Critical Care Scenarios

Dive into the intricacies of managing elevated intracranial pressure with expert insights. Discover the importance of assessing the true nature of ICP spikes and the critical role of cerebral perfusion pressure. EVD troubleshooting tips reveal common complications while hyperosmolar therapies like 3% saline and mannitol are compared. Learn when to escalate care, the considerations for craniectomy, and the impacts of thoracoabdominal pressures on cerebral drainage. Plus, explore team communication during crises and strategies for optimizing patient outcomes.

Dr. Prem Kandiah, a neurointensivist and ammonia expert, dives deep into the complexities of ammonia physiology and its critical care implications. The discussion highlights the unique ways ammonia can affect the brain, including mechanisms of injury and the importance of timely measurement. Kandiah explores less-known causes of hyperammonemia, such as urease-producing infections and malnutrition, especially in post-bariatric patients. He also offers practical tips for accurate ammonia testing and discusses acute management strategies.

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Dr. David Janz, a pulmonary and critical care intensivist and former director of a critical care Clinical Research Unit, dives deep into the use of steroids for treating septic shock. He explains their mechanisms and how they can act as immune modulators, highlighting the conditions under which they offer the most benefit. Janz discusses critical trials that showcase their effectiveness and the potential risks, such as hyperglycemia and infection. He also shares practical recommendations on dosage and timing, ensuring clarity in a complex area of patient care.

We explore the fascinating intricacies and unique features of the burned critically ill patient, with Clint Leonard, NP in the burn ICU at Vanderbilt and ABLS instructor. Learn more at the Intensive Care Academy! Want to work at the University of Kentucky? UK’s Anesthesia Critical Care department is hosting a hiring webinar on November 20, … Continue reading "Lightning rounds 57: Burn critical care with Clint Leonard"

Dr. Martin Tobin, a renowned pulmonologist and author of influential texts on mechanical ventilation, shares his expertise on spontaneous breathing trials (SBTs). He highlights the shift from prolonged weaning to brief trials and critiques common practices that misinterpret patient readiness. Tobin emphasizes practical SBT methods, like T-piece tests, and instructs on recognizing work of breathing without invasive tools. He discusses the importance of timely extubation and shares insights on managing sedation and respiratory drive during trials for optimal patient outcomes.

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