Critical Matters

Join Dr. Edilberto Amorin, a neurologist with expertise in critical care and epilepsy, as he delves into essential neurological support for cardiac arrest survivors. They discuss various topics, including targeted temperature management and innovative monitoring techniques like optic nerve ultrasound. Dr. Amorin highlights the significance of individualized treatment strategies and the complexities of managing brain edema and seizures. The conversation emphasizes the critical balance of optimism and caution while navigating recovery in these vulnerable patients.

Dr. Iqbal Ratnani, an intensivist at the DeBakey Heart & Vascular Center, dives into the complexities of vasoplegia, a critical post-cardiac surgery condition. He discusses its refractory nature and the significant mortal risks associated. The conversation shifts to the importance of tailoring mean arterial pressure (MAP) targets, exploring new treatment strategies like hydroxycobalamin. Dr. Ratnani emphasizes the need for individual patient assessment and the future of vasoplegia research, highlighting ongoing trials aiming for better management outcomes.

Laura Bontempo, an associate professor at the University of Maryland, and Sara Manning, an Indiana University assistant professor, dive into the intricate world of tracheostomy emergencies. They discuss the prevalence of complications like obstruction and hemorrhage, stressing the urgency for effective management. Key techniques, including the use of inflatable balloons for bleeding, are shared, along with the overarching themes of empathy and collaboration in emergency care. The conversation also touches on the emotional impact of literature in shaping healthcare perspectives.

Today, we are revisiting one of our favorite episodes from last year - The Forgotten Patient. Dr. Zanotti focuses on the loved ones and families of critically ill patients and explores the topic through the lens of a cardiac arrest co-survivor. His guest is Kristin Flanary, a cognitive neuroscientist and social psychologist. Kristin is a co-survivor of cancer(twice) and a co-survivor of sudden cardiac arrest. She is also known for her social media alter ego – Lady Glaucomflecken. In 2022 Kristin co-founded Glaucomflecken LLC, where she works to advocate for caregivers and co-survivors of medical trauma and critical illness, community CPR and AED use, and sudden cardiac arrest survivorship. She has written about her experience as a co-survivor in medical journals and has received an EMS Cardiac Arrest Save Challenge Coin, the Citizen CPR Foundation’s '40 Under 40' award, and the American Heart Association’s Resuscitation Champion award. Additional Resources: The Quiet Place. K. Flanary. Journal of Cardiac Failure, 2021: www.onlinejcf.com/article/S1071-91…00403-6/fulltext Roger. K Flanary. CHEST. 2022: journal.chestnet.org/article/S0012-…029-6/fulltext Life after Cardiac Arrest: The importance of engaging with the “forgotten patient.” K Haywood & K Dainty. Resuscitation, 2018: www.resuscitationjournal.com/article/S0…0195-3/pdf Link to the Glaucomflecken’s website: glaucomflecken.com/ Books Mentioned in this Episode: In Shock. By Rana Awdish: bit.ly/441b0Cx

In this episode, Dr. Zanotti covers temporary pacing in the ICU. He is joined by Dr. Christopher Noel, a Critical Care Attending at Cooper University Healthcare, and an Assistant Professor of Medicine at Cooper Medical School of Rowan University. In addition, Dr. Noel is the Associate Program Director for the Critical Care Medicine Fellowship and the Director of the Medical Student Critical Care Clerkship. Additional resources: Temporary Epicardial Pacing After Cardiac Surgery. Cronin b, et al. Journal of Cardiothoracic and Vascular Anesthesia 2022: https://pubmed.ncbi.nlm.nih.gov/36180288/ Temporary epicardial pacing after cardiac surgery: a practical review. Part 1: General considerations in the management of epicardial pacing. M.C. Reade. Anesthesia 2007: https://pubmed.ncbi.nlm.nih.gov/17300304/ Temporary epicardial pacing after cardiac surgery: a practical review. Part 2: Selection of epicardial pacing modes and troubleshooting. M.C. Reade. Anesthesia 2007: https://pubmed.ncbi.nlm.nih.gov/17381573/ Medtronic Educational Resources on Temporary Pacemakers: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/pacemakers/temporary-external-pacemakers.html Books mentioned in this episode: Crucial Conversations: Tools for Talking When Stakes are High. By Joseph Grenny, et al.: https://bit.ly/3XWFo0d The Mutiny on the Bounty. By Peter FitzSimons: https://bit.ly/4cwGkNb

In this engaging discussion, Dr. Adam Rizvi, a neurologist specializing in critical care and tele-neurology, shares insights on performing neurological assessments in the ICU. He emphasizes key factors for non-neurologists to recognize signs of strokes and other conditions in sedated patients. The conversation highlights innovative exam techniques, including assessing brainstem reflexes and alternative methods for increased safety. Dr. Rizvi also discusses the profound impact of kindness and empathy in critical care settings, reflecting on the teachings of Marcus Aurelius.

Join Bindu Akkanti, an expert in pulmonary and critical care, as she dives deep into temporary mechanical circulatory support. Discover the vital role of interdisciplinary collaboration for ICU teams managing complex patients. Learn about overcoming challenges with LVAD patients experiencing GI bleeds and the intricate management of device complications like Impella. Bindu also reflects on the importance of work-life balance in healthcare and the comforting power of music, connecting personal experiences with professional insights.

Dr. Bindu Akkanti, an esteemed associate professor and Medical Director of the Heart Failure ICU at UTHealth Houston, dives into the crucial role of mechanical circulatory support in treating cardiogenic shock. The conversation highlights shock management, emphasizing timely interventions and the complexity of patient dynamics. They explore the differences between various mechanical support devices, their physiological benefits, and the importance of teamwork in critical care. Additionally, they touch on pioneering research aimed at improving survival rates for critically ill patients.

With over 700 modes of mechanical ventilation available today, it can be overwhelming to find the best application of technology at the bedside. Focused on goal-directed mechanical ventilation, this discussion covers the taxonomy of mechanical ventilation modes and provides a framework for a rational approach at the bedside. Dr. Zanotti is joined by Dr. Eduardo Mireles-Cabodevila, Director of the Medical Intensive Care Unit and the Simulation and Advanced Skills Center at the Cleveland Clinic. In addition, Dr. Mireles-Cabodevila is the Vice-Chair of the Division of Critical Care Medicine, Department of Pulmonary and Critical Care, within the Integrated Hospital-Care Institute at the Cleveland Clinic. Additional Resources: How do I ventilate patients with ARDS: Goal-directed mode selection. E. Mireles-Cabodevila. Med Intensiva 2022: https://pubmed.ncbi.nlm.nih.gov/36220727/ A Rational Framework for Selecting Modes of Ventilation. E. Mireles-Cabodevila, et al. Respir Care 2013: https://pubmed.ncbi.nlm.nih.gov/22710796/ Closing the Gap in Patient-Ventilator Discordance Recognition. A. Liendo and E. Mireles-Cabodevila. Respir Care 2024: https://pubmed.ncbi.nlm.nih.gov/38267228/ Standardized Education for Ventilatory Assistance (SEVA) resources page; https://my.clevelandclinic.org/departments/respiratory/medical-professionals/seva#seva-resources-tab Mechanical Ventilation Mode Taxonomy App: iPhone: https://apps.apple.com/us/app/ventilator-mode-map/id1508307955 Android: https://play.google.com/store/apps/details?id=org.ccf.vmm&hl=en_US Books mentioned in this episode: Solito: A Memoir. By Javier Zamora: https://bit.ly/4b6hPG8

In this episode, Dr. Zanotti discusses the management of acute life-threatening asthma exacerbations in the ICU with this guest, Dr. Haney Mallemat, a physician trained in EM/IM and Critical Care. Dr. Mallemat is currently an Associate Professor of Emergency Medicine and Internal Medicine at the Cooper Medical School at Rowan University. Additional Resources: How Not to Kill an Asthmatic – Presented at CODA Change by Haney Mallemat: https://codachange.org/severe-asthma Management of Acute Life-Threatening Asthma Exacerbations in the Intensive Care Unit. Talbot T, et al. Appl. Sci 2024: https://www.mdpi.com/2076-3417/14/2/693 ResusX,- a medical resuscitation conference created by Dr. Mallemat: https://www.resusx.com Last Week Now! - A curated newsletter by ResusX: https://www.resusx.com/newsletter Keynotable – a course for beginners and seasoned speakers: https://www.keynotable.net Books mentioned in this episode: How to Win Friends and Influence People. By Dale Carnegie: https://bit.ly/49WlcOd