Critical Care Scenarios

Harvey Castro, MD, emergency physician and AI enthusiast, shares his thoughts on how we can be using AI tools to support medical care today. Check out the Intensive Care Academy here!

How to like to teach (and learn) POCUS in the ICU. Check out the Intensive Care Academy here! References Oto B, Baeten R, Chen L, Dalal P, Dancel R, Fox S, Lange Iv CW, Baston C, Bornemann P, Dugar S, Goldsmith A, Herbst MK, Kirkpatrick JN, Koratala A, Lanspa MJ, Lobo V, Nomura JT, Pustavoitau … Continue reading "Lightning rounds 72: How to teach POCUS"

A critical look at lung POCUS and where it truly earns a place in acute care. The discussion explores rapid pneumothorax checks, pleural effusion detection, B-lines, pulmonary edema, and the challenges of assessing pneumonia or consolidation. It also weighs the practical burden of thorough scanning and the importance of combining ultrasound findings with cardiac imaging and clinical context.

Brian Cuthbertson, an anesthesiologist, intensivist, and lead author of the OSCAR trial, traces the rise and fall of high-frequency oscillatory ventilation. They explore how HFOV works, its history in severe ARDS, contrasting OSCAR and OSCILATE results, and why adult use has nearly vanished. The conversation also examines pediatric practice, ECMO alternatives, clinical expertise, and how negative trials can reshape critical care.

Theresa Human, former academic clinical pharmacist in neurocritical care and now medical liaison for a large pharmaceutical company, chats about late-career transitions and working for private industry. Check out the Intensive Care Academy here!

Nick Ghionni, pulmonary and critical care attending at MedStar Baltimore who teaches mechanical ventilation, argues against routine use of PRVC. He defines how PRVC titrates tidal volume breath-by-breath. They explore patient effort confounding, hidden loss of support and asynchrony. Practical guidance on when PRVC helps versus when simpler modes are safer.

Olivia Serigano, an EM intensivist and researcher at University of Vermont, discusses PEEP-setting strategies for patients with obesity. She compares simple BMI/3 and universal PEEP 10 rules against esophageal pressure-guided targets. Conversations cover physiology of esophageal manometry, safety concerns with higher PEEP, study design in OR patients, and how heuristics perform across body sizes.

A practical walk-through of caring for intraparenchymal brain bleeds, from who manages care to who needs ICU-level monitoring. They cover terminology and where bleeds occur. Expect clear discussion of blood pressure targets, anticoagulant reversal options, and timing of repeat brain scans. Neurochecks, imaging to find causes, and how teams decide when to step down or restart anticoagulation are highlighted.

Jerry Snow, medical toxicologist and fellowship director, and Andrew Sheen, medical toxicology fellow with an EM background, dissect a puzzling metformin-associated lactic acidosis case. They explore causes of extreme lactatemia, dialysis choices and timing, mechanisms of mitochondrial toxicity, adjunctive therapies, and practical ICU management tips. Call tox early and consider renal replacement promptly.

A fast-paced dive into practical IV fluid strategies and when to give or stop them. Short versus rapid boluses, pump limits, and how access affects flow are explored. Tips on fluid choice like balanced crystalloids, colloids, and hypertonic options are discussed. Focus on avoiding set-and-forget maintenance drips and using clear reasons for fluid therapy.