The RAGE Podcast

Indispensable RAGE team member Cliff Reid was a keynote speaker at the ACEM Annual Scientific Meeting in 2013. He was tasked with delivering a talk titled ‘What a great job!’ … and, of course, he well and truly delivered. httpv://vimeo.com/93460243 Hopefully this tides you over until the next RAGE session and inspires you as much as it inspires us. Special thanks to ACEM for allowing the audio to be released as FOAM on the RAGE Podcast. RAGE on… Thanks again for listening to the RAGE!

As promised in SMACCGOLD IS ALL THE RAGE here is the smaccGOLD edition of the RAGE podcast. This podcast represents the first time all the RAGE podcasters have been together in person. In addition to the RAGE team we had a bunch of friends helping us out: Photo via @markhwilson From left to right: * Rich Levitan (@airwaycam) * Scott Weingart (@emcrit) * Haney Mallemat (@CriticalCareNow) * Michaela Cartner (@mjcartner) * Karel Habig (@karelhabig) * Chris Nickson (@precordialthump) * John Hinds (@docjohnhinds) * Cliff Reid (@cliffreid) * Mark Wilson (@markhwilson) Unfortunately, missing from the photo is my great friend and SMACC co-conspirator Oli Flower (@oliflower). Also, the third founder of SMACC, the ‘SMACC Big Cheese’ Roger Harris (@RogerRDHarris)  wasn’t included because we’d just have to bleep  out everything he’d say anyway… Sorry Rog! The audio quality is a tad marginal in places, but that’s what you get with an impromptu recording of 10 slightly manic people in a room with one mic. All the same, we hope it is an engaging audio experience and gives a good insight into the SMACC experience and what to look out for as the talks are released online. Thanks to Haney for helping me get this audio into the best shape possible. This is ’17 minutes’, the amazing video by Tamara Hills and family mentioned in the podcast (nearly 7,000 views and counting): Look out for all the talks being released on the SMACC podcast and the affiliated FOAM websites in the coming months. Follow the @smaccteam on Twitter for updates. For other accounts of smaccGOLD (based on a list originally made by Alan Batt), check out: * smaccGOLD transcript on symplur.com * smaccGOLD analytics on symplur.com * Lessons learned from smaccGOLD – “Bye-bye dogma, hello best practice!” – Alan Batt from PrehospitalREsearch.eu * You gotta have love – Tim Leeuwenburg from KI Docs * Friendship, Motivation and Altruism @ smaccGOLD – Rob Rogers from iTeachEM * smaccGOLD: Lessons from Down Under – Eve Purdy from Manu et Corde *

This RAGEback includes commentary and reaction to the RAGE Session Three discussion of severe life-threatening acute asthma. It features comments from Mary Shue on THAM, Greg Miller on lignocaine and someone called Scott Weingart (anyone heard of him?) on non-invasive ventilation. Here’s some stuff on lignocaine (a fairly evidence free zone!): * BestBets: Lignocaine as a pretreatment to Rapid Sequence Induction of patients with Status Asthmaticus  * Maslow AD, Regan MM, Israel E, Darvish A, Mehrez M, Boughton R, Loring SH. Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma. Anesthesiology. 2000 Nov;93(5):1198-204. PubMed PMID: 11046206. [Free Full Text] * More recently though, this paper suggested some beneficial effects on bronchoconstriction post-intubation: Adamzik M, Groeben H, Farahani R, Lehmann N, Peters J. Intravenous lidocaine after tracheal intubation mitigates bronchoconstriction in patients with asthma. Anesth Analg. 2007 Jan;104(1):168-72. PubMed PMID: 17179265. Some stuff by Scott Weingart on Emcrit.org relevant to this discussion: * EMCrit Podcast 15 — The Severe Asthmatic * EMCrit Podcast 19 — Non-invasive Ventilation * EMCrit Podcast 40 — Delayed Sequence Intubation (DSI)  Finally, some useful links from the LITFL Critical Care Compendium: * LITFL CCC — Alkali Therapies * LITFL CCC — Non-invasive ventilation (NIV) and asthma * LITFL CCC — Pretreatment drugs for Rapid Sequence Intubation (RSI) Thanks again for listening to the RAGE!

Just in time for smaccGOLD, RAGE Session Three is here! It is 67 min 53 sec long and includes: * Introduction, including an ERCAST shout out and apologies from Haney… (starts 00:00 min) * ‘What’s bubbling up?’ (starts 01:30 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring pre-hospital spinal immobilisation, astronaut Chris Hadfield, ‘Mistakes were made’, EMA’s 25th anniversary edition and the need to tailor blood pressure targets to the individual. * the RAGE team discussing acute  life-threatening asthma (starts 15:52  min) * the RAGE team discussing ‘Medical Reversal’ (starts 52:52 min) * ‘A blast from the past’ by Karel Habig on ‘Ether Day’ and the origins of general anaesthesia (starts 63:42 min) * ‘Words of Wisdom’ featuring a quote from Cliff Reid’s role model, and some other guy (starts 66:32 min) The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here. Here are the show notes for RAGE Session Three: Introduction * How to run a code (ERCast) * RAGEback: Minh Le Cong, Verapamil and SVT (RAGE Podcast) What’s bubbling up? * Connor D, Greaves I, Porter K, Bloch M; consensus group, Faculty of Pre-Hospital Care. Pre-hospital spinal immobilisation: an initial consensus statement. Emerg Med J. 2013 Dec;30(12):1067-9. doi: 10.1136/emermed-2013-203207. PubMed PMID: 24232011; The Telegraph — Firemen cut roof off police car; Pre-hospital spinal immobilisation: an initial consensus statement (PHARM); Progress in prehospital spinal injury management (ScanCrit) * An Astronaut’s Guide to Life on Earth * Mistakes Were Made (but Not by Me) * EMA Journal Silver Anniversary Edition, with links to all the free full text articles (LITFL) * Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R. Mean perfusion pressure deficit during the initial management of shock–an observational cohort study. J Crit Care. 2013 Oct;28(5):816-24. doi: 10.1016/j.jcrc.2013.05.009. Epub 2013 Jul 10. PubMed PMID: 23849541. Life-threatening severe asthma * Acute Severe Asthma (LITFL CCC) * Non-invasive ventilation (NIV) and asthma (LITFL CCC) * Bronchospastic Blood Pressure Badness  (LITFL Case-based Q&A) * Heliox (LITFL CCC) * Management of the Severe Asthmatic in the ED (EMCrit) *

The discussion of verapamil as an option for the treatment of supraventricular tachycardia (SVT) in RAGE Session Two went off like a fire cracker in the FOAM world. In this RAGEback, Minh Le Cong from the PHARM podcast explains why the RAGE discussion is not going to change his practice, which is to use adenosine as a first line agent. This is followed by a response by RAGErs Karel and Cliff. You — the listener — are left to make up your own mind about which patients (if any) you’ll consider verapamil as an option. References and Links Minh cites these references (in the order they were mentioned): * Leitner RP, Hawker RE, Celermajer JM. Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children. Aust Paediatr J. 1983 Mar;19(1):40-4. PubMed PMID: 6870700. * Delaney B, Loy J, Kelly AM. The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis. Eur J Emerg Med. 2011 Jun;18(3):148-52. doi: 10.1097/MEJ.0b013e3283400ba2. Review. PubMed PMID: 20926952. * Hood MA, Smith WM. Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-crossover trial. Am Heart J. 1992 Jun;123(6):1543-9. PubMed PMID: 1595533. * Anugwom C, Sulangi S, Dachs R. Adenosine vs. calcium channel blockers for supraventricular tachycardia. Am Fam Physician. 2007 Jun 1;75(11):1653-4. Review. PubMed PMID: 17575655. [Free Full Text] * Brady WJ Jr, DeBehnke DJ, Wickman LL, Lindbeck G. Treatment of out-of-hospital supraventricular tachycardia: adenosine vs verapamil. Acad Emerg Med. 1996 Jun;3(6):574-85. PubMed PMID: 8727628. Karel and Cliff added these to the mix: * Holdgate A, Foo A. WITHDRAWN: Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database Syst Rev. 2012 Feb 15;2:CD005154. doi: 10.1002/14651858.CD005154.pub3. Review. PubMed PMID: 22336809. [Free Full Text] (note: withdrawn by the author due to lack of time and resources to update) * Miyagawa K, Dohi Y, Ogihara M, Sato K. Administration of intravenous calcium before verapamil to prevent hypotension in elderly patients with paroxysmal supraventricular tachycardia. J Cardiovasc Pharmacol. 1993 Aug;22(2):273-9. PubMed PMID: 7692169. * Riaz R, Mishra J, Hussain S, Sinha LM. Adenosine Versus Verapamil for the Treatment of Supra-ventricular Tachycardia: Randomized Comparative Trial. Pakistan J Med & Health Sci. 2012 Jul-Sept [Free Full Text] * Lapage MJ, Bradley DJ, Dick M 2nd. Verapamil in infants: an exaggerated fear? Pediatr Cardiol. 2013 Oct;34(7):1532-4. doi: 10.1007/s00246-013-0739-8. Epub 2013 Jun 26. PubMed PMID: 23800976. Roie Tal’s Prezi journal club presentation on the Lapage et al 2013 article: The links mentioned at the end are: * ERCAST.org — How to run a code (2014) (includes Anand Swaminathan’s discussion of using calcium chan...

As promised in RAGE Session Two, Andy Buck and Amit Maini from the Emergency Trauma Management (ETM) course are here to give their side of the story of what happened when a slide from their course was tweeted out of context leading to an unexpected backlash. Be sure to check out: * ETM Course * FOAMcc Google Plus Community * smaccGOLD Thanks again for listening to the RAGE! 

The wait is over, RAGE Session Two is here! RAGE Session Two is 80 min 19 sec long and includes: * Introduction, including some bad news… (starts 00:00 min) * ‘What’s bubbling up?’ (starts 00:58 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring codeine in kids, post-intubation sedation, adenosine versus verapamil for SVT and how to do a good vagal manoeuvre, the ETM Twitter fiasco, the FOAMcc Google Plus Community and smaccGOLD. * the RAGE team discussing a case of submassive pulmonary embolism and the role of thrombolysis (starts 22:14  min) * the RAGE team’s discussion on ‘Humans in the resus room: ‘when your back-up gets your back up’’ (starts 51:50 min) * ‘A blast from the past’ on WW2 hero and chain-smoking legend Edgar Patz, the only man to complete an entire Masters degree unconscious!  (starts 73:00 min) * ‘Wise Words’ featuring the art of observation, the immortal John Hunter and the infinitely wise Sir William Osler (starts 77.55 min) The RAGE podcast is on  iTunes here and the RAGE podcast audio feed is available here. Here are the show notes for RAGE Session Two: What’s bubbling up? * 6 PEM papers that could change your practice – #1 – codeine (Don’t Forget the Bubbles) * Binks: Practice Changing Articles in PEM (Free Emergency Medicine Talks) * Podcast 115 – A New Paradigm for Post-Intubation Pain, Agitation, and Delirium (EMCrit) * I Hate Adenosine (Prehospital Wisdom) * Valsalva maneuver by pressing on the abdomen  (ALIEM) * Walker S, Cutting P. Impact of a modified Valsalva manoeuvre in the termination of paroxysmal supraventricular tachycardia. Emerg Med J. 2010 Apr;27(4):287-91. doi: 10.1136/emj.2009.073866. PubMed PMID: 20385681. * Best of 2013 – Eight is Enough & Social Media Update (EMCrit) * Airways in the ED and on Twitter (LITFL) * FOAMcc Google Plus Community (join in, it’s free) * smaccGOLD  Submassive Pulmonary Embolus and Thrombolysis FOAM: * Submassive Pulmonary Embolus and Thrombolysis (LITFL CCC) * Thrombolysis in submassive PE – still equipoise? (Resus.ME) —  summary of the AHA guidelines * MOPETT – Half-Dose tPA for PE (EMLON) * EMCrit Wee – The Mopett Trial (EMCrit) * Podcast 51: Fibrinolysis...

You’d be forgiven for thinking it was never going to happen… but it has… the first RAGE Session is finally here! RAGE Session One is 71 min 7 sec long and includes: * Introduction, including the RAGE team ‘meet and greet’ (starts 00:00 min) * ‘What’s bubbling up?’ (starts 05:40 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring CO2 retention in COPD, the LINC trial, intraosseous blood transfusion, Rory Spiegel’s EM Nerd, the ‘quick look’ CT in ‘semi-stable’ trauma patients and fallen cycling legend Martyn Ashton * the RAGE team discussing ‘The post-TTM era: homeopathic hypothermia or aggressive normothermia?’ (starts 25:20 min) * the RAGE team’s discussion on ‘Septic and hypotensive: what next?’ (starts 39:06 min) * ‘A blast from the past’ on critical care deity Peter Safar, presented by Haney Mallemat (starts 63.57 min) * ‘Wise Words’ featuring Descartes and Diderot, presented by Michelle Johnston (starts 67.58 min) It’s early days and we expect to incrementally improve the format, presentation and audio quality with each episode. To make this happen, we need your feedback — leave comments on this post or contact us here (especially if you want to appear on the show, correct us or respond to an episode in audio format). The RAGE podcast has been submitted to iTunes , but is not yet available there  and is available here. The RAGE podcast audio feed is available here. Read on for the ‘show note’ links for RAGE Session One… Intro * FOAM (LITFL) * RAGE Team What’s bubbling up? * The LITFL Review (LITFL) * Oxygen and CO2 Retention in COPD (LITFL CCC) * Harris M, Balog R, Devries G. What is the evidence of utility for intraosseous blood transfusion in damage-control resuscitation? J Trauma Acute Care Surg. 2013 Nov;75(5):904-6. doi: 10.1097/TA.0b013e3182a85f71. PubMed PMID: 24158214. (Note that the first author has a potential conflict of interest in that he is CMO of a company that makes equipment for assisting in difficult vascular access) * Mechanical CPR and the LINC trial (ALIEM) * EM Nerd * Unstable Patient & Pelvic Fracture + Hemoperitoneum (Trauma Professional’s Blog) * RAPTOR suite (ScanCrit) * Reasons To Be Cheerful – One, Two, Three (Interview with Martyn Ashton) httpv://www.youtube.com/watch?v=HhabgvIIXik The post-TTM era: homeopathic hypothermia or aggressive normothermia? * Nielsen N et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med Nov 17 2013 doi: 10.1056/NEJMoa1310519 * Reports of therapeutic hypothermia’s death are greatly exaggerated...