Critical Care Scenarios

MARCH 27, 2024

Find us on Patreon here! Buy your merch here! We discuss the phenomenon of CPR-induced consciousness (i.e. patients demonstrating awakeness during resuscitation) with Jack Howard, Intensive Care Paramedic at Ambulance Victoria in the northern suburbs of Melbourne, Australia, and first author on a recent literature review and Delphi-derived expert guideline on CPRIC management.

CPR 124

CPR Paramedicine Paramedicine Ambulance 124

Critical Care Scenarios

MARCH 20, 2024

Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here! Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here!

OR 124

OR 124

Critical Care Scenarios

MARCH 13, 2024

We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC. Find us on Patreon here! Buy your merch here! We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC.

Critical Care 161

Critical Care 161

Critical Care Scenarios

MARCH 6, 2024

You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here! You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here!

117

117

Critical Care Scenarios

FEBRUARY 28, 2024

We discuss the medications typically used after organ transplant, their impact on critical illness, and how to manage them when these patients show up sick—with Olivia Philippart, transplant clinical pharmacist specializing in liver and kidney transplant at University of Kentucky HealthCare. Find us on Patreon here! Buy your merch here! Takeaway lessons References From: Fishman … Continue reading "Episode 71: Transplant medications with Olivia Philippart" Photo by Tim Webb We discuss the medicat

ICU 100

ICU OR 100

Critical Care Scenarios

FEBRUARY 21, 2024

How I make patients poop. Find us on Patreon here! Buy your merch here! How I make patients poop. Find us on Patreon here! Buy your merch here!

124

124

Critical Care Scenarios

FEBRUARY 14, 2024

A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation. Thanks to Pat Posa, Martha Roberts, Juliana Barr, Kelly Drumright, and Ben Lassow for their input. Resources A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation.

Critical Care 136

Critical Care ICU 136

Critical Care Scenarios

FEBRUARY 7, 2024

How to document your ultrasound findings. Find us on Patreon here! Buy your merch here! How to document your ultrasound findings. Find us on Patreon here! Buy your merch here!

117

117

Critical Care Scenarios

JANUARY 31, 2024

We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr. Jed Wolpaw, anesthesiologist and intensivist from Johns Hopkins, anesthesiology residency program director, and host of the ACCRAC podcast. Find us on Patreon here! Buy your merch here! Takeaway lessons References We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr.

OR 286

OR 286

Critical Care Scenarios

APRIL 27, 2020

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)" Neurointensivist and palliative care physician Jess Mc

ICU 100

ICU ED OR 100

Critical Care Scenarios

MAY 19, 2020

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?

ICU 100

ICU OR 100

Critical Care Scenarios

MAY 31, 2020

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 book Buy the new textbook (Bryan edited, Brandon authored a

Critical Care 100

Critical Care Epinephrine ED ALS 100

Critical Care Scenarios

JUNE 14, 2020

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 c

Critical Care 130

Critical Care ED ALS OR 130

Critical Care Scenarios

JUNE 28, 2020

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" A restless patient experiences a series of dyssynchrony events during mechanical ventilati

OR 130

OR 130

Critical Care Scenarios

JULY 12, 2020

A grueling interfacility transfer gives Tyler Christifulli, FP-C, EMT-P (@christifulli88) and Sam Ireland FP-C, EMT-P (@ireland_sam1) the opportunity to show us how they handle airway management, GI bleeding, mechanical ventilation, cardiac arrest, and more, all from the confines of a helicopter. Check out the great educational content from Tyler and Sam over at FOAMfrat, including … Continue reading "Episode 11: Flight medicine with Tyler Christifulli and Sam Ireland (part 1)" A grueling interf

EMT 100

EMT EMT Critical Care Ambulance 100

Critical Care Scenarios

JULY 26, 2020

Part two of our interfacility transfer from Hell. Tyler Christifulli, FP-C, EMT-P (@christifulli88) and Sam Ireland FP-C, EMT-P (@ireland_sam1) show us how they handle GI bleeding, arrhythmias, shock, cardiac arrest, and more, all from the confines of a helicopter. Listen to Part 1 here. Check out the great educational content from Tyler and Sam over … Continue reading "Episode 12: Flight medicine with Tyler Christifulli and Sam Ireland (part 2)" Part two of our interfacility transfer from Hell.

EMT 100

EMT EMT EMS 100

Critical Care Scenarios

AUGUST 9, 2020

A typical case of severe intraparenchymal hemorrhage with resulting herniation. Takeaway lessons DOACs like apixaban (Eliquis), although not usually monitored using routine coagulation assays, tend to elevate the INR only slightly (e.g. 1.0–1.3 or so). A strikingly INR in warfarin-like ranges should raise suspicion for an additional occult cause of coagulopathy.

OR 130

OR 130

Critical Care Scenarios

AUGUST 23, 2020

The conclusion of our scenario of severe intraparenchymal hemorrhage with resulting herniation, with a closer look at neurological exams, prognostication, and the flow of care after initial stabilization, as well as our mindset as caregivers in these psychologically challenging cases. Takeaway lessons Early tracheostomy may not hold concrete benefits for neuro patients (i.e. improved mortality), … Continue reading "Episode 14: Intracerebral hemorrhage and elevated ICP (part 2)" The conclusion of

ICU 100

ICU 100

Critical Care Scenarios

SEPTEMBER 6, 2020

A detailed look at cirrhosis and acute-on-chronic liver failure as we typically see it in the ICU, with Dr. Elliott Tapper, gastroenterologist and transplant hepatologist, and director of the cirrhosis program at the University of Michigan in Ann Arbor. Takeaway lessons When treating liver patients, think infection, infection, infection—and understand that with good care and … Continue reading "Episode 15: Liver failure with Elliott Tapper" A detailed look at cirrhosis and acute-on-chronic liver

ICU 100

ICU OR 100

Critical Care Scenarios

SEPTEMBER 20, 2020

Quick takes on common controversies in the ICU, with Bryan and Brandon: Stress ulcer prophylaxis: drug selection, candidates, and when to discontinue Stress dose steroids: candidates, dosing, lab tests, and weaning Titrating PEEP: considering the disease process, PEEP/FiO2 tables, driving pressure trials, and pragmatic approaches Quick takes on common controversies in the ICU, with Bryan and Brandon: * Stress ulcer prophylaxis: drug selection, candidates, and when to discontinue* Stress dose ste

ICU 100

ICU 100

Critical Care Scenarios

OCTOBER 4, 2020

An overview of interventional radiology with Dr. Bobby Chiong, board-certified interventional radiologist and chair of radiology at SBH Health System, with a focused look at what IR’s all about, coordination between care teams, vascular access, and troubleshooting. Takeaway lessons Interventional radiologists can’t do everything, but they potentially can do almost anything, and you usually won’t … Continue reading "Episode 16: Interventional radiology with Bobby Chiong (part 1)" An overview of i

OR 100

OR 100

Critical Care Scenarios

OCTOBER 18, 2020

The second part of our overview of interventional radiology with Dr. Bobby Chiong, board-certified interventional radiologist and chair of radiology at SBH Health System, with a focused look at some common IR procedures, namely abscess drainage and GI bleeding. Listen to part 1 here. Takeaway lessons Common goals would be INR 50k. If … Continue reading "Episode 17: Interventional radiology with Bobby Chiong (part 2)" The second part of our overview of interventional radiology with Dr.

OR 100

OR 100

Critical Care Scenarios

NOVEMBER 1, 2020

A look at oncology-related emergencies in the ICU, with Leon Chen (@CCMNP), NYC nurse practitioner specializing in oncology critical care. Takeaway lessons Extremely elevated leukocyte count should always raise suspicion for a “liquid tumor” such as leukemia. The principal acute complication is leukostasis from poor flow, potentially causing hyperviscosity issues such as stroke, MI, pulmonary … Continue reading "Episode 18: Oncologic emergencies with Leon Chen" A look at oncology-related emergen

Critical Care 100

Critical Care ICU OR 100

Critical Care Scenarios

NOVEMBER 15, 2020

A few rapid-fire cases from the emergency department, with Dr. Seth Trueger (@mdaware), emergency physician at Northwestern University and digital media editor for JAMA Network Open. [Sorry for the shotty audio quality in this one!–eds.] Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. … Continue reading "Episode 19: Emergency medicine with Seth Trueger" A few rapid-fire cases from the emergency department, with Dr.

ICU 100

ICU Life Support Emergency Department ED 100

Critical Care Scenarios

NOVEMBER 29, 2020

Looking at the workflow of a fresh post-op open heart surgery patient, as well as what to do when it devolves into cardiac tamponade, with (returning) guest Brendan Riordan, cardiothoracic ICU PA (@concernecus) at the University of Washington, and his NP colleague Kris Ramilo (@krsrml0). [Audio quality was a bit dodgy in this one; sorry … Continue reading "Episode 20: Post-CABG emergencies with Kris Ramilo and Brendan Riordan" Looking at the workflow of a fresh post-op open heart surgery patient

ICU 100

ICU Epinephrine OR ED 100

Critical Care Scenarios

DECEMBER 13, 2020

A patient with multiple abdominal gunshot wounds, resuscitated before and after damage control surgery by the legendary Scott Weingart (@emcrit): emergency physician, surgical intensivist by way of Shock Trauma in Baltimore, director of an emergency critical care program, and longtime innovator in medical education and FOAM via the EMCrit podcast and blog.

FFP 100

FFP Critical Care OR ED 100

Critical Care Scenarios

DECEMBER 27, 2020

Initial approach, supportive care, risk stratification, and management of the troublesome complications for ruptured subarachnoid aneurysm, with Thomas Lawson (@TomLawsonNP), nurse practitioner in the neurocritical care unit at OSU Wexner Medical Center. Takeaway lessons SAH + shock or hypoxemia = suspect neurogenic pulmonary edema and/or Takotsubo cardiomyopathy.

OR 100

OR 100

Critical Care Scenarios

JANUARY 10, 2021

Best practices in care of the critically ill patient with COVID-19 pneumonia are not known at this time. However, practical lessons from the ground are filtering in from those who have seen many of these patients, and Dr. Nicole King—critical care anesthesiologist, ECMO-ologist at the University of Cincinnati, and alumnus of the New York City … Continue reading "Episode 23: COVID-19 pneumonia with Nicole King" Best practices in care of the critically ill patient with COVID-19 pneumonia are not k

Critical Care 100

Critical Care Plasma ICU OR 100

Critical Care Scenarios

JANUARY 24, 2021

Scene management, logistics, and stabilization of a blunt trauma patient in the Australian outback with Dr. Minh Le Cong (@ketaminh), rural GP and retrieval physician for the Royal Flying Doctor Service and host of the PHARM podcast. Takeaway lessons If there is reasonable suspicion of the presence of a pneumothorax (of any size), have a … Continue reading "Episode 24: Rural retrieval medicine with Minh Le Cong" Scene management, logistics, and stabilization of a blunt trauma patient in the Aust

Paramedic 100

Paramedic OR 100

Critical Care Scenarios

FEBRUARY 7, 2021

The COVID-19 pandemic will hopefully wind down this year. What happens next with these patients? A powerful discussion with Eve Leckie (@browofjustice), RN, CCRN, formerly of the CVCC at Dartmouth-Hitchcock and now disabled after contracting COVID. Learn about their acute course of illness, the challenges of navigating the healthcare system with this new disease, and … Continue reading "Special episode: Surviving COVID-19 with Eve Leckie" The COVID-19 pandemic will hopefully wind down this year.

OR 100

OR 100

Critical Care Scenarios

FEBRUARY 21, 2021

Initial workup, fluid management, renal replacement, and other subtleties of caring for the critically ill patient with rhabdomyolysis. Takeaway lessons Rhabdomyolysis is defined by elevated levels of creatinine kinase and/or myoglobin in the serum secondary to skeletal muscle breakdown with release of cellular contents. Common causes are crush or compartment syndrome, prolonged downtime on hard … Continue reading "Episode 25: Rhabdomyolysis" Initial workup, fluid management, renal replacement,

OR 100

OR 100

Critical Care Scenarios

MARCH 7, 2021

How to manage the intubated critically ill patient while keeping them awake, non-delirious, and mobile, with Dr. Dale Needham, FCPA, MD, PhD. Dr. Needham is a Professor of Pulmonary and Critical Care Medicine as well as Physical Medicine and Rehabilitation at the Johns Hopkins University. He is also director of their Outcomes After Critical Illness … Continue reading "Episode 26: ICU sedation, mobility, and delirium with Dale Needham" How to manage the intubated critically ill patient while keep

ICU 100

ICU Critical Care OR 100

Critical Care Scenarios

MARCH 21, 2021

Management of an alpine medicine scene including discussion of HAPE (High Altitude Pulmonary Edema), HACE (High Altitude Cerebral Edema), and suspension syndrome, with Dr. Ross Hofmeyr (@rosshofmeyr), anesthesiologist in the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town, as well as cofounder and medical director of WildMedix, the oldest wilderness medicine … Continue reading "Episode 27: Wilderness medicine with Ross Hofmeyr" Management of an alpine medicine

OR 100

OR 100

Critical Care Scenarios

APRIL 4, 2021

How to take the well-resuscitated critically ill patient, get fluid out of them, deescalate their antibiotics, wean their sedation, reduce vent support, extubate, and get them out of the ICU—with Dr. Matt Siuba (Twitter: @msiuba), an intensivist at the Cleveland Clinic with an abiding interest in “zentensivism,” the art of doing less. Takeaway lessons Portal … Continue reading "Episode 28: Diuresis, deescalation, and liberation with Matt Siuba" How to take the well-resuscitated critically ill pa

ICU 100

ICU OR 100

Critical Care Scenarios

APRIL 18, 2021

A vascular access roundtable, discussing our practices surrounding arterial lines, central lines, PICC lines and midlines, and PA catheters. When do we place them? When can they come out? What sites do we like? When (and how) do we use ultrasound? What’s up with the axillary site, why does Brandon hate PICCs, the age-old debate … Continue reading "Episode 29: Lightning rounds #2" A vascular access roundtable, discussing our practices surrounding arterial lines, central lines, PICC lines and midl

100

100

Critical Care Scenarios

MAY 2, 2021

Diagnosing and treating DKA, including fluid management, lab studies, insulin management, managing acid-base abnormalities, transitioning off your drips, and all the rest. Takeaway lessons Calculate your anion gap and perhaps your strong ion difference (or bicarb gap). In most cases, consider checking a b-hydroxybutyrate and a lactate to confirm the diagnosis, but hyperglycemia + anion … Continue reading "Episode 30: Diabetic ketoacidosis" Diagnosing and treating DKA, including fluid management,

OR 100

OR 100

Critical Care Scenarios

MAY 16, 2021

The art of taking a critically ill, heavily sedated, floridly delirious patient on aggressive vent support and pulling them out of the loop of sedation, immobility, and delirium. With Kali Dayton, ACNP-BC (@HomeIcu), critical care nurse practitioner and host of the Walking Home from the ICU podcast, where she looks closely at these issues, including … Continue reading "Episode 31: Practical mobility, awakening, and delirium prevention with Kali Dayton" The art of taking a critically ill, heavily

ICU 100

ICU Critical Care OR 100