The Internet Book of Critical Care Podcast

IBCC Episode 128 - ABG, VBG and Pulse Oximetry May 13, 2023

Welcome to the origin story of PULMCRIT!

In this episode, we cover how best to practically monitor the balance between oxygenation, oxygen delivery and oxygen consumption. Controversial to say the least.

Come take a listen, and learn about the pulsatility index, a space we should all be watching for in the future.

IBCC Episode 127 - Spontaneous Bacterial Peritonitis (SBP) Apr 28, 2023

We are back! Come dust off our shows spot in your favourite podcast app, and listen to why its important to hunt for SBP like it's the Red October (forgive the Sean Connery reference, I had too). We cover diagnosis (aka tap-y-tap) and treatment.

IBCC Episode 126 - Myocardial Ischemia Dec 02, 2022

Annnnnnnnd We are back. Sorry, but after Andor has finally finished we have now got time to discuss the old type 1 MI, aka STEMI aka Occlusive Myocardial Infarction. Come listen for all those basics and some nuances around myocardial infarction in critically unwell patients. We talk when to DAPT, who gets full anticoagulation, hemodynamic support, and when to wake our Cardiology friends up in the night.

IBCC Episode 125 - Left Ventricular Outflow Tract Obstruction Aug 02, 2022

Being Dynamic is usally a great thing... but not when youre crushing the only good way out of the left ventrile.

In this episode we cover dynamic obstruction of the LVOT (specifically sub-valvular):

what is it?

who gets it?

What to do about it.

We missed ya'll, so come have alisten and brush up on a rare but important phenomena in our critically ill patients.

IBCC Episode 124- Neuroprognostication After Cardiac Death Apr 09, 2022

In this beast of a 53 minute podcast, we tackle the approach to prognosticating neurologic function of our patients after cardiac arrest. This is hard! As Dick Cheney taught us, there are lots of known and unknown-unknowns. Read through the chapter, then come listen to all things: nuances around confounders, using structural and functional tests. How imaging can lead us astray. Is there a troponin of the brain? Josh even admits to what he'd take to the proverbial desert island.

IBCC Episode 123 - Respiratory Alkalosis Mar 07, 2022

In this episode, we follow up with last week's podcast and explain the drivers of hypocapnia and subsequent respiratoy alkalosis. Come listen to a primer for all things ASA, sepsis, encephalopathy or strait mountain biking - induced panic.

IBCC Episode 122 - Respiratory Acidosis Mar 01, 2022

In this lean and mean episode, we cover the outrageously broad topic of respiratory acidosis. Come listen to help structure your approach to Won't Breathe, Can't Breathe, and Breathing Won't Work. If you remeber nothing else, its that hypercapnia does not always mean BIPAP

IBCC Episode 121 - Pneumocystis Jiroveci Pneumonia Feb 21, 2022

In this episode we cover the rare but important driver of your patients respiratory failure: Pneumocystis Jiroveci Pneumonia. Come listen to why you should always delineate HIV status, how to approach patient workup and treatment via an invasive and non invasive manner, and why heatwaves is just a sick song.

IBCC Episode 120 - Tamponade Dec 15, 2021

In this episode, we cover that terrible T... Tamponade. Sit back, and get your learn on while we go beyond Beck's triad, discussing all things pulses paradox, ultrasound assessment, pitfalls, stabilization, and Josh will even melt your mind with low pressure tamponade.

IBCC Episode 119 - Sympathomimetic Toxicity Dec 01, 2021

In this episode, we cover all things "Upper(s)." Come listen to all things critical care level cocaine, meth and bath salts. Organ dysfunction, rapid control, immersive cooling and more!

IBCC Episode 118 - Necrotising Fasciitis Oct 28, 2021

In this episode, we cover that scary presentation where your patient goes from seemingly well, to skin melting off and in multi organ failure.

Come take a listen for all things clinical presentation, anti-toxin antibiotics regimes, skin cut downs and surgical debridement.

IBCC Episode 117- SCAPE Oct 25, 2021

We're back... maybe by popular demand? In this episode, we cover those two phenotypes of acute pulmonary edema: the hyper-acute sympathetic crashing acute pulmonary edema (SCAPE) patient, versus that fluid overload sub acute pulmonary edema (FOSPE). Come listen to all things NIV, nitro, and soothing calm clinical approach.

IBCC Episode 116 - Hepatorenal Syndrome Aug 16, 2021

It has been a hot minute, Josh blames Adam. Adam Blames existential crisis, wildfires and the Rona.

Come listen to this comeback cast: Hepatorenal Syndrome. We talk all things systemic dilation with renal constriction. We talk newish classification, albumin, pressers and more. So leave your Map goal of 60 behind you, and enjoy these pearls.

IBCC Episode 115 - Invasive Candidiasis Jun 29, 2021

In this episode, we cover that variable response to when the lab calls with a culture positive for candida. Lines, blood, Urine. Labs, Anti-fungals, imaging... we got it all.

IBCC Episode 114 - Atrial Fibrillation Jun 21, 2021

In this episode, we aim to arm you with a basic approach to the rhythm that loves to make the monitors go ping: atrial fibrillation. The age old argument: rate vs rhythm control. What rate is acceptable? Who gets all of the drugs? Why do we love amiodorone? When do you dust off old sparky? Come join us for 42 minutes of Josh giggling and educating us all.

IBCC Episode 113 - Sodium Channel Blocker Toxicity Jun 03, 2021

In this episode we cover one of the hallmarks of the poisoned patient, that ECG tracing with a widening QRS. After reading the post, come listen for the nuances around all things hypertonic bicarb for sodium delivery, preventing acidosis with isotonic bicarb, how those sneaky-brilliant toxicologists will use lidocaine, and when to push the "panic button" on intra-lipid.

IBCC Episode 112 - Valproic Acid Toxicity May 10, 2021

In this episode we cover the obvious, and subtleties around Valproic Acid toxicities. We talk everything from cerebral edema, giving that L-Carnitine and when to spin that IHD machine.

IBCC COVID-19 Update #8 Mar 11, 2021

In this episode we summarize the new COVID Chapter (well not so new, but spot on predictions from Jan 26th).

Steroids = Yes. Dose... 6mg and keep going up?

Toci / Bari = maybe

Cocktails / Plasma = Nope

Come take a listen for all things anticoagulation, immune modulation and organ support.

IBCC Episode 111- Purpura Fulminans Feb 19, 2021

In this episode we continue on the path of DIC: the scary sub-phenotype that is Purpura Fulminans. When your patient is necrosing everything, you need to act quickly before they start losing organs and digits. Come listen for identification, anticoagulation, protein C and all its goodness, when to give Vitamin K, and why to really be careful about Warfarin.

IBCC Episode 110 - Disseminated Intravascular Coagulation Jan 18, 2021

In this episode, we cover disseminated intravascular coagulation. It sounds bad, because it is. Come listen and refresh your skills around supporting the bleed-bleedy versus the cloth-clotty, how to differentiate DIC and chronic liver failure and a few more juicy clinical pearls.

IBCC Episode 109 - Lithium Toxicity Jan 14, 2021

In this episode, we cover the spectrum of lithium toxicity, from the acute ingestion, to the patient with saturated brain tissue. Come take a listen to explore the nuances around volume repletion, when or should you reach for dialysis, what SILENT is or does it exist.

IBCC Episode 108 - Toxic Shock Syndrome Dec 23, 2020

In this episode we cover those super antigens that cause all the trouble with staph and strep infections. Come take a listen around pathophysiology, identification, antimicrobials and all things IVIG.

IBCC Episode 107 - BRASH Syndrome Dec 15, 2020

In this episode, we cover the OG-Farkas description of the age-old interplay between bradycardia / renal failure / AV nodal blocking agent / Shock / and Hyperkalemia. Don't just try and snipe one off at a time, carpet bomb them all at once.

IBCC Episode 106 - Massive Transfusion Protocol Dec 11, 2020

In this episode we cover the crucial approach to what drives hemorrhagic shock: lots of bleeding. Come take a listen for the nuances around an organized approach to 1:1:1 and may we be as bold to say... 1:1:1:1 (fibrinogen, YAY). All things hypocalcemia, hypothermia, acidosis and what lines to use.

IBCC COVID-19 Update #7 Dec 04, 2020

We were actively trying to fill your life with non-covid things... but we just had to talk about these big new things. Come take a listen of aerosol transmission, why Remdesivir just doesn't work in the real world, why not to make the same mistake with the -mab du jour, and a few other tid bits.

IBCC Episode 105 - Ventilator Associated Pneumonia Dec 01, 2020

In this episode, we cover that daily issue: Is this a VAP? Come take listen to level up beyond leukocytosis, inflammation, consolidation, worsening oxygenation and positive cultures.

Viva la Piptazo - Linezolid/Vanco diad.

IBCC Episode 104 - Hemophagocytic LymphoHistiocytosis (HLH) Nov 28, 2020

In this episode, we cover another great white whale in critical care: Hemophagocytic LymphoHistiocytosis (HLH). When your macrophages turn into paceman and start chomping your own cells, you're in trouble. Com listen about genetic predisposition to unchecked immune response, and a conversation around immunomodulation.

IBCC Episode 103 - Gastrointestinal hypomotility in critical care Nov 16, 2020

In this episode we cover the big picture view of ileus, gastroparesis and colonic pseudo-obstruction. Come take a listen so summarize these issues you will encounter on the daily.

IBCC Episode 102 - Cerebral Venous Thrombosis Oct 23, 2020

In this episode, we cover the DVT of the Brain... Cerebral Venous Thrombosis. Lace up your shoes, start washing those dishes, do whatever you need to do while we remind you about presentation, workup and most of all, treatment. As 1% of all strokes and the most common cause of stroke in young patients, you'll want to know this one cold.

IBCC Episode 101 - Stress Hyperglycemia in the ICU Oct 19, 2020

In this episode we cover the often overlooked topic of glycemic control in the ICU. What blood sugar should we be targeting? Is that hyperglycaemia a stress response? Insulin resistance? Iatrogenic? All of the above. Come listen to our discussion, and Josh's attempt at clearing up a confused evidence base.

IBCC Episode 100 - Wernicke encephalopathy Oct 16, 2020

We've reached a milestone, 100 episodes! In this podcast, we cover ICU level thiamine deficiency, not just your white-whale of Wernicke encephalopathy. Come take a listen for dosing, clinical features and complications.

IBCC Episode 99 - Hypertriglyceridemic Pancreatitis Oct 13, 2020

In this episode, we cover the approach to the not-so-rare cause of ICU level pancreatitis: hypertriglyceridemia. Come take a listen for nuances around insulin management, and second thoughts around using heparin and plasmapheresis.

IBCC Episode 98 - Antifungal Agents Sep 14, 2020

In this episode we simplify the approach to covering your invasive fungal infections in critically unwell patients.

Yeast vs Mold vs Endemic Mycoses

Azoles vs Echinocandins vs Amphotericin

IBCC Episode 97 - Nausea & antiemetics Sep 12, 2020

Its the rare occasion you go one complete day without treating Nausea and vomiting in the ICU. In this episode, we cover the ddx you can't miss, and the multiple receptors to target in your patients.

IBCC Episode 96 - Analgesia for the critically ill patient Aug 28, 2020

In this episode, we cover the essentials of analgesia for your critically ill patients. Spoiler alert, multimodal approaches are the way to go. If your MAR only has opiates on it, there may be a problem.

Come listen for a new twist on the ladder approach, all things ketamine / precedes and lidocaine... with much much more.

IBCC Episode 95 - Inhaled Pulmonary Vasodilators Aug 08, 2020

In this episode we cover the widely use, but poorly supported inhaled pulmonary vasodilators:

-Oxygen

-Nitroglycerin / Nitric Oxide

-Epoprostenol

-Milrinone

IBCC Episode 94 - Hyperosmolar Hyperglycemic State Aug 06, 2020

In this episode, we cover the more sinister twin of DKA... HONK aka HHS (Hyperosmolar Hyperglycemic State).

Come listen to how not to blow up your patients brain in the tug-of-war between glucose and sodium.

IBCC Episode 93 - Guillain-Barre Syndrome Jul 28, 2020

In this episode we cover Guillain-Barre Syndrome. Everything from presentation, to why you should stop checking negative inspiratory pressure and just stick with FVC. Read the post then come take a listen.

IBCC Episode 92 - Intracranial hemorrhage Jul 23, 2020

In this episode we cover one of the most fatal and moribund conditions we see regularly, Intracranial hemorrhage.

Etiology, diagnosis and treatment (of course we spend time on BP goals).

IBCC Episode 91 - Catastrophic Antiphospholipid Syndrome Jul 22, 2020

In this episode we cover Catastrophic Antiphospholipid Syndrome. A very rare and often missed diagnosis. Come take a listen to brush up on high risk patient population, clinical diagnosis, labs, steroids / anticoagulation and more treatment options.

IBCC Episode 90 - Fever Jul 18, 2020

In this episode we talk about fever... fever in the ICU... ICU acquired fever. It is not all VTE or VAPS, Chole or CLABSI. We cover a thoughtful approach to not just sending pan culture, and adding piptazo-vanco.

IBCC Episode 89 - CAUTI Jul 10, 2020

In this episode, we cover the sasquatch of ICU derived fever: catheter associated urinary track infection. Farkas is on the fence whether it is clinically relevent:

Come listen for those pearls: IDSA diagnostic criteria. Treatment coverage. Purple bag syndrome, and more!

IBCC Episode 88 - Sickle Cell Acute Chest Syndrome Jul 08, 2020

In this episode we cover a major cause of mortality for our sickle cell patients: Acute Chest Syndrome. This is a very serious entity you must keep a low clinical threshold for working up and treating.

Diagnosis

Pain Control, Volume Resuscitation

Antimicrobials

Exchange transfusions and more

IBCC Episode 87 - Epiglottitis Jul 02, 2020

In this episode, we cover the rare but life threatening Epiglottitis.

Highlights:

Presentation not as you learned in medical school

Vast majority do not need intubation, but for those that due it can be catastrophic

Nasolaryngoscopy, Steroids, broad spectrum antibiotics and early airway plans are the way to go

IBCC Episode 86 - PJP Pneumonia Jun 29, 2020

In this episode, we cover ICU level Pneumocystic Jirovicii Pneumonia (previously known as Pneumocystic Carinii Pneumonia).

Suggested approach:

HIV +(ve) vs HIV -(ve)

Invasive vs Non invasive diagnostic strategy

Treatment w. Septra vs other line therapies

IBCC Episode 85 - Vocal Cord Dysfunction Jun 22, 2020

In this episode, we cover the lesser of evil stridor aetiologies: Vocal cord dysfunction, a.k.a paradoxical vocal cord motion, a.k.a Paradoxical Vocal Fold Movement. Read the post, then listen to review approach, diagnostic modalities (fibre-optic visualization, CT scan to rule out other entities) and treatment.

IBCC Episode 84 - Invasive pulmonary aspergillosis Jun 15, 2020

In this episode we cover that not so friendly-Fingi: Aspergillus

Come get acquinted with the two forms: angioinvasive (think neutropenia) vs bronchoinvasive (the not so immunosuppressed). Don't forget to add this to your Ddx for nosocomial post-influenza & COVID-19.

IBCC Episode 83 - Refeeding Syndrome Jun 08, 2020

In this episode we cover the often overlooked entity that is re-feeding syndrome.

High Risk populations

Signs & Symptoms

Insulin mediated edema, and more

IBCC Episode 82 - Takotsubo Cardiomyopathy Jun 01, 2020

In this episode, we cover the presentation, clinical signs / symptoms and workup of takotsubo cardiomyopathy. Come take a listen so you'll never miss that octopus-trap of a clinical confounder, with juicy pearls around LVOT obstruction.

IBCC Episode 81 - Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin May 26, 2020

In this episode we cover the work horses we use daily in critical care patients: anticoagulants: Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin. We also cover BID dosing of LMWH prophylaxis and the essential section here is on heparin resistance. Enjoy!

IBCC Episode 80 - Acute Exacerbation of COPD May 19, 2020

In this episode, we cover that bread and butter presentation, chronic obstructive pulmonary disease.

Clinical Features

Respiratory support

Pharmacotherapy

Approach to ventilation and extubation

IBCC COVID-19 Update #6 May 17, 2020

In this episode we update therapeutics: Kaletra is back. Before/after for Steroids. Anakinra is here. We also delve into coagulopathy and super spreaders.

IBCC COVID-19 Update #5 May 06, 2020

In this Episode:

We update new understandings from NYC, Lung pathology (AFOP), Cowboys Vs Ivory Towers, Remdesivir and COVID-19 Phenotypes.

Stay Healthy!

IBCC COVID-19 Update #4 Apr 21, 2020

In this update:

The Fall of Remdesivir?

HCQ no so bueno?

Fluid status

Learning from Tobin, Gattinoni, and our patients physiology

Steroids!?!?

IBCC COVID-19 Update #3 Apr 13, 2020

In our 3rd installment of correcting things we've said that were wrong 🤓, here we cover COVID-19 coagulopathy, respiratory pathophysiology, immune modulation and APRV.

IBCC COVID-19 Update #2 Mar 30, 2020

In this episode, we right some wrongs. As we said in the beginning, given the fast pace we were bound to be wrong, and will be again.

1) New paradigm for COVID-19 patients

2) Procalcitonin: not as good as we thought

3) Malignant atelectasis and the crashing hypoxemia

4)SARS-COV-2 & DIC

5) Awake Proning / CPAP / Vent Splitting / Extubation

6) Ethical dilemmas

IBCC COVID-19 Update # 1 Mar 22, 2020

In this episode, we update you on:

Transmission

HFNC/CPAP

Steroids?

The fall of Kaletra

Come take a listen. Know that we are all in this together.

IBCC Episode 79 - COVID-19 Mar 11, 2020

There is a lot of attention to this growing global health concern. Come listen for what will be a continuing update for all thing clinically pertaining to COVID-19.

Pathogenesis

Transmission/PPE

Respiratory support

ARDS management

Steroids?

Antivirals

IBCC Episode 78 - Vasoactive Agents Feb 20, 2020

In this episode, we cover a core component of any resuscitationists tool kit: vasoactive agents.

We've got your vasopressors, your inodilators, your inopressors, you oral cheat code and some hail merry approaches. Come listen for all things pressure and flow.

IBCC Episode 77 - Anaphylaxis Feb 17, 2020

In this episode, we cover one of those cardinal causes of vasodilatory shock; anaphylaxis.

Come listen to solidify your clinical diagnosis, and domination of all things epinephrine.

IBCC Episode 76 - Status Epilepticus Feb 10, 2020

In this episode we cover that rapidly progressive, big stakes entity that is Status epilepticus - the unrelenting seizure. Definition, Big Benzoes and where to go after that first line. Come listen for all things Keppra, Propofol and Ketamine.

IBCC Episode 75 - Hypocalcemia Jan 31, 2020

In this episode we cover the last common electrolyte derangement you'll face in the ICU; hypocalcemia. From tetany to hypotension, we've got you covered for an approach to recognition and treatment.

IBCC Episode 74 - Toxic Alcohols Jan 27, 2020

In this episode we cover that rather bothersome component of your AGMA... toxic alcohols. Who is high risk, when and how to screen, and of course a tight approach to treatment. Don't forget... always call your local friendly toxicologist.

IBCC Episode 73 - Line Infection Jan 14, 2020

In this episode, we cover that daily discussion point... can this line, possibly, be infected? Come refresh yourself on diagnosis, microbiology and treatment.

IBCC Episode 72 - Dominating the Diuresis Jan 09, 2020

In this hallmark episode (we just hit 500k in downloads!), we cover an approach to dominating the diuresis. We cover all the major points:

-Loop diuretics and how not to screw them up

-Using thiazides to maximize ongoing diuresis

-When to add spironolactone

-How not to always just cheat and start the CRRT machine

IBCC Episode 71 - Myxedema Coma Jan 02, 2020

Welcome to 2020, everyone! In this fresh new podcast we cover all things severe hypothyroidism; AKA Myxedema Coma.

Diagnosis. Treatment. Whats the deal with T4 vs T3. Who gets the roids. Come listen to it all!

IBCC Episode 70 - Non-Invasive Respiratory Support Dec 28, 2019

Happy Holidays everyone! In this episode we cover the general support of those patients that are working hard to breathe. Come listen about NIPPV (BiPAP and High Flow Nasal Cannula).

IBCC Episode 69 - Acute Promyelocytic Leukemia Dec 19, 2019

In this episode, we cover that rapidly progressive, easy to miss, relatively better survived leukemia: acute promyelocytic leukemia.

Come read about pathophysiology, and then listen to the summary that covers when to suspect clinical APL, the use of ATRA, and that scary hyperfibrinolysis (DIC but worse). Just to leave you with more, we cover Differentiation syndrome (aka retinoic acid syndrome).

IBCC Episode 68 - Hyponatremia Dec 12, 2019

In this episode, we cover all things ICU level hyponatremia. From a mild inconvenience to a refractory seizing patient, we've got you covered for diagnosis, treatment and risk stratification.

IBCC Episode 67 - Hypokalemia Dec 05, 2019

In this episode we cover that low serum potassium, aka Hypokalemia. From the minor repletion to the immediate resuscitation of a patient with VF arrest secondary to severe hypokalemia, we have you covered. So read the post, then come take a listen to review all things hypo K!

IBCC Episode 66 - Brain Death Nov 28, 2019

In this episode we cover the definition and concrete way how to identify and correctly diagnose brain death. This is something we need to get right, so grab a coffee and come take a listen.

IBCC Episode 65 - Hypothermia Nov 21, 2019

In this episode we cover both accidental and non-accidental hypothermia. Come listen for a good review on:

Clinical Clues
Passive and Active re-warming
Modification of standard ACLS approach
Complications of hypothermia
and much much more...

PS: Many apologies to cardiac anesthesiologists and perfusionists: core after-drop is a thing, but we don't want to cloud the issue of priorities in rewarming.

IBCC Episode 64 - Bupropion Toxicity Nov 14, 2019

In this episode, we cover the 2019 version of a TCA overdose: Bupropion. AKA: Wellbutrin / Illbutrin (Shoutout to Tox & The Hound).

Read the post then get an audio summary of the clinical diagnosis, risk stratification, Activated charcoal, whole-bowel irrigation and finally all things VA-ECMO for the extreme toxicities.

IBCC Episode 63 - Acalculus Cholecystitis Nov 12, 2019

In this episode, we cover that sneaky presentation of acalculus cholecystitis. When that ALP/GGT start climbing, or your chronically critically ill patient gets septic again, you need to know about this!

IBCC Episode 62 - Carbon Monoxide Poisoning Nov 10, 2019

In this episode, we cover that pesky Carbon monoxide. From minor exposure to critically ill, we have you covered for:

-Diagnosis

-Testing

-Hyperoxia

-Hyperbaric

-Bleeding Edge Therapies

IBCC Episode 61 - Post MI Complications Oct 24, 2019

Just when you thought your post MI patient has made it through the woods... they start to crump! In this episode we cover the Ddx and approach to post myocardial infarction complications. Come listen to review all the greatest hits.

-Rupturing things

-Pericarditis

-Access issues

-Arrythmias

IBCC EP 60 - Methemoglobinemia Oct 15, 2019

In this episode we cover that rare but fun element to your cyanosed patient Ddx. When your hemoglobin gets oxidized to Fe3+, badness can ensure. Enjoy this quick refresher.

IBCC EP 59 Diffuse Alveolar Hemorrhage & Pulmonary Vasculitis Oct 10, 2019

In this episode, we cover one check box on your bilateral airspace opacification differential diagnosis. Come take a listen for Diffuse alveolar hemorrhage and pulmonary vasculitis in the ICU.

-Imaging findings

-Bronch?

-What labs to order (you can't just write "vasculitis work up")

IBCC Episode 58 - Asthma Oct 08, 2019

We know you all have been waiting for it! Here is one of the foundational chapters for the IBCC. All things asthma. We've got everything from physiology, to bleeding edge sedation approaches.

Come take a (longer) listen to solidify everything you read in the post:

-Presentation / patient phenotypes

-Initial management

-Escalation to salvage treatments

-Vent Management & ECMO

IBCC Episode 57 - Metabolic Alkalosis Sep 26, 2019

In this episode, we further explore the acid-base-palooza with Metabolic Alkalosis.

We give you 10 things to treat said event with, however, sometimes its best to let sleeping dragons lie. Josh even snuck in some acid infusion!

IBCC Episode 56 - NAGMA Sep 19, 2019

In this episode we have a quick little refresher on Non-Anion-Gap Metabolic Acidosis for you! Enjoy!!!

IBCC Episode 55 - AGMA Sep 17, 2019

Continuing on with metabolic-palooza:

Here is the core approach to Anion-Gap Metabolic Acidosis. We've got the KULT, we've got the labs/treatment and everything in between.

IBCC Episode 54 - Approach to Acid Base Disorders Sep 12, 2019

In this episode, we cover the foundations to every day clinical medicine in the ICU: Acid base. As our patients are either often too sick to regulate their own homeostasis, or what we are doing to them prevents their lungs or kidneys from doing so, we give you the approach to recognizing Acid Base disorders.

Step 1: Calculate the Anion Gap

Step 2: Look at the Bicarbonate level

Step 3: Compare the change in Anion Gap to the Change in Bicarbonate

IBCC Episode 53 - Submassive & Massive Pulmonary Embolism Sep 10, 2019

In this episode we explore the controversies in how to classify the hemodynamic effects of pulmonary embolisms.

We also cover:

-Risk Stratification

-Thrombolysis

-Anticoagulation

-Novel therapies

-The crashing & hypoxemic PE patient

IBCC Episode 52 Anticoagulation Reversal Aug 29, 2019

In this episode, we cover all the big hits for anticoagulant management in your bleeding patients.

-Warfarin

-DOAC

-Anti platelets

-Heparin and LMWH

-And More!

IBCC Episode 51 - Tumor Lysis Syndrome Aug 22, 2019

In this episode, we cover all things you need to know cold when your patient's cells are bursting all over the place.

-Life threatening Hyperkalemia

- Purine Nucleotide Management

-Rasburicase

-Dialysis

IBCC Episode 50 - Hyper and Hypomagnesemia Aug 15, 2019

In this episode, we take a break from controversial subjects and cover all thing magnesium related for critical care.

Come take a listen for diagnosis, identification, and treatment of low and high levels of magnesium.

IBCC Episode 49 - Septic Shock Aug 08, 2019

Here it is, a total beast of a podcast. We cover one specific approach to patients in septic shock. We highlight all the must-know aspects:

-patient identification and risk stratification

-fluids

-vasopressors/inotropes

-The Metabolic Resuscitation Protocol

We even re-leak the CITRIS-ALI trial for you... its going to be an epic Doozy. So make sure you have a proper 60+min to really take it all in.

IBCC Episode 48 Angioedema Aug 01, 2019

In this episode we cover the simultaneous approach of sorting out the airway from hell, and treating both the histamine and bradykinin induced angioedema. We even snuck some novel use of TXA into the post!

IBCC Episode 47 Hyperthermia Jul 31, 2019

In this episode, we follow-up on the very "heated" debate that this post sparked on the interwebs. Come listen to all things ICU level-hyperthermia. We've got the ice baths. The cold fluids. The dry air. We cover it all!

IBCC Episode 46 - Massive Hemoptysis Jul 25, 2019

In this episode we go over a general approach to your patient with Massive Hemoptysis. When lungs have blood in them = badness. We give you a targeted approach to stay cool, find the bleed, and stop it in the most efficient manner possible. Come listen for discussions around securing airway, protecting the good lung, CT first, and definitive management.

IBCC Episode 45 ETOH Withdrawal Jul 20, 2019

In this episode, we cover the last half of phenobarbital week! This is a long one, but we cover the Farkas manifesto on by phenobarb is superior to standard approaches to alcohol withdrawal management.

-Dosing

-Indications/Contraindication

-Adjuvant therapies & more

IBCC Episode 44 - Community Acquired Biliary Sepsis Jul 11, 2019

In this episode, we will cover all those pesky things that can make your patient sick from the RUQ: namely the biliary tract!

Ascending cholangitis, Cholecystitis and all the important pearly for imaging, antibiotics and source control options.

IBCC Episode 43 Clostridium Difficile Jul 05, 2019

If your nursing colleagues can smell it, and you can't, fear not! We've got you covered for all things C. Diff on an ICU-level. Also, the audio quality is particularly bad on this episode, we apologize. Just the realities of recording on the road!

IBCC Episode 42 Fluid Selection & pH Guided Resuscitation Jun 27, 2019

In this episode, we cover the always vexing crystalloid vs colloid debate. Farkas also brings it to the next level with a new paradigm for using large volume resuscitations to treat your patient's acid-base disturbances. Come take a listen for all things alkalinizing, acidifying and maintaining.

IBCC Episode 41 - Hypercalcemia Jun 20, 2019

In this episode, we've got you covered for all things hypercalcemia. Erase those memory banks that are filled with hyper-hydration and forced diuresis and come fill them back up with appropriate fluid resuscitation, the 1-2-punch for those osteoclasts and all the rest of the pearls for hypercalcemia.

IBCC Episode 40 - Serotonin Syndrome / Toxicity Jun 13, 2019

Pull those ankle socks up, and get ready for some ankle-clonus-good-times. In this episode, we cover one of those "hot and bothered" presentations of Serotonin Toxicity. Come listen to a summary of the chapter that includes, definition, clinical presentation, treatment and clinical pearls.

IBCC Episode 39 - TickBorne Illness Jun 06, 2019

In this episode, we cover an often overlooked infectious cause of that ICU level patient presenting with all kinds of badness: come listen for a sound education on all things babesiosis, anaplasmosis & ehrlichiosis, and rocky mountain spotted fever (RMSF).

IBCC Episode 38 - Hepatic Encephalopathy May 30, 2019

Either its a glaringly obvious diagnosis (because your patient is bright yellow and wont wake up) or its apart of a complex presentation, hepatic encephalopathy is one presentation you need to have down!

Come listen to consolidate your knowledge around nitrogen reduction, shunts (the good, the bad, the ugly) and all things HE!

IBCC Episode 37 - Rhabdomyolysis May 16, 2019

In this episode, we help you take a more nuanced approach to those patients with "coca-cola urine." When that CK is a climbing and you don't know what to do, remember these pearls!

IBCC Episode 36 - All things Phosphate May 09, 2019

In this episode, you get a two-for-one. Come for the hypophosphatemia, stay for the hyperphosphatemia.

IBCC Episode 35 - Contrast Induced Nephropathy May 02, 2019

Contrast induced nephropathy is the "white walker" of critical care and emergency medicine. Come take a listen as we discuss the potential error in creating a clinically non-meaningful entity, and how we should address this in our daily clinical work.

IBCC Episode 34 - Endocarditis Apr 25, 2019

In this episode we cover all those big highlights for infective endocarditis. Come solidify your approach to clinical presentation of both left and right sided disease, approach to imaging, and empiric therapy. We've even got the hot topic of dual coverage down!

IBCC Episode 33 - VF/VT Storm Apr 19, 2019

In this episode we cover the finer points of the high stakes resuscitation of VF / VT "Storm."

Come get a solid approach to identification, resuscitation and nuanced management.

IBCC Episode 32 - Metformin Toxicity Apr 11, 2019

Have you ever seen that patient with a bicarb of 6 and a lactate of 14, and they are just smiling at you and texting their spouse about taxes? In this episode, we explore the direct, indirect, and obscured role that metformin can play in your critical care patients. Come listen for all things diagnosis, classification and some special discussion around GIK, Methylene Blue and when to spin that dialysis machine.

IBCC Episode 31 - Penicillin Allergy Apr 04, 2019

This often mis-understood "penicillin allergy" can have far more dire impacts on the population you would think. Come take a listen and explore the pathophysiology of R1-side chain impact on true allergy, what to do about it, and how it impacts antimicrobial selection and use.

IBCC Episode 30 - Pre-Eclampsia Mar 30, 2019

In this episode, we've got you covered for this hypertensive emergency that you need to know cold. Come take a listen for all things around diagnosis, risk factors, clinical presentation, labs and treatment. We've got your magnesium. We've got your labetolol. We even have a few new tricks for hemolysis.

IBCC Episode 29 - Hypertensive Emergency Mar 23, 2019

Just like when you were a kid and that science fair volcano was spewing badness everywhere... an unchecked perfusion pressure can wreak havoc on your end organs. In this podcast, we cover the true primary emergency that results from too high of perfusion pressure. Come take a listen for all things diagnosis, treatment and even a nice coverage of PRES.

IBCC Episode 28 - Abdominal Compartment Syndrome Mar 14, 2019

In this episode, we cover the often missed "abdominal compartment syndrome." Lace up those shoes, get ready for your commute, and let us review for you the diagnosis and treatment of this critical care quagmire.

IBCC Episode 27 - Myasthenia Gravis Crisis Mar 07, 2019

In this episode we explore this rare but commonly seen entity of NMJ caused weakness. Come listen to review the patient population, identification and management of MG CRISIS.

IBCC Episode 26 - Acetaminophen Toxicity Feb 28, 2019

In this episode, we start off with all those familiar aspects of APAP toxicity that you've heard about. Then we kick it up a notch and give you new pearls around Massive ingestions and high dose NAC infusions, when to Dialyze (you read that correctly) and even more great pearls! Come take a listen.

IBCC Episode 25 - Hypernatremia Feb 21, 2019

In this episode we will cover all the highlights you need to know about hypernatremia. Serum sodium... we see you yawning already! But if you want to level up your critical care skills, you need to pay attention to this often missed cause of serious morbidity in our ICUs.

IBCC Episode 24 - Salicylate intoxication Feb 17, 2019

Toxicology is fun. Salicylate overdoses can be intimidating, so come take a listen to get you ready for the next patient you see, so you can keep them out of that death-spiral!

IBCC Episode 23 - Thyroid Storm Feb 11, 2019

In this episode, we cover the diagnosis of this must-not-miss-unicorn. Come take a listen for a lengthy discussion around management, including the controversial use of beta-blockade.

IBCC Episode 22 - Thrombocytopenia Jan 31, 2019

In this episode, we've got a great approach to low platelets in the ICU patient population. Come take a listen for approach, management, what not to miss, and all things HITT.

IBCC Episode 21 - Antibiotics Jan 27, 2019

Here it is... it took a mythical amount of time to prepare, so we hope you enjoy this long format cast on the broad topic of antibiotics. We cover the highlights of all the usual suspects, beta-lactams, cephalosporins, aminoglycosides, macrolides and all the weird and wonderful.

Make sure you read the post before diving into this beast!

IBCC Episode 20 - Shock Jan 17, 2019

Every resuscitationist MUST have this basic approach down cold. Come take a listen to the foundation of our specialties in what the French like to say "Reanimation."

Approach and treatment for all those SICK looking patients.

IBCC Episode 19 - Severe Influenza Jan 10, 2019

ICU level Influenza. Very pertinent for this time of year. Come take a listen and explore clinical management pearls, and some bleeding edge discussion for adjuvant therapy on your hardcore viral patients.

IBCC Episode 18 - Acute Kidney Injury Jan 03, 2019

Come take a listen to keep you regimented towards this must-not-mess-up presentation.

We've got classification, management and some juicy pearls. Arm yourself with the knowledge to stop ordering that FeNa!

IBCC Episode 17 - Community Acquired Urosepsis Dec 26, 2018

Merry Christmas / Happy Holidays everyone!

Here is a little present for you during these cold times. For those of you who have seen this population, they can get sick, fast! However, when you've got your approach and management down, they can get better, just as fast! Come take a listen for the identification, microbiology and treatment or urosepsis.

IBCC Episode 16 - Immune Checkpoint Inhibitors Dec 19, 2018

Don't know what immune checkpoint inhibitors are? Don't worry, neither did I until Farkas through some major knowledge on me. Come take a listen about what this class of drugs can do to every organ in your body!

IBCC Episode 15 Adrenal Crisis Dec 12, 2018

In this short podcast, we cover the identification, workup and treatment of that often missed cause of vasodilatory shock: adrenal insufficiency.

Come take a listen for all things population, ACTH stim-test and how to manage these patients.

IBCC Episode 14 Post Cardiac Arrest Management Dec 05, 2018

These patients can truly be the sickest of the sick. Come take a listen for the summary of a chapter that is bound to be one of your go-to resources.

ROSC management

TTM

Sedation

Steroids

We've got it all.

IBCC Episode 13 Meningitis Nov 28, 2018

In this episode we tackle the identification & treatment of central nervous system infections, aka badness. You'll be equipped with a standard treatment regime for your patients with meningitis or that brain-melting encephalitis.

IBCC Episode 12 - Torsades De Pointes Nov 21, 2018

Do those squiggly lines on the ECG monitor have you patient down in the hypotensive dumps? Don't know what to do? Well we have you covered. Identification, common causes and treatment of TDP can all be found in this one podcast.

IBCC Episode 11 Hyperkalemia Nov 14, 2018

Whether its your first day seeing patients, or your last, you need to have a solid approach to hyperK. Come check out the cast for all things hyperkalemic bombs, and a plea to STOP the madness with kayexalate.

IBCC Episode 10 - Delirium Nov 07, 2018

We've got you covered for identifying, evaluating and treating this all to common (and sometimes missed) syndrome. Take a listen, and go to the post to discuss the controversies of atypical antipsychotics, regular use of melatonin, and the elixir of the gods (dexmedetomidine).

IBCC Episode 9 - Anemia Oct 31, 2018

Is your patient's low hemoglobin got you down? We've got you covered then. Come take a listen for all things related to diagnosis, transfusion targets and special populations. This one is sure to be a treat for halloween.

IBCC Episode 8 - Pancreatitis Oct 25, 2018

In this episode, we summarize the sometimes intimidating topic of pancreatitis. We've got your education needs covered when it comes to identification, workup and treatment of this common presentation.

IBCC Episode 7 - Cardiogenic Shock & Severe LV Dysfunction Oct 17, 2018

Join your regular hosts in exploring all things cardiogenic shock. Warm & Dry to Cold and Wet. We've got an approach strategy for you.

IBCC Episode 6 - Hypoglycemia Oct 10, 2018

Welcome to the 6th podcast, it will not disappoint. Hypoglycemia is something you MUST know cold. So grab a coffee, and give this one a listen.

IBCC Episode 5 - Bradycardia Oct 03, 2018

Bradycardia can be scary. Especially when your cardiac output is being pulled down by that slow rate. Take a listen to hone your resuscitation skills in the electrical and medical arms of the bradycardia treatment.

IBCC Episode 4 - Community Onset Pneumonia Sep 26, 2018

Have you been confused with your approach to CAP/HAP/VAP? Here is a stepping stone to the approach from a new perspective: Community onset pneumonia.

Here we outline the definition, approach and management including antimicrobial selection, triaging, HFNC and so much more.

IBCC Episode 3 - Approach to the GI Bleed Sep 19, 2018

In this episode we summarize the approach to the patient with a bleeding GI tract. Whether its upper, lower, or anything in between... we've got you covered.

IBCC Episode 2 - Ischemic Evaluation in the Non-Cardiac Patient Sep 12, 2018

In this episode, Josh takes us through how to approach the type 1 versus type 2 acute coronary syndrome in the ICU. In other words, take a listen to find out what to do with that ECG and troponin.

IBCC Episode 1 - DKA Sep 06, 2018

In this episode, we cover the anatomy of a DKA resuscitation. Check the post out for some juicy pearls.

As always, the pitfalls:

Missing an underlying cause of DKA, especially sepsis. The primary cause of death among patients admitted with DKA isn't the DKA itself, but rather associated conditions (mostly sepsis).
Bolusing large volumes of normal saline will make the patient more acidotic. This is generally not a major problem, but it can be for the patient who starts out severely acidotic at baseline.

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