Critical Matters

Latest Episodes:

ICU Management of Acute Ischemic Stroke Oct 10, 2019

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Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Intensive care management of strokes is focused on reducing complications related to reperfusion treatment and decreasing secondary neurological injury. In this episode of Critical Matters, we will discuss the critical care management of acute ischemic strokes. Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago. Additional Resources: AHA 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: http://bit.ly/30TJkxL Educational video on performing the NIH Stroke Scale: http://bit.ly/2opldcZ Link to a pdf document with the NIH Stroke Scale: http://bit.ly/2LVtWMV How to do a four-minute neurological examination: http://bit.ly/328IXRr Books Mentioned in this Episode: Lincoln's Hundred Days: The Emancipation Proclamation and the War for the Union by Louis P. Masur: https://amzn.to/2VlTTse

Acute Abdominal Complications In The ICU Sep 26, 2019

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Acute abdominal complications developing in critically ill patients in the ICU can be associated with significant morbidity and mortality. In this episode of Critical Matters, we discuss a variety of acute abdominal complications such as abdominal compartment syndrome, acalculous cholecystitis, toxic megacolon and ischemic bowel. Our guest is Dr. Samuel Tisherman. Dr. Tisherman is a surgical critical care physician at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center and a Professor of Surgery at the University of Maryland School of Medicine. Additional Resources: World Society of Abdominal Compartment Syndrome (WSACS) consensus definitions and recommendations: https://bit.ly/2l9m6EQ Acute Acalculous Cholecystitis: A Review. Huffman J, Schenker S. Clinical Gastroenterology and Hepatology: https://bit.ly/2nfssTL Ogilvie’s Syndrome: Management and Outcomes. Haj, M et al. Medicine: https://bit.ly/2mKLVM5 Books Mentioned in this Episode: Complications: A Surgeon’s Note on an Imperfect Science. By Atul Gawande: https://amzn.to/2laETzB

Personalization Of Vasopressor Therapy In The Treatment Of Vasodilatory Shock Sep 12, 2019

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In this episode of Critical Matters, listen to the recording of Sound Critical Care’s webinar, Personalized Selection of Vasopressors in the Treatment of Shock. Our guest for this episode is Dr. Lakhmir Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. During this webinar, we discuss lessons learned from the clinical use of the new vasopressor Angiotensin II, as well as personalization of vasopressor therapy in the treatment of vasodilatory shock. Watch the video recording: https://bit.ly/2jZ1z5h

Disorders of Sodium and Water Balance in the ICU Aug 22, 2019

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Hyponatremia and hypernatremia are common in ICU patients and they are associated with increased morbidity and mortality. In this episode of Critical Matters, we discuss the diagnostic approach and treatment of sodium disorders in the ICU. Our guest is Dr. Lawrence Weisberg, Head of the Division of Nephrology and Deputy Chair of Medicine at Cooper University Health Care. Dr. Weisberg is also Professor of Medicine and Assistant Dean for Curriculum at the Cooper Medical School of Rowan University, in Camden, New Jersey. Additional Resources: Disorders of Plasma Sodium - Causes, Consequences, and Correction: https://bit.ly/2TT9SNB Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients: https://bit.ly/2P2wxrY Evidence for Managing Hypernatremia: Is It Just Hyponatremia in Reverse?: https://bit.ly/2HjZn0S Books Mentioned in this Episode: From Fish to Philosopher; the Story of our Internal Environment by Homer William Smith: https://amzn.to/30nrraU Operating Manual for Spaceship Earth by R. Buckminster Fuller: https://amzn.to/2Z6coWt Critical Path by R. Buckminster Fuller: https://amzn.to/2MA9vH9

Neuromuscular Blockers In ARDS Aug 08, 2019

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In this episode of Critical Matters, we will discuss the role of early neuromuscular blockers in the treatment of severe ARDS. Our guest is Dr. Arthur Slutsky, Professor of Medicine, Surgery and Biomedical Engineering at the University of Toronto. Dr. Slutsky is a world-renowned clinician and investigator with a special interest in ARDS. We will review a recently published clinical trial and discuss its result within the context of available evidence. Additional Resources: Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome: https://bit.ly/2YwXxnG Neuromuscular Blocking Agents in ARDS: https://bit.ly/2KmMZiA Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome: https://bit.ly/2ROMJea Early Paralytic Agents for ARDS? Yes, No, and Sometimes: https://bit.ly/2ZONDuB Books Mentioned in this Episode: Nudge: Improving Decisions About Health, Wealth and Happiness by Richard H. Thaler and Cass R. Sunstein: https://amzn.to/2Kv75pD Misbehaving: The Making of Behavioral Economics by Richard H. Thaler: https://amzn.to/2YRm5Dc Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou: https://amzn.to/2MPDjyN

End of Life Care in the ICU Jul 25, 2019

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One in five US residents receives ICU care at the end of life. In this episode of Critical Matters, we discuss different aspects of end of life care in the ICU. Our guest is Dr. BJ Miller, a palliative care physician at the University of California, San Francisco and former Executive Director of Zen Hospice Project. He is a powerful advocate for the role of our senses, community, and presence in delivering palliative care and for ushering in a new perspective on living with death. Additional Resources: What really matters at the end of life, BJ Miller presented at TED 2015: https://bit.ly/1PlAuNP Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. Scheunemann LP et al, JAMA Internal Medicine, 2019: https://bit.ly/2LEH0Y5 A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller and Shoshana Berger: https://amzn.to/30VVWEV Vital Talk courses, a set of online and in person courses designed to equip clinicians with the tools to have difficult conversations with patients and families:https://bit.ly/30SPrm6 Books Mentioned in this Episode: Man’s Search for Meaning by Viktor Frankl: https://amzn.to/2JPJjFQ Mortally Wounded: Stories of Soul Pain, Death and Healing by Michael Kearney: https://amzn.to/2YkDPuF Bering Mortal: Medicine and What Matters in the End by Atul Gawande: https://amzn.to/2GsTXjH The Denial of Death by Ernest Becker: https://amzn.to/2SyY7LI

Angiotensin II for Vasodilatory Shock: 2019 Update Jul 10, 2019

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In this episode of Critical Matters, we discuss lessons learned from the clinical use of Angiotensin II (GIAPREZA™), which was approved for use in patients with vasodilatory shock a little over a year ago. Our guest is Dr. Lakhmir S. Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. Dr. Chawla was the designer and lead investigator of the ATHOS (Angiotensin II for the Treatment of High Output Shock) trial which results led to the ATHOS 3 trial, (The Phase 3 clinical trial of angiotensin II, for the treatment of catecholamine-resistant hypotension). ADDITIONAL RESOURCES: ATHOS-3 Clinical Trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock: https://bit.ly/2r5SpG0 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II: https://bit.ly/2JttWTj Sensitivity to angiotensin II dose in patients with vasodilatory shock: a prespecified analysis of the ATHOS-3 trial: https://bit.ly/2xDVVsr ALBUMS AND BOOKS MENTIONED IN THIS EPISODE: The Dark Side of the Moon, Pink Floyd: https://amzn.to/2XZr34x Wish You Were Here, Pink Floyd: https://amzn.to/2Lc2lbb Loonshots: How to Nurture the Crazy Ideas That Win Wars, Cure Diseases, and Transform Industries, Safi Bachall: https://amzn.to/2S4IrPU

Critical Care of Neuromuscular Disorders Jun 17, 2019

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In this episode of Critical Matters, we discuss acute neuromuscular disorders in the intensive care unit with Dr. M. Kamran Athar. The discussion focuses on the Guillain-Barre Syndrome and Myasthenia Gravis. Dr. M. Kamran Athar is a practicing neuro intensivist at the Farber Institute for Neuroscience in Philadelphia. Dr. Athar is an assistant professor of Medicine and of Neurology at the Jefferson School of Medicine in Philadelphia. Additional Resources: The clinical management of neuromuscular disorders in intensive care: https://bit.ly/2wWlYe1 Early predictors of mechanical ventilation in Guillain-Barré syndrome: https://bit.ly/2Icb1vi International consensus guidance for management of myasthenia gravis: https://bit.ly/2Ic2g4I Books Mentioned in this Episode: How Doctors Think by Jerome Groopman: https://amzn.to/2ZmHSmV

Compassion in the ICU Jun 12, 2019

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In this episode, we discuss compassion in the ICU with Dr. Stephen Trzeciak. Dr. Trzeciak is Chief of Medicine at Cooper University Health Care, and Professor and Chair of Medicine at Cooper Medical School of Rowan University in Camden, New Jersey. He is the co-author of a recently published book “Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. In addition, Dr. Trzeciak and his research group have published several original research papers focusing on compassion in healthcare. Additional Resources: Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study: http://bit.ly/2Wio1re Development and Validation of a Tool to Measure Patient Assessment of Clinical Compassion: http://bit.ly/2JR1ifr For patients, caregiver compassion is essential. The Washington Post: https://wapo.st/30yYtW1 Books and Albums Mentioned in This Episode: Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference by S. Trzeciak and A. Mazzarelli: https://amzn.to/2JQXv1y The Joshua Tree by U2: https://amzn.to/2JvU4hu The Koln Concert by Keith Jarrett: https://amzn.to/2VVBYMn

Toxicology in the ICU – Part 2 Jun 12, 2019

Show notes

In this episode, we discuss Toxicology in the ICU. This is part two of a two-part series. Today’s episode will focus on specific toxic ingestions and their management. Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA, which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College. Additional Links: American Association of Poison Control Centers Website: https://aapcc.org/ A three-part review series published in CHEST on Toxicology in the ICU. Part 1: https://bit.ly/2OhO2k5 Part 2: https://bit.ly/2UuLQY1 Part 3: https://bit.ly/2OiGM7A Albums Mentioned in this Episode: Live at the BBCby The Beatles: https://amzn.to/2vIrX5M

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