Shows
Critical Care ScenariosLightning rounds 59: The nuances of nebulizers, with Keith LambWe explore the practical intricacies of nebulized medications, including timing, dosing, types of devices, and more, with Keith Lamb (@kdlamb1), RRT, RRT-ACCS, FAARC, FCCM. Learn more at the Intensive Care Academy!
2026-01-1435 minCritical Care ScenariosEpisode 85: Tracheostomy basics with Vinciya PandianWe discuss the basics of evaluation for tracheostomy placement, periprocedural care, and post-procedure complications with Vinciya Pandian, PhD, ACNP, FCCM, tracheostomy nurse practitioner and researcher. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
2025-02-0546 minCritical Care ScenariosLightning rounds 41: Respiratory therapy with Keith LambWe explore the profession of respiratory therapy in the US, including their role and training and how to optimize our clinical relationships, with Keith Lamb (@kdlamb1), RRT, RRT-ACCS, FAARC, FCCM. Keith is an RT at the University of Virginia in Charlottesville, working clinically in neuro/surgical/trauma critical care, who has been active in research and has … Continue reading "Lightning rounds 41: Respiratory therapy with Keith Lamb"
2024-06-1240 minCritical Care ScenariosTIRBO #36: Liberty or deathA brief overview and call to arms around the key concepts of ICU liberation.
2023-05-3127 minCritical Care ScenariosEpisode 61: ECPR with Scott WeingartWe 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
2023-05-2459 minCritical Care ScenariosTIRBO #35: Vent double-triggeringUnderstanding the causes of doubled vent breaths, including premature/short cycling and reverse triggering, plus a basic approach to managing them.
2023-05-1712 minCritical Care ScenariosLightning rounds #27: Our favorite FOAMBryan and Brandon share their favorite podcasts, blogs, social media, and other online channels for medical education. Podcasts Blogs/websites Twitter accounts So, with Twitter, we could post all day and still leave a bunch of people out. Here are a few…the best way to find good Twitter followers is to start with these and see … Continue reading "Lightning rounds #27: Our favorite FOAM"
2023-05-1037 minCritical Care ScenariosTIRBO #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.
2023-05-0310 minCritical Care ScenariosEpisode 59: Takotsubo cardiomyopathy with Vincent SorrellWe 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"
2023-04-2648 minCritical Care ScenariosTIRBO #33: Positioning patients in bedWhen scooching a patient in the bed can make a difference.
2023-04-1915 minCritical Care ScenariosTIRBO #32: Approaching bacteremiaWhat does bacteremia mean to you? A brief overview of how this affects the picture of an infected patient.
2023-04-0514 minCritical Care ScenariosEpisode 58: Toxic alcohols with Jerry SnowWe 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"
2023-03-291h 05Critical Care ScenariosTIRBO #31: Giving better lecturesSome basic tactics for keeping attention in your live talks, presentations, and lectures. Find us on Patreon here! Buy your merch here!
2023-03-2218 minCritical Care ScenariosLightning rounds #26: How we follow the medical literatureWe 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!
2023-03-1550 minCritical Care ScenariosTIRBO #30: Experience is lying to youWhen the lessons of memory, clinical experience, and time may be more deceptive than instructive. Find us on Patreon here! Buy your merch here!
2023-03-0812 minCritical Care ScenariosEpisode 57: Hyponatremia with Paul AdamsWe 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
2023-03-0159 minCritical Care ScenariosTIRBO #29: Understanding blood transfusionA 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!
2023-02-2221 minCritical Care ScenariosLightning 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!
2023-02-1500 minCritical Care ScenariosTIRBO #28: How I set PEEPA 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!
2023-02-0832 minCritical Care ScenariosEpisode 56: Resuscitation psychology with Dan DworkisDiscussing 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"
2023-02-011h 13Critical Care ScenariosTIRBO #27: The halo effectAn 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!
2023-01-2518 minCritical Care ScenariosLightning rounds #24: Getting into leadership rolesAfter 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!
2023-01-1854 minCritical Care ScenariosTIRBO #26: RadioPEEP discordanceOn 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!
2023-01-1115 minCritical Care ScenariosEpisode 55: Undifferentiated encephalopathy and autoimmune encephalitis, with Casey AlbinHow 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"
2023-01-041h 01Critical Care ScenariosTIRBO #25: Two things NOT to hearOn today’s TIRBO: A couple common lines I’d rather stop hearing people say in the ICU.
2022-12-2809 minCritical Care ScenariosLightning rounds #23: How we do end-of-life careA 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"
2022-12-2151 minCritical Care ScenariosTIRBO #24: Two things people need to hearOn 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!
2022-12-1412 minCritical Care ScenariosEpisode 54: The critically ill patient with pulmonary hypertension, with Ray FoleyWe 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"
2022-12-0745 minCritical Care ScenariosTIRBO #23: Cultivating clinical calmMuch 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!
2022-11-3019 minCritical Care ScenariosLightning rounds #22: Our drugs of choiceBryan and Brandon go through their default, go-to drugs for common clinical indications in the ICU: stress ulcer prophylaxis, empiric antibiotics, hypertension, and more.
2022-11-2357 minCritical Care ScenariosTIRBO #22: Understanding “weak” traineesYou 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.
2022-11-1618 minCritical Care ScenariosEpisode 53: Documentation and coding with Robert OubreAn 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
2022-11-091h 09Critical Care ScenariosTIRBO #21: Locating, securing, and dressing linesHow to locate, secure, and dress your lines so they’ll stay put and stay clean.
2022-11-0219 minCritical Care ScenariosLightning rounds #21: CME, merch, Patreon, and other podcast updatesUpdates 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!
2022-10-2626 minCritical Care ScenariosTIRBO #20: Understanding the needleUnderstanding 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.
2022-10-1935 minCritical Care ScenariosEpisode 52: Pleural effusions in the ICU with Emily FridenmakerDiscussing 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"
2022-10-1244 minCritical Care ScenariosTIRBO #19: Guidewire safetyEnsuring patient and operator safety with Seldinger guidewires, with considerations such as losing wires, transecting them, and perforating vessels.
2022-10-0519 minCritical Care ScenariosLightning rounds #20: Being efficientBrandon and Bryan chat about tricks and methods of increasing efficiency and getting things done at work.
2022-09-2553 minCritical Care ScenariosTIRBO #18: Mastering dilationA deep dive into dilation during Seldinger techniques, such as central line placement: tips, pitfalls, and pearls.
2022-09-1826 minCritical Care ScenariosEpisode 51: Resuscitating and deresuscitating with hypertonic saline, with Sean BarnettWe 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"
2022-09-1143 minCritical Care ScenariosTIRBO #17: Being cool is a privilegeRuminations on nursing post-nominals, understated wealth, and how it’s easiest to not show your power when you already plenty of it.
2022-09-0412 minCritical Care ScenariosLightning rounds #19: How to write a journal articleContinuing 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.
2022-08-2853 minCritical Care ScenariosTIRBO #16: Are PAs as good as doctors?How do PAs and other APPs compare with physicians in the clinical context?
2022-08-2131 minCritical Care ScenariosEpisode 50: Rib fractures and surgical plating with Ron BarbosaWe 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"
2022-08-1450 min2022-08-0720 minCritical Care ScenariosLightning rounds #18: How to give a conference presentationBrandon 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.
2022-07-311h 05Critical Care ScenariosTIRBO #14: Trajectories of illness and critical careHow the arc of disease peaks and falls, and how the curve of our care should match it to avoid under- or over-treatment.
2022-07-2414 minCritical Care ScenariosEpisode 49: Invasive pulmonary aspergillosis with Shmuel ShohamWe 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"
2022-07-1744 minCritical Care ScenariosTIRBO #13: Hospital relativityTime is always a factor in the ICU, but some time matters more than other time.
2022-07-1008 minCritical Care ScenariosLightning rounds #17: Reading chest x-raysBrandon and Bryan share their approaches to the chest x-ray in the ICU. Plus: Bryan’s an FCCM! Here’s the Radiology Masterclass.
2022-07-0344 minCritical Care ScenariosTIRBO #12: On heroics (or: is critical care hard?)Some musings in response to people who are impressed by the work we do.
2022-06-2612 minCritical Care ScenariosEpisode 48: Undifferentiated hypotensionBrandon 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"
2022-06-1956 minCritical Care ScenariosTIRBO #11: Mastering wire guidanceAdvanced techniques for manipulating the guidewire during non-fluoroscopic bedside procedures such as central line placement.
2022-06-1213 minCritical Care ScenariosLightning rounds #16: How we do case-based teachingBrandon and Bryan talk about how they assemble, implement, and leverage case-based learning, from this podcast to simulation to oral scenarios to internal visualization.
2022-06-0544 minCritical Care ScenariosTIRBO #10: Put the I back in TeamWhen it’s a bad idea to help out others with their work.
2022-05-2907 minCritical Care ScenariosEpisode 47: ICU triage with Eddy GutierrezDiscussing 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"
2022-05-2248 minCritical Care ScenariosTIRBO #9: Some quotes about whyA selection of lesser-known quotes relevant to the practice of medicine.
2022-05-1515 minCritical Care ScenariosLightning rounds #15: Night shiftsBryan 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!
2022-05-0840 minCritical Care ScenariosTIRBO #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!
2022-05-0109 minCritical Care ScenariosEpisode 46: Neurologic catastrophe and brain death with Casey AlbinWe 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"
2022-04-241h 10Critical Care ScenariosTIRBO #7: Selecting vasopressorsA practical approach to choosing and escalating vasopressors for patients in shock.
2022-04-1711 minCritical Care ScenariosLightning rounds #14: Abdominal compartment syndromeBrandon 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!
2022-04-1029 minCritical Care ScenariosTIRBO #6: The many varieties of subclavian lineReviewing the different approaches to placing central venous catheters in the subclavian vein.
2022-04-0315 minCritical Care ScenariosEpisode 45: Amniotic fluid embolism with Stephanie MartinWe 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"
2022-03-2747 minCritical Care ScenariosEpisode 44: Physical therapy with Heidi EngelA 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"
2022-03-201h 09Critical Care ScenariosTIRBO #5: Tracheoinnominate fistulasA quick review of tracheoinnominate fistulas: how they happen, what they look like, and most importantly, what you’ll need to do.
2022-03-1309 minCritical Care ScenariosLightning 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.
2022-03-0653 minCritical Care ScenariosTIRBO #4: HopeWhy 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.
2022-02-2710 minCritical Care ScenariosEpisode 43: Resuscitative TEE with Felipe TeranThe 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"
2022-02-2056 minCritical Care ScenariosTIRBO #3: Weaning vs TitrationWhen 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.
2022-02-1409 minCritical Care ScenariosLightning rounds #12: Co-managing patients in a surgical ICUBrandon 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.
2022-02-0637 minCritical Care ScenariosTIRBO #2: Procedural handednessWhen should you place a line or perform other procedures using your left (or non-dominant) hand? Brandon reflects on a few situations.
2022-02-0209 minCritical Care ScenariosTIRBO #1: ToughnessThe first episode of Brandon’s intermittent solo rants, in this case discussing toughness, stress tolerance, and flexibility in clinical medicine.
2022-01-2720 minCritical Care ScenariosEpisode 42: Clinical pharmacists with Laura Means EbbittAn 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"
2022-01-2350 minCritical Care ScenariosLightning rounds #11: Reflections on two years of the podcastBryan 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.
2022-01-0939 minCritical Care ScenariosEpisode 41: Preventing and managing complications (part 2) with Matt SiubaPart 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"
2021-12-2655 minCritical Care ScenariosLightning rounds #10: Physical examination in the ICUBryan 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"
2021-12-1252 minCritical Care ScenariosEpisode 40: Making the diagnosis with André MansoorDr. 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"
2021-11-281h 10Critical Care ScenariosLightning rounds #9: Notes and documentationBryan 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.
2021-11-1457 minCritical Care ScenariosEpisode 39: ECMO for COVID-19 with Kim BoswellAn 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"
2021-10-3158 minCritical Care ScenariosLightning rounds #8: Five things you’re getting wrongBryan’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"
2021-10-1711 minCritical Care ScenariosEpisode 38: GI bleeding with Elliot TapperBack 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"
2021-10-0349 minCritical Care ScenariosLightning rounds #7: Operationalizing clinical skillDiscussing 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?
2021-09-2036 minCritical Care ScenariosEpisode 37: Airway management for COVID-19Back 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"
2021-09-0557 minCritical Care ScenariosLightning rounds #6: Point of care ultrasoundWe 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…
2021-08-2239 minCritical Care ScenariosEpisode 36: Preventing and managing complicationsBack 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"
2021-08-081h 03Critical Care ScenariosLightning rounds #5: Career development for critical care APPsConceiving, 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.
2021-07-251h 08Critical Care ScenariosEpisode 35: When to operate in trauma with Dennis KimLooking 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"
2021-07-111h 03Critical Care ScenariosEpisode 34: Lightning rounds #4Wrapping 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.
2021-06-271h 03Critical Care ScenariosEpisode 33: Ischemic stroke with Thomas LawsonEvaluation 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"
2021-06-1342 minCritical Care ScenariosEpisode 32: Lightning rounds #3Following 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.
2021-05-3045 minCritical Care ScenariosEpisode 31: Practical mobility, awakening, and delirium prevention with Kali DaytonThe 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"
2021-05-161h 00Critical Care ScenariosEpisode 30: Diabetic ketoacidosisDiagnosing 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"
2021-05-0245 minCritical Care ScenariosEpisode 29: Lightning rounds #2A 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"
2021-04-1838 minCritical Care ScenariosEpisode 28: Diuresis, deescalation, and liberation with Matt SiubaHow 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"
2021-04-041h 06Critical Care ScenariosEpisode 27: Wilderness medicine with Ross HofmeyrManagement 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"
2021-03-211h 08Critical Care ScenariosEpisode 26: ICU sedation, mobility, and delirium with Dale NeedhamHow 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"
2021-03-0745 minCritical Care ScenariosEpisode 25: RhabdomyolysisInitial 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"
2021-02-2133 minCritical Care ScenariosEpisode 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)"
2020-06-1431 minCritical Care ScenariosEpisode 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)"
2020-05-3131 min