TopMedTalk

"It's airway, breathing, circulation"

This piece focuses upon treating patients outside of Philidelphia at an "all COVID unit"; what can we learn from someone who stands at the cutting edge of fighting this terrible virus?

How are staffing concerns being dealt with? What about on the job training and upskilling? How do we maximise human resources during this crisis?

There is also a detailed conversation about the care of COVID patients, the changing thoughts on ventilation and continuous positive airwave pressure (CPAP); what are 'the basics' of caring for these patients?

There is also time for reflections about the pressures of being a healthcare provider, how do we face difficult personal challenges and yet still remain ready to be at our best?

The article mentioned in this piece, by Luciano Gattinoni, is here:

https://www.esicm.org/wp-content/uploads/2020/04/684_author-proof.pdf

Presented by Desiree Chappell with Monty Mythen and Kathy Crawford, MSN, RN, CCRN, critical care nurse with 29 years of experience, Philidelphia.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

Why does the US have the highest maternal mortality rate of any developed country? This piece tackles a very controversial issue in healthcare head on, could the problem be due to racism? The chances of a serious issue is "substantially higher if you come from a minority group, in particular if you are African-American".

We also cover the issue of postpartum hemorrhage, what are the key signs that a patient is at risk? Furthermore, how are quality care initiatives and standardization of care helping improve the field of obstetrics? Also, what is the latest thinking on home births, are they a financial decision for some?

The California Maternal Quality Care Collaborative is here: https://www.cmqcc.org/

For more info on the Society for Obstetric Anesthesia and Perinatology (SOAP) go to www.soap.org

Presented by Desiree Chappell and Monty Mythen with their guest Alexander J Butwick, Obstetric Anesthesiologist and Researcher in maternal hemorrhage, pain relief in labor, and obstetric epidemiology at Stanford University.

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Like this, want more?

On the subject of obstetrics find out more here:

EBPOM Highlight 1.27 | Obstetric anaesthesia - https://www.topmedtalk.com/ebpom-highlight-1-27-obstetric-anaesthesia/

ASA 2018 San Francisco | Smith's Medical Symposium on Enhanced Recovery – Part 5 - https://www.topmedtalk.com/asa-2018-san-francisco-smiths-medical-symposium-on-enhanced-recovery-part-5/

Periop Coach 4.10 | Enhanced Recovery for obstetrics https://www.topmedtalk.com/periop-coach-4-10-enhanced-recovery-for-obstetrics/

This piece sees the welcome return of our favorite live musician, Jeremy Sassoon, intended as a chance for listeners to TopMedTalk to both raise money for the effort to tackle COVID 19 and fight the 'burnout blues' while doing so.

If you enjoyed this piece please check out this live video (which features on the podcast) here: https://www.youtube.com/watch?v=HbdJAFpRz34

And find Jeremy Sassoon here: https://www.facebook.com/jeremysassoon

Presented by Monty Mythen with Desiree Chappell and their guest Jeremy Sassoon.

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Although this is a fun piece there is a very important side to what it represents. Having fun is something you should be serious about - particularly if you are a medical professional and want to maintain a high level of focus and productivity.

TopMedTalk has previously provided extensive evidence behind why it is important to relax here:

TopMedTalk | Burn out – a frank discussion https://www.topmedtalk.com/topmedtalk-burn-out-a-frank-discussion/

Sunday Special | Burn out? https://www.topmedtalk.com/sunday-special-burn-out/

AANA | Emotional Intelligence and Occupational Stress https://www.topmedtalk.com/aana-emotional-intelligence-and-occupational-stress/

"The peak keeps getting pushed..."

What's the difference between a strategy of rationing as compared with one where the aim is concordence?

As the crisis rumbles on, how do we decide who should have surgery, as well as the pressing question of how and where? The principles of perioperative medicine kick in here, pre-optimisation and enhanced recovery are uniquely suited within the profession to assist in the worldwide battle against this pandemic.

What about the need for end of life conversations? How does the process of informed decision making apply here, how also does it apply to providers? How can we protect our essential human resources?

Finally, the conversation wraps with an important nod from the healthcare profession to the overwhelming goodwill being expressed around the world to people in medicine who are risking their lives to defeat this virus.

Presented by Desiree Chappell and Monty Mythen with their guest Professor of Anesthesia, Angela Bader, Harvard Medical School and Vice Chair of Perioperative Medicine at Mass General Brigham.

If you loved Angela Bader's incisive take why not listen to this popular interview we previously featured here on TopMedTalk: https://www.topmedtalk.com/topmedtalks-to-angela-bader/

We also mention an upcoming appearance form TopMedTalk favourite Carol Peden, why not check out her appearance here: https://www.topmedtalk.com/talks-to-carol-peden/

Regular listeners will also be pleased to hear Bobbie Jean Sweitzer is also to appear on TopMedTalk soon, why not listen to this popular piece featuring her here: https://www.topmedtalk.com/periop-medicine-sig18-perioperative-frailty-panel-discussion/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"Increasing the richness and the reach of what we do" is the mantra of 'Anesthesiology'; hear from its Editor in Chief how it managed to self study and discover the essential idea behind the journal: "trusted evidence, from discovery to practice".

Conversation then moves on to methadone, the overlooked opiate; where do you use it and what sort of dose is appropriate? What are the benefits of including this in your practice and should it really be considered in the same category as most other opioids?

The podcasts mentioned are here: https://anesthesiology.pubs.asahq.org/multimedia.aspx?mediaType=Podcasts

Presented by Desiree Chappell and Monty Mythen with Korey Springman and their guest Evan Kharasch, Professor of Anesthesiology, Vice Chair for Innovation, Director, Academic Entrepreneurship, Duke University School of Medicine and Editor-in- Chief, Anesthesiology.

"If you ring up and start to apply pressure to them to say 'have you thought about giving my loved one drug A or drug B?' It might be helping them to get better but you might be encouraging them to do something that might hurt your loved one; so we have to do this with trials".

This piece gets into one of the debates surrounding the treatment of COVID 19. What do we mean when we suggest people think outside the box? Do we still need to bother about ideas and principles such as evidence and data collection or should a more cavalier approach be taken to medicine in this unusual time?

The following articles are discussed in this piece:

"Incidence of thrombotic complications in critically ill ICU patients with COVID-19" https://doi.org/10.1016/j.thromres.2020.04.013

"Chloroquine diphosphate in two different dosages [...];" https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v1.full.pdf

"Effectiveness of Hydroxychloroquine in Covid-19 Patients (Covid)" https://clinicaltrials.gov/ct2/show/NCT04328272

"Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19" https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

Presented by Desiree Chappell with Monty Mythen.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

The UK has accelerated the graduation of medical students to help fight COVID 19. We speak to some of Britain's newest doctors to hear what it's like getting ready for - and going into - action against one of the most dramatic health crisis in living memory. Discussions about palliative care, end of life decisions and rapid patient decline are just some of the experiences they are learning to cope with, fresh out of medical school.

Presented by Desiree Chappell and Dr Henry Howe with Dr Dolcie Paxton, Dr Chloe Hall, Dr Beth Robinson, Dr Jessica Hatrick of Southmead Hospital in Bristol.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

(REPOST)

After a quick update from Desiree and Monty this piece focuses on Philadelphia Pennsylvania and gets into specifics regarding caring for COVID 19 positive patients.

As regards The Jefferson Hospital; where has the ICU "take over" expanded to? Have critical care ventilators been deployed to all new ICU beds or have acceptable compromises been made? "Staffing is tougher than the equipment" but how has a "critical care pool" system, prepared over a year ago, helped? What does the typical COVID 19 critical care patient look like? Enormous quantities of oxygen are being used by institutions to care for them, have there been issues with supply? What about aerosolisation issues regarding the virus? How many of these patients can be proned?

Crucially we get into the important differences between this - and the way it is treated - and acute respiratory distress syndrome (ARDS) patients. How do COVID 19 patients differ from 'usual' cases where ventilation or breathing assistance is used?

"What the renal teams are saying I respect, they've never seen anything like this" we're told, "the climb of creatinine, had a trajectory that is inconsistent with a cardio renal syndrome".

"This is a climb that is pushing us into almost round the clock use of the dialysis nurses to handle these patients [...] because they're encephalopathic, their BUN's [blood urea nitrogen] are very, very high - and because the creatinine trajectory has gone from '1' on Monday, to '3' on Tuesday, to '9' on Wednesday! This is astonishing."

Also, hear how a comprehensive approach to planning and innovative ideas about nurse training, upskilling and basic critical care education have helped.

Presented by Monty Mythen and Desiree Chappell with their guest, Herbert Patrick, Pulmonologist and Critical care physician, Jefferson Hospital, Philadelphia, Pennsylvania.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

This piece is intended as a chance for listeners to TopMedTalk to both raise money for the effort to tackle COVID 19 and have a bit of relaxation and entertainment while doing so.

Our Editor in Chief Monty Mythen will be joining our guest, Jeremy Sassoon live on Facebook at 5pm on Saturday 11th of April.

In advance of that this piece explains how the two of them got to know each other along with some live music from Jeremy and reflections on how this crisis is effecting everyone.

Presented by Desiree Chappell with Monty Mythen, Sol Aronson and their guest Jeremy Sassoon.

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Although this is intended as a fun piece, having fun is something you should be serious about; TopMedTalk has previously provided extensive evidence behind why it is important to relax here:

TopMedTalk | Burn out – a frank discussion https://www.topmedtalk.com/topmedtalk-burn-out-a-frank-discussion/

Sunday Special | Burn out? https://www.topmedtalk.com/sunday-special-burn-out

AANA | Emotional Intelligence and Occupational Stress https://www.topmedtalk.com/aana-emotional-intelligence-and-occupational-stress/

This piece is both a chance to relax and an opportunity to join the TopMedTalk team online as we unwind to our favourite Jazz musician, Jeremy Sassoon. As well as being an excellent and renowned musical talent he also happens to be a school friend of Monty's so we managed to convince him to join us for an exclusive interview tomorrow, in advance of which we're giving you a heads up that he will be live in concert on Facebook raising money for NHS Charities Together.

Follow this link and click "interested": https://www.facebook.com/events/215607516450867/

Find out more details here: https://uk.virginmoneygiving.com/JeremySassoon

The music featured comes from here: https://youtu.be/cyiarwJe008

The online performance starts at 5pm UK time on FACEBOOK LIVE.

More details on NHS Charities Together here: https://www.nhscharitiestogether.co.uk/

Presented by Desiree Chappell