Critical Care Scenarios

Tyler Christifulli, a flight paramedic and co-founder of FOAMfrat, alongside seasoned paramedic Sam Ireland, tackle the high-pressure world of flight medicine. They vividly share their experiences managing complex cases during interfacility transfers, including airway management and cardiac arrests. Listeners gain insights into the nuances of diabetic ketoacidosis care, evaluating lab results mid-transport, and the intricacies of bicarbonate administration. The duo emphasizes teamwork and split-second decision-making in critical care scenarios.

A restless patient experiences a series of dyssynchrony events during mechanical ventilation. Come see how Bryan wades through it all, and allow us to offer an academic, yet practical approach to this sometimes-confusing subject. Case files Takeaway lessons Start with ABCs and stabilizing the patient, then put on your thinking cap and try to optimize … Continue reading "Episode 10: Ventilator dyssynchrony"

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Bryan Boling, DNP, ACNP; Kevin Hatton, MD, FCCM; Tonja Hartjes, DNP, ACNP-BC, CCRN, FAANP The podcast The second piece of our in-depth look at the management of right heart failure, with … Continue reading "Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 2)"

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Bryan Boling, DNP, ACNP; Kevin Hatton, MD, FCCM; Tonja Hartjes, DNP, ACNP-BC, CCRN, FAANP The podcast An in-depth look at the management of right heart failure, with a focus on preserving … Continue reading "Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 1)"

The second part of our look at a case of catastrophic intracranial hemorrhage, with a focus on goals of care, family interaction, prognostication, and other end-of-life aspects, with neurointensivist and palliative care physician Jess McFarlin (@JessMcFarlinMD). See Part 1 here. Takeaway lessons Useful phrase: “Can I tell you what to expect during the dying time?” … Continue reading "Episode 8: Palliative care with Jessica McFarlin (part 2)"

Neurointensivist and palliative care physician Jess McFarlin (@JessMcFarlinMD) walks us through a case of catastrophic intracranial hemorrhage, with a focus on goals of care, family interaction, prognostication, and other end-of-life aspects. See Part 2 here. Takeaway lessons We can undo most things except death, so in most cases, a short trial (perhaps 3 days) of … Continue reading "Episode 7: Palliative care with Jessica McFarlin (part 1)"

Neurologist and neurointensivist Gracia Mui shows us the workup, initial management, and escalation of care for a case of refractory status epilepticus. Takeaway lessons First-time unprovoked seizures usually need no further workup except screening for an underlying trigger, such as a tox screen, basic chemistries, and imaging as appropriate. Initial seizure therapy: wait around 5 … Continue reading "Episode 6: Status epilepticus with Gracia Mui"

Brendan Riordan, a cardiothoracic critical care PA at the University of Washington, shares his expertise on managing cardiogenic shock. He discusses practical approaches to initiating and managing ECMO and Impella devices, focusing on achieving hemodynamic stability. Riordan dives into the complexities of heparin management, balancing bleeding risks and circuit longevity. He also offers insights into patient recovery monitoring and the intricacies of assessing hypoxia in patients on VA ECMO, highlighting the collaborative efforts needed in critical care.

A fast-tracked update: what we know about the active pandemic of the novel coronavirus (SARS-CoV-2) and its resulting respiratory syndrome, COVID-19. Takeaway lessons Treat like viral pneumonia/ARDS. High PEEP. Prone early. Keep fluid balance dry. Probably avoid CPAP/BiPAP except perhaps for very short trials. Unclear role for HFNC. Watch out for myocarditis-type picture with cardiogenic … Continue reading "Special episode: COVID-19 brief"

Intensivist and passionate slayer of venous congestion Philippe Rola (@thinkingcc) shows us how to deresuscitate the septic patient, with guidance from his handy ultrasound. Takeaway lessons Fluid overload is harmful and should be actively reduced, even in a patient in active shock; it will not harm them. The VEXUS exam is a good method for … Continue reading "Episode 4: Venous congestion with Philippe Rola"