Critical Care Scenarios

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"

What stops do you make along the garden path of hypoxic respiratory failure? Resources References An ARDS review: Fan E, Brodie D, Slutsky A. Acute Respiratory Distress: Syndrome Advances in Diagnosis and Treatment. JAMA. 2018;319(7):698-710 Lung protective ventilation (The original ARDSnet ARMA trial): Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with … Continue reading "Episode 3: Refractory ARDS"

The hosts dive into a complex case of a 65-year-old woman battling severe sepsis in the ICU. They tackle the intricate evaluation of her hypoxia and hypotension, discussing potential cardiac issues and treatment strategies. The management of ventilated septic patients highlights the importance of respiratory support and targeted antibiotics. A deep dive into Takotsubo cardiomyopathy unveils its diagnostic challenges and treatment options, emphasizing the need for thorough ultrasound assessments and appropriate pharmacological interventions.

A troubling case of a painful finger. Resources References Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017 Dec 7;377(23):2253-2265. Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll … Continue reading "Episode 1: Necrotizing Soft Tissue Infection"

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