ResusX:Podcast

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.

In this podcast episode, Dr. Evie Marcolini addresses the management of elevated Intra Cranial Pressure (ICP) in diverse medical scenarios, particularly in emergency departments. She emphasizes understanding the mechanisms and effective treatments for conditions like Traumatic Brain Injury (TBI), Intracerebral Hemorrhage, and Subarachnoid Hemorrhage. Dr. Marcolini outlines a tiered approach to managing ICP, starting with simple measures such as elevating the head of the bed, administering Fentanyl for analgesia, and employing Osmotic Therapy with Mannitol or Hypertonic Saline. She delves into more invasive options like Ventriculostomy and Inodilators for severe cases while cautioning against therapeutic hypothermia. Overall, the episode provides valuable insights into ICP management strategies, encouraging healthcare professionals to consider the specific mechanisms of each case.

This week's ResusX:Podcast features Dr. Colin McCloskey, an EM Intensivist, provides valuable insights on identifying and managing Cardiogenic Shock. This life-threatening condition has a 50% in-hospital mortality rate. He highlights the importance of differentiating it from other shocks, emphasizing key signs such as low systolic blood pressure, narrow pulse pressure, and cool extremities. Echocardiography and bedside physical examination play a crucial role in confirming the diagnosis. Dr. McCloskey discusses resuscitation, starting with inopressors to defend MAP, with norepinephrine as the first-line choice. Inotropic medications like dobutamine or milrinone may be used if needed to improve cardiac output and coronary perfusion pressure. Mechanical circulatory support devices can be considered when inotropes are insufficient, and a multidisciplinary approach involving heart failure cardiologists, cardiac surgeons, and CT intensivists is crucial for optimal management. Early diagnosis, appropriate medical care, and collaboration among healthcare professionals are highlighted as essential factors in effectively managing Cardiogenic Shock and improving patient outcomes. Don't forget to subscribe to this channel for more critical care and emergency medicine content.

Dr. Rory Spiegel, an EM Critical Care physician, discusses post-arrest care and the optimal blood pressure for patients who have been resuscitated from cardiac arrest. Previous retrospective studies suggested that higher MAPs were associated with better outcomes, but these findings were confounded by the overall health status of the patients. Dr. Spiegel highlights three recent small randomized control trials that compared lower and slightly higher MAP targets but found no significant difference in outcomes. He emphasizes a recently published large randomized trial that investigated blood pressure targets in comatose survivors of cardiac arrest. Dr. Spiegel questions the effectiveness of identifying an ideal MAP for specific patient populations, citing previous studies in sepsis and other conditions that have failed to determine an optimal blood pressure target. He explains that MAP, although commonly used as a surrogate for perfusion, does not accurately represent micro-hemodynamics. Different organs have varying resistance, affecting their perfusion, and disease states can further complicate the relationship between macro-circulation and microcirculation. Overall, Dr. Spiegel suggests that while MAP is frequently measured and easily accessible, it may not be the best indicator of perfusion. He highlights the need to consider micro-hemodynamics and individual organ perfusion in each patient's management.    

In this YouTube video, critical care and emergency medicine expert Dr. Sarah Sarah Crager introduces a new way of thinking about shock and challenges the traditional categorization of shock into four types: distributive, cardiogenic, hypovolemic, and obstructive. She highlights the limitations of this classification system and emphasizes the importance of considering shock precipitants and shock physiology as distinct entities. Dr. Crager introduces the "tank, pipes, pump" model as an alternative approach to understanding shock. The key takeaway is that shock is not solely about hypotension but rather hypoperfusion. Blood pressure and tissue perfusion are not always closely linked, and microcirculatory dysfunction can have significant implications for patient outcomes independent of macrocirculatory parameters. Dr. Crager emphasizes the importance of considering tissue perfusion and microcirculation, rather than solely focusing on blood pressure and forward pressures.