Critical Matters

As we begin a new year with the podcast, I have decided to depart from our customary guest format and usual clinical topics to focus on personal growth and mastery. I am a firm believer that mastery (learning new skills) is the key to an engaged and joyful clinical career. In this episode of the podcast, we will discuss Skills, Super Skills, and Ultra Skills. We will discuss this new framework for understanding and developing skills relevant to our professional and personal growth. Please reach out with comment on Twitter (@sergio_zanotti) or LinkedIn. Books and Podcasts Mentioned in this Episode: The Fearless ICU – Critical Matters Podcast with Amy Edmondson: http://bit.ly/3I7rq3o The Infinite Game. By Simon Sinek: https://bit.ly/3XhMgBe Drive. By Daniel Pink: https://bit.ly/3XlhFCS Deep Work. By Cal Newport: https://bit.ly/3YyXD99 Switch. By Chip Heath & Dan Heath: https://amzn.to/3IaXQdc Mindset. By Carol Dweck: https://bit.ly/3XhXS7l Leonardo Da Vinci. By Walter Isaacson: https://bit.ly/40AmwmJ Range. By David Epstein: https://bit.ly/3jGZ1ro Essentialism. By Greg McKeown: https://bit.ly/3xruX6B Mastery. By Robert Greene: https://bit.ly/3RKjicc Linchpin. By Seth Godin: https://bit.ly/3jKBu8U

In this episode of the podcast, we will discuss the first hour of clinical care post return of spontaneous circulation in cardiac arrest survivors. Our guest is Dr. Haney Mallemat a critical care intensivist and emergency medicine clinician at Cooper University Health. He is also an associate professor of medicine and of emergency medicine at Cooper Medical School of Rowan University, in Camden, New Jersey. Additional Resources: Critical Care Now: A site for intensivists and resuscitationists.: https://criticalcarenow.com/ RESUS-X: The ultimate resuscitation educational experience: https://www.resusx.com/ https://pubmed.ncbi.nlm.nih.gov/25599355/ European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care: https://link.springer.com/article/10.1007/s00134-021-06368-4 Oxygen Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208686 Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208687 Books Mentioned in this Episode: SmartLess. One of Haney’s favorite podcasts: https://podcasts.apple.com/us/podcast/smartless/id1521578868 How to win Friends & Influence People. By Dale Carnegie: bit.ly/3VVlTRQ EMRAP. A leading educational platform recommended by Haney: https://www.emrap.org/

Dr. Eelco Wijdicks, a neurology professor at the Mayo Clinic, dives deep into acute metabolic encephalopathies. He discusses the pitfalls of overusing the term 'metabolic encephalopathy' and urges a careful diagnostic approach. The conversation covers how severe electrolyte imbalances impact consciousness, alongside the complexities of EEG interpretations. Eelco also highlights the importance of recognizing structural injuries and shares insights on managing prolonged neurologic recovery, emphasizing compassion in critical care after pandemic challenges.

In this episode of the podcast, we will discuss the management of conflict in the intensive care unit (ICU). Our guest is Dr. Joshua Kayser. Dr. Kayser is Section Chief for Medical Critical Care Medicine and Medical ICU Director at the VA Medical Center in Philadelphia. He is also Professor of Clinical Medicine and Professor of Medical Ethics and Healthy Policy at the University of Pennsylvania. Additional Resources: Conflict Management in the ICU. JB Kayser and LJ Kaplan: https://pubmed.ncbi.nlm.nih.gov/32618689/ How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care. AS Spijkers et al.: https://link.springer.com/article/10.1007/s00134-022-06771-5 Center to Advance Palliative Care Website – with great resources: https://www.capc.org/ Vital Talk website. A great resource for developing communication skills in healthcare: https://www.vitaltalk.org/ Books Mentioned in this Episode: In Shock. By Rana Awdish: https://amzn.to/3UzJtTg

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

Dr. David Greer, a leading neurologist and chair of the neurology department at Boston University, delves into the crucial topic of brain death. He explains the World Brain Death Project's goals to standardize brain death determination practices. Interesting discussions include the challenges of accurately determining brain death, the importance of detailed clinical examinations, and the role of ancillary testing. Dr. Greer emphasizes the need for meticulousness and conservative approaches in these life-and-death decisions, making it vital for clinicians to familiarize themselves with best practices.

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