The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail How does giving a loop diuretic actually cause the body to retain CO2??? What does that have to do with fluid management?! Surprise, quite a bit actually. Tune in and find out!

Send us Fan Mail SIRS and especially qSOFA just don't stack up. Not in adults, and definitely not in pediatrics. This has begged the question for a while of is there a better sepsis screening tool out there for children given how well they compensate and hide insult from occult shock... Recently a pediatric age/vitals-specific sepsis screening tool has been proposed, called the qPS4 scale, an...

Send us Fan Mail Who are you more concerned about, the patient with a blood pressure of 96/70 or the patient with a blood pressure of 200/35? Besides the fact that this episode is titled Isolated Diastolic Hypotension, can you figure out why option B is more concerning to me if I had to choose just based off of blood pressure? Tune in and see if you are correct in your reasoning! Your future patie...

Send us Fan Mail If you are like me, you probably have trouble remembering the difference between heart murmur grades, whether S4 comes before S1, S3 after S2, and why it even matters. This episode breaks this down as simple as I think it can possibly be broken down, with the "why" behind it.

Send us Fan Mail If you interpret lab values, you have most assuredly fallen into the same trap I have in the past of taking something at face value and not reasoning against trends or in conjunction with other lab values. In medicine this can cause dangerous conditions of either inappropriately-diagnosing someone with something they don't have, or missing a diagnosis of something they do hav...

Send us Fan Mail This episode is a review on the pharmacology behind Phenylephrine, a very potent alpha vasopressor, its uses, cautions, and more!

Send us Fan Mail We are all most likely pretty adept at initial fluid resuscitation and repletion rates for pediatrics. What happens after the patient is more stable-ish? In that time period where we must now maintain the patient? How do we calculate appropriate fluid infusions and electrolyte infusions?

Send us Fan Mail DKA is a wild animal. Taming it in our sick patients can be incredibly challenging. The newest criteria are out for diagnosis of DKA, and there have been a few bigger changes. Tune in to keep up!

Send us Fan Mail I see quite often providers not obtaining ECG's on pediatric patients. There seems to be this idea especially in EMS that cardiac issues are reserved for anyone over the age of puberty. How about we correct that thinking today and talk about 4 of the pediatric ECG findings you really need to know about. 

Send us Fan Mail 2026 is the Year of Sepsis! There are big changes and pushes for identification and treatment of sepsis both in the hospital and pre-hospital. Tune into this episode for an overview of the changes to the guidelines with evidence-based recommendations!

Send us Fan Mail Oxygen nanoparticles? What the heck am I talking about now? Hypoxia can be an incredibly complex cascade in the body, and is not just a one-size-fits-all issue or treatment. We have to identify the type of hypoxia, the process(es) involved, where we are on the curve, and more. This episode will look at the concept of oxygen nanoparticles and how they play into all of this.

Send us Fan Mail Take a second and really think...how solid is your understanding of acute kidney injury vs chronic kidney disease? Are these conditions silos, or is there overlap? How do lab values play into diagnostics beyond face value? What does it really mean on a complexity level system-wide when someone has AKI superimposed on CKD?

Send us Fan Mail One of the very first episodes I covered was on a concept called ALM Therapy. For those not familiar, this is a mix of Adenosine, Lidocaine, and Magnesium infusion therapy in trauma patients. Why? Great question. Tune into this episode as I outline more about what this is and what the advancements are that have been made since I last covered this.

Send us Fan Mail What is euvolemic, or normal volume, cardiogenic shock, and how does this differ from what we typically expect??

Send us Fan Mail The magic of Ketorolac...the power of narcotics packed neatly into an NSAID's body. But is it a wonder-drug, or are there issues to be aware of? When should it be used, and what do we need to look for? These questions and more are answered here.

Send us Fan Mail Do lab values constantly leave you confused? You are not alone. Many healthcare providers can have difficulty not just with memorizing lab values as a whole, but knowing how to interpret them in context with clinical picture. This episode looks specifically at TSH, T3, and T4, and how to use these to help determine various thyroid issues at hand in your patients. 

Send us Fan Mail We seem to discuss lactate a bit on these episodes, and for good reason. This episode takes it a step further and breaks down Type A vs Type B hyperlactatemia, and those patients who may also have both at the same time. How does this change things for us?

Send us Fan Mail The head bones are indeed connected to the foot bones, albeit with a bunch of things in between. So too is the heart connected to the kidneys, and what affects one will assuredly affect the other. This episode looks at the relationship in detail between both organ systems to help understand why this may be the case and how to better care for these patients. 

Send us Fan Mail Why do patients respond so poorly to aortic stenosis and aortic regurgitation? What is happening in the heart and systemically when these are occurring? Why is an IABP contraindicated for one of these conditions? How can I use a better understanding of these conditions to prepare for and manage patients who have acute vs chronic stenosis or regurgitation of the aortic valve?

Send us Fan Mail This episode dives into the concept of Cardiac Output. What is it, how do we calculate it, and how do we use it? What parameters does this use to be calculated, and how can we apply cardiac output to our patients to better manage them? This episode looks at all of this and more!

Send us Fan Mail It is incredibly important to understand the differences in pathophysiology and presentation physically and lab-wise when it comes to differentiating DKA vs HHS (previously known as HHNK). We will discuss both of these in detail, as well as the condition known as SIADH. It is more common than you may think, so it is imperative to be able to recognize it and treat it appropriately!

Send us Fan Mail Hemo lympho what? Why are we talking about something you have never heard of before? Is this like Dr. House, with random oddball medical diagnosis'? What if I said a good chunk of the patients we believe to be septic actually are suffering from this condition? Would that change your mindset? Let's dive in and find out more!

Send us Fan Mail This episode is all about the concept of coronary perfusion pressure. It is essential that we understand these concepts so that we can predict, react, and treat our patients better than just a guess. This episode will get your comfort levels up in regard to the ideas that surround coronary perfusion pressure, diastole vs systole, and more. 

Send us Fan Mail There are some things that are taken for granted in medicine, and some that make sense. There are some things that "just made sense" and were followed but then evidence later on shows it was not appropriate. The CAST Trial is one of those instances, and is probably very much accountable for why we now perform trials the way we do, vs just going off of what makes sense ph...

Send us Fan Mail This episode is a review of the sepsis biomarkers and lab values, as well as an in-depth discussion into the cytokine storm that drives sepsis, specifically what is happening at the cellular and tissue levels that makes this such a significant problem.