182: When to Press-Vasopressors with Doug
In this episode, Doug and Dennis discuss the appropriate use of vasopressors, specifically epinephrine and norepinephrine, in the management of shock. They highlight the importance of fluids in sepsis resuscitation and the potential dangers of using high concentrations of epinephrine. They also discuss the different effects of epinephrine and norepinephrine on heart rate and blood pressure, and the potential side effects of epinephrine, such as arrhythmias and lactic acidosis. The conversation concludes with a discussion on the use of epinephrine in anaphylaxis and the importance of individualizing treatment based on the patient’s response.
Podcast 178: Calcium and Trauma with Steve Shauer
In this podcast episode, Dennis interviews Steve Schauer about his calcium study in trauma patients. Steve provides an introduction to himself and his background in emergency medicine and research. He explains that the study aims to determine the prevalence of calcium derangement in trauma patients upon arrival at the trauma center. The study is being conducted at three different trauma centers and has completed enrollment. Steve also discusses the challenges of extrapolating research findings from military trauma to civilian trauma. They also touch on the limitations of the Injury Severity Score (ISS) in assessing military trauma. The conversation then delves into the logistics of the study, including the collection of calcium levels and the potential impact of pre-hospital blood transfusions on calcium levels. They discuss the importance of timing and accuracy in collecting calcium levels and the need for better documentation in trauma care. They also explore the administration of calcium and the differences between calcium gluconate and calcium chloride.
Podcast 172: Gas Anesthesia
This conversation explores the topic of gas anesthesia, its historical background, and its use in various environments. The conversation covers the shift to the TIVA technique, the importance of the anesthesia machine and equipment, and the training required to administer gas anesthesia. It also discusses the combined techniques used in the operating room and the stages of anesthesia. The conversation highlights the advantages and disadvantages of ether and chloroform as anesthetics. It emphasizes the need for vigilant monitoring and the use of IV induction agents for safety. The conversation concludes by discussing the duration of gas anesthesia and the importance of witnessing wakeups.
Podcast 166: JR Pickett on Excited Delerium
In this podcast episode, Dennis interviews JR Pickett, an ER physician and EMS medical director, about excited delirium. They discuss the definition and history of excited delirium, the challenges faced by law enforcement and medical providers in managing these cases, and the importance of timely intervention. They also explore the differences between excited delirium and other conditions, such as combative patients in combat situations. The conversation highlights the need for proper assessment and observation of patients exhibiting excited delirium and the selection of appropriate medications for sedation. The podcast concludes with a discussion on the criminalization of medical care and the impact it may have on patient outcomes.
PFC Podcast 152: Esketamine with PAC
Dennis welcomes his friend PAC to discuss “S-Ketamine.” PAC, an anesthetist with extensive experience, shares insights on using it in various medical settings including his experience in providing medical care during the Russian invasion of Afghanistan. He highlights its potential advantages, such as improved analgesia and reduced hallucinogenic effects in mid-doses.
Podcast 146: Versed and Procedural Sedation with Kevin and Paul
This episode, is all about “Versed.” We’ve got Kevin and Paul here, chatting about patient positioning and the intricacies of using Versed, a benzodiazepine, for sedation. They touch on how different patients react to the drug, emphasizing the art of medicine over strict calculations, especially in challenging scenarios. The podcast delves into dosing strategies, dealing with hemodynamically unstable patients, and the complexities of maintaining sedation during procedures. Remember, every patient is unique, so adapt the approach accordingly.