Episode 173: Innovation In The Time of Covid: The MasksOn.org story with Drs. Sanjay Vakil, Jackie Boehme and Alex Stone

In this episode I welcome Sanjay Vakil, Jackie Boehme and Alex Stone to the show. Jackie and Alex are two of the co-founders of MasksOn.org and Sanjay is the Executive Director. We discuss the story of their company that provides free masks to healthcare workers and how people can go about innovating to help others dealing with COVID-19.

Their website to get masks and/or donate: MasksOn.org

A map of where they’ve sent masks so far:

Random Recs:

The Sculptor: https://www.amazon.com/Sculptor-Scott-McCloud/dp/1596435739

Scriblio: https://skribbl.io

Avatar the last air bender: https://en.wikipedia.org/wiki/Avatar:_The_Last_Airbender

Outlander: https://www.starz.com/us/en/series/21796/episodes?season=1

Episode 172: A Pregnant Patient with Congenital Heart Disease

In this 172nd episode I welcome a panel of experts to discuss the management of a pregnant patient with congenital heart disease. Drs. Hofkamp, Vaught and Meng join me to discuss the preoperative evaluation, obstetric management, and postoperative care.

Episode 171: Anesthetic Management of Ruptured Cerebral Aneurysm with Dave Mintz

In this 171st episode, a follow up to episode 113, I welcome Dr. Mintz back to the show to discuss anesthetic management for cerebral aneurysm surgery.

References:

Chapter 13 Anesthetic management of cerebral aneurysm surgery in Cottrell and Young, Neuroanesthesia

http://www.joacp.org/article.asp?issn=0970-9185;year=2014;volume=30;issue=3;spage=328;epage=337;aulast=Kundra

The Guns of August: https://www.amazon.com/Guns-August-Pulitzer-Prize-Winning-Outbreak/dp/0345476093

Cognitive Aid website: www.rnsascar.com

Episode 170: Lessons from 40 COVID Patients in the ICU with Brian Garibaldi

In this 170th episode I welcome Dr. Brian Garibaldi to the show to discuss his experience taking care of 40 critically ill COVID patients and what we’ve learned. We got through by system, head to toe, and discuss strategies and approaches.

References:

Lessons from China: https://jamanetwork.com/journals/jama/fullarticle/2762130

Convalescent Plasma: https://jamanetwork.com/journals/jama/fullarticle/2763983?widget=personalizedcontent&previousarticle=2762130

Management of patients with COVID: https://jamanetwork.com/journals/jama/fullarticle/2763879

Episode 169: PPE and Modified Difficult Airway Algorithm for COVID

In this episode I introduce Dr. Christina Miller’s video, linked below, that goes through PPE considerations including how to safely don and doff, and suggestions for how to handle a difficult airway in COVID patients.

Video: https://drive.google.com/file/d/1AFYIouqGVLRlstU3xXSOJTHbtorWvQ7L/view

Episode 168: COVID in Pregnancy with Dr. Nixon

In this 168th episode I welcome Dr. Heather Nixon to the show to discuss what is being done for pregnant women and women in labor who have or are suspected to have COVID-19.

The COVID book for kids by Taylor Purvis: https://playatrickonthecoronas.weebly.com/

Link for Anesthesia Toolbox daily online learning session: https://www.anesthesiatoolbox.com/docs/DOC-5178

References:

https://s3.amazonaws.com/cdn.smfm.org/media/2277/SMFM-SOAP_COVID_LD_Considerations_3-27-20_(final)_PDF.pdf

SOAP website: https://soap.org/

Episode 167: COVID Clinical Care Update

In this 167th episode I review the most recent changes that we’ve made to our protocols for caring for COVID patients and share a fantastic one page summary sheet that 3 of our ICU fellows put together. Huge thanks to Drs. Navarette, Herekar and Baronos for their work on this. It is available for download below. References are on the second page of the attachment.

Episode 166: COVID Airway Management with Aliaksei Pustavoitau

In this 166th episode I welcome Dr. Aliaksei Pustavoitau to the show to discuss management of the hypoxemia COVID-19 patient including initial triage, escalating support, endotracheal intubation, and ventilator management.

References:

Episode 165: COVID with Drs. Scott, Cereda and Nacoti

In this 165th episode I welcome Drs. Scott and Cereda from University of Pennsylvania and Dr. Nacoti from Italy to talk about COVID-19, what it is, what we know about it, what it’s like on the ground in Italy right now, and what we can learn from their experience to try to prevent it from happening here.

References:

 Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. doi:10.1001/jama.2020.4031 

Episode 164: Keywords part 9: Fentanyl and Breathing Circuits

In this 164th episode I welcome back Dr. Gillian Isaac to do another ABA keywords episode. We discuss fentanyl and breathing systems (Mapleson and Circle systems).

Great info from Aaron Sandock:

The toxicity was reported in rats and research was published in the early-mid 90’s. 

Gonsowski, C., Laster, M., Eger, E., Ferrell, L. and Kerschmann, R. Toxicity of Compound A in Rats: Effect of a 3-Hour Administration

Anesthesiology. 1994;80(3):566-573. 

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1949689

It is actually the case that follow up studies were done in the US on volunteer patients through University of Arizona and Medical College of Wisconsin in the later 1990’s.Ebert, T., Frink, E. and Kharasch, E. Absence of Biochemical Evidence for Renal and Hepatic Dysfunction after 8 Hours of 1.25 Minimum Alveolar Concentration Sevoflurane Anesthesia in Volunteers. Anesthesiology. 1998;88(3):601-610.

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1948570

Kharasch, E. and Jubert, C. Compound A Uptake and Metabolism to Mercapturic Acids and 3,3,3-Trifluoro-2-fluoromethoxypropanoic Acid during Low-flow Sevoflurane Anesthesia. 

Anesthesiology. 1999;91(5):1267-1278.

https://www.ncbi.nlm.nih.gov/pubmed/10551576

The key point of the final article concludes that humans are nearly devoid of renal beta lyase, the key enzyme in directing biodegradation of compound A to the toxic renal thiol. Essentially, this research was done in the late 90’s but the original possibility of renal toxicity in humans from just a few years prior has stuck in peoples’ minds (and therefore textbooks). 

More recent studies agree:

Ong Sio LDela Cruz R,  and Bautista A. Sevoflurane and renal function: a meta-analysis of randomized trials.

Med Gas Res. 2017 Oct 17;7(3):186-193.

https://www.ncbi.nlm.nih.gov/pubmed/29152212

Gillian’s random recommendation: Born a Crime by Trevor Noah

Circle C Farm: https://www.circlecfarmfl.com