Podcasts about txa

Message us!In this episode, we sit down with Autumn Vest, Executive Director of Midland Shared Spaces (MSS), to learn the story behind how this dynamic organization has been powering nonprofits since 2014.This special non-profit focused episode is guest hosted by Evan Green as a continuance of our legacy Whitley Penn Cares podcast series. In this episode, we hear about Autumn's early passion for service to housing 12+ orgs with full admin and IT support at MSS. This empowering conversation shows how their team is redefining what shared impact looks like in your community. Topics Discussed:How deep collaboration is rooted in their missionHow MSS is supporting nonprofits in Midland, TXA sneak peek at their July community socialFill out this form to have new episodes sent right to your inbox! Follow Whitley Penn on LinkedIn, Instagram, Facebook, and X for more industry insights and thought leadership!

Welcome back to the Pre-Hospital Care Podcast. In this episode, I'm joined by Stephen Wood, emergency nurse practitioner, educator, and host of Tac Medic Whiskey: The Tactical Medicine Podcast. Steve brings a wealth of experience from pre-hospital care, the emergency department, and the tactical environment, and he's become a prominent voice in the evolving landscape of high-threat medicine. His podcast dives deep into the challenges and innovations of tactical pre-hospital care, blending clinical insight with real-world operational experience.In our conversation, we explore everything from the use of TXA and calcium chloride in trauma to the nuanced decisions between needle decompression and finger thoracostomy. We'll talk about the importance of team cohesion, the mental toll of working in high-stress environments, and how to build resilience in the field. We also examine emerging technologies, training innovations, and what the future might hold for tactical medics across the globe. Whether you're on the frontline, training the next generation, or just curious about the realities of medicine in hostile or austere environments, this episode offers invaluable insights from an educator and Nurse Practitioner, Steve Wood. You can find the Tac Medic Whiskey Podcast here: https://podcasts.apple.com/il/podcast/tac-medic-whiskey-the-tactical-medicine-podcast/id1777426233** This podcast is for information purposes only and should not replace clinical guidelines or your local service policies. **This podcast is sponsored by PAX.⁠Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

Podcast summary of articles from the March 2025 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include pediatric airways, IV contrast induced nephropathy, toxic mushrooms, TXA for ACEI angioedema, bias in patient surveys, and hyperbaric oxygen therapy.  Guest speaker is Dr. Matthew Carvey.

Today, we're excited to bring back Emily Funk, DNP, CRNA to talk about tranexamic acid, or TXA—a drug making waves for its ability to control bleeding and improve surgical outcomes. Originally developed decades ago, TXA has gained new momentum due to its remarkable ability to control bleeding and improve surgical outcomes. Join us as we explore the fascinating story behind TXA's discovery, its evolving applications, and the impact it's having on patient safety and recovery. Here's some of what we discuss in this episode:

Don't miss this podcast, where Ingram Micro's John Fago explains how the platform company is elevating the power of community by bringing its two Five-Star partner communities—Ingram Micro SMB Alliance and Ingram Micro Trust X Alliance (TXA)—together under the international brand of TXA. He explores how this move is creating a strong, industry-leading global peer-to-peer community of 500+ premiere Technology Advisors and MSPs across 7 countries, where members can connect with peers facing the same challenges and situations, and learn from and support one another. Throughout the discussion, John and Doug review the history of Ingram Micro's communities, the drivers behind the decision to unite the two programs, and what it all means for Community members. John also shares a sneak peek at what's next for Trust X Alliance. For more information on Trust X Alliance, click here.

Join Patrick Georgoff as he welcomes Dr. Gene Moore and Dr. Ian Roberts, two giants in trauma surgery and epidemiology, to discuss tranexamic acid (TXA) in trauma care. Dr. Moore, a legendary trauma surgeon and researcher, and Dr. Roberts, the architect of the CRASH trials, break down the science, controversies, and practical applications of TXA. They explore who should get TXA, when it should be given, optimal dosing, and its potential risks. With insights from landmark trials like CRASH-2, STAMP, PATCH, and ROC TXA, this episode cuts through the confusion surrounding TXA in trauma and traumatic brain injury. Is early administration the key to saving lives? Should TXA be given intramuscularly prehospital? Tune in as we tackle these critical questions and define the future of TXA in trauma care! This episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page. ***Fellowship Application Link: https://forms.gle/PQgAvGjHrYUqAqTJ9 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen BIG T Trauma Series: https://app.behindtheknife.org/podcast-series/big-t-trauma

What does it take to lead an association that represents thousands of architects in one of the largest economies in the world? How do you balance tradition with innovation in an industry that values tradition and longstanding practices?In this episode of Associations Thrive, host Joanna Pineda interviews Jennifer Briggs, EVP & CEO, of the Texas Society of Architects (TxA). Jennifer discusses:How TxA represents 8,000 architects across Texas, making it the third-largest component of the American Institute of Architects (AIA).The three-tiered membership structure of AIA, which requires architects to be members at the local, state, and national levels.The importance of advocacy in protecting the licensing process and ensuring TxA is involved in key projects affecting public health, safety, and welfare.How TxA revamped its leadership development and nomination process to cast a wider net and better identify future leaders.The redesign of Texas Architect magazine after a decade, balancing bold new design with respect for the profession's rich traditions.TxA's partnership with the TV series "America by Design", which showcases architecture projects and highlights innovative products used by architects.The shift in Architect Day at the Capitol, expanding the event to better prepare members for meetings with legislators and provide valuable networking opportunities.The misguided perception of architecture as a luxury profession, and how TxA works to change that narrative by highlighting the everyday work of architects in designing schools, workplaces, and public spaces.Jennifer's passion for change management, why she embraces it, and how she has implemented it throughout her career.The experience of transitioning from leading an accounting association to leading an architecture association, and her advice for other executives making similar industry jumps.References:TxA Website

In this month's episode, Ryan and Rory discuss TXA administration in pediatric trauma, trends in respiratory viral testing, a novel clinical decision rule for vertigo and much more.

The JournalFeed podcast for the week of Feb 10-14, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:Giving 1g IV tranexamic acid (TXA) prophylactically after delivering a baby in a high-risk patient prevented severe postpartum hemorrhage.Friday Spoon Feed:This systematic review of 13 studies found slightly higher rates of adverse events after administration of diltiazem versus metoprolol, when treating atrial fibrillation (a-fib) with RVR.

2/13/2025Seven Minute Summary1. High Dose vs. Low dose TXA in Adult deformity Surgery. JBJS. Dec 20242. Incidence of revision surgery and outcomes following surgery for spondylolisthesis. JNS. Jan 2025

Today, we're talking about the use of tranexamic acid or “TXA” for rotator cuff repair surgery. First, what is TXA? If you're not an arthroplasty surgeon or a traumatologist, you may not be as familiar with this medication. TXA is drug that inhibits the enzymatic breakdown of fibrin blood clots, also known as fibrinolysis. By doing this, TXA stabilizes the thrombi, or blood clots, and thus decreases bleeding. TXA was originally developed to treat postpartum hemorrhage but its use has evolved over the years. It is now often used perioperatively in the setting of elective surgery to reduce blood loss, blood transfusions, ecchymosis, and hematoma formation.In the field of orthopedics, use of TXA has traditionally been limited to big open surgeries where large volume blood loss is a concern, such as total joint replacement, fracture fixation and spine procedures. However, sports medicine procedures that rely extensively on visual clarity of the surgical field, such as knee and shoulder arthroscopy, can also greatly benefit from the use of TXA. By lessening intraoperative bleeding, TXA may result in better visualization of the surgical field, potentially decreasing operative time and subsequent postoperative swelling and pain. That is the clinical question that our paper today aimed to investigate. The article that we are reviewing is titled “Tranexamic Acid for Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” 

In this episode of the PFC Podcast, Dennis and John discuss the ongoing updates and changes within the Tactical Combat Casualty Care (TCCC) guidelines. They delve into the role of the TTC Committee, the importance of literature reviews in developing algorithms for trauma care, and the proposed changes to the March algorithm, emphasizing the need for resuscitation before decompression. The conversation also covers the overhaul of the analgesic section, the recommendations for antibiotics, and the role of TXA in treating hemorrhagic shock. Additionally, they touch on the significance of triage in mass casualty situations and the future directions of the committee's work. Takeaways TCCC is continuously updated to reflect new research. Resuscitation should be prioritized over decompression in trauma care. The March algorithm may undergo significant changes to improve outcomes. Analgesic options are being re-evaluated due to supply issues. Rocephin is being recommended as a primary antibiotic. TXA is crucial for managing hemorrhagic shock in trauma patients. Triage protocols are essential for effective mass casualty management. The committee is open to innovative ideas and solutions. Training and education are vital for implementing new guidelines. Future meetings will focus on finalizing and voting on proposed changes. Chapters 00:00 Introduction to the PFC Podcast 02:46 Understanding the TTC Committee and Its Role 06:06 Literature Review and Algorithm Development 09:00 Resuscitation vs. Decompression in Trauma Care 12:07 Proposed Changes to the March Algorithm 15:06 Analgesic Section Overhaul and Alternatives 18:09 Antibiotic Recommendations and Changes 20:54 TXA and Its Role in Hemorrhagic Shock 23:51 Triage in Mass Casualty Situations 26:45 Future Directions and Upcoming Votes 30:06 Conclusion and Final Thoughts Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Justin and i are back fro the first episode of the Journal Jam for 2025.  we discuss a lot of stuff about TXA, adrenaline, salt correction, dissection and infections!  Lots of great #FOAMed for the month of January.

Bleeding patient outside the 3 hr window...Can I redose TXA? Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55 Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

This conversation kicks off a new series that takes a deep dive into anything blood-related. During this episode, Dr. Andrew Jenzer revisits the podcast alongside Dr. Maxwell Lloyd to demystify some of the key ideas underpinning hemostasis, coagulation, and PTT levels. Join us as we discuss helpful tools to navigate detection, monitoring, testing, and all the factors that may affect results. From PTT and D-Dimer testing to mixed testing options and thrombal elastography, we cover it all. Next, we get into abnormalities and all the elements to consider before going about an invasive surgery of this nation. We get into detail about Von Willebrand's disease and what testing can tell you, after considering why clinical history is specifically important for the treatment of bleeding issues. Lastly, we discuss OMS-specific hemostatic agents, and the impact of CRASH 1, 2, and 3 trials on how we implement TXA. Join us today to hear all this and more. Key Points From This Episode:Introducing Drs. Andrew Jenzer and Maxwell Lloyd.Dr. Jenzer's upcoming mock boards course for residents.The topic of this episode which kicks off a new series: blood and anything blood related.Differentiating between primary and secondary hemostasis. Understanding intrinsic and extrinsic pathways. Why all coagulation factors are ultimately made in the liver.The importance of interpreting the lab values.Using the WETT acronym in the context of anti-coagulation.Monitoring through PTT. D-Dimer testing and why it is so often misunderstood. What is essential to do when mixing tests together. Another test option: thrombal elastography.Thinking about the risks and benefits of stopping anticoagulation. Developing a schema to think about abnormalities. Understanding how to address Haemophilia A and B. Why clinical history is particularly important for bleeding issues.Demystifying Von Willebrand's disease and what testing can tell you. OMS-specific hemostatic agents, which ones work best, and more. CRASH 1, 2 and 3 trials and TXA. Links Mentioned in Today's Episode:Dr. Maxwell Lloyd on Google Scholar — https://scholar.google.com/citations?user=D0agka0AAAAJ Dr. Andrew Jenzer Email — andrew.jenzer@gmail.com Dr. Andrew Jenzer — https://surgery.duke.edu/profile/andrew-clark-jenzer CRASH-1 — https://pmc.ncbi.nlm.nih.gov/articles/PMC33506/ CRASH-2 — https://pmc.ncbi.nlm.nih.gov/articles/PMC4576020/ CRASH-3 — https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/ Dr. Grant Stucki Email — grantstucki@gmail.com Dr. Grant Stucki Phone — 720-441-6059

Does TXA cause hypotension or is it just correlated due to the types of trauma patients it's indicated for? Link to full podcast: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55

In this episode of the PFC Podcast, Dennis speaks with John McClellan, a military trauma surgeon, about the use of Tranexamic Acid (TXA) in trauma care. They discuss the mechanism of TXA, its applications in pre-hospital settings, potential complications, and evolving dosing strategies. John emphasizes the importance of TXA in managing hemorrhage and the need for standardized protocols in trauma care, especially for medics in the field. Takeaways TXA is a lysine analog that helps stabilize clots. The ideal patient for TXA is anyone suspected of needing massive transfusion. TXA is considered a low-risk drug for trauma patients. Pre-hospital administration of TXA is crucial for patient outcomes. Complications from TXA are not increasing significantly. Current dosing strategies for TXA are evolving towards higher initial doses. Preloading TXA can save time in emergency situations. TXA has solidified its role in trauma care over the years. Understanding the pharmacokinetics of TXA is essential for effective use. Standardized protocols are vital for medics in the field. Chapters 00:00 Introduction to TXA and Trauma Care 03:12 Understanding TXA: Mechanism and Applications 05:53 Pre-Hospital Administration of TXA 08:48 Complications and Concerns with TXA 12:06 Dosing Strategies and Evolving Guidelines 15:02 Practical Considerations for Medics 17:57 The Future of TXA in Trauma Care Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Posting tomorrow...Down and dirty chat with John on TXA and Trauma. Link to full episode: https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-212-TXA-e2sss55

Welcome to the first episode of 2025! This month, we're diving into the critical role of Tranexamic Acid (TXA) in pre-hospital trauma care. Dr. Erik Vu, a critical care flight paramedic, emergency physician, and intensivist, joins us to discuss the latest insights and applications of TXA, particularly in dynamic and tactical environments. From its role in stabilizing clots to its use in mass casualty scenarios, we break down everything you need to know about this cost-effective and life-saving medication. Learn about the benefits of intramuscular (IM) administration, the importance of timely intervention, and how TXA fits into modern trauma care systems. What You'll Learn in This Episode: What TXA is and how it works. The history and research behind its pre-hospital use. Why IM administration is a game-changer in tactical and unpredictable environments. Best practices for dosing and administration. TXA's role in mitigating hemorrhagic shock and improving patient outcomes. Practical tips for integrating TXA into your trauma care toolkit.

Here's another great podcast from early '24. This was a great conversation and finished the year at #5. In this episode of the PFC Podcast, Dennis interviews Steve Schauer, an active duty lieutenant colonel in the US Army, about his research on calcium levels in trauma patients. They discuss the significance of calcium in trauma care, the challenges of conducting research in military settings, and the methodology of their study. Steve shares insights on the correlation between calcium derangements and patient outcomes, the importance of data collection, and the implications for trauma care practices. The conversation also touches on the prioritization of interventions in trauma situations and the evolving nature of medical practices.TakeawaysCalcium levels are critical in trauma care.The study aims to assess calcium derangements in trauma patients.There are significant differences between military and civilian trauma.Injury severity scores may not accurately reflect military trauma.Pre-hospital care can impact calcium levels upon arrival.Data collection is complex but essential for accurate results.Calcium administration should be approached cautiously.TXA is prioritized after blood in trauma interventions.Future research will provide more insights into calcium's role.Medical practices are constantly evolving based on new research.Chapters00:00 Introduction to Calcium Study in Trauma02:49 Understanding Calcium's Role in Trauma05:54 Challenges in Trauma Research09:05 Data Collection and Methodology11:50 Calcium Levels and Patient Outcomes15:00 Retrospective Data Insights18:02 Calcium Administration in Trauma Care20:55 Prioritizing Interventions in Trauma24:13 Future Research Directions27:06 Conclusion and Future InsightsThank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley provide a comprehensive update for October 2024. They discuss key blog posts covering diverse medical topics, including highlights from the Royal College of Emergency Medicine's academic science conference focusing on toxicology, high-potency opioids, novel benzodiazepines, and the use of flumazenil. They also explore the Green ED project and the impact of climate change on healthcare. Additionally, they delve into recent research on ventricular fibrillation pad positions, the use of tranexamic acid (TXA) in trauma care, and the importance of maintaining a positive outlook amidst winter challenges by seeking small wins and engaging in enjoyable aspects of emergency medicine. The episode offers valuable insights and updates for emergency medicine professionals. 00:00 Welcome and Introduction 01:27 Highlights from the Royal College of Emergency Medicine Conference 01:50 Toxicology Insights: High Potency Opioids and Benzodiazepines 05:11 Climate Change and Healthcare: The Green ED Project 08:23 Medical Conferences: A Phoenix from the Ashes 10:38 Ventricular Fibrillation and Pad Position: New Insights 17:22 Tranexamic Acid (TXA) in Trauma Care 24:01 Maintaining Positivity in Challenging Times

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast About the Hosts Daniel J. Ozzello, MD - Dr. Daniel J. Ozzello is a dedicated faculty member in the Division of Oculoplastics at the University of Colorado. With a rich background that includes training in ophthalmology at the Wills Eye Hospital and an ASOPRS fellowship in San Diego under the esteemed Dr. Don Kikkawa and Dr. Bobby Korn, Dr. Ozzello has established a diverse practice in oculoplastics as well as urgent and inpatient ophthalmic care. At Colorado, he engages in clinical care, research and teaching. Caroline Vloka, MD - Dr. Caroline Vloka recently completed her fellowship at the University of Colorado following her residency in Pittsburgh. Bringing fresh perspectives and insights, she has already made a substantial impact as a new faculty member. Her interests lie in advancing oculoplastic surgery techniques and patient outcomes, carrying forward her rigorous training and passion for patient care. Episode Summary: In this informative episode of the OculoFacial Podcast, Dr. Daniel J. Ozzello teams up with Dr. Caroline Vloka to delve into the latest advancements in oculoplastic surgery, focusing on two significant blepharoplasty studies. The discussion revolves around the effectiveness of tranexamic acid (TXA) in surgery, alongside an exploration of the cost-effectiveness of these surgical interventions and their impacts on patient care. Introducing listeners to these critical insights, the duo unpacks recent research findings, igniting conversations on how these might enhance surgical practices and patient outcomes. The analysis begins with an examination of a study concerning the preoperative use of TXA in eyelid surgery, meant to reduce bruising and improve patient satisfaction. Highlighting its potential benefits, Dr. Ozzello and Dr. Vloka weigh the simplicity and cost-effectiveness of incorporating TXA into regular surgical protocols. The conversation then shifts towards evaluating the economic and quality-of-life impacts that blepharoplasty offers. The pair discuss a study that aligns the procedure with high cost-effectiveness scores, emphasizing its beneficial role in elevating patient functioning and wellbeing. Key Takeaways: Tranexamic Acid Efficacy: Recent studies demonstrate that tranexamic acid significantly reduces bruising and enhances patient satisfaction in blepharoplasty procedures. Oculoplastics Cost-Effectiveness: Blepharoplasty is proven to be highly cost-effective, providing substantial improvements in quality of life for patients with dermatochalasis Importance of Context: The subjective nature of cosmetic and functional outcomes can vary based on demographic factors and patient profiles. Thorough Patient Education: Managing patient expectations about postoperative outcomes is crucial for satisfaction, especially when comparing with other surgeries like cataract interventions. Collaborative Inquiry: There is a call for larger-scale studies and collaborative data pooling in oculoplastic research to better address rare conditions like idiopathic orbital myositis Resources: University of Colorado - Division of Oculoplastics: Official Website Publications on Tranexamic Acid and Blepharoplasty: Recent articles in OPRS (Oculoplastic and Reconstructive Surgery). Listen to the full episode for valuable insights and stay tuned for more enlightening and engaging content from the OculoFacial Podcast!  

“Labor is supposed to happen naturally. It's not this big medical intervention that occasionally happens naturally. It's this natural process that occasionally needs medical intervention.”Paige Boran is a certified nurse-midwife from Fort Collins, Colorado. She and her colleague, Jess, practice independently at A Woman's Place. They have rights to deliver babies at the hospital but are not employed through the hospital system so they are not subject to physician oversight. Their patients benefit from a low-intervention environment within a hospital setting but without the restriction of hospital policies.Lily Wyn, our Content Creator and Social Media Admin, joins us today as well! Lily shares why she chose Paige to support her through her current VBAC pregnancy. Lily is a beautiful example of how to diligently interview providers, keep an open mind, process past fears with the provider you choose, and what developing a relationship looks like to create an empowering birthing experience. Paige shows us just how valuable midwifery care can be, especially when going for a VBAC. If you're looking for a truly VBAC-supportive provider, this is a great episode on how to do it! The VBAC Link's VBAC Supportive Provider ListA Woman's PlaceHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Paige: Yeah, so I'm a certified nurse-midwife. I work in northern Colorado in Fort Collins at A Woman's Place. We're a small midwifery-owned practice. Right now, there are just two CNMs. That's the whole practice. It's just me and my colleague, Jess, who owns it which is really cool because we get to push the boundaries because we are not really locked into the hospital system. We are able to catch babies there but we are not actually employed through the bigger hospital systems which is nice because we don't have that physician oversight and stuff like that. I think we are able to do a lot more and honor that midwifery care model which is really cool. Sometimes people feel locked into policies and their overseeing physician and things like that but when it's just two midwives, we get to do what we want and what feels best for the patient. I really like that. That was a big thing when I first got into the certified nurse midwifery world. I was like, where do I want to work? I had offers from bigger hospital systems and it just didn't feel like the right fit so working at a small, privately-owned practice felt like the right answer for me so I was able to practice in a way I felt was right for people. I didn't want to be locked in by a policy and overseeing physicians. I just wanted to grow with other midwives. Meagan: Yes. I love that so much. I don't know. Maybe I should say I know it feels to me– I don't know it as an actual fact, but that feels like a unique situation and a unique setup to me. We don't really have that that I know of here in Utah. We either have out-of-hospital CPMs or we have in-hospital CNMs who are just hospital. I know that one hospital system is trying to do the attached birth center, but it is still very different. They are still the hospital umbrella midwives I guess I could say. So is that unique or is that just something that feels like it?Paige: I think it's unique because where I came from in Florida, if you were a CNM, you 100% practiced in the hospital which we do but it was that you were owned by a larger group of physicians essentially. Florida was working towards independent practice when I was there. Colorado is an independent-practiced state for nurse practitioners which is really cool because we don't have to have that oversight. I don't know if Florida ever got there but I know it varies state to state on if you have to be overseen by a physician or not. Honestly, that's why a lot of people when they are ready to become a midwife, if they don't have independent practice rights as a CNM even if they are a nurse, they will go for a CPM which is a certified professional midwife because they actually have more autonomy to do what they want outside of the hospital because they are not bound by all of the laws and stipulations which is interesting. Meagan: Exactly. I think that's a big thing– the CPM/CNM thing when people are looking for midwives. Do you have any suggestions about CPM versus CNM? If a VBAC mom is looking at a CPM, is that a safe and reasonable option?Paige: Absolutely. Yes. I think CPMs and CNMs are both reasonable, safe options. They both have training in that. They both can honor your holistic journey. I would say the biggest thing is who you feel most connected to because I think trusting your team, you will have people who have the worst birthing outcome and horrible stories but they are like, “I look back and I feel so good about it because I trusted my team.” I think that is what's important. If a CPM seems like your person and that's who you are going to trust, then that's who you should go for whereas a CNM, if that seems like that's your person and who you trust, I think that would be a good route too. I think a lot of people think, “Oh, they do home births. They must catch babies in a barn and there is no regulation. Even sometimes when I say, “midwife,” people are like, “What? Do you dress like a nun and catch babies in a barn?”Meagan: Yes, this is real though. These are real thoughts. If you are listening, and not to make fun of you if you think this, this is a real thing. This is a myth surrounding midwifery care, especially out-of-hospital midwives where a lot of people think a lot of different things. Paige: Absolutely. Meagan: I think I had a chicken chaser or something where a dad was like, “Do you chase chickens?” I was like, “What?” He said, “Well, that's what the midwives do so that's what the doulas do.” I'm like, “What? No, we don't chase chickens.” Paige: That is such old-school thinking but realistically, midwives started in the home and that was their history. It's cool that they've been able to step into the hospital and bring some of that back into the hospital because I think that is needed. Meagan: It is needed, yeah. Paige: We are starting to see that physicians are starting to be a little bit more holistic and see things in the whole picture, but I'm glad that the midwives did step into the hospital because I think that needed to be there but I'm so glad that people are still doing it at home because I think that is such a good option for people. Meagan: Yeah, so talking abou the midwives in the hospital, a lot of people are talking about how they are overseen by OBs. Is this common? Does this happen where you are at? You kind of said you are separated but do the hospital midwives in your area or in most areas, are they always overseen by OBs? Paige: Not necessarily. It would vary state to state and hospital to hospital. We actually just got privileges and admitting privileges a couple of years ago. Actually, my boss, Jess, who owns the practice where I work, had worked in Denver where they were allowed to admit their patients and everything. They didn't have to have any physician oversight but when she was there, she had to have physician oversight. She was like, “It's an hour drive north, why would that make a difference?” It was the same hospital system so she fought when she bought the practice and the physician who owned it prior left, she was alone and she had to have that physician oversight so she fought for independent practice privileges and she got it. Some of the midwives at first weren't so happy about it because they had liked being overseen by the doctor and someone signing off on all of their things. Some of the midwives were like, “Finally. We should be able to practice independently.” It's going to vary at each place. But I think that's a good thing to ask, “If something is going wrong, will a physician just come unannounced into my room in the hospital?” That's not the case with ours. We have to invite them in and if we are inviting them in, we've probably had a conversation multiple times with the patient where it's like, we need to have this. Meagan: Yeah. For the patients who do have the oversight of the OBs, do you have any suggestions? I feel like sometimes, at least here in Utah with my own doula clients when we have that situation, it can get a little confusing and hard when we've got an OB over here saying one thing but then we've got a midwife saying another. For instance with a VBAC candidate, “Oh, you really have a lower chance of having a VBAC. I'll support it. I'll sign off, but you have a really low chance,” but then the midwife is like, “Don't worry about that. You actually have a great chance. It is totally possible.” It gets confusing. Paige: Yeah, and it's like, who do you trust in that scenario? I think that's where evidence comes in because I think midwives and physicians both practice evidence-based but some people may have newer evidence than others. I've worked with OBs who probably roll over in their grave when I say certain things because it wasn't the old way but it is the new way. If somebody can come in with their own evidence and they're like, “I've looked into this and I think I'm a good candidate for x, y, and z,” I think physicians respond well to that because they are like, “Okay, they've done their research. Maybe I need to do some research.” Meagan: Yeah. Paige: When they have that thought, they know that this is an educated person and I can't just say whatever I want and they're going to take my word as the Holy Bible. Meagan: Yeah. No, really. Exactly. It always comes down to education and the more information we can have in our toolbelt or in our toolbox or whatever it may be, it's powerful so I love that you point that out. I think it's also important to note that if you do have two providers saying different things, that it's okay to ask for that evidence. “Hey, you had mentioned this. Can you tell me where you got that from or why you are saying that?” Then you can discuss that with your other provider. Paige: Yeah, and following intuition too. I think you can have all of the evidence in the world. What is your gut telling you too? Who do you trust more and what feels right in your body in the moment? I think we are all experts of our own bodies and there's a lot that goes into a VBAC and stuff like that. It's more than just the evidence. People have to feel mentally and physically ready for it too. I wish more people focused sometimes on the mental and spiritual aspect of it because I think a lot of people get ready physically but maybe mentally they weren't prepared for the emotional switch there. Meagan: Totally. Thinking about that, Paige, I mean Lily, tell us a little bit about why you went the midwifery route. I know you really wanted to find the right provider. Lily: Yeah. So I think for me, I have always been drawn to midwifery care. I was a little bit of a birth nerd prior to even working for The VBAC Link or even having my own kiddos. Prior to my son, we had a miscarriage and an ectopic pregnancy so I experienced OB care with my ectopic. I was bounced around a lot in a practice and had OBs who were great and equally some OBs where it was such a rushed visit that I had an OB miss an infection in my incisions because my pain was dismissed and just some really tough stuff. When it came to getting our rainbow rainbow baby, I was like, I really don't want to be in a hospital at all. I want midwives. That's the route that we went. The very brief story of my son is that he flipped breech 44 hours into labor and that's when we legally had to transfer to the hospital and I had my Cesarean. So in planning my VBAC, I planned to go back to the birth center and was a little devastated when it was out of our financial means this time. I was so panicked. I remember texting you, Meagan, and being like, “What do I do? I can't be at the birth center anymore and I don't want to be in a hospital.” We interviewed another birth center that's about an hour away that is in network with our insurance and talk about trusting your gut, it just didn't feel right. It didn't feel warm and fuzzy. Those are the feelings I got with our first birth center. I loved them so much and I still do. Then I met with Paige and her practice partner, Jess, and I came in loaded to the teeth. I was prepared to fight with someone because that's what I had in my brain and that's what I expected. I sat down with them. They met me after hours after clinic. I sat down with my three pages of questions and by the way, if you are listening and you have questions, we have a great blog on it and some social media posts of the questions that I specifically used. We talked for over an hour and every question I asked, they just had the ultimate answer to. I felt so at peace after talking with both of them and I remember telling my husband going into it, “I'm really worried that I'm going to like these people because I don't want to deliver at a hospital and then I'm going to have to choose a far away birth center that is out-of-hospital or providers that I like but it's a hospital.” It just feels like everything has been serendipitous for us. Our hospital opened a low-intervention portion of their birth floor so I'll still get to have the birth tub and all of the things, but truly have just been blow away by Paige and have just buddied up. She's dealt with all of my anxiety in pregnancy and VBAC and all of my questions. It just feels like such holistic care compared to my experience with OBs in the past. Meagan: That is so amazing and I was actually going to ask how has your care been during this pregnancy? It sounds like it's just been absolutely incredible and exactly what you needed. I remember you texting me and feeling that, oh crap. I don't know what to do. What do I do? You know? I just think it's so great that you have found Paige. Did you say that Jess is your partner? Paige: Yes. Meagan: Jess, yeah. I'm so glad that you found them because it really does sound like you are exactly where you need to be. Lily: Yeah. It made a huge difference for me and I just tell Paige all the time I truly didn't know that care in a hospital setting could look the way that it does. I feel like I'm getting– I experienced birth center care. I had an out-of-hospital experience until we transferred and I can say with confidence that my care has been the same if not better with Paige and just having the conversations and the good stuff and feeling really safe and confident. One thing that they pointed out that I thought was great when I went in and asked all of my questions is that Jess looked at me and she was like, “Okay, it sounds like you have a lot of anxiety around hospital transfer.” And I did. With my son, that was my worst fear and it came true. I had a lot of anxious, what if I have to transfer? She was like, “The thing is there is no transferring. We can induce you if you need to be induced and we can come with you into the OR with your Cesarean if that ever happened to be another thing.” For me, that brought a lot of peace to know that no matter what, the provider that I know and feel comfortable with is going to be with me. I again, didn't expect to feel that way, but it's been a really great reassurance for me personally. Meagan: Yeah. It's the same with a doula. Knowing that there's someone in your corner that you know who you've established care with who can follow you to your birth with you in your journey is just so comforting. So Paige, I wanted to talk about midwifery care and also just lowering the chance of Cesarean. Sometimes people do choose midwifery care specifically because they are like, “I think I have a lower chance of a Cesarean if I go the midwifery route.” Can we talk to that a little bit?Paige: Yes, that's true. A lot of people know that there are benefits to midwives but I think when people think of midwives, it's just like, “Oh, it's just a better experience. I trust my team more.” That's definitely there. There have been studies and people felt more at peace and empowered through their birthing journeys with midwives than they did with OBs. It's been studied but there is also a decrease in C-section risk. Your C-section risk drops 30-40% when you have a midwife which I think is a pretty significant drop. Meagan: Yeah. Paige: Yeah, especially when we look at the United States at our birthing outcomes and birthing mortality and C-section rates, it is way too high for as developed of a country as we are. I think that's really where midwifery care is stepping in and starting to help lower those rates to get it down to where it should be. The World Health Organization has been nominating and promoting midwifery care because it really is the answer to how we get these C-section rates lowered and these bad outcomes lowered. Midwives also have lower chance of an operative vaginal birth. That would be with forceps or a vacuum or an episiotomy so lower chances of those things as well. Lower chance of preterm birth which is interesting and probably because one, we do take lower-risk people. I think that's true but also because we are looking at it holistically. We are looking at everything. We are not just looking at you as a sick person. A lot of people look at pregnancy as an illness and pregnancy is not an illness. It's just a natural part of life and we've got to look at the whole picture of life if we're just going to look at the one thing too. I think that helps to reduce preterm birth risk. We also have lower interventions just overall. We're more in tune with people's bodies and we want to honor what their bodies are meant to do. Labor is supposed to happen naturally. It's not this big medical intervention that occasionally happens naturally. It's this natural process that occasionally needs medical intervention. The midwifery model is so important. I think when you go to the traditional medical model, you look at the present illness so they see pregnancy as an illness. What can go wrong? Don't get me wrong. There are a sleu of things that can go wrong in pregnancy and you do have to watch for them. But I think with midwifery care, you know when to use your hands but you also know when to sit on them. Meagan: Yes. Oh my gosh. I love that so much. I feel like we need– we used to get quotes from our podcast episodes and turn them into t-shirts and I feel like that is a t-shirt podcast quote-worthy. Oh my gosh. It's a worthy quote. That is amazing and it's so true though. Paige: It is. Meagan: It's not to rag on OBs. You guys, OBs are amazing. They are wonderful. They do an amazing job. We love the. But there is something different with midwifery care. You mentioned preterm birth. I remember when I was going through my interview process to have my VBAC after two C-section baby and I finally established care mid-pregnancy because I switched. That was one of the things in the very beginning that my midwife was like, “Let's talk about things. Let's talk about nutrition. Let's talk about supplements. Let's talk about where you are at.” It was just honing in on that which I was surprised by because I figured she'd be like, “Let's talk about your history. Let's talk about this,” but it was like, “No. Let's talk about what we can do to make sure you have the healthiest pregnancy,” but also started commentingo n mental stuff. It helped me get healthy in my mind. I just would never have had that experience with OB where they wanted to learn what I was scared about and what I was feeling and all of those things. Not only was I learning how to nourish myself physically, but mentally and it was just a really big deal. I do feel like it played a big impact in my labor. Paige: Yeah. A lot of people discredit how much nutrition and debunking fears and stuff like that can go because I think a lot of that– I mean, we look at nutrition-wise and we could avoid almost all of preeclampsia with nutrition alone which is incredible. I'm like, “I really think you should read Real Food for Pregnancy and people are like, “Oh, but it's such a big book,” and I'm like, “But it's so important to know this information about what we should be putting in our bodies.” 100 grams of protein– you've already got it. Meagan: I want to see how many pages for it. It's got, okay. We've got 300 pages but it has recipes and all of these amazing things in the end so it's not even a full book. Paige: Yes. People are like, “Oh man, I don't know if I want to read the whole thing,” but I'm like, “It's so important.” I think when people do read it, they come back and are like, “Did you know that I could decrease my risk of this if I ate more Vitamin A?” I'm like, “Yes. That's why I wanted you to read this book.” It is a wealth of information and I have such healthier pregnancy outcomes when people follow that high protein diet and looking at micronutrients with their Vitamin A, their choline, and all sorts of things. Meagan: Yeah. All of the things that we talk about a lot here on the podcast because we are partnered with Needed and we love them so much because we talk about the choline and the Vitamin A and the Vitamin B's and the Vitamin D's. Lily Nichols, not this Lily on the podcast today, she also wrote Real Food for Gestational Diabetes and that's another really powerful book as well. But yeah. It's just hard because OBs don't tend to have the time. I think some OBs would actually love the time to sit down and dig deep into this but they don't have the time either. I do think that's a big difference between OBs and midwives. What does your standard prenatal look like? When a mom comes in, a patient comes in, what do you guys do through a visit? Paige: Yeah. We follow the standard what everywhere in America does like once a month roughly in the first trimester and second trimester then when you hit 28 weeks, every 2 weeks, and then when you hit 36 weeks, every week. If you go to 41, we'll see you twice in that week. We follow those stipulations but our appointments are a little bit longer. When you are in a big practice, a lot of time it's driven by RVU use so the more patients somebody can see, the more they are going to get paid and the bigger their bonus is at the end of year. A lot of people feel like they are running through the cattle herd and they've been in and out in 15 minutes if that. At my practice, it's a little bit different because we are not RVU based. We're not getting any bonus. We're not trying to see as many patients as we can. Will we ever be the richest at what we do? No, but that's okay with me and Jess. We are small on purpose and we love to take the time. At Lily's appointments, we always book her for at least 30 minutes because we know that me and her like to talk. We've done an hour for some people because we know there is always going to be that long conversation. Don't get me wrong though, that fourth mom whose had three vaginal births and going for her fourth, she may be like, “Paige, there's really nothing to talk about today and that's okay.” Sometimes they are 15 minutes. Sometimes they are 30. Sometimes they are an hour. Our first appointment is always an hour because there is just so much to dive into with how we can be preparing ourselves, what does your history look like especially if they are brand new to our practice and we've never met them before, starting to build that relationship early on. It just depends on how far along they are, who the person is, and those things. But I do like that I can spend as much time as I need. Sometimes I tell my people, “Bring a book because I tend to get behind because I tend to talk to people longer than I book for,” but that's okay. We know that we can do that because we are a smaller practice. I think when people are thinking about what kind of care they want, they should probably consider how are these people paid? Is it by how many they can see in a day? Because you're probably going to get a different level of care than a practice that isn't drive by those RVUs. Yeah, that's a really good point. I feel like my shortest visit with my midwife was 20 minutes. Paige: Yeah. Lily: Yeah. Meagan: Which to me is pretty dang long because when I was going with my other two daughters, I think it was probably 6-7 minutes if that with my provider. I mean, it was get in. My nurse would check my fundal height and all of that and then oh, the doctor will be in here. Then came in, quick out. Yeah. It is really, really different. Lily: I know for me too, I love that we don't just talk about nutrition and things like that but even in my last appointment, I was talking with Paige about the things that can be triggering coming back into labor and going back into a hospital so my ectopic pregnancy was at the hospital that I'll be delivering at and I had to go into the emergency room and the way that you go to labor and delivery after hours is through the ER so Paige and I were talking. She was like, “I can just meet you outside. We will badge you in and we will avoid the emergency room if that feels triggering.” It's just those things that you don't get with an OB necessarily to talk through tiny little triggers. They are probably generally less accommodating to those little things of, “Well that's just the standard. You're going to have to get over that and just go through the ED and come on up.” I think that's been huge. I also have a dear friend who is going to school to be an OB. I told Paige at my last appointment that she may possibly be at my birth. She's my crunchy friend so she'll be a great OB but I have such a desire to be like, “Come see a VBAC. Come see it so that you have it in your brain and you know that they can be safe and look at what can be done,” so I think that is so huge too as we continue to train and uplift our next generation of providers. What does that look like to show them? I think her internship or something is going to be a midwife and OB partnership practice which is really cool but I'm like, “Yes. Come. Come to my birth. Please. I want you to see all the things.” That's really cool too and that Paige is open to, “My friend might be there.” Meagan: Yeah. Paige: Bring whoever. Meagan: I love that. I love that you were pointing out too this next generation of providers. Let's see that birth and VBAC is actually very normal and very possible because there's a lot of people who have maybe seen trauma or an unfortunate situation which could have happened because we blasted them with interventions or could have happened out of a fluke thing. You don't know all of the time. But I do think if we can keep trying to get these providers, these new provider to see a different light, we will also see that Cesarean rate drop a little bit. We really, I always tell people that we have a problem. They're like, “It's really not that big of a deal.” I'm like, “No, it's a very big deal. It's a very, very big deal. We have a problem in this medical world.” I do believe that it needs to change and midwifery care is definitely going to impact that. I hope that what you were saying in the beginning how policies don't trump a lot of the midwives. I wanted to ask you. This isn't something we talked about, but is it possible to ask your midwife, “Hey, what policies do you lie under?” Is that appropriate? Paige: Yes. Actually, that was one of my favorite things when Lily came in to meet and greet us. She came and she was like, “What are the policies for a VBAC?” We dove into that. We've been diving into that and what are we going to be okay with and what are we not going to be okay with? That's the beauty is that I'm not employed by the larger hospital system that I work under so I feel like a policy is not a law. I feel like there is informed consent and I think informed consent is so important but at the same time, there is informed declination and you should be able to decline anything. That's true. We can never force anybody into surgery. We can never force anybody into anything. I think a lot of people aren't having those conversations where it's actually informed so then people are like, “Oh, they are just refusing everything.” I hate the word refuse because no, they are not refusing it. They are declining it because they are informed. They know the risk. They have all the information at their fingertips and they know that this is the best decision for them and their baby and we have to honor that. That's why I'm really glad that I'm able to practice in that way, but I do know I've met and I've worked with people who feel like they are boxed in and have to follow those policies. We've started to talk about what our policies are with TOLACs and VBACs and things like that. One of them is that they are supposed to have two IVs. I've already gone against that before and I've had a beautiful, unmedicated VBAC. She walked in. I said, “We've talked about it. She was also laboring outside when we talked about it. It's not an issue when you come in. You know what? When we get up there, I'm just going to tell them that you know why they recommend two IVs and you are declining.” She walks in and she's clearly going to have this baby within the hour. I told the nurse, “We're not doing the IVs. We've talked about it. We're going to decline them.” That was the end of the discussion. We didn't have to talk about it again which was nice. She shouldn't have had to advocate in that moment for herself. We've already had those conversations. Meagan: Yes. Paige: Another one is continuous monitoring and the whole idea is if you start to rupture, that's how we are going to catch it. The baby is going to tank and that's how we are going to save the baby's life. Don't get me wrong. I think continuous monitoring can be really valuable for a lot of things but it's actually not evidence-based. We have not improved neonatal outcomes with continuous fetal monitoring. We've talked about that with Lily and she's going to opt for intermittent oscillation and I think that's very appropriate because she plans to go unmedicated. Let's be honest, if you are unmedicated and your uterus starts to rupture, moms will tell me that something is not right. This is beyond labor. Her saying that and being aware of that, we would notice it a lot sooner than we would the baby tanking kind of thing. Meagan: Yeah. I do know that with uterine rupture, we can have decelerations but like you were saying, there's usually so many other signs before baby is actually even struggling and I know a couple of uterine rupture stories where providers didn't believe the mom that something was going on because that one thing wasn't happening. The baby wasn't struggling. Paige: Yes. Meagan: It's like, you guys! When it comes to continuous fetal monitoring in the hospital, people have to fight to have that intermittent. It's yeah. Anyway. These policies are not law. I love that you said that too. There's another t-shirt quote. Paige: I think people should start asking if they are planning a VBAC, start asking what is the policy and start thinking, is that what they want? I do have some moms who are like, “No, I want the two IVs because it's hard for me to get a stick,” and they need that backup in case. That makes them feel more at peace but other people are like, “It makes me feel like a patient. I don't like it.” People don't like needles and that's okay. They have that right to say no. I tell people that in a true emergency, we will get an IV in you if something really, really bad were to be happening. That's part of training if somebody walks in off the street. We're not going to be like, “Oh, when was the last time you ate? Sorry, you can't have the surgery.” We know something bad is happening right now. We will get the IVs. We will do all of the things. Getting the IVs really won't save as much time as people think it will. Meagan: Yeah, and there are other things. Say we are having our baby and we are having higher blood loss than we would like or we have some concern of some hemorrhaging, there are other things that we can do. We can put Pitocin in a leg. We can do Cytotec rectally. There are things that we can do. We can get that baby to our breast and start stimulating and try to help that way. There are things that we can do while we are waiting for an IV, right? Paige: Yes. I tell people that all the time. Most of the postpartum hemorrhage meds that we use can be given without an IV. There is only one that truly has to be given through an IV and that's TXA but the rest can all be given other routes. A lot of times, those work better than IV Pitocin. Sometimes the ion Pitocin works better. Sometimes the ion Methergine works better. It's not this, oh we have to have a little just in case kind of thing because if there was a just in case moment, yes. We can be working on the IV and doing other things. I have to be kind of secretive about it. I have tinctures and stuff with shepherd's purse and yarrow. Those things actually have great evidence. They are really helpful for postpartum blood loss. I have a lot of moms who are more interested in doing something more holistic and natural before they try medication. Cypress essential oil, you can rub that in. I'll have doulas use my cypress roller and give them a massage while I'm trying to manage the hemorrhage and that cypress oil can help a lot too. Sometimes going back to our instinctual, old medicine that we have been using well before medicine was used for birth. Meagan: Yeah. This is a random question for both of you. Lil, I really wonder if you have seen it or heard about this too because you are so heavily in our DMs. This is going to be weird. People are going to be like, what? But I did this. We did this because we weren't sure. We cut the umbilical cord and put it in our mouth. It's really weird. Paige is like, what? You put it down in the gum area like in between your teeth and your cheek. It sits there. Okay, you guys. I've seen it just a couple of times, myself included. Yes, I put my umbilical cord in my mouth. Yes, it's weird. Paige: That's okay. Meagan: It felt like a little gummy. It was fine. I wasn't chewing on it. It was just sitting there. But anyway, it's weird but with my other client too we did it and all of her hemorrhaging symptoms just went away. Paige: That's cool. Meagan: I know this is really random but we just cut a little piece of our umbilical cord and put it in their mouth. Paige: That's so interesting. So a piece of the umbilical cord or the entire thing once it's clamped and cut and still attached? Meagan: They clamped and cut it, cut a piece, and put it in my mouth. Paige: I would be so willing to try that. I mean, what is there in that nun? Meagan: I don't know. I don't know, but it did diminish the hemorrhaging symptoms. Paige: Cool. Meagan: So very interesting, right? Okay, so are midwives restricted when it comes to VBAC on what they can accept? Lily, you are a VBAC. I was a VBAC after two C-sections. You can obviously take Lily. Could you accept me?Paige: Yes. Luckily in midwifery care, at least in Colorado, there is a lot of gray for certified nurse midwives. It's not always black and white. VBACs are okay but there is no direct, “Oh, if you have this many C-sections, we can't do it.” I think that's because ACOG also strangely doesn't have an opinion on that. They actually agree. There is limited evidence beyond one C-section. My practice has done several VBACs after two Cesareans. I don't think we've ever done one for a third or greater than two probably because I think those people a lot of times don't even consider VBAC and they just already have been seeing their doctor for their repeat C-section with each pregnancy. But I'd love to see more people going for a VBAC after multiple Cesareans because I think VBACs after two Cesareans have a whole different level of feeling empowered after that. I thin that's really cool and even special scars and stuff, there is really limited evidence on all of these things and I'd like to see more people pushing the limits a little bit. Especially since I am in a hospital, I do have an OB hospitalist on call 24/7 at the disposal of my fingertips if I need them. We are close to an OR so I think if for somebody the fear is there and they are like, “I just don't know if it's more risky because of this,” I think it's worth it to try because the more people who go for it and are successful, the better evidence we're going to get from it. Meagan: Yeah. That is exactly what I am thinking. There's not a lot of evidence after two Cesareans because it's just not happening. It hasn't really been studied and a lot of that is because people aren't even given the option. Paige: Yeah. I'll have people where it is their third or fourth C-section and they were never even given that option. They were told, “Oh, I was told I have CPD.” I'm like, “The chances of you actually having CPD are low.” Then you look at their records and it was fetal distress or something like that. Yeah. CPD is so rare. I've heard it so many times. “Baby is never going to come out of that pelvis ever.” That breaks my heart every time I hear it because there are times when I'm like, I don't know and then an 8-pound baby comes out. We can't go off of those things because the body does what it's supposed to in those moments. Don't get me wrong. Things do go wrong and C-sections do happen sometimes but yeah. To hear everybody has CPD just because they've had three C-sections, I'm like, I don't know. That would be quite a few people. Way more than we know are true. Meagan: Yeah. We're all walking around with tiny pelvises. That's just what everyone thinks anyway.Lily, being in our DMs, hearing the podcast, understanding and seeing so many of these people and what they say, do you have any advice for them when they are looking for their provider or just any advice in general? Do you have any advice from a VBAC-prepping mom? Lily: Yeah, I think for me, it is to go into it open-handed. I think we hear so many horror stories about providers often and I think that's why I went into looking for a provider with both fists up ready to fight and what has surprised me the most is just I think I said earlier that I didn't know hospital care could look like this. I remember we even posted something and I had posted on The VBAC Link that a hospital birth can be equally as beautiful as an out-of-hospital birth and there were people arguing and people saying, “No, absolutely that's not possible. That's not a thing.” Gosh, how discouraging if we go into things thinking that we can't have beautiful outcomes in different settings. Certainly, there are areas around our country that need improvement. There's not a low-intervention floor at every hospital and there are not midwives who are doing what Paige is doing everywhere but I think the more that we seek out that care and look for that care and advocate for that care, the more we will see it. As much as it sucks that we have to be our advocates, it's also a really cool opportunity that we pave the way for VBAC moms and the moms who have never had a C-section that we are paving the way for care that doesn't end up in a Cesarean. I would just say to be open-handed and yes. You can be prepared to fight and you can be prepared with your statistics. Be prepared to ask the why behind questions, but ultimately, I think that care can be so much more than we expected if we go into it thinking, Gosh, well what can I get out of this and how can I make these things happen? Like Paige said, we've had lots of conversations around, Well, this is the policy, but the policy is not the law. I'm here to support you in that. At our last appointment, she was like, “Hey, make sure you bring your doula to your appointment where we are going to talk about your birth plan because I want to make sure that she is there, that we all hear each other, that we are on the same page.” I think that's helpful too. And then having a doula. My doula was my doula with my C-section. She was with us. She was whoever was on call at the birth center actually and again, I think it was so serendipitous because she is a VBAC mom. I think I needed her then and I'm so stoked to have her now that she is just a really special human who I know is also always in my corner and constantly texting her like, “Oh my gosh, look at the new birth rooms. Oh my gosh, I had this great conversation. Oh my gosh, I'm so excited.” I think having your doula there to be your partner in advocacy is really helpful too. Meagan: Yes. Okay, that's a good question too when it comes to doulas and midwives. Sometimes I think people think that if I'm hiring a midwife, I don't need a doula and then we of course know that a lot of people just mistake doulas and midwives together. But Paige, how do you feel about doula care and working with doula care? Is it necessary? How do you work together as doula and midwife?Paige: Yes. I love doulas. I wish everybody had access to a doula truly because doulas, just like midwives, have been studied and they have better birth outcomes, more empowered births, and all of the things. Doulas are so important and doulas and midwives work really closely. I think a doula is there with that constant presence, that constant helping with anything and a really good advocate which I think is important especially if you don't have a good relationship with your provider maybe or you don't know who you're going to get. Maybe you see 7 different providers and you get who you're going to get when you're in labor. So to have that doula there to constantly be advocating for you is such an important piece. Yeah, I really wish everybody could have access to a doula because it just makes a world of difference. I can't think of any bad outcomes I've ever had when a doula was present. It's just a different level of care. Usually, people who have sought out a doula have also taken the time to seek out and do all of the things that are going to make a healthier pregnancy and a better birthing outcome. It's why I think everybody deserves doula care. It's because it does lead to better outcomes. Midwives are always known to work closely with doulas and really support them. It's a team effort. Meagan: Yeah. Yeah. We love our relationships with our midwives here. It's really great to just know how we work and know how we need to support the client and it is sometimes hard when we go to a hospital and we don't know who we are getting. And sometimes that OB or that midwife we have worked with before and sometimes it's a whole new face so it does bring us comfort to know that the client and the family know us and we know them and we can all work together. I love that. Okay, do either of you guys have anything else that you would like to say to our beautiful VBAC community before we go? Paige: I don't think so. Yeah, thank you so much for having me. This was wonderful and I just hope that everybody who is thinking about a VBAC really does their research and looks for the best provider and really finds that perfect fit because there are so many good providers out there– OBs, midwives, professional midwives, all the things. Meagan: I agree. It's okay to interview multiple people. It's also okay that if mid-pregnancy, the end of pregnancy, during, and even in labor that if something is not feeling right, you can request a different provider. You can go out and start interviewing again and find that provider that is right for you. Paige: Yes. Meagan: Well, thank you Paige and Lily for joining us today, and thank you so much for doing so much in your community. I really love your setup and hope that we can see that type of setup happening in the US because it just feels perfect in a lot of ways. Yeah. Yes. I'm loving it. Okay, ladies. Well, thank you so much. Paige: Thank you. Lily: Yeah, thanks, Meagan. Meagan: Bye. Lily: Bye!ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Interview med Paramediciner Svend Vittinghus vedr. hans semester opgave på Bachelor of science i Paramedic studies. Svend har lavet en opgave med udgangspunkt i et scoping review, et form for litterature review. Svend har forsøgt at belyse den tilgængelige viden om behandlingen af epistaxis med topical TXA præhospitalt.

Welcome back after the summer break! Three more papers for you to feast your ears on this month and as always make sure you go and check them out yourselves after you've had a listen! First up, following on really nicely from the DOSE-VF paper on dual sequential defibrillation we take a look at the paper that looks at the association between shock interval and VF termination. We might be biased but this shines a light on an area that could make a huge difference to the outcomes for patients with refractory VF! Next; when you're seeing a patient with an upper GI bleed, which scoring/prognostication tool do you use and is it the best? We cover a paper that looks at exactly this question. Finally we look at whether TXA predisposes patients to a higher risk of venous thromboembolism and whether it might affect our practice patterns. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

In this episode, Dennis and Alex discuss the importance of reading research papers and critically analyzing their applicability to the operational environment. They review a paper on the role of red blood cells in thrombosis and post-transfusion hypercoagulability. The study found that red blood cell aggregation increased in the presence of tissue factor and calcium. While the study had limitations in terms of sample size and external validity, it raised questions about the use of calcium and tranexamic acid (TXA) in trauma patients. Dennis emphasizes the need to critically assess the need for these interventions based on individual patient factors. The conversation explores the complexity of blood clotting and the challenges of managing critically ill trauma patients. The hosts discuss the activation of blood components, the role of red blood cells in clot formation, and the use of thrombin matrix. They also touch on the age of blood and its impact on clotting, as well as the importance of trauma surgeons in managing these patients. The conversation emphasizes the need for continuous learning and clinical decision-making based on individual patient scenarios. Takeaways Reading research papers and critically analyzing their applicability is important in the operational environment. The study discussed the role of red blood cells in thrombosis and post-transfusion hypercoagulability. Red blood cell aggregation increased in the presence of tissue factor and calcium. The study raised questions about the use of calcium and tranexamic acid (TXA) in trauma patients. It is important to critically assess the need for interventions based on individual patient factors. Blood clotting is a complex process involving the activation of various blood components. Red blood cells play a role in clot formation and can drift to the site of injury. The age of blood does not significantly affect clotting ability. Trauma surgeons are crucial in managing critically ill trauma patients. Clinical decision-making should consider individual patient scenarios and the nuances of clotting. Continuous learning is essential in the field of trauma medicine. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

In this episode of the PFC Podcast, Colonel Stacey Shackelford discusses abdominal trauma and exsanguinating hemorrhage. He highlights the findings from studies on casualties who died before reaching a surgical hospital, with close to 90% of those deaths caused by bleeding. The majority of potentially survivable injuries resulting in death were from torso hemorrhage, particularly abdominal injuries. The current toolkit for managing abdominal trauma includes pressure dressings, blood transfusions, TXA, and calcium. However, there is a need for further research and development of advanced pre-hospital care options. Takeaways Studies have shown that a significant number of casualties die before reaching a surgical hospital due to bleeding from abdominal trauma. The majority of potentially survivable injuries resulting in death are from torso hemorrhage, particularly abdominal injuries. The current toolkit for managing abdominal trauma includes pressure dressings, blood transfusions, TXA, and calcium. Further research and development is needed for advanced pre-hospital care options to improve survival rates for abdominal trauma. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In this journal club recap, Dr Sarah Moulds recaps a recent meta-analysis of papers looking at the therapeutic effect of TXA in patients with severe trauma. Are their higher rates of thromboembolic complications? Is mortality improved? This article by Fouche et al attempts to answer these questions.

Join us on the Anesthesia Patient Safety Podcast as we confront a critical patient safety issue: the recurring wrong drug, wrong route errors involving Tranexamic acid (TXA) and Bupivacaine. Elizabeth Rebello, an anesthesiologist at the University of Texas MD Anderson Cancer Center, sheds light on this alarming trend where lookalike vials lead to catastrophic outcomes, including paralysis and death. Learn why this issue demands urgent action and the steps that are essential for anesthesia professionals to prevent such devastating mistakes.We'll uncover real-world incidents and delve into the underlying challenges faced by anesthesia teams, from lack of standardization to high-pressure environments. Hear about the staggering 50% mortality rate associated with this error and revisit our previous coverage on a National Alert Network warning about similar TXA administration errors. This episode is a must-listen for those dedicated to advancing perioperative patient safety and mitigating the risks of medication administration errors in anesthesia care.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/209-preventing-catastrophic-medication-errors-the-dangers-of-txa-and-bupivacaine-mix-ups/© 2024, The Anesthesia Patient Safety Foundation

1. The relationship between hip and knee osteoarthritis and spinal sagittal alignment. 2. Risk of thromboembolic events in high risk patients with TXA after spinal deformity surgery

The JournalFeed podcast for the week of June 17-21, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Thursday Spoon Feed:This bias-adjusted meta-analysis of randomized controlled trials (RCT) finds a one-month mortality benefit in trauma patients receiving tranexamic acid (TXA) during initial emergency management.Friday Spoon Feed:Reliance on landmark guidance for chest tube placement may pose significant safety issues in pediatric patients.

What new car in 2024 would you drive forever? Would it be the same car if you had no budget?   Hey if you have any suggestions or want some good and bad advice about what you should buy next. email us at thebscarguys@gmail.com   Anna backup: https://shop.ford.com/configure/bronco/config/paint/Config[%7CFord%7CBronco%7C2024%7C1%7C1.%7C...PS6...A6UAC.ABAAQ.C1XAC.2DR.FHIAE.77H.]   Anna Pick: https://www.jeep.com/bmo.wrangler.html#/build/interior/27205/CUJ202410JLJS72B/2TY/APA,PBJ,X9,ERC,DEM,DMF,Z1E,TXA,WFV,VL,SDD,UBX,XE5,CWA,LFR,MMU,23Y   Charger Build and Price a Charger | Dodge Charger for Sale Stelvio Q4 Build & Price a Alfa Romeo Stelvio Today! | Alfa Romeo USA Macan GTS Macan GTS | Porsche Car Configurator GT-R GT-R Configurator | Summary | Nissan USA CT-5 V Blackwing 2024 CT5 | Summary | Cadillac RS Q8 Summary > 2024 RS Q8 > 2024 > RS Q8 [REDIRECT] > Audi | Luxury sedans, SUVs, convertibles, electric vehicles & more (audiusa.com) X3M Build Your Own – View Build and Get a Quote – BMW USA Alpina B8 Build Your Own – View Build and Get a Quote – BMW USA   Bill backup: https://www.audiusa.com/us/web/en/models/a6/rs6-avant/2024/overview/summary.html   Bill Pick: https://configurator.porsche.com/en-US/model/992880?options=04D.0I1.0NA.0P8.0TC.1BV.1G8.1LX.1MI.1N3.1NE.1P0.1X2.2C5.2D0.2V1.2W6.3FF.3HB.3J7.4GP.4L2.5KS.5MK.6BA.6E1.6F0.6FW.6NA.6Q2.6XA.7AL.7HB.7K3.7M3.7UG.8JU.8LH.8T1.8VH.9AD.9JA.9VL.9WT.APP.AYX.BHM.D2Q.F37.FM7.G0W.G9.KA2.KQ1.Q1K.QH1.QJ2.QQ0.QU4.ST.UI2.UP9.UX6.VC2.VR0.VW4.Z1S.ZGA&viz-environment=studio --- Send in a voice message: https://podcasters.spotify.com/pod/show/thebscarguys/message

In this podcast, Dr. Chris Solie, an emergency physician, along with Jason Hicks, Fred DeMeuse, Greta Sowels (physician assistants), working for Emergency Medicine Physicians and Consultants (EMPAC) who review journals and papers around emergency medicine. *Disclosure note: None of the speakers or planners for this education activity have relevant financial relationships to disclose with any inelgible company - who's primary business is producing marketing, selling, re-selling, or distributin healthcare products used by or on patients. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice changing. Differentiate between using a HEAR score versus a HEART score when assessing patients coming into the ED with chest pain. Restate whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV) - associated lower respiratory tract illness in newborns and infants. Discuss the rate of wound infection from suturing with sterile gloves, dressings, drapes, etc. versus non-sterile gloves, dressings in emergency department. Discuss the risk-benefit of using tranexamic acid (TXA) in the treatment of gastrointestional bleeds. Identify interventions designed to reduce fatigue among emergency department physicians. Determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk pencillin allergy. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. RESOURCES Article 1: O'Rielly, C.M., Andruchow, J.E., McRae, A.D. et al. External validation of a low HEAR score to identify emergency department chest pain patients at very low risk of major adverse cardiac events without troponin testing. Can J Emerg Med 24, 68–74 (2022). https://doi.org/10.1007/s43678-021-00159-y Article 2: Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480 Article 3: Zwaans JJM, Raven W, Rosendaal AV, et al. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022;39(9):650-654. doi:10.1136/emermed-2021-211540 Article 4: HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 Article 5: Fowler LA, Hirsh EL, Klinefelter Z, Sulzbach M, Britt TW. Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2023;30(3):166-171. doi:10.1111/acem.14606 Article 6: Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. 2023;183(9):944-952. doi:10.1001/jamainternmed.2023.2986   Thank-you for listening to the podcast. Thanks to Dr. Chris Solie, Jason Hicks, Fred DeMeuse and Greta Sowels for their expert knowledge and contribution to this podcast.

In this podcast episode, Dennis interviews Steve Schauer about his calcium study in trauma patients. Steve provides an introduction to himself and his background in emergency medicine and research. He explains that the study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. The study is being conducted at three different trauma centers and has completed enrollment. Steve also discusses the challenges of extrapolating research findings from military trauma to civilian trauma. They also touch on the limitations of the Injury Severity Score (ISS) in assessing military trauma. The conversation then delves into the logistics of the study, including the collection of calcium levels and the potential impact of pre-hospital blood transfusions on calcium levels. They discuss the importance of timing and accuracy in collecting calcium levels and the need for better documentation in trauma care. They also explore the administration of calcium and the differences between calcium gluconate and calcium chloride. Steve emphasizes the importance of administering calcium slowly to avoid adverse effects. They also discuss the timing of calcium administration in relation to blood transfusions and the challenges of determining the optimal calcium levels in trauma patients. The episode concludes with a discussion on the need for iStat machines in trauma centers to monitor calcium levels in real-time. In this conversation, Dennis and Steven Schauer discuss the administration of calcium in trauma patients. They explore the role of calcium in the coagulation cascade and its potential benefits in improving hemodynamics. They also discuss the challenges of administering calcium in the field and the need for further research to determine its efficacy. The conversation highlights the importance of prioritizing blood and tranexamic acid (TXA) administration before considering calcium. Overall, the conversation provides valuable insights into the use of calcium in trauma care. Takeaways The study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. Extrapolating research findings from military trauma to civilian trauma poses challenges due to differences in injury mechanisms. The Injury Severity Score (ISS) has limitations in assessing military trauma. Timing and accuracy are crucial in collecting calcium levels in trauma patients. Calcium administration should be done slowly to avoid adverse effects. Determining the optimal calcium levels in trauma patients is challenging. iStat machines can be valuable in monitoring calcium levels in real-time. Calcium is a cofactor in the coagulation cascade and may play a role in improving hemodynamics in trauma patients. The administration of calcium should be prioritized after blood and tranexamic acid (TXA) in trauma care. The optimal method of calcium administration, such as infusion plus drip, is still under investigation. Further research is needed to determine the efficacy of calcium in trauma care. The availability of resources and logistics may influence the choice of calcium formulation for administration. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠ or ⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Episode 36! In this episode we talk about tranexamic acid in GI bleeds. We flip the script a little bit and talk about our OLD article first, HALT-IT or "Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial" published in Lancet in 2020. This sets the stage for our new trial "Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis" published in Kumar et al in Hepatology (a new journal for us!)HALT-IT: https://pubmed.ncbi.nlm.nih.gov/32563378/TXA and cirrhosis: https://pubmed.ncbi.nlm.nih.gov/38441903/If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

Dr. Van Wyk discusses updates in traumatic brain injury (TBI) management, focusing on the CRASH 3 trial and the use of tranexamic acid (TXA). He explains that TXA is safe and reduces head injury-related death, particularly in patients with moderate and mild TBI. He also discusses the use of hypertonic saline and recommends considering higher concentrations, such as 23.4%, which have been shown to be safe and effective. Dr. Van Wyk mentions the use of sodium bicarbonate as an alternative and emphasizes the importance of clinical judgment in determining the appropriate treatment. He also discusses monitoring options for cerebral edema and increased intracranial pressure, such as optic nerve sheath diameter measurements. Finally, he touches on the topic of decompressive hemicraniectomy and the considerations for performing this procedure in austere environments. Takeaways Tranexamic acid (TXA) is safe and reduces head injury-related death in patients with moderate and mild traumatic brain injury (TBI). Higher concentrations of hypertonic saline, such as 23.4%, may be considered as they have been shown to be safe and effective. Sodium bicarbonate can be used as an alternative to hypertonic saline, particularly in austere environments. Optic nerve sheath diameter measurements can be used to monitor cerebral edema and increased intracranial pressure. Decompressive hemicraniectomy may be considered in severe TBI cases, and general surgeons may be trained to perform the procedure in the absence of a neurosurgeon. Thank you to Delta Development Team for in part, sponsoring this podcast. ⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care

MedFlight Radio talks about pediatric trauma for the month of November.  We sit down with Dr. Chelsea Kadish, Recent Graduate EMS Fellow and Current Emergency Room Physician at Nationwide Children's Hospital.      The talk starts off with what we are doing well and what we can improve on in our pediatric trauma management in central Ohio.  We discuss TXA in our pediatric trauma patient, blood administration and is permissible hypotension ok in kids in certain types of trauma.  We answer these tough questions and so much more.  This is some really cool stuff.      Come listen in!  

Jae Yang is the CEO of Tacen and the Chief Architect of Project TXA. Tacen and Project TXA are sister projects - Project TXA develops the hybrid decentralized exchange protocol (hDEX) and the decentralized settlement layer (DSL), while Tacen develops the world's first hDEX interfaces for traders to use (Tacen Swap and Tacen Exchange). Why you should listen Jae Yang is the CEO of Tacen and the chief architect of Project TXA, an open-source project that aims to build a cross-chain settlement network. Tacen is a commercial entity building an exchange on top of the TXA settlement network.  Both projects were inspired by Jae's frustrations with traditional crypto exchanges including custody issues, lack of transparency in proof of reserves, and centralization. Project TXA seeks to address these issues by providing fast cross-chain transactions and noncustodial exchanges.  The target audience is experienced traders looking for secure and low-cost options beyond centralized exchanges. Jae Yang also emphasizes compliance with regulations while maintaining user privacy. Tacen Exchange is live on multiple networks with various crypto pairs available for trading. Interested individuals can learn more through technical documentation, code repositories, joining Discord, or visiting the exchange website. Supporting links Bitget Bitget Academy Bitget Research Bitget Wallet Tacen Projext TXA Andy on Twitter  Brave New Coin on Twitter Brave New Coin   If you enjoyed the show please subscribe to the Crypto Conversation and give us a 5-star rating and a positive review in whatever podcast app you are using.  

Listen in as we explore the world of military medicine, focusing on hemorrhagic shock and its relationship with damage control surgery and resuscitation. Joined by Colonel Dr. Jeremy Cannon, we unravel the dangers of time and shock to the human body, the importance of whole-blood resuscitation in combat casualty care, and how to diagnose and respond to severe cases of shock. The discussion also brings to light the ABC score, a helpful tool developed by Brian Cotton and Tim Nunez to distinguish between subtle and severe cases of shock.   In the second part of our discussion, we tackle the vital role of damage control resuscitation in treating hemorrhagic shock. We talk about the performance measures, the one-to-one-to-one ratio for blood products, the importance of calcium and TXA administration, and the benefits of using whole blood. Joined by Dr. Cannon, we also go through the opening sequence of surgery and the process of packing the four quadrants. As we wrap up, we take a look at the resources available for military surgeons and those interested in military medicine, highlighting WarDocs, a platform that showcases the gripping reality of war and medicine. Don't miss out on this enlightening discussion! --------- EPISODE CHAPTERS --------- (0:00:00) - Military Hemorrhagic Shock and Damage Control Principles (0:12:40) - The Concept of Damage Control Resuscitation (0:23:40) - Military Surgeons Curriculum and Resources

Contributor: Aaron Lessen MD Educational Pearls: Tranexamic acid (TXA) is a common medication to achieve hemostasis in a variety of conditions Patients visiting the ED for gross hematuria (between March 2022 and September 2022) were treated with intravesical TXA 1 g tranexamic acid in 100 mL NS via Foley catheter Clamped Foley for 15 minutes Subsequent continuous bladder irrigation, as is standard in most EDs Compared with a cohort of patients visiting the ED for a similar concern between March 2021 and September 2021, the TXA patients had: A shorter median length of stay in the ED (274 min vs. 411 mins, P < 0.001). A shorter median duration of Foley catheter placement (145 min vs. 308 mins, P < 0.001) Fewer revisits after ED discharge (2.3% vs. 12.3%, P = 0.031) References 1. Choi H, Kim DW, Jung E, et al. Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: A before-and-after study. Am J Emerg Med. 2023;68:68-72. doi:10.1016/j.ajem.2023.03.020 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII

An EBM-packed episode where Iain and Simon go over ten of the top papers from the last year discussing all manners of things Emergency Medicine, including TXA in trauma, use of video laryngoscopy, defibrillation strategies in refractory VF, and ten-second triage in major incidents. There's also a very pertinent discussion about whether the age of your Emergency Physician might affect your outcome... Thank you again for listening to the St Emlyn's podcast. Please do like and subscribe and get in touch if there is anything you'd like us to discuss or if you'd like to get involved. 

Trial of the Week: CRASH-3 Special Guest: Ruben Santiago, PharmD, BCPS, BCCCP Ruben Santiago joins me to discuss the landmark article “Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3)” published in Lancet. We review the history of TXA use in trauma, what the CRASH-3 study ultimately found, how does this compare to previous studies, what are guideline recommendations, applying this info in the viscoelastic testing era, and much more. Reference list: https://pharmacytodose.files.wordpress.com/2023/10/crash3-tow-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

In our most recent episode on vaginal prep at C-section, we referenced a parallel topic where individual data pieces seem to be contradictory: prophylactic TXA at time of cesarean section. In that past episode, we referenced a systematic review and meta-analysis that showed prophylactic TXA was indeed beneficial. Well… we are going to build on that data regarding prophylactic TXA in this quick/targeted episode that we call our NEW DATA BLURB. In this episode, we will highlight a fantastic, brand new, systematic review and meta-analysis published by one of our very own podcast family members out of Arizona. Dr. “KC”… Great job and congratulations to you and your co-authors on a wonderful publication.

The JournalFeed podcast for the week of June 24-28, 2023.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:Prehospital administration of tranexamic acid (TXA) did not result in greater functional survival in patients with major trauma and suspected trauma-induced coagulopathy.　 Wednesday Spoon Feed:Verified physician answers to patient questions on a public social media forum were compared to Chatbot answers to the same questions by rating the quality and empathy of responses. Guess who won?

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX.  He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I'm Still Alive – Is it due to TXA? first appeared on The Skeptics Guide to Emergency Medicine.

There have been some huge trials released over the last month and we've got three brilliant papers to discuss! First up we take a look at an RCT on video versus direct laryngoscopy for patients requiring emergency intubation with the DEVICE trial. The VL versus DL debate has been ongoing for quite some time now, so is this a final nail in the coffin for DL? Next up we take a look at an RCT of prehospital TXA use in patients at risk of bleeding from major trauma in the PATCH trial. The results seen in the trial look at a glance to oppose those seen in CRASH-2, so is this the end of TXA in this cohort of patients? Finally we have a great paper giving us further information on whether we should we be initiating immediate antihypertensive treatment for patients admitted to hospital with asymptomatic hypertension. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

The last time we took a good look at head injuries was back in 2018 in our Roadside to Resus episodes and for all of the foundational stuff on incidence, assessment, management and loads more  make sure you go and check that episode out.  But this episode is one of our new UPDATES episodes, because we're pretty old now… and whilst we've been having a go at this for a while evidence and guidelines will have progressed, which clearly have implications on how we manage certain cases and that's where these come in! So they'll focus mainly on the last 5 years of practice. The new NICE head injury guidance has just been released and it's the first major overhaul since 2014.  Now we know it's a UK guideline, but there's some really key practice updates and evidence in there that's relevant irrespective of where you find yourself listening this!  So in this episode we're going to be having a look at the most recent TXA evidence, with in terms of indications, timing and dosing. We'll be having a look at the risk of intracerebral injury with regards to anticoagulants and antiplatelet agents and a few other bits and pieces that can help us inform and improve our care. Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

After Chris defends his position on TXA, Spencer UTTERLY STUMPS him in this week's episode where a patient is KILLED by HIP PAIN! Spoiler: Patient not actually killed by hip pain.

Emergency Medicine Clinical Pearls and EMPoweRx Conference  Special Guest: Megan Rech, PharmD, MS, BCCCP, FCCM, FCCP   https://empowerx-conference.com https://rutgers.cloud-cme.com/course/courseoverview?P=0&EID=17157&formid=2931 https://empharmnet.org/ 03:35 – EMPoweRx Conference 12:28 – TXA in Epistaxis 21:40 – DDAVP in Antiplatelet-Associated ICH 34:47 – Awareness with Paralysis Reference List: https://pharmacytodose.files.wordpress.com/2023/03/em-pearls-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices