Critical Care Scenarios

Latest Episodes:

Episode 21: Trauma resuscitation with Scott Weingart Dec 13, 2020

Show notes

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"

Episode 20: Post-CABG emergencies with Kris Ramilo and Brendan Riordan Nov 29, 2020

Show notes

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"

Episode 19: Emergency medicine with Seth Trueger Nov 15, 2020

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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"

Episode 18: Oncologic emergencies with Leon Chen Nov 01, 2020

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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"

Episode 17: Interventional radiology with Bobby Chiong (part 2) Oct 18, 2020

Show notes

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)"

Episode 16: Interventional radiology with Bobby Chiong (part 1) Oct 04, 2020

Show notes

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)"

Episode 16: Lightning rounds #1 Sep 20, 2020

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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

Episode 15: Liver failure with Elliott Tapper Sep 06, 2020

Show notes

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"

Episode 14: Intracerebral hemorrhage and elevated ICP (part 2) Aug 23, 2020

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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)"

Episode 13: Intracerebral hemorrhage and elevated ICP (part 1) Aug 09, 2020

Show notes

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)"

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