Critical Care Scenarios

Hallie Prescott, pulm/crit physician and co-chair of the recent Surviving Sepsis guideline writing committee, gives some insight into the new document, including a few interesting additions and some points of controversy. For more thoughts, especially from an EM perspective, Scott Weingart also interviewed Hallie over at EMcrit. Learn more at the Intensive Care Academy! Takeaway … <a href="https://icuscenarios.com/lightning-rounds-64-the-new-surviving-sepsis-guidelines-with-hallie-prescott/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 64: The new Surviving Sepsis guidelines with Hallie Prescott"</span></a>

Scott Weingart, ED intensivist and seminal educator from the EMCrit podcast, shares his thoughts on how we should be finding truth nowadays: how to read journals, choose experts, use AI, and resolve disagreement. Learn more at the Intensive Care Academy! Takeaway pearls

We chat about managing a complex MICU patient with RV failure in the setting of renal failure and sepsis, with Amos Dodi, nocturnal intensivist at Einstein/Montefiore and author of a recent narrative review on the RV. Learn more at the Intensive Care Academy! CHEST’s Procedural Skills for the Critical Care Clinician, April 23-24 2026 References … <a href="https://icuscenarios.com/episode-98-rv-failure-in-the-micu/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 99: RV failure in the MICU"</span></a>

We dive into the confusing rabbit hole of medical staffing, credentialing, and privileging, particularly for the critical care APP, with Chris Newman, pediatric critical care PA and Vice Chair for Clinical Performance at the University of Colorado. Check out the REVIVE conference here! Check out the CHEST Procedural Skills for the Critical Care Clinician course … <a href="https://icuscenarios.com/lightning-rounds-61-credentialing-and-privileging-with-christopher-newman/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 61: Credentialing and privileging, with Christopher Newman"</span></a>

We chat with Melissa Nestor, clinical pharmacist in neurocritical care, about tho subtleties of glucose and insulin management in the ICU. Learn more at the Intensive Care Academy!

We discuss the practicalities of running a rapid response, including crowd management, coordinating with primary services, working outside the ICU, and rapidly obtaining and synthesizing diagnostic data. Learn more at the Intensive Care Academy!

We 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!

We explore the practical basics of managing an elevated ICP with impending herniation, including EVD troubleshooting, hyperosmolar therapies, and the role of craniectomy. Learn more at the Intensive Care Academy! References

With Dr. Prem Kandiah, neurointensivist, transplant intensivist, and ammonia enthusiast, we explore the physiology of hyperammonemia, the nuances of its measurement and interpretation, and unpack some less-recognized causes, including infection by urease-producing organisms and malnutrition/gastric bypass. Learn more at the Intensive Care Academy! References and resources Acute Liver Failure Overall management of ALF CRRT in … <a href="https://icuscenarios.com/episode-96-understanding-ammonia-with-prem-kandiah/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 96: Understanding ammonia, with Prem Kandiah"</span></a>

Learn more at the Intensive Care Academy!

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 … <a href="https://icuscenarios.com/lightning-rounds-58-steroids-for-septic-shock-with-david-janz/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 58: Steroids for septic shock with David Janz"</span></a>

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, … <a href="https://icuscenarios.com/lightning-rounds-57-burn-critical-care-with-clint-leonard/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 57: Burn critical care with Clint Leonard"</span></a>

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 … <a href="https://icuscenarios.com/episode-95-spontaneous-breathing-trials-with-martin-tobin/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 95: Spontaneous breathing trials with Martin Tobin"</span></a>

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

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 … <a href="https://icuscenarios.com/episode-93-fluid-in-sepsis-and-the-flopatch-with-jon-emile-kenny/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 93: Fluid in sepsis and the FloPatch, with Jon-Emile Kenny"</span></a>

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

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

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

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!

Learn more at the Intensive Care Academy!

Learn more at the Intensive Care Academy!

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!

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!

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

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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

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 … <a href="https://icuscenarios.com/episode-89-thrombectomy-for-stroke-with-justin-fraser/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 89: Thrombectomy for stroke, with Justin Fraser"</span></a>

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 … <a href="https://icuscenarios.com/episode-87-maternal-fetal-monitoring-with-stephanie-martin/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 87: Maternal-fetal monitoring with Stephanie Martin"</span></a>

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

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 … <a href="https://icuscenarios.com/episode-86-eegs-in-the-icu-with-carolina-maciel/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 86: EEGs in the ICU with Carolina Maciel"</span></a>

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.) … <a href="https://icuscenarios.com/lightning-rounds-51-hemodynamic-interfaces-with-philippe-rola/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 51: Hemodynamic interfaces with Philippe Rola"</span></a>

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

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 … <a href="https://icuscenarios.com/lightning-rounds-50-mastering-pa-catheter-placement-with-matt-siuba/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 50: Mastering PA catheter placement with Matt Siuba"</span></a>

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

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!

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

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

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

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 … <a href="https://icuscenarios.com/lightning-rounds-48-complete-airway-closure-with-thomas-piraino/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds 48: Complete airway closure with Thomas Piraino"</span></a>

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

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!

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

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!

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!

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!

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

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!