Podcasts about cicu

Sharing data transparently, whether at a local or a national level, is a foundational contributor to healthcare quality. Atul Gawande wrote about this in his 2004 essay labeled ‘The Bell Curve'. Over the last several decades, we have seen many pediatric specialties organize and collaborate around data collection at a national scale to improve care. We've seen firsthand how our hospital's participation in a national cardiac critical care registry has driven quality improvement, better measurable outcomes and improved cardiac arrest rates for patients. Getting the data collection right is the first challenge. In between that first step and actually seeing improvements is a tremendous amount of work. In this episode, we explore the value of data sharing and transparency to improve outcomes for kids. Our experts for this episode are Carly Scahill, DO, and Kelly O'Neil. Dr. Scahill specializes in pediatric cardiology as a pediatric cardiac intensivist. She is also the Fellowship Director for pediatric cardiology and the cardiac intensive care unit (CICU), as well as an associate professor of pediatrics at the University of Colorado School of Medicine. Kelly O'Neil is a registered nurse and the Manager of the Heart Institute Data Registries and Outcomes. Before her current role, she was a CICU nurse for over ten years. Some highlights from this episode include:  The purpose and use of clinical registries  How data collection improves measurable outcomes  The future of data collection in healthcare  How to get more entities involved  For more information on Children's Colorado, visit: childrenscolorado.org.    

Stuart Goldstein, MD is a Professor of Pediatrics at the University of Cincinnati, where he serves as the Clark D. West Endowed Chair. He is a practicing pediatric nephrologist at Cincinnati Children's where he also is the Director for the Center for Acute Care Nephrology and the Medical Director for the Pheresis Service. Dr Goldstein is the Founder and Principal Investigator for the Prospective Pediatric Acute Kidney Injury Research Group and has evaluated novel urinary AKI biomarkers in the pediatric critical care setting. Dr. Katherine Melink (at time of recording) is currently finishing her residency at Cincinnati Children's Hospital where she was able to conduct research in biomarkers for the prediction of kidney injury in critically ill children (particularly in the CICU). Her exposure to CRRT under physicians like Dr. Goldstein at Cincinnati Children's has served as a motivating factor to participate in this episode! She is excited to start PICU fellowship at Boston Children's Hospital in July.Learning Objectives:By the end of this podcast, listeners should be able to discuss:CRRT fundamentals, including how it differs from conventional hemodialysis and the rationale for its use in critically ill pediatric patients.Key differences in ultrafiltration, diffusion, and convection and their clinical applications in CRRT.Patient selection and indications for CRRT (AKI, fluid overload, toxic metabolite/ingestion among others)Key evidence guiding use of CRRT in critically ill children.Components of a CRRT prescription and guiding principles of how to titrate therapy.Pitfalls and complications of CRRTCommon anticoagulation strategies in CRRTGeneral principles guiding liberation from CRRT.Selected references:Sutherland et al; ADQI 26 Workgroup. Epidemiology of acute kidney injury in children Pediatr Nephrol. 2024 Mar;39(3):919-928. doi: 10.1007/s00467-023-06164-w. Epub 2023 Oct 24. Basu et al. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2014 Mar;85(3):659-67. doi: 10.1038/ki.2013.349. Epub 2013 Sep 18. PMID: 24048379; Fuhrman et al; ADQI 26 workgroup. A proposed framework for advancing acute kidney injury risk stratification and diagnosis in children. Pediatr Nephrol. 2024 Mar;39(3):929-939. doi: 10.1007/s00467-023-06133-3. Epub Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Join us for a re-release of one of our most popular episodes on fostering teamwork and collaboration amongst the CICU and CV surgery. Host/Editor: Saidie Rodriguez (Children's Healthcare of Atlanta/Emory Univ) Guests: Alaa Aljiffry (Children's Healthcare of Atlanta/Emory Univ) and Subi Shashidharan (Children's Healthcare of Atlanta/Emory Univ). Producers: Saidie Rodriguez/Deanna Todd Tzanetos (Norton Healthcare/U of Lousiville)

Stuart Goldstein, MD is a Professor of Pediatrics at the University of Cincinnati, where he serves as the Clark D. West Endowed Chair. He is a practicing pediatric nephrologist at Cincinnati Children's where he also is the Director for the Center for Acute Care Nephrology and the Medical Director for the Pheresis Service. Dr Goldstein is the Founder and Principal Investigator for the Prospective Pediatric Acute Kidney Injury Research Group and has evaluated novel urinary AKI biomarkers in the pediatric critical care setting. Dr. Katherine Melink (at time of recording) is currently finishing her residency at Cincinnati Children's Hospital where she was able to conduct research in biomarkers for the prediction of kidney injury in critically ill children (particularly in the CICU). Her exposure to CRRT under physicians like Dr. Goldstein at Cincinnati Children's has served as a motivating factor to participate in this episode! She is excited to start PICU fellowship at Boston Children's Hospital in July.Learning Objectives:By the end of this podcast, listeners should be able to discuss:CRRT fundamentals, including how it differs from conventional hemodialysis and the rationale for its use in critically ill pediatric patients.Key differences in ultrafiltration, diffusion, and convection and their clinical applications in CRRT.Patient selection and indications for CRRT (AKI, fluid overload, toxic metabolite/ingestion among others)Key evidence guiding use of CRRT in critically ill children.Components of a CRRT prescription and guiding principles of how to titrate therapy.Pitfalls and complications of CRRTCommon anticoagulation strategies in CRRTGeneral principles guiding liberation from CRRT.Selected references:Sutherland et al; ADQI 26 Workgroup. Epidemiology of acute kidney injury in children Pediatr Nephrol. 2024 Mar;39(3):919-928. doi: 10.1007/s00467-023-06164-w. Epub 2023 Oct 24. Basu et al. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2014 Mar;85(3):659-67. doi: 10.1038/ki.2013.349. Epub 2013 Sep 18. PMID: 24048379; Fuhrman et al; ADQI 26 workgroup. A proposed framework for advancing acute kidney injury risk stratification and diagnosis in children. Pediatr Nephrol. 2024 Mar;39(3):929-939. doi: 10.1007/s00467-023-06133-3. EpubQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

In this replay of our milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace.doi: 10.1007/s00134-004-2504-1

On this week's episode, we welcome Carlee to share her story. Carlee and her husband received a hypoplastic left heart syndrome diagnosis for thier son, James, during Carlee's pregnancy. James passed away at 6 weeks old after being in the CICU, and Carlee has since created the James Doss Memorial Foundation to honor his life while supporting other families who have lost children to congenital heart defects.In this episode you will hear:- Preparing for delivery with a devastating diagnosis- Delivery via cesarean section in a cath lab at the children's hospital - Making heartbreaking decisions as first-time parents- Creating the James Doss Memorial Foundation- Advice for those who are dealing with a CHD (or other) diagnosisIf you have a birth trauma story you would like to share with us, click this link and fill out the form. For more birth trauma content and a community full of love and support, head to my Instagram at @birthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

Pete Johnson, Pharm.D. is Professor of Pharmacy Practice and President's Associate Presidential Professor at the University of Oklahoma College of Pharmacy and Adjunct Professor at the University of Oklahoma College of Medicine in Oklahoma City, Oklahoma. Over the last 17 years, Dr. Johnson has practiced in both the Pediatric Intensive Care Unit (PICU) and Cardiac Intensive Care Unit (CICU) at Oklahoma Children's Hospital at OU Health. Currently, he spends most of his clinical time in the CICU where he also precepts pharmacy residents and students. Dr. Johnson serves as the Residency Program Director for the PGY2 Pediatric Pharmacy Residency at the OU College of Pharmacy. Dr. Johnson received his B.S. in Pharmaceutical Sciences and Doctor of Pharmacy degrees from the University of Mississippi School of Pharmacy. Following his tenure at Ole Miss, Dr. Johnson completed a Pharmacy Practice Residency followed by a Pediatric Pharmacy Practice Residency at the University of Kentucky Chandler Medical Center. He is board certified in Pediatric Pharmacy and is a fellow of the Pediatric Pharmacy Association (FPPA), American College of Critical Care Medicine (FCCM), and American Society of Health-System Pharmacy (ASHP). His research/scholarship focuses in pain management and sedation in children, pharmacokinetic alterations in critically ill children, and education/training in post-graduate pharmacy trainees. Pete N. Johnson, Pharm.D., BCPPS, FPPA, FCCM, FASHP Host Jena Quinn, PharmD, BCPPS, Pediatric Pharmacist Justin W. Cole PharmD, BCPS, Chair of Pharmacy Practice, Associate Professor at Cedarville University

The following question refers to Section 9.5 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Keck School of Medicine USC medical student & former CardioNerds Intern Hirsh Elhence, answered first by Vanderbilt Cardiology Fellow and CardioNerds Academy Faculty Dr. Breana Hansen, and then by expert faculty Dr. Javed Butler. Dr. Butler is an advanced heart failure and transplant cardiologist, President of the Baylor Scott and White Research Institute, Senior Vice President for the Baylor Scott and White Health, and Distinguished Professor of Medicine at the University of Mississippi The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #31 Mrs. Hart is a 70-year-old woman who was admitted to the CICU two days ago for signs and symptoms consistent with cardiogenic shock. Since her admission, she has been on maximal diuretics, requiring greater doses of intravenous dobutamine. Unfortunately, her liver and renal function continue to worsen, and urine output is decreasing. A right heart catheterization reveals elevated biventricular filling pressures with a cardiac index of 1.7 L/min/m2 by the Fick method.   What is the next best step? A Continue current measures and monitor for improvement B Switch from dobutamine to norepinephrine C Place an intra-aortic balloon pump (IABP) D Resume guideline directed medical therapy Answer #31 Explanation The Correct answer is C – Place an intra-aortic balloon pump. This patient is between the SCAI Shock Stages C and D with elevated venous pressures, decreased urine output, and worsening signs of hypoperfusion. She has been started on appropriate therapies, including diuresis and inotropic support. The relevant Class 2a recommendation is that in patients with cardiogenic shock, temporary MCS is reasonable when end-organ function cannot be maintained by pharmacologic means to support cardiac function (LOE B-NR). Thus, the next best step is a form of temporary MCS. IABP is appropriate to help increase coronary perfusion and offload the left ventricle. In fact, for patients who are not rapidly responding to initial shock measures, triage to centers that can provide temporary MCS may be considered to optimize management (Class 2b, LOE C-LD).    The guidelines further state that in patients presenting with cardiogenic shock, placement of a pulmonary arterial line may be considered to define hemodynamic subsets and appropriate management strategies (Class 2B, LOE B-NR). And so, if time allows escalation to MCS should be guided by invasively obtained hemodynamic data via PA catheterization. Several observational experiences have associated PA catheterization use with improved outcomes, particularly in conjunction with short-term MCS. Additionally, PA catheterization is useful when there is diagnostic uncertainty as to the cause of hypotension or end-organ dysfunction, particularly when the patient in shock is not responding to empiric initial measures, such as in this patient. There are additional appropriate measures at this time that are more institution-dependent. An institutional shock team would be very helpful here as they often comprise multidisciplinary teams of heart failure and critical care specialists,

En la primera hora de Capital Intereconomía miramos a la actualidad económica y de los mercados. Lo hacemos en el primer análisis de la mañana con Juan Pablo Calzada, Economista y Asesor Financiero. La Puntilla con Miguel Ángel Cicuéndez, Socio Director de Consulae EAF y vicepresidente de ASEAFI. Y repasamos las principales portadas de la prensa económica, nacional e internacional para contar sus titulares.

This episode features Nashifa Momin, an Atlanta based CICU SLP. On this episode, Nashifa shares details about working in the CICU with infants and how to get your foot in the door. We also got into some conversations about CF licensure which lead me into some research for you all! Plus, we sprinkle in some conversations about the SLPD! You can find Nashifa on: - Instagram: @nashifa - Cookie Instagram: @atlcookiejar - Email: nashifa@gmail.com Resources Discussed: - National Pediatric Cardiology Collaborative: NPCQIC - Catherine Shaker: Seminars - Erin Ross: Soffi Method - State Licensure Google Doc You can follow us on instagram ⁠⁠⁠⁠⁠⁠⁠@speechingitreal⁠⁠⁠⁠⁠⁠⁠   Email anytime with questions, general comments, or guest suggestions at speechingitreal@gmail.com

HFpEF is the lesser talked about, but still equally important type of CHF! We discuss the evidence and give you a run-down on everything you need to know about HFpEF. Written by Dr. Aishwarya Roshan, Internal Medicine resident, and reviewed by Dr. Krishnan Ramanathan, Cardiology and CICU, and Dr. Alison Lai, Internal Medicine. Infographic by Dr. Caitlyn Vlasschaert, Internal Medicine Resident. Support the show

Sobrevivimos al 2023, o eso creemos. Para cerrar nuestra cuarta temporada elegimos hacerlo a equipo completo: Cicu, nuestro productor debuta en el piso y hablamos les cuatro sobre los elementos: agua, aire, fuego y tierra. Para saber cómo seguimos, seguinos en @datoencerrado en instagram.

Dr. Tarif Choudhury is a pediatric cardiac intensivist at Columbia University College of Physicians and Surgeons. After finishing his residency in pediatrics at Cohen Children's Medical Center, he completed his cardiology fellowship at Lurie Children's Hospital in Chicago followed by a pediatric critical care fellowship at Morgan Stanley Children's Hospital at Columbia University School of Medicine. His areas of interest are the impact of clinical simulation to improve team performance, clinical outcomes of PCICU patients and clinical outcomes of patients on mechanical circulatory support in the PCICU.Dr. Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.ObjectivesBy the end of this podcast series, listeners should be able to:     Strategize how to approach an arrest as the code leaderRecognize the key elements of high-quality CPR and how to optimize perfusion during an arrest Recall airway management, oxygenation, and ventilation during CPRRecall different approaches to physiological monitoring during an arrest to guide therapy      Recognize appropriate resuscitation drug administration and timing during CPRRecall management with manual defibrillation for arrests with a shockable rhythmDevelop approach to determining code duration and when to discontinue CPRHow to support PedsCritPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Dr. Tarif Choudhury is a pediatric cardiac intensivist at Columbia University College of Physicians and Surgeons. After finishing his residency in pediatrics at Cohen Children's Medical Center, he completed his cardiology fellowship at Lurie Children's Hospital in Chicago followed by a pediatric critical care fellowship at Morgan Stanley Children's Hospital at Columbia University School of Medicine. His areas of interest are the impact of clinical simulation to improve team performance, clinical outcomes of PCICU patients and clinical outcomes of patients on mechanical circulatory support in the PCICU.Dr. Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.ObjectivesBy the end of this podcast series, listeners should be able to:     Strategize how to approach an arrest as the code leaderRecognize the key elements of high-quality CPR and how to optimize perfusion during an arrest Recall airway management, oxygenation, and ventilation during CPRRecall different approaches to physiological monitoring during an arrest to guide therapy      Recognize appropriate resuscitation drug administration and timing during CPRRecall management with manual defibrillation for arrests with a shockable rhythmDevelop approach to determining code duration and when to discontinue CPRHow to support PedsCritPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Priya Bhaskar, M.D. is an Associate Professor of Pediatrics at UT Southwestern and an attending in the Cardiac ICU at Children's Medical Center Dallas. She completed her pediatric residency at Inova Children's Hospital in Virginia and critical care fellowship at UTSW prior to completing a 1 year CICU fellowship at Laurie Children's in Chicago. Prior to her current position here at UTSW she was a cardiac intensivist at Arkansas Children's Hospital. Her professional interests include extracorporeal support and education. She serves on the ECMO team as a core staff physician, and she has co-authored a review on this topic that we will use to guide our conversation. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The general indications for VA-ECMO in pediatrics.The anatomic and physiologic rationale supporting various VA-ECMO cannulation strategies.Physiologic targets to ensure adequate oxygen delivery for patients on VA-ECMO.Hemodynamic complications of VA-ECMO such as left atrial hypertension and harlequin syndrome and general strategies in their management. Liberation strategies for VA-ECMO either to decannulation or conversion to ventricular assist device.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.References:Bhaskar, P., Davila, S., Hoskote, A., & Thiagarajan, R. (2021). Use of ECMO for Cardiogenic Shock in Pediatric Population. Journal of clinical medicine, 10(8), 1573. https://doi.org/10.3390/jcm10081573Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, Deshpande SR, Menon AP, Rozen T, Raman L, Alexander PMA. Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO J. 2021 May 1;67(5):463-475. doi: 10.1097/MAT.0000000000001431. Erratum in: ASAIO J. 2022 Jul 1;68(7):e129. PMID: 33788796.Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Ann Cardiothorac Surg. 2019 Jan;8(1):9-18. doi: 10.21037/acs.2018.11.07. PMID: 30854308; PMCID: PMC6379183. https://www.elso.org/ecmo-resources/elso-ecmo-guidelines.aspx https://www.congenitalheartacademy.com/home Support the show

Dr. Eric Silver is an Associate Professor of pediatrics at Columbia University Medical Center. He completed his cardiology fellowship at Columbia University College of Physicians and Surgeons and his electrophysiology fellowship at Stanford's Lucile Packard Children's Hospital. He is a certified specialist in pediatric electrophysiology and his research has focused on invasive management of AV nodal reentrant tachycardia in children, the response of the transplanted heart to adenosine therapy, and placement of pacemakers and ICDs with minimal fluoroscopy utilizing 3-dimensional mapping systems.Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program next year. He is interested in pursuing a career in cardiac intensive care.Learning Objectives:  By the end of this podcast, listeners should be able to:Recognize common indications for temporary pacing in the CICUUnderstand the nomenclature used to describe temporary epicardial pacemakers and different pacing modalitiesRecall the function of each pacing mode and which clinical settings in which it is usedRecognize the surgical and pre surgical factors that lead to higher risk of arrhythmiasRecognize and troubleshoot temporary pacemaker dysfunctionDevelop a mental framework for managing those who require prolonged pacingHow to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please complete our Listener Feedback SurveyThank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.References:Pediatric & Congenital Electrophysiological Society: https://pacesep.org/Heart University: https://www.heartuniversity.orgSupport the show

Specific considerations of hypokalemia in the CVICU/CICU. 

About our Guests: Dr. Warren Zuckerman is an associate professor of pediatrics as well as the associate director of the pediatric cardiology division at the Columbia University College of Physicians and Surgeons in New York. He completed both his pediatric residency and his cardiology fellowship at Columbia University College of Physicians and Surgeons. He is now a practicing pediatric cardiologist at Morgan Stanley Children's Hospital. His research interests include pediatric cardiomyopathies, donor- and recipient-related issues surrounding pediatric heart transplantation, and drug therapies for prevention and treatment of graft rejection following heart transplantation.Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program in July 2023. He is interested in pursuing a career in cardiac intensive care. Learning Objectives:By the end of this podcast, listeners should be able to:Describe the common indications for pediatric heart transplant.Recall the goals of preoperative management of heart failure patients and medical optimization for heart transplant.Recall the general surgical strategies for cardiac implantation. Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.Recognize the common and important postoperative complications and develop an approach to their management.Develop a mental framework of the expected postoperative CICU course with a focus on common or important barriers to ICU discharge.Recall important long-term complications of heart transplant with an emphasis on those that might result in critical illness.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

About our Guests: Dr. Warren Zuckerman is an associate professor of pediatrics as well as the associate director of the pediatric cardiology division at the Columbia University College of Physicians and Surgeons in New York. He completed both his pediatric residency and his cardiology fellowship at Columbia University College of Physicians and Surgeons. He is now a practicing pediatric cardiologist at Morgan Stanley Children's Hospital. His research interests include pediatric cardiomyopathies, donor- and recipient-related issues surrounding pediatric heart transplantation, and drug therapies for prevention and treatment of graft rejection following heart transplantation.Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University's critical care fellowship program in July 2023. He is interested in pursuing a career in cardiac intensive care. Learning Objectives:By the end of this podcast, listeners should be able to:Describe the common indications for pediatric heart transplant.Recall the goals of preoperative management of heart failure patients and medical optimization for heart transplant.Recall the general surgical strategies for cardiac implantation. Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.Recognize the common and important postoperative complications and develop an approach to their management.Develop a mental framework of the expected postoperative CICU course with a focus on common or important barriers to ICU discharge.Recall important long-term complications of heart transplant with an emphasis on those that might result in critical illness.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children's Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children's and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children's National Hospital in Washington, DC. How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:1. Understand the physiologic considerations that influence preoperative care in the cardiac intensive care unit (CICU).2. Recall the goals and general steps of operative repair.3. Recognize the key information provided in post-op handoff that will affect management.4. Recognize important postoperative complications and develop an approach to their management.5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.Support the showSupport the show

CardioNerds Co-Founder, Dr. Amit Goyal, along with Series Co-Chairs, Dr. Yoav Karpenshif and Dr. Eunice Dugan, and episode Lead, Dr. Sean Dikdan, had the opportunity to expand their knowledge on the topic of ventricular tachycardia and electrical storm from esteemed faculty expert, Dr. Janice Chyou. Audio editing by CardioNerds Academy Intern, Dr. Maryam Barkhordarian. Electrical storm (ES) is a life-threatening arrhythmia syndrome. It is characterized by frequently occurring bouts of unstable cardiac arrythmias. It typically occurs in patients with susceptible substrate, either myocardial scar or a genetic predisposition. The adrenergic input of the sympathetic nervous system can perpetuate arrythmia. In the acute setting, identifying reversible triggers, such as ischemia, electrolyte imbalances, and heart failure, is important. Treatment is complex and varies based on previous treatments received and the presence of intra-cardiac devices. Many options are available to treat ES, including medications, intubation and sedation, procedures and surgeries targeting the autonomic nervous system, and catheter ablation to modulate the myocardial substrate. A multidisciplinary team of cardiologists, intensivists, electrophysiologists, surgeons, and more are necessary to manage this complex disease. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Management of Ventricular Tachycardia and Electrical Storm Electrical storm is defined as 3 or more episodes of VF, sustained VT, or appropriate ICD shocks within 24 hours. It occurs more commonly in ischemic compared to non-ischemic cardiomyopathy, and it is associated with a poor prognosis and high cardiovascular mortality. The classic triad of electrical storm is a trigger, a myocardial susceptible substrate, and autonomic input perpetuating the storm. Triggers for electrical storm include ischemia, heart failure, electrolyte abnormalities, hypoxia, drug-related arrhythmogenicity, and thyrotoxicosis. A thorough evaluation of possible triggers is necessary for each patient, but it is uncommonly found. The evaluation may include laboratory studies, genetic testing, advanced imaging, or invasive testing. Acute treatment options involve acute resuscitation, pharmacotherapy with antiarrhythmics and beta-blockers, device interrogation and possible reprogramming, and sedation. Subacute treatment involves autonomic modulation and catheter ablation. Surgical treatments include sympathectomies and, ultimately, heart transplant. Catheter ablation is safe and effective for the treatment of electrical storm. In select patients, hemodynamic peri-procedural hemodynamic support should be considered. Show notes - Management of Ventricular Tachycardia and Electrical Storm Simple diagram of the classic “triad” of ES (see reference 10). Treatment algorithm provided by the 2017 AHA/ACC/HRS guidelines (see reference 1). 1. Define electrical storm. Electrical storm (ES), also called “arrhythmic storm” or “VT storm” refers to a state of cardiac instability associated with 3 or more episodes of VF, sustained VT, or appropriate ICD shocks within 24 hours. Sustained VT refers to 30 seconds of VT or hemodynamically unstable VT requiring termination in < 30 seconds. Incessant VT refers to continued, sustained hemodynamically stable VT that lasts longer than one hour. VT is incessant or recurrent when it recurs promptly despi...

Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children's Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children's and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children's National Hospital in Washington, DC. How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:1. Understand the physiologic considerations that influence preoperative care in the cardiac intensive care unit (CICU).2. Recall the goals and general steps of operative repair.3. Recognize the key information provided in post-op handoff that will affect management.4. Recognize important postoperative complications and develop an approach to their management.5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.Support the showSupport the show

Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children's Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children's and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children's National Hospital in Washington, DC. How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:1. Understand the physiologic considerations that influence preoperative care in the cardiac intensive care unit (CICU).2. Recall the goals and general steps of operative repair.3. Recognize the key information provided in post-op handoff that will affect management.4. Recognize important postoperative complications and develop an approach to their management.5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.Support the showSupport the show

Please join us during Mental Health Awareness month for a discussion about wellbeing and stress among CICU workforce with our specials guests Casey N. Bor, MS, CPNP-AC, BSN, RN (Univ of Maryland Medical Ct) and ), David Werho (Rady Children's Hospital/UC San Diego). Co-hosts: Monica Mafla MS, PNP-AC (Lucile Packard Children's Hospital Stanford), Co-Host/Editor/Producer: Saidie Rodriguez, MD (CHOA/Emory Univ).

The practice of critical care cardiology relies on the use of invasive hemodynamics, mechanical ventilation, mechanical circulatory support, and other advanced techniques to help our patients recover from critical cardiac illnesses. To facilitate these interventions, it is essential to have a broad understanding of how sedation and analgesia keep our patients comfortable and safe throughout their time in the CICU. In this episode, series co-chair, Dr. Yoav Karpenshif, and CardioNerds co-founder, Dr. Daniel Ambinder, are joined by Dr. Natalie Tapaskar, cardiology fellow and CardioNerds FIT Ambassador from Stanford, and faculty expert, Dr. Chris Domenico, to discuss sedation in the cardiac ICU. Notes were drafted by Dr. Natalie Tapaskar. Audio editing by CardioNerds academy intern, Anusha Gandhi. We discuss the use of analgesics and sedative medications in the cardiac ICU. We dissect three cases of VT storm, heart failure associated cardiogenic shock, and cardiac arrest. We assess the hemodynamic, arrhythmic, and metabolic effects of opioids and sedatives and delve into the altered pharmacokinetics of these drugs during targeted temperature management. Most importantly, we highlight the use of structured pain and sedation scoring systems and discuss the recognition and management of ICU delirium both from a pharmacologic and non-pharmacologic standpoint. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Sedation in the Cardiac ICU with Dr. Christopher Domenico Think about analgesia and sedation as separate entities with management of analgesia first and sedation second. Frequent re-assessment of needs should be performed to reduce ICU delirium and improve long-term outcomes. Fentanyl is generally a good starting point for analgesia in the ICU since it is fast on/fast off, but can stick around for a long time the longer it is used. The choice of bolus or continuous infusion opioids depends on the clinical scenario and personal/institutional preference. Remember to administer bolus doses that are 50-100% of the hourly continuous infusion dose to reach steady state faster. When managing refractory VT storm with sedative agents (propofol, benzodiazepines and/or dexmedetomidine), you should target the deepest level of sedation necessary to suppress sympathetic drive. For cardiogenic shock patients, the choice of sedative agent is a nuanced decision. Think about etomidate first for intubation as it has the least cardiovascular and hemodynamic impact. And remember the propofol trifecta: negative inotropy, direct vasodilation, and bradycardia! Pharmacokinetics are disrupted during targeted temperature management, thus be weary of overly sedating patients due to reduced drug clearance. Show notes - Sedation in the Cardiac ICU with Dr. Christopher Domenico How do we initiate analgesics and sedatives? Analgesia first and sedation second! Analgesia: think about how to reduce a patient's painEveryone has a different pain tolerance and critically ill patients can have moderate to severe pain at baseline. Metrics to assess pain include self-reported scales, behavioral scales, facial expressions, extremity movement, compliance with the ventilator, tachycardia, tachypnea, and hypertension. Sedation: think about how to reduce a patient's agitation or anxietyThe target depth of sedation depends on the clinical scenario.For example,

Renal replacement therapy (RRT) is routinely utilized in the CICU. Series co-chairs Dr. Eunice Dugan and Dr Karan Desai along with CardioNerds Co-founder Dr. Daniel Ambinder were joined by FIT lead and CardioNerds Ambassador from University of Washington, Dr. Tomio Tran. Our episode expert is world-renowned nephrologist Dr. Joel Topf. Dr. Topf is Medical Director of Research at St. Clair Nephrology, and editor of the Handbook of Critical Care Nephrology. In this episode, we describe a case of cardiogenic shock due to acute myocardial infarction resulting in renal failure, ultimately requiring continuous RRT (CRRT). We discuss the most common causes of AKI within the cardiac ICU, indications for initiating RRT, evidence on the timing of RRT, different modes of RRT, basic management of the RRT circuit, and how to transition patients off of RRT during renal recovery. Episode notes were drafted by Dr. Tomio Tran. Audio editing by CardioNerds Academy Intern, Dr. Maryam Barkhordarian. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Approach to Renal Replacement Therapy in the CICU Do not commit “Renalism” - withholding lifesaving treatments from patients with renal impairment due to fear of causing renal injury. Shared decision making is key. In the ICU, most of the time, AKI is caused by ATN due to adverse hemodynamics. Nephrologists can help determine the cause if the patient has an atypical presentation. Late dialysis initiation is non-inferior to early dialysis initiation. Early initiation may lead to higher rates of prolonged time on dialysis. Slow low efficiency daily diafiltration (SLEDD) vs CRRT are equivalent in terms of outcomes and are the preferred methods among patients with hypotension. Intermittent Hemodialysis (iHD) can be used once patients are hemodynamically stable. A “Furosemide Stress Test” can be used to test intact renal function or renal recovery by challenging the nephron to make urine. Show notes - Approach to Renal Replacement Therapy in the CICU What are the risk factors and differential for AKI in the CICU? Start by using the pre-renal vs intrinsic renal vs post-renal framework. Additional considerations in cardiac patients include contrast induced nephropathy, pigment nephropathy, cardiorenal syndrome. Enjoy Episode 262. Management of Cardiorenal Syndrome in the CICU. In the ICU setting, intrinsic renal injury due to ATN is among the most common etiology of AKI. Many risk factors for AKI are not modifiable in the ICU. Optimize renal function by avoiding nephrotoxins, minimizing contrast usage, and keeping the MAP >65-75 mmHg. Contrast nephropathy as an etiology is questionable and may be a marker of a sicker patient population. Avoid “Renalism” - providing substandard care to patients with renal disease due to fear of worsening renal function. Most etiologies are treated with supportive care. What is the approach to timing of renal replacement therapy initiation? Definitions for early vs late vs very late initiation of RRT:Early – Worsening AKI without indications for RRTLate – Worsening AKI with relative indications for RRT Very late – Worsening AKI with strict indications for RRT Late initiation is noninferior in terms of mortality; early initiation is associated with higher rates of prolonged/permanent RRT.1,2,3 Very late initiation associated with worse outcomes.4 In general,

The Cardiorenal Syndrome is commonly encountered, and frequently misunderstood. Join the CardioNerds team as we discuss the complex interplay between the heart and kidneys with Dr. Elliott Miller (Assistant Professor of Medicine at Yale University School of Medicine and Associate Medical Director of the Cardiac Intensive Care Unit of Yale New Haven Hospital), and Dr. Nayan Arora (Clinical Assistant Professor of Medicine and Nephrologist at the University of Washington Medical Center). We are hosted by FIT lead Dr. Matthew Delfiner (Cardiology Fellow at Temple University), Cardiac Critical Care Series Co-Chairs Dr. Mark Belkin (AHFTC faculty at University of Chicago) and Dr. Karan Desai (Cardiologist at Johns Hopkins Hospital), and CardioNerds Co-Found Dr. Dan Ambinder. In this episode we discuss the definition and pathophysiology of the cardiorenal syndrome, explore strategies for initial diuresis and diuretic resistance, and management of the common heart failure medications in this setting. Show notes were developed by Dr. Matthew Delfiner. Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Management of Cardiorenal Syndrome in the CICU Cardiorenal syndrome (CRS) represents a range of clinical entities in which there is both heart and kidney dysfunction, and can be driven by one, or both, of the organs. CRS is caused by reduced renal perfusion, elevated renal congestion, or a combination of the two. Treatment therefore focuses on increasing perfusion, by optimizing cardiac output and mean arterial pressure, and reducing congestion through diuresis. Patients should be monitored for an adequate response to the initial diuretic dose within 2 hours of administration. If the response is inadequate, the loop diuretic dose should be doubled. Diuretic resistance can be managed via sequential nephron blockade, most commonly with thiazide diuretics, but also with amiloride, high-dose spironolactone, or acetazolamide, as these target different regions of the nephron. In cases of refractory diuretic resistance, hypertonic saline can be considered with the help of an experienced clinician. Continuation or cessation of renin-angiotensin-aldosterone system (RAAS) inhibitors in the setting of CRS should be made on a case-by-case basis. Show notes - Management of Cardiorenal Syndrome in the CICU 1. Cardiorenal syndrome (CRS) is a collection of signs/symptoms that indicate injury to both the heart and kidneys. Organ dysfunction in one can drive dysfunction in the other. Cardiorenal syndrome can be categorized as: Type 1 - Acute heart failure causing acute kidney injury Type 2 - Chronic heart failure causing chronic kidney injury Type 3 - Acute kidney injury causing acute heart failure Type 4 - Chronic kidney injury causing chronic heart failure Type 5 - Co-development of heart and kidney injury by another systemic process. These categories can be helpful for education, discussion, and research purposes, but they do not usually enter clinical practice on a regular basis since different categories of cardiorenal syndrome are not necessarily treated differently. 2. CRS is caused by either reduced renal perfusion, elevated renal congestion, or a combination of the two. When dealing with CRS, note that: CRS can be caused by poor kidney perfusion,

This week we delve into the world of neonatal congenital heart surgery and review a recent work on changes in the incidence of brain injury following congenital heart surgery. How common is it to see brain injury on the MRI's in this patient group? How have incidences changed over time and what is the likely reason for this? Can the types of inotropic agents used in the postoperative period potentially explain some of the improvements in outcomes that have been observed and what is the proposed mechanism for this? We speak with this week's first author, noted authority on neurodevelopmental outcomes of patients undergoing neontal heart surgery, Associate Professor of Pediatrics at UCSF, Dr. Shab Peyvandi.DOI: 10.1016/j.jacc.2022.10.029 Editorial accompanying this week's work: DOI: 10.1016/j.jacc.2022.11.027

This episode is focused on Palliative Care and Shared Decision-Making in the CICU. In this episode, we learn about how the principles of palliative care and shared decision-making apply to our patients across the spectrum of cardiovascular care, especially in the cardiac intensive care unit. We discuss pivotal trials of specialty palliative care and decision aids in cardiology and how they might inform our practice to enhance patient quality of life and improve goal-concordant care. Finally, we discuss practical tips and communication strategies for how to engage patients about end-of-life decisions and topics that can be utilized from outpatient to inpatient to critical care settings. “We need to help patients hope for the best and plan for the worst as time goes on.” Dr. Larry Allen Series co-chairs Dr. Eunice Dugan and Dr. Karan Desai, along with CardioNerds Co-founder Amit Goyal are joined by FIT lead, Dr. Sarah Chuzi. Dr. Chuzi is a Chicagoan and completed her internal medicine residency, cardiology fellowship, AHFTC fellowship and is now Assistant Professor at Northwestern University. Our episode expert is a true national leader in shared decision-making and palliative care in heart failure – Dr. Larry Allen, Medical Director of Advanced Heart Failure and the Co-Director of the Colorado Program for Patient-Centered Decisions at the University of Colorado School of Medicine. Audio editing by CardioNerds Academy Intern, Dr. Christian Faaborg-Andersen. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Palliative Care and Shared Decision-Making in the CICU 1. “Much of what we do in cardiology is thinking about how to make people feel better (not just improving cardiac function or length of life). So, on a day-to-day basis we are really providing primary palliative care.” – Dr. Larry Allen 2. “Risk models in cardiology can only be so accurate… While risk models can give us some grounding, we also need to embrace the concept of uncertainty, and help patients understand that there are a variety of things that might happen to them, suggest some things they might plan for, and continue to iteratively come back to the patient and reevaluate what their options are.” – Dr. Larry Allen 3. “Our goal is to help people live happy, healthy, full lives. But, everyone dies. So understanding that death is a part of life and understanding how to help them make those transitions is critical” – Dr. Larry Allen 4. “Having good deaths is a part of good healthcare. We can't ignore that. We can't fight against it. We should embrace it. And we have the opportunity to do that.” – Dr. Larry Allen 5. We should still keep in mind the concept of medical futility and determining what options are reasonable for patients. Part of shared decision-making includes discussing what interventions would not be feasible or helpful with patients and families Show notes - Palliative Care and Shared Decision-Making in the CICU Notes drafted by Dr. Sarah Chuzi. 1. How are the basic principles of palliative care relevant to cardiology, and can you define the key concepts of shared decision-making, primary palliative care, specialty (or secondary) palliative care, and hospice care? Throughout medicine, we confront the concepts of symptom control, difficult medical decision-making, and end-of-life. These are the principles of palliative care and they apply very easily across the spec...

About our guest:Melinda Cory, M.D., is an Assistant Professor in the Department of Pediatrics at UT Southwestern Medical Center. She earned her medical degree at UT Southwestern, where she also completed her residency in pediatrics. She gained advanced training through fellowships in pediatric cardiology and pediatric critical care medicine at Emory University School of Medicine.Board certified in pediatrics, pediatric cardiology, and pediatric critical care, she attends in the cardiovascular intensive care unit at Children's Medical Center in Dallas, TX. She is also very active in medical education including serving as the associate program director for the pediatric cardiology fellowship program and helps lead the pediatric critical care simulation team.Learning objectives:After listening to this episode on atrioventricular septal defects, learners should be able to:Recognize the relevant preoperative anatomy that influences operative plan and postoperative care in the cardiac intensive care unit (CICU).Recall the goals and general options for operative repair.Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.Recognize the common and important postoperative complications and develop an approach to their management.Develop a mental framework of the expected postoperative CICU course with a focus on common or important barriers to ICU discharge.References:Atrioventricular Septal Defects. Peter Sassalos MD, Ming-Sing Si MD, Richard G. Ohye MD, Edward L. Bove MD and Jennifer C. Romano MD, MS. Critical Heart Disease in Infants and Children, 50, 606-614.e2Peterson JK, Setty SP, Knight JH, Thomas AS, Moller JH, Kochilas LK. Postoperative and long-term outcomes in children with Trisomy 21 and single ventricle palliation. Congenit Heart Dis. 2019 Sep;14(5):854-863. doi: 10.1111/chd.12823. Epub 2019 Jul 22. PMID: 31332952; PMCID: PMC7329297.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

After listening to this episode on Tetralogy of Fallot with Pulmonary Stenosis, learners should be able to:Recognize the relevant preoperative anatomy that influences operative plan and postoperative care in the cardiac intensive care unit (CICU).Recall the goals and general steps of operative repair.Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.Recognize the common and important postoperative complications and develop an approach to their management.Develop a mental framework of the expected postoperative CICU course with a focus on common or important barriers to ICU discharge.About our guest:Dr. Laura Ortmann is an Associate Professor in the Department of Pediatrics at the University of Nebraska College of Medicine. She serves as the Medical Director of the Cardiovascular Intensive Care Unit at Children's Hospital and Medical Center in Omaha, Nebraska. She a CPR researcher and a great medical educator. She is a host on the Healing Hearts Podcast featuring her ongoing cardiac lesions series and produces MedEd videos on YouTube at DrOrtmannCICU. References:Ortmann LA, Keshary M, Bisselou KS, Kutty S, Affolter JT. Association Between Postoperative Dexmedetomidine Use and Arrhythmias in Infants After Cardiac Surgery. World J Pediatr Congenit Heart Surg. 2019 Jul;10(4):440-445. doi: 10.1177/2150135119842873. PMID: 31307294.How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Dr. Narayana Sarma V. Singham, a Critical Care Cardiologist at Washington Hospital Center Heart & Vascular Institute presents a lecture entitled "Temporary Mechanical Circulatory Devices in the CICU" as part of the DC5 lecture series.

This week we delve into the world of cardiac critical care when we review a recent report on an attempt to use a multidisciplinary group of hospital professionals plus parents to design an optimal family meeting structure. How should teams prepare for these meetings? What roles should different care providers play in the team meeting? Is there evidence that a better planned meeting can be more effective in transmitting information and allaying parental fears? We speak with pediatric palliative care expert, Assistant Professor of Pediatrics Dr. Jennifer Walter of The Children's Hospital of Philadelphia about this vital topic. https://doi.org/10.1016/j.jpainsymman.2022.03.010

In this episode, we welcome nurse manager, Katie English MSN, RN, CPN, to the show! We discuss her transition to become a nurse manager, management styles, a typical day in the life, work-life balance, and more.We Discuss(0:00) Introduction(2:00) How Katie got into nurse management(7:40) Transitioning roles from nurse to nurse manager(10:02) Katie's style of nurse management(14:53) Prioritizing time as a nurse manager(21:20) Typical day in the life of a nurse manager(25:00) Work-life balance for nurse managers(30:22) The best & most difficult aspects of being a nurse manager(36:44) What Katie has learned as a nurse manager(42:28) Characteristics That Make a Good Nurse ManagerAbout Katie English MSN, RN, CPNKatie English is currently a clinical manager in a pediatric cardiac ICU. She first came to love peds and nursing as a CNA, then started as a new grad in a CICU and never looked back. While working bedside, Katie often served as a preceptor, where her passion for mentorship developed. She also worked as a clinical instructor for a period of time. Katie loves to spend time outdoors and explore new restaurants with friends and family.Katie's LinkedIn: https://www.linkedin.com/in/kathleen-m-grahamAbout the ShowProducer – Jonathan Cary Assistant Producers – Katie Schrauben & Sam MacKay Powered by American Mobile

4x01 ¡Bienvenidos a todos y todas a la cuarta temporada de Finect Talks! Después de unas merecidas vacaciones hemos vuelto con mucha ilusión y algunos cambios. Y no solo por la novedad de algunas secciones, también por el movimiento de los mercados. Qué te vamos a decir que ya no sepas. Si estás invertido, lo estás sufriendo. Y si no estás invertido, estás ahí más tenso que una cama elástica pensando en si invertir o no. Pero lo más curioso de todo, es que mientras la mayoría de los activos caen en bolsa, va un fondo español y se hace una rentabilidad de más del 60%. Como lo lees. Y como teníamos curiosidad por ver cómo se pueden hacer esos números en un año como éste hemos invitado a Luis Bononato, asesor del Global Allocation de Renta 4 para que nos lo cuente. "Es un fondo extraño. Intentamos siempre tener el tipo de activo que tenga más sentido tener", nos dice el propio Bononato. El asesor nos ha dado también su visión de mercado: "nos estaban regalando el dinero, pero la realidad es tozuda. Pero la riqueza no se genera en un despacho dándole a un botón", ha comentado en referencia a la política de los bancos centrales. De hecho, Bononato cree que habrá muchas más subidas de tipos y que esto solo acaba de empezar... Antes de la entrevista, Antonio Villanueva inaugura una nueva sección, “El corrillo”, en el que os va a traer las últimas novedades o lo que más nos ha chocado que hemos visto por el mercado. Y para terminar Carmen os pide ayuda, una respuesta, algo de luz. ¿Empieza a invertir o mejor espera a que pase lo peor? AGENDA FINECT - Jueves 8 de septiembre: ¿Dónde INVERTIR en RENTA VARIABLE ahora? con Lorenzo González de Nordea AM - Lunes 12 de septiembre: Finect Live Una RECESIÓN muy distinta… ¿Cómo enfrentarse a ella? Con José Ignacio del Castillo y Gonzalo Melián, de la OMMA Business School Madrid - Martes 13: consultorio sobre el tema de tipos de interés y cómo nos afecta con Miguel Ángel Cicuéndez y José Manuel García Rolán de Consulae EAF - Miércoles 14: Finect Live sobre cómo encontrar ahora oportunidades en renta fija con Ignacio Albizuri de Miralta Bank 🎥 Podrás ver todos estos eventos cada día a las 18:00 por aquí https://www.youtube.com/channel/UCzKnSeOq30zVvgosDFlne5g Ficha del Global Allocation en Finect: https://www.finect.com/fondos-inversion/ES0116848005-Global_allocation_r_fi

Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children's Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children's and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children's National Hospital in Washington, DC. How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:1. Understand the preoperative anatomy that influences surgical plan and postoperative care in the cardiac intensive care unit (CICU).2. Recall the goals and general steps of operative repair.3. Recognize the key information provided in post-op handoff that will affect management.4. Recognize important postoperative complications and develop an approach to their management.5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.Support the show

The modern CICU has evolved to include patients with complex pulmonary mechanics requiring more non-invasive and mechanical ventilation. Series co-chairs Dr. Eunice Dugan and Dr. Karan Desai along with CardioNerds Co-founder Dr. Amit Goyal were joined by FIT lead, Dr. Sam Brusca, who has completed his NIH Critical Care and UCSF Cardiology fellow and currently faculty at USCF. We were fortunate enough to have two expert discussants: Dr. Burton Lee, Head of Medical Education and Global Critical Care within the National Institutes of Health Critical Care Medicine Department and master clinician educator with the ATS Scholar's Critical Care for Non-Intensivists program, and Dr. Chris Barnett, ACC Critical Care Cardiology council member and Section Chair of Critical Care Cardiology at UCSF.  In this episode, these experts discuss the basics of mechanical ventilation, including the physiology/pathophysiology of negative and positive pressure breathing, a review of ventilator modes, and a framework for outlining the goals of mechanical ventilation. They proceed to apply these principles to patients in the CICU, specifically focusing on patients with RV predominant failure due to pulmonary hypertension and patients with LV predominant failure. Audio editing by CardioNerds Academy Intern, student doctor, Shivani Reddy. The CardioNerds Cardiac Critical Care Series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Mark Belkin, Dr. Eunice Dugan, Dr. Karan Desai, and Dr. Yoav Karpenshif. Pearls • Notes • References • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Positive Pressure Ventilation in the CICU Respiratory distress, during spontaneous negative pressure breathing can lead to high transpulmonary pressures and potentially large tidal volumes. This will increase both RV afterload (by increasing pulmonary vascular resistance) and LV afterload (by increasing LV wall stress). An analogy for the impact of negative pleural pressure during spontaneous respiration on LV function is that of a person jumping over a hurdle. The height of the hurdle does not increase, but the ground starts to sink, so it is still harder to jump over. Intubation in patients with right ventricular failure is a tenuous situation, especially in patients with chronic RV failure and remodeling (increased RV thickness, perfusion predominantly during diastole, RV pressure near or higher than systemic pressure). The key tenant to safe intubation is avoiding hypotension, utilizing induction agents such as ketamine or etomidate, infusing pressors, and potentially even performing awake intubations. Non-invasive positive pressure ventilation in HFrEF has hemodynamic effects similar to a cocktail of IV inotropes, dilators, and diuretics. CPAP decreases pulmonary capillary wedge pressure (LV preload), decreases systemic vascular resistance (afterload), and increases cardiac output. Airway pressure during mechanical ventilation is based on the “equation of motion”: Pressure = Volume/Compliance + Flow*Resistance + PEEP. Our goals of oxygenation on mechanical ventilation include achieving acceptable PaO2/Sat with the lowest FiO2 possible (avoiding oxygen toxicity) and optimal PEEP (which increases oxygenation but can have detrimental impact on cardiac output) Our goals of ventilation on mechanical ventilation include achieving acceptable pH and PaCO2 while preventing ventilator induced lung injury and avoiding auto-PEEP. We prevent lung injury by reducing tidal volume (ideally

About our Guest:Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children's Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children's and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children's National Hospital in Washington, DC. How to support PedsCrit:Please rate and review on Spotify or Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Objectives for this series:1. Understand the preoperative anatomy that influences surgical plan and postoperative care in the cardiac intensive care unit (CICU).2. Recall the goals and general steps of operative repair.3. Recognize the key information provided in post-op handoff that will affect management.4. Recognize important postoperative complications and develop an approach to their management.5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.Support the show

Dr Maher attended medical school at the University of Maryland and stayed there for a pediatric residency and chief residency.   He then attended the University of Michigan for a fellowship in pediatric cardiology.  Following fellowship, he joined the faculty at Thomas Jefferson University/Nemours Children's Hospital in  Wilmington DE.  He received additional critical care training there with Dr Russel Raphaely and Dr William Norwood.  He joined the program at Emory University/Children's Healthcare of Atlanta in 2004 where he serves as executive director of the cardiac intensive care unit and is a professor of pediatrics at Emory University.  His research involves the application of new technology to pediatric cardiac care, medical device development, and innovation in pediatrics.  Dr. Hamrick completed her medical school and pediatric residency at UNC- Chapel Hill.  She pursued her neonatology fellowship at UCSF, and then stayed on faculty there for a few years before joining Emory/Children's Healthcare of Atlanta in 2006.  Her research interest focuses on brain injury/neuroimaging in congenital heart disease, which is what originally led her to spend significant time in the CICU. She attends in the surgical NICU at Egleston Children's Hospital in Atlanta, where she serves as Medical Director. Find out more about Shannon and Kevin and this episode at: www.the-incubator.org______________________________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

Shawn Sen, MD, is an Assistant Professor in Pediatrics in both the Division of Neonatal-Perinatal Medicine and Pediatric Cardiology at Northwestern University in Chicago, IL. After graduating from medical school at the University of Oklahoma, Dr. Sen completed his residency in Pediatrics at Columbia University at the Morgan Stanley Children's Hospital of New York. He then went on to complete two fellowships, one in Neonatology at the University of Texas Southwestern Medical Center and his second in Pediatric Cardiology at Stanford University, Lucile Packard Children's Hospital. Dr. Sen is now an attending neonatologist and CICU attending in both the level IV neonatal and cardiac intensive care units at Anne & Robert H. Lurie Children's Hospital of Chicago and Northwestern Medicine Prentice Women's Hospital. His clinical research interests include neonatal pulmonary hypertension, cardiovascular and congenital heart disease, and hemodynamic assessment of critically ill neonates using echocardiography.Find out more about Shawn and this episode at: www.the-incubator.org______________________________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

In this interview, we sit down with Dr. Greg Yurasek to discuss the general framework for promotion in academic medicine & how to enjoy the journey.Dr. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children's Hospital of Boston followed by a pediatric cardiology fellowship at Harvard University and a Critical Care fellowship at Massachusetts General Hospital.  Today, he is a cardiac intensivist at the Children's National Hospital and the director of their simulation program. 

Listen to this fascinating discussion and article review of “Workforce demographics and unit structure in pediatric cardiac critical care in the US” with first and senior authors Robin Horak (Children's Hospital Los Angeles) and Catherine Krawczeski (Nationwide Children's Hospital). Hosted by Neha Purkey (Lucile Packard Children's Hospital) and Saidie Rodriguez (Children's Hospital of Atlanta). Editor: Neha Purkey, MD; Producer: Deanna Tzanetos (Norton Children's Hospital) and David Werho, MD (UC San Diego).

In EPISODE 31 I am joined by Andrew @papaperspective!  He shares about his dad journey, the first month of his son's life in the CICU, having "mental breakdowns," PPD, what it means to be "strong," trauma and stress, the art of listening, and his love language.Join Mailing List & Get Involved!CLICK HERE: MAILING LISTConnect and Support Andrew:Instagram: @papaperspectiveConnect and Support Travis:YouTube: Travis GoodmanCheck out the Website: Therapy4Dads.comInstagram: @Therapy4Dads

Episode 58: PCICS Journal Club - Delirium in the CICU We are excited to begin a new series of podcasts sharing our PCICS Advanced Trainee Journal Club with all our listeners. In this episode, Dr. Mike Mount from Children's Healthcare of Atlanta presents a discussion of "Delirium in a Tertiary Pediatric Cardiac Intensive Care Unit: Risk Factors and Outcomes". The article is linked below and the slides can be accessed by PCICS members on our website PCICS.org/podcasts. Host/Editor/Producer: David Werho, MD (UC San Diego). https://doi.org/10.1177%2F08850666211066892

On this episode, we dove into the world of anesthesia and what it means to be a CRNA. Special guest, Blaise Sims MSN MBA, CRNA, joined us to talk about his CRNA career, outline common misconceptions about CRNA, share tips and advice for new CRNAs, and more.We Discuss(0:00) Introduction(2:07) Did Blaise Always Know He Wanted to Be a CRNA?(3:40) What is CRNA School Like(9:10) Imposter Syndrome When Starting Out(13:00) CRNA School Prerequisites(14:18) Common Misconceptions About CRNA(22:13) What Assessments Do You Have During Surgery(27:55) How Much Variety Do You See in Your Day(33:11) Most Difficult CRNA Procedures(44:05) Logistics of Being a CRNA(49:17) 24hr Shifts as a CRNA(52:10) Difference Between 1099 vs W2 Nurses(57:03) Tips & Advice for New CRNAsAbout Blaise Sims MSN, MBA, CRNABlaise is a CRNA currently working as site chief in the Houston Gulf Coast region, nine years into his anesthesia practice. Before anesthesia, he worked as an ER tech and RN intern, then as an RN he worked in a trauma neuro ICU full time and worked PRN in the MICU, SICU, CICU, and ER. His previous anesthesia experience includes working at the Debakey Heart and Vascular Institute where he performed Heart, Lung, and Kidney transplants as well as all major aorta and vascular procedures. In December of 2020, Blaise graduated from LSUS with a Master's in Business Administration (MBA). He chose to pursue his MBA to educate himself for future leadership opportunities and obtain a more comprehensive understanding of the business side of healthcare and anesthesia. He gives back to the nursing community by mentoring young RNs new to their career, providing guidance and advice. He also has a charity that performs service trips in areas of need abroad. These service trips provide critical access to surgeries otherwise not available. They also provide amazing learning opportunities for the volunteer RNs that participate. When not working, Blaise is married with two children. His wife and kiddos are the reason behind everything he does. Where to Find Blaise OnlineInstagramLinkedInHis Charity's WebsiteAbout the ShowProducer – Jonathan Cary Assistant Producer – Katie SchraubenAssistant Producer – Sam MacKay Powered by American Mobile

In this milestone 200th episode of Pediheart, we review a 2005 paper from the team at Nicklaus Children's Hospital on how lactate level was used to monitor oxygen delivery and consumption in the postop congenital heart patient and the impact that a protocol involving frequent monitoring and response to this value improved outcomes in the pediatric CICU. Joining us is the first author of the work, Dr. Anthony Rossi, former chief of cardiology at NIcklaus Children's Hospital. Once again, let's come 'on rounds' with this master of postoperative care to learn how he developed his approach to assessing the pediatric postoperative patient in his quest to identify the right 'goal' of therapy that could potentially mitigate the need only for experience at the bedspace. doi: 10.1007/s00134-004-2504-1