The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail I recently had a few EMS crews asking about the pregnancy-related emergencies they may encounter. When I asked them about what is "normal" in each trimester, it became clear that this is a topic area that is not often covered in initial training let alone in follow-up education, which spurned this podcast episode. This is a short and to-the-point compilation of some of t...

Send us Fan Mail What does it mean when the left ventricle is hyperdynamic? What are we looking at exactly on ultrasound? What do the ventricular walls "kissing" tell us about the patient?

Send us Fan Mail How many times have you run into issues with dampening, arterial monitoring collapse, etc? How often have you stopped to wonder if the issues you were having in the shock patients with poor arterial tracing might be avoided if you switched from peripheral to central monitoring sites? Many might argue it isn't worth it, or the femoral site is dirty, full of issues, etc, but le...

Send us Fan Mail It is the same drug, right? Whether I give NO via IV or nebulization, it will do the same thing, won't it? Won't it??? If I had to devote an entire episode to this one topic, I am sure you have guessed at this point that this is not the case. Join me and see why these are two very different concepts even though it is the same medication.

Send us Fan Mail Yes, Cyanokits...Hydroxocobalamin...the same expensive medication we can administer to patients who have been exposed to smoke inhalation from say, a structure fire. Why would we ever consider giving it to a patient suffering from Vasoplegic shock? How does this even help out patients who have been exposed to dangerous chemicals in smoke, let alone vasoplegia? 

Send us Fan Mail "Shoot for a target MABP of 65mmHg!" It sounds great in theory, except like many other numbers and concepts in medicine, this is one of those that I truly feel make us as the Provider feel better than it actually does much for our patient. We know patients need a MABP of at least 65, but then again, some don't...some can go lower and not suffer from it...and some ne...

Send us Fan Mail What do these three sedative drugs have in common when it comes to status epilepticus? Are there uses for them? Together or separate? How do they work in our favor and our patient's favor? Tune in to find out!

Send us Fan Mail Welcome to Episode 1 of our 4th Season! I can't express how grateful I am for the continued support from around the world as this podcast continues to grow! We are now hosted on multiple streaming sites and have listeners regularly tuning in from as far away as India, Great Britain, Australia, and more! Thank you so much and I look forward to continuing to deliver the very be...

Send us Fan Mail For those who aren't aware, there really isn't much benefit to SpO2 >94%. We have talked about this ad nauseum in other episodes before. The AHA tells us 94-99% for an SpO2 range for various reasons. However a recently-released trial, the Oxy-PICU trial, a multi-center randomized control trial, recently released data showing that children actually fair better if kept...

Send us Fan Mail Sodium channel blockers can cause a host of nasty effects in the body, and the heart unfortunately can take the brunt of a lot of it. We will examine this in today's episode with what to look for, signs and symptoms, treatments, etc. 

Send us Fan Mail Shock is not just about BP. In fact, in adults in hemorrhagic shock, we typically need to lose at least 1.5L of blood before BP changes, which is stage III shock. In kids? That can vary but is much more on the occult side. You can be in shock with severe anemia and have no blood pressure change. So how do we better evaluate our patients for shock??? Enter systolic and diastolic sh...

Send us Fan Mail This episode brings a review of the appropriate diagnostics and care for patients with aortic dissections and rupture as well as a review of the pathophysiology and classification types. Are you familiar with the newer HR and BP goals? Why is this a pulsatility issue more than anything else? What is your bundle of care?

Send us Fan Mail Today is a review of most things having to do with spinal injuries. Anterior, posterior, and Brown-Sequard syndromes...Spinal vs Neurogenic shock differentiation (yes they are different!), and SCIWORA. We will examine each of these and what you need to know whether sitting for a board exam or just beefing up your knowledge for the next trauma patient!

Send us Fan Mail Many of us were taught to place ECG precordial "V" leads under large breast tissue, replace/set down the tissue after, and then obtain the image. However, did you ever stop to think about how much large breast tissue can displace the ECG leads on the chest and dramatically alter the image? How do we get around this? Is there anything better that could be done?

Send us Fan Mail PPV is notorious for dropping cardiac output by changing intrathoracic pressures and decreasing preload return by forcing lung tissue against major vessels and alveoli compression. However, is there ever a circumstance when PPV can actually improve cardiac output? This episode may just cover that!

Send us Fan Mail Ok...I get it. We were and still are often told that Calcium's role in the treatment of hyperkalemia is to "stabilize the cell membrane walls." In the most simplistic of explanations, this is still not entirely correct. This episode brings actual science, recent evidence-based study, and basic reasoning into the mix to explain what Calcium is ACTUALLY doing in hyper...

Send us Fan Mail There are certain aspects of Pharmacology and Pharmacokinetics that are non-negotiable. One of those is the aspect of time in relation to antibiotic effectiveness. How much time is the antibiotic in the system for, vs how long does it take to reach peak effect or be cleared before hand. Certain antibiotics must be ordered and administered over a much longer time than we are used t...

Send us Fan Mail Is hand placement on the sternum mid-line halfway up the breastbone really the best place for compressions? What does the evidence show? How can we use POCUS in and out of the hospital to determine where hand placement is most effective, and how is it showing that traditional hand placement is actually obstructing the left ventricular outflow tract more than we think, causing resu...

Send us Fan Mail This seems to be an area many people struggle with, trying to figure out sympathetic vs parasympathetic, muscarinic vs nicotinic, and how these all relate. Who has what for primary transmitters? How do we navigate this? I am showing you a quick and easy way to get this right that you can easily teach to others!

Send us Fan Mail Thank you for tuning into the last episode of Season 3! This episode dissects the highs and lows of ultrasound of the IVC for volume status. Where does it excel? Where does it let us down, and how do we add other components of assessments in to beef it up? This is very much an adjunct, not something to hang your hat and full spectrum of treatments on. Even if you are just starting...

Send us Fan Mail We have heard about O2 and CO2 in patients like COPD'ers...but what happens truly when CO2 builds up to dangerous levels in the body? How does ventilation actually shut down? What do we do about it?

Send us Fan Mail There are some things in medicine that, when you learn the mechanics behind it, are just, well,...cool! Unfortunate, but cool to see. One wouldn't initially think something like aortic regurgitation would be that, but this episode looks at how AR can actually cause head-bobbing in patients. It is rarer than you think but still something to look for!

Send us Fan Mail Thrombocytopenia and Heparin aren't usually thought of together, at least Heparin not as being a potential cause. This episode will look at how that can be possible!

Send us Fan Mail Similar to the Aortic Stenosis and head-bobbing, Mitral stenosis can also cause a peculiar side effect, that being Dysphagia. Can you figure out how this might happen before listening? See if you were right!

Send us Fan Mail We have most likely all had the phone call from the lab before, asking for a re-draw on our patient due to lab hemolysis. Have you ever thought about why that happens and how we can reduce it? It is not just the desire of a larger-bore IV catheter...you can pull fantastic non-hemolyzed labs off of a 24G IV catheter...let's talk about how!