Critical Matters

In this discussion, Dr. Christopher Knoll, a critical care attending and associate program director at Cooper University Healthcare, dives into managing complications after cardiac surgery. He shares insights on the intricacies of handling hemorrhage and cardiac arrest, emphasizing the need for effective communication between surgical and intensive care teams. Dr. Knoll highlights the role of advanced technologies in improving outcomes and the importance of interdisciplinary collaboration. The conversation also takes a lighter turn, exploring music and travel interests, showcasing his engaging personality.

In this episode, Dr. Sergio Zanotti discuss the management of critically ill patients undergoing hyperglycemic emergencies. He is joined by Dr. George Willis, a practicing emergency medicine physician. Dr. Willis is an Associate Professor and Associate Program Director for Emergency Medicine at the University of Texas Health Science Center in San Antonio, where he also serves as Vice Chair of Faculty Affairs. A recognized clinical educator, he holds a particular interest in endocrine emergencies, vascular emergencies, procedural education, and medical education. Additional resources: Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. GE Umpierez, et al. Diabetes Care 2024: https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis. WH Self, et al. JAMA 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670314/ Evaluation and Management of the Critically Ill Adult with Diabetic Ketoacidosis. B Long, GC Willis, S Lentz, et al. J Emerg Med 2020: https://pubmed.ncbi.nlm.nih.gov/32763063/ The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis) Impacts on ED operational Metrics. Acad Emerg Med 2023: https://pubmed.ncbi.nlm.nih.gov/36775281/ Books mentioned in this episode: Kintsugi: Finding Strength in Imperfection. By Celine Santini: https://bit.ly/3NCdAYB

This episode, Dr. Sergio Zanotti discusses music and critical illness and explores the topic through the lens of his guest – Andrew Schulman. Andrew is the first musician to be accepted as a professional Society of Critical Care Medicine (SCCM) member. He is a member of the SCCM ICU Liberation Committee, where he met and had the opportunity to work with Dr. Zanotti. Andrew and his wife Wendy, are the subjects of Josh Aronson's documentary film Andrew & Wendy (2015), which has aired multiple times on PBS-TV. He is the author of Waking The Spirit: A Musician’s Journey Healing Body, Mind, and Soul. Since its release in the U.S. in August 2016, Waking the Spirit has been chosen as an Oliver Sacks Foundation Best Book of the Year Selection, Finalist for the Books for a Better Life Award, and a People Magazine Pick in Nonfiction. Additional Resources: Andrew Schulman’s Website https://andrewschulmanmusic.com/about Books and Albums mentioned in this episode: Waking The Spirit: A Musicians’s Journey Healing Body, Mind and Soul. By Andrew Schulman: https://us.macmillan.com/books/9781250132222 Musicophilia: A Tale of Music and the Brain. By Oliver Sacks: https://bit.ly/4dCTjwv St. Matthew Passion – Johann Sebastian Bach (Composer), Leonard Bernstein (Conductor): https://amzn.to/4eZmgE5 Lute Sonatas Nos. 30 & 39 & 96: 11 Silvius Leopold Weiss (Composer), Robert Barto (Performer): https://bit.ly/3YfXha2

D. Jeannie Callum, Director of Transfusion Medicine and Professor at Queens University, dives deep into the complexities of intravenous albumin use in critical care. She discusses emerging evidence that questions its safety and efficacy, alongside challenges of inconsistent practices worldwide. Callum also addresses the financial implications and potential risks associated with albumin, especially in vulnerable patient groups. The conversation underlines the necessity of solid evidence and patient inclusion in treatment guidelines for better healthcare outcomes.

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.