Critical Care Scenarios

We discuss the practicalities of running a rapid response, including crowd management, coordinating with primary services, working outside the ICU, and rapidly obtaining and synthesizing diagnostic data. Learn more at the Intensive Care Academy!

Delve into the world of nebulizers and their vital role in inpatient care. Discover why nebulizers often outperform inhalers in patients with dyspnea. Learn about continuous albuterol therapy and the logistics behind it. Hear contrasting insights on small-volume vs. vibrating mesh nebulizers and their efficiency. Explore the complexities of dose, dilution, and optimal delivery methods. Join a lively debate on the role of bronchodilators in secretion clearance and the importance of tailored therapy for better resource stewardship.

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.

Learn more at the Intensive Care Academy!

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.

Dive into the complex world of burn critical care with insights from an NP specializing in the burn ICU. Discover how different burn mechanisms, from flames to electrical injuries, shape patient treatment. Learn about fluid resuscitation strategies, the timing of excisions, and innovative grafting techniques. Clint Leonard shares the challenges of hypermetabolism and nutrition needs in burn patients, highlighting the importance of a multidisciplinary approach to care. Tune in for a blend of practical advice and compelling patient stories!

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"