English, Health / Medicine, 1 seasons, 150 episodes, 3 days 21 hours 7 minutes
Critical Care Scenarios
English, Health / Medicine, 1 seasons, 150 episodes, 3 days 21 hours 7 minutes
Join us as we talk through clinical cases in the ICU setting, illustrating important points of diagnosis, treatment, and management of the critically ill patient, all in a casual, "talk through" verbal scenario format.
TIRBO #49: The universal acuity equation
Explaining the ultimate expression of prognosis: Morbidity = (Severity x Duration)/Reversibility
29/11/2023 • 0
Lightning rounds #34: … When?
When should you…
22/11/2023 • 47 minutes 47 seconds
TIRBO #48: Choosing a line site
Which site should you select for your central line placement? A discussion of some considerations.
15/11/2023 • 16 minutes 33 seconds
Episode 67: Whipples with Michael Cavnar
We learn about pancreaticoduodenectomy (the Whipple) with Michael Cavnar (@DrMikeCavnar), surgical oncologist at University of Kentucky, with a fellowship in Complex General Surgical Oncology from Sloan Kettering. He specializes in GI surgical oncology (liver, pancreas, stomach, etc), with ongoing research in GI stromal tumors and hepatic artery infusion pump chemotherapy. Find us on Patreon here! … Continue reading "Episode 67: Whipples with Michael Cavnar"
08/11/2023 • 43 minutes 12 seconds
TIRBO #47: Why do we prone?
A review of the physiological and practical reasons to position patients with ARDS in the prone position.
01/11/2023 • 20 minutes 7 seconds
Lightning rounds #33: Transitioning to academics with Janelle Bludorn
We chat with Janelle Bludorn (@JanelleRBlu), former emergency medicine PA, Assistant Professor and Academic Coordinator at the Duke PA program, about transitioning from clinical work into teaching and academia. Find us on Patreon here! Buy your merch here! Resources
25/10/2023 • 54 minutes 19 seconds
TIRBO #46: Being curious
The value of being curious about practice differences, not judgmental.
18/10/2023 • 6 minutes 24 seconds
Episode 66: Aortic dissection with Travis Hughes
We explore aortic dissection with Travis Hughes, vascular surgery fellow from the University of Kentucky, including classification, medical management, and nuances of the surgical perspective. Find us on Patreon here! Buy your merch here! Takeaway lessons
11/10/2023 • 52 minutes 54 seconds
TIRBO #45: SBT failure phenotypes
What are the ways that patients fail breathing trials, and what can they tell us about how to optimize them for next time?
04/10/2023 • 13 minutes 32 seconds
Lightning rounds #32: Creating a POCUS system with Leon Chen
We chat with Leon Chen about his work setting up infrastructure for clinical POCUS at Memorial Sloan Kettering. Leon is an Adult/Gerontology Acute Care Nurse Practitioner in the ICU, Clinical Program Manager of Research and Simulated Learning, and an Associate Professor at Columbia University School of Nursing. Find us on Patreon here! Buy your merch … Continue reading "Lightning rounds #32: Creating a POCUS system with Leon Chen"
27/09/2023 • 1 hour 4 minutes 44 seconds
TIRBO #44: The things I carry
A brief discussion of the stuff in your pockets as you practice medicine.
20/09/2023 • 13 minutes 21 seconds
Episode 65: Obstructive UTI with Ashley Winter
We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter (@AshleyGWinter), board certified urologist with a fellowship in male and female sexual medicine, and chief medical officer of Odela Health. Find us on Patreon here! Buy your merch here! Takeaway lessons
13/09/2023 • 41 minutes 17 seconds
TIRBO #43: Lying to ourselves (the clinician’s perspective on end-of-life care)
From the Critical Concepts blog, thoughts on our personal biases and lack of humility when contemplating end-of-life decision making.
06/09/2023 • 18 minutes 49 seconds
Lightning rounds #31: How to not get fired
Bryan and Brandon chat about holding down jobs, conflict resolution and interpersonal skills, and how to protect yourself as an employee.
30/08/2023 • 49 minutes 13 seconds
TIRBO #42: The mobile locus of control
When are patient outcomes your fault?
23/08/2023 • 7 minutes 56 seconds
Episode 64: Neurologic POCUS with Aarti Sarwal
We explore the cutting edge practice of point-of-care ultrasound of the brain, including optic nerve sheath measurement, transcranial doppler, assessing midline shift, and more, with Aarti Sarwal, neurologist and neurointensivist, director of the neurocritical care unit at Wake Forest, and director of their neurovascular lab and ultrasound courses. Find us on Patreon here! Buy your … Continue reading "Episode 64: Neurologic POCUS with Aarti Sarwal"
16/08/2023 • 43 minutes 50 seconds
TIRBO #41: Tissue compression and elasticity during procedures
Dealing with the good and bad aspects of tissue mobility during percutaneous procedures.
09/08/2023 • 10 minutes 56 seconds
Lightning rounds #29: Making APP and physician collaboration work, with Matt Siuba
We chat with friend of the podcast Matt Siuba (@msiuba), Mr. Zentensivist, to share our distinct perspectives on the relationship between APPs (PAs or NPs) and the intensivists we work alongside.
02/08/2023 • 1 hour 12 minutes 8 seconds
TIRBO #40: Ventilating the breathing patient
The dilemma of lung-protective ventilation in patients with strong spontaneous breathing.
26/07/2023 • 15 minutes 36 seconds
Episode 63: Understanding dialysis, with Paul Adams
We dive into when to initiate renal replacement therapy, the modalities, settings, and physics involved, troubleshooting problems, and more, with Dr. Paul Adams, a dual-trained nephrologist and intensivist at the University of Kentucky. Find us on Patreon here! Buy your merch here! Takeaway lessons
19/07/2023 • 52 minutes 38 seconds
TIRBO #39: 5 rules for clinical excellence
5 things you pretty much must be doing if you want to be excellent at critical care. See also on the blog: The ten laws of critical care Practicing medicine like an adult
12/07/2023 • 15 minutes 48 seconds
Lightning rounds #28: Online learning with Callie Tennyson
We chat with Callie Tennyson, DNP, ACNP-BC, AACC, CHSE, assistant professor from the Duke University School of Nursing, about the use of the internet and social media for medical education: trends, challenges, and principles for doing it right.
05/07/2023 • 48 minutes 41 seconds
TIRBO #38: Why you should follow up
The value of performing chart checks to see how your patients are doing after your care.
28/06/2023 • 13 minutes 57 seconds
Episode 62: Running a cardiac arrest
Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons
21/06/2023 • 1 hour 14 minutes 3 seconds
TIRBO #37: Remote brains
The importance of using an app to keep notes and establish a second, more reliable medical memory.
14/06/2023 • 15 minutes 29 seconds
Lightning rounds #27: Burnout and career satisfaction
We chat about why people get burned out in medicine, how to weigh the pros and cons of our work, and the right perspective on job satisfaction.
07/06/2023 • 57 minutes 3 seconds
TIRBO #36: Liberty or death
A brief overview and call to arms around the key concepts of ICU liberation.
31/05/2023 • 27 minutes 28 seconds
Episode 61: ECPR with Scott Weingart
We chat with Scott Weingart of Emcrit about the use of crash VA ECMO for the cardiac arrest patient. Check out the REANIMATE course here! Listen to the ED ECMO podcast on ECPR here Find us on Patreon here! Buy your merch here! Takeaway lessons
24/05/2023 • 59 minutes 23 seconds
TIRBO #35: Vent double-triggering
Understanding the causes of doubled vent breaths, including premature/short cycling and reverse triggering, plus a basic approach to managing them.
17/05/2023 • 12 minutes 2 seconds
Lightning rounds #27: Our favorite FOAM
Bryan and Brandon share their favorite podcasts, blogs, social media, and other online channels for medical education.
10/05/2023 • 37 minutes 22 seconds
TIRBO #34: What makes it a central line?
Reflections on the definition of a central line, whether it’s arbitrary, and the clinical implications of making the distinction.
03/05/2023 • 10 minutes 35 seconds
Episode 59: Takotsubo cardiomyopathy with Vincent Sorrell
We look at stress (Takotsubo) cardiomyopathy in the setting of critical illness, with Dr. Vincent Sorrell. Dr. Sorrell is a cardiologist at the University of Kentucky, where he helped develop the Advanced Cardiovascular Imaging Program, and is current Acting Chief of both the Division of Cardiovascular Medicine and the Gill Heart and Vascular Institute. Find … Continue reading "Episode 59: Takotsubo cardiomyopathy with Vincent Sorrell"
26/04/2023 • 48 minutes 26 seconds
TIRBO #33: Positioning patients in bed
When scooching a patient in the bed can make a difference.
19/04/2023 • 15 minutes 31 seconds
TIRBO #32: Approaching bacteremia
What does bacteremia mean to you? A brief overview of how this affects the picture of an infected patient.
05/04/2023 • 14 minutes 21 seconds
Episode 58: Toxic alcohols with Jerry Snow
We look at evaluating the patient with encephalopathy and unexplained anion gap, including the workup and treatment of toxic alcohol poisoning, with guest Dr. Jerry Snow (@ToxicSnowEM), medical toxicologist and director of the toxicology fellowship at Banner University Medical Center in Phoenix. Find us on Patreon here! Buy your merch here! Click here to claim … Continue reading "Episode 58: Toxic alcohols with Jerry Snow"
29/03/2023 • 1 hour 5 minutes 54 seconds
TIRBO #31: Giving better lectures
Some basic tactics for keeping attention in your live talks, presentations, and lectures. Find us on Patreon here! Buy your merch here!
22/03/2023 • 18 minutes 13 seconds
Lightning rounds #26: How we follow the medical literature
We discuss our approach to keeping up with research, learn about new studies, interpret them, and some general thoughts on how to apply new literature to our practice. Find us on Patreon here! Buy your merch here!
15/03/2023 • 50 minutes 17 seconds
TIRBO #30: Experience is lying to you
When the lessons of memory, clinical experience, and time may be more deceptive than instructive. Find us on Patreon here! Buy your merch here!
08/03/2023 • 12 minutes 51 seconds
Episode 57: Hyponatremia with Paul Adams
We tackle the knotty dilemma of diagnosing and treating hyponatremia, with Dr. Paul Adams, a dual-trained nephrologist and intensivist at the University of Kentucky. Find us on Patreon here! Buy your merch here! Takeaway lessons Resources
01/03/2023 • 59 minutes 13 seconds
TIRBO #29: Understanding blood transfusion
A review of the basics of blood donation, storage, typing, screening, matching, and transfusion. Transfusion medicine series at Critical Concepts Find us on Patreon here! Buy your merch here!
22/02/2023 • 21 minutes 59 seconds
Lightning rounds #25: FailureFest! (Why we’re bad and so are you)
A candid discussion of our flaws, mistakes, weaknesses, and errors, and a look at why it’s important to reflect on these things in medicine, acknowledge them, and try to improve. Find us on Patreon here! Buy your merch here!
15/02/2023 • 0
TIRBO #28: How I set PEEP
A review of the methods of PEEP setting, including stress index, PV loops, esophageal manometry, and PEEP tables, and finally my preferred method of driving pressure trials. Find us on Patreon here! Buy your merch here!
08/02/2023 • 32 minutes 53 seconds
Episode 56: Resuscitation psychology with Dan Dworkis
Discussing the psychology of emergency response, team dynamics, and debriefing with Dan Dworkis, MD, PhD, FACEP. He’s the Chief Medical Officer at the Mission Critical Team Institute, a board-certified emergency physician, and an assistant professor of emergency medicine at the Keck School of Medicine of USC where he works at LAC+USC. He performed his emergency … Continue reading "Episode 56: Resuscitation psychology with Dan Dworkis"
01/02/2023 • 1 hour 13 minutes 40 seconds
TIRBO #27: The halo effect
An important cognitive bias in medicine, and how the COVID pandemic has shown us that generalizing the assumption of competence is a treacherous pitfall. Find us on Patreon here! Buy your merch here!
25/01/2023 • 18 minutes 41 seconds
Lightning rounds #24: Getting into leadership roles
After our recent episodes on publishing papers and giving talks, we close off with a review of leadership and academic rank: sitting on committees, educational roles, faculty appointments, and more. Find us on Patreon here! Buy your merch here!
18/01/2023 • 54 minutes 1 second
TIRBO #26: RadioPEEP discordance
On today’s TIRBO: A sinister pitfall that may lead you to injuring lungs and worsening outcomes. Find us on Patreon here! Buy your merch here!
11/01/2023 • 15 minutes 40 seconds
Episode 55: Undifferentiated encephalopathy and autoimmune encephalitis, with Casey Albin
How to evaluate the patient with unexplained encephalopathy, and a practical approach to diagnosing autoimmune encephalitis with an emphasis on anti-NMDA receptor encephalitis—with Dr. Casey Albin (@CaseyAlbin), neurologist and neurointensivist, assistant professor of Neurology and Neurosurgery at Emory, and part of the NeuroEmcrit team. Claim your CME credit here! Find us on Patreon here! Buy … Continue reading "Episode 55: Undifferentiated encephalopathy and autoimmune encephalitis, with Casey Albin"
04/01/2023 • 1 hour 1 minute 33 seconds
TIRBO #25: Two things NOT to hear
On today’s TIRBO: A couple common lines I’d rather stop hearing people say in the ICU.
28/12/2022 • 9 minutes 49 seconds
Lightning rounds #23: How we do end-of-life care
A general discussion about how we recognize patients are dying, how we steer into discussions regarding goals of care, and the many biases and errors we often bring to the table. Two-part blog post at Critical Concepts on palliative care ICU admissions, including a detailed script for the conversation. Three-part blog post at Critical Concepts … Continue reading "Lightning rounds #23: How we do end-of-life care"
21/12/2022 • 51 minutes 37 seconds
TIRBO #24: Two things people need to hear
On today’s TIRBO, a couple things worth saying when a patient is struck down with unexpected critical illness: it’s going to take time, and it wasn’t anyone’s fault. Find us on Patreon here! Buy your merch here!
14/12/2022 • 12 minutes 47 seconds
Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley
We look at the patient with known pulmonary hypertension admitted for new issues like sepsis and pneumonia, and how they differ from our usual bread and butter, with help from Dr. Raymond Foley, director of the medical ICU and the pulmonary/critical care fellowship at UConn Health, as well as director of their pulmonary vascular disease … Continue reading "Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley"
07/12/2022 • 45 minutes 36 seconds
TIRBO #23: Cultivating clinical calm
Much is made of “staying cool” during emergencies, but what does this really mean? What is calm, what role does it play in a clinical environment, when is it appropriate, and how do we learn it? This and more on today’s TIRBO. Find us on Patreon here! Buy your merch here!
30/11/2022 • 19 minutes 59 seconds
Lightning rounds #22: Our drugs of choice
Bryan and Brandon go through their default, go-to drugs for common clinical indications in the ICU: stress ulcer prophylaxis, empiric antibiotics, hypertension, and more.
23/11/2022 • 57 minutes 42 seconds
TIRBO #22: Understanding “weak” trainees
You have a trainee, orientee, intern/resident/fellow, student, or other learner who just seems slower than the rest. What should that mean to you? A perspective on this week’s TIRBO.
16/11/2022 • 18 minutes 22 seconds
Episode 53: Documentation and coding with Robert Oubre
An exploration of clinical documentation and billing/coding with Dr. Robert Oubre (@Dr_Oubre), full-time hospitalist and CDI Medical Director for a community hospital in southern Louisiana. Takeaway lessons References
09/11/2022 • 1 hour 9 minutes 32 seconds
TIRBO #21: Locating, securing, and dressing lines
How to locate, secure, and dress your lines so they’ll stay put and stay clean.
02/11/2022 • 19 minutes 13 seconds
Lightning rounds #21: CME, merch, Patreon, and other podcast updates
Updates on the podcast, including how to claim credit for continuing education, how to support us by becoming a patron or buying merchandise, and our general perspective on making money through free medical education. Find us on Patreon here! Buy your merch here!
26/10/2022 • 26 minutes 9 seconds
TIRBO #20: Understanding the needle
Understanding the various needles in your central line kit, how to get really, really good at ultrasound guidance, what to do when your view stinks, and more needle-related tips.
19/10/2022 • 35 minutes 30 seconds
Episode 52: Pleural effusions in the ICU with Emily Fridenmaker
Discussing pleural effusions in the critically ill, including how and when to drain them, methods of drainage, interpreting laboratory studies, and managing complications, with Dr. Emily Fridenmaker (@emily_fri), pulmonologist and intensivist at Charleston Area Medical Center in West Virginia. Continuing education for this episode CME credit provided courtesy of Academic CME. To claim your CME … Continue reading "Episode 52: Pleural effusions in the ICU with Emily Fridenmaker"
12/10/2022 • 44 minutes 41 seconds
TIRBO #19: Guidewire safety
Ensuring patient and operator safety with Seldinger guidewires, with considerations such as losing wires, transecting them, and perforating vessels.
05/10/2022 • 19 minutes 2 seconds
Lightning rounds #20: Being efficient
Brandon and Bryan chat about tricks and methods of increasing efficiency and getting things done at work.
25/09/2022 • 53 minutes 40 seconds
TIRBO #18: Mastering dilation
A deep dive into dilation during Seldinger techniques, such as central line placement: tips, pitfalls, and pearls.
18/09/2022 • 26 minutes 39 seconds
Episode 51: Resuscitating and deresuscitating with hypertonic saline, with Sean Barnett
We explore the controversial area of using hypertonic saline to support hemodynamics, protect the kidneys, and facilitate diuresis in the critically ill patient. Our guest is Dr. Sean Barnett, hypertonic aficionado and nephrologist with a focus in critical care. Takeaway lessons The furosemide stress test in the shocked patient is a useful means to assess … Continue reading "Episode 51: Resuscitating and deresuscitating with hypertonic saline, with Sean Barnett"
11/09/2022 • 43 minutes 23 seconds
TIRBO #17: Being cool is a privilege
Ruminations on nursing post-nominals, understated wealth, and how it’s easiest to not show your power when you already plenty of it.
04/09/2022 • 12 minutes 18 seconds
Lightning rounds #19: How to write a journal article
Continuing the discussion from last Lightning Rounds about presenting at conferences, Brandon and Bryan chat about writing for peer-reviewed journals: why, how, and the process from choosing co-authors to choosing journals to navigating the submission.
28/08/2022 • 53 minutes 34 seconds
TIRBO #16: Are PAs as good as doctors?
How do PAs and other APPs compare with physicians in the clinical context?
21/08/2022 • 31 minutes 39 seconds
Episode 50: Rib fractures and surgical plating with Ron Barbosa
We look at the rib fracture patient requiring ICU admission, including a discussion of surgical repair, with Dr. Ron Barbosa (@rbarbosa91), Portland trauma surgeon and SICU director at Legacy Emmanual Medical Center. Takeaway lessons Algorithms and protocols for admitting disposition exist but are generally poorly predictive. ICU admission in rib fracture patients is still most … Continue reading "Episode 50: Rib fractures and surgical plating with Ron Barbosa"
14/08/2022 • 50 minutes 28 seconds
TIRBO #15: Reviewing ultrasound modes
07/08/2022 • 20 minutes 46 seconds
Lightning rounds #18: How to give a conference presentation
Brandon and Bryan chat about academic presentations… how to prepare and submit them, selecting the right venue, giving a good talk, and the elephant in the room: why to do it at all.
31/07/2022 • 1 hour 5 minutes 1 second
TIRBO #14: Trajectories of illness and critical care
How the arc of disease peaks and falls, and how the curve of our care should match it to avoid under- or over-treatment.
24/07/2022 • 14 minutes 43 seconds
Episode 49: Invasive pulmonary aspergillosis with Shmuel Shoham
We discuss invasive aspergillosis, with a focus on when to consider and how to make this difficult diagnosis in the general ICU population—with Dr. Shmuel Shoham (@ShohamTxID), Associate Professor of Medicine at Johns Hopkins, transplant infectious disease physician, and an extensively published expert in invasive fungal infections as well as host of the Transplant ID … Continue reading "Episode 49: Invasive pulmonary aspergillosis with Shmuel Shoham"
17/07/2022 • 44 minutes 21 seconds
TIRBO #13: Hospital relativity
Time is always a factor in the ICU, but some time matters more than other time.
10/07/2022 • 8 minutes 21 seconds
Lightning rounds #17: Reading chest x-rays
Brandon and Bryan share their approaches to the chest x-ray in the ICU. Plus: Bryan’s an FCCM! Here’s the Radiology Masterclass.
03/07/2022 • 44 minutes 53 seconds
TIRBO #12: On heroics (or: is critical care hard?)
Some musings in response to people who are impressed by the work we do.
26/06/2022 • 12 minutes 5 seconds
Episode 48: Undifferentiated hypotension
Brandon walks Bryan through a case of new, unexplained hypotension in the ICU, with a focus on approaching shock, the use of POCUS, and risk stratifying unexplained problems. Takeaway lessons Sudden changes in vital signs or other status are often due to precipitating factors, such as iatrogenic stimuli, whereas more gradual changes are often due … Continue reading "Episode 48: Undifferentiated hypotension"
19/06/2022 • 56 minutes 37 seconds
TIRBO #11: Mastering wire guidance
Advanced techniques for manipulating the guidewire during non-fluoroscopic bedside procedures such as central line placement.
12/06/2022 • 13 minutes 41 seconds
Lightning rounds #16: How we do case-based teaching
Brandon and Bryan talk about how they assemble, implement, and leverage case-based learning, from this podcast to simulation to oral scenarios to internal visualization.
05/06/2022 • 44 minutes 47 seconds
TIRBO #10: Put the I back in Team
When it’s a bad idea to help out others with their work.
29/05/2022 • 7 minutes 38 seconds
Episode 47: ICU triage with Eddy Gutierrez
Discussing ICU triage, risk stratification, and patient disposition with intensivist Eddy Joe Gutierrez (@eddyjoemd) of the Saving Lives Podcast. For 20% off the upcoming Resuscitative TEE courses (through July 23, 2022), listen to the show for a promo code for CCS listeners! Takeaway lessons When a patient has borderline indications for requiring the ICU, generally, … Continue reading "Episode 47: ICU triage with Eddy Gutierrez"
22/05/2022 • 48 minutes 18 seconds
TIRBO #9: Some quotes about why
A selection of lesser-known quotes relevant to the practice of medicine.
15/05/2022 • 15 minutes 9 seconds
Lightning rounds #15: Night shifts
Bryan and Brand talk about night shifts, how to handle them, managing the disruption of your circadian rhythm, and more. For 20% off the upcoming Resuscitative TEE courses (through July 23, 2022), listen to the show for a promo code for CCS listeners!
08/05/2022 • 40 minutes 6 seconds
TIRBO #8: What does skin really tell you about hemodynamics?
The relationship between skin warmth and color, cardiac output, and systemic vascular resistance. For 20% off the upcoming Resuscitative TEE courses (through July 23, 2022), listen to the show for a promo code for CCS listeners!
01/05/2022 • 9 minutes 33 seconds
Episode 46: Neurologic catastrophe and brain death with Casey Albin
We review a case of massive intraparenchymal hemorrhage progressing to brain death, including the process of brain death testing and declaration, with Dr. Casey Albin (@CaseyAlbin), neurologist and neurointensivist, assistant professor of Neurology and Neurosurgery at Emory and part of the NeuroEmcrit team. For 20% off the upcoming Resuscitative TEE courses (through July 23, 2022), … Continue reading "Episode 46: Neurologic catastrophe and brain death with Casey Albin"
24/04/2022 • 1 hour 10 minutes 29 seconds
TIRBO #7: Selecting vasopressors
A practical approach to choosing and escalating vasopressors for patients in shock.
Brandon and Bryan discuss a practical approach to abdominal compartment syndrome: when to suspect it, confirming the diagnosis with bladder pressure or other monitoring, management, and prognosis. Sorry for the audio on this one!
10/04/2022 • 29 minutes 3 seconds
TIRBO #6: The many varieties of subclavian line
Reviewing the different approaches to placing central venous catheters in the subclavian vein.
03/04/2022 • 15 minutes 55 seconds
Episode 45: Amniotic fluid embolism with Stephanie Martin
We discuss the clinical presentation and management of AFE with guests Dr. Stephanie Martin (Twitter: @OBCriticalCare, Instagram: @criticalcareob), medical director for Clinical Concepts in Obstetrics and a Maternal Fetal Medicine specialist in Scottsdale, Arizona with expertise in critical care obstetrics. She is also co-host of the Critical Care Obstetrics podcast. We’re also joined for a … Continue reading "Episode 45: Amniotic fluid embolism with Stephanie Martin"
27/03/2022 • 47 minutes 23 seconds
Episode 44: Physical therapy with Heidi Engel
A look at rehabilitation and mobility in the critically ill, from the perspective of our skilled therapists—with Heidi Engel, PT, DPT of UC San Francisco, long-term provider of acute care therapy, researcher in ICU rehabilitation, and founding member of the SCCM’s ICU Liberation program. Takeaway lessons Tolerance of pressure support ventilation is often a good … Continue reading "Episode 44: Physical therapy with Heidi Engel"
20/03/2022 • 1 hour 9 minutes 2 seconds
TIRBO #5: Tracheoinnominate fistulas
A quick review of tracheoinnominate fistulas: how they happen, what they look like, and most importantly, what you’ll need to do.
13/03/2022 • 9 minutes 53 seconds
Lightning rounds #13: What’s the deal with nurses?
Brandon and Bryan reflect on the qualities that define good and bad ICU nurses, the challenges they face, and how APPs and physicians can enable them to be their best.
06/03/2022 • 53 minutes 40 seconds
TIRBO #4: Hope
Why an assumption in your training should be to call for assistance, but expect it will never arrive. Plan to manage problems yourself. Let help surprise you—otherwise hope becomes your plan.
27/02/2022 • 10 minutes 42 seconds
Episode 43: Resuscitative TEE with Felipe Teran
The hows, whys, logistics, and applications of focused, bedside transesophageal echocardiography performed by critical care and EM providers, with Felipe Teran, assistant professor of emergency medicine at Weill Cornell and director of the Resuscitative TEE Project. Takeaway lessons As a rule, resuscitative TEE is performed in patients with a secured airway. TEE views are not … Continue reading "Episode 43: Resuscitative TEE with Felipe Teran"
20/02/2022 • 56 minutes 21 seconds
TIRBO #3: Weaning vs Titration
When do interventions need to be “weaned”? Stop using this word when you don’t mean it! Titrate, target to effect, but only wean when there is a physiologic dependence.
14/02/2022 • 9 minutes 7 seconds
Lightning rounds #12: Co-managing patients in a surgical ICU
Brandon and Bryan talk about the practicalities of communication, collaboration, and compromise in a surgical ICU, when the surgical and critical care teams are both involved, one is the “primary” team on paper, but everyone needs to be heard.
06/02/2022 • 37 minutes 9 seconds
TIRBO #2: Procedural handedness
When should you place a line or perform other procedures using your left (or non-dominant) hand? Brandon reflects on a few situations.
02/02/2022 • 9 minutes 3 seconds
TIRBO #1: Toughness
The first episode of Brandon’s intermittent solo rants, in this case discussing toughness, stress tolerance, and flexibility in clinical medicine.
27/01/2022 • 20 minutes 11 seconds
Episode 42: Clinical pharmacists with Laura Means Ebbitt
An overview of the role and contributions of a clinical pharmacist in the ICU, with Laura Means Ebbitt of the University of Kentucky, a clinical pharmacist specializing in colorectal/ENT surgery and critical care. Takeaway lessons A clinical pharmacist is a “knowledge pharmacist,” dispensing advice rather than medications. They round with the team to review meds … Continue reading "Episode 42: Clinical pharmacists with Laura Means Ebbitt"
23/01/2022 • 50 minutes 14 seconds
Lightning rounds #11: Reflections on two years of the podcast
Bryan and Brandon look back on the two-year anniversary of the show and reflect on where it’s been, where it’s going, lessons learned, and other deep thoughts.
09/01/2022 • 39 minutes 31 seconds
Episode 41: Preventing and managing complications (part 2) with Matt Siuba
Part two of our discussion with fan favorite Matt Siuba (@msiuba), Cleveland Clinic intensivist, on complications in critical care and how to prevent and manage them. Today we focus on respiratory failure after extubation, and unintentional self-extubation. Takeaway lessons When considering extubation of borderline patients, extubating to high flow nasal cannula or CPAP/BiPAP is often a good … Continue reading "Episode 41: Preventing and managing complications (part 2) with Matt Siuba"
26/12/2021 • 55 minutes 35 seconds
Lightning rounds #10: Physical examination in the ICU
Bryan and Brandon talk about the physical exam: how we apply it in the ICU, its utility and changing role in the setting of modern diagnostic modalities, and its best and most practical use-cases. References McNamara LC, Kanjee Z. Counterpoint: Routine Daily Physical Exams Add Value for the Hospitalist and Patient. J Hosp Med. 2021 … Continue reading "Lightning rounds #10: Physical examination in the ICU"
12/12/2021 • 52 minutes 57 seconds
Episode 40: Making the diagnosis with André Mansoor
Dr. André Mansoor (@AndreMansoor), associate professor of medicine in Portland, Oregon, author of the excellent Frameworks for Internal Medicine, and contributor to Physical Diagnosis PDX, talks us through a complex case of encephalopathy and respiratory failure to illustrate some principles of diagnostic reasoning. Takeaway lessons The hardest part of treating most diseases is making the … Continue reading "Episode 40: Making the diagnosis with André Mansoor"
28/11/2021 • 1 hour 10 minutes 10 seconds
Lightning rounds #9: Notes and documentation
Bryan and Brandon chat about notes: what makes a good one, their many and conflicting purposes, some structures and approaches, system- versus problem-based charting, and more.
14/11/2021 • 57 minutes 4 seconds
Episode 39: ECMO for COVID-19 with Kim Boswell
An overview of VV ECMO with a focus on COVID-19, with Dr. Kimberly A. Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. We discuss evaluating for candidacy, induction, maintenance, weaning, and general approaches to the COVID patient. Takeaway lessons The limited amount of ECMO … Continue reading "Episode 39: ECMO for COVID-19 with Kim Boswell"
31/10/2021 • 58 minutes 13 seconds
Lightning rounds #8: Five things you’re getting wrong
Bryan’s off this week, so Brandon flies solo to explain five wrong-headed notions that many people believe without thinking about them. Are diuretic infusions more effective than intermittent boluses? Are antipsychotic (neuroleptic) agents a good treatment for ICU delirium? Is pressure control or volume control a better form of assist control? Does renal failure cause … Continue reading "Lightning rounds #8: Five things you’re getting wrong"
17/10/2021 • 11 minutes 57 seconds
Episode 38: GI bleeding with Elliot Tapper
Back with returning guest Dr. Elliot Tapper (@ebtapper), gastroenterologist, transplant hepatologist, and director of the cirrhosis program at the University of Michigan in Ann Arbor, to talk about critical GI bleeding. Takeaway lessons Consider the Glasgow-Blatchford score to stratify risk and need for admission, GI consultation, etc. Octreotide (or terlipressin) is indicated in every cirrhotic … Continue reading "Episode 38: GI bleeding with Elliot Tapper"
Discussing a pickle of a topic: outside of academic milestones, how do we recognize, acknowledge, reward, and move towards clinical excellence in medicine after one’s training is complete? In fact… do we?
19/09/2021 • 36 minutes 33 seconds
Episode 37: Airway management for COVID-19
Back again with Dr. Ross Hofmeyr (@rosshofmeyr), anesthesiologist in the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town, to discuss an expert’s perspective on airway management in the COVID-19 patient. Takeaway lessons Good practices for intubating COVID patients are, by and large, good practices for intubating anybody. Using a standardized protocol, … Continue reading "Episode 37: Airway management for COVID-19"
05/09/2021 • 57 minutes 44 seconds
Lightning rounds #6: Point of care ultrasound
We chat about focused, clinician-performed point-of-care ultrasound (POCUS) in the ICU. How do you learn it? What are our favorite applications? What are some of the particulars and caveats surrounding credentialing, documentation, and billing? All that and more…
22/08/2021 • 39 minutes 33 seconds
Episode 36: Preventing and managing complications
Back in the arena with one of our favorites, Matt Siuba (@msiuba), Cleveland Clinic intensivist and Mr. Zentensivism, to discuss complications in critical care and how to prevent and manage them. Today we focus on atrial fibrillation with RVR and bleeding after thoracentesis and related other procedures. Takeaway lessons Rapid atrial fibrillation in the ICU … Continue reading "Episode 36: Preventing and managing complications"
08/08/2021 • 1 hour 3 minutes 9 seconds
Lightning rounds #5: Career development for critical care APPs
Conceiving, planning, and building your career as a critical care PA or NP. Determining if this field is for you, finding your first job, pinpointing your interests or “niche” during your early career, nurturing your growth during the mid-career period, and some thoughts on life and priorities in your late career.
25/07/2021 • 1 hour 8 minutes 7 seconds
Episode 35: When to operate in trauma with Dennis Kim
Looking at trauma from the perspective of a surgeon, with a focus on the perennial dilemma of when a patient needs surgery. Our guest is trauma surgeon Dr. Dennis Kim (@traumaicurounds), associate professor of Clinical Surgery at UCLA and medical director of the Harbor-UCLA Medical Center SICU, as well as host of the Trauma ICU … Continue reading "Episode 35: When to operate in trauma with Dennis Kim"
11/07/2021 • 1 hour 3 minutes 16 seconds
Episode 34: Lightning rounds #4
Wrapping up our series on procedures with a talk about airway management. Who should manage airways in the ICU? What’s the role of intensivists, APPs, anesthesia, etc? What’s the “correct” balance of expertise, distribution of labor, and training? Our general approach to supraglottic airways, mask ventilation, intubation, cricothyrotomy, drugs, assessing airway anatomy, training, and more.
27/06/2021 • 1 hour 3 minutes 8 seconds
Episode 33: Ischemic stroke with Thomas Lawson
Evaluation of ischemic stroke, decisions for tPA and thrombectomy, supportive critical care, and monitoring for cerebral edema—with returning guest Thomas Lawson (@TomLawsonNP), nurse practitioner in the neurocritical care unit at OSU Wexner Medical Center and James Cancer Hospital. Thomas is now also a PhD student at the OSU College of Nursing where he studies the … Continue reading "Episode 33: Ischemic stroke with Thomas Lawson"
13/06/2021 • 42 minutes 56 seconds
Episode 32: Lightning rounds #3
Following up from the last lightning rounds on vascular procedures, we look at non-vascular bedside procedures in the ICU: paracentesis, thoracentesis (including chest tubes), lumbar punctures, and bronchoscopy. How do we tap, what are our tricks, what’s the role of ultrasound, who needs a bronch, and more.
30/05/2021 • 45 minutes 41 seconds
Episode 31: Practical mobility, awakening, and delirium prevention with Kali Dayton
The art of taking a critically ill, heavily sedated, floridly delirious patient on aggressive vent support and pulling them out of the loop of sedation, immobility, and delirium. With Kali Dayton, ACNP-BC (@HomeIcu), critical care nurse practitioner and host of the Walking Home from the ICU podcast, where she looks closely at these issues, including … Continue reading "Episode 31: Practical mobility, awakening, and delirium prevention with Kali Dayton"
16/05/2021 • 1 hour 59 seconds
Episode 30: Diabetic ketoacidosis
Diagnosing and treating DKA, including fluid management, lab studies, insulin management, managing acid-base abnormalities, transitioning off your drips, and all the rest. Takeaway lessons Calculate your anion gap and perhaps your strong ion difference (or bicarb gap). In most cases, consider checking a b-hydroxybutyrate and a lactate to confirm the diagnosis, but hyperglycemia + anion … Continue reading "Episode 30: Diabetic ketoacidosis"
02/05/2021 • 45 minutes 45 seconds
Episode 29: Lightning rounds #2
A vascular access roundtable, discussing our practices surrounding arterial lines, central lines, PICC lines and midlines, and PA catheters. When do we place them? When can they come out? What sites do we like? When (and how) do we use ultrasound? What’s up with the axillary site, why does Brandon hate PICCs, the age-old debate … Continue reading "Episode 29: Lightning rounds #2"
18/04/2021 • 38 minutes 9 seconds
Episode 28: Diuresis, deescalation, and liberation with Matt Siuba
How to take the well-resuscitated critically ill patient, get fluid out of them, deescalate their antibiotics, wean their sedation, reduce vent support, extubate, and get them out of the ICU—with Dr. Matt Siuba (Twitter: @msiuba), an intensivist at the Cleveland Clinic with an abiding interest in “zentensivism,” the art of doing less. Takeaway lessons Portal … Continue reading "Episode 28: Diuresis, deescalation, and liberation with Matt Siuba"
04/04/2021 • 1 hour 6 minutes 7 seconds
Episode 27: Wilderness medicine with Ross Hofmeyr
Management of an alpine medicine scene including discussion of HAPE (High Altitude Pulmonary Edema), HACE (High Altitude Cerebral Edema), and suspension syndrome, with Dr. Ross Hofmeyr (@rosshofmeyr), anesthesiologist in the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town, as well as cofounder and medical director of WildMedix, the oldest wilderness medicine … Continue reading "Episode 27: Wilderness medicine with Ross Hofmeyr"
21/03/2021 • 1 hour 8 minutes 51 seconds
Episode 26: ICU sedation, mobility, and delirium with Dale Needham
How to manage the intubated critically ill patient while keeping them awake, non-delirious, and mobile, with Dr. Dale Needham, FCPA, MD, PhD. Dr. Needham is a Professor of Pulmonary and Critical Care Medicine as well as Physical Medicine and Rehabilitation at the Johns Hopkins University. He is also director of their Outcomes After Critical Illness … Continue reading "Episode 26: ICU sedation, mobility, and delirium with Dale Needham"
07/03/2021 • 45 minutes 8 seconds
Episode 25: Rhabdomyolysis
Initial workup, fluid management, renal replacement, and other subtleties of caring for the critically ill patient with rhabdomyolysis. Takeaway lessons Rhabdomyolysis is defined by elevated levels of creatinine kinase and/or myoglobin in the serum secondary to skeletal muscle breakdown with release of cellular contents. Common causes are crush or compartment syndrome, prolonged downtime on hard … Continue reading "Episode 25: Rhabdomyolysis"
21/02/2021 • 33 minutes 5 seconds
Special episode: Surviving COVID-19 with Eve Leckie
The COVID-19 pandemic will hopefully wind down this year. What happens next with these patients? A powerful discussion with Eve Leckie (@browofjustice), RN, CCRN, formerly of the CVCC at Dartmouth-Hitchcock and now disabled after contracting COVID. Learn about their acute course of illness, the challenges of navigating the healthcare system with this new disease, and … Continue reading "Special episode: Surviving COVID-19 with Eve Leckie"
07/02/2021 • 55 minutes 26 seconds
Episode 24: Rural retrieval medicine with Minh Le Cong
Scene management, logistics, and stabilization of a blunt trauma patient in the Australian outback with Dr. Minh Le Cong (@ketaminh), rural GP and retrieval physician for the Royal Flying Doctor Service and host of the PHARM podcast. Takeaway lessons If there is reasonable suspicion of the presence of a pneumothorax (of any size), have a … Continue reading "Episode 24: Rural retrieval medicine with Minh Le Cong"
24/01/2021 • 1 hour 2 minutes 50 seconds
Episode 23: COVID-19 pneumonia with Nicole King
Best practices in care of the critically ill patient with COVID-19 pneumonia are not known at this time. However, practical lessons from the ground are filtering in from those who have seen many of these patients, and Dr. Nicole King—critical care anesthesiologist, ECMO-ologist at the University of Cincinnati, and alumnus of the New York City … Continue reading "Episode 23: COVID-19 pneumonia with Nicole King"
10/01/2021 • 56 minutes 23 seconds
Episode 22: Aneurysmal subarachnoid hemorrhage with Thomas Lawson
Initial approach, supportive care, risk stratification, and management of the troublesome complications for ruptured subarachnoid aneurysm, with Thomas Lawson (@TomLawsonNP), nurse practitioner in the neurocritical care unit at OSU Wexner Medical Center. Takeaway lessons SAH + shock or hypoxemia = suspect neurogenic pulmonary edema and/or Takotsubo cardiomyopathy. Aneurysmal SAH is much different from traumatic and … Continue reading "Episode 22: Aneurysmal subarachnoid hemorrhage with Thomas Lawson"
27/12/2020 • 45 minutes 43 seconds
Episode 21: Trauma resuscitation with Scott Weingart
A patient with multiple abdominal gunshot wounds, resuscitated before and after damage control surgery by the legendary Scott Weingart (@emcrit): emergency physician, surgical intensivist by way of Shock Trauma in Baltimore, director of an emergency critical care program, and longtime innovator in medical education and FOAM via the EMCrit podcast and blog. Our 1st anniversary … Continue reading "Episode 21: Trauma resuscitation with Scott Weingart"
13/12/2020 • 40 minutes 9 seconds
Episode 20: Post-CABG emergencies with Kris Ramilo and Brendan Riordan
Looking at the workflow of a fresh post-op open heart surgery patient, as well as what to do when it devolves into cardiac tamponade, with (returning) guest Brendan Riordan, cardiothoracic ICU PA (@concernecus) at the University of Washington, and his NP colleague Kris Ramilo (@krsrml0). [Audio quality was a bit dodgy in this one; sorry … Continue reading "Episode 20: Post-CABG emergencies with Kris Ramilo and Brendan Riordan"
29/11/2020 • 55 minutes 10 seconds
Episode 19: Emergency medicine with Seth Trueger
A few rapid-fire cases from the emergency department, with Dr. Seth Trueger (@mdaware), emergency physician at Northwestern University and digital media editor for JAMA Network Open. [Sorry for the shotty audio quality in this one!–eds.] Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. … Continue reading "Episode 19: Emergency medicine with Seth Trueger"
15/11/2020 • 41 minutes 25 seconds
Episode 18: Oncologic emergencies with Leon Chen
A look at oncology-related emergencies in the ICU, with Leon Chen (@CCMNP), NYC nurse practitioner specializing in oncology critical care. Takeaway lessons Extremely elevated leukocyte count should always raise suspicion for a “liquid tumor” such as leukemia. The principal acute complication is leukostasis from poor flow, potentially causing hyperviscosity issues such as stroke, MI, pulmonary … Continue reading "Episode 18: Oncologic emergencies with Leon Chen"
01/11/2020 • 42 minutes 54 seconds
Episode 17: Interventional radiology with Bobby Chiong (part 2)
The second part of our overview of interventional radiology with Dr. Bobby Chiong, board-certified interventional radiologist and chair of radiology at SBH Health System, with a focused look at some common IR procedures, namely abscess drainage and GI bleeding. Listen to part 1 here. Takeaway lessons Common goals would be INR 50k. If … Continue reading "Episode 17: Interventional radiology with Bobby Chiong (part 2)"
18/10/2020 • 22 minutes 29 seconds
Episode 16: Interventional radiology with Bobby Chiong (part 1)
An overview of interventional radiology with Dr. Bobby Chiong, board-certified interventional radiologist and chair of radiology at SBH Health System, with a focused look at what IR’s all about, coordination between care teams, vascular access, and troubleshooting. Takeaway lessons Interventional radiologists can’t do everything, but they potentially can do almost anything, and you usually won’t … Continue reading "Episode 16: Interventional radiology with Bobby Chiong (part 1)"
04/10/2020 • 32 minutes 21 seconds
Episode 16: Lightning rounds #1
Quick takes on common controversies in the ICU, with Bryan and Brandon: Stress ulcer prophylaxis: drug selection, candidates, and when to discontinue Stress dose steroids: candidates, dosing, lab tests, and weaning Titrating PEEP: considering the disease process, PEEP/FiO2 tables, driving pressure trials, and pragmatic approaches
20/09/2020 • 23 minutes 11 seconds
Episode 15: Liver failure with Elliott Tapper
A detailed look at cirrhosis and acute-on-chronic liver failure as we typically see it in the ICU, with Dr. Elliott Tapper, gastroenterologist and transplant hepatologist, and director of the cirrhosis program at the University of Michigan in Ann Arbor. Takeaway lessons When treating liver patients, think infection, infection, infection—and understand that with good care and … Continue reading "Episode 15: Liver failure with Elliott Tapper"
06/09/2020 • 54 minutes 28 seconds
Episode 14: Intracerebral hemorrhage and elevated ICP (part 2)
The conclusion of our scenario of severe intraparenchymal hemorrhage with resulting herniation, with a closer look at neurological exams, prognostication, and the flow of care after initial stabilization, as well as our mindset as caregivers in these psychologically challenging cases. Takeaway lessons Early tracheostomy may not hold concrete benefits for neuro patients (i.e. improved mortality), … Continue reading "Episode 14: Intracerebral hemorrhage and elevated ICP (part 2)"
23/08/2020 • 33 minutes 22 seconds
Episode 13: Intracerebral hemorrhage and elevated ICP (part 1)
A typical case of severe intraparenchymal hemorrhage with resulting herniation. Takeaway lessons DOACs like apixaban (Eliquis), although not usually monitored using routine coagulation assays, tend to elevate the INR only slightly (e.g. 1.0–1.3 or so). A strikingly INR in warfarin-like ranges should raise suspicion for an additional occult cause of coagulopathy. Manage elevated ICPs using … Continue reading "Episode 13: Intracerebral hemorrhage and elevated ICP (part 1)"
09/08/2020 • 32 minutes 48 seconds
Episode 12: Flight medicine with Tyler Christifulli and Sam Ireland (part 2)
Part two of our interfacility transfer from Hell. Tyler Christifulli, FP-C, EMT-P (@christifulli88) and Sam Ireland FP-C, EMT-P (@ireland_sam1) show us how they handle GI bleeding, arrhythmias, shock, cardiac arrest, and more, all from the confines of a helicopter. Listen to Part 1 here. Check out the great educational content from Tyler and Sam over … Continue reading "Episode 12: Flight medicine with Tyler Christifulli and Sam Ireland (part 2)"
26/07/2020 • 43 minutes 37 seconds
Episode 11: Flight medicine with Tyler Christifulli and Sam Ireland (part 1)
A grueling interfacility transfer gives Tyler Christifulli, FP-C, EMT-P (@christifulli88) and Sam Ireland FP-C, EMT-P (@ireland_sam1) the opportunity to show us how they handle airway management, GI bleeding, mechanical ventilation, cardiac arrest, and more, all from the confines of a helicopter. Check out the great educational content from Tyler and Sam over at FOAMfrat, including … Continue reading "Episode 11: Flight medicine with Tyler Christifulli and Sam Ireland (part 1)"
12/07/2020 • 35 minutes 46 seconds
Episode 10: Ventilator dyssynchrony
A restless patient experiences a series of dyssynchrony events during mechanical ventilation. Come see how Bryan wades through it all, and allow us to offer an academic, yet practical approach to this sometimes-confusing subject. Case files Takeaway lessons Start with ABCs and stabilizing the patient, then put on your thinking cap and try to optimize … Continue reading "Episode 10: Ventilator dyssynchrony"
28/06/2020 • 42 minutes 15 seconds
Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 2)
The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Bryan Boling, DNP, ACNP; Kevin Hatton, MD, FCCM; Tonja Hartjes, DNP, ACNP-BC, CCRN, FAANP The podcast The second piece of our in-depth look at the management of right heart failure, with … Continue reading "Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 2)"
14/06/2020 • 31 minutes 14 seconds
Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 1)
The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Bryan Boling, DNP, ACNP; Kevin Hatton, MD, FCCM; Tonja Hartjes, DNP, ACNP-BC, CCRN, FAANP The podcast An in-depth look at the management of right heart failure, with a focus on preserving … Continue reading "Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 1)"
31/05/2020 • 31 minutes 10 seconds
Episode 8: Palliative care with Jessica McFarlin (part 2)
The second part of our look at a case of catastrophic intracranial hemorrhage, with a focus on goals of care, family interaction, prognostication, and other end-of-life aspects, with neurointensivist and palliative care physician Jess McFarlin (@JessMcFarlinMD). See Part 1 here. Takeaway lessons Useful phrase: “Can I tell you what to expect during the dying time?” … Continue reading "Episode 8: Palliative care with Jessica McFarlin (part 2)"
19/05/2020 • 30 minutes 38 seconds
Episode 7: Palliative care with Jessica McFarlin (part 1)
Neurointensivist and palliative care physician Jess McFarlin (@JessMcFarlinMD) walks us through a case of catastrophic intracranial hemorrhage, with a focus on goals of care, family interaction, prognostication, and other end-of-life aspects. See Part 2 here. Takeaway lessons We can undo most things except death, so in most cases, a short trial (perhaps 3 days) of … Continue reading "Episode 7: Palliative care with Jessica McFarlin (part 1)"
27/04/2020 • 29 minutes 33 seconds
Episode 6: Status epilepticus with Gracia Mui
Neurologist and neurointensivist Gracia Mui shows us the workup, initial management, and escalation of care for a case of refractory status epilepticus. Takeaway lessons First-time unprovoked seizures usually need no further workup except screening for an underlying trigger, such as a tox screen, basic chemistries, and imaging as appropriate. Initial seizure therapy: wait around 5 … Continue reading "Episode 6: Status epilepticus with Gracia Mui"
27/04/2020 • 30 minutes 32 seconds
Episode 5: Cardiogenic shock and ECMO with Brendan Riordan
Cardiothoracic critical care PA Brendan Riordan (@concernecus) shows us his initial approach to the patient in cardiogenic shock, including initiating mechanical support, managing ECMO (plus Impella), and eventual weaning and discontinuation of support. Some pearls Anticoagulation on VA ECMO can be titrated to bleeding risk, with a balance between bleeding and circuit longevity—the latter being … Continue reading "Episode 5: Cardiogenic shock and ECMO with Brendan Riordan"
29/03/2020 • 48 minutes 10 seconds
Special episode: COVID-19 brief
A fast-tracked update: what we know about the active pandemic of the novel coronavirus (SARS-CoV-2) and its resulting respiratory syndrome, COVID-19. Takeaway lessons Treat like viral pneumonia/ARDS. High PEEP. Prone early. Keep fluid balance dry. Probably avoid CPAP/BiPAP except perhaps for very short trials. Unclear role for HFNC. Watch out for myocarditis-type picture with cardiogenic … Continue reading "Special episode: COVID-19 brief"
13/03/2020 • 51 minutes 39 seconds
Episode 4: Venous congestion with Philippe Rola
Intensivist and passionate slayer of venous congestion Philippe Rola (@thinkingcc) shows us how to deresuscitate the septic patient, with guidance from his handy ultrasound. Takeaway lessons Fluid overload is harmful and should be actively reduced, even in a patient in active shock; it will not harm them. The VEXUS exam is a good method for … Continue reading "Episode 4: Venous congestion with Philippe Rola"
01/03/2020 • 32 minutes 51 seconds
Episode 3: Refractory ARDS
What stops do you make along the garden path of hypoxic respiratory failure? Resources References An ARDS review: Fan E, Brodie D, Slutsky A. Acute Respiratory Distress: Syndrome Advances in Diagnosis and Treatment. JAMA. 2018;319(7):698-710 Lung protective ventilation (The original ARDSnet ARMA trial): Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with … Continue reading "Episode 3: Refractory ARDS"
01/02/2020 • 41 minutes 14 seconds
Episode 2: Takotsubo (Stress) Cardiomyopathy
A tricky case of refractory heart failure. Case files Resources References Champion S, Belcour D, Vandroux D, et al. Stress (Tako-tsubo) cardiomyopathy in critically-ill patients. Eur Heart J. 2015;4(2):189-96. Chockalingam A. Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms. Indian Heart J. 2018;70(1):177-84. Dawson D. Acute stress-induced (takotsubo) cardiomyopathy. … Continue reading "Episode 2: Takotsubo (Stress) Cardiomyopathy"
01/01/2020 • 37 minutes 11 seconds
Episode 1: Necrotizing Soft Tissue Infection
A troubling case of a painful finger. Resources References Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017 Dec 7;377(23):2253-2265. Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll … Continue reading "Episode 1: Necrotizing Soft Tissue Infection"
09/12/2019 • 31 minutes 4 seconds
Episode 0: Introduction
Getting to know the podcast, your hosts, and why we’re all here in this digital classroom.