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In this bonus episode Andrea Samadi introduces the Predictable Performance System, a practical roadmap from her Brain's Operating System. She shows how measuring patterns—not chasing daily scores—plus consistent movement and targeted recovery behaviors create reliable adaptations and better performance over time. Andrea shares two real-world experiments (including a nine-day green recovery streak), five clear steps—measure, move, recover, adapt, perform—and a simple 7-day challenge to help you discover the single habit that unlocks more consistent results. On BONUS EPISODE 2, we will cover: Why high performance isn't about being “green” every day (using a wearable device) What nearly 2,000 recovery scores taught me about consistency and performance Why your daily inputs matter more than any single recovery score How I reached a personal best of 9 green recoveries in a row What happened when hard training caused my recovery to drop—and why that wasn't failure How another WHOOP user improved his recovery by identifying one key gap: hydration How to find your own gap in sleep, hydration, stress, movement, training load, or recovery The Predictable Performance System™: Measure → Move → Recover → Adapt → Perform → Repeat Why recovery is the bridge between today's effort and tomorrow's capacity How to create your own 7-Day Predictable Performance Experiment The key question to ask yourself: “What is the one missing input that could unlock my next level of performance?” The goal: Find your gap. Uncover your recipe. Build the system that works for you. BONUS EPISODE 2 The Predictable Performance System™ How Small Daily Inputs Create Better Recovery, Adaptation and More Consistent Results WELCOME BACK Welcome back to the Neuroscience Meets Social and Emotional Learning Podcast, where we explore how understanding the brain can help us create measurable improvements in our well-being, achievement, leadership, productivity, and results. I'm Andrea Samadi, and over the past several months, we've been building something much bigger than a collection of interviews. We've been building what I call The Brain's Operating System—a roadmap for understanding how our brain and body work together to create optimal human performance. Before we jump into today's second Bonus Episode, let's quickly remember where we've been. PHASE 1 — REGULATION & SAFETY Everything begins with regulation. Before the brain can learn, perform, or grow, it first needs the biological conditions that support safety and stability. In Phase 1, we explored sleep, stress regulation, trauma, resilience and the nervous system. The lesson was simple: Regulation creates the conditions for growth. PHASE 2 — NEUROCHEMISTRY & MOTIVATION Then we asked: What moves us into action? We explored dopamine, beliefs, motivation, habits, attention and sustained effort. We learned that motivation isn't simply about willpower. Our brain is continually learning: What's worth pursuing? What should I repeat? Where should I invest my energy with? Phase 2 gave us some direction. PHASE 3 — MOVEMENT, LEARNING & COGNITION And now we're deep inside Phase 3. This is where movement becomes much more than exercise. Movement activates the brain. It supports attention. Learning. Memory. Metabolism. And when movement is paired with adequate recovery, something important happens: Adaptation. That's where our system begins to change. So the basic sequence we've been studying is: Movement → Recovery → Adaptation → Performance. But while studying this process, another question kept coming back to me. Why do some people consistently improve...while others feel like they're starting over every Monday and they are searching for the right formula. That question led me to today's framework: THE PREDICTABLE PERFORMANCE SYSTEM™ And this Bonus Episode is where I want to put the science into action. Throughout The Brain's Operating System, these Bonus Episodes will give me an opportunity to step away from the interviews and show you what happens when I apply what we're learning to my own life. I'll share the experiments. The data. What worked. What didn't. And most importantly... what we can learn from it, so we can ALL apply this information to our own lives. Because neuroscience becomes much more useful when we can turn what we know into something we can actually do. THE QUESTION THAT STARTED THIS EXPERIMENT Over the past five years, I've tracked close to 2,000 recovery scores using WHOOP (wearable device). And recently something happened that surprised me. I recorded nine green recoveries in a row (which meant for 9 days in a row, I had mastered recovery (my body's ability to take on strain and perform). This recovery score is calculated overnight using my RHR, HRV, RR, SpO2 (blood O2) and skin temperature. Factors like strain, stress and lifestyle choices affect this Recovery Score. That was a personal record. For years, I could put together a few strong days. Sometimes even a strong week. My record for years was 7 days in a row. But eventually something would interrupt the pattern. I'd train too hard. Sleep poorly. Travel. Get busy. Or simply fail to give myself enough time to recover. So when I reached nine consecutive green recoveries, instead of just celebrating the streak, I became curious. I asked: What changed? Because I wasn't on vacation. My work hadn't disappeared. I was still recording the podcast. Still exercising. Still traveling. Waking up early. Eating the same diet. In those green days most of the days I avoided alcohol (something I have learned from measuring everything I ingest—this will automatically tank my recovery score) but I did have one drink a couple of these days and still managed to keep a green score. Something that was highly unusual. I kept wondering what was I doing differently. Life hadn't suddenly become easy. So what was different? I went back through my data. And I stopped looking at individual scores. Instead, I started looking for patterns. That distinction changed everything. DON'T CHASE THE SCORE. STUDY THE PATTERN. When I first started tracking recovery, I'd look at each morning individually. Green? Great. Yellow? What did I do wrong? Red? I must have done something terribly wrong!   Looking at the patterns, I did learn that after a 4-hour hike, even one alcoholic drink will kick my recovery score into the red unrecovered zone. When you push your body hard, it's just not worth it to ingest a neuro-toxin. At least for me, it's not worth it. We are all different, and that's why measuring your own data is a valuable activity. What tanks my score, might not tank yours. Now I'm wondering what happens repeatedly? What tends to happen before my strongest recoveries? What happens before my worst ones? (the recipe was beyond clear here). What habits disappear when my recovery starts declining? And which habits consistently appear when it improves? That's where the story became much clearer. It wasn't one workout. It wasn't one supplement. It wasn't one perfect night's sleep. And it definitely wasn't motivation. It was the accumulation of small behaviors being repeated consistently. And that led me to one of the most important lessons from this entire experiment: The recovery score doesn't create the result. The behaviors that happened before the recovery score create the conditions for the result. I learned my recipe to create a RED recovery, and how to create a GREEN. The wearable device simply gives us feedback on how well we are doing with our recipe for success. THE DATA TELLS TWO STORIES When I looked at the data, I realized I actually had two experiments happening. The first was mine. I had the recipe for how to recover, and how to tank my score. The second belonged to another WHOOP user. And together, they revealed something much more interesting than either story alone. STORY ONE — MY DATA When I zoomed out across 6 months, my average recovery was around 58%. That's real life. There were excellent weeks. There were difficult weeks. Travel. When I was away internationally, sometimes without internet, the data didn't record correctly, but this is a good picture of what my scores look like. Work. Training. Stress. Vacations. Life happens. But recently that monthly average climbed to approximately 63%—an 11% improvement over the month before. For me, that mattered. Historically, when my monthly recovery averages climbed substantially, it was often because I had removed myself from normal life. Maybe I was on vacation. Maybe I was completely unplugged. But this time I wasn't. I was working. Training. Recording. Traveling. Living normal life. Life didn't become easier. My daily system became more consistent. And eventually that consistency produced something I'd never seen before: Nine green recoveries in a row. But here's what happened next. If you look at the graph…I just went about life as usual. I trained hard. My recovery dropped. And that became perhaps an even more important part of the experiment. Because this time I didn't panic. I didn't interpret one lower score as failure. I simply returned to the consistent behaviors that had been working in my GREEN streak. Sleep. Hydration. Movement. Stress management. Recovery time. And within a few days, the stronger recovery scores returned. That taught me something important: Predictable performance does NOT mean perfect performance. It means that you've got to find a system you know how to return to. My GREEN scores are now predictable. STORY TWO — FIND THE LEVER Around the same time, another WHOOP user turned to me and asked “why am I stuck in RED (unrecovered) everyday?” His pattern looked completely different. His monthly recovery average was around 41%. Lots of yellow. Lots of red. And very little improvement. Instead of randomly changing everything, we looked at the inputs. Sleep. Stress. Training load. Recovery time. Hydration. And one variable stood out to me. Hydration. So rather than redesigning his entire life, we focused on consistently improving that one behavior. When I say he improved hydration, we increased not just water, but we added an electrolyte drink (Liquid IV sugar free[i]) to his water to replenish minerals like sodium and potassium that he was losing from sweating in the 115 degree weather we are experiencing at the moment in AZ. Then we watched the data. His recovery pattern improved. More yellows appeared. His averages increased. And his recovery became more consistent. Today I asked him what he's noticed with this one change, and he let me know that his scores have been creeping up slowly. No green scores yet, but he's high yellow, which shows me that he's cracking his recovery recipe. Now, that doesn't mean hydration is the magic answer for everyone. That's not the lesson. The lesson is: Find YOUR lever. For one person, it might be hydration. For someone else, it might be sleep. Alcohol. Stress. Training volume. Late-night eating. Travel. Or simply not allowing enough recovery between difficult training sessions. Your job isn't to copy someone else's system perfectly. Your job is to use feedback to discover what matters most for you. Find your gap in your recovery system and you unlock more consistent, predictable performance. TAKEAWAY #1 STOP GUESSING. START MEASURING. You cannot recognize a pattern you aren't observing. And you don't need WHOOP to do this. Just find what tool works best for you. You could track five simple things each morning: Sleep How well did I sleep? Energy How energetic do I feel? Stress How stressed or regulated do I feel? Movement What did I do yesterday? Recovery behaviors Did I hydrate, recover and give my body what it needed? Give each category a simple score out of 10. Then look at the entire week. Not  just one day. TIP TO IMPLEMENT: For the next seven days, spend 30 seconds each morning recording: Hours of sleep Energy from 1–10 Stress from 1–10 Yesterday's movement One recovery behavior Don't change anything yet. First, collect information. Look for patterns before looking for the solution. THE BIG REALIZATION As I studied both experiments, the framework became obvious. Recovery isn't something that simply happens to us. There are many things we can't control. But every day we can influence the probability of recovering well. Our choices create patterns. Patterns create trends. Trends influence adaptation. And over enough time... those adaptations influence performance. Which brings us to the system. THE PREDICTABLE PERFORMANCE SYSTEM™ There are five steps. STEP 1 — MEASURE Awareness comes first. Track enough information to recognize trends. But remember: The goal isn't to become obsessed with data. (I'm borderline obsessed with mine). The goal is to use data to make better decisions. ASK YOURSELF: What's improving? What did I do to get this improvement? Write it down. What's declining? What did I do to tank my score? Write it down. And what repeatedly happens before each pattern? Learn your recovery recipe. What works for you? What does not work? TIP: Look at your weekly average instead of judging yourself by one day. One bad night doesn't define your health. One hard workout doesn't destroy your fitness. One red recovery doesn't erase your progress. Look for the trend. Learn what your personal recipe for success is. STEP 2 — MOVE Movement is the input. This is where Phase 3 begins. Movement challenges the system. We don't want to aim for a month of all green or high recoveries, because then we aren't challenging our system. Movement activates the brain and body and provides the stimulus from which adaptation can occur. But movement doesn't always mean crushing yourself in the gym. It might mean: Walking. Strength training. Hiking. Mobility. Cycling. Running. Playing a sport. Or simply interrupting long periods of sitting. TIP TO IMPLEMENT: Ask yourself each morning: "How will I move today?" Don't leave movement to chance. Put something on the calendar. Even a 20-minute walk counts. Consistency matters. STEP 3 — RECOVER This is the step I underestimated for years. I understood effort. I understood discipline. I understood training. But I didn't fully appreciate that the work isn't complete when the workout ends. The brain and body still have to process the stimulus. So recovery becomes an active part of the performance system. Protect sleep. Hydrate. Manage stress. Build recovery into the schedule. And learn when not to push. TIP TO IMPLEMENT: Create what I call your Recovery Minimums. Choose three behaviors that you protect even during busy weeks. For example: My Recovery Minimums ✓ Consistent sleep (going to bed and waking up at the same time) ✓ Daily hydration (I use liquid IV in the day and LMNT hot chocolate at night) ✓ Daily movement (I walk every morning, hike on the weekends, fit in gym workouts and strength training) to keep movement going. ✓ Stress regulation (always a work in progress, but breath work is my current way to manage stress) ✓ Time for recovery (I stack meditation and infrared sauna use together to save time). Your list may look different. But decide what your minimums are before life gets busy and you aren't putting time into recovery. STEP 4 — ADAPT This is the part we usually can't see. And it's one of the reasons people quit too early. Adaptation happens behind the scenes. You train. You recover. And your system responds. Over time, movement becomes easier. Your capacity expands. Your cardiovascular system becomes more efficient. Skills become more automatic. Your tolerance for challenge increases. Then one day... something that once felt difficult feels normal. TIP TO IMPLEMENT: Don't only measure outcomes. Look for evidence of adaptation. Ask: Is this workout getting easier? Am I recovering faster? Is my resting heart rate trending differently? Am I sleeping better? Look for how many wakes you have each night. Can I handle more work without feeling depleted? Is my concentration improving? Am I stronger? Do I have more energy? Those are clues that the system is adapting.   STEP 5 — PERFORM This is where most people want to start. Results. Achievement. The High Performance. But performance isn't Step One. It's Step Five. First we provide the stimulus. We move. Then we recover. Then we adapt. And eventually... performance becomes evidence that the earlier steps worked. You will notice you can sit longer, stay focused on one task, and see tasks through to completion. This changes the question from: "How can I perform better today?" to: "What can I do today that makes better performance more likely tomorrow?" That's a very different way of thinking. TAKEAWAY #2 DON'T TRY TO FIX EVERYTHING. One of the most useful things we learned from the second recovery experiment was that sometimes one behavior acts as a bottleneck. For the person with the low recovery score, hydration appeared to be an important lever. Stick to changing ONE thing at a time. When I first saw his HRV, I wanted to go there, but we started with hydration. So here's something you can try. Look at your own patterns and ask: "What is the ONE behavior that would make everything else work better?" Maybe it's getting to bed earlier. Maybe it's drinking more water. Maybe it's moving every day. Maybe it's reducing alcohol. Maybe it's taking a recovery day. Maybe it's managing evening stress. Start there. TIP: Run a seven-day experiment. Change one variable. Keep everything else reasonably consistent. Track what happens. Then evaluate. Don't guess. Test. This has been the most eye-opening part of finding my own personal recipe for high performance. Once you uncover yours, you can create your own predictable formula for high performance.   TAKEAWAY #3 CREATE A BASELINE YOU CAN RETURN TO. One of the biggest changes in my thinking came after the nine-green streak ended. My recovery dropped after hard training. But I knew what to do. I returned to the system. That's resilience. Not maintaining perfect conditions forever. But knowing how to return to your baseline when life knocks you away from it. Ask yourself: "When everything gets busy, what behaviors bring me back?" Write them down. That becomes your reset protocol. That's how I was able to create high recoveries the past few days making my monthly recovery a 16% increase over last month. TAKEAWAY #4 RECOVERY IS THE BRIDGE While developing this framework, I kept seeing the same image in my mind. A bridge. On one side is today's effort. On the other side is tomorrow's capability. Recovery is the bridge connecting the two. Without sufficient recovery, today's effort may never fully become tomorrow's capacity. With recovery, we give the brain and body an opportunity to adapt. Today's habits create the conditions for today's recovery. Recovery supports tomorrow's adaptation. Adaptation creates future capacity. And expanded capacity improves performance. That's the system. YOUR 7-DAY PREDICTABLE PERFORMANCE EXPERIMENT Here's your action step from today's episode. For the next seven days: MEASURE Track sleep, energy, stress and how overall recovered you feel each day. If you don't have a device to do this, just rank yourself on a scale of 0-10. MOVE Do something intentional every day. RECOVER Protect the recovery behaviors you've identified as most important. Mine are daily meditation, journaling, hydration, breath work and sauna use. LOOK FOR ADAPTATION Notice what begins becoming easier or more consistent. Where do you feel stronger? REVIEW YOUR PERFORMANCE At the end of seven days, ask: What improved? What got worse? What behavior had the biggest effect? What should I repeat next week? That's it. You're not trying to create a perfect week. You're trying to learn how your own system works. I don't know what your recipe for high performance will look like, but once you've got this recipe, your life will never be the same. THE BIG TAKEAWAY After nearly 2,000 recovery scores, here's what I believe matters most. Don't chase the score. Chase the behaviors that create the score. (Notice what they are—write them down). Don't chase one perfect workout. Build consistency. Don't panic when the data drops. Investigate. Don't change ten things at once. Find the lever. And above all... don't confuse effort with adaptation. Sometimes the thing that moves us forward isn't doing more. It's allowing the work we've already done to become part of us. The goal isn't perfect recovery. The goal isn't nine green days (while I've got my eye on how I can make this 10)… The goal isn't controlling every variable in our lives. The goal is to create a system that makes better outcomes more likely. Better days become better weeks. Better weeks become better months. And over enough time... what once felt difficult can become your new normal. REVIEW AND CONCLUSION To review and conclude BONUS EPISODE 2: Find the Gap—How Recovery Unlocks Predictable Performance, here's where we are in The Brain's Operating System. Phase 1 taught us to regulate. Before we can learn, perform, or grow, we need the biological conditions that support safety and stability. Phase 2 taught us what drives us to act. We explored motivation, dopamine, beliefs, attention, and the internal chemistry that moves us toward a goal. And now... Phase 3 is teaching us how we change. We move. We create a stimulus. We recover. The brain and body adapt. Our capacity expands. And eventually, that adaptation shows up as better performance. That's why today's framework matters. Because when performance feels inconsistent, the answer isn't always to work harder. Sometimes we need to ask: Where is the gap in my system? Is it movement? Sleep? Hydration? Stress? Recovery time? Consistency? Because when we can identify the gap, we can begin to change the input. And when we change the input consistently... we create new conditions for adaptation. That's how performance begins to change. So remember the sequence: Measure. Move. Recover. Adapt. Perform. And then repeat. Because performance isn't a finish line. It's feedback from the system you're building.   When we complete Phase 3, we'll soon move into Phase 4—Connection, Emotion & Social Intelligence, where another layer enters the system: Other people. Relationships. Emotion. Trust. Communication. Empathy. Leadership. And then in Phase 5—Integration & Human Performance, we'll bring everything together: Regulation. Motivation. Movement. Recovery. Emotion. Relationships. Learning. Purpose. And performance. Because ultimately, no system works in isolation. Human performance is the result of all of these systems working together. FINAL TAKEAWAY If there's one idea I hope you remember from today's episode, it's this: Don't just chase the outcome. Study the system producing it. If your results aren't where you want them to be... find the gap. Because the gap may not be in your effort. It may be in your recovery. And when you find the gap in your recovery system... you unlock your next level of adaptation, capacity, and performance. Thank you for joining me for this second Bonus Episode. If today's framework helped connect the dots for you, I'd love to hear what you discover. What's the one habit that has the greatest impact on your recovery and performance? Sleep? Movement? Hydration? Stress management? Recovery time? And if you try the 7-Day Predictable Performance Experiment, pay attention to what your own data teaches you. Not whether every day is perfect. But what patterns begin to emerge. Until next time... Keep measuring. Keep moving. Keep recovering. Give your brain and body time to adapt. And keep building the systems that make better performance more predictable. Have an incredible week and we'll see you on EP 405 where we revisit Dr. Kristen Holmes and dive deep into more ways to improve our recovery., RESOURCES:   Phase 1: Regulation & Safety The Foundation Core Question: Is the nervous system safe enough to learn? Everything begins with regulation. Before we can focus, learn, lead, or perform, the brain first asks one fundamental question: Am I safe? Throughout Phase 1, our guests showed us that regulation isn't simply about reducing stress—it's about creating the biological conditions that allow the brain to learn, adapt, and thrive. Together we explored: Baland Jalal – how sleep, curiosity, imagination, and creativity prepare the brain for learning. https://andreasamadi.podbean.com/e/hypnagogic-genius-capture-your-best-ideas-at-the-edge-of-sleep/ Dr. Bruce Perry – why regulation, rhythm, and relationships form the foundation of every healthy nervous system.  https://andreasamadi.podbean.com/e/safety-first-why-a-regulated-brain-is-the-key-to-learning/ Dr. Sui Wong – how lifestyle medicine and autonomic balance build lifelong brain resilience. https://andreasamadi.podbean.com/e/your-eyes-the-brain-s-early-warning-system/ Rohan Dixit – how heart rate variability gives us real-time feedback on our ability to regulate stress. https://andreasamadi.podbean.com/e/breathe-to-reset-how-hrv-tech-reveals-hidden-stress/ Dr. Kristen Holmes – how recovery metrics reveal our physiological readiness to perform. https://andreasamadi.podbean.com/e/kristen-holmes-from-whoopcom-on-unlocking-a-better-you-measuring-sleep-recovery-and-strain/ Dr. Antonio Zadra – how sleep and dreaming consolidate memories, regulate emotions, and generate insight. https://andreasamadi.podbean.com/e/when-brains-dream-how-sleep-integrates-emotion-insight-and-creativity/ Together these conversations taught us that sleep and stress regulation aren't optional—they're the operating system that allows every higher brain function to work. Phase 2: Motivation & Neurochemistry The Direction Core Question: What moves us into action? Once the brain feels safe, it becomes ready to pursue goals. In Phase 2, we explored the internal chemistry that transforms intention into action. Our experts helped us understand that sustainable motivation isn't about willpower—it's about aligning our beliefs, thoughts, attention, energy, and movement. Together we discovered: Bob Proctor — our beliefs determine the direction of our lives. https://andreasamadi.podbean.com/e/belief-first-the-neuroscience-of-motivation/ Dr. Carolyn Leaf — our thinking literally changes our brain chemistry. https://andreasamadi.podbean.com/e/thoughts-as-biology-how-your-mind-shapes-neurochemistry/ Dr. John Medina — attention determines what the brain encodes and remembers. https://andreasamadi.podbean.com/e/theory-of-mind-the-missing-link-between-attention-reward-and-motivation Dr. Anna Lembke- Dopamine, Motivation and Why the Brain Repeats Behavior https://andreasamadi.podbean.com/e/dopamine-nation-the-pleasure%e2%80%93pain-balance-that-drives-motivation/ Dr. Friederike Fabritius — managing our energy allows high performance to become sustainable. https://andreasamadi.podbean.com/e/fun-fear-focus-closing-the-motivation-loop/ Dr. Chuck Hillman & Paul Zientarski — movement activates the brain, preparing it to learn. https://andreasamadi.podbean.com/e/move-to-learn-how-movement-activates-the-brain-and-fuels-motivation/ By the end of Phase 2, we introduced what became The Motivation Loop, showing how beliefs influence thoughts, thoughts influence actions, actions create results, and results reinforce future beliefs. Phase 3: Movement, Learning & Human Performance The Transformation Core Question: How does movement change the brain—and how does recovery transform that change into performance? Now we're taking the next step. Phase 3 builds on everything we've learned so far. If Phase 1 created a regulated nervous system... If Phase 2 created motivation and direction... Phase 3 explains how the brain and body actually become stronger. Together we've explored this process through conversations with: Dr. Chuck Hillman & Paul Zientarski — why movement activates the brain before learning. https://andreasamadi.podbean.com/e/movement-first-how-a-20%e2%80%91minute-walk-lights-up-the-brain/ Dr. John Ratey — how exercise builds a healthier, younger brain. https://andreasamadi.podbean.com/e/movement-matters-how-every-move-rewires-the-brain/ Dr. Kristen Holmes — why recovery determines adaptation and readiness. Dr. John Medina — how attention transforms movement into lasting learning. Jason Whitrock — how metabolism and cellular energy fuel long-term performance. WHERE WE ARE GOING NEXT Phase 4 — Connection, Emotion & Social Intelligence The Human System Core Question: How do we thrive with other people? The brain didn't evolve in isolation—it evolved through relationships. In Phase 4, we'll explore emotional intelligence, empathy, communication, trust, leadership, and psychological safety to understand how our relationships shape learning, well-being, and performance. Phase 5 — Integration & Human Performance The Complete System Core Question: How do all the systems work together? In our final phase, we'll bring everything together—regulation, motivation, movement, emotion, relationships, learning, and recovery—into one integrated framework. We'll discover how these systems work together to create measurable improvements in our well-being, achievement, leadership, productivity, and results. REFERENCES: [i] Liquid IV https://www.liquid-iv.com/collections/hydration-multiplier-sugar-free    

In this episode we walk through how noninvasive ventilation for pediatric respiratory distress moved from an idea to standard practice in central Ohio. Guests Rob Glaze and Kyle Goodknight describe a child's near‑miss, the partnership with Nationwide Children's Hospital, and Westerville Fire's rollout. They debunk myths—kids won't tolerate masks, PEEP will harm hypotensive children, blow‑by works—and explain why work of breathing, not SpO2, should trigger CPAP. Check out a link to their ebook here: https://pages.kylegoodknight.com/peds-cpap-landing

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Jeff to tackle one of the most time-sensitive and under-appreciated threats in tactical and austere medicine: anoxic brain injury. They break down exactly what it is, how fast it can progress from unnoticed hypoxia to devastating outcomes, and why the MARCH algorithm plus aggressive prevention of secondary injury are your most powerful tools when oxygen and resources are limited.Key Takeaways:Anoxic brain injury exists on a spectrum — brief drops in SpO2 can cause real damage, and recovery (when it happens) can take days, weeks, months, or even years of rehab.The landmark Arizona pre-post TBI study showed hypoxia and hypotension each increase mortality 2–3×; combined they increase it 5–6×. Updated analysis reveals harm begins at SpO2

On this week's episode of The MacRumors Show, we discuss Google's latest wave of announcements for Android and Gemini, the newly announced Fitbit Air, and Apple Watch Series 12 rumors.The centerpiece of Google's announcements this week was Gemini Intelligence, Google's new umbrella platform for AI across phones, watches, cars, and laptops. Its headline capability is cross-app automation: users can photograph an event flyer and ask Gemini to find tickets on Expedia, or pull up a grocery list and have it build a cart in a shopping app. A companion feature called Create My Widget lets users describe a home screen widget in natural language and have Gemini generate it, drawing from Gmail and Calendar to build a personalized dashboard.Google also unveiled the Googlebook, a new laptop category designed from the ground up around Gemini with partners including Acer, Asus, Dell, HP, and Lenovo arriving this fall. Gemini in Chrome for Android gained an agentic browsing layer rolling out end of June, and Android Auto received AI-generated contextual replies and DoorDash voice ordering. A Meta partnership brings Ultra HDR, native stabilization, and night mode to Instagram on Android flagship devices.In January, Apple and Google announced a partnership under which Gemini would power the next generation of Apple Foundation Models, including a more personalized Siri expected this year. Apple's equivalent cross-app ‌Siri‌ actions were announced at WWDC 2024 but have not yet shipped; Gemini Intelligence is rolling out this summer using the same underlying technology.Google also unveiled the Fitbit Air this week, a screenless fitness tracker priced at $99 that ships on May 26. The device weighs just 12 grams with the band and tracks heart rate, AFib, HRV, SpO2, and sleep stages in a pill-shaped pebble with no display, no buttons, and no notifications. Battery life lasts for seven days, with a five-minute fast charge delivering a full day of use. A Stephen Curry Special Edition is priced at $129, with core tracking free and Google Health Premium adding an AI Coach for $9.99 per month after a three-month trial.The launch accompanies a broader rebrand. The Fitbit app becomes Google Health on May 19, with Google Fit folded in, Apple Health data supported on iOS, and APIs for Garmin, Whoop, and Oura. Bloomberg's Mark Gurman reported earlier this year that Apple has scaled back a comparable Health+ coaching service, with the feature now unlikely to launch. The Apple Watch SE starts at $249 and requires daily charging, and the Fitbit Air's $99 price with no mandatory subscription addresses a segment Apple does not cover.We also discuss the Apple Watch Series 12, which is shaping up to be an incremental upgrade. Bloomberg's Mark Gurmansaid in March that he does not expect any major design changes, and a significant redesign is now not expected until 2028.The leaker known as Instant Digital said this week that Touch ID, which appeared in leaked Apple code last year, has been deprioritized in favor of battery life improvements. DigiTimes previously reported an eight-sensor array on the back of at least one 2026 model, though blood pressure monitoring is said to be further out. A new chip is expected, with leaked code indicating a meaningful upgrade from the S10 used across the last three series, and watchOS 27 will be previewed at WWDC on June 8. Start your business with Shopify and get everything you need to sell online and in person. Start today at https://www.shopify.com/mac

Explore the launch of the Google Fitbit Air, the evolution of distraction‑free health tracking, upcoming AI and Android developments from Google I/O 2026, and how Lutron is making homes smarter with intelligent lighting and accessible automated blinds. Steven Scott and Shaun Preece dive into a wide‑ranging discussion on mainstream tech. They begin with the Google Fitbit Air, a screenless fitness tracker focused on comfort and core health features like 24/7 heart rate monitoring, AFib alerts, SpO2, and sleep tracking. The hosts examine its real‑world benefits, from week‑long battery life to fast charging and the promise of a distraction‑free experience. They also consider the new Google Health app and how AI health coaching may create meaningful insights. The conversation moves to Google I/O 2026 and the Android Show, previewing big updates to Gemini AI, Android 17, Android XR, and the potential debut of Aluminium OS for AI‑driven laptops. They also discuss the growing momentum of smart glasses and the importance of agentic AI for hands‑free productivity. In the second half, Marc Aflalo interviews Melissa Andresko from Lutron, exploring how automated blinds, intelligent lighting, and natural light optimisation are redefining home comfort, wellness, and accessibility. The episode closes with a look at AI‑powered robotic companions coming soon from Roomba and the US military's latest UFO video releases. Relevant Links Google Fitbit Air: https://store.google.com/gb/product/google_fitbit_air Lutron Caséta: https://www.casetawireless.com ----Follow on:YouTube: https://www.doubletaponair.com/youtubeX (formerly Twitter): https://www.doubletaponair.com/xInstagram: https://www.doubletaponair.com/instagramTikTok: https://www.doubletaponair.com/tiktokThreads: https://www.doubletaponair.com/threadsFacebook: https://www.doubletaponair.com/facebookLinkedIn: https://www.doubletaponair.com/linkedinSubscribe to the Podcast:Apple: https://www.doubletaponair.com/appleSpotify: https://www.doubletaponair.com/spotifyRSS: https://www.doubletaponair.com/podcastiHeadRadio: https://www.doubletaponair.com/iheartAbout Double TapHosted by the insightful duo, Steven Scott and Shaun Preece, Double Tap is a treasure trove of information for anyone who's blind or partially sighted and has a passion for tech. Steven and Shaun not only demystify tech, but they also regularly feature interviews and welcome guests from the community, fostering an interactive and engaging environment. Tune in every day of the week, and you'll discover how technology can seamlessly integrate into your life, enhancing daily tasks and experiences, even if your sight is limited."Double Tap" is a registered trademark of Double Tap Productions Inc. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Think you know how to use a pulse oximeter? Most people don't. From nail polish mistakes to positioning errors, discover the step-by-step guide to getting accurate oxygen readings at home - and learn when those numbers demand immediate medical attention. Learn more at https://womedsup.com/blogs/health-wellness-blogs/ilent-hypoxemia-the-hidden-oxygen-problem-many-people-dont-feel Worldwide Medical Supply City: Stuart Address: 611 SW Federal Hwy, Ste E, FL Website: https://womedsup.com/

Make a Logo on Fiverr The Carbinox Edge is a durable smartwatch built for people who work, travel, hike, build, sweat and occasionally put their gear through situations most wearables would never survive. In this first look, the Carbinox Edge gets unboxed, paired, tested and then frozen inside a block of ice for one of the most extreme smartwatch durability tests I have ever done. A Rugged Smartwatch Built for Real Abuse The Carbinox Edge comes across as a smartwatch made for rougher environments. It features a stainless steel body, Gorilla Glass, IP69K protection, 5 ATM water resistance and a 1.96-inch AMOLED display. It is designed for users who want something tougher than a basic fitness watch, especially if they work on construction sites, spend time outdoors or simply want a watch that can handle more abuse than a typical smartwatch. The watch also includes dual-band GNSS with six tracking systems, which means it can track location without relying only on your phone. That could be useful for hiking, job sites, emergency situations or anywhere phone-free tracking matters. What Comes in the Box Inside the box, the Carbinox Edge includes the watch body, a band, a manual, a USB-C charging cable and a proprietary charging base. The charging dock is magnetic and connects to the back of the watch using two contact points. The included band uses quick-release pins, making it easier to attach or swap out. That is a nice touch if you want to change bands or replace one after heavy use. Setup and App Pairing Pairing the Carbinox Edge is straightforward. After powering on the watch, the setup process asks for a language selection and displays a QR code for app pairing. The watch connects through the Carbinox Max app, and once paired, it can show notifications, weather, fitness data, health tracking, watch settings and firmware updates. The watch works with both iPhone and Android devices. During setup, it connected quickly over Bluetooth and displayed battery level, GPS satellite data and watch face options through the app. Display, Battery and Features The Carbinox Edge has a 410-by-502 resolution AMOLED display with 331 PPI and up to 1,000 nits of brightness. That should make it easier to read indoors and outdoors. Battery life is one of the biggest selling points. The watch has a 500 mAh battery, with Carbinox claiming up to 25 days depending on use. In the test, the watch still had plenty of battery before being frozen, and after being removed from the ice, it still powered back on and reconnected. Health and utility features include heart rate, SpO2, sleep, stress, mood, activity tracking, workouts, weather, calls, alarms, music controls and notifications. The Extreme Ice Test Instead of simply scratching the screen, hitting it with a hammer or running it over, this test took a different approach. The Carbinox Edge was frozen inside a block of ice for 24 hours. The idea was to simulate an extreme situation where the watch might be buried, frozen or stuck in a harsh environment. After about 12 to 14 hours, the watch stopped responding to the phone while still frozen. But once it was chipped out of the ice, it powered back on, showed the correct time and reconnected to the phone. Even while wet, the touchscreen still responded. The buttons continued working, and the display showed no visible scratches after additional scraping and impact testing. What Worked Well The biggest win is durability. The Carbinox Edge survived being frozen in ice for a full day, then came back to life after being removed. The screen held up well, the buttons still worked and the watch remained usable even while wet. The long battery life is also a major plus. A durable smartwatch is only useful if it can stay powered long enough to matter, and the Carbinox Edge appears built with that in mind. The display is bright, the body feels rugged and the quick-release band system makes it easier to manage than older watch designs. A Few Issues to Watch There were a couple of issues during use. When traveling to Las Vegas, the phone updated to the new time zone, but the watch did not update until the Carbinox app was opened. That could likely be fixed in a firmware update. Notifications were another concern. The watch did not clearly separate text messages from other app notifications, activity alerts or reminders. Turning off unwanted notifications also affected text alerts. Again, this feels like something that could improve through software updates. Final First Look The Carbinox Edge is an extreme smartwatch for people who need more than basic fitness tracking. It is rugged, bright, long-lasting and surprisingly tough. Freezing it in a block of ice for 24 hours did stop it from responding temporarily, but once it came out, it powered back on and kept working. For anyone looking for a durable smartwatch that can handle harsh conditions, the Carbinox Edge makes a strong first impression. Get the Carbinox Edge Here: https://geni.us/carbinoxedge Check out the Geekazine Merch, including "I AM AI " T-Shirt.  Thanks for reading! Don't forget to subscribe to Geekazine: RSS Feed - YouTubeTwitter - Facebook Tip Me via Paypal.me Send a Tip via Venmo RSS Bandwidth by Cachefly Get a 14 Day Trial Be a Patreon: Part of the Sconnie Geek Nation! Reviews: Geekazine gets products in to review. Opinions are of Geekazine.com. Sponsored content will be labeled as such. Read all policies on the Geekazine review page.  Reviews: Geekazine is also an affiliate of Amazon Last Updated on June 9, 2026 3:42 pm by Jeffrey PowersThe post Carbinox Edge Unboxing First Look and Most Extreme Durability Test Ever appeared first on Geekazine.

In this edition of the new CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, CA, USA, speaks with expert guest Rakesh Arora, Director of Cardiothoracic Critical Care and a professor in the Department of Surgery and Anesthesia at Northwestern Medicine, Chicago, IL, USA. They discuss managing arrest in patients with temporary mechanical circulatory support (tMCS), focusing on a paper Arora authored titled “EACTS/STS/AATS Guidelines on Temporary Mechanical Circulatory Support in Adult Cardiac Surgery.”   Chapters  00:00 Intro  01:08 Guidelines Background  02:02 Resuscitation, Monitoring Parameters  07:37 Approach to Patients in Extremis  11:39 Quality Assurance, Internal Data  12:22 End-Tidal  13:17 Bleeding Management  15:33 Arrhythmia, Defibrillation  17:21 Optimizing Tissue Perfusion  18:09 Key Points  20:26 Devices & Flow Patterns  They began by exploring how this paper was developed and how Arora became involved in this project. They discussed the importance of expediting the resuscitation process and examined the recommendations for a tMCS implantation in patients experiencing post-procedural low cardiac output syndrome (LCOS). Key considerations included oxygen saturation levels (SpO2) and point-of-care ultrasound (POCUS), as well as the significance of pulsatility. Additionally, they discussed the interaction between devices and patients and the importance of team training and simulation. They also addressed crucial topics such as coagulation, anticoagulation, and defibrillation. Finally, they examined optimizing tissue perfusion for better patient outcomes.   Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don't miss next month's episode!  Related Resources  EACTS/STS/AATS Guidelines on Temporary Mechanical Circulatory Support in Adult Cardiac Surgery  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Respiratory crises in the field rarely fit textbook categories. JEMS Development Editor Mike Brown talks with Hamilton Medical's Jesse Carroll to separate Type 1 (hypoxemic) from Type 2 (hypercapnic) respiratory failure and recognize the mixed presentations clinicians actually see. They walk through practical cues (SpO2 trends vs end‑tidal CO2), common causes (CHF, COPD, obesity, neuromuscular weakness), and epidemiology: roughly 360,000 prehospital respiratory calls annually with 41% involving COPD and obesity rates rising from 32% to about 60% since 1988. Jesse explains why pressure, flow and volume, not oxygen alone, drive meaningful physiologic change, how device limitations (disposable CPAP, pneumatic and turbine systems) affect flow delivery, and when early noninvasive strategies can buy time or prevent intubation.

Wearables are tracking more than ever—heart rate, sleep, stress, recovery—but what do all those numbers actually mean for how you live, train, and make decisions? In this episode of The Collective, Shaun and Chance sit down with experts in biometric technology to unpack how data from your body can become real-world wisdom.​Our guests:Latha Nachiyamai – Program Manager, Biosensor Platform Technology at Garmin Canada. Latha manages the research, development, and integration of biosensors—including optical heart rate, SpO2, and ECG—into Garmin's wearable products. Scott Burgett - Senior Director of Garmin Health Engineering since 2015. He has responsibility for managing biosensor innovation and development globally at Garmin.We dig into:What biometrics like heart rate, HRV, SpO2, and ECG can truly tell you—and what they can't.How Garmin and other wearables turn biosensor data into usable insights for athletes and everyday users.The risks of over-focusing on metrics vs actually listening to your body.Practical ways to use biometric data to live, train, and recover better.​

In this episode of Working Short, we chat with Rob Timmings from ECT for Health about essential strategies for managing chest pain in emergency settings. Rob introduces the OPQRST method—an effective framework for assessing chest pain.Rob highlights the importance of quick diagnostics, emphasizing that ECGs should be performed within 10 minutes and troponin levels monitored. He discusses the critical medications for chest pain management, including aspirin, GTN, heparin, and tenecteplase (TNK), while also stressing the updated approach to oxygen therapy—now reserved for patients with SpO2 below 94%.Tune in for a comprehensive look at effective chest pain management that can significantly impact patient outcomes in emergency nursing!

Hypothetical Case: You are called to MFAU to see a woman who has just arrived via RFDS (royal flying doctor service) She is a 23 y.o indigenous woman from the Kimberley in the far north of WA. She is 33/40 G1P0 complex social history and possible substance use disorders She has PPROM (pre term premature rupture of membranes) and suspected early chorioamniotis and has been given antibiotics / nifedipine and a few litres of crystalloid fluid during the flight. The obstetric team have evaluated her – she has small for gestational age baby, and is complaining of dyspnoea. Her observations are: HR 110, NIBP 124/60, SpO2 91% on room air, T38.1 Her bloods are relatively normal except for an unexpected high BNP. You do a focussed bedside transthoracic ECHO and unexpectedly see on the PLAX (parasternal long axis view) a classical hockey stick / domed appearance of severe mitral stenosis. She also has Pulmonary B-lines (indicating pulmonary oedema) and a flattened interventricular septum, very large atrium & doppler through the tricuspid valve confirms severe pulmonary hypertension. The team decides she would be better cared for in a hospital with cardiothoracic services – however she suddenly becomes more breathless – SpO2 86% on oxygen, NIBP 80/40 HR 125, and there is a prolonged foetal bradycardia………………… Hi Everyone, This week I am joined by Dr Clinton Ellis, a cardiothoracic anaesthetist based in Sir Charles Gairdner Hospital, and Graeme. We discuss the management of rheumatic heart disease in pregnancy – a challenging condition which unfortunately is still relatively prevalent amongst indigenous women here in Australia. This was a wide ranging discussion so I have decided to split this into two 40min episodes. Even though we talk for over 80min I feel like we just scratched the surface on this! If you have any questions or comments send them through – I will try and get Clinton to answer them. Finally a huge shout out and thank you to the Darwin based authors of the ANZCA 2023 Blue Book article on this condition: Namrata Jhummon-Mahadnac, Matthew Mathieson, and Akshay Hungenahally! See the link to their well written narrative review on this topic below: References Australasian Anaesthesia 2023 (aka the Blue Book) – see page 39 “Obstetric anaesthesia in rheumatic heart disease – a unique perspective from the Top End” Oral vaccine could prevent rheumatic heart disease in NZ VIDEO: Researchers close to a vaccine for strep-A and rheumatic heart disease

Hypothetical Case: You are called to MFAU to see a woman who has just arrived via RFDS (royal flying doctor service) She is a 23 y.o indigenous woman from the Kimberley in the far north of WA. She is 33/40 G1P0 complex social history and possible substance use disorders She has PPROM (pre term premature rupture of membranes) and suspected early chorioamniotis and has been given antibiotics / nifedipine and a few litres of crystalloid fluid during the flight. The obstetric team have evaluated her – she has small for gestational age baby, and is complaining of dyspnoea. Her observations are: HR 110, NIBP 124/60, SpO2 91% on room air, T38.1 Her bloods are relatively normal except for an unexpected high BNP. You do a focussed bedside transthoracic ECHO and unexpectedly see on the PLAX (parasternal long axis view) a classical hockey stick / domed appearance of severe mitral stenosis. She also has Pulmonary B-lines (indicating pulmonary oedema) and a flattened interventricular septum, very large atrium & doppler through the tricuspid valve confirms severe pulmonary hypertension.  The team decides she would be better cared for in a hospital with cardiothoracic services – however she suddenly becomes more breathless – SpO2 86% on oxygen, NIBP 80/40 HR 125, and there is a prolonged foetal bradycardia………………… Hi Everyone, This week I am joined by Dr Clinton Ellis, a cardiothoracic anaesthetist based in Sir Charles Gairdner Hospital, and Graeme. We discuss the management of rheumatic heart disease in pregnancy – a challenging condition which unfortunately is still relatively prevalent amongst indigenous women here in Australia. This was a wide ranging discussion so I have decided to split this into two 40min episodes. Even though we talk for over 80min I feel like we just scratched the surface on this! If you have any questions or comments send them through – I will try and get Clinton to answer them. Finally a huge shout out and thank you to the Darwin based authors of the ANZCA 2023 Blue Book article on this condition: Namrata Jhummon-Mahadnac, Matthew Mathieson, and Akshay Hungenahally! See the link to their well written narrative review on this topic below: References Australasian Anaesthesia 2023 (aka the Blue Book) – see page 39 “Obstetric anaesthesia in rheumatic heart disease – a unique perspective from the Top End” Oral vaccine could prevent rheumatic heart disease in NZ VIDEO: Researchers close to a vaccine for strep-A and rheumatic heart disease

You are called to assess a pregnant woman who presents to your hospital complaining of shortness of breath. She is 36 weeks pregnant with twins and tells you she had been getting progressively short of breath over the last month but put it down to the physical effects of the twin pregnancy in her abdomen. However last night she couldn't get her breath lying flat, had to sleep sitting up on 3-4 pillows and feels that "it is much worse". On examination she has a respiratory rate of 24/min, SpO2 = 92%, HR 105/min, BP 95/45 and you can hear crepitations in both lung fields. Her initial blood tests come back showing a raised plasma BNP and a bedside ECHO is done by a helpful colleague - who says "subjectively her LV isn't contracting very well". Hi everyone, This week I sit down with Dr Faith Njue the most qualified person here in WA to discuss the rare but important disease - peripartum cardiomyopathy. (See Faith's Bio below). Join us in our wide ranging discussion which touches on the diagnostic challenges, demographics, proposed mechanisms and general principles involved in managing these complex patients. Thanks Faith for a great discussion! Dr Faith Njue - Bio Faith Njue graduated from the University of Western Australia and completed cardiology training in Perth. She undertook further subspeciality training in advanced heart failure/ heart transplantation at Fiona Stanley Hospital and the University of Ottawa Heart Institute in Canada. Thereafter, she undertook further fellowship in cardio-obstetrics at the John Radcliffe hospital in Oxford (UK). She has special interest in women's cardiovascular health, heart disease in pregnancy and heart failure. Faith runs the dedicated Western Cardiology cardio-obstetrics clinic, designed to support women at risk of or with pre-existing heart conditions, through preconception counselling, pregnancy and into the post-partum period. Cardio-obstetrics is an expanding subspecialty that focuses on prevention, early detection, and appropriate management of cardiovascular disease in pregnancy. She holds public consultant positions at Sir Charles Gairdner and Fiona Stanley hospitals. She is part of the Advanced heart Failure and Cardiac Transplant team at FSH. She is the cardiology clinical lead for High Risk pregnancy at FSH. References Anaesthesia and peripartum cardiomyopathy Chapman, K. Njue F, Rucklidge M. BJA Education, Volume 23, Issue 12, 464 - 472 Melanie Ricke-Hoch, Tobias J. Pfeffer, and Denise Hilfiker-Kleiner. Peripartumcardiomyopathy: basic mechanisms and hope for new therapies. Cardiovascular Research (2020) 116, 520–531. doi:10.1093/cvr/cvz252​ Bauersachs J, König T, van der Meer P, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019 Jul;21(7):827-843. doi: 10.1002/ejhf.1493. Epub 2019 Jun 27. PMID: 31243866​ 2018 ESC Guidelines for the Management of Cardiovascular Disease During Pregnancy. European Heart Journal 2018. Vol 39;3165-3241​ Bromocriptine: Koenig T, Bauersachs J, Hilfiker-Kleiner D. Bromocriptine for the Treatment of Peripartum Cardiomyopathy. Card Fail Rev. 2018 May;4(1):46-49. doi: 10.15420/cfr.2018:2:2. PMID: 29892477; PMCID: PMC5971672 Hilfiker-Kleiner D, Haghikia A, Berliner D, Vogel-Claussen J, Schwab J, Franke A, Schwarzkopf M, Ehlermann P, Pfister R, Michels G, Westenfeld R, Stangl V, Kindermann I, Kühl U, Angermann CE, Schlitt A, Fischer D, Podewski E, Böhm M, Sliwa K, Bauersachs J. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J. 2017 Sep 14;38(35):2671-2679. doi: 10.1093/eurheartj/ehx355. PMID: 28934837; PMCID: PMC5837241.

Before you start listening this article, I want you to sit back, relax, and take a deep breath. How refreshing was that? That was a nice 21.3% (ish) atmospheric oxygen breath that your body just enjoyed. Please keep that thought in the back of your mind for a minute. We will revisit that. We will spend a moment on PEEP, not the delicious and iconic Easter marshmallow treats that have become a yearly staple for many, but Peak End Expiratory Pressure. For this bit of time we have together, we will focus on why PEEP should be your go-to for desaturating patients or patients needing their SpO2 to rise. Read the full article on EMS Airway.

What happens when AI stops reacting and starts anticipating? In this episode, Shirish Nimgaonkar joins us to explore the power of predictive, self-healing AI in transforming enterprise infrastructure, minimizing downtime, and personalizing IT support like never before. Shirish is the Founder and CEO of eBliss, an autonomous AI platform built to revolutionize the digital workplace. By integrating predictive analytics and intelligent automation, eBliss delivers a new standard of operational performance, reducing friction between users and technology. Tune in to discover: How AI-based personalization can dramatically reduce enterprise IT costs. What “self-healing AI” really means for everyday device management. Where predictive tech is making the biggest impact across industries. Why autonomous AI platforms are key to the next wave of enterprise innovation. With decades of experience scaling high-growth software companies and advising global startups, Shirish brings rare insight into the future of AI for business. He currently serves as an Entrepreneur in Residence at Harvard Business School and holds degrees from IIT Bombay, Stanford, and Harvard. Click here to learn more about Shirish's groundbreaking work and where SmartTech is heading next! Episode also available on Apple Podcasts: https://apple.co/38oMlMr

What is “self-healing AI?” How do prediction and personalization deliver a superior ROI and enhanced user experience? In this episode, we are joined by Shirish Nimgaonkar to dive into this intriguing and revolutionary topic… Shirish is an entrepreneur, advisor, and investor who focuses his skills on software and AI. He is currently the Founder and CEO of eBliss, a revolutionary AI-driven autonomous end-user computing platform dedicated to streamlining the digital workplace – boosting operational performance, anticipating and resolving IT issues, and elevating both productivity and user satisfaction. Hit play to find out: How businesses can reduce operational costs using personalized AI. The problems that exist within different categories of devices. The ways that predictive analytics can improve productivity.  Industries that benefit from AI solutions. Shirish is a seasoned tech leader who has led and scaled high-growth software companies. He has held leadership roles at several PE and VC-backed tech firms and previously founded and led the South Asia group at a global investment bank, where he oversaw over 30 client acquisitions. Currently, he serves as an Entrepreneur in Residence at Harvard Business School and advises multiple startups. Shirish holds degrees from IIT Bombay, Stanford, and Harvard Business School. You can find out more about Shirish and his work here! Episode also available on Apple Podcasts: https://apple.co/30PvU9C

Educational Pearls: Physiologic stimulation of ventilation occurs through changes in levels of: Arterial carbon dioxide (PaCO2) Arterial oxygen (PaO2) Hypercapnia is an elevated level of CO2 in the blood - this primarily drives ventilation Hypoxia is a decreased level of O2 in the body's tissues - the backup drive for ventilation Patients at risk of hypercapnia should maintain an O2 saturation between 88-92% Normal O2 saturation is 95-100% In patients who chronically retain CO2, their main drive for ventilation becomes hypoxia An audit was performed of SpO2 observations of all patients with a target range of 88–92% at a single hospital over a four-year period This found that excessive oxygen administration was more common than insufficient oxygen and is associated with an increased risk of harm Individuals at risk of hypercapnia include but are not limited to patients with COPD, hypoventilation syndrome, or altered mental status References Homayoun Kazemi, Douglas C. Johnson, Respiration, Editor(s): V.S. Ramachandran, Encyclopedia of the Human Brain, Academic Press, 2002, Pages 209-216, ISBN 9780122272103, https://doi.org/10.1016/B0-12-227210-2/00302-2. O'Driscoll BR, Bakerly ND. Are we giving too much oxygen to patients at risk of hypercapnia? Real world data from a large teaching hospital. Respir Med. 2025 Mar;238:107965. doi: 10.1016/j.rmed.2025.107965. Epub 2025 Jan 30. PMID: 39892771. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

The intersection of technology and health has seen remarkable advancements in recent years, with wearables emerging as a pivotal element in personal health monitoring. Among these innovations, the smart ring stands out as a revolutionary tool that combines convenience, functionality, and advanced health monitoring capabilities. The Circular smart ring, recently introduced at the Consumer Electronics Show (CES), exemplifies this evolution, offering features that empower users to take control of their health in unprecedented ways.A New Era of Health MonitoringAt the heart of the Circular smart ring's innovation is its ability to perform electrocardiogram (ECG) readings. This feature allows users to monitor their heart health with a simple touch of the ring, making it a game-changer in the realm of personal health devices. Traditionally, obtaining an ECG required a visit to a healthcare professional, involving cumbersome equipment and often lengthy procedures. In recent years, the technology has been added into larger wearable devices, such as watches.Circular's integration of this technology into a small wearable format not only streamlines the process but also democratizes access to vital health information. With the capability to detect arrhythmias - irregular heartbeats - within just 30 seconds, users can gain insights into their cardiac health without the need for immediate medical intervention.The Journey of CircularThe inception of Circular was rooted in a desire to enhance personal wellness through innovative technology. Initially, the company's founders sought to create a ring that would wake users with gentle vibrations, a concept that highlights the importance of personalized experiences in health technology. However, upon collaborating with medical professionals, the focus shifted towards integrating health and wellness features. This pivot led to the development of functionalities such as sleep analysis, activity tracking, and stress monitoring, laying the groundwork for the advanced capabilities present in the latest iteration of the ring.Comprehensive Health InsightsThe Circular smart ring does not merely focus on heart health; it encompasses a broad spectrum of health metrics. Through its accompanying app, users can monitor various indicators, including sleep quality, physical activity, and even blood oxygen levels (SpO2). The ring records data every two minutes, providing a minute's worth of information for each health metric. This level of detail allows users to identify patterns and make informed decisions about their health, such as recognizing symptoms of sleep apnea through the analysis of blood oxygenation levels during sleep.Moreover, the incorporation of artificial intelligence (AI) enhances the ring's functionality. By analyzing anonymized data from users, the AI can offer personalized recommendations, translating complex health metrics into understandable insights. This feature is particularly beneficial in a world where many individuals may not fully grasp what terms like heart rate variability (HRV) or SpO2 mean. The ring effectively bridges the gap between advanced medical technology and everyday usability, making health management accessible to a broader audience.Ethical Considerations and Data PrivacyAs with any device that collects health data, ethical considerations are paramount. Circular is committed to adhering to stringent data protection regulations, such as the General Data Protection Regulation (GDPR) in Europe. The company emphasizes the importance of anonymizing data to ensure user privacy while still leveraging this information to enhance the accuracy and efficacy of its health monitoring features. This careful approach underscores the balance between innovation and ethical responsibility, fostering trust among users.The Circular smart ring represents a significant milestone in the evolution of wearable health technology. Its ability to offer ECG readings, coupled with a comprehensive suite of health monitoring features, positions it as a leader in the market. As consumers increasingly seek convenient ways to manage their health, the smart ring stands out as a promising solution, combining functionality with a sleek design.Conclusion: The Future of Wearable Health TechnologyIn conclusion, the Circular smart ring is not just a novel gadget; it is a transformative tool that empowers individuals to take charge of their health. By integrating advanced medical technology into a user-friendly format, it paves the way for a future where health monitoring is as effortless as wearing a piece of jewelry. As innovation continues to drive the wearable technology landscape, the potential for smart rings and similar devices to enhance personal wellness is boundless, heralding a new era of health empowerment for all.Interview by Marlo Anderson of The Tech Ranch.Sponsored by: Get $5 to protect your credit card information online with Privacy. Amazon Prime gives you more than just free shipping. Get free music, TV shows, movies, videogames and more. The most flexible tools for podcasting. Get a 30 day free trial of storage and statistics.

The intersection of technology and health has seen remarkable advancements in recent years, with wearables emerging as a pivotal element in personal health monitoring. Among these innovations, the smart ring stands out as a revolutionary tool that combines convenience, functionality, and advanced health monitoring capabilities. The Circular smart ring, recently introduced at the Consumer Electronics Show (CES), exemplifies this evolution, offering features that empower users to take control of their health in unprecedented ways.A New Era of Health MonitoringAt the heart of the Circular smart ring's innovation is its ability to perform electrocardiogram (ECG) readings. This feature allows users to monitor their heart health with a simple touch of the ring, making it a game-changer in the realm of personal health devices. Traditionally, obtaining an ECG required a visit to a healthcare professional, involving cumbersome equipment and often lengthy procedures. In recent years, the technology has been added into larger wearable devices, such as watches.Circular's integration of this technology into a small wearable format not only streamlines the process but also democratizes access to vital health information. With the capability to detect arrhythmias - irregular heartbeats - within just 30 seconds, users can gain insights into their cardiac health without the need for immediate medical intervention.The Journey of CircularThe inception of Circular was rooted in a desire to enhance personal wellness through innovative technology. Initially, the company's founders sought to create a ring that would wake users with gentle vibrations, a concept that highlights the importance of personalized experiences in health technology. However, upon collaborating with medical professionals, the focus shifted towards integrating health and wellness features. This pivot led to the development of functionalities such as sleep analysis, activity tracking, and stress monitoring, laying the groundwork for the advanced capabilities present in the latest iteration of the ring.Comprehensive Health InsightsThe Circular smart ring does not merely focus on heart health; it encompasses a broad spectrum of health metrics. Through its accompanying app, users can monitor various indicators, including sleep quality, physical activity, and even blood oxygen levels (SpO2). The ring records data every two minutes, providing a minute's worth of information for each health metric. This level of detail allows users to identify patterns and make informed decisions about their health, such as recognizing symptoms of sleep apnea through the analysis of blood oxygenation levels during sleep.Moreover, the incorporation of artificial intelligence (AI) enhances the ring's functionality. By analyzing anonymized data from users, the AI can offer personalized recommendations, translating complex health metrics into understandable insights. This feature is particularly beneficial in a world where many individuals may not fully grasp what terms like heart rate variability (HRV) or SpO2 mean. The ring effectively bridges the gap between advanced medical technology and everyday usability, making health management accessible to a broader audience.Ethical Considerations and Data PrivacyAs with any device that collects health data, ethical considerations are paramount. Circular is committed to adhering to stringent data protection regulations, such as the General Data Protection Regulation (GDPR) in Europe. The company emphasizes the importance of anonymizing data to ensure user privacy while still leveraging this information to enhance the accuracy and efficacy of its health monitoring features. This careful approach underscores the balance between innovation and ethical responsibility, fostering trust among users.The Circular smart ring represents a significant milestone in the evolution of wearable health technology. Its ability to offer ECG readings, coupled with a comprehensive suite of health monitoring features, positions it as a leader in the market. As consumers increasingly seek convenient ways to manage their health, the smart ring stands out as a promising solution, combining functionality with a sleek design.Conclusion: The Future of Wearable Health TechnologyIn conclusion, the Circular smart ring is not just a novel gadget; it is a transformative tool that empowers individuals to take charge of their health. By integrating advanced medical technology into a user-friendly format, it paves the way for a future where health monitoring is as effortless as wearing a piece of jewelry. As innovation continues to drive the wearable technology landscape, the potential for smart rings and similar devices to enhance personal wellness is boundless, heralding a new era of health empowerment for all.Interview by Marlo Anderson of The Tech Ranch.Sponsored by: Get $5 to protect your credit card information online with Privacy. Amazon Prime gives you more than just free shipping. Get free music, TV shows, movies, videogames and more. The most flexible tools for podcasting. Get a 30 day free trial of storage and statistics.

Dr. Stephanie Martin and Suzanne McMurtry Baird discuss the technology of pulse oximetry. Understand the WHY of SpO2 values.The experts at Clinical Concepts in Obstetrics pool their decades of experience caring for critically ill pregnant women to discuss the challenges encountered in caring for these vulnerable women. Dr Stephanie Martin is the Medical Director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist with expertise in critical care obstetrics. Suzanne McMurtry Baird, DNP, RN is the Nursing Director for Clinical Concepts in Obstetrics with many years of experience caring for critically ill pregnant women. Julie Arafeh, RN, MS is the Simulation Director for Clinical Concepts in Obstetrics and a leading expert in simulation.Follow us: Instagram: https://www.instagram.comDr Martin's LinkedIn: http://linkedin.com/in/stephanie-martin-65b07112aCCOB LinkedIn: https://www.linkedin.com/company/clinical-concepts-in-obstetrics/Twitter/X: https://twitter.com/OBCriticalCareCCOB Facebook: https://www.facebook.com/clinicalconceptsinobstetricsDr Martin's Facebook: https://www.facebook.com/profile.php?id=100024366859192

In this episode, we explore the critical role nurses play in advancing health equity within the ICU. Jennifer Adamski, president of the American Association of Critical-Care Nurses, shares insights on how nurses can make a difference at the bedside and the challenges they face. We also discuss strategies for empowering nurses and fostering a culture of equity in critical care.This episode is sponsored by Medtronic.Areia C, King E, Ede J, Young L, Tarassenko L, Watkinson P, Vollam S. Experiences of current vital signs monitoring practices and views of wearable monitoring: A qualitative study in patients and nurses. Journal of advanced nursing. 2022 Mar;78(3):810-22Williams EC, Polito V. Meditation in the Workplace: Does Mindfulness Reduce Bias and Increase Organisational Citizenship Behaviours? Front Psychol. 2022 Apr 11;13:747983. doi: 10.3389/fpsyg.2022.747983. PMID: 35478759; PMCID: PMC9035788.Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook. 2023 Sep-Oct;71(5):102032. doi: 10.1016/j.outlook.2023.102032. Epub 2023 Sep 6. PMID: 37683597.Bhavani SV, Wiley Z, Verhoef PA, Coopersmith CM, Ofotokun I. Racial Differences in Detection of Fever Using Temporal vs Oral Temperature Measurements in Hospitalized Patients. JAMA. 2022;328(9):885–886. doi:10.1001/jama.2022.12290P Malhotra, L Shaw, J Barnett, E Hayter, N Hill, P Stockton. St Helens and Knowsley. P179 Patient safety alert: a prospective study on 100 patients highlighting inaccuracy of pulse oximeter finger probes used on ear lobes. Teaching Hospitals NHS Trust, Prescot, UK. 10.1136/thorax-2018-212555.336Torp KD, Modi P, Pollard EJ, Simon LV. Pulse Oximetry. 2023 Jul 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262014Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Med Devices (Auckl). 2014 Jul 8;7:231-9. doi: 10.2147/MDER.S47319. PMID: 25031547; PMCID: PMC4099100Giuliano KK, Bilkovski RN, Beard J, Lamminmäki S. Comparative analysis of signal accuracy of three SpO2 monitors during motion and low perfusion conditions. J Clin Monit Comput. 2023 Dec;37(6):1451-1461. doi: 10.1007/s10877-023-01029-x. Epub 2023 Jun 2. PMID: 37266709; PMCID: PMC10651546Gudelunas MK, Lipnick M, Hendrickson C, et al. Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesth Analg. 2024;138(3):552-561. doi:10.1213/ANE.0000000000006755

The SpO2 climbs while the patient declines? What?! A fed up patient and Paramedic who, if they only could, would swap places with just about anyone on this week's call!

The JournalFeed podcast for the week of June 3-7, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:In this RCT, successful intubation on the first attempt in critically ill neonates was much higher in patients when video laryngoscopy (VL) was used compared to direct laryngoscopy (DL).Tuesday Spoon Feed:Data supporting pediatric cardiac arrest guidelines are limited. This study found increases in the longest pause in chest compressions (CC) during pediatric in-hospital cardiac arrest (pIHCA) were inversely associated with survival and ROSC.Wednesday Spoon Feed:This secondary analysis derives and validates a machine learning model that supports the use of personalized oxygen saturation targets (SpO2) in mechanically ventilated critically ill adults based on individual patient characteristics.PILOT & ICU-ROX

This week's episode features Ken Hooks, a sleep specialist and founder of True Sleep Diagnostics. He offers home sleep tests (“HST”) and has extensive experience in the field. Ken previously worked at Bon Secours St Francis and Greenville Technical College and co-authored a case report on treating pediatric sleep apnea.Join Ken and Hallie as they discuss the results of Hallie's follow-up HST, comparing it to her first HST from March 2022. Listen as they explore the validity and interpretation of home sleep tests, highlighting the importance of deep sleep and REM sleep. They also discuss the impact of upper airway resistance on sleep quality and the challenges with end-title CO2 monitoring. Their conversation covers various topics related to home sleep studies and airway health including discussions on insurance coverage, the importance of spO2 pleth in sleep studies, the impact of cardiac function during sleep, airflow dynamics and resistance, and more!If this episode has resonated with you in some way, take a screenshot of you listening, post it to your Instagram Stories, and tag Hallie @halliebulkinFor more episodes visit www.untetheredpodcast.com Hosted on Acast. See acast.com/privacy for more information.

Hosts:Pradip Kamat, Children's Healthcare of Atlanta/Emory University School of MedicineRahul Damania, Cleveland Clinic Children's HospitalIntroductionToday, we discuss the case of an 8-month-old infant with severe bronchospasm and abnormal blood gas. We'll delve into the epidemiology, pathophysiology, and evidence-based management of acute bronchiolitis.Case SummaryAn 8-month-old infant presented to the ER with decreased alertness following worsening work of breathing, preceded by URI symptoms. The infant was intubated and transferred to the PICU, testing positive for RSV. Initial blood gas showed 6.8/125/-4, and CXR revealed massive hyperinflation. Vitals: HR 180, BP 75/45, SPO2 92% on 100% FIO2, RR 12 (prior to intubation), now around 16 on the ventilator, afebrile.Discussion PointsEtiology & Pathogenesis: Bronchiolitis is primarily caused by RSV, with other viruses and bacteria playing a role. RSV bronchiolitis is the most common cause of hospitalization in infants, particularly in winter months. Immuno-pathology involves an unbalanced immune response and can lead to various extra-pulmonary manifestations.Diagnosis: Diagnosis is clinical, based on history and examination. Key signs include upper respiratory symptoms followed by lower respiratory distress. Blood gas, chest radiography, and viral testing are generally not recommended unless warranted by severe symptoms or clinical deterioration.Management Framework: For patients requiring PICU admission, focus on oxygenation and hydration. High-flow therapy and nasal continuous positive airway pressure (CPAP) can be used. Hydration and feeding support are crucial. Antibiotics, steroids, and bronchodilators are generally not recommended. Mechanical ventilation and ECMO may be necessary in severe cases.Immunoprophylaxis & Nosocomial Infection Prevention: Palivizumab and nirsevimab are used for RSV prevention in high-risk infants. Strict infection control measures, including hand hygiene and isolation, are essential to prevent nosocomial infections.ConclusionRSV bronchiolitis is a common and potentially severe respiratory illness in infants. Management focuses on supportive care, with a careful balance between oxygenation and hydration. Immunoprophylaxis and infection control are crucial in preventing the spread of the virus.Thank you for listening to our episode on acute bronchiolitis. Please subscribe, share your feedback, and visit our website at picudoconcall.org for more resources. Stay tuned for our next episode!ReferencesRogers - Textbook of Pediatric Critical Care Chapter 49: Pneumonia and Bronchiolitis. De Carvalho et al. page 797-823Reference 1: Dalziel, Stuart R; Haskell, Libby; O'Brien, Sharon; Borland, Meredith L; Plint, Amy C; Babl, Franz E; Oakley, Ed. Bronchiolitis. The Lancet. , 2022, Vol.400(10349), p.392-406. DOI: 10.1016/S0140-6736(22)01016-9; PMID:...

BeamO est un appareil de santé à domicile combinant thermomètre, SpO2, électrocardiogramme, et stéthoscope numérique. Destiné aux familles et aux personnes nécessitant un suivi médical régulier, il peut gérer jusqu'à huit utilisateurs. Les données collectées sont synchronisées avec l'application Withings pour un partage facile avec les médecins. En attente d'approbation de la FDA et du CE médical, BeamO devrait être disponible dès juin de cette année en Europe, aux États-Unis et au Canada.

Mark Peters and Doug Gould (both London) present the results of the OXY-PICU trial, comparing conservative with liberal oxygenation targets (SpO2 88-92% vs >94%) in critically ill children receiving invasive mechanical ventilation. Luregn Schlapbach (Zurich) delivers an independent editorial. They are joined by Victoria Cornelius (London), Bronagh Blackwood (Belfast), & Matthew Semler (Nashville) for a panel discussion. The session is chaired by Howard Bauchner (Boston).

Omri Shor, Co-Founder and CEO of Medisafe is driven to help patients manage their medications. Omri emphasizes that medication adherence is influenced by various factors, including access to healthcare providers, ability to refill prescriptions, side effects, and cost. Medisafe tools support patients by providing reminders, tracking medication intake, and managing drug-to-drug interactions. Partners include drug manufacturers and pharma companies that want to support patients to improve outcomes. Omri explains, "People think medication management is one problem, but it is not. There are so many drivers and challenges behind it, and it is very personalized to the individual on one end. It's also aligned with the specific condition and the specific drug. There is no clear answer to who's more prone." "In many cases, what we want to see is actually connected to outcomes. So, if the patient takes a medication to get to a specific outcome, they can track those outcomes in Medisafe. There are roughly 70 or 80 trackers for blood pressure, glucose levels, SpO2, sleep, moods, etc. We will then use those trackers and allow patients to share that information with HCPs healthcare professionals, whether their pharmacist, nurse, or physician, so they can share this information with the right individuals to continue supporting them."   "We have recently concluded a study that looked at healthcare utilization. We saw patients with MS and epilepsy after starting to use Medisafe. We did a pre-post analysis and found that patients with epilepsy experienced a 36% reduction in ER visits. For patients with MS, we observed a 63% reduction in ER visits. The monetary implications were roughly between $4,500 and $6,000 in cost reduction per patient annually. So, better process management yields better outcomes, which was wonderful for us to observe at Medisafe." #Medisafe #MedicationAdherence #HealthLiteracy #DigitalHealth #MedicationManagement #DigitalCompanion medisafe.com Download the transcript here

Omri Shor, Co-Founder and CEO of Medisafe is driven to help patients manage their medications. Omri emphasizes that medication adherence is influenced by various factors, including access to healthcare providers, ability to refill prescriptions, side effects, and cost. Medisafe tools support patients by providing reminders, tracking medication intake, and managing drug-to-drug interactions. Partners include drug manufacturers and pharma companies that want to support patients to improve outcomes. Omri explains, "People think medication management is one problem, but it is not. There are so many drivers and challenges behind it, and it is very personalized to the individual on one end. It's also aligned with the specific condition and the specific drug. There is no clear answer to who's more prone." "In many cases, what we want to see is actually connected to outcomes. So, if the patient takes a medication to get to a specific outcome, they can track those outcomes in Medisafe. There are roughly 70 or 80 trackers for blood pressure, glucose levels, SpO2, sleep, moods, etc. We will then use those trackers and allow patients to share that information with HCPs healthcare professionals, whether their pharmacist, nurse, or physician, so they can share this information with the right individuals to continue supporting them."   "We have recently concluded a study that looked at healthcare utilization. We saw patients with MS and epilepsy after starting to use Medisafe. We did a pre-post analysis and found that patients with epilepsy experienced a 36% reduction in ER visits. For patients with MS, we observed a 63% reduction in ER visits. The monetary implications were roughly between $4,500 and $6,000 in cost reduction per patient annually. So, better process management yields better outcomes, which was wonderful for us to observe at Medisafe." #Medisafe #MedicationAdherence #HealthLiteracy #DigitalHealth #MedicationManagement #DigitalCompanion medisafe.com Listen to the podcast here

Charese presents a history of chronic obstructive pulmonary disease (COPD) performs a six-minute walk test. Which outcome, if observed during the test, would indicate an exacerbation or worsening of the patient's COPD? A. Increased stride length B. Decreased use of accessory muscles for breathing C. A decrease in SpO2 below 90% D. A decrease in respiratory rate LINKS MENTIONED: Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com --- Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support

Today, we're diving deep into pneumothorax and hemothorax. Pneumothorax can quickly become an emergency, especially when it's not about the pressure but the declining SPO2. But where's the line between tension and hemothoraces? Our ICU doc expert clarifies that it's all about the impaired blood return to the heart. When your preload drops, it affects the cardiac output. If vitals are stable, though, it's not tension physiology. Also, did you know there are folks walking around with untreated pneumothoraces? The literature suggests only treating those affecting over 30% of the thoracic cavity. And, oh boy, many pneumothoraces come from trauma, but spontaneous cases exist. Especially with COVID, the lung scarring has made things fragile. Add trauma and narcotics, and things can get dicey. But remember, before deciding to treat a pneumothorax, be sure it's the right move. Better safe than sorry! 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

Jaquay is treating a patient with chronic obstructive pulmonary disease (COPD) who complains of dyspnea during daily activities. The patient's SpO2 levels tend to drop below 88% with mild exertion. In addition to continuing with a general exercise program, which of the following interventions would be the MOST beneficial for this patient? A. Instructing the patient in diaphragmatic breathing and pursed-lip breathing. B. Encouraging the patient to hold their breath during activities to conserve oxygen. C. Reducing the intensity of the exercise program to avoid any further dyspnea. D. Training the patient in quick, shallow breathing to increase oxygen intake. LINKS MENTIONED: Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com --- Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support

The following question refers to Section 9.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by Keck School of Medicine USC medical student & CardioNerds Intern Hirsh Elhence, answered first by Cedars Sinai medicine resident, soon to be Vanderbilt Cardiology Fellow, and CardioNerds Academy Faculty Dr. Breanna Hansen, and then by expert faculty Dr. Anu Lala.Dr. Lala is an advanced heart failure and transplant cardiologist, associate professor of medicine and population health science and policy, Director of Heart Failure Research, and Program Director for the Advanced Heart Failure and Transplant fellowship training program at Mount Sinai. Dr. Lala is Deputy Editor for the Journal of Cardiac Failure. Dr. Lala has been a champion and role model for CardioNerds. She has been a PI mentor for the CardioNerds Clinical Trials Network and continues to serve in the program's leadership. She is also a faculty mentor for this very 2022 heart failure decipher the guidelines series.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #23 Mrs. Hart is a 63-year-old woman with a history of non-ischemic cardiomyopathy and heart failure with reduced ejection fraction (LVEF 20-25%) presenting with 5 days of worsening dyspnea and orthopnea.   At home, she takes carvedilol 12.5mg BID, sacubitril-valsartan 24-46mg BID, empagliflozin 10mg daily, and furosemide 40mg daily.   On admission, her exam revealed a blood pressure of 111/79 mmHg, HR 80 bpm, and SpO2 94%. Her cardiovascular exam was significant for a regular rate and rhythm with an audible S3, JVD to 13 cm H2O, bilateral lower extremity pitting edema with warm extremities and 2+ pulses throughout.  What initial dose of diuretics would you give her? A Continue home Furosemide 40 mg PO B Start Metolazone 5 mg PO C Start Lasix 100 mg IV D Start Spironolactone Answer #23 Explanation The correct answer is C – start Furosemide 100 mg IV. This is the most appropriate choice because patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to improve symptoms and reduce morbidity (Class 1, LOE B-NR). Intravenous loop diuretic therapy provides the most rapid and effective treatment for signs and symptoms of congestion. Titration of diuretics has been described in multiple recent trials of patients hospitalized with HF, often initiated with at least 2 times the daily home diuretic dose (mg to mg) administered intravenously. Titration to achieve effective diuresis may require doubling of initial doses, adding a thiazide diuretic, or adding an MRA that has diuretic effects in addition to its cardiovascular benefits. Choice A is incorrect as continuing oral loop diuretics is not recommended for acute decongestion. Moreover, Ms. Hart has become congested despite her home, oral diuretic regimen. Choice B and D are incorrect as starting a thiazide diuretic or a mineralocorticoid receptor antagonist are not first-line therapy for acute HF. Rather, in patients hospitalized with HF when diuresis is inadequate to relieve symptoms and signs of congestion, it is reasonable to intensify the diuretic regimen using either: a.

On this week's episode of the Android Central Podcast, Shruti Shekar, Jerry Hildenbrand, Andrew Myrick, and Derrek Lee discuss what Android 15 needs to steal from iOS 17, what iOS 17 needs to learn from Google, the Samsung Galaxy Watch & Google Pixel Watch's new health features, review the Moto G Stylus 5G, rave about the Amazon Fire Max 11, and more! Links:  iOS 17 is a big nothing-burger - Android Central 4 things Android 15 needs to steal from iOS 17 - Android Central Amazon Fire Max 11 review - Android Central Samsung details availability of important Galaxy Watch health feature - Android Central The Google Pixel Watch's SpO2 monitoring finally becomes operational - Android Central Moto G Stylus 5G (2023) review - Android Central Android Central Podcast Sponsors:  NetSuite: Get the visibility and control you need to weather any storm, check out netsuite.com/android. Follow us on Twitter: @AndroidCentral @Shruti_Shekar @gbhil @AndyMyrick @TheeBranLee

Hands-free photos, SpO2 and more for the Pixel family. @MishaalRahman: Android 14 Beta 3 and Platform Stability. Here is what's new in Android 14 Beta 3. @lockheimer: Today I'm excited to share that we're working with AT&T to accelerate adoption of the RCS standard, and that AT&T's default Android messaging will now be via the Jibe platform, so their users will get the latest RCS features instantly. @MishaalRahman: Google is retiring Android TV 13, I can now confirm. See this thread for the full details on what's changing. @MishaalRahman: I'm looking through the first Android TV 14 beta right now to find what's new! Here's what I've found so far. Exclusive: These are the leaked camera specs for the Google Pixel 8 series. Exclusive: Everything you want to know about the Pixel 8's processor leaked. Join us for the official launch on July 11th, 11:00 EST on nothing.tech. Exclusive Nothing Phone (2) First Look: Get a Sneak Peek at Carl Pei's Highly Anticipated Nothing Phone 2. OnePlus' foldable phone is launching in... August! The Reddit App War Is Getting Messy. Apollo will close down on June 30th. Reddit's recent decisions and actions have unfortunately made it impossible for Apollo to continue. Sync will shut down on June 30, 2023. Pocket Casts for Wear OS is now available in beta. JR's tip of the week: Reading Mode. Followup to fan who wrote about wireless charging issues with Pixel 6 Pro. Pixel 7a fan review: The battery is not good. Why I installed GrapheneOS on the Pixel 7a. Read our show notes here: https://bit.ly/3qx3C2n Hosts: Jason Howell and Ron Richards Co-Hosts: Mishaal Rahman and JR Raphael Subscribe to All About Android at https://twit.tv/shows/all-about-android. Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Sponsors: fastmail.com/twit cachefly.com

Hands-free photos, SpO2 and more for the Pixel family. @MishaalRahman: Android 14 Beta 3 and Platform Stability. Here is what's new in Android 14 Beta 3. @lockheimer: Today I'm excited to share that we're working with AT&T to accelerate adoption of the RCS standard, and that AT&T's default Android messaging will now be via the Jibe platform, so their users will get the latest RCS features instantly. @MishaalRahman: Google is retiring Android TV 13, I can now confirm. See this thread for the full details on what's changing. @MishaalRahman: I'm looking through the first Android TV 14 beta right now to find what's new! Here's what I've found so far. Exclusive: These are the leaked camera specs for the Google Pixel 8 series. Exclusive: Everything you want to know about the Pixel 8's processor leaked. Join us for the official launch on July 11th, 11:00 EST on nothing.tech. Exclusive Nothing Phone (2) First Look: Get a Sneak Peek at Carl Pei's Highly Anticipated Nothing Phone 2. OnePlus' foldable phone is launching in... August! The Reddit App War Is Getting Messy. Apollo will close down on June 30th. Reddit's recent decisions and actions have unfortunately made it impossible for Apollo to continue. Sync will shut down on June 30, 2023. Pocket Casts for Wear OS is now available in beta. JR's tip of the week: Reading Mode. Followup to fan who wrote about wireless charging issues with Pixel 6 Pro. Pixel 7a fan review: The battery is not good. Why I installed GrapheneOS on the Pixel 7a. Read our show notes here: https://bit.ly/3qx3C2n Hosts: Jason Howell and Ron Richards Co-Hosts: Mishaal Rahman and JR Raphael Subscribe to All About Android at https://twit.tv/shows/all-about-android. Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Sponsors: fastmail.com/twit cachefly.com

Hands-free photos, SpO2 and more for the Pixel family. @MishaalRahman: Android 14 Beta 3 and Platform Stability. Here is what's new in Android 14 Beta 3. @lockheimer: Today I'm excited to share that we're working with AT&T to accelerate adoption of the RCS standard, and that AT&T's default Android messaging will now be via the Jibe platform, so their users will get the latest RCS features instantly. @MishaalRahman: Google is retiring Android TV 13, I can now confirm. See this thread for the full details on what's changing. @MishaalRahman: I'm looking through the first Android TV 14 beta right now to find what's new! Here's what I've found so far. Exclusive: These are the leaked camera specs for the Google Pixel 8 series. Exclusive: Everything you want to know about the Pixel 8's processor leaked. Join us for the official launch on July 11th, 11:00 EST on nothing.tech. Exclusive Nothing Phone (2) First Look: Get a Sneak Peek at Carl Pei's Highly Anticipated Nothing Phone 2. OnePlus' foldable phone is launching in... August! The Reddit App War Is Getting Messy. Apollo will close down on June 30th. Reddit's recent decisions and actions have unfortunately made it impossible for Apollo to continue. Sync will shut down on June 30, 2023. Pocket Casts for Wear OS is now available in beta. JR's tip of the week: Reading Mode. Followup to fan who wrote about wireless charging issues with Pixel 6 Pro. Pixel 7a fan review: The battery is not good. Why I installed GrapheneOS on the Pixel 7a. Read our show notes here: https://bit.ly/3qx3C2n Hosts: Jason Howell and Ron Richards Co-Hosts: Mishaal Rahman and JR Raphael Subscribe to All About Android at https://twit.tv/shows/all-about-android. Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Sponsors: fastmail.com/twit cachefly.com

Hands-free photos, SpO2 and more for the Pixel family. @MishaalRahman: Android 14 Beta 3 and Platform Stability. Here is what's new in Android 14 Beta 3. @lockheimer: Today I'm excited to share that we're working with AT&T to accelerate adoption of the RCS standard, and that AT&T's default Android messaging will now be via the Jibe platform, so their users will get the latest RCS features instantly. @MishaalRahman: Google is retiring Android TV 13, I can now confirm. See this thread for the full details on what's changing. @MishaalRahman: I'm looking through the first Android TV 14 beta right now to find what's new! Here's what I've found so far. Exclusive: These are the leaked camera specs for the Google Pixel 8 series. Exclusive: Everything you want to know about the Pixel 8's processor leaked. Join us for the official launch on July 11th, 11:00 EST on nothing.tech. Exclusive Nothing Phone (2) First Look: Get a Sneak Peek at Carl Pei's Highly Anticipated Nothing Phone 2. OnePlus' foldable phone is launching in... August! The Reddit App War Is Getting Messy. Apollo will close down on June 30th. Reddit's recent decisions and actions have unfortunately made it impossible for Apollo to continue. Sync will shut down on June 30, 2023. Pocket Casts for Wear OS is now available in beta. JR's tip of the week: Reading Mode. Followup to fan who wrote about wireless charging issues with Pixel 6 Pro. Pixel 7a fan review: The battery is not good. Why I installed GrapheneOS on the Pixel 7a. Read our show notes here: https://bit.ly/3qx3C2n Hosts: Jason Howell and Ron Richards Co-Hosts: Mishaal Rahman and JR Raphael Subscribe to All About Android at https://twit.tv/shows/all-about-android. Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Sponsors: fastmail.com/twit cachefly.com

Hands-free photos, SpO2 and more for the Pixel family. @MishaalRahman: Android 14 Beta 3 and Platform Stability. Here is what's new in Android 14 Beta 3. @lockheimer: Today I'm excited to share that we're working with AT&T to accelerate adoption of the RCS standard, and that AT&T's default Android messaging will now be via the Jibe platform, so their users will get the latest RCS features instantly. @MishaalRahman: Google is retiring Android TV 13, I can now confirm. See this thread for the full details on what's changing. @MishaalRahman: I'm looking through the first Android TV 14 beta right now to find what's new! Here's what I've found so far. Exclusive: These are the leaked camera specs for the Google Pixel 8 series. Exclusive: Everything you want to know about the Pixel 8's processor leaked. Join us for the official launch on July 11th, 11:00 EST on nothing.tech. Exclusive Nothing Phone (2) First Look: Get a Sneak Peek at Carl Pei's Highly Anticipated Nothing Phone 2. OnePlus' foldable phone is launching in... August! The Reddit App War Is Getting Messy. Apollo will close down on June 30th. Reddit's recent decisions and actions have unfortunately made it impossible for Apollo to continue. Sync will shut down on June 30, 2023. Pocket Casts for Wear OS is now available in beta. JR's tip of the week: Reading Mode. Followup to fan who wrote about wireless charging issues with Pixel 6 Pro. Pixel 7a fan review: The battery is not good. Why I installed GrapheneOS on the Pixel 7a. Read our show notes here: https://bit.ly/3qx3C2n Hosts: Jason Howell and Ron Richards Co-Hosts: Mishaal Rahman and JR Raphael Subscribe to All About Android at https://twit.tv/shows/all-about-android. Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Sponsors: fastmail.com/twit cachefly.com

Hands-free photos, SpO2 and more for the Pixel family. @MishaalRahman: Android 14 Beta 3 and Platform Stability. Here is what's new in Android 14 Beta 3. @lockheimer: Today I'm excited to share that we're working with AT&T to accelerate adoption of the RCS standard, and that AT&T's default Android messaging will now be via the Jibe platform, so their users will get the latest RCS features instantly. @MishaalRahman: Google is retiring Android TV 13, I can now confirm. See this thread for the full details on what's changing. @MishaalRahman: I'm looking through the first Android TV 14 beta right now to find what's new! Here's what I've found so far. Exclusive: These are the leaked camera specs for the Google Pixel 8 series. Exclusive: Everything you want to know about the Pixel 8's processor leaked. Join us for the official launch on July 11th, 11:00 EST on nothing.tech. Exclusive Nothing Phone (2) First Look: Get a Sneak Peek at Carl Pei's Highly Anticipated Nothing Phone 2. OnePlus' foldable phone is launching in... August! The Reddit App War Is Getting Messy. Apollo will close down on June 30th. Reddit's recent decisions and actions have unfortunately made it impossible for Apollo to continue. Sync will shut down on June 30, 2023. Pocket Casts for Wear OS is now available in beta. JR's tip of the week: Reading Mode. Followup to fan who wrote about wireless charging issues with Pixel 6 Pro. Pixel 7a fan review: The battery is not good. Why I installed GrapheneOS on the Pixel 7a. Read our show notes here: https://bit.ly/3qx3C2n Hosts: Jason Howell and Ron Richards Co-Hosts: Mishaal Rahman and JR Raphael Subscribe to All About Android at https://twit.tv/shows/all-about-android. Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Sponsors: fastmail.com/twit cachefly.com

Imagine a patient with a SPO2 in the 80's, not in distress, and acting normal. Their echocardiogram shows an atrial septal defect and a pulmonary artery pressure of 95!!! What can we do for this patient? What could cause such a high PA pressure?Today's guest Nick McGowan MSN, RN, CCRN, had this experience and is sharing his patient's story with Sarah. Nick revisits how this case evolved, from getting test results to discovering his shockingly high PA pressure and transferring the patient to the ICU.Many nurses haven't heard of this condition before, but you'll understand the pathophysiology of Eisenmenger syndrome and its prognosis by the end of this episode. We also go over the importance of establishing goals of care with patients, and the role of nurses in the ICU.Nick is also a nursing educator, so tune in to learn his helpful tips on treating elevated PA pressures!Topics discussed in this episode:Nick finding his passion in intensive care nursingHow he became a Nursing EducatorInitial assessment of his Eisenmenger syndrome patientThe pathophysiology of Eisenmenger syndromeTreatment optionsWhat to remember when treating elevated PA pressuresLearn more from Nick here:Website: https://www.ccrnacademy.comLinkedIn: https://www.linkedin.com/in/ccrnacademy/Instagram: https://www.instagram.com/critical_care_academy/Youtube: https://www.youtube.com/@criticalcareacademy8312Facebook: https://www.facebook.com/CCRNacademy/Use the code "RAPID10" to get 10% off his e-learning course just for being a podcast listener! https://www.ccrnacademy.comANDIf you would like to check out Sarah's 1hr, 1 CE course, go to: http://www.rapidresponseandrescue.comTo get the FREE Rapid Response RN Assessment Guide and the coupon code for $10 off the cost of the course, message Sarah on Instagram @TheRapidResponseRN and type the word PODCAST!This episode was produced by Podcast Boutique http://www.podcastboutique.com

Dr. Crowe returns to the EMS Lighthouse Project Podcast from our “vacation” in Mexico to discuss the impact of variations between pulse oximetry and blood gas values across races.   Citation: Sudat SEK, Wesson P, Rhoads KF, et al. Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course. Am J Epidemiol. Published online September 2022:kwac164. doi:10.1093/aje/kwac164 Fawzy A, Wu TD, Wang K, et al. Racial and Ethnic Discrepancy in Pulse Oximetry and Delayed Identification of Treatment Eligibility Among Patients With COVID-19. JAMA Intern Med. 2022;182(7):730. doi:10.1001/jamainternmed.2022.1906    See omnystudio.com/listener for privacy information.

In this episode we unpack and discuss recent neonatal research published in The Journal of Pediatrics. Tune in to hear from Dr. Bharath Srivatsa on what he and the research team aimed to learn about the effect of a novel oxygen saturation targeting strategy for extremely preterm neonates. We talk about the findings, a solution on how NICUs can incorporate simultaneous SpO2 and FiO2 monitoring, and more.This episode is sponsored by Pediatrix.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode a three-year-old girl with altered mental status and acute respiratory failure Here's the case presented by Rahul— A three-year-old presents to the PICU with altered mental status and difficulty breathing. Per the mother, the patient was in the usual state of health on the day prior to admission when the mother left her in the care of her maternal grandmother. When mom arrived home later in the afternoon, mom was unable to wake her and reported that she seemed "stiff". She did not have any abnormal movements or shaking episodes. Mom called 911 and the patient was brought to our ED. No known head trauma, though the patient is in the care of MGM throughout the day. No emesis. Nhttp://emesis.no/ (o) recent sick symptoms. No witnessed ingestion, however, the patient's mother reports that MGM is on multiple medications (Xarelto, zolpidem, Buspar, gabapentin, and acetaminophen) and uses THC-containing products specifically THC gummies. In the ED: The patient had waxing and waning mentation with decreased respiratory effort. GCS was recorded at 7. Arterial blood gas was performed showing an initial pH of 7.26/61/31/0. The patient was intubated for airway protection in the setting of likely ingestion. The patient has no allergies, immunizations are UTD. BP 112/52 (67) | Pulse 106 | Temp 36.2 °C (Tympanic) | Resp (!) 14 | Ht 68.5 cm | Wt 14.2 kg | SpO2 100% | BMI 30.26 kg/m² Physical exam was unremarkable-pupils were 4-5mm and sluggish. There was no rash, no e/o of trauma Initial CMP was normal with AG of 12, CBC was unremarkable, and Respiratory viral panel was negative. Serum toxicology was negative for acetaminophen, salicylates, and alcohol. Basic Urine drug screen was positive for THC To summarize key elements from this case, this patient has: Altered mental status: - waxing and waning with GCS less than 8 suggestive of decreased ventilatory effort pre-intubation impending acute respiratory failure Dilated but reactive pupils All of which brings up a concern for possible ingestion such as THC (but cannot rule out other ingestion) This episode will be organized… Pharmacology of Cannabis Clinical presentation of Cannabis toxicity Workup & management of Cannabis toxicity The Cannabis sativa plant contains over 500 chemical components called cannabinoids, which exert their psychoactive effect on specific receptors in the central nervous system and immune system. The 2 best-described cannabinoids are THC and cannabidiol (CBD)—and are the most commonly used for medical purposes. Patients with intractable epilepsy or chronic cancer pain may be using these drugs. THC is the active ingredient of the cannabis plant that is responsible for most symptoms of central nervous system intoxication. The term cannabis and the common name, marijuana, are often used interchangeably). Rahul, can you shed some light on the pharmacokinetics/pharmacodynamics of cannabis? Cannabis exists in various forms: marijuana (dried, crushed flower heads, and leaves), hashish (resin), and hash oil (concentrated resin extract), which can be smoked, inhaled, or ingested. THC is the active ingredient of the cannabis plant that is responsible for most symptoms of central nervous system intoxication, in contrast to CBD, the main non-psychoactive component of cannabis. The potency of cannabis is usually based on the THC content of the preparation. The THC is lipid soluble and highly protein bound and has a volume of distribution of 2.5 to 3.5...

Episode 110: Pulse Ox in Dark-skinned People.  Learn about the most recent findings in pulse oximeters in dark-skinned people. Bahar and Arianna explain the new recommendations by FDA regarding this topic.  Written by Bahar Hamidi, MS4; and Arianna Crediford, MS4. American University of the Caribbean (AUC). Comments by Hector Arreaza, MD.    ________________This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice._________________Bahar: When I first saw this news breakout on CNN I was stunned! A cohort study just published (7/11/22) in JAMA called “Assessment of Racial and Ethnic Differences in Oxygen Supplementation Among Patients in the Intensive Care Unit” revealed that Asian, Black, and Hispanic patients received less supplemental oxygen than White patients, because of the differences in pulse oximeter performance, which may contribute to known race and ethnicity–based disparities in care. I cannot believe this discovery has not been given the attention it deserves earlier. I believe maybe COVID had a lot to do with it; as checking the pulse ox deciphered the patients' treatment plan. Let's think about it for a moment, how important is the pulse ox accuracy?Arianna: Well, we know that insufficient administration of supplemental oxygen can make changes in the initiation and management of noninvasive verse invasive mechanical ventilation. The study mentions some other important points like pulse oximeter performance disparities playing a role in decision-making regarding fluid management, specialty service consultation, and even intensive care unit (ICU) admission.  Bahar: It states, “artificially high SpO2 readings in the emergency department could also affect the perceived need for cardiology service admission for heart failure management, possibly explaining the finding that Black and Hispanic patients were less likely than White patients to be admitted to a cardiology service.”Arianna: So how you may ask the study really put this to the test? The large cohort study had 3,069 patients in the intensive care unit, so what they did was they took the average hemoglobin oxygen saturation for each patient and tracked how much supplemental oxygen was given to the patients and lo and behold, the data revealed that Asian, Black, and Hispanic patients had a higher adjusted time-weighted average pulse oximetry reading and were administered significantly less supplemental oxygen compared with White patients even with adjusting for potential confounders.Bahar: And what is the solution you may ask? Well, the FDA issued a new draft guidance that recommends companies making medical products submit a “race and ethnicity diversity plan” to the agency early in their development of products, and that a plan should include enrolling diverse groups of people into their clinical trials as of April 2022. As a reminder, it's been a year since CDC declared racism a public health threat.  Arianna: Rutendo Jakachira is a Ph.D. student in Brown University's Department of Physics. She is studying racial disparities in pulse oximetry. She stated that COVID-19 likely helped uncover the suspected pulse oximeter limitations in dark-skinned people. Kimani Toussaint is a professor and senior associate dean in the School of Engineering at Brown University. Jakachira, Toussaint, and their colleagues from Engineering at Brown University are developing non-invasive methods to make pulse oximeters more accurate in blood oxygen readings for people with dark skin tones.Bahar: Toussaint stated that they are “trying to mitigate the skin tone issues by doing something interesting with the light, but it's a significant challenge and this really highlights the need to have diversity and inclusion.”  Pulse oximeters work by sending beams of light through the fingertips to measure blood oxygen levels, they are actually measuring how much oxygen has been absorbed by hemoglobin. Melanin is the brown pigment that gives color to our skin, hair, and eyes. It turns out that both hemoglobin and melanin absorb light at similar wavelengths and it can be challenging to separate their contributions to the detected level of oxygen.  Arianna: Toussaint explains that melanin will overlap with the absorption properties of the hemoglobin in your blood, which can lead to inaccurate pulse oximeter readings because people have different amounts of melanin.Bahar: Jakachira and Toussaint are trying to cancel out the effect of melanin on how pulse oximeters measure blood oxygen levels. The result of this work would be a contribution that can be applied to other similar-based technologies that measure levels of substances through the skin, but they could not share additional details of their proceedings as the research team is currently completing a patent application. Now what is also shocking is that there have actually been prior studies that have shown differences of several percentage points in SpO2 for a given hemoglobin oxygen saturation between Black and White patients, but in the past, the clinical significance of these findings was discounted and downplayed.  Arianna: I think this study and discovery urges further studies in different regions and not just at one institution or geographic location. The article encourages further exploration of specific factors within a racial and ethnic group that could put some patients at particularly high risk of oxygenation disparities, including skin tone, degree of desaturation, exposure to specific oxygen delivery devices, comorbidities, and other sociodemographic factors.  Bahar: Some other studies they hope will be performed are:-Differences in oxygen supplementation in patients receiving invasive or noninvasive positive pressure ventilation and a potential association of vasopressors and inotropes AND Clinical decisions other than oxygen delivery that may be affected by pulse oximeter performance discrepancies.Arianna: So we can definitely say that some groundwork has been done but further research is needed to confirm these findings and explore other clinical factors associated with treatment disparities.Bahar: It is great to stay in the loop and know what health care providers should look out for, I hope this podcast will raise awareness of the matter and hopefully we come up with a more accurate Pulse Ox prototype that will be fit for all ethnicities and skin tones.____________________________Conclusion: Now we conclude episode number 110 “Pulse Ox in Dark-skinned People.” Today we learned that pulse oximeters are being adjusted to become more accurate in different shades of skin. We are working together to make medicine a better science for all. “Not everything that is faced can be changed, but nothing can be changed until it is faced,” said James Baldwin. This week we thank Hector Arreaza, Bahar Hamidi, Arianna Crediford, Valeri Civelli, and Ariana Lundquist. Audio by Adrianne Silva.Even without trying, every night, you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!  _____________________References:Gottlieb ER, Ziegler J, Morley K, Rush B, Celi LA. Assessment of Racial and Ethnic Differences in Oxygen Supplementation Among Patients in the Intensive Care Unit. JAMA Intern Med. Published online July 11, 2022. doi:10.1001/jamainternmed.2022.2587. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794196Howard, Jacqueline, Scientists are searching for solutions after studies show pulse oximeters don't work as well for people of color, CNN Health, Published on July 11, 2022. https://www.cnn.com/2022/07/11/health/pulse-oximeters-dark-skin-study/index.htmlRoyalty-free music used for this episode: Good Vibes Alt Mix by Videvo, downloaded on May 06, 2022 from https://www.videvo.net/royalty-free-music-track/good-vibes-alt-mix/1017292/ 

The JournalFeed podcast for the week of Sept 5-9, 2022. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Spoon Feed Patients with long COVID had a host of symptoms, poorer quality of life, and more anxiety and depression, but they did not have a specific cause identified for symptoms despite a comprehensive exam and battery of tests. Spoon Feed Occult hypoxemia occurred more often in Black than White patients.  In other words, if a patient's skin tone is darker, what appears to be an acceptable SpO2 (i.e. 92%) may actually be lower when measured with SaO2.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat coming to you from Children's Healthcare of Atlanta/Emory University School of Medicine and I'm Rahul Damania from Cleveland Clinic Children's Hospital and we are two Pediatric ICU physicians passionate about all things MED-ED in the PICU. PICU Doc on Call focuses on interesting PICU cases & management in the acute care pediatric setting so let's get into our episode: Welcome to our Episode an 18 -year old with sore throat, and unilateral L-sided neck pain for ~2 weeks. Here's the case presented by Rahul: An 18-year-old female presents to the ED with cough, fever, fatigue, sore throat, and unilateral L-sided neck pain for ~2 weeks. The patient also has been having non-specific chest pain, weight loss, and decreased appetite for ~ 1 month. Patient has no recent travel h/o, no h/o of vaping or illicit drug use, and there were no sick contacts at home. Vitals revealed an HR 105, BP 116/66, Temp 38.3, and respiratory rate 35, She was 65 Kg and SPO2 on 2L NC was 100%. Physical exam was negative except (L) neck tender to palpation. There was no goiter, lymphadenopathy or hepatosplenomegaly. An initial chest x-ray was significant for possible multi-lobar pneumonia versus metastases. A Chest CT revealed multifocal septic emboli in the lungs. Echo did not show any gross vegetation. She has no rash or any trauma to the neck or difficulty swallowing, no oral ulcers, joint pain, or diarrhea. She had no recent dental work or drinking of unpasteurized milk or eating raw fish or meat. She was admitted to the PICU as she had hypotension requiring fluid boluses, and lab works significant for hyponatremia, rhabdomyolysis, worsening AKI, elevated ferritin, and elevated D-dimer. Her serum uric acid was 9.9, LDH = 230 (normal) ,ESR 78 (normal = 20 or less). Her serum lactate and serum troponin and BNP were all normal. Pertinently, US neck revealed an occlusive thrombus in the (L) IJ vein (done so as to avoid contrast in face of AKI), and blood cultures sent. To summarize key elements from this case, this 18-year-old female presents with fever +cough+sore throat Fatigue + Weight loss (L) neck pain Hypotension with abnormal labs including a concerning WBC with (L) shift, anemia, AKI, elevated uric acid, and ESR Chest CT with possible pulmonary emboli US showing occlusion. All of which brings up a concern for possible malignancy or pulmonary emboli from a septic focus in the neck and a possible diagnosis of Lemierre syndrome This episode will be organized… Definition Diagnosis (physical, laboratory) Management Rahul: What is the definition of Lemierre's syndrome? Lemierre's syndrome, also known as post-anginal septicemia or necrobacillosis, is characterized by bacteremia, internal jugular vein thrombophlebitis, and metastatic septic emboli secondary to acute pharyngeal infections. All of which are seen in our above case presentation. Previously called as the forgotten disease as its incidence was decreasing due to the increasing use of antibiotics especially penicillin for URI. However, recently there is an increase in Lemierre's disease cases with decreased use of antibiotics due to antibiotic stewardship. The recent increase in Lemierre disease due to decreased antibiotic use has not been proven and remain controversial. Rahul what are some of the causative organisms of Lemierre syndrome? The most common causative agent of Lemierre's syndrome is Fusobacterium necrophorum, followed by Fusobacterium nucleatum and anaerobic bacteria such as streptococci, staphylococci, and Klebsiella pneumoniae. Rahul: Can you tell our listeners about the pathophysiology of Lemierre's syndrome? Lemierre syndrome can occur in health adults (more common in males in the age group of 14-24 years). Risk factors include immunocompromised patients, organisms, and environmental conditions. Lipopolysaccharides in F. necrophorum have endotoxic...

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat My name is Rahul Damania, a current 3rd-year pediatric critical care fellow and we are coming to you from Children's Healthcare of Atlanta Emory University School of Medicine Today's episode is dedicated to the transition between NICU & PICU. We will focus on the ventilation of the ex-premature infant who graduated from NICU care and transitioned to the PICU. I will turn it over to Rahul to start with our patient case. Case: A 4-month-old ex-27 week baby boy is transferred to our PICU after an echo at an outside hospital showed elevated pulmonary pressures. The infant was born via a stat C-section due to maternal complications during pregnancy. His birth weight was 560 g. The patient was intubated shortly after delivery and had a protracted course in the NICU which included a sepsis rule out, increased ventilator settings, and a few weeks on inhaled nitric oxide (iNO). The intubation course was complicated pulmonary hemorrhage on day 1 after intubation. After such an extensive NICU course, thankfully, the infant survived & was sent home on 1/2 LPM NC, diuretics, albuterol, inhaled corticosteroids, Synthroid, multivitamin with iron as well as Vitamin D. The patient was able to tolerate breast milk via NG tube and had a home apnea monitor with pulse oximetry. After about a week's stay at home, the mother noted that the patient's SPO2 was in the low 80s. The mother took the patient to the local hospital, where the patient was started on HFNC which improved his saturations. An echo done at the OSH showed elevated RV pressures (higher than the prior echo). The patient was subsequently transferred to our hospital for further management. At our hospital, the patient presented hypoxemic, tachycardic, and tachypneic. On physical exam: Baby appeared well developed, had a systolic murmur heard throughout the precordium, and there was increased WOB with significant intercostal retraction. There was no hepatosplenomegaly. Due to worsening respiratory distress, and increasing FIO2 requirement despite maximum RAM cannula, the patient was intubated and placed on conventional MV. A blood gas prior to intubation revealed a pH of 7.1/PCO2 of 100. An arterial line and a central venous line were also placed for better access and monitoring. Initial vent settings post intubation PRVC ventilation: TV 32cc, (25/10), 0.7 time, rate 0 (patient sedated/paralyzed). To summarize, What are some of the features in H&P that are concerning for you in this case: Ex-27 week prematurity with a birth weight of 560 gms Prolonged MV in the NICU Home O2 requirement Abnormal echo showing high pulmonary pressures hypercarbia despite the use of RAM cannula As mentioned, our patient was intubated, can you tell us pertinent diagnostics which were obtained? CXR revealed: Hazy airspace opacification in the right upper lung concerning developing pneumonia. Streaky airspace opacity in the left lung base medially may represent atelectasis. I do want to highlight that the intubation of an ex-premie especially with elevated RV pressures is a high-risk scenario, it is best managed by a provider with experience, in a very controlled setting with optimal team dynamics. Adequate preparation to optimize the patient prior to the intubation as well as the knowledge to manage the post intubation cardiopulmonary interactions are essential. I would highly advise you to re-visit our previous podcast on intubation of the high-risk PICU patient by Dr. Heather Viamonte. Like many Peds ICU conditions, the management of the EX-NICU graduate in the PICU is a multidisciplinary team sport. Our patient likely has the diagnosis of Bronchopulmonary Dysplasia or BPD, Pradip, can you comment on the evolving definition of this diagnosis? Let me first define BPD — Clinically, BPD is defined by a requirement of oxygen supplementation either at...