ResusX:Podcast

In this podcast episode, Laura Duggan, an associate professor at the University of Ottawa, discusses the topic of awake intubation. She emphasizes the importance of awake techniques in cases of blunt and penetrating airway trauma and explains that while penetrating airway trauma can often be managed post-induction, there are instances where an awake approach is necessary. Duggan shares her personal approach to awake intubation, drawing from her 20 years of experience in anesthesia and emergency medicine. She highlights the need for evidence-based decision-making and procedural skills, emphasizing the importance of staying updated with current techniques and involving other specialists when dealing with complex airways. The podcast addresses the question of why awake intubation is still necessary despite the availability of video laryngoscopy (VL). Duggan presents research showing that even with the widespread use of VL, awake intubations still occur in approximately 1% of cases. She explains that anatomically difficult airways and physiologically challenging cases are the main reasons for opting for awake intubation. Throughout the episode, Duggan discusses various challenging airway scenarios, including burn patients, post-cervical spine fusion bleed, Ludwig's angina, and patients with physiological difficulties like pneumonia or pulmonary embolism. She highlights the importance of maintaining the patient's own spontaneous or negative pressure ventilation in such cases and the need for a team approach involving the patient. The podcast also covers key aspects of awake intubation, such as the use of glycopyrrolate for drying up secretions, the avoidance of sedation, the importance of well-maintained equipment, and the technique of topicalization using atomization and paste for effective anesthesia. Duggan emphasizes the significance of using the right concentration of lidocaine and provides practical tips for applying topical anesthesia. In conclusion, the podcast episode provides valuable insights into awake intubation, its indications, and its techniques. It emphasizes the need for continued learning and collaboration in managing difficult airway cases, ultimately aiming for successful outcomes and patient comfort.   ✨Sign up here for the incredible cardiac arrest conference, ResusX:ROSC Conference happening July 11 & 12, 2023. https://www.resusx.com/resusx-rosc

In this podcast episode, Dr. Scott Weingart discusses the role of the trauma team leader in emergency medicine and the importance of training residents in this role. He highlights that emergency medicine residents should be the ones learning to lead trauma teams, rather than general surgery residents, as general surgeons often have limited involvement in trauma cases. Scott and his colleague Chris Hicks have created a taxonomy of the skills and knowledge required for a trauma team leader, which they discuss in detail throughout the episode. The episode covers various aspects of being a trauma team leader, starting with the "zero point survey" where the team ensures safety, equipment availability, and team cohesion before the patient arrives. The trauma team leader stands at the foot of the bed to have control over the room and focuses on creating a calm and quiet environment. They emphasize the use of closed-loop communication and regular sit-reps to keep everyone informed and open to suggestions. The trauma team leader also assigns someone else to maintain awareness during procedures, using the concept of "eyes on, eyes off." The podcast delves into the role of the podium nurse as a partner to the trauma team leader, discussing their responsibilities such as running pre-briefings, coordinating tasks and equipment, and managing certain aspects like finger stick and tetanus. The trauma team leader is advised to stay out of procedures and assign others to take charge while maintaining situational control. The primary survey is explained, highlighting the key components: airway, breathing, circulation, disability, and environmental factors. Scott introduces the concept of "exsanguination" as an additional consideration in the primary survey. The podcast explores the need for advanced airway management and emphasizes the importance of using checklists and considering different intubation techniques based on the patient's condition. Monitoring is discussed, including the use of saturation, end-tidal CO2, and arterial lines. The podcast suggests considering temperature monitoring with a temperature foley catheter if available. The episode also covers assessing and managing hypotensive or malperfused patients, focusing on finding the source of bleeding through various assessments and imaging techniques. The podcast addresses chest decompression, emphasizing the trauma team leader's role in requesting the necessary equipment and ensuring the procedure is performed correctly. It also touches on establishing vascular access, the use of blood transfusions and tranexamic acid, and the importance of using appropriate transfusion devices. The episode highlights the significance of maintaining adequate calcium levels and suggests considering viscoelastic testing for guidance. The role of sedation and balancing blood pressure is discussed, with the aim of achieving a high-flow, low-pressure state. The podcast suggests using fentanyl or ketamine for sedation, considering paralysis if necessary. The importance of laboratory tests and the potential use of TEG and ROTEM for assessing coagulation status are also mentioned. Lastly, the podcast emphasizes the need to stabilize pelvic or femur injuries, discussing the use of binders or splints depending on the situation. Overall, the episode provides valuable insights into the responsibilities and considerations of a trauma team leader in emergency medicine, emphasizing the importance of training and equipping residents with the necessary skills for this role.

In this video, Dr. Steve Haywood discusses crucial preparations and considerations before initiating intubation in critical care and emergency medicine settings. He emphasizes the importance of being aware of potential complications and taking necessary steps to prevent adverse outcomes. Dr. Haywood introduces a mnemonic, SOAP P-ME-E, to guide the pre-intubation checklist. The mnemonic includes the following key elements: suction, oxygenation, airway equipment, pharmacology, positioning, monitor setup, emergency backup plan, and end-tidal CO2 monitoring. Dr. Haywood highlights the gravity of every intubation having the potential for adverse events, stressing that even successful intubations can lead to death. He explains the risks associated with post-intubation cardiac arrest and the high mortality rates associated with such events. The discussion delves into the selection of induction agents, particularly Ketamine, highlighting its advantages over other agents while acknowledging its potential complications. The importance of proper positioning, monitoring, and emergency backup plans, including video laryngoscopy and bougie usage, are also emphasized. This informative video provides critical insights and practical tips for healthcare professionals involved in intubation procedures, with the ultimate goal of enhancing patient safety and optimizing outcomes. Remember to like and subscribe to our channel for more valuable content on critical care and emergency medicine!

Register HERE for the ResusX:ROSC conference!  In this video, Sara Crager discusses the management of Unstable A-Fib (Atrial Fibrillation). She highlights the importance of distinguishing between primary and secondary causes of instability before considering immediate cardioversion. Sara emphasizes that not all patients with A-Fib and low blood pressure require immediate intervention. Factors such as fluid status, electrolyte levels, and sympathetic activity should be evaluated to determine the underlying cause of instability. Sara advocates for a comprehensive approach that goes beyond the choice between beta blockers and calcium channel blockers. She introduces seven key questions to guide the management of Unstable A-Fib, including primary versus secondary causes, rate versus rhythm issues, the necessity of immediate cardioversion, electrolyte correction, fluid status assessment, and the use of appropriate medications. Sara suggests considering Amiodarone as a go-to option for rate and rhythm control in unstable A-Fib cases, while also addressing blood pressure support with medications like phenylephrine or vasopressin. Overall, this video provides valuable insights and strategies for effectively managing Unstable A-Fib. Check out https://www.resusx.com for education on resuscitation

In this ResusX video Dr. Rory Spiegel discusses the use of phenobarbital for treating alcohol withdrawal. He explains the physiology of alcohol withdrawal, which involves an imbalance between excitatory and inhibitory neurotransmitters in the brain, mainly glutamate and GABA, leading to symptoms like tachycardia, seizures, and agitation. Traditionally, benzodiazepines, which work by augmenting the effects of GABA, have been used for treating alcohol withdrawal. They require the presence of GABA in the system to work effectively. Rory prefers a symptom-triggered approach for treatment, which means the severity of the disease state determines the medication dosage. This approach has been found to be more effective and less likely to lead to complications compared to a fixed dosing approach. He critiques lorazepam, a commonly used medication for alcohol withdrawal, for its short half-life and the need for constant re-dosing, which necessitates intensive monitoring and an ICU stay. Dr. Spiegel suggests phenobarbital as a superior option due to its predictability in dosage and effect, wide therapeutic effect, safety, and long half-life that allows for a built-in taper. This makes the monitoring process simpler and reduces the need for ICU stays.        

In this episode, Dr. Colin McCloskey, an EM Intensivist from University of Hospitals Cleveland, talks about transvenous and epicardial pacers, and explains how to place a transvenous pacer. He emphasizes that transvenous pacing is a high acuity low opportunity event that requires deliberate practice to achieve competence. McCloskey outlines the common indications and contraindications for transvenous pacing and stresses the importance of knowing the location of the kit and the contents of the kit before attempting to place a transvenous pacer. He also provides step-by-step instructions on how to place a transvenous pacer, including the use of a sterile sheath, the connection to the pacer box, and how to achieve mechanical capture. McCloskey discusses potential pitfalls and offers solutions to overcome them. Overall, he emphasizes that transvenous pacing is a simple procedure that is within the skill set of healthcare providers.

Welcome to another episode of the ResusX:FOAMed! Today, we have a special and personal story from Dr. Mike Winters about an anaphylaxis case that hits close to home. Mike shares the experience of when his son Hayden had a severe anaphylactic reaction after eating an oatmeal raisin cliff bar. This incident fueled Mike's passion for understanding, recognizing, and treating anaphylaxis. In this episode, we discuss the definition, clinical features, and latest guideline updates on anaphylaxis. We also delve into the various clinical formulas, pathophysiology, and the importance of treating anaphylaxis as a distributive, hypovolemic, and cardiogenic form of shock. Join us as we explore the critical goals of anaphylaxis treatment, including the administration of oxygen, intravenous fluids, and epinephrine. We'll also discuss second-line medications and their role in anaphylaxis management. Lastly, we'll touch upon the discharge and follow-up care of patients who have experienced an anaphylactic reaction. Don't miss this gripping and informative episode that can help you better manage and treat anaphylaxis in your clinical practice. #AnaphylaxisAwareness #EmergencyMedicine #AnaphylacticShock #EpinephrineTreatment #ResuscitationTips #AllergicReactions #AnaphylaxisManagement #LifeSavingTips #AnaphylaxisEducation #EmergencyResponse #AllergyEmergencies

Discover the Power of the Cognitive Pause During Resuscitation with Dr. Anand Swaminathan! In this ResusX:FOAM episode, Anand shares invaluable insights and life-saving techniques about the crucial role of cognitive pause in resuscitation and critical care. 1. The Science of Cognitive Pause with Dr. Anand Swaminathan - Why It Matters 2. Cognitive Pause in Resuscitation: Maximizing Success 3. The Role of Cognitive Pause in Critical Care Decision-making 4. Real-life Cases: Cognitive Pause in Action 5. Expert Tips from Dr. Swaminathan: Mastering Cognitive Pause for Better Outcomes Watch the YouTube video here.

Chest pain can be a concerning chief complaint in a standard patient, but chest pain in pregnancy can be down right frightening. The differential diagnosis ranges from benign to life threatening. Thankfully we have Dr. Tarlan Hedayati to take us through the threatening possibilities as well as a practical approach to the workup of these patients. She'll discuss spontaneous coronary artery dissection (S.C.A.D.), pulmonary embolism, aortic dissection and more. This lecture was recorded from the ResusX:ReVolved conference in 2022. Signup for our weekly newsletter so you never miss any education from us: https://www.resusx.com/newsletter