Shows
Resus NowEpisode 11 - A Brief Look Into Opiate Addiction Treatment, Part 2The second part of my interview with Dr. Kenji Oyasu.Dr. Oyasu is an Emergency Room Physician and also runs ModernMed Recovery.https://www.modernmedrecovery.com/2021-06-0840 min
Resus NowEpisode 10 - A Brief Look Into Opiate Addiction Treatment, Part 1I promised you content and I finally delivered! Dr. Kenji Oyasu joins me for this fascinating look into the world of addiction medicine.Dr. Oyasu is an Emergency Room Physician and also runs ModernMed Recovery.https://www.modernmedrecovery.com/2021-06-0129 minResus Now5 Minute Bit #43 - We're Back!2021-05-0105 minResus NowResus Now - Show Status Update!Just a quick update on what's going on with the show. New episodes coming soon!2021-03-1303 min
Resus Now5 Minute Bit #42 - Hyperkalemia, Part 12021-02-1606 min
Resus Now5 Minute Bit #41 - Capnography2021-02-1307 minResus Now5 Minute Bit #40 - Paramedic Series, Part 5 - Permissive Hypotension & CABC2021-02-0906 min
Resus Now5 Minute Bit #39 - Paramedic Series, Part 4 - Aortic Catastrophe2021-02-0605 min
Resus Now5 Minute Bit #38 - Paramedic Series, Part 3 - Stroke: Last Known Well Time2021-02-0206 minResus Now5 Minute Bit #37 - Paramedic Series, Part 2 - Esophageal Intubations2021-01-3005 min
Resus Now5 Minute Bit #36 - Paramedic Series, Part 1 - Intubations2021-01-2607 minResus Now5 Minute Bit #35 - Subclavian Series Part 3: Pitfalls and pearls2021-01-2307 min
Resus Now5 Minute Bit #34- Subclavian Series Part 2: ultrasound guided approach2021-01-1907 min
Resus Now5 Minute Bit #33 - Subclavian Series Part 1 - Blind ApproachThis is part 1/3 in our subclavian central line series. First we discuss the blind approach and see this excellent video on the procedure. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiWi9bi16HuAhXBQc0KHfqwCY4QFjAMegQIAxAC&url=https%3A%2F%2Fjomi.com%2Farticle%2F290.14%2FBlind-Technique-for-Subclavian-Central-Line-Placement&usg=AOvVaw1GYu3SgBKI4_a-SQGWlz_phttps://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiWi9bi16HuAhXBQc0KHfqwCY4QFjANegQIHhAC&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DRDtgzNWmYBw&usg=AOvVaw29uSjDYjpH_bJ1e...2021-01-1606 min
Resus Now5 Minute Bit #32 - Retrograde IntubationThe retrograde intubation! An oldy but goody and a nice trick to keep in your back pocket.1. Prep the neck2. Identify the anatomy and your Cricothyroid membrane3. Introduce your needle with syringe attached through cricothyroid membrane in a cranial (cephalad) direction. Withdraw plunger and confirm position with whisp of air in syringe (can have saline in syringe to look for bubbles).4. Pass wire through needle until operator at the head retrieves it with forceps. Continue passing the wire until most is exiting the oral cavity.5. Clamp wire at the front of the neck with...2021-01-1307 min
Resus Now5 Minute Bit #31 - Surgical Airway Series Part 4Part 4 of 4! Things we talk about:1. Reinforce safety, never have your finger in the same hole as a scalpel.2. Extend your incision from sternal notch to hyoid bone (in the midline) if anatomy is not palpable.3. Be wary of previous front of the neck surgical scars!4. The wired jaw airway emergency. See below5. Nasotracheal intubation and fiberoptic techniques. Check out this reference on steps and pictures of cutting the vertical fixation wires:http://sjrhem.ca/wiredjaw/Article on nasotracheal intubation:https://www.ncbi.nlm.nih.gov/pmc/articles/PM...2021-01-0907 min
Resus Now5 Minute Bit #30 - Surgical Airway Series Part 3This is part 3 of 4 in the surgical airway series. We discuss pitfalls including entering a false passage with the bougie. Watch the below video from EMCrit, George Kovacs, as I referenced in the podcast demonstrates that “hold up” is possible in a false passage. All credit goes to Dr. Weingart, Dr. Kovacs and all the brilliant airway gurus for continuing to teach and perfect these techniques. Enjoyhttps://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=video&cd=&cad=rja&uact=8&ved=2ahUKEwiAzYaXy6HuAhVIVs0KHQyDCv0QtwIwAHoECAAQAg&url=https%3A%2F%2Fwww.youtube.com%2Fwatch...2021-01-0605 minResus Now5 Minute Bit #29 - Surgical Airway Series Part 2This is part 2 of 4 in a our surgical airway series. Below are some good videos on the proper approach and technique. Credit goes to Scott Weingart, my RLA professor and the host of EMCrit podcast as this technique was adopted from his teaching. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KHWG2AosQwqsBMAB6BAgOEAM&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQ0RVlgwC9rs&usg=https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KH...2021-01-0207 min
Resus Now5 Minute Bit #28 - Surgical Airway Series Part 1This is part 1 of 4 in a our surgical airway series. Below are some good videos on the proper approach and technique. Credit goes to Scott Weingart, my RLA professor and the host of EMCrit podcast as this technique was adopted from his teaching. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KHWG2AosQwqsBMAB6BAgOEAM&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQ0RVlgwC9rs&usg=https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KH...2020-12-2906 minResus Now5 Minute Bit #27 - TXA Series Part 3 - Pre Hospital Use2020-12-2609 minResus Now5 Minute Bit #26 - TXA Series Part 2 - When To Hold OffOn this episode, We discuss some contraindications, controversies, data analysis of different clinical trials of TXA, and much more! Please see links below for referenced articles in the show.http://www.emra.org/emresident/article/critcare-alert-crash3/https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04623-5https://emcrit.org/pulmcrit/crash3/https://first10em.com/halt-it-trial/https://www.thebottomline.org.uk/summaries/icm/tich-2/https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31033-X/fulltexthttps://www.bmj.com/content/343/bmj.d3795https://rebelem...2020-12-2307 min
Resus Now5 Minute Bit #25 - TXA Series Part 1 - What, When & WhyIn this 5 minute bit, we describe the mechanism of action of tranexamic acid and its many indications as it applies to emergency conditions. Please see below for articles and evidence related to the show.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023891/https://pubmed.ncbi.nlm.nih.gov/23477634/2020-12-2007 minResus Now5 Minute Bit #24 - The RUSH Exam, Part 2https://emcrit.org/rush-exam/original-rush-article/https://emcrit.org/wp-content/uploads/2011/03/New-RUSH-Review-Article1.pdfhttps://emcrit.org/wp-content/uploads/2011/03/new-rush-study.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485910/2020-12-1507 min
Resus Now5 Minute Bit #23 - The RUSH Exam, Part 1https://emcrit.org/rush-exam/original-rush-article/https://emcrit.org/wp-content/uploads/2011/03/New-RUSH-Review-Article1.pdfhttps://emcrit.org/wp-content/uploads/2011/03/new-rush-study.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485910/2020-12-0908 minResus Now5 Minute Bit #22 - Vasopressors, Part 3In this 5 minute bit, we discuss scenario based pressor selection, vasopressors to choose in the face of RV failure or pulmonary hypertension, and peripheral vasopressors. Below you will find evidence related articles on vasopressin and dobutamine effect on pulmonary vascular resistance, safety profile of peripheral pressors and an interesting article about using midline catheters as an alternative to central lines for vasopressor administration (not prime time yet). https://pubmed.ncbi.nlm.nih.gov/12682485/http://www.emdocs.net/the-crashing-pulmonary-hypertension-patient/https://emcrit.org/emcrit/peripheral-vasopressors-extravasation/https://pubmed.ncbi.nlm.nih.gov/26014852/h...2020-12-0507 min
Resus Now5 Minute Bit #21 - Vasopressors, Part 2In this 5 minute bit we discuss Phenylephrine, Angiotensin II, Dobutamine and Milrinone. Please see attached evidence related to our topic:*Just to clarify, dobutamine and milrinone can both be used for right ventricular systolic failure but there is some evidence that milrinone may provide better pulmonary vascular afterload reduction than dobutamine. NO MILRINONE IN RENAL FAILURE. MILRINONE IS LONG ACTING. *Just to clarify, Angiotensin II data was not solely tested against placebo. The actual randomized trial had both groups on high dose norepinephrine and one group had placebo as a second agen...2020-12-0208 min
Resus NowEpisode 9 - COVID Update with Dr. Srinivasan & Dr. PatelIn this episode, 2 Intensivists Dr. Srinivasan and Dr. Patel visit Resus Now to discuss todays approach on taking care of patients with COVID 19 illness. Please see below articles for evidence related to todays topic.Dexamethasone article:https://www.nejm.org/doi/full/10.1056/NEJMoa2021436Tocilizumab article:https://www.nejm.org/doi/full/10.1056/NEJMoa2028836Vitamin C article:https://link.springer.com/article/10.1007/s43440-020-00176-1Reading about zinc:https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/zinc/Reading about melatonin:https://consultqd.clevelandclinic.org/melatonin-a-promising-candidate-for-prevention-and-treatment-of-covid-19/2020-11-2829 min
Resus Now5 Minute Bit #20 - Vasopressors, Part 1In this 5 minute bit, we discuss pearls and pitfalls with Norepinephrine, epinephrine, dopamine and vasopressin. Please see below for evidence related to our topic.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495871/https://pubmed.ncbi.nlm.nih.gov/18654759/https://emcrit.org/pulmcrit/renal-microvascular-hemodynamics-in-sepsis-a-new-paradigm/https://www.nejm.org/doi/full/10.1056/nejmoa09071182020-11-2508 min
Resus Now5 Minute Bit #19 - COVID Fatigue: Be Kind2020-11-1804 min
Resus Now5 Minute Bit #18 - Dialysis Catheter PlacementReview the below articles thoroughly before placing a temporary dialysis catheter. Remember RIJ is site of choice followed by femoral. LIJ not ideal and avoid subclavian. Enjoy and thank you for all of your support for Resus Now!https://www.ncbi.nlm.nih.gov/books/NBK539856/http://maryland.ccproject.com/2014/03/11/vascular-access-renal-replacement-therapy/2020-11-1109 min
Resus Now5 Minute Bit #17 - Final Thoughts on Chest Tubes & Pneumothorax2020-11-0707 min
Resus Now5 Minute Bit #16 - Pneumothorax Imaging ModalitiesPlease review below articles pertaining to todays show!https://www.ncbi.nlm.nih.gov/pmc/articles/PMC558461/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299161/2020-11-0407 min
Resus NowEpisode 8 - ED Thoracotomy, Part 2IT'S THE HALLOWEEN SPECIAL, PART TWO! Ralph & Dr. Barker are joined by Dr. Daniel Liesen, who is here to discuss thoracotomies in the emergency department. Remember:1. Know your indications and contraindications and ensure back up is available and on their way.2. Prepare your equipment3. Incise and gain entry also intubate right mainstem and know how to use your spreaders!4. LOOK!!! 5. Control hemorrhage that is visible and open pericardium-control direct cardiac bleeding6. Clamp the aorta above the diaphragm- Time is ticking.....7. Open cardiac massage/defibrillation8. Avoid further air embolism if any pr...2020-10-3130 min
Resus NowEpisode 7 - ED Thoracotomy, Part 1IT'S THE (EARLY) HALLOWEEN SPECIAL, PART ONE! Ralph & Dr. Barker are joined by Dr. Daniel Liesen, who is here to discuss thoracotomies in the emergency department.Remember:1. Know your indications and contraindications and ensure back up is available and on their way.2. Prepare your equipment3. Incise and gain entry also intubate right mainstem and know how to use your spreaders!4. LOOK!!! 5. Control hemorrhage that is visible and open pericardium-control direct cardiac bleeding6. Clamp the aorta above the diaphragm- Time is ticking.....7. Open cardiac massage/defibrillation8. Avoid further air embolism if...2020-10-2728 min
Resus Now5 Minute Bit #15 - Chest Tubes and Treatment of Simple PneumothoraxIn this 5 minute bit, we talk about treatment and chest tube size options for the simple pneumothorax. Please see below for evidence related articles:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334075/http://jtd.amegroups.com/article/view/8006/html https://www.cookmedical.com/critical-care/in-favor-of-small-bore-the-efficacy-of-pigtail-catheters-for-pleural-and-pericardial-drainage/ 2020-10-2407 min
Resus Now5 Minute Bit #14 - Tension Pneumothorax and The Finger ThoracostomyIn this 5 minute bit, we discuss the emergency treatment of the tension pneumothorax using the finger thoracostomy. Please see attached evidence based articles associated with the episode. https://pubmed.ncbi.nlm.nih.gov/22987168/2020-10-2107 min
Resus Now5 Minute Bit #13 - Intra-Cardiac Arrest Arterial LinesIn this episode Ralph goes over the use of the arterial line in cardiac arrest. Please see below evidence related articles to supplement this 5 minute bit. https://pubmed.ncbi.nlm.nih.gov/4064112/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4087068/pdf/nihms-598128.pdfhttps://emcrit.org/wp-content/uploads/2018/07/DBP-vs-ETCO2.pdfBelow is an excellent blog post and podcast done by Scott Weingart of EMCrit. This clears up where your diastolic value is during mechanical CPR. https://emcrit.org/emcrit/dbp-cpr/https://emottawablog.com/2020/04/nurse-led-acls/2020-10-1708 min
Resus Now5 Minute Bit #12 - DKA Series Part 5 - Ralph's Miscellaneous Thoughts on DKA2020-10-1406 min
Resus Now5 Minute Bit #11 - DKA Series Part 4 - Is My Patient Improving?2020-10-1005 min
Resus NowEpisode 6 - Difficult Airway Series, Part 2Ralph is joined by Dr. Kelly Wren in a discussion about an anhydrous ammonia spill and the aftermath in the Emergency Department.https://journals.lww.com/em-news/Fulltext/2020/08000/News__Toxic_Gas_Leak_Holds_Lessons_for_COVID_19.8.aspx2020-10-0350 min
Resus Now5 Minute Bit #10 - DKA Series Part 3 - Which Fluid Do I Choose?2020-09-3005 min
Resus Now5 Minute Bit #9 - DKA Series Part 2 - Mind The Gap2020-09-2506 min
Resus Now5 Minute Bit #8 - DKA Series Part 1 - Volume Resuscitation of DKA2020-09-2305 min
Resus NowEpisode 5 - Difficult Airway Series, Part 1Ralph is joined by Dr. Brock Franklin, who presents an interesting airway case.2020-09-1933 min
Resus Now5 Minute Bit #7 - A Bloody Emergency- The bleeding tracheostomyA 5 minute bit on a tracheostomy emergency that deserves some attention. Ralph describes this emergency, the etiology, the recognition, the management steps and prognosis. Please see evidence related articles and sites regarding this topic.https://www.ncbi.nlm.nih.gov/books/NBK482505/ https://emergencymedicinecases.com/tracheo-innominate-fistula/http://www.downstatesurgery.org/files/cases/tif.pdf2020-09-1606 min
Resus NowEpisode 4 - Emergent Treatment of Rapid A-Fib & A-FlutterEmergent treatment of rapid atrial fib/flutter with Dr. Dave Zull. Please see below for Evidence based annotated articles Arrigo M. New Onset Atrial Fibrillation in critically ill patients and it’sassociation with mortality. Int J Cardiol 266:95-99, Sept 2018Bosch, NA, et al. Atrial Fibrillation in the ICU CHEST 154:1424-1434. Dec 2018Nice review of A fib in the critically ill patient. Emphasis first on correcting precipitants like sympathomimetics, electrolytes, volume and intercurrent illness. Esmolol implied to be best rate control drugDeSouza IA, et al. Pharmacologic Cardioversion of recent onset Atrial Fibrillation a...2020-09-1238 min
Resus Now5 Minute Bit #6 - Avoiding Central Line ComplicationsA 5 minute bit that discusses the feared complication of inadvertent arterial placement of central lines. We discuss some strategies to avoid this and other complications. We use ultrasound for needle insertion (even for subclavian lines), tube manometry, guidewire localization with ultrasound, and the agitated saline test using POC echo at the bedside. Please see below evidence based articles, blogs and pictures associated with the show.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296410/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613416/https://pubmed.ncbi.nlm.nih.gov/26256713/https://ww...2020-09-0907 minResus NowEpisode 3 - Cardiac Arrest with ROSC: Who Goes to the Cath Lab?Dean Ferrera MD, Interventional Cardiologist visits Resus Now to discuss which post arrest ROSC patients without a STEMI on the EKG should go to the cath lab. Please see below for evidence related articles related to the show.https://www.nejm.org/doi/full/10.1056/https://wikem.org/wiki/STEMI_equivalents2020-09-0454 min
Resus Now5 Minute Bit #5- The Bleeding AV FistulaIn this 5 minute bit, Ralph discusses some methods of managing a patient with a bleeding AV fistula.Sorry, we ran way over 5 minutes........Hopefully it’s worth it.aShow Notes:Suture required is usually 5.0-6.0 prolene with a non cutting needle. Don’t forget local anesthesia. https://www.acepnow.com/article/dialysis-access-emergencies/https://emblog.mayo.edu/2015/04/27/how-to-stop-a-post-dialysis-site-bleeding/https://i1.wp.com/rushemergencymedicine.org/wp-content/uploads/2019/03/Cutting-vs.-Non-cutting-needles.jpg?w=638&ssl=1https://i1.wp.com/rushemergencymedicine.org/wp-content/uploads/2019/03/Purse-string.jpeg?resize=177%2C140&ssl=1http...2020-09-0108 min
Resus Now5 Minute Bit #4- Every Kiss Begins With K(etamine)https://link.springer.com/article/10.1007/s12028-013-9950-yhttps://pubmed.ncbi.nlm.nih.gov/24996763/2020-08-2206 minResus NowEpisode 2 - Airway Management Part 2: The Drugs of RSIIn this episode, Ralph & Dr. Barker discuss the different drugs available for RSI.Evidence based articles related to our topics, click links below:https://coreem.net/core/parenteral-benzodiazepines/https://link.springer.com/article/10.1007/s12028-013-9950-yhttps://pubmed.ncbi.nlm.nih.gov/24515638/https://www.uptodate.com/contents/induction-agents-for-rapid-sequence-intubation-in-adults-outside-the-operating-roomhttps://emj.bmj.com/content/22/6/456https://emedicine.medscape.com/article/80222-periprocedurehttps://www.nejm.org/doi/full/10.1056/nejmoa10053722020-08-2241 min
Resus Now5 Minute Bit #3 - Nurses RoundtableRalph brings in some of his favorite ER nurses to voice their complaints about ER providers.2020-08-1206 minResus Now5 Minute Bit #2 - Push Dose PressorsIn this 5 minute bit, Ralph goes over a few options that you have for push dose pressors.Questions? Email us at ResusNowQuestions@gmail.comPlease click on the links below for evidence related to this topichttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052865/pdf/ceem-15-010.pdfhttp://www.emdocs.net/push-dose-vasopressors-an-update-for-2019/https://www.tandfonline.com/doi/abs/10.1080/10903127.2019.1588443?journalCode=ipec20https://emcrit.org/wp-content/uploads/2017/08/holden-push-dose.pdfhttps://pubmed.ncbi.nlm.nih.gov/28248702/Below is a link to a printable mixing...2020-08-0506 minResus NowEpisode 1 - Airway Management, part 1The long awaited first episode of Resus Now! This episode is the first in our multipart series on Airway Management.Questions? Email us at ResusNowQuestions@gmail.comResus Now- episode 1-Airway management-part 1 show notes1. Talk about preparing to intubate a patient, gathering equipment, assigning roles, back up plans for failure2. Basic equipment needed in EVERY intubation- preOX equipment= BVM w/ PEEP valve, NC at 15 LPM, suction that works, Monitor, BP cuff, pulse ox, capnography, IV access confirmed to be patent, meds for RSI, premedication stuff for special circumstances, push dose...2020-07-3037 minResus Now5 Minute Bit #1 - Welcome to Resus Now!Welcome to Resus Now! This 5 minute bit serves as an introduction to our concept and gives some background on our philosophies. Welcome!2020-07-2505 min