Critical Care Time - Critical Care Time Podcast

37. ARDS: Unpacking Acute Respiratory Distress Syndrome from Pathophysiology to Treatment Approaches Nov 18, 2024

On this week’s episode, Cyrus & Nick tackle one of their biggest challenges yet: Acute Respiratory Distress Syndrome, more commonly known as ARDS.***WARNING*** this is no shorty! We cover all things ARDS from pathophysiology, diagnosis, treatments and things NOT to do. Dare we say, this is the definitive FOAM-ARDS experience for anyone and everyone who cares for people suffering from ARDS. Give it a listen and as always, send us your feedback!!

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36. Inotropes Nov 04, 2024

Get excited for a new episode jam-packed with Critical Care goodness! Nick & Cyrus deconstruct, demystify and unpack inotropes. These medications are essential in the world of critical care when we have to manage cardiogenic shock. What are the different inotropes? How can you decide which one is right for your patient? And... what's the difference between an Inotropic and an Ionotropic agent? You'll learn all this and so much more on this week's episode of Critical Care Time: The Podcast for Everyone Who Cares for the Critically Ill!

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REBOOTED - 7. Vasopressors - Part 2 Oct 21, 2024

In this REBOOTED episodes of Critical Care Time, Cyrus and Nick go beyond the basics of vasopressor management. This thing is jam-packed with high-yield pearls, where we discuss important topics such as how to titrate vasopressors, what can be done when vasopressors seem to be failing and how to wean patients from vasopressors in order to successfully get them out of the ICU and ultimately home. Sit back, relax, and enjoy this hour long master-class on Vasopressors - Beyond the Basics!

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REBOOT - 6. Vasopressors - Part 1 Oct 21, 2024

In this REBOOTED episodes of Critical Care Time, Cyrus and Nick explore the basic in’s and out’s of vasopressors, providing a framework for understanding them and recommendations for the who, what, when, where and why as it pertains to their use! If you are new to the ICU or work anywhere that vasopressors may be used to treat your patients, this is the episode for you!

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35. Pulmonary Embolism Masterclass with Dr. Rich Channick Oct 07, 2024

On this week's release, Cyrus and Nick revisit one of their favorite topics: Pulmonary Embolism! In this episode - a follow up to our two-parter from season 1 - we sit down with Dr. Rick Channick of UCLA to talk about his approach to PE management with a focus on catheter directed therapies & PE response teams. This episode is packed full of expert insights and practical clinical pearls. Give it a listen and let us know what you think!

Risk Stratification Methodologies

What is the landscape of risk stratification in Pulmonary Embolism (PE)?

Broadly, what interventions does each risk category group warrant?

Rule of Thumb: The greater the risk to the patient, the more likely aggressive interventions will be considered.
Most patients with PE are low risk:
Typically treated with systemic anticoagulation
Excellent prognosis
High risk PE patients typically have hemodynamic involvement and can present in shock requiring emergent management :
No contraindications + shock due to PE systemic thrombolysis
Absolute contraindications:
Prior history of ICH
Known cerebrovascular lesion
Known malignant intracranial neoplasm
Non-acute ischemic stroke, within the last 3 months
Suspect aortic dissection
Intermediate risk patients:
Management options exist and are tailored to each specific patient.
Most, but not all, patients with PE deemed to be at intermediate risk will do well with systemic anticoagulation.
Some patients are good candidates for catheter directed therapies such as thrombectomy or thrombolysis.
Who? We don’t really know with a high degree of certainty. Considerations should be made for those with numerous risk factors for poor PE-related outcomes OR those with significant cardiopulmonary reserve / excellent functional status who theoretically could benefit from more brisk reversal of their acute pulmonary hypertension.

See more in depth show notes at criticalcaretime.com

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34. Anatomically Difficult Airway Part 2 Sep 23, 2024

In this week's episode of Critical Care Time, Cyrus & Nick close out their discussion (for now anyway!) on difficult airways! Here we build upon episode 33 by working through some scenarios we've seen where we've needed to implement some of the strategies previously discussed. We close out by covering 10 pitfalls and pearls when it comes to anatomically difficult airways. As always, give us a listen and let us know what you think!

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**33. Anatomically Difficult Airway Part 1** Sep 09, 2024
On this week’s episode of Critical Care Time, Nick & Cyrus return to talk about airway management in the ICU. In season 1 we focused on the physiologically difficult airway. Now we will begin to unravel the anatomically difficult airway. Today we will break things down by covering foundational concepts, discussing some of the physical and cognitive tools you can use to address an airway, and basically set the stage for part II where we will go through some case studies and leave you with our pitfall and pearls for anatomically difficult airways. This episode is packed with clinical pearls that will empower you to take on even the spiciest of airways!
As always - give us a watch or a listen and let us know what you think! Don’t forget those reviews!!

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32. 3 Wishes Project with Dr Thanh Neville, MD MSHS Aug 26, 2024

On this week’s episode of Critical Care Time, Nick & Cyrus have the honor of hosting Dr. Thanh Neville, MD, MSHS (X @thanh_neville) the director of the 3 Wishes Program out of UCLA. In this moving discussion we explore the importance of dying with dignity when curative intent is no longer a realistic option. We dovetail this with an impassioned exploration Dr. Neville’s incredible work with 3WP which relies on modest funding and the power of humanism to grant priceless gifts - Wishes, if you will - to dying patients and their loved ones in their 11th hour. Please give us a listen and let us know what you think!

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31. Tele-Critical Care with Drs. Bill Beninati and David Guidry Aug 12, 2024

Tele-health is blowing up in 2024 and that is as true for critical care as it is for other fields of medicine! On this episode of Critical Care Time, Nick and Cyrus interview Drs. Bill Beninati and David Guidry: Two experts in the world of tele critical care. We cover all the in’s and out’s of delivering critical care service from afar with a focus on implementation, logistics, benefits and challenges. Give this a listen and let us know what you think!

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30. Hypoxemia Masterclass Jul 29, 2024

Join Nick and Cyrus as they teach a master class on hypoxemia for everyone and anyone who is ICU adjacent! We discuss why oxygen is so crucial, share some very interesting animal physiology and - perhaps most importantly- discuss the 6 causes of hypoxemia you MUST know… and what you can do about them! Take a listen, let us know what you think, and leave us a review!

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29. Pleural Disease Part 2: Hemothorax & BPF with Dr. Michal Sobieszczyk, MD Jul 15, 2024

On this episode - part 2/2 if you will - we continue our discussion of pleural disease with a focus on hemothorax & management of bronchopleural fistulas. Small tube or large tube? When do you call in the reinforcements? What about endobronchial valves for persistent air leaks? Learn the answers to these questions - and so much more -n with Dr. Mike Sobieszczyk our expert interventionalist!

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28. Pleural Disease Part 2: Effusions and more with Dr. Michal Sobieszczyk Jul 01, 2024

On this episode of Critical Care Time, Nick & Cyrus revisit the pleural space! We had SO much great content we opted to split the episode into two parts. We also figured it would be nice to get an interventionalists take on this and we thus recruited Dr. Mike Sobieszczyk to help navigate this complex topic! Here we discuss things like hepatic hydrothorax, indwelling pleural catheters and all things parapneumonic effusion. Check it out and leave us a review! If you missed our first episode on pleural disease, head on back to episode 10 and get caught up. If you like what you heard here, make sure to come back in 2 weeks for the second part!

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27. Season 1 Listener Mailbag Jun 17, 2024

Join Cyrus and Nick as they review listener questions and feedback from season one of Critical Care Time! Where did we goof up? Where did we hit the "Mark"? Give this episode a listen as we investigate a potpourri of clinically relevant topics courtesy of YOU - our incredible audience whom we are so thankful for.

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26. The PREOXI Trial with Dr. Kevin Gibbs, MD Jun 13, 2024

Extra Extra - Read All About It!! It is our pleasure to bring to you - hot off the presses - the results from the PREOXI Trial which looks at whether or not preoxygenation with non-invasive positive pressure ventilation results in better peri-intubation outcomes versus non-pressurized preoxygenation strategies. Joining us is the primary author on this paper, Dr. Kevin Gibbs, MD of Wake Forest University School of Medicine. Practice changing? Practice affirming? Does it even matter?! Check out our interview with Dr. Gibbs and see what you think! Leave us a comment and let us know if this is going to impact your practice in the ICU and beyond!

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25. Diuresis & Negative Fluid Balance Jun 03, 2024

Diuretics are essential tools used by clinicians to manage volume status in ambulatory patients and in the critically ill… but are we using them correctly? Join Nick & Cyrus as they explore principles of fluid balance and teach a masterclass on how to approach diuresis in the critically ill patient. You won’t want to miss this high-yield episode discussing an evergreen topic in the world of critical care medicine!

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24. Thrombocytopenia with Dr. Matthew Rendo, MD. May 20, 2024

Thrombocytopenia is a puzzling, yet common problem in the ambulatory setting, on the wards and certainly in critically ill patients! Having an understanding of why it matters, why it can happen and what we should do about it, is of paramount importance to you if you are committed to excellent patient care.

Given that patient care is first and foremost for us at Critical Care Time, we’ve teamed up - once again - with hematologist extraordinaire Matthew Rendo (X: RendOncology) to help us develop a pragmatic approach to managing the patient with thrombocytopenia.

Please give it a listen and let us know what you think!

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23. Resuscitative TEE with Dr. Ross Prager May 06, 2024

On Critical Care Time we are - of course - HUGE fans of POCUS. On this episode, Nick and Cyrus take this love for POCUS to the next level with our discussion on Resuscitative Transesophageal Echocardiography (Resus-TEE) with Canadian intensivist, Dr. Ross Prager (@ross_prager), Resus-TEE expert aficionado! On this show, we discuss the basics of Resus-TEE including indications, pitfalls and pearls, the practicality of implementing this modality at your hospital and some of the medico-legal considerations. We had a ton of fun recording this with Ross and hope you enjoy listening to it!

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22. Bronch emergencies with the PulmPEEPS Apr 22, 2024

Like that time the Jetsons met the Flintstones or the more recent colab between Lululemon and Peloton, join us for an epic pairing between Critical Care Time hosts Cyrus & Nick and the PulmPEEPS - Drs. Dave Furfaro and Kristina Montemayor. On this show we use a case based approach to answer the question: How can a bronchoscope save your @$$ in the ICU and beyond? We take a practical look at airway bleeds, trach emergencies and so much more with our friends from PulmPEEPs! Make sure to give this a listen and let us know what you think!

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21. Feeding in Critical Illness with Paul Wischmeyer, MD Apr 08, 2024

On this MEGAsode of Critical Care Time, Cyrus & Nick are joined by world-renowned expert in ICU nutrition, Dr. Paul Wischmeyer (X: Paul_Wischmeyer & IG: paul_wischmeyermd) to discuss all things ICU nutrition. This episode is highly fortified with practice changing pearls from soup to nuts! In addition to getting to know who Paul is and why he does what he does, we demystify metabolic carts, talk about protein needs and metabolism in the critically ill, discuss steroids and other supplements - all while dispelling some major ICU myths regarding gastric residuals, TPN and more. Grab a healthy snack, sit back and get ready to enjoy some remarkable content in an oft overlooked field in medicine!

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20. AKI & CRRT with Dr Kevin Chung Mar 25, 2024

On this week’s episode of Critical Care Time, Nick and Cyrus discuss continuous renal replacement (or kidney replacement) therapy and acute kidney injury with master intensivist and extra corporeal aficionado, Dr. Kevin Chung. Dr. Chung is a retired colonel in the United States Army, the principal force behind an intensivist-run renal replacement program in San Antonio, and is currently the Chief Medical Officer for our season one sponsor, Seastar Medical.In this episode, we discuss an approach to acute kidney injury, demystify elements of continuous renal replacement therapy, and then discuss various applications to include blood purification technology in 2024. Give us a listen and let us know what you think!

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19. Metabolic Acidosis w/ NephMadness Mar 15, 2024

In this Critical Care Time x Neph Madness colab, Nick & Cyrus host Drs. Tim Yau and Jeff Kott for a comprehensive discussion of metabolic acidosis with a focus on critically ill patients. We start by outlining a pragmatic approach to acid/base derangements peppered with some fact finding and myth busting, CCT style! We then turn our attention to working up and treating metabolic acidosis in the ICU. If you are looking for a one stop shop when it comes to metabolic acidosis in the ICU - look no further. You may even figure out what Spanx & sodium bicarb have in common!

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18. Journal Club - DL VS VL: The Device Trial Feb 26, 2024

On this week’s installment of Critical Care Time, Nick & Cyrus tackle the recent multicenter, randomized control DEVICE Trial, which compared direct to video laryngoscopy in 17 American ICUs & EDs with the primary outcome of interest being successful intubation on first attempt. During this episode, we’ll take a deep dive into the paper, discuss other literature, and weigh-in ourselves based upon our own experiences and the data that’s available. Give it a listen and let us know what YOU think!

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17. Hyponatremia in Critical Illness with Dr Joel Topf Feb 12, 2024

Sit back and grab some salty treats as you enjoy the mindful musings of master nephrologist Dr. Joel Topf (X: @Kidney_Boy) who joins Nick & Cyrus to chat about hyponatremia in critical illness - a very common condition. Here we discuss diagnosis and management of hyponatremia with special attention to those in the intensive care unit. Of course, no discussion is complete without plenty of time dedicated to osmotic demyelination syndrome (aka: central pontine myelinolysis) which gets plenty of face-time during this episode. Give it a listen and leave feeling confident in your ability to diagnose and manage a very prevalent condition in our patient population!

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16. Pulmonary Embolism Part II Jan 29, 2024

In Part II of our discussion of PE, Nick & Cyrus discuss the Pillars of PE Management! We review the literature behind lytics in non-massive PEs, talk about airway management, hemodynamics and more! Make sure you listen to Part I if you missed it as it sets the stage for this fantastic, treatment focused discussion.

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15. Pulmonary Embolism Part 1 Jan 15, 2024

There are few things in medicine Nick & Cyrus enjoy talking about more than PE! Join the guys from Critical Care Time as they tackle this massive topic via a two part epic that’ll prove to be the best saga since The Lord of The Rings! In part one they talk about diagnosis, clinical decision support tools and demystify the pathophysiology behind pulmonary emboli. Check it out, and be sure to catch the second half in two weeks! We promise you’ll get your money’s worth!

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14. Massive Hemoptysis Jan 01, 2024

Hemoptysis can be a scary thing to encounter in medicine and massive hemoptysis - i.e. life threatening hemoptysis - is a serious emergency that often requires cognitive agility and technical prowess. Join Nick & Cyrus as they talk with Dr. Whittney Warren - an intensivist and interventional pulmonologist - who walks us through her pragmatic approach to life-threatening hemoptysis. What medications can we use to stabilize these patients? How would we go about intubating such a patient? What bronchoscopic tools do we have at our disposal? Listen to this first CCT episode of 2024 and find out!

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13. ICU Rounds: Focusing on the Patient Dec 04, 2023

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12. DVT Prophylaxis In The Critically Ill Nov 20, 2023

Every time we admit or care for a critically ill patient, we must consider their risk for deep venous thrombosis, or DVT. Many of our patients are at higher risk for DVT than the general population, but anticoagulants are not wholly benign drugs. What do we do? How do we decide who to treat medically, who to treat with mechanical compressive devices and identify patients who may NOT need anything? When do risks outweigh benefits? What agent is best?

Join Nick and Cyrus as they interview hematologist & oncologist Dr. Matthew Rendo (Twitter/X: Rendoncology) as they do a deep dive into managing DVT prophylaxis in the critically ill patient!

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11. The Physiologically Difficult Airway Nov 06, 2023

Airway management in the critically ill can be one of the most challenging, stressful and rewarding elements of critical care medicine. While the anatomically challenging airway is often the first place our minds go when discussing difficult airways, the physiologically difficult airway is both more common and often requires more savvy to overcome. Join Cyrus & Nick as they take a pragmatic, case-based approach to this topic with the hopes of equipping you with the tools you need to successfully take a physiologically difficult airway, or support an airway operator charged with this task!

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10. Intro to The Pleura & Conquering Oct 23, 2023

Whether you work in the ICU, on the medicine wards or in the prehospital setting, you've got to be familiar with the unsung hero of the thorax - the pleura! On this episode of Critical Care Time, Cyrus & Nick extol the virtues of this humble structure, cover a little comparative physiology and spend the latter half of their chat discussing all things pneumothorax. Sit back, relax and enjoy this episode packed with pulmonary and critical care pearls that will take your breath away!

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9. Cardiac Arrest & Running a Code Oct 09, 2023

Running a code is a stressful proposition. The code team leader is responsible for conducting an orchestra in a most austere environment, with the goal of guiding the team towards success - defined hopefully by a successful resuscitation. The code team leader needs to have the presence of mind to lead, but also needs to know how to delegate responsibilities and quickly cultivate a shared mental-model between the various team members. Join Nick and Cyrus as they try to demystify some of the elements of leading a code by providing practical pearls and shedding light on potential pitfalls during this episode on Cardiac Arrest and Running a Code.

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8. Legal Considerations and Patient Care with Drs. Erin DeMartino & Matthew Griffith Sep 25, 2023

The intersection between patient care and the legal system can be a tricky one to navigate. Our duty as members of the healthcare team - irrespective of a patient’s social history - is to provide the best care we can, while protecting a patient’s privacy. Unfortunately, this can sometimes be easier said than done, and traveling such choppy waters can be challenging! Join Nick & Cyrus as they host Drs. Erin DeMartino & Matthew Griffith of Scopes and Shields for a case-based discussion which will hopefully equip you with some knowledge and tools for the next time you have a patient who is in custody or otherwise involved with the legal system.

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7. Vasopressors - Part 2 Sep 11, 2023

On this episode of Critical Care Time, Cyrus and Nick go beyond the basics of vasopressor management. This thing is jam-packed with high-yield pearls, where we discuss important topics such as how to titrate vasopressors, what can be done when vasopressors seem to be failing and how to wean patients from vasopressors in order to successfully get them out of the ICU and ultimately home. Sit back, relax, and enjoy this hour long master-class on Vasopressors - Beyond the Basics!

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6. Vasopressors - Part 1 Aug 28, 2023

On this episode of Critical Care Time, Cyrus and Nick explore the basic in’s and out’s of vasopressors, providing a framework for understanding them and recommendations for the who, what, when, where and why as it pertains to their use! If you are new to the ICU or work anywhere that vasopressors may be used to treat your patients, this is the episode for you! Whether you are ordering them, titrating them or looking out for complications associated with their use, Nick & Cyrus have got your back!

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5. Zorses and Hebras Aug 14, 2023

They say that when you hear hoofbeats, you should look for horses. This age-old medical adage makes sense in many circumstances, but what do you do when the paradigm is flawed? What if what we generally accept as a common entity, is actually rare? What about the reverse? In this first episode of Zorses & Hebras, Nick & Cyrus will discuss some of these very entities in the context of critical illness, shed some light on them, and explain why focusing on the Horses & Zebras model may bite you on the tail!

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4. ICU Delirium with Dr. Wes Ely, MD. Jul 31, 2023

Delirium is a common but serious complication of critical illness. Nick and Cyrus discuss this important topic with Dr. Wes Ely, MD. They cover prevention, diagnosis, and treatment of delirium; Dr. Ely's award-winning book "Every Deep Drawn Breath", and how his life story led him to become a world expert in brain dysfunction in the ICU.

Go to https://criticalcaretime.com for more information

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3. Journal Club - Platelets and Lines Jul 19, 2023

Join Nick & Cyrus as they take on their first journal club episode! This week the duo provides their take on the NEJM paper from van Baarle and colleagues entitled Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. They also provide some of their tips and tricks for safe central line placement. Give it a listen and let us know what you think!

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2. Undifferentiated Shock Part 2 Jul 05, 2023

We've already discussed how to identify shock, or how to assess a patient whom you are worried may be in shock... but what's next? Listen as Nick & Cyrus discuss the Pump, Pipe & Tank framework for determining the type of shock your patient is suffering from. In this episode we discuss the pathophysiology of the different types of shock, the tools you can use to help differentiate one type of shock from another, and scratch the surface on some initial treatment considerations.

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1. Undifferentiated Shock Part 1 Jul 03, 2023

In critical care medicine - it's not just a priority, but it's critical that you know how to identify, assess and stratify shock. Join Nick & Cyrus in Part 1 of a 2-part, deep-dive into undifferentiated shock. On this episode we discuss how we define and assess a patient in shock; laying down the foundation for our shock framework.

Go to https://criticalcaretime.com for more information

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0. Introducing Critical Care Time Jul 03, 2023

Cyrus Askin & Nick Mark are two intensivists with a passion for education and a penchant for taking care of the sickest patients in the hospital. Join the two of them as they embark on a journey through the world of critical medicine - leaving no stone unturned.

In this episode, Nick & Cyrus share a little about themselves and a lot about what Critical Care Time is... and isn't!"

Go to https://criticalcaretime.com for more information

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The Podcast for everyone who cares for the critically ill (60 sec trailer) Jul 03, 2023

Critical Care Time is the podcast for everyone who cares for the critically Ill. Whether you work in an ICU, a Med-Surg unit, an ED, a PACU or the back of an ambulance - Dr. Cyrus Askin & Dr. Nick Mark provide practical insights and useful tips to enhance your skillset. They are triple board-certified intensivists who love patient care and teaching.

Journey with them through deep dives into physiology and practical pearls, leaving no stone unturned in the world of critical care medicine. Through their own insights, expert interviews and targeted reviews of the literature, Nick and Cyrus provide practical, relevant critical care pearls.

If you bill for critical care time, you must make time for Critical Care Time!

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