Critical Matters

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

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