Critical Care Scenarios

Bryan and Brandon talk about the physical exam: how we apply it in the ICU, its utility and changing role in the setting of modern diagnostic modalities, and its best and most practical use-cases. References McNamara LC, Kanjee Z. Counterpoint: Routine Daily Physical Exams Add Value for the Hospitalist and Patient. J Hosp Med. 2021 … Continue reading "Lightning rounds #10: Physical examination in the ICU"

Dr. André Mansoor (@AndreMansoor), associate professor of medicine in Portland, Oregon, author of the excellent Frameworks for Internal Medicine, and contributor to Physical Diagnosis PDX, talks us through a complex case of encephalopathy and respiratory failure to illustrate some principles of diagnostic reasoning. Takeaway lessons The hardest part of treating most diseases is making the … Continue reading "Episode 40: Making the diagnosis with André Mansoor"

Bryan and Brandon chat about notes: what makes a good one, their many and conflicting purposes, some structures and approaches, system- versus problem-based charting, and more.

An overview of VV ECMO with a focus on COVID-19, with Dr. Kimberly A. Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. We discuss evaluating for candidacy, induction, maintenance, weaning, and general approaches to the COVID patient. Takeaway lessons The limited amount of ECMO … Continue reading "Episode 39: ECMO for COVID-19 with Kim Boswell"

Brandon takes the reins to dispel five common misconceptions in critical care. He questions the effectiveness of diuretic infusions compared to intermittent boluses. The discussion includes the role of antipsychotic agents in treating ICU delirium, shedding light on their effectiveness. He also debates the merits of pressure control versus volume control in ventilation. Lastly, he highlights the importance of accurately interpreting troponin levels in patients with renal issues and emphasizes nuanced neurological assessments.

Back with returning guest Dr. Elliot Tapper (@ebtapper), gastroenterologist, transplant hepatologist, and director of the cirrhosis program at the University of Michigan in Ann Arbor, to talk about critical GI bleeding. Takeaway lessons Consider the Glasgow-Blatchford score to stratify risk and need for admission, GI consultation, etc. Octreotide (or terlipressin) is indicated in every cirrhotic … Continue reading "Episode 38: GI bleeding with Elliot Tapper"

Discussing a pickle of a topic: outside of academic milestones, how do we recognize, acknowledge, reward, and move towards clinical excellence in medicine after one’s training is complete? In fact… do we?

Back again with Dr. Ross Hofmeyr (@rosshofmeyr), anesthesiologist in the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town, to discuss an expert’s perspective on airway management in the COVID-19 patient. Takeaway lessons Good practices for intubating COVID patients are, by and large, good practices for intubating anybody. Using a standardized protocol, … Continue reading "Episode 37: Airway management for COVID-19"

The hosts dive into the fascinating world of focused point-of-care ultrasound (POCUS) in the ICU. They share insights on learning the technique through hands-on practice and expert guidance. Common applications like lung exams and vascular assessments are highlighted, along with the pros and cons of credentialing and billing challenges. They emphasize POCUS as a valuable clinical tool for quick decision-making in emergencies, rather than a precision instrument. Ultimately, they share practical strategies to enhance daily ICU use.

Back in the arena with one of our favorites, Matt Siuba (@msiuba), Cleveland Clinic intensivist and Mr. Zentensivism, to discuss complications in critical care and how to prevent and manage them. Today we focus on atrial fibrillation with RVR and bleeding after thoracentesis and related other procedures. Takeaway lessons Rapid atrial fibrillation in the ICU … Continue reading "Episode 36: Preventing and managing complications"