Critical Care Scenarios

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

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.

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

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

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

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.

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

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

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

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.

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

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

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

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 … <a href="https://icuscenarios.com/lightning-rounds-27-our-favorite-foam/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds #27: Our favorite FOAM"</span></a>

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

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 … <a href="https://icuscenarios.com/episode-58-takotsubo-cardiomyopathy-with-vincent-sorrell/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 59: Takotsubo cardiomyopathy with Vincent Sorrell"</span></a>

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

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

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 … <a href="https://icuscenarios.com/episode-58-toxic-alcohols-with-jerry-snow/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 58: Toxic alcohols with Jerry Snow"</span></a>

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

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!

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

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

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!

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!

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!

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 … <a href="https://icuscenarios.com/episode-56-resuscitation-psychology-with-dan-dworkis/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 56: Resuscitation psychology with Dan Dworkis"</span></a>

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!

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!

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!

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 … <a href="https://icuscenarios.com/episode-55-undifferentiated-encephalopathy-and-autoimmune-encephalitis-with-casey-albin/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 55: Undifferentiated encephalopathy and autoimmune encephalitis, with Casey Albin"</span></a>

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

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 … <a href="https://icuscenarios.com/lightning-rounds-23-how-we-do-end-of-life-care/" class="more-link">Continue reading<span class="screen-reader-text"> "Lightning rounds #23: How we do end-of-life care"</span></a>

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!

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 … <a href="https://icuscenarios.com/episode-54-the-critically-ill-patient-with-pulmonary-hypertension-with-ray-foley/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley"</span></a>

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!

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.

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.

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

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

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!

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.

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 … <a href="https://icuscenarios.com/episode-51-pleural-effusions-in-the-icu-with-emily-fridenmaker/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 52: Pleural effusions in the ICU with Emily Fridenmaker"</span></a>

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

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

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

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 … <a href="https://icuscenarios.com/episode-51-resuscitating-and-deresuscitating-with-hypertonic-saline-with-sean-barnett/" class="more-link">Continue reading<span class="screen-reader-text"> "Episode 51: Resuscitating and deresuscitating with hypertonic saline, with Sean Barnett"</span></a>

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

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.

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