The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail Wait a minute...what?? Why would you transduce an IO drill site for vascular access, and think that you would get a pressure reading off of it? Is it even similar to an arterial access site? How would this work, and why does it work? Join me on this episode and I will introduce this concept and the group of researchers pushing the boundaries in Texas to make it happen. 

Send us Fan Mail This episode discusses the insult to the cells and compartments in relation to Compartment Syndrome, as well as Rhabdomyolysis. What are these? How do they occur? What actually happens at the cellular level, and how do these patients spiral? How do we treat them, and is there any way to actually monitor compartment pressures in transport if I don't have a transducer system? T...

Send us Fan Mail What is the ONSD, and why would this be something I would care about in emergency medicine, transport medicine, or critical care? What does measuring it show me, and how would I use ultrasound to measure it? All good questions! Tune in to find out!

Send us Fan Mail Feel unsure about how to treat sick OB patients? How about those in labor? What is the difference between Tocolytics and the other OB-related drugs? All of this and more in this episode. 

Send us Fan Mail Diabetes insipidus is the topic of the day, but it has nothing to do with blood sugar. This is one of the reasons why you may see the name change soon, as people don't often take the time to understand it. Join me on this episode to set the record straight and help prepare you for future patients with this condition!

Send us Fan Mail Wouldn't it be amazing if we had the ability to obtain digital X-rays in the field prior to arriving at the hospital? How would this impact the care we can deliver? Wouldn't we have to have a bigger ambulance for this? Or what if there was a device that fit in a backpack, that sent real-time images to the receiving hospital as well? You'll just have to tune in to se...

Send us Fan Mail We have all heard about THC inducing cyclical vomiting syndrome and a host of other issues, often attributed to the biphasic effects of THC on the sympathetic and parasympathetic systems, depending on dosages. Were you aware that THC usage is also being linked to complete AV Block/3rd degree heart block? This episode stems from a recent case and is a fascinating look at the possib...

Send us Fan Mail This episode is geared towards those EMS providers using the Zoll Z-Vent (formerly the EagleVent) and the ED staff/respiratory therapy staff who may assist in preparing patients for transport/receiving patients from transport crews. This discusses the difference between Additive (PEEP-Compensated) vs Absolute (Uncompensated) ventilators, and how you can use Rise Time and Cycle % a...

Send us Fan Mail Recently I was asked "If you could create and work at the perfect critical care transport system, with whatever resources and support you needed, what would it look like?"  This podcast episode stems from 20 years of experience in volunteer, paid, union, municipal, hospital-based, flight, ground, and military medicine programs. Seeing what works, what doesn't, how h...

Send us Fan Mail This episode is as much a light-hearted poke as it is a bit of therapy and thinly-veiled plea for those in our profession to step up their game. Over 20 years I have watched my own performance as well as that of my partners. I have taken notes, tried to do the right thing, failed and learned and overcome, and wished for more from those I worked with. For the longest time I focused...

Send us Fan Mail This episode is bringing a topic out of the archives, but one that deserves a review. The theory behind IV drive lines, carrier lines/fluid, mixing, and why a patient can crash when you transfer IV infusions to other pumps/tubing is one that needs a solid understanding and some respect. This episode will hopefully be a review for some, new info for others, and a reminder to keep y...

Send us Fan Mail In the world of venous access, there are many considerations to be made. There are times and situations where certain options are appropriate. IO's have also become mainstream and with that, procedures like the external jugular, or EJ, and the saphenous cut-down have become less common. This episode discusses these two methods, when and how they are performed, why, and limita...

Send us Fan Mail A bit of a departure from the normal A&P, pathophys, and pharmacology topics but today is a look at how backwards and inconsistent the national EMS model is, and what steps *could* theoretically be taken to clean this mess up. I say theoretically because the amount of legislature and administrative rules that would need to be changed/updated in each of the 50 states is mind-bl...

Send us Fan Mail For the longest time I was taught that SIMV, especially SIMV in pressure mode, was a great transport alternative for patients. As more and more evidence comes out, and more ventilation modes are developed, it is time to look at whether or not SIMV is a dead mode of ventilation relegated only for weaning trials, or if it still has some utility?

Send us Fan Mail For many of our medications we administer, we have to consider how they are absorbed and utilized in the body. Some various medications are what we call lipophilic, meaning they combine or dissolve in fats. When the levels of these drugs becomes toxic, it can be hard to treat overdoses. This is where an IV bolus and/or infusion of a fatty lipid solution can be helpful. If this piq...

Send us Fan Mail Digitalis is not just a beautiful flower to look at. This drug was once widely prescribed, but has since fallen out of favor for other, newer, less-problematic options. However, patients are still seen with this in their medication list, and given how infrequently we see it now, it warrants a review of the drug, how it works, its narrow therapeutic window, and how to reverse it. S...

Send us Fan Mail We have discussed transthoracic POCUS in cardiac arrest and the challenges that come with that. We have discussed an alternative view of the carotids during arrest as well. But is there feasibility in performing resuscitative transthoracic echo in the field? In this episode I will discuss what this is, the barriers to it, and the services and their related data where it is being p...

Send us Fan Mail The traditional treatment for PSVT's, whether AVNRT or AVRT, is vagals, Adenosine, and possibly synchronized cardioversion. These require trained medical professionals, IV access, etc. What if there was a way for repeat *stable* PSVT patients to treat themselves at home and convert their rhythm without all of this? Or for EMS to be able to administer a medication to *stable*...

Send us Fan Mail There are many conditions to be aware of in emergency and critical care medicine, and sometimes it can feel overwhelming to remember them all. However one to be very much aware of is pericardial tamponade, not just because it is one of the causes of cardiac arrest. What is it, how do we diagnose it, what are the actual signs and symptoms, and how is it treated? All of this and mor...

Send us Fan Mail Most people have heard of left ventricular hypertrophy, but few have heard of Armstrong Algorithm used to identify MI hiding under the massive voltages of LVH. Even fewer seem to remember how to identify right ventricular hypertrophy on the ECG. In this episode I discuss LVH and RVH, criteria for identification, as well as the Armstrong Algorithm for evaluation of MI underlying LV...

Send us Fan Mail The FAST-ED score is a modified stroke scale combining elements of the NIHSS and other simplified stroke scales used to evaluate for LVO in the front 2/3rd of the brain. NIHSS is a very detailed stroke assessment to identify severity. However, both have their pros and cons. In this episode I am examining both of these, their utility in various settings, and proposing a change to t...

Send us Fan Mail This episode is all about pacing bradycardic symptomatic patients. Transcutaneous vs transvenous pacing, pearls and pitfalls of both, how effective they are, etc. I also discuss the importance of receiving facility staff NOT TOUCHING the transport team's pacer pads/device until yours is also on the patient, and how you work both devices together to phase one out and bring you...

Send us Fan Mail We have discussed Acid-Base before, using various methods to identify the disorder, whether it is the First, Middle, Last Name method or others. Today, we take it a step further. In this episode, we move past whether this is just a respiratory/metabolic acidosis/alkalosis, and use the anion gap, the delta gap, the expected compensation (15 Rule), and serum osmolar gap to identify...

Send us Fan Mail For those of you are nervous to deliver and care for a neonatal patient during the initial resuscitation and stabilization periods, this episode is for you. Traditional EMS initial training programs woefully fail to prepare you accurately for this at any level, and there are key steps and tips that must be observed depending on what presents in front of us. In this episode, I will...

Send us Fan Mail Ever find yourself in a seemingly endless conversation trying to identify the pros and cons of Epinephrine in cardiac arrest? Or maybe wondering why we blindly give it per the guidelines in every cardiac arrest when in reality very few may need it? In this episode I will discuss this and more, including how Epinephrine can actually *worsen* refractory V-Fib arrests, is not helpful...