his work and other rapid-fire answers from Dr. Mill. His parting words of wisdom.Links Mentioned in Today's Episode:Dr. Dallen Mill on LinkedIn — https://www.linkedin.com/in/dallen-mill-055338/ Dr. Dallen Mill on Instagram — https://www.instagram.com/dallenmillmd/ Dr. Dallen Mill Email — dr.mill@pvanesthesia.comPeak View Anesthesia — https://www.pvanesthesia.com/  Percy Jackson and the Olympians — https://www.imdb.com/title/tt12324366/  Sherlock — https://www.imdb.com/title/tt1475582/ KLS Martin — https://www.klsmartin.com/en/   KLS Martin 35% Discount Code — StuckiFavs Dr. Stucki's KLS Martin Instrument List & Instruction Video — https://www.klsmartin.com/dr-stucki-instruments Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059 

Ano Novo, artigos novos,  podcast novo.  A partir de agora, nossos ouvintes têm a opção de escolher direto o artigo que querem escutar, na ordem que preferirem. 90 versus 60 min of early skin-to-skin contact on exclusive breastfeeding rate in healthy infants' ≥35 weeks: A randomised controlled trialNosso primeiro artigo mostra como 30 minutos a mais podem influenciar positivamente a saúde dos recém-nascidos por até 14 semanas. Quer saber mais? Acesse o artigo em https://doi.org/10.1111/ apa.17021Trends in infant mortality due to haemolytic disease and other perinatal jaundice in the USA, 1999–2020Traz uma carta de um dos maiores estudiosos em icterícia na atualidade: Vinod K Bhutani. Um levantamento que nos faz pensar que apesar de toda a evolução da Neonatologia, ainda perdemos bebês para causas evitáveis. https://fn.bmj.com/content/early/2023/09/21/archdischild-2023-326006The Irritable Infant in the Neonatal Intensive Care Unit: Risk Factors and Biomarkers of Gastroesophageal Reflux DiseaseSempre que o nosso paciente apresentar sintomas de irritabilidade e de arqueamento das costas a gente precisa iniciar tratamento para DRGE? Descubra aqui: https://pubmed.ncbi.nlm.nih.gov/37777170/Use of Dexmedetomidine and Opioids in Hospitalized Preterm InfantsQual o crescimento do uso de Precedex nos últimos anos para sedação em neonatologia? Qual o impacto desse medicamento no uso de opioides?https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811321?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamanetworkopen.2023.41033 Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Se estiver gostando do nosso Podcast, por favor deixe sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. O nosso objetivo é democratizar a informação. Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.org

TAKEAWAYSScott challenged the protocols the hospital was using to treat Grace and was promptly escorted from the premises for doing so Grace was heavily sedated with Precedex, which her father believes was being used to prep her for an unneeded ventilatorScott does not believe that Grace died of Covid - he says she died from an alleged deadly blend of powerful drugsObamacare's real goals are chillingly aimed at culling the population through collectivistic medical protocols

Contributor: Aaron Lessen, MD Educational Pearls: What is Tranq? Tranq is the street name for xylazine, a sedative drug typically used in veterinary medicine. Xylazine has recently emerged as a recreational drug, often mixed with heroin or fentanyl.  The mechanism of action of xylazine is similar to dexmedetomidine (Precedex), an alpha-2 adrenergic receptor agonist. At toxic levels, either by itself or when combined with opioids, can cause apnea, bradycardia, coma, and hypotension. How is it different from other adulterants, such as fentanyl? Because It is not an opioid, naloxone (Narcan) does not reverse its effects. It may cause local peripheral vasoconstriction leading to necrotic ulcerations at sites of repeated injection. How do you treat a suspected overdose of Tranq +/- an opioid? Consult with a clinical toxicologist. Naloxone should still be used despite its limited effect. At the very least it will not make the situation worse. Be ready to intubate. Provide supportive care. Non-selective alpha antagonists are NOT recommended. References Ruiz-Colón K, Chavez-Arias C, Díaz-Alcalá JE, Martínez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature. Forensic Sci Int. 2014 Jul;240:1-8. doi: 10.1016/j.forsciint.2014.03.015. Epub 2014 Mar 26. PMID: 24769343. Ayub S, Parnia S, Poddar K, Bachu AK, Sullivan A, Khan AM, Ahmed S, Jain L. Xylazine in the Opioid Epidemic: A Systematic Review of Case Reports and Clinical Implications. Cureus. 2023 Mar 29;15(3):e36864. doi: 10.7759/cureus.36864. PMID: 37009344; PMCID: PMC10063250. Malayala SV, Papudesi BN, Bobb R, Wimbush A. Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA. Cureus. 2022 Aug 19;14(8):e28160. doi: 10.7759/cureus.28160. PMID: 36148197; PMCID: PMC9482722. United States Drug Enforcement Administration. DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine | DEA.gov. (n.d.). https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine  Summarized by Jeffrey Olson, MS1 | Edited by Meg Joyce & Jorge Chalit, OMSII

Are you using Precedex for alcohol withdrawal? Hear my take on why I don't like this idea, with evidence from a recently-published meta-analysis.Follow HERE!References:All references for Episode 94 are found on my Read by QxMD collectionSupport the showFind ER-Rx: - On Instagram: @ERRxPodcast - On the website: errxpodcast.com - On YouTube Disclaimer: The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is not meant to replace professional medical judgement, and does not constitute a provider-patient relationship between you and the authors. Information contained herein may be accidentally inaccurate, incomplete, or outdated, and users are to use caution, seek medical advice from a licensed physician, and consult available resources prior to any medical decision making. The contributors of the ER-Rx podcast are not affiliated with, nor do they speak on behalf of, any medical institutions, educational facilities, or other healthcare programs.

On Oct. 13, 2021, at 7:27 pm, beautiful Grace Schara—an inquisitive young woman with Down-Syndrome—died a tragic and preventable death at a Wisconsin hospital. Rather than using treatments proven to combat COVID-19, Ascension's St. Elizabeth's Hospital followed the U.S. government's ineffective COVID-19 treatment protocols, for which they reap significant financial rewards. On the final day of Grace's life, as her doctor assured her parents she was doing well, Dr. Gavin Shokar also “unilaterally labeled Grace a DNR and ordered a lethal combination of IV sedatives and narcotics”—a fatal combination of the drugs Precedex, Lorazepam, and Morphine—which were administered over an incredibly short period of time. Notably, all three drugs are manufactured by mRNA “vaccine” maker and pharmaceutical giant Pfizer.Who Was Grace Schara?Grace Schara was full of love. Properly describing the magical impact Grace had on every life she touched—especially her mom, dad, and sister—would require more space than this. Her family and all those who knew and loved Grace were clearly blessed to have her in their lives for 19 years. Besides bringing an incredible amount of joy everywhere she went, Grace could read and write, drive a car, ride a horse, play the violin, and drive her riding lawnmower, and so much more. Truly, Grace loved absolutely everything about the life she was living. UncoverDC spoke at length with Scott Schara, Grace's father, about the tragic and immoral circumstances leading up to his daughter's death. Describing Grace, Scott recently wrote:“Grace was our bright, beautiful, fun-loving 19-year-old daughter with Down Syndrome. Her precious life was taken from us at St. Elizabeth's Hospital in Appleton, Wisconsin, on Oct. 13, 2021. She was an angel who loved her Lord and Savior, Jesus. Everyone knew Grace. I was known only as ‘Grace's dad.' She had a sense of her Heavenly Father that very few people ever have. She called me her ‘Earthly dad.' Who does that?”Note:Per Dr. Elizabeth Lee Vliet, President and CEO of Truth for Health Foundation, (Published in Wisconsin Christian News, Volume 22 No 7) The COVID Protocol hospital physicians must follow, in lockstep across the U.S., appears to be the implementation of the 2009-2010 “Complete Lives System” developed by Dr. Ezekiel Emanuel for rationing medical care for people older than 50. Dr. “Zeke” Emanuel, who was the senior White House health policy adviser to President Obama and has been advising President Joe Biden about COVID-19, stated in his classic 2009 Lancet paper: “When implemented, the Complete Lives System produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.” “Attenuated” means rationed, restricted, or denied medical care that commonly leads to premature death. In 2021, whistleblower doctors, nurses, attorneys, patient advocates and journalists have exposed egregious hospital abuses, neglect of patients, and denial of vital intravenous fluids and basic medicines to hospitalized COVID patients across the U.S. The Complete Lives Protocol apparently derives from the 1990s U.K. National Health Service “Liverpool Pathway,” which in effect constituted euthanasia.Scott Schara can be contacted at https://www.ouramazinggrace.net/home

CAUTION be to thee whom cross the threshold into a hospitalLearn more about Scott and his daughter Grace here: https://ouramazinggrace.netIt's not just Murder for Money. These doctors and nurses are doing it for the same reason over 60% of the participants in the Milgram experiments administered what they thought was a lethal shock to patients. Evil has become so commonplace in the halls of institutions, so banal, that it's often not even recognized as "Evil" by those who carry it out.We talk about hard, documented proof of deliberate, premeditated, incentivised MURDER of innocent people, including children, in hospitals everywhere. In your local hospitals... Happening in your neighborhood! Innocent lives are being taken deliberately.Admittedly I had a different impression of the Garden of Eden story where I asked "Why wouldn't we want to know the difference between right and wrong? How could we know if we were causing harm, or if harm was being done to us without that inherent understanding? If we didn't know the difference?" But Scott helped me understand the Hegelian dialectic as being outside of, and apart from God. The Good-Bad debate is but a mind trap outside of God. Maybe I need to rethink my views on this element.Many of the guests you see on Stew Peters make there way onto Ba'al Busters for very unique, deep, and information rich conversations. I look for the humanity in my guests, and I tap into their genuine sincerity for the most Real discussions you'll ever find anywhere.Support the Show, Feel Better about Yourself: https://GiveSendGo.com/BaalBustersBuy stuff that makes you more attractive:https://my-store-c960b1.creator-spring.com/Learn Stuff that Makes You the Smarty at Every Party: https://riseupintohealth.com/?via=baalbustersLearn Health Tips from a guy who Drinks his own Pee Here: https://autoimmunesecrets.com/?a=633dd49fb4ebcADD My FREE Roku TV Baal Busters Channel here:https://channelstore.roku.com/details/a44cff88b32c2fcc7e090320c66c4d09/baal-busters-broadcastJoin BB Telegram Here: https://t.me/BaalBustersStudiosPods: https://www.spreaker.com/show/baal-busters-podcastRadio stations: https://tunein.com/radio/JoshWho-Talk-Radio-s265808/https://directory.shoutcast.com/Search?query=joshwhoSubscribe to the Main Baal Busters here:https://BaalBuster.joshwhotv.comI am the Disillusioned Bodhisattva-Daniel KristosDad, US Coast Guard Veteran, Small Business Owner, Author, and Presenter of Truth

Precedex, ketamine, lidocaine, magnesium and more! Here we talk through the MOAs and dosing for these drugs as well as how we try to incorporate them into our personal practice. Support the show

The post Episode 79. Stop the flex with Precedex: The Use of Dexmedetomidine for Procedural Sedation appeared first on The Pharm So Hard Podcast.

Contributor: Peter Bakes, MD Educational Pearls: When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for patients with intracranial bleeds Precedex is a milder sedative used in the ICU because it decreases time to extubation and reduces the risk of complications associated with long term intubation  Ketamine should be used in hypotensive patients because it does not lower blood pressure, and its bronchodilatory effect is beneficial for asthmatic patients  Versed and ativan are the most commonly encountered benzodiazepine sedatives, but they are infrequently used because they increase the risk of delirium and delay extubation Benzodiazepines are useful for sedation in patients with delirium tremens For post intubation analgesia, fentanyl is the drug of choice since it has a lower risk of hypotension than is seen in other narcotics In the emergency department, intubated and sedated patients should initially be sedated to a RASS of -2 while obtaining imaging, but aim for a RASS of -1 after to decrease side effects and promote earlier extubation References Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983-2991. Garner O, Ramey JS, Hanania NA. Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022. Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015;75(10):1119-1130. McKeage K, Perry CM. Propofol: a review of its use in intensive care sedation of adults. CNS Drugs. 2003;17(4):235-272. Ramos-Matos CF, Bistas KG, Lopez-Ojeda W. Fentanyl. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 2022.   Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD Emergency Medical Minute's Palliative screening event is tonight! There is still time to buy tickets to this intimate evening diving into the nuance of pediatric palliative care, purchase tickets on eventbrite!

Scott is the father of Grace Schara who died at the hands of “hospital protocol” October 13th, 2021 after being admitted on October 6th for COVID-19 treatment. Grace's death occurred after she was given a lethal combination dosage of Precedex, Lorazepam, and Morphine within a period of 30 minutes by the attending medical team. Find out more about Grace at https://www.ouramazinggrace.net www.libertymonks.com Facebook page Follow us on: Twitter and Gettr See Select Videos on: YouTube Rumble Brighteon Listen on iTunes, Spotify and Anchor Show Notes: Despite having NO prior authorization from her medical power of attorney, Grace was labeled DNR by the attending physician, in violation of Wisconsin State Statute 154. Hospital staff put Grace in restraints simply because she wanted to get up to use the restroom, a disability rights violation. Medical advocate/parent was removed by an armed guard from the hospital room in direct violation of guidelines from the US Department of Health and Human Services to support and protect people with disabilities during the pandemic. No one has satisfactorily explained why that particular cocktail of medicines was used. It is especially odd considering the family was told she had a good day the day before, prompting the doctor to recommend a feeding tube be placed on the morning of the day Grace later died. “It is so important that EVERYONE knows Grace's story,” said Grace's dad Scott Schara. “Grace, nor any other disabled person, should have to endure what she did. No family should have to live through this, either.” “Grace was a beautiful, inquisitive young woman who loved Elvis, geography, dancing, fishing, horse riding, and playing the violin, among many other interests. She loved the Lord. The sky was truly the limit with Grace, and we were blessed to have her in our lives for 19 years. We don't want her death to be in vain.” said Schara.

On Oct. 13, 2021, at 7:27 pm, Grace Schara—an inquisitive young woman with Down-Syndrome—died a tragic and preventable death at a Wisconsin hospital. Rather than using treatments proven to combat COVID-19, Ascension's St. Elizabeth's Hospital followed the U.S. government's ineffective COVID-19 treatment protocols, for which they reap significant financial rewards. On the final day of Grace's life, as her doctor assured her parents she was doing well, A Doctor “unilaterally labelled Grace a DNR (Do not resuscitate) and ordered a lethal combination of IV sedatives and narcotics”—a fatal combination of the drugs Precedex, Lorazepam, and Morphine—which were administered over an incredibly short period of time. Notably, all three drugs are manufactured by mRNA maker and pharmaceutical giant Pfizer.Who Was Grace Schara?Grace Schara was full of love. Properly describing the magical impact Grace had on every life she touched—especially her mom, dad, and sister—would require more space than this article. Her family and all those who knew and loved Grace were clearly blessed to have her in their lives for 19 years. Besides bringing an incredible amount of joy everywhere she went, Grace could read and write, drive a car, ride a horse, play the violin, and drive her riding lawnmower, and so much more. Truly, Grace loved absolutely everything about the life she was living. “Grace was our bright, beautiful, fun-loving 19-year-old daughter with Down Syndrome. She was an angel who loved her Lord and Savior, Jesus. Everyone knew Grace. I (Scott) was known only as ‘Grace's dad.' She had a sense of her Heavenly Father that very few people ever have. She called me her ‘Earthly dad.' Who does that?”http://www.ouramazinggrace.net/Support the show

To Learn who Grace Schara was, visit: https://ouramazinggrace.netFor Dr Ardis, visit: https://thedrardisshow.com/Baal Busters receives no incentive from these above links. These are just good people.To Help the Show itself Go here:BA'AL BUSTERS shirts and merch https://my-store-c960b1.creator-spring.com/ ADD My FREE RokuTV Baal Busters Channel here:https://channelstore.roku.com/details/a44cff88b32c2fcc7e090320c66c4d09/baal-busters-broadcastBaal Busters Radio Show airs every Thursday 9am-12pm EST on Revolution.Radio in Studio BJoin the Telegram Group: t.me/BaalBustersStudiosWant me to Read your comment on air? Go here: https://www.tipeeestream.com/baal-busters/donationTelegram: t.me/BaalBustersStudios IG: @BaalBustersSubscribe to the Main Baal Busters here:https://BaalBuster.joshwhotv.comhttps://BrandNewTube.com/@BaalBustersI am the Disillusioned Bodhisattva, Daniel Michael KristosBaal Busters is also available on JoshWhoRadio.com, FactHunterRadio.com, Spotify, iTunes, and more.FREE Movie Channel Here: https://joshwhotv.com/channel/BaalBustersMovies I share all my favorite movies with you

195 - Scott Schara joins the podcast to tell the story of his daughter Grace. She was admitted to the hospital in October 2021 and was killed after being given lethal doses of Precedex, Lorazepam & Morphine to "treat Covid." This is the inside story of what happens to patients in the hospital under government protocols. Topics of discussion include: -The light that fills Grace's spirit and is still shining on the world -Grace's hospital experience and how she was targeted by doctors for having Down syndrome -The financial incentives of standard government protocols for treating Covid-How Grace was a victim of government-funded eugenics targeting the disabled and elderly -Remaining grounded in faith during times of darkness Please consider donating:GiveSendGoOurAmazingGrace.netConnect with Evan:Subscribe on Substackevanmcdermod.orgWork With Me:Tarot ReadingsAnimal Spirit ReadingsShadow Work ConsultationsHomeschool Curriculum SupportTeaching/Tutoring ServicesMasculinity CoachingSupport my work directly:Donations: PayPal | Venmo | CryptoThe Fifth Dimension ShopSocial Media:InstagramTelegramTwitterYoutubeIf you like the show, please subscribe & leave us a Review :)Theme Music:Highland Song by Alexander Nakarada | https://www.serpentsoundstudios.comMusic promoted by https://www.free-stock-music.comAttribution 4.0 International (CC BY 4.0)https://creativecommons.org/licenses/by/4.0/Support the show (https://www.paypal.com/paypalme/evanmcdermod)

Elsa talks with Scott Schara, father of Grace Schara, a promising young woman with Down Syndrome, who died at the hands of “hospital protocol” October 13th after being admitted on October 6th for COVID-19 treatment. This occurred after she was given a lethal combination dosage of Precedex, Lorazepam, and Morphine within a period of 30 minutes by the attending medical team.

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!________________________________________________________________________________________Show notes and articles can be found on our website: www.nicupodcast.com/052-journal-club/This podcast is proudly sponsored by Chiesi and by Reckitt/Mead-Johnson

Grace Schara, a promising young woman with Down Syndrome, died at the hands of “hospital protocol” October 13th after being admitted on October 6th for COVID-19 treatment. This occurred after she was given a lethal combination dosage of Precedex, Lorazepam, and Morphine within a period of 30 minutes by the attending medical team.This was a death that was PREVENTABLE, especially when you consider these facts:Despite having NO prior authorization from her medical power of attorney, Grace was labeled DNR by the attending physician, in violation of Wisconsin State Statute 154.Hospital staff put Grace in restraints simply because she wanted to get up to use the restroom, a disability rights violation.Medical advocate/parent was removed by an armed guard from the hospital room in direct violation of guidelines from the US Department of Health and Human Services to support and protect people with disabilities during the pandemic.No one has satisfactorily explained why that particular cocktail of medicines was used. It is especially odd considering the family was told she had a good day the day before, prompting the doctor to recommend a feeding tube be placed on the morning of the day Grace later died.“It is so important that EVERYONE knows Grace's story,” said Grace's dad Scott Schara. “Grace, nor any other disabled person, should have to endure what she did. No family should have to live through this, either.”“Grace was a beautiful, inquisitive young woman who loved Elvis, geography, dancing, fishing, horse riding, and playing the violin, among many other interests. She loved the Lord.  The sky was truly the limit with Grace, and we were blessed to have her in our lives for 19 years. We don't want her death to be in vain.” said Schara.Watch on YouTubeSupport the show

The Biden Administration is falling apart. Republicans can make big gains. The Party is improving. But a lot of the candidates still don't understand exactly what they need to do, or they're too frightened to really do it, or they're still surrounded by clueless advisors and comms specialists and grifters who push them in the wrong direction. Speaking of grifters, listeners to this program know that Vernon Jones is one. But there are alternatives. One of those alternatives is Kandiss Taylor. What's her plan to make Georgia a better state and keep it from going the way of Virginia? She joins us to discuss. Scott Schara is the father of a 19-year-old daughter with Down Syndrome, Grace, whom he believes was killed by her hospital. Grace had Covid, but even then, Scott says she should have been fine. He believes she was killed by a combination of questionable medications given to her by hospital staff. Grace was labeled as a DNR – Do Not Resuscitate – against her family's wishes, and then was overdosed on a combination of Precedex, Lorazepam, and morphine, all within a 30-minute window. Scott Schara joins us. It's been almost a week since Scott Quiner was rescued from Mercy Hospital in Coon Rapids, Minnesota and flown to Texas to be treated by a doctor who isn't eager to kill him. Obviously, there's still a long road to recovery, but we're very hopeful that with real care Scott Quiner will eventually wake up and even join us on this program. Scott's wife Anne joins us with an update on his condition. Deanna Lorraine discusses the new globalist plot to harass the unvaccinated through financial regulations. Get Dr. Zelenko's Anti-Shedding Treatment, NOW AVAILABLE FOR KIDS: http://zStackProtocol.com Go Ad-Free, Get Exclusive Content, Become a Premium user: https://redvoicemedia.com/premium Follow Stew on social media: https://linktr.ee/StewPeters See all of Stew's content at https://StewPeters.TV Watch full episodes here: https://redvoicemedia.net/stew-full-shows Check out Stew's store: http://StewPeters.shop Support our efforts to keep truth alive: https://www.redvoicemedia.com/support-red-voice-media/

We discuss Scott and Cindy's daughter, Grace (19), who had Downs Syndrome and passed away on October 13. She died at a COVID hospital after a doctor labeled her DNR (Do Not Resuscitate) against the family's wishes, and then proceeded to overdose her on Precedex, Lorazepam, and Morphine within a 30-minute window. These meds should never be used together and warning labels (black boxes) on medications indicate as much.  Daily podcast, relevant articles on issues pertaining to Christians and more can be found on Stand Up For The Truth.

We offered interviews a few weeks ago and we HAVE A WINNER! Ben interviewed this listener of 2 Male Nurses podcast and is now a SRNA! Collab to discuss his admission to CRNA school and a review of Precedex! Enjoy this special episode. More in-depth Precedex review to come. We wished we had mentioned

A physician attempts to ease a patient's pain, a painful moment somewhat eased by the joy of music.   TRANSCRIPT SPEAKER 1: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. [MUSIC PLAYING]   RICHARD LEITER: Ode to Joy. "Is now an OK time?" I asked as I quietly entered the dimly lit room on a Saturday afternoon. "Yes, we've been waiting for you," my patient's wife Julie responded in the same calm, composed voice she had maintained all week. "Before we start, what questions do you have?" "I think you answered all of them this morning. I'm ready. Tom is ready. We just don't want him to suffer anymore." "OK, we'll get started." When I was in training, I had seen my preceptors initiate palliative sedation, but this was my first experience doing so as an attending physician. After being dormant for so long, my impostor syndrome returned. Though I was confident that I was taking the clinically-appropriate next step, I was nervous. I asked Tanya, our charge nurse and the nurse who was primarily caring for him over the last few days, to draw up the syringe. She did so with practiced confidence and handed it to me. I held it between my fingers, wondering how slowly I would need to push it to ensure the 2 milliliters of midazolam went in over a full five minutes. Tanya cleaned off the side port of his IV. I twisted the syringe into place. I looked up at Julie. She squeezed Tom's hand. I had first heard about Tom nearly a week earlier, when my colleague was handing off the service to me. "He's in his 50s, metastatic cancer. He was home on hospice and came in yesterday with uncontrolled pain. We started him on ketamine and he looks much better. The plan is to wean his ketamine, increase his methadone, and get him back home, hopefully in the next day or two." Stoic from years of pain from cancer eating away at his bones, Tom lay in bed with his eyes closed, his furrowed brow the only sign of his ongoing agony. When the nurses tried to move him, he screamed. After we weaned his ketamine, his pain quickly worsened. We increased methadone and hydromorphone. Neither gave him adequate relief. We restarted ketamine, but it proved to be no match for his pain. On rounds one morning, Julie asked if Tom could make it home. I told her I didn't think so and explained how worried I was about his pain. If we sent him home, I was concerned the pain would force him to come right back. Julie told me her kids would be disappointed, but that they'd understand, as she did. Easing Tom's suffering was more important. The hospital bed his family had set up in the living room would remain empty, a physical manifestation of cancer's unending cruelty. The hospital bed his family had set up in the living room would remain empty, a physical manifestation of cancer's unending cruelty. We talked about what would come next. If further titrating his medications proved ineffective, which I worried it would be, we would need to consider palliative sedation. "Whatever you need to do," Julie responded, her voice barely betraying the exhaustion I imagine she was feeling. Palliative sedation is a procedure used to relieve refractory suffering in a terminally-ill patient. Clinicians carefully sedate the patient, often to the point of unconsciousness, to relieve symptoms such as pain, nausea, shortness of breath, or agitated delirium. It is a procedure of last resort, and in our hospital, requires the approval of two attending physicians and the unit's nursing director. Though palliative sedation may shorten a patient's life, ethicists and clinicians have long regarded it as acceptable because its goal is not to hasten death but rather to relieve suffering. This is known as the doctrine of double effect, by which an action with at least one possible good effect and at least one possible bad effect can be morally permissible. Back in his room on that Saturday afternoon, I looked over at Tanya, the nurse, then at Harry, my fellow, who had been caring for Tom all week. I took in a breath under my mask, then slowly began to inject the contents of the syringe into his IV. In the quiet, I could hear the music coming from Julie's phone, which she had placed on the pillow beside his head. A pianist played a slow, mournful rendition of the final movement of Beethoven's Ninth Symphony, the Ode to Joy. In my head, I sang along. (SINGING) Joyful, joyful, we adore thee. I went to a traditionally Anglican school. 600 boys of all faiths and backgrounds, we'd rise each morning in assembly and sing hymns together. We cheered, yelled, and thumped on our pews-- a few minutes of raucous togetherness before we devolved into the usual bullies and cliques for the rest of the day. Tom's room couldn't have been more different. He remained completely still. Though Julie held his hand, he was alone, as we all felt in that room. (SINGING) Hearts unfold like flowers before thee, opening to the sun above. I felt the soft resistance of the syringe's plunger hitting the barrel. I looked back up at Tom. His chest fell, but didn't rise. I waited. He didn't breathe. The music slowed down. I felt Harry's eyes pivoting back and forth between my face and Tom's chest. I fixed my eyes on Julie's hands wrapped around her husband's. Despite the tension of the last week, she was calm, gentle. I matched my breath to hers. If she could exude such peace, so could I, I thought. I noticed Tom's hands. He had a piano player's fingers, long and slender. I pictured him sitting at the piano in their living room. I wondered who would take his place on the bench. I wondered if he could hear the song playing beside him. Had he and Julie chosen it for this moment? Did it bring back joyful memories, as it did for me? (SINGING) Melt the clouds of sin and sadness, drive the dark of doubt away. He didn't breathe. Did my first attempt at palliative sedation become euthanasia? Even if so, was this OK? I rehashed our conversations from the last few days. We talked about the risks. I went over the dose. Double effect, I reassured myself. Even so, as bedside nurses have told me, it's easier to talk about philosophy when you're not holding the syringe. I thought about how I would explain Tom's death to Julie. I wondered if she would be angry, upset, relieved? With the help of my outpatient colleagues, they had spent years preparing for his death. His financial affairs were in order, and he had done legacy work with his kids. More than nearly anyone I had cared for, they were ready. Were we? Was I? (SINGING) Mortals join the happy chorus which the morning stars began. He breathed in. Not a grand gasp, a slow, soft inhalation. Tom's hand flexed ever so slightly around Julie's. In my head, I thumped a pew. [MUSIC PLAYING]   SPEAKER 2: Welcome to "JCO's Cancer Stories-- The Art of Oncology," brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all of the shows, including this one, at podcast.asco.org. SPEAKER 3: The guest on this podcast episode has no disclosures to declare. [MUSIC PLAYING] LIDIA SCHAPIRA: Welcome to "Cancer Stories-- The Art of Oncology" podcast series. I'm your host Lidia Schapira. And with me today is Dr. Richard Leiter, physician and member of the Psychosocial Oncology and Palliative Care team at Dana-Farber Cancer Institute in Boston and the Brigham and Women's Hospital. Welcome to our podcast. RICHARD LEITER: Thank you so much for having me. LIDIA SCHAPIRA: It's a real pleasure. You submitted a beautiful narrative piece called "Ode to Joy." And I'd like to start today, Richard, by just focusing first on the case that you present to us. Let me tell you how I understand Tom's history, and then you can correct me if this is not the way that you'd like him to be understood. And remember, Tom is a man in his 50s who's lived with metastatic cancer to bones for years. In your narrative, you're very careful and document the fact that you've worked with many members of your palliative medicine team for a long time, that there had been many efforts to control his pain, his suffering, and he had to be hospitalized for pain management. He was already receiving home hospice care. There was a bed in the living room in the center of the family home. And he had a very supportive family and a wife that we'll call Julie at bedside. Is that the proper framing for the story? RICHARD LEITER: Exactly. Yep. Yeah. I think what I would add is that the goal was really to control his pain and get him back home. LIDIA SCHAPIRA: So now you're there as the fresh attending in palliative medicine, and you're called in, and it becomes quite clear to you after a few days of changing his medications that the pain is refractory. And that it-- you note here that he screams when he is moved, that the level of pain reaches what you have called agony. So tell us a little bit more about how a palliative medicine consultant or physician approaches this kind of situation in hospital today. RICHARD LEITER: Yeah, no. Great. Thanks so much. So we were, I would say, lucky enough to have him on our intensive palliative care unit, where we're caring for patients with difficult and sometimes refractory symptoms at any stage of the disease. So not only for end of life. But we do see a number of cases like his every year, every few months, where someone is getting closer to the end of life. The goal is to really focus on intensive symptom management. And their symptoms are challenging to control. So I think the first step, always, is a good history, right? Where is this pain coming from? What treatments have they tried already? What's worked? What hasn't? We're going to titrate medications, but select medications based on that and titrate them. I think someone who has been involved with my outpatient colleagues and has been receiving hospice services at home has often gone through many treatment modalities. So it's really taking what they've been on before and starting to add to it. So for Tom, I had inherited him from one of my colleagues, who had admitted him a couple of days earlier. And at that point, he was already on a hydromorphone infusion and ketamine, as I talk about in the piece. Ketamine had been started, hopefully, as a bridge to get him back home. And he had been on methadone, which is one of our most potent agents for, not only nociceptive pain, so our basic kind of bony pain or visceral organ pain, but also if there's pain with a neuropathic component. Methadone is an opioid that can be particularly effective there. So I think it's saying, OK, well, have we hit all of our receptors in managing their pain? Are we managing the anxiety on top of that? Are we doing everything we can? Are there procedures that we could do to help with their pain? Sometimes we're talking about intrathecal pumps for instance. And obviously, that's a more involved discussion. How much time does someone have left? Are the goals really to put them through a procedure in order to get their pain under control? But we frequently work with our interventional pain colleagues to tease out whether a procedure would be helpful for a particular patient. So those are the thoughts that always go through my mind when I'm approaching someone with severe cancer-related pain. LIDIA SCHAPIRA: So this is a very thoughtful approach. And I think one of the messages is that it seems palliative medicine and pain management are integrated into the care of patients with advanced cancer, which is a very important message for our listeners and our readers. And here you are, you have all of this, you have good communication, it seems, with your team members, with the patient's family, and there's nothing more that you can think of doing. And you're now starting to think about interventions that we normally don't think of, except as a last resort. Bring this to the bedside. Tell us a little bit about the recommendation for palliative sedation and when that's indicated in care. RICHARD LEITER: Yeah. So palliative sedation, as I write in the piece, it's a measure of last resort. And certainly, in our hospital's protocol, it explicitly states it's when all other options have been tried. As we start to integrate more options, it's always a conversation we're having among our team-- is when is palliative sedation truly indicated. How many boxes do we need to check before going down the palliative sedation route? And I think-- so we started to think about-- we had him on ketamine. We tried to wean him off, it didn't go well. We restarted ketamine. We started dexmedetomidine, which can be useful. Precedex, the brand name, they oftentimes use it in the ICU for sedation, but we find that it can be helpful in cases of refractory pain as well. And my practice has been-- and though I haven't gotten to palliative sedation until this case-- when I'm thinking about Precedex, I'm also starting conversations with the patient or their family, and certainly our team, about palliative sedation to say if this doesn't work, this is where we're headed. LIDIA SCHAPIRA: And why is this situation so difficult, so personally anxiety-provoking for you? You do use words that convey that you are feeling nervous, or perhaps even anxious. Tell us why. RICHARD LEITER: I think it's-- relieving our patient's suffering, relieving their families suffering is certainly the core of much of medicine and very much the core of what we do in palliative care. And I think to have someone in just such a terrible situation-- putting aside the pain, right? This is a man who's dying of his cancer, has a relatively young family. That alone is an awful situation. And my job is to make that situation a little bit less bad, is to ease the suffering. LIDIA SCHAPIRA: And there's something about this particular procedure, however, that adds a level of intensity and nervousness for you, and that is that perhaps-- you can describe this better than I-- but the fact that in some cases, this could have the unintended effect of actually causing respiratory depression or even hastening death and something that you have explained in your piece, if I understood you correctly, as the double effect. Did I get that right? RICHARD LEITER: Yeah, that's right. So the worry or one of the considerations with palliative sedation is that it could hasten someone's death. Oftentimes, the doses of the medications that we're using, if we're titrating them slowly, there are studies that show that it doesn't necessarily. I do think, though, when we tie it into withholding artificial nutrition and hydration, in that case, had the person been awake enough to eat and drink before, we do know that it would probably hasten their death, right, from that part of it, but not necessarily the sedation aspect. So double effect is basically saying this is ethically OK-- and there are a number of criteria. But if we are intending the good effect and not the bad effect and that it's proportional to the gravity of the situation so that not every patient who comes in with bad pain undergoes palliative sedation. LIDIA SCHAPIRA: My favorite line, Richard, in the piece-- and one that I now have read probably dozens of times-- is this-- "the double effect, I reassured myself. Even so, as bedside nurses have told me, it's easier to talk about philosophy when you're not holding the syringe." And that just gives me goosebumps thinking about it. What did you feel when you were holding the syringe? RICHARD LEITER: Exactly as I wrote about. There's all of the cognitive processes going on. And I ran it by another attending, I ran it by the nursing director, I ran-- everyone was on the same page, that this was medically indicated in this situation. And yet, when I'm standing there in the room-- patient, his wife, my fellow, and the nurse-- and I'm the one holding the syringe, watching the medication go in, it felt completely different to me. And there's a power that comes with it. In one sense, I felt like I was there for my patient. Here I am, standing here doing this to ease his suffering. And then the other, the unintended consequences of the sedation are real, and that feels different when you're the one physically doing it. LIDIA SCHAPIRA: I think one of the incredible gifts you've given us as readers is to share this with us and really adds a different dimension to the discussion of the complexity of what it is to be present, not just as a witness, in this case, but as somebody, as you say, with a power to really control so many things in the situation. And I thank you for sharing that with us. And question to you is, did writing about it in any way help you process this emotional, very powerful experience? RICHARD LEITER: Absolutely. I write to process. I write when I feel like I have something to say. And oftentimes, I write when a particular moment struck me. And I think that that moment, sitting there, pushing the medication, waiting for that breath while the music was playing was so poignant for me that I walked out of the room and I remember thinking to myself that night as I was decompressing on my walk home from work, I think I need to write about this. LIDIA SCHAPIRA: So thank you for writing about it, and then, of course, for submitting for review and to share it with people. Let me bring the music in. Music is such an important part of our sensory experience. So as you were holding the syringe, Julie, Tom's wife, puts the phone on the pillow and she plays the piano version of Ode to Joy from Beethoven's Ninth Symphony, which I want to play for our listeners now. [MUSIC PLAYING]   So Ode to Joy meant something, clearly, to Tom and Julie. And you said that you watched-- perhaps you were watching for his reactions. But tell me a little bit about what it meant to you. You sprinkled your essay with the lines for the choral for Ode to Joy, which has a religious significance as well. So tell us a little bit about that. RICHARD LEITER: Yeah. So I grew up in Toronto. I went to an all-boys school there that had a traditionally Anglican background, though I'm not-- I'm Jewish. We would sing hymns. And over the course of my time there, the hymns became less denominational and more multicultural and inclusive. And it was a moment-- it was a nice moment where everyone got into it. It's 600 boys singing, and so I still remember the words to Ode to Joy vividly. Anytime I hear it, I can replay the words in my head. And I found myself, in those moments in the room, really thinking about it. And the words were still-- as I was processing and watching Tom and Julie and making sure I was pushing the medication at the right speed, there was this soundtrack. It's a strange moment too, because they're good memories for me, and yet I'm in this incredibly solemn, intimate moment in my patient's room. LIDIA SCHAPIRA: And so as we're getting to the end of the piece and there's all of this tension that you've built up in the writing and the narrative-- and here you are, you're waiting and you hear the music and so on-- and then you finally let the tension out and he breathes. It's not a huge breath, but it's a soft, slow inhalation. And you see that the hand is flexed slightly around his wife, so he's still breathing. And you finish with this line that you say, "In my head, I thumped a pew." And I have to ask you about that. What does that mean to you? RICHARD LEITER: Yeah. So in that moment, it was relief, is what it was. Just the sense of, OK, this went-- it's my first time doing this, and this went OK. He appears more comfortable. He is still breathing. This is OK. And it just brought me back when we would thump the pews as we were singing the hymns. Our principal did not like it, but-- [LAUGHTER] But I think it was just that it was relief. I hesitate to say it was joy because I don't think there's joy in a situation like that, in the room. But there was a sense of satisfaction maybe, or professional satisfaction, the, OK, this is what we can do. And as bad as the situation is, there was something that we could do to make him somewhat more comfortable. LIDIA SCHAPIRA: Well, I certainly learned a lot. I wonder if now that some time has passed since this event, if you have any additional reflections on how this story has impacted your professional delivery of care, or perhaps the way you teach others, and if there are any parting comments that you'd like to leave us with. So I haven't had another case where I've needed to do palliative sedation, though we've thought about it in a couple of cases. I do think it's helped me, when I talk about palliative sedation with our trainees, to add the emotional valence. I think I was pretty good at talking about the importance of making sure everyone's on the same page and talking to the patient and the family and nursing staff. But to really talk about the significance of that moment for us as clinicians and how it does feel different-- at least it did for me-- and I think drawing on my personal experience is helpful in teaching it to the fellows that it's OK to feel like that when you're doing this. LIDIA SCHAPIRA: There are moments in medicine-- certainly in what you do-- that are really difficult. And this, probably, I would imagine, ranks as one of the top things. And it should never be easy. It will never be easy. The day that you think it's easy, you need to find something else, right? RICHARD LEITER: I think that's right. I think that's right. LIDIA SCHAPIRA: Well, thank you so much, Richard. You made me laugh, you made me cry reading this, and I thank you very much. My last question is, have you had a chance to talk with Tom's widow Julie about what that moment felt like to her? RICHARD LEITER: I have not, although I hope to in the near future. LIDIA SCHAPIRA: And that will be your next piece for us. [CHUCKLES] All right. Well, thank you very much and until the next time. Hope you all enjoy reading Ode to Joy. RICHARD LEITER: Thank you so much. SPEAKER 1: Until next time, thank you for listening to this "JCO's Cancer Stories-- The Art of Oncology" podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. "JCO's Cancer Stories-- The Art of Oncology" podcast is just one of ASCO's many podcasts. You can find all of the shows at podcast.asco.org. [MUSIC PLAYING]

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!________________________________________________________________________________________03:20 - Use of Antenatal Corticosteroids at 22 Weeks of Gestation. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/09/use-of-antenatal-corticosteroids-at-22-weeks-of-gestation09:40 - Parent Preferences for Transparency of Their Child's Hospitalization Costs. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/278439819:55 - Monitoring of carbon dioxide in ventilated neonates: a prospective observational study. https://fn.bmj.com/content/early/2021/08/02/archdischild-2021-322138 31:00 - Medication Use in the Neonatal Intensive Care Unit and Changes from 2010-2018. https://www.jpeds.com/article/S0022-3476(21)00860-X/fulltext37:50 - Early-Onset Sepsis Among Very Preterm Infants. https://pediatrics.aappublications.org/content/148/4/e202105245646:15 - Dexmedetomidine versus intermittent morphine for sedation of neonates with encephalopathy undergoing therapeutic hypothermia. https://www.nature.com/articles/s41372-021-00998-853:40 - Survival prediction modelling in extreme prematurity: are days important? https://www.nature.com/articles/s41372-021-01208-158:50 - Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants. https://onlinelibrary.wiley.com/doi/10.1002/ppul.2561062:30 - Burnout and Perceptions of Stigma and Help-Seeking Behavior Among Pediatric Fellows. https://pediatrics.aappublications.org/content/148/4/e2021050393

What's a breakthrough case? What are they doing with sedatives like Precedex? Why hasn't Fyzer done any promoting? I think I'm taking the week off! --- Support this podcast: https://anchor.fm/lastcallwithchrismichaels/support

What's a breakthrough case? What are they doing with sedatives like Precedex? Why hasn't Fyzer done any promoting? I think I'm taking the week off! --- Support this podcast: https://anchor.fm/lastcallwithchrismichaels/support

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!--------------------------------------------------------------------------------------------------------------------Please find the titles and links to the articles mentioned in this week's journal club and timestamps for your convenience:02:30 - Effect of Systemic Hydrocortisone Initiated 7 to 14 Days After Birth in Ventilated Preterm Infants on Mortality and Neurodevelopment at 2 Years' Corrected Age: Follow-up of a Randomized Clinical Trial. https://jamanetwork.com/journals/jama/article-abstract/278231307:50 - Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia. https://www.karger.com/Article/FullText/51595018:30 - Temporal Trends in Neurodevelopmental Outcomes to 2 Years After Extremely Preterm Birth. https://jamanetwork.com/journals/jamapediatrics/article-abstract/278214926:00 - An assessment of dexmedetomidine as an opioid-sparing agent after neonatal open thoracic and abdominal operations. https://www.nature.com/articles/s41372-021-01175-732:23 - Association of time of day and extubation success in very low birthweight infants: a multicenter cohort study. https://www.nature.com/articles/s41372-021-01168-639:27 - Caffeine citrate for apnea of prematurity—One dose does not fit all a prospective study. https://www.nature.com/articles/s41372-021-01172-w43:40 - Early High-Dose Caffeine Improves Respiratory Outcomes in Preterm Infants. https://www.mdpi.com/2227-9067/8/6/50148:35 - Low Rate of Spontaneous Closure in Premature Infants Discharged with a Patent Ductus Arteriosus: A Multicenter Prospective Study. https://jpeds.com/retrieve/pii/S002234762100702255:36 - Effects of single family room architecture on parent–infant closeness and family centered care in neonatal environments—a single-center pre–post study. https://www.nature.com/articles/s41372-021-01137-z60:53 - Asynchronous telemedicine for clinical genetics consultations in the NICU: a single center's solution. https://www.nature.com/articles/s41372-021-01070-164:00 - Cortical hemodynamic activity and pain perception during insertion of feeding tubes in preterm neonates: a randomized controlled cross-over trial. https://www.nature.com/articles/s41372-021-01166-8

Precedex

Interested in knowing when to use Precedex in patients? What about steroids in sepsis? Make sure to check out this episode and journal review.

[4 of 12] Hear Section on Intraoperative Neurophysiological Monitoring (IONM) Co-Chairs Dr. Rich Vogel and Dr. Adam Doan discuss the question, "What are the anesthetic recommendations for neuromonitoring in various spine surgeries and why?” The Co-Chairs discuss when and why they recommend total intravenous anesthesia (TIVA) vs 0.5 MAC. Is Ketamine really beneficial to MEPs? Why is Precedex contraindicated for MEPs? What train-of-four ratio is recommended for monitoring, when and why? They'll answer all these questions and more. Disclosures: Doan, Adam: Private Investments (including venture capital, start-ups): Veridical RCM, LLC (D). Vogel, Richard: Board of Directors: American Board Of Neurophysiologic Monitoring (Nonfinancial, Examiner for Board), American Society Of Neurophysiological Monitoring (Nonfinancial, President of the Society (2019-2020)); Consulting: Medicolegal Expert Witness Consulting (D); Other: NuVasive (Salary); Speaking and/or Teaching Arrangements: Neurophysiology Services Australia (None); Trips/Travel: North American Spine Society (Travel Expense Reimbursement), University Of Sydney (Travel Expense Reimbursement). Key: A: $100-$1,000; B: $1001-$10,000; C: $10,001-$25,000; D: $25,001-$50,000; E: $50,001-$100,000; F: $100,001- $500,000; G: $500,001-$1M; H: $1,000,001- $2.5M; I: $2.5M+