Episodes

Dec 10

Learn more at the Intensive Care Academy!

Nov 26

We dive into the common dilemma of when to give stress-dose corticosteroids in septic shock, with Dr. David Janz, pulm/crit intensivist with a Masters of Science in Clinical Investigation, former director of the Clinical Research Unit for the critical care section at LSU, founding member of the Pragmatic Critical Care Research Group, and associate Chief … Continue reading "Lightning rounds 58: Steroids for septic shock with David Janz"

Nov 12

We explore the fascinating intricacies and unique features of the burned critically ill patient, with Clint Leonard, NP in the burn ICU at Vanderbilt and ABLS instructor. Learn more at the Intensive Care Academy! Want to work at the University of Kentucky? UK’s Anesthesia Critical Care department is hosting a hiring webinar on November 20, … Continue reading "Lightning rounds 57: Burn critical care with Clint Leonard"

Oct 29

We discuss the evidence and practicalities of spontaneous breathing trials and ventilator weaning with Martin Tobin, pulmonologist and intensivist, author of seven textbooks including “Principles and Practice of Mechanical Ventilation,” researcher, and pioneer of the entire concept of SBT as well as the RSBI (or “Tobin index”). Learn more at the Intensive Care Academy! References … Continue reading "Episode 95: Spontaneous breathing trials with Martin Tobin"

Oct 15

We explore the vagaries and nitty-gritty of drugs for seizure termination, including benzos and ASMs, with the great Tom Bleck, MD MCCM FNCS, neurointensivist, professor, and founding member of the Neurocritical Care Society. Check out the REVIVE conference here! Learn more at the Intensive Care Academy! More reading Takeaway lessons

Oct 1

We dive into fluid resuscitation in sepsis, with Dr. Jon-Emile Kenny, pulmonary and critical care physician, author of the physiology textbook Heart-lung.org, and inventor of the FloPatch device. Disclosures: Dr. Kenny appears here as both a clinician as well as a representative of his company and product, and should be presumed to retain a degree … Continue reading "Episode 93: Fluid in sepsis and the FloPatch, with Jon-Emile Kenny"

Sep 16

We discuss propofol infusion syndrome (PRIS) and propylene glycol toxicity from lorazepam infusions, with medical toxicologist Dr. Jerry Snow, director of the toxicology fellowship at Banner University Medical Center in Phoenix. Learn more at the Intensive Care Academy! Takeaway lessons

Sep 3

Brandon and Bryan mock up a goals of care discussion for a critically ill patient, and reflect on the right and wrong ways to execute this complex procedure. Learn more at the Intensive Care Academy! Resources Center to Advance Palliative Care The Conversation Project

Aug 20

We chat about neuromuscular blockade, monitoring, and reversal in the ICU, including why sugammadex isn’t more widely used, with Sara J Hyland, PharmD, BCCCP, FCCP, researcher and clinical pharmacist in perioperative and emergency medicine. Learn more at the Intensive Care Academy! Takeaway lessons References

Aug 6

We chat with Leeah Sloan, PA-C, co-chair of the Critical Care APP Steering Committee for the American College of CHEST Physicians (CHEST), about the newly available CHEST critical care certification for APPs. The Vandalia CAMC Charleston APP critical care fellowship Learn more at the Intensive Care Academy!

Jul 30

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Jul 23

Learn more at the Intensive Care Academy!

Jul 9

Melissa Bridges, director of PA fellowships at Atrium Health and president of the Association of Post-graduate PA Programs (APPAP), chats with us (Bryan is president of APGAP, the Association of Post Graduate APRN programs) about PA/NP residencies/fellowships in critical care. Learn more at the Intensive Care Academy!

Jun 25

Andrew Schulman, medical musician, former ICU patient, and president of the Medical Musician Initiative, tells us how music can help the critically ill. Learn more at the Intensive Care Academy!

Jun 11

From constipation to hepatorenal syndrome. Fan favorite Elliot Tapper (@ebtapper, @ebtapper), gastroenterologist, transplant hepatologist, academic chief of hepatology, and director of the cirrhosis program at the University of Michigan, returns to answer a grab-bag of GI questions. Learn more at the Intensive Care Academy! Takeaway lessons

Jun 1

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May 28

We chat with Dr. Michael Lanspa, intensivist and director of the Intermountain Critical Care Echocardiography Core Lab, about common pitfalls among bedside POCUS users and tricks for doing it better. Learn more at the Intensive Care Academy! Find us on Patreon here! Takeaway lessons

May 14

We explore the world of thrombectomy for acute ischemic stroke with Justin F. Fraser (@doctorjfred), MD, FAANS, FAHA, Professor and Vice-Chair of Neurological Surgery and Director of Cerebrovascular Surgery and Neuro-interventional Radiology at University of Kentucky, where he specializes in cerebrovascular, endovascular, skull base, and endoscopic transsphenoidal surgery. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy … Continue reading "Episode 89: Thrombectomy for stroke, with Justin Fraser"

Apr 30

We learn about the basics of fetal monitoring in the critically ill pregnant woman and how to integrate them into our ICU workflows, with Stephanie Martin, MFM obstetrician and host of the Critical Care Obstetrics podcast and teacher at the Critical Care Obstretrics Academy. Learn more at the Intensive Care Academy! Find us on Patreon … Continue reading "Episode 87: Maternal-fetal monitoring with Stephanie Martin"

Apr 23

Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!

Apr 16

We discuss the basics of EEG in the ICU, including when to do it, selecting the appropriate study, and the basics of bedside interpretation, with Carolina B Maciel, MD, MSCR, FAAN, triple boarded in neurology, neurocritical care, and critical care EEG. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your … Continue reading "Episode 86: EEGs in the ICU with Carolina Maciel"

Apr 2

Philippe Rola, intensivist, master of the VEXUS scan, and founder of the Hospitalist and Resuscitationist conference, shares his recent model of four hemodynamic interfaces to describe the entire circulatory system. Register for the H&R conference (May 22-23 2025) here with the discount code provided in the show. (No, we’re not sponsored, just a cool event.) … Continue reading "Lightning rounds 51: Hemodynamic interfaces with Philippe Rola"

Mar 19

A roundup from members of the SCCM’s ICU Liberation committee, recorded at SCCM Congress 2025. Included:

Mar 5

We learn the vanishing art of placing the PA (Swan-Ganz) catheter, with intensivist and friend of the podcast Matt Siuba (@msiuba). Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway points References Insertion video Wedge distance How measurement technique affects diagnosis Thermo in TR review POCUS for … Continue reading "Lightning rounds 50: Mastering PA catheter placement with Matt Siuba"

Feb 19

We learn about the Vortex approach to airway management, as well as airway algorithms and mental models in general, with Vortex creator and anesthesiologist Dr. Nicholas Chrimes, anaesthetist and cofounder of the Safe Airway Society. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! References

Feb 5

We 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!

Jan 29

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Jan 22

We discuss assessment, monitoring, medical stabilization, and when to consider transplant of the patient with acute liver failure. We are joined by Dr. Sergio Navarrete, anesthesiologist and intensivist with fellowship training in transplant anesthesia. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons References

Jan 8

We talk about the nitty-gritty details of a well-run cardiac arrest, with Scott Weingart of Emcrit (@emcrit), ED intensivist. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons Resources

Dec 25, 2024

We talk about the phenomenon of airway closure during mechanical ventilation, with Thomas Piraino, RRT, FCSRT, FAARC, adjunct lecturer for the Department of Anesthesia at McMaster University, editor of The Centre of Excellence in Mechanical Ventilation Blog, and a member of the editorial board of Respiratory Care. Learn more at the Intensive Care Academy! Find us on … Continue reading "Lightning rounds 48: Complete airway closure with Thomas Piraino"

Dec 11, 2024

Our approach to common problems and troubleshooting: Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!

Nov 27, 2024

We chat about the post-op transition of care from the OR to the ICU, including questions to ask, workflows, and pitfalls. Check out the Intensive Care Academy here! Bryan’s textbook: Concepts in Surgical Critical Care Find us on Patreon here! Buy your merch here!

Nov 13, 2024

We talk about diagnosis, treatment, and subsequent care of the patient with bacterial meningitis, with Emory neurointensivist Casey Albin, MD (@caseyalbin). Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons Resources

Oct 30, 2024

We chat with Nick Ghionni, pulm/crit attending at MedStar Baltimore Hospital, about identifying and combating cognitive biases in our clinical decision-making. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!

Oct 16, 2024

We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC (@daytonicu), host of the Walking Home from the ICU podcast, and consultant to ICUs working on these issues. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!

Oct 2, 2024

We chat with Noelia Bischoff, recently off orientation in the medical ICU at Johns Hopkins as a nurse practitioner, about the transition from her role as a bedside ICU nurse. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!

Sep 18, 2024

We discuss transfusion reactions, risks, and management, including infection, consent, TRALI, TACO, and hemolytic reactions—with Dr. Joe Chaffin (@bloodbankguy), the “Blood Bank Guy” and transfusion medicine specialist. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons

Sep 4, 2024

Experts in critical care share their approach to post-intubation sedation. Contributors: Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!

Aug 21, 2024

We talk the nitty-gritty of assessing the right heart using echocardiography, with our friend Matt Siuba (@msiuba), intensivist at the Cleveland Clinic and master of zentensivism. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons

Aug 7, 2024

We explore the fascinating world of artificial intelligence and its role in medicine, with Nawar Shara (@NawarShara), PhD, Chief of Research Data Science at Medstar Health Research Institute and cofounding director of the AI Collab between Medstar and Georgetown. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!

Jul 31, 2024

We share our grand new project, the Intensive Care Academy, an online, video-based, subscriber-only educational platform. Check it out at icu101.com!

Jul 24, 2024

We discuss the practicalities of using airway pressure release ventilation (APRV) with Dr. Rory Spiegel (@EMnerd_), emergency physician and intensivist at MedStar Washington Hospital Center (and EMNerd at Emcrit). Find us on Patreon here! Buy your merch here! Takeaway lessons

Jul 10, 2024

We learn about the training, role, and benefits of hospital chaplains, with Christine V. Davies, MDiv, MSW, Director of Chaplaincy at Robert Wood Johnson University Hospital. Find us on Patreon here! Buy your merch here!

Jun 26, 2024

We discuss the field of rehabilitation psychology, and how it can help patients with persistent critical illness, with Dr. Megan Hosey (@DrMeganHoseyPhD), clinical psychologist and assistant professor at Johns Hopkins School of Medicine, where she practices in the medical ICU. Find us on Patreon here! Buy your merch here! Takeaway lessons Resources

Jun 12, 2024

We 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"

Jun 5, 2024

Responsible self-directed learning occurs in a zone between comfort and novelty. Find us on Patreon here! Buy your merch here!

May 29, 2024

We discuss the principles and application of automatic tube compensation (ATC) on modern ventilators, with its creator Ben Fabry. Dr. Fabry is a professor and chair of biophysics at University of Erlangen-Nuremberg, originally trained as an electrical engineer, who originally developed ATC as part of his PhD program. Find us on Patreon here! Buy your … Continue reading "Episode 75: Automatic tube compensation, with Ben Fabry"

May 22, 2024

Brandon summarizes his recent publication describing best practices for performing POCUS. Read the paper open access at POCUS Journal. Find us on Patreon here! Buy your merch here!

May 10, 2024

Our collaboration with Sarah Lorenzini of the Rapid Response RN podcast, discussing a case and general principles for diagnosing and managing obstructive shock. Check out the other episodes on shock in the Nurses’ Podcrawl 2024! Find us on Patreon here! Buy your merch here!

May 8, 2024

We chat about pulmonary/critical care medicine fellowship with recent graduate Nicholas Ghionni (@pulmtoilet), a first-year attending at the MedStar Baltimore Hospital system. He completed PCCM fellowship at MedStar Washington Hospital Center where he also served as chief fellow. Find us on Patreon here! Buy your merch here!

May 1, 2024

The difference between people and institutions. Find us on Patreon here! Buy your merch here!

Apr 24, 2024

We discuss the role of point-of-care ultrasound in evaluating the patient with kidney injury and assessing volume status, with Abhilash Koratala (@nephroP), nephrologist, Director of Clinical Imaging for Nephrology at the Medical College of Wisconsin, and champion of nephrology-focused ultrasound. Find us on Patreon here! Buy your merch here! Takeaway lessons References Episode 4 with … Continue reading "Episode 73: POCUS for nephrology, with Abhilash Koratala"

Apr 17, 2024

The nuts and bolts of how we produce the show. Find us on Patreon here! Buy your merch here!

Apr 10, 2024

We explore critical care transport medicine from both a clinical and career perspective, including helicopters (HEMS), fixed wing jet, and ground ambulance transports, with Jace Mullen, flight paramedic and airway educator out of Denver. Find us on Patreon here! Buy your merch here!

Apr 3, 2024

When do patients deaths bother us?

Mar 27, 2024

Find us on Patreon here! Buy your merch here! We discuss the phenomenon of CPR-induced consciousness (i.e. patients demonstrating awakeness during resuscitation) with Jack Howard, Intensive Care Paramedic at Ambulance Victoria in the northern suburbs of Melbourne, Australia, and first author on a recent literature review and Delphi-derived expert guideline on CPRIC management. Takeaway lessons … Continue reading "Episode 72: CPR-induced consciousness with Jack Howard"

Mar 20, 2024

Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here!

Mar 13, 2024

We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC. Find us on Patreon here! Buy your merch here!

Mar 6, 2024

You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here!

Feb 28, 2024

We discuss the medications typically used after organ transplant, their impact on critical illness, and how to manage them when these patients show up sick—with Olivia Philippart, transplant clinical pharmacist specializing in liver and kidney transplant at University of Kentucky HealthCare. Find us on Patreon here! Buy your merch here! Takeaway lessons References From: Fishman … Continue reading "Episode 71: Transplant medications with Olivia Philippart"

Feb 21, 2024

How I make patients poop. Find us on Patreon here! Buy your merch here!

Feb 14, 2024

A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation. Thanks to Pat Posa, Martha Roberts, Juliana Barr, Kelly Drumright, and Ben Lassow for their input. Resources

Feb 7, 2024

How to document your ultrasound findings. Find us on Patreon here! Buy your merch here!

Jan 31, 2024

We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr. Jed Wolpaw, anesthesiologist and intensivist from Johns Hopkins, anesthesiology residency program director, and host of the ACCRAC podcast. Find us on Patreon here! Buy your merch here! Takeaway lessons References

Jan 24, 2024

Arterial lines are resuscitative tools.

Jan 17, 2024

Bedside nurses and providers (physicians, PAs, NPs) tend to see the world differently, much of it driven by their training and the systems they work within. We chat about reconciling this and how to best function as a team.

Jan 10, 2024

In general, medical decisions that avoid error are better than those that optimize care.

Jan 3, 2024

We discuss head and neck surgery with Dr. Alexandra Kejner, otolaryngologist at the Medical University of South Carolina specializing in transoral robotic surgery, reconstructive surgery including microvascular free tissue transfer, salivary neoplasms, and sialoendoscopic procedures. Find us on Patreon here! Buy your merch here! Takeaway lessons References

Dec 27, 2023

The core disorders of critical care are mostly syndromes, not diseases. What should this mean to us?

Dec 20, 2023

Discussing the new 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline, with the joint first authors: Dr. Ariane Lewis, neurointensivist, professor of neurology and neurosurgery at NYU Langone, director of neurocritical care, and chair of the Langone ethics committee, and Dr. Matthew Kirschen, pediatric neurointensivist and associate director of pediatric … Continue reading "Lightning rounds #35: Brain death updates, with Ariane Lewis and Matthew Kirschen"

Dec 13, 2023

If you produce academic work, use the research to produce multiple products. Once is a waste.

Dec 6, 2023

We learn about liver transplant with Dr. Meera Gupta, transplant surgeon at the University of Kentucky Healthcare Transplant Center, and surgical director of the Kidney and Pancreas Transplant Program. We discuss eligibility, triage, the peri-operative course, and important post-op complications. Find us on Patreon here! Buy your merch here! Takeaway lessons

Nov 29, 2023

Explaining the ultimate expression of prognosis: Morbidity = (Severity x Duration)/Reversibility

Nov 22, 2023

When should you…

Nov 15, 2023

Which site should you select for your central line placement? A discussion of some considerations.

Nov 8, 2023

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"

Nov 1, 2023

A review of the physiological and practical reasons to position patients with ARDS in the prone position.

Oct 25, 2023

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

Oct 18, 2023

The value of being curious about practice differences, not judgmental.

Oct 11, 2023

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

Oct 4, 2023

What are the ways that patients fail breathing trials, and what can they tell us about how to optimize them for next time?

Sep 27, 2023

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"

Sep 20, 2023

A brief discussion of the stuff in your pockets as you practice medicine.

Sep 13, 2023

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

Sep 6, 2023

From the Critical Concepts blog, thoughts on our personal biases and lack of humility when contemplating end-of-life decision making.

Aug 30, 2023

Bryan and Brandon chat about holding down jobs, conflict resolution and interpersonal skills, and how to protect yourself as an employee.

Aug 23, 2023

When are patient outcomes your fault?

Aug 16, 2023

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"

Aug 9, 2023

Dealing with the good and bad aspects of tissue mobility during percutaneous procedures.

Aug 2, 2023

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.

Jul 26, 2023

The dilemma of lung-protective ventilation in patients with strong spontaneous breathing.

Jul 19, 2023

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

Jul 12, 2023

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

Jul 5, 2023

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.

Jun 28, 2023

The value of performing chart checks to see how your patients are doing after your care.

Jun 21, 2023

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

Jun 14, 2023

The importance of using an app to keep notes and establish a second, more reliable medical memory.

Jun 7, 2023

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.

May 31, 2023

A brief overview and call to arms around the key concepts of ICU liberation.

May 24, 2023

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

May 17, 2023

Understanding the causes of doubled vent breaths, including premature/short cycling and reverse triggering, plus a basic approach to managing them.

May 10, 2023

Bryan 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"

May 3, 2023

Reflections on the definition of a central line, whether it’s arbitrary, and the clinical implications of making the distinction.

Apr 26, 2023

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"

Apr 19, 2023

When scooching a patient in the bed can make a difference.

Apr 5, 2023

What does bacteremia mean to you? A brief overview of how this affects the picture of an infected patient.

Mar 29, 2023

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"

Mar 22, 2023

Some basic tactics for keeping attention in your live talks, presentations, and lectures. Find us on Patreon here! Buy your merch here!

Mar 15, 2023

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!

Mar 8, 2023

When the lessons of memory, clinical experience, and time may be more deceptive than instructive. Find us on Patreon here! Buy your merch here!

Mar 1, 2023

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

Feb 22, 2023

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!

Feb 15, 2023

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!

Feb 8, 2023

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!

Feb 1, 2023

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"

Jan 25, 2023

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!

Jan 18, 2023

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!

Jan 11, 2023

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!

Jan 4, 2023

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"

Dec 28, 2022

On today’s TIRBO: A couple common lines I’d rather stop hearing people say in the ICU.

Dec 21, 2022

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"

Dec 14, 2022

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!

Dec 7, 2022

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"

Nov 30, 2022

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!

Nov 23, 2022

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.

Nov 16, 2022

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.

Nov 9, 2022

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

Nov 2, 2022

How to locate, secure, and dress your lines so they’ll stay put and stay clean.

Oct 26, 2022

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!

Oct 19, 2022

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.

Oct 12, 2022

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"

Oct 5, 2022

Ensuring patient and operator safety with Seldinger guidewires, with considerations such as losing wires, transecting them, and perforating vessels.

Sep 25, 2022

Brandon and Bryan chat about tricks and methods of increasing efficiency and getting things done at work.

Sep 18, 2022

A deep dive into dilation during Seldinger techniques, such as central line placement: tips, pitfalls, and pearls.

Sep 11, 2022

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"

Sep 4, 2022

Ruminations on nursing post-nominals, understated wealth, and how it’s easiest to not show your power when you already plenty of it.

Aug 28, 2022

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.

Aug 21, 2022

How do PAs and other APPs compare with physicians in the clinical context?

Aug 14, 2022

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"

Aug 7, 2022

Jul 31, 2022

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.

Jul 24, 2022

How the arc of disease peaks and falls, and how the curve of our care should match it to avoid under- or over-treatment.

Jul 17, 2022

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"

Jul 10, 2022

Time is always a factor in the ICU, but some time matters more than other time.

Jul 3, 2022

Brandon and Bryan share their approaches to the chest x-ray in the ICU. Plus: Bryan’s an FCCM! Here’s the Radiology Masterclass.

Jun 26, 2022

Some musings in response to people who are impressed by the work we do.

Jun 19, 2022

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"

Jun 12, 2022

Advanced techniques for manipulating the guidewire during non-fluoroscopic bedside procedures such as central line placement.

Jun 5, 2022

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.

May 29, 2022

When it’s a bad idea to help out others with their work.

May 22, 2022

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"

May 15, 2022

A selection of lesser-known quotes relevant to the practice of medicine.

May 8, 2022

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!

May 1, 2022

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!

Apr 24, 2022

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"

Apr 17, 2022

A practical approach to choosing and escalating vasopressors for patients in shock.

Apr 10, 2022

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!

Apr 3, 2022

Reviewing the different approaches to placing central venous catheters in the subclavian vein.

Mar 27, 2022

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"

Mar 20, 2022

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"

Mar 13, 2022

A quick review of tracheoinnominate fistulas: how they happen, what they look like, and most importantly, what you’ll need to do.

Mar 6, 2022

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.

Feb 27, 2022

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.

Feb 20, 2022

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"

Feb 14, 2022

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.

Feb 6, 2022

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.

Feb 2, 2022

When should you place a line or perform other procedures using your left (or non-dominant) hand? Brandon reflects on a few situations.

Jan 27, 2022

The first episode of Brandon’s intermittent solo rants, in this case discussing toughness, stress tolerance, and flexibility in clinical medicine.

Jan 23, 2022

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"

Jan 9, 2022

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.

Dec 26, 2021

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"

Dec 12, 2021

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"

Nov 28, 2021

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"

Nov 14, 2021

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.

Oct 31, 2021

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"

Oct 17, 2021

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"

Oct 3, 2021

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"

Sep 19, 2021

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?

Sep 5, 2021

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"

Aug 22, 2021

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…

Aug 8, 2021

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"

Jul 25, 2021

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.

Jul 11, 2021

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"

Jun 27, 2021

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.

Jun 13, 2021

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"

May 30, 2021

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.

May 16, 2021

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"

May 2, 2021

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"

Apr 18, 2021

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"

Apr 4, 2021

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"

Mar 21, 2021

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"

Mar 7, 2021

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"

Feb 21, 2021

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"

Feb 7, 2021

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"

Jan 24, 2021

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"

Jan 10, 2021

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"

Dec 27, 2020

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"

Dec 13, 2020

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"

Nov 29, 2020

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"

Nov 15, 2020

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"

Nov 1, 2020

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"

Oct 18, 2020

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)"

Oct 4, 2020

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)"

Sep 20, 2020

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

Sep 6, 2020

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"

Aug 23, 2020

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)"

Aug 9, 2020

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)"

Jul 26, 2020

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)"

Jul 12, 2020

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)"

Jun 28, 2020

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"

Jun 14, 2020

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)"

May 31, 2020

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)"

May 19, 2020

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)"

Apr 27, 2020

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)"

Apr 27, 2020

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"

Mar 29, 2020

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"

Mar 13, 2020

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"

Mar 1, 2020

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"

Feb 1, 2020

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"

Jan 1, 2020

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"

Dec 9, 2019

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"

Dec 9, 2019

Getting to know the podcast, your hosts, and why we’re all here in this digital classroom.