THE DESI EM PROJECT

Sally K Norton did her bachelor's in nutritional science from Cornell University and her Master's in Public Science from University of North Carolina. She is also the author of the best selling book - "TOXIC SUPERFOODS" which delves into the mysterious world of all things OXALATES. Listen to us chat up about oxalate toxicity and dumping and much much more!

You can follow her youtube channel - https://www.youtube.com/@sknorton

Check out her website - https://sallyknorton.com/

Follow her on her IG handles - @sknorton ; @toxicsuperfoods_oxalate_book

In this episode I discuss some of the salient points needed to remember when dealing with the crashing asthmatic patient. As an emergency physician, you got to hold your nerves and go step by step and remember to keep the next step resources ready!

Go through the following sites to know more -

1. https://emergencymedicinecases.com/crashing-asthmatic-life-threatening-asthma/

2.https://emcrit.org/pulmcrit/crashing-asthmatic/

3.https://emcrit.org/ibcc/asthma/#nontubed

4.https://rebelem.com/rebelcast-crashing-asthmatic/

5. https://emcrit.org/emcrit/severe-asthmatic

Listen to Monique Attinger talk about one of the most dreaded antinutrients found in plant foods - Oxalates. What it does to you, how to get rid of them and what the low ox life is all about.

You can visit her website - www.lowoxcoach.com

Follow her on her socials -

X,Instagram,TikTok,Patreon - @lowoxcoach

Dr Anthony Chaffee joins me today to converse all things carnivore and keto. We go through some really important points. You can see the passion he has for the optimal human species specific diet.

Login to his website for the monthly carnivore challenge - https://www.howtocarnivore.com/

You can follow him on his social media -

Instagram - @anthonychaffeemd

X - @anthonychaffeemd

Youtube channel - Plant Free MD - @anthonychaffeemd

In my 50th episode, I talk about how metabolic fitness is important and how it is linked to the majority of patients brought into emergency departments everyday. These can be prevented if only everyone follows the right nutrition. A huge burden on health can be reduced if people reverse their conditions which is not going to take place by popping medicines.

Listen to James aka The Carnivorist as he takes us through his journey from pescetarian to vegan to oxalate toxicities all the way to the Carnivore lifestyle!

Follow him on his

IG - @the_carnivorist

X - @the_carnivorist

or email him on jamesthecarnivorist@gmail.com

Follow his podcast Carnivorist Chats -

https://open.spotify.com/show/5yUt1iK1Q0z12TzJhhmyRV?si=4a6575026f1740b4

Watch and listen to Mahek Lokhandwala who moved onto a carnivore journey after experimenting with other diets and finally got it right. Also pay attention to how her husband found relief from all his ailments thanks to going carnivore. She also produces some amazing goat tallow. Give her a follow.

You can follow Mahek on her IG - @indian_carnivore

Listen to Natalie speak about the damage high oxalate foods did to her and how she went into recovery mode and evolved with animal based diet and cutting off the oxalate bombs to a minimum.

You can follow her on her IG - @meat.kaizen

In this episode, I have with me the wonderful Emma from Essex talking about her carnivore lifestyle and how it helped during her premenopausal and post menopausal journey. Listen to her pearls and maybe just maybe something will click for you.

You can get in touch with Emma on her Instagram - @the_inked_pinup

Talking about one of my favourite topics - Trauma Shocks. Giving out some pearls here specially for the newbies and the ones who have not updated themselves regarding trauma care. Just a few pointers. Don't just believe me. Do your own research too!

I have got Jen Winkler in the house. What a fantastic conversation we had regarding going carnivore and a whole lot of things. Just one of the first few chats we have had! Had to compress the the audio file a bit hence you may hear some static. Apologies for the same!! You can follow her on her Insta - @coachjenwinkler

This finale episode of 2023 is dedicated to my cousin Abhijeet whom we lost at the young age of 30. he gave me insights into how cancer cells feed into sugars. Strengthened my resolve to educate more people regarding diet and nutrition. This is just a snippet into how I reversed my metabolic age. There's a lot more to talk about and I look forward to it in 2024. Happy New Year.

Welcome back to Season 3 of The DESI EM PROJECT! Hope you all have had a fantastic 2023 and here's wishing you a fab 2024. Starting off this season with conversations with fellow carnivore Dr Pallavi Aga. Always interesting to learn from others and their experiences. Lost her for a bit due to network issues but will be back with her for more conversations. You can follow her on her Instagram @pallaviaga

I have got the lovely Mehak Arora to talk to us about the world of psychoanalysis. This is just the beginning. The field is massive and we will be dishing out more episodes. Mental health is important. If you want to get in touch with her for help, you can connect to her on her email address - mehakarora017@gmail.com or DM her on her IG - @me.hak1516

Calling the cardiologist unnecessarily from the ED for every little raised troponin is one of my pet peeves. In this episode, I discuss what troponins are and what are the conditions in which they shoot up. Don't just believe me. Do your own research too. You can go through some of the following literature -

1. https://pubmed.ncbi.nlm.nih.gov/20685679/

2. https://pubmed.ncbi.nlm.nih.gov/15136402/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554225/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860726/

5. https://pubmed.ncbi.nlm.nih.gov/15736582/

6. https://pubmed.ncbi.nlm.nih.gov/12460876/

7. https://pubmed.ncbi.nlm.nih.gov/9510880/

8. https://pubmed.ncbi.nlm.nih.gov/22105197/

9. https://pubmed.ncbi.nlm.nih.gov/26346942/

I have noticed a lot of patients receiving unnecessary oxygen over the years. It's one of my pet peeves. So in this short episode I talk a little about how toxic unnecessary or over oxygenation can be. Go ahead and do your research. You can also go through the following papers -

1. Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM; AVOID Investigators. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015 Jun 16;131(24):2143-50

2. Vali P, Lakshminrusimha S. The Fetus Can Teach Us: Oxygen and the Pulmonary Vasculature. Children (Basel). 2017 Aug 3;4(8):67. doi: 10.3390/children4080067.

3. Mach WJ, Thimmesch AR, Pierce JT, Pierce JD. Consequences of hyperoxia and the toxicity of oxygen in the lung. Nurs Res Pract. 2011;2011:260482.

4. Singer M, Young PJ, Laffey JG, Asfar P, Taccone FS, Skrifvars MB, Meyhoff CS, Radermacher P. Dangers of hyperoxia. Crit Care. 2021 Dec 19;25(1):440.

5. Hofmann R, James SK, Jernberg T, Lindahl B, Erlinge D, Witt N, Arefalk G, Frick M, Alfredsson J, Nilsson L, Ravn-Fischer A, Omerovic E, Kellerth T, Sparv D, Ekelund U, Linder R, Ekström M, Lauermann J, Haaga U, Pernow J, Östlund O, Herlitz J, Svensson L; DETO2X–SWEDEHEART Investigators. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med. 2017 Sep 28;377(13):1240-1249

6.Phillips M, Cataneo RN, Greenberg J, Grodman R, Gunawardena R, Naidu A. Effect of oxygen on breath markers of oxidative stress. Eur Respir J. 2003 Jan;21(1):48-51. 

7.The Fetal Circulation. Peter John Murphy. doi 10.1093/bjaceaccp/mki030

8.Rønning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999 Oct;30(10):2033-7.

9. Iscoe S, Beasley R, Fisher JA. Supplementary oxygen for nonhypoxemic patients: O2 much of a good thing? Crit Care. 2011;15(3):305. doi: 10.1186/cc10229

3 weeks into my 24 hour intermittent fasting and I feel fantastic. So I thought why not share what I have learnt and researched with all my followers and listeners. You can go through some of the papers here and do your own research before you plan to embark on your journey of Intermittent fasting (if you decide to do so).

1. Stockman, M.C.; Thomas, D.; Burke, J.; Apovian, C.M. Intermittent Fasting: Is the Wait Worth the Weight? Curr. Obes. Rep. 2018,7, 172–185

2. Swi ˛atkiewicz, I.;Wo´zniak, A.; Taub, P.R. Time-Restricted Eating and Metabolic Syndrome: Current Status and Future Perspectives. ´Nutrients 2021, 13, 221.

3. Asher, G.; Sassone-Corsi, P. Time for food: The intimate interplay between nutrition, metabolism, and the circadian clock. Cell 2015, 161, 84–92

4. Anton, S.D.; Moehl, K.; Donahoo, W.T.; Marosi, K.; Lee, S.A.; Mainous, A.G.; Leeuwenburgh, C.; Mattson, M.P. Flipping the Metabolic Switch: Understanding and Applying the Health Benefits of Fasting. Obesity 2018, 26, 254–268.

5. Vasim I, Majeed CN, DeBoer MD. Intermittent Fasting and Metabolic Health. Nutrients. 2022 Jan 31;14(3):631.

6. Krishnamoorthy Y, Rajaa S, Murali S, Rehman T, Sahoo J, Kar SS. Prevalence of metabolic syndrome among adult population in India: A systematic review and meta-analysis. PLoS One. 2020 Oct 19;15(10):e0240971

A lot of people have misconceptions regarding cholesterols and their blood work and the need for medications. In this episode I have attempted to bust some myths and point the people towards the right direction. You can go through the research and do your own to come to your own conclusions and choices obviously.

1. https://pubmed.ncbi.nlm.nih.gov/27618496/

2. https://pubmed.ncbi.nlm.nih.gov/27617709/

3. https://pubmed.ncbi.nlm.nih.gov/27292972/

4. https://pubmed.ncbi.nlm.nih.gov/34684304/

5. https://pubmed.ncbi.nlm.nih.gov/34764414/

6. https://pubmed.ncbi.nlm.nih.gov/26339496/

7. https://pubmed.ncbi.nlm.nih.gov/27071971/

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881926/

9. https://meddocsonline.org/annals-of-epidemiology-and-public-health/the-LDL-paradox-higher-LDL-cholesterol-is-associated-with-greater-longevity.pdf

10. https://pubmed.ncbi.nlm.nih.gov/23902788/

11. https://pubmed.ncbi.nlm.nih.gov/25032333/

Got Cliff again. Conversation about learning from mistakes and cognitive forcing. Hope you all learn something from this episode.

One of my inspirations in Emergency Medicine, Cliff Reid is in the house to have some EM related conversations over beers. He flew down from Sydney to be with us and have an experience and what an experience it has been! Do not miss out on this episode! Many more coming up with him!

Yes i have been MIA for a month now! Was at Amsterdam to participate at the ICEM 2023 conference. What an experience it was! Loved it! Got to meet my idol Cliff Reid too! That was the icing! but I am back and speaking today about sustainable EDs and how healthcare contributes to climate change. yes it does! Go through some of the papers cited here -

1. Walsh O, Harris R, Flower O, Anstey M, McGain F. Everyone’s a winner if we test less: the CODA action plan. Aust Health Rev. 2022 Aug;46(4):460-462. doi: 10.1071/AH22145. PMID: 35772927.

2. Linstadt H, Collins A, Slutzman JE, Kimball E, Lemery J, Sorensen C, Winstead-Derlega C, Evans K, Auerbach PS. The Climate-Smart Emergency Department: A Primer. Ann Emerg Med. 2020 Aug;76(2):155-167. doi: 10.1016/j.annemergmed.2019.11.003. Epub 2020 Jan 23. PMID: 31983497.

3. McAlister S, Barratt AL, Bell KJ, McGain F. The carbon footprint of pathology testing. Med J Aust. 2020 May;212(8):377-382. doi: 10.5694/mja2.50583. Epub 2020 Apr 18. PMID: 32304240.

4. Tennison I, Roschnik S, Ashby B, Boyd R, Hamilton I, Oreszczyn T, Owen A, Romanello M, Ruyssevelt P, Sherman JD, Smith AZP, Steele K, Watts N, Eckelman MJ. Health care's response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021 Feb;5(2):e84-e92. doi: 10.1016/S2542-5196(20)30271-0. PMID: 33581070; PMCID: PMC7887664.

5. Kanem N, Murray CJL, Horton R. The Lancet Commission on 21st-Century Global Health Threats. Lancet. 2023 Jan 7;401(10370):10-11. doi: 10.1016/S0140-6736(22)02576-4. Epub 2022 Dec 15. PMID: 36529147; PMCID: PMC9754642.

In this episode I talk about my experience with carnivore diet, some facts, some myths and some anecdotes.

Ever had trouble convincing other specialties and seniors to do the right thing in your bleeding trauma patient and not give fluids? I am sure everyone has. So I had a light bulb moment and came up with the "Milkshake Paradigm" that you could use on them. I tried it on some and it worked. Well if you think it helps you, remember where you heard it the first!

In this podcast, I've spoken about the complexity of ARDS, risk factors, pathophysiology and treatment strategies. You can check out the references -

1. Gragossian A, Siuba MT. Acute Respiratory Distress Syndrome. Emerg Med Clin North Am. 2022 Aug;40(3):459-472. doi: 10.1016/j.emc.2022.05.002. Epub 2022 May 10. PMID: 35953211; PMCID: PMC9085508.

2. Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet. 2021 Aug 14;398(10300):622-637. doi: 10.1016/S0140-6736(21)00439-6. Epub 2021 Jul 1. PMID: 34217425; PMCID: PMC8248927.

3. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15;354(24):2564-75. doi: 10.1056/NEJMoa062200. Epub 2006 May 21. PMID: 16714767.

4. Yadav H, Thompson BT, Gajic O. Fifty Years of Research in ARDS. Is Acute Respiratory Distress Syndrome a Preventable Disease? Am J Respir Crit Care Med. 2017 Mar 15;195(6):725-736. doi: 10.1164/rccm.201609-1767CI. PMID: 28040987.

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 Med 2015;65(4):410–5.

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 investigators consortium (ToxIC). J Med Toxicol 2016;12(1):95–9

10. Hayes BD, Gosselin S, Calello DP, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin Toxicol 2016;54(5):365–404

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
Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med 2006;47(4):373–80.

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):
272–3

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

Short sweet and concise information on strokes for the general public. This episode aims at reducing the knowledge gap and improving the awareness regarding strokes in the community. 

In this episode I have spoken about the young adult epidemic that I have been talking about for months now linking it with metabolic syndromes. To check your metabolic health, you can get the following tests done -  "Fasting Hba1C, homocysteine, insulin, sugars, lipid profile, GGTP, SGOT, Uric acid". Please do your own research too. Everything I have spoken about in this episode is based on the research I have done in the past year, my knowledge as a doctor, my experiences and learnings from Dr Robert Lustig. 

What an academic feast organized by the SEMI-WB on the weekend of 16-17th July 2022 for the academic residents of emergency medicine. I start of the episode by talking about the EZECON. Also the 24th Annual Conference of SEMI is happening in Kerala from 23-27th November. Do register for it. In this episode I give an insight towards dealing with acid base disorders using the modified stewart's approach. Following are the references you can go through to understand more and change your practice - 

1. https://emcrit.org/wp-content/uploads/acid_base_sheet_2-2011.pdf

2. Story DA. Stewart Acid-Base: A Simplified Bedside Approach. Anesth Analg. 2016 Aug;123(2):511-5. doi: 10.1213/ANE.0000000000001261. PMID: 27140683.

3. Jones NL. A quantitative physicochemical approach to acid-base physiology. Clin Biochem. 1990 Jun;23(3):189-95. doi: 10.1016/0009-9120(90)90588-l. PMID: 2115411.

4. Mallat J, Michel D, Salaun P, Thevenin D, Tronchon L. Defining metabolic acidosis in patients with septic shock using Stewart approach. Am J Emerg Med. 2012 Mar;30(3):391-8. doi: 10.1016/j.ajem.2010.11.039. Epub 2011 Jan 28. PMID: 21277142.

5. Morgan TJ. The Stewart approach--one clinician's perspective. Clin Biochem Rev. 2009 May;30(2):41-54. PMID: 19565024; PMCID: PMC2702213.

6.Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med. 2004 May;32(5):1120-4. doi: 10.1097/01.ccm.0000125517.28517.74. PMID: 15190960.

7. Malatesha G, Singh NK, Bharija A, Rehani B, Goel A. Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment. Emerg Med J. 2007 Aug;24(8):569-71. doi: 10.1136/emj.2007.046979. PMID: 17652681; PMCID: PMC2660085.

8. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001 Sep;18(5):340-2. doi: 10.1136/emj.18.5.340. PMID: 11559602; PMCID: PMC1725689.

9. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology. 2014 Feb;19(2):168-175. doi: 10.1111/resp.12225. Epub 2014 Jan 3. PMID: 24383789.

So the International Conference on Emergency Medicine 2022 is on in Melbourne. There is quite a bit of representation from India at the biggest EM conference! In today's episode, I talk about how India emergency physicians are contributing to the academic fest in Melbourne. Enjoy!

In this episode I bid farewell to my passing out residents and discuss some trauma myths like Manual in line stabilization and the use of steroids in acute spinal cord injuries. You all can go through the following articles to learn more - 

1. Ellis DY, Harris T, Zideman D. Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Ann Emerg Med. 2007 Dec;50(6):653-65. doi: 10.1016/j.annemergmed.2007.05.006. Epub 2007 Aug 3. PMID: 17681642.

2.Manoach S, Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Ann Emerg Med. 2007 Sep;50(3):236-45. doi: 10.1016/j.annemergmed.2007.01.009. Epub 2007 Mar 6. PMID: 17337093.

3. Thiboutot F, Nicole PC, Trépanier CA, Turgeon AF, Lessard MR. Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anaesth. 2009 Jun;56(6):412-8. doi: 10.1007/s12630-009-9089-7. Epub 2009 Apr 24. PMID: 19396507.

4. Kapp JP. Endotracheal intubation in patients with fractures of the cervical spine [technical note]. J Neurosurg. 1975;42:731-732.

5. Hachen HJ. Idealized care of the acutely injured spinal cord in Switzerland. J Trauma. 1977;17:931-936

6. Bohlman HH. Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am. 1979;61:1119-1142.

7. Podolsky S, Baraff LJ, Simon RR, et al. Efficacy of cervical spine immobilization methods. J Trauma. 1983;23:461-465.

8. Hugenholtz H, Cass DE, Dvorak MF, Fewer DH, Fox RJ, Izukawa DM, Lexchin J, Tuli S, Bharatwal N, Short C. High-dose methylprednisolone for acute closed spinal cord injury--only a treatment option. Can J Neurol Sci. 2002 Aug;29(3):227-35. doi: 10.1017/s0317167100001992. PMID: 12195611.

9. Suberviola B, González-Castro A, Llorca J, Ortiz-Melón F, Miñambres E. Early complications of high-dose methylprednisolone in acute spinal cord injury patients. Injury. 2008 Jul;39(7):748-52. doi: 10.1016/j.injury.2007.12.005. Epub 2008 Jun 9. PMID: 18541241.

10. Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990 May 17;322(20):1405-11. doi: 10.1056/NEJM199005173222001. PMID: 2278545.

11. Bracken MB, Collins WF, Freeman DF, Shepard MJ, Wagner FW, Silten RM, Hellenbrand KG, Ransohoff J, Hunt WE, Perot PL Jr, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984 Jan 6;251(1):45-52. PMID: 6361287.

12. Evaniew N, Noonan VK, Fallah N, Kwon BK, Rivers CS, Ahn H, Bailey CS, Christie SD, Fourney DR, Hurlbert RJ, Linassi AG, Fehlings MG, Dvorak MF; RHSCIR Network. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry. J Neurotrauma. 2015 Nov 1;32(21):1674-83. doi: 10.1089/neu.2015.3963. Epub 2015 Jul 17. PMID: 26065706; PMCID: PMC4638202.

In this episode of myths in emergency medicine, I talk about Oxygen in STEMI patients, Epinephrine in digital anaesthesia, C- line for CVP monitoring and MILS in trauma patients. You can go through some of the following papers and decide what you want to do with your EM practice - 

1. Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM; AVOID Investigators. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015 Jun 16;131(24):2143-50. doi: 10.1161/CIRCULATIONAHA.114.014494. Epub 2015 May 22. PMID: 26002889.

2. Hofmann R, Befekadu Abebe T, Herlitz J, James SK, Erlinge D, Yndigegn T, Alfredsson J, Kellerth T, Ravn-Fischer A, Völz S, Lauermann J, Jernberg T, Lindahl B, Langenskiöld S. Routine Oxygen Therapy Does Not Improve Health-Related Quality of Life in Patients With Acute Myocardial Infarction-Insights From the Randomized DETO2X-AMI Trial. Front Cardiovasc Med. 2021 Mar 15;8:638829. doi: 10.3389/fcvm.2021.638829. PMID: 33791349; PMCID: PMC8006541.

3. Krunic AL, Wang LC, Soltani K, Weitzul S, Taylor RS. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol. 2004 Nov;51(5):755-9. doi: 10.1016/j.jaad.2004.05.028. PMID: 15523354.

4. Mohan, P P. “Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Epinephrine in digital nerve block.” Emergency medicine journal : EMJ vol. 24,11 (2007): 789-90. doi:10.1136/emj.2007.053793

5. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008 Jul;134(1):172-8. doi: 10.1378/chest.07-2331. PMID: 18628220.

6. Ellis DY, Harris T, Zideman D. Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Ann Emerg Med. 2007 Dec;50(6):653-65. doi: 10.1016/j.annemergmed.2007.05.006. Epub 2007 Aug 3. PMID: 17681642.

7. Santoni BG, Hindman BJ, Puttlitz CM, Weeks JB, Johnson N, Maktabi MA, Todd MM. Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Anesthesiology. 2009 Jan;110(1):24-31. doi: 10.1097/ALN.0b013e318190b556. PMID: 19104166.

8. Manoach S, Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Ann Emerg Med. 2007 Sep;50(3):236-45. doi: 10.1016/j.annemergmed.2007.01.009. Epub 2007 Mar 6. PMID: 17337093.

9. Wiles MD. Manual in-line stabilisation during tracheal intubation: effective protection or harmful dogma? Anaesthesia. 2021 Jun;76(6):850-853. doi: 10.1111/anae.15472. PMID: 33939842.

In today's episode, I invite Drs Sanjay and Shivani back to the show to discuss the 6 steps to manage hyponatremia in your ED in a little bit more detail. This will be a learning curve for the young (and the old) emergency physicians. Later on, I would have them back to discuss real life cases that have been managed in our department using the 6 cases. Enjoy! For any questions you can DM us on our twitter handles -  @anksv25 (Ankur), @drshivanisarda (Shivani) and @drbobby71sanjay (Sanjay) 

In this episode, I have discussed a little bit about some advances in trauma resuscitation, some goals and how ATLS should be the basic trauma skill an emergency physician should have. I did not mean to break any hearts, but yes trauma resus goes beyond ATLS. Do not believe what I say blindly, do your research. You can go through the following mind blowing papers and up your trauma game and prepare your own trauma protocols for your emergency departments. 

The papers you can go through (not in any order of preference). And these are not exhaustive - 

1. Harris T, Davenport R, Mak M, Brohi K. The Evolving Science of Trauma Resuscitation. Emerg Med Clin North Am. 2018 Feb;36(1):85-106. doi: 10.1016/j.emc.2017.08.009. PMID: 29132583.

2. Leibner E, Andreae M, Galvagno SM, Scalea T. Damage control resuscitation. Clin Exp Emerg Med. 2020;7(1):5-13. doi:10.15441/ceem.19.089

3. Carrick MM, Leonard J, Slone DS, Mains CW, Bar-Or D. Hypotensive Resuscitation among Trauma Patients. Biomed Res Int. 2016;2016:8901938. doi: 10.1155/2016/8901938. Epub 2016 Aug 9. PMID: 27595109; PMCID: PMC4993927.

4.  https://www.jsomonline.org/References/PDF/Damage_Control_Resuscitation_03_Feb_2017_ID18.pdf

5. Petrosoniak A, Hicks C. Resuscitation Resequenced: A Rational Approach to Patients with Trauma in Shock. Emerg Med Clin North Am. 2018 Feb;36(1):41-60. doi: 10.1016/j.emc.2017.08.005. PMID: 29132581.

6. Mutschler, M., Nienaber, U., Münzberg, M., Wölfl, C., Schoechl, H., Paffrath, T., Bouillon, B., Maegele, M., & TraumaRegister DGU (2013). The Shock Index revisited - a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU. Critical care (London, England), 17(4), R172. https://doi.org/10.1186/cc12851

7. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003 Jun;54(6):1127-30. doi: 10.1097/01.TA.0000069184.82147.06. PMID: 12813333.

8. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, del Junco DJ, Brasel KJ, Bulger EM, Callcut RA, Cohen MJ, Cotton BA, Fabian TC, Inaba K, Kerby JD, Muskat P, O'Keeffe T, Rizoli S, Robinson BR, Scalea TM, Schreiber MA, Stein DM, Weinberg JA, Callum JL, Hess JR, Matijevic N, Miller CN, Pittet JF, Hoyt DB, Pearson GD, Leroux B, van Belle G; PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3;313(5):471-82. doi: 10.1001/jama.2015.12. PMID: 25647203; PMCID: PMC4374744.

9. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98. doi: 10.1186/s13054-019-2347-3. PMID: 30917843; PMCID: PMC6436241.

10. Spinella PC, Holcomb JB. Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev. 2009 Nov;23(6):231-40. doi: 10.1016/j.blre.2009.07.003. Epub 2009 Aug 19. PMID: 19695750; PMCID: PMC3159517.

11. Wiles MD. ATLS: Archaic Trauma Life Support? Anaesthesia. 2015 Aug;70(8):893-7. doi: 10.1111/anae.13166. PMID: 26152249.

12. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Wyen H, Peiniger S, Paffrath T, Bouillon B, Maegele M; TraumaRegister DGU. A critical reappraisal of the ATLS classification of hypovolaemic shock: does it really reflect clinical reality? Resuscitation. 2013 Mar;84(3):309-13. doi: 10.1016/j.resuscitation.2012.07.012. Epub 2012 Jul 24. PMID: 22835498.

In today's episode I am joined by Dr Abbas and we discuss the young adult epidemic - emergency conditions that young adults suffer from and lose their lives to. We discuss as to why this may be happening and what can be done. Again - these are our opinions and experiences. We apologise if we hurt some sentiments in this one!