ResusX:Podcast

In this episode, Dr. George Willis discusses the critical diagnosis and management of aortic dissection, emphasizing the importance of considering it in patients presenting with chest, back, and abdominal pain. Drawing from a case scenario and clinical experience, Dr. Willis highlights the challenges in diagnosing and managing aortic dissection, particularly when patients deteriorate rapidly. He provides practical insights into using ultrasound for diagnosis, the significance of resuscitation before intubation, and the cautious approach to pericardiocentesis. The episode underscores the necessity of early recognition and intervention to optimize patient outcomes in this high-stakes emergency.

In this ResusX Podcast episode, Dr. Tarlan Hedayati discusses the ongoing debate surrounding airway management during cardiac arrest, exploring the effectiveness of endotracheal intubation, supraglottic airways, and bag-valve-masks. Drawing from recent studies and meta-analyses, Dr. Hedayati emphasizes the importance of prioritizing CPR and shares insights into selecting the most suitable airway intervention based on the patient's condition and available resources. Tune in to gain a comprehensive understanding of the latest evidence-based practices in cardiac arrest management.

In this episode, Dr. Mohammed Hagahmed discusses the critical management of a patient presenting with suspected pulmonary embolism (PE) and right ventricular failure in the emergency department (ED). Highlighting the importance of optimizing resuscitation before intubation, he emphasizes strategies to address hypotension, optimize preload, and improve myocardial contractility while avoiding systemic hypotension. Dr. Hagahmed shares practical insights on medication choices, ventilatory settings, and the significance of careful patient monitoring, aiming to equip healthcare providers with essential knowledge for managing such high-risk cases effectively.

In this podcast episode, Dr. Eddy Gutierrez explores innovative approaches to treating Septic Shock with Hydroxocobalamin and Methylene Blue. Emphasizing the need for unconventional strategies due to high mortality rates with current treatments, he discusses the mechanisms of these medications in addressing the overdrive of the immune system in Sepsis. Methylene Blue, with a history dating back to the 1800s, is highlighted for its role in inhibiting inducible nitric oxide synthase and soluble guanylyl cyclase. The "SHOCKEM - Blue" trial results are discussed, indicating benefits such as faster discontinuation of vasopressors and reduced ICU length of stay. Dr. Gutierrez also delves into Hydroxocobalamin, a vitamin B12 variant, sharing findings from a recent Phase 2 study showing promising catecholamine sparing effects. Despite potential side effects, the cost-effectiveness of these treatments is considered, and ongoing clinical trials suggest a growing interest in exploring these mechanisms for Septic Shock management.

In this podcast episode, Dr. Salim Rezaie explores the intriguing topic of norepinephrine dosage in critical care, asking "Norepinephrine: How High Can You Go?" After posing the question to the ResusX community, he delves into four retrospective studies and a unique case report, shedding light on the highest recorded doses ranging from 1.4 to 2.91 micrograms per kilogram per minute. With a lack of randomized clinical trials on maximum dosage, Dr. Rezaie discusses survival rates, digit necrosis, and the duration of high doses. Emphasizing the rarity of such instances, he offers insights into assessing patients, suggesting considerations like accurate blood pressure measurement, echocardiography, and source control. Dr. Rezaie encourages critical evaluation during escalating doses, sharing his clinical approach and stressing the importance of recognizing underlying causes. This episode serves as a thought-provoking exploration of norepinephrine limits in critical care, sparking valuable debate and conversation within the medical community.  

In this podcast episode, Dr. Steve Haywood addresses crucial aspects of using a ventilator in emergencies, emphasizing the significance of the PEEP valve. Dr. Haywood underscores the common misuse of PEEP valves, debunking misconceptions and shedding light on their essential role. He guides listeners through the steps of optimizing oxygen delivery, from ensuring proper oxygen connection to highlighting the importance of a Pressure Manometer. Additionally, he advises maintaining continuous monitoring using Waveform End-Tidal CO2, debunking traditional colorimetric indicators. Dr. Haywood's insights provide valuable knowledge for healthcare professionals dealing with acute patient scenarios, offering practical tips for effective ventilator use and patient care.

In this podcast episode, Dr. Rory Spiegel discusses the challenges of breathing, particularly in cases of wet, heavy lungs and increased dead space. The focus shifts to APRV (Airway Pressure Release Ventilation) as a mode of ventilation and its benefits in returning patients to Functional Residual Capacity (FRC). Dr. Spiegel emphasizes the importance of understanding FRC in the context of ARDS (Acute Respiratory Distress Syndrome) and dispels myths surrounding APRV. He delves into the physiological aspects, including the viscoelastic nature of the lung and the impact on dead space. The episode concludes by highlighting the practical goal of maintaining patients at FRC for improved outcomes, touching on aspects like heart function, sedation, and reduced barotrauma.

In this podcast episode, Dr. Dan Patino delves into the intricacies of awake intubation, a critical procedure in emergency medicine. He highlights the potential risks associated with paralyzing patients, emphasizing how it can worsen acidosis and increase the chances of Peri-Intubation Arrest. Dr. Patino contrasts the standard approach of Rapid Sequence Intubation (RSI) with the scenarios where awake intubation proves essential, shedding light on the characteristics of ideal candidates and the categories of difficult airways. The episode covers crucial steps in preparing for the procedure, including room setup, drying the mouth, and effective topicalization techniques. Dr. Patino provides valuable insights into the use of medications, such as ketamine, and outlines the procedural nuances for both oral and nasal intubation. Listeners gain a comprehensive understanding of awake intubation, its indications, and the meticulous approach required for optimal patient outcomes.  

In this podcast episode, Dr. Shaila Quazi, a seasoned medical professional, shares insights on pacemakers, aiming to simplify the assessment and treatment of patients with these devices. Drawing on her experience as a resident, she emphasizes the importance of reading EKGs or monitors to identify signs of pacemaker failure or the need for a pacemaker. Dr. Quazi breaks down key indicators, such as pauses, lack of response, and abnormal ventricular rates, offering a practical approach for healthcare providers. She delves into scenarios where external pacing might be necessary and discusses the steps involved in transvenous pacing, providing valuable guidance for emergencies. The episode highlights the significance of correlating symptoms, such as chest pain or shortness of breath, with EKG findings and outlines the steps for initiating appropriate interventions, including medications, external pacing, or transvenous pacing when needed.

In this episode, trauma expert Dr. Zaf Qasim engages in a candid and insightful discussion on trauma management with a focus on resuscitation strategies. The conversation covers various aspects, from challenging dogmas in trauma care to addressing specific scenarios like traumatic arrest. Zaf emphasizes the importance of tailoring interventions based on the unique physiology of traumatic arrest, distinguishing it from medical arrest. He delves into the sequence of procedures, advocating for a methodical approach that prioritizes addressing reversible issues. The debate extends to the use of vasopressors in trauma-induced hypotension, with a spotlight on vasopressin as a potential agent. The discussion also touches on crystalloid administration in the absence of immediate blood availability and the role of calcium in trauma resuscitation. Zaf provides insights into the evolving consensus on tranexamic acid (TXA) use, including dosing considerations, and sheds light on the integration of TXA into trauma protocols. The episode concludes with audience questions, exploring topics such as RSI in trauma, including considerations for induction doses, and the role of pericardiocentesis in trauma patients with effusion or tamponade. Overall, the episode offers a valuable blend of evidence-based practices and practical considerations for trauma resuscitation.