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  • Till The Cows Come Home
  • What Happened Again?
  • Highly Meditated
  • Sarita at SolHenge Podcasts
  • American State Trials, Volume 1 by John D. Lawson (1852 – 1921)
  • Be Gold
  • Earth 894 | Now Reviewing MCU Phase 4, Guardians of the Galaxy Holiday Special, and the Latest Marvel News
  • Chill Bruhhhhh & Catch These Vibez
  • Podcast – Narcissist Abuse Support
  • The Wide World of Real Estate – get in where you fit in
  • That Show Hasn’t Been Funny In Years: an SNL podcast on Radio Misfits
  • The After Show
  • American Patchwork & Quilting Podcast
  • SAP and Enterprise Trends Podcasts from Jon Reed (@jonerp) of diginomica.com
  • EMplify by EB Medicine
  • Werk It: The Podcast
  • Mr. B’s Social Studies Podcasts
  • 100 Reasons 4 College Podcast
  • D’s Nuggets
  • History. Rated R.
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  • Coming Up

    Till The Cows Come Home

    Till The Cows Come Home

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    Since Mar 11, 2020 19:57 UTC

    Until The Cows Come Home is a weekly podcast hosted by React Radio. Guests on the show will debrief on the show and talk about any and everything that’s going on in their lives.

    —————————————————————

    Hosted on Acast. See acast.com/privacy for more information.

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    What Happened Again?

    What Happened Again?

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    Since Dec 7, 2019 20:49 UTC

    This podcast aims to bring you movies, from start to finish, in no time at all. Don’t have time to rewatch all of the MCU before the newest Avengers film? Don’t have the desire to sit through a whole movie but still want the story? Or maybe you just enjoy listening to how other people view movies. I mean, that’s why you’re listening to a movie podcast, right?

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    Highly Meditated

    Highly Meditated

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    Since Jul 29, 2019 23:17 UTC

    Amidst the struggle of living by society’s expectations in her 20’s, host Dani Nadeau found herself in a spiritual and psychic awakening. The new-found knowledge and experiences were too powerful not to share. Dani hosts guests to create relatable conversations on all things mind, body, and spirit. If you’re into wellness, meditation, yoga, spirituality, personal growth, intuition, or have ever craved a more meaningful life, this podcast is for you.

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    Sarita at SolHenge Podcasts

    Sarita at SolHenge Podcasts

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    Since Jan 6, 2020 13:00 UTC

    www.sarita-sol.com
    Are you looking to expand your consciousness?
    Are you looking to heal your body?
    Are you looking to find your purpose and manifest your best life?
    Are you looking to find gratitude and peace through every challenge?
    Are you looking for authentic relationship with loved ones and friend’s?

    If the answer is yes to any of the above then you have come to the right place.
    Start your journey at www.sarita-sol.com

    Between the quantum fields of ancient shamanic techniques and the future of humanity…..How can we navigate our lives to ascend in our awareness? This channel will help you to transcend the ordinary and realize the truth of who you are as quantum, vibrational being. I believe everyone has the potential to have extraordinary, wonderful and uplifting lives if we can understand that we are all part of source consciousness and are creating our realities in every now moment. I share my human perspective as well as ancient information coupled with quantum meditations which give you practical tools to be able to transcend matter, manifest your dreams, heal and become heart centered. Please join me on Patreon for Q and A sessions, group meditations and much more:https://www.patreon.com/Sarita_Sol. For private mentoring , distant healing, virtual meditation classes and Retreats go to www.sarita-sol.com Please feel free to be in touch for information. Sending all blessing to you all. solhengeretreats@gmail.com. Instagram@sarita_solhenge.Meditation can offer a bounty of awareness and deep healing and support your life into the truth of your own sovereignty I hope my podcast brings you connection love, light, insights and happiness. Please know that any channelling, meditations, practises or comments I share on my channel are for entertainment purposes only and are not a substitute for financial, medical, legal and professional mental health advice. My sharings should not be used to replace the advice of any doctor, lawyer or licenced professional.

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  • Coming Up

    American State Trials, Volume 1 by John D. Lawson (1852 – 1921)

    American State Trials, Volume 1 by John D. Lawson (1852 – 1921)

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    Since Sep 29, 2023 12:45 UTC

    “A collection of the important and interesting criminal trials which have taken place in the United States from the beginning of our government to the present day”. To the general public this series will certainly appeal as the most interesting and instructive work which has been published in this country for many years. The trial of judicial causes has even more charms than biography and history, for it is a drama of real life. We enter the halls of justice, the judges and jurors are before us, the criminal is brought in, we behold him surrounded by an eager and excited populace; the whole scene passing before the mind’s eye as a living and moving picture. There is nothing in the Grecian drama that surpasses, in touching pathos, scenes in the trials and prosecutions of these men and women, sometimes innocent and sometimes guilty, but always awaiting with trembling the verdict of the jury which is to send them back to their families and friends or to the scaffold or prison. Here are the poor and ignorant confronted with their accusers but relying upon their advocates; there the rich and powerful surrounded by a host of counsel and braving even the power of the government to convict them. Sometimes the mere report of the evidence in the case and the verdict gives a complete picture of the crime and criminal but in most cases the full dramatic effect cannot be shown in a narrative, but stands out broadly and as vividly as the actual trial when the witnesses, the counsel, the judge and the prisoner are suffered to speak for themselves. in many cases the great points of interest are the eloquent arguments at the bar by the advocates, and in this collection will be included all the great forensic efforts which have been made in trials in all the States by the orators and leaders of the American Bar from the beginning of American Courts down to the present time. When it is considered how prone our people are to litigation, what a vast number of causes are decided every year, how eagerly the public attention is directed to many of them, what an amount of learning and talent are centered in the legal profession, greater perhaps than in any other, how fond American people are of attending courts, and especially the magnitude of many causes that are tried, it is extraordinary that there should not have appeared up to this time in the country a series of American State Trials. – Summary from the Introduction

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    Be Gold

    Be Gold

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    Since Feb 27, 2021 17:30 UTC

    This podcast brings conversations with creatives from around the world. “Unlike other metals, gold doesn’t corrode on contact with dirt, air, or chemicals. Be like gold, stay true to yourself no matter the outside circumstances and shine. Be Gold.” – Mimi diLuna

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  • Coming Up

    Earth 894 | Now Reviewing MCU Phase 4, Guardians of the Galaxy Holiday Special, and the Latest Marvel News

    Earth 894 | Now Reviewing MCU Phase 4, Guardians of the Galaxy Holiday Special, and the Latest Marvel News

    by

    Since Mar 5, 2021 12:00 UTC

    Join Earth 894’s mightiest hosts, Devin Stone and Louie Tonnarini, as they band together to discuss and review the latest news, films, and everything else in the Marvel Cinematic Universe! Visit www.earth894podcast.com for the entire catalog of episodes.

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    Chill Bruhhhhh & Catch These Vibez

    Chill Bruhhhhh & Catch These Vibez

    by

    Since Jun 5, 2018 17:22 UTC

    Aye Chill …… Chill B has a series called LAKERS 82/16! Where we cover The grind of a 82 game long season. Where it takes 16 wins to get a chip in the end. Also, talk fantasy football Talk. In reality we cover the NFC SOUTH & Chill B’s Favorite team Atlanta Falcons. music reviews and more !!!

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  • Coming Up

    Podcast – Narcissist Abuse Support

    Podcast – Narcissist Abuse Support

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    Since Feb 5, 2020 16:48 UTC

    My name is Tracy Malone and I am a surTHRIVER of Narcissistic Abuse. I am an internationally recognized expert on emotional abuse and narcissistic personality disorder, a narcissist abuse survival coach, author, and founder of NarcissistAbuseSupport.com, a global resource to empower victims of emotional abuse. A frequent participant at summits and on podcasts, I speak on DV, narcissistic abuse, financial abuse, as well as many aspects of a victim’s journey. I began this Narcissist Abuse Support channel for my own personal journey of healing, sharing, exposing, teaching, and learning to be vulnerable; now I use it to help victims of abuse get educated on narcissistic abuse and acquire the tools to heal. My most recent book, Divorcing Your Narcissist: You Can’t Make This Shit Up, is available on Amazon and Barnes and Noble in paperback, Audible, and Kindle. It offers quick, enlightening glimpses into methods used to outlast your narcissists attempts to destroy you and how you can flourish after the dust has settled.

    Subscribe in a reader Dr. Anne Brown is Author of Backbone Power – https://amzn.to/3V7GvGa Dr Anne Brown Website – https://backbonepower.com/ FREE – AUDIOBOOK FROM AUDIBLE – http://www.audibletrial.com/Narcissist *As an Amazon Associate I earn from qualifying purchases. Listen to my podcasts anytime by subscribing with your favorite provider!

    The post The Dangers of Not Setting Boundaries – Anne Brown appeared first on Narcissist Abuse Support.

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    The Wide World of Real Estate – get in where you fit in

    The Wide World of Real Estate – get in where you fit in

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    Since Jul 18, 2021 21:18 UTC

    Varied topics on the subject of real estate. The goal is to create a conduit to identify and expand upon topics of interest pertaining to this subject. YouTube Channel can be found here: https://www.youtube.com/channel/UC9_byuOlz4d2pd6pRFdCy4w

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    That Show Hasn’t Been Funny In Years: an SNL podcast on Radio Misfits

    That Show Hasn’t Been Funny In Years: an SNL podcast on Radio Misfits

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    Since Jan 4, 2023 19:28 UTC

    Award-winning radio personality, podcaster, and SNL fanatic/historian NICK DIGILIO hosts this weekly deep dive into the world of the granddaddy of all sketch-comedy shows.

    Nick, a Second City grad and veteran of Chicago comedy and theater, has watched every single episode of SNL since George Carlin hosted the premiere on October 11th, 1975.

    Consisting of new and old episode analysis; SNL-relates guests; historical impact; and even entire episodes dedicated completely to just one sketch…this is every SNL fan’s dream podcast, and proof that that tired, cliched statement: “That show hasn’t been funny in years,” is simply NOT true.

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    The After Show

    The After Show

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    Since Feb 19, 2016 18:00 UTC

    Chaz, AJ, Ashley and Phil give you a bonus show every Friday. A no holds barred podcast that gives you a behind the scenes of Connecticut’s #1 morning show.

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    American Patchwork & Quilting Podcast

    American Patchwork & Quilting Podcast

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    Since May 23, 2016 04:00 UTC

    Welcome to the American Patchwork & Quilting podcast, a podcast aimed at making your quilting life more fun and creative, while connecting with quilters just like you. Join the staff of the magazines you love for a great episode filled with tips and tricks. Enjoy! Visit www.allpeoplequilt.com/podcast to see our complete podcast archives!

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  • Coming Up

    SAP and Enterprise Trends Podcasts from Jon Reed (@jonerp) of diginomica.com

    SAP and Enterprise Trends Podcasts from Jon Reed (@jonerp) of diginomica.com

    by

    Since Mar 22, 2006 07:21 UTC

    Free spirited, old school podcasts on all things enterprise with Jon Reed of diginomica.com, along with troublemakers and/or special guests. This feed includes live recordings from the road, as well as interviews for diginomica.com and debates on the future of the enterprise. Frequent topics include the impact of cloud, mobile, in-memory (including HANA), and analytics on the enterprise – but with an eye towards customer realities and genuine skills needs. Guests are free to call BS on Jon, and each other – a dash of enterprise humor is always welcome.

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    EMplify by EB Medicine

    EMplify by EB Medicine

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    Since Jan 30, 2017 12:42 UTC

    Get quick-hit summaries of hot topics in emergency medicine. EMplify summarizes evidence-based reviews in a monthly podcast. Highlights of the latest research published in EB Medicine’s peer-reviewed journals educate and arm you for life in the ED.

    Show Notes
    Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta.
    Nachi: For our regular listeners, you probably noticed a lapse in recent episodes as we pulled away from our usual monthly releases.
    Jeff: With both of us having increasing demands on our time — myself with business school and the busiest 21 month old in the world and Nachi with yet another entrepreneurial endeavor on the horizon — we decided that it would be best to pass the podcast on to another host, so EMplify can continue to create and deliver the high quality materials that you deserve.
    Nachi: We have obviously really enjoyed creating this podcast and working closely with EB Medicine to produce it. We are deeply appreciative of you, our listeners, and your wonderful feedback and comments over the years. Without you, there would be no point in us working so hard on this.
    Jeff: And keep the feedback coming as we hand the reins to Dr. Sam Ashoo as the new host of EMplify. Dr. Ashoo is an Emergency Physician based out of Tallahassee Florida with a keen interest in informatics who has been featured on several other podcasts you may have heard. We can’t think of a better person to take over for EMplify. I’m sure you’ll really like him and the content he produces. Well, with that, let’s get started on our final scheduled episode of EMplify!
    Nachi: As we are just about to see one of the busiest travel days of the year, that would be the Wednesday before Thanksgiving, we thought there would be no better time to discuss the September 2019 issue of EMP: Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls.
    Jeff: This was a fantastic issue, thanks to the hard work by Drs. DeLaney and Greene, both of the University of Alabama Birmingham School of Medicine. Thanks as well to the peer editors, Dr. Knight, and Dr. Hill of the University of Cincinnati.
    Nachi: And I think you have a bit of a disclosure for this month…
    Show More v

    Jeff: Well, this is a first! Finally at the point in my career where I can announce a disclosure, though it’s more of a potential conflict of interest than an actual disclosure, but certainly still worth noting. I currently spend some of my time working for STAT-MD – which is an airline consultation service run by the Center for Emergency Medicine and UPMC. Though I’m certainly a junior member of the team, in some sense, I’ve responded nearly 500 inflight emergencies over the last two years.
    Nachi: And this definitely places you are in a particularly nice position to share some information with our listeners this month, and I’ll have some questions scattered throughout the episode for you too.
    Jeff: Sounds great, so let’s dive in, starting with what I think is the most important point – qualified, active, licensed, and sober providers should volunteer to assist in the event of a medical emergency rather than decline out of fear of medicolegal concerns.
    Nachi: I couldn’t agree more, so let me reiterate, please trust the evidence. And volunteer to help should you hear the call. We’ll get to this in a bit but there is little medicolegal concern and you owe it to the sick passenger to help.
    Jeff: So what are the chances you are called – well, they are not particularly high, but certainly not negligible either. In 2019, of the 4 billion passengers expected to fly, there will be an estimated 60,000 medical emergencies. That means there will be about 1 emergency per every 604 flights.
    Nachi: So, I fly about 4 times a month for work. At 4 times per month, over the next 12 years I can expect about one medical emergency. Already excited! Let’s start with some physiology. Cabin pressurization varies, but is typically equivalent to an altitude of 8000 feet.
    Jeff: And this has a huge effect, in one study of healthy volunteers, this change in pressure resulted in a 4-10 point decrease in oxygen saturation and a 35 point drop in arterial oxygen partial pressure from 95 mm Hg to 60.
    Nachi: In another study of healthy volunteers on a long haul flight, this change caused 7% of passengers to report symptoms consistent with acute altitude illness.
    Jeff: Due to the principles of Boyle’s law, decreased cabin pressure also causes expansion of gases within anatomical spaces in the body such as the eye, GI tract, sinuses, middle ear, etc. This expansion can potentially threaten surrounding structures.
    Nachi: So there must be guidelines for those recent post-op for flying – right?
    Jeff: There certainly are, but I don’t think we need to get into the weeds on this one since nobody listening will likely be doing pre-flight screenings. I think one thing to remember here, is that though cabins are pressurized to several thousand feet, they CAN be pressurized even further if necessary. The airlines don’t do this because it takes a tremendous quantity of fuel to do so, but if pressurization will defer a diversion, this option may peak their interest. Though an anecdote, the only time I’ve ever suggested it is on a flight from someone recent post-op eye surgery who went blind midflight. We pressurized the cabin from 8000 to 4000 and then finally to sea level and his vision returned. Pretty cool stuff. But getting back to the text, next we have air quality. Only 50% of inflight air is recirculated, all of the flow is compartmentalized between sections of rows, and all the air is run through a HEPA filter. The authors note that the air is actually comparable to that of an operating room.
    Nachi: Then why are people always getting sick after flying…?
    Jeff: Well it’s hard to prove, but experts believe that most post flight respiratory illnesses are likely caused by exposure to fomites on high-risk surfaces of airplanes and in airports – like the trays on the seat back.
    Nachi: Interesting.
    Jeff: It’s also worth noting that the air is quite dry, though this is unlikely to produce any clinically significant events. Most of the dehydration that occurs is more likely due to inadequate water intake and excess caffeine and alcohol consumption depending on the time of day.
    Nachi: Don’t judge. Even though it may be 8 am, some of our night shift locums friends may prefer an airport cocktail after a long week away.
    Jeff: Oh I’m definitely not judging, facts only over here. Anyway, let’s move on to a little epidemiology.
    Nachi: Syncope and cardiac events account for a large proportion of in-flight emergencies, with cardiac events accounting for the largest percentage of diversions.
    Jeff: Gi, endocrine and respiratory emergencies follow syncope and cardiac events, with specific percentages varying based on which study you look at.
    Nachi: Thankfully obstetric emergencies are relatively rare, accounting for less than 0.1% of all emergencies.
    Jeff: Trauma and substance abuse related complaints have also been reported, but represent only a small percentage of inflight emergencies.
    Nachi: I think that covers the main pathologies you may encounter. Next we should touch upon the actual responders. Physicians reportedly respond 44% of the time, followed by nurses at 20% and EMS providers at about 4%. Interestingly, despite physicians being there only 44% of the time, they were involved in the care for over 70% of diversions.
    Jeff: It might seem crazy, but that’s definitely my experience. Many physicians, especially non-ED physicians are not familiar with caring for the acutely ill. Additionally, most physicians are very uncomfortable actually witnessing someone syncopize and then immediately checking vitals and finding the passenger to be bradycardic and hypotensive as is the case with many patients immediately after a vasovagal syncopal episode. I cannot tell you how many times we get called by pilots considering diversion based on a physician’s request only to have the symptoms completely resolve in just 10 minutes. Be patient, this is a common in flight pathology.
    Nachi: Your experience has not failed you – data from your own group showed that 31% of cases resolved before arrival. Even in cases where EMS was requested, patients were only transported 37% of the time and of those, only 8% were actually admitted for further work up. Death is also a very rare phenomenon, occurring in only 0.3% of cases.
    Jeff: Alright, so let’s move onto the actual logistics of responding. Each airline has its own protocols and policies with respect to medical responders – some will require credentials, others may not. In some instances, you may be the first responder, in others, the flight crew may have already been in contact with their ground based medical control.
    Nachi: In terms of supplies, the FAA requires an emergency medical kit and an AED on all commercial flights. These kits cannot be opened without direction from a medical professional on the ground or on board.
    Jeff: And while airlines may add additional drugs at their discretion, the FAA mandates certain supplies. You can remember these supplies by thinking of the 5 A’s – asthma, allergy, altered mental status, ACS, and ACLS. The 5 As should help you remember the bronchodilators, epinephrine, antihistamine, dextrose, nitroglycerine, aspirin, and lidocaine as the one antiarrhythmic available. Of course, there are also gloves, an IV start kit, and a few other basic supplies.
    Nachi: AEDs are also required and have been since 2001 and amazingly when a shock was delivered in flight, 40% survived to hospital discharge with a good outcome.
    Jeff: Just as on the ground, shockable rhythms do well with good BLS care. And lastly, airlines also have a portable oxygen tank in addition to the emergency oxygen that is stored in the event of cabin depressurization. The exact quantity varies, but portable cylinders are certainly available.
    Nachi: So next we have to talk about a topic that I’m sure many of you have wondered about – what are the medico-legal risks of intervening?
    Jeff: As with most incidents of concern over medico-legal risk, we really just shouldn’t be too concerned over the potential legal ramifications. Though we’ll get into specifics, the short answer is that you should definitely volunteer your services – there are lots of protections in place with a paucity of case reports of legal actions against medical volunteers who volunteers in flight.
    Nachi: Perhaps most importantly, remember that ultimately the captain is in charge and you are functioning in a strict advisory capacity. Remember that most airlines can handle most emergencies with their ground based medical control, their typical staff, and predefined protocols – you are an added bonus.
    Jeff: For many ED providers, functioning as a consultant will be unfamiliar.
    Nachi: If I’m a consultant, I’m going to demand a WBC before seeing the patient, as I’m fairly certain that’s rule number 1 in consultant school…
    Jeff: It’s actually rule #12, now get out of your seat and come see the patient…. But back to medicolegal issues. In the US, health care professions are protected by the good Samaritan law and the 1998 federal aviation medical assistance act.
    Nachi: The Good Samaritan law provides legal protection to medical providers who perform their services in response to medical emergencies outside of the hospital. The exact verbiage of the law differs from state to state, but all 50 states have some version of it in their legislation.
    Jeff: Similarly the aviation medical assistance act applies to “medically qualified individuals and offers broad medico-legal protection to the airlines in the event that a medical volunteer is accused of malpractice as well as to medical providers who respond to an in-flight emergency.”
    Nachi: More specifically, the act states that “…an individual shall not be liable for damages arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.”
    Jeff: That’s a bit of a mouth full to get out. But basically, you need to remember that the AMAA protects you from everything shy of gross negligence. Because of this, there have been no reports to date of a medical professional falling below that standard.
    Nachi: There is one caveat to all of this though: don’t forget about your own mental status – for example if you have taken any sleeping aids or had any alcoholic drinks. Though this may not preclude you completely from rendering care, do so only with extreme caution.
    Jeff: And I don’t think we were clear enough about this up front. Up until this point we have mostly talked about US based flights. Flights run by International airlines are a somewhat different ball game for a number of reasons. First, medication kits will vary widely. Many will carry medications similar to those mandated by the FDA, but there certainly is no international standard. Next, the availability of ground based medical consultation is similarly widely variable, with many in the middle east contracting for this service and almost no airlines in Africa offering such services.
    Nachi: And lastly, with respect to legal risk – the international laws also vary widely. According to French law, for example, a French physician who does not volunteer may be committing willful negligence. Similar laws exist in Germany, Australia, and Canada. However proving you were there and refused to provide care would be quite difficult. And lastly, it’s unclear how to determine which countries’ laws apply when – for example, is it the sending country’s laws, the receiving country’s laws, or the country whose airspace you are currently in?
    Jeff: All excellent points. Next, we are moving to my favorite topic of the article – diversion. This is a tremendously complicated topic and I think the authors handled it quite well. Remember, the decision to divert is multifactorial and you are only there to communicate your medical opinion about the passenger – leave the decision for diversion up to the flight crew. I cannot stress this enough. Getting on the radio with the pilot and ground based medical control and demanding a diversion is often very unhelpful and simply not the right approach and can really be quite costly.
    Nachi: All of this is so interesting. I can’t believe you do this and divert planes…. Can you go into a bit more detail about everything the pilot considers when they are deciding to divert?
    Jeff: So there’s quite a bit, but I can touch on some of the main considerations. First, you have to consider the medical needs of the passenger – can he or she be temporized to get to the destination? Is there a suitable airport for diversion with an accessible local hospital with the required resources? Logistically, you need to find an airport that can not only safely accommodate the plane you are on but also one in which the airline can refuel and guarantee that the passengers and crew are safe. Remember, if you are on an A380, there are only so many airports with runways long enough for a safe landing. Fun fact: planes also take off heavy – with tons of fuel that will be burned prior to landing. Say you were to take off from London, bound for the US. To turn around and land back at London Heathrow, you may have to literally dump thousands of gallons of fuel to get the plane to a safe weight for landing. Alternatively, you may have to fly in circles for some time to burn fuel off in planes that cannot dump. A heavy landing necessitates a thorough maintenance overhaul of the landing gear and can cost the airlines not only money but significant time, which is equally as valuable.
    Nachi: Speaking of cost – while exact costs are unknown, one airline estimates that the cost can be as high as $600,000 – we are not dealing with small numbers here…
    Jeff: No definitely not. That’s why it’s so frustrating when medical volunteers demand the plane divert without talking through the medical scenario with the crew and ground based control – often temporizing measures are adequate.
    Nachi: And we alluded to this earlier – Physicians advise diversion more frequently at 9% of the time followed by EMS providers and nurses. When the airlines are left to their own means, they divert at rates roughly half that – just 5% of the time. At half a million dollars for some diversions, and an overall very low level of morbidity and mortality, a 50% reduction amounts to massive savings for possibly no clinical difference.
    Jeff: I can’t stress this enough – you are a consultant, helping the captain and the ground based medical control to come to most appropriate plan of action. When your advice causes the airlines to deviate from their standard protocols, that’s where they potentially run into trouble.
    Nachi: There are just two controversies to discuss this month and I actually think they are extremely pertinent. The first one relates to using personal medication or medications from other passengers. Given the relative paucity of medications in most airline medical kits, it may occur to you that someone else may have a helpful medication on board. While there is no strict rule against this, it could result in an increased level of scrutiny if there is an adverse event. So consider this a last resort.
    Jeff: The next controversy to discuss is the issue of gifts. There is a widespread belief that accepting gifts from the airlines would void legal protections. To date, there is ample airline-based data to suggest that medical providers’ legal protections are not negated in the event that the airlines wanted to reward a medical volunteer. Additionally, there are no reported cases of providers losing legal protection for receiving compensation for their services in flight.
    Nachi: Interestingly, some international carriers even offer points or other bonuses for registering as a medical volunteer. While I’m hesitant to call this controversy a myth, it seems like there isn’t much evidence to support it.
    Jeff: Agreed, don’t expect a gift, but if you do receive one, you can keep it and enjoy it without concern for your legal protections.
    Nachi: Alright so that wraps up the new material for this special edition of EMplify – let’s close out with some key points and clinical pearls.
    Jeff: Aircraft cabins are typically pressurized to about 8000 ft, resulting in a 4-10 point drop in oxygen saturation in healthy adults as well myalgias, fatigue, and generalized discomfort on long haul flights.
    Nachi: Only 50% of the cabin air is recirculated. When recirculated, it is subjected to HEPA filtration, which is adequate to prevent infection by airborne pathogens but not the infectious respiratory viruses, which are spread by droplets.
    Jeff: Dehydration on long flights is likely due to inadequate water intake and the increased use of diuretics such as caffeine and alcohol.
    Nachi: There is about 1 in-flight emergency per 11,000 passengers or 1 in 604 flights. Syncope and cardiac events are most common followed by GI, respiratory, and neurologic events.
    Jeff: Most in-flight emergencies are minor. When EMS is requested upon arrival, roughly 1/3rd are transported and less than 10% are admitted, with mortality estimated at 0.3% of cases.
    Nachi: AEDs are required on all US-based flights.
    Jeff: Airlines have a limited supply of supplemental oxygen for use in medical emergencies in addition to that provided to the entire plane in the event the cabin becomes depressurized
    Nachi: All US airlines have some form of ground-based medical assistance. Ultimately any decisions are the responsibility of the pilot in command – medical volunteers function in a strictly advisory capacity.
    Jeff: Medical volunteers are protected by both the Good Samaritan law and the 1998 Aviation Medical Assistance Act.
    Nachi: The Aviation Medical Assistance Act protects medically qualified individuals, unless they are guilty of gross negligence or willful misconduct.
    Jeff: International laws and protections vary widely. In some European countries, for a physician to not offer their services during an in-flight emergency may constitute willful negligence.
    Nachi: The decision to divert is multifactorial and can cost as much as $600,000 in some circumstances.
    Jeff: When physicians and EMS providers respond to in-flight emergencies, diversion rates are nearly double that of when the airlines work solely with their ground based support, increasing diversion events from 5% to 9%.
    Nachi: It is largely a myth that accepting any gift or payment after responding to an in-flight emergency would void your legal protections; the AMAA has no language regarding compensation and to date there are no such reported cases of lost legal protection.
    Jeff: And that’s the end of this months episode of EMplify: Assisting With Air Travel Medical Emergencies. This also marks the end of our run as your hosts. Over the past 3 years, we’ve thoroughly enjoyed hosting EMplify and having the unique opportunity to share high quality evidence based medicine with you all. As health care continues to move towards a quality over quantity paradigm, understanding evidence based practice will be increasingly more important.
    Nachi: We thank you all for giving us your ears and your time to help hone your clinical practice. Naturally, a big thanks also goes out to all of the contrubutors to Emergency Medicine Practice — authors, peer reviewers, and of course the kind and thoughtful staff at EB Medicine.
    Jeff: We have no doubt that Dr. Ashoo, who will be taking over, will keep you on the edge of your seat as he brings new material to you. Couldn’t be more excited to have him as our successor.
    Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s – make sure to use the code APP4 at checkout to save 50%.
    Jeff: The [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net.

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  • Coming Up

    Werk It: The Podcast

    Werk It: The Podcast

    by

    Since Jun 23, 2016 04:00 UTC

    The Werk It festival brings together women from around the world who host, produce, edit, sound design and love podcasts, for a few days of workshops, conversations and presentations. This podcast is the on-demand version of the live event. Think of it as the ICYMI, FOMO version for podcast geeks everywhere. We’ve kept only the best stuff in. Our episodes are in no particular order, so you can dive in and out and just explore, on your own time. If you’ve got a long road trip, go ahead and binge listen! If you’ve got a 20-minute commute, we’ve got something for that, too! Final thought: This podcast is for everyone; the voices you’ll hear belong to women, but the messages are universal. WNYC Studios is the producer of other leading podcasts, including Radiolab, Death, Sex & Money, Nancy and many more.

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  • Coming Up

    Mr. B’s Social Studies Podcasts

    Mr. B’s Social Studies Podcasts

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    Since Sep 18, 2012 03:55 UTC

    Mr. B’s student based and student created podcasts.

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  • Coming Up

    100 Reasons 4 College Podcast

    100 Reasons 4 College Podcast

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    Since Jun 1, 2018 00:57 UTC

    Welcome to the 100 Reasons 4 College Podcast podcast, where college students share their hacks, tips and experiences of how to win in college.

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  • Now

    History. Rated R.

    History. Rated R.

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    Since Jan 12, 2022 19:16 UTC

    Let’s be honest. History is full of f*cked up sh*t. But what are we gonna do, pretend like it never happened? Have a drink with your host, actor and writer Will Sterling, and his more qualified former Presidential Speechwriting co-host, Dr. Craig Smith. They unpack the silly, salacious, scandalous, and serious stuff in history. If we don’t learn from the past, we’re doomed to repeat it. So let’s at least try to do it with honesty and, wherever possible, a laugh. Francisco Franco was the dictator who couldn’t be killed! By time at least. Dude ran the country from the 40’s to the 70’s. During his reign he also managed to keep Spain out of WWII, which we guess is okay. But more importantly, Argentina’s superstar and inspiration for the hit musical, Evita makes a STRONG guest appearance. Much more important than shitty dictator Frank.

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