ICU Rounds

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 approach.

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.

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.

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.

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

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

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.  

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.  

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.  

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

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

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.   

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.

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.

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

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

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

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 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.

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.  

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

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

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

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.

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

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.

A discussion on nosocomial infections and VAP.

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

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

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

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

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

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

Discussion of the technology of the pulse oximeter

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.

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

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

Evaluation and treatment of elevated serum sodium is presented.

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

Review of a recent publication from Annals of Surgery

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

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

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. 

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.

This episode explores what is needed to make surgery safer for the patient with cardiovascular disease. 

Tight glucose control has been widely introduced into critical care. This meta-analysis, recently published in JAMA, critically evaluates the effects of these trials in reduction of sepsis as well as mortality. The results might surprise you.

This is the second installment of this topic. In this episode we talk about the role of angioplasty and role of various medications in the treatment of the patient having an MI.

It is Sunday 8.31.08 and for hurricane Gustav is bearing down on the city of New Orleans.  This podcast will discuss the basic elements of disaster planning and management. (This was reposted due to some technical problems with the server.)