My Media List and Wish List

Bronze Setup (current)

libsynPodcast Hosting which I currently run through Libsyn using their 250mb storage plan. This is the total amount I can use each month which allows me to upload 3-4 podcasts per month of about 45-50 minutes per episode. Cost £10 per month.

Bluehost website hosting. Needed to run from where I base the podcast and many of the posts I write. Cost £5 per month.bh_180x150_05

Mailchimp is the service I use to enable me to run Newsletters which allows me to keep in touch with those members of my audience that want it. I currently produce 2 newsletters, one every two weeks, and the other is monthly. I give away a free resource in order to encourage people to sign up which has made a big difference. Cost £6 per month.mailchimp

Total cost per month approx £21 or £252 per year.

Silver Set Up

If I could afford some extras then I could move further forward and become more professional. I am hoping to add some of these one by one when finances allow.

Podcast Hosting I would increase to Libsyns 400mb storage plan as this would allow me to access their advanced statistics. this would mean that I could keep a better track on who was listening, when they stopped listening in each episode and where in the world they were. This would prove to be very useful information to help me tailor my content to my audiences needs. Cost £15 per month.

Voice recorder I am hoping to be attending at least 2 conferences this year and this is a valuable opportunity to get some insights form the speakers. H4nIn order to do this I will need a good quality voice recorder which is portable. The Zoom H4n is the one I would like to purchase as it always gets very good reviews and would seem to do all I need. Cost £180

Microphones to connect to voice recorder and also to improve the quality of the sound when podcasting. I would like a Rode Procaster which offers good depth of sound and cuts out much of the background noise. This would give the podcast a more professional feel. Cost £125rode

Music Radio Creative provide intros and outros for podcasters. In an effort to aim to higher production standards this is something I would like to purchase from them. They work with the podcaster to make sure the voices, script and music they use is appropriate to your subject. MRC

Get the complete audio branding solution for your podcast. A fully produced intro, outro and 3 feature jingles are included in the price. Our audio specialist will select theme music to brand your package and give it a strong identity.” Cost £190

Royalty Free Images. The bane of my life. Currently I take a risk and use a lot of pictures I do not have the rights to as purchasing pictures is very costly. Ideally I would like a subscription to something like iStockphoto so that I could put proper images on my site and in my social media which will help attract people to what I have to offer. Cost £50 per month approx.

MackieMixer desk (Mackie 402-VLZ4 Live Mixer) which will allow me to mix my sounds and interviews as I record which will save many hours over the year. This would be used along side the voice recorder to make the post production a much simpler one. Cost £93

AudioJungle will allow me access to effects and music. I know this does not seem essential to a medical podcast but the more I listen to well produced podcasts the more I am aware thataudio good production, which may include some non intrusive background music, makes it a pleasure to listen too. I gain so much more from those podcasts with high quality production. Cost £10 per month max.

Adobe Audition is the program I would prefer to use to mix my podcasts. Currently I use a free program called Audacity which does all of the basics, but does not automate in the way that Adobe Audition will do. This again would save a lot of time in post production allowing me more time to concentrate on the content. Cost £17 per month.

Gold Set Up (all of the above plus…)

Long term plans would include teaching videos, webinars and on line conferences. Some of the requirements are;

Video Camera which would be used in a studio type setting at home to produce high quality teaching and promotional material for the podcast and conferences. This could also be used to record teaching sessions in my working environment which could then be turned into an e-learning resource for the growing body of practitioners. Cost £400 approx.

Video editing software (Cyber Link Power Director)- essential if the videos are going to be edited to a good standard. Cost £35.

micLavalier clip on microphone which would go along with the video camera to ensure that the videos have quality sound. Cost £35

Lighting. Production of quality video will require good lighting. this is a relatively cheap out lay surprisngly.  Cost £90lighting


…And maybe one day……

Processing of video and audio takes a lot of computer power. imacWhen I win the lottery I will buy myself and iMac to achieve all this lightening fast!

Cost £1500!!

Originally posted 2015-01-21 20:10:10. Republished by Blog Post Promoter

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Critical Care Practitioner makes it into a magazine!! Nurses FYI.

details768x1024I was asked by the editor of the E-Magazine Nurses FYI if I would like to submit an article for the latest edition. Having seen a couple of examples via iTunes I was only to happy to.

The articles are submitted by various guest authors on a range of subjects. To use the editors words in iTunes:

“Each monthly edition contains nursing articles and nursing videos from international nursing experts. With Nurses fyi Magazine a nurse can connect with or follow the world’s leading nurses.”

Go an have a look following these instructions:

1. Download the app from the Apple App store by searching Nurses fyi

2. Open the app on your iPad/iPhone/iPod touch.

3. Tap Subscribe.

4. Tap current subscribers

and when you get there if you enter freefor3 then you will get the first 3 months free. Each edition after that is only £1.99 which I think offers great value.

[Stitcher_Radio_Logo] [get_in_touch_with_jonathan] [123-contact-form i882618]

Originally posted 2014-05-23 12:58:03. Republished by Blog Post Promoter

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Rapid sequence induction practices in the United States and the United Kingdom-a comparative survey study.

Laryngoscope_optPurpose: We aimed to survey the members of anesthesia departments in two large university hospitals, University of Washington (Seattle, USA) (UW-US) and University of Nottingham (Nottingham, UK) (UN-UK) to compare differences in their current approach to rapid sequence induction (RSI). Link here..

Originally posted 2013-02-19 04:34:59. Republished by Blog Post Promoter

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ARISE Trial- Early Goal Directed Therapy Is Not The Gold Standard…

Goal-Directed Resuscitation for Patients with Early Septic Shock

The ARISE Investigators and the ANZICS Clinical Trials Group


Emmanuel Rivers trial found a big difference in 90 day mortality when using early goal directed therapy and as a consequence the Surviving Sepsis Guidelines have advocated the use of this algorithm. EGDT

The recent PROCESS trial possibly indicated that no one approach to resuscitation was better than another and therefore the use of a central line in a patient was not always required.


Prospective, randomized, parallel group trial in 51 tertiary care and non tertiary care metropolitan and rural hospitals mainly in Australia and New Zealand.


The Method

Two groups:

Usual Care- Decisions about the location of care delivery, investigations, monitoring and all treatments were made by the treating clinical team. ScvO2 measurement were not permitted in the 6 hour intervention period.

EGDT- An arterial catheter and ScvO2 catheter were inserted one hour after randomisation. Resuscitation algorithm was based on the original EGDT algorithm. These patients had a dedicated study team trained in EGDT delivery. Care providers and location of delivery dependent on local resources.

Inclusion Criteria

Patients 18 years or older. Confirmed or suspected infection and two or more criteria for SIRS with evidence of refractory hypotension (systolic blood pressure of less than 90 or a MAP of less than 65 after a fluid challenge of 1 litre within a 60 minute period) or hypoperfusion (blood lactate level of 4mmol/l or more).

Commencement of first dose IV antimicrobial therapy prior to randomisation.

Exclusion Criteria

Contraindication to CVC insertion in the SVC and contraindication to blood products. Heamodynamic instability due to active bleeding, aggressive care deemed unsuitable by clinician, inability to deliver EGDT within 1 hour of randomisation or inability to deliver EGDT for 6 hours.


Primary outcome was death from any cause within 90 days.

Secondary outcomes included 28 day mortality, in hospital mortality at 60 days, length of stay in ED and ITU, receipt and duration of mechanical ventilation , vasopressor support, renal replacement therapy and destination at discharge.


792 patients in the EGDT group and 796 in the usual care group.

Total fluid administrated for both groups was approx. 2.5 litres (35mls/kg) with an average lactate of 6.6-6.7 mmol/l

Similar groups in age, gender, APACHE II, invasive ventilation, non invasive ventilation and use of vasopressors.

Time from ED presentation to first anti microbial dose was 67-70 mins in both arms.ARISE Fluids


Use of fluids, RBC and dobutamine significantly reduced in the usual care arm in the first 6 hours.

The differences in the use of vasopressors and dobutamine persisted up to 72 hours but there was no difference in the use of fluids between the two arms over this period.

High degree of compliance with all resuscitative endpoints and goal directed therapies.

No difference in the endpoint goals in either arm.

No difference between EGDT and usual care in 90 day all cause mortality

EGDT 18.6% vs usual care 18.8%

EGDT had a shorter length of stay in ED and more were admitted to ICU direct from ED (however in a number of participating sites patients needed to be admitted to the ICU for the EGDT to be delivered).

More EGDT patients received a vasopressor infusion.

No other differences between the two groups in any of the secondary outcomes.

EGDT NOT associated with decreased mortality, time spent in ICU or hospital or duration of organ support. The Botttom Line

See Jones Trial- Is Lactate Clearance a Useful Indicator on this website

See also Rivers Trial on this web site

EMBasic- Introducing EM Basic Essential Evidence- The Rivers Sepsis Study

WikiJournalClub- Rivers Trial

Paul Mariks assertion that Lactate clearance is flawed


EMCRIT- Podcast 54- Dr Rivers on Severe Sepsis

Originally posted 2014-10-03 06:42:33. Republished by Blog Post Promoter

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Pressure Support Ventilation Curves

pressure support curves_opt


This is the information from a pressure supported breath. We have the pressure generated at the top, the flow generated in the middle and the subsequent volume at the bottom.

There are a number of important points to note. If we look at the pressure graph, we can see a slight dip below the base line before each breath, where each red arrow is pointing. This is the negative pressure created by the patient as they try to initiate a breath. Therefore the breath will always be patient triggered in pressure support ventilation.

Each breath, after initiation, will then be pressure limited as you can see by the plateau on each breath. We set that pressure when we decide how much pressure support the patient needs.

If we look at the flow curves in the middle section we can see the difference between pressure controlled and pressure support ventilation. In pressure support ventilation the breath is cycled by flow. So as the patient takes a breath in they generate an inspiratory flow which will peak at point 1 on this diagram and will then decline down the point two, which is when the ventilator will then cycle to the next breath. In pressure controlled ventilation, where we set a rate, the breath is time cycled.

The consequence of this on the volume curve is that we don't see an inspiratory pause. As soon as the ventilator detects a reduction in the flow rate it triggers to expiration. The breath is not held for a period of time as it would be in pressure controlled ventilation.

  • Pressure at the mouth is only supplied during a patients spontaneous inspiratory efforts.
  • P(mouth) is positive, but P(alveoli) is negative during inspiration.
  • Work of breathing is reduced but pressure support ventilation is more physiologically akin to spontaneous breathing.


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Trainee Advanced Clinical Practitioner Diary- Day 2

This section of the website will be formed from the diary I keep for my own portfolio and learning needs as I develop as a Trainee Advanced Clinical Practitioner. I will add all the resources I come across to help me in my learning and hopefully you can benefit too.

Calf laceration and the Gastrocnemius muscle. LeForts Fracture.

Again two patients in particular had learning points for me to focus on.

The first patient was a boy who had  lacerated the back of his left leg. There were no other injuries and it just required suturing.

The depth of the wound was partial to full thickness which refers to the dermal layers and there was no muscular or tendon involvement which may have been of more concern. The practitioner I was working with also tested the Achilles tendon to ensure that that was not involved. This involved something called the Simmonds test which involved the patient kneeling on a chair and the practitioner squeezing the calf to ensure that the foot will still plantar flex.

From an anatomy point of view the muscle involved was the gastrocnemius muscle



The next patient was a gentleman who had  fallen to the ground. He presented with pain in his left hip a swollen and closed left eye and superficial skin injuries to his thumb.

I took a full history from this patient but when reflecting with my supervisor I perhaps needed to focus a little bit more on the mechanism of the fall and exclude such things as loss of consciousness, dizziness, chest pains etc.

This was towards the end of our shift so the patient was sent for an x-ray of his hip and I did not stay for the outcome of this x-ray. I need to follow this up when next back at work.

Another learning point which came out of this particular patient was the possibility of LeForts fracture in his face due to the nature of his fall. There all 3 possible types of Le Forts fractures depending on the mechanism of the injury and as a consequence they all have slightly different signs and symptoms.

Le Fort Fracture

This was excluded after examination. From discussion with my supervisor there was no pain around his eye on palpation and there was no sub conjunctival haemorrhage.

Le Fort fracture of the skull- Wiki

Originally posted 2014-10-17 11:45:10. Republished by Blog Post Promoter

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