Podcasts about spo2

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

En este episodio de Bioresp hablaremos de la importancia de la curva de Fotopletismografia de spo2 , su interpretación y el valor de esta en el monitoreo hemodinámico básico , bienvenidos !

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

[Ep44] You're listening to Episode 17 of 30 ... for National Podcast Post Month! Aka - NaPodPoMo.This episode's featured topic is tips for using the 'ol SpO2 sensor. This is most applicable for anyone new to healthcare!About National Podcast Post MonthThe event gives everyone in the podcast community a chance to challenge their skills by posting an episode every day for the entire month of November! So that's what High-Fidelity Conversations will be doing. In order to keep my sanity, the episodes will be shorter (a few minutes), and the topics will be all over the place (still healthcare-themed). Each of the episodes associated with this event will be marked with "NaPodPoMo" somewhere in the title, so you know when all this chaos starts and ends. I hope you enjoy this adventure for November! We'll be back to our normal, monthly pattern for December.Do you have ideas for future guests or topics on this podcast? Maybe you have some thoughts on how to improve the show? If that sounds like you, take a moment to answer the 3 questions on our anonymous feedback survey!Podcast artwork was made with the awesome resources from CanvaMusic and Sound FX for the show obtained from Pixabay and Pond5Email the show at hfconversations@gmail.comClosed Captioning Resources:Podnews article (for Apple/Android phones and Google Chrome browsers)Microsoft Windows article (live captions for Windows users)Apple article (live captions for Mac users)Disclaimer:The thoughts and opinions expressed in this podcast belong solely to those saying them, and do NOT represent the positions, strategies or opinions of Trinity Health, or Mount Carmel Health System. This podcast is intended for educational and entertainment purposes only. Nothing in this podcast establishes a patient care relationship with you, the listener. The host(s) and guests of this show are NOT your healthcare provider and if you need medical attention, seek an appropriate and qualified professional. 

Acil tıbbın geniş kapsamı, güncel literatürü takip etmeyi sağlık profesyonelleri için bir zorluk oluşturmaktadır. Acil tıbbın karşılaştığı çok çeşitli hastalık ve durumlar, sürekli olarak değişen tedavi yaklaşımlarını takip etmeyi gerektirir. Bu gerekliliği göz önünde bulunduran Acil Tıp Farmakoterapi Araştırma Ağı (EMPHARM-NET), her yıl önemli farmakoterapi ile ilgili literatürü gözden geçirmekte ve derlemektedir. Bu yazıda, EMPHARM-NET'in 2023 yılı boyunca acil tıpta farmakoterapi alanında yayımlanan en dikkat çekici çalışmaları derledikleri yazısını özetlemekteyiz.1 İleri okuma için makalenin tam metnine buradan ulaşabilirsiniz. 2023 yılı, acil serviste farmakoterapinin önemli gelişmeler gösterdiği bir yıl olmuştur. Özellikle hızlı ardışık entübasyon, kardiyak arrest yönetimi ve travma sonrası majör kanamaların tedavisi gibi kritik konularda güncellemeler yapılmıştır. Ayrıca, iskemik inme tedavisinde kullanılan zaman ve tedavi modaliteleri, toplumsal kökenli pnömonide steroid kullanımı ve hedeflenen kan ürünlerinin uygulanması gibi çeşitli konularda da önemli gelişmeler kaydedilmiştir. Bu yazı, acil serviste farmakoterapi alanında 2023 yılında yayımlanan en önemli 13 makaleyi, 6 rehberi ve 5 meta-analizi kapsamaktadır. Makaleler, modifiye bir Delphi yöntemi kullanılarak seçilmiş ve ilgili dergilerde yayımlanan makaleler GRADE sistemi aracılığıyla bağımsız olarak değerlendirilmiştir. GRADE 1A ve 1B olarak kabul edilen yayınlar, incelemeye dahil edilmek üzere grup tarafından yeniden incelenmiştir. Yazımız iki bölümden oluşmaktadır. Toksikoloji, resüsitasyon ve nöroloji alanlarındaki 2023 yılı gelişmelerine odaklanan Dr. Faruk Danış tarafından yazılan bölüme buradan ulaşabilirsiniz. Bu ikinci bölümde ise pulmoner, travma, enfeksiyon hastalıkları ve diğer çeşitli konular üzerine odaklanacağız. 4. Pulmoner 4.1. Society of Critical Care Medicine (SCCM) Kritik Hastalarda Hızlı Sıralı Entübasyon (RSI) için Klinik Uygulama Kılavuzu2 SCCM, kritik hastalardaki yetişkinler için hızlı sıralı entübasyon (RSI) hakkında ilk kılavuzlarını yayınladı. Yazarlar, entübasyondan önce oksijen toleransını artırmak için belirli hastalarda ilaç destekli preoksijenasyon kullanımını dikkatli bir şekilde önermektedirler (koşullu öneri, çok düşük kanıt kalitesi). Ketaminin entübasyon öncesi sedasyon için kullanımı, entübasyon öncesi SpO2'yi iyileştirmiştir, ancak bu uygulamanın riskleri net değildir. Entübasyon sırasında hipotansiyonun optimal tedavisi belirsizliğini korumaktadır; vasopressörler ile sıvı resüsitasyonu arasında yeterli kanıt bulunmadığından spesifik bir öneri yapılamamaktadır. Nöromüsküler blokaj ajanları (NMBA) kullanıldığında, sedatif-hipnotiklerin de kullanılması önerilmektedir (en iyi uygulama bildirisi, derecelendirilmemiş kanıt kalitesi). Etomidat, diğer indüksiyon ajanlarına (ketamin, midazolam, propofol) göre mortaliteyi iyileştirmemiştir. Ancak, etomidatın entübasyon sırasında daha avantajlı hemodinamik etkiler sunabileceği belirtilmiştir (koşullu öneri, orta kanıt kalitesi). Etomidat kullanıldığında, adrenal yetmezlik endişesine rağmen kortikosteroidlerin eşzamanlı verilmesi önerilmemektedir (koşullu öneri, düşük kanıt kalitesi). Rokuronyumun RSI için varsayılan NMBA olarak kullanılması için yeterli kanıt bulunmamaktadır; suksinilkolin kontrendikasyonları yoksa, suksinilkolin veya rokuronyum kullanılabilir (koşullu öneri, düşük kanıt kalitesi). NMBA'lar, entübasyon koşullarını optimize etmek için sedatif-hipnotik ajanlar kullanıldığında tercih edilmelidir (güçlü öneri, düşük kanıt kalitesi). Bu kılavuzlar, RSI farmakoterapisinde kanıt eksikliklerine dikkat çekmekte ve gelecekteki araştırmalar için öneriler sunmaktadır. 4.2. Hızlı Sıralı Entübasyon İçin Sedatif Dozu ve Entübasyon Sonrası Hipotansiyon: Bir İlişki Var mı? [Grade 1B]3 Hipotansiyon, RSI uygulamasının bir komplikasyonu olarak kalmaya devam etmekte ve bu durum hastane içi mortalite artışı ile ilişkili olabilmektedir.

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!

Would you happen to know? Irrespective of the country you live in or the ethnicity or religion our body temperature is constant at 36.1 degrees C, Blood pressure 120/80, Heart rate 60-100, Respiratory rate 12-20/Minute, SPO2 95-100%. At the same time, we differ so much!!! How united humanity is not good for politics and politicians and how they divide citizens basis hate, religion, common danger. How this leads to the decline of democracy and the rise of authoritarian regime, example Bangladesh?

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

Dr. Latif Emrah Yanmaz author of "Two different smartwatches exhibit high accuracy in evaluating heart rate and peripheral oxygen saturation in cats when compared with the electrocardiography and transmittance pulse oximetry in: Journal of the American Veterinary Medical Association Volume 261 Issue 2 (2023) (avma.org)," discusses how two different smartwatches exhibited high accuracy in evaluating heart rate and SpO2 in cats. Hosted by Associate Editor, Dr. Sarah Wright, and Editor-in-Chief, Dr. Lisa Fortier.INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA OR AJVR?JAVMA: https://avma.org/JAVMAAuthorsAJVR: https://avma.org/AJVRAuthorsFOLLOW US:JAVMA:Facebook: Journal of the American Veterinary Medical Association - JAVMA | FacebookInstagram: JAVMA (@avma_javma) • Instagram photos and videosTwitter: JAVMA (@AVMAJAVMA) / Twitter AJVR: Facebook: American Journal of Veterinary Research - AJVR | FacebookInstagram: AJVR (@ajvroa) • Instagram photos and videosTwitter: AJVR (@AJVROA) / TwitterJAVMA and AJVR LinkedIn: https://linkedin.com/company/avma-journals#VeterinaryVertexPodcast #JAVMA #AJVRINTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ? JAVMA ® : https://avma.org/JAVMAAuthors AJVR ® : https://avma.org/AJVRAuthorsFOLLOW US:JAVMA ® : Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook Instagram: JAVMA (@avma_javma) • Instagram photos and videos Twitter: JAVMA (@AVMAJAVMA) / Twitter AJVR ® : Facebook: American Journal of Veterinary Research - AJVR | Facebook Instagram: AJVR (@ajvroa) • Instagram photos and videos Twitter: AJVR (@AJVROA) / Twitter JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

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

The administration of a high fraction of oxygen following the return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Join us at the next PCRF Journal Club as we review a study that evaluated whether targeting a lower oxygen saturation in the early phase of post-resuscitation care for out-of-hospital cardiac arrest improves survival at hospital discharge.Article: Bernard SA, Bray JE, Smith K, Stephenson M, Finn J, Grantham H, Hein C, Masters S, Stub D, Perkins GD, Dodge N, Martin C, Hopkins S, Cameron P; EXACT Investigators. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Oct 26. doi: 10.1001/jama.2022.17701. Epub ahead of print. PMID: 36286192. Link: https://pubmed.ncbi.nlm.nih.gov/36286192/To view the video, visit: https://youtu.be/vXfqIMtcOFE

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.

Episode 105: Antidotes to toxidromes. Some poisonings share common signs and symptoms and may be treated with antidotes without laboratory confirmation of the offending agent. Dr. Francis discussed with Dr. Arreaza some of those toxidromes and how to treat them. Written by Aida Francis, MD. Participation by Hector Arreaza, MD. Definitions: • Antidotes are substances given as a remedy that inhibit the effects of another drug of abuse or poison. Most are not 100% effective and fatality is still possible after administration. • Toxidrome is a constellation of signs and symptoms caused by an overdose or exposure to chemicals or drugs that interact with neuroreceptors. Toxidrome is the combination of the word “toxin” and “syndrome”. Management strategies of toxidromes are determined by the signs and symptoms even when the causative agent has not been identified. A little bit of Background: The World Health Organization reported that 13% of deaths caused by poisonings are children and young adults. Intentional poisoning attempts are more frequent among adolescent women than men. It is difficult to evaluate poisoned patients because they are too altered to provide history and there is often not enough time to perform a physical exam or obtain serum studies prior to life-saving interventions. To diagnose a toxidrome clinically, you need three elements: pupil size, temperature, and bowel sounds. For example: Pinpoint pupils with hyperactive bowel sounds point to cholinergic toxidrome, and dilated pupils with high temperature, and hypoactive bowel sounds point to anticholinergic (see details below). Pinpoint pupils -> Bowel sounds -> Hyperactive: CHOLINERGIC -> Hypoactive: OPIOIDS Normal or dilated pupils -> Temperature -> High -> Bowel sounds -> Hyperactive: SYMPATHOMIMETIC -> Hypoactive: ANTICHOLINERGIC -> Normal or Low -> Bowel sounds -> Hyperactive: HALLOCUNOGENIC -> Hypoactive: SEDATIVE-HYPNOTICS Anticholinergic Toxidrome and the Physostigmine antidote: • Anticholinergics inhibit the binding of acetylcholine to the muscarinic receptors in the central nervous system and the parasympathetic nervous system. Examples of anticholinergics include atropine and tiotropium. Other substances that may cause anticholinergic toxidrome include antihistamines (especially first-generation: diphenhydramine), antipsychotics (quetiapine), antidepressants (TCAs, paroxetine), and antiparkinsonian drugs (benztropine). Symptoms of toxicity include tachycardia, non-reactive mydriasis, anhidrosis, dry mucous membranes, skin flushing, decreased bowel sounds, and urinary retention. Neurological symptoms include delirium, confusion, anxiety, agitation, mumbling, visual hallucination, and strange behavior. Neurological symptoms last longer because of the anticholinergic lipophilic properties which cause them to distribute into fatty organs and tissues like the brain. “Mad as a hatter, red as a beet, blind as a bat, hot as a hare, dry as a bone” [Spanish: loco como una cabra, rojo como un tomate, ciego como un topo, seco como una piedra, caliente como el infierno] • The antidote for anticholinergic toxidrome is physostigmine. It is an acetylcholinesterase inhibitor and prevents the metabolism of acetylcholine. This increases the level of acetylcholine in both the central nervous system and peripheral nervous system. Physostigmine can cause seizures and arrhythmia, so close monitoring in the hospital is required during treatment. Cholinergic toxidrome and its antidotes atropine and pralidoxime: Acetylcholine is part of the parasympathetic nervous system and cholinergic substances can induce a parasympathetic response. Some of these substances include pesticides, organophosphates, carbamate, and nerve gas. Chlorpyrifos had been used to control insects in homes and fields since 1965. It has been used in our crops in Bakersfield, and the most recent mass exposure was in May 2017. it was banned on food crops in the US in August 2021. It has been banned for residential use for a longer period. Repeated exposure to chlorpyrifos causes autoimmune disorders and developmental delays in children and fetuses. The symptoms of cholinergic toxidrome can be summarized with the SLUDGE/ “triple” BBB acronym. This includes salivation, lacrimation, urination, defecation, gastrointestinal cramping, emesis, bradycardia, bronchorrhea, and bronchospasm. There can also be muscle fasciculations and paralysis. • The antidote is Atropine. Pralidoxime is used for organophosphates only because it cleaves the organophosphate-acetylcholinesterase complex to release the enzyme to degrade acetylcholine. Pralidoxime should be used in combination with atropine, not as monotherapy. It requires hospital admission, and a note for organophosphate, remember that the patient needs external decontamination (shower). Let's go to part 2 of our discussion, environmental exposure. Carbon Monoxide Toxidrome and the antidote oxygen: Carbon monoxide intoxication is usually due to smoke inhalation injury. Carbon monoxide is a silent gas produced by carbon-containing fuel or charcoal. Carboxyhemoglobin (COHb) forms in red blood cells when hemoglobin combines with carbon monoxide, reducing the binding and availability of oxygen at the tissue level. It's like CO falls in love with hemoglobin and hemoglobin cheats on Oxygen by binding to CO instead, and neglects oxygen delivery to tissues. Carbon monoxide also causes direct cellular toxicity. The symptoms and signs of poisoning include headache, altered mental status, nausea, vomiting, visual disturbance, Cherry-red lips, coma, and seizure. You can also see lactic acidosis and pulmonary edema. Neurological symptoms can be chronic, so it's important to follow up. The blood COHb level must be used to confirm the diagnosis because standard pulse oximetry (SpO2) and arterial partial oxygen pressure (PaO2) cannot differentiate COHb from normal oxygenated hemoglobin. You must obtain a serum COHb level. • The antidote is 100% oxygen or hyperbaric oxygen therapy and close follow-up. Consider intubating if there is edema of the airways due to inhalation injury. Cyanide Toxidrome which include sodium nitrite, sodium thiosulfate, and hydroxocobalamin In combination with Carbon Monoxide poisoning Cyanide poisoning can simultaneously be caused by inhalation of smoke or colorless hydrogen cyanide or ingestion of cyanide salts or prolonged use of sodium nitroprusside (ICU for hypertensive emergency). Symptoms are very similar to carbon monoxide poisoning. There may be long-term neurologic deficits and Parkinsonism. Diagnosis is clinical and waiting for serum cyanide levels can cause treatment delay. However, serum lactate levels over 10 mmol/L suggest cyanide poisoning. • Since cyanide poisoning resembles carbon monoxide poisoning and both toxidromes typically present simultaneously in the pathognomonic fire victim, treat simultaneously with sodium nitrite, sodium thiosulfate, and hydroxocobalamin as well as oxygen as mentioned with carbon monoxide poisoning. Hypnotic and sedative substances (antidote: flumazenil) Examples of hypnotic or sedative substances are alcohol, benzodiazepines, or zolpidem. Signs and symptoms of toxicity include slurred speech, ataxia, incoordination, disorientation, stupor, and coma with mild and rare hypoventilation and bradycardia. • The antidote is flumazenil which is a competitive antagonist at the benzodiazepine receptor. After treatment monitor patients for seizures in case of TCA poisoning, arrhythmia, or epilepsy. Opioid toxidrome (antidote: naloxone) Examples of opioid intoxication in children would be heroine in adolescents or accidental ingestion of pain medication in young children. Signs and symptoms are similar to the sedative toxidrome except for the pathognomonic finding of miosis or “pinpoint pupils” on physical exam. There will also be respiratory depression, hyporeflexia, bradycardia, muscle rigidity, and absent bowel sounds or constipation. Hypoventilation is severe and can cause death. • The antidote is naloxone which is a synthetic opioid receptor antagonist that can diagnose and treat opioid poisoning. It is indicated if the respiratory rate is less than 12. It has a short half-life and is repeatedly administered every 3-5 minutes until the respiratory drive is restored in order to avoid rebound respiratory depression and intubation. It has a rapid onset so the patient must be observed for 24 hours for opioid withdrawal symptoms. Summary: It is important to be able to recognize a toxidrome and antidote early. Once the antidote is administered, you should observe the patient 24 hours for symptoms of rebound toxicity or withdrawal. Consider repeat administration of the antidote if rebound symptoms occur and treat withdrawal symptoms as needed. Don't forget to consider multidrug poisoning if symptoms are non-specific. Thank you for having me on your podcast to review this topic. ____________________________ Conclusion: Now we conclude our episode number 108, “Antidotes to Toxidromes.” Remember you can start treatment of a patient with typical signs and symptoms of specific toxidromes, especially in patients who are unstable. We hope you enjoyed this episode. We thank Hector Arreaza, Aida Francis, and Arianna Lundquist. Audio Edition by Adrianne Silva. Even without trying 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: 1) Jaelkoury, CC BY-SA 3.0 , via Wikimedia Commons. 2) Hon KL, Hui WF, Leung AK. Antidotes for childhood toxidromes. Drugs Context. 2021;10:2020 11-4. Published 2021 Jun 2. doi:10.7573/dic.2020-11-4, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177957/. 3) Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.

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...

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. I am Pradip Kamat. I am Rahul Damania, a current 3rd year pediatric critical care fellow. I am Kate Phelps- a second year pediatric critical care medicine. We come to you from Children's Healthcare of Atlanta Emory University School of Medicine. We are delighted to be joined by guest expert Dr Stephanie Jernigan Assistant Professor of Pediatric-Pediatric nephrology, Medical Director of the Pediatric Dialysis Program at Children's Healthcare of Atlanta. She is the Chief of Medicine and Campus Medical Director at Children's Healthcare of Atlanta, Egleston Campus. Her research interests include chronic kidney disease, and dialysis. She is on twitter @stephaniejern13 I will turn it over to Rahul to start with our patient case... A 3 year old previously healthy male presents with periorbital edema. Patient was initially seen by a pediatrician who prescribed anti-histamines for allergy. After no improvement in the eye swelling after a two week anti-histamine course, the patient was given a short course of steroids, which also did not improve his periorbital edema. The patient progressed to having abdominal distention and was prescribed miralax for constipation. Grandparents subsequently noticed worsening edema in his face, eyes, and feet. The patient subsequently had low urine output, low appetite and lack of energy patient was subsequently brought to an ED and labs were obtained. Grandparents denied any illness prior to presentation, fever, congestion, sore throat, cough, nausea, vomiting, gross hematuria, or diarrhea. In ED patient was noted to be hypertensive (Average systolic 135-highest 159mm HG), tachycardic (HR 130s-140s), breathing ~20-30 times per minute on RA with SpO2 92%. Admission weight was recorded at 16.5Kg. Physical exam showed periorbital edema, edema of ankles, there was mild abdominal distention (no tenderness and no hepatosplenomegaly), heart and lung exams were normal. There were no rashes on extremities. Labs at the time of transfer to the PICU: WBC 10 (62% neutrophils, 26% lymphocytes) Hgb 7.2, Hct 21, Platelets 276. BMP: Na 142/K 8.4/Cl 102/HCO3 19/BUN 173/creatinine 5.8. Serum phosphorus was 10.5, Total Ca 6.4 (ionized Ca= 3.4), Mag 2.0, albumin 2.6, AST/ALT were normal. An urine analysis showed: 1015, ph 7.5, urine protein 300 and rest negative. Chest radiograph revealed small bilateral pleural effusions. After initial stabilization of his hyperkalemia-patient was admitted to the PICU. PTH intact 295 (range 8.5-22pg/mL). Respiratory viral panel including for SARS-COV-2 was negative. C3 and C4 were normal. A nephrotic syndrome/FSGS genetic panel was sent. A renal US showed: bilateral echogenic kidneys and ascites (small volume). Pradip: Dr Phelps what are the salient features of the above case presented? Kate Phelps: This patient has a subacute illness characterized by edema, anemia, and proteinuria. His labs show that he has severe acute kidney injury with significantly elevated BUN and Creatinine, hyperkalemia, hyperphosphatemia, and hypocalemia. Rahul: Dr Jernigan welcome to PICU Doc on Call Podcast. Thanks Kate, Rahul and Pradip for inviting me to your podcast. This is a such a great way to provide education and it is my pleasure to come today to speak about one of my favorite topics, pediatric dialysis. I have no financial disclosures or conflicts of interest and am ready to get started. Rahul: Dr Jernigan as you get that call from the ED and then subsequently from the PCCM docs, as a nephrologists whats going on in your mind ? When I get the call from the outside hospital my first job is to make sure the patient is safe and stable for transfer to a tertiary care center. This includes concern about airway, breathing and level of alertness. From a renal standpoint, I am worried about elevated blood pressure, electrolyte abnormalities, in this case primarily the hyperkalemia, and fluid...

It's hard to believe it's been more than 10 years ago since FitBit pioneered the fitness wearables market. As the technology has advanced, the lines between what is a consumer wellness device and what is a medical-grade wearable have begun to blur, with a number of companies sitting at the intersection of consumer wellness and medical-grade wearables. One such company is Movano. John Mastrototaro, CEO at Movano, joins the latest episode of Let's Talk Medtech to discuss that intersection of consumer and medical-grade wearables, and why he joined Movano. The Pleasanton, CA-based company is creating consumer products designed to deliver medical-grade data. Founded in 2018, the company recently announced that its first product will be a fitness ring designed specifically for women that measures heart rate, heart rate variability, sleep, respiration, temperature, blood oxygen, steps, and calories. Movano is currently conducting clinical trials with its radio frequency-enabled technology and developing algorithms to add medical data, including non-invasive glucose monitoring and cuffless blood pressure, to its core product in the future. The company plans to execute accuracy studies to pursue FDA clearances on its vital signs monitoring capabilities including heart rate, SpO2, and respiration rate. The Movano Ring is expected to be available through a beta release in the second half of 2022.

This week's EYE ON NPI is getting fit and staying healthy, with ams OSRAM's AS7038RB Biosensor Solution with Embedded ECG Channel (https://www.digikey.com/en/product-highlight/a/ams/as7038rb-biosensor-solution). This all-in-one biological sensing and health sensor combines an optical PPG (https://en.wikipedia.org/wiki/Photoplethysmogram) pulse oximetry sensor (https://en.wikipedia.org/wiki/Pulse_oximetry) with electrical ECG front end (https://en.wikipedia.org/wiki/Electrocardiography) as well as skin temperature reading with a low cost NTC thermistor, and conductivity - a.k.a GSR - so you can get a lot of heart and blood health information in one convenient package. This is very nice and cost-effective as usually there's one sensor to manage the optical blood-gas sensing and one to do the electrical heart activity sensing and maybe other sensors for skin temperature and conductivity. However, for telemedicine or self-monitoring, it might be beneficial to see the electrical activity waveforms as well as the SpO2 measurements since they can signify different health issues. Even though we are highlighting the AS7038RB (https://www.digikey.com/short/mjq0vjrn) we also want to point out the AS7030B (https://www.digikey.com/short/z308w2wr) which is a 'modularized' version of the 'RB but with a plastic body and three emitter LEDs for an even simpler installation. We're particularly fond of any PPG sensor that has both the emitter and detector diodes built into the package, it makes sourcing and tuning a lot easier! With the proliferation of smart watches and wristbands, many are now including optical sensors on the bottom - and this sensor is a great way to add that capability to your design without a ton of extra components or work. Pulse oximetry, especially, has become an essential home measurement for folks who have COPD or have tested positive for COVID as low blood oxygen and high pulse rate indicate cardiovascular damage that sometimes the patient doesn't even notice (https://en.wikipedia.org/wiki/Silent_hypoxia). A full time wearable PPG using the AS703x would be great for detecting hypoxia even if the patient forgets to check their pulseox. This sensor comes jam packed with many built in filters and configuration registers to tweak the LED current, optical sensor gains, low pass, high pass, offset and drift reduction. This is usually the hardest part of getting PPG/ECG data in a pure-digital system: filters and offsets can be easy to implement in analog-land but annoying for a microcontroller to continuously calculate while also trying to stay in a low power mode. Instead, that work is done so that clean data can be read from I2C directly when ready. There's also a Feather-friendly eval board available for purchase (https://ams.com/as703x-eval-kit), with a built in Particle Argon Feather board for fast IoT prototyping using the default ams Windows application. The app lets you tweak and set various values and gives some good starting points, especially for customers with different skin tones! Sounds great, right? If you wanna pick up the ams OSRAM AS7038RB Biosensor Solution with Embedded ECG Channel (https://www.digikey.com/short/mjq0vjrn) It's in stock right now at Digi-Key, for immediate shipment! Order today and you can be PPG-EKG-GCR'ing to your heart's content (ha!) by tomorrow afternoon.

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 2nd-year pediatric critical care fellow. We come to you from Children's Healthcare of Atlanta-Emory University School of Medicine. Today's episode is dedicated to pediatric post-cardiac arrest care. We are going to split this topic into two episodes, part one of pediatric post-cardiac arrest syndrome will address the epidemiology, causes, and pathophysiology. I will turn it over to Rahul to start with our patient case... 11 yo previously healthy M who is admitted to the PICU after cardiac arrest. The patient was noted to be found unresponsive and submerged in a neighborhood pool. He was pulled out by bystanders and CPR was started for 5 minutes with two rounds of epinephrine prior to achieving ROSC. During transport to the OSH, the patient developed hypotension requiring a continuous epinephrine infusion. His initial blood gas was notable for a mixed respiratory and metabolic acidosis: 7.0/60/-20 His initial serum lactate was 6.8 mmol/L. He presents to the PICU with a temperature of 36.6, HR 130s, MAPs 50s on Epinephrine infusion at 0.03mcg/kg/min He is mechanically ventilated with notable settings PEEP of 10, FiO2 65%. The patient is taken to head CT which shows diffuse cerebral edema and diffusely diminished grey-white differentiation most pronounced in the basal ganglia. Great Rahul, can you please comment on his physical exam & PMH? Important physical exam findings include an unresponsive intubated patient with a cervical collar and bilateral non-reactive pupils at 4mm. The patient received mechanical ventilation with coarse breath sounds. A heart exam revealed tachycardia with no murmur or gallop. The patient does not respond to stimuli, intermittent jerking movements of arms and legs were observed. There was no evidence of rash or trauma. No past medical history of seizures or any heart disease. No home medications or toxic ingestions are suspected. So now he is transferred to the ICU, what did we do? An arterial line, central venous line, urinary catheter, esophageal temperature probe was placed. The patient was ventilated using a TV of 6cc/kg and a PEEP of 10 (FIO2 ~65%) to keep SPO2 >94%. The patient initially had runs of ventricular tachycardia for which lidocaine was used. Although the initial EKG showed mild QTc prolongation, it subsequently normalized and was considered to be due to his cardiac arrest and resuscitation. An echocardiogram revealed normal biventricular systolic function (on epinephrine) and also showed normal origins of the coronary arteries. Comprehensive Arrhythmia Panel did not identify a specific genetic cause for the patient's sudden cardiac arrest. The patient was placed on continuous EEG, which demonstrated severe diffuse encephalopathy with myoclonic status likely from anoxic brain injury Patient was also started on Levetiracetam and valproic acid. Initial portable CT scan done on day # of admission showed diffuse cerebral edema and diffusely diminished gray-white differentiation (most pronounced in the basal ganglia). MRI was deferred due to patient instability. The case we talked about highlights a patient who had a trigger that then resulted in cardiac arrest is common is one of the common reasons for admission to the PICU at Children's hospitals whether from submersion injury, trauma, ingestion, cardiac arrhythmia, sepsis, etc. Can we start by defining post-cardiac arrest syndrome? Successful resuscitation from cardiac arrest results in a post-cardiac arrest syndrome, which can evolve in the days to weeks after the return of spontaneous circulation. The components of post-cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Prior to 2008, the AHA pediatric advanced life support (PALS) guidelines...

ABOUT THE EPISODE   It got famous for tracking sleep. Now it's aiding research on COVID-19, women's health, and so much more. This week we're talking with you again about the Oura ring. Mostly because we love it…but also because it's loaded with a lot of new features, making it an even more important tool you can use to improve your health and well-being.   Our guest is Caroline Kryder. She is the Science Communications Lead for Oura. In this episode, she explains many of the new features like SpO2 sensing, period prediction, workout tracking, and daytime heart rate tracking, and more to come later this year.   Join us for this episode and learn why when it comes to fitness trackers there really is one ring to rule them all. What We Discuss with Caroline: 00:00 Intro 05:43 What is the Oura Ring? 08:18 Period prediction and women's health tracking 12:21 What's a good sleep score? 13:51 A different approach to HRV (Heart Rate Variability) 17:31 Why Oura is helpful for athletes 19:21 Know you're getting sick before you have symptoms 21:00 What your readiness score means 22:46 Hack your way to better sleep 23:41 Your ring can tell when you're pregnant 29:31 Why Oura now has a membership 31:06 Hidden features in the Oura app Like this show? Please leave us a review here – even one sentence helps! Post a screenshot of you listening on Instagram & tag us so we can thank you personally! Episode Resources: Guest Website Get your Free One Year Supply of Vitamin D + 5 Travel Packs from Athletic Greens! Connect with The Fit Mess Podcast on: Website Twitter Instagram Facebook Facebook Group YouTube info@thefitmess.com

EMS A to Z: Neonatal Fever Show Notes: From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn   Definition of a neonate: An infant that is < 30 days old (from their expected gestational date), meaning that if they were born 21 days early, you subtract those days from their current age.   What are some of the reasons we may see these newborns?  Fever  Fussiness Respiratory symptoms  BRUE Vomiting / spitting up  Rash  Poor weight gain    When assessing neonates, are there any specific considerations?  Pediatric assessment triangle Appearance Circulation  Work of breathing  Vitals: HR, RR, SpO2, Temp Reference normal vitals for age (don't let that HR of 150 scare you)  Glucose    What if you have the following case:   10-day old female with 1 day of nasal congestion, just developed a fever of 101.4 per parent's thermometer, calls EMS, says she has a pediatrician appointment tomorrow but isn't sure if she should wait There are some other factors that may be good to note: Sick contacts Feeding Urine / stool output Birth history  While those (along with the patient's appearance, vitals, etc.) can be helpful, the bottom line is that any neonate with a fever needs transport to the ED    Why?   These patients are at a high risk of bacterial infection (10-20%) with associated increased morbidity  Neonates have poorly developed immune systems that cannot “fight” even simple infections like urinary tract infections as an older child or adult can They have increased risk that infections will become systemic – spread to the bloodstream or cerebrospinal fluid In the ED, these kids will get bloodwork, including cultures, lumbar punctures, antibiotics, and admitted to the hospital   There is some nuance to this with guidelines from the American Academy of Pediatrics, however from the pre-hospital standpoint the idea is simple: these patients need ED eval https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing    Can they go to their pediatrician's office?  These

With Gareth Myles and Ted SalmonJoin us on Mewe RSS Link: https://techaddicts.libsyn.com/rss iTunes | Google Podcasts | Stitcher | Tunein | Spotify  Amazon | Pocket Casts | Castbox | PodHubUK   Feedback and Contributions: People seem to be getting their £19.99 Stadia Premium Packs now. Get 3 months of Stadia Pro Another (yes, another) Google Pixel Watch rumor is here Andrew Manning in our MeWe Group: Will be interesting to see whether Google will make a go of it - even if it's just to drive forward other Android watch makers. There are plenty of good options already - 24 day Amazfit watches, superb cross device Garmin watches, Samsung watches... and for iOS users, the Apple Watch is still well ahead for integrated functionality and great customisation. Hardline on the hardware: New Samsung Smart Speaker Vodafone is testing wind powered mobile phone masts ASUS PureGo checks the cleanliness of your fruit and vegetables Elasto ergonomic mouse with light click free floating buttons Stanford's bird-legged bot always sticks the landing Qualcomm announces the Snapdragon G3x Gen 1 Gaming Platform with a Razer developer kit Sony Working on PlayStation DualShock-Like Controller for Smartphones, Alleged Patent Suggests Motorola Moto Edge X30's live image surfaces, display officially detailed Oppo reports record-breaking sales of Reno7, stock sold out in 15 minutes - Reno7 Pro vs Reno7 vs Reno7 SE nubia Red Magic 7 gets 3C certified with a whopping 165W charging support I'd rather have Qualcomm's always-on camera than not Flap your trap about an App: More than a third of world's population have never used internet, says UN 12 cameras collect 29 data points for every player 50 times per second in new Automated Offside Policing How to turn off those 'allow site notifications?' pop-ups in every browser Official Steam for Chromebooks support could launch this month Twitter expands safety policy, bans posting images of people without their consent You can now unlock your BMW with your Pixel 6, Pixel 6 Pro, or Galaxy S21 Evercade VS - Gareth's Unboxing and First Play Hark Back:  Nomenclature - Example of Yesteryear Bargain Basement: Best UK deals and tech on sale we have spotted Sony Xperia 10 III 5G in White - £299 delivered (UK Mainland)  HUAWEI FreeBuds 3  Motorola Moto G8 Power Lite 5000 mAH battery, Dual SIM, 4/64GB Royal Blue Smartphone - Was £149.99 now £90.99 Samsung Galaxy S20 FE 128GB  Samsung Galaxy S20 FE 256GB  Samsung Galaxy Buds2 - White - Bluetooth Earbuds, True Wireless, Noise Cancelling - WAs £139.99 now £99.99 (and £59.99 with cashback) Sony SRS-XB13  HUAWEI Watch GT 2 (46 mm) Smart Watch, 1.39 Inch AMOLED Display with 3D Glass Screen, 2 Weeks Battery Life, GPS, SpO2, 15 Sport Modes, 3D Glass Screen, Bluetooth Calling Smartwatch, Pebble Brown - Was: £119.00 Now: £84.00  Google Store UK    Main Show URL: http://www.techaddicts.uk | PodHubUK Contact:: gareth@techaddicts.uk | @techaddictsuk Gareth - @garethmyles | garethmyles.com Ted - tedsalmon.com | Ted's PayPal | Ted's Amazon | tedsalmon@post.com YouTube: Tech Addicts The PodHubUK PodcastsPodHubUK - Twitter - MeWe PSC Group - PSC Photos - PSC Classifieds - WhateverWorks - Camera Creations - TechAddictsUK - The TechBox - AAM - AAWP - Chewing Gum for the Ears - Projector Room - Coffee Time - Ted's Salmagundi - Steve's Rants'n'Raves - Ted's Amazon - Steve's Amazon - Buy Ted a Coffee

What happens when your patient has been given a cric or intubated but continues to decline… SpO2 continues to slowly drop despite taking control of the airway. You have placed your patient on a ventilator and slowly adjusted the PEEP up to 20cmH20… which quickly leads to hypotension. Do you go lower? Higher? Change volume or rate? You are out of bottled O2 and your oxygen concentrator does not seem to have much effect. The SpO2 continues dropping. Telemedicine is not available. You try positioning the patient by sitting them up. You try a couple other recruitment maneuvers you heard about. Nothing is working. What would Doug do? Prone the patient??? Your patient may be suffering from ARDS, Acute Respiratory Distress Syndrome caused by a number of etiologies such as pneumonia or other lung injury. Carefully turning your patinet on their stomach may improve oxygenation by recruiting alveoli formerly compressed and “drowned” as demonstrated in the picture below. Positioning your patient on their stomach in the prone position must be practiced with anyone who will be helping you. Put someone else in a similar position and have the team with which you plan to help move the real patient do a couple rehearsals. You don't want to flip them over only to lose your IVs, IOs and yank the airway out. Check out this Brazilian article which includes a proning checklist and some informative pictures and tips. You also don't get an automatic win by flipping them on their belly and calling it a day. You will have to be even more vigilant about any potential complications with a dedicated airway person as is is a little harder to recognize a patient in distress if you are not used to it. You will also have to do more nursing care on the delicate skin of the face and other surfaces not normally on the down side: Shoulders, hips, knees tops of the feet. Put yourself in this position for a few minutes on a litter and you can quickly tell where the major pressure points will be. All of these complications increased along with the benefits of the study. While no prolonged field care patient should be on a bare litter, there is even more reason to move them to a mattress or other more comfortable padded surface. For more content, visit www.prolongedfieldcare.org

EMS A to Z: The Dyspneic Patient Show Notes: From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn  Intro:  Over the last year, EMS systems have experienced a lot of change and challenges. When COVID-19 was first declared a pandemic, we saw an overall decrease in call volumes and ED visits across the nation, as well as changes in our prehospital guidelines and treatments. Working during this pandemic, without a doubt, changed how we think about patient encounters for respiratory complaint. The differential diagnosis for shortness of breath, cough, or fever became much smaller in our minds as everything became “suspected COVID.”  As we begin widespread vaccination with overall declining case numbers, I wanted to take a few minutes to remind us about some of the other things that can make a patient dyspneic, and some prehospital therapies that we may begin re-employing. Does anyone else miss nebs? I miss nebs. I know that the “data” suggests they aren't significantly more effective than inhalers, but patients love them, I love them, respiratory therapy may not love them, but that's ok.   Let's go through a few cases to remember our undifferentiated dyspnea differential diagnoses – say that 5 times fast!     Case 1)  Dispatch: 54M with dyspnea, leg swelling. You arrive to find an age-appropriate, obese appearing male, seated in his dining room, in mild-moderate respiratory distress. On your assessment, you note that he has increased work of breathing, diminished breath sounds with possibly some crackles, and lower extremity edema that goes all the way up under his gym shorts. He tells you none of his pants fit anymore, and he can only wear his house slippers... His vitals are: HR 97, RR 24, BP 170/90, SpO2 88% on RA; improves to 94% on 6L NC. His wife reports a history of hypertension.  What is your most likely diagnosis, and some others to consider?  CHF ACS / arrhythmia  Pneumonia COPD/asthma PE Pneumothorax The patient agrees to be transported to the hospital. In the back of the truck, however, he continues to be tachypneic and have increased work of breathing.   What other therapy / ies can we give him?  Nitro ASA CPAP Just a quick reminder, nitro works in CHF by dilating blood vessels – predominately veins – and reducing the amount of venous return to the heart, making it easier for the heart to pump out the blood that' it's getting. The heart is like a water balloon, if it's over-filled, some of the elasticity or squeeze is lost. Nitro also lowers BP, so it's not recommended in patients with hypotension. CPAP works in CHF in a few different ways: first, it stents open alveoli at the end of a breath, to allow better oxygen / CO2 exchange – thereby improving hypoxia and work of breathing. It also increases the intra-thoracic pressure, which decreases blood return to the heart – similar to the nitro that we just mentioned.   The patient is given sublingual nitro and placed on CPAP. His work of breathing, SpO2, and BP all improve en route to the ED, and he's ultimately admitted for his likely heart failure.     Case 2)   Dispatch: 25F with shortness of breath and wheezing. You arrive on scene to find an age-appropriate female in the living room of her apartment in moderate-severe respiratory distress. On your assessment you note tachypnea, increased work of breathing, and diffuse coarse wheezes throughout her lung fields. Her vitals are: HR 130, RR 30, BP 110/70, SpO2 92% on RA. She is speaking in 2–3-word phrases, and says she has asthma, had been doing well until today, when these symptoms developed pretty quickly. She tried her home inhalers without relief.   What is your most likely differential diagnosis, and some others to consider?  Asthma Anaphylaxis Viral respiratory illness Pneumonia PE Pneumothorax Arrhythmia  The patient requests transport to the hospital, and you appropriately start nebulized albuterol / ipratropium in the ambulance, while working on an IV for fluid bolus, solumedrol. In this severely distressed patient, you also prepare to administer magnesium.   En route, she starts to improve slightly – or so you thought – as her respiratory rate had slowed, and her ETCO2 went up from the 20 it was initially to almost 40 now. But you look more closely, and you see that her mental status is declining and she's becoming less responsive now.   What other things are in your toolbox for severe asthma exacerbations? Is there another possible diagnosis to consider?  Other items to consider:  Epi CPAP Could this be anaphylaxis?   You administer IM epi at 0.01mg/kg and place the patient on CPAP with in-line nebs ongoing. She starts to improve, and her mental status returns to normal. The ED is super impressed with your treatment and your aggressive interventions helped save the patient from an intubation!   Remember, in critical asthma patients, the goal is to dilate the bronchioles as much as possible – while albuterol / ipratropium are the most commonly used and when nebulized have direct access to the pulmonary tissues, other therapies like magnesium and epi can also provide some bronchodilation and help in critical patients. We often administer steroids in the prehospital setting / ED, but their effect can take a few hours to set in, so while important, they won't act as quickly as our other therapies.     Case 3)  Dispatch: 30M involved in MCC. You arrive on scene to find a motorcycle on it's side after hitting the side of a truck trying to beat a red light turning left. The driver of the truck is ambulating around, but the motorcyclist is sitting on the ground clutching the right side of his chest. Fortunately, he was wearing a helmet and full protective gear. On your assessment, you note an intact airway, bilateral upper extremity pulses, but severely diminished breath sounds on the right. He is speaking in short sentences and complains only of the chest pain. While you're doing your secondary survey, getting him out of the protective gear, checking c-spine, etc. He abruptly loses consciousness.   What is your most likely differential diagnosis, and some others to consider?  Pneumothorax Hemothorax Pulmonary contusion Cardiac contusion Hemorrhagic shock  The patient has weak pulses, agonal breathing. You quickly needle decompress his right chest with a rush of air. Gradually his pulses become less thready, and his breathing improves. You expertly toss in bilateral 18-gauge IVs and transport him to the trauma center, where he is ultimately treated for his right sided pneumothorax with a chest tube. He has a few rib fractures, bumps and bruises, but recovers well, thanks to your quick recognition and treatment of his tension pneumothorax!   Remember, tension pneumothoraxes are fatal unless treated! The increased intrathoracic pressure essentially prevents blood return to the heart and prevents it from pumping. What's the difference between a simple and tension pneumothorax?  Hypotension Tracheal deviation JVD Cardiac arrest