The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail Ok folks, here's another episode that I must ask you to hang your dogmatic practices on the shelf before tuning in. If you can't do that, this episode may not be the one for you! We will look at the history behind obtaining two sets of cultures (aerobic and anaerobic) on patients, why they have to come from different sites, and why we seem to cling desperately to this id...

Send us Fan Mail We all know the idea behind the GCS...but how good are you at it really? Are there times where it just doesn't work? Do you actually trend it out and obtain multiple scores? What about for intubated patients/sedated/paralyzed patients? In this episode we will examine the GCS, as well as alternatives such as the SMS and FOUR Score systems and when/where those may be of better...

Send us Fan Mail This simple concept is responsible for what we call "Clean Kills" in medicine, especially when providers at any level are not aware of the various methods to discern VTach from SVT with pre-existing aberrant conduction (think bundle branch blocks). In this episode I will discuss several different methods and criteria sets to use to help you in the future, and what can ha...

Send us Fan Mail aVR is often taught as the "non-diagnostic" lead, or the "forgotten" lead. aVL is often not viewed as the only truly reciprocal lead (to III), but also that isolated T-wave inversion or ST-elevation in aVL can be a very ominous finding, even though traditional STEMI criteria do not recognize these findings. Join me on this episode as we establish what to look f...

Send us Fan Mail For as long as I can remember, I have been taught that Early Repolarization was, well, Benign...a good thing, a no-nothing finding that is very common in young males and athletes. However, back in 2008, that changed. Subsets of ER were found to be very much linked to episodes of spontaneous ventricular fibrillation and sudden cardiac death syndrome. How do we know when Early Repol...

Send us Fan Mail Similar to the ACLS, PALS, and BLS updates, the AHA and the ASA have released their joint 2026 Stroke Guidelines updates. This episode is a short review on what has changed, from mobile EMS stroke units, to tPA vs TNK, establishment of the first pediatric stroke guidelines, and more. 

Send us Fan Mail This episode is both a notice to providers about Andexxa's removal from the market for DOAC reversal, specifically Eliquis and Xarelto, as well as a dive into the FDA's rapid approval process for drugs that propose to be game-changers for lifesaving conditions. The evidence just didn't pan out for this specific drug, and it leaves questions about how the FDA approve...

Send us Fan Mail Let's talk all things TXA. From the history to where it is going in the future, and everything in between. Clean up some myths, set some facts straight, and make sure you are comfortable using it on your trauma patients when the time is right!

Send us Fan Mail How confident are you at controlling possible junctional hemorrhage? It is not as simple as applying pressure. You can apply all the pressure you want, but if you are even an inch off the mark, it will not matter. Know your anatomy. Tune in to find out more! 

Send us Fan Mail Remember what tidalling is? Are there supposed to be bubbles in the suction chamber? Why do we set suction to -20mmHg? This and more in this quick review of chest drain systems!

Send us Fan Mail Have you ever administered a drug to a patient too quickly and seen what can happen? Or are you one of those that brushes off that part of pharmacology? Rate of administration is just as important as drug choice and contraindications, and in this episode we will discuss some of the more important drugs to pay careful attention to rate of administration on. 

Send us Fan Mail For those hospitals and critical care transport teams who are not able to provide PAC/Swan-Ganz monitoring, but want real-time invasive monitoring that relies on something your patient probably already has, an arterial line, the FloTrac monitoring system is a possibility to look at. This device gives us real-time information about cardiac output, stroke volume, stroke volume varia...

Send us Fan Mail EtCO2...is it over-used? Is it just a thing of pestering QA/CQI nightmare? Or is there actually use for it? When does it work and when does it just not? Is the information you are obtaining actually useful to you for your specific patient? Or are you just checking a box you might not even fully understand? Let's see where this goes!

Send us Fan Mail Many patients and healthcare providers alike do not fully understand Postural Orthostatic Tachycardia Syndrome. What is it, how many forms are there, and how do we diagnose and treat it? Is it really that simple? This is a short but in-depth review on the condition. 

Send us Fan Mail Cardiogenic and vasodilatory shock can be incredibly difficult conditions to recognize and treat for some providers. There are nuances that can complicate things, and certain medications and procedures may be more beneficial than others during these times. This podcast is a small dive into cardiogenic vs vasodilatory shock, as well as what to do when both are present together. 

Send us Fan Mail Traditional STEMI criteria continue to fail us with sensitivity vs specificity. There are certain conditions and presentations on ECG that do not meet the traditional criteria, but absolutely should be activated for cardiac cath under the OMI mindset. This podcast episode explores Aslanger's pattern, with non-traditional identification criteria discussed. 

Send us Fan Mail Tired of the "doom-and-gloom" ECG reviews of late? Don't worry, there's more where they came from! But until then, join me for a look at an ECG finding that maybe isn't quite as scary, but still a good one to know about!

Send us Fan Mail Subxiphoid view for POCUS in cardiac arrest is more or less the standard go-to during compressions. However, what if there was another site that could be used as a surrogate, and is actually even easier to obtain? One that showed evidence of perfusion, not just wall movement? A recent study on paramedics using POCUS in the field evaluated carotid POCUS views vs subxiphoid views in...

Send us Fan Mail Ok, I'll be the first to admit it...often I overlook the RDW-SD, MCV, MCH, and the MCHC. Why do we need these anyways, I just need the WBC, RBC, H&H, and platelet count! However, these components, known as the RBC Indices, gives us a lot of information towards our differential diagnosis' when it comes to blood issues. If you have no idea what these are, or need that...

Send us Fan Mail We often focus heavily on STEMI vs NSTEMI, OMI vs NOMI...what about Precordial Swirl? No, it's not an ice cream flavor! What about Northern OMI? Has nothing to do with geopolitics! Bifasicular block, new onset? Excuse me? Confused? Tune in to find out more! You may just end up saving a future patient's life when others would have not even noticed these on ECG.

Send us Fan Mail How many of our patients are told they have hypercholesterolemia? How many are on statins? How many seem to do very poorly on statins, and seem to be told to chase lower and lower cholesterol levels? What does this actually do to the body? What does the science vs. "Big Pharma" actually say? We know too much cholesterol is not good...but what about too little?

Send us Fan Mail How well do you know your way around the Circle of Willis? Can you predict where the occlusion is in a stroke patient based on their presentation of signs or symptoms? This episode is all about linking those together to help you better understand your patient and their stroke. We also discuss the FAST-ED, how turning it into the BEFAST-ED helps increase its sensitivity from just L...

Send us Fan Mail Have you ever had an AV Block that didn't respond to transcutaneous pacing? Is that even a real thing? This episode details this phenomenon, the Phase 4 AV Block, and discusses what it is, how it happens, and why our traditional therapies don't work. It is a bit heavy on the A&P and pathophys, but that is necessary for the understanding of why our treatments won&apos...

Send us Fan Mail We are overloaded with tools, scales, and other job aids in healthcare. It can be very difficult to know which ones are helpful or not, which ones are too hard to remember or to navigate, etc. In this episode, I review 4 gaps and their equations that are actually fairly relevant to emergency department and critical care interactions. Want to know what they are? You'll just ha...

Send us Fan Mail We have all seen massive textbooks devoted simply to IV fluids. Colloids and crystalloids...balanced vs not...dextrose variations...so many to choose from. How do we choose? What is right for my patient? This episode is an attempt to break down these hundred-page textbooks into a summary for you. Keep it short, simple, and effective, right? Let's take a look at some of the mo...