Podcasts about swan ganz

CardioNerds Critical Care Cardiology Council members Dr. Gurleen Kaur and Dr. Katie Vanchiere meet with Dr. Yash Patel, Dr. Akanksha, and Dr. Mohammed El Nayir from Trinity Health Ann Arbor. They discuss a case of pulmonary air embolism, RV failure, and cardiac arrest secondary to an ocular venous air embolism. Expert insights provided by Dr. Tanmay Swadia. Audio editing by CardioNerds Academy intern, Grace Qiu. A 36-year-old man with a history of multiple ocular surgeries, including a complex retinal detachment repair, suffered a post-vitrectomy collapse at home. He was found hypoxic, tachycardic, and hypotensive, later diagnosed with a pulmonary embolism from ocular venous air embolism leading to severe right heart failure. Despite a mild embolic burden, the cardiovascular response was profound, requiring advanced hemodynamic support, including an Impella RP device (Abiomed, Inc.). Multidisciplinary management, including fluid optimization, vasopressors and mechanical support to facilitate recovery. This case underscores the need for early recognition and individualized intervention in cases of ocular venous air embolism. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest Hypoxia, hypotension and tachycardia in a patient following ocular instrumentation are classic findings suggestive of pulmonary embolism from possible air embolism. The diagnosis of RV failure is based on clinical presentation, echocardiographic findings (such as McConnell's sign), and invasive hemodynamic assessment via right heart catheterization. Mechanical circulatory support can be considered as a temporary measure for patients with refractory RV failure. Central Figure: Approach to Pulmonary Embolism with Acute RV Failure Notes - Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest 1. What is an Ocular Venous Air Embolism (VAE), and how can it be managed in critically ill patients? An Ocular Venous Air Embolism is defined as the entry of air into the systemic venous circulation through the ocular venous circulation, often during vitrectomy procedures. Early diagnosis is key to preventing cardiovascular collapse in cases of Ocular Venous Air Embolism (VAE).  The goal is to stop further air entry. This can be done by covering the surgical site with saline-soaked dressings and checking for air entry points. Adjusting the operating table can help, especially with a reverse Trendelenburg position for lower-body procedures. The moment VAE is suspected, discontinue nitrous oxide and switch to 100% oxygen. This helps with oxygenation, speeds up nitrogen elimination, and shrinks air bubbles. Hyperbaric Oxygen Therapy can reduce bubble size and improve oxygenation, especially in cases of cerebral air embolism, when administered within 6 hours of the incident. Though delayed hyperbaric oxygen therapy can still offer benefits, the evidence is mixed. VAE increases right heart strain, so inotropic agents like dobutamine can help boost cardiac output, while norepinephrine supports ventricular function and systemic vascular resistance, but this may also worsen pulmonary resistance.  Aspiration of air via multi-orifice or Swan-Ganz catheters has limited success, with success rates ranging from 6% to 16%. In contrast, the Bunegin-Albin catheter has shown more promise, with a 30-60% success rate. Catheterization for acute VAE-induced hemodynamic compromise is controversial, and there's insufficient evidence to support its ...

In today's episode of the Legal Nurse Podcast, we delve into the life-saving world of cardiac stents with expert cardiologist Joshua Willis. Discover the evolution of stents, from their inception to their transformative role in treating heart disease. Joshua shares insights into the critical procedures that follow stent insertion and navigates the complexities of balancing patient care with available resources. You'll discover how these medical advancements have changed lives and the collaborative decision-making involved in this vital field. Tune in and explore the fascinating journey of cardiac care! Heart Procedures: Cardiac Stents and Beyond Addresses these Questions: Join us for this episode, during which we discuss these questions. How did the concept of cardiac stents develop, and who was a key figure in their development? What are the differences between bare metal stents and drug-eluting stents, and how do they function in preventing coronary artery blockages? What are the typical medications used post-stent insertion to prevent clot formation, and why are they crucial? How does the radial approach differ from the femoral approach in cardiac procedures, and why has it become more favored? What role does shared governance play in deciding between stent insertion and coronary artery bypass surgery for a patient? Listen to our podcasts or watch them using our app, Expert.edu, available at legalnursebusiness.com/expertedu. Get the free transcripts and also learn about other ways to subscribe. Go to Legal Nurse Podcasts subscribe options by using this short link: http://LNC.tips/subscribepodcast. Are you finding it tough to Grow Your LNC Business? You are not alone! Join us for the 12th LNC SUCCESS® 3-DAY ONLINE CONFERENCE on November 13, 14, & 15, 2025! It's a chance to learn how to overcome common challenges and gain the skills you need to succeed in legal nurse consulting. Connect with industry experts who will share practical strategies for standing out, building strong relationships with attorneys, and effectively presenting your value. No matter your experience level, this conference will empower you to discover fresh opportunities and advance your business. What to Expect Expert-Led Sessions: Engage with sessions led by top industry professionals. Interactive Workshops: Participate in hands-on workshops designed to enhance your consulting skills. Networking Opportunities: Build lasting connections with peers and potential clients. Resource Materials: Receive exclusive materials that will support your ongoing professional development. Don't miss this chance to make a real impact on your business. Register Today Secure your spot at the 12th LNC SUCCESS® 3-DAY ONLINE CONFERENCE on November 13, 14, & 15, 2025, and take your first step toward becoming a leading legal nurse consultant! We look forward to welcoming you to this pivotal event in February 2025! Your Presenter for Heart Procedures: Cardiac Stents and Beyond Joshua M Willis, MD Dr. Willis completed a cardiology fellowship at the Cleveland Clinic Foundation (2007-2010) and an Interventional Cardiology fellowship at the University of Florida (2010-2011).       In 2011, he took a private cardiology practice job in Chattanooga, Tennessee, splitting his time between hospital-based procedures (cardiac catheterizations, percutaneous coronary interventions, Swan Ganz catheterization for invasive hemodynamic measurements, Impella device placement etc.) and clinic duties, and seeing approximately 24-26 patients per full clinic day. His job responsibilities at Wellstar include three days in the hospital, providing Interventional and General Cardiology coverage and 1.5 days in clinic seeing outpatients, total of 35-40 outpatient visits per week. Connect with Joshua M Willis, MD by email at cardioexpertwitness@gmail.com,

There was time during the early 70's when the field of oncology began to take hold where the singular focus was to extend the patient's life. In this ASCO Education podcast, our guest was one of the first to challenge that notion and rethink methods that focused the patient's QUALITY of life. Dr. Patricia Ganz joins us to describe her transition from cardiology to oncology (6:00), the moment she went beyond treating the disease and began thinking about treating the WHOLE patient (10:06) and the joy of the increasing numbers of patients who survive cancer (21:47).  Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Patricia Ganz: Leadership - Intrinsic LifeSciences  Stock and Other Ownership Interests - xenon pharma,  Intrinsic LifeSciences, Silarus Therapeutics, Disc Medicine, Teva,  Novartis, Merck. Johnson & Johnson, Pfizer, GlaxoSmithKline, Abbott Laboratories Consulting or Advisory Role - Global Blood Therapeutics, GSK, Ionis, akebia, Rockwell Medical Technologies, Disc Medicine, InformedDNA, Blue Note Therapeutics, Grail Patents, Royalties, Other Intellectual Property - related to iron metabolism and the anemia of chronic disease, Up-to-Date royalties for section editor on survivorship Resources If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT  Disclosures for this podcast are listed on the podcast page.   Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: The field of oncology is relatively new. The first person treated with chemotherapy was in the 1940s. Medical oncology was just recognized as a specialty during the 1970s. And while cancer was considered by most people to be a death sentence, a steady growth of researchers sought to find cures. And they did for many cancers. But sometimes these treatments came at a cost. Our next guest challenged the notion that the singular focus of oncology is to extend the patient's duration of life. She asked whether an oncologist should also focus on addressing the patient's quality of life.  Dave Johnson: The doctor asking that question went to UCLA Medical School, initially planning to study cardiology. However, a chance encounter with a young, dynamic oncologist who had started a clinical cancer ward sparked her interest in the nascent field of oncology. She witnessed advances in cancer treatment that seemingly took it from that inevitable death sentence to a potentially curable disease. She also recognized early on that when it came to cancer, a doctor must take care of the whole patient and not just the disease.  From that point forward, our guest has had a storied career and an incredible impact on the world of cancer care. When initially offered a position at the West LA VA Medical Center, she saw it as an opportunity to advance the field of palliative care for patients with cancer. This proved to be one of her first opportunities to develop a program that incorporated a focus on quality of life into the management of cancer. Her work also focused on mental, dietary, physical, and emotional services to the long-term survivors of cancer.  That career path has led to many accomplishments and numerous accolades for our guest. She is a founding member of the National Coalition for Cancer Survivorship, served as the 2004 Co-chair of ASCO's Survivorship Task Force, and currently directs UCLA's Cancer Survivorship Center of Excellence, funded in part from a grant from Livestrong. Our guest is Dr. Patricia Ganz. Dr. Patricia Ganz: It's great to be with both of you today. Dave Johnson: We always like to ask our guests a little about their background, where they grew up, a little about their family. Dr. Patricia Ganz: Yes. I grew up in the city of Beverly Hills where my parents moved when I was about five years old because of the educational system. Unlike parts of the East Coast, we didn't have very many private schools in Los Angeles, and so public education was very good in California at that time. So I had a good launch and had a wonderful opportunity that many people didn't have at that time to grow up in a comfortable setting. Dave Johnson: Tell us about your mom. I understand she was a businesswoman, correct? Dr. Patricia Ganz: Yes, actually, my parents got married when my mom was 19 and my dad was 21. He was in medical school at the University of Michigan. His father and mother weren't too happy with him getting married before he could support a wife. But she worked in a family business in the wholesale produce business in Detroit. One of six children, she was very involved with her family in the business. And they were married, and then World War II started, my father was a physician in the military, so she worked in the family business during the war. After finally having children and growing up and being in Beverly Hills, she sat back and was a homemaker, but she was always a bit restless and was always looking for something to do. So wound up several years later, when I was in my early teens, starting a business with one of my uncles, an automobile parts business. They ultimately sold it out to a big company that bought it out.  Pat Loehrer: Where did your father serve in World War II? Dr. Patricia Ganz: He was actually D-Day Plus 21. He was in Wales during the war. They had to be stationed and moved down into the south before he was deployed. I have my parents' correspondence and letters from the war. He liberated some of the camps. Actually, as I have learned about the trauma of cancer and post-traumatic stress that happens in so many people, our military veterans, most recently, I think he had post-traumatic stress. He didn't talk very much about it, but I think liberating the camps, being overseas during that time, as it was for that silent generation, was very profound in terms of their activities.   He wound up practicing medicine, and Los Angeles had a practice in industrial medicine, and it was a comfortable life. He would work early in the morning till maybe three or four in the afternoon and then go to the gym, there were moonlighting physicians who worked in the practice. But I kind of saw an easy kind of medicine, and he was always very encouraging and wanted me to go into medicine -- that I could be an ophthalmologist or a radiologist, good job for a woman. But I didn't really see the tough life of some of the internists and other people who were really working more 24/7, taking care of patients in the way medicine used to be practiced. Dave Johnson: Yeah. So you were interested in, early in your career, in cardiology. Could you tell us about that, and then a little bit more about the transition to oncology?  Dr. Patricia Ganz: I went away to college, I went to Harvard Radcliffe and I came home during the summers. And was interested in doing something during the summer so I actually in a pediatric cardiology research laboratory as a volunteer at UCLA for a couple of summers between my freshman and sophomore year then my sophomore and junior year. And then I actually got a California Heart Association Fellowship between my junior and senior year in college.  And this pediatric cardiology lab was very interesting. They were starting to give ketamine, it had an identification number, it wasn't called ketamine. But they were giving it to children in the cardiac cath lab and then were very worried about whether it would interfere with measuring the pressures in the heart. So we had intact dogs that had catheters implanted in the heart, and the drug would be given to the animals and we would then measure their pressures in the heart.  That cardiology experience in 1970, the summer between my first and second year of medical school, the Swan-Ganz catheter was being tested. I worked at Cedars that summer and was watching them do the various studies to show the value of the catheter. And so by the time I was kind of finishing up medical school, I'd already invested all this time as an undergraduate. And then a little bit when I was in medical school and I kind of understood the physiology of the heart, very exciting. So that's kind of where I was headed until we started my internship. And I don't know if any of you remembered Marty Cline, but he was the oncologist who moved from UCSF to Los Angeles to start our hem-onc division. And very exciting, a wonderful bedside teacher.   And so all of a sudden, I've never been exposed to oncology and this was very interesting. But at the same time, I was rotating through the CCU, and in came two full-arrest patients, one of whom was a campus cop who was very obese, had arrested at his desk in the police station. And we didn't have emergency vehicles to help people get on campus at that time. This was 1973 or 1974, something like that. And he came in full arrest, vegetable. And then another man had been going out of his apartment to walk his dog and go downstairs, and then all of a sudden his wife saw him out on the street being resuscitated by people. And he came in also in full arrest.   So those two experiences, having to deal with those patients, not being able to kind of comfort the families, to do anything about it. As well as taking care of patients in my old clinic who had very bad vascular disease. One man, extremely depressed with claudication and angina, all of a sudden made me feel, “Well, you know what? I'm not sure I really want to be a cardiologist. I'm not sure I like the acute arrest that I had to deal with and the families. And also, the fact that people were depressed and you couldn't really talk to them about how serious their disease was.” Whereas I had patients with advanced cancer who came in, who had equally difficult prognoses, but because of the way people understood cancer, you could really talk about the problems that they would be facing and the end-of-life concerns that they would have.  So it was all of those things together that made me say, “Hmm.” And then also, Pat, you'll appreciate this, being from Indiana, we were giving phase II platinum to advanced testicular cancer patients, and it was miraculous. And so I thought, “Oh my gosh, in my lifetime, maybe cancer is going to be cured! Heart disease, well, that's not going to happen.” So that was really the turning point.   Pat Loehrer: When many of us started, we were just hoping that we could get patients to live a little bit longer and improve the response rate. But you took a different tack. You really looked at treating the whole patient, not just the disease. That was really a novel approach at the time. What influenced you to take that step forward? Dr. Patricia Ganz: Well, it was actually my starting– it was thought to be in a hospice ward. It would turn out it was a Sepulveda VA, not the West LA VA, but in any case, we have two VAs that are affiliated with UCLA. And it was an intermediate care ward, and there was an idea that we would in fact put our cancer patients there who had to have inpatient chemotherapy so they wouldn't be in the acute setting as well as patients who needed to travel for radiation. Actually, the West LA VA had a hospice demonstration project. This is 1978. It's really the beginning of the hospice movement in England, then in Canada, Balfour Mount at Montreal and McGill was doing this. And so I was very much influenced by, number one, most of our patients didn't live very long. And if you were at a VA Hospital, as I was at that time, you were treating patients with advanced lung cancer, advanced colon cancer, advanced prostate cancer, other GI malignancies, and lung cancer, of course. So it was really the rare patient who you would treat for curative intent.  In fact, small cell lung cancer was so exciting to be treating in a particularly limited small cell. Again, I had a lot of people who survived. We gave them chemo, radiation, whole brain radiation, etc. So that was exciting. This was before cisplatin and others were used in the treatment of lung cancer. But really, as I began to develop this ward, which I kind of thought, “Well, why should we wait just to give all the goodies to somebody in the last few weeks of life here? I'm treating some patients for cure, they're getting radiation. Some of them are getting radiation and chemo for palliation.” But it was a mixed cancer ward. And it was wonderful because I had a team that would make rounds with me every week: a pharmacist, a physiatrist, a psychologist, a social worker, a dietitian. This was in 1978 or ‘79, and the nurses were wonderful. They were really available to the patients. It wasn't a busy acute ward. If they were in pain, they would get their medication as soon as possible. I gave methadone. It was before the days of some of the newer medications, but it was long-acting. I learned how to give that. We gave Dilaudid in between if necessary. And then we had Brompton solution, that was before there was really oral morphine.  And so the idea was all of these kinds of services should really be available to patients from the time of diagnosis until death. We never knew who was going to be leaving us the next few days or who was going to be living longer and receiving curative intent. We had support groups for the patients and their families. It was a wonderful infrastructure, something that I didn't actually have at UCLA, so it was a real luxury. And if you know the VA system, the rehabilitation services are wonderful. They had dental services for patients. We had mostly World War II veterans, some Korean, and for many of these individuals, they had worked and lived a good life, and then they were going to retire and then they got cancer. So this was kind of the sadness. And it was a suburban VA, so we had a lot of patients who were in the San Fernando Valley, had a lot of family support, and it was a wonderful opportunity for me to learn how to do good quality care for patients along the continuum.  Dave Johnson: How did you assemble this team? Or was it in place in part when you arrived, or what? Nobody was thinking about this multidisciplinary approach?  Dr. Patricia Ganz: I just designed it because these were kind of the elements that were in a hospice kind of program. And I actually worked with the visiting nurses and I was part of their boards and so forth. And UCLA didn't have any kind of hospice or palliative care program at that time. But because the VA infrastructure had these staff already, I didn't have to hire them, you didn't have to bill for anything. They just became part of the team. Plus there was a psychiatrist who I ultimately began doing research with. He hired a psychologist for the research project. And so there was kind of this infrastructure of interest in providing good supportive care to cancer patients. A wonderful social worker, a wonderful psychologist, and they all saw this patient population as very needy, deserving, and they were glad to be part of a team.  We didn't call it a hospice, we called it a palliative care unit. These were just regular staff members who, as part of their job, their mission was to serve that patient population and be available. I had never been exposed to a physiatrist before. I trained at UCLA, trained and did my residency and fellowship. We didn't have physiatry. For whatever reason, our former deans never thought it was an important physical medicine, it wasn't, and still isn't, part of our system. Pat Loehrer: Many decisions we make in terms of our careers are based on singular people. Your dad, maybe, suggesting going into medicine, but was there a patient that clicked with you that said, "Listen, I want to take this different direction?" Or was it just a collection of patients that you were seeing at the VA? Is there one that you can reflect back on? Dr. Patricia Ganz: I don't know if you all remember, but there was something called Consultation Liaison Psychiatry where, in that time, the psychiatrist really felt that they had to see medical patients because there were psychological and sometimes psychiatric problems that occurred on the medical ward, such as delirium. That was very common with patients who were very sick and very toxic, which was again due to the medical condition affecting the brain. And so I was exposed to these psychiatrists who were very behaviorally oriented when I was a resident and a fellow, and they often attended our team meetings in oncology on our service, they were on the transplant service, all those kinds of things. So they were kind of like right by our side.  And when I went to the VA, the psychiatry service there also had a couple of really excellent psychiatrists who, again, were more behaviorally focused. Again, you have to really remember, bless her heart, Jimmie Holland was wonderful as a psychiatrist. She and Barrie Cassileth were the kind of early people we would see at our meetings who were kind of on the leading edge of psychosocial oncology, but particularly, Jimmie was more in a psychiatric mode, and there was a lot of focus on coping. But the people that I began to work with were more behaviorally focused, and they were kind of interested in the impact of the disease and the treatment on the patient's life and, backwards, how could managing those kinds of problems affect the well-being of the patient. And this one psychiatrist, Richard Heinrich, had gotten money from the VA, had written a grant to do an intervention study with the oncology patients who I was serving to do a group intervention for the patients and their families. But, in order to even get this grant going, he hired a project manager who was a psychologist, a fresh graduate whose name was Anne Coscarelli, and her name was Cindie Schag at that time. But she said, "I don't know much about cancer. I've got to interview patients. I've got to understand what's going on." And they really, really showed me that, by talking to the patient, by understanding what they were experiencing, they could get a better handle on what they were dealing with and then, potentially, do interventions. So we have a wonderful paper if you want to look it up. It's called the “Karnofsky Performance Status Revisited.” It's in the second issue of JCO, which we published; I think it was 1984.  Dave Johnson: In the early 90s, you relocated back to UCLA. Why would you leave what sounds like the perfect situation to go back to a site that didn't have it? Dr. Patricia Ganz: Okay, over that 13 years that I was at the VA, I became Chief of the Division of Hem-Onc. We were actually combined with a county hospital. It was a wonderful training program, it was a wonderful patient population at both places. And we think that there are troubles in financing health care now, well, there were lots of problems then. Medicaid came and went. We had Reagan as our governor, then he became president, and there were a lot of problems with people being cared for. So it was great to be at the VA in the county, and I always felt privileged. I always had a practice at UCLA, which was a half-day practice, so I continued there, and I just felt great that I could practice the same wherever I was, whether it was in a public system, veteran system, or in the private system.   But what happened was, I took a sabbatical in Switzerland, '88 to '89. I worked with the Swiss International Breast Cancer Consortium group there, but it was really a time for me to take off and really learn about quality of life assessment, measurement, and so forth. When I came back, I basically said, "I want to make a difference. I want to do something at a bigger arena." If I just continue working where I am, it's kind of a midlife crisis. I was in my early 40s, and my office was in the San Fernando Valley at the VA, but my home was in West Los Angeles. One day I was in UCLA, one day I was at the VA, one day I was at the county, it was like, "Can I practice like this the next 20 years? I don't know that I can do this. And I really want to have some bigger impact.” So I went to Ellen Gritz who was my predecessor in my current position, and I was doing my NCI-funded research at UCLA still, and I said, “Ellen, I really would like to be able to do research full time. I really want to make a difference. Is there anything available? Do you know of anything?" And she said, "Well, you know, we're actually recruiting for a position that's joint between the School of Public Health and the Cancer Center. And oh my goodness, maybe I can compete for that, so that's what I did. And it was in what was then the department called Health Services, it's now called Health Policy and Management. I applied, I was competing against another person who I won't name, but I got the position and made that move.  But again, it was quite a transition because I had never done anything in public health, even though UCLA had a school of public health that was right adjacent to the medical school. I had had interactions with the former dean, Lester Breslow, who I actually took an elective with when I was a first-year medical student on Community Medicine. So it kind of had some inklings that, of what I was interested in. I had actually attendings in my medical clinic, Bob Brook, a very famous health policy researcher, Sheldon Greenfield. So I'd been exposed to a lot of these people and I kind of had the instinctive fundamentals, if you will, of that kind of research, but hadn't really been trained in it. And so it was a great opportunity for me to take that job and really learn a lot and teach with that.  And then took, part of my time was in the cancer center with funding from the core grant. And then, within a year of my taking this position, Ellen left and went to MD Anderson, so all of a sudden I became director of that whole population science research group. And it was in the early ‘90s, had to scramble to get funding, extramural funding. Everybody said to me, "How could you leave a nearly full-time position at the VA for a soft money position?" But, nevertheless, it worked out. And it was an exciting time to be able to go into a new career and really do things that were not only going to be in front and center beneficial to patients, but to a much larger group of patients and people around the world.  Pat Loehrer: Of all the work that you have done, what one or two things are you most proud of in terms of this field? Dr. Patricia Ganz: Recognizing the large number of people who are surviving cancer. And I think today we even have a more exciting part of that. I mean, clearly, many people are living long-term disease-free with and without sequelae of the disease. But we also have this new group of survivors who are living on chronic therapy. And I think the CML patients are kind of the poster children for this, being on imatinib or other newer, targeted agents over time, living with cancer under control, but not necessarily completely gone. And then melanoma with the immunotherapy, lung cancer, all of these diseases now being converted to ones that were really fatal, that are now enjoying long-term treatment.   But along with that, we all know, is the financial toxicity, the burdens, and even the ongoing symptoms that patients have. So the fact that we all call people survivors and think about people from the time of diagnosis as potentially being survivors, I think was very important. And I would say that, from the clinical side, that's been very important to me. But all of the work that I was able to do with the Institute of Medicine, now the National Academy of Medicine, the 2013 report that we wrote on was a revisit of Joe Simone's quality of care report, and to me was actually a very pivotal report. Because in 2013, it looked like our health care system was in crisis and the delivery of care. We're now actually doing a National Cancer Policy Forum ten-year follow-up of that report, and many of the things that we recommended, surprisingly, have been implemented and are working on. But the healthcare context now is so much more complicated.  Again, with the many diseases now becoming rare diseases, the cost of drugs, the huge disparities, even though we have access through the Affordable Care Act and so forth, there's still huge disparities in who gets care and treatment. And so we have so many challenges. So for me, being able to engage in the policy arena and have some impact, I think has been also very important to me. Dave Johnson: 20 years ago, the topic of survivorship was not that common within ASCO, and you led a 2004 task force to really strengthen that involvement by that organization, and you also were a founding member of the National Coalition for Cancer Survivorship. I wonder if you might reflect on those two activities for us for a moment. Dr. Patricia Ganz: In 1986, Fitzhugh Mullen, who in 1985 had written a really interesting special article for the New England Journal called "Seasons of Survivorship" - he was a young physician when he was found to have a mediastinal germ cell tumor and got very intensive chemotherapy and radiation therapy and survived that, but realized that there was no place in the healthcare system where he could turn to to get his questions answered, nor get the kind of medical care that was needed, and really wrote this very important article. He then, being somebody who was also kind of policy-oriented and wanting to change the world, and I would say this was a group of us who, I think went to college during the Vietnam era - so did Fitz - and we were all kind of restless, trying to see how we could make a difference in the world and where it was going.   And so he had this vision that he was going to almost develop an army of survivors around the country who were going to stand up and have their voices heard about what was going on. Of course, most people didn't even know they were a survivor. They had cancer treatment, but they didn't think about themselves as a survivor. And so he decided to get some people together in Albuquerque, New Mexico, through a support group that he had worked with when he was in the Indian Health Service in New Mexico. And there were various people from the American Cancer Society, from other support organizations, social workers, and a couple of us who are physicians who came to this meeting, some Hodgkin survivors who had been treated at Stanford and were now, including a lawyer, who were starting to do long term late effects work. And we gathered together, and it was a day and a half, really, just kind of trying to figure out how could a movement or anything get oriented to try and help patients move forward.  So that's how this was founded. And they passed the hat. I put in a check for $100, and that was probably a lot of money at that time, but I thought, well, this is a good investment. I'll help this organization get started. And that was the start. And they kind of ran it out of Living Beyond Cancer in Albuquerque for a few years. But then Fitz, who was in the Washington, DC. area decided they weren't going to be able to get organizations all over the country organized to do this, and they were going to have to do some lobbying. So Ellen Stovall, who was a Hodgkins survivor living in the Washington area, beginning to do policy work in this area, then became the executive director and took the organization forward for many years and championed this, got the Office of Cancer Survivors established at the NCI in the 1990s, and really did a lot of other wonderful work, including a lot of the work at the Institute of Medicine. She was very involved with the first Quality of Care report and then ultimately the survivorship report, the Lost and Transition report in 2005, 2006, I was on that committee. So that was really how things were evolving.  And by that time, I was also on the ASCO board, 2003 to 2006. And so all of these things were kind of coming together. We had 10 million survivors. That was kind of an important note and a lot of diseases now - lymphoma, breast cancer, multi-agent therapy had certain benefits, but obviously toxicities. We lived through the horrible time of high-dose chemotherapy and transplant for breast cancer in the ‘90s, which was a problem, but we saw a lot of toxicities after that. And so there were people living after cancer who now had sequelae, and the children obviously had been leading the way in terms of the large number of childhood cancer survivors. So this was this idea that the children were kind of the canary in the coal mine. We saw them living 20, 30 years later after their cancer diagnosis, and we were now beginning to see adults living 10, 15, 20 years later, and we needed to think about these long-term and late effects for them as well. Dave Johnson: I'm glad you mentioned Fitz's article in the New England Journal that still resonates today, and if listeners have not read it, "Seasons of Survivorship" is a worthwhile five-minute read.  What do you think the most pressing issues and challenges in cancer survivorship care today?  Dr. Patricia Ganz: Many people are cured with very little impact. You can think of somebody with T1 breast cancer maybe needing endocrine therapy for five years, and lumpectomy radiation. That person's probably not going to have a lot that they're going to be worried about. But if they're a young breast cancer patient, say they're 35 or 40, you're going to get five years of ovarian suppression therapy. You're going to be put into acute menopause. You're going to lose bone density. You're going to have cardiac risk acceleration. You may have cognitive changes. You may have also problems with cognitive decline later. I mean, all of these things, the more intense treatments are associated, what we're really thinking about is accelerated aging. And so a lot of what I've been studying the last 20-25 years in terms of fatigue and cognitive difficulties are related to neuroinflammation and what happens when somebody has intensive systemic therapy and that accelerated process that's, again, not everyone, but small numbers of patients, could be 10-15-20%. So I worry a lot about the young patients. So I've been very focused on the young adult population who are treated intensively for lymphoma, leukemia, and breast. And that's, I think, something that we need to be looking out for.  The other thing is with the newer therapies, whether it's immunotherapy or some of the targeted therapies, we just don't know what the late effects are going to be. Where we're very schooled now in what the late effects of radiation, chemo, and surgery could be for patients, we just don't know. And another wonderful part of my career has been to be able to do quality-of-life studies within the Clinical Trials Network. I've been affiliated with NSABP, I was SWOG previously, but NSABP is now NRG Oncology doing patient-reported outcomes and looking at long-term outcomes in clinical trials. And I think we're going to need this for all of these new agents because we have no idea what the long-term toxicities are going to be. And even though it's amazing to have people surviving where they wouldn't have been, we don't know what the off-target long-term effects might be. So that's a real challenge right now for survivorship.  And the primary care doctors who we would want to really be there to orchestrate the coordinated care for patients to specialists, they are a vanishing breed. You could read the New England Journal that I just read about the challenges of the primary care physician right now and the overfilled inbox and low level of esteem that they're given in health systems. Where are we going to take care of people who really shouldn't be still seeing the oncologist? The oncologist is going to be overburdened with new patients because of the aging of the population and the many new diagnoses. So this is our new crisis, and that's why I'm very interested in what we're going to be looking at in terms of a ten-year follow-up report to the 2013 IOM report. Dave Johnson: The industry-based trials now are actually looking at longer-term treatment. And the trials in which interest is cancer, we cut it down from two years of therapy down to nine weeks of therapy, looking at minimizing therapy. Those are difficult trials to do in this climate today, whereas the industry would just as soon have patients on for three to five years worth of therapy as opposed to three to five months. Talk a little about those pressures and what we should be doing as a society to investigate those kinds of therapies and minimizing treatments. Dr. Patricia Ganz: Minimizing treatments, this is the place where the government has to be, because we will not be able to do these de-escalation studies. Otherwise, there will be countries like the UK, they will be able to do these studies, or other countries that have national health systems where they have a dual purpose, if you will, in terms of both financing health care and also doing good science. But I think, as I've seen it, we have a couple of de-escalation trials for breast cancer now in NRG Oncology, which is, again, I think, the role that the NCTN needs to be playing. But it's difficult for patients. We all know that patients come in several breeds, ones who want everything, even if there's a 1% difference in benefit, and others who, “Gee, only 1 out of 100 are going to benefit? I don't want that.” I think that's also the challenge. And people don't want to be denied things, but it's terrible to watch people go through very prolonged treatments when we don't know that they really need it for so long.  Dave Johnson: Pat and I both like to read. I'm wondering if there's something you've read recently that you could recommend to us. Dr. Patricia Ganz: It's called A Gentleman in Moscow by Amor Towles. I do like to read historical fiction. This one is about a count at the time of the Bolshevik Revolution who then gets imprisoned in a hotel in Moscow and how constrained his life becomes, but how enriched it is and follows him over really a 50-year period of time and what was happening in the Soviet Union during that time. And of course, with the war in Ukraine going on, very interesting. Of course, I knew the history, but when you see it through the drama of a personal story, which is fictional, obviously it was so interesting.   My husband escaped from Czechoslovakia. He left in '66, so I had exposure to his family and what it was like for them living under communism. So a lot of that was interesting to me as well.  Dave Johnson: Thank you for joining us. It's been a wonderful interview and you're to be congratulated on your accomplishments and the influence you've had on the oncology world.  We also want to thank our listeners of Oncology, Etc., and ASCO Educational Podcast where we will talk about oncology, medicine and beyond. So if you have an idea for a topic or a guest you'd like us to interview, by all means, email us at education@asco.org. To stay up to date with the latest episodes and explore other ASCO educational content, please visit education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

Highlights: Choosing Registry Nursing: Discover the driving forces that led me to embrace registry nursing. Explore the advantages of increased pay and the freedom to craft my own schedule. Gain insights into how registry nursing has transformed my work-life balance. First-Week Orientation: A Remarkable Encounter: Join me as I narrate the exhilarating moments of my first week as a registry nurse. Listen to my experience dealing with a patient on CRRT, accompanied by an IABP, and managed with a Swan Ganz catheter. Understand how I navigated this complex medical scenario and collaborated with the healthcare team to deliver exceptional patient care. Instagram: https://www.instagram.com/cupofnurses/ Website: https://fanlink.to/CONsite Shop: https://fanlink.to/CONshop Free Travel Nursing Guide: https://fanlink.to/Travelnursingchecklist Nclex Guide: https://fanlink.to/NCLEXguide Interested in Travel Nursing? https://fanlink.to/TravelNurseNow Cup of Nurses FB Group: https://www.facebook.com/groups/cupofnurses YT: https://www.youtube.com/@CUPOFNURSES

In deze aflevering bespreken we drie vormen van geavanceerde hemodynamische monitoring. De Swan Ganz, de PiCCO en de Flotrac/Vigileo.We bespreken onder andere de voordelen, de nadelen, de indicaties en de verschillen tussen deze systemen. Er komen weer veel mythes en dogma's aan bod en we duiken de pathofysiologie in.Veel plezier met luisteren!Bronnen:Deranged Physiology - PiCCOLife in the Fast Lane - PiCCOEddy Joe MD - Cardiogenic Shock & Swan GanzDeranged Physiology - Utility of CVP monitoringSystematic review of uncalibrated arterial pressure waveform analysis to determine cardiac output and stroke volume variationPulse Wave Analysis to Estimate Cardiac OutputPerformance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac/Vigileo) in haemodynamically unstable patientsMinimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precisionPulmonary artery catheters for adult patients in intensive carePrognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studiesDynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literatureDoes the Central Venous Pressure Predict Fluid Responsiveness? An Updated Meta-Analysis and a Plea for Some Common Sense Central venous pressure: A useful but not so simple measurementBedankt voor het luisteren!Volg @intensiefdepodcast op InstagramVragen? intensiefdepodcast@gmail.com

While you might not work with Swan-Ganz catheters on your unit often, principles from understanding the waveforms apply. This episode is a surface-level overview, join us in the Confident Care Academy membership for the full Swan-Ganz catheter lecture. CRAVING MORE IN-DEPTH NEW GRAD ICU EDUCATION? JOIN THE NEW TO ICU MEMBERSHIP! https://confidentcareacademy.com/p/ne... Website: https://www.confidentcareacademy.com Anna's Youtube: https://www.youtube.com/channel/UCY5d... Anna's Instagram: https://www.instagram.com/annasrna Chrissy's Instagram: https://www.instagram.com/chrissycrna PRODUCTS WE LIKE (AMAZON STOREFRONT): https://www.amazon.com/shop/chrissycrna CONTACT: For potential business inquiries and partnerships: confidentcareacademy@gmail.com

Choque no pós-operatório imediato de cirurgia cardíaca: como interpretar os parâmetros do Swan-Ganz? Quais as principais causas de choque? Devo me preocupar com o lactato? Azul de metileno e óxido nítrico têm algum espaço nesse contexto? Host Luís Augusto CarvalhoGraduado em Medicina pela  Universidade Federal da Bahia (UFBA). Residência em Clínica Médica pelo Hospital Sírio Libanês (HSL). Residência médica em Cardiologia clínica pelo Instituto Dante Pazzanese de Cardiologia (IDPC). Titulado especialista em Cardiologia pela Sociedade Brasileira de Cardiologia (SBC). Pós-graduado em Gestão em Saúde pelo Hospital Israelita Albert Einstein (HIAE). Plantonista da Unidade Coronariana e de Cuidados Pós-Operatórios de Cirurgia Cardíaca do IDPC, do Hospital São Luiz Anália Franco e do Hospital Vila Nova Star.A emergência é desafiadora, exige essas habilidades em um pacote só, e o nosso paciente, diversas vezes, não tem tempo, ele precisa de todos esse anos de conhecimento agora. O Clube da Cardio convida você a continuar se preparando SEMPRE para esse momento. “Como?” Com o SAFER, o método de ensino de emergências cardiovasculares do Clube da Cardio. Transforme seu conhecimento e sua prática com o SAFER e seja referência. Seja excelente! Torne-se EXCELENTE AGORA

Most Interesting Deathbed Confessions A deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

World's Shocking Deathbed ConfessionsA deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

Clinically Dead and Back to Life Experiences A deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

Most Interesting Deathbed Confessions A deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

Clinically Dead and Back to Life Experiences A deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

World's Shocking Deathbed ConfessionsA deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

Most Interesting Deathbed Confessions A deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

World's Shocking Deathbed ConfessionsA deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

Clinically Dead and Back to Life Experiences A deathbed confession is an admittance or confession when someone is nearing death, or on their "death bed". This confession may help alleviate any guilt, regrets, secrets, or sins the dying person may have had in their life. These confessions can occur because the dying want to live the last moments of their life free of any secrets they have been holding in for a portion - or entirety - of their life. Or, if religious, the person may perhaps believe they will be forgiven by a higher power before they die, allowing them entrance to a better place, such as Heaven, after death. A deathbed confession can be given to anyone, but a family member is usually with their loved one during this time. Doctors and nurses may also hear a deathbed confession because they are often present in a person's last moments.These confessions can range from a confession of sins that have been committed to crimes that have been committed or witnessed. Often, these confessions are made to clear the dying's conscience. A common type of confession is either religious or spiritually based. On the death bed, the dying will confess sins or mistakes they have made in their lifetime, and ask for forgiveness, so that they may move on to the afterlife according to their religion. Different religions have different protocols for the deathbed confession, but all religions seek to provide relief for the dying. People may also confess their feelings for another person while dying. This can relieve the dying of the internal struggle with hiding how they actually feel for someone. These emotions can range from hatred to love, and everything in between.Many confessions have involved the admittance of a crime that the dying has committed, which obviously cannot be prosecuted once the perpetrator has died. On the other hand, someone can confess that they have knowledge of or witnessed a crime that has been committed: This kind of confession, known as a "dying declaration", can sometimes be admissible in court to get a conviction, depending on the circumstances of the statement. Another use for a deathbed confession in the criminal justice system is to re-open a case that may have gone cold to get closure for the victim's family or friends, even if prosecution is not an option.Working in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

35 Creepy Last Words Uttered by Patients Before Dying as Shared by Doctors and NursesWorking in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

35 Creepy Last Words Uttered by Patients Before Dying as Shared by Doctors and NursesWorking in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

35 Creepy Last Words Uttered by Patients Before Dying as Shared by Doctors and NursesWorking in health care will teach you that death is inevitable. You'll be one of those few people to know how life starts and how it will end.1. “But I don't know how to get there…” Grandpa in hospice. Hadn't spoken in days. Died about two hours later.2. Not a doctor but I overheard an old lady whisper this to her old husband dying of kidney problems.“You are going to beat this, you got away with murder, this is nothing.”3. I work in a cardiac ICU. We had a patient who had a pulmonary artery rupture (a rare, but known complication of a Swan-Ganz catheter).One minute he was joking around with us and the next bright red blood was spewing out of his mouth. His last words before he died were “why is this happening to me?”It still haunts me years later.4. Nurse here – had a patient come into the ER with shortness of breath. He started deteriorating in the ER, and then quite rapidly on the transport up the ICU.We got him wheeled into his room, replaced the ER lines and tubes with our own, and transferred him from the transport stretcher to his ICU bed.He actually did most of the transfer himself. He didn't say anything, but just before he died he pleasantly adjusted his own pillow, laid his head down, and then his eyes went blank. This man just made himself comfortable before laying down to die.5. I'm a nurse and was previously working at an assisted living community on the dementia/Alzheimer's unit.My very favorite patient had been declining pretty steadily so I was checking on him very frequently. We would have long chats and joke around with each other, but in the last two weeks of his life, he stopped talking completely and didn't really acknowledge conversation directed at him at all.I finished my medication rounds for the evening and went to see him before I left. I told him I was leaving for the night and that I'd see him the following day, and he looked me in the eyes and smiled SO genuinely and said, “You look like an angel.” I thought it was so sweet because he had not seemed lucid in weeks.He died the next morning. It really messed with me.

Do Cardiogenic Shock Pts Need a Swan-Ganz/Pulmonary Artery Catheter? Let's look at the data. Let's also look at the devices such as pulse-contour analysis and bioreactance to see if they could replace the PA catheter in the management of cardiogenic shock. Show Notes: https://eddyjoemd.com/cardiogenic-shock-swan/ Mechanical Circulatory Support Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/eddyjoemd/support

In this episode, we explore how you can determine your patient's fluid status in any situation. This ranges from patients that only have a blood pressure cuff to patients that have a full-on Swan-Ganz hemodynamic setup. After listening to this episode you will have several techniques to use in your practice to help you and your other clinicians determine if your patient will be fluid responsive. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

The hemodynamic evaluation of cardiogenic shock obtained via a Swan-Ganz catheter plays an essential role in the characterization of cardiogenic shock patients. Join Dr. Nosheen Reza, (Assistant Professor of Medicine and Advanced Heart Failure and Transplant cardiologist at the Hospital of the University of Pennsylvania), episode fellow lead Dr. Brian McCauley (Interventional and Critical Care Fellow at the Hospital of the University of Pennsylvania), Dr. Mark Belkin (Cardiac Critical Care Series Co-Chair and AHFT fellow at University of Chicago), and CardioNerds Co-Founders, Amit Goyal and Dan Ambinder, for this tour through the heart aboard the Swan-Ganz catheter. In this episode, we evaluate three separate admissions for a single patient to highlight pearls regarding waveform assessment, evaluating cardiac output, phenotyping hemodynamic profiles, targeted therapies based on hemodynamics and so much more. Episode introduction and audio editing by Dr. Gurleen Kaur (Director of the CardioNerds Internship). Claim free CME for enjoying this episode! Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Hemodynamic Evaluation of Cardiogenic Shock Swan-Ganz catheters are not dead #ReviveTheSwan!  They remain a useful tool to characterize cardiac patients & to help direct therapy, especially in Cardiogenic Shock.When looking at Swan-Ganz catheter data, it is important to always interpret your own tracings, to know what values are acquired directly, and which values are derived.It is important to understand the strengths and weakness of hemodynamic characterization by Swan-Ganz cathetersAdvanced metrics such as cardiac power output, pulmonary artery pulsatility index, and aortic pulsatility index are extremely useful in further phenotyping patients as well as guiding mechanical support platforms“The data will be wrong if the preparation is not right” Show notes - Hemodynamic Evaluation of Cardiogenic Shock 1. Swan-Ganz catheters are a useful tool to characterize cardiac patients and to direct therapy.  With the ESCAPE trial in 2004, Swan-Ganz catheter utilization dropped drastically outside transplant centers across the United States (2). While the ESCAPE trial did demonstrate the possibility of harm when using a Swan-Ganz catheter, many of the truly ill cardiac patients we care for would have been excluded from the trial. For instance, patients on dobutamine at doses above 3 µg/kg/min or any dose of milrinone during the hospitalization were excluded from the trial.This is a classic example of “throwing the baby out with the bath water.”In a recent large, multicenter cardiogenic shock registry, complete hemodynamic assessment using pulmonary artery catheters prior to MCS is associated with lower in-hospital mortality compared with incomplete or no assessment (3). 2. When looking at Swan-Ganz catheter data, it is important to always interpret your own tracings, to know what values are acquired directly, and which values are derived. Incomplete or incorrect data can lead to mischaracterization of our patients. Therefore, it is essential to review all of the tracings, calculations, and data acquired for each individual patient before any clinical adjustments are made (1). An incomplete pulmonary capillary wedge tracing is an example from clinical practice (causing the PCWP, and therefore the left-sided filling pressures to be overestimated).  It is equally important to know the limitations of cardiac output equations, and that no one measurement is perfect.Foibles of the Fick equation include assumed rather than measured oxygen consumption and variations in hemoglobin concentration. Traditionally,

Two time World Kickboxing Champion under the Professional Karate Association (PKA), 8th Dan black belt in USA Goju Karate, Professional Wrestling trainer and former bounty hunter, Dan Magnus is not fighting for another championship, he is fighting for his life. The 64-year-old Magnus, a native of New York and California resident, is waiting on a heart transplant. However, his situation is extremely rare in comparison to others in his hospital ward. Magnus, who previously had three surgeries is quite possibly the healthiest person in the hospital as he has a stationary bike and dumbbells in the Intensive Care Unit (ICU). "It's pretty funny because I have no symptoms. I'm not breathing hard or anything, it's just the tests show my heart's weak. They save we have to wait and get you a good heart. There were two offers already but they weren't strong enough. It's really weird. Usually when you're having a heart transplant you take what ever you can get but they have to find me a heart that strong enough to do what I do," said Magnus from his hospital room. Magnus spends a minimum of 30 minutes on his stationary bike in the ICU ward and uses 3 lb. weights during his shadow boxing sessions. Mangus would lift heavier weights, but the doctors will not allow it. When going for walks around the hospital floor, he practically laps his nursing staff and quips that the wheelchair they follow him around with, he will eventually have to push them once he's tired them out. Magnus has a Swan-Ganz catheter attached through his neck leading to his heart that feeds the medication directly into his valves. Once they took it out of his neck, Magnus went about 20 laps around the ward, walking for an hour just to keep himself active. "My biggest fear when I get out of the hospital is not that I am going to do too much, it is that Tracee is going to yell at me a lot. I'm actually scared! She's prepared. She's by my side. It's going to be a little different for me because with my other two heart surgeries I had nobody," said Magnus about his girlfriend Tracee Meltzer, professionally known as Roxy Astor in the original incarnation of the Gorgeous Ladies Of Wrestling (GLOW). Magnus received an outcry of support from legends within the Karate World including Jeff Smith, Don "The Dragon Wilson and Billy Blanks. Magnus continued to work, train, find love and now fights for his life and when listening to the interview, wants to fight one more 12-round fight for his old title, only this time with a healthy heart. "Let me tell you, I'm a human being, I'm scared. I just don't let it effect me. I make it like a fight; you get nerves. Anybody that says go into a professional fight and they're not scared or they're not nervous; they're liars! That's what keeps you going, but you have to over come it. You have to accept it...this is going to be a long road, but I've been down this road a couple of time," said Magnus about his pending transplant. #DanMagnus #Kickboxing #HeartTransplant #Survival #Fighting

CardioNerds (Amit Goyal & Daniel Ambinder) join Houston Methodist cardiology fellows (Isaac Tea, Stephanie Fuentes, Peter Rothstein) for a trip to Hermann Park! They discuss a challenging case of right ventricular (RV) infarction leading to acute RV failure treated with right ventricular assist device (RVAD) support. Dr. Mahwash Kassi provides the E-CPR and program director Dr. Stephen Little provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Tommy Das with mentorship from University of Maryland cardiology fellow Karan Desai.  Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A man in his early 70s with ASCVD risk factors and known CAD (PCI to proximal LAD 4 years prior) presented with typical angina refractory to maximal medical therapy. A nuclear stress test showed a reversible perfusion defect in the RCA territory, and he was referred for PCI. Coronary angiogram showed severe stenosis of the proximal RCA and a DES was successfully deployed with TIMI 3 flow, though several large acute marginal branches were jailed.   The night following PCI, the patient developed bradycardia, hypotension, and tachypnea. Physical exam showed newly elevated JVP, lower extremity edema, and bibasilar crackles without a new cardiac murmur. ECG showed ST elevation in V1-V4, and bedside echocardiogram showed a severely dilated RV with decreased systolic function. With concern for acute RV failure, the patient was fluid resuscitated, started on dopamine for chronotropy, and was admitted to the CCU. A Swan-Ganz catheter was placed, showing a CVP 12, RV 41/15, PA 36/20 (25), PCWP 18, CI 1.6 (by Fick method). The calculated PAPi was 0.84.   The patient was transitioned to dobutamine to improve RV inotropy, epinephrine in the setting of hypotension, and inhaled nitric oxide in an attempt to decrease RV afterload. Despite these interventions, the patient had worsening shock, anuric renal failure requiring CVVH, and respiratory failure requiring intubation. A centrifugal RA to PA pump was placed (Protek Duo) for right-sided mechanical circulatory support, with improvement in RV hemodynamics and cardiogenic shock. Notably, a repeat angiogram was done, which showed a patent left coronary circulation as well as a right coronary artery without flow in the acute marginal branches. After 6 days of mechanical circulatory support, the patient was ultimately able to be weaned from vasoactive agents, and the Protek Duo was removed. He continued to have junctional bradycardia, and a permanent pacemaker was placed. After a nearly month-long admission, the patient was discharged to rehab; at 4 months follow-up,

In this episode, we'll cover the brilliant but difficult character of Guillaume Dupuytren, and of course the disease which bears his name. In addition to his life, we'll take a deep dive into the history of Dupuytren's disease, also known as the Viking's disease, the curse of the MacCrimmons, and the Hand of Benediction, among others. There are lots of side stories, too, including a bit of history of the bagpipes! And 'Suture Tales' makes a return for the 50th anniversary of the Swan-Ganz catheter!

Dr Carolyn Lam:                                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the Journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center, and Duke National University of Singapore. Dr Greg Hundley:                             And I'm Greg Hundley, associate editor as well, at Circulation, and director of the Pauley Heart Center in Richmond, Virginia at VCU Health. Carolyn, this issue, we've got a super-exciting interaction to follow related to SGL2 inhibitors on 24-hour ambulatory blood pressure in African-Americans, something used to treat diabetes, and maybe a positive effect on blood pressure, but more to come on that. Now, Carolyn, you're also planning to discuss some results from another SGL2 study. Dr Carolyn Lam:                                You bet. This time, I'm taking you to Japan for the results of the SACRA study which stands for SGLT2 Inhibitor and Angiotensin Receptor Blocker Combination Therapy in Patients with Diabetes and Uncontrolled Nocturnal Hypertension and this is from Dr Kario and colleagues from Tochigi in Japan. It's a multi-centered, double-blind parallel study of 132 non-obese older adults with type 2 diabetes and uncontrolled nocturnal hypertension, receiving stable antihypertensive therapy, including angiotensin receptor blockers, who were then randomized to 12 weeks' treatment with empagliflozin 10 milligrams once daily or placebo. Clinic blood pressure was performed at baseline in weeks four, eight and 12. Twenty-four hour ambulatory blood pressure monitoring was performed at baseline and week 12 and morning home blood pressure was determined for five days before each visit. The primary efficacy endpoint was changed from baseline in nighttime blood pressure. Dr Greg Hundley:                             So, what did they find, Carolyn? Dr Carolyn Lam:                                Well, empagliflozin significantly reduced nighttime systolic blood pressure versus the baseline. The reductions in daytime 24-hour morning, home, and clinic systolic blood pressure at 12 weeks with empagliflozin was also greater than placebo. Between group differences in body weight and glycosylated hemoglobin reductions were significant, but small and the changes in antihypertensive medication during the study also did not differ significantly between the groups. Dr Greg Hundley:                             Very good. Well, I'm going to switch gears and talk also on the same theme of sugar and diabetes and evaluate the long-term consumption of sugar-sweetened and artificially-sweetened beverages and the risk of mortality in U.S. adults. This is a study by Vasanti Malik from the Harvard School of Public Health. Now, as you know, in epidemiologic studies, intake of sugar-sweetened beverages has been associated with weight gain, a higher risk of type 2 diabetes, coronary heart disease and stroke, but to date, few studies have examined the association between sugar-sweetened beverages and intake and mortality. All right, Carolyn, I'm going to give you a quiz now. Here's the first question. Dr Carolyn Lam:                                What? Dr Greg Hundley                               That's right, sugar-sweetened beverages are the single largest source of added sugar in the U.S. diet, true or false? Dr Carolyn Lam:                                I'm going to guess true. Dr Greg Hundley:                             Okay, so all those consumption of sugar-sweetened beverages in the United States has decreased in the past decade. National survey data show a slight rebound in consumption in recent years among adults in many age groups. With the average equivalent being, multiple choice, 2%, 6.5% or 10% of our total energy requirements? Dr Carolyn Lam:                                Oh, my goodness. One of the higher ones. I'm just going to go in the middle, 6.5. Dr Greg Hundley:                             Excellent, good choice, you're a good multiple-choice taker, 6.5%. So, among younger adults, sugar-sweetened beverages contributed. They're a little bit higher, 9.3% of the daily calories in men and 8.2% in women in the United States. Now, how about other parts of the world, particularly developing countries? The intake of sugar-sweetened beverages, is it dropping, is it flat or is it rising dramatically? Dr Carolyn Lam:                                Sorry, Greg, but that one's too easy. It's definitely rising. Dr Greg Hundley:                             Yup, you got that right. Dr Carolyn Lam:                                I live in those other developing countries, so I've seen so. Dr Greg Hundley:                             And it's really thought due to widespread urbanization and beverage marketing. So, now we've got an alternative, artificially-sweetened beverages. And they're often suggested as alternatives to sugar-sweetened beverages and intake levels have increased of these alternative sweeteners in the United States. So, next question. Are the artificially sweetened beverages a better alternative to sugar--sweetened beverages in regard to cardiovascular or all-cause mortality? Dr Carolyn Lam:                                Yikes. Okay, so Greg I'm afraid to guess on this one because I have to admit I sometimes, with a sweet tooth, like to take these alternative beverages. I think you're going to be telling us. Dr Greg Hundley:                             Well, we don't know. Most of the data in this area is from research and comes from associative analyses utilizing longitudinal cohorts and some studies suggest yes, some studies, no. For example, one in the elderly suggested artificially-sweetened beverages, but not sugar-sweetened beverages were associated with adverse events, but critiques indicated that finding may have related to reverse causation because the elderly patients were switching from sugar-sweetened to artificially-sweetened beverages. So, where are we now? Well this study, in our Journal, examined the associations between the consumption of sugar-sweetened beverages and artificially-sweetened beverages with the risk of total and cause-specific mortality among 37,716 men from the Health Professionals Follow-up Study between 1986 and 2014 and 80,647 women from the Nurse's Health Study from 1980 to 2014, who were free from chronic diseases. Dr Carolyn Lam:                                Wow, that's a huge combined cohort. So, come on, what were the results? Dr Greg Hundley:                             So, the researchers found after adjusting for major diet and lifestyle factors, consumption of sugar-sweetened beverages was associated with a higher risk of total mortality and cardiovascular mortality and cancer mortality and, thus, the results provide further support for the recommendations and policies to limit intake of sugar-sweetened beverages and to consume artificially-sweetened beverages in moderation did improve overall health. Now, what were the results from artificially-sweetened beverages? Well, they were associated with total and cardiovascular disease mortality in the highest intake category only. So, those consuming large amounts of those daily, but only in the cohort of women from the Nurse's Health Study, not from the men in the Health Professionals Follow-up Study. Artificially-sweetened beverages were not associated with cancer mortality in either cohort. So, moving forward, the positive association between high intake of artificially-sweetened beverages and total and cardiovascular disease mortality observed among women requires more study and further confirmation and also, we might consider that even though artificially-sweetened beverages could be used to replace sugar-sweetened beverages among habitual sugar-sweetened beverage consumers, higher consumption of the artificially-sweetened beverages would probably be discouraged. Finally, policies and recommendations should continue to call for reductions and limits on sugar-sweetened beverages intake and also address alternative beverage offerings with an emphasis on our favorite, water. Dr Carolyn Lam:                                Sweet, Greg! Or maybe not so sweet. Oh, goodness. All right, well my paper deals with related, but not related perhaps, but talking about ketone body, 3-hydroxybutyrate and the cardiovascular effects of treatment with this ketone body in chronic heart failure and this is from corresponding author, Dr Nielsen from Aarhus University Hospital in Denmark and his colleagues. Now, they performed a series of studies. In the first 16 chronic HFrEF patients were randomized in a crossover design to three hours' infusion of 3-hydroxybutyrate or placebo and monitored invasively with a Swan-Ganz catheter and studied with echocardiography and they found that infusion of 3-hydroxybutyrate increased cardiac output by two liters per minute or 40% with an absolute improvement in left ventricular ejection fraction of 8%, and the observed defects were accompanied by vasodilation with a resultant stable systemic and pulmonary blood pressure. Now, in the second part of the study, they studied eight HFrEF patients examined at increasing infusion rates of 3-hydroxybutyrate and they found a dose response relationship with a significant increase in cardiac output. And, finally, they studied 10 HFrEF patients and 10 age-matched volunteers, randomized in a crossover design to a three hour infusion of 3-hydroxybutyrate or placebo and they looked this time at myocardial external energy efficiency and oxygen consumption using 11-carbon acetate PET and what they found was 3-hydroxybutyrate increased oxygen consumption without altering myocardial external energy efficiency. The response did not differ between HFrEF and age-matched volunteers. Dr Greg Hundley:                             Wow, Carolyn, there was a lot of data in that study. So, what's your main take home? Dr Carolyn Lam:                                In summary, 3-hydroxybutyrate, this ketone body, demonstrated dose-dependent beneficial cardiac and hemodynamic effects in patients with heart failure reduced ejection fraction without deteriorating mechano-energetic coupling and without causing any safety issues. And what's significant is that this opens the door to modulating circulating 3-hydroxybutyrate as a novel treatment option in patients with heart failure. Dr Greg Hundley:                             Right, Carolyn, so I've got an interesting study from the world of basic science that's looking at the role of potassium channels as novel molecular targets and bradyarrhythmia’s and even, perhaps, in atrial fibrillation. This is from Yoshihiro Asano from Osaka University in Japan. So, the acetylcholine activated potassium channel is expressed in the sinus node, atrium, and atrioventricular node and contributes to heart rate slowing triggered by the parasympathetic nervous system. So the potassium, activated potassium channel is a heterotetramer of 2 inwardly rectifying potassium channel proteins encoded by two genes, KCNJ3 and KCNJ5, respectively. Dr Carolyn Lam:                                Okay, so what did this study show? Dr Greg Hundley:                             What it showed is a selective potassium acetylcholine channel blocker effectively inhibited a mutant potassium channel and up-regulated heart rate and bradyarrhythmias using a zebra fish model. And this is really interesting, Carolyn, because two conclusions are worth considering. First, future studies could determine the prevalence of bradyarrhythmias associated with dysfunctional mutation in this potassium channel. And, second, results raise the possibility that pharmacologic blockade of this channel might serve as a therapy for increasing heart rate and be especially beneficial for bradyarrhythmias in patients with gain of function mutations in the channel and, therefore, genetic testing for KCNJ3 and KCNJ5 in patients with bradyarrhythmias may provide a drug treatment option in lieu of an invasive surgical implantation of a pacemaker. Dr Carolyn Lam:                                Fascinating! Thanks, Greg. What a great issue and now onto an even greater feature discussion. Dr Greg Hundley:                             Welcome, everybody, to the second part of this interview. We've got a very exciting paper to discuss with you. Remember this is our backstage pass to Circulation and we've got today, Keith Ferdinand from Tulane University in Louisiana and our Associate Editor, our hypertensive expert, Dr Wanpen Vongpatanasin from the University of Texas Southwestern Medical School in Dallas. We're going to be discussing the anti-hyperglycemic and blood pressure effects of empagliflozin in African-Americans with type two diabetes and hypertension. Keith, we're going to start with you. What was your hypothesis for this study? Who's the study population? Review a little bit about your design and, importantly, what were your results? Dr Keith Ferdinand:                         Well, my hypothesis was that one of the new classes of medications, the SGLT2 inhibitors, which have a mild diuretic effect and a mild natriuretic effect, may have benefits in self-described African-Americans in not only controlling glucose, but also controlling hypertension. These medicines are approved, of course, as medications for type 2 diabetes, but we had seen in some earlier trials that did not include self-defined African-Americans, that there may be a blood pressure effect. We know that diabetes is higher in blacks, almost twice that seen in the general population and, of course, hypertension and uncontrolled hypertension is disproportionate. So, here's a medication that may be even more beneficial in that population and we wanted to study it. Dr Greg Hundley:                             And tell us a little bit about who was in the study and what was your design? Dr Keith Ferdinand:                         The design was to be a placebo-controlled randomized trial using empagliflozin starting at 10 milligrams and force-titrating to 25 milligrams versus placebo on the background of conventional anti-hypertensive agents. Everyone was on one or more anti-hypertensive agents. We used the gold standard for blood pressure control with 24-hour ambulatory blood pressure and that was the means by which patients entered the study, although the primary endpoint was changed in hemoglobin A1c, we actually designed and powered the study to see if there would be a change in blood pressure. Additionally, we looked for changes in weight, losing calories with the effects of the SGLT2 inhibitors with glycosuria has translated in some preliminary trials to weight loss. So, this was a study looking at a population. Most of them had diabetes for approximately nine to 10 years, 59 years of age, definite hypertension, obesity, a high risk population, to see if a new class of medications would be beneficial. Dr Greg Hundley:                             And what did you find? Dr Keith Ferdinand:                         Fortunately, we did find an effect. It did lower the primary endpoint of a change in hemoglobin A1c, but remember it was powered also by blood pressure effect and fortunately, we did see that both with the ambulatory and clinic blood pressure, both at 12 weeks and 24 weeks. The clinic blood pressure was a trend, but the ambulatory blood pressure was positive at 12 weeks and both had a strong difference in terms of confidence intervals for blood pressure lowering. About five millimeters of mercury at 12 weeks and up eight millimeters of mercury at 24 weeks for the change in ambulatory blood pressure which, in a large population would translate into a significant blood pressure lowering, the hemoglobin A1c reduction was also significant. But, although that was the primary endpoint, my concern is as a cardiologist and cardiovascular specialist. Dr Greg Hundley:                             And what dose did you select? Did you have to up-titrate this at all and, finally, were there any side effects? Dr Keith Ferdinand:                         You know, with the SGLT2 inhibitors, you have an effect both in terms of glycosuria, some osmotic diuresis and some natriuresis, and with the loss of body weight. But the change in body weight really wasn't that much, about 1.2 kilos and the change in blood pressure was discordant with the change in body weight. So, we think that the effects in blood pressure may be from extended diuretic effect, but it may also be from effects on endothelial function that are outside those significantly related to diuresis, per se. Because you're urinating glucose, glycosuria, you would expect the potential for superficial infections, mycotic infections and that was seen. The rates were not prohibitive and not dissimilar to what's been seen in other studies. So, overall, the drug was well-tolerated. It did not have any significant adverse effects outside of a few mycotic infections, which are basically superficial fungal infections and that's been seen in other uses of the SGLT2 inhibitors, but nothing that I think would be unusually disturbing in this population. Dr Greg Hundley:                             Outstanding. So, Wanpen, going to switch over to you and ask you to help us put this in the context of treating African-American men, women with hypertension. How do we think about using this new finding? How would we integrate it with other therapies that these individuals already might be taking? Dr Wanpen Vongpatanasin:         Sure, so I think that this study is very intriguing and interesting that empagliflozin to me actually had more prominent benefit on lowering 24-hour blood pressure than the previous study that the true analysis showed the effects of 24-hour blood pressure is much less or almost half of four to five millimeters of mercury and that could be that this was not that significant in African-Americans and maybe this drug is particularly effective and, as you know, African-Americans tend to have more salt sensitive form of hypertension and I wonder if that could explain the results, but I think it's very encouraging because this drug class approved for treatment of diabetes and medication. African-American have higher blood pressures than other ethnic groups and having diabetes makes them prone to having more resistant hypertension. In this particular trial, almost 40% of the patients enrolled is already taking three or more antihypertensive medications, so adding this on top and having that benefit is as good as adding spironolactone, for example, and I didn't see from the manuscript, how many patients are taking spironolactone already, but I would be curious to see that, as well. But I think that is something that physicians should think about and this drug is already FDA-approved for treating diabetes, so if you have a patient with difficult to control blood pressure and already needed something for diabetes, this could make a lot of sense to use it. Dr Greg Hundley:                             Keith, do you have any thoughts on Wanpen's comment regarding the use of spironolactone in the study population? Dr Keith Ferdinand:                         No, I don't have those specific data available at the time that we're speaking now, but that's certainly something that I will attempt to look at the database and get more information. But, I think Wanpen is absolutely right. If you look at some of the previous studies, for instance, EMPA-REG, the major outcomes trial that led to the indication of a decrease in cardiovascular death and heart failure, the blood pressure lowering wasn't that robust, maybe 4/2, but here we saw at week 24, 10 millimeters of mercury of blood pressure reduction and if you placebo subtract, which is what I mentioned in my first comments, you're talking about 8 to 8.5 millimeters of mercury reduction and that's a significant reduction, especially for ambulatory blood pressure measurement. Dr Greg Hundley:                             Absolutely. So, I'm going to go with each of you separately, but taking this manuscript and this work that Keith, you've performed, we'll start with you. What do you think of the next steps in the research in this area, both from the perspective of using this family of agents in individuals with both diabetes and hypertension? Dr Keith Ferdinand:                         What I would hope in the future is another outcome study is done with an SGLT2, any numbers of that class, that they particularly target enough African-Americans to see if this robust blood pressure reduction not only is found again, but also translates to decreased cardiovascular events. You know, NHLBI, for instance and ALLHAT, selectively over-represents African-Americans. They had 35% African-Americans in ALLHAT and the reason for that is you have a population that has a disproportionate degree of hypertension and a disproportionate degree of associated cardiovascular disease and renal disease, so you want to make sure that any medication that's been shown to be effective is effective in the higher risk population. So a future outcome study, regardless of whether they're renal-based or related to heart failure, I hope will target an increased population of blacks to see some of the robust reduction we have, translates in cardiovascular events. My suspicion is that self-defined African-American versus a genetic factor, describes the phenotype of patients who tend to be more obese, have more salt sensitivity, perhaps subclinical kidney disease and will respond to a medication that has some diuretic natriuretic effects and effects with endothelial dysfunction and sympathetic discharge. Dr Greg Hundley:                             Very good, well I heard sympathetic discharge. Wanpen, any comments there? That's your area. Dr Wanpen Vongpatanasin:         I think that definitely needs to be studied. To my knowledge, there was only one small study that published that tried to measure sympathetic nerve activity directly, but unfortunately that study after a very short-term treatment for like four or five days, so I’m sure that there will be more studies to come and also hope that the future study will shed light on any particular markers with surrogate that will identify patients that will respond better, for example, PATHWAY-2 trials that were done to test the effects of spironolactone on resistant hypertension they found that the lower the reading, the more likely you can have better response to Aldactone and I wonder if this might apply to empagliflozin and be something else. I think the fact that the blood pressures continued to decline from the week 12 to week 24 is very, very interesting when the body weight effect doesn't necessarily go down much further. This really tells us there's something else beyond weight and perhaps glucose that would explain this. Dr Greg Hundley:                             Very good. Well, I certainly want to thank you both for this outstanding discussion. Keith, we want to thank you for bringing this manuscript to Circulation and identifying this new application for this therapy in African-Americans. Wanpen, thank you also for your time and comments. On behalf of Carolyn and myself, we really appreciate you listening. Have a great week and we look forward to seeing you next week. Dr Carolyn Lam:                                This program is a copyright of American Heart Association 2019.  

Episode 11: "There are no boundaries to the human condition." A personal history in nursing - Linda Sorensen, RN Patient names have been "bleeped" in order to protect patient privacy in accordance with HIPPA.  Show Notes (helpful to non-clinical listeners!) LVN – Licensed Vocational Nurse, a different type of nursing license still offered by many states, also called LPN in some parts of the country. This type of license is not as liberal as RN licenses, i.e. LVNs cannot perform some skills like blood product administration (varies by state) “step up program” – once RN licensure became the norm many educational programs were created to allow LVNs and LPNs bridge to RN licensure CNA – Certified Nursing Assistant, or a “nurse’s aide” – many nurses have practiced as CNAs and aides prior to becoming fully licensed nurses “Float” nurse – nurses that work typically in different hospital units rather than just the same one all the time “CCRN” – Critical Care Certified Registered Nurse – a national certification offered by the AACN to recognize expertise in critical care. Not many nurses around have had this distinction for as long as Linda has. Hospital administrations are just now starting to offer bonuses and pay differential to nurses with this certification. “Swan” – a piece of medical equipment inserted through a large vein and threaded into the heart’s pulmonary artery. Also called a pulmonary artery catheter, it allows clinicians to measure advanced hemodynamics and diagnose heart failure. First used in 1970 and we still use Swan-Ganz catheters today. “ICP drain” – intracranial pressure drain; much like the Swan-Ganz, it is a diagnostic as well as a therapeutic tool inserted into the skull to relieve cerebral swelling and measure pressures “precepted” – “Precepting” is a term used by nurses to identify the training of new nurses and newly hired nurses mariemacmillan.com macmillanpages@gmail.com Podcast feedback line: 503-512-0185

In this episode I go over some tips and tricks for maximizing your success with peripheral IVs, arterial lines, central venous catheters and pulmonary artery catheters (Swan Ganz catheters). The New England Journal videos that I recommend you take a look at for detailed reviews of each of these are here: Peripheral IV: http://www.nejm.org/doi/full/10.1056/NEJMvcm0706789 Arterial: … Continue reading "Episode 18: Tips and Tricks for Line Placement"

Hosts: Vincent Racaniello and Rich Condit Vincent and Rich discuss fruit fly viruses, one year without polio in Nigeria, and a permissive Marek's disease viral vaccine that allows transmission of virulent viruses.   Links for this episode Virology tenure-track position at NCI (pdf) ASM Agar Art Contest Nigeria on brink of polio eradication (Nature) Dengue in Africa (Tyler Sharp) Permissive vaccines and virulence (PLoS Biol) Marek's disease vaccines and virulence (Ed Yong) Image credit Letters read on TWiV 348 This episode is sponsored by ASM GAP Weekly Science Picks Rich - Swan-Ganz catheter (Wiki, video)Vincent - Mobile DNA III Listener Pick of the Week Kevin - Synthetic prions Send your virology questions and comments (email or mp3 file) to twiv@twiv.tv

Wedge or PAOP is perhaps the most quoted and poorly understood variable generated by a Swan-Ganz.