Apologies for being MIA for a month now. Been busy! But am back and in this episode talk about calcium channel blocker toxicity. The physiology behind it, a little pharmacology and then the treatment. Busting some myths and reinforcing the need for proactive emergency medicine evidence based treatment. You can check out these papers and do more research for yourselves too -

1. Wightman RSHRA. Cardiologic Principles II: Hemodynamics. In: Nelson LS, Howland MA, Lewin NA, et al, editors. Goldfrank’s toxicologic emergencies. 11th Edition. New York City, NY: McGraw Hill; 2019. p. 260–7

2. Levine M, Brent. Beta-Receptor Antagonists. In: Brent J, Burkhart K, Daragan P, et al, editors. Critical care toxicology. New York City, NY: Mosby; 2017. p. 771–86.

Wallukat G. The beta-adrenergic receptors. Herz 2002;27(7):683–90.

4. Ranniger C, Roche C. Are one or two dangerous? Calcium channel blocker exposure in toddlers. J Emerg Med 2007;33(2):145–54

5. Gummin DD, Mowry JB, Beuhler MC, et al. 2019 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol 2020;58(12):1360–541.

6. Holger JS, Engebretsen KM, Obetz CL, et al. A comparison of vasopressin and glucagon in beta-blocker induced toxicity. Clin Toxicol 2006;44(1):45–51

7. Jang DH, Donovan S, Nelson LS, et al. Efficacy of methylene blue in an experimental model of calcium channel blocker-induced shock. Ann Emerg

8. Laes JR, Williams DM, Cole JB. Improvement in hemodynamics after methylene blue administration in drug-induced vasodilatory shock: a case report. J Med Toxicol 2015;11(4):460–3.

9. Wang GS, Levitan R, Wiegand TJ, et al. Extracorporeal membrane oxygenation (ECMO) for severe toxicological exposures: review of the toxicology

10. Hayes BD, Gosselin S, Calello DP, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin

11. American College of Medical Toxicology. ACMT position statement: guidance for the use of intravenous lipid emulsion. J Med Toxicol 2017;13(1):124–5.

12. Kerns W 2nd. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am. 2007 May;25(2):309-31; abstract viii. doi: 10.1016/j.emc.2007.02.001. PMID: 17482022.

13. Cole JB, Arens AM. Cardiotoxic Medication Poisoning. Emerg Med Clin North Am. 2022 May;40(2):395-416. doi: 10.1016/j.emc.2022.01.014. Epub 2022 Apr 5. PMID: 35461630.

In this episode I talk about my fitness journey and the research I have done. I totally promote an animal based diet and talk about awareness regarding food and nutrition. I also take on a bit of the processed food industry that is hurting us in many ways and ask everyone to steer away from them. I also discuss some bioavailability of nutrients in food items. Some of the papers are mentioned below but you can do your own research too. Your health is in your hands. 

1. Swanson D, Block R, Mousa SA. Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv Nutr. 2012 Jan;3(1):1-7. doi: 10.3945/an.111.000893. Epub 2012 Jan 5. PMID: 22332096; PMCID: PMC3262608.

2. Smith NW, Fletcher AJ, Hill JP, McNabb WC. Modeling the Contribution of Meat to Global Nutrient Availability. Front Nutr. 2022 Feb 2;9:766796. doi: 10.3389/fnut.2022.766796. PMID: 35187029; PMCID: PMC8849209.

3. Pereira PM, Vicente AF. Meat nutritional composition and nutritive role in the human diet. Meat Sci. 2013 Mar;93(3):586-92. doi: 10.1016/j.meatsci.2012.09.018. Epub 2012 Oct 31. PMID: 23273468.

4.Melse-Boonstra A. Bioavailability of Micronutrients From Nutrient-Dense Whole Foods: Zooming in on Dairy, Vegetables, and Fruits. Front Nutr. 2020 Jul 24;7:101. doi: 10.3389/fnut.2020.00101. PMID: 32793622; PMCID: PMC7393990.

5. Lee JE, McLerran DF, Rolland B, Chen Y, Grant EJ, Vedanthan R, Inoue M, Tsugane S, Gao YT, Tsuji I, Kakizaki M, Ahsan H, Ahn YO, Pan WH, Ozasa K, Yoo KY, Sasazuki S, Yang G, Watanabe T, Sugawara Y, Parvez F, Kim DH, Chuang SY, Ohishi W, Park SK, Feng Z, Thornquist M, Boffetta P, Zheng W, Kang D, Potter J, Sinha R. Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies. Am J Clin Nutr. 2013 Oct;98(4):1032-41. doi: 10.3945/ajcn.113.062638. Epub 2013 Jul 31. PMID: 23902788; PMCID: PMC3778858. 

This is a short and sweet episode on managing anaphylactic airways. Key points to remember, drugs that can be used and some pearls. But do your own research and do not just take my word for it! Happy airways!

In this episode I explore the small yet deadly world of Anaphylaxis. Remember the most common cause of death in anaphylaxis is the wrong dose at the wrong time of epinephrine! Feel free to go through the following references - 

1. McHugh K, Repanshek Z. Anaphylaxis: Emergency Department Treatment. Emerg Med Clin North Am. 2022 Feb;40(1):19-32. doi: 10.1016/j.emc.2021.08.004. Epub 2021 Oct 29. PMID: 34782088.

2. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–second National

3. Manivannan V, Hess EP, Bellamkonda VR, et al. A multifaceted intervention for patients with anaphylaxis increases epinephrine use in adult emergency department. J Allergy Clin Immunol Pract 2014;2(3):294–9.e1.

4. Alqurashi W, Ellis AK. Do corticosteroids prevent biphasic anaphylaxis? J Allergy Clin Immunol Pract 2017;5(5):1194–205.

5. Thomas M, Crawford I. Best evidence topic report. Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. Emerg Med J 2005;22(4):

6. Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2020;75(4):509–28.

In the first episode of this season I talk about using high dose Nitroglycerine and Bipap for the sympathetic crashing acute pulmonary edema (SCAPE) patients in you ED. Don't take my word for it. Go through the following references and make your own protocol for your department. We have had fantastic results!

1. Paone S, Clarkson L, Sin B, Punnapuzha S. Recognition of Sympathetic Crashing Acute Pulmonary Edema (SCAPE) and use of high-dose nitroglycerin infusion. Am J Emerg Med. 2018 Aug;36(8):1526.e5-1526.e7. doi: 10.1016/j.ajem.2018.05.013. Epub 2018 May 10. PMID: 29776826.

2. Mathew R, Kumar A, Sahu A, Wali S, Aggarwal P. High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A Prospective Observational Pilot Study. J Emerg Med. 2021 Sep;61(3):271-277. doi: 10.1016/j.jemermed.2021.05.011. Epub 2021 Jun 30. PMID: 34215472.

3.Hsieh YT, Lee TY, Kao JS, Hsu HL, Chong CF. Treating acute hypertensive cardiogenic pulmonary edema with high-dose nitroglycerin. Turk J Emerg Med. 2018 Feb 2;18(1):34-36. doi: 10.1016/j.tjem.2018.01.004. PMID: 29942881; PMCID: PMC6009803.

4. Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, Dunne R, Zalenski R. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007 Aug;50(2):144-52. doi: 10.1016/j.annemergmed.2007.02.022. Epub 2007 May 23. PMID: 17509731.

5.Houseman BS, Martinelli AN, Oliver WD, Devabhakthuni S, Mattu A. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2023 Jan;63:74-78. doi: 10.1016/j.ajem.2022.10.018. Epub 2022 Oct 18. PMID: 36327753.

In this season finale episode I am joined with my residents Drs Nainika and Ashutosh talking about central lines and chest tubes from emergency medicine trainees' perspective. We talk about the indications, contraindications and complications and the basic steps of performing the 2 most common procedures performed in the ED. This is not an exhaustive list but an insight into the world of central line and chest tube insertions in the ED. 

In this episode after a month, I talk about an offbeat topic - The what, how and where of issuing a media bulletin. Those who want to know more about it can go check out the following links - 

1. Telg, Ricky, and Lisa Lundy. 2021. “News Writing for Television and Radio: WC193/AEC531, Rev. 6/2021”. EDIS 2021 (3). https://doi.org/10.32473/edis-wc193-2021.

2. Telg, Ricky, and Lisa Lundy. 2021. “News Writing for Print: WC191/AEC529, Rev. 6/2021”. EDIS 2021 (3). https://doi.org/10.32473/edis-wc191-2021.

3. https://www.ap.org/about/news-values-and-principles/telling-the-story/

4. https://jacklimpert.com/2016/04/flash-bulletin-when-ten-bells-or-five-bells-really-meant-something/

5. https://edis.ifas.ufl.edu/publication/WC191

In this episode, I am joined by Dr Sanjay who has been a stalwart of emergency medicine for about 25-30 years in India. We discuss how to make emergency medicine teams and what are the qualities one needs to have to be a good team and how to move onto becoming a great emergency medicine team. Hope you enjoy listening in. 

In this episode I speak a little about my favourite topic. You got that right - Airways. In this short episode I share some airway pearls that I have picked up in my experience and learnt from many different difficult airway courses , workshops and conferences. Remember, first pass success is the international standard for safe airway management. If you want to discuss something you can DM me on my twitter @anksv25

In this episode, I speak about a little bit about my experience in CODA 22 in Melbourne followed by airway techniques that can be used in the daily practice of an emergency physician. You can go through the following papers  - 

1. Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The Physiologically Difficult Airway. West J Emerg Med. 2015 Dec;16(7):1109-17. doi: 10.5811/westjem.2015.8.27467. Epub 2015 Dec 8. PMID: 26759664; PMCID: PMC4703154.

2. Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, Constantin JM. Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care. 2015 Jun 18;19(1):257. doi: 10.1186/s13054-015-0975-9. PMID: 26084896; PMCID: PMC4495680.

3. Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA Guidelines in the remote location. J Clin Anesth. 2004 Nov;16(7):508-16. doi: 10.1016/j.jclinane.2004.01.007. PMID: 15590254.

4. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002. Epub 2011 Nov 3. PMID: 22050948.

5. Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed sequence intubation: a prospective observational study. Ann Emerg Med. 2015 Apr;65(4):349-55. doi: 10.1016/j.annemergmed.2014.09.025. Epub 2014 Oct 23. PMID: 25447559.

6. Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018 Jul;43(5):456-466. doi: 10.1097/AAP.0000000000000806. PMID: 29870457; PMCID: PMC6023582.

7. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011 May;57(5):449-61. doi: 10.1016/j.annemergmed.2010.11.030. Epub 2011 Jan 21. PMID: 21256625.

8. Sehdev RS, Symmons DA, Kindl K. Ketamine for rapid sequence induction in patients with head injury in the emergency department. Emerg Med Australas. 2006 Feb;18(1):37-44. doi: 10.1111/j.1742-6723.2006.00802.x. PMID: 16454773.

9. Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care. 2014 Aug;21(1):163-73. doi: 10.1007/s12028-013-9950-y. PMID: 24515638.

10. Tsan et al. Comparison of Macintosh Laryngoscopy in Bed-up-Head-Elevated Position With GlideScope Laryngoscopy: A Randomized, Controlled, Noninferiority Trial. Anesth Analg. PMID: 31348051.