The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail Today is a shorter episode but an important one, looking at some important parts of Acid Base issues, driving factors, considerations, and a bit of a introductory dive into Winter's Formula for expected CO2 compensation. 

Send us Fan Mail Today's episode is a really interesting case to review and discuss. This is not a case from our system, but has some really interesting learning points, and is a great example of when to treat vs not to treat, and how to not just chase numbers, as well as an example of playing the "Which of these came first and which is the effect of the other" game. Put on your det...

Send us Fan Mail What else can be done for the internally-hemorrhaging trauma patient? How can we buy them more time to get to definitive surgery? In this episode I will discuss REBOA, how it works, why it can help our patients, and even an external alternative to REBOA, albeit a single-use expensive alternative!

Send us Fan Mail Are you really aware of how Fentanyl works outside of the vial? How you actually can or can't be exposed to powder forms of the medication? Let's debunk some of the myths circulating in the media about Fentanyl and other opioids similar to Fentanyl to set the records straight!

Send us Fan Mail Join me as we take a dive into some incredibly important tips for medical legal documentation in today's litigious society. We will talk about the differences in EMS vs hospital documentation (Summary vs contemporaneous), what to know about statute of limitations, what you need to have in your documentation to survive in court, etc. I also explain the process for being reques...

Send us Fan Mail You've probably heard of Keturonium, or Rocketamine...but have you heard of Ketofol? If not, have no fear, as this episode will present the basics of procedural sedation, a little refresher on Ketamine and Propofol, and discuss why it make make sense to combine the two into one super-charged tool for procedural sedation. Is it right for every time? No. And the evidence presen...

Send us Fan Mail Piggybacking off of the Cocaine "Party Powder" episode from earlier, we take a deeper dive into sodium channel toxicity, how to recognize it, the pathology, and treatment rationale. These can be incredibly challenging patients to treat, mostly because we often find ourselves going down a different diagnosis route than where we need to be. 

Send us Fan Mail Sepsis, despite the bundles and attention it has recently gotten, still seems to take a back seat in the medical world to heart attacks, strokes, and trauma. We will spend some time this episode discussing SIRS, Sepsis, Severe Sepsis, and Septic Shock, look at how the standard Medicare SEPSIS "bundle" and fluid resuscitation can cause more problems than not when generica...

Send us Fan Mail Whether working in EMS/pre-hospital and obtaining an informed refusal of treatment/transport, or obtaining an AMA documentation in the hospital, this procedure is one of the most common causes of healthcare workers findings themselves deposed in court to testify. After having served as an Expert Witness in court testifying for and against EMS personnel in regard to documentation a...

Send us Fan Mail The world of ECG's can be very intimidating and complex. Not everyone is walking around examining them with calipers and computer-aided vector programs. For those of us non-Cardiologists, this episode will give a brief overview of the various wide-complex tachycardias, how to keep from making the ACLS-driven assumption that all wide complex tachycardias are V-Tach, how to ide...

Send us Fan Mail Similar to the right-ventricular shock patient's death spiral, were you aware that poor mechanical ventilator treatment/setting choices can send our patients into similar death spirals? This episode aims to help identify an example of a common mistake in scenario form, then break it down to help understand why these problems add up into sometimes unrecoverable obstructive sho...

Send us Fan Mail This episode is a very brief add-on/refresher to the in-person training provided in the ED last month, to help fill any gaps in understanding surrounding the medication, its uses, mechanism, contraindications, set-up, and tips/tricks. 

Send us Fan Mail Following a brief dive into acidosis, we will explore the basics behind sodium bicarbonate (NaHCO3), Calcium, and THAM, or Tromethamine, as treatments for the severely acidotic patient. This episode will look at when each option is suitable, the downsides for each, and why THAM is actually a decent option to reach for. 

Send us Fan Mail Join me as I discuss RSI vs DSI, the choices of medications for induction and paralysis, tips and tricks, and cautions to be aware of. RSI is not rapid. It is not done in disregard for the patient. It IS different from a Crash Airway and that will be discussed as well. I am joined for this episode by a star-studded cast including Etomidate, Ketamine, Succinylcholine, Rocuronium, t...

Send us Fan Mail This episode is a case study and discussion on the challenges of poly-substance ingestion and ECG interpretation, especially on the challenges of Cocaine when mixed with alcohol and other party substances. The effects are not what you would typically expect! 

Send us Fan Mail Have you found yourself wondering what the doctors and paramedics are looking at and obsessing over on the ECG's? In this episode, we examine T-waves, from the cardiac memory-induced changes to pathologic changes, and the various non-STEMI (but still potentially OMI!) conditions that need to be seen by cardiology and how to identify them on ECG.  In this episode: -Those STEMI...

Send us Fan Mail A brief departure from the actual world of medicine itself, I wanted to take some time to promote respect not only between the medical disciplines of EMS, nursing, mid-level, and physicians, but also self-respect. We are all part of the same healthcare family, we all face the same overall hurdles...let's work together to build a better future and more cohesive present for us...

Send us Fan Mail Join me for a quick "coffee talk" chat regarding commonly-asked questions about the helicopter teams that are often seen at the hospital, including: 1) Why aren't they flying today, the weather is great here? 2) Why did they turn down the mission request? How do they determine if they will fly or not? 3) How come they keep asking for our meds and supplies? 4) How ca...

Send us Fan Mail Today's episode looks specifically at: -OMI/NOMI vs STEMI/NSTEMI -Newer ACC/AHA criteria for identification of OMI -LBBB/Ventricular-Paced Rhythms and Sgarbossa/Modification Criteria -LVH and proposed OMI criteria -Hypertrophic Obstructive Cardiomyopathy (HOCM) -Really Really Wide Complex Tachycardias (RRWCT) The goal is to help familiarize you with some of these difficult co...

Send us Fan Mail Let's take a dive into the world of Vasopressin, or ADH. This drug choice is often overlooked or seen as a "back-up date" to Norepinephrine and the other "front-line" meds, but Vasopressin has its uses, and should not be overlooked. We will also discuss off-label uses for Vasopressin emerging in the world of pediatric autism treatment and to aid in differe...

Send us Fan Mail Join me for a brief overview of the typical treatments for hyperkalemia as well as discuss the downsides to Kayexalate vs other newer options such as Lokelma to consider. This discussion centers around a case of a teenager with critical potassium levels with baseline kidney failure. 

Send us Fan Mail A quick dive into the various components of blood products, antigens and antibodies, differences between Cross & Match vs Type and Screen, blood transfusion issues, and administration logistics. 

Send us Fan Mail Let's navigate the intricacies of pediatric epinephrine administration and easy ways to cognitively offload when we are trying to administer Code Dose (1:10) Epinephrine. These tips are specific to the Code Dose (1:10 or 1:10,000) Epi concentration. 

Send us Fan Mail Some quick tips in the form of a rhyme to help cut through the stories and see if the story fits the presentation of the infant. These tips could help make the difference between identifying potential cases of infant abuse vs allowing a cycle to continue. 

Send us Fan Mail This short episode details a quick and simple test used worldwide to help identify possible critical congenital heart defects prior to an infant leaving the hospital, or within the first few weeks of life.