ResusX:Podcast

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. 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.

In this final installment of the "Airway Hotseat," Dr. Terren Trott guides us through the intricacies of video airway analysis. Discussing cases ranging from inhalation injuries to challenging cardiac arrest intubations, Trott emphasizes the critical decisions and preparations required in emergency scenarios. The importance of a double setup, considerations for patients with potentially burned airways, and the strategic use of tools like bougies for difficult airways are highlighted. The episode delves into specific cases, such as a swollen epiglottis, and debate on intubation techniques. Trott wraps up with insights on troubleshooting tube placement and emphasizes the value of lube in facilitating smoother procedures. This episode offers a comprehensive exploration of airway management complexities, providing valuable lessons for medical professionals and enthusiasts alike.   

In this podcast episode, Dr. Terren Trott conducts a video airway review with three doctors. They discuss the use of video laryngoscopy at the University of Kentucky, emphasizing the importance of recording intubation videos for later asynchronous review. The focus is on challenging airways, with participants analyzing three different cases. Swami shares his approach to managing a soiled airway, advocating for leading with a suction catheter before the laryngoscope. The discussion covers techniques for controlling the tongue, including finger placement and suction catheter use. External Laryngeal Manipulation is highlighted as a valuable tool, offering insights into its application and benefits. The episode concludes with the analysis of a challenging intubation case, addressing issues such as glottic exposure loss, the proximity of the camera, and the potential need for alternative airway approaches during critical situations. The doctors stress the importance of preparedness, a standardized approach, and the role of the bougie in managing difficult airways. The podcast encourages a proactive mindset in airway management and prompts listeners to consider optimizing their techniques for various scenarios.

In this episode, titled "Why You Suck at Vascular Access," the speaker, known as The Vascular Guy, shares insights on improving ultrasound-guided vascular access. Reflecting on personal experiences, he emphasizes the shift from blind procedures to using ultrasound, highlighting it as a game-changer for success rates. The episode covers practical tips, such as the "Gel Tower" technique for pediatric patients, needle entry angles, and the importance of visualizing the catheter in a long view. The host addresses challenges like valve obstruction, offering strategies like bending the needle for better maneuverability. The episode concludes by stressing the significance of understanding ultrasound technology and making informed equipment choices. Listeners are encouraged to enhance their ultrasound skills for more effective vascular access procedures.