Critical Care Scenarios

We discuss the evidence and practicalities of spontaneous breathing trials and ventilator weaning with Martin Tobin, pulmonologist and intensivist, author of seven textbooks including “Principles and Practice of Mechanical Ventilation,” researcher, and pioneer of the entire concept of SBT as well as the RSBI (or “Tobin index”). Learn more at the Intensive Care Academy! References … Continue reading "Episode 95: Spontaneous breathing trials with Martin Tobin"

Join neurointensivist Tom Bleck, a leading expert in seizure management, as he delves into the intricacies of seizure pharmacology. He breaks down the benefits of IM midazolam and discusses timing for treating seizures. Tom explains his preference for lorazepam in hospitals, the effective use of levetiracetam, and the emerging role of ketamine for benzodiazepine-resistant seizures. Learn when to intubate, how to manage refractory seizures, and the importance of EEG in guiding therapy. A treasure trove of knowledge for anyone in critical care!

We dive into fluid resuscitation in sepsis, with Dr. Jon-Emile Kenny, pulmonary and critical care physician, author of the physiology textbook Heart-lung.org, and inventor of the FloPatch device. Disclosures: Dr. Kenny appears here as both a clinician as well as a representative of his company and product, and should be presumed to retain a degree … Continue reading "Episode 93: Fluid in sepsis and the FloPatch, with Jon-Emile Kenny"

Join medical toxicologist Jerry Snow as he dives into the critical topic of propofol infusion syndrome (PRIS) and its associated risks. He explains how high doses can lead to mitochondrial dysfunction and key clinical signs to watch for, like elevated lactate and cardiac changes. The discussion shifts to propylene glycol toxicity from prolonged lorazepam infusions, outlining safe dosage thresholds and its metabolic implications. Jerry emphasizes early detection and the need for careful monitoring in critically ill patients. A must-listen for anyone in emergency medicine!

Brandon and Bryan mock up a goals of care discussion for a critically ill patient, and reflect on the right and wrong ways to execute this complex procedure. Learn more at the Intensive Care Academy! Resources Center to Advance Palliative Care The Conversation Project

Sara J Hyland, PharmD, BCCCP, FCCP, is a researcher and clinical pharmacist specializing in perioperative and emergency medicine. She dives into the intricacies of neuromuscular blockade reversal in the ICU, particularly the use of sugammadex versus traditional agents. The conversation highlights the challenges of underutilization, the importance of rigorous monitoring for patient safety, and the risks associated with sugammadex, including rare complications. Hyland emphasizes the need for better protocols and collaborative practices to optimize patient outcomes.

In this conversation, Leeah Sloan, PA-C and co-chair of the Critical Care APP Steering Committee for CHEST, reveals exciting news about a new certification for Critical Care Advanced Practice Providers. She discusses the challenges of traditional training and the urgent need for standardized certification to enhance APP competency. Leeah also critiques the dangers of unstructured learning and the importance of collaborative approaches in critical care. This insightful talk shines a light on evolving inclusivity in the medical field.

Learn more at the Intensive Care Academy!

Explore the concept that true mastery in critical care relies on a broad understanding rather than deep specialization. The discussion highlights how adaptability and generalization enhance decision-making in the ICU. It also delves into how AI innovations support this approach, emphasizing that effective expertise is about simplifying complex choices into manageable components. Challenge conventional beliefs and discover why breadth of knowledge might just be the key to success in clinical environments.

Melissa Bridges, director of PA fellowships at Atrium Health and president of the Association of Post-graduate PA Programs (APPAP), chats with us (Bryan is president of APGAP, the Association of Post Graduate APRN programs) about PA/NP residencies/fellowships in critical care. Learn more at the Intensive Care Academy!