Hello and welcome back to ACRAC, I'm Jed Wolpa and this is the 200th episode of ACRAC.

It's been five years and 200 episodes since I started and it has been quite a ride and I thought that for the 200th episode I would respond to some commonly asked or I guess really a commonly asked audience question which is what are my favorite episodes or most memorable episodes over the past five years and so to commemorate this landmark episode I'm going to go back through a little tour from episode one all the way up through

this current episode 200 and just talk about some of the highlights along the way. Now first let me say that I'm definitely not going to talk about all 200 and there will be plenty of episodes I will skip over that were still wonderful and that those guests were fantastic. I don't want anyone to feel slighted in any way but what I'm going to try to do is just highlight for you some of what I really think of as the key moments key episodes that have really stuck out for me.

Before I start let me just say that I am incredibly grateful to all of you for being listeners many of you from the beginning for all of the wonderful comments emails that have come in over the years from all over the world it is really been an incredible pleasure to get to read those to communicate with many of you and to know how much this has really impacted many people out there it is absolutely fantastic.

It's a ton of work but it's that kind of stuff that makes it all worthwhile. All right, so let's go back to 2016. It was April I think of 2016 so you know very close to exactly five years ago when I started this whole thing and many of you know the story but I had no idea what I was doing I had always kind of thought of this having started off an emergency medicine and listening to MRAP I had always thought man we need something to do.

Something like this and anesthesiology but you know didn't know what I was doing had thought about trying it but just didn't know how to do it and I had finally finished residency I was a couple years into attending I was getting more and more involved in the residency program here and I thought to myself you know this would really be so valuable and then the program director at the time my predecessor came to me and said you know hey do you know about any audio resources our residents keeps asking for more audio resources and I thought all right well at that.

That's not a sign I don't know what is I should make this happen of course the problem was I had no idea how to make it happen but I thought you know what I'm sure I can figure out how to record myself doing something and so I just took a talk that I was giving anyway in person on the properties and laws of volatile anesthetics and I figured out how to record it on my computer now I had no nothing in the way of microphone it was just me in my laptop.

I opened up garage band after and this was no small thing it took me quite a while to read and watch on YouTube how to even make garage band work not that it's complicated I just have no technical ability whatsoever but I figured it out and I opened up garage band I pushed record and I just started talking and the if you go back and listen to that first episode the sound quality is horrendous I did not have a microphone I was just talking.

But I got it recorded I know what to do with it so what I did is I turned it into an MP3 and I just emailed it out to my residents at the time and I said you know here you go if you're interested feel free to listen and some of them came back to me and said you know this is fantastic you need to put this online you should make this available like on iTunes and I had no idea how to do that but got some really wonderful help from some of the residents and figured out how to do it how to make a website how to put that way.

I had a website online how to get things recorded and uploaded into the internet and that was the birth of a crack it since has undergone some changes new website different logo that logo we had a whole logo contest and chose a winner and really is very nice much nicer than what had come initially from me playing around on Photoshop.

It's gone through a lot of changes we've even got a team of really wonderful folks now who are helping out and I think the show notes have been incredible Brian Park has done an amazing job with those even making them interactive and the rest of the team April and Kimia have also done an incredible job so it's just been a great journey let's go through some of the episodes so it talked about the first one and how that that was quite an adventure.

The fourth episode I'm pretty sure I'm right here that it's the fourth one that somehow managed to be recorded in such a way that it only plays in one year when you listen to it on earphones and I still to this day don't know how that happened and I still get emails of people saying you know I think something's wrong with episode four I can only hear it on one ear and I say yeah it's definitely true and I have no idea how to fix it and it will probably never get fixed but it may just be one of those classic aircraft.

Blunders that will always live on so that's episode four the episode six was the Paraglossal approach to intubation and that was really significant because it's probably one of the most commonly cited by my own residents they will bring it up they want to try the Paraglossal approach

and I just remember being so taken aback when I learned this as a resident and I think I tell the story on that episode but I was in the OR with an attending from either Australia or New Zealand and he said

you know and I was a CA three and he said you know do you want to do the Paraglossal approach with the Miller and I said the what and he said yeah the Paraglossal approach and I couldn't believe there was an approach to intubation that I had never heard of and I was a CA three

and yet here it was so he told me what it was I tried it I really loved it and then now of course I did an episode on it and I teach it to residents and people really like it.

It's a nice approach and something to have in your back pocket and I love that it was this thing that I just had never heard of and it just goes to show you that you should never assume you know a lot.

You should always assume there's stuff out there even within your own field of expertise that you don't know about and be looking for because how fun to have learned this new thing.

Alright, episode 11 was one of my personal favorite topics hyperoxia and I love this for a variety of reasons but most significantly because I love things where we do think we do something because it's how it's always been done and yet it's not what the evidence would suggest is the best way to do it and for me hyperoxia is just one of the real examples of this.

We kind of have for a long time in medicine thought of oxygen as just a totally benign intervention that has only upsides and no downsides with the exception of newborns where clearly high levels of oxygen can be harmful but for adults it was just thought of I mean not long ago when I was in medical school the idea of putting a nasal cannula on people was just there was no one ever brought up a downside of that.

And certainly for example if somebody came into the ED with cardiac ischemia or any concern for cardiac ischemia no matter what they would be setting 100% and one of the first things you were taught to do was put oxygen on give them oxygen and I also love this because it makes so much sense when we think about it right oh their heart doesn't have enough oxygen so we should give them some more it's just so logical and yet it's totally wrong and that's what I love.

I love examples where we are so wrong about things we think we're so right about and this is one so I loved this I love talking about it I talk about it when I'm in the ICU and you know we'll have a patient on the vent they're on 40% oxygen and their PO 2 is 180 and you know everyone thinks they don't think twice about it right they look at the ABG they read the ABG and they say great ABG and I say well there's one real problem with that ABG right everyone's looking and they're like well wait a second.

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