The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail In this short episode, we will take a look at some little pearls of wisdom in regard to atrial fibrillation. Join me to find out more, to apply to your future patients!

Send us Fan Mail Is misting in the tube, and even immediate EtCO2 waveform/numeric values really enough to truly confirm placement of ET tubes? Have you ever placed an ET in the field or in-facility, and confirmed via multiple methods only to find out shortly thereafter that it was actually an esophageal intubation? Join me on this episode to discuss what is being recommended as the new standard o...

Send us Fan Mail Yes, you read that right...what is behind this push to consider Lidocaine in stroke patients when tPA is administered? Is there data to support this, and what is the reasoning behind it? Listen in to find out!

Send us Fan Mail When performing invasive monitoring for parameters such as CVP, PAP, etc, there are certain considerations and adjustments that must be made to ensure accuracy. These modifications are essential to obtain correct measurements to direct treatment appropriately. Tune in to find out exactly what you need to consider!

Send us Fan Mail Are you still stuck in the older mantra that CVP monitoring is the best tool we have for fluid status and most other things perfusion? Have no idea what CVP monitoring is? That's ok if you answered "yes" to both! Join me on this episode while I present why pulmonary artery pressure (PAP) is the most ideal of all invasive monitoring parameters to focus on. 

Send us Fan Mail You are taught in school that a QRS complex is just that, a Q-R-S. But most people do not have Q-waves, although it can be quite normal for children. When should we be worried about Q-waves? What is a normal one and what is pathological? Tag along on this episode and find out!

Send us Fan Mail Is that a faulty reading on the NiBP? Do you keep hitting re-cycle hoping that it is false? Reach for the manual BP cuff and dust off your basic skills? Well what happens when that patient presents with marked hypotension, but NO tachycardia...will you fall for that trap?

Send us Fan Mail The question routinely comes up on how do you decide after the patient's first few breaths what you will set your respiratory rate, or really, the "f" at, on the ventilator. In this episode we will explore specifically the RCexp with the Hamilton ventilators, and how to leverage this to help us determine an appropriate rate for the patient. 

Send us Fan Mail In this brief episode we will dive into the concept of Pulse Pressure, discuss what it is and what really is helpful to know when taking care of our patients. 

Send us Fan Mail What is the real deal behind CO2 in the body? Yes, we know about PaCO2 and EtCO2, or do we really? How does the body truly like to transport and eliminate CO2? What happens when these processes' fail, and what can we do about it? 

Send us Fan Mail In today's world of medication shortages, particularly the seemingly near-constant eb-and-flow of sedative shortages, who would have thought that a beta-blocker like Propranolol might actually be useful in assisting with sedation and decreasing the need for sedatives? In this episode, we will examine a recent study looking at this very topic, and the results, while just one s...

Send us Fan Mail If you have ever participated in potassium repletion before, you are probably aware that for every 10mEq of K+ we administer, we should expect the serum K+ lab value to increase by 0.1mEq/L. Well, what happens when we give K+, and lots of it, but the serum potassium doesn't budge? Might I recommend remembering it's partner-in-crime, the magnesium? In this episode, we wil...

Send us Fan Mail Is NS better? What about LR? Plasmalyte? What does "better" actually mean? Should we instead focus on which one(s) might do more harm in the hyperkalemic patient? Can you take a guess? I will give you a hint...don't focus on the potassium concentration in the fluid... Join me to find out the answers!

Send us Fan Mail If you have been paying attention to mechanical ventilation in the past few years, you know there have been significant changes and improvements to the reliability and options, proprietary modes, etc. Some have been reliable, some not so much. While AI and machine-driven ventilation poses some great advancements in healthcare, it is also something to use cautiously. Today I bring...

Send us Fan Mail STEMI and NSTEMI have been the unchallenged terminology for too long. However, unlike the modern culture of just simply changing things to see them changed, the push across interventional cardiology to change "STEMI" and "NSTEMI" to OMI and NOMI is driven out of the understanding that: a) Traditional STEMI criteria just flat out miss too many occlusions, and b)...

Send us Fan Mail Hang on...didn't I just spend almost an entire episode talking about how we should not delay getting OMI and "NSTEMI" patients to the cath lab??? Now what is this about delaying catheterization??? Join me and find out about this potential game-changer and the DTU-STEMI trial. Credit for some of this presentation goes to Bruce Hoffman, RN/CCRN, Baystate Medical Cente...

Send us Fan Mail We have all probably encountered the hypoxic patient who did not improve with oxygen. Why might that have been? Did you stop at that moment and consider which of the four types of hypoxia they may be suffering from? Or whether this was a ventilation and oxygenation problem? A perfusion problem? Multiple of the above? Is there some way we could tell in the moment where exactly the...

Send us Fan Mail Coming soon to a valley near you! What: 2025 Mt. Washington Valley Emergency Medicine Conference When: Saturday, June 14th and Sunday June 15th Where: Grand Summit Hotel at Attitash (Bartlett) Open to all area EMS and hospital emergency medicine/critical care staff. Join us on the 14th for awesome optional pre-conference workshops (extra fees may be associated) and on June 15th fo...

Send us Fan Mail Taking a deeper dive after our Cardiogenic Shock episode, we will look at Dobutamine and Milrinone more in-depth, compare the two, and see which one is more beneficial at specific times. 

Send us Fan Mail Sound like a cryptic title? So too can ECG's seem cryptic...however, if you approach them all with a standardized approach, apply rules of cardiology, the world opens up and much more is possible with them than just ST-elevations and depressions...care to join me and find out?

Send us Fan Mail ...Which is the better of them all? Alkalosis, or Acidosis? We know both can be incredibly challenging to treat, but what about the theory that athletes are intentionally making themselves alkalotic to see improved health benefits? How can there be benefits to it if shallow-water blackouts are related to the induced alkalosis? It all seems contradictory, but join me as we dissect...

Send us Fan Mail Considered one of the more challenging types of shock to treat, Cardiogenic shock can present in different ways in different patients, and each patient may require a different treatment modality depending on cause, physiologic differences, etc. Do you reach for the Norepi? Epi? Milrinone? Dobutamine? Some fluids? Or maybe something mechanical in nature? Let's find out!

Send us Fan Mail If you have taken any type of 12-Lead ECG training, you have probably heard of a condition known as LVH, or left ventricular hypertrophy. It is possible that you also heard there is no way to diagnose an Occlusion Myocardial Infarction (OMI/STEMI) if LVH is present. What is LVH exactly, how does it affect our patients, and what tools can we use to evaluate if LVH is hiding an MI?

Send us Fan Mail Where are my tPA holdouts? And what about my TNK fans? Let's take a look at why TNK is quickly becoming the "ringleader" for STEMI, and more frequently, in off-label usage in CVA situations.

Send us Fan Mail First of all...no. Not quite. But I got your attention, didn't I? Recently a *Retrospective case study with meta-analysis* was released that basically purports that there is no place or evidence for Calcium Chloride/Gluconate in Hyperkalemia without ECG changes, no place or evidence for Calcium Chloride/Gluconate in Hyperkalemia WITH ECG changes, and really no place for sodiu...