Critical Matters

Latest Episodes:

Severe Acute Pancreatitis Nov 11, 2021

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In this episode of Critical Matters, we discuss the management of severe acute pancreatitis. Our guest is Dr. Marc G Besselink (@MarcBesselink). He is Professor of pancreatic and hepatobiliary(HPB) surgery, at Amsterdam University Medical Centers in the Netherlands. Dr. Besselink is a member of the Dutch Pancreatitis Study Group and is the senior investigator of the POINTER clinical trial (recently published in the New England Journal of Medicine). Additional Resources: Acute Pancreatitis: https://bit.ly/3D6kONK POINTER Clinical Trial - Immediate Versus Postponed Intervention for Infected Necrotizing Pancreatitis: https://bit.ly/3wxRLQN PYTHON Clinical Trial - Early Versus On-demand Nasoenteric Tube Feeding in Acute Pancreatitis: https://bit.ly/3km1STK APEC Clinical Trial - Urgent Versus Conservative ERCP for Acute Pancreatitis: https://bit.ly/3qlVK1I Books Mentioned in this Episode: The House of God by Samuel Shem: https://amzn.to/3wy8Lq2

Fluid BaSICS Oct 28, 2021

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In this episode of Critical Matters, we will discuss two important clinical questions regarding intravenous fluids. First: Does the composition of intravenous fluids impact patient outcomes? Second: Does the mode of administration (rapid bolus vs. slower infusion) matter? Our guest is Michael J. Connor, Jr., MD, a practicing intensivist and nephrologist. He is an Associate Professor & Senior Physician of Critical Care Medicine & Nephrology at the Division of Pulmonary, Allergy, Critical Care, & Sleep Medicine, Emory University School of Medicine. In addition, Dr. Connor is the Director for Critical Care Nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional Resources: Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU?: https://bit.ly/DDtMOT BaSICS Trial – Balanced Solutions vs. 0.9 % Saline: https://bit.ly/3pH7Q51 BaSICS Trial – Slower vs, Faster Intravenous Fluid Bolus Rates: https://bit.ly/2ZvYSgy The SPLIT Randomized Clinical Trial: https://bit.ly/3El5op1 The SMART Clinical Trial: https://bit.ly/DGMDQb Books Mentioned in this Episode: Quiet: The Power of Introverts in a World that Can’t Stop Talking by Susan Cain: https://amzn.to/AZza5g Talk Like TED: The 9 Public-Speaking Secrets of the World’s Top Minds by Carmine Gallo: https://amzn.to/3pG0e2V

Ivermectin For COVID - 19 Oct 14, 2021

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In this episode of Critical Matters, we will discuss Ivermectin as a potential treatment for COVID-19. During the COVID-19 Delta surge, we have seen a sharp increase in the noise surrounding the use of Ivermectin. A record number of prescriptions have been filled during the last months and numerous news stories report families suing hospitals refusing to provide Ivermectin to patients. We will discuss the available evidence and the role of misinformation in this phenomenon. Additional Resources: The FDA approved drug Ivermectin inhibits replications of SARS-CoV2 in vitro: https://bit.ly/3ayUhvE Ivermectin to prevent hospitalizations in patients with COVID-19 (IVER-COVID 19): https://bit.ly/3DCOwJZ Effect of Ivermectin on Time to Resolution of Symptoms among Adults with Mild COVID-19: https://bit.ly/3v8QaQw Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines: https://bit.ly/3lB7rPh Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis: https://bit.ly/3mU9s8w Ivermectin for preventing and treating COVID-19: Review: https://bit.ly/30dDzQD Books Mentioned in this Episode: Think Again: The Power of Knowing What You Don’t Know by Adam Grant: https://amzn.to/3j1CrGy

TTM Post-Cardiac Arrest Sep 09, 2021

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In this episode of Critical Matters, we will discuss the results of the recently published TTM2 clinical trial and the current state of evidence for Targeted Temperature Management in the post cardiac arrest patient. Our guest is Dr. Niklas Nielsen. Dr. Nielsen is an associate professor at the Department of Clinical Sciences at Helsingborg, Lund University, and consultant in Anesthesiology and Intensive Care at Helsingborg Hospital. He was the principal investigator for the TTM1 and TTM 2 clinical trials. Additional Resources: The International Cardiac Arrest Registry (INTCAR): https://bit.ly/2Xbe0yt Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest: https://bit.ly/3nad5Jo Targeted Temperature Management at 33C versus 36C after Cardiac Arrest: https://bit.ly/38THRO9 Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm: https://bit.ly/2X19aUj 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: https://bit.ly/3z0k7T3 Books Mentioned in this Episode: Oxygen: The Molecule that Made the World by Nick Lane: https://amzn.to/2WYMmVz Anna Karenina by Leo Tolstoy: https://amzn.to/3yVao0v

Choosing Wisely for Critical Care Jul 08, 2021

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In this episode of Critical Matters, we will explore the Choosing Wisely for Critical Care. These are evidenced-based best practices to avoid waste and promote value in the practice of critical care medicine. We are fortunate to have with us today three of the authors of the recently published guidelines for critical care medicine – Choosing Wisely for Critical Care: The Next Five. Our guests are Jerry Zimmerman, Pamela Smithburger, and Anita Reddy. Jerry Zimmerman is a physician from the Department of Pediatrics, Seattle Children’s Hospital, Harborview Medical Center, University of Washington School of Medicine, in Seattle. Pamela Smithburger is a doctor in clinical pharmacy from the University Of Pittsburgh School Of Pharmacy, in Pittsburgh. Anita Reddy is a physician from the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cleveland Clinic, in Cleveland. Additional Resources: Choosing Wisely For Critical Care: The NEXT Five. Critical Care Medicine 2021: https://bit.ly/3hQFkbx Medicine’s Ethical Responsibility for Health Care Reform- The Top Five List: https://bit.ly/36nDhGI The Choosing Wisely Website – ABIM: https://bit.ly/3hLdsWt Society of Critical Care Medicine – Choosing Wisely Website: https://bit.ly/3yG4TTN Society of Critical Care Medicine – Knowledge and Education Group (KEG): https://bit.ly/36tKvJb Books Mentioned in this Episode: Pediatric Critical Care Medicine 6th Edition by Jerry Zimmerman Alexandre T. Rotta: https://amzn.to/3ADJk82 One Hundred Years of Solitude by Gabriel Garcia Marquez: https://amzn.to/3ARKJYS Love in the Times of Cholera by Gabriel Garcia Marquez: https://amzn.to/3jXWsyL

Management Of The Difficult Airway Jun 24, 2021

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In this episode of Critical Matters, we will discuss the management of the difficult airway. Our guest is Dr. Thomas Heidegger. Dr. Heidegger practices anesthesia and intensive care medicine. He is a Professor in the Department of Anesthesia, Spital Grabs, in Grabs and the Department of Anesthesiology, and Pain Medicine, Bern University Hospital, University of Bern, in Bern – both in Switzerland. Additional Resources: Management of the Difficult Airway: https://bit.ly/2T0mXsj Major Complications of Airway Management - Fourth National Audit Project (NAP4): https://bit.ly/2UwJZHT Understanding Sensitivity and Specificity with the Right Side of the Brain: https://bit.ly/3gOqF1h Canadian Airway Focus Group Updates Consensus-Based Recommendations for Management of Difficult Airways: https://bit.ly/3h0tkUt Video - Face Mask Ventilation - Two-Handed Technique: https://bit.ly/3w0RNPj Video - Emergent Surgical Airway (Cricothyrotomy): https://bit.ly/3zPsAKx Books Mentioned in this Episode: West Pulmonary Physiology: The Essentials: by John B. West and Andrew M. Luks; https://amzn.to/3gOdfm8 Thinking Fast and Slow by Daniel Kahneman: https://amzn.to/3d4bnTN Noise: A Flaw in Human Judgment by Daniel Kahneman: https://amzn.to/35KpdXJ

Management Of Anaphylaxis Jun 10, 2021

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In this episode of Critical Matters, we will discuss the critical care management of the patient with anaphylaxis. Our guest is Dr. Guha Krishnaswamy. Dr. Krishnaswamy is a Professor of Medicine in the Section of Pulmonary, Critical Care, Allergy and Immunology and the Section of Infectious Diseases in the Wake Forest School of Medicine. He is also chief, of the Section of Allergy, Asthma and Immunology at the Bill Hefner VA Hospital and Affiliated Clinics in Salisbury, NC. Additional Resources: Critical Care Management of the Patient with Anaphylaxis: A Concise Definitive Review: https://bit.ly/3zfkA58 Anaphylaxis- Practice Parameter Update: https://bit.ly/3ctbGaG American College of Allergy, Asthma and Immunology Website: https://bit.ly/3zcKvL6 Hereditary Alpha-Tryptasemia: A Commonly Inherited Modifier of Anaphylaxis: https://bit.ly/3w5tJLZ Books Mentioned in this Episode: Everyday Zen: Love and Work by CJ Beck: https://amzn.to/3g5U9Ye Jonathan Livingston Seagull by Richard Bach: https://amzn.to/3w9FCjR The Wasteland by TS Elliot: https://amzn.to/3gjcDDA

Clinician Well-Being May 27, 2021

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May is Mental Health Awareness Month, a time to reflect on important aspects of mental health, work to alleviate its burden, and reduce the stigma associated with mental health problems. After an unprecedented year in critical care with the COVID-19 pandemic, these topics are more relevant than ever. In this episode of Critical Matters, we will discuss the topic of clinician well-being. We will discuss the impact of COVID-19 on clinician well-being, the relationship of burnout with mental health, and end with a focus on some actionable steps within our control to promote clinician well-being. Additional Resources: Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals: A Longitudinal Cohort Study: https://journals.lww.com/ccmjournal/ One More Time: How Do You Motivate Employees?: https://hbr.org/2003/01/one-more-time-how-do-you-motivate-employees An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action: https://pubmed.ncbi.nlm.nih.gov/27396776/ Out of the Straitjacket: https://pubmed.ncbi.nlm.nih.gov/29490178/ National Suicide Prevention Lifeline (1-800-273-8255): https://suicidepreventionlifeline.org/ Physician Support Line (1-888-409-0141): https://www.physiciansupportline.com/ The Emotional PPE Project: https://www.emotionalppe.org/ Talk Space:https://www.talkspace.com/ How Will You Measure Your Life?: https://hbr.org/2010/07/how-will-you-measure-your-life Time for Happiness: https://hbr.org/2019/01/time-for-happiness Taking Action Against Clinician Burnout: https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional Books Mentioned in this Episode: The Echiridion by Epitectus: https://www.amazon.com/Enchiridion-Adapted-Contemporary-Reader/dp/1521308861/ref=sr_1_2_sspa Why We Sleep by M Walker: https://www.amazon.com/Why-We-Sleep-Science-Dreams/dp/0141983760/ref=tmm_pap_swatch_0

Judgment Under Uncertainty May 13, 2021

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In this episode of Critical Matters, we will discuss judgment under uncertainty and how to make better decisions. The episode is based on a recent webinar I had the opportunity to present as part of Sound Critical Care’s Leadership Week. During this episode I will discuss judgments in the context of the COVID-19 pandemic, explore the science behind how we make decisions and finally share some thoughts on tools we can utilize to improve our decision process under uncertain conditions. Additional Resources: Judgment Under Uncertainty Webinar: https://bit.ly/2RLwp1S2 An Organization-Wide Approach to Good Decision Making: https://bit.ly/3uVgywc Noise: How to Overcome the High, Hidden Cost of Inconsistent Decision Making: https://bit.ly/3w1vXLH Performing a Project Premortem: https://bit.ly/3odxJH1 Sensible Medicine—Balancing Intervention and Inaction During the COVID-19 Pandemic: https://bit.ly/33DgQfh Books Mentioned in this Episode: Thinking, Fast and Slow by Daniel Kahneman: https://amzn.to/3hjzot1

ICU Liberation COVID Mode Apr 22, 2021

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In this episode of Critical Matters, we will discuss ICU Liberation and the A-F Bundles during the COVID-19 pandemic. Our guest is Dr. Wesley Ely (@WesElyMD), professor of medicine at Vanderbilt University School of Medicine. He is the co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center), which has enrolled thousands of patients into clinical trials, answering vital questions about ICU acquired brain disease and other components of ICU survivorship. Additional Resources: Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study: https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930552-X Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019: https://journals.lww.com/ccejournal/pages/articleviewer.aspx?year=2020&issue=06000&article=00016&type=Fulltext ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study: https://journals.lww.com/ccejournal/fulltext/2021/03000/abcdef_bundle_and_supportive_icu_practices_for.12.aspx Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://www.icudelirium.org Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://www.ncbi.nlm.nih.gov/pubmed/?term=Caring+for+Critically+Ill+Patients+with+the+ABCDEF+Bundle%3A+Results+of+the+ICU+Liberation+Collaborative+in+Over+15%2C000+Adults Books Mentioned in this Episode: Arrowsmith by Sinclair Lewis: https://www.amazon.com/Arrowsmith-Sinclair-Lewis/dp/B08VYFJVC7/ref=sr_1_3_sspa?crid=D2EL30QJYDN9&dchild=1&keywords=lewis+sinclair&qid=1619044221&sprefix=lewis+sin%2Caps%2C158&sr=8-3-spons&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUEyMlBCNlBVUkI0RjI1JmVuY3J5cHRlZElkPUEwOTQwMTcyMTE3UVZGRVlDSjhDRyZlbmNyeXB0ZWRBZElkPUExMDI5MDI2M0VBREtVSEFQNE5OViZ3aWRnZXROYW1lPXNwX2F0ZiZhY3Rpb249Y2xpY2tSZWRpcmVjdCZkb05vdExvZ0NsaWNrPXRydWU East of Eden by John Steinbeck: https://www.amazon.com/East-Eden-John-Steinbeck-ebook/dp/B08YLXQ2BC/ref=sr_1_1?dchild=1&keywords=east+of+eden&qid=1619044327&sr=8-1 Extreme Measures by Jessica Nutik Zitter: https://www.amazon.com/Extreme-Measures-Finding-Better-Path-ebook/dp/B01KGZVQOM/ref=sr_1_1?dchild=1&keywords=extreme+measures&qid=1619044537&s=books&sr=1-1 Knocking on Heaven's Door by Katy Butler: https://www.amazon.com/Knocking-Heavens-Door-Better-Death-ebook/dp/B00A285OF6/ref=sr_1_1?dchild=1&keywords=knocking+on+heavens+door&qid=1619044674&s=books&sr=1-1

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