Podcasts about litfl

A caddy offers words of wisdom to their golfer.  Some of their advice is relevant to urgent care.     Check out the paper mentioned Gotlieb R, Praska C, Hendrickson MA, Marmet J, Charpentier V, Hause E, Allen KA, Lunos S, Pitt MB. Accuracy in Patient Understanding of Common Medical Phrases. JAMA Netw Open. 2022 Nov 1;5(11):e2242972. doi: 10.1001/jamanetworkopen.2022.42972. PMID: 36449293; PMCID: PMC9713608.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713608/    Check out the LITFL article, by Chris Nickson, Nov 2020  https://litfl.com/communication-in-a-crisis/    www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep's Clothing Birnbaumer, Diane MD. A Wolf in Sheep's Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens' missed. Then returns with Wellens' with dynamic T-wave inversion. Dr. Smith's ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We'll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can't wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Join Matt and Keith as they are nearing the end of season 1 of LiTFL! --- Support this podcast: https://anchor.fm/life-in-the-fast-lane/support

Join in today's episode with a overview of hyperkalemia. Like most topics in paramedic school, this is one that "you don't really need to know". Well turns out its pretty darn important. Check out some resources below and infographics on topics discussed.   Check out LITFL for some awesome hyperkalemia EKG examples https://litfl.com/hyperkalaemia-ecg-library/  Check out IAMED on facebook on Thursdays at 1900 CST for some great updates on COVID-19 and awesome weekly topics with the industries best clinicians.    Mental wellness is important in this busy time! Check out the Motivated Medic and 911 Buddy Check for some great resources on mental wellness and inspiration.    SUBSCRIBE AND LEAVE A RATING ON ITUNES!!! If you have any questions please feel free to contact me at pushdosemedic@gmail.com TWITTER- @pushdosemedic The Push Dose Medic website is live!!!  www.pushdosemedic.com Merchandise is available through the store. Remember that 75% of proceeds go directly to Uniformed Services Peer Council at https://uniformedhelp.org

Cast:Joel TopfJennie LinSamira FaroukSwapnil HiremathShow Notes:NephJC coverage of SONAR: http://www.nephjc.com/news/sonarSONAR in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30995972Avosentan for overt diabetic nephropathy, the ASCEND trial: https://www.ncbi.nlm.nih.gov/pubmed/20167702RADAR coverage at NephJC, May 2014: http://www.nephjc.com/atrasentanRADAR in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24722445/Google Hangout on RADAR: https://www.youtube.com/watch?v=pkkQbb-isog&feature=youtu.beVlado Perkovic: https://twitter.com/VladoPerkovicSONAR: https://en.wikipedia.org/wiki/SonarNephmadness adaptive trial: https://ajkdblog.org/2016/03/10/nephmadness-2016-statistics-in-nephrology-region/#adaptiveKIDNEYcon adaptive trial tweet thread: https://twitter.com/hswapnil/status/1117194018331471873?s=21Excellent NEJM review on adaptive trials: https://www.nejm.org/doi/10.1056/NEJMra1510061Potential role of Adaptive trials in AKI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869991/BNP levels in CKD: https://cjasn.asnjournals.org/content/3/6/1644Generalizability from Wikipedia: https://en.wikipedia.org/wiki/Generalizability_theoryAnemia (and other adverse effects) of Endothelin antagonists: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5210319/Data safety monitoring boards: https://www.nidcr.nih.gov/research/human-subjects-research/interventional-studies/data-and-safety-monitoring-board-guidelinesAbbVie Allergen Merger: https://www.barrons.com/articles/abbvie-allergan-merger-pharma-deals-takeda-celgene-bristol-myers-squibb-51563890831Tangri Kidney Failure Risk Equation: https://qxmd.com/calculate/calculator_308/kidney-failure-risk-equation-4-variableFragility index paper: https://www.ncbi.nlm.nih.gov/m/pubmed/24508144/LITFL write up: https://litfl.com/fragility-index/Calculator: https://clincalc.com/Stats/FragilityIndex.aspxCANVAS Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1811744Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study by David Juurlink et al.: https://www.nejm.org/doi/full/10.1056/NEJMoa040135Vinay Prasad: https://en.wikipedia.org/wiki/Vinay_PrasadClassic mouse studies looking at endothelin: https://www.jci.org/articles/view/119297/pdfhttps://www.ncbi.nlm.nih.gov/pubmed/8377387/https://diabetes.diabetesjournals.org/content/65/8/2429Nice reviews:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698004/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216619/Review of vascular effects:https://www.ncbi.nlm.nih.gov/pubmed/28223322

At the last SMACC event in Sydney the Brazilians turned up in force. It was impressive. They came to learn but quickly it became apparent that we should be learning from them too. I won’t pretend to be a SoMe expert but I have never come across such sophisticated use of Instagram as a #FOAMed tool. Instagram is pretty huge and it may well be the number one SoMe platform for the generation that is entering medicine now. So if you are interested in things like teaching young nurses, doctors, paramedics then you might learn something really useful from an unusual source. Instagram is not a fringe #FOAMed platform when Nursing Educators have nearly 200000 followers on Instagram. First let’s quickly talk about the weird thing that just happened to you if you listened to the podcast first. Yes the podcast is 80% Português. It starts with that annoying Irish guy and then the Português starts at 6:20 when Henrique Herpich takes over. The English starts again at 24:20, cue laughs and we are done. We immediately went out for drinks and there is a reason that the Irish and the Brazilians get on very well. (My brother in law is Brazilian. He is extremely cool. Olá Gustavo!) But why? Why would I try to alienate the listeners to this podcast by hitting them with a podcast in another language? The Lusophone Commonwealth is why. Brazil, Angola, Mozambique, Portugal, Guinea-Bissau, East Timor, Equatorial Guinea, Macau, Cape Verde and São Tomé and Príncipe. 207 million Portuguese speakers in Brazil alone. Most Portuguese speakers are in countries where medicine is either developing very fast or in need of developing very fast! So they could do with some Português FOAMed. So we need FOAM other than English; #FOAMOTE The hope is that everyone involved with #FOAM and #FOAMed will look to their language-other-than-English colleagues and see opportunities and not barriers. These people want to work together and the fact that YOU don’t speak their language does NOT mean that you cannot work together. (That and the fact that @Sandnsurf speaks Portugueś and wanted to hear more Portugueś podcasts.) 
This PodcastThese are the #FOAMedBRA people that were in the room: Ian, Henrique, Lucas, Jule, Niciole and Daniel. @breakem www.breakem.org Go there and click on “Quem seguimos” (Who we Follow). (Nearly Dr) Henrique Herpich Twitter @H_Herpich Dr Lucas Oliveira J. e Silva @Lucasojesilva12 isaem.net Dr Jule Santos emergenciarules.com Twitter; @julesantosER Instagram; Emergencia Rules and a podcast! https://podcasts.apple.com/au/podcast/emerg%C3%AAncia-rules/id1387183276 Dr Nicole Pinheiro @nicolepin Dr Daniel Schubert Twitter @ducschub So what I want all #FOAMedBRA people to do is spread this around all the nurses, doctors, paramedics in the Portugueś speaking world and get them to visit this post, listen to this podcast because this is a felicitation. This is people like me and people like you saying “HelloMyNameIsXXXX, nice to meet you, how can I help?” to the entire Lusophonic world. There is more that unites us than divides us.
 FOAMbra Links are all on LITFL.com and TheTopEnd.org

Hypothermia is a common problem for both pre and in-hospital clinicians. Understanding the underpinning physiology helps us deliver first class care to our patients, decreasing associated morbidity and mortality. There is some extremely difficult decision making to be done in severe cases of hypothermia and the podcast gives us an opportunity to explore them further. We'll cover the subject in depth with particular reference to the following categories of hypothermia; treatment, modifications in cardiac arrest and prognostication. Enjoy! Simon, Rob & James References ERC 2015; Cariac arrest in specialist circumstances LITFL; hypothermia RCEMLearning; hypothermia Up to Date; Hypothermia At the bedside, out of the cold: management of hypothermia and frostbite.BiemJ.CMAJ. 2003 The prehospital management of hypothermia - An up-to-date overview. Haverkamp FJC. Injury. 2018  Accidentalhypothermia-an update: The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Paal P. Scand J Trauma Resusc Emerg Med. 2016 Accidental hypothermia. Brown DJ. 2012 N Engl J Med.

How well do you know your colleagues? How much do you socialise with them? Do you have an annual retreat for your colleagues and their families?   After you listen to this episode you may reflect on these questions. To give your patients the very best care possible it seems obvious that your team needs to know each other, understand the strengths and weaknesses of each other, and combine and communicate well in the clinical environment. So how much time does your department devote to fostering a department culture that feels like a family? Including getting to know each team member’s actual family. How much do you do? My Intensive Care department does this pretty well but we could always do better. And we haven’t done a retreat in my time working there. In the final episode of 2018, you’ll listen to Dr June Goh who is all about fostering such a family environment. She came up with the idea of taking her colleagues and their families on an annual weekend retreat over a decade ago. And she organises regular resident and medical officer engagement sessions with fun activities. All of which I suspect brings them tighter together as a more harmonious team, thereby helping their patients. June is a Senior Consultant in Singapore General Hospital and the Director of Neuroanaesthesia and Neurocritical Care. She is very involved in teaching both medical students and post graduate doctors as member of the Core Faculty Anaesthesia Residency Programme, Chair of the Residency Welfare Committee, Adjunct Assistant Professor Duke-NUS Graduate Medical School and Clinical Lecturer in the Yong Loo Lin Medical School. She chairs the Singapore General Hospital transplant oversight committee. June also currently serves on the Yong Siew Toh Conservatory of Music Board, Dover Park Hospice Governing Council and co-chairs the fundraising committee. She has been an active member and past president of the Association of Women Doctors Singapore (AWDS) helping out with the various activities organised by AWDS. June is currently President of the Singapore Council of Women’s Organisations and is passionate about women's family and health issues. This episode was recorded in May 2018 as a live interview in front of a conference audience at the 5th SG-ANZICS Asia Pacific Intensive Care Forum. Thanks to that meeting's Organising Committee, representing Singapore’s Society of Intensive Care Medicine (SICM), Singapore, and the Australian and New Zealand Intensive Care Society (ANZICS), I was invited to conduct several live interviews for this podcast. Many thanks to Tan Hon Liang and David Ku for this opportunity. In this conversation June also spoke on topics such as: Her early career Her perspective on Singaporean gender equality How she mixed bringing up her children with being a busy doctor Building trust and rapport to strengthen communication with patient’s families Her perspective on some of the innovations in medical education Coping with work stresses to stay balanced Managing our device usage in the smartphone era Identifying and mentoring successors to our institutional roles Her thoughts on lifestyle factors such as yoga, exercise and sleep Her enjoyment of fashion The Mastering Intensive Care podcast is aimed to inspire and empower you, as an intensive care clinician, to bring your best self to the intensive care unit, through conversations with thought-provoking guests. My hope is that by listening to the show you’ll hear at least one thing to help you improve, as either a healthcare professional or as a person, with the ultimate aim of helping your patients. Please help me to spread the message by simply telling one of your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. This is an enjoyable, thought-provoking and wide-ranging discussion with a woman doctor who is advancing the cause of women in and out of medicine whilst also compassionately caring for her patients and her team   Thanks for listening. Andrew Davies   -------------------- People, organisations and resources mentioned in the episode: June Goh at Singapore Council of Women’s Organisations: http://www.scwo.org.sg/about-us/who-we-are/dr-june-goh/ June Goh at Association of Women Doctors (Singapore): http://www.awds.org.sg/dr-june-goh/ SG-ANZICS Asia Pacific Forum: http://sg-anzics.com/ Human Organ Transplant Act (Singapore): https://www.gov.sg/factually/content/what-is-hota-all-about Article by June Goh on Gender Equality: https://www.channelnewsasia.com/news/singapore/commentary-on-gender-equality-and-whether-women-can-have-it-all-9114542 June Goh featured in Bazaar Magazine: https://www.harpersbazaar.com.sg/exclusives/bazaar-magazine/bazaar-stylish-women-2017-june-goh-rin/ June Goh featured in The Peak Magazine: https://thepeakmagazine.com.sg/interviews/june-goh-doctor-teacher-family-woman-fashionista/ New Normal Project podcast: http://newnormalproject.libsyn.com/ New Normal Project podcast - Episode 45 with Neal Barnard: http://newnormalproject.libsyn.com/episode-45-neal-barnard-how-to-start-plant-based-eating-and-which-health-benefits-you-might-expect New Normal Project podcast - Episode 46 with Andy Ramage: http://newnormalproject.libsyn.com/episode-46-andy-ramage-using-an-alcohol-free-challenge-to-reframe-your-relationship-with-alcohol Mastering Intensive Care podcast - Episode 37 with Michael O’Leary: http://masteringintensivecare.libsyn.com/episode-37-michael-oleary-dealing-with-the-frustrations-of-the-changing-icu-landscape-sg-anzics-special-episode Book: “In Shock” (by Dr Rana Awdish) https://www.ranaawdishmd.com/book Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Our ICUs might be growing larger in size but there seem to be the same number of very sick patients to care for overall. All of which means we seem to be admitting a greater proportion of less unwell patients to our ICUs, especially in the larger tertiary ICUs. Given we also suffer from “bed block”, where there are no available beds in the hospital to transfer patients to, when they are no longer critically ill, our ICUs can become holding bays for effectively "ward-level" patients. This may be great for the patients but it means longer ward rounds, and a level of frustration for intensive care teams, who may feel like they are not making a significant enough difference for these less sick patients. When A/Prof Michael O’Leary started out in Intensive Care nearly 30 years ago, he remembers being enthusiastic and busy, performing many interventions on mostly sick patients. Having now moved across the world and gained a few decades of experience, he has a great perspective on some of the challenges our larger ICUs face. Michael is former President of the Australian & New Zealand Intensive Care Society and a Senior Specialist in Intensive Care in Sydney, working at Royal Prince Alfred Hospital and St George Private Hospital. He is Clinical Associate Professor at Sydney Medical School, The University of Sydney, and Co-State Medical Director of the New South Wales Organ and Tissue Donation Service. Michael trained in anaesthesia in the United Kingdom and holds a Fellowship of the Royal College of Anaesthetists (FRCA). His intensive care training commenced in the UK in Cambridge and continued in Sydney where he achieved Fellowship of the College of Intensive Care Medicine of Australia and New Zealand (FCICM). Michael was a Research Fellow at St Bartholomew’s Hospital, London, UK where he completed his MD degree with studies into the metabolic response to sepsis and use of glutamine and growth hormone in the amelioration of catabolism. In recent years his main interests have been in end-of-life care and organ donation in the ICU. This episode was conducted in May 2018 as a live interview in front of a conference audience at the 5th SG-ANZICS Asia Pacific Intensive Care Forum. Thanks to that meeting's Organising Committee, representing Singapore’s Society of Intensive Care Medicine (SICM), Singapore, and the Australian and New Zealand Intensive Care Society (ANZICS), I was invited to conduct several such live interviews for this podcast. Many thanks to Tan Hon Liang and David Ku for this opportunity. Apart from his observations about the growth and change in Intensive Care over the last few decades, Michael and I talked about: How the SG-ANZICS meeting came to be His career history Being a part-time intensivist Playing the role of Co-State Medical Director of an organ donation service The characteristics of good intensivists Being President of ANZICS and the importance of being involved with professional societies Some perspectives on good communication and clinical care. The Mastering Intensive Care podcast is aimed to inspire and empower intensive care clinicians to bring their best selves to the intensive care unit through conversations with thought-provoking guests. I genuinely believe we can help each other to improve, as both professionals and as people, so as to give the absolute best possible care to our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Andrew Davies   -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Michael O’Leary on LinkedIn: https://www.linkedin.com/in/michael-o-leary-a1222b11/?originalSubdomain=au  SG-ANZICS Asia Pacific Forum: http://sg-anzics.com/ Episode 36 with Hayley Gershengorn: http://masteringintensivecare.libsyn.com/episode-36-hayley-gershengorn-allocating-icu-resources-to-optimise-patient-outcomes-and-job-satisfaction Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care New Normal Project podcast: http://newnormalproject.libsyn.com/ Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

What number of patients should an intensivist simultaneously care for to optimise outcomes? Is a system with different day and night intensivists best for all? These are two of the questions discussed during the latest episode of Mastering Intensive Care in which Hayley Gershengorn shares her research and personal thoughts about resourcing our Intensive Care Units. There is no easy answer to matching supply and demand in our workforces, not least because it is very different between the different health professionals that work in the ICU. The current resources available and the average daily demands seem to be the key decision-making drivers in many institutions and we probably have a lot to learn from analysing big data in this area. Doctors could learn a lot from how nurses staff themselves, and likely vice versa. It is also vital that we find ways to delicately balance the needs of clinician wellness and job satisfaction with the obvious requirement for optimal patient outcomes. Turning up the screws on our staff by working them more often, in longer stretches and with an increasing number and acuity of patients, will inevitably increase burnout rates and lead to suboptimal patient outcomes. The more we can talk about this, and study it, as Hayley is doing, the better. Hayley is an Associate Professor of Pulmonary and Critical Care Medicine at the University of Miami, Miller School of Medicine. She received her medical degree from Harvard Medical School and completed a residency in Internal Medicine at New York Presbyterian Hospital-Cornell and a fellowship in Pulmonary and Critical Care Medicine at New York Presbyterian Hospital-Columbia. Hayley’s research program focuses on the allocation of ICU resources and the impact such allocation has on the outcomes of critically ill patients. In particular, she is interested in understanding how (1) ICU staffing and (2) practices which may be tied to staffing, affect patient outcomes. In addition to ICU resourcing Hayley talked about: Her medical training background Her initial study of mathematics A “gap” year she took as a management consultant What gives her the most enjoyment in intensive care Her thoughts on her own institution’s staffing model Why some people choose to be full-time nocturnal intensivists The concept of strain - on ICUs and on intensivists How we might better understand staff well-being The benefits to her of switching between clinical duties and research The advice her parents gave about achieving balance Her own lifestyle including exercise, movies, outdoor activities and sleep Bringing her best self to work often involves asking for help The benefits of having trainees always watching her Using group messaging service chats to attend to emotional needs The struggles of finding people to trust when moving institutions Thoughts on mentoring and coaching in intensive care medicine Her focus on human connection in communication Being open with families by answering personal questions Crediting her psychologist mother for helping her communicate The Mastering Intensive Care podcast is aimed to inspire and empower intensive care clinicians to bring their best self to the intensive care unit through conversations with such thought-provoking guests as Hayley Gershengorn. I genuinely believe we can help each other to improve, as both professionals and as people, so as to give the absolute best possible care to our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Andrew Davies    -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Hayley Gershengorn profile: https://doctors.umiamihealth.org/provider/Hayley+Beth+Gershengorn/525503 Twitter handle for Hayley Gershengorn: @HBGMD UK-based study conducted by Hayley and colleagues: https://www.ncbi.nlm.nih.gov/pubmed/28118657 Episode 35 with Paul Wischmeyer: http://masteringintensivecare.libsyn.com/episode-35-paul-wischmeyer-never-underestimate-the-simple-things-we-do-to-our-patients Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care New Normal Project podcast: http://newnormalproject.libsyn.com/ Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

How did your patient feel that time you took several attempts to place a CVC? What might happen after a dose of haloperidol for delirium?   In this compelling episode, Professor Paul Wischmeyer, shares some of his experiences as a patient in the ICU. Since he was 15 he has endured multiple hospitalizations and ICU stays for his inflammatory bowel disease. This has given him an excellent vantage point to notice what we as ICU professionals do and say to our patients. And from Paul’s perspective we could do much better. Some of the procedures we might think are simple (like placing intravenous or intra-arterial cannulae) can cause significant suffering. And if we treat these procedures as something just to tick off on our list we may diminish the person-centred care we should all be attempting to deliver. Paul’s passion for helping patients recover from illness and surgery arises from his personal experiences as both a doctor and patient in the ICU. As a trained intensivist, anaesthetist, clinical pharmacologist and research scientist, he works predominantly as a Perioperative physician who specializes in enhancing preparation and recovery from surgery and critical care at Duke University. He practices on the Critical Care and Nutrition clinical teams, serves as the Director of Perioperative Research for the Duke Clinical Research Institute, as Associate Vice Chair for Clinical Research in the Department of Anesthesiology and as Director of the Nutrition Support Team. Paul has been awarded significant amounts of funding, won many awards, published over 135 papers and given hundreds of invited presentations. Five days ago Paul tweeted he was back in hospital so I thought it was a good time to bring this interview we did a few months ago. I’m hoping he is much better today and that he’ll be out of hospital and back home very soon. Paul has a lot of valuable things to say in this interview. We also spoke about: How in the early part of his career he loved the physiology and pharmacology but now he loves the family interactions and teaching Learning from people all around the world makes him a better doctor How his personal experiences have helped him to use more sedation in his practice Our need to get away from the concept of keeping a patient quiet with sedatives so we can have a peaceful night in the ICU The effects on his mother of a child psychiatrist asking her about her parenting in the work up of Paul’s illness His reflections on the difference in ward rounds between his current and previous institutions His views on having a close partnership between intensivists and the palliative care team, especially in family meetings The importance of body position and body language in communication How he feels less healthy in a system of 12 hour shifts for intensivists because scheduling self-care can be difficult The anxiety he notices when he doesn’t exercise His views on a good diet and the supplements he takes His need to feel ready to be hospitalised at any time due to his illness The benefit of having a good department chair who helps him say no to too many responsibilities How he deals with feeling overwhelmed The importance of staying well-hydrated during our work His main points about giving a great lecture, including the use of images and developing the skill of inspiring or convincing the audience with emotion Some tips for younger clinicians, including being open minded, keeping up with the literature and focusing on connection to patients My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Paul Wischmeyer. I genuinely believe we can all improve, as both professionals and as human beings, so that we can do the absolute best for the people we are privileged to care for as patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Andrew Davies   -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Paul Wischmeyer profile: https://scholars.duke.edu/person/paul.wischmeyer Paul’s webpage on Duke Clinical Research Institute website: https://dcri.org/our-work/therapeutic-expertise/perioperative-nutrition/ Twitter handle for Paul Wischmeyer: @Paul_Wischmeyer Book: “Presentation Zen Design” (by Garr Reynolds): http://www.presentationzen.com/presentationzen/2010/02/presentation-zen-design-the-book.html Book “In Shock” (by Dr Rana Awdish): https://www.ranaawdishmd.com/book TARGET study: https://clinicaltrials.gov/ct2/show/NCT02306746?term=TARGET+nutrition&type=Intr&cntry=AU&city=Adelaide&rank=1 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Do you have too many career interests outside of your basic clinical practice? Are your daily focus areas as few as three? Family, clinical and perhaps one other thing?   In this episode Australian intensivist, Marianne Chapman, speaks about how she keeps her life under control by focussing on her big three - family, clinical and research. This allows her to manage the stresses of an intensive care career. She sometimes has to say no very deliberately, and although she finds this hard, it helps her manage the workload. She notices that some of her colleagues seem to want to be experts in several areas, and whilst this may be important at the beginning of our careers, this can be a recipe for disaster for some of us over the longer term. Marianne is a Senior Staff Specialist in Intensive Care Medicine at the Royal Adelaide Hospital and a Clinical Professor of Acute Care Medicine in the School of Medicine at the University of Adelaide, both in Adelaide, Australia. Her clinical research interests include gastrointestinal dysfunction underlying problems with the administration of enteral nutrition and the clinical effects of nutrition in the critically ill. Marianne is an eminent international researcher in this field and has published extensively on these topics. Marianne and I recorded our conversation a little while ago and it’s great to be able to air it now. In the interview, Marianne spoke about: How she sees every clinical encounter as a teaching experience, and how she learns a lot from her senior trainees The feeling of being drained and tired from a busy day teaching at work How caring for the patient and their outcome, whilst improving our knowledge base, helps us become the best we can be What it is like to have moved into a new building at her hospital The benefits of doing multi-disciplinary and collaborative Grand Rounds What role she takes in urgent clinical encounters How deaths in her own family have made her realise that how we approach families can significantly influence grief How huge cost savings may eventuate if intensivists are well-trained in communication with families What words and phrases she uses in communication encounters The pros and cons of 7 day stretches for ICU consultants Why research helps her feel like she is doing better care for patients The difficulties of a research career – which brings a different form of stress to clinical work How she manages stress by remembering that family comes first The value she sees from physical exercise The difficulty associated with looking after colleagues we are worried about How she has balanced family and work over her career Her thoughts on the issues of gender in intensive care How she might manage the transition towards retirement Her concerns about some clinicians having a need to always do something – and that maybe less is better Becoming involved with clinical trials groups is a great way to start a research career My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Marianne Chapman. I genuinely believe we can all improve, as both professionals and as human beings, so that we can do the absolute best for the people we are privileged to care for as patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Marianne is an erudite, thoughtful, patient and humble intensivist with an excellent approach to not becoming overloaded. Please enjoy listening to the podcast. Andrew Davies   -------------------- Show notes (people, organisations, resources and links mentioned in the episode): ANZICS Clinical Trials Group: https://www.anzics.com.au/about-the-ctg/ TARGET study: https://clinicaltrials.gov/ct2/show/NCT02306746?term=TARGET+nutrition&type=Intr&cntry=AU&city=Adelaide&rank=1 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

Do you spend time finding out what the “why” is for your patient? Have you considered it’s not what is the matter with the patient but what matters to the patient? What the patient thinks their purpose is? Or at the very least, what they wish for during the next part of life, however short that may be? In this episode American intensivist, Dr Wes Ely, tells us how he deeply cares about the whole patient – the body, the mind and the spirit. He is passionate about really getting to know his patients. And to do that he thinks we need to be heavily focused on both ICU liberation and good listening. The ICU liberation bit sounds easy. It's removing the patient from the sedatives, the ventilator and whatever other harmful interventions are no longer needed when their situation is improving. But it's harder than we think. And to help with this, he has led the development of the ABCDEF bundle. With the assistance of many colleagues, and based on high quality science, he has progressively developed a simple 6 factor approach that has been shown to speed up ICU liberation and improve patient outcomes. And in this podcast he describes how he uses it, and how you can too. Listening to our patients also sounds easy. But how many of us spend the time required, and really be there for that person with grace and humility, so we can truly find out what matters to them, and respect their spiritual faith. Wes will be well known to many of you. He is a Pulmonary and Critical Care specialist who conducts patient-oriented, health services research as a Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University School of Medicine, in Tennessee, USA. He is also a practicing intensivist with a focus on Geriatric ICU Care, as the Associate Director for Research for the VA Tennessee Valley Geriatric Research and Education Clinical Center. His research has focused on improving the care and outcomes of critically ill patients with ICU-acquired brain disease. Wes has built the ICU Delirium and Cognitive Impairment Study Group and his team have developed the primary tool by which delirium and health-related quality of life outcomes are measured, the CAM-ICU. He has over 350 peer-reviewed publications and over 50 published book chapters and editorials. In this conversation, Wes and I cover many other topics including: How he chose medicine after observing family illness as he grew up The enjoyment he receives from holding the hands of and looking into the eyes of patients How good doctors are not distracted by technology A Wall St journal and a CNN.com article he has penned which display his ability to find out what really mattered to 2 of his patients The importance of reading - and the 3 types of reading we should do How his ICU ward round is patient-centric and heavily nurse-focused The need to understand our unconscious biases and to have humility The concept of becoming the best version of our selves That life balance requires exercise, sleep and healthy eating His passion for triathlons, including the ironman How he balances family and work How his spiritual faith helps him to minimize stress His understanding that there is something bigger than us happening around us How burnout is simply an imbalance in the fundamentals of life The Nietzsche quote “He who has a why to live can bear any how” His appreciation of the work of the 3 Wishes Project (links below) What happened when he read the Jabberwocky poem (link below) to one of his patients His advice that young clinicians should be patient and truthful What the mnemonic DR-DRE means to him My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Wes Ely. I passionately believe we can all get better, both as carers and as people, so we can do our absolute best for those patients whose lives are truly in our hands. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Wes Ely is a genuine leader of our specialty and is a wise, philosophical and compassionate doctor with a refreshing spiritual perspective. Please enjoy listening to the podcast. Andrew Davies   -------------------- Show notes (people, organisations, resources and links mentioned in the episode): Wall St journal article about bringing a swimming pool to the ICU: https://www.wsj.com/articles/a-swimming-pool-in-the-icu-1466117000 This article was published in the medical literature too: https://link.springer.com/article/10.1007/s00134-016-4434-0 CNN.com article about patient Paul: https://edition.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-opinion/index.html The ABCDEF bundle: http://www.iculiberation.org/Bundles/Pages/default.aspx Lancet article on an RCT of no sedation: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62072-9/abstract New England Journal of Medicine article on RCT of daily interruption of sedative infusions: https://www.ncbi.nlm.nih.gov/pubmed/10816184 New England Journal of Medicine article on RCT of spontaneous breathing: https://www.ncbi.nlm.nih.gov/pubmed/8948561 Lancet article on Awakening and Breathing Controlled RCT: https://www.ncbi.nlm.nih.gov/pubmed/18191684 Lancet article on RCT of early physical and occupational therapy: https://www.ncbi.nlm.nih.gov/pubmed/19446324 Critical Care Medicine article about the ABCDEF bundle: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830123/ Critical Care Medicine article about a single-centre ABCDE bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/24394627 Critical Care Medicine article about a multi-centre ABCDEF bundle trial: https://www.ncbi.nlm.nih.gov/pubmed/27861180 William Osler: https://en.wikipedia.org/wiki/William_Osler Dalai Lama: https://www.dalailama.com/ Matthew Kelly: http://www.matthewkelly.com/ Fulton Sheen: https://www.fultonsheen.com/ David Bennett: https://www.rushu.rush.edu/faculty/david-bennett-md The Merton prayer: https://reflections.yale.edu/article/seize-day-vocation-calling-work/merton-prayer Friedrich Nietzsche: https://en.wikipedia.org/wiki/Friedrich_Nietzsche Viktor Frankl: https://en.wikipedia.org/wiki/Viktor_Frankl Annals of Internal Medicine article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/26167721 Another article on the 3 Wishes Project: https://www.ncbi.nlm.nih.gov/pubmed/27525361 Poem “Jabberwocky” by Lewis Carroll: https://www.poets.org/poetsorg/poem/jabberwocky Mother Teresa: http://www.motherteresa.org/index.html Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

More amazing pearls from our Bellevue morning report series. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_153_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Intoxication, Discitis, ESRD, Necrotizing Fasciitis Show Notes Read More Core EM: Spinal Epidural Abscess REBEL EM: Cauda Equina Syndrome Radiopaedia: Discitis LITFL: Necrotizing Fasciitis REBEL Cast: Episode 50 – Intoxicated Patients Can Equal Badness Read More

More amazing pearls from our Bellevue morning report series. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_153_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Intoxication, Discitis, ESRD, Necrotizing Fasciitis Show Notes Read More Core EM: Spinal Epidural Abscess REBEL EM: Cauda Equina Syndrome Radiopaedia: Discitis LITFL: Necrotizing Fasciitis REBEL Cast: Episode 50 – Intoxicated Patients Can Equal Badness Read More

Managing external haemorrhage is easy right?! Then why does haemorrhage remain a major cause of death from trauma worldwide? Ok, some of that is from internal sources, but…. No one should die from compressible external haemorrhage With the right treatment applied in a timely fashion, the vast majority of these bleeds can be stopped. But with new advances like haemostatic agents, changing advice surrounding tourniquet use and practice changing evidence coming out of conflict zones can mean it’s difficult to remain current with the latest best practice. So what options are available to us, how do we use them and what’s the evidence. Here’s the line-up for this months’ podcast: Haemorrhage control ladder Evidence based guidelines on haemorrhage control Direct pressure Enhanced pressure dressings Haemostatic agents and wound packing Tourniquets Case studies As always we welcome feedback via the website or on Twitter and we look forward to your engagement. Enjoy! Simon, Rob & James   References & Further Reading Bennett, B. L & Littlejohn, L. (2014) Review of new topical hemostatic dressings for combat casualty care. Military Medicine. Volume 179, number 5, pp497-514. Lee, C., Porter, K. M & Hodgetts, T. J. (2007) Tourniquet use in the civilian prehospital setting. Emergency Medicine Journal. Volume 24, pp584-7.  Nutbeam, T & Boylan, M. (2013) ABC of prehospital emergency medicine. Wiley Blackwell. London. Shokrollahi, K., Sharma, H & Gakhar, H. (2008) A technique for temporary control of haemorrhage. The Journal of Emergency Medicine. Volume 34, number 3, pp319-20. Trauma! Extremity Arterial Hemorrhage; LITFL  The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Rolf Rossaint. Critical Care 2016. NICE 2016. Major Trauma; Assessment and Initial Management FPHC 2017; Position statement on the application of Tourniquets    

Is your ward round stimulating and educational?   Do you help learning by creating debates on the ward round for and against the simple interventions we use?   In this week’s episode, Belgian intensivist, Professor Jean-Louis Vincent describes what happens in his ICU, on a daily basis, and indeed on the ward rounds. He tells us how he enjoys going several times a day to see what is happening in his ICU, the schedule of ward rounds there, the importance of a single conversation on the ward round, and how much we can learn from our patients, especially about their physiology. Jean-Louis is perhaps the most well-known intensivist in the world. He is a major leader of his generation and in fact a pioneer of the large international conference, having run the Brussels International Symposium of Intensive Care and Emergency Medicine (ISICEM) for a staggering 38 consecutive years. Jean-Louis is a Professor of Intensive Care Medicine at the University of Brussels and an intensivist in the Department of Intensive Care at Erasme University Hospital in Brussels. He is a Past-President of the World Federation of Societies of Intensive and Critical Care Medicine, the European Society of Intensive Care Medicine, the European Shock Society, the Belgian Society of Intensive Care Medicine and the International Sepsis Forum. Jean-Louis has published over 900 original articles, over 400 book chapters and review articles and has edited 102 books. He is the editor-in-chief of Critical Care, Current Opinion in Critical Care, and ICU Management & Practice and he is a member of the editorial boards of about 30 other journals. In this conversation, Jean-Louis and I also covered topics such as: Why the speed of change with patients is what he loves the most His enjoyment of a combination of clinical, research and education Mentoring trainees starts by having them present their organized thoughts about each patient’s problems and their management plans How his ICU uses the SOAP approach (subjective, objective, assessment, plan) on ward rounds How trainees should try to learn a couple of important things every day (rather than everything they are told) Communication requires being open and honest including when there is imprecision The need for optimal personal behaviour during communication encounters The benefits of differing opinions in clinical care How large conferences fit in to overall educational activity How his active social life keeps him balanced The benefits of coming to work with a smile to encourage others in your team to be in a good mood How developing research activity widens our career horizon We should all be trying to improve ourselves every day The diversity of intensive care makes it the best job in medicine My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to work and to adopt some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. If you wish to connect, leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Professor Jean-Louis Vincent has had incredible influence and an imposing career. I first heard him speak 24 years ago and was mesmerized by his exuberant, passionate and entertaining presentation style on a diverse range of topics about which he seemed deeply knowledgable. I suspect many of you have heard Jean-Louis speak at a conference, with his wonderful Belgian accent. But how many of us have heard him speak about what really happens in his own clinical environment? Please enjoy listening to this episode. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Twitter handle for Professor Jean-Louis Vincent: @jlvincen International Symposium on Intensive Care and Emergency Medicine (ISICEM): https://www.intensive.org/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Instagram handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

This episode reviews the identification and management of patients with salicylate toxicity. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_147_0_Final_Cut.m4a Download 4 Comments Tags: Aspirin, Salicylate, Toxicology Show Notes Take Home Points Always consider salicylate toxicity: In patients with tachypnea, hyperpnea, AMS and clear lungs In the presence of an anion gap metabolic acidosis with a respiratory alkalosis Treat salicylate toxicity by alkalinizing the blood and urine to increase excretion Avoid intubation until absolutely necessary. If you do have to intubate, minimize apneic time and consider awake intubation and nake sure your ventilator settings match the patient's necessary high minute ventilation Think about chronic salicylate toxicity in unexplained altered mental status, tachypnea or metabolic acidosis in elderly Know indications for hemodialysis in salicylate toxic patients Read More REBEL EM: Salicylate Toxicity LITFL: Salic...

This episode reviews the identification and management of patients with salicylate toxicity. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_147_0_Final_Cut.m4a Download 4 Comments Tags: Aspirin, Salicylate, Toxicology Show Notes Take Home Points Always consider salicylate toxicity: In patients with tachypnea, hyperpnea, AMS and clear lungs In the presence of an anion gap metabolic acidosis with a respiratory alkalosis Treat salicylate toxicity by alkalinizing the blood and urine to increase excretion Avoid intubation until absolutely necessary. If you do have to intubate, minimize apneic time and consider awake intubation and nake sure your ventilator settings match the patient’s necessary high minute ventilation Think about chronic salicylate toxicity in unexplained altered mental status, tachypnea or metabolic acidosis in elderly Know indications for hemodialysis in salicylate toxic patients Read More REBEL EM: Salicylate Toxicity LITFL: Salicylates

In this week’s episode you’ll hear an invigorating conversation with Francesca Rubulotta. This power-packed, enthusiastic, passionate, water polo-playing, Italian doctor, now living and working in London, UK, is seriously ambitious to help patients other than those in her ICU, mostly by advancing education using technological innovation. Francesca is a Consultant and Honorary Senior Clinical Lecturer in Anaesthesia and Intensive Care Medicine at Imperial College Medical School. She studied medicine and anaesthesia in Italy and intensive care in Belgium, but also worked in the USA and the Netherlands on a journey that arrived in London 10 years ago. Francesca has been the Chair of the past division of professional development of the European Society of Intensive Care Medicine (ESICM) and is currently the Chair of the ESICM’s CoBaTrICE project. She leads and has led many other committees and organisations, and is presently the first ever female Presidential candidate in the ESICM general election (with the ballot open until June 11). Francesca has diverse clinical interests including end of life care, ethical aspects of intensive care, rapid response systems, and clinical research. She speaks 5 European languages, travels and speaks around the globe and has won masters world championships as a waterpolo player. In this conversation, Francesca demonstrates a deep understanding of, a strong passion for and substantial experience in running educational programs and courses in an innovative way using digital technology. She also tells of her desire to maximize the reach of education to less-developed areas of the world and her hope for more balance between the genders in intensive care. We also cover: The story of her multinational career so far How she obtained her current job in the United Kingdom How her intensive care career began by translating her intensivist father’s slides into English as a high school student How both she and her sister are now intensivists The benefits of training under some of the superstars of intensive care Her observation that the best intensivists keep it simple A story about how her change in demeanour helped her team understand how a clinical situation had turned serious The importance of empowering junior staff to make decisions Her fundamental desire to have daily physical contact with each patient How she took an ex-long-term ICU patient to the pub Raised expectations that educators should now deliver TED-like talks The honour of standing as an election candidate to be ESICM President The possibility of a global intensive care society one day Her passion for waterpolo and the vital importance of following our passions outside of medicine How yoga helps her look after her mind Learning from the mistakes she has made along the way And some thoughts about gender inequality in intensive care. My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to work and to adopt some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. Feel free to leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Link to Francesca Rubulotta’s ESICM President campaign: https://mailchi.mp/b3364cf0ed73/francesca-rubulotta-esicm?utm_source=mailchimp&utm_campaign=030026c6e1f0&utm_medium=page Francesca Rubulotta’s logo, suggesting representation (globe), education (eye) and innovation (light): Twitter handle for Francesca Rubulotta: @frubulotta Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Twitter handle for Andrew Davies: @andrewdavies66 Email Andrew Davies: andrew@masteringintensivecare.com

This week is International Nurses Week culminating in International Nurses Day on Saturday May 12th, the date on which Florence Nightingale was born. To celebrate this, my special guest this week is an intensive care nurse, Claire Davies. Claire is my wife. To me, she is intelligent, caring, kind and compassionate, as both a nurse and a person. So after struggling for a while with the choice of who I should have as my first nurse guest on the podcast, it gradually became obvious that it should be Claire. Claire began as an intensive care nurse back in 1999 as a Critical Care Course student at the Alfred Hospital’s Intensive Care Unit in Melbourne. After rising to become an Associate Nurse Unit Manager there a few years later, Claire took time off to rear our 2 beautiful daughters before reestablishing herself as a Critical Care Liaison Nurse at the Epworth Hospital, also in Melbourne. Whilst Claire is definitely an excellent nurse, with a keen focus on developing healthy and valuable nurse-doctor relationships which place the patient’s needs above anything else, she is also the long-suffering partner of an intensivist, me. This gives Claire the perfect perspective to talk about being an intensivist’s partner, something we do towards the end of this conversation. We also talk about: Her career journey What is it like being an intensive care nurse The dynamic and challenging environment of an ICU The characteristics of good intensive care doctors An instance where she confronted an intensivist about how she felt intimidated by him The aim to bring everything back to being about the patient Communication between ICU doctors and nurses How nurses are good at pattern recognition How important decisiveness is Respecting and not unfairly judging prior clinical decisions Drug and other types of errors An interesting tale of one of her patients falling out of bed How Claire felt in the period afterwards and how she dealt with it Communicating in family meetings, including the use of silence Prioritising rest to bring her best self to work Some other wellness habits including eating well, exercise and yoga Seeing the drinking of water as an important goal during a shift The “funny jokes” intensivists often tell on their ward rounds Her thoughts to help intensivists be more connected to their partners and families Her interest in a more focused acknowledgement of death in the ICU when it happens My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. Feel free to leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode): Twitter handle for Claire Davies: @cldavies22 Instagram handle for Claire Davies: @clairedavies22 New Normal Project podcast: http://newnormalproject.libsyn.com/ Insight Timer app: https://insighttimer.com/ Dr Craig Hassed: https://www.monash.edu/medicine/spahc/general-practice/about/staff-students/hassed Study focusing on the “Sacred Pause”: https://www.ncbi.nlm.nih.gov/pubmed/29618221 5th SG-ANZICS Asia Pacific Intensive Care Forum: www.sg-anzics.com Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care Email Andrew Davies: andrew@masteringintensivecare.com Twitter handle for Andrew Davies: @andrewdavies66

Does each bedside decision you make actually help your patient to feel, function or survive? Have you considered how frightening and intimidating the Intensive Care Unit environment is to your patients and their families? Do you feel empowered by the people you work with and the culture in your ICU?   Simon Finfer loves telling a tale. In this episode you’ll hear the story of the serendipitous and multi-national route Simon took to end up working for 25 years in one of Australia’s premiere Intensive Care Units. An Intensive Care Department where his colleagues and the culture they developed has fostered him to become one of Australia’s prominent intensive care researchers. You’ll also hear how he teaches his junior colleagues to question everything they do at the bedside to ensure their decisions truly help the patient. Simon is a Professorial Fellow in the Critical Care and Trauma Division at The George Institute for Global Health, a Senior Intensivist at Royal North Shore Hospital and Director of Intensive Care at the Sydney Adventist Hospital in Sydney, Australia. He is an Adjunct Professor at the University of New South Wales, a Clinical Professor at the University of Sydney and is a past-Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Simon is a world leader in Sepsis and is an international expert in the design and conduct of large scale randomised controlled trials in Intensive Care. Simon has collaborated with me (and many others) through the ANZICS Clinical Trials Group, so we caught up at the Group’s recent 20th Annual Meeting on Clinical Trials in Intensive Care at Noosa Heads in Queensland. We had a fascinating conversation in which Simon talked about: His early career in London where he was simply working too hard The circuitous route he took to Royal North Shore Hospital in Sydney The magnificent people-oriented culture inspired by Malcolm Fisher His early collaboration with the George Institute for Global Health How showing you care is what matters most in an end of life discussion His thoughts on having family at the bedside for ward rounds How the golf course is the only place he doesn’t think about patients How moving to a property with animals has brought relaxation and peace The rekindling of his passion for motorbike riding Why he got a Twitter account and how social media is both a force for good and an echo chamber How it’s almost “too easy” to write a paper in modern times The unlikelihood of a magic bullet arriving anytime soon His advice to look after our selves, to embrace uncertainty and to maintain our humanity My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode) 5th SG-ANZICS Asia Pacific Intensive Care Forum: www.sg-anzics.com ANZICS Clinical Trials Group: http://www.anzicsctg.org/ More information about Simon Finfer: https://www.georgeinstitute.org/people/simon-finfer Twitter handle for Simon Finfer: @icuresearch SAFE study: https://www.ncbi.nlm.nih.gov/pubmed/15163774 NICE-SUGAR study: https://www.ncbi.nlm.nih.gov/pubmed/19318384 SMACC: https://www.smacc.net.au/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/ Email Andrew Davies: andrew@masteringintensivecare.com Twitter handle for Andrew Davies: @andrewdavies66

How well do you understand what happens to your patients after they leave the ICU? Do you find out how they go and feed this back to your ICU team?   Most of you give excellent care to your patients whilst they are in the intensive care unit. No doubt this will be compassionate, appropriate, diligent, information-driven, holistic, team-based and communicative care. But when they leave the ICU, do you know what happens to them? Do you know if they actually leave the hospital? Do you know how they sleep, how long they remain confused for? What their final diagnosis on hospital discharge was? This is what A/Prof John Santamaria genuinely cares about. This is what he endeavours to find out. He is curious. John wants to know these things so he can better inform his patients before they leave the ICU and so he can keep his team up to date with what happened. Of course much of it is straightforward. The lady with pneumonia gradually got better and went home. The old man who had the laparotomy remained confused for 10 days, and then gradually became well enough to go off to rehabilitation. But sometimes there are surprises. The woman you thought had a simple urinary tract infection actually developed a secondary pneumonia in the ward and died after the treating team deemed another round of ICU to be inappropriate. The man with the acute pulmonary oedema who rapidly responded to CPAP but then developed a pulmonary embolism out on the ward. I know I could do better at understanding these things. It’s not that I’m not curious, it’s more that I get busy with the new patients, or the other jobs I have. Or recording the next podcast! I think after listening to this episode of Mastering Intensive Care with John Santamaria, you might think a bit about following up your ex-ICU patients more carefully. John is Director of Intensive Care at St Vincent’s Hospital in Melbourne, Australia. He trained both at St Vincent’s and Royal Melbourne Hospitals, in respiratory and intensive care medicine. After completing a doctorate of medicine on the control of breathing and postdoctoral studies in Vancouver, Canada, he returned to St Vincent’s in 1985. John has been a past chair of the Victorian branch of ANZICS and President of ANZICS. He currently chairs the Victorian Intensive Care Data Review Committee. His interests include mechanical ventilation, performance monitoring, clinical outcomes and clinical informatics. John is the current longest-serving Director of Intensive Care in Melbourne and anyone who works at St Vincent’s speaks so highly of his clinical care and his departmental leadership. He willingly let me interview him and we talked about a range of topics including: How he came to intensive care from respiratory medicine His appointment as ICU director at age 28 How some of his early career mentors influenced him The importance of close examination of patients How he balances teaching and clinical work on a ward round His perspectives on an electronic medical record and how the data from it can improve the quality of practice The need for intensivists to be open to suggestions from other team members The regular offer he makes to his nurses to call him when he is on call His take on end of life care and the family conversations involved How he collects data on his ICU’s patients on a daily basis (now over 30,000 patients) The use of technology like list managers, automatic reminders and SMS notifications of abnormal results His love of exercise, particularly early in the morning John’s advice on how to have a medical literature reading program Some thoughts about sleep, sleep deprivation and alerting medications And a few regrets he has... My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode) MANIC Course: https://www.baxterprofessional.com.au/manic/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

More pearls from our fantastic morning report series. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_134_0_Final_Cut.m4a Download 2 Comments Tags: ALL, Altered Mental Status, Hyperleukocytosis, Hyponatremia, Leukostasis Show Notes Take Home Points 1. When seeing patients with AMS, think of the 5 broad categories of pathologies – VS abnormalities, toxic-metabolic, infectious causes, CNS abnormalities and, lastly as a diagnosis of exclusion – psychiatric issues 2. In kids with AMS, think of zebra diagnoses and toxic ingestions and remember that primary psychosis is rare 3. Patients with ALL are susceptible to developing hyperleukocytosis. If the WBC is > 100K, think about getting hematology on the line to initiate chemo induction and leukopheresis 4. Always think about electrolyte disorders, particularly hypoNa in patients with global AMS. Remember to treat severe hypoNa w/ hypertonic saline and, to correct slowly as to avoid ODS Read More LITFL: HSV Encephalitis EM Cases: Episode 60 – Emergency Management of Hyponatremia

More pearls from our fantastic morning report series. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_134_0_Final_Cut.m4a Download 2 Comments Tags: ALL, Altered Mental Status, Hyperleukocytosis, Hyponatremia, Leukostasis Show Notes Take Home Points 1. When seeing patients with AMS, think of the 5 broad categories of pathologies – VS abnormalities, toxic-metabolic, infectious causes, CNS abnormalities and, lastly as a diagnosis of exclusion – psychiatric issues 2. In kids with AMS, think of zebra diagnoses and toxic ingestions and remember that primary psychosis is rare 3. Patients with ALL are susceptible to developing hyperleukocytosis. If the WBC is > 100K, think about getting hematology on the line to initiate chemo induction and leukopheresis 4. Always think about electrolyte disorders, particularly hypoNa in patients with global AMS. Remember to treat severe hypoNa w/ hypertonic saline and, to correct slowly as to avoid ODS Read More LITFL: HSV Encephalitis EM Cases: Episode 60 – Emergency Management of Hyponatremia Core EM:

How do you balance the use of your clinical experience with the literature-based evidence? Are you a good enough listener? Is the clinical handover in your ICU the best it could be?   I’ve been reflecting on these questions since I talked to A/Prof Peter Kruger for this week’s Mastering Intensive Care podcast. Peter is Deputy Director of Intensive Care at the Princess Alexandra Hospital in Brisbane, Australia and an Associate Professor at both the University of Queensland and Monash University in Melbourne. He holds specialist qualifications in both Anaesthesia and Intensive Care and has experience in both laboratory and clinical research. He is the immediate past chair and a senior examiner for the first part examination of the College of Intensive Care Medicine of Australia and New Zealand and a primary examiner for the Australian and New Zealand College of Anaesthetists. He is a board member of the College of Intensive Care Medicine and of The Intensive Care Foundation. In addition to his clinical and teaching roles his active research interests include clinical trial design, utilising clinical information systems to facilitate research, weaning patients from mechanical ventilation and the management of severe sepsis. Peter is one of those doctors who mixes research, teaching and clinical care really well. So he is perfectly placed to speak on a bunch of topics in this episode, like: How the people and the variety keeps him coming back to work in the ICU Why he enjoys working in a “strong” ICU and what that means Some of the habits he noticed in his mentors The importance of not being in a rush when on clinical duties The varying style of his clinical ward rounds The value of making brief contact with families during bedside handovers What he talked about when he recently gave a presentation entitled “Does what I think I know matter anymore?” How anecdotal experience does impact on our clinical practice Following up those who survive as patients in the ICU (and their families too) can help prevent a series of future problems The value of eye contact, listening, deliberate use of words and pauses in good communication Peter’s change in thinking about shift handover after reading a paper 10 years ago How talking to families is the highlight of his job The value he sees in sailing yachts to help mind, body and soul His thoughts on aging and working as an intensivist Some vital tips for the less experienced My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   -------------------- Show notes (people, organisations, resources or links mentioned in the episode) MANIC Course: https://www.baxterprofessional.com.au/manic/ Princess Alexandra Hospital: https://metrosouth.health.qld.gov.au/princess-alexandra-hospital University of Queensland: https://www.uq.edu.au/ Monash University: https://www.monash.edu/ CICM: https://www.cicm.org.au/ ANZCA: http://www.anzca.edu.au/ Intensive Care Foundation: http://www.intensivecarefoundation.org.au/ ANZICS CTG: http://www.anzics.com.au/Pages/CTG/CTG-home.aspx ANZICS/ACCCN annual conference: http://intensivecareasm2017.com.au/ Journal article on “Patient Care, Square-Rigger Sailing, and Safety": https://www.ncbi.nlm.nih.gov/pubmed/18840843 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

This week we explore the presentation, diagnosis and management of SBP. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_131_0_Final_Cut.m4a Download Leave a Comment Tags: Gastroenterology, Infectious Diseases, SBP Show Notes Take Home Points SBP is a difficult diagnosis to make because presentations are variable. Consider a diagnostic paracentesis in all patients presenting to the ED with ascites from cirrhosis An ascites PMN count > 250 cells/mm3 is diagnostic of SBP but treatment should be considered in any patient with ascites and abdominal pain or fever Treatment of SBP is with a 3rd generation cephalosporin with the addition of albumin infusion in any patient meeting AASLD criteria (Cr > 1.0 mg/dL, BUN > 30 mg/dL or Total bilirubin > 4 mg/dL) Read More Oyama LC: Disorders of the liver and biliary tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen's Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 90: p 1186-1205. REBEL EM: Spontaneous Bacterial Peritonitis EMRAP: C3 Live Paracentesis Video LITFL: Spontaneous Bacterial Peritoniti...

This week we explore the presentation, diagnosis and management of SBP. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_131_0_Final_Cut.m4a Download Leave a Comment Tags: Gastroenterology, Infectious Diseases, SBP Show Notes Take Home Points SBP is a difficult diagnosis to make because presentations are variable. Consider a diagnostic paracentesis in all patients presenting to the ED with ascites from cirrhosis An ascites PMN count > 250 cells/mm3 is diagnostic of SBP but treatment should be considered in any patient with ascites and abdominal pain or fever Treatment of SBP is with a 3rd generation cephalosporin with the addition of albumin infusion in any patient meeting AASLD criteria (Cr > 1.0 mg/dL, BUN > 30 mg/dL or Total bilirubin > 4 mg/dL) Read More Oyama LC: Disorders of the liver and biliary tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 90: p 1186-1205. REBEL EM: Spontaneous Bacterial Peritonitis EMRAP: C3 Live Paracentesis Video LITFL: Spontaneous Bacterial Peritonitis

What are the biggest challenges when beginning as a fully-fledged intensive care clinician? How do you best use your senior colleagues when your experience bank is still small? What can you do to help achieve gender equity in intensive care medicine?   These are some of the questions you’ll ponder as you listen to the latest Mastering Intensive Care podcast guest Dr Sarah Yong from Melbourne. Having started off 2018 with two “Best of 2017” episodes on the podcast, today allows you the opportunity to hear a new interview. I am enthusiastic and passionate about bringing you some further valuable perspectives on improving how we do our jobs in intensive care units around the world. And this year I’m hoping to branch out a bit and try some new things and some new types of guests. Mastering Intensive Care is not just about interviewing older and experienced intensivists. It’s also about hearing some of the challenges from less experienced intensivists as they traverse the early days of their careers. So in this episode you’ll hear from Sarah who is right in the middle of this phase working at the Alfred Hospital in Melbourne, Australia. After graduating from The University of Melbourne, she completed training in general medicine before obtaining her fellowship of intensive care medicine. Along with critical care, she has a strong interest in education, simulation and the free open-access medical education (FOAMed) revolution. She is currently completing a Masters in Clinical Education in non-technical skills in intensive care. Sarah is a strong advocate for her peers including convening the Victorian Primary Exam Course, chairing the Trainee Committee and being the New Fellows' Representative for the College of Intensive Care Medicine here in Australia and New Zealand. She is a founding convenor of the Women in Intensive Care Medicine Network, which is dedicated to improving the gender balance in Australasian Intensive Care Medicine through advocacy, research and networking. I really enjoyed talking with Sarah. She is eloquent, mature, humble and honest; and she has a great perspective on how we can all take action to achieve improved gender balance in intensive care. In the episode we talk about many things, including: What attracted Sarah to intensive care The rewards of delivering end of life conversations Whether she can sustain a lifelong career in the specialty How she dealt with the transition between trainee and fully fledged specialist Her utilization of other colleagues to support her ever-improving experience base The characteristics of the senior specialists who stood out to her What habits she is concentrating on to develop professionally How she has learnt and developed her communication skills Her excellent approach to a family conversation Dealing with the demands of an intensive care career Preparing at home for a busy clinical week Blending family and career The main gender-related issues women face in intensive care Sarah’s work with the Women In Intensive Care network Her advice for current trainees My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies   Show notes (people, organisations, resources or links mentioned in the episode): CICM: https://www.cicm.org.au/ Sarah Yong on Twitter: @drsarahyong Women In Intensive Care Medicine Network: http://www.womenintensive.org/ Women In Intensive Care Medicine Network on Twitter: @womenintensive Women In Intensive Care Medicine Network on Facebook: womenintensive Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

We welcome Meghan Spyres back to the podcast to discuss toxic alcohol ingestion diagnosis and management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_129_0_Final_Cut.m4a Download Leave a Comment Tags: Ethylene Glycol, Fomepizole, Methanol, Toxic Alcohols, Toxicology Show Notes Take Home Points Suspect a toxic alcohol in any patient with a large osmol gap or a large anion gap metabolic acidosis and consider treating these patients empirically. Fomepizole is the critical antidote for toxic alcohol ingestions but, patients are likely going to require dialysis as well. Call your local poison control center if you suspect a toxic alcohol ingestion to help guide management. Read More LITFL: Toxic Alcohol Ingestion ER Cast: Mind the Gap: Anion Gap Acidosis FOAMCast: Episode 43 – Alcohols Read More

We welcome Meghan Spyres back to the podcast to discuss toxic alcohol ingestion diagnosis and management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_129_0_Final_Cut.m4a Download Leave a Comment Tags: Ethylene Glycol, Fomepizole, Methanol, Toxic Alcohols, Toxicology Show Notes Take Home Points Suspect a toxic alcohol in any patient with a large osmol gap or a large anion gap metabolic acidosis and consider treating these patients empirically. Fomepizole is the critical antidote for toxic alcohol ingestions but, patients are likely going to require dialysis as well. Call your local poison control center if you suspect a toxic alcohol ingestion to help guide management. Read More LITFL: Toxic Alcohol Ingestion ER Cast: Mind the Gap: Anion Gap Acidosis FOAMCast: Episode 43 – Alcohols Read More

This week’s Mastering Intensive Care podcast features Dr Felicity Hawker who is one of the true female pioneers of Intensive Care in Australia and New Zealand. I had the privilege of working with Felicity for over a decade from when I began as a brand new intensive care consultant over 20 years ago and I came to admire her greatly. Mainly because I witnessed first hand someone who was a master clinician – astute, careful, diligent, systematic, thoughtful, compassionate and knowledgeable. Felicity always handed over the patients in a considered and packaged patient-focused manner. She was a pleasure to work with and I learnt so much from such a high quality role model. Felicity grew up and went to medical school in the Australian state of Tasmania, before completing specialist training in Melbourne, Glasgow and Sydney. She became the Co-director of the ICU at Royal Prince Alfred Hospital in 1985 before moving to Melbourne to be the Director of the Cabrini Hospital ICU from 1995 until 2008, during which time she also worked as a part time intensive care specialist at the Alfred Hospital. She continues to work at Cabrini as the Chair of the Deteriorating Patient Committee. None of this spells out well enough that in the late 1970s and early 1980s, when Felicity was doing her specialist training, intensive care was an almost totally male-dominated specialty (certainly in Australia and New Zealand). Many more women have joined her and us over the years but surely the path she forged can’t have been easy. Nevertheless, Felicity has published extensively, written a book on the liver in critical illness, spoken at many scientific meetings and been highly respected in our community. Felicity’s other major contribution has been her committee work at every level of education and training in the various Australian and New Zealand intensive care training institutions since the early 1990s. With other colleagues she was instrumental in bringing together the anaesthetic and the physician training programs through several iterations to ultimately become what is now a stand-alone College of Intensive Care Medicine (CICM), and where she is now the Director of Professional Affairs. Felicity was the inaugural Dean of the then Joint Faculty of Intensive Care Medicine (JFICM) from 2000-2002 and was awarded the JFICM medal in 2009. Since 2005 she has been honoured with the annual presentation of the prestigious Felicity Hawker Medal to the best research presentation by a trainee at the Annual Scientific Meeting of the CICM. I am extremely grateful to have had the opportunity to talk with Felicity, as in my eyes she has been a brilliant clinician at the bedside, a female pioneer in our specialty and a person who has strived to ensure proficient, knowledgeable and professional intensive care specialists are developed over the course of specialty training in Australia and New Zealand. In the episode we talk about many things, including: The early course of her career and what attracted her to intensive care The enjoyable relationships she has made with intensive care trainees The importance of diagnosis and the need to remain curious and sceptical Her time spent training in Glasgow as a Shock Team registrar The influence of a dynamic female consultant during her own training How attitudes and outcomes have changed since when she was one of 2 consultants at what is now one of the biggest ICUs in Sydney The characteristics she thinks good intensivists require Communicating with colleagues and patient’s families Her highly valuable published survey of the issues female intensivists face How research has changed since her early career Her views on winding down an active intensive care career Her earlier successful horse riding career Her current role as a doctor at professional horse racing meetings How she has dealt with the stress of an intensive care career Her observation that many intensivists want to be educationalists Her enjoyment of family, cryptic crosswords, reading and travel And some valuable advice to 35 year old intensive care doctors This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, our fellow healthcare professionals and indeed ourselves so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies     Show notes (people, organisations, resources or links mentioned in the episode) CICM: https://www.cicm.org.au/ CICM honours: https://www.cicm.org.au/About/Honours-Awards Felicity Hawker medal: https://www.cicm.org.au/Trainees/Assessments-and-Examinations/Formal-Projects#FelicityHawkerMedal Published paper on survey of female specialists in intensive care medicine: https://www.ncbi.nlm.nih.gov/pubmed/27242111 Felicity Hawker on LinkedIn: https://www.linkedin.com/in/felicity-hawker-728a3025/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

This week we discuss a quick case leading into the management of MALA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_124_0_Final_Cut.m4a Download 2 Comments Tags: Metformin, Toxicology Show Notes Take Home Points In patients with shortness of breath and clear lungs, consider metabolic acidosis with respiratory alkalis as a potential cause Suspect MALA in any patient on metformin who presents with abdominal pain, nausea and vomiting and/or AMS Patients with MALA will have a low pH, a high-anion gap metabolic acidosis and high lactate levels Call your tox consultant to assist with management which will focus on fluid resuscitation with isotonic bicarbonate and dialysis Read More Bosse GM. Antidiabetics and Hypoglycemics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank's Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link Accessed October 31, 2017 LITFL: Metformin-Associated Lactic Acidosis LITFL: Metfo...

This week we discuss a quick case leading into the management of MALA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_124_0_Final_Cut.m4a Download 2 Comments Tags: Metformin, Toxicology Show Notes Take Home Points In patients with shortness of breath and clear lungs, consider metabolic acidosis with respiratory alkalis as a potential cause Suspect MALA in any patient on metformin who presents with abdominal pain, nausea and vomiting and/or AMS Patients with MALA will have a low pH, a high-anion gap metabolic acidosis and high lactate levels Call your tox consultant to assist with management which will focus on fluid resuscitation with isotonic bicarbonate and dialysis Read More Bosse GM. Antidiabetics and Hypoglycemics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank’s Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link Accessed October 31, 2017 LITFL: Metformin-Associated Lactic Acidosis LITFL: Metformin...

Are we truly making healthcare safer? Do we adequately understand human factors in how we work in hospitals? How would you respond if your partner died from a “routine operation”?   These are just 3 of the questions you are likely to ponder as you listen to this interview with Martin Bromiley OBE from the United Kingdom on the Mastering Intensive Care podcast. Whilst many people that we care for in our Intensive Care Units receive excellent care, sadly there are some who end up in our ICUs after something goes unexpectedly wrong during a routine operation. Tragically some of these people die. Not due to anything they did, but from medical error. In the final DasSMACC special episode, I speak to Martin Bromiley, who became a widower when his wife, Elaine, died in such circumstances 12 years ago. In what has been described as “the direct result of human factors and failings in non-technical skills, created by systemic failings in the healthcare system”. Martin didn’t blame, shame or complain. He did his best to move forward by researching the culture in healthcare around safety and human factors. And he recognised that although there were pockets of excellence the UK’s National Health Service was culturally a long way behind most other high risk industries. As a result of his experiences Martin supported the making of a DVD entitled “Just a routine operation” which explored the lessons of his late wife’s death, as well as a BBC Horizon programme about human factors called "How to avoid mistakes in surgery". Professionally Martin works in aviation where he is a pilot for a major UK airline and where he has a background specialising in human factors. Therefore, Martin founded the Clinical Human Factors Group, a non profit-making charitable trust which aims to advise and promote best practice around human factors. Since then the Group has promoted human factors at the highest levels in healthcare, making a significant contribution to current thinking. More significantly though, the terms human factors and system safety are becoming much more commonly understood in healthcare, much of which is due to Martin’s efforts and leadership. His work has been recognised through awards from the Royal College of Anaesthetists, the Difficult Airway Society, and the patient support group “Action Against Medical Accidents”. In the 2016 New Year Honours list Martin was awarded an OBE for his work to further patient safety. Martin was a speaker at the DasSMACC conference in Berlin back in June, and after delivering an enthralling talk entitled “How To Fail”, we went to a quiet room to record an interview. We had an important conversation and touched on: The tragic case of Elaine and her death after a routine operation How Martin dealt with it What support Martin received in and out of the hospital What Martin has been doing to try to improve safety in healthcare What healthcare can and cannot learn from the aviation industry His 3 key messages about human factors How he uses mental rehearsal to be the best airline pilot he can be This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Please also consider making a donation to the Clinical Human Factors Group here. Thanks for listening. Please do the very best you can for your patients.   Andrew Davies   --------------------   Links related to Martin Bromiley Martin Bromiley Martin Bromiley on Twitter: @MartinBromiley Martin Bromiley on LinkedIn Clinical Human Factors Group Donations to Clinical Human Factors Group Video “Just a routine operation” Video “How to Fail…Part Two” (a talk by Martin Bromiley at DasSMACC conference) Video “Martin Bromiley, a Patient’s Perspective” (talk by Martin Bromiley at Patient Safety Movement) Anonymous version of an Independent Report on the death of Elaine Bromiley Article “The husbands story: from tragedy to learning and action” (authored by Martin Bromiley) Article "Clinical Human Factors" (co-authored by Martin Bromiley) Article 1 on Martin Bromiley Article 2 on Martin Bromiley Article 3 on Martin Bromiley Article “Lessons from the Bromiley Case” (by Mike Cadogan on Life In The Fast Lane)   Links to other resources (in order of mentioning) SMACC TED Book “Black Box Thinking” (by Matthew Syed) Paper on the Safety 1 and Safety 2 model Second paper on the Safety 1 and Safety 2 model Third article on the Safety 1 and Safety 2 model Jim Harlow on Twitter   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies

Do you play the role of the exemplary leader in the ICU? Are you charming, funny, friendly and extroverted – even when these aren’t your natural personality characteristics? Do you throw yourself into your series of consecutive days in the ICU like you are going away to adventure camp? Do you outline specific objectives that a patient should meet over a timeframe of a few days to decide whether treatment should continue? And how regularly do you talk to your patient’s family when you are pretty sure the patient is dying? These are some of the questions you may ask yourself after listening to this episode of the Mastering Intensive Care podcast with American intensivist Jack Iwashyna. This is the fifth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Jack is Associate Professor of Pulmonary and Critical Care Medicine at the University of Michigan where he is a practicing medical intensivist at both the University of Michigan and the VA Ann Arbor Health System. He also devotes significant energy to training clinician scientists and is best known for his work defining the concept of “survivorship” after ICU and measuring aspects of the post-intensive care syndrome. Jack’s keynote talk at DasSMACC was entitled “Persistent Critical Illness” and as you’ll hear in this podcast he is the perfect person to talk about this given he does 14 day blocks in his ICU allowing him ample opportunity to understand what happens in the evolution of a patient’s critical illness. Despite Jack self-proclaiming he is introverted, this episode of the podcast reveals him to be a diverse conversationalist with well-matured thoughts, views and reflections on his own experience about how a consultant intensivist should act, whether that be in throwing ourselves 100% into our clinical service, playing a specifically crafted leader’s role, wisely mentoring less experienced clinicians, regularly communicating to patient’s families, simply having fun doing our job with our colleagues and respecting our spouses and families for supporting the work that we do. We cover a myriad of topics including: Jack’s powerful answer as to why he loves his job How invigorating it can be to talk to people he has only just met How he has previously done 30 day stretches of continual clinical service As a researcher he tries not to study his own ICUs too closely Our fixation on short-term survival is inadequate for most patient families His use and the benefits of time-limited trials of life support How he uses a school-like A-F range grading to mark patient’s progress The benefits of taking his children away on academic trips His somewhat raw reflections about not feeling as good a father and husband as he is a doctor The difference between mentoring in research and in clinical practice Our role is to try to help all trainees to improve, however good we perceive them to be Burnout is a systems issue – where the system is being run too hard The importance of sleep and afternoon naps This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies   Show notes (people, organisations, resources or links mentioned in the episode): Jack Iwashyna at University of Michigan: http://ihpi.umich.edu/our-experts/tiwashyn Jack Iwashyna on Twitter: @iwashyna DasSMACC: www.smacc.net.au

Are you receiving elderly intubated patients where someone else says they want “everything” done? Are the doctors who refer patients to intensive care finding out what their patients really want towards the end of life? Does this frustrate you on a daily basis?   This is a huge topic in intensive care. Finding out the wishes of our patients before they end up on a ventilator with no one to speak for them is vital if we wish to deliver optimal healthcare. Yet so often we intensivists are left to deal with this situation. And whilst in most cases we do this very well, many of us like Dr Alex Psirides, a UK, New Zealand and Australian-trained intensivist, feel the despair as we hold another lengthy meeting with a patient’s family. In this episode I spoke with Alex about this topic, which he had just delivered a brilliant TED-like talk on at the DasSMACC international conference in June. Alex has a great perspective to share as two of his specific clinical interests are managing dying patients and rapid response systems for deteriorating patients. This is the fourth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Alex is an Intensive Care specialist at Wellington Regional Hospital in Wellington, New Zealand. His work and research in the area of rapid response systems has led to an appointment as the clinical lead for the New Zealand Health Quality & Safety Commission’s 5-year national ‘Deteriorating Patient’ programme. He is also the clinical lead for Wellington’s aeromedical retrieval service, which covers the lower North and upper South Islands of New Zealand. In his spare time, when not walking his dog or children, he builds websites & designs logos for Wellington ICU’s prodigious research department, as well as sending a few tweets via Twitter handle @psirides. Given Alex has been an ICU consultant for less time than most of my other guests, I had to talk him into doing an interview, but I’m really glad he agreed. There is so much to like about this conversation. Alex is honest and humble enough to say he’s not so sure he’s that good at predicting patient outcomes, at least in neurosurgical patients, which is the precise reason he has something to teach us on the podcast. We also cover topics including: Why Alex loves intensive care (with a great answer) How his consultant team work so cohesively The need to respect co-worker’s opinions and to avoid tribalism How a team of intensivists meeting with a team of neurosurgeons away from the patients can make practice more consistent and evidence-based How his team uses simulation to reduce rudeness and lack of respect How efficiently his hospital ran when there was a 3 day doctors strike A good ward round requires asking for and addressing the nurse’s concerns but also finishes with a clear plan to move the patient forwards Bringing his best self to work requires feeling loved at home and having a great team to work with Some of the non-textbook medical books Alex has been enjoying reading Hobbies allow him to escape from work and to use his creativity How far away he feels right now from burnout What he can get better at over the next 5 years How palliative care physicians can be helpful in teaching us and our trainees about end of life discussions This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues or posting on social media. Feel free to leave a comment or a question. I hope we can build community through Mastering Intensive Care so colleagues can share their thoughts and tell us how they are mastering their own skills. Leave a comment on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook “mastering intensive care” page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies     Show notes (people, organisations, resources or links mentioned in the episode): Wellington Intensive Care medical team: http://www.wellingtonicu.com/AboutUs/Staff/SMO/ DasSMACC: www.smacc.net.au Alex Psirides talk on “Doing everything at end of life”: http://wellingtonicu.com/Data/Doing%20Everything%20DasSMACC.pdf Book “Being Mortal” by Atul Gawande: http://atulgawande.com/book/being-mortal/ Book “Do No Harm” by Henry Marsh: https://henrymarshdonoharm.wordpress.com/reviews/ Alex Psirides on Twitter: @psirides

Are your ICU patients ever in a holding pattern? Do you aim to liberate your patients from ICU as soon as possible? Is your caution about moving things forward harmful to our patients?   I don’t think we talk often enough about the dangers of conservatism in intensive care. About how if we are cautious in thinking the patient is not quite ready to be extubated, or have the sedation turned off, or stop the antibiotics, then we sometimes don’t realize the harm our inaction may cause. A topic you will enjoy hearing about in this interview with Professor John Marshall on the Mastering Intensive Care podcast. John is a Professor of Surgery at the University of Toronto, and a trauma surgeon and intensivist at St. Michael’s Hospital in Toronto, Canada. John has an active clinical research interest in sepsis and ICU-acquired infection, and in the design of clinical trials and outcome measures. He has published more than 325 manuscripts, and 85 book chapters, and is the editor of 2 books. He is the founding chair of the International Forum of Acute Care Trialists (InFACT) – a global network of investigator-led critical care clinical research groups, he is Secretary-General of the World Federation of Societies of Intensive and Critical Care Medicine, and vice-chair of the International Severe Acute Respiratory and Emerging Infections Consortium.  He is also past-chair of the International Sepsis Forum, past-President of the Surgical Infection Society, and past-chair of the Canadian Critical Care Trials Group. He has given invited lectures at more than 470 meetings around the world, is a member of seven journal editorial boards, and an Associate Editor of Critical Care Medicine and Critical Care. In this conversation we also cover topics including: Being both a surgeon and an intensivist – and why ICU might be more fun Humility and curiosity as the two most important habits for intensivists That surgeons seem to own their complications more than intensivists The benefits of family member presence on the ICU ward round Why we should question everything we do in a provocative dialogue How research helps us at the bedside The value of collaborative research networks The observations that some ICUs can feel joyless Withdrawing interventions may not always lead to death The time when John was involved in a 4 hour CPR If we can’t define what an intervention can or cannot do, perhaps we shouldn’t do it The privilege John feelsto be able to make mistakes that might cost people their lives His artistic pursuits outside of medicine (including the story of a rock band) The constant feeling of rejection in academia The skills required to give a good talk How developing academic capital might be the best way to get a job With this podcast please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media. If you have a comment or a question, let’s engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care. Thanks for listening. Please go out and do the best you can for your patients. Andrew Davies

This week we sit down with toxicologist Meghan Spyres to talk about Wernicke's Encephalopathy. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_115_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Abuse, Thiamine, Toxicology, Wernicke's Encephalopathy Show Notes Take Home Points Consider the diagnosis in all patients with nutritional deficiencies, not just alcoholics. Look for ophthalmoplegia, ataxia and confusion in patients that have risk factors for thiamine deficiency. Don't think that it can't be Wernicke's because the triad isn't complete; any two of the components (dietary deficiency, oculomotor abnormalities, cerebellar dysfunction or altered mental status) makes the diagnosis. Treat Wernicke's with an initial dose of 500 mg of thiamine IV and admit for continued parenteral therapy. Read More LITFL: Thiamine Deficiency EMRAP: Remember to Take Your Vitamins ALiEM: Mythbusting the Banana Bag Read More

This week we sit down with toxicologist Meghan Spyres to talk about Wernicke's Encephalopathy. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_115_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Abuse, Thiamine, Toxicology, Wernicke's Encephalopathy Show Notes Take Home Points Consider the diagnosis in all patients with nutritional deficiencies, not just alcoholics. Look for ophthalmoplegia, ataxia and confusion in patients that have risk factors for thiamine deficiency. Don’t think that it can’t be Wernicke’s because the triad isn’t complete; any two of the components (dietary deficiency, oculomotor abnormalities, cerebellar dysfunction or altered mental status) makes the diagnosis. Treat Wernicke’s with an initial dose of 500 mg of thiamine IV and admit for continued parenteral therapy. Read More LITFL: Thiamine Deficiency EMRAP: Remember to Take Your Vitamins ALiEM: Mythbusting the Banana Bag Read More

Do you say “I don’t know” when you really don’t have an answer? Might seeking that knowledge help your patients? This is just one component of a wonderful conversation I held with Professor Flavia Machado when I interviewed her at the recent DasSMACC conference in Berlin. Flavia is doing a great job at raising the awareness of sepsis globally but her other great job is in running a large Intensive Care department in Sao Paolo, Brazil, where she told me that the resources are quite limited. To deal with this challenge she believes optimal communication is vital. How does Flavia lead her ICU on the issue of communication? She does this (1) by having an environment where her team members can ask important questions, (2) by using the WhatsApp messenger app on smartphones, (3) by teaching trainees using courses on how to break bad news, how to speak with families, and how to deal with doctors who have different clinical opinions, and (4) by saying “I don’t know” when finding the knowledge will help the patient. Flavia is the Professor of Intensive Care at the Federal University of São Paulo in São Paulo where she is Head of the Intensive Care Section of the Anesthesiology, Pain and Intensive Care Department. Flavia has trained in Internal Medicine, Infectious Diseases and Critical Care, making the field of sepsis something she has become a world leader in. She is one of the Founders of and now the CEO of the Latin America Sepsis Institute (LASI), having been its President. LASI is devoted to quality improvement in Brazilian hospitals as well as to coordination of multicenter studies in the field of sepsis. She is part of the executive board of the Global Sepsis Alliance and the executive committee for the World Sepsis Day. Flavia has served on the board of the Surviving Sepsis Campaign International Guidelines. She is also a member of both the Executive and Scientific Committee of the Brazilian Research in Intensive Care Network-BRICNET. Finally, Flavia is the editor-in-chief of “Revista Brasileira de Terapia Intensiva”, the official journal of the Brazilian Critical Care Association and the Portuguese Critical Care Association. In this conversation we also cover topics including: Raising awareness of sepsis through the Global Sepsis Alliance Mentoring and being mentored The need for a multi-professional program in ICUs with a multi-disciplinary ward round Setting goals and using checklists How the limited resources in Brazilian healthcare require strict admission rules The use of simple and short protocols based on the evidence How to best deal with conflict with another doctor Using dinner time to connect with family How running is good for the mind The joys of reading books With this podcast please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media. If you have a comment or a question, let’s engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care.

We have a significant way to go with respect to our cardiac arrest management. ‘Cardiopulmoary Resuscitation is attempted in nearly 30,000 people who suffered OHCA in England each year, but survival rates are low and compare unfavourably to a number of other countries’ -  Resuscitation to Recovery 2017 25% of patients get a ROSC with 7-8% of patients surviving to hospital discharge, which as mentioned is hugely below some countries. In this podcast we run through cardiac arrest management and the associated evidence base, right from chest compressions, through to drugs, prognostication and ceasing resuscitation attempts. Make sure you take a look at the papers and references yourself and we would love to hear you feedback! Enjoy! Simon, Rob & James References & Further Reading Resuscitation to Recovery Document "Kids Save Lives": Educating Schoolchildren in Cardiopulmonary Resuscitation Is a Civic DutyThat Needs Support for Implementation. Böttiger BW. J Am Heart Assoc. 2017 Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival.Andersen LW. JAMA. 2017 Double sequential Defibrillation therapy for out-of-hospital cardiac arrests: the London experience. Emmerson AC, et al. Resuscitation. 2017 Dual sequential defibrillation: Does one plus one equal two? Deakin CD. Resuscitation. 2016 Thrombolysis during resuscitation for out-of-hospital cardiac arrest. Böttiger BW. N Engl J Med. 2008 Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Perkins GD. Lancet. 2015 Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. Rubertsson S. JAMA. 2014 Effect of epinephrine on survival after cardiac arrest: a systematic review and meta analysis. Patanwala AE. Minerva Anestesiol. 2014 Impact of cardiopulmonary resuscitation duration on survival from paramedic witnessed out-of-hospital cardiac arrests: An observational study. Nehme Z. 2016 Mar;100:25-31. doi: 10.1016/j.resuscitation.2015.12.011. Epub 2016 Jan 13. Predicting in-hospital mortality during cardiopulmonary resuscitation. Schultz SC. Resuscitation. 1996 Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Tsou PY. Resuscitation. 2017 End-tidal CO2 as a predictor of survival in out-of-hospital cardiac arrest. Eckstein M. Prehosp Disaster Med. 2011 LITFL; cessation of CPR

This podcast takes a deep dive into the presentation, diagnosis and management of preeclampsia and eclampsia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_113_0_Final_Cut.m4a Download Leave a Comment Tags: Eclampsia, Hypertensive Disorders of Pregnancy, Obstetrics, Preeclampsia Show Notes Take Home Points Suspect preeclampsia in any pregnant women presenting with epigastric/RUQ pain, severe or persistent headache, visual disturbances, nausea or vomiting, shortness of breath, increased edema or weight gain Evaluate for preeclampsia by looking at the blood pressure, urine for protein and obtaining a panel to evaluate for HELLP syndrome Severe preeclampsia and eclampsia are treated with bolus and infusion of MgSO4 Emergency delivery is the “cure” for preeclampsia and eclampsia. Consult obstetrics early for an evaluation for delivery Don't forget to consider preeclampsia and eclampsia in the immediate postpartum period Read More Core EM: Preeclampsia and Eclampsia LITFL:

This podcast takes a deep dive into the presentation, diagnosis and management of preeclampsia and eclampsia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_113_0_Final_Cut.m4a Download Leave a Comment Tags: Eclampsia, Hypertensive Disorders of Pregnancy, Obstetrics, Preeclampsia Show Notes Take Home Points Suspect preeclampsia in any pregnant women presenting with epigastric/RUQ pain, severe or persistent headache, visual disturbances, nausea or vomiting, shortness of breath, increased edema or weight gain Evaluate for preeclampsia by looking at the blood pressure, urine for protein and obtaining a panel to evaluate for HELLP syndrome Severe preeclampsia and eclampsia are treated with bolus and infusion of MgSO4 Emergency delivery is the “cure” for preeclampsia and eclampsia. Consult obstetrics early for an evaluation for delivery Don’t forget to consider preeclampsia and eclampsia in the immediate postpartum period Read More Core EM: Preeclampsia and Eclampsia LITFL: Preeclampsia and Eclampsia

How did you feel the first day you worked in ICU? Was it like walking on the moon? So foreign, because you didn’t understand much about the machines, the techniques, or even the words that were being used. That’s what it felt like for me, all those years ago. Thanks to one of my consultants who really “held my hand” on that first day, I was OK, but I wish I could have completed a BASIC course like most resident doctors in Australia (and many other countries) do today when they start their term in intensive care. The BASIC course that those resident doctors now complete is mostly due to the efforts of Charles Gomersall. Over a decade ago, he realised the difficulties these junior doctors had in understanding what the Intensive Care consultants were both talking about and doing, so with a bunch of friends he set up BASIC (The Basic Assessment & Support in Intensive Care) course with the aim to teach participants, over 2 days, to rapidly assess seriously ill patients and provide initial treatment and organ support. Topics like airway management, acute respiratory failure, mechanical ventilation, haemodynamic monitoring, management of shock, interpretation of arterial blood gases, transport of critically ill patients, severe trauma, neurological emergencies, oliguria & acute renal failure, cardiopulmonary resuscitation, arrhythmias, nutrition, sedation and analgesia, etc. This week my guest is Charles who is Professor in the Department of Anaesthesia & Intensive Care at The Chinese University of Hong Kong. In his words, his minor claims to fame are persuading some friends to write the BASIC course and denying a British prime minister entry to a London Intensive Care Unit, and his remaining ambition is to become a professional chef. That’s all he wanted me to say about his background but let me say that having resident doctors rapidly brought up to speed on basic intensive care skills and practice, mostly so that they can feel comfortable at the ICU bedside in their first few weeks, is something I think is hugely valuable, not only to them, but also to me as a consultant and especially our patients. So that makes Charles a hero in my eyes. Of course, BASIC has gone on to now consist of many other courses, which now help up-skill nurses, medical students, advanced trainees, consultants (by providing refresher courses) in many countries, including in the developing world. So I think Charles is a legendary educator, an inspiring leader and an outstanding clinician. He is softly spoken, humble, unassuming but incredibly well considered. He powerfully helps the patients in his own ICU and dramatically helps patients all around the world by providing BASIC. What a master. In this week’s episode you will hear all about the BASIC course, how it came to be, and where it is right now in amongst the other work of the BASIC Collaborative. You’ll also hear Charles speak about: How he became both a doctor and an intensivist by accident How difficult it is to objectively judge the value of education The prime importance of putting the patient first in clinical, academic and educational practice Understanding the good and bad that surrounds us in our Intensive Care department culture How ICU specialists are like the hotel concierge of the hospital How paying back the support we received as trainees to our upcoming trainees is vital to the system of ICU education His views on sleep, cycling to work and listening to music The story of being on duty in a London hospital after a train crash people The benefits of communicating humanely to our patient’s families when things are not going well And, how there is compulsory retirement at age 60 in Hong Kong With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media. If you have a comment or a question, let’s engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care. Thanks for listening. Do the best you can for those unfortunate people in our ICUs we call patients, and strive to get better at what you do, whilst looking after yourself.   Show notes (people, organisations, resources or links mentioned in the episode) Prof Charles Gomersall: https://www.cuhk.edu.hk/med/ans/prof_gomersall.htm BASIC course: https://www.aic.cuhk.edu.hk/web8/BASIC.htm

Do you think your procedural skills are more important than your ability to lead and to mentor? Do you have a department head who talks about your personal wellness with you? How do you maintain and improve your skills in leading a family meeting?   Professor Brian Cuthbertson believes that our non-technical skills, those human factor aspects like leadership, mentoring, communication and leading meetings with patient’s relatives, are more important than our clinical procedural skills as we evolve in our careers. But do we talk enough about them? In this episode Brian discusses several of these important non-technical skills giving some powerful insights as a highly experienced clinician and leader in the field of intensive care. Brian is Chief of the Department of Critical Care Medicine at Sunnybrook Health Sciences Centre and Professor in the Interdepartmental Division of Critical Care Medicine at the University of Toronto in Toronto, Canada. He is also an Honorary Professor of Critical Care Medicine at the University of Aberdeen and an Honorary Professorial Fellow at the George Institute of Global Health in Sydney. Brian’s research interests include improving outcomes from critical illness and major surgery. He has over 135 peer-reviewed publications and $17 million of research grants as well as playing a leading role in a number of key clinical guidelines. Brian was very keen to talk about how much he values the human factors we all need to concentrate on to be the best we can be. Some of the main topics of discussion include: Brian’s love for intensive care, which began with the machines and is now much more about humans The benefits he has realised from having high-class mentors in different areas His role as a mentor to others and how there needs to be some structure to this relationship How leadership at the bedside is like conducting an orchestra where everyone needs to be heard The need for senior trainees to stay in charge of resuscitation teams even when the consultant arrives How being a good team-player often requires us to drop our egos The value of good habits at the start of a ward round The need for department heads to address their team member’s personal wellness requirements to maximise vitality and balance The importance of family members being at the bedside on clinical rounds to represent the values of the patient The fact that the highest level skill we can have is the ability to lead a family meeting, especially in culturally-diverse cities Placing the patient’s values and needs at the centre of any inter-professional discussions, particularly differences in opinion The requirement for greater academic study of all of these non-technical skills With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media. If you wish to send a comment or respond to something Brian said on this episode, feel free to email me andrew@masteringintensivecare.com, leave a comment on the Mastering Intensive Care podcast page on LITFL or on Facebook, or post on twitter using #masteringintensivecare. Please take the very best care of your patients, their families and your colleagues. And above all, consider that taking care of yourself might actually be the best thing you can do for your patients. I hope you have a great week. ____________________________________________________________________________________________ Show notes (people, organisations, resources or links mentioned in the episode) Sunnybrook Health Sciences Centre: http://sunnybrook.ca/ Brian Cuthbertson: http://sunnybrook.ca/team/member.asp?t=17&page=2780&m=407 Malcolm Fisher: http://www.nslhd.health.nsw.gov.au/newsevents/Pages/MalcolmFisherICU.aspx Nigel Webster: https://www.abdn.ac.uk/ims/profiles/n.r.webster Marion Campbell: https://www.abdn.ac.uk/hsru/people/m.k.campbell/ Mentorship in Academic Medicine – Author Sharon Strauss: http://www.mentorshipacademicmedicine.com/ Atul Gawande: http://atulgawande.com/

This is the second part of the Roadside to Resus discussion on asthma. Make sure you’ve listened to part 1 before delving into this one! Part 2 covers Ketamine Ultrasound in asthma NIV in asthma Asthma related cardiac arrest Imaging Management Discharge We hope you enjoy the episode and would love to hear your feedback! Simon, Rob & James   References & Further Reading BTS Asthma Guidelines 2016 Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Goodacre S. Lancet Respir Med. 2013  Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Sauter TC. Emerg Med J. 2017 Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Laan DV. Injury. 2016 TheResusRoom; Needle Thoracostomy podcast TheResusRoom; BTS Asthma Guidelines 2016 podcast LITFL; Non-invasive ventilation (NIV) and asthma Intensiveblog; Asthma mechanical Ventilation Pitfalls BestBets; In a severe Exacerbation of asthma can Ketamine be used to avoid the need for mechanical ventilation in adults?  

What sort of things do you tell yourself when you are resuscitating a patient? Are you self-critical about your ability to deal with the situation? Is your inner voice so loud that you can’t concentrate on the task? This is a topic we don’t speak enough about in intensive care. The inner dialogue, which can often be very negative, is commonly going on in the background as we do our work. And as Associate Professor Sara Gray, a dual-trained intensive care and emergency physician from Canada points out, it can become louder and more critical as we become more stressed with the situation in front of us (eg. a difficult resuscitation). In this episode Sara talks about how observing the inner voice and trying to make it kinder is a form of self-compassion which can lead to improvements in our performance, thereby helping us to bring the best outcomes to our critically unwell patients. Such self-compassion can also provide the additional benefits of making us happier, more mentally healthy, and helping us to perform better in other areas of life. But it’s not easy to change these voices in our heads. And we need to slowly begin to develop the ability to simply observe them before we can do the more difficult work of making the voices kinder. This is the first of a series of DasSMACC special episodes, where I interview speakers from the recent DasSMACC conference held in Berlin. This was the third SMACC conference I have attended, and I enjoyed it for its international and multi-disciplinary flavour, as well as the excellent speakers and the exceptional program including topics from resuscitation and critical care interventions to communication and our own health and well-being. Dr Sara Gray is cross-trained in Emergency Medicine and Critical Care. She works in both areas at St. Michael’s Hospital in Toronto, Canada, and is an Associate Professor at the University of Toronto. She is also the Medical Director for Emergency Preparedness at St Mike’s. Her academic interests include knowledge translation and optimizing performance; specifically how to improve the care of critically ill patients in the Emergency Department. Her most important achievements are her kids, who don’t care what she does at work all day, and who remind her of what really matters in life. Sara spoke in the opening plenary session with a talk entitled “Voices in my head”. In this podcast interview, we discuss the premise of her talk, which is mainly about developing self-compassion by noticing our inner voice. We speak about some resources Sara has used to develop her own self-compassion, including the use of mindfulness meditation, which she now regularly practices. Sara is insightful, thoughtful, a true leader, a caring doctor, and above all a woman blazing a path to helping us to look after ourselves, our work colleagues, and indeed our patients. She is really helping to modernize the thinking in intensive care and emergency medicine circles. We covered several other topics including: Sara’s own career combining emergency medicine and intensive care The potential benefits to the organisation of having doctors trained in both specialties How intensivists can develop better relationships with their emergency department colleagues The potential benefit of teaching our children to meditate so that it becomes a normal part of an adult’s life Sara’s attitude to sleep, how she is not a good napper, and how she benefits from getting an even number of hours sleep How getting away by herself to read a book for just 30 minutes twice a week can revitalise her How doctors need to listen more and talk less – and some techniques to do that better How the ICU ward round in the St Michael’s Hospital is structured Some of the phrases she uses when talking with colleagues and patient’s families How being a patient in her own hospital reminds her to approach patients with what may seem minor complaints in a more engaged manner How burnout is not a binary outcome, and more something that she swings closer to or further from depending on the circumstances With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media (using #DasSMACC, #SMACC or #FOAMed) If you want to send a comment or respond to something Sara said on this episode, feel free to email me andrew@masteringintensivecare.com, leave a comment on the Mastering Intensive Care podcast page on LITFL or on Facebook, or post on twitter using #masteringintensivecare. I’d love to hear what you think are your major take-aways. Thanks so much for listening. Please give your patients the very best care you can, and take care of yourself too. ____________________________________________________________________________________________ Show notes (people, organisations resources or links mentioned in the episode): Dr Kristin Neff’s website: www.selfcompassion.org MBSR course: Mindfulness-based stress reduction Jon Kabat-Zinn: Founder of MBSR program Headspace meditation: www.headspace.com Sara Gray’s previous SMACC talk on “Optimising critical care in the emergency department”: https://itunes.apple.com/au/podcast/optimising-critical-care-in-emergency-department-by/id648203376?i=1000359000551&mt=2 Scott Weingart’s SMACC talk on “Kettlebells for the Brain”: https://itunes.apple.com/au/podcast/kettlebells-for-the-brain/id648203376?i=1000375455720&mt=2 DasSMACC website: www.smacc.net.au Dr Sara Gray: https://saragray.org/

Asthma is a common disease and presents to acute healthcare services extremely frequently. The majority of presentations are mild exacerbations of a known diagnosis and are relatively simple to assess and treat, many being completely appropriate for out patient treatment. On the other hand around 200 deaths per year are attributable in the UK to asthma, and therefore in the relatively young group of patients there is a real potential for critical illness with catastrophic consequence if not treated effectively. The majority of these deaths occur prior to the patient making it to hospital making the prehospital phase extremely important and hugely stressful in these cases. It is also worth noting that of the deaths reported that many were associated with inadequate inhaled corticosteroids or steroid tablets and inadequate follow up, meaning that our encounter with these patients at all stages of their care even if not that severe at the point of assessment is a key opportunity to discuss and educate about treatment plans and reasons to return. In part 1 of this podcast we will run through Pathophysiology How patients present Guidelines Treatment Salbutamol Ipratropium Steroids Magnesium Part 2 will be out shortly, we hope you enjoy the episode and would love to hear your feedback! Simon, Rob & James References & Further Reading BTS Asthma Guidelines 2016 Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Goodacre S. Lancet Respir Med. 2013  Detection of pneumothoraces in patients with multiple blunt trauma: use and limitations of eFAST. Sauter TC. Emerg Med J. 2017 Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Laan DV. Injury. 2016 TheResusRoom; Needle Thoracostomy podcast TheResusRoom; BTS Asthma Guidelines 2016 podcast LITFL; Non-invasive ventilation (NIV) and asthma Intensiveblog; Asthma mechanical Ventilation Pitfalls BestBets; In a severe Exacerbation of asthma can Ketamine be used to avoid the need for mechanical ventilation in adults?

Is the patient the centre of every action you take in the ICU? Do you exude calm and enthusiastic energy and greet other team members warmly and genuinely? Do you seek pleasure in seeing colleagues grow to become more skilled than you are? These are 3 questions you might ask yourself after you listen to this episode with Professor Julia Wendon, a well respected intensivist from the United Kingdom. Julia gives great advice on how helping people converse with each other, often by picking up the phone and demonstrating good consultant to consultant communication can be really valuable in helping a patient receive the best care. She also outlines exemplary behaviour such as saying hello to the patient, whether they are intubated or not, and then telling them the plan after the ward round review. Julia, from King’s College London in the United Kingdom, is Professor of Hepatology, Executive Medical Director, and a highly experienced intensive care physician. Her appointment at King’s began as a consultant in 1992 and since then she has played a key role in the development of the internationally respected King’s liver service, including the expansion of the hospital's intensive care bed capacity. Her primary clinical areas of interest are severe liver injury, multi-organ failure, immune dysfunction and the role of extracorporeal therapies for the management of acute liver failure. She is a respected academic, has published over 150 papers, and is regularly invited to lecture at national and international conferences. Julia is an articulate, thoughtful, caring and compassionate intensivist, as well as a tremendous stage presenter. Julia was an international speaker at the Australian and New Zealand CICM ASM in Sydney in May 2017 and this gave me a brilliant opportunity to interview her. Having helped to develop a world-leading liver ICU service at King’s, Julia gives highly useful reflections on how noone can achieve anything without colleagues and great teamwork; smiling, saying hello and thank you is an important role of being a consultant leader; seeking second opinions is a really valuable regular practice to make sure we aren’t missing anything; learning from trainees who have come from other continents and cultures is a huge privilege; looking after patients should always come before attending hospital meetings; and how she revels in allowing less experienced people to step forward and grow so that they can eventually overtake her. Also hear Julia speak about how: After enjoying intensive care as a very junior doctor working on a cardiac ambulance team, she trained at Middlesex Hospital in London under role models like David Bihari and Jack Tinker, who taught physiology enthusiastically at the bedside She learned so much from the senior intensive care nurses in her younger days Intensive care careers sometimes need to be varied in pace, and even head off in different directions at times Much can be gained by visiting other colleagues ICUs and even doing a ward round to see how others interact and manage patients She often reflects over a cup of tea on how a day in the ICU went and how she could have done things better The running of a family conversation can be difficult, is often done better by some than others, is a learnable skill, and requires accurate knowledge of what is happening with the patient, as well as asking the family what their present understanding is, all with the aim that the family can cope with the memories that they will leave with Making time for the important things in our lives helps us manage stress; and for Julia this includes clinical work, reading papers, reflecting, doing research, spending time with family, cooking and skiing Everyone in a department has different needs, and these should be recognised so that people can be allowed to do what fits with their needs, whether that be research, education, management or even playing golf Starting a 7 day week on a Friday can allow for some relief on the sixth or seventh consecutive day if this is required; which is less possible if the week starts on a Monday She would love to go back and study pure mathematics She worries we think about stress and burn out but that we don’t do enough planning for what we will do when we are finished medicine We could use our journal clubs to allow us to present our favourite life habit to our colleagues Handover has become a greater responsibility as ICU teams have got bigger With this podcast, and the previous episodes, please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you helped spread the word by simply emailing your colleagues or posting on social media. If you want to send a comment or respond to something Julia said on this episode, feel free to email me andrew@masteringintensivecare.com, leave a comment on the Mastering Intensive Care podcast page on LITFL or on Facebook, or post on twitter using the hashtag #masteringintensivecare. Thanks so much for listening. Please give your patients the very best care you can, and take care of yourself too.

This week we discuss the identification, prevention and treatment of local anesthetic systemic toxicity. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_95_0_Final_Cut.m4a Download 6 Comments Tags: Antidote, Bupivicaine, Intralipid, Lidocaine, Toxicology Show Notes LITFL: Local Anesthetic Toxicity Wiki EM: Local Anesthetic Systemic Toxicity References: Schwartz DR, Kaufman B. Local Anesthetics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank's Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link Neal JM et al, American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med 2012;37:16–8. PMID: 22189574 Cao D et al. Intravenous lipid emulsion in the emergency department: a systematic review. J Emerg Med 2015; 48(3): 387-97. PMID:

This week we discuss the identification, prevention and treatment of local anesthetic systemic toxicity. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_95_0_Final_Cut.m4a Download 6 Comments Tags: Antidote, Bupivicaine, Intralipid, Lidocaine, Toxicology Show Notes LITFL: Local Anesthetic Toxicity Wiki EM: Local Anesthetic Systemic Toxicity References: Schwartz DR, Kaufman B. Local Anesthetics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank’s Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link Neal JM et al, American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med 2012;37:16–8. PMID: 22189574 Cao D et al. Intravenous lipid emulsion in the emergency department: a systematic review. J Emerg Med 2015; 48(3): 387-97. PMID: 25534900

This week we cover a workshop from our conference on CNS infections focusing on meningitis. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_93_0_Final_Cut.m4a Download 3 Comments Tags: Bacterial Meningitis, CNS Infections, Infectious Diseases, Meningitis, Neurology Show Notes CSF Analysis (LITFL) EM Lyceum: Viral Meningitis “Answers” EM RAP: Meningitis LITFL: Bacterial Meningitis

This week we cover a workshop from our conference on CNS infections focusing on meningitis. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_93_0_Final_Cut.m4a Download 3 Comments Tags: Bacterial Meningitis, CNS Infections, Infectious Diseases, Meningitis, Neurology Show Notes CSF Analysis (LITFL) EM Lyceum: Viral Meningitis “Answers” EM RAP: Meningitis LITFL: Bacterial Meningitis

Mark Wilson; Neurosurgeon, Retrieval Physician, App Designer, Sceptic and Gentleman. It is hard not to like this chap. Mark Wilson somehow found time to talk to Matt McPartlin at SMACC. He really had an awful lot to do in Dublin too. Mark was presenting, fighting, drinking, dancing, facing his PhDemons and listening to @Kangaroodoc, all of which are frankly exhausting. But then he was asking for trouble by being so good at everything and even better at certain sexy media friendly matters. Mark knows concussion like very few people ever will. He is a neurosurgeon that gets down and dirty in the streets of London with the paramedics as a Retrieval Physician. He invents apps that go huge and actually save people lives. He has essentially created a way of real-time crowd-sourcing a medic when you really really want one. I wish I could do that. Mark is the main person behind the GoodSAM app which as been reviewed by Tessa Davis here on LITFL. (Link to be pasted over” GoodSAM app which as been reviewed by Tessa Davis” http://lifeinthefastlane.com/techtool-thursday-050-goodsam/ ) Lots of us have little moments of App inspiration but Mark has done it. It is free so it is genuine #FOAMed. It is also much more in that; it mobilises an entire community of volunteer responders which crosses the divide between clinician and non-clinician. The follow up is interesting too. Mark released this App back in 2014. Being one of the more successful Apps it really didn’t end there. The app is now in version 5. It has a life of its own and Mark still maintains it, updates it, promotes it, fixes it up when problems arise. It is an ongoing concern. Have a listen to Mark and Matt, have a look at https://goodsamapp.org and have a think about getting involved.

This week we discuss facial trauma and the disasters it can cause to your airway management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_79_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Cricothyroidotomy, RSI, Trauma Show Notes Take Home Points In a patient with significant head and neck trauma, EACH step of the airway management can be more difficulty. BVM may be hard, LMA may be hard, RSI may be hard, so don't be afraid to ask for help early. Decide whether the patient has an actual obstruction of their airway. If they are obstructed above the larynx, don't bother with your usual airway maneuvers, go directly to the surgical airway. When you do attempt RSI, have double suction and multiple airway techniques set up. This is the time to have your friend standing at your side, scalpel in hand and ready to move directly down the difficult airway algorithm if trouble arises. Finally, consider keeping the patient awake and preserving their own respiratory drive as it may give you more time to secure the airway. Read more LITFL: Facial Trauma LITFL:

This week we discuss facial trauma and the disasters it can cause to your airway management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_79_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Cricothyroidotomy, RSI, Trauma Show Notes Take Home Points In a patient with significant head and neck trauma, EACH step of the airway management can be more difficulty. BVM may be hard, LMA may be hard, RSI may be hard, so don’t be afraid to ask for help early. Decide whether the patient has an actual obstruction of their airway. If they are obstructed above the larynx, don’t bother with your usual airway maneuvers, go directly to the surgical airway. When you do attempt RSI, have double suction and multiple airway techniques set up. This is the time to have your friend standing at your side, scalpel in hand and ready to move directly down the difficult airway algorithm if trouble arises. Finally, consider keeping the patient awake and preserving their own respiratory drive as it may give you more time to secure the airway. Read more LITFL: Facial Trauma LITFL:

This week we do a little spaced repetition on adrenal insufficiency and then discuss fluid responsiveness and resuscitation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_75_0_Final_Cut.m4a Download Leave a Comment Tags: Adrenal Insufficiency, Critical Care, Fluid Responsiveness, Fluid Resuscitation, Sepsis, Septic Shock Show Notes Read More Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med 2016. PMID: 26571187 LITFL: Adrenal Insufficiency EMCrit: Podcast 64 – Assessing Fluid Responsiveness with Dr. Paul Marik Core EM: Adrenal Crisis Core EM: Episode 15.0 – Adrenal Crisis

This week we do a little spaced repetition on adrenal insufficiency and then discuss fluid responsiveness and resuscitation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_75_0_Final_Cut.m4a Download Leave a Comment Tags: Adrenal Insufficiency, Critical Care, Fluid Responsiveness, Fluid Resuscitation, Sepsis, Septic Shock Show Notes Read More Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med 2016. PMID: 26571187 LITFL: Adrenal Insufficiency EMCrit: Podcast 64 – Assessing Fluid Responsiveness with Dr. Paul Marik Core EM: Adrenal Crisis Core EM: Episode 15.0 – Adrenal Crisis References

This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they're not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don't forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage

This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they’re not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don’t forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage EMCrit:

This week, we discuss Boerhaave syndrome focusing on making the diagnosis and managing the patient. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_66_0_Final_Cut.m4a Download One Comment Tags: Chest Pain, Pulmonary Show Notes Take Home Points Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain.  We don't see it often, but it's a real thing.  Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting.  So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind.  Other causes you might see, though less common, are childbirth, seizure, prolonged coughing or laughing, or weightlifting. ED management is essentially ABCs and broad spectrum antibiotics, and maybe even antifungals. As soon as you make this diagnosis, get you CT surgeon on board as the length of time to definitive treatment is directly related to mortality. Read More Radiopaedia: Boerhaave Syndrome LITFL:

This week, we discuss Boerhaave syndrome focusing on making the diagnosis and managing the patient. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_66_0_Final_Cut.m4a Download Leave a Comment Tags: Chest Pain, Pulmonary Show Notes Take Home Points Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain.  We don't see it often, but it's a real thing.  Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting.  So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind.  Other causes you might see, though less common, are childbirth, seizure, prolonged coughing or laughing, or weightlifting. ED management is essentially ABCs and broad spectrum antibiotics, and maybe even antifungals. As soon as you make this diagnosis, get you CT surgeon on board as the length of time to definitive treatment is directly related to mortality. Read More Radiopaedia: Boerhaave Syndrome LITFL:

This week, we discuss Boerhaave syndrome focusing on making the diagnosis and managing the patient. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_66_0_Final_Cut.m4a Download Leave a Comment Tags: Chest Pain, Pulmonary Show Notes Take Home Points Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain.  We don’t see it often, but it’s a real thing.  Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting.  So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind.  Other causes you might see, though less common, are childbirth, seizure, prolonged coughing or laughing, or weightlifting. ED management is essentially ABCs and broad spectrum antibiotics, and maybe even antifungals. As soon as you make this diagnosis, get you CT surgeon on board as the length of time to definitive treatment is directly related to mortality. Read More Radiopaedia: Boerhaave Syndrome LITFL: Roast Duck an...

This week we discuss the presentation and treatment of hypokalemia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_61_0_Final_Cut.m4a Download Leave a Comment Show Notes Take Home Points Hypokalemia has a wide variety of presentations ranging from generalized weakness, to paralysis, to cardiac arrhythmia or cardiac arrest. When you discover hypokalemia, be sure to check and EKG. Think about underlying causes of hypokalemia, because it is rarely a solo event. Treat with oral potassium supplementation of 40-60 orally every 4-6 hours for mild hypokalemia and 10-20 mEq/hour IV for severe or symptomatic hypokalemia. Additional Reading LITFL: Hypokalemia LITFL: Hypokalemic Periodic Paralysis Core EM: Hypokalemia Read More

This week we discuss the presentation and treatment of hypokalemia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_61_0_Final_Cut.m4a Download Leave a Comment Show Notes Take Home Points Hypokalemia has a wide variety of presentations ranging from generalized weakness, to paralysis, to cardiac arrhythmia or cardiac arrest. When you discover hypokalemia, be sure to check and EKG. Think about underlying causes of hypokalemia, because it is rarely a solo event. Treat with oral potassium supplementation of 40-60 orally every 4-6 hours for mild hypokalemia and 10-20 mEq/hour IV for severe or symptomatic hypokalemia. Additional Reading LITFL: Hypokalemia LITFL: Hypokalemic Periodic Paralysis Core EM: Hypokalemia Read More

This week we discuss the presentation and treatment of hypokalemia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_61_0_Final_Cut.m4a Download Leave a Comment Show Notes Take Home Points Hypokalemia has a wide variety of presentations ranging from generalized weakness, to paralysis, to cardiac arrhythmia or cardiac arrest. When you discover hypokalemia, be sure to check and EKG. Think about underlying causes of hypokalemia, because it is rarely a solo event. Treat with oral potassium supplementation of 40-60 orally every 4-6 hours for mild hypokalemia and 10-20 mEq/hour IV for severe or symptomatic hypokalemia. Additional Reading LITFL: Hypokalemia LITFL: Hypokalemic Periodic Paralysis Core EM: Hypokalemia Read More

So SMACC Dublin is nearly upon us. I wouldn’t like to be organising it. Paul Young is going and he is hilarious. And very smart. And a research rising star. I certainly have all his mind maps via LITFL. He knows how to put a meeting together having recently been the Medical Convener of the ASM of the worlds first College of Intensive Care Medicine. (He is, however, rather humble about how hard it was to dream it all up.) And he controls the weather. Is there anything he cannot do? Well, he couldn’t comment when he was asked comment on the goings on at the notorious Boogie Wonderland Night Club late one night in Wellington. The plot thickens.

Ep #12 @JavaDrake – Trauma US and the E-FAST exam   For more on Yale’s Emergency Ultrasound Program: http://medicine.yale.edu/emergencymed/ultrasound/ For more information on the Prehospital Pilot Program, scheduled to launch at our CC US conference in Newport, RI this September: http://medicine.yale.edu/emergencymed/ultrasound/courses/   Check out our prehospital friends & POCUS bloggers: http://emspocus.com/   There are a tremendous amount of #FOAMed Ultrasound resources out there and it’s only natural to want to consume it all!  Trust me when I say nobody will blame you for getting excited about point of care US.  Resources are very nicely summarized and linked by @sandnsurf on the LITFL blog: http://lifeinthefastlane.com/ultrasound-in-emergency-medicine/.  Lot’s of additional links also in the comments section.     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org  

Emergent placement of a temporary TV pacer is a life-saving procedure. We review the procedure along with some pearls along the way. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_25_0_TV_Pacemakers_Final_Cut.m4a Download Leave a Comment Tags: Transvenous Pacemaker Show Notes Bessman ES: Emergency Cardiac Pacing, in Roberts JR, Hedges JR, Custalow CB, et al (eds): Clinical Procedures in Emergency Medicine, ed 6. Philadelphia, Saunders, 2013, Ch 15:p 277-300. Read More: EM Updates: Electromechanical Dissociation LITFL: Temporary Transvenous Cardiac Pacing

Emergent placement of a temporary TV pacer is a life-saving procedure. We review the procedure along with some pearls along the way. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_25_0_TV_Pacemakers_Final_Cut.m4a Download Leave a Comment Tags: Transvenous Pacemaker Show Notes Bessman ES: Emergency Cardiac Pacing, in Roberts JR, Hedges JR, Custalow CB, et al (eds): Clinical Procedures in Emergency Medicine, ed 6. Philadelphia, Saunders, 2013, Ch 15:p 277-300. Read More: EM Updates: Electromechanical Dissociation LITFL: Temporary Transvenous Cardiac Pacing

Emergent placement of a temporary TV pacer is a life-saving procedure. We review the procedure along with some pearls along the way. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_25_0_TV_Pacemakers_Final_Cut.m4a Download Leave a Comment Tags: Transvenous Pacemaker Show Notes Bessman ES: Emergency Cardiac Pacing, in Roberts JR, Hedges JR, Custalow CB, et al (eds): Clinical Procedures in Emergency Medicine, ed 6. Philadelphia, Saunders, 2013, Ch 15:p 277-300. Read More: EM Updates: Electromechanical Dissociation LITFL: Temporary Transvenous Cardiac Pacing

Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia Show Notes Diabetic Ketoacidosis LITFL: EBM Diabetic Ketoacidosis emDocs: Myths in DKA Management REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis? Hyperkalemia LITFL: Hyperkalaemia Core EM: Hyperkalemia Core EM: Podcast 7.0 Intubation in Severe Metabolic Acidosis EMCrit: Podcast 3 – Laryngoscope as a Murder Weapon Series – Ventilatory Kills – Intubating the Patient with Severe Metabolic Acidosis

Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia Show Notes Diabetic Ketoacidosis LITFL: EBM Diabetic Ketoacidosis emDocs: Myths in DKA Management REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis? Hyperkalemia LITFL: Hyperkalaemia Core EM: Hyperkalemia Core EM: Podcast 7.0 Intubation in Severe Metabolic Acidosis EMCrit: Podcast 3 – Laryngoscope as a Murder Weapon Series – Ventilatory Kills – Intubating the Patient with Severe Metaboli...

Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia Show Notes Diabetic Ketoacidosis LITFL: EBM Diabetic Ketoacidosis emDocs: Myths in DKA Management REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis? Hyperkalemia LITFL: Hyperkalaemia Core EM: Hyperkalemia Core EM: Podcast 7.0 Intubation in Severe Metabolic Acidosis EMCrit: Podcast 3 – Laryngoscope as a Murder Weapon Series – Ventilatory Kills – Intubating the Patient with Severe Metabolic Acidosis Core EM:

A Christmas review of the world of EM, CC and resuscitation #FOAMed. This review is no way exclusive and focuses on sites that people may not be  familiar with. Take it as read that EMCRIT, LITFL, PHARM, ICN, SGEM, EMLitofNote, ALiEM, Resus.me, KI docs, etc. are already known to be awesome. Check them out and follow the many excellent #FOAMed sites around the world. Check out the big hitters here http://www.aliem.com/social-media-index/ There are also so many other sites that we have not mentioned, but which we regularly visit and listen to. vb S

Anand ‘Swami' Swaminathan is an Emergency Physician in New York. He is one of the co-creators of EM Lyceum, and a major contributor to LITFL.com. Swami is a skeptic of the benefit of adrenaline in cardiac arrest. This is his brief response to Scott Weingart's Cutting Edge Intra-Arrest Care at smaccGOLD and Weingart's subsequent discussion about intra-arrest meds with Rob Mac Sweeney on EMCrit.

Iain and Simon chat about how we can start to translate research findings in to natural frequency summaries that help clinicians and patients alike understand the value of therapeutic interventions. The NNT site we mention is just fantastic. Visit them here  Great revision page here by the amazing LITFL crew  The NNT for tranexamic acid is 67 not 50. S

The sound was just too poor to publish this one on LITFL etc but these guys were great. Bummer. I really want to catch them again. They had literally just dropped from the ceiling at the SIM wars feature at the end of the SMACC.

Listen to LITFL's Chris Nickson give 5 pearls on managing cardiotoxic drug overdoses. Punchy and memorable. Never surrender! The excelllent slides are available for free on Intensive Care Network.