Podcasts about stridor

Take Home Points Anticipate anatomically challenging airways and consider early intubation prior to loss of airway anatomy. Skip the zones of the neck and focus on hard signs of vascular (Shock w/o another source, Pulsatile bleeding, Expanding hematoma, Audible bruit, Signs of stroke) or aerodigestive (Airway compromise, Bubbling wound, Extensive SubQ air, Stridor, Significant hemoptysis/hematemesis). ... Read more The post REBEL Core Cast 127.0 – Penetrating Neck Injuries appeared first on REBEL EM - Emergency Medicine Blog.

In the June 2024 episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang discuss identifying and managing patients with sepsis and stridor in pediatric patients. As always, you'll also hear about the hot topics covered in CDEM's regular features, including methotrexate-induced leukoencephalopathy mimicking a stroke in Clinical Pediatrics, medial clavicle fracture in Orthopedics and Trauma, perimortem cesarean delivery in The Critical Procedure, multisystem inflammatory syndrome in children in The LLSA Literature Review, and gastrostomy tube complication in The Critical Image.

Asthma bronchiale ist eine chronische entzündliche Erkrankung der Atemwege, die durch Überempfindlichkeit des Bronchialsystems, wiederkehrende Atemwegsobstruktion, Atemnot, Husten und Stridor gekennzeichnet ist. Üblicherweise tritt diese Erkrankung anfallsartig auf. Es handelt sich um eine der häufigsten chronischen Erkrankungen weltweit und betrifft Menschen jedes Alters, auch wenn sie oft in der Kindheit beginnt. Asthma kann in unterschiedlichen Schweregraden auftreten, von milden bis hin zu lebensbedrohlichen Exazerbationen.Du wirst Menschen mit diesem Krankheitsbild pflegen und auch kann dies Inhalt Deiner Leistungskontrollen sein. Wir machen dich also wieder fit für Deine Ausbildung.

In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Briac Thierry, Pediatric ENT at Necker Hospital for Sick Children in Paris, France, review stridor in newborns, with a special emphasis on laryngomalacia. --- SHOW NOTES First, Briac and Gopi discuss how a newborn with stridor can present. Though stridor does occur among NICU babies, most of Briac's patients are referred by outpatient pediatricians. They discuss a list of questions to ask while taking a history and emphasize the importance of assessing growth trends. In the absence of other medical problems, declining weight can suggest severe aerodigestive tract abnormality. Any pathology that narrows the airway can cause stridor: in infants, these include laryngomalacia, vallecular cysts, subglottic cysts, tracheal rings, and bilateral vocal fold immobility. Then, Briac talks listeners through his physical exam, with special attention paid to flexible fiberoptic laryngoscopy. Briac shares his tips to maximize visualization and clinician ergonomics when scoping a small child. If bilateral vocal fold immobility is suspected, Briac recommends performing a longer fiberoptic exam so that the clinician can determine whether vocal fold immobility is present at rest or due to an uncomfortable child crying. Next, Gopi and Briac differentiate between mild, moderate, and severe laryngomalacia and the indications for going to the operating room for an airway evaluation. As 20% of children with laryngomalacia have secondary airway lesions, a meticulous laryngoscopy/bronchoscopy is mandatory in these patients when a trip to the OR is required. Moving to the OR, Briac talks about his workflow when performing diagnostic bronchoscopy/laryngoscopy (DLB) to assess various causes of stridor. The episode concludes with Briac's meditations on airway surgery as a team endeavor. --- RESOURCES Briac's Necker Hospital Profile: https://www.aphp.fr/offre-de-soin/medecin/3168653/061/16 International Pediatric ORL Group (IPOG) Laryngomalacia Consensus Recommendations: https://www.sciencedirect.com/science/article/abs/pii/S0165587616300519 Pediatric Airway Channel in Paris (@voies_aeriennes): https://www.youtube.com/@voies_aeriennes

Show notes at pharmacyjoe.com/episode851. In this episode, I’ll discuss how racemic epinephrine via nebulization is thought to help treat stridor. The post 851: Why Is Racemic Epinephrine Nebulized To Help Treat Stridor? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode851. In this episode, I’ll discuss how racemic epinephrine via nebulization is thought to help treat stridor. The post 851: Why Is Racemic Epinephrine Nebulized To Help Treat Stridor? appeared first on Pharmacy Joe.

PEMplaybook.org

The First Principles of Croup that can get you through your paediatrics rotation: what is it, what do you do about it, and what type of barking cough do you hear? === Other Links === Check out our new website ⁠⁠⁠⁠1pm.wiki⁠⁠⁠⁠ for the ⁠⁠⁠⁠Notion document⁠⁠⁠⁠, free Anki flashcards, and podcast episodes. Check out our Instagram: ⁠⁠⁠⁠https://www.instagram.com/firstprinciplesofmedicine/⁠⁠⁠⁠ Recorded 15 March 2023 Co-hosts: Jay Cheyyur, JT Yeung⁠⁠⁠⁠⁠ & Adian Izwan⁠⁠⁠⁠⁠ feat. Alex Truong. Produced by Rushil D'Cruz & Adian Izwan. If you have any ideas or feedback, comment on this Notion document, or shoot us an email at ⁠⁠⁠⁠hello@1pm.wiki⁠⁠⁠⁠ *** We're really excited to be collaborating with Becky from Becky's notes, a UK based resource, to produce infographics for our visual learners out there. Becky's notes brings together all the key topics medical students need to know in a readily available place, reviewed by specialists in the field. These visually striking notes are a refreshing change from all the boring textbooks. You can check her out on Instagram at @beckysnotes01 and get her books at ⁠⁠⁠⁠https://linktr.ee/Beckysnotes⁠⁠⁠⁠ === Timestamps === (01:10) What is Croup? (01:35) Anatomy & physiology (03:58) Airway diameter (04:36) Top viruses (07:53) Signs & symptoms (09:11) Stridor (11:38) Examination (15:37) Exam summary (15:53) Severity of Croup (21:38) Severity summary  (22:19) Investigations (24:47) Management (26:15) Dexamethasone vs Prednisolone (34:50) Management summary (35:24) Complications (36:13) Differentials (38:16) Three key takeaways  

Take Home Points Caustics are substances that injure tissue upon physical contact. Caustic potential is not purely a function of pH. The decision to admit is dependent on the history and physical. Vomiting, drooling, and stridor are concerning. Stridor alone or 2/3 symptoms should warrant admission and gastroenterology consultation for potential endoscopy. The lack of ... Read more The post REBEL Core Cast 103.0 – Caustic Ingestions appeared first on REBEL EM - Emergency Medicine Blog.

Für Eltern und Kind ist eine Atemnotsituation bei „viralem Krupp“ etwas sehr Beängstigendes. Experte PD Dr. Tobias Ankermann, Kinderpneumologe und Chefarzt der Städtischen Kinderklinik in Kiel, hebt im Gespräch mit Moderator Dr. Axel Enninger hervor, was wichtig ist, wenn die Regio subglottis bei einem kleinen Kind infektionsbedingt anschwillt. Zunächst heißt es Ruhe ausstrahlen, unnötige Interventionen vermeiden und das Kind mit dem typischen bellenden „Krupphusten“ und inspiratorischen Stridor aufrecht hinsetzen. Doch welche Differenzialdiagnosen sollte man ausschließen und was sind Warnzeichen für eine Verschlechterung? Spielt Feinstaub tatsächlich eine Rolle und gibt es Evidenz für verbreitete Tricks wie die Zufuhr feucht-kühler Luft? Gut zu wissen: Die meisten Fälle sind mit Glukokortikoiden, am besten als Saft gegeben, gut beherrschbar. Literatur: Die Neuauflage des Consilium Themenheftes „Krupp“ von PD Dr. Tobias Ankermann finden Sie voraussichtlich im Herbst auf der Lernplattform www.wissenwirkt.com. Die AWMF-Leitlinie „Stenosierende Laryngotracheitis (Krupp) und Epiglottitis“ aus dem Jahr 2006 ist abgelaufen und wird zurzeit überarbeitet. Studien zu Auswirkung von Luftverschmutzung auf die Atemwege: Garcia E, Berhane KT, Islam T et al. (2019) Association of changes in air quality with incident asthma in children in California, 1993-2014. Jama 321(19) 1906–1915. Wichmann HE, Hübner HR, Malin E et al. (1989) Die Bedeutung gesundheitlicher Risiken durch “outdoor pollution,” erläutert anhand der Querschnittstudien zum Pseudokrupp in Baden-Württemberg. Öff Gesundh-Wes 51 414–420. Englischer Abctract: https://pubmed.ncbi.nlm.nih.gov/2531323/   Information für Eltern Patientenratgeber „Krupp“, InfectoPharm Arzneimittel und Consilium GmbH In deutscher und türkischer Sprache erhältlich. PDF zum Download: https://www.infectopharm.com/fuer-patienten/patienten-ratgeber/krupp/ Kontakte: Feedback zum Podcast? podcast@infectopharm.com Homepage zum Podcast: www.infectopharm.com/consilium/podcast/ Für Fachkreise: www.wissenwirkt.com und App „Wissen wirkt.“ für Android und iOS Homepage InfectoPharm: www.infectopharm.com Disclaimer: Der consilium – Pädiatrie-Podcast dient der neutralen medizinischen Information und Fortbildung für Ärzte. Für die Inhalte sind der Moderator und die Gäste verantwortlich, sie unterliegen dem wissenschaftlichen Wandel des Faches. Änderungen sind vorbehalten.

$5 Q-BANK: https://www.patreon.com/highyieldfamilymedicine Intro 0:30, Asthma 1:29, COPD 7:50, Pulmonary function tests 13:03, Interstitial lung disease 16:23, Pneumonia 21:09, Tuberculosis 27:55, Fungal lung infections 32:03, Bronchiolitis 34:14, Acute bronchitis 35:14, Stridor 36:06, Croup 36:57, Foreign body aspiration 37:30, Epiglottits 39:38, Anaphylaxis 40:12, Angioedema 41:40, Nasopharyngeal obstructions 42:39, Lung cancer 45:05, Pulmonary embolism 47:43, Pneumothorax 51:00, Pleural effusion 54:09, Congestive heart failure and pulmonary edema 57:20, Non-cardiogenic pulmonary edema 1:01:38, Pulmonary hypertension 1:05:07, Honorable mentions 1:08:04, Practice questions, 01:10:42

Show notes at pharmacyjoe.com/episode791. In this episode, I’ll discuss what dose of steroids can prevent post-extubation stridor. The post 791: What dose of steroids can prevent post-extubation stridor and re-intubation appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode791. In this episode, I’ll discuss what dose of steroids can prevent post-extubation stridor. The post 791: What dose of steroids can prevent post-extubation stridor and re-intubation appeared first on Pharmacy Joe.

2.05  Rales, Wheezing, Ronchi, and Stridor   Pulmonary system review for the USMLE Step 1 exam.

Today's Episode Dr. Parastou Khalessi Hosseini reviews the case of a 12 year old boy presents to the emergency department with worsening stridor for 3 days. His mother also reports tactile fever and decreased oral intake. Today's Host Dr. Parastou Khalessi Hosseini is a current second year pediatric resident at LAC-USC who will be pursuing a career in pediatric gastroenterology. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj www.BeyondThePearls.net The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? Crush Step 1 Step 2 Secrets Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast Study on the go for free! Download the Audio QBank by InsideTheBoards for free on iOS or Android. If you want to upgrade, you can save money on a premium subscription by customizing your plan until your test date on our website! Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan Executive Producer: Patrick C. Beeman, MD Legal Stuff InsideTheBoards is not affiliated with the NBME, USMLE, COMLEX, or any professional licensing body. InsideTheBoards and its partners fully adhere to the policies on irregular conduct outlined by the aforementioned credentialing bodies. The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

Discuss the types of stridor and the levels of obstruction associated with each type.Review of how to evaluate stridor and its associated symptoms.Describe Differential Diagnosis for noisy breathing/stridor by sound and by age.

After going through In-Vitro and premature labor, Dana's son Brady (now 16), was born with “Stridor”, a disruption in the nerve function in the vocal cords. As a young boy he required Feeding therapy had trouble gaining weight, and they had a lot of visits to the hospital.  At 18 months old, after a high fever lasting for 3 days, he stopped talking and she says “they lost him”. When he entered school, Dana, who works at the public school as an educational diagnostician for hearing impaired children, now found herself sitting at the other side of the table discussing her own son's IEP (Individual Education Plan). She was not getting what she felt she needed for her son, so she had to hire an attorney. In 4th grade he became very aggressive and was injuring himself, so he ended up in the hospital ER covered in blood. She is currently on the Autism Family Guidance Committee at Texas Children's Hospital and we discuss the year long wait to get children evaluated and diagnosed.

Derin boyun enfeksiyonları, üst solunum yolu ve sindirim sisteminden kaynaklanarak boynun derin dokularını etkileyen bakteriyel enfeksiyonlardır. Enfeksiyon lenfadenit, boyun dokulularının sellüliti şeklinde görülebileceği gibi ilerlemiş abse formu da izlenebilir. Bilinen en eski tıbbi kaynaklardan biri olan M.Ö. 1550 yazılmış Eberns Papirüsü​​1​ çürük dişlerden, kullanılan tedavilerden ve bu bölgedeki abselerden bahsetmektedir. Ancak derin boyun enfeksiyonları ilk olarak ikinci yüzyılda Galen (Bergamalı Galen ya da Galenos) tarafından tanımlanmıştır. ​2​ Derin boyun enfeksiyonları en sık mandibular dişler, bademcikler, parotis bezi, derin servikal lenf düğümleri, orta kulak veya sinüslerin septik odağından kaynaklanır.​3,4​ Derin boyun enfeksiyonu insidansı antibiyotiklerin yaygın kullanımı ile önemli ölçüde azalmasına rağmen, bu durum hala yaygındır ve mediastinit, hava yolu obstrüksiyonu, juguler ven trombozu, perikardit, plevral ampiyem ve arteriyel erozyon gibi ölümcül komplikasyonlara yol açabilir. Ek olarak, antibiyotiklerin yaygın kullanımı ve/veya derin immünosupresyon ile, bu enfeksiyonların yüksek ateş, sistemik toksisite ve lokal eritem, ödem ve fluktasyon gibi klasik belirtileri görülmeyebilir. Bergamalı Galen (Pierre-Roch Vigneron ) Genel Klinik Özellikleri Her ne kadar enfeksiyonun primer sebebine yönelik semptomlar ön planda olsa da, derin boyun enfeksiyonlarının bazı ortak klinik özellikleri vardır. Genellikle boğaz ağrısı ve/veya trismus ile ilişkilidirler. Trismus; çiğneme kaslarını (maseter ve pterygoidler) etkileyen basınç veya enfeksiyonu veya trigeminal sinirin motor dalının tutulumunu gösterir, bu da spazm nedeniyle hastanın ağzını açamamasına sebep olur. Bunlar dışında hastalarda disfaji ve odinofaji olabilir. Enfeksiyonun derin boyun bölgesinde olması nedeniyle, fluktasyon veren bir kitle kolayca fark edilmez. Ancak eğer palpasyonu mümkünse karakteristik belirtileri, palpasyon çukurlaşma gösteren veya hamur kıvamlı bir oluşumdur. Stridor ve dispne; hastalığın mediastene yayıldığının ve hava yolu obstrüksiyonunun belirtileri olabilir. Disfoni ve ses kısıklığı ise boyun enfeksiyonlarında geç bulgulardır. 12. kranial sinir tutulumu olması takdirde, tek taraflı dil parezi izlenebilir. Peritonsiller Abse (sağ) Klinik Şüphe ve Görüntüleme Tanı çoğunlukla klinik şüphe ile başlar. Bariz olmamakla birlikte AFR yüksekliği beklenir. Derin boyun boşluğu enfeksiyonunu düşündüren herhangi bir belirti veya semptom varlığında, enfeksiyonu teşhis etmek, kesin bölgesini belirlemek ve potansiyel yayılmayı değerlendirmek için acil görüntüleme alınmalıdır. Bu belirtiler ve semptomlar arasında: şiddetli tek taraflı boğaz ağrısı; faringeal duvar, yumuşak damak veya orofarenks tabanının şişmesi; boyun ağrısı veya şişmesi; kas spazmı nedeniyle tortikolis ; boyun tutulması; krepitasyon varlığı; veya hava yolu tıkanıklığını düşündüren diğer belirtiler vardır. (örneğin, boğuk ses, salya akması veya tükürük birikmesi, stridor veya diğer solunum sıkıntısı belirtileri). Hava yolu tıkanıklığından şüpheleniliyorsa, bu tür hastalar öncelikle entübasyon ve olası cerrahi müdahale için derhal değerlendirilmelidir. Direkt Grafi Düz radyografi, derin boyun boşluğu enfeksiyonlarının değerlendirilmesinde sınırlı yarar sağlarKolay ve ucuzdur.Özellikle retrofarengial abse tanısında değerli Diş kaynaklı enfeksiyonların saptanmasında panaromik mandibula grafisi Pnömoni ve mediastinit gibi komplikasyonların değerlendirilmesinde düz akciğer grafileri faydalı olabilir.​5​ Kontrastlı Bilgisayarlı Tomografi (BT) Tanıda altın standartdır.Derin ve yüzeyel anatomik yapıları daha ayrıntılı gösterir.Abse ve sellülit ayırımı yapar.Dezavantajları arasında radyasyon , artefaktlar, yumşak doku seçiciliği MR kadar iyi olmaması sayılabilir. Manyetik Rezonans Görüntüleme (MRG) Yumuşak doku tutulumunun derecesini değerlendirmek ve vasküler komplikasyonları tanımlamak için yararlıdır. Anatomik ayrım,

S2D: The Symptom to Diagnosis Podcast presents case-based discussions of signs, symptoms, and diagnostics tests to improve clinical reasoning and evidence-based practice. Sponsored by McGraw Hill, S2D features Scott D. C. Stern, MD, FACP Professor of Medicine and Clinical Director of Clinical Pathophysiology and Therapeutics at the University of Chicago Pritzker School of Medicine, and Adam S. Cifu, MD, FACP  Professor of Medicine and Associate Dean for Medical School Academics at the University of Chicago Pritzker School of Medicine.Wheezing and Stridor: All that wheezes is not asthma blah blah blah...

Case Introduction You are working a shift at your local free-standing emergency room when a family of three checks in to be seen (a father and his two sons). Initial Vitals#1 (Chris, 18mo with stridor) Temp 100.4F HR 120 RR 40 O2 93% Critical Actions#1 (Chris, 18mo with stridor) Check pulse oximetry (hidden) Administer PO […]

Guest: Shelagh A. Cofer, M.D. (@ShelaghCoferMD) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Stridor is a musical sound due to disrupted airflow in an individual's airway. In many instances it's due to a benign cause but it can also represent a serious problem, possibly even life-threatening. In today's podcast, we'll learn about the various causes of stridor and when we need to be concerned that it represents a serious health issue. Our guest for this podcast is Dr. Shelagh Cofer, a pediatric otolaryngology specialist at the Mayo Clinic. We'll discuss how stridor differs from wheezing, the most common causes of stridor in both children and adults and what symptoms we should be watching for that might suggest a serious cause for stridor. We'll also cover the evaluation of patients with stridor, which imaging studies may be helpful and when an ENT consultation is warranted. Specific topics: Definition of stridor Difference between stridor, stertor, and wheezing Most common causes of stridor in both children and adults Croup as a form of stridor Important questions we should be asking our patients about stridor to identify those at risk for airway obstruction – including the SPECS-R mnemonic Tests and imaging studies which may be helpful in the evaluation of a patient with stridor Treatments for the more common causes of stridor Additional resources: Zoumalan, R; Maddalozzo, J; Holinger, LD. Etiology of stridor in infants. Ann Otol Rhinol Laryngol. 2007; 116(5):329-334. doi: 10.1.1896.429 https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.896.429&rep=rep1&type=pdf Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Brian V. Klein & special guest Dale Morris join J. Scotty to cover the original 1980s Filmation cartoon in preparation for Kevin Smith's new series Master of The Universe: Revelations releasing on NetflixTOP 10 Essential Filmation MOTU EpisodesDiamond Ray of DisappearanceS1 - E1The intended pilot for the show, sets up the formula for the series and manages to introduce a bunch of characters (or new toys for Mattel), while also setting up future character traits like Prince Adam being a disappointment to his father.Teela's QuestS1 - E2Paul Dini written script, features some great action while also establishing the relationship between Teela and the Sorceress.Prince Adam No MoreS1 - E15More Paul Dini writing showing that he really gets the main cast of charactersA Friend in NeedS1 - E16A fun episode showing the trickery of Skeletor, the only appearance of Ileena, and a good moral at the end.The Dragon's GiftS1 - E18This is the story that got Larry DiTillio the job as staff writer and was even adapted into a minicomic. Feature's the first appearance of Granamyr, lots of action, and He-Man showing wisdom and compassion, not just brute strength.Double Edged SwordS1 - E22Also adapted into a minicomic, this is the anti-violence episode, good moral.Origin of the SorceressS2 E12Written by J. Michael Straczynski, fantastic story, only appearance of Stridor. BattlecatS2 E33D.C. Fontana written story, features Melaktha, and will make you appreciate Cringer and Battle Car for more than just comic relief.Teela's TriumphS2 E43More great writing for Teela, sort of a sequel to ‘Teela's Quest', and Skeletor actually sits on the throne of Castle Grayskull. The Problem with PowerS2 E 45Huge concepts and story ideas for this episode, serves as a natural finale to the Filmation series in my head cannon.

As an Emergency Physician, my biggest concern (and the first thing I need to address) is the airway. I like to think of the Pediatric airway as simple. Upper and lower. Viral croup is a very common upper airway obstruction.  

Kane De Wilde is on the leading edge of wing foiling as both athlete and designer.  Listen, learn, and apply it on the water! Interview transcript: Aloha. It's Robert Stehlik, welcome to the Blue Planet Show where I interview wing foil athletes, designers, and thought leaders, right here for my home office in the garage. We talk about Wing foiling technique and equipment, and I'm also trying to get to know my guests, their background, what inspires them, and how they live each day to the fullest. You can watch these long interviews on YouTube or listen to them as a podcast on the go, just search for the blue planet show on your favorite podcast app. This show was made for those of you who are as crazy about wing foiling as I am. I'm not rushing through these interviews. This is like the opposite of a 30 second Instagram video. They're super long interviews, and I know they're not for everyone. And really I'm just making these for the 5% of you that actually watch the whole thing. So I hope you're one of those elite people at the very top, the five percenters and that you're going to watch the whole thing. Today's interview is with Kane De Wilde He is an amazing young athlete. And before I talked to Kane, I didn't realize how involved is in the design aspect of the sport, a foil design board design, and also developing an R and D and wings. So he has some really in-depth knowledge, probably more than anyone I've talked to so far. And that's why this interview goes pretty long, but I think you'll find every minute of it is very interesting and I could have actually kept going for a lot longer. So without further ado here is Kane De Wilde: All right, Kane. Welcome to the blue planet show. It's great to have you here. So to get started, maybe just tell us a little bit about your background, start from the very beginning. Where did you grow up and tell us about your early childhood memories that kinda got you into water sports and so on. Hi, Robert, thanks so much for having me on it's super cool that you're that you're hosting something like this and I love listening to him. So that's going to be fun. I started the whole journey probably in middle school, getting into sailing, super into surfing skateboarding and. Through sailing. I was dinghy racing actually. I have a natural evolution of dinghy racing. I wanted to learn how everything works and how to improve and how I could do my sail better and shift my weight in the boat better to go, to get a slight edge. And so I started researching, how boats workout, how sales work, how your rudder and daggerboard work. And that's kinda what started it after that. So sorry, but you were born and raised on Maui or? Yeah, born and raised Valley. I grew up country lifetime surfer. Okay. And how old are you now? I am now 20, just turned 20. And and can you also tell us your weight that people always ask about that, right? Yeah. I'm six, six Oh and 195 pounds. That's very similar to me. So early on you started dinghy racing and then I think glider. Yeah. So it think directing your racing is so much fun and it's such a deep sport. It's crazy how the tiniest little fail tuning or tiniest little thing can give you such an edge. That's in white Kai on a wahoo new King day in an open Vic. I remember being terrified to go out that day. And my coach is K a K E N, or you gotta go, you gotta go, you gotta go. And eventually pushed me enough to get in the water. That's probably until that my, my best session ever. So that one was the boat on the right. I actually have that right here. This is the first thing I ever 3d modeled. Oh, cool. Okay. All right. And it's the first thing I ever glass. And it's what set me on this track. Really. So that's like a model of a like a displacement D sailboat. Is that what, it's more of a planning hall. But I made three different variations of these and took them to a river and tested the resistance with little scale. And that was my project, my big project for eighth grade. How did you test it in the river? I took it to a river with really consistent flow and it might be a little hole. There's a little hole on the front here, tied a rope through it, put a a gram fishing scale. I really finally find a fishing fill and just let it sit and took an average over a few minutes. And then why did you take test some variations of it or? Yeah, so I have three variations. I don't know where the other ones are right now, but I just changes in the outline or the rocker changes in the bottom just to see what kind of effect they have. That's amazing. And how old were you when you were working on that eighth grade? So pretty young. You were a little bit more, a little bit chubby before you got tall and lanky. I was flailing magic, isn't it? I know. There's like a lot of people look a lot skinnier after they started foiling. Yeah. Oh look, I was into kite boiling too. I, before I, I ever did it, but I made a little model foils. And took them in the river too. Wow. That's pretty cool. Yeah. Super fun. So we have a forklift and when my friends came over from hood river, awesome. We hooked up a bar to the forklift over the trampoline and I'm aware we're practicing our move and these posts are super old because I actually started to cover my college thing. If I could document all these different things to eventually show to a college when I want to get them cool. And it just evolved from there. Yeah. You did like glider planes. Yeah. Stridor, planes, kiting, all kinds of stuff there with my rudder cool cards. All right. And I met you a couple of years ago, you came over to a wahoo and you did that pumping contest where the point was to catch a hundred ways with your team. And I was sitting in the channel at Queens watching you are in the heat before us, and you were just going round and round, pumping back out, touching another way of going back out and kinda so cool to watch you like so efficient. And then even sometimes you would like rest and put your hands on your knees and glide a little bit to rest your legs and stuff like that. That was really impressive. Do you have any pointers on pumping technique? The biggest thing pumping is finding the right rhythm and speed for your foil. And being able to learn to have enough control of your pump to be able to vary like your speed and tempo until you find that. And it took a while of telling tuning in front wing and board placement to get a nice rhythm and be able to ride super efficiently. Another cool thing pumping is if you want to go for a super long time, the spot and wave and conditions, make a massive difference. So all of my longest waves have been on at spots with a good amount of power, right off peak and ideally two peaks next to each other, and a pretty consistent wave. That's why big, bigger waves are good because what you can do is only stay on pump out to a wave and only stay on it long enough to get your speed back up and then instantly kick out again. And basically do figure eight between the two peaks. And the goal was to not pump between the two. So you just stay on it long enough to get your feet back up, kick out with enough speed. So you can just collide into the next way without even pumping at all. Is that what you're saying? Yeah, I've had some like 45 minute ride and it was at that same, the same kind of setup where you dropped down the face of maybe a head high wave and then just two pumps to the next peak and do the same thing the other way. And the only limiter, which was really how consistent the waves were. So what killed me there was was a big break. So I know you've tried a lot of different wings and foils and you design them as well. So what what's your favorite right now? Which wing do you use for like combination of pumping and surfing? What's your favorite. I use a 10 80 mid aspects mostly right now. And I vary the tailing depending on the condition. So if I'm surfing and doing some low speed pumping, I'll use a different tail wing. And if I'm at, if I'm going like high feed, downwind, or winging, I'll use the tailoring more suited to that. But I actually have one of those links right here, the screen share, this is a version of that 10 80. I have one new carbon, but this is a carbon insert. And just the design up. And I've been refining for a few months. So this is, yeah, this is CMC that a G 10 with with an 11 millimeter. So this is a 11 millimeter carbon insert it's in here or epoxy didn't hear. And there's no, you can't feel any gap between the two material. And this is all credit to Dennis partner tectonics. He does just an insane job of CMC and finishing these wings so that, and that's where the signature line. No, this is just my own stuff. I originally did it super modified meal prep, but I have it here. I got everything ready. So I made this fuselage to fit that it's front wings. It might hard to see behind your black shirt. Yeah. Okay. Wow. Yeah, that looks really beefy. It's beefy in the center, but really the fender is. So I use signature old signature uniform mask. And center's just big enough for that connection. And the rest is pretty skinny. I tried to lower the drag, but still keep it stiff. Yeah, this is the Moses fuselage reference, right? So it's pretty similar in size to the motor. It's the width is the same, but the thicknesses it's thicker. So that gives it a little bit more rigidity by the mat around the mask. Yeah. Cool. It's just big enough to fit that math connection. So you do foil designs? Right now you're working with signature and Neil pride, right? You, yeah. Yeah. So I, yeah, I've done some work with signature and Neil pride and I'm pretty happy with how it all turned out. I can I don't know how to explain it. The no private thing was funny. I met Robert stray who was at the time the portfolio guy just at the beach. And we started talking to Zion Oh, we're looking for, we're looking for someone to make a photo. And I heard like you're designing stuff. And so somehow I ended up designing a full set for them. Or I originally designed to one wing is to called the medium slim. And there's some pretty cool videos of Calgary writing it, but they went really well. So after that I designed a whole line, but. It's kinda being thrown into the fire as far as designs, because we didn't do any prototyping. So I got one shot, like you got to design something and it goes straight to a stainless production mold. That was pretty intimidating for the first time. But I'm actually really happy with how it all came out. It's available now. I've been seeing some videos of people riding it. Wow. Yeah. I That's super impressive for you at 20 years old to be like a professional designer basically already. Yeah. And that design was probably one and a half years ago. So you started using 3d modeling software back in eighth grade. You'd said like with that kind of was your first class project that you worked on with the 3d modeling. And can you, like earlier you showed me on your computer, you had some design stuff. So maybe show us a little bit and talk a little bit about what kind of stuff you do on the design side. The super interesting I find, yeah, I can show a little bit of it. So this is the stuff I'm showing is mostly really old stuff. So my modeling is definitely trade secrets screen. So here's the, there's two. We did two versions of it, the one on the left and the one on the right is super solid. And it's amazing how much, like a tiny difference around here will make. Oh, it's just a front between the mass in the fuselage. It's a little bit more thick. Yeah. It's hard to see. I can see it. Yeah. A little rounded in there. Yeah. That's the difference between super solid and just spending until it breaks. Wow. Yeah, they were funny on our wings too. Like having that little bit more especially between the mass and the front wing it's the forces are amazing, like the, so that is a really important area. And the other thing is having your volume distribution along the length of the fuselage, as smooth as possible, because any breaks in that aluminum doesn't like that would be a failure point. Another big difference is the whole depth was different for this one had too deep of holes. And that took a lot of material out of the top of the fuselage, where this one has a slightly shallower holes that are still strong enough for the, both the wing on, but leave a lot more material in the top of the fuselage where you really need that string. Interesting. An access fuselage that cracked right at the front of the square mast opening, like at the end of the square mass opening. Yeah. I was wondering, I guess it makes it more inter compatible to have that square opening, but I was thinking, wouldn't it make more sense to have that mass opening in the shape of the mass, like the then out to back in front so that you have more material around the mask, without having a square rear end on the mass, if you just put the master directly into the fuselage, it would make it stronger between the mass and the few sizes. Yeah. I'm not an expert on structure. Someone smarter than me would know more, but It's probably better not to have sharp corners on your mask. Insert, I guess it just makes sense. If you want to switch between a carbon mass and an aluminum mass or whatever, or different size masks. Cause if you had, if you add the profiles of mass and you could only use that one mass with the fuselage, I guess so that, I think that's the main reason why they're doing that. Yeah. And it's a pretty good way to, I think these are based off of whatever cuddle or pro ball pro box insert. So it's a well-proven design. So what about wings? What have you learned about wing design? So yeah, these are tails that is for signature. These both were based off of a pale that I hand shaped and cleaned up the profile and cleaned it up a lot. But I was riding the stealth of the truck a lot of the time made  and would core carbon lay up Hills that I really liked and were awesome with those foils. And yeah, I base these off of it. There they go really good on the Palm itself, especially it's very similar except for the tips, right? Yeah, they are very similar. This one has a little more span and tips. I made it basically for the one 65 all the trough and this one was pretty much made for the one 75. And so I find the angles and everything like that, the wingtips were needed because the the high aspect links, just like a little bit more stability also because of the math, the different, there's a difference in math placement between the two foil, for people that don't know that much about oil tales. I always stay like that. Those tips are almost like fins on a board. It gives you like directional stability and having a flatter, you, it just makes the tail more loose, like having basically smaller fins or you can slide out the tail almost like you're saying. Yeah, you can turn on the mask instead of doing that. The other thing I really paid attention to when doing tips like this cause I've got a few tails is I wanted to make the tips thin enough and small enough that at low speed you can still pivot and stall the tips out or walk, wash them out. And so at low speed coming up the face, you can still pivot the turn, but going fast, they would lock in. So I made them thin and low cord and pretty vertical. Yeah, low drag probably. Aren't so good for pumping. Nice. Okay. What about front winks? So front wings, these are a bunch of a bunch different wings, but I worked on with Neil pride. Some of these made it to production. Some of these didn't for example, this is the XXL 2300 these are both 17 hundreds, but with different aspect ratios, small, medium, large, extra large. And this is super interesting and this is where I learned most of my, a lot of my idea of how I should design foil and how to do, center connection. It helped me a lot. And these are the pills impressive that you're already doing all this stuff at your age. I can only imagine where you're going to go from there. What are your plans in the future in terms of that kind of stuff? Do you have any professional aspirations to become an engineer or design like designer? What is, what are your plans? For now, I'm pretty happy. I get to, delve super deep into design and I get to surf every day while I'm young and living in Hawaii. So right now I'm pretty happy, but in the future it would be nice to do something other than, because I'm from the surf industry and it would be nice to go to school and further explore this kind of path. It seems like to me, it seems like you're doing fine teaching yourself. And for things like, in the water, the foiling and winging, it's so much more like Rob widow was saying too it's more about the feel and, you can have the scientific theories to explain it afterwards, but really without the, trying it and feeling it out and trying to figure out what, how, what works and what doesn't work actually in the water, you don't really know what's going to work or not until you try it. Really. Yeah. So that's what I've been getting into recently is first I went super deep into like simulation and trying to predict how these things work, but. Some of the results I got didn't match up with what I felt in the water. So I've been slowly climbing my way back to finding, okay, this is what happens on the computer. And this is what I feel in the water. And ideally I want to be able to predict everything on the computer and run through designs. And so in the last month or so I've been getting closer and closer to doing that. It's really hard and I definitely am not an expert on it. By any means, pretty impressive. I don't know if you're not an expert. I don't know who is. And then you also design boards, right? Like you said, you do some board designs and then you work with Mark Rapa horse. He builds them for you basically. Yeah. Huge. Thank you at the marker up. He's amazing. His construction is unmatched so far, but I'll share my screen again. So these are some old downwind boards I prototyped. So this is one that actually came out. You could probably feel my Instagram page. It's a blue board, white stripes big step six. So by 20, I think it's 25. And this is what I, this is the first design. I was like super psyched on it on a fucking deck. But there's the practical limitations to making this, like the thickness of the blanks you need. And so I ended up making this, tried some interesting stuff with the rocker and it worked really well. And it led me to my, my, my more recent board with the pin tail because this board, if there's two, I found there's two ways to get it to wave. Now you can either pull up paddle and glide into them, or you can move the board a lot. It's pumped into them, right? And this board did insane for gliding into waves. And I found it worked really well, pronoun winning because you don't have the ability to pump up on the flow. But stand up, I had a hard time because of all this volume and with the Mattel and also lower order, it was hard to get it up on the foil. What's the bottom design on this one? Like the bottom shape. It's pretty flat. I checked some interesting stuff on the rocker. There's a rapper. Is, there's a concave here in the center, rockers different from the rail rocker. Yeah. The bottom is actually, this is actually the bottom surface of an airfoil. And you're saying that because the, because it's flat and straight on the bottom and is good for gliding in, but not as good for pumping into pumping up onto the foil. Is that what you're saying? Yeah. And I can see it could be fixed with more rocker in the tail, but then at planting speeds, it really doesn't that rocket tends to stick. And the takeoff speeds for getting to downwind are into the planting speed. So you can't have that. And it ended up with my pin tail design, which still can be improved, but I have basically dead flat rock throughout the tail. So it can release in plaintiff at speed, but not a lot of surface area or volume in the tail. So it can still move and pump on the foil. I see. So you're keeping the bottom flat, but just by having a narrow tail, it allows you to like hop on, hop up on the foil easier. Yeah. And I think Dave designed to probably have a more refined version of this. But this, the board of, and writing works really well. And the other cool thing is because there's so little material and the nose and tail it reduces your swing weight a lot and it changes the center of gravity of the board. So on this Pentel board, I pretty much stand in the dead in the center. And so there's no notes in front of you for that. So you might the ride purely like a five, four. So next board is probably gonna be a six, four. Instead of a six and 22 wide or something. So that's for downwind foiling. What about wink, foil board design, like what's what, w how does it differ from stand-up and foil board design? What kind of boards do you design, or you it's funny because pretty, you could pretty much get anything up on foil, but it really matters in light wind. What I found is you are not my pin tail board and you want, or you don't want any of my stand-up boards, because they're hard. For some reason, they're hard to steer it's something with the outline. And then the little rocker makes them, like, when you in the parent planning transition zone or speed, they'll do opposite fearing like a boat, or like a race standup board. Oh yeah. Yeah. And it's probably a low nose rocker or something, but yeah, definitely avoid that. And my pin tail board, so much area in the nodes versus the tail, but the note pushes down, going up wind, and you need to compensate for that with extra pill paling angle. You're saying when you're up on the foil, having that chat knows has like more drag in the wind, basically. Yeah. Okay. Big time. If you designed a, have you designed a board that's just for wing foiling or what would the design specs would be on a wing for a bomb? Pretty much just take your on board and scale it up. Like direct, like you can scale all dimensions up to five foot and it's perfectly, if you just had one wing board for you that you can use in light, wind and all wind conditions, like what size and volume do you think would be good that you would use right now? I guess 22 to 24 wide and 70, 75 liters. Sorry.  bye bye. So 20 to 24, probably 75 liters. Oh, wow. That's pretty similar to what I have four sticks, liters, bottom shape. Super simple, no concave, no, nothing special, no steps, no concave, just as simple as possible because that I found that gets you up really fast. I like, and Dave Kalama talked about it too, but there's that theory that the con the convex shapes just releases from the water easier, like the word, when it comes off the water just slides off of it versus concaves and tight edges. Sometimes the water can stick to it or like the surface tension of the water gets stuck on the, on those hard edges, yeah. The other thing with the wing board is sometimes like when you touch down, a lot of the times you're touching down at a weird angle to chop and concave and sharp edges in the front, instead of just going through it we'll create a lift in some direction and shoot you off one way or another. So yeah, simple bottoms like convex or concave works. I, I totally agree with that, but obviously there's two schools of thought here. Like a lot of the prone boards have a lot of a lot of concaves and sharp edges and stuff. And I guess, there, there's gotta be some advantage to that. I I guess it has more lifts at lower speeds creates more lift, but yeah, like I said, there's definitely downsides. So it's so what's your, yeah. As far as my experience riding them, I haven't found any advantages. But they look really cool and they do make a lot of lifts at low speed. Yeah. Does it help a little bit with the takeoff or I guess on balanced, do you think don't think it's worth it to have all those concaves and hard edges, personally, I don't think it's worth it. I don't mean any disrespect to anyone who does it because done right. They can work really well. Yeah, something that's really helped me when I, setting up the board, was when you said, like you, you check your, basically the thickest part of the foil. Do you have your board upside down? If you lift up the board by the foil, the thickest part of the front wing profile, then it should, the board should be pretty much flat and balanced. So I thought that was really helpful. And then, it's interesting too, because sometimes different wings like have an access for an, I changed from the seven 60 to the eight, 10, and the, for some reason, like the distance of that profile is so much different that after go from the seven, 10 is like at the front of my box and on the eight, the seven 60, sorry. And then on the eight, 10, it's all the way in the back, so it's like a big, pretty big difference where the foil is located in terms of, keeping my feet in the same position, the same foot strap positions. Yeah. The biggest part of that is, is keeping your, it keeps your front wing in the same position. So they probably have different distances between the front wing and the mask. So the mask will move, but the frontline stays in the same spot. And and then I was thinking about why it is that it works well like that. And then I guess when you're when you're pumping and unwavering, the board by itself is balanced on, on the foil. So it's not like it wants to like nose dive or stall or whatever, even if you completely on way the board will be sitting there and gliding. But my, my kind of school of thought around it is ideally you want the board to fly pretty neutral as far as the pressure. And you want that foot pressure to be consistent across all, all speed. You want it to be consistent across if you're in a turn or if you're going straight or if you're pumping. So what doing that does is it puts the center of gravity of the board over the center of lift of the wing. And that means when you put it in a turn and put some extra T4 on it or yeah, mainly if you put it into the turn with that extra G force, it won't change the balance. If it's nose heavy and you put it in a turn. That center of gravity, push, push down and pull your nose into the water. And if it's too far back, it'll do the opposite and pull you out of the water. And so that's a baseline and depending on, I always pick a tool with me in the water and change it a little bit, depending on how the foil students, but a big difference. Something that I noticed for myself, like when I used to just stand up paddle surf or pro surf, I used to have my back foot a little bit more forward, but then when I started wind foiling, my back leg always got so tired from always putting more pressure on my back foot. And so what I started doing was putting my back foot further and further back. So basically now I have my feet. So the center of lift of that foil underneath me is right between my feet. And I've got just equal pressure on both feet and that's something I learned from wing foiling. And now I also do, when I'm Santa filing, I always have that same foot position just because it's way more comfortable and efficient. Is that kinda how you balance out too, or? Yeah. And it's, if you watch a lot of my clips or watch. I'm usually sometimes my back sits way in front of the master. And you think, Oh, that's weird. Most people have their backs up behind the mask, but my front foot is really far back too. So I try and keep my center of gravity always right over the front line. And if he can see it I just got them downwind clip. There's a good video clip. Let's click play one of these. So is the Harbor one of your favorite spots on Maui or Harvard? A pretty good spot. Flailing ruined me. So pier one is my favorite spot now, but just directly outside the Harbor, but there's also a spot on the West side. That's really fun. Foco right off the line of sight of poco. And that's. That's one of my favorite waves ever. It's crazy. That's obviously an older footage and the board looks so huge compared to what you're writing now. Yeah. I really liked that part though. Sometimes I'm actually going to bigger boards now. That's a, FORO that's on the screen. That's a four by 20 now I'm writing a 42 by 19 and my next board is a four, six 18.5. And just to be able to catch the wave easier and paddle back out easier. What's the idea behind going a little bit longer. Again, is. Think bigger waves. I want, I live on the North shore of Mallee and most of the spots in the winter are a bit bigger than, and I want to paddle into my, on my 42. And the other thing is hitting of pitting the whitewater or getting critical and critical sections of the wave. My 42 has a nice rocker curve, but it doesn't have enough rocker. So I basically on my four six, I just extended that rocker curve to the most of the board. Same, but I have a little bit extra nose for recovery mostly. And yeah. So when you put it in, in a head high bit of foam or the lip, it doesn't really care. Like you can recover weight easier. So actually that's another question I had for you on the rocker, like people have been playing around with the shims underneath the mass blatant stuff like that. And it's basically, you can put a little bit of rocker in the board and get the little bit of that, is just, what's your, what is your feeling? And I guess it depends on the foil of course too. And do you like to have the mass or the plate completely parallel to the bottom of the board? Or do you like to have it like a slight rocker to it and then the tail that, where the manual, most of. I do most of it in the doc with the referee, my board. But I know people are put, are going like really, almost negative with their Shem. So that's interesting. And I think it works really well on smaller waves where your front wings running a higher angle of attack on big, I found on small waves. I liked boards with lower, almost parallel angle between the foil and the deck or the box and the deck and on bigger waves. I like a lot more like my front foot up a bit. Yeah. Like to me especially when you're going faster if like that having that negative angle helps with it's a little scare. Oh yeah. Yeah. You're going fast. And especially like on it, like if you're toying in or going fast and you have that, the nose is pointed down a little bit, as soon as you touch down just slightly, you done. It's like your board sucks down when your nose down. Yeah. Yeah. So it depends on the wave. And I, I just have my boards have a really light tail rock. I can always show the front wing too. This is my setup. It lets me. Shit in the front wing to different angles. So that's useful. Yeah. So I was going to ask about that too. So do you, I guess the wing designs you have are mostly like, where the front wing screws flat onto the fuselage with two or three screws. And then so it's basically just the screws holding the, holding it down against that flat area. Do you ever have issues with it, like loosening up or like how do you keep those screws completely tighten and keep it from having any play? I use about I they're big torque screws and I use probably six, six inch lever and just crank them way too tight. But the reason I use that connection is the limitation of how I build the wing. I make the wings out of a solid panel with carbon and on a three axis CNC machine. So there's not a good way to get enough thickness in the connection area or go in from the side to make a male-female connection. So the on top kind of works really well. For example, I just made the swing fit, active case series. This is for the access case series and that's a similar kind of fuselage work. Just it just bolts right on top. And the reason I couldn't do like the black series or their old sq floss is just because it's too thick for my panel. The wing, the wings are too thick and the connections too thick. So this is the only thing that would let me get thin enough. Yeah. You're going super thin with your foot. For design sounds crazy for us for higher speeds, right? That's basically less drag. Is that the idea behind it or, yeah, you do. You do sacrifice a little at super low speed. But I, if you use the right foil section, you don't sacrifice that much. So do you on NASA foil sections or how do you use this, modify them or what you come up with your first sections? I designed my own sections, just trial and error. What works for you and no using trailers, inverse design. So I specified the surface velocity of the fluid over, over the top and bottom of the wing basically. And that'll give you your shape. Wow. The maximum velocity you can fly at with your wings. Like that 800 probably top, it has a low tops size. It probably pops out at 39. Just because it's a fairly blunt foil, but the good thing is with that one, it's super stable until that speed. So I actually, I've never hit the tough beat on it. I have one right here, 600 insanely fast, and it's basically a super, super fan. So what's the idea behind having that pointy tip on the front? It looks like a, like an airplane, the fuselage being too long for the quarter. I need to get it in. I need to set it in the right spot and otherwise I would end up with kind of an ugly front connection. Yeah. So the tip it's not like it's just to make up for the length of the few slides that either the design. Yeah. Yeah. If you're going really fast like the America's cup boats use it, it's called a what is it called? Where it raises keeps the pressure more, even around that connection. And it reduces cavitation around that, around the interface of multiple wings, but I'm not going fast enough and I'm not designing it to do that. He droves. Do you put the hydro into your wing a little bit or do you just keep pretty limited? This one has some freedom. Very slight dihedral on the center. Oh yeah. I've got some freedom with winglets. And the winglets on, these are more for a, more like a bit of a locked in feeling because if you go dead flat, it can, it gets washy sometimes. So you can play with changing your oil sections at the clip you can play with changing your like winglets or a neutral up a tip. Or you can do some fun stuff with twists to get a bit more of a locked feel. It's slightly turned up wingtips. Is that so you can breach the foil easier in terms? Yeah, it makes a really big difference in, in breaching terms. It's way gentler and upward one tip what you breached breaches tip at a lower angle. So on a following, in a turn, you can breach it. It doesn't matter if you have a wind load or not, but if you're a little straighter up, so like this will breach, but like this you want a little bit of a wingless if you're super worried about. Okay. Just so the tip comes out first and the, and disrupts the water surface less. I've found the angle between the wing tip and the water surface is super important. So the more perpendicular they are, the general area of a wingtip reach you'll have in general for section makes a huge difference. For example, like the oil foil section is insane for breaching. Like you'd never feel it. Yeah. The velocity across the top surface is really consistent. There's no pressure spikes and it's pretty impressive. So it turns out my buddy Derek comma does on the psyche on the geo and then those go for wings. Is this amazing? Like how are you coming out? Yeah, cool. I'm having a lot of fun on this. That's super interesting. I could just talk about design this hole for a couple of hours, but I guess we should probably move on to some other things as well. I don't know. I think everyone that's listening is going to be super interested in this as well, but let's talk a little bit about a wing design. In terms of, wing foiling wings, it's, this is supposed to be a wing foiling show more than anything, but what's your experience? What kind of wings have you tried and what do you like the best and so on? So I. I work with with a winged pretty talented wing designer. And so get to try a lot of prototypes from, for a lot of different brands and a lot of different materials and styles and handle them all kinds of stuff. And it seems like they're going to more and more attention to the Cathy of flutter shape a stiffer shape, and you can get a big increase in speed and efficiency from that. So I really like having you like having a flatter wing shape, less profile, basically. Yeah, definitely. A flatter profiles are nice just because the apparent wind angles they can handle it. It makes it nice for the wind or going up wind have really high are tight angles. It doesn't let her as much when you're going at a tight angle, yeah. Another thing is stability. I'm not an expert on wing design, but having a stable wing that's that, that flies neutral and wouldn't be powered is it's pretty important. And makes a lot easier. So I've been liking the wing rides and the emphasis. I tried some PPC stuff that's insane. And also the BRM. I really love the BRM wing. I think tested and helped with the design and so on. The BRM. Yeah. So talk about the BRM. What's what makes that one special? So my dad's had a BRM link for a long time now and the way they eat Gus is super impressive. That's what kind of surprised me the most when I wrote it in gusta conditions, it's just smoothed out everything. Your power is really consistent and they can handle high speed, low wingspan sense for surfing too. I haven't tried the wings. What is it about it that you think makes it work like that? Or what are the design features that you think work well on the BRM? They're pretty low aspects. That probably helped I really don't know. The handles are super solid pretty low flex and they don't have any windows, so it's a really consistent reaction or material across the canopy. Personally, too, like after trying wings without windows, I like it, I like not having a window, but what's your take on that windows versus no windows? That's always one of those big arguments. If you're riding around a lot of people especially a lot of beginners use the windows or windows really nice. Being able to easily check your tack, like before you do attacker drive is great. I tend to ride like at hook Keepa where there's not a ton of people and there's a clear rotation, so I prefer window windows. Yeah, it's also better for packing them up and you don't have to worry about creasing it and so on. And a lighter way. And I don't know, there's a lot of dependencies to not having a window, but yeah, definitely the safety aspect. Although I find that it's pretty easy to just look under your wing, right? You just lift it up a little bit and it is, the best windows I've tried are on the new Cabrina wing. The windows are massive. They're really the first one or one of the first ones that you can actually, you can see everything through. Yeah. One thing I really like about the wing is the handles. It's a soft handle, but you have probably a good 10, 12 inches to move your hand around. And that's really nice for adjusting to different conditions and different kinds of writing. Like a boom. Yeah. Having the longer handles, it does help with tacking and stuff like that. Cause you can put in right next to the other one and stuff, but do you find that sometimes the longer handles have a little bit more give so there's less control with your risks? Do you find that at all? Or? Yeah, I do. And some of the newer styles that I've handled I've tried or are stiffer and have a lot less of that you definitely have more control. The one thing I really like about booms is in the last week, I've started riding with a harness and having a boom is really nice to hear if you're riding with a harness and harness line. I've never tried harness before, but like Alan cages talked about it and I'm interested in trying it. I definitely would do want to try it out. Yeah, it's nice. Because I started doing it because I've been doing up winners from  on Maui and I don't know how many miles that is probably five miles upwind and it was just, it just destroys your arms and your hands. So it's nice to have something stick a load off, so was this from your knee when you had your knee surgery? Ooh. When did I have my knee surgery? Yeah, that's uh, right after I, I injured it. I've done that a few times. I originally did it surfing. Just went up for a top turn and busted. My knee was out for a few weeks. Doctor said after probably three weeks, he was like, Oh, you're good. You should be good to go back in the water third way of doing it again. So without, for awhile after that did a ton of PT came back, was good for a few months. I think I did it again in boarding. I'm sorry, I couldn't hear what you said. What was the injury? Originally, so that the injury originally was from surfing. I went through a tough tournament, dislocated my kneecap. So my knee cap went from the center all the way to the, basically the outside side of my knee. Like from overextending it backwards or like what happened? Like how did it happen? Not really sure. After all the x-rays and stuff, it seemed like just, it's just like a genetic thing. Like my kneecap far off, far off to the side, especially on my back knee, which got stressed a lot from surfing that kind of tuck knee position you do surfing. It's not good for your knee. So it's basically kneecap slips off the front of the knee. Is that what happened? Like sideways it slipped. So if this is the top of your knee and you're looking from the front or from the bottom of your leg, it's slipped off to the side. Outside of uni to the outside. And there's just a little a little whatever ligament holding that in as well as your quad. But when that happened or the ligaments probably stretched the first few times, and then the last few, it probably broke. I know in the last one it was broken. And then, so the surgery, they had to replace that ligament or, yeah, the surgery is called an MPFL reconstruction and or replacements. And there's two ways to do it. Where the one way they'll take some of your hamstring and replace that ligament with your hamstring. And the other one is where they take a cadaver from an Achilles or a hamstring and do the same thing. And luckily I got the cadaver. The cadaver is really strong. It's like the third and put it in a good way. It's like upgrading from accomplish to a jaws leaf. So my old ligament, like on my left knee is it's accomplished and the other one is the job. So it's pretty cool. And it's it's an amazing surgery. You can actually it's full weight bearing 45 minutes after. Wow. Pretty until you had to recover for a while. And yeah, it took us probably a week to get walking again or walking comfortably. And what'd you say you were hunting back to a hundred percent now. Like he can do everything. Yeah. I'm at least 95%. Now your quad does a lot of work and keeping, keeping your kneecap stable. And as long as you, you pay close attention to how tired or exhausted your quad is. And I've been doing like yoga and using the foam roller as the ways of managing, managing it, managing my leg and keeping everything stretched out. And it's a good way. Good way to recovery. Yeah, definitely. Sorry, go ahead. That experience and doing that a few times definitely taught me a lot about paying attention to my body and knowing when to stop. I think that's a valuable lesson to learn knowing how to recover, because when my age, like I'm 53 and it takes a lot longer to recover from stuff like that. So it's good that figuring it out at your age. Yeah. There's been a few sketchy moments, but the last probably few months have been awesome. Nice. So in terms of other, do you do other legs, sports cross-training hobbies other than foiling and water sports and so on? Not too much. I tried keep a good variety of foiling. I've been doing yoga recently. That's actually been super fun, but yeah, occasionally I'll go mountain biking. That's a good bit of cross train. Okay. Do you have a routine that you follow every morning or like what's a typical day in your life? Starting when you get up out of bed? Nah, I don't have a, I don't have a super, super strict routine, but generally I wake up and I do a little bit of stretching in the morning. I do maybe a little bit of rolling depending on the amount. Depends on how I feel. And then. Whenever you either try and get a good breakfast and do some work shift, shift tales, or do some designing. And then I usually go for an afternoon session. So then your busy time for getting some mornings, generally my busy time and also late at night, I do a lot of computer work. So most of my designing stuff is after dinner. So when you work on the computer and you're really into something and like how long will you stay up and work on your computer? Are you like an all night? It depends. I try if I'm really into it. I try and go to bed before at 12 I'm like, okay, I got it. I got to stop now. But sometimes I'll get really into it. Especially if I have a big project I'm working on or make a breakthrough and I'll go 10 to 14 hours just locked in on the computer. You're more like an, you get creative at night and in the nighttime, huh? Yeah. For example, a foil I just designed, I spent. Probably 10 hours a day straight for a week, just like on it, super focused remember in the future, like what, where do you see wing foiling or foiling going? And do you have any new ideas or new projects that you're working on? Anything you can share stuff that's coming in the future or things you, you can imagine or see for the future? Yeah. So my, my favorite part of wing foiling is probably the accessibility of it. And that you can get so many people in the water learning to fail, going fast, having a ton of fun, and you can do it in so many places. I like, I'm at the Harbor a lot and that's the Mecca on Maui for learning to win foil. It's cool to see entire families that, that sometimes don't even surf. And I've never done a wind sport getting up and you can watch them improve. And in two weeks they're up and going up land and having a blast. It's definitely pretty cool. This video is at the Harbor, right? Yeah, this is pretty cool. Where you're handing from the, doing a takeoff from the boat ramp and then grabbing the wing on your way out. Talk a little bit about why that was funny. I showed up one day with my weighing I'll to go. I think I just got that sale. And it was way too light to go out. But luckily I ran into Scott Mackey and Jason Hall and I was like, Hey Scott, can you start at the end of the pier and hold my way. Instead of beat started managed to somehow make it and actually thought that was a super fun session. Yeah. This looks like you just had to get out to the wind line, pump out to the wind lane and then it was windy enough out there. Yeah, it was probably like 15 that day and back on the generation. One way. That was pretty light women. Yeah. That's cool. Let's see. Oh, this one. This is cool. People talk about that one a lot. That was a fun session out on a board of Sean. It looks like your friend is almost on the nose of the boredom. Yeah. He had an old belly board. They put some foil tracks then. And I forgot how long it was. I think it was a two foot board. So the front of my front foot was basically off the edge and my back foot was pretty much the same. And it was just like a good, consistent day out a thousand peaks. And later that day I had my longest drive ever. That must be pretty hard to take off on that board though, right? Yeah. The only you can't catch the wave on it pretty much. So you have to beat you started, Oh, that's what you did. What was the beach started? That was the only way I could get it up on foil is the beach start. But this video is a little deceiving. Like people are like, Oh my God, how do you pump that far for that long on the inside. There's a rock wall and there's backwash coming off the wall. And so most of the way out, or pretty much all the way up back to the peak, you can get a decent backwash of so the whole time like pumping, I was less focused on my pumping efficiency and more focused on all right. How do I stay in the power of this tiny little backwash wave. Cool. So you basically time your kick-out with trying to find the pump. That's going back out again to take you back out. Yeah. And one thing that saves a lot of energy pumping back out into a wave is trying to stop pumping super early and glide into the wave. I catch myself a lot pumping all the way up until I'm going up the face and then turning when really I should be stopping 30 feet, 15, 30 feet before. And just gliding into it because then once you turn, you create more lift and then once you're on the face, then you don't. Yeah, I'll get the part, you can save a good three or four pounds. Interesting. I find like when I first started connecting ways that if I stopped pumping too early or turned too early on the wave, then I was basically drop off before I got on the wave. So it's kinda, you do want turn pretty high on that. So the other thing was pumping is staying as high as possible on your mask because by thing as high as possible, you store you story or your gravitational energy and you ranked in the possible glide slope and your wings also more efficient. Plus the surface. But if you come into doing that really high on your math, you can use that all that gravitational energy you've stored to collide into the wave. And then once you're on the wave, you have enough power to bring it back up again. Yeah. That makes sense. And so I guess that's the reason why you do do those kinds of short, quick pumps. So you don't like, you basically keep the mass pretty high out of the water and the foil closer to the surface. Yeah. Part of the short, quick pumps is they work really well from a body mechanics point where by changing how short, quick or long, like a shorter long your pumps are, you can stress your body in different ways. So a really long pump will be easier on your muscles but your heart and your lungs will work harder. The short pump are harder on your muscles, but don't stress your heart or lungs as much. So explain why do you think the foil creates more? It seems like the foil creates more lift when it's close to the water surface. Is it, or is it, is the reason why it's more efficient because there's less mass than the water and has less drag or is it because it just creates more lift when it's close to the surface? What's the, I don't have a solid answer on it, but I have a few theories. So one of them only left master the water that makes a big difference to you are moving, the foil is moving less water around itself, right? So th the low pressure side of the foil makes a lot of the lifts and it pulls a lot of water in that water column, above it down to make that lift. And by being closer to the surface, there's less water available to pull. And so before I was actually doing less work and making less drag I don't think you're making any more lifts, but you're definitely making less dry. The other part of it is by bringing your foil close to the surface. This is this the part I'm really not sure about this. You could be end plating the tip vortex, especially on really flat foils where. There, there might be some kind of interaction with the wingtip Portex and the surface of the water that reduces it. I see. So basically you, because you're closer to the surface, there's less room for it to create turbulence basically on the table. Yeah. I'm not sure about that because if you're really close to the surface that actually creates a wave and that could use more energy than I'm not sure about it, but definitely moving less water around appending, less water or less mass in the water. It makes a difference. Interesting. Yeah. I've been trying to figure out why that works. I've also noticed that there's definitely a ground effect. If you're pumping over shallow reef and the Reese right underneath you, you can go to push it. Yeah. Yeah. Something I do a lot winging is especially if there's a Sandy beach is go really fast towards shore and put the foil in six inches of water and try and glide down the beach as far as possible. So you got to stay super high and almost touch your foil. The bottom and see how far you can glide in ground effect only works for the flight wings. So generally I don't do it in six inches of water, but we have a spot where you have to go over the shallow reef to go come in, and and definitely, yeah, you feel like basically, even that lower speeds, you just got more lift off the foil when you're right up right over the grief. Yeah. I think the general rule on plans is that if you're within half your wingspan from the ground as a real effect or a noticeable effect, we can have your wingspan. So how long is this video? This is like a half minutes and you're still flying. It's amazing. I guess that was the dog that can't believe his eyes. Huh? G P is hilarious. Yeah. Yeah. The AI, if you haven't seen this video, you got to listen to the content comments commentary. Awesome. Yeah. Yeah. I almost want them to just hire the film and commentate on it because it's great. So hard to see this, but yeah. So yeah, so I actually started passing the wing behind my back when I'm going upwind on the waves, but I guess you're going downwind and then you're passing it in front of you on a bottom turn. So yeah. Talk a little bit about that. The technique. Yeah. It's mostly, I mostly do it. To control my upper body rotation. So by, by passing it to my front hand on the bottom, turn it left my shoulders, open up towards the face of the wave. And by switching it to my backhand on the top turn, I can actually twist my body around and point my front arm more far, farther, backwards. And more recently I've been, I've been using the wings power and leverage through turns. And my limitation is still when I do that I'm still working on it, but I like using the power of the wing on the top turn. But then your wing is still on your front hand. So on the way down and you have to switch it and open your hands up again, and it's hard to get your speed. You need a bunch of speed to get out in front of the wave for your next bottom term. So it's in progress to get some video of that soon. Let's talk a little bit about wing size. Okay. Do you what wing size do you like to use? Do you like to use a bigger wing for jumping or do you like to use a smaller wing for handling or what's I use, I have a two, five. I love when it's nuking and I have a bunch of sizes, but pretty much 99% of the time I use my two, five, or my three, five and the two fives. Great. But hard to get up, you need a seriously. And with the three, five, I can get a prone and probably 18 knots and I can get up, stand up in six months. Yeah. I guess probably you're always trying to, my theory is always try to use the smallest swing I can get up on, basically, because once you're up, you don't really need much of much wing size. Recently I found I don't need anything bigger than a three, five, three, five will get me up in the lowest wind. My foil can fly in. Which is about how many nights would you say six nights with the three, five wing? It's funny. Cause there was Rob whittle was saying that he likes to use like either a three more three meter for me here in that four meters is the biggest he uses now. And he can get up and tend to 12 knots. And there was a bunch of people that were commenting that's impossible and blah, blah, blah. But I have to agree that you can get up with a small wing and pretty light winds. Sometimes you might have to wait for a little gust or, and just really work at it. But once you're up, then you don't really don't need that much wing. It's really all dependent on your board. If you have a good board, you can get up with a much, much smaller wing and way less wins. So what kind of board is that you would use? I use my downwind stand up word. Didn't you say you need to have the planning speed to get that thing going. So you get it up to planning speed with a small way. Yeah. On my take off speeds, like eight, eight, nine miles an hour. But if I check in like when they get the different tailwind that probably lowers that about a four mile an hour. So a bigger tail wing or more angle on the tailwinds are both different funds okay. So a little bit thicker. Oh, okay. It's just a different, yeah. A different floor section and a little more cord. Interesting. So Lakeland like the front Wayne compared to the tail wing like in terms of, the effect it has on the foiling experience, like how would you compare it? Is it like 80, 20 or 70 30, or is it hard to start to hard to quantify? Steph would be 30 or 60. 40 is probably a a good number. Actually, no 70. So basically what I'm saying is, with the same front wing, about how much can you change it by changing the tail wing? It depends on how well tuned the rest of your setup is, but I'd probably give 50% or 60% till your full board box placement. And you're telling to me interesting. Wow. Yeah, those are good. It really makes a difference. Like it doesn't matter what frontline you're on. It'll ride good. If you're killing a student. And you're in, it's in the right spot on the board. And if it's off, then you're gonna, no matter what front line you're on, you're going to have a really hard time writing. Okay. I think we're going super long, but it's super interesting to me, so I'm sure other people will find it interesting as well. So I'm just going to keep going. So what was I going to say? Sorry. Oh, beginner. So if you have a friend that wants to learn how to wink foil, or you're taking out someone what are the, what are your tips? And what are some common mistakes people make and so on? So when I, every time I teach people first thing I do is put them on a reasonably sized foil, but put it all the way back in the box and further first few waves or for half of the first session or until they're comfortable have them take off and keep the board on the water, just have them keep the board on the water, ride, the wave like that don't even think about coming up. That'll get them. Wander their safety position and safely that's their safety safety move. They know how to keep it on the water. And the other thing that'll do is get them used to riding with a mask big mask at foil under their board. So once, once they're comfortable riding the board touched down on the water for the wave, then it's time to move the file forward a little bit and slowly start bringing it up on foil. It's nice to have a consistent way of the Harbor that, that, that is smooth water and decent power for a long time. And at least teach them a little bit beforehand. So they understand a little bit about how the field works, because that's another thing too, on the beach before they let them go in the wall. Yeah. Big time. Yeah. Yeah. Wing handling on the beach is huge. A big problem I see is people try and control the wind too much. Really what you want is your front arm is your anchor and your back arm does most of the control and just the weight of your back arm will keep the wing fine. So I, I teach people the way I learned cutting, which is sit on the beach and learn how to put and hold the wing in different positions. One, o'clock three, o'clock, two o'clock, one, o'clock 12 o'clock in the wind, the window. And and vary the power and just get comfortable and familiar with it before getting in the water. Because for a lot of people swinging they're getting on the foil board for the first time too. And it's a totally unfamiliar space where you're not comfortable with any part of it. And having some baseline understanding, and experience and building a tiny bit of muscle memory. We'll make a big improvement in their learning. It is said that he puts people on a, on the old wind surf board with the daggerboard in the middle, and then he just makes, and once they can go back and forth and stay up when then they're ready to go try the foil. And that's how he does it. And I've also heard people say that they put people on the board and just take the foil, the wings off the foil. So it's just the mask. So they can't busy, they can foil, but the mass has enough. It's like almost like a dagger board because it keeps you from drifting too much. So I thought that was a good idea. I've never tried it, but that's a good idea. Those are all good ideas taking the wings off the mask and make it a lot less stable though. So it would be interesting to make something that would bring that stability back almost like a keel for it. Just use it in Oakland. What if you took off the tail wing, but then would make it just I'll take off just the front link. Could work take off the front wing and the front wing. Yeah, that could work. Or maybe use a really small wing that doesn't, this is not going to lift. Cause I think even if you tell people don't lift off the water, once they start going fast and hard to control it, keep it from them. Yeah. That's the other thing I do teaching surf foiling is I never put them on a really big front wing. The first time I put them on like a front wing I would surf on. So that if they do lift, not like they can bring it back down and it's, they can control it. They can handle it, they can handle it. But I think for learning to wing foil is definitely an advantage of using a bigger wing because you end up having it's more stable and you can fly slower at lower speeds and you can take your time through transitions and stuff. So once you're comfortable going in and out yeah. If you're buying a new foil, don't get a big foil that lifts at low speeds basically. That's, is that what you would advise as well for beginners? Yeah, just get something easy to ride. My advice and a good board at the board table board, right? I think the new phonetic boards look nice. It was real simple bottom. The customs are always nice, but almost shapes for third grade. A lot of stuff out there works. Yeah. The equipment is definitely improving a lot. Like just the second and third generations of the wings are so much better than what we survive in the beginning, yeah. Another thing, a lot of people on the beach asked me about packing. A lot of people have trouble packing attacking you. Yeah. The biggest thing I noticed and actually Allen could, he's taught me, taught me how to attack is people switch the, switch, their hands on the wing way too late and that, so they'll go into attack and forget and don't switch their hands. And then they end up falling backwards or there's too much drag so an attack. If you come in with a decent amount of speed, you can actually switch your hand super early. And by switching your hands and bringing the wing over your head, it'll force the rest of your body and foil to follow and keep you in control the whole time. And that actually usually does the trick for people. So if anybody out there is having trouble typing, switch your hands super early. Yeah. That's a good tip. Usually works. And then talking to my dad because he learned to pack on his own. And he said, riding behind people who are going attacking and watching as they do it really helps. Yeah. I think what I've learned too is you want to throw the wing over your head. And with, I think with the backhand before you let it go, you kinda throw it so that it tips over, so that when it, when you grab it on the other side, it's already in the right position, you don't have to like, bring it over to the other side. Yeah. I, when I pack, I always give my backhand a little like push right. And let the momentum over the wing bank it over. So that way, when you grab it on the other side, it's already in the right position, you got power right away. You don't have to like, bring it back into the power position. Yeah. Totally. Those are good tips. Yeah. What about for the foiling part of the turn, I guess you want to keep the foil high, but not too. Like when I started attacking, I noticed I over foiled a lot. I would breech, I would go into like too fast, too high, and then I would focus on the wing and I would just breech cause I was going too fast. So I don't know. Yeah. I don't know. Just be comfortable with the foil and if you're comfortable breaching the tip. Of your waiting in thirds just a little bit, that'll help a lot because generally if you come into attack that the tip is going to come up a little bit I know just being comfortable and be comfortable with your drivers, be comfortable to be comfortable with your wing handling. And you should get it pretty fast. Yeah. Especially the front side tax, I find pretty easy, but the guy going backside is a little bit more tricky. Like when you have to throw it behind, grab it. Yeah. And then for the more advanced riders, if you want to get a better acceleration of your tax as you come through the wind and down use progressively more back foot pressure. If you come up, when you get back on the power, you want to be as high on the mask as possible, because then you can accelerate down the math and yeah. Your gravitational potential energy. That's a good pointer. I've noticed too. Like when I kick out of a wave and attack, kicking out, like once I get over the tip of the wave, I actually point

Stridor is a noun that refers to a harsh, grating sound. The Latin word stridere (STREE dare ay) means ‘to creak.’ Around the mid 17th century, this word was imported into English and became our word of the day, which is a synonym of creak or other harsh sounds. The stridor coming from my car’s engine irked me on the road trip. Imagine a harsh creak for four hours. That’s describes my road trip through South Dakota.

Show notes at pharmacyjoe.com/episode562. In this episode, I’ll discuss how racemic epinephrine via nebulization is thought to help treat stridor. The post 562: How does racemic epinephrine via nebulization help treat stridor? appeared first on Pharmacy Joe.

Encouraging research for targeting location of stem cell therapies; Flavonoid-rich chocolate is good for your brain! Hyperbaric oxygen treatments prove to help longevity; Difficulty swallowing because of esophageal spasm; Follow up on woman with stridor -- sounds when breathing in and out; The physiology of eating a big meal, how the hormones are supposed to work and practical advice; Side effect of a birth control pill is explored; Could Long COVID symptoms be related to PTSD and treated with hyperbaric O2? Why do children do better with COVID-19? More about hyperbaric oxygen and COVID-19

Encouraging research for targeting location of stem cell therapies; Flavonoid-rich chocolate is good for your brain! Hyperbaric oxygen treatments prove to help longevity; Difficulty swallowing because of esophageal spasm; Follow up on woman with stridor -- sounds when breathing in and out; The physiology of eating a big meal, how the hormones are supposed to work and practical advice; Side effect of a birth control pill is explored; Could Long COVID symptoms be related to PTSD and treated with hyperbaric O2? Why do children do better with COVID-19? More about hyperbaric oxygen and COVID-19

In this episode, we cover the lesser of evil stridor aetiologies: Vocal cord dysfunction, a.k.a paradoxical vocal cord motion, a.k.a Paradoxical Vocal Fold Movement. Read the post, then listen to review approach, diagnostic modalities (fibre-optic visualization, CT scan to rule out other entities) and treatment.

This episode covers laryngomalacia.Written notes can be found at https://zerotofinals.com/paediatrics/respiratory/laryngomalacia/ or in the respiratory section in the Zero to Finals paediatrics.The audio in the episode was expertly edited by Harry Watchman.

In this episode, we discuss the use of prophylactic corticosteroids for patients at high risk of reintubation. Please leave us a comment for your chance to win a medically-related prize! References:Kuriyama A, et al. Prophylactic corticosteroids for prevention of postextubation stridor and reintubation in adults: a systematic review and meta analysis. CHEST. 2017; 151(5): 1002-1010Girard TD, et al. An official American Thoracic Society/ American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults. Am J Respir Crit Care Med. 2017; 195(1): 120-133

Our guest today is Dr. Tiara Calhoun (@tiaraforsyth), an internal medicine resident at the Massachusetts General Hospital.  She is an active contributor to FLARE (Fast Literature Assessment and Review), a newsletter that appraises the rapidly evolving literature on SARS-CoV-2.  Check FLARE out here: https://www.massgeneral.org/news/coronavirus/treatment-guidance/fast-literature-updates An additional question for our listeners to dive into is the optimal timing of steroid administration. Let us know what you find!  Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- Full references on Episode Webpage.  https://us19.campaign-archive.com/?u=ef98149bee3f299584374540a&id=fe09c50f3a

In this episode, Dr. Tipton answers listener questions on safety issues faced by people with multiple system atrophy (MSA). Topics include difficulties regulating ones blood pressure and urinary function, speech and swallowing difficulties, as well as a very serious issue of particular sleep disturbances. These issues are common in MSA and some can be life-threatening.

Türkiye'den Avrupa, İngiltere ve ABD Board sınavlarına giren meslektaşlarımla ilgili birçok haber alıyorum. Pediyatrinin travma dışı konuları ile ilgili sorular bu sınavlarda sıkça karşımıza çıkıyor ancak bu soruları yanıtlamak için bence TUKMOS’un Acil Tıp Eğitimi Müfredatı’na aldığı konulardan bir adım daha detaylı bilgiler gerekiyor. Türkiye'de yeni yeni oturan yeterlilik sınavının sorularına göz atma fırsatım olmadı ama diğer sınavların içeriklerinden çok farklı olmadığını tahmin ediyorum. Dolayısıyla hem günlük yaşamında daha çok pediyatrik hasta bakan meslektaşlarıma hem de board sınavlarına hazırlanan acil tıp doktorlarına faydalı olmasını umduğum bu yazıda sık karşımıza çıkan akut stridor ile ilgili pratik birkaç bilgiyi paylaşmak istedim. Travma dışı pediyatrik acillerler her zaman kendimi çok güvende hissetmediğim bir alan oldu. Halit Aytar’ın pediyatrik hastaya yaklaşım yazısı benim gibi hisseden herkes için kesinlikle faydalı bir kaynak. Stridor Nedir? Daralan havayolundan geçen türbülanslı havanın oluşturduğu sese stridor diyoruz. Normalde glottis üzeri havayolu tıkanıklarında duyulan, inspiratuar kökenli solunum sesidir. Ekspiratuar olursa trakeobronşiyal tıkanıklıkları düşündürür. Eğer bifazik duyuluyorsa hem subglottik hem glottik tıkanıklık akla gelmelidir. (trakeomalazi, laringomalazi gibi) Stridorun ses yüksekliği tıkanıklığın derecesi ile ilişkili değildir. Sesin giderek azalıyor olması ya kliniğin iyileştiğine ya da tıkanıklığın parsiyel halden tam tıkanıklık haline yaklaştığını gösterdiğinden dikkat edilmesi gereken bir bulgudur. Fizyoloji derslerinden aklımızda kalan Poiseuilles Yasasına göre havayolu çapındaki 1 birim azalma, hava geçimine direçte çapın 4. Kuvveti kadar etki göstereceğinden klinikteki yansıması oldukça dramatik oluyor. pediyatrik havayolu Stridordan bahsederken pediyatik havayolu anatomisindeki farklılıkları gözardı etmemeliyiz. Zeretzke-Bien C.M. (2018) Airway: Pediatric Anatomy, Infants and Children. In: Zeretzke-Bien C., Swan T., Allen B. (eds) Quick Hits for Pediatric Emergency Medicine. Springer, Cham Erişkine göre daha kolay kollaps olabilen, aksesuar kasların daha güçsüz olması nedeniyle daha az destek alan bir yapı. Şekil olarak erişkindeki silindirik borudan ziyade giderek çapı daralan bir koniye daha yakın. Bunun yanında kaslar ve özellikle diyafram erişkine göre daha kolay yorulabiliyor. Kotlar yine erişkindekine göre daha paralel. Tüm bunlar havayolunun verimliliğini azaltıyor. Ayrıca fonksiyonel rezidüel kapasitenin daha küçük, respiratuar rezervin daha az olması daha hızlı dekompansasyona yol açıyor. Bütün bunlar pediyatrik havayolunu erişkine göre daha az dayanıklı yapıyor. Stridor sebepleri Akut stridorun yaklaşık %80’i Krup kaynaklı olarak gözleniyor. Geri kalan %20'lik grupta yaşamı tehdit edebilecek birçok sebep var. Stridor sebeplerini yaşa ya da akut-kronik olmasına göre ayırabileceğimiz gibi görülme sıklığına göre de gruplayabiliriz. SıkDaha NadirÇok Nadir KrupEpiglotitAnjyonörotik ödem Subglottik tıkanıklıklara veya laringomalaziye eşlik eden enfeksiyonlarBakteriyel TrakeitDifteri (özellikle aşısız grupta) Yabancı cisimlerRetrofaringeal abse Anaflaksi Bilateral tonsillit veya pertonsiller abse Akut stridor sebepleri genellikle enfeksiyöz veya inflamatuar kökenliyken, kronik stridor laringomalazi, trakeomalazi, konjenital larinks malformasyonları (hemanjiyom, laringeal web vs) gibi yapısal bozukluklar ve vokal kord fonksiyon bozukluklarında gözlenebilir. Krup Burak Bekgöz’ün krupla ilgili detaylı yazısına buradan ulaşabilirsiniz. Kısaca değinmek gerekirse krup havayolunun inflamasyonu nedeniyle oluşan üst havayolu tıkanıklığı. Tipik etkeni Parainfluenza virus tip 1 veya 3. En sık 6-36 ay arasında görülüyor, 12-24 ayda peak yapıyor. Erkeklerde 1.5 kat daha sık görülüyor. NICE kılavuzuna göre (2019) krup ciddiyetine göre 3’e ayrılıyor: ...

Türkiye’den Avrupa, İngiltere ve ABD Board sınavlarına giren meslektaşlarımla ilgili birçok haber alıyorum. Pediyatrinin travma dışı konuları ile ilgili sorular bu sınavlarda sıkça karşımıza çıkıyor ancak bu soruları yanıtlamak için bence TUKMOS’un Acil Tıp Eğitimi Müfredatı’na aldığı konulardan bir adım daha detaylı bilgiler gerekiyor. Türkiye’de yeni yeni oturan yeterlilik sınavının sorularına göz atma fırsatım olmadı …

Show notes at pharmacyjoe.com/episode443. In this episode, I’ll discuss what dose of steroids can prevent post-extubation stridor. The post 443: What dose of steroids can prevent post-extubation stridor? appeared first on Pharmacy Joe.

A look at one of the most common and potentially concerning upper respiratory infections in children. Host: Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Croup.mp3 Download One Comment Tags: Airway, Infectious Diseases, Pediatrics Show Notes Background Croup is a viral infection starts in the nasal and pharyngeal mucosa but spreads to the larynx and trachea Subglottic narrowing from inflammation Dynamic obstruction Barking cough Inspiratory stridor Causes: Parainfluenza virus (most common) Rhinovirus Enterovirus RSV Rarely: Influenza, Measles Age range: 6 months to 36 months Seasonal component with high prevalence in fall and early winter Differential Bacterial tracheitis Acute epiglottitis Inhaled FB Retropharyngeal abscess Anaphylaxis Presentation & Diagnosis Classically a prodrome of nonspecific symptoms for 1-3 days with low grade fevers, congestion, runny nose. Symptoms reach peak severity on the 4th day “Steeple sign” on Xray (subglottic narrowing) present in only 50% of patients with croup Assess air entry, skin color, level of consciousness, for tachypnea, if there are retractions / nasal flaring (if present at rest or with agitation) & coughing “Westley Croup Score” (https://www.mdcalc.com/westley-croup-score) Chest wall retractions Stridor Cyanosis Level of consciousness Air entry Management

A look at one of the most common and potentially concerning upper respiratory infections in children. Host: Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Croup.mp3 Download Leave a Comment Tags: Airway, Infectious Diseases, Pediatrics Show Notes Background Croup is a viral infection starts in the nasal and pharyngeal mucosa but spreads to the larynx and trachea Subglottic narrowing from inflammation Dynamic obstruction Barking cough Inspiratory stridor Causes: Parainfluenza virus (most common) Rhinovirus Enterovirus RSV Rarely: Influenza, Measles Age range: 6 months to 36 months Seasonal component with high prevalence in fall and early winter Differential Bacterial tracheitis Acute epiglottitis Inhaled FB Retropharyngeal abscess Anaphylaxis Presentation & Diagnosis Classically a prodrome of nonspecific symptoms for 1-3 days with low grade fevers, congestion, runny nose. Symptoms reach peak severity on the 4th day “Steeple sign” on Xray (subglottic narrowing) present in only 50% of patients with croup Assess air entry, skin color, level of consciousness, for tachypnea, if there are retractions / nasal flaring (if present at rest or with agitation) & coughing “Westley Croup Score” (https://www.mdcalc.com/westley-croup-score) Chest wall retractions Stridor Cyanosis Level of consciousness Air entry Management Mild Croup

A 2-year old with severe stridor. What are different types of stridor, causes and management of stridor, extrathorcic and intrathoracic airway obstrution.

This podcast covers chronic stridor in children, including differentiating stridor from wheeze, major causes of stridor, appropriate investigations, and management.  This podcast was developed by Hannah Kraicer-Melamed a student at McMaster University and Dr. Jonathan Rayment is a Pediatric Respirologist at B.C. Children’s Hospital.

Chris is joined by Dr. Alicia Apple a pediatric emergency physician who is passionate about helping EMS grow in the care of pediatric patients. In a new segment we like to call “Apple Time” we kick things off with a conversation about the assessment of stridor during different phases of life for pediatric patients.  We would love for you to subscribe and rate Mind Body Medic on iTunes or other podcast apps! We can’t tell you how much we appreciate you listening and joining in on the discussion!

In the November 2018 episode of the JAAPA Podcast, hosts Kris Maday and Adrian Banning discuss CME articles on post-traumatic stress disorder in combat veterans and preventing sudden infant death syndrome. Our co-hosts also review articles on infectious mononucleosis and the causes of congenital stridor in infants. Plus, what do PAs and mashed potatoes have in common?   We would love to hear your thoughts on on the podcast! Leave a review on Apple Podcasts or Stitcher and find JAAPA and our podcast hosts on Twitter!

Dr Sarah Simons and Dr Ian Lewins make a series of silly noises as they discuss stridor and croup, and manage not to fall out over the dosage of dexamethasone.

Show notes at pharmacyjoe.com/episode308. In this episode, I ll discuss the causes, treatment, and prevention of stridor. The post 308: Causes, treatment, and prevention of stridor appeared first on Pharmacy Joe.

Find the show on twitter @potu4motu and find me in stocks in the town square where rotten tomatoes will be thrown at me for run on sentences and thinking Stridor not Strider was in the episode.

Ian Jacobs, MD, Medical Director of the Center for Pediatric Airway Disorders at Children's Hospital of Philadelphia, discusses common causes of stridor, including croup, foreign body aspiration, and laryngomalacia. He also talks about the most dangerous foreign body ingestions in young children and the latest clinical advances and research underway in the airway clinic at CHOP. Published February 2018. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2018 by Children's Hospital of Philadelphia, all rights reserved.

Often regarded as one of the "lame" characters, it's our opinion that while a little out there in some ways, Fisto is an obviously unique and completely wonky character, worthy of a place at the Masters of the Universe table. We also briefly discuss the robotic horse, Stridor, and we also delve a little into dsome 2019 MOTU film discussion! All of this, and a little more on this episode of Make Eternia Great Again!                      

Select segment from PediaCast. For full-length episodes, visit PediaCast.org, Apple Podcasts, Google Play, Stitcher, Tune-In, iHeart Radio, Spotify or wherever else podcasts are found!

You have all of the skills you need to care for an acutely ill infant.  Learn a few pearls to make this a smoother endeavor. The Pediatric Assessment Triangle is a rapid, global assessment tool using only visual and auditory clues to make determinations on three key domains: appearance, work of breathing, and circulation to the skin.  The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Appearance "TICLS"Tone - the newborn should have a normal flexed tone; the 6 month old baby who sits up and controls her head; the toddler cruises around the room. Interactiveness - Does the 2 month old have a social smile?  Is the toddler interested in what is going on in the room?  Consolability - A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise.  Look/gaze - Does the child track or fix his gaze on you, or is there the "1000-yard stare"? Speech/cry - A vigorously crying baby can be a good sign, when consolable - when the cry is high-pitched, blood-curling, or even a soft whimper, something is wrong.  If the child fails any of the TICLS, then his appearance is abnormal. Work of Breathing Children are respiratory creatures - they are hypermetabolic - we need to key in on any respiratory embarrassment. Look for nasal flaring.   Uncover the chest and abdomen and look for retractions.  Listen - even without a stethoscope - for abnormal airway sounds like grunting or stridor.  Grunting is the child's last-ditch effort to produce auto-PEEP.  Stridor is a sign of critical upper airway narrowing.Look for abnormal positioning, like tripodding, or head bobbing Circulation to the skin Infants and children are vasospastic - they can change their vascular tone quickly, depending on their volume status or environment.  Without even having to touch the child, you can see signs of pallor, cyanosis, or mottling.  If any of these is present, this is an abnormal circulation to the skin. Pattern of Abnormal Arms = Category of Pathophysiology Differential Diagnosis in a Sick Infant: "THE MISFITS"     Trauma - birth trauma, non-accidental - check for a cephalohematoma which does not cross suture lines and feels like a ballotable balloon, as well as for subgaleal hemorrhage, which is just an amorphous bogginess that represents a dangerous bleed.  Do a total body check.     Heart disease or Hypovolemia - is there a history of congenital heart disease? Was there any prenatal care or ultrasound done?  Does this child look volume depleted?     Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock? Look for clitoromegaly in girls, or hyperpigmented scrotum in boys.  Could this be congenital hypothyroidism with poor tone and poor feeding?  Any history of maternal illness or medications? Congenital hyperthyroidism with high output failure?     Metabolic - What electrolyte abnormality could be causing this presentation? Perhaps diGeorge syndrome with hypocalcemia and seizures?      Inborn Errors of Metabolism - there are over 200 inborn errors of metabolism, but only four common metabolic pathways that cause a child to be critically ill.  Searching for an inborn error of metabolism is like looking for A UFO - amino acids, uric acids, fatty acids, organic acids.  If the child's ammonia, glucose, ketones, and lactate are all normal in the ED, then his presentation to the ED should not be explained by a decompensation of an inborn error of metabolism.        Seizures - Neonatal seizures can be notoriously subtle - look for little repetitive movements of the arms, called "boxing" or of the legs, called "bicycling"     Formula problems - Hard times sometimes prompt parents to dilute formula, causing a dangerous hyponatremia, altered mental status, and seizures.  Conversely, concentrated formula can cause hypovolemia     Intestinal disasters - 10% of necrotizing enterocolitis occurs in full-term babies - look for pneumatosis intestinalis on abdominal XR; also think about aganglionic colon or Hirschprung disease; 80% of cases of volvulus occur within the 1st month of life     Toxins - was there some maternal medication or ingestion?  Is there some home remedy or medication used on the baby?  Check a glucose ad drug screen     Sepsis - Saved for last - You'll almost always treat the sick neonate empirically for sepsis - think of congenital and acquired etiologies. Hyperoxia TestThe hyperoxia test is the single most important initial test in suspected congenital heart disease - we can test the child's circulation by his reaction to oxygen on an arterial blood gas.  Place the child on a non-rebreather mask, and after several minutes, perform an ABG.  (Ideally you obtain a preductal ABG in the right upper extremity, and compare that with one on the lower extremity, but this may not be practical.) In a normal circulatory system, the pO2 should be high - in the hundreds - and certainly over 250 torr. This effectively excludes congenital heart disease as a factor.  If the pO2 on supplemental oxygen is less than 100, then this is extremely predictive of hemodynamically significant congenital heart disease.  Between 100 and 250, you have to make a judgement call, and I would side on worst first. If you are giving this child 100% O2, and he doesn't improve 100% -- that is, his ABG is not at least 100 - then he has congenital heart disease until proven otherwise.  Give prostaglandin if the patient is less than 4 weeks old (typical presentation is within the first 1-2 weeks of life).  Start at 0.05 mcg/kg/min.  PGE keep the systemic circulation supplied with some mixed venous blood until either surgery or palliation is decided.  Summary Points* When you see a sick infant, keep THE MISFITS around to keep you out of trouble.* Before you decide on sepsis, ask yourself, could this be a cardiac problem?* When in doubt, perform the hyperoxia test.* All the rest, you have time to look up. Before You Go: The Availability HeuristicSelected References Brousseau T, Sharieff GQ. Newborn Emergencies: The First 30 Days of Life. Pediatr Clin N Am. 2006; 53:69-84. Cloherty JP, Eichenwald EC, Stark AR: Manual of Neonatal Care, 5th edition. Philadelphia, PA, Lipincott Williams & Wilkins, 2004. Horeczko T, Young K: Congenital Heart Disease, in Pediatric Emergency Medicine-A Comprehensive Study Guide, 4th Ed. ACEP/McGraw-Hill, 2013. McGowan et al. Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines. Circulation. 2010;122:S909-S919. Okada PJ, Hicks B. Neonatal Surgical Emergencies. Clin Ped Emerg Med. 2002; 3:3-13.

This podcast deals with stridor. Five common causes of acute stridor are discussed, along with the appropriate management in each case. This podcast was written by Chris Gerdung and reviewed by Dr. Melanie Lewis. Chris is a medical student at the University of Alberta. Dr. Lewis is a general pediatrician at the Stollery Children’s Hospital in Edmonton. She is also the Year 3 Clerkship Director for Pediatrics at the University of Alberta. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes. You can find more great pediatrics content on www.pedscases.com. Related Content: Case: Breathing difficulty in a 12 year old boy Case: Fever, cough and stridor in a 4 year old girl Case: Foreign body aspiration in an infant Case: Fever and sore throat in a 3 year old male Case: Runny nose, cough and sore throat in a 2 year old girl

What is the role of giving an adult steroids to prevent stridor or reintubation following extubation.    This epidose looks at the data.