In this episode, Dr. Mohammed Hagahmed, a faculty physician at the University of Pittsburgh Medical Center, shares a compelling case of a patient named Miss Z, a recent immigrant with COPD. Dr. Hagahmed discusses the challenges of caring for crashing patients, focusing on the critical importance of peri-intubation resuscitation. He delves into factors that can lead to peri-intubation cardiac arrest, such as hypoxemia, hypotension, and high shock index. He also discusses the choice of sedation and paralytic agents, emphasizing the need to ensure appropriate sedation when intubating patients. Dr. Hagahmed provides valuable insights into managing these high-risk scenarios and the latest research findings on the topic.

In this podcast episode, Dr. Evie Marcolini discusses a real case involving a 72-year-old patient who experienced a biking accident. The patient's condition raises important questions about managing blood pressure in neuropatients. Dr. Marcolini emphasizes the significance of tailoring blood pressure goals to the specific condition a patient is suffering from, be it Traumatic Brain Injury or Hemorrhagic Stroke. She underscores the need to maintain Cerebral Perfusion Pressure, highlighting the importance of individualized care based on the patient's health history. The episode also touches on various medical considerations, including the use of medications like fentanyl and the role of hydration in ensuring safe intubation. Ultimately, Dr. Marcolini's message is that thoughtful and well-informed blood pressure management can significantly impact patient outcomes.

In this episode, Dr. Sara Crager discusses the complexities of selecting vasoactive medications, known as "pressors," for patients in shock. She emphasizes the importance of not just memorizing tables but understanding the underlying principles of why, when, and which pressor to use. Dr. Crager points out the limitations of relying solely on evidence-based medicine for such decisions, highlighting the uniqueness of each patient and the importance of considering provider expertise. She explores various factors, including the need for vasoconstriction, vasodilation, increased inotropy, and concerns about side effects like arrhythmias and pulmonary pressures, to guide the thoughtful selection of the most suitable pressor or combination of pressors to improve tissue perfusion in shock patients.

In this podcast episode, Dr. Abhilash Koratala from the Medical College of Wisconsin provides a comprehensive overview of VEXUS (Venous Excess Ultrasound), a valuable tool for assessing a patient's hemodynamics and fluid status at the bedside. Dr. Koratala explains the three key components of evaluating the hemodynamic circuit, which includes Forward Flow, Fluid Responsiveness, and Backward Pressures of the heart. He emphasizes the importance of assessing Systemic Venous Congestion and its impact on organ perfusion, particularly the kidneys. VEXUS combines various ultrasound parameters, including Inferior Vena Cava, Hepatic Vein, Portal Vein, and Intrarenal Vein, to quantify venous congestion and predict the risk of organ injury. The podcast also includes practical insights and case examples of how VEXUS can guide treatment decisions and monitor patient response to therapy.

In this episode, Dr. Laura Duggan, an Associate Professor in the Anesthesia Department in Ottawa, delves into the complexities of traumatic airway management. Dr. Duggan emphasizes the importance of combining opinions and evidence to provide the best patient care. She highlights the challenges of maintaining airway management skills and the shift toward evidence-based decision-making. Dr. Duggan also discusses the risks associated with blunt and penetrating airway trauma, the significance of assessing the mechanism of injury, and the value of visualizing both above and below the glottic entry during intubation. She encourages collaborative efforts between specialties and the use of nasopharyngoscopy for assessing airway trauma while stressing the importance of teamwork in critical situations. Check out ResusX for more from Laura and our other amazing faculty!

In this lively podcast debate from ResusX:ReVolved, Salim Rezaie and Anand Swaminathan tackle the contentious topic of Mechanical versus Manual CPR. Swaminathan, also known as "The Swami," begins by arguing against Mechanical CPR, asserting that there is no compelling high-quality evidence to support its superiority over Manual CPR. He emphasizes the critical importance of high-quality CPR and early defibrillation in achieving good neurologic outcomes in cardiac arrest cases. Swaminathan raises concerns about the obstacles, costs, and training required for Mechanical CPR devices, suggesting that they may not be justified in many settings. He concedes, however, that there might be a role for these devices in scenarios with limited rescuers or prolonged transport times. Rezaie, "The Rebel," counters by acknowledging their shared belief in the significance of compressions and defibrillation but argues that humans often struggle to maintain the quality of compressions. He highlights the potential cognitive offload that Mechanical CPR offers and cites a meta-analysis that found no significant difference in outcomes between Mechanical and Manual CPR. Rezaie also mentions scenarios where Mechanical CPR could be particularly beneficial, such as in ECMO/eCPR cases and scenarios with limited personnel. The debate leaves the audience with plenty to ponder regarding the use of Mechanical CPR devices in cardiac arrest management.

In this captivating podcast episode, Dr. Joe Bellezzo, an ER physician from San Diego, shares their groundbreaking journey of integrating ECMO into their Emergency Department for Refractory Ventricular Fibrillation cases. Beginning with his inaugural case involving a patient named Ralph, the episode explores the transformation of ECMO from a tool designed for surgeons to a life-saving ER procedure. Dr. Bellezzo emphasizes the significance of deliberate movements in critical situations, drawing parallels to motorcycling's "whiskey throttle" concept. The episode also highlights their shift towards a culture of resuscitation excellence, driven by remarkable survival stories, and introduces the concept of "Code Choreography" to optimize resuscitation procedures. Tune in to witness how innovation and dedication have reshaped emergency medical practices, propelling the possibilities of meaningful survival. Don't forget to register for the ResusX:Reset conference, live in Philadelphia or virtual (https://www.resusx.com/Reset)

Join Dr. Terren Trott as he explores the often-overlooked world of "Ventilation in Cardiac Arrest." In this episode, Terren breaks down the guidelines, dives into pathophysiology, and questions the one-size-fits-all approach to ventilation. He discusses the interplay between chest compressions and ventilation, delves into the effects of hypoventilation and hyperventilation, and introduces the concept of Positive Expiratory Pressure. Terren highlights the potential of mechanical ventilation for precise control and patient-centric customization. Tune in for a comprehensive understanding of ventilation strategies during cardiac arrest, empowering healthcare providers for optimized patient outcomes.

In this episode, Dr. Corey Slovis dives into the contentious realm of cardiac arrest management, discussing the use of various drugs including epinephrine, bicarbonate, and calcium. As an expert in emergency medicine, he explores the complexities surrounding these interventions, shedding light on what works and what doesn't in the critical context of cardiac resuscitation. Dr. Slovis emphasizes the importance of securing the ABCs—airway, breathing, and cardiovascular stability—while providing insightful commentary on the recommended dosages and timing of epinephrine administration. He highlights the pivotal role of shockable and non-shockable rhythms in determining the efficacy of epinephrine, drawing from both historical studies and recent double-blind placebo-controlled trials. The host explores the nuanced relationship between epinephrine and neurologic outcomes, addressing the intricate balance between survival and functional quality of life. Dr. Slovis delves into the controversial topics of bicarbonate and calcium use during cardiac arrest, discussing studies that challenge their effectiveness and present potential risks. He advocates for judicious use of these agents and provides practical insights for recognizing scenarios where their administration might be warranted. Throughout the episode, Dr. Slovis engages listeners with his comprehensive review of the literature, critical analysis of evidence, and candid observations on the current state of resuscitative practices. He wraps up the discussion by outlining key takeaways for clinicians, emphasizing the importance of making informed decisions based on the available evidence and patient needs. This episode offers a thought-provoking exploration of the ever-evolving landscape of cardiac arrest management, inviting listeners to rethink established practices and consider the implications for patient outcomes.

In this podcast episode, Dr. Amal Mattu from the University of Maryland School of Medicine discusses the critical importance of interpreting Post-Arrest 12-lead Electrocardiograms (ECGs) in Acute Care Medicine. Hosted by Haney Mallemat, the episode features a fictional case of a patient with chest pain progressing to cardiac arrest in the Emergency Department. Dr. Mattu emphasizes the significance of distinguishing between ST-segment elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (ACS) when analyzing post-arrest ECGs. Recent literature suggests that patients without ST-segment elevation might not need immediate catheterization, allowing for potential delayed catheterization. The discussion delves into the intricacies of interpreting dysrhythmias, particularly wide complex tachycardias that can mimic ventricular tachycardia (V-tach). Dr. Mattu advises caution in diagnosing V-tach when the rate falls below 120-130 bpm or the QRS complex exceeds 200 ms. He highlights real cases where patients faced adverse outcomes due to incorrect diagnosis and inappropriate treatment with sodium channel-blocking anti-arrhythmic agents. Throughout the episode, Dr. Mattu underscores the need for evidence-based decisions and careful consideration when interpreting post-arrest ECGs to ensure optimal patient care.