Episode Summary We’re returning to the ring for another Q & A! The crowd is cheering and asking for more, so let’s give them another round…say what! In this episode, we’ll test your mental toughness with questions that review pharmacology, pathophysiology, and airway. Along the way, we’ll give you tips and suggestions to help dust out the cobwebs and bring that anesthesia knowledge back into the forefront of your mind. So, put those gloves together, “ding ding!” it’s time to get back into the ring!  Say what? That’s right, it’s Q & A day!APEX family…grab a big glass of milk and let’s talk calcium!   What You'll Learn Review the medication that should be avoided in a patient with adrenal insufficiency. Examine the electrolytes that can precipitate cardiac toxicity. Discuss the physiologic effects of beta receptors in several organs. Explain the local anesthetics that are affected by a pseudocholinesterase deficiency. Review anatomy for a superior laryngeal nerve block.   Want to Attend an APEX Live Event? Get the clarity you need to pass the CPC Exam with ease. Earn 20 Class A credits by attending an APEX Live Virtual Conference.  Click here to learn more.   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Podcast music by Eino Toivanen, kongano.com  

APEX Live Anesthesia

30. Say What? Q & A Round 3

Episode Summary In this episode of the APEX Live Anesthesia podcast, we review the essentials of calcium and the physiologic consequences that occur when this important cation becomes low. We’ll discuss how the body regulates calcium, the signs of hypocalcemia, something called the “Lethal Diamond” and so much more. APEX family…grab a big glass of milk and let’s talk calcium! What You'll Learn     Assess how the body regulates calcium.      Examine normal calcium values.     Discuss the physiologic manifestations of acute and chronic hypocalcemia.     Explain the concept of the “Lethal Diamond”.     Review effective methods to replace calcium.   Want to Attend an APEX Live Event? We know that you miss going to live events right now - and we do too! That's why we decided to pull out all the stops on our APEX Live Virtual CPC Review Course. By attending virtually, there are no long flights, no rental cars, and no forgetting things at home. You can even show up in your PJs if you'd like! If you want an engaging review for the NBCRNA CPC Exam, with the flexibility to attend virtually, then you came to the right place. Our previous events were a blast! Check out the rest of our 2021 dates in the link below. Click here to learn more.   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Podcast music by Eino Toivanen, kongano.com  

29. Hypocalcemia

Episode Summary We went into the ring and knocked out the first Q & A in episode 25. Because of the overwhelmingly positive feedback, we are back for another round…Say What! In this episode, we’ll go over several pharmacology questions that range from medications that affect hypoxic pulmonary vasoconstriction to platelet inhibitors. Along the way, we’ll give you tips and suggestions to help dust out the cobwebs and bring that anesthesia knowledge back into the forefront of your mind. So exercise that mind, we are going back into the ring!   Say what? That’s right, it’s Q & A day!   What You'll Learn     Review the medications that inhibit hypoxic pulmonary vasoconstriction.     Examine the metabolism of cisatracurium.     Discuss the physiologic effects associated with phenylephrine.     Explain the medications contraindicated during malignant hyperthermia.     Review the most appropriate time to stop platelet inhibitors.   Want to Attend an APEX Live Event? We know that you miss going to live events right now - and we do too! That's why we decided to pull out all the stops on our APEX Live Virtual CPC Review Course. By attending virtually, there are no long flights, no rental cars, and no forgetting things at home. You can even show up in your PJs if you'd like! If you want an engaging review for the NBCRNA CPC Exam, with the flexibility to attend virtually, then you came to the right place. Our previous events were a blast! Check out the rest of our 2021 dates in the link below. Click here to learn more.   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Podcast music by Eino Toivanen, kongano.com  

28. Say What? Q & A Round 2

Episode Summary Anesthesia-induced hypotension is commonly treated with push dose vasopressors. Today we dive into what the newest evidence is showing us about the use of phenylephrine, ephedrine, and norepinephrine IV bolus doses. We talk about cerebral oxygen concentrations and cardiac output when administering these vasopressors and ultimately ask ourselves…should we be less pushy?   What You'll Learn Review usual practice standards for anesthesia-induced hypotension. Discuss the most commonly used push dose vasopressors. Examine the evidence comparing commonly administered vasopressors. Discuss the physiologic consequences of push dose vasopressor use.    Want to Attend an APEX Live Event? Get the clarity you need to pass the CPC Exam with ease. Earn 20 Class A credits by attending an APEX Live Virtual Conference.  Learn more at www.apexlive.com   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Podcast music by Eino Toivanen, kongano.com  

27. Vasopressors for Hypotension During Anesthesia – Should We Be Less Pushy?

Our episode today is with the one and only Dr. John Nagelhout PhD, CRNA, FAAN. He is a pharmacology master who has taught thousands of CRNAs over the years. He the creator and has been the primary author of the core nurse anesthesia textbook “NURSE ANESTHESIA” for the last 20 years. Jeremy and Sass have an engaging discussion about his experience as a nurse anesthetist since the 1970’s, the story behind his creation of the first and subsequent editions of Nurse Anesthesia, how he came to teach pharmacology to so many CRNAs, his opinion on the greatest strength of a CRNA, and his thoughts on the future of nurse anesthesia. This episode is a treasure you won’t want to miss!

26. Anesthesia through the eyes of the grand master! A conversation with John Nagelhout.

Episode Summary Over the past several months we’ve had many CRNAs request a podcast that evaluates answering test questions. Basically, something that helps to dust out the cobwebs and bring that anesthesia knowledge and that question answering expertise back into the forefront of your mind. APEX family…we hear you! In this episode Sass and Jeremy review several multiple choice questions related to anesthesia. The topics range from postoperative visual loss to signs you may see when giving sugammadex. Say what?  That’s right, it’s Q & A day! What You'll Learn Determine the signs associated with Sugammadex administration. Examine the physiologic effects of naloxone. Discuss what medications may cause confusion and hyperthermia. Explain an accurate indicator for preoxygenation. Review the factors that contribute to cerebral oxygenation. Want to Attend an APEX Live Event? We know that you miss going to live events right now - and we do too! That's why we decided to pull out all the stops on our APEX Live Virtual CPC Review Course. By attending virtually, there are no long flights, no rental cars, and no forgetting things at home. You can even show up in your PJs if you'd like! If you want an engaging review for the NBCRNA CPC Exam, with the flexibility to attend virtually, then you came to the right place. Our previous events were a blast! Check out the rest of our 2021 dates in the link below. www.apexlive.com How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts. Legal Disclaimer APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Podcast music by Eino Toivanen, kongano.com

25. Say what? Q&A

Episode Summary Today we dive into a discussion about Parkinson’s disease. We talk about what causes this disease, how it is medically and pharmacologically managed, and most important for CRNAs…what is the best evidence for taking care of patients who have Parkinson’s disease. There’s no doubt that at some point you will provide anesthesia for these patients and we want to help you, so sharpen those pencils and get ready to take some notes! What You'll Learn Determine the difference between Parkinson’s disease and Parkinsonism. Examine how Parkinson’s disease is pharmacologically managed. Discuss how Parkinson’s disease is non-pharmacologically and surgically managed. Determine evidence-based practices for the perianesthetic management of Parkinson’s disease. Review the potential drug interactions and critical events that could occur during the anesthetic management of a patient with Parkinson’s disease. Want to Attend an APEX Live Event? We know that you miss going to live events right now - and we do too! That's why we decided to pull out all the stops on our APEX Live Virtual CPC Review Course. By attending virtually, there are no long flights, no rental cars, and no forgetting things at home. You can even show up in your PJs if you'd like! If you want an engaging review for the NBCRNA CPC Exam, with the flexibility to attend virtually, then you came to the right place. Our first event was a blast! Check out our 2021 dates in the link below. www.apexlive.com How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts. Legal Disclaimer APEX Anesthesia Review, LLC and APEX Live expressly disclaim any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Podcast music by Eino Toivanen, kongano.com

24. Anesthesia Management for Parkinson’s Disease

Episode Summary This is our first interview and we wanted it to be with CRNAs on the front lines of the COVID-19 pandemic who are getting it done! We focus our discussion on the expanding roles of CRNAs within the hospital and within our communities. We talk to retired Navy Commander and veteran clinical coordinator Valerie Sedor CRNA, about her roles in the ICU and ED, and what it’s like during this COVID surge. We also talk with author and clinical expert Mark Gabot CRNA, about his experience working as a primary member on the Rapid Airway Response Team. Buckle up, this is a great discussion!       What You’ll Learn Discover the expanded role CRNAs are currently taking on in the ICU and ED. Learn about working as a primary provider in Rapid Airway Response Teams. Examine the emotional side of working in these roles and taking on these responsibilities.   Want to Attend an APEX Live Event? Get the clarity you need to pass the CPC Exam with ease. Earn 20 Class A credits by attending an APEX Live Virtual Conference. We have 6 events scheduled for 2021. We hope to see you there! Learn more at www.apexlive.com   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Eino Toivanen, kongano.com  

23. Kicking COVID Butt with Valerie Sedor CRNA and Mark Gabot CRNA

Episode Summary In this episode of the APEX Live Anesthesia Podcast, we address more of the questions we’ve received from our listeners. And yes, we do our best to answer these intelligent questions with even more marvelously mediocre answers. It’s a fun conversation about random topics that will leave you on the edge of your seat wanting more!   What You’ll Learn What are the recommended vasopressors for stenotic and regurgitant valves? Is alpha or beta blockade preferred in a patient with a pheochromocytoma? Which herbal medications influence anticoagulation? Why does bradycardia occur after a spinal anesthetic? What are the complications of a cricothyrotomy and transtracheal jet ventilation?   Want to Attend an APEX Live Event? Get the clarity you need to pass the CPC Exam with ease. Earn 20 Class A credits by attending an APEX Live Virtual Conference. We have 6 events scheduled for 2021. We hope to see you there! Learn more at www.apexlive.com   Episode Sponsor The University of Kansas Health System is committed to creating a culture in which the employees thrive.  We are all living through challenging times and learning how to succeed in our new normal. Rapid growth has given us the opportunity to expand our team. Over the last 5 years our CRNA group has grown from 35 to 100+ and shows no signs of slowing down. We are looking for individuals who align with our style and culture. We are seeking self-starters, critical thinkers and team players. Based in Kansas City, Kansas, with locations throughout the state, the health system has become a staple of the community. A household name in the Kansas City metro area, we value many local partnerships, including with the Kansas City Royals, the Kansas City Chiefs, T-Mobile Center and Kansas Speedway. Please contact dpennington2@kumc.edu or jkessen@kumc.edu for more information.   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Eino Toivanen, kongano.com  

22. Ask an Intelligent Question; Get Another Mediocre Answer

Episode Summary In this episode of the APEX Live Anesthesia Podcast we’ll give you a little taste of our virtual conference…let’s call them appetizers! Sass talks a bit about volatile agent pharmacology, Jeremy talks airway in a patient with elevated ICP, and we finish off discussing shock.   What You’ll Learn What is the difference between oil/gas and blood/gas solubility of a volatile agent? Which volatile agent is the most potent? How should an airway be managed when a patient has elevated ICP? What are the hemodynamic parameters that should be maintained during intubation in a patient with elevated ICP? Will someone please discuss the pathophysiology of shock?   Want to Attend an APEX Live Event? Our first (and only event of 2020) was a blast! We'll announce our 2021 dates soon, so check out www.apexlive.com for details.   Episode Sponsor The University of Kansas Health System is committed to creating a culture in which the employees thrive.  We are all living through challenging times and learning how to succeed in our new normal. Rapid growth has given us the opportunity to expand our team. Over the last 5 years our CRNA group has grown from 35 to 100+ and shows no signs of slowing down. We are looking for individuals who align with our style and culture. We are seeking self-starters, critical thinkers and team players. Based in Kansas City, Kansas, with locations throughout the state, the health system has become a staple of the community. A household name in the Kansas City metro area, we value many local partnerships, including with the Kansas City Royals, the Kansas City Chiefs, T-Mobile Center and Kansas Speedway. Please contact dpennington2@kumc.edu or jkessen@kumc.edu for more information.   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Eino Toivanen, kongano.com 

21. APEX Live Virtual Conference Appetizers

Episode Summary When was the last time you used a cognitive aid in the OR? You probably have some in your OR, albeit they’re likely buried in a drawer somewhere. In today's episode, we'll discuss all things related to anesthesia checklists and how they can help you improve patient care.   What You’ll Learn Where did anesthesia crisis checklists originate? Do crisis checklists improve performance? Why don’t we use crisis checklists more often? What does the current evidence say about anesthesia crisis checklists? Which anesthesia crisis checklists are currently available?   Want to Attend an APEX Live Event? Our first (and only event of 2020) was a blast! We'll announce our 2021 dates soon, so check out www.apexlive.com for details.   Episode Sponsor The University of Kansas Health System is committed to creating a culture in which the employees thrive.  We are all living through challenging times and learning how to succeed in our new normal. Rapid growth has given us the opportunity to expand our team. Over the last 5 years our CRNA group has grown from 35 to 100+ and shows no signs of slowing down. We are looking for individuals who align with our style and culture. We are seeking self-starters, critical thinkers and team players. Based in Kansas City, Kansas, with locations throughout the state, the health system has become a staple of the community. A household name in the Kansas City metro area, we value many local partnerships, including with the Kansas City Royals, the Kansas City Chiefs, T-Mobile Center and Kansas Speedway. Please contact dpennington2@kumc.edu or jkessen@kumc.edu for more information.   How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Legal Disclaimer APEX Anesthesia Review, LLC expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Eino Toivanen, kongano.com

20. Crisis Checklists – Bringing the Team Together

How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Episode Summary What's your plan D during an airway crisis? In this episode of the APEX Live Anesthesia Podcast, we’ll discuss all things cricothyrotomy and give you everything you need to know if you ever need to use it in your practice.   What You’ll Learn What's the history of cricothyrotomy? How often is emergency front of neck access (eFONA) required in clinical practice? What are the indications for eFONA and FONA? How do you perform cricothyrotomy?   Want to Attend an APEX Live Event? Our first (and only event of 2020) was a blast! We'll announce our 2021 dates soon, so check out www.apexlive.com for details.   Legal Disclaimer APEX Anesthesia Review, LLC expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Eino Toivanen, kongano.com

19. Plan D - Cric It While It's Hot

How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts.   Episode Summary In this episode of the APEX Live Anesthesia Podcast, we’ll discuss one of the anesthetic crises we all learned about in anesthesia school…malignant hyperthermia. We’ll talk about how to recognize MH, and most importantly, how to manage this emergency if it ever happens to you!   What You’ll Learn What is the genetic defect that leads to MH susceptibility? How can you identify MH in the operating room? Which tests can confirm the diagnosis of MH? What are the specific treatments and medications needed to manage MH successfully?   Want to Attend an APEX Live Event? We know that you miss going to live events right now - and we do too! That's why we decided to pull out all the stops on this year's APEX Live Virtual CPC Review Course. By attending virtually, there are no long flights, no rental cars, and no forgetting things at home. You can even show up in your PJs if you'd like! If you want an engaging review for the NBCRNA CPC Exam, with the flexibility to attend virtually, then you came to the right place. Click here to learn more.

18. Malignant Hyperthermia: It’s Getting Hot In Here

In this episode of the APEX Live Anesthesia Podcast we talk clotting…or more specifically how to promote blood clotting and STOP BLEEDING by giving an antifibrinolytic. We review the mechanisms of how a clot is formed and broken down. We then discuss several large trials published within the last decade that focus on situations where antifibrinolytics may be useful. What You’ll Learn How are blood clots formed and broken down? What are the mechanisms of action of the various antifibrinolytic agents? Which antifibrinolytic agents are currently being used? What are the surgical situations where antifibrinolytics are used? What are the CRASH 2 and CRASH 3 trials? Recommended Resources Bennett C, Klingenberg SL, Langholz E, Gluud LL. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2014;2014(11):CD006640. Published 2014 Nov 21. https://pubmed.ncbi.nlm.nih.gov/25414987/ Brenner, A., Afolabi, A., Ahmad, S.M. et al.Tranexamic acid for acute gastrointestinal bleeding (the HALT-IT trial): statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial. Trials 20, 467 (2019). https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3561-7 Cole, E., et al. Tranexamic Acid Use in Severely Injured Civilian Patients and the Effects on Outcomes: A Prospective Cohort Study. Annals of Surgery 2015;261(2):390. https://pubmed.ncbi.nlm.nih.gov/25412319/ Gayet-Ageron A, Prieto-Merino D, Ker K, et al. Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. Lancet. 2018;391(10116):125-132. https://pubmed.ncbi.nlm.nih.gov/29126600/ Levy JH, Koster A, Quinones QJ, Milling TJ, Key NS. Antifibrinolytic Therapy and Perioperative Considerations. Anesthesiology. 2018;128(3):657‐ https://pubmed.ncbi.nlm.nih.gov/29200009/ Perel P, Al-Shahi S, Kawahara T, et al. CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury–a nested randomised, placebo-controlled trial. Health Technol Assess. 2012;16(13):iii-xii, 1-54. https://www.ncbi.nlm.nih.gov/pubmed/22417901. Poeram, J., et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United states: Retrospective analysis of effectiveness and safety. BJM. Aug 2014;349:g4829. https://www.bmj.com/content/349/bmj.g4829 Roberts I, Coats T, Edwards P, et al. HALT-IT–tranexamic acid for the treatment of gastrointestinal bleeding: study protocol for a randomised controlled trial. Trials. 2014;15:450. https://www.ncbi.nlm.nih.gov/pubmed/25409738. Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10):1-79. https://www.ncbi.nlm.nih.gov/pubmed/23477634. Salim Rezaie, "It’s Time for Tranexamic Acid (TXA) in Massive Hemorrhage", REBEL EM blog, November 20, 2017. Available at: https://rebelem.com/its-time-for-tranexamic-acid-txa-in-massive-hemorrhage/. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60835-5/fulltext Sprigg N, Flaherty K, Appleton J, et al. Tranexamic acid for hyperacute primary Intra-Cerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018;391(10135):2107-2115. https://www.ncbi.nlm.nih.gov/pubmed/29778325. The CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. October 14, 2019. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext WOMAN trial collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. 2017;389(10084):2105-2116. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30638-4/fulltext Zehtabchi S et al. Tranexamic Acid for Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Am J Emerg Med 2014. PMID: 25447601. https://pubmed.ncbi.nlm.nih.gov/25447601/ Zhang, H., et al. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012 Sep;20(9):1742-52. https://pubmed.ncbi.nlm.nih.gov/22065294/  

17. Stop Bleeding! Antifibrinolytics.

How Are We Doing? We’re here to help you improve your practice, and we want to make sure our content is relevant for you. Click here to share your thoughts. Episode Summary In this episode of the APEX Live Anesthesia Podcast, we are going to dive into the world of ketamine. We’ll review the little brother to PCP, and talk about all the situations where it can be useful…it really is the swiss army knife of anesthetic meds! Episode Webpage https://www.apexlive.com/blog/episode-16 Attend an APEX Live Conference Learn more about APEX Live events at www.apexlive.com Legal Disclaimer APEX Anesthesia Review, LLC expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Eino Toivanen, kongano.com

16. Ketamine: The Swiss Army Knife of Anesthetic Drugs

Practical anesthesia knowledge and wisdom for CRNAs by CRNAs.

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APEX Live Anesthesia

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