Critical Care Time

On this week's release, Cyrus and Nick revisit one of their favorite topics: Pulmonary Embolism! In this episode - a follow up to our two-parter from season 1 - we sit down with Dr. Rick Channick of UCLA to talk about his approach to PE management with a focus on catheter directed therapies & PE response teams. This episode is packed full of expert insights and practical clinical pearls. Give it a listen and let us know what you think!Risk Stratification MethodologiesWhat is the landscape of risk stratification in Pulmonary Embolism (PE)?Broadly, what interventions does each risk category group warrant?Rule of Thumb: The greater the risk to the patient, the more likely aggressive interventions will be considered.Most patients with PE are low risk:Typically treated with systemic anticoagulationExcellent prognosis High risk PE patients typically have hemodynamic involvement and can present in shock requiring emergent management :No contraindications + shock due to PE systemic thrombolysisAbsolute contraindications:Prior history of ICHKnown cerebrovascular lesionKnown malignant intracranial neoplasmNon-acute ischemic stroke, within the last 3 monthsSuspect aortic dissectionIntermediate risk patients:Management options exist and are tailored to each specific patient.Most, but not all, patients with PE deemed to be at intermediate risk will do well with systemic anticoagulation.Some patients are good candidates for catheter directed therapies such as thrombectomy or thrombolysis.Who? We don’t really know with a high degree of certainty. Considerations should be made for those with numerous risk factors for poor PE-related outcomes OR those with significant cardiopulmonary reserve / excellent functional status who theoretically could benefit from more brisk reversal of their acute pulmonary hypertension.See more in depth show notes at criticalcaretime.com Hosted on Acast. See acast.com/privacy for more information.

In this week's episode of Critical Care Time, Cyrus & Nick close out their discussion (for now anyway!) on difficult airways! Here we build upon episode 33 by working through some scenarios we've seen where we've needed to implement some of the strategies previously discussed. We close out by covering 10 pitfalls and pearls when it comes to anatomically difficult airways. As always, give us a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

On this week’s episode of Critical Care Time, Nick & Cyrus return to talk about airway management in the ICU. In season 1 we focused on the physiologically difficult airway. Now we will begin to unravel the anatomically difficult airway. Today we will break things down by covering foundational concepts, discussing some of the physical and cognitive tools you can use to address an airway, and basically set the stage for part II where we will go through some case studies and leave you with our pitfall and pearls for anatomically difficult airways. This episode is packed with clinical pearls that will empower you to take on even the  spiciest  of airways!As always - give us a watch or a listen and let us know what you think! Don’t forget those    reviews!! Hosted on Acast. See acast.com/privacy for more information.

On this week’s episode of Critical Care Time, Nick & Cyrus have the honor of hosting Dr. Thanh Neville, MD, MSHS (X @thanh_neville) the director of the 3 Wishes Program out of UCLA. In this moving discussion we explore the importance of dying with dignity when curative intent is no longer a realistic option. We dovetail this with an impassioned exploration Dr. Neville’s incredible work with 3WP which relies on modest funding and the power of humanism to grant priceless gifts - Wishes, if you will - to dying patients and their loved ones in their 11th hour. Please give us a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

Tele-health is blowing up in 2024 and that is as true for critical care as it is for other fields of medicine! On this episode of Critical Care Time, Nick and Cyrus interview Drs. Bill Beninati and David Guidry: Two experts in the world of tele critical care. We cover all the in’s and out’s of delivering critical care service from afar with a focus on implementation, logistics, benefits and challenges. Give this a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

Join Nick and Cyrus as they teach a master class on hypoxemia for everyone and anyone who is ICU adjacent! We discuss why oxygen is so crucial, share some very interesting animal physiology and - perhaps most importantly- discuss the 6 causes of hypoxemia you MUST know… and what you can do about them! Take a listen, let us know what you think, and leave us a review! Hosted on Acast. See acast.com/privacy for more information.

On this episode - part 2/2 if you will - we continue our discussion of pleural disease with a focus on hemothorax & management of bronchopleural fistulas. Small tube or large tube? When do you call in the reinforcements? What about endobronchial valves for persistent air leaks? Learn the answers to these questions - and so much more -n with Dr. Mike Sobieszczyk our expert interventionalist! Hosted on Acast. See acast.com/privacy for more information.

On this episode of Critical Care Time, Nick & Cyrus revisit the pleural space! We had SO much great content we opted to split the episode into two parts. We also figured it would be nice to get an interventionalists take on this and we thus recruited Dr. Mike Sobieszczyk to help navigate this complex topic! Here we discuss things like hepatic hydrothorax, indwelling pleural catheters and all things parapneumonic effusion. Check it out and leave us a review! If you missed our first episode on pleural disease, head on back to episode 10 and get caught up. If you like what you heard here, make sure to come back in 2 weeks for the second part! Hosted on Acast. See acast.com/privacy for more information.

Join Cyrus and Nick as they review listener questions and feedback from season one of Critical Care Time! Where did we goof up? Where did we hit the "Mark"? Give this episode a listen as we investigate a potpourri of clinically relevant topics courtesy of YOU - our incredible audience whom we are so thankful for. Hosted on Acast. See acast.com/privacy for more information.

Extra Extra - Read All About It!! It is our pleasure to bring to you - hot off the presses - the results from the PREOXI Trial which looks at whether or not preoxygenation with non-invasive positive pressure ventilation results in better peri-intubation outcomes versus non-pressurized preoxygenation strategies. Joining us is the primary author on this paper, Dr. Kevin Gibbs, MD of Wake Forest University School of Medicine. Practice changing? Practice affirming? Does it even matter?! Check out our interview with Dr. Gibbs and see what you think! Leave us a comment and let us know if this is going to impact your practice in the ICU and beyond! Hosted on Acast. See acast.com/privacy for more information.

Diuretics are essential tools used by clinicians to manage volume status in ambulatory patients and in the critically ill… but are we using them correctly? Join Nick & Cyrus as they explore principles of fluid balance and teach a masterclass on how to approach diuresis in the critically ill patient. You won’t want to miss this high-yield episode discussing an evergreen topic in the world of critical care medicine! Hosted on Acast. See acast.com/privacy for more information.

Thrombocytopenia is a puzzling, yet common problem in the ambulatory setting, on the wards and certainly in critically ill patients! Having an understanding of why it matters, why it can happen and what we should do about it, is of paramount importance to you if you are committed to excellent patient care.Given that patient care is first and foremost for us at Critical Care Time, we’ve teamed up - once again - with hematologist extraordinaire Matthew Rendo (X: RendOncology) to help us develop a pragmatic approach to managing the patient with thrombocytopenia. Please give it a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

On this week’s episode of Critical Care Time, Nick and Cyrus discuss continuous renal replacement (or kidney replacement) therapy and acute kidney injury with master intensivist and extra corporeal aficionado, Dr. Kevin Chung. Dr. Chung is a retired colonel in the United States Army, the principal force behind an intensivist-run renal replacement program in San Antonio, and is currently the Chief Medical Officer for our season one sponsor, Seastar Medical.In this episode, we discuss an approach to acute kidney injury, demystify elements of continuous renal replacement therapy, and then discuss various applications to include blood purification technology in 2024. Give us a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

On this week’s installment of Critical Care Time, Nick & Cyrus tackle the recent multicenter, randomized control DEVICE Trial, which compared direct to video laryngoscopy in 17 American ICUs & EDs with the primary outcome of interest being successful intubation on first attempt. During this episode, we’ll take a deep dive into the paper, discuss other literature, and weigh-in ourselves based upon our own experiences and the data that’s available. Give it a listen and let us know what YOU think! Hosted on Acast. See acast.com/privacy for more information.

Sit back and grab some salty treats as you enjoy the mindful musings of master nephrologist Dr. Joel Topf (X: @Kidney_Boy) who joins Nick & Cyrus to chat about hyponatremia in critical illness - a very common condition. Here we discuss diagnosis and management of hyponatremia with special attention to those in the intensive care unit. Of course, no discussion is complete without plenty of time dedicated to osmotic demyelination syndrome (aka: central pontine myelinolysis) which gets plenty of face-time during this episode. Give it a listen and leave feeling confident in your ability to diagnose and manage a very prevalent condition in our patient population! Hosted on Acast. See acast.com/privacy for more information.

In Part II of our discussion of PE, Nick & Cyrus discuss the Pillars of PE Management! We review the literature behind lytics in non-massive PEs, talk about airway management, hemodynamics and more! Make sure you listen to Part I if you missed it as it sets the stage for this fantastic, treatment focused discussion. Hosted on Acast. See acast.com/privacy for more information.

There are few things in medicine Nick & Cyrus enjoy talking about more than PE! Join the guys from Critical Care Time as they tackle this massive topic via a two part epic that’ll prove to be the best saga since The Lord of The Rings! In part one they talk about diagnosis, clinical decision support tools and demystify the pathophysiology behind pulmonary emboli. Check it out, and be sure to catch the second half in two weeks! We promise you’ll get your money’s worth! Hosted on Acast. See acast.com/privacy for more information.

Hemoptysis can be a scary thing to encounter in medicine and massive hemoptysis - i.e. life threatening hemoptysis - is a serious emergency that often requires cognitive agility and technical prowess. Join Nick & Cyrus as they talk with Dr. Whittney Warren - an intensivist and interventional pulmonologist - who walks us through her pragmatic approach to life-threatening hemoptysis. What medications can we use to stabilize these patients? How would we go about intubating such a patient? What bronchoscopic tools do we have at our disposal? Listen to this first CCT episode of 2024 and find out!  Hosted on Acast. See acast.com/privacy for more information.

Hosted on Acast. See acast.com/privacy for more information.

Every time we admit or care for a critically ill patient, we must consider their risk for deep venous thrombosis, or DVT. Many of our patients are at higher risk for DVT than the general population, but anticoagulants are not wholly benign drugs. What do we do? How do we decide who to treat medically, who to treat with mechanical compressive devices and identify patients who may NOT need anything? When do risks outweigh benefits? What agent is best?Join Nick and Cyrus as they interview hematologist & oncologist Dr. Matthew Rendo (Twitter/X: Rendoncology) as they do a deep dive into managing DVT prophylaxis in the critically ill patient!  Hosted on Acast. See acast.com/privacy for more information.