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Sepsis Basics - Septic Shock Pathophysiology | Clinical Medicine

In this foundational clinical medicine video, we break down the basics of sepsis and septic shock, focusing on the underlying pathophysiology that drives this life-threatening condition.
✅ What is sepsis? Definitions and criteria.
🧬 Pathophysiology of septic shock: Inflammatory response, cytokine storm, vasodilation, organ dysfunction, micro thrombi, adrenal suppression, capillary permeability, mitochondrial dysfunction, multi organ failure
💉 Progression to shock: How sepsis leads to hypotension and multi-organ failure
🧪 Key clinical features and diagnostic markers
📈 Overview of current clinical understanding and relevance in critical care
🦠🦠Sepsis Playlist:
https://youtube.com/playlist?list=PLf5bMa9_tvRhC6NDyogE1sw2cdBkAOBPM&si=jE1Ioh4viA1iIJDu
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YouTube Video:
https://www.youtube.com/watch?v=JMjS0TOtzoI 
 

Extracorporeal Membrane Oxygenation (ECMO) Basics - Comprehensive Overview | Clinical Medicine

Extracorporeal Membrane Oxygenation, more commonly referred to as ECMO, first started in the pediatric world before becoming more and more prominent in adults. It is used for patients with severe respiratory or hemodynamic failure as a means to try and support these patients long enough for their heart or lungs to recover. This video is an introduction to understanding ECMO. We discuss the general principles of what ECMO is and how it works. We then dive into the different types of ECMO, such as VV-ECMO (venovenous) and VA-ECMO (venoarterial). We illustrate the differences between these two types of ECMO, their indications, and the anatomy related to how they work. We then discuss the indications and contraindications for cannulating a patient for ECMO. We go into what needs to be done by the care team daily to maintain the ECMO circuit and optimize the patient. Lastly, we dive into the many potential complications that can result when a patient is on ECMO. 
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YouTube Video:
https://www.youtube.com/watch?v=WPf5I0CP_yE 
 

Acute Respiratory Distress Syndrome (ARDS) Basics - Diagnose, Manage, Trials | Clinical Medicine

Acute Respiratory Distress Syndrome (ARDS) affects critically ill patients and has a very high mortality rate. The management of ARDS is critical with a number of landmark trials to help guide that management.
We talk about the Berlin Criteria used to diagnose ARDS including how to gauge ARDS severity. We then dive into the general management approach including tidal volume, plateau pressures, respiratory rate, oxygen saturation goals, pH goals, and more.
Finally, we dive into the different landmark trials as a way to understand the management of ARDS. This includes the ALVEOLI Trial on low versus high PEEP, PROSEVA Trial on proning, ACURASYS and ROSE Trials on neuromuscular blockage (paralysis), ARDS Network Trials on tidal volumes and plateau pressures, as well as fluid strategies, and the more recent DEXA-ARDS Trial on steroids for ARDS. All studies linked at the bottom.
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YouTube Video:
https://www.youtube.com/watch?v=tj699KeEY14 
 

Cardiac Physiology Basics - Output, Index, Preload, Afterload, Contractility | Clinical Medicine

Cardiac output and cardiac index are two critical concepts to understand. We tie together preload, afterload, contractility, heart right, end diastolic volumes, the cardiac cycle, Frank Starling curves, Anrep Affect, and more in a clear and concise manner! We also talk about the physiologic things that contribute to these different variables.
Cardiac output is the amount of blood the heart squeezes out every minute. It is equal to the stroke volume times the heart rate. What contributes to these two variables though? The stroke volume is the end diastolic volume minus the end systolic volume and is affected by three things: preload, afterload, and contractility. The preload is the end diastolic volume, which is essentially the amount of blood in the ventricle right before is starts to contract in systole. As it increases, stroke volume tends to increase up until the ventricle becomes overstretched as demonstrated by the Frank Starling curve. The after load is the pressure that the ventricle has to contract against. Typically, as the after load increases the stroke volume decreases. The exception to this is the Anrep Affect, which we explain. Contractility is how powerful of a contraction the heart muscles make. As it increases, the strove volume increases. It is intimately connected to and affected by preload and afterload. Heart rate is more straightforward, but remember that there is a point where continued increases in heart rate actually decrease cardiac output given too short of time for diastolic filling. Cardiac index then is the cardiac output divided by the body surface area, which provides a more informative look at how well the body is being supplied with blood.
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YouTube Video:
https://www.youtube.com/watch?v=NEDln5Gc6SU 
 

Mechanical Ventilation Advanced - Hemodynamics And Cardiovascular Effects | Clinical Medicine

Intubating a patient and placing them on mechanical ventilation is often used as a lifesaving technique to support a patient while giving them time to heal. Mechanical ventilation though is not a "natural" process and has a number of significant effects on the hemodynamics/cardiovascular system of the patient. We discuss the most common hemodynamic changes that are critical to know when caring for these patients. Specifically, we will illustrate mechanical ventilation's effects on the right side of the heart (venous return/preload/afterload), pulmonary vasculature (alveolar and extra-alveolar pulmonary vascular resistance), and left side of the heart (preload/afterload). 
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YouTube Video:
https://www.youtube.com/watch?v=GJ7ORabbVc0 
 

Arterial Blood Gas Basics - Sampling, Interpreting, Clinical use, Acid-Base | Clinical Medicine

In this podcast we discuss the basics of the arterial blood gas or ABG. This is a blood draw that some may consider a small procedure. It is important for all of those in the healthcare field to understand what this is, how to perform the procedure, the various components, and how to interpret the results. Here, we go over these things and more! We talk about blood gases in general, including the arterial blood gas, capillary blood gas, and venous blood gas. 
You can sample any arterial site, but most often the radial or femoral artery. Textbooks would suggest performing the Allen's Test first, which we will review. We then go over the procedure itself.
Interpreting the ABG involves understanding the various results. This includes the measured results, being the pH, PaO2, and PaCO2. The calculated components are the base excess, HCO3, and SaO2. ABGs are great for looking at oxygenation, ventilation, and acid-base status.
We will finish with a very basic introduction to the acid-base assessments including how to identify whether it's acidotic or alkalotic and then whether it is primary respiratory or metabolic.
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YouTube Video:
https://www.youtube.com/watch?v=cFkgWDbD_OQ 
 

Alveolar-Arterial (Aa) Gradient Basics - Definition, Equations, Physiology, Use | Clinical Medicine

In this podcast we dive into the Alveolar-arterial gradient or the Aa Gradient. We start by explaining what exactly it is in terms that make sense. We then dive into the math and equations to calculate the gradient. We explain the math as related to the physiology to better understand it. We then go into a normal Aa Gradient versus an abnormal gradient and the differential diagnosis for each.
The Aa Gradient is the difference between the alveolar oxygen content and the arterial oxygen content. It is a measure of whether you are having trouble diffusing oxygen across your alveoli into the blood vessels and/or not perfusing or getting blood flow to the alveoli, versus not ventilating or breathing enough oxygen into the alveoli. It can help you differentiate between different causes of hypoxia, or low oxygen levels in the blood.
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YouTube Video:
https://www.youtube.com/watch?v=GOaNcOo5sQk 
 

Acute Hypoxic Respiratory Failure Basics - Approach Using An ABG and Chest X-ray | Clinical Medicine

In this podcast we discuss a clinical approach to hypoxemia, or low oxygen levels in the blood, that requires just an arterial blood gas and chest x-ray!
Low Aa Gradient with a high carbon dioxide level (PaCO2 from your ABG!) suggests hypoventilation, such as COPD, OHS, opioid overdose, and etc. Low Aa Gradient with a normal pCO2 suggests things like high altitude.
High Aa Gradient is then divided into vascular and alveolar pathologies. Chest X-ray negative makes vascular pathologies more likely. This is then divided into oxygen responsive and oxygen non-responsive. Oxygen responsive conditions include things like pulmonary embolism, whereas oxygen non-responsive conditions tend to be shunts, such as cardiac or pulmonary shunting.
High Aa Gradient with chest x-ray findings suggests alveolar pathologies. This is then divided into filled, collapsed, or loss. Filled suggests conditions like pulmonary edema, pneumonia, bleeding, acute respiratory distress syndrome, and more. Loss implies conditions like COPD. Collapsed may be mucous plugging, pneumothorax, and more!
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YouTube Video:
https://www.youtube.com/watch?v=ujuJUW-h4XM 
 

Acid Base Basics - Comprehensive Overview Of Everything You Need To Know | Clinical Medicine

This is a conglomeration of our 5 podcast series on Acid-Base Disorders! We put them together to make it easier for those interested in a full, comprehensive education on this topic. By the end of the podcast, you should have a comprehensive understanding on all things acid base from A to Z. 
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YouTube Video:
https://www.youtube.com/watch?v=O-f8XUrGyfE 
 

Acid Base Basics - Metabolic Vs Respiratory, Compensation, Acute Vs Chronic | Clinical Medicine

Here we dive into using the arterial blood gas to determine acidosis vs alkalosis and then the bicarbonate and carbon dioxide levels to determine if it is primary metabolic or respiratory. After that we dive into determining if the acidosis or alkalosis is compensated from both a metabolic and respiratory standpoint. We then go over several must know equations to determine compensation including Winter's Formula for a metabolic acidosis, an equation for a metabolic alkalosis, and a straight forward chart to determine appropriate compensation for a respiratory acidosis or alkalosis that is either acute or chronic. We pepper in some tips and tricks based on our own experiences!
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YouTube Video:
https://www.youtube.com/watch?v=8cT6qgju0wk