The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail No, we aren't going for a drive. Instead, we will look at what driving pressure actually is, and why it is such an important part of mechanical ventilation in general. What tends to trip people up is the strict adherence to one specific equation, when in reality, especially when dealing with Hamilton ventilators, it is just not that simple. Still confused? Tune in and hopeful...

Send us Fan Mail The Gregg Phenomenon? The Garden Hose Principle? What are these? How do they apply to our patients? What specific patients do these apply to? This is a great episode to tune into and learn something that impacts patients almost daily.

Send us Fan Mail Is sepsis really just about fluids and antibiotics? What if there was something else we could do to actually remove part of the problem and get patients on the road to recovery quicker? Something that could filter out the endothelial damage byproducts? The circulating inflammatory particles? Stay tuned on this episode for a review of some of the newest potential therapies for seps...

Send us Fan Mail LVSD vs LVDD...HFpEF vs HFrEF...what is all of this gibberish? This episode looks at the differences between left ventricular systolic vs diastolic dysfunction...in other terms, Heart Failure with Preserved (or Reduced) Ejection Fraction. We will talk about what this means, how to differentiate these, and the differences in treatments. 

Send us Fan Mail What is hypoxic pulmonary vasoconstriction? Is it entirely a bad thing, or can it actually be protective? How do we alter it, and when is altering or blunting it actually a bad thing vs a good thing? Tune in to find out!

Send us Fan Mail If you have ever put a patient on NiPPV and wondered "Ok, how do I know how long to keep them on, and when do I find out if the patient fails NiPPV and needs to be intubated?," then this episode is for you. HACOR score is useful for EMS and hospital realms as a tool for judging the effect of NiPPV and whether or not you need to intubate the patient. It is validated, easy...

Send us Fan Mail I've said this before...there are NO randomized control trials evaluating the safety and efficacy of parachutes...we put our faith in them when we step out of an airplane. With the evidence that already exists out there, both from military and civilian realms, it is absolutely mind-boggling when it comes to the amount of kick-back and resistance that occurs when an EMS agency...

Send us Fan Mail It's been a while since we looked at Acid-Base, and I figured now is as good a time as any to really dive into full acid-base interpretation. Brush off your skills, sit back and enjoy a little review if this is something you are very comfortable with, but don't get too comfortable! We will also review something known as the SID, or strong ion difference, and how this als...

Send us Fan Mail Can Influenza cause NSTEMI? Cardiomyopathy? Elevated troponins in general? Especially with this nasty flu/respiratory season, expect to see this more and more. What is the mechanism behind this relationship? Are these true NSTEMI's and cardiomyopathies? Do they have lasting effects on the body? Tune in to find out!

Send us Fan Mail Welcome back to the Synapse! We are starting Season 3 off with a look at some of the bigger items, procedures, and changes coming down the line in the medical fields that will impact emergency, interfacility transport, critical care transport, and ICU's around the country in the next year or two. From continuing research on the islet cell therapy for Type 1 Diabetics, to chan...

Send us Fan Mail By now most of you have probably heard of ECMO, and if you tuned into my Intro to ECMO podcast, you should have a pretty solid understanding of what it is and how it helps oxygenate our patients when traditional methods fail. Well, what about severe ARDS refractory to standard treatments where we need super-lung-protective volumes and minute volumes with Vt's down near 3-4mL/...

Send us Fan Mail Our healthcare system is broken. Nurses and paramedics are leaving at rates never seen before. Is it really just the pay? The hours? Or is there something a bit more obvious, but often shunned or denied, that is part of the driving cause? Are the patients really supposed to be the Number 1 focus of the management, or should it be more along the lines of what Fortune 500 rescuer Ri...

Send us Fan Mail Did you know that seizures can bring about a cardiac arrhythmia in your patient? Have you ever stopped to think about how the brain and heart are connected and how this could occur? In this episode I discuss the anatomy and physiology behind these connections and what can happen in the heart when the brain goes haywire. This is a two-part episode to cap off Season 2 of The Synapse...

Send us Fan Mail Piggybacking off of episode 100, we examine AVNRT and AVRT, two types of PSVT's that can be brought on by seizure activity, or just from other causes, as well as each of their own specific sub-types. I discuss how to identify them on ECG and how each one will be affected by Adenosine, Procainamide, and other treatments. For those who are primarily treating arrhythmias in thei...

Send us Fan Mail The world of PIFT protocols vs CCT can be a very confusing place for sending hospitals to dwell in and navigate. Some crews are able to take patients at higher levels of care needs than others. Some don't have the same training or experience, or more importantly, the confidence and comfort levels. Many PIFT paramedics have been pressured or even threatened in their career eit...

Send us Fan Mail What is a stress dose? Why do the adrenal glands need help? Who exactly needs this, what do they need, and why? All important questions, friends. Join me on this episode and all will be explained!

Send us Fan Mail Ok, we talked about Winters Formula for expected PaCO2 in metabolic acidosis...but what happens if our patient has the opposite issue, and is metabolic alkalosis instead? Is there a magical (albeit empirical) equation to help with PaCO2 prediction there too? Well, ask and thee shalt receiveth! There IS an equation, but it is the lesser-known (and un-named) cousin to Winters Formul...

Send us Fan Mail How can we determine where a patient with metabolic acidosis *should* be compensating in regard to expected PaCO2? Enter Winters Formula. In this episode we will talk about how it was derived, its strengths and weaknesses, how to use it, and more. You may be surprised by when and how it was derived, and how long we went without any extra evidence to support it. Predicted PaCO2 = 1...

Send us Fan Mail It feels like Captain Sparrow and Captain Barbosa locked in eternal battle from the first Pirates movie...except it is Etomidate and Ketamine. The study just released purports that Etomidate is better than Ketamine again...but is it? Before we swap sides yet again in this tug-of-war, should we examine this more closely, and maybe also not fail to remember it's not about the i...

Send us Fan Mail Many of you that have been following along know I have put several episodes out on Sodium Bicarb, and you also know I don't typically put Sodium Bicarb high up on my Rx list. This episode looks at how NaHCO3 can actually cause or worsen pre-existing pulmonary HTN, just in case we wanted some more reasons to possibly avoid regular usage of the bicarb.

Send us Fan Mail Wouldn't it be amazing if Type 1 Diabetics had a cure? What would we see happen to our case load in healthcare from accidental insulin overdoses or hyperglycemia from under-dosing? Would it be that easy if there was an option? VX-880 is a novel islet cell therapy that has shown amazing results so far in the small cohorts and phase 1 & 2 trials, with patients who have rece...

Send us Fan Mail This is never an easy topic to discuss, but we are going to tackle it today. Whether you are EMS/pre-hospital or in the hospital, you are unfortunately involved in some of the most dangerous professions in our country today. Instances of violence, both verbal and physical, are rising. And that is just what is actually reported. What can we do to strengthen ourselves, the job sites...

Send us Fan Mail Nitrous? Sure...but it comes with a host of issues. Methoxyflurane? Wasn't that banned in the US by the FDA? It was...but it's making a comeback globally and stands poised to change inhaled analgesia for good. Want to know more? Join me in this episode as we take a ride on the Green Whistle!

Send us Fan Mail The search for a suitable replacement for Succinylcholine has been ongoing for decades...a non-depolarizing agent that has the same onset and duration times as Succinylcholine, but without all the nasty side effects...wouldn't that be wonderful? Especially if it was reversible??? Enter Gantacurium...well...it almost entered anyways. A bit of stage fright? Not so much. Join me...

Send us Fan Mail We know beta blockers are a staple treatment in outpatient CHF/HFpEF and stable HFrEF patients. However, what is it about the nature of beta blockers that makes them potent killers in the decompensated HFrEF patient? Why do we routinely mix up the two variations of Metoprolol and why is the common Metoprolol Tartate considered the Metoprolol Mistake in HFrEF patients? Listen in to...