ResusX:Podcast

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.

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.