The Critical Care Commute Podcast

In this episode of the Critical Care Commute podcast, Dr. Smith discusses the multifaceted future of critical care medicine, touching on economic, political, and technological challenges. The conversation delves into the role of artificial intelligence in enhancing healthcare, the importance of clinician well-being, and the need for a human touch in medicine. The discussion also explores personal interests, travel experiences, and the ethical implications of AI in clinical practice, emphasizing the balance between technology and human interaction.Guests: Drs Marcus Peck and Jonny Wilkinson. Chapters00:00 The Future of Critical Care Medicine02:40 Artificial Intelligence in Healthcare05:38 Human Factors and Clinician Well-being08:22 Economic Challenges in Healthcare11:09 The Role of Politics in Healthcare14:13 The Turing Test and AI's Evolution16:41 Personal Interests and Travel Experiences19:57 AI's Impact on Clinical Practice22:38 Ethical Considerations of AI in Medicine25:19 The Future of AI and Human Interaction

The Power of Kindness in Healthcare: A Conversation with Dr. Suzanne Crowe. In this episode, Peter Brindley and Leon Byker speaks with Dr. Suzanne Crowe, pediatric intensivist and president of the Medical College of Ireland, at the College of Intensive Care meeting in Tasmania, 2025. They explore the significant impact of kindness on patient outcomes, emphasizing its vital role in healthcare. Dr. Crow highlights the necessity of incorporating kindness as a core practice, noting that it reduces mistakes, improves diagnostic accuracy, and fosters better cooperation from patients. They discuss the effectiveness of empathy training and the importance of leadership in fostering a culture of kindness within healthcare systems. Dr. Crow also shares practical tips for healthcare professionals on how to demonstrate kindness in daily interactions, such as sitting beside patients and offering comforting gestures.00:00 Introduction and Guest Welcome00:34 The Power of Kindness in Healthcare01:24 Defining and Recognizing Kindness02:20 Microdosing Kindness in Practice03:19 Teaching and Modeling Kindness03:54 Empathy Training and Its Importance05:07 Challenges and Barriers to Kindness06:57 Kindness in Patient Interactions09:27 Systemic Kindness and Leadership17:17 Empathy Training Techniques19:00 Conclusion and Final Thoughts

Join Peter Brindley and Leon Byker as they host David Bertoni, an ED physician and ECMO clinical lead, and Jorian 'Joe' Kippax, a trauma specialist and reservist, for an incredible story of a remote river rescue in Tasmania. The team responds to a distress call from a trapped rafting party in the Franklin River, one of Tasmania's most remote and formidable areas. The rescue involves complex logistical challenges, a field amputation, and the use of ECMO technology amidst perilous conditions. The patient, after 20 hours trapped in frigid water, undergoes a harrowing yet successful rescue and recovery. This episode offers a gripping recount of teamwork, medical ingenuity, and human resilience.00:00 Introduction and Guest Overview00:40 Setting the Scene: Remote River Rescue01:39 The Rescue Operation Begins03:13 Challenges and Techniques in the Rescue07:25 Field Amputation and Extraction18:35 Transport and ECMO Preparation23:20 Hospital Arrival and ECMO Procedure26:18 Patient Recovery and Reflections30:45 Conclusion and Final Thoughts

In this episode, we welcome Professor Mervyn Singer, author of Sepsis 3.0. Sepsis remains one of the most complex and deadly conditions in critical care. In this conversation,Professor Singer shares his perspectives on the shifting landscape of sepsis treatment, the role of antibiotics, steroids, metabolic interventions, and the future ofprecision medicine. He also challenges some long-standing dogmas and emphasizes the importance of individualized care over rigid guidelines.Key Topics and Chapters:The Evolution of Sepsis ManagementHistorical perspectives on sepsis treatmentEarlier recognition and intervention leading to improved outcomesCurrent Challenges and Research DirectionsOrgan dysfunction and recovery in sepsisThe importance of metabolic manipulation and mitochondrial functionThe Role of the Immune System in SepsisUnderstanding hyper- and hypo-inflammatory responsesSteroid use in critical illness—when it works and when it doesn’tAntibiotics in Sepsis: How Soon, How Long, and How Much?The changing approach to antibiotic timing and durationThe impact of microbiome disruption and antibiotic toxicityRethinking the one-hour antibiotic ruleLessons from COVID-19 and Their Impact on Sepsis ResearchThe importance of phenotype-driven treatmentsMissed opportunities in clinical trials and biobankingThe Beta-Blocker Debate in SepsisPotential benefits in selected patientsThe challenge of distinguishing compensatory tachycardia from harmful sympathetic overdriveRethinking Fever ManagementIs fever protective or harmful?When to treat and when to leave it aloneGuidelines vs. Individualized CareThe balance between evidence-based medicine and clinical expertiseThe dangers of rigid mandates and protocolsThis engaging discussion provides a fresh perspective on the current state and future of sepsis management, emphasizing the need for precision medicine, nuanced clinical decision-making, and ongoing research.References:Im Y, Kang D, Ko RE, et al. Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study. Crit Care. 2022;26(1):19. Published 2022 Jan 13. doi:10.1186/s13054-021-03883-0 HereSakkat A, Alquraini M, Aljazeeri J, Farooqi MAM, Alshamsi F, Alhazzani W. Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials. J Crit Care. 2021;61:89-95. doi:10.1016/j.jcrc.2020.10.016 HereHasegawa D, Sato R, Prasitlumkum N, et al. Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chest. 2021;159(6):2289-2300. doi:10.1016/j.chest.2021.01.009 Here

Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.About the Episode:This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.Topics CoveredDefining Long-Term Outcomes:Beyond survival: functional independence, mental health, cognition, and system resource use.Key Findings from Ontario Cohort42% of cardiogenic shock survivors require increased levels of care15% die within a year post-dischargeModest impact of revascularization or mechanical support on long-term outcomesMorbidity and Quality of LifeLoss of independence and inability to return to workHigh incidence of PTSD, depression, and caregiver burdenDelayed functional recovery and unmet expectationsPrognostic Factors and Predictive MarkersFrailty as a key indicatorPre-existing mental health as a predictor of post-ICU mental health outcomesIn-hospital arrest characteristics: rhythm, downtime, comorbiditiesICU Follow-Up ClinicsValue in knowledge translation and emotional supportReal-world insights on functional recovery and patient satisfactionCommon patient sentiment: gratitude mixed with traumaCommunication with FamiliesAvoiding value impositionEmphasizing trajectory over fixed timelinesBalancing hope with realismRethinking Endpoints in ResearchLimitations of 28-day mortalityNeed for patient-centered, long-term functional outcomesTrajectory-based data over snapshot metricsKnowledge Translation as the InterventionEquipping clinicians and patients with realistic expectationsNormalizing psychological responsesShaping future research directions around lived experience

In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.Dr. Belley-Côté walks us through:The five SCAI stages (A through E): what they mean and how they’re used.How this classification system improves communication between specialties.The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.With Dr. Belley-Côté’s clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.

In this episode, we’re joined by Dr. James Downar, a leading Canadian voice in palliative and critical care, for a wide-ranging discussion on the emerging role of psychedelics in managing psychological and existential distress.Psychedelics have gone from fringe to forefront in recent years, and we dig into what that shift might mean for patients facing critical illness or the end of life.What psychedelics are and how they workSubstances like psilocybin, LSD, ketamine, and MDMAKey effects: altered perception, ego dissolution, and emotional insightRisks and benefits in vulnerable populationsPsychedelic-assisted therapy: structure and processThe three-phase model: preparation, the session itself, and integrationMicro dosing vs. full therapeutic sessionsWhere current evidence standsPotential applications in critical care and palliative medicineHelping patients process fear, isolation, and sufferingHow psychedelics differ from traditional symptom management tools like opioidsLimitations in advanced illness due to physiological concernsResearch and implementation challengesProblems with study design and placebo controlsThe importance of ‘set and setting’Defining success in existential or spiritual distressEthical considerations and clinical integrationBalancing innovation with compassion and cautionAvoiding reductionism: why psychedelics should complement—not replace—human careThe future role of these therapies in ICU and palliative settings

Recorded live at the Canadian Critical Care Forum 2024 in Toronto, this episode dives into the complex world of ischemia-reperfusion syndrome — the paradox where restoring blood flow causes further injury. We explore the underlying mechanisms, clinical implications, and future directions in managing this phenomenon.Joining us for the third time is Prof. Mervyn Singer, ICU physician, researcher, and thought leader in critical care physiology. Known for challenging dogma and making complex science accessible, Prof. Singer unpacks this important topic with clarity and insight.

Dr. Mike Christian is a critical care and pre-hospital medicine specialist with extensive experience in aeromedical transport and military medicine. His diverse career spans work as a paramedic, internal medicine and critical care training, and roles as a flight physician with London Air Ambulance and the Canadian military. He is a leading advocate for integrating interprofessional teams and advancing physician-led pre-hospital care in Canada. Currently, he is involved in the MedResponse BC initiative, which aims to enhance critical care delivery outside of hospitals.In this episode, Peter and Leon sit down with Mike to explore the evolving landscape of pre-hospital critical care. From his unconventional career path to the integration of AI in emergency response, he shares insights on improving outcomes in pre-hospital medicine and the lessons Canada can learn from global high-performance systems.Key Topics & ChaptersMike’s Career JourneyFrom paramedic to physician: an unconventional pathMilitary and aviation medicine experienceThe shift to leadership in pre-hospital carePre-Hospital Critical Care: Canada vs. The WorldHow Canada’s HEMS (Helicopter Emergency Medical Services) differs from global modelsLessons from the UK, Australia, and DenmarkThe role of AI in dispatch and triageThe Role of Physicians in Pre-Hospital MedicineThe evolving need for physician-led care outside the hospitalThe impact of interprofessional teams on survival ratesMentorship, coaching, and cultural change in pre-hospital systemsThe Role of the Physician in Pre Hospital Medicine. AI-powered dispatch and GoodSAM app in improving CPR and trauma responseScoop and run vs. stay and play: What actually saves lives?Addressing Canada’s geographical challenges with rural and remote careFuture Directions in Pre-Hospital MedicineThe rise of telemedicine and virtual ICUsDeveloping triage physicians and training programsMedResponse BC: A new model for interprofessional pre-hospital careKeywords:Pre-hospital care, critical care transport, HEMS, trauma response, paramedics, physician-led pre-hospital medicine, telemedicine, AI in emergency medicine, interprofessional teams, rural emergency care, GoodSAM app, London Air Ambulance, MedResponse BC.Links of Interest: CCCF Presentation:  https://youtu.be/MVDHaYaZRSI  (Web view)Recent Publication:  https://doi.org/10.1186/s13049  (Web view)

In this episode, hosts Leon Byker and Peter Brindley are joined by Dr. Elizabeth Viglianti, an assistant professor at the University of Michigan, Pulmonologist and Critical Care Specialist, to discuss the crucial issue of gender based harassment in medicine. Gender-Based Harassment refers to any unwelcome behavior, comment, or conduct that demeans, intimidates, or disadvantages someone based on their gender or gender identity. This can include derogatory remarks, exclusion, stereotyping, unequal treatment, or threats, whether or not the behavior is sexual in nature. In the workplace, it undermines professional dignity and contributes to a hostile or inequitable environment.Dr. Viglianti shares her personal experience that led her to study this field, detailing the prevalence and impact of such harassment. The discussion covers key findings from the National Academies of Science, Engineering, and Medicine's framework on addressing sexual and gender based harassment, gender disparities, organizational factors contributing to harassment, and her research on the topic. Practical steps and recommendations for institutions to mitigate harassment are also explored.00:00 Introduction and Welcome01:08 Personal Experience with Sexual Harassment03:06 Understanding Gender Based Harassment in Medicine05:34 Organizational Factors and Solutions07:50 Gender Disparities in Academic Medicine17:42 Impact on Trainees and Reporting Challenges24:46 Addressing Patient-Perpetrated Harassment28:59 Practical Strategies and Training32:26 Conclusion and Call to Action

We take another break as we are joined by Prof. Wendy Sligl, formidable ID and ICU doc, to discuss the critical topic of optimizing antibiotic prescribing in critical care settings. The discussion covers various aspects of antibiotic use, including the importance of timely administration, the role of communication in ensuring effective treatment, and the nuances of dosing strategies such as loading doses and continuous infusions. The conversation also delves into the duration of antibiotic therapy, emphasizing the need for individualized treatment based on patient response. Takeaways:Infections are common in intensive care units, and sepsis is a life-threatening condition.Identifying the clinical syndrome is crucial for appropriate antibiotic therapy.Empiric therapy is often necessary before culture data is available.Timely administration of antibiotics is linked to better patient outcomes.Communication among healthcare teams is essential for effective antibiotic delivery.Loading doses can help achieve therapeutic levels quickly in critically ill patients.Continuous infusions of certain antibiotics may improve clinical outcomes.Shorter courses of antibiotics can be as effective as longer ones.Monitoring patient response is key to adjusting antibiotic therapy.Consulting infectious disease specialists can enhance treatment strategies.Chapters:00:00Introduction to Antibiotic Optimization01:07Understanding Infections and Sepsis02:47Emergency Room Protocols for Antibiotic Administration04:56Identifying Sepsis and Administering Antibiotics06:33Communication and Timeliness in Antibiotic Delivery08:42Optimizing Antibiotic Dosing Strategies10:59Pharmacodynamics and Continuous Infusions12:44Duration of Antibiotic Therapy18:52Monitoring and Adjusting Antibiotic Treatment21:39The Debate on Antibiotic Duration26:37Specific Infections and Treatment Duration31:24Practical Strategies for Antibiotic Stewardship32:43Rapid Fire Questions on Antibiotic Use

Following the discussion on ECLS in AMI and cardiogenic shock, we go on to discuss eCPR for cardiac arrest specifically. This episode was recorded live at the Critical Care Canada Forum 2024 as part of our special series on cardiac intensive care. Our guest is Dr. Darryl Abrams, Associate Medical Director and Director of Research for the Medical ECMO Program at New York-Presbyterian/Columbia University. Dr. Abrams joins us for an in-depth discussion on the current state and future direction of extracorporeal cardiopulmonary resuscitation, or eCPR.We dive into the complex world of eCPR in refractory cardiac arrest, starting with a breakdown of the three landmark trials that have shaped the field: the ARREST trial, the Prague OHCA trial, and the INCEPTION trial. Each study offers a unique perspective, from the dramatic early findings of ARREST to the pragmatic design of Prague OHCA and the sobering multicenter outcomes of INCEPTION. A major theme throughout the episode is the role of system design. Dr. Abrams emphasizes the importance of minimizing low-flow time, rapid cannulation, and consistent team expertise—factors that can make or break the success of eCPR. We also explore the ethical and practical considerations that come with rolling out such a resource-intensive intervention, including the balance between innovation and equity. Is it fair that access to eCPR may depend on geography or institutional resources? And how do we make meaningful improvements in survival when only a few centers can offer this advanced care?The episode closes with a practical lens: how should clinicians approach building an ECMO program? What are the essential pieces that need to be in place before considering eCPR? And how do you select patients in a way that balances risk, benefit, and system capacity?Chapters:Introduction and guest welcomeSetting the scene: What is eCPR and why now?The ARREST trial: Small study, big impactThe Prague OHCA trial: Early randomization, broader populationThe INCEPTION trial: Multicenter reality and negative resultsComparing the evidence: Why do outcomes differ?Low-flow time and speed of cannulationThe role of meta-analyses and what they do (and don’t) tell usOpportunity cost: What are we giving up to fund eCPR?Duration of support: How long is too long?Will there be another trial? Challenges of equipoiseBuilding a responsible eCPR programPatient selection: Who qualifies and why?Cannulation techniques and adjunct devicesSystem design: U.S. vs. Canada vs. U.K.Ethical concerns and access inequitiesGuidelines and final takeaways

In this episode, recorded live at the Critical Care Canada Forum in Toronto, we dive into extracorporeal life support (ECLS) in cardiogenic shock, with Dr Sean van Diepen. He is an Associate Professor at the University of Alberta, Co-Director of the CCU at the Mazankowski Alberta Heart Institute, and a leading voice in cardiac critical care. Join us as we explore the evolving landscape of mechanical circulatory support, the latest evidence from the DANGER and ECLS-SHOCK trials, and the complexities of patient selection. Key Topics Covered:1. The Evolution of ECLS in Cardiogenic Shock • The 25-year gap since the last positive cardiogenic shock trial. • How mechanical circulatory support expanded despite limited evidence.2. The DANGER Trial – Impella in AMI-Associated Cardiogenic Shock • Mechanism and function of the Impella device. • Trial results: 20% mortality reduction at 180 days. • Complications: Limb ischemia, hemolysis, and high costs. • Real-world application: Who actually qualifies?3. ECLS-SHOCK Trial – ECMO for Cardiogenic Shock • A "negative" trial, but a crucial wake-up call. • No mortality benefit but significantly higher complication rates. • Controversies: Inclusion of cardiac arrest patients and transition to destination therapy. • Future directions: Can patient selection improve outcomes?4. ECPR – Extracorporeal Support in Refractory Cardiac Arrest • Review of the ARREST, PRAGUE, and INCEPTION trials. • Why the evidence remains unclear and institution-dependent. • The role of high-volume ECMO centers and standardized pathways.5. The Future of ECLS – Cost, Ethics, and Decision-Making • How should institutions decide who gets ECMO? • The role of cardiogenic shock teams. • Could AI play a role in decision-making? • The challenge of resource allocation in a single-payer system.Key Takeaways:✅ Impella shows promise in carefully selected AMI shock patients but is costly and high-risk.✅ ECMO for cardiogenic shock remains controversial—patient selection is key.✅ ECPR is promising but needs further trials and structured implementation.✅ Cardiogenic shock management should be a team decision, not an individual one.🔊 Listen now and join the conversation on the future of cardiac critical care!

We’re taking a break from our Cardiac Critical Care series to bring you a conversation with one of the most influential figures in medicine. Peter had the huge privilege of interviewing Major General Tim Hodgetts, the recently retired, most senior medical advisor in the UK forces. Hodgetts shares his remarkable journey in transforming emergency medicine from its infancy to maturity, detailing poignant experiences from his early career that steered him towards this specialty. The discussion ranges from Hodgetts' pioneering efforts in combat casualty care, the evolution of battlefield first aid, and innovative medical practices in conflict zones, to his concepts on leadership, international collaborations, and coping with trauma. The segment also touches on Hodgetts' recent retirement and his ongoing contributions to medical and military communities through teaching, charity work, and writing.Chapters: 00:00 Introduction and Guest Overview02:56 Early Career and Influences06:25 Pioneering Emergency Medicine in the Military08:13 Revolutionizing Combat Casualty Care17:55 International Collaboration and Cultural Insights30:31 Leadership in Crisis35:35 Coping with Trauma and Personal Reflections39:43 Retirement and Legacy42:29 Conclusion and Final ThoughtsThis has been one of my absolute favorite podcasts to produce! What an honor to have Major General Tim Hodgetts join us on the Critical Care Commute!

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for changeReferences: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer:This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.

Welcome to our first episode in a series on Cardiac Intensive Care, recorded live at the Critical Care Canada Forum 2024. We kick off by looking at the latest Clinical Practice Update on post cardiac arrest care and refractory cardiac arrest. The "Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care" CCS was published in 2024, and provides comprehensive recommendations for the management of patients following cardiac arrest. Join us as Dr Janek Senaratne unpacks this Clinical Practice Update (CPU), and guides us through the evidence for the recommendations made. Dr. Janek Senaratne is a dual-trained cardiologist and intensivist based in Edmonton, Alberta. He serves as an Associate Clinical Professor in the Department of Medicine at the University of Alberta. University of Alberta In his clinical roles, Dr. Senaratne practices at the University of Alberta Hospital and Grey Nuns Hospital, and is one of the Vital Heart Response physicians for the province. Further Reading:

Recorded live at the Toronto Critical Care Canada Forum, this episode features a conversation with Prof. Derek Angus, Professor at the University of Pittsburgh, senior editor at JAMA, and Vice Chair of Innovation. We discuss the evolution of healthcare systems, the art of decision-making, the role of AI, and how to inspire the next generation of clinicians. Chapters: Welcome to the Forum Introductions and reflections on the energy of in-person conferences post-COVID. Setting the stage with Dr. Angus and his storied career. Conferences: More Than Just Science The dual role of conferences as spaces for rigorous science and informal discussion. How smaller, focused meetings like CCR foster deeper conversations. How We Communicate Science Reflections on the digital age: Do we risk dumbing things down too much? The balance between simplicity and nuance in medical publishing. The AI Frontier in Medicine Separating hype from reality: Why AI isn’t replacing doctors just yet. The cognitive load of decision-making and where technology fits in. Thinking, Fast and Slow Exploring System One and System Two decision-making. The growing interest in how groups make decisions in critical care settings. Redefining Careers in Medicine Moving beyond traditional roles to focus on leadership, innovation, and teamwork. Advice for the next generation on thinking outside the box. Building Better Healthcare Systems Shifting accountability from individual outcomes to system-wide improvement. Transparency and trust: Why they’re essential for the future of healthcare. Closing Thoughts Dr. Angus reflects on his legacy and hopes for the next wave of clinicians. A heartfelt thanks and a promise for more conversations ahead.

Health Economics 101: "Code Green - How the big lie in health care affects us all." Prof. John Kellum, is a Professor of Critical Care Nephrology and now provocative author! Join us as he talks to us about his book: "Code Green - How the Big Lie in Healthcare Affects Us All." Conflict Declaration: The hosts and producers of this podcast declare no financial gain or conflict of interest from this episode or the promotion of Code Green. Our only goal is to share the insights and expertise of Dr. Kellum with our audience. Episode Chapters: Welcome and Introduction Why Code Green? The inspiration behind the book. The Evolution of U.S. Healthcare: From the 1980s to today. The "Big Lie" in Healthcare: How hospitals maintain profits while claiming financial distress. Trust and Its Erosion in Medicine: Exploring the misalignment between physicians, hospitals, and patient care. Burnout or Moral Injury? Understanding the psychological toll of compromised care. Aligning Values with Care: Dr. Kellum’s actionable solutions for a better healthcare system. The Role of Patients in Reform: How patients can become advocates for systemic change. Closing Thoughts and Takeaways: Dr. Kellum’s message to healthcare professionals and patients alike. Further Resources: • Code Green: How the Big Lie in Healthcare Affects Us All

In this episode, we dive into the fascinating world of Hyperbaric medicine with Dr. Jeff Kerrie, a Hyperbaric specialist from British Columbia, Canada. Dr. Kerrie takes us through the science, history, and practical applications of Hyperbaric oxygen therapy (HBOT) as we explore the approved indications, physiological effects, and logistics of managing hyperbaric chambers. Episode Chapters: Introduction Meet Dr. Jeff Kerrie and learn about his journey in hyperbaric medicine and the unique setup of Vancouver Island’s hyperbaric program. History of Hyperbaric Medicine A look at the origins of hyperbaric therapy, from 1600s pressurized chambers to its modern evolution. The Physiology of HBOT Understanding the effects of supra-physiologic oxygen pressures on microcirculation, angiogenesis, and inflammation. Indications and Evidence: Decompression Sickness The mechanisms of treating “the bends” and why HBOT works so effectively. Air or Gas Embolism Insights into diagnosing and treating air embolism, including critical resuscitation tips. Carbon Monoxide Poisoning How HBOT prevents long-term neurological damage, with considerations for pregnant patients and associated toxins like cyanide. Necrotizing Soft Tissue Infections The role of HBOT in treating Fournier’s gangrene and clostridial infections alongside surgery. Crush Injuries and Anemia Exploring HBOT’s utility in tissue salvage and sustaining oxygenation in severe anemia. Newer Indications: Sudden Hearing and Vision Loss The emerging role of HBOT in sudden sensorineural hearing loss and central retinal artery occlusion. Risks and Safety in the Chamber Barotrauma, oxygen toxicity, fire safety, and managing emergencies during dives. Logistics of Hyperbaric Medicine A behind-the-scenes look at hyperbaric chamber setups, patient care protocols, and equipment considerations. Closing Thoughts Dr. Kerrie’s perspective on the future of hyperbaric medicine and ongoing research opportunities. Key Indications for HBOT: 1. Decompression sickness ("The Bends") 2. Air or gas embolism 3. Carbon monoxide poisoning 4. Necrotizing soft tissue infections 5. Crush injuries and compartment syndromes 6. Severe anemia (e.g., in patients unable to receive transfusions) 7. Radiation tissue injury (e.g., osteoradionecrosis) 8. Sudden sensorineural hearing loss Resources and Links: • Undersea and Hyperbaric Medical Society Approved Indications for Hyperbaric Oxygen Therapy - Oceanside Hyperbaric • Hyperbaric Medicine | © 2018 The Royal College of Physicians and Surgeons of Canada. All rights reserved. Disclaimer: This episode provides general information and is not a substitute for professional medical advice. Always consult with a specialist for specific clinical decisions.

In this episode, Peter Brindley and Leon Byker sit down with Dr. Rob Bevan, immediate past president of the College of Intensive Care Medicine (CICM) and Critical Care Director at Auckland City Hospital, Auckland, New Zealand. Dr. Bevan shares his journey through leadership in intensive care, the role of intensive care colleges, and the evolution of critical care training. He also explores the political, social, and ethical dimensions of critical care, from workforce sustainability to the unique role of intensivists as brokers of care. Episode Highlights: The Evolution of CICM: History of the CICM and the differences between the CICM and similar organizations globally. Training for Critical Care: The training pipeline in Australasia. Advocacy and Political Engagement: The role of the CICM in advocating for intensive care resources. The Value of College Convocations: Celebrating new fellows and their families and the role of meaningful ceremonies. The Intensivist as a Broker of Care: Defining the role of the ICU specialist in complex patient care. The Future of Critical Care Workforce: Addressing workforce challenges and it's sustainability. The Upcoming CICM Annual Meeting: Highlights of the upcoming 2025 meeting in Tasmania. Reflections on Leadership and Administration: Dr Bevan's Journey into administration and why it matters.