ICU Rounds

Splitting a Ventilator: Multipatient Ventilation for COVID?

April 23, 2020 01:46 - 16 minutes - 29.8 MB

Throughout the pandemic, there has been considerable discussion about the possibility of running our of ventilators. One potential solution that was brought forward was putting multiple patients on a single ventilator. This is a lot harder than merely attaching a plastic splitter on a ventilator. In this episode, we explain safety and physiological considerations. Also, we briefly discuss specific patient care issues and ventilator settings if your circumstance requires you to adopt this app...

Prone Ventilation for ARDS (COVID-19)

April 12, 2020 20:52 - 19 minutes - 36 MB

This week we have a brief conversation about prone mechanical ventilation for ARDS. Does it provide a benefit? When should we use it, and why does it work? I hope this is helpful as prone ventilation has been reported to provide benefit to patients with ARDS secondary to Coronavirus (COVID-19) infection.

ARDS and Mechanical Ventilation / COVID-19 Care

April 05, 2020 15:13 - 33 minutes - 61.3 MB

Today we discuss the approach to oxygenating and mechanically ventilating a patient suffering from ARDS. We will cover elements relevant and essential in the management of COVID patients and all others with ARDS.

ICU Care of Coronavirus (COVID-19)

March 29, 2020 15:26 - 48 minutes - 88.9 MB

I'm back. I plan on providing you with some useful information when caring for patients infected with COVID-19 (Coronavirus). In this episode, I will provide you an overview of the current evidence and best practices with some explanation and commentary from the recent Surviving Sepsis COVID-19 guidance.

Colloids: Details and Myths

July 09, 2012 16:14 - 18 minutes - 25.2 MB

This episode provide some basic description of colloids as will as some myths.

Random Serum Cortisol Levels are misleading

March 12, 2012 18:15 - 17 minutes - 15.7 MB

A physiological explanation why random cortisol levels are NOT helpful in evaluating adrenal function

EARLY use of Tranexamic Acid may improve survival from bleeding in trauma

February 20, 2012 05:00 - 19 minutes - 17.9 MB

In this episode we talk about the results of the CRASH-2 trial published in Lancet. This trial showed that the EARLY use of Tranexamic acid may improve survivial, but delayed use may be associated with an increased mortality.

Pediatric IVC diameter determination with ultrasound

February 09, 2012 17:40 - 15 minutes - 14.5 MB

If you are using ultrasound to evaluate IVC diamter in children, what is considered a normal IVC diameter? You can determine the IVC/Ao ratio or correct the IVC diamter based on the child's body surface area.

Takotsubo Cardiomyopathy

January 31, 2012 19:05 - 12 minutes - 11.6 MB

This is a condition that mimics acute coronary syndrome (ACS) that may be caused by acute emotional or physical stress. Patient's may appear to have profound cardiogenic shock, but these patients have a very high survivial rate with little more than supportive care.

Necrotizing Soft Tissue Infection (NTSI)

December 06, 2011 18:56 - 26 minutes - 12.1 MB

This episode discusses the pathophysiology, presentation, and treatment of NTSI.

Different Cardiac Output Monitors & Physiology

November 26, 2011 05:00 - 31 minutes - 14.2 MB

This episode will discuss the physiology behind various CO output monitors such as pulmonary artery catheters, PICCO, pulse wave form analysis, and LiDCO.

Lactic Acidosis - Type B

November 19, 2011 05:00 - 16 minutes - 7.56 MB

Now these are the types of lactic acidosis that most people are not familiar. They can be caused by medications, underlying disease, or inborn errors of metabolism.

Lactate Acidosis - Type A

November 12, 2011 20:09 - 22 minutes - 10.1 MB

This podcast is a description of how lactate is produced and metabolized. I will discuss the role of lactate in the diagnosis and management of shock. This podcast will focus on Type A lactic acidosis.

Endotracheal tube cuff leaks and self-extubations

August 03, 2011 04:00 - 24 minutes - 11.1 MB

A brief description on what to consider when confronted with a patient with an air leak from the ET tube or a patient that self-extubates.

Pulmonary Embolus

July 28, 2011 02:38 - 33 minutes - 15.1 MB

A description of the risk factors, diagnosis, and treatment of PE.

Smoke Inhalation Injury

July 06, 2011 00:49 - 30 minutes - 14.1 MB

Smoke Inhalation injuries can be deadly. This episode explains why smoke can be so deadly, and how to care for those patients with suspected smoke inhalation injuries.

Propofol Related Infusion Syndrome

June 05, 2011 22:37 - 24 minutes - 11 MB

Propofol Related Infusion Syndrome is a potentially fatal complication of propofol. If you use this common ICU drug you need this information.

Wedge: Everyone elses favorite Swan number

December 12, 2010 21:29 - 25 minutes - 11.7 MB

Wedge or PAOP is perhaps the most quoted and poorly understood variable generated by a Swan-Ganz.

SVO2 My favorite Swan Number

December 05, 2010 17:57 - 18 minutes - 8.6 MB

The most helpful number for me on a Swan is the SvO2. This is a brief description of how I use this variable in evaluating critically ill and injured patients.

Therapeutic Hypothermia After Cardiac Arrest

October 21, 2010 17:49 - 34 minutes - 15.6 MB

Therapeutic hypothermia after cardiac arrest is part of ACLS and is used by several EMS agencies around the US. Despite good data and improved patient outcomes, many providers fail to used this modality. This podcast will focus on a presentation of the data, methods of cooling, and potential complications.

Pancreatitis - Surgical Indications and Procedures

July 23, 2010 00:53 - 26 minutes - 12.1 MB

This is the third in the series on severe pancreatitis and necrotizing pancreatitis. This episode reviews the indications for surgery, morbidity and mortality of surgery, and what are the surgical options.

Severe Acute Pancreatitis: Part 2 ICU Considerations

June 02, 2010 00:00 - 18 minutes - 8.27 MB

A brief discussion of the considerations of ICU care of the patient with severe pancreatitis, fluid resuscitation, respiratory, renal, and nutrition.

Pancreatitis - Part 1

May 25, 2010 18:30 - 26 minutes - 11.9 MB

This is an initial presentation of the causes and diagnosis of acute pancreatitis.

That peripheral IV can kill you: Suppurative Thrombophlebitis

February 25, 2010 20:40 - 13 minutes - 6.29 MB

All the recent emphasis on venous catheter infections has been on central lines. Those peripheral IVs are also dangerous.

Acute Colonic Pseudoobstruction (Ogilvie's Syndrome)

February 15, 2010 23:29 - 32 minutes - 14.7 MB

Acute Colonic Pseudoobstruction (ACPO) is commonly called Ogilvies Syndrome. ACPO presents massive dilation in critically ill patients, and might result in invasive procedures to avoid ischemia or perforation of the colon.

Hemoglobin Based Oxygen Carriers (a.k.a. Artificial Blood)

January 18, 2010 15:41 - 23 minutes - 11 MB

A brief summary of what are hemoglobin based oxygen carriers (HBOC) and where are they in development.

Catheter-Related Bloodstream Infection: Diagnosis

September 24, 2009 16:34 - 18 minutes - 8.6 MB

Discussion of what is the difference between a CVC infection and a catheter-related blood stream infection. They are treated differently so it is important to know the difference.

Ventilator Associated Pneumonia

September 17, 2009 14:41 - 34 minutes - 31.2 MB

A discussion on nosocomial infections and VAP.

Complications of Dwelling Central Lines

August 04, 2009 02:20 - 34 minutes - 15.8 MB

What horrible things can happen with central lines once they have been inserted.

Central Line Insertion Complications

July 16, 2009 16:32 - 32 minutes - 14.7 MB

A discussion of the potential problems encountered while inserting central venous catheters.

Pulmonary Physiology and General Anesthesia

June 21, 2009 23:55 - 30 minutes - 13.9 MB

This episode discusses the effects and risks of anesthesia on patients with pulmonary disease as well as the effects of anesthesia on pulmonary physiology.

Caustic Ingestions

May 13, 2009 02:50 - 38 minutes - 17.7 MB

Ingestion of caustic materials can be fatal and difficult to evaluate. These patients are often referred to our burn center.

IV Fluids (Part 1)

May 03, 2009 22:21 - 36 minutes - 16.7 MB

An introduction to the basic science in fluids used to treat hypovolemia.

Arterial Blood Gases

April 26, 2009 18:42 - 36 minutes - 16.8 MB

This episode is a discussion about how to approach an arterial blood gas result.

Pulse Oximetery

March 30, 2009 02:08 - 29 minutes - 13.6 MB

Discussion of the technology of the pulse oximeter

Discussion on Fluids: The last Cotton lecture

March 05, 2009 16:38 - 24 minutes - 11.2 MB

This is an interview that I did on www.medtalknetwork.com with Dr. Brian Cotton. Dr. Cotton recently left Vanderbilt to take a new position at UT Houston. He is an excellent teacher and his opinions on fluids resuscitation are cutting edge.

Refeeding Syndrome

February 21, 2009 22:12 - 27 minutes - 12.6 MB

When and how can providing a starving patient nutrition be potentially deadly.

Hypoxia: physiological causes

February 15, 2009 05:01 - 23 minutes - 21.6 MB

Understanding the root cause of hypoxia will allow for more appropriate treatment.

Hypernatremia

February 12, 2009 03:04 - 16 minutes - 14.9 MB

Evaluation and treatment of elevated serum sodium is presented.

Hyponatremia: common but dangerous

February 07, 2009 05:08 - 23 minutes - 21.9 MB

Hyponatremia or a low serum sodium is a common electrolyte problem that is dangerous if ignored or treated improperly.

Prehospital/Battlefield Tourniquet Use

February 01, 2009 18:04 - 14 minutes - 13 MB

Review of a recent publication from Annals of Surgery

Environmental Hypothermia

January 28, 2009 20:48 - 28 minutes - 26.2 MB

Following the recent crash of the US Airways in the Hudson River, it is an appropriate time to discuss the clinical manifestations and treatment of hypothermia.

Peak Inspiratory Pressure: Physiological Determinants

January 19, 2009 12:00 - 27 minutes - 12.4 MB

Peak inspiratory pressure (PIP) the center of a great deal of discussion of ventilator management. Knowing the factors that increase or decrease PIP are important to those managing critically ill patient. This podcast is steeped in physiology and perhaps more difficult than my typical podcasts. PIP= [Tv/ (Compliance Lung & Thorax)] + (Resistance of airway + flow )

Hyperkalemia

January 12, 2009 03:30 - 28 minutes - 26.2 MB

Hyperkalemia is a very common and potentially dangerous electrolyte disorder that commonly occurs in ICU patients.

Some Swan Stuff

December 29, 2008 11:30 - 24 minutes - 22.6 MB

A brief discussion regarding some of the commonly used values obtained from a pulmonary artery catheter.

Therapeutic Hypothermia following Cardiac Arrest

December 22, 2008 18:48 - 19 minutes - 17.7 MB

Therapeutic Hypothermia following cardiac arrest has been demonstrated to improve outcomes. Starting Jan 1, 2009 Ney York City EMS will dorect patients to those hospitals able to delivery such care.

Radiation Injury / Nuclear MCI

December 12, 2008 19:28 - 28 minutes - 13.2 MB

The US government last week released a report that the threat of a nuclear device used in an act of terrorism is high in the next couple of years. In this episode we discuss the some concepts of the medical care required to those exposed to radiation as well as blast injuries. I hope this is information that none of you will ever need.

Episodes