Critical Matters

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

Dr. Neha Dangayach, a neurocritical care physician at Mount Sinai, dives deep into neuroprognostication after cardiac arrest. She highlights the evolution of prognosis methodologies, emphasizing the importance of multimodal testing beyond a single exam. Uncertainty in outcomes is addressed, stressing shared decision-making to avoid premature life support withdrawal. Dr. Dangayach also discusses influential factors like arrest history, temperature, and biomarkers, urging a cautious approach to brain death declarations and the necessity for ongoing assessments post-arrest.

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

This is a previously released episode that I thought would be of great interest to our listeners. As we move forward post 24 months of COVID-19 reconnecting with our purpose and core values is more important than ever. In this episode, we discuss the practice of respect in the intensive care unit. Our guest is Samuel M. Brown, MD, MS, a practicing intensivist and Director of the Center for Humanizing Critical Care, at Intermountain Medical Center in Murray, Utah. Dr. Brown holds an academic appointment as Associate Professor of Medicine at the University Of Utah School Of Medicine, Murray UT. He is a prolific investigator and author with a wide range of interests including complexity in critical illness, echocardiography, and ethics. Our conversation covers topics such as dignity, respect, compassion, and burnout. Join us in a fascinating discussion with a thought leader in bringing humanism to critical care. Additional Resources: Recent article co-authored by Dr. Brown and colleagues reviewing important aspects of the practice of respect in critical care medicine: https://bit.ly/3uFLou8 The Center for Humanizing Critical Care works with researchers and clinicians with the goal of helping patients and family members make it through critical illness with their humanity intact: https://bit.ly/3JTxfjp Speak, Memory: An autobiography revisited. By Vladimir Nabokov: https://amzn.to/3iKaXVc

In a recent episode of the podcast, we had a wonderful conversation with Amy Edmondson (Twitter: @ AmyCEdmondson), on the elements of high-performing teams in complex environments. In this episode of the podcast, we examine psychological safety, teaming, and learning from failure within the context of building better ICU teams. The episode is a recording of a webinar I recently presented entitled “The Fearless ICU: Building a Culture of Healing and Transformation.” Additional Resources: Critical Matters podcast episode with Amy Edmondson – The Fearless ICU: https://bit.ly/365bjmv Webinar- The Fearless ICU: Building a Culture of Healing and Transformation: https://bit.ly/3u2zlXs What Google Learned in its Quest to Build the Perfect Team. New York Times: https://nyti.ms/3p84qHk Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. A. Edmondson et al. Management Science 2007: https://bit.ly/3JJXisP

The last 24 months have pushed ICU teams around the world to their limits. As we move forward, we need to heal and rebuild our critical care teams. Healthcare more than ever will require ICU teams to perform at the highest levels and to continuously innovate to deliver high-value care to the sickest of the sick. In today’s episode of the podcast, we will discuss the elements of The Fearless ICU. Our guest is Amy Edmondson (@AmyCEdmondson), the Novartis Professor of Leadership and Management at the Harvard Business School. For the last two decades, she has studied the elements of high-performing teams in complex environments. Additional Resources: Faculty page for Amy Edmondson. A great jumping point to her vast body of work: https://www.hbs.edu/faculty/AmyEdmondson How to turn a group of strangers into a team. TED Talk by Amy Edmondson: https://bit.ly/3vaKwzA The Fearless Organization. By Amy Edmondson: https://amzn.to/3v7JzrJ What Google Learned in its Quest to Build the Perfect Team. New York Times: https://nyti.ms/3p84qHk Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. A. Edmondson et al. Management Science 2007: https://bit.ly/3JJXisP Books Mentioned in this Episode: Get Rid of the Performance Review! By Samuel Culbert: https://amzn.to/354mYl3 Mindset. By Carol Dweck: https://amzn.to/3LRR2B8

In today’s episode, we will discuss the management of severe alcohol withdrawal in the intensive care unit. Our guest is Dr. Nick Mark (@nickmmark), a critical care physician practicing in Seattle, Washington. Dr. Mark is the founder and creator of www.onepagerICU.com - a wonderful resource that provides regularly updated comprehensive and practical one-page summaries on various critical care topics. Additional Resources: Link to the onepager on Alcohol Withdrawal. -https://onepagericu.com/ A statement on research needs for inpatient management of severe alcohol withdrawal from the American Thoracic Society. - https://www.atsjournals.org/doi/10.1164/rccm.202108-1845ST Guidelines for clinical management of alcohol withdrawal from American Society of Addiction Medicine (ASAM). - https://bit.ly/3GIRkq6 Books mentioned in this episode: Surely You’re Joking, Mr. Feynman! By Richard Feynman. - https://amzn.to/34IZBgs Sapiens: A Brief History of Humankind. By Yuval Noah Harari. - https://amzn.to/3HGqsbE

Fluid resuscitation is a cornerstone of our treatment for circulatory failure and is often quite challenging to get right. In today’s episode of the podcast, we will discuss the prediction of fluid responsiveness. 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://bit.ly/3nXtWih Prediction of fluid responsiveness: a review. Enev R, et al. 2021. - https://bit.ly/33NNHBT Prediction of fluid responsiveness: an update. Monnet X, et al. 2016. - https://bit.ly/3H2R6ew Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and metanalysis. Alvarado Sanchez JI, et al. 2021 - https://bit.ly/3KJ6D5l Music and Podcasts mentioned in this episode: Haney’s musical recommendation – listen to the band Wilco. - https://wilcoworld.net/ 99% Invisible. One of Haney’s favorite podcasts. Open access. - https://99percentinvisible.org/ The Joe Rogan Experience. Popular podcast on Spotify. - https://open.spotify.com/show/4rOoJ6Egrf8K2IrywzwOMk EMRAP. A leading educational platform recommended by Haney. - https://www.emrap.org/

As we start a new year, we look forward with the hope to grow and improve critical care medicine. In today’s episode of the podcast, we will discuss a path forward focused on healing, recovery, and transformation. Our guest is Dr. Wes Ely, professor of medicine at Vanderbilt University School of Medicine and co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center). Dr. Ely is the author of Every Deep-Drawn Breath – a wonderful book that will guide our discussion in this episode. Additional Resources: Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://www.icudelirium.org Kaleidoscope by Wes Ely: https://pubmed.ncbi.nlm.nih.gov/25599355/ Don’t give COVID-19 long-haulers the Silent Treatment by Wes Ely: https://bit.ly/3GfgJbC ABCDEF Bundle and Supportive ICU Practices for Patients with Coronavirus Disease 2019 Infection - An International Point Prevalence Study. K Liu, et al. Critical Care Explorations 2021: https://bit.ly/3qepqgS Caring for Critically Ill Patients with the ABCDEF Bundle - Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://bit.ly/3FeX0Hw Books Mentioned in this Episode: Every Deep-Drawn Breath by Wes Ely: https://www.icudelirium.org/every-deep-drawn-breath In Shock by Rana Awdish: https://amzn.to/3JY9p6n Arrowsmith by Sinclair Lewis: https://amzn.to/339MJ2m East of Eden by John Steinbeck: https://amzn.to/3JXpRDN