Administrative Items (13:40)
Nurse medic Sean Smith introduces himself, discusses his military and ER background, explains the break schedule, and provides his email address. He self-funds medical mission trips to Haiti and receives donated equipment. He also provides additional web resources.
Pathophysiology Topics and Shock Management (13:03)
Smith discusses the importance of cerebral perfusion in emergency situations; paramedics often inadvertently damage kidneys and lungs. Hear why 90 is the minimum acceptable systolic blood pressure. The cerebral perfusion equation is CPP=MAP-ICP; MAP=(2xDiastole + 1xSystole)/3.
Complex, Multi-System Problem Solving (16:23)
Smith discusses the interconnectedness of body systems and provides an organizational tool for tracking hormones in endocrine and metabolic disorders, using vasopressin as an example. Hormone disorders are either quantitative, lack target tissue response, or a combination thereof.
Endocrine System and Disorders (13:25)
Chronic illness depletes steroid hormones; sepsis patients should have a cortisol stem test. Smith discusses pathologies involving thyroid binding sites and the cortical feedback loop.
Hormone Biosynthesis and Secretion Disorders (31:30)
Gland removal, damage or necrosis causes hormone hypofunction; hyperfunction is usually related to neoplasia. Smith describes issues with hormone transcription, transportation, modification, and reception. Hypophysis function disturbances refer to pituitary issues. Hear why Foley catheters can save trauma patients.
Hormone Groups and Pathogenesis (11:17)
Hormones groups include amines, steroid, polypeptides, proteins, hypothalamics, GIs, opioid peptides, tissue growth factors, transforming growth factors, and interferons. Smith covers general effects, specific rates, and secretion patterns. Learn about alteration mechanisms causing disorders.
Hyponatremia and Dosing (12:25)
Smith discusses correcting serum sodium levels by five mEq using 3% NaCl or sodium bicarb. In diabetes insipidus, urine is dilute but serum is concentrated. Strokes and brain injury often cause DI and SIADH. Smith believes all stabilized patients should do PT and OT.
Pituitary Gland Disease Spectrum (16:28)
Smith goes over consequences of mild to severe pituitary issues, including ACTH, TSH, FSH, and LH deficiencies and hormone overproduction from pituitary and hypothalamus adenomas. Hear specific symptoms and downstream effects of acute adrenal insufficiency, androgen disorders, hyperthyroidism and hypothyroidism.
Hematologic Hormone Disorders (08:26)
Smith discusses normocytic normochromic anemia, macrocytic and microcytic anemias, and iron deficiency. Common nutritional anemias are caused by vitamin B12 deficiency and folate malabsorption. Smith describes complications in patients that are not kept mobile through PT.
Hypoparathyroidism and Hyperparathyroidism (10:59)
Smith addresses risks of removing parathyroid tissue in thyroid surgery. Learn about hypocalcemia and hypercalcemia symptoms.
Jaundice and Apoptosis (04:40)
Jaundice indicates excess bilirubin, either through production, metabolism or elimination. Higher conjugated levels indicate obstruction; unconjugated levels indicate a hemolytic problem. Liver metabolizes protein; a damaged liver can cause ascites and coagulopathy. Smith relates jaundice to emergency care.
Basic Cardiac Physiology (13:46)
Smith explains the Frank-Starling law, including preload, contractility and afterload components, and shows a Wigger's diagram. Heart rate times stroke volume equals cardiac output. Learn about atrial fibrillation. A heart murmur indicates abnormal valve function.
Heart Failure (22:32)
Aortic stenosis causes murmurs that indicate blood flowing past an obstruction. Smith discusses when it leads to sustained systemic hypertension and pulmonary hypertension, and explains why to give fluid gradually during resuscitation. Learn about ischemic and non-ischemic heart failure causes and mechanisms.
Right Ventricular Infarction (07:11)
Smith explains how to determine whether a patient is having a left or right sided MI, using a 12-lead EKG. Hear why it is important to give volume, rather than restricting it, in right-sided MIs. They affect blood flow to lungs.
Diagnosing Heart Failure (12:23)
Smith discusses heart failure diagnostic tools, including ultrasound and serum BNP. He goes over signs and symptoms.
Non-Cardiogenic Pulmonary Edema (09:20)
Infection, inhalation injuries and ARDS cause lung fluid. Smith discusses risks of injuring patient lungs via mechanical ventilation in emergency care. Hear how to distinguish between cardiogenic and non-cardiogenic edema on x-rays and lab values.
Treating Heart Failure (17:39)
BNP correlates with heart failure, in the absence of renal disease. Smith discusses using the EKG diagnostically. Learn about ACE inhibitors, ARBs, beta blockers, diuretics, and magnesium deficiency. Smith talks about slowing progression, optimizing workload, and sodium toxicity in CHF.
Heart Failure Drugs (27:28)
Smith explains indications for ACE inhibitors, beta blockers, ARBs, nitrates, and aldosterone blockers. Respiratory distress is either cardiac or pulmonary; Smith summarizes diagnosis and treatment methods. Hear why diuresing CHF patients will not decrease lung fluid, and why to cardiovert with analgesics.
Kidneys and Brain (12:26)
Hypertension compromises end organ function, and is linked to diabetes, renal disease, and hemorrhagic stroke. Smith explains hypertrophic heart disease, renal arterial sclerosis, and malignant hypertension, and discusses draining the brain of blood through a ventricular catheter.
Chronic Obstructive Pulmonary Disease (18:56)
Smith explains the air trapping mechanism in COPD; learn about ventilator associated pneumonia risk. Smith advocates initiating BiPAP early and administering benzodiazepines for anxiety. Causes include smoking and cystic fibrosis. Smith discusses increasing expiratory time by decreasing the respiratory rate to correct hypoxia.
Treating COPD Exacerbation (20:14)
Learn about signs and symptoms. Smith discusses drugs that open airways and reduce inflammation while administering BiPAP. Albuterol, Atrovent and magnesium treat "swelling, sputum and spasm" characteristic of asthma and bronchitis. Smith provides a medication protocol web resource for asthma and COPD.
Asthma and Anaphylactic Shock Treatment (17:23)
Increasing expiratory time slows breathing and reduces hypoxemia. Smith discusses using epinephrine and ketamine to block histamine release and bronchodilate patients. Learn about reactive airway disease drugs and hear why to avoid intubation, if possible.
Arterial Blood Gases (15:59)
ABGs reveal oxygenation, ventilation and pH status. Pulse oximetry measures serum oxygen while ABG measures hemoglobin bound oxygen; Smith provides relationship numbers and examples. Learn about pH and CO2 ranges and compensation, including the ROME mnemonic for acid base balance.
Smith describes shock in terms of oxygen supply and demand. Lactic acid determines anaerobic metabolism. Smith discusses diagnostic characteristics and treatments for cardiogenic, hypovolemic, neurogenic, anaphylactic, and septic shock.
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