Critical Matters

In this episode of the podcast, we discuss the management of Acute Ischemic Stroke (AIS). Our guest is Dr. Fred Rincon, a neurologist and critical care specialist with expertise in the resuscitation and management of acute brain injured patients. He is a Professor of Neurology at Cooper Medical School of Rowan University and Director of the Neuro-ICU at Cooper University Health Care in Camden, New Jersey. Additional Resources Management of Acute Ischemic Stroke. F. Herpich and F. Rincon: https://pubmed.ncbi.nlm.nih.gov/32947473/ AHA Guidelines for the Management of Acute Ischemic Stroke (2019): https://pubmed.ncbi.nlm.nih.gov/31662037/ Link to NIHSS Certification Course: https://www.nihstrokescale.org/ The intensive care management of acute ischemic stroke. D. Sharma and M. Smith: https://pubmed.ncbi.nlm.nih.gov/35034076/ Association of Neurocritical Care Services with Mortality and Functional Outcomes for Adults With Brain Injury. Meta-analysis. JAMA Neurology 2022: https://pubmed.ncbi.nlm.nih.gov/36036899/ Book Recommendations: The Servant: A Simple Story of About the True Essence of Leadership. By James C. Hunter: https://amzn.to/3U6u6SI How to Be a Leader: An Ancient Guide to Wise Leadership. By Plutarch: https://amzn.to/3eMBxhU

In this episode of the podcast, we will discuss tracheostomy emergencies. Tracheostomies are common in ICU patients. Every intensivist should be capable of recognizing and providing initial management to potentially serious complications associated with tracheostomies. Our guests are Drs. Laura Bontempo and Sara Manning, emergency physicians and educators with a special interest in the topic. Dr. Laura Bontempo is an associate professor of emergency medicine, and serves as Assistant Director for Faculty Development & Resident Education, in the Department of Emergency Medicine at the University of Maryland Medical School. Dr. Sara Manning is an Assistant Professor of Clinical Emergency Medicine, in the Department of Emergency Medicine at the Indiana University School of Medicine. Additional Resources: Tracheostomy Emergencies. LJ Bontempo and SL Manning. Emerg Med Clin N Am 2019: https://pubmed.ncbi.nlm.nih.gov/30454773/ Link to Onepager on Tracheostomy Emergencies: https://onepagericu.com/trach-emergencies Bleeding Tracheostomy. Kenji Inaba MD. Presented at Essentials of EM: https://www.facebook.com/EssentialsofEM/videos/1163679590380038/ Book Recommendations: Who Moved my Cheese?: An A-Mazing Way to Deal with Change in Your Work and in Your Life. By Spencer Johnson, et al: https://amzn.to/3pq0CkR Where the Red Fern Grows. By Wilson Rawls: https://amzn.to/3AawH6a

In this episode of the podcast, we will discuss dogma in critical care medicine. How do we fight dogma when the evidence is weak? Our guest is Dr. Mervyn Singer, an internationally recognized critical care clinician, investigator, and educator. Dr. Singer is professor of intensive care medicine at University College London. Additional Resources: Challenging management dogma where evidence is non-existent, weak, or outdated. By D. A Hofmaenner and M. Singer https://link.springer.com/article/10.1007/s00134-022-06659-4 Link to Gapminder, an independent educational non-profit fighting global misconceptions https://www.gapminder.org/ Think Again: The Power of Knowing What You Don’t Know. By Adam Grant https://amzn.to/3bceyLu Books Mentioned in this Episode: Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think. By Hans Rosling https://amzn.to/3S4kWFj

In this episode, we will discuss Brain Death / Death by Neurologic Criteria. Brain Death remains an important topic within the practice of critical care medicine. However, there are still inconsistencies in the concept, criteria, practice, and documentation of brain death. Today we will discuss this topic through the lens of "The World Brain Death Project." Our Guest is Dr. David Greer, Chair of the Department of Neurology at the Boston University School of Medicine. Dr. Greer is a renowned clinician, educator, and researcher. Additional Resources Determination of Brain Death / Death by Neurologic Criteria. The World Brain Death Project. D. Greer et al. JAMA 2020 https://pubmed.ncbi.nlm.nih.gov/32761206/ Determination of Brain Death / Death by Neurologic Criteria. The World Brain Death Project. VIDEO https://edhub.ama-assn.org/jn-learning/video-player/18529668 Controversies in Brain Death Declaration: Legal and Ethical Implications in the ICU. S Biel, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223748/ Books Mentioned in this Episode The Boys in the Boat. By Daniel J. Brown https://www.amazon.com/Boys-Boat Brain Death. By Eelco Wijdicks https://www.amazon.com/Brain-Death-Eelco-F-M-Wijdicks/

In this episode of the podcast, we will discuss tracheal intubation-associated hypotension. Endotracheal intubation is a common procedure in the clinical care of critically ill patients. Tracheal intubation in the ICU is often associated with cardiovascular complications that can include hypotension, cardiac arrest, or death. A recently published clinical trial evaluating the impact of a 500ml- bolus of crystalloid solution intravenously on cardiovascular complications post-intubation is the catalyst for our discussion. Additional Resources Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation. A Randomized Clinical Trial. The PREPARE II Investigators. https://jamanetwork.com/journals/jama/fullarticle/2793545 Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PREPARE) a randomized controlled trial. The PREPARE Investigators. https://pubmed.ncbi.nlm.nih.gov/31585796/ Previous episodes of Critical Matters discussing other Intravenous Fluid topics. Critical Matters_Fluid Responsiveness: https://bit.ly/3bBTOg7 Critical Matters_Fluid BaSICS: https://bit.ly/3y99S0j Link to REBELEM post on Post Intubation Hypotension: The AH SHITE mnemonic. https://rebelem.com/post-intubation-hypotension-the-ah-shite-mnemonic/ Link to PulmCrit Blog on PREPARE clinical trial. https://emcrit.org/pulmcrit/prepare/ Books mentioned in this episode: Leonardo Da Vinci. By Walter Isaacson. https://amzn.to/3Nw0PfG Benjamin Franklin. By Walter Isaacson. https://amzn.to/3OM3N0C

In this episode of the podcast, we will discuss the science behind the benefits of being Other-Focused and of having a Live-to-Give attitude. Our guest is Dr. Stephen Trzeciak, a practicing intensivist, physician scientist, professor, and chair of medicine at Cooper Medical School of Rowan University in Camden, New Jersey. Dr. Trzeciak is the co-author of “Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself”, a wonderful book soon to be published and the focus of our conversation today. Additional Resources Website for the book: Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself: https://www.wonderdrugbook.com/ Link to previous podcast episode with Dr. Trzeciak on Compassionomics: https://bit.ly/3tqBdJU Curricula for empathy and compassion training in medical education: A systematic Review. Patel s, et al: https://pubmed.ncbi.nlm.nih.gov/31437225/ Need for compassion in prehospital and emergency care: A qualitative study on bus crash survivor’s experiences. Doohan I, et al: https://pubmed.ncbi.nlm.nih.gov/25257225/ “Unsung Hero” a beautifully executed commercial of what it means to be Live to Giver: https://www.youtube.com/watch?v=uaWA2GbcnJU Books Mentioned in this Episode: Man’s Search for Meaning. By Viktor Frankl: https://amzn.to/3xv9n1J Against Empathy: The Case for Rational Compassion. By Paul Bloom: https://amzn.to/3MtzXg1

We are taking a short break from recording new episodes this month. I hope you enjoy this previously released episode on 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 Resources: Link to the website for the American Association of Poison Control Centers: https://aapcc.org/ A three part review series published in CHEST on Toxicology in the ICU: https://www.ncbi.nlm.nih.gov/pubmed/21896525 https://www.ncbi.nlm.nih.gov/pubmed/21972388 https://www.ncbi.nlm.nih.gov/pubmed/22045882 Albums Mentioned in this Episode: The Beatles Live at the BBC: Dr. Leikin’s recommendation for the one album he would take on a deserted island: https://amzn.to/2vIrX5M

We are taking a short break from recording new episodes this month. I hope you enjoy this previously released episode on Toxicology in the ICU. This is part one of a two part series. Today’s episode will focus on an overview of toxic ingestions and their general 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 Resources: Link to the website for the American Association of Poison Control Centers: https://aapcc.org/ A three-part review series published in CHEST on Toxicology in the ICU. https://www.ncbi.nlm.nih.gov/pubmed/21896525 https://www.ncbi.nlm.nih.gov/pubmed/21972388 https://www.ncbi.nlm.nih.gov/pubmed/22045882 Books mentioned in this episode: Biographies on Louis Armstrong: https://amzn.to/3wsdT0z https://amzn.to/38DfEP5 Albums by Louis Armstrong: https://amzn.to/3Pt40qO

Patients who survive a cardiac arrest often sustain a severe anoxic brain injury. Determining their neurological prognosis is a critical component of post-cardiac arrest care. In this episode of the podcast, we will discuss best practices for Neuroprognostication after Cardiac Arrest. Our guest is Dr. Neha Dangayach, a neurocritical care physician at Mt. Sinai Medical Center in New York. Dr. Dangayach is an Assistant Professor of Neurology and Neurosurgery at the Icahn School of Medicine at Mt. Sinai. Additional Resources: Predicting outcome from hypoxic-ischemic coma. Levy DE, et al. JAMA 1985: https://pubmed.ncbi.nlm.nih.gov/3968772/ Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Sandroni C et al. Intensive Care Medicine 2020: https://pubmed.ncbi.nlm.nih.gov/32915254/ Books Mentioned in this Episode: How to Win Friends & Influence People. By Dale Carnegie: https://amzn.to/3Lk9rpn Dare to Lead. By Brene Brown: https://amzn.to/3vi1dse Think Again. By Adam Grant: https://amzn.to/3OB3l6a

This is an encore for a previous episode of Critical Matters. One in five US residents receives ICU care at the end of life. In this episode, we discuss different aspects of end of life care in the ICU. Our guest is Dr. BJ Miller, a physician, author, and speaker. He is a practicing hospice and palliative medicine physician and is best known for his 2015 TED Talk, "What Really Matters at the End of Life." BJ has been on the teaching faculty at UCSF School of Medicine since 2007. 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/3EcOslB Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. Scheunemann LP et al, JAMA Internal Medicine, 2019: https://bit.ly/3jzNqqD A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller and Shoshana Berger: https://amzn.to/3rpl6LM 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://www.vitaltalk.org/courses/ Books Mentioned in this Episode: Man’s Search for Meaning. Viktor Frankl: https://amzn.to/37l3Mk9 Mortally Wounded: Stories of Soul Pain, Death and Healing. Michael Kearney: https://amzn.to/3xsyAKI Bering Mortal: Medicine and What Matters in the End. Atul Gawande: https://amzn.to/3Jz3OlG The Denial of Death. Ernest Becker: https://amzn.to/3vfQ22e