The Synapse Critical Care & Emergency Medicine Podcast

Send us Fan Mail Ok, because we touched on Sodium Bicarb in the last episode, I felt it made sense to not only re-visit this topic, but to also look at ways to reduce the negative effects of the hypertonicity with dilution in D5W, when to consider diluting and when to just full-send the 8.4% IV bolus, and a few other situations to consider administration of IV sodium bicarb that have nothing to do...

Send us Fan Mail From Epinephrine administration to dual-sequential defibrillation, changes for hypothermic arrests, and much more, let's look at some considerations for your next cardiac arrest resuscitation!

Send us Fan Mail Intubation of the conscious or semi-conscious patient is an incredibly invasive and painful experience. Propofol alone is not sufficient nor appropriate for a patient. Join me as I discuss not only sedation strategies, but just as important, analgesia for these patients. 

Send us Fan Mail Pediatric resuscitations can be incredibly challenging mentally and physically. From maintaining your composure and separating yourself mentally, to ensuring you provide the best care possible, it is never easy. Now throw in massive trauma as well, and the case becomes even harder. Join me for a review of a case study of a pediatric patient who went into arrest after a trauma, and...

Send us Fan Mail When you think causes of cardiac arrest, I bet your mind doesn't typically go right to candy as the cause. Maybe when we talk about our H's & T's, we should expand our "toxicology T" to something more than just opioids/opiates...what else could there be? Join me and find out!

Send us Fan Mail Have you ever administered Droperidol before? What would we give it for, and what do we need to consider when it comes to age of the patient, medication clearance, and what can go wrong if administration is done properly? We will explore these questions and more!

Send us Fan Mail Why do we obtain a 12-lead ECG on every syncope patient? What are we looking for? What are the possible causes of syncope from the cardiac and pulmonary side of the anatomy/physiology "house?" Tune into this episode and add these to your mental bank for your next syncope patient evaluation!

Send us Fan Mail The question came up of what do you look for on all your vent transports? This episode covers the initial steps in a systematic approach for each and every time you take over a vented patient. 

Send us Fan Mail We know large fluid bolus' in massive PE are not helpful. What about early vasopressor usage while awaiting the TNK? This begs the question of which pressor and why? Perhaps Norepi is not the one we should reach for first, and maybe look for something that can provide inotropy, despite the increase in HR...?

Send us Fan Mail This episode dissects an unfortunate case from across the country, where a significant number of medical errors in decision-making were made, and little accountability was taken, if any. The father of the patient has made it his goal for the remainder of his life to honor his late son's life by pushing this story out to all EMS, critical care transport, and hospital personnel...

Send us Fan Mail Let's take a look at commonly asked questions surrounding lactate, as well as a dive into the use of and background surrounding C-Reactive Protein, or CRP. What can we really use these for, and what do their results indicate? Join me and let's find out!

Send us Fan Mail In this episode designed specifically for the hospital personnel and ambulance transport teams, we will discuss the Medical Necessity form, or PCS/N-PCS form, why it is so important that it be filled out accurately, completely, and truthfully, and what can happen if these are not. While this is not the most exciting topic in the world, anyone (MD, DO, RN, EMT-P, case manager, etc)...

Send us Fan Mail Recently, information was released about a retrospective review study looking at over 1.5 million patient records and reporting that Etomidate showed bad voodoo when it came to use as an induction agent for intubation. But is everything as they really portrayed it? In this short episode, we will take a brief look...

Send us Fan Mail Leave the dogma behind! Is Ketamine to be overlooked in TBI? I would suggest for those who say yes still, and believe it increases ICP, maybe this episode is for you.

Send us Fan Mail Is sepsis just the infection? The antibiotics and fluids? Let's discover another aspect of the condition that also should be considered! We don't typically think about the thyroid in sepsis, but this is an episode you shouldn't miss!

Send us Fan Mail Is it anaphylaxis? Is it Lupus? Dr. House might think so, but perhaps we consider another differential in this episode. Let's take a look at a rare but challenging condition, the pathophysiology behind it, and how we can treat these special subsets of patients.

Send us Fan Mail A patient arrives at your facility with severe hypertension but is bradycardic...and paralyzed below T6...before we reach for the beta-blockers or nitrates, what else should we be thinking? What is this patient's body trying to tell us, and how does it do what it is doing? We will explore these questions and the pathophysiology behind this condition to help us shape our medic...

Send us Fan Mail How many units of blood can we really give a patient? How about 100? Seems like a lot, but often at major trauma centers, this number is not out of the realm. In our smaller facilities, even ten units might overwhelm the capabilities of the blood bank, but even at these lower numbers it is important to understand the concepts of MTP and DCR. We will discuss these concepts and re-h...

Send us Fan Mail Cerebral vasospasm in the setting of SAH is a concerning finding and one that can cause significant issues for us to manage, and obviously these issues can hamper patient outcomes and recovery. Triple-H therapy has become widely adopted around the country, but is another one of those treatment modalities that has little supporting evidence, only good theory behind it. We will unwr...

Send us Fan Mail In this episode we will discuss needle, finger, and tube thoracostomies, with the emphasis on the finger method, to include supplies, procedure, reasoning, cautions, and more. The importance of BVM ventilation during the interim before either a chest seal with drain or a tube with wet-vac drain system can be placed is also discussed with emphasis on deviation from normal A&P t...

Send us Fan Mail Let's discuss IV and IO access, flow rates, what size catheters you ACTUALLY need, and more. Do all trauma patients really need bilateral 14 gauge IV's? We will explore this and more!

Send us Fan Mail Think back to your last pediatric or young adult trauma patient...especially those who were tachycardic but normotensive. Did you brush off their tachycardia as anxiety, pain, etc? Maybe we need to reconsider this group of patients. We will use some basic math to show just how unstable they actually are, well-before the BP drops!

Send us Fan Mail If you remember back to your New England Organ Donor Services (NEDS) training, T3 and T4 protocols may be used to preserve organ function for donation. What if we applied the same knowledge of anatomy, physiology, and the idea behind the T3 and T4 protocols to perhaps treat a condition like Sepsis? In this episode I will discuss why this came to mind, why it makes sense, and explo...

Send us Fan Mail Adenosine is for ACLS...Lidocaine is for ACLS...Magnesium is for ACLS...so why the heck are we talking about a trauma patient here? Let's look at the combination of Adenosine, Lidocaine, and Magnesium together as a bolus and infusion for various trauma patients and see how this solution can be a solution for trauma!

Send us Fan Mail The Cath Lab and PCI is not just for "STEMI" and "NSTEMI" patients! There are at least 6 conditions that also warrant urgent or emergent PCI, and today's topic is one of the more rare ones to encounter, but also one of the more dangerous given the nature of the condition. I will walk you through a scenario, criteria to use on ECG, and talk about false-posi...