Emergency correction of acute critical physiological disorders
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We're joined by Dallas-area cardiac arrest management thought leaders from Best EMS and Parker County Hospital District to discuss the Resuscitation Academy. Where did this thing start? How can you and your service benefit? What RA lessons have we implemented here at MCHD? Learn how to improve your cardiac arrest survival rates without breaking the bank. REFERENCES 1. https://www.resuscitationacademy.org
This episode covers newborn resuscitation.Written notes can be found at https://zerotofinals.com/paediatrics/neonatology/newbornresuscitation/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.
When faced with the challenge of reviving a patient in cardiac arrest, paramedics rely on an arsenal of tools, techniques, and medications. Among these are two stalwarts of advanced cardiac life support (ACLS): amiodarone and lidocaine. Although both drugs have long been included in protocols as viable options for shockable cardiac arrests, a new study published in Resuscitation sheds fresh light on their effectiveness, offering compelling insights into why lidocaine might deserve a closer look. The research, led by Tanner Smida, MD/PhD candidate at West Virginia University, employed a meticulous approach known as “target trial emulation.” This method is designed to minimize bias in observational studies, aligning results more closely with what randomized controlled trials would reveal. The study analyzed data spanning five years, from 2018 to 2023, drawing on over 23,000 cardiac arrest cases treated by EMS professionals in real-world settings.
In this episode of NLN Nursing Edge Unscripted, hosts Dr. Kellie Bryant and Dr. Raquel Bertiz welcome guests Dr. Sarah Beebe and Dr. Donna Guerra to discuss Resuscitation Quality Improvement (RQI) and its impact on CPR training. They explore how RQI's simulation-based, self-directed model enhances skill retention by replacing traditional biennial certification with quarterly, high-frequency, low-dose training. The guests share success stories demonstrating how RQI has boosted provider confidence and improved patient outcomes, including students effectively performing CPR in clinical settings. They discuss the implementation process in academic and healthcare institutions, addressing challenges, faculty and staff engagement, and system maintenance. The episode concludes with tips for organizations considering RQI, emphasizing clear communication, early staff buy-in, and the long-term benefits of integrating this innovative training approach.Learn more about the RQI for Nursing Education program.Research on RQIImplementation of the RQI System: Baseline Skills and Self-Report Competence and Confidence Data From 12 NLN Inaugural Change Agent Nursing Programs Authors: S. Kardong-Edgren, D. Nikitas, E. Gavin, et al. Nursing Education, 2025 Mota, S. (2023). Resuscitation quality improvement: improving clinicians' performance. AACN Advanced Critical Care, 34(3), 182-188.Mota, S. (2023). Resuscitation quality improvement: improving clinicians' performance. AACN Advanced Critical Care, 34(3), 182-188.Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, Bluesky, and YouTube. For more information, visit NLN.org.
In this episode of STEMulating Conversations, we sit down with Dr. Katherine Y. Brown, affectionately known as The CPR Lady—a title earned not just from her passion for teaching lifesaving skills, but from a life committed to reviving potential in every form. From going door to door in her community to teach CPR, to leading efforts that breathe life into careers, organizations, and people, Dr. Brown has made “resuscitation” more than a medical term—it's her mission. Whether she's saving lives, uplifting others, or reigniting purpose, she reminds us that revival is always possible. Join us for an inspiring conversation about purpose, perseverance, and the power of showing up—heartbeat by heartbeat. Dr. Brown is a passionate volunteer with the American Heart Association, having trained over 300,000 people internationally in CPR and wants to ensure that everyone is trained in this life saving technique. Learn more about Dr. Brown's CPR work by listening to her TEDx Talk
In this episode, we delve into a quality improvement project that transformed the resuscitation trolley system at our trust, saving over £7,500. What began as a problem with 14 separate orders for the same supplies—where items, like airways, were purchased in boxes of 50 when only one was needed—became an opportunity to streamline the process and reduce waste. By centralising stock and improving the ordering system, we eliminated unnecessary duplication and ensured better efficiency
This conversation delves into the critical aspects of tourniquet management in trauma care, focusing on the distinction between tourniquet conversion and replacement, the importance of resuscitation, and the physiological implications of prolonged tourniquet use. The speakers discuss techniques for safe conversion, the challenges faced in the field, and the assessment of limb salvageability, emphasizing the need for preparedness and patient assessment in high-stress environments. This conversation delves into the complexities of patient care in trauma situations, focusing on the challenges faced by medics in making critical decisions about limb salvage, managing acidosis, and understanding reperfusion injury. The speakers emphasize the importance of resuscitation, the need for adequate resources, and the moral dilemmas that arise in emergency medical situations. They provide practical advice for medics on how to navigate these challenges effectively while ensuring patient safety and care quality.TakeawaysTourniquet conversion is essential in trauma care.Understanding the difference between conversion and replacement is crucial.Resuscitation is a key factor before converting a tourniquet.The two-hour mark for tourniquet use is based on physiological considerations.Prolonged tourniquet time can lead to significant metabolic issues.Be prepared for reperfusion injury when converting a tourniquet.Confidence in tourniquet conversion skills is often lacking among providers.Patient assessment is critical before converting a tourniquet.Limb salvageability can vary and should be assessed carefully.The decision to convert a tourniquet should prioritize patient stability. Imperfect situations require difficult decisions in patient care.Triage decisions are crucial when resources are limited.Resuscitation is the primary goal in trauma care.Understanding reperfusion injury is essential for medics.Managing acidosis can significantly impact patient outcomes.Blood transfusions are critical in trauma situations.Medics must be prepared for potential complications.Always monitor and assess the patient's condition continuously.Reading medication labels is vital for safe practice.Confidence in converting tourniquets is essential for medics.Chapters00:00 Introduction to Tourniquet Management02:56 Understanding Tourniquet Conversion vs. Replacement06:10 Resuscitation Goals and Tourniquet Timing08:58 Physiological Implications of Prolonged Tourniquet Use11:47 Techniques for Safe Tourniquet Conversion15:09 Challenges in Tourniquet Management17:53 Assessing Limb Salvageability and Patient Stability25:44 Navigating Imperfect Situations in Patient Care30:32 Triage Decisions: When to Save a Limb31:03 Understanding Reperfusion Injury and Its Challenges35:43 Managing Acidosis in Trauma Patients46:34 Advice for Medics: The Importance of ConversionThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content, go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Shelly, Mawi, Paul, and Stephen have a great discussion on volume resuscitation strategies, maximum blood products given, and what to give when pH is whack. The nephrologist has some knowledge to drop....
In Episode #38 of EM Logic, Dr. Pregerson reviews what you can do before intubation in order to prevent triggering a subsequent cardiac arrest. Read more details here in the Show Notes.
Jaclyn Duncan, RN shares details of a research study on preparing nurses to support family presence in resuscitation.
Send us a textToday we interviewed Cally, who shared her experiences across two very different births. Her first pregnancy took place during COVID, where limited access to care led her to an OB by default. Red flags emerged throughout the pregnancy, but she continued with the same provider. After a long posterior labour that ended in an epidural and Syntocinon, she began to reflect more deeply on her birth choices.We also spoke about her breastfeeding journey—navigating early challenges, pumping and bottle-feeding for nearly two years—and her experience with a medically managed miscarriage, which she approached with intention and care.In her third pregnancy, Cally initially returned to her OB but switched to a private midwife at 26 weeks after feeling unsupported in her birth preferences. She went on to plan a homebirth that honoured her values and autonomy. When a postpartum hemorrhage occurred, it was swiftly and effectively managed by her midwifery team at home—including resuscitation—demonstrating the high level of skill and preparedness within well-supported homebirth care.Links:Mama Midwives Core & Floor Restore Free Antenatal ClassesThe Pink Elephant Support Network Red Nose Info on APGAR Score Ten years of publicly funded homebirth services in Victoria Mothers & Babies Report - APGAR dataNational Core Maternity Indicators - APGARWhat is Medical management of miscarriage Support the show@homebirthstoriesaustralia Support the show by buying us a coffee! Please be advised that this podcast may contain explicit language. Listener discretion is advised.The information, statistics, and research presented in this podcast are for informational purposes only and are not intended to constitute or replace medical or midwifery advice. All information discussed can be found online and is provided in the links in the show notes. It is always recommended to conduct your own research and make informed decisions. We advise you to discuss any topics or concerns with your healthcare provider. While we strive to incorporate the most up-to-date research in our episodes, we do not warrant or guarantee the accuracy of the information discussed on the show.
In this episode of the PFC Podcast, Dennis and Alex delve into the complexities of burn resuscitation, discussing recent advancements in fluid management and the importance of urine output monitoring. They explore the historical context of burn care, the role of glycocalyx in fluid dynamics, and evaluate various resuscitation protocols. The conversation emphasizes the need for careful fluid management to avoid complications and improve patient outcomes, particularly in emergency and military settings.TakeawaysBurn injuries require specialized and intensive care.Fluid management is critical in burn resuscitation.The glycocalyx plays a significant role in fluid dynamics.Urine output is a key indicator of patient status.Over-resuscitation can lead to severe complications.Plasma therapy shows promise in improving outcomes.Historical protocols may need reevaluation based on new evidence.Monitoring urine output is essential for adjusting fluid therapy.Collaboration with burn centers is crucial in managing severe cases.Understanding the physiological changes in burn patients is vital.Chapters00:00 Introduction to Burn Resuscitation03:09 Understanding Burn Injuries and Their Management06:00 Fluid Management in Burn Patients09:05 The Role of Glycocalyx in Fluid Dynamics12:04 Evaluating Burn Resuscitation Protocols15:08 Comparing Fluid Resuscitation Strategies17:51 The Importance of Urine Output Monitoring20:47 Outcomes of Different Resuscitation Approaches24:01 Recommendations for Burn Care in the Field26:59 Final Thoughts on Burn ResuscitationThank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content, go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Hint...It has nothing to do with the formula. Posting tomorrow.Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content, go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In 1960, Norwegian toymaker Åsmund Lærdal began selling his latest invention - a life-size training dummy designed to teach mouth-to-mouth resuscitation.Resusci Anne is made of soft plastic and resembles an unconscious person. Åsmund wanted as many people as possible to be trained in this new method of life saving and he hoped that a female manikin would be less threatening to trainees.Anne's now believed to have saved the lives of more than two million people around the world.Jacqueline Paine speaks to Åsmund's son Tore Lærdal, who explains how his father had been inspired by a near-death experience Eye-witness accounts brought to life by archive. Witness History is for those fascinated by the past. We take you to the events that have shaped our world through the eyes of the people who were there. For nine minutes every day, we take you back in time and all over the world, to examine wars, coups, scientific discoveries, cultural moments and much more. Recent episodes explore everything from football in Brazil, the history of the ‘Indian Titanic' and the invention of air fryers, to Public Enemy's Fight The Power, subway art and the political crisis in Georgia. We look at the lives of some of the most famous leaders, artists, scientists and personalities in history, including: visionary architect Antoni Gaudi and the design of the Sagrada Familia; Michael Jordan and his bespoke Nike trainers; Princess Diana at the Taj Mahal; and Görel Hanser, manager of legendary Swedish pop band Abba on the influence they've had on the music industry. You can learn all about fascinating and surprising stories, such as the time an Iraqi journalist hurled his shoes at the President of the United States in protest of America's occupation of Iraq; the creation of the Hollywood commercial that changed advertising forever; and the ascent of the first Aboriginal MP.(Photo: Åsmund Lærdal with Resusci Anne in water rescue. Credit: Lærdal Medical)
Contributor: Aaron Lessen, MD Educational Pearls: Point-of-care ultrasound (POCUS) is used to assess cardiac activity during cardiac arrest and can identify potential reversible causes such as pericardial tamponade Ultrasound could be beneficial in another way during cardiac arrest as well: pulse checks Manual palpation for detecting pulses is imperfect, with false positives and negatives Doppler ultrasound can be used as an adjunct or replacement to manual palpation for improved accuracy Options for Doppler ultrasound of carotid or femoral pulses during cardiac arrest: Visualize arterial pulsation Use color doppler Numerically quantify the flow and correlate this to a BP reading - slightly more complex Doppler ultrasound is much faster than manual palpation for pulse check Can provide information almost instantaneously without waiting the full 10 seconds for a manual pulse check The main priority during cardiac arrest resuscitation is to maintain quality compressions If pulses are unable to be obtained through Doppler within the 10-second window, resume compressions and try again during the next pulse check References Cohen AL, Li T, Becker LB, Owens C, Singh N, Gold A, Nelson MJ, Jafari D, Haddad G, Nello AV, Rolston DM; Northwell Health Biostatistics Unit. Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation. 2022 Apr;173:156-165. doi: 10.1016/j.resuscitation.2022.01.030. Epub 2022 Feb 4. PMID: 35131404. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/
Wrapping up a series of 5 episodes, Dr Jarvis finishes his discussion of mechanical CPR devices (MCDs) talking about papers from Utah, Vienna, Anchorage, and Cincinnati and then gives his take on how to interpret the literature and put it into practice.Papers discussed:1) Youngquist ST, Ockerse P, Hartsell S, Stratford C, Taillac P: Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: A propensity score analysis. Resuscitation. 2016;September;106:102–7.2) Zeiner S, Sulzgruber P, Datler P, Keferböck M, Poppe M, Lobmeyr E, Van Tulder R, Zajicek A, Buchinger A, Polz K, et al.: Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation. 2015;November;96:220–5.3) Levy M, Yost D, Walker RG, Scheunemann E, Mendive SR: A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation. Resuscitation. 2015;July;92:32–7.4) Morgan S, Gray JJ, Sams W, Uhl K, Gundrum M, McMullan J: LUCAS Device Use Associated with Prolonged Pauses during Application and Long Chest Compression Intervals. Prehospital Emergency Care. 2023;March 9;28(1):114–7.5) Grunau B, Reynolds J, Scheuermeyer F, Stenstom R, Stub D, Pennington S, Cheskes S, Ramanathan K, Christenson J: Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital? Prehospital Emergency Care. 2016;September 2;20(5):615–22. FAST25 | May 19-21, 2025 | Lexington, KY
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!
In this episode of Critical Levels, we dive into the cutting-edge strategies shaping pre-hospital and emergency department care. Our guests discuss how data-driven decision-making, high-performance CPR, and improved handover processes are revolutionizing patient outcomes. Key Topics Covered: ✅ High-Performance CPR: The role of real-time feedback, mechanical CPR devices, and quality metrics in improving survival rates. ✅ Data-Driven Protocols: How data influences resuscitation techniques, including push-dose epinephrine, early vasopressor administration, and optimizing CPR pauses. ✅ Seamless Transitions of Care: Addressing the challenges of pre-hospital to hospital handover, minimizing interruptions, and ensuring continuity of life-saving interventions. ✅ Training & Coaching: The impact of structured CPR coaching, debriefing sessions, and real-time monitoring in refining paramedic performance. ✅ Future Directions: Exploring nurse-led ACLS, multidisciplinary teamwork, and technology-driven improvements in emergency medicine. Key Takeaways:
In this episode of the Saving Lives Podcast, we discuss a study from Intensive Care Medicine that explores whether baseline serum chloride and pH affect outcomes with balanced fluids versus saline. The findings from the PLUS trial show no significant interaction, but intriguing trends suggest that hyperchloremic patients may benefit more from balanced fluids. The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: https://amzn.to/47qJZe1 (Affiliate Link)My Store: https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook (Use "podcast" to save 10%)Citation: Ramanan M, Hammond N, Billot L, Delaney A, Devaux A, Finfer S, Li Q, Micallef S, Venkatesh B, Young PJ, Myburgh J; PLUS Investigators. Serum chloride concentration and outcomes in adults receiving intravenous fluid therapy with a balanced crystalloid solution or 0.9% sodium chloride. Intensive Care Med. 2025 Feb;51(2):249-258. doi: 10.1007/s00134-024-07764-2. Epub 2025 Feb 10. PMID: 39928118.
On the corner of Skyland Drive and 23 in a little town called Sylva in Western North Carolina, sit's PJ's gas station. One hot summer day back in 2005, I was filling up the tank in a convalescent transport van on my very first day as an EMT-Basic. That's the most basic, entry-level certification of […]
Medsider Radio: Learn from Medical Device and Medtech Thought Leaders
In this episode of Medsider Radio, we had an insightful discussion with Drs. Asha Parekh and Adam Power, co-founders of Front Line Medical Technologies. The company's COBRA-OS (Control of Bleeding, Resuscitation, Arterial Occlusion System) is a compact, minimally invasive device, designed for temporary aortic occlusion in trauma situations. Asha has a PhD in Biomedical Engineering from Western University, and combines technical expertise with entrepreneurial leadership. Adam is an academic and practicing vascular surgeon at Western University, with extensive training from institutions including Dalhousie, McMaster, and Mayo Clinic.In this interview, they discuss how their clinical-engineer partnership accelerated development, their approach to clinical studies for regulatory clearance across multiple geographies, and their strategic decision to avoid VC funding during early development—and how that decision paid off.Before we dive into the discussion, I wanted to mention a few things:First, if you're into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You'll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and 3 packages that will help you make use of our database of 750+ life science investors more efficiently for your fundraise and help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the latest Medsider Mentors Volume VII. If you're interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Asha Parekh and Adam Power.
A new study has found rodents perform "mouse-to-mouse resuscitation" on each other, much like human CPR, when finding another rodent unresponsive. Also new research has found that solar farms that are built and managed with biodiversity in mind can host up to three times as many birds as crop fields. All to discuss with Dr Ruth Freeman in this week's 'Green Scene'All with thanks to Repak.
'The Suspicious Death of Liam Farrell" - Brendan & Bernie FarrellThe Garda Commissioner is to appoint a senior officer to carry out a peer review of the garda investigation into the death of Liam Farrell.The 87-year-old who lived alone in Rooskey, Co Leitrim, was found by his daughter slumped on his back at the back door of his home on Sunday 13 January 2020.He was covered in blood, his shoes and socks were removed, his watch was broken and he had bruising to his left eye and his feet.Resuscitation efforts were not successful and the family believe he may have been attacked.Gardaí said they carried out a full investigation into the circumstances of Mr Farrell's death and that an investigation file was submitted to the Director of Public Prosecutions, but no prosecution was directed.Garda Commissioner Drew Harris said the peer review is being carried out "with an investigative view in mind".He said a fresh investigation was "not practically possible" and that gardaí "can't start again at day one".I spoke with Brendan & Bernie Farrell who say their only focus is to get justice for Liam. They said if it happened to anyone else, Liam would not stop, so they won't stop until they get answers. If you have any information please call the Garda Confidential Line: 1800 666 111 Hosted on Acast. See acast.com/privacy for more information.
In this episode, we drop in on the Colorado ACEP Leadership Symposium with a talk by Dr. Chris Tems as he poses the question on whether ECMO is the future of EM cardiac arrest resuscitation.
Do you find yourself saying: “Hey, what's the big idea with that newfangled whole blood in the refrigerator next to the trauma bay?” Like using whole blood but not sure why? Don't like using whole blood but not sure why? Join us for a 30 minute power session in whole blood where we try to get you the information you need to know! Hosts: - Michael Cobler-Lichter, MD, PGY4/R2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (X/twitter) - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow University of Pennsylvania Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency @urrechisme (X/twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending: Loma Linda University Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship - Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 6 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @jpmeizoso (twitter) Learning Objectives: - Describe the proposed benefits of whole blood resuscitation in trauma - Identify current problems with synthesizing the existing literature on whole blood resuscitation in trauma - Propose needed areas for future research regarding whole blood resuscitation in trauma Quick Hits: 1. There is significant heterogeneity in study design across whole blood resuscitation studies, complicating comparison 2. There is likely a mortality benefit to whole blood resuscitation in trauma, however this is likely dependent on the specific population 3. Future research directions should focus on prospective randomized work to try and better quantify the exact benefit of whole blood, and determine in which populations this benefit is actually realized References 1. Hazelton JP, Ssentongo AE, Oh JS, Ssentongo P, Seamon MJ, Byrne JP, Armento IG, Jenkins DH, Braverman MA, Mentzer C, Leonard GC, Perea LL, Docherty CK, Dunn JA, Smoot B, Martin MJ, Badiee J, Luis AJ, Murray JL, Noorbakhsh MR, Babowice JE, Mains C, Madayag RM, Kaafarani HMA, Mokhtari AK, Moore SA, Madden K, Tanner A 2nd, Redmond D, Millia DJ, Brandolino A, Nguyen U, Chinchilli V, Armen SB, Porter JM. Use of Cold-Stored Whole Blood is Associated With Improved Mortality in Hemostatic Resuscitation of Major Bleeding: A Multicenter Study. Ann Surg. 2022 Oct 1;276(4):579-588. doi: 10.1097/SLA.0000000000005603. Epub 2022 Jul 18. PMID: 35848743. https://pubmed.ncbi.nlm.nih.gov/35848743/ 2. Sperry JL, Cotton BA, Luther JF, Cannon JW, Schreiber MA, Moore EE, Namias N, Minei JP, Wisniewski SR, Guyette FX; Shock, Whole Blood, and Assessment of Traumatic Brain Injury (SWAT) Study Group. Whole Blood Resuscitation and Association with Survival in Injured Patients with an Elevated Probability of Mortality. J Am Coll Surg. 2023 Aug 1;237(2):206-219. doi: 10.1097/XCS.0000000000000708. Epub 2023 Apr 11. PMID: 37039365; PMCID: PMC10344433. https://pubmed.ncbi.nlm.nih.gov/37039365/ 3. Meizoso JP, Cotton BA, Lawless RA, et al. Whole blood resuscitation for injured patients requiring transfusion: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2024;97(3):460-470. doi:10.1097/TA.0000000000004327 https://pubmed.ncbi.nlm.nih.gov/38531812/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Last episode we described the literature showing no survival benefit to patients with the AutoPulse device. Fear not, I wasn't ignoring the LUCAS, I just felt it deserved it's own episode. We'll cover the LINC and PARAMEDIC randomized controlled trials and the secondary analysis of LINC in shockable rhythms. I switched to a new production process using a new mic (Rode NT1) and started using ecamm to record. Yes, I know there is a bit of AV dysynchrony.. I'm working on it. I still have a lot to learn about ecamm but am optimistic about it. Citations on LUCAS device:1. Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, et al.: Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: The LINC Randomized Trial. JAMA. 2014;January 1;311(1):53–61.2. Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther A-M, Woollard M, Carson A, et al.: Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. The Lancet. 2015;385(9972):947–55.3. Hardig BM, Lindgren E, Östlund O, Herlitz J, Karlsten R, Rubertsson S: Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial—A randomised, controlled trial. Resuscitation. 2017;June;115:155–62. Citations on Jeff's Tamiflu Rant1. Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ: Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014;348:g2545.2. Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Onakpoya I, Heneghan CJ: Risk of bias in industry-funded oseltamivir trials: comparison of core reports versus full clinical study reports. BMJ Open. 2014;4(9):e005253.3. Jefferson T: The Tamiflu Story: Why We Need Access To All Data From Clinical Trials. Open Knowledge Foundation Blog. FAST25 | May 19-21, 2025 | Lexington, KY
About our Guest: Dr. Philip C. Spinella is a professor in the Departments of Surgery and Critical Care Medicine and the Director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. He also co-founded the THOR network for trauma and hemostasis research and has as been involved with multiple nationally-funded research programs.References:Use of whole blood in pediatric trauma: a narrative review - PubMed (nih.gov)Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital - PubMed (nih.gov)Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative - PubMed (nih.gov)Whole Blood Transfusion - PubMed (nih.gov)Pediatric traumatic hemorrhagic shock consensus conference recommendations - PubMed (nih.gov)Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial - PubMed (nih.gov)Precision Platelet Transfusion Medicine is Needed to Improve Outcomes - PubMed (nih.gov)Just chill—it's worth it! (wiley.com)Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
Recorded at Evidence Based Perioperative Medicine (EBPOM) in London last year this presentation is part of a series of talks given under the session heading: “Implementation – what works and what doesn't?”. This piece is part one of four, with two more presentations to come and then a fascinating panel discussion to conclude. This first session focuses on the implementation of clinical trials, covering research methodologies, clinical implementations, and their challenges, and looking at the lengthy process of translating medical discoveries into clinical practice, emphasizing the ethical obligation to disseminate trial results effectively. The under-representation of certain demographics in trials, the gap between research findings and clinical practice, and the need for better communication strategies is stressed alongside solutions, including training for researchers, involving key stakeholders from the start, and the role of funders in supporting effective dissemination and implementation of research findings. Our presenter is, Joyce Yeung, Professor of Anaesthesia and Critical Care Medicine at the University of Warwick. She is Theme Lead of the Emergency, Prehospital, Perioperative and Critical Care Trials group within Warwick Clinical Trials Unit. Clinically she holds appointments as a Consultant in Critical Care Medicine at University Hospital Birmingham NHS Foundation Trust. Joyce is Director of UK Perioperative Medicine Clinical Trials Network. She is joint Clinical Speciality Lead for Anaesthesia, Perioperative Medicine and Pain for West Midlands Comprehensive Research Network. She is also the Chair of Resuscitation Council UK Immediate Life Support Subcommittee and is a member of Scientific and Education Committee at European Resuscitation Council. She serves as expert systematic reviewer and International Liaison Committee on Resuscitation taskforce member. Joyce is Chief Investigator for a major grant examining the impact of volatile versus intravenous anaesthesia in non-cardiac surgery (VITAL trial). Her research interests are applied health research and clinical trials including improving perioperative patient outcomes, chronic pain, post-operative cognitive dysfunction, and resuscitation. For more information about EBPOM and the conferences they are organising this year please go to www.ebpom.org
About our Guest: Dr. Philip C. Spinella is a professor in the Departments of Surgery and Critical Care Medicine and the Director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. Dr. Spinella is a well-established clinical trialist who has published extensively in the field and contributed to research programs for the FDA, NIH, and DoD. He also co-founded the THOR network for trauma and hemostasis research and has been involved with multiple nationally funded research programs.References:Use of whole blood in pediatric trauma: a narrative review - PubMed (nih.gov)Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital - PubMed (nih.gov)Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative - PubMed (nih.gov)Whole Blood Transfusion - PubMed (nih.gov)Pediatric traumatic hemorrhagic shock consensus conference recommendations - PubMed (nih.gov)Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial - PubMed (nih.gov)Precision Platelet Transfusion Medicine is Needed to Improve Outcomes - PubMed (nih.gov)Just chill—it's worth it! (wiley.com)Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
Our story so far.. episode 92 looked at a study showing lower survival from in-hospital cardiac arrest in patients treated with mechanical compression devices. Episode 93 discussed an implementation study of implementing LUCAS devices in a system with high quality pit crew CPR also showing lower survival, despite spending lots of time in training on how to optimally apply the LUCAS to avoid prolonged compression interruptions and movement. Now we're diving into the literature around AutoPulse, the load-distributing band device. We'll cover two randomized controlled trials and one well-done observational study comparing AutoPulse to manual CPR. Don't worry, LUCAS studies will be in the next episode.Citations1. Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN, Van Ottingham L, Olsufka M, Pennington S, White LJ, et al.: Manual Chest Compression vs Use of an Automated Chest Compression Device During Resuscitation Following Out-of-Hospital Cardiac Arrest: A Randomized Trial. JAMA. 2006;June 14;295(22).2. Ong MEH, Ornato JP, Edwards DP, Dhindsa HS, Best AM, Ines CS, Hickey S, Clark B, Williams DC, Powell RG, et al.: Use of an Automated, Load-Distributing Band Chest Compression Device for Out-of-Hospital Cardiac Arrest Resuscitation. JAMA. 2006;June 14;295(22).3. Wik L, Olsen J-A, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, Van Grunsven PM, et al.: Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014;June;85(6):741–8.
With Inara, Boddy, Plame, and Stagram all near death and Fawin's magic nearly exhausted, the Party must find some place within the crypts to rest and recover. Will Boddy's inconsistent healing skills and Plame's unpredictable "blessed touch" be enough to keep the Party alive? Or will another Guardian of the Tomb be drawn towards them and forever silence the explorers from Breachill? Special Thanks:Theme Music - "Together We Rise" by Wind Rose (used with permission) Sound Effects and additional music courtesy of Table Top Audio, Ovani Sound and Monument StudiosDice for the cast of Wayfinder Legends provided by Esty Way Gaming.Wayfinder Legends is a Red Dirt RPG, LLC production.JOIN THE PARTY! CAST:Jeremy - Boddy, a Hobgoblin seeking a new purposeHal - Plame, a charismatic and entertaining, young goblinEmily - Inara, a confident and hot-headed, young Kellish womanBrook - Fawin, an Aiuvarin (half-elven) born into privilegeStacy - Pathfinder 2e Gamemaster
Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for changeReferences: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer:This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.
We discuss the impact of family presence during resuscitations. Hosts: Ellen Duncan, MD, PhD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Family_Presence_During_Resuscitation.mp3 Download Leave a Comment Tags: Critical Care, Pediatrics Show Notes Overview Historical Context: The conversation around allowing family members in the room during resuscitation events began gaining attention in 1987. Since then, the practice has been increasingly encouraged. Current Practices in Pediatrics: Family presence during pediatric resuscitations remains inconsistent, with healthcare provider acceptance ranging from 15% to 85%. Many subspecialists and consultants still request that families step out, often due to outdated concerns. Common Concerns & Myths: Interference in resuscitation → Studies show minimal disruption. Legal risks → No increased litigation risk has been demonstrated. Family trauma → Research suggests that presence may help with grieving and reduce PTSD symptoms. Evidence from the Literature New England Journal of Medicine study on Family Presence During Cardiopulmonary Resuscitation (Jabre et al., 2013): In a randomized controlled trial of 570 relatives, PTSD-related symptoms were significantly higher in family members who were not offered the oppo...
Dr Paul Luckin is an anaesthetist, with a very unique background.As an authority on human survivability he's a medical advisor to the Police Search and Rescue teams and the Australian Maritime Safety Authority (that's AMSA), providing time-frames for human survival during Search and Rescue operations.He teaches the medical aspects of Search and Rescue, and is on the directing staff of the National Police Search and Rescue Managers Course.A humble and highly trained specialist clinician and expert in search and rescue, he has served as a Captain in the Royal Australian Naval Reserve in Bougainville, East Timor, in the Resuscitation and Retrieval Team for the victims of the first Bali bombing, and in the first foreign medical team into Banda Aceh following the 2004 tsunami, and much, much more.In 2015, he was made a Member of the Order of Australia, AM, for significant service to thecommunity through emergency medicine, and he joins me today…
What if the lessons learned from a conflict zone could transform military medicine worldwide? Join us as we promise to reveal groundbreaking insights into combat casualty care with John Quinn, MD, MPH, PhD, EMT-P, a leading voice in Emergency Medicine and Combat Casualty Care. Dr. Quinn shares his experiences and pivotal lessons from the war in Ukraine, providing an in-depth look at how military medical operations have evolved in response to the challenges faced in high-stakes environments. Gain valuable knowledge on damage control, resuscitation, and the strategic decisions made from the point of injury to more advanced medical roles. The complexities of combat medicine are not for the faint-hearted. In this compelling episode, we confront the realities of triage and care under fire, with medical personnel often working without senior guidance amidst the chaos of large-scale combat. Our discussion sheds light on the critical importance of Tactical Combat Casualty Care and the intricate decisions around tourniquet use when resources are stretched thin. Dr. Quinn emphasizes the skills required to manage such intense scenarios, ensuring listeners understand the vital balance between operational readiness and effective medical intervention. Handling pain management and blood supply logistics in conflict zones is no small feat. We explore the intricate challenges of ensuring adequate supplies and effective pain medication, particularly in the context of Ukraine's ongoing conflict. Dr. Quinn delves into the necessity of a robust supply of universal donor blood and the pressing need for improved clinical governance to support pre-hospital blood transfusion capabilities. The episode addresses the pressing issue of antimicrobial resistance and antibiotics' critical role in these settings, highlighting the need for structured guidance and oversight to navigate the complexities of treating diverse patient populations. Chapter Timestamps 00:02 Military Medicine and Operational Readiness 09:30 Combat Medicine and Triage Challenges 14:08 Challenges in Pre-Hospital Pain Management 17:43 Combat Medic Challenges and Solutions Chapters with Summaries (00:02) Military Medicine and Operational Readiness This chapter explores the insights and experiences shared by Dr. John Quinn, the lead author of a pivotal article on pre-hospital lessons from the war in Ukraine, focusing on damage control, resuscitation, and surgery from point of injury to role two. Dr. Quinn, with a background as a paramedic and emergency medicine physician, recounts his involvement in Ukraine since 2014, highlighting the evolution of military medical operations up to the large-scale invasion by Russia. We discuss the collaborative effort behind the article, featuring a diverse team of experts, including traumatology surgeons, paramedics, and academic figures, all working to enhance combat casualty care. Dr. Quinn emphasizes the importance of incorporating Ukrainian academics' insights and using NATO's terminology for lessons learned, providing a comprehensive look at the on-the-ground experiences and challenges faced in providing timely and effective medical care in conflict zones. (09:30) Combat Medicine and Triage Challenges This chapter addresses the complex challenges faced by medical personnel in large-scale combat operations, particularly in the context of the ongoing conflict involving Russian forces. We explore how medical workers, including international volunteers, are specifically targeted, necessitating unique approaches to operational security, communication, and personal protective equipment. The discussion emphasizes the importance of tactical combat casualty care, especially in making critical triage decisions without the guidance of senior clinical decision-makers. With an overwhelming number of patients and limited evacuation capabilities, medical personnel must navigate the intricacies of tourniquet use, balancing between preventative application and conversion to pressure dressings as per TCCC protocols. The chapter highlights the essential skills required to manage care under fire and the need for timely assessment by qualified providers to reduce morbidity and enhance force effectiveness in the battlefield. (14:08) Challenges in Pre-Hospital Pain Management This chapter addresses the challenges and intricacies of pain management and blood supply logistics in conflict zones, particularly focusing on the context of Ukraine. We explore the inadequacies of certain medications like Nalbuphine, which can complicate effective pain management when transitioning patients to higher levels of care. The importance of having access to more effective drugs such as ketamine and fentanyl is emphasized, although logistical challenges in their distribution are acknowledged. Additionally, we highlight the critical need for an ample supply of universal donor blood and low-titer O blood products during large-scale combat operations. The chapter underscores the logistical hurdles in ensuring these supplies are available before they spoil and discusses the inadequacy of traditional walking blood banks in high-casualty scenarios, advocating for improved clinical governance to enable broader pre-hospital blood transfusion capabilities. (17:43) Combat Medic Challenges and Solutions This chapter highlights the critical importance of antibiotics in deployed medical settings, emphasizing the challenges of antimicrobial resistance, particularly in Ukraine. We explore the need for a structured antimicrobial guidance system, informed by biogram data, to prevent inappropriate dosing and resistance. The discussion extends to the complexities of treating diverse age groups, including elderly and pediatric patients, who may have additional medical conditions or require specialized care. Additionally, we stress the significance of clinical governance in ensuring that medical personnel, whether affiliated with NGOs or the military, operate under proper oversight and standards. Finally, we identify the top three priorities for improvement: ensuring an unlimited supply of low-titer universal donor blood, enhancing training and clinical decision-making, and leveraging data for effective medical logistics and planning. Take Home Messages: Evolving Military Medical Practices: The podcast delves into the evolution of military medical operations in Ukraine, highlighting the lessons learned from the ongoing conflict. It emphasizes the importance of adapting medical practices to the realities of modern warfare, particularly in large-scale conflicts where traditional medical procedures may not suffice. Challenges in Battlefield Medicine: Listeners are exposed to the myriad challenges faced by medical personnel in combat zones, including the complexities of tactical combat casualty care and the necessity for rapid, autonomous decision-making under fire. The episode underscores the need for enhanced training and preparation to handle these high-pressure situations effectively. Pain Management and Medical Logistics: The discussion reveals significant hurdles in managing pain and logistics in conflict zones, with specific reference to Ukraine's current crisis. It stresses the need for reliable access to effective medications and blood supplies, highlighting the logistical challenges that can impact patient outcomes. Antimicrobial Resistance and Clinical Governance: The episode sheds light on the critical role of antibiotics in deployed medical settings and the growing concern of antimicrobial resistance. It advocates for structured guidance systems and emphasizes the importance of clinical governance to ensure high standards of care are maintained, especially when relying on NGOs and international volunteers. Data-Driven Medical Improvements: The conversation calls for the collection and analysis of medical data to enhance military medical practices. It stresses the importance of leveraging lessons learned from current conflicts to refine medical logistics, decision-making processes, and training, ensuring better preparedness for future challenges. Episode Keywords: Military Medicine, Operational Readiness, Combat Medicine, Triage, Ukraine Conflict, Russian Invasion, Damage Control, Resuscitation, Surgery, Battlefield, Tactical Combat Casualty Care, Tourniquets, Pressure Dressings, Pain Management, Logistical Hurdles, Antimicrobial Resistance, Clinical Governance, Medical Logistics, Training, Data Analysis Hashtags: #CombatMedicine #UkraineConflict #BattlefieldHealthcare #MilitaryMedicine #EmergencyCare #TacticalCombatCasualtyCare #FrontlineMedicine #WarfareInnovations #ConflictZoneMedicine #DrJohnQuinn Article Citation: Quinn J et al. Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2. Mil Med. 2024 Jan 23;189(1-2):17-29. doi: 10.1093/milmed/usad253. PMID: 37647607. Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield,demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast
Welcome to our first episode recorded at the London Trauma Conference 2024. In this episode, hosts Iain Beardsell and Natalie May are joined by Matt Hooper from Adelaide to discuss his unique career path, from emergency medicine to pre-hospital and retrieval medicine, intensive care, and more recently, palliative and end-of-life care. The conversation centres around the principles of end-of-life care, particularly in acute and traumatic scenarios, and how these can be integrated with life-saving efforts. Key points include the challenges of shifting focus from survival to quality of death, the importance of recognizing and supporting witnesses and caregivers, and the concept of 'compassionate resuscitation.' Practical tools such as the 'pause' are also explored, aiming to humanize highly charged medical environments and potentially prevent burnout and PTSD among healthcare providers. 00:00 Introduction and Guest Welcome 01:00 Key Messages on Death and Palliative Care 02:12 Challenges in End-of-Life Care 03:20 Improving Quality of Death and Relationships 04:32 Emotional Impact on Care Providers 06:41 Navigating End-of-Life Conversations 12:17 Practical Applications in Intensive Care 16:41 The Pause: A Tool for Reflection 21:58 Conclusion and Final Thoughts The Guest - Matt Hooper Matt is an accomplished intensive care specialist with a diverse background in emergency medicine, prehospital & retrieval medicine, and palliative care. Notable for his leadership in developing critical care service models, he founded South Australia's MedSTAR Emergency Medical Retrieval Service. He has also co-authored a highly regarded case-based text book and held key teaching and examining roles nationally and internationally in prehospital and retrieval medicine. With a strong focus on high-performance teams working within high acuity, high consequence environments, Matt's expertise has also extended to human factors in healthcare, cardiothoracic intensive care, ECMO, and clinical ultrasound. More recently however, he has pivoted towards palliative and end of life care, pursuing a Master's degree at Cardiff University and consulting at Mary Potter Hospice in Adelaide. He is passionate about exploring new and innovative ways to prevent potentially avoidable suffering and enhance end of life outcomes for patients in acute care clinical environments.
Why are they changing MARCH to Resus before managing the Chest? Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-214-TCCC-Updates-e2to67f Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC Podcast, Dennis and John discuss the ongoing updates and changes within the Tactical Combat Casualty Care (TCCC) guidelines. They delve into the role of the TTC Committee, the importance of literature reviews in developing algorithms for trauma care, and the proposed changes to the March algorithm, emphasizing the need for resuscitation before decompression. The conversation also covers the overhaul of the analgesic section, the recommendations for antibiotics, and the role of TXA in treating hemorrhagic shock. Additionally, they touch on the significance of triage in mass casualty situations and the future directions of the committee's work. Takeaways TCCC is continuously updated to reflect new research. Resuscitation should be prioritized over decompression in trauma care. The March algorithm may undergo significant changes to improve outcomes. Analgesic options are being re-evaluated due to supply issues. Rocephin is being recommended as a primary antibiotic. TXA is crucial for managing hemorrhagic shock in trauma patients. Triage protocols are essential for effective mass casualty management. The committee is open to innovative ideas and solutions. Training and education are vital for implementing new guidelines. Future meetings will focus on finalizing and voting on proposed changes. Chapters 00:00 Introduction to the PFC Podcast 02:46 Understanding the TTC Committee and Its Role 06:06 Literature Review and Algorithm Development 09:00 Resuscitation vs. Decompression in Trauma Care 12:07 Proposed Changes to the March Algorithm 15:06 Analgesic Section Overhaul and Alternatives 18:09 Antibiotic Recommendations and Changes 20:54 TXA and Its Role in Hemorrhagic Shock 23:51 Triage in Mass Casualty Situations 26:45 Future Directions and Upcoming Votes 30:06 Conclusion and Final Thoughts Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Ever wonder what would happen to cardiac arrest survival after a system implements LUCAS devices and trains really hard to deploy them appropriately? Wonder no more. Dr Jarvis reviews a paper from the Austin/Travis County EMS System that will shed some light on the question. This is the second episode in a series on mechanical compression devices. Citations:1. Gonzales L, Oyler BK, Hayes JL, Escott ME, Cabanas JG, Hinchey PR, Brown LH: Out-of-hospital cardiac arrest outcomes with “pit crew” resuscitation and scripted initiation of mechanical CPR. The American Journal of Emergency Medicine. 2019;May;37(5):913–20.2. Crowley C, Salciccioli J, Wang W, Tamura T, Kim EY, Moskowitz A: The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study. Resuscitation. 2024;May 1;198.
In this episode Tracy McCallin, MD, FAAP, explains the focused update on drowning guidelines published by the AAP and the American Heart Association. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Devlynne Sasha Ondusko, MD, FAAP, about her research into the experiences of Black families in the Neonatal Intensive Care Unit. For resources go to aap.org/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
We know the literature on mechanical CPR devices on mortality in out of hospital cardiac arrest (we DO know this literature, right?), but what about in-hospital arrest? Dr. Jarvis reviews a recent paper that uses the AHA Get With The Guidelines - Resuscitation registry to assess the association between MCDs and mortality. Citations1. Crowley C, Salciccioli J, Wang W, Tamura T, Kim EY, Moskowitz A: The association between mechanical CPR and outcomes from in-hospital cardiac arrest: An observational cohort study. Resuscitation. 2024;May 1;198.2. Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, et al.: Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: The LINC Randomized Trial. JAMA. 2014;January 1;311(1):53–613. Hardig BM, Lindgren E, Östlund O, Herlitz J, Karlsten R, Rubertsson S: Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial—A randomised, controlled trial. Resuscitation. 2017;June;115:155–62.4. Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther A-M, Woollard M, Carson A, et al.: Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. The Lancet. 2015;385(9972):947–55.5. Wik L, Olsen J-A, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, Van Grunsven PM, et al.: Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014;June;85(6):741–8.6. Bonnes JL, Brouwer MA, Navarese EP, Verhaert DVM, Verheugt FWA, Smeets JLRM, Boer M-J de: Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies. Ann Emerg Med Annals of emergency medicine. 2016;67(3):349-360.e3.7. Gonzales L, Oyler BK, Hayes JL, Escott ME, Cabanas JG, Hinchey PR, Brown LH: Out-of-hospital cardiac arrest outcomes with “pit crew” resuscitation and scripted initiation of mechanical CPR. The American Journal of Emergency Medicine. 2019;May;37(5):913–20.8. Koster RW, Beenen LF, Van Der Boom EB, Spijkerboer AM, Tepaske R, Van Der Wal AC, Beesems SG, Tijssen JG: Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. European Heart Journal. 2017;October 21;38(40):3006–13.9. Primi R, Bendotti S, Currao A, Sechi GM, Marconi G, Pamploni G, Panni G, Sgotti D, Zorzi E, Cazzaniga M, et al.: Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest—Device Matters: A Propensity-Score-Based Match Analysis. JCM. 2023;June 30;12(13):4429.10. Youngquist ST, Ockerse P, Hartsell S, Stratford C, Taillac P: Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: A propensity score analysis. Resuscitation. 2016;September;106:102–7.11. S, Sulzgruber P, Datler P, Keferböck M, Poppe M, Lobmeyr E, Van Tulder R, Zajicek A, Buchinger A, Polz K, et al.: Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation. 2015;November;96:220–5. 12. Morgan S, Gray JJ, Sams W, Uhl K, Gundrum M, McMullan J: LUCAS Device Use Associated with Prolonged Pauses during Application and Long Chest Compression Intervals. Prehospital Emergency Care. doi: 10.1080/10903127.2023.2183294 (Epub ahead of print).13. Levy M, Yost D, Walker RG, Scheunemann E, Mendive SR: A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation. Resuscitation. 2015;July;92:32–7.14. Li H, Wang D, Yu Y, Zhao X, Jing X: Mechanical versus manual chest compressions for cardiac arrest: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2016;December;24(1):10.15. Sheraton M, Columbus J, Surani S, Chopra R, Kashyap R: Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis. WestJEM. 2021;July 19;22(4):810–9.16. Wang PL, Brooks SC: Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev The Cochrane database of systematic reviews. 2018;20;8:CD007260.17. Zhu N, Chen Q, Jiang Z, Liao F, Kou B, Tang H, Zhou M: A meta-analysis of the resuscitative effects of mechanical and manual chest compression in out-of-hospital cardiac arrest patients. Crit Care. 2019;December;23(1):100.
Which elements of your current pre-shift preparation contribute most to your mental clarity and performance, and what new practices might further optimize your readiness? With interruptions shown to increase task errors and decision fatigue, how can you strike a balance between being approachable to colleagues and safeguarding your focus for patient care? When confronted with a particularly challenging or emotionally charged case, what strategies have you found most effective for maintaining professionalism and clear decision-making under pressure? How often do you debrief after high-stakes scenarios, and what impact has debriefing—whether formal or informal—had on your team's learning, emotional recovery, and future preparedness? What strategies do you use to foster open communication and ensure all team members feel empowered to provide input during high-stakes situations? How do you mentally and emotionally shift from managing a critical resuscitation to treating lower-acuity patients without compromising your focus or energy? When faced with a complex case where diagnostic clarity is elusive, how do you prioritize your next steps while maintaining confidence in your decision-making process? How can apps, personalized workflows, or EMR tools be better utilized to minimize cognitive load and enhance clinical decision-making during shifts? These are just some of the questions we pose in this 2-part podcast series on How the Experts Think with Dr. Reuben Strayer, Dr. Scott Weingart and Dr. Mike Betzner... Please consider a donation to ensure EM Cases continues to provide you high quality Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/
It's that time of year again. Let's finish the year off strong with your favorite podcasts. Don't worry...I already have new episodes in the pipe starting in January. In this episode of the PFC Podcast, Dennis and Jeff delve into the complexities of anoxic brain injury, discussing its causes, recovery processes, and prevention strategies in tactical environments. They emphasize the importance of monitoring, airway management, and resuscitation goals, while also addressing the management of hypotension and shock. The conversation highlights the significance of preventing secondary brain injuries and the role of basic medical practices in saving lives. Takeaways Anoxic brain injury is caused by a lack of oxygen to the brain. Recovery from brain injuries can take time and various therapies. Preventing blood loss is crucial in tactical environments. Monitoring oxygen saturation is essential for early detection. Airway management decisions should be based on the patient's condition. Resuscitation goals should focus on maintaining adequate blood pressure and oxygen levels. Hypotension can arise from various causes and needs to be managed effectively. Resuscitation targets should aim for optimal blood pressure and oxygen saturation. Preventing secondary brain injuries is critical for patient outcomes. Basic medical practices can significantly impact survival rates. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this episode of the PFC podcast, Dennis and Doug delve into the practical aspects of lab values in trauma care. They discuss when to draw labs, the significance of pH, the role of bicarbonate and calcium in resuscitation, and the interpretation of blood gas values. The conversation also covers the limitations of hemoglobin measurements, the management of potassium levels in crush injuries, and the use of hypertonic saline in head injury cases. The episode emphasizes the importance of understanding lab values in the context of patient care and the need for timely interventions. Takeaways The pH level is crucial for assessing trauma patients. Resuscitation strategies should be based on lab values. Calcium and bicarbonate play significant roles in trauma care. Blood gas values are essential for ventilator management. Hemoglobin levels may not accurately reflect bleeding severity. Lactate levels can be misleading in trauma situations. Frequent lab draws are not always necessary in stable patients. Hypertonic saline can be beneficial in head injuries. Potassium management is critical in crush injuries. Understanding lab values helps in making informed clinical decisions. Chapters 00:00 Introduction to Trauma Labs 03:02 Understanding pH and Its Importance 06:06 Resuscitation Strategies in Trauma 08:58 The Role of Calcium and Bicarbonate 11:53 Interpreting Blood Gas Values 15:04 The Limitations of Hemoglobin Measurements 18:00 Ventilator Management and Blood Gases 20:47 Frequency of Lab Draws in Trauma 23:55 Managing Potassium Levels in Crush Injuries 26:48 Head Injury Management and Hypertonic Saline 30:08 Lactate Levels and Their Significance 33:13 Conclusion and Key Takeaways Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Send us a textIn this inaugural episode of From the Heart, Drs. Nim Goldshtrom and Adrianne Bischoff explore critical neonatal hemodynamics and cardiovascular care developments. Aimed at neonatologists, the series focuses on research, journal clubs, and expert discussions to deepen understanding of neonatal cardiac intensive care. This episode reviews four groundbreaking studies, including advancements in PDA closure techniques, the role of lung MRIs in understanding pulmonary hypertension, and the outcomes of targeted neonatal echocardiography (TNE) programs.Dr. Goldshtrom presents an analysis of transcatheter versus surgical PDA closures, highlighting the evolving utility of these techniques. Dr. Bischoff dives into lung MRI studies, emphasizing their potential to refine the diagnosis and management of BPD and pulmonary hypertension. Together, they discuss the impact of TNE consultations, showcasing its role in reducing mortality and guiding treatment strategies for critically ill neonates.The hosts advocate for a balanced approach to hemodynamic assessment, debating centralized expertise versus broad training in point-of-care ultrasound. They emphasize the value of physiology-driven care and the continuous evolution of neonatal cardiovascular medicine. With engaging discussions and actionable insights, From the Heart establishes itself as a vital resource for neonatal professionals. 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. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
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/
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