The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail Sodium...Potassium...Calcium...the "big 3." But what about their relationships with each other, as well as say, magnesium and phosphate? Why won't your patient's potassium go back up after oral and IV repletion? Join me to see the "why's" behind this and other questions that you have probably asked during your patient care!

Send us Fan Mail We see acidotic patients almost daily. This comes as no surprise. However, how often have you actually thought about the effects of the acidosis on more than just what you immediately see, or connect the dots on why it affects medication absorption, vitals, and response to treatments? This case study will examine all of that and more!

Send us Fan Mail In this episode, we will dive into the benefits of the Lewis Lead when you really need a close look at the atria/P-waves in ECG monitoring, and how this trick can be the difference in preventing mistaken diagnosis and incorrect treatment. We will also discuss the modified chest leads, or MCL-1 and MCL-6, and their uses. Finally, we address the age-old issue of limb lead (LL, RL, L...

Send us Fan Mail To oxygenate? To ventilate? To give the patient a chance to rest? To correct isolated values like EtCO2, or chase after parts of the ABG blindly? What are the true goals of mechanical ventilation? 

Send us Fan Mail Well...NTG...to withhold in right ventricular MI or not to withhold? What does the evidence say? For the longest time we have been absolutely a no-go for administration, that your patient will suffer the consequences...Is it really that simple though?

Send us Fan Mail I have said it over and over, ECG interpretation is not always straight-forward or easy. MI's come in all shapes, sizes, and "flavors," and we cannot hinder our interpretation by looking for just "traditional" criteria. In this case review, we will look at a patient who was nearly 100% occluded and did not have textbook criteria present on ECG, as well as...

Send us Fan Mail This episode will further expand on the notion of the Lewis Lead, and add a few more tips, tricks, and pearls to keep in mind specifically in regard to this enhanced view of the atria and P-waves, to make your diagnostic abilities that much greater!

Send us Fan Mail Have you ever seen a patient be transferred from one ventilator to another and all of a sudden they decompensate? Only to then hear a healthcare provider state "Well, the patient didn't tolerate that too well." In this episode we will look at differences in ventilators that you MUST be aware of and why it is so important to not just "copy and paste" settin...

Send us Fan Mail The world of inflammation and differential diagnosis of the etiologies of inflammation goes well beyond a CBC differential and lactate. Join me and review the pros and cons of those markers as well as others such as C-Reactive Protein, Procalcitonin, and more!

Send us Fan Mail Another must-listen! How many times have we seen seizure patients who continue to seize, and providers in the field and in the hospitals give 2.5mg Versed, or 1mg Ativan, then another similar dose, struggle to find IV's, put all their faith in Keppra, Valproic Acid, etc, and wonder why the patient continues to seize? In this episode, we are going to look at all of this and mo...

Send us Fan Mail It feels like we have revived a topic from last season, and I have absolutely done so for good reason. In this episode I present multiple reasons why, if you are not already a fan of Lidocaine, you may want to listen and possibly change your practice. I am willing to be there will be some things in here about the two medications you may not have even heard of before, and that goes...

Send us Fan Mail This episode is sure to ignite some fiery debate, and this is the intention. Regardless of which alphabet-soup canned trauma course you subscribe to, the National Association of EMS Physicians (civilian and military) Trauma Compendium has released a landmark review of 4,000+ studies, papers, cases, and reviews covering the use of rigid cervical collars and backboards....sorry to b...

Send us Fan Mail Quite frequently we hear medical staff confusing lactic acidosis and lactate. It may seem that it is the same, but these are quite different, especially on the molecular level. Where does each one come from, which one(s) are we actually testing for and when, and what do their levels mean for our patients? This episode looks at all of this and more. 

Send us Fan Mail For those who didn't check out the LVAD episode from way back in 2024 during season 1, here is a little refresher and some newer information to help get you up to speed. For those who have never heard of an LVAD before, or a VAD in general, tune in and find out what these are all about! We will cover some treatment and evaluation tips and some trouble-shooting ideas in case y...

Send us Fan Mail Similar to the P/F Ratio, we can use the A-a gradient to help us understand more about the pathophysiology affecting our respiratory patients, how we can tweak our treatment pathways, and more. This isn't your high school algebra class, and is something you can use on your ventilated and even non mechanically-ventilated patients. 

Send us Fan Mail I've said it before, and I will say it again. The world of ECG's is full of so much more than just ST-elevations and depressions related to MI's. Today's topic looks at another must-know finding that while rare, is a dead giveaway that your patient will soon be, well, just join me and find out the rest!!

Send us Fan Mail If you interpret ECG's, you have probably at least heard of Sgarbossa criteria for Left Bundle Branch Blocks (LBBBs) and ventricular-paced rhythms. Maybe you have heard of Smith Modification Criteria, or Modified Sgarbossa. But have you heard of the Barcelona criteria? Join me and discover what this is all about and how much further it pushes the specificity and sensitivity o...

Send us Fan Mail What is the anion gap in the comprehensive metabolic panel? What does that number mean, and why do we care about "closing the gap" in many of our patients? Join me as we look at the anion gap, as well as the osmolar gap and how understanding these will help with your differential diagnosis'. 

Send us Fan Mail Back by request, this is a brief overview of some of the more common, and one not-so-common, vasoactive and inotropic agents we see in our patients. Remember when treating patient's hypotension, besides figuring out the cause, don't forget positioning, pH drops, fluid status, alpha, beta, Vaso, and AGII receptors in your treatment plan if needed. 

Send us Fan Mail What is the cardiac power output, and how do we calculate this? What is it for, and how can it provide important information to help our sickest of patients?

Send us Fan Mail We frequently check for PT, aPTT, and/or INR levels in our patients to assess for coagulopathy or therapeutic levels. However, this only looks at the tiniest part of the puzzle. Many of the forward-thinking institutions are starting to implement the use of ROTEM and TEG in their Emergency Departments and ICU's to obtain fuller pictures of the clotting factors and other aspect...

Send us Fan Mail Your patient comes in with a calcium channel blocker or beta blocker overdose, with subsequent associated cardiogenic shock. You are ordered to administer insulin to the patient at doses multiple times higher than anything you would see in a diabetic. Why might this be the case, and how will this help? Tune in to find out!

Send us Fan Mail What aspects of mechanical ventilation do we change to alter CO2 transport? Do we chase EtCO2? What if I said EtCO2 is putting on charades in the body, and shouldn't be blindly trusted unless we can correlate it to a current PaCO2? We will go over this and more in this episode!

Send us Fan Mail King LT's....Combitubes....LMA's...iGels...Cobras...the list goes on. Which supraglottic airway device(s) really seem to be better for patients? What makes them rise above the rest, and what are some "cheat codes" we can use to fully unlock the potential of these devices?

Send us Fan Mail This one is sure to ruffle some feathers, and rightfully so. It makes little sense for us to teach personnel to perform an emergency front-of-neck airway, or surgical cric, by finding the anatomy first, then cutting the airway open and making a bloody slippery mess with a small hole. Even Dr. Rich Levitan, the "Father of Airways," recently lectured on this at a renowned...