Critical Care Scenarios

We look at the rib fracture patient requiring ICU admission, including a discussion of surgical repair, with Dr. Ron Barbosa (@rbarbosa91), Portland trauma surgeon and SICU director at Legacy Emmanual Medical Center. Takeaway lessons Algorithms and protocols for admitting disposition exist but are generally poorly predictive. ICU admission in rib fracture patients is still most … Continue reading "Episode 50: Rib fractures and surgical plating with Ron Barbosa"

Brandon and Bryan chat about academic presentations… how to prepare and submit them, selecting the right venue, giving a good talk, and the elephant in the room: why to do it at all.

How the arc of disease peaks and falls, and how the curve of our care should match it to avoid under- or over-treatment.

We discuss invasive aspergillosis, with a focus on when to consider and how to make this difficult diagnosis in the general ICU population—with Dr. Shmuel Shoham (@ShohamTxID), Associate Professor of Medicine at Johns Hopkins, transplant infectious disease physician, and an extensively published expert in invasive fungal infections as well as host of the Transplant ID … Continue reading "Episode 49: Invasive pulmonary aspergillosis with Shmuel Shoham"

Time is always a factor in the ICU, but some time matters more than other time.

Brandon and Bryan share their approaches to the chest x-ray in the ICU. Plus: Bryan’s an FCCM! Here’s the Radiology Masterclass.

Some musings in response to people who are impressed by the work we do.

Brandon walks Bryan through a case of new, unexplained hypotension in the ICU, with a focus on approaching shock, the use of POCUS, and risk stratifying unexplained problems. Takeaway lessons Sudden changes in vital signs or other status are often due to precipitating factors, such as iatrogenic stimuli, whereas more gradual changes are often due … Continue reading "Episode 48: Undifferentiated hypotension"

Advanced techniques for manipulating the guidewire during non-fluoroscopic bedside procedures such as central line placement.