Podcasts about neurocritical care

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, welcomes back Andrew Webb, PharmD, to unpack "Effect of Desmopressin on Attaining Therapeutic Hypernatremia with Hypertonic Saline Continuous Infusion in Intracranial Hemorrhage," recently published in Neurocritical Care. Desmopressin has become a familiar tool for blunting antiplatelet-associated bleeding in intracranial hemorrhage, but its vasopressin-receptor activity raises a concern. Does it work against efforts to raise sodium with hypertonic saline? Dr. Webb traces desmopressin's path from a 1970s antidiuretic drug for diabetes insipidus to a hemostatic agent borrowed from the hemophilia literature, then walks through its pharmacokinetics, typical hemostatic dosing and the relatively modest side-effect profile clinicians should watch for. The conversation turns to a single-center retrospective study that paired a protocolized, TEG-guided desmopressin dose with a nurse-driven hypertonic saline sliding-scale infusion targeting a sodium goal of 150–155 mEq/L. Drs. Choi and Webb walk through how the study was designed and what it found, touching on sodium goal attainment, TEG changes, 3% saline volumes and thromboembolic risk. They also dig into the study's limitations, including its more conservative desmopressin dosing relative to practice at other centers, and agree a randomized trial is still needed to settle desmopressin's role in ICH management more broadly. For clinicians giving desmopressin alongside hypertonic saline, Dr. Webb offers a practical piece of advice worth tuning in for. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, FCCM, speaks with Tarek El Halabi, MD, who leads acute neurology services at the American University of Beirut Medical Center, about his Currents article, "Neurocritical Care in Lebanon: Progress Within Constraint." El Halabi didn't build a neuro ICU from the ground up. He joined an already established mixed medical-surgical unit and worked to change it from within, winning over colleagues and standardizing care for the emergencies that arise most often, including stroke, status epilepticus and bleeds. He and Koffman talk through what that took, from identifying the right people to lead each effort to investing heavily in nursing and resident training. While technical skills can be learned relatively quickly, building a lasting culture takes much longer. They also dig into what "resource-limited" really means in a country with highly trained physicians and advanced medicine. In Lebanon, El Halabi explains, the constraint isn't expertise, but financial access and consistency, since a patient's care can depend heavily on their insurance and where they happen to present. He describes how his team redesigned stroke workflows to meet AHA/ASA benchmarks despite these limits, as well as where the program goes from here, including adding more faculty, developing a neuro ICU fellowship, strengthening research ties with NCS's MENA region colleagues, and eventually expanding telemedicine outreach beyond Beirut. To read the full article, visit NCS Currents. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this bonus episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, continues his conversation with Andrew Webb, PharmD, with a preview of "Subarachnoid Hemorrhage: Clazosentan vs. Fasudil for Vasospasm Prevention (SAVIOR) Study: Study Protocol for a Prospective, Multicenter, Randomized Trial," published in Neurocritical Care. They review the history of nimodipine as the standard treatment for improving outcomes after aneurysmal subarachnoid hemorrhage and compare its mechanism with those of fasudil and clazosentan. Dr. Webb explains why fasudil is commonly used for vasospasm prevention in Japan and discusses previous research showing that clazosentan can reduce vasospasm without consistently improving functional outcomes when added to nimodipine. The conversation also explores how the SAVIOR trial will directly compare clazosentan and fasudil in a nimodipine-free population. They consider whether the trial could establish a preferred approach in Japan, what its results might mean for practice elsewhere and whether clazosentan may eventually have a role for selected patients who cannot tolerate nimodipine. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, is joined by Andrew Webb, PharmD, to discuss the article "Valproic Acid for the Management of Agitation in Neurosurgical Intensive Care Unit Patients," published in Neurocritical Care. Their conversation examines the complex causes of delirium and agitation in the neurocritical care setting, including neurologic injury, medication effects, sleep disruption and frequent clinical interventions. They review nonpharmacologic approaches to delirium prevention, current sedation strategies and the potential role of valproic acid as an adjunct when agitation remains difficult to control. They also discuss findings from the retrospective study, in which valproic acid use was associated with reduced requirements for opioids, benzodiazepines and dexmedetomidine, along with fewer positive agitation scores and less use of physical restraints. Dr. Webb reviews the medication's multimodal effects, potential adverse events and drug interactions, and patient populations that may benefit from its use. He also emphasizes the need for careful monitoring, eventual deprescribing and prospective research to clarify valproic acid's role in neurocritical care. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Eric Lawson, MD, speaks with NCS Vice President and Annual Meeting Planning Committee Chair Lori Shutter, MD, FNCS, for a preview of the NCS 24th Annual Meeting, taking place Oct. 20-23 in Seattle. Dr. Shutter discusses this year's theme, "Reaching New Heights: Advancing the Future of Neurocritical Care," and how it reflects the Society's continued growth and optimism about the future of the field. The conversation offers a look at expanded workshop offerings, including sessions on the essentials of neurocritical care, critical care procedures, point-of-care and neurofocused ultrasound, and informatics and big data. Dr. Shutter also previews keynote addresses from Walter Koroshetz, MD, and Lisa Meeks, PhD, along with sessions focused on clinical trials, physiology, pediatric neurocritical care, global health, professional development and sustainability in the ICU. Listeners will also learn about opportunities for first-time attendees and new members, the return of the leadership closing panel and an open brainstorming session focused on the Society's next major area of research. Dr. Shutter shares how attendee feedback shaped this year's program and offers advice for making the most of the meeting's concurrent sessions, networking opportunities and special events. The views expressed on the NCS Podcast are solely those of the host and guest and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

Navigating the complexities of medical malpractice cases demands a unique blend of clinical expertise and legal insight. This episode of the Legal Nurse Podcast welcomes a board-certified physician in emergency medicine, internal medicine, and neurocritical care, who brings more than 24 years of experience as an expert witness with over 300 trial testimonies. Together, they delve into the evolving role of medical experts, from pre-litigation consultations to providing critical insights on causation and damages in both medical malpractice and nursing home cases. Listeners will gain a behind-the-scenes look at how clinicians become involved in the legal world, how reviewing cases sharpens clinical practice, and the ever-changing nature of medical recordkeeping from handwritten notes to searchable digital PDFs and the emerging role of artificial intelligence in case review. Share practical advice for new experts, discusses the importance of honest, evidence-based opinions, and explore the challenges experts face when attorneys or clients may want to influence findings. Whether you're a legal professional, a clinician considering expert witness work, or simply interested in the intersection of medicine and law, this episode provides invaluable perspectives and actionable guidance for navigating tough cases and maintaining integrity in your practice. What You'll Learn in This Episode is The Intersection of Medicine and Law: Dr. Stein Shares Witness Strategies Here are 5 discussion questions answered by Pat Iyer and Kenny Stein in the podcast: How does a multi-specialty background inform his approach to reviewing medical malpractice cases? What are some of the key differences identified between being a testifying and a non-testifying expert? What potential and limitations does see in using AI to analyze medical records or assess standards of care? What are the biggest challenges and advantages that experience when working with electronic medical records compared to traditional paper records? How does recommend handling emotionally invested attorneys or families when a case does not have merit? Listen to our podcasts or watch them using our app, Expert.edu, available at legalnursebusiness.com/expertedu. Get the free transcripts and also learn about other ways to subscribe. Go to Legal Nurse Podcasts subscribe options by using this short link: http://LNC.tips/subscribepodcast. Your Presenters for The Intersection of Medicine and Law: Dr. Stein Shares Witness Strategies Pat Iyer Pat Iyer is a seasoned legal nurse consultant and business coach, renowned for her expertise in guiding new legal nurse consultants to successfully break into the field. As the host of the Legal Nurse Podcast, Pat addresses critical challenges that legal nurse consultants face, such as difficulty in landing clients and a lack of response from attorneys. Through her insightful episodes, she emphasizes the importance of effectively communicating one's value to potential clients. With a wealth of experience, Pat has empowered countless consultants to overcome these hurdles and thrive in their careers. Connect with Pat Iyer by email at patiyer@legalnusebusiness.com Kenny Stein Dr. Stein is board-certified in Emergency Medicine, Internal Medicine, and Subspecialty-certified in Neurocritical Care. Dr. Stein has been an Expert Witness for 24 years, reviewing over 800 cases for both plaintiff and defense. Dr. Stein has testified over 300 times at depositions and trials. Connect with Kenny Stein by email at kennystein1@gmail.com

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, is joined by Chiara Robba, MD, PhD, to discuss the article "The Effects of Milrinone Systemic Administration on Cerebral Perfusion as Measured with Computed Tomography in Aneurysmal Subarachnoid Hemorrhage Patients," published in Neurocritical Care. Their conversation explores the complex, multifactorial pathophysiology of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage and the potential role of intravenous milrinone as a rescue therapy. They discuss how milrinone may influence both systemic and cerebral hemodynamics, as well as the role of CT perfusion imaging in evaluating cerebral blood flow and perfusion heterogeneity. They also review findings from the retrospective study, including milrinone's association with increased cardiac index but not a consistent increase in cerebral blood flow. Among patients who did not develop delayed cerebral ischemia, cerebral perfusion became more spatially homogeneous as the milrinone dose increased. Dr. Robba explains why the distribution of cerebral blood flow may be more informative than its average value, the potential of perfusion heterogeneity as a marker of treatment response and why larger prospective studies are needed before these findings can inform changes in clinical practice. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

We've heard you guys and we are ready to deliver! We are proud to bring you guys our first of several episodes on Neurocritical Care! On this episode - our introductory show - we had the pleasure of hosting Dr. Casey Albin a neurologist & neurointensivist who introduces the topic of neurocritical care with a special focus on basic tenets of stroke management. What type of imaging should you order? What do you do with anticoagulation? Who get's seizure prophylaxis? We cover all this and more with Dr. Albin. Please take a listen and let us know what you think and what else you want to hear from us! Hosted on Acast. See acast.com/privacy for more information.

In this episode of Compassion & Courage, trauma surgeon Tim Pohlman shares his experiences from the hospital walls, the emotional toll of trauma care, and the importance of compassionate presence in medicine. Discover the realities of emergency resuscitation, ethical dilemmas, and how to maintain resilience in high-stakes environments.Resources for you: More communication tips and resources for how to cultivate compassion: https://marcusengel.com/freeresources/Connect with Marcus on LinkedIn: https://www.linkedin.com/in/marcusengel/Learn more about Marcus' Books: https://marcusengel.com/store/Subscribe to our podcast through Apple: https://bit.ly/MarcusEngelPodcastSubscribe to our podcast through YouTube: https://bit.ly/Youtube-MarcusEngelPodcastAbout Timothy Pohlman, M.D., F.A.C.S.:Timothy Pohlman, M.D., F.A.C.S. is a board-certified surgeon who specializes in Trauma Surgery. He is also board-certified in Surgical Critical Care, and board-certified in Neurocritical Care. Dr. Pohlman is former Professor of Surgery at Indiana University School of Medicine (IUSOM). During that time, Dr. Pohlman was a staff surgeon at Indiana University Health Methodist Hospital in Indianapolis, IN., Medical Director of Trauma Intensive Care, Director of Trauma Outreach, and Assistant Medical Director for LifeLine Critical Care Transport for Trauma. Dr. Pohlman graduated from Knox College in 1973 with a bachelor's degree in biology. He received a doctorate in medicine from Rush Medical College in Chicago, IL, being elected into the Alpha Omega Alpha Medical Honor Society his senior year. Dr. Pohlman then completed internship and residency in general surgery at the University of Wisconsin in Madison, WI, serving as Chief Resident his fifth year. Dr. Pohlman obtained advanced training as a Fellow in trauma and burn surgery at the University of Washington in Seattle, WA. During his training, he was supported by a National Institutes of Health Research Service Award. After fellowship training, Dr. Pohlman remained in Seattle, joining the faculty of the University of Washington as assistant professor of surgery. He was subsequently promoted to full professor, with tenure in 2000. While at the University of Washington he was awarded research grants from the National Institute of Health to study human responses to injury. In 2005 he was recruited to IUSOM in Indianapolis, IN to serve as director of Surgical Critical Care. Dr. Pohlman has received numerous awards during his career, including Outstanding Teacher of the Year from the University of Washington, School of Medicine. Dr. Pohlman is a member of over 20 professional organizations, including the Society of University Surgeons, The Eastern Association for the Surgery of Trauma, The Neurocritical Care Society, Surgical Infection Society, where he serves on the Informatics Committee, the Society of Critical Care Medicine, and the Chest Wall Injury Society, where he serves on the Publication Committee. He has authored or coauthored over 80 peer-reviewed journal articles, book chapters, eMedicine articles, and scholarly book reviews. In 2004, he was Visiting Professor in the Department of Thoracic & Cardiovascular Surgery, Mie University School of Medicine, Osaka, Japan. In Indiana, Dr. Pohlman has served on the Board of Directors of the Indiana Rural Health Association. Currently he serves on the Board of Directors of the Brain Injury Association of Indiana and is a member of the Indiana Spinal Cord and Brain Injury Research Board. He is also a member of the Medical Executive Committee of the Rehabilitation Hospital of Indiana, and a member of the Physician Advisory Committee of the Indiana Donor Network. Dr. Pohlman is a former co-chair of the Transfusion Committee for IU Health, which oversees an annual budget of $16.5 million. Dr. Pohlman also served for a number of years as track surgeon for the Indianapolis Motor Speedway. He also has been a NASCAR-certified on-track physician (designated in track radio transmissions as the “99”).Date: 7/27/2026 Name of show: Compassion & Courage: Conversations in Healthcare Episode number and title: Episode 184 – The Hidden World of Emergency Rooms with Tim Pohlmankeywordstrauma surgery, emergency medicine, resilience, medical ethics, compassionate care, hospital stories

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Shraddha Mainali, Sahar Zafar and Brooke Murtaugh about their Currents article, "Neurocritical Care Disorders of Consciousness: Do We Have the Education We Need to Provide Care?" The guests discuss the clinical spectrum of disorders of consciousness and the importance of accurately assessing patients using standardized bedside examinations, neuroimaging and other multimodal tools. They also examine the role of neuroprognostication in guiding conversations with families and ensuring that patients are given appropriate opportunities for recovery. The conversation explores findings from a pilot survey on educational needs related to disorders of consciousness. The panel discusses barriers to care and education, including limited access to centralized resources, time constraints and knowledge gaps in assessment, diagnosis, prognosis and treatment. They also highlight the Curing Coma® Campaign's efforts to expand access to evidence-based education through webinars, online resources, World Coma Day and interdisciplinary global collaboration. To read the full article, visit NCS Currents. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this month's EM Quick Hits Podcast, Amna Karabegovic joins us for an EMC² case of pediatric altered LOA and neurocritical care, Anand Swaminathan simplifies the high-risk management of pulmonary hypertension and right ventricular failure, and Brit Long reviews how to recognize and treat Cytokine Release Syndrome. Plus, Andrew Tagg on whether uncomplicated pediatric distal radius fractures need reduction, Jesse McLaren on a systematic approach to ECG interpretation in the bradycardic patient, and Sara Gray and Katie Lin return for Part 2 of “Coaching the EM Mind,” with practical strategies for managing stress and optimizing psychological safety on shift… Please consider a donation to ensure EM Cases continues to be high quality Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, is joined by Eric Rosenthal, MD, to discuss the article "Surgical Intervention for Super-Refractory Status Epilepticus," a systematic review published in Neurocritical Care. Their conversation explores why super-refractory status epilepticus can become increasingly difficult to control, the limited evidence guiding treatment after standard medical therapies have failed and how surgical approaches may fit into care for selected patients. They also discuss the review's findings across 114 reported cases, including high rates of status epilepticus termination after surgical intervention, the distinction between terminating status and achieving long-term freedom from disabling seizures and the potential role of earlier multidisciplinary collaboration with epilepsy and neurosurgery teams. Dr. Rosenthal also emphasizes the importance of matching the intervention to the patient's underlying etiology, seizure localization and goals of care. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, is joined by Alejandro Rabinstein, MD, Shraddha Mainali, MD, and Krishna Rajajee, MD, to discuss the article "Guidelines for Neuroprognostication in Critically Ill Adults With Acute Ischemic Stroke," published in Neurocritical Care. Their conversation explores the development of the guideline, including the need for a more structured, evidence-based approach to prognostication in critically ill patients with acute ischemic stroke. The guests discuss why early prognostication is especially high-stakes, how uncertainty and the risk of self-fulfilling prophecy shaped the recommendations and why no single clinical variable or prediction model is reliable enough to guide individual decisions about poor outcomes. They also review the role of early neurological improvement as a moderately reliable predictor of good outcomes, the limitations of existing prediction models in the era of reperfusion therapy, and the importance of multimodal assessment, ongoing family conversations, long-term outcome counseling and shared decision-making rooted in each patient's values. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Perspectives series, host Nicholas Morris, MD, leads a roundtable discussion with neurocritical care fellowship directors Jenna Ford, MD; Rishi Malhotra, MD; Fiona Lynch, MD; and Matt Bevers, MD, on the current state of neurocritical care fellowship training. The panel discusses what distinguishes their programs, how fellowship leadership roles evolve and the ways Accreditation Council for Graduate Medical Education (ACGME) accreditation has shaped training programs. The conversation also examines key challenges in fellowship education, including recruitment, changing learner expectations, wellness, faculty development and collaboration with neurosurgery, APPs and other critical care teams. The group also shares practical advice for fellowship applicants, including what programs look for in strong candidates and the questions applicants should ask when evaluating potential programs. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Ryan Hakimi, DO, MS, a neurointensivist at Prisma Health and member of the Neurocritical Care Society Board of Directors, about his Currents article, "The Business of Neurocritical Care: Understanding Physician Benefits." Dr. Hakimi explores the often-overlooked financial side of physician compensation, focusing on how retirement benefits can meaningfully shape the overall value of an employment offer. He explains the differences between 401(a), 403(b), 401(k), and 457(b) plans, including employer contributions, tax advantages, vesting periods and expense ratios. He also discusses why a lower base salary may sometimes be offset by a stronger overall benefits package. The conversation highlights why physicians should request and review benefits information during contract negotiations rather than focusing only on salary, title and work expectations. This episode offers practical guidance for physicians seeking to better understand the long-term financial impact of their benefits package and make more informed career decisions. To read the full article that inspired this conversation, visit "The Business of Neurocritical Care: Understanding Physician Benefits" on NCS Currents. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

Westchester Magazine's 2026 Healthcare Heroes Luncheon united an inspiring community to celebrate the extraordinary individuals whose dedication has profoundly shaped regional healthcare. Held on Thursday, May 14th, at Mulino's at Lake Isle Country Club in Eastchester, NY, the event provided guests with a meaningful afternoon dedicated to honoring and connecting with this year's honorees. Recognized for their exceptional compassion and excellence, the remarkable stories of these distinguished professionals will be featured in the upcoming May issue of Westchester Magazine.Dr. Fawaz Al-Mufti, a neurologist, neurocritical care specialist, and neuroendovascular surgeon with the Westchester Medical Center and New York Medical College, shared his professional journey with host Bob Marrone. He described the high-stakes reality of treating neurological catastrophes—such as brain hemorrhages, ruptured aneurysms, and acute ischemic strokes—both through emergency procedures and intensive care management. Dr. Al-Mufti, who began his medical career in emergency medicine with Doctors Without Borders, also serves as the Associate Dean for Research and Innovation at New York Medical College, where he oversees a broad range of medical research. Expressing deep passion for his field, he emphasized that it is an absolute privilege to care for his patients and credited his success to the collective efforts of his team at the Brain and Spine Institute.

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, is joined by Katharina Busl, MD, MS, to discuss the article "Infratentorial Pressure Monitoring in Cerebellar Stroke: Feasibility and Prognostic Utility," recently published in Neurocritical Care. Their conversation examines why pressure in the posterior fossa may differ from supratentorial measurements in patients with cerebellar stroke and why that distinction may matter clinically. They discuss the physiologic basis for compartmentalized intracranial pressure, the challenges of posterior fossa management and the potential implications for monitoring and treatment. Dr. Busl reviews the study's design and key findings, including evidence of a significant pressure gradient between infratentorial and supratentorial compartments and an early signal that higher infratentorial pressures may be associated with worse outcomes. She also discusses important limitations, including the study's small sample size, single-center nature and unanswered questions about surgical variables such as decompression size. The discussion further considers how this proof-of-concept work could inform future studies on monitoring, prognostication and treatment selection in cerebellar stroke. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, is joined by Melissa Dang, PharmD, BCCCP, neurocritical care pharmacist at MedStar Franklin Square Medical Center, to discuss the article "Levetiracetam Dosing Optimization in Neurocritical Care Population: Neuro-ARC Study", recently published in Neurocritical Care. Their conversation explores how augmented renal clearance may reduce levetiracetam exposure in neurocritical care patients and the implications for seizure management in clinical practice. Dr. Dang breaks down the study's pharmacokinetic modeling, highlights key dosing findings and reviews the patient factors most strongly associated with increased drug clearance. She also discusses the study's limitations and emphasizes the need for caution when applying its findings across broader clinical settings. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

What if stroke treatment could start in the ambulance instead of the hospital? In this conversation, Dr. Ritvij Bowry sits down with us to explain how mobile stroke units are helping patients get faster care when every second matters. When a stroke happens, time is critical. The sooner doctors can diagnose the problem and begin treatment, the better the chances of recovery. Dr. Bowry shares how specially equipped ambulances with CT scanners and expert teams are bringing stroke care directly to patients – thus changing the possibilities of emergency medicine… Hit play to find out: Early interventions that can help people after suffering a stroke. The three types of stroke, and why they are treated differently. The two most commonly used medicines for stroke.  What the future of emergency stroke care may look like. Dr. Ritvij Bowry is a board-certified neurologist specializing in Neurocritical Care, stroke treatment, and vascular neurology. He serves as Associate Professor at UTHealth Houston, where his research focuses on acute neurological emergencies and innovative approaches to stroke care. He earned his medical degree from Ross University School of Medicine in Miramar, Florida. After completing his residency at New York University Medical Center and an internship at New York Presbyterian Hospital in Queens, he pursued advanced fellowship training at the University of Texas Health Science Center at Houston in both Neurocritical Care and Stroke/Vascular Neurology. Dr. Bowry's primary research focus includes the BEST-MSU study (Benefits of Stroke Treatment Using a Mobile Stroke Unit), a multi-center trial evaluating whether delivering stroke treatment directly in the field leads to better outcomes than traditional emergency department care. To learn more about Dr. Bowry, click here now!

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, is joined by Wendy Ziai, MD, professor of neurology and critical care medicine at Johns Hopkins University, to discuss the article "Prophylactic Anti-Seizure Medication in Patients with Lobar Intracerebral Hemorrhage", recently published in Neurocritical Care. Their conversation explores the ongoing debate surrounding prophylactic antiseizure medication use in patients with lobar intracerebral hemorrhage. They review current guideline recommendations, highlight limitations in the existing evidence and consider the challenge of balancing seizure prevention with the risk of adverse effects. Dr. Ziai reviews key findings from prior trials as well as the featured study, which demonstrated lower rates of early seizures among patients who received prophylaxis. She also addresses questions related to patient selection, nonconvulsive status epilepticus and long-term cognitive outcomes. The discussion further considers the role of continuous EEG monitoring in the first 48 hours and how future study designs may help clarify which patients, if any, are most likely to benefit. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society. 

In this episode of the Neurocritical Care Society Podcast Hot Topics series, host Richard Choi, DO, FNCS, joins Melissa Dang, PharmD, BCCCP, a neurocritical care pharmacist at MedStar Franklin Square Medical Center, to discuss the article Real-World Antiseizure Medication Prophylaxis and Outcomes in Hospitalized Adults with Acute Brain Injuries, recently published in Neurocritical Care. Together, they examine the real-world use of antiseizure medication prophylaxis in patients with acute brain injury, including ischemic stroke, hemorrhagic stroke and traumatic brain injury. Dr. Dang highlights variability in current practice, key factors influencing prophylaxis decisions and the balance between seizure prevention and medication-related risks. She also reviews the study's limitations and underscores the ongoing importance of risk stratification in guiding patient care. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode, editor in chief Joseph E. Safdieh, MD, FAAN, highlights articles about ACGME neurocritical care accreditation, how neurologists in Jamaica are recovering from hurricane damage, and the use of rituximab maintenance dosing in multiple sclerosis.

In this episode of the Neurocritical Care Society Podcast Hot Topics series, host Richard Choi, DO, FNCS, speaks with Wendy Ziai, MD, MPH, professor of neurology and critical care medicine at Johns Hopkins University, about the article The Association Between Hourly Systolic Blood Pressure Variability and Outcomes in Patients With Intracerebral Hemorrhage Is Time-Dependent: A Post Hoc Analysis of the ATACH-2 Trial, recently published in Neurocritical Care. Their discussion explores why blood pressure variability — not just absolute blood pressure targets — may play a critical role in outcomes following acute intracerebral hemorrhage. Dr. Ziai reviews key findings from ATACH-2 and INTERACT trials, the physiologic mechanisms that may link variability to hematoma expansion and neurologic deterioration and why the timing of variability within the first 8 to 12 hours appears especially important. They also examine the unresolved question of causation versus association, implications for antihypertensive management in the ICU and how emerging trials focused on variability may shape future practice. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM, FAAN, a neurointensivist at Prisma Health, about his Currents article on billing in neurocritical care. Their conversation explores why billing and documentation education is often absent from medical training, how staffing models and split/shared billing affect physician productivity and key considerations when working with advanced practice providers. Dr. Hakimi also shares practical insights on aligning documentation and billing practices with institutional metrics to support sustainable neurocritical care programs. To read the full article, visit Business of Neurocritical Care: Billing Under the Attending Physician or APP—Which One is Right For You? The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Perspectives series, host Nicholas Morris, MD, speaks with Cherylee Chang, MD, division chief of neurocritical care and professor of neurology, neurosurgery and medicine at Duke University. Dr. Chang reflects on her journey from an early interest in cardiothoracic surgery to neurology, and ultimately, to the "intersectional" work that drew her to neurocritical care. She discusses her early training in the field, efforts to establish certification and fellowship accreditation pathways and the challenges of defining the essential components of what constitutes neurocritical care. Dr. Chang also shares insights from Duke's advanced practice provider model, her work to broaden multidisciplinary inclusion within NCS and her current focus on leadership development, workforce shortages and strategies to better attract the next generation to the field. Dr. Chang recommends the following books for those interested in developing their leadership potential:Difficult Conversations by Douglas Stone, Bruce Patton and Sheila HeenExtreme Ownership by Jocko Williams Leadership and Self-Deception by The Arbinger InstituteThe Fearless Organization by Amy EdmonsonThe Leader's Guide to Mastering Feedback by Joan HibdonThe Let Them Theory by Mel Robbins The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, speaks with Katharina Busl, MD, MS, FNCS, division chief of neurocritical care at the University of Florida and assistant editor for Neurocritical Care journal, about transfusion strategies in patients with acute brain injury. They discuss recent randomized trials and a new systematic review examining restrictive versus liberal red blood cell transfusion thresholds across traumatic brain injury, intracerebral hemorrhage and subarachnoid hemorrhage. Their conversation highlights the physiologic rationale behind transfusion, challenges in interpreting trial and meta-analysis data, and how overlapping hemoglobin ranges complicate bedside decision-making. Dr. Busl also shares how this evolving evidence is influencing clinical practice and the importance of individualized transfusion decisions. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, speaks with Katharina Busl, MD, MS, FNCS, division chief of neurocritical care at the University of Florida and assistant editor for Neurocritical Care journal. They explore new research on cerebrospinal fluid (CSF) clearance after aneurysmal subarachnoid hemorrhage. They also discuss the study Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage: The Lumbar Catheter Extension (PILLAR XT) Trial, which evaluates a dual-lumen intrathecal catheter designed to filter CSF and accelerate removal of red blood cells and inflammatory byproducts. Their conversation highlights the rationale behind CSF drainage, how prior work like the Early Drain trial shaped the field, and what this early-phase device trial reveals about feasibility, safety, and reductions in CSF RBC and protein levels. Dr. Bussel and Dr. Choi also touch on implementation challenges and the need for larger trials before this approach can move into broader clinical use. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Masterclass series, hosts Jon Rosenberg, MD, and Stephan Mayer, MD, speak with Jamie Odell, MD, assistant professor of neurocritical care and emergency medicine at the University of Maryland School of Medicine. Together, they explore paroxysmal sympathetic hyperactivity – how it develops after brain injury, why symptoms differ among patients and what current research suggests about its underlying neural networks. Dr. Odell offers practical guidance on recognizing patterns, avoiding anchoring bias and distinguishing PSH from other causes of instability. The conversation also covers common treatment approaches, scoring tools used at the bedside and areas of ongoing study. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Perspectives series, Nicholas Morris, MD, speaks with Werner Hacke, MD, PhD, DSc (hon. mult.), FAHA, FESC, senior professor of neurology at Heidelberg University and a major leader in vascular neurology and neurocritical care. Professor Hacke reflects on his path from psychiatry and psychology to helping establish Germany's early neurological intensive care units and advancing modern acute stroke care. He discusses his contributions to thrombolytics, intra-arterial therapy and the DESTINY trials in decompressive surgery. Professor Hacke also shares perspectives on the evolution of neurocritical care training in Europe, ethical challenges in randomized trials and the importance of collaboration among neurology, neurosurgery and neuroradiology. He touches on individualized decision making, standard-of-care gaps and the ongoing need for progress in hemorrhagic stroke research. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.    

In this episode of the NCS Podcast Hot Topics series, host Dr. Nicholas Morris speaks with Dr. Wendy Ziai, professor of neurology at Johns Hopkins and senior editor for Neurocritical Care, and Dr. Richard Choi, neurointensivist at MedStar Franklin Square and social media editor for the journal. This episode also introduces Dr. Richard Choi as the new host of the NCS Podcast Hot Topics series, which will continue to feature high-impact articles from Neurocritical Care. They discuss a new study, Postoperative Monitoring After Elective Intracranial Surgery in a Postanesthesia Care Unit is Safe, Efficient and Cost-Effective, by Arthur Wagner and colleagues in Munich, Germany. The conversation examines the 10-year experience with more than 5,500 patients, complication rates and how PACU-based pathways may ease ICU demand while supporting safe outcomes. Dr. Ziai and Dr. Choi also share perspectives on ICU capacity and the importance of collaboration across departments, showing how this research connects to real-world practice. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Perspectives series, Nicholas Morris, MD, is joined by Chere Chase-Gregory, MD, MHS, senior vice president and chief health equity officer at Novant Health and a practicing neurointensivist. Dr. Chase-Gregory, also an adjunct faculty member at the University of North Carolina and founding member of the Women in Neurocritical Care Committee, shares her path into leadership, the origins of the committee and her ongoing work to advance health equity, mentorship and community partnerships. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

On this EM Quick Hits podcast: Pediatric Torticollis with Dr. Deb Shconfeld, Approach to Stable Wide Complex Tachydysrhythmias with Dr. Anand Swaminathan, Post-intubation Neurocritical Care 5 best practices with Dr. Andrew Petrosoniak, Hyponatremia Correction Rates with Dr. Justin Morgenstern, Paronychia Management with Dr. Andrew Tagg, and Women in EM Leader Series with Judith Tintinalli and Dr. Victoria Myers...Donate to EM Cases to help ensure continued Free Open Access Medical Education in the future here: https://emergencymedicinecases.com/donation/

if you have any feedback, please send us a text! Thank you!Welcome to another episode of Vital Times, the CSA podcast! I'm your host, Dr. Rita Agarwal, and today we're revisiting an important topic: mentorship. We've discussed mentoring before, but its significance in the lives and careers of anesthesiologists makes it worth exploring again.Strong mentorship can have a transformative impact, especially for early career anesthesiologists. Yet, despite its many benefits, building effective mentorship programs continues to be a challenge. In this episode, we'll focus on how mentorship can help young professionals truly thrive.We're joined by two outstanding guests:Dr. Titi Aina-Jones, Associate Professor of Anesthesiology at Texas Children's Hospital. She trained at the University of Connecticut, University of Florida, and Boston Children's Hospital, and is currently pursuing a Master's in Medical Education at the University of Pennsylvania.Dr. Ioana Pasca, Associate Professor at Riverside and Loma Linda University Medical Center in the Department of Anesthesiology, Critical Care, and Neurocritical Care. She also serves as Associate Program Director and Director of Neuroanesthesia at Riverside University Health System, and like Dr. Aina-Jones, is currently enrolled in the Medical Education Master's Program at the University of Pennsylvania.

Rush University Medical Center's neurocritical care team treats patients with complex, emergent neurological conditions, providing them with advanced care that is available 24 hours a day, seven days a week. In this episode of Rounding at Rush, Rajeev Garg, MD, chief of the Division of Neurocritical Care at Rush, talks about how Rush clinicians collaborate closely with stroke specialists and neurosurgeons to treat patients with a range of severe neurological injuries, including aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, large ischemic strokes, traumatic brain injuries, status epilepticus and spinal cord injuries. “Time is brain. The longer an injured brain remains without treatment, the worse the damage and the worse the outcomes. As neurointensivists, our goal is to limit damage to the brain and provide patients the best possible outcomes for recovery.”

In this episode of the NCS Podcast Perspective series, Nicholas Morris, MD, is joined by Immediate Past-President of NCS, Paul Vespa, MD, a professor of neurology and neurosurgery at UCLA. Dr. Vespa shares his path into neurocritical care, as well as his views on the growth of neuro ICUs and advances in continuous EEG monitoring and microdialysis. He discusses the future of AI in EEG, the value of patient stories and the importance of clinician-investigators, mentorship, and teamwork. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.  

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Clio Rubinos, MD, MS, and Rommel Morel, MD, about the urgent need to improve pre-hospital neurocritical care in low- and middle-income countries. They explore disparities in emergency response, the reality of patients arriving via family or bystanders and community-driven solutions like Colombia's Bootstrap consensus and Uganda's MOTOR trial. The conversation highlights how global collaboration, data-driven strategies and shared passion are essential to improving outcomes and reducing inequities in neurocritical care. Read the accompanying article:Traumatic Brain Injury in a Resource-Limited Setting: A Reflection on the Importance of Timely Interventions in Neurocritical Care Have questions or interested in collaborating?Contact the authors directly: crubinos@unc.edu rommellmorel121@gmail.com The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

Most people believe that strokes only affect adults, but children can experience them too. Although rare, strokes in kids can lead to catastrophic outcomes if not treated properly. Seizure or migraines are often misdiagnosed in this population, making it crucial to have proper protocols in place. While many never think of stroke as something that can impact kids, it's still in the top 10 causes of death in children.  To understand the scope of pediatric stroke and the strides being made to prevent and treat it, we are joined by two experts. Timothy Bernard, MD, is the Director of Education for the section of Child Neurology, and the Director of the Childhood Stroke Program here at Children's Hospital Colorado. He is also a Professor of Pediatrics and Neurology at the University of Colorado School of Medicine. Ethan Rosenberg, MD, is the Director of Inpatient Childhood Stroke and Neurocritical Care. He is also an Assistant Professor of Pediatrics and Neurology.  Some highlights from this episode include:  Understanding diagnosis in this population  What causes stroke in kids  Why there are delays in recognizing stroke symptoms in younger children  The role of the primary care provider with stroke protocol   For more information on Children's Colorado, visit: childrenscolorado.org. 

In this episode of Perspectives, Dr. Nicholas Morris is joined by neurocritical care fellows Dr. Diana Alsbrook, Dr. Sonja Darwish and Dr. Scott Sparks to discuss the future of the field. They share insights on choosing a fellowship, the challenges of training and what it takes to become a well-rounded neurointensivist. From clinical autonomy and mentorship to wellness and preparing for life after fellowship, this conversation provides valuable perspectives for both aspiring fellows and experienced practitioners. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

Send us a textIt was a blast talking about all things neuro-ICU pharmacy with Dr. Andy Webb!Check out his very informative website NeuroWiseRx You can also find him on X/Twitter @AJWPharmSome of the resources mentioned in the podcast can be found here:Pharmacotherapy Of Neurocritical Care Series (PONS)Neurocritical Care Society Pharmacists ResourcesEditing by Avani Bhadang Check out our website at www.theneurotransmitters.com to sign up for emails, classes, and quizzes! Would you like to be a guest or suggest a topic? Email us at contact@theneurotransmitters.com Follow our podcast channel on

Join us for an illuminating discussion with Dr. Soojin Park, an Associate Professor of Neurology (in Biomedical informatics) and an Associate Attending Physician at Columbia University. Dr. Park discusses her career trajectory in neurocritical care and biomedical informatics as well as the potential of machine learning techniques to leverage clinical data to improve patient care.

In this episode of Perspectives, Dr. Nicholas Morris talks with Diane McLaughlin, FNCS, about her journey into neurocritical care and the vital role of postgraduate training for APPs. She highlights the importance of ultrasound, sharing how she developed her skills and discusses strategies for staff retention and career growth. She also reflects on advancements in stroke treatment and the benefits of professional society involvement.

In this week's podcast, Neurology Today's editor-in-chief highlights articles on proposed updated criteria for diagnosing MS before symptoms manifest, the use of large language models to address administrative burden with electronic medical records, and the growth of training programs in neonatal neurocritical care.

      Can a career in military medicine offer unexpected opportunities to innovate and shape the future of healthcare? Join us as we explore this intriguing question with Air Force Neurologist Lieutenant Colonel Adam Willis, MD. From his initial fascination with physics to his pivotal role in supporting operational medicine, Adam recounts his unique journey and the moment that brain-computer interface technology ignited his passion for neurology. Discover how neurologists make crucial contributions in managing traumatic brain injuries and seizures in combat zones while addressing the longer-term challenges of headaches, sleep disruptions, and cognitive performance.     In this episode, we unravel the complexities of trauma patient evacuation and the innovative strides being made to enhance survival rates. Adam sheds light on the "golden hour" concept and the development of groundbreaking technologies that ensure rapid access to care. As an insider at DARPA through the Service Chiefs Fellowship Program, Adam shares how his experiences have spurred projects to revolutionize field intensive care medicine. Learn about his work on a game-changing intravascular cannula project, which promises to transform medical care from the injury site through evacuation.     Finally, dive into the world of DARPA with insights into projects like SNAP, which seeks to assess warfighters' readiness using non-invasive biomarkers. Adam's story serves as a reminder of the power of commitment and proactivity in military medicine careers. Individuals can unlock doors to additional training and career advancement by aligning personal goals with the organization's mission. Hear how seizing unexpected opportunities and embracing new challenges can lead to meaningful contributions to the future of military medicine.   Chapters: (00:04) Neurology in Military Medicine (15:39) Advances in Trauma Patient Evacuation (23:16) Revolutionizing Field Intensive Care Medicine (28:01) Innovating Military Technology With DARPA (40:48) Commitment and Innovation in Military Medicine   Chapter Summaries: (00:04) Neurology in Military Medicine    Air Force neurologist discusses role in military medicine, managing TBI and seizures, and innovative intravascular cannula for polytrauma patients. (15:39) Advances in Trauma Patient Evacuation   Maximizing survival from traumatic injuries through rapid patient movement and exploring innovative projects at DARPA. (23:16) Revolutionizing Field Intensive Care Medicine    Collaboration between DARPA and industry to develop a miniaturized, non-anticoagulated ECMO-like system for extending the golden hour in emergency medical situations. (28:01) Innovating Military Technology With DARPA     DARPA program manager crafts questions to harness innovation, funded by DoD, SNAP project for non-invasive warfighter readiness assessment. (40:48) Commitment and Innovation in Military Medicine     Commitment and proactivity in military medicine careers can lead to opportunities for training and advancement.   Take Home Messages: Career Flexibility and Innovation: The journey from a physics background to a career in military neurology demonstrates the importance of being open to unexpected career paths. Embracing new technologies, such as brain-computer interfaces, can lead to groundbreaking roles in fields like military medicine. Neurology's Critical Role in Combat Medicine: Neurologists play a vital role in managing traumatic brain injuries and seizures in combat situations. Their expertise extends beyond acute care, addressing post-TBI issues like headaches and cognitive disruptions, which are essential for maintaining operational readiness. Advancements in Trauma Evacuation: Innovations in trauma care, such as extending the "golden hour," are crucial for improving survival rates from traumatic injuries. Technologies that facilitate rapid and scalable patient movement to definitive care can significantly impact outcomes. Integration of Technology and Medicine: The collaboration between military medicine and advanced research agencies, like DARPA, showcases the potential of integrating artificial intelligence and biotechnology to revolutionize trauma care. Projects like SNAP, which use non-invasive biomarkers, highlight the future of assessing warfighter readiness. Importance of Commitment and Networking: Aligning personal ambitions with organizational missions, seizing opportunities, and proactive networking are key strategies for career advancement in military medicine. Taking initiative and being open to new challenges can lead to significant contributions in the field.   Episode Keywords: Military Medicine, Combat Neurology, Brain-Computer Interface, Traumatic Brain Injury, Battlefield Innovation, DARPA, Adam Willis, Trauma Care, Intravascular Cannula, SNAP Initiative, Artificial Intelligence, Biotechnology, Military Healthcare, Neurocritical Care, Trauma Patient Evacuation, Field Intensive Care, Military Technology, Warfighter Readiness Hashtags: #MilitaryMedicine #CombatNeurology #BattlefieldInnovation #BrainInjuryCare #DARPA #TraumaCareTech #NeuroInnovation #OperationalMedicine #MilitaryHealthcare #WarfighterReadiness   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield,demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast

Renita Miller (Diversity, Equity, and Inclusion Officer at Wharton) and Doctor Joshua Levine (Chief of Penn Medicine's Neurocritical Care) join the show to discuss why financial wellness and health must go hand-in-hand to build stronger communities ahead of The Wellness Empowerment Project Summit. Hosted on Acast. See acast.com/privacy for more information.

In this episode of the St Emlyn's podcast, Iain Beardsell is joined by Dan Horner, a consultant in Emergency Medicine and Neurocritical Care, and Tom Roberts, an Emergency Medicine Registrar and clinical lecturer, to discuss their recently published SHED study on subarachnoid haemorrhage in the Emergency Department (ED). This landmark study, published in the Emergency Medicine Journal, explores the safety of CT scans in diagnosing subarachnoid haemorrhage up to 24 hours after headache onset and evaluates the role of further investigations like a lumbar puncture. The study examines acute severe headache presentations in the ED and the diagnostic approach to ruling out subarachnoid haemorrhage, a critical and often feared diagnosis among emergency physicians. Conducted through the Trainee Emergency Research Network (TURN), the study included over 3,600 patients from 88 UK EDs with acute severe headaches reaching maximum intensity within one hour and no focal neurology. Data collection included CT scans, lumbar puncture results, and 28-day follow-up to identify missed cases of subarachnoid hemorrhage. Key findings from the study revealed a 6.5% prevalence of subarachnoid haemorrhage, with a significant number presenting within six hours of headache onset. The sensitivity of CT scans remained high beyond the traditional six-hour window, suggesting that CT alone could safely rule out subarachnoid haemorrhage up to 18 hours in many cases, potentially reducing the need for lumbar puncture. The risk of missing an aneurysmal subarachnoid haemorrhage after a negative CT was found to be extremely low, around 1 in 1,000. These findings challenge the routine use of lumbar puncture in patients presenting beyond six hours if the CT scan is negative, potentially changing ED practice and reducing unnecessary invasive procedures. The discussion also emphasized the importance of shared decision-making and recognizing that diagnostic testing is about managing probabilities, not certainties. For clinicians, the episode highlights the need to expedite CT scans for patients with acute severe headaches, especially those presenting within 10 minutes of onset, as they are more likely to have significant pathology. Emergency physicians are encouraged to own the decision-making process for ruling out serious causes of headaches and not defer solely to 'specialists'. The SHED study supports extending the diagnostic window for CT scans in ruling out subarachnoid hemorrhage up to 18 hours, reducing the need for lumbar puncture in many cases. This data empowers emergency clinicians to make informed decisions, manage patient expectations, and streamline ED processes.  For more information, listeners are encouraged to read the SHED Study in the Emergency Medicine Journal and explore the related blog post on the St Emlyn's website. Emergency clinicians are also invited to connect with TERN to get involved in future research opportunities.  This episode provides valuable insights for clinicians in managing acute severe headaches, emphasizing a more nuanced approach to subarachnoid hemorrhage diagnosis and the importance of clinical decision-making in the ED.

Have you ever been confused about the concept of brain death, or struggled to explain brain death to a patient's family or your fellow clinicians? Join the Behind the Knife Surgical Palliative Care team and our special guest, neurologist & neurointensivist Dr. Sarah Wahlster, as we explore the 2023 Pediatric & Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline and what this updated guideline means for our practice in surgical palliative care! Hosts: Dr. Katie O'Connell (@katmo15) is an Associate Professor of Surgery at the University of Washington in the division of Trauma, Burn, and Critical Care Surgery. She is a trauma surgeon, palliative care physician, Director of Surgical Palliative Care, and founder of the Advance Care Planning for Surgery Clinic at Harborview Medical Center in Seattle, WA. Dr. Virginia Wang is a PGY-3 General Surgery resident at the University of Washington. Guest: Dr. Sarah Wahlster (@SWahlster) is an Associate Professor of Neurology at the University of Washington. She is a neurologist, neurointensivist, and Program Director of the Neurocritical Care Fellowship at Harborview Medical Center in Seattle, WA. Learning Objectives: ·      Understand the concept of assent and how it can be helpful in communicating with families of patients who have sustained brain death ·      Explain the main steps required for diagnosis of brain death (prerequisites, clinical exam, apnea testing, ancillary testing) ·      Understand key differences between the 2023 guideline and previous (2010 & 2011) guidelines ·      Be able to name the 3 accepted modalities of ancillary testing for brain death ·      Know basic communication best practices with families of patients who have sustained brain death from the surgical palliative care perspective (consistency of language & messaging; avoidance of phrases such as “life-sustaining treatment”, “comfort-focused measures”) References: 1.     Greer, D. M., Kirschen, M. P., Lewis, A., Gronseth, G. S., Rae-Grant, A., Ashwal, S., Babu, M. A., Bauer, D. F., Billinghurst, L., Corey, A., Partap, S., Rubin, M. A., Shutter, L., Takahashi, C., Tasker, R. C., Varelas, P. N., Wijdicks, E., Bennett, A., Wessels, S. R., & Halperin, J. J. (2023). Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline. Neurology, 101(24), 1112–1132. https://doi.org/10.1212/WNL.0000000000207740 2.     Lewis, A., Kirschen, M. P., & Greer, D. (2023). The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline: A Comparison With the 2010 and 2011 Guidelines. Neurology. Clinical practice, 13(6), e200189. https://doi.org/10.1212/CPJ.0000000000200189 3.     AAN Interactive Brain Death/Death by Neurologic Criteria Evaluation Tool – https://www.aan.com/Guidelines/BDDNC 4.     AAN Brain Death/Death by Neurologic Criteria Checklist – https://www.aan.com/Guidelines/Home/GetGuidelineContent/1101 5.     Kirschen, M. P., Lewis, A., & Greer, D. M. (2024). The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know. Critical care medicine, 52(3), 376–386. https://doi.org/10.1097/CCM.0000000000006099 6.     Greer, D. M., Shemie, S. D., Lewis, A., Torrance, S., Varelas, P., Goldenberg, F. D., Bernat, J. L., Souter, M., Topcuoglu, M. A., Alexandrov, A. W., Baldisseri, M., Bleck, T., Citerio, G., Dawson, R., Hoppe, A., Jacobe, S., Manara, A., Nakagawa, T. A., Pope, T. M., Silvester, W., … Sung, G. (2020). Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA, 324(11), 1078–1097. https://doi.org/10.1001/jama.2020.11586 7.     Lele, A. V., Brooks, A., Miyagawa, L. A., Tesfalem, A., Lundgren, K., Cano, R. E., Ferro-Gonzalez, N., Wongelemegist, Y., Abdullahi, A., Christianson, J. T., Huong, J. S., Nash, P. L., Wang, W. Y., Fong, C. T., Theard, M. A., Wahlster, S., Jannotta, G. E., & Vavilala, M. S. (2023). Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus, 15(4), e37687. https://doi.org/10.7759/cureus.37687 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Patients with severe acute brain injury often lack the capacity to make their own medical decisions, leaving surrogate decision makers responsible for life-or-death choices. Patient-centered approaches and scientific methodologies can guide clinicians' prognostications. In this episode, Teshamae Monteith, MD, FAAN, speaks with Susanne Muehlschlegel, MD, MPH, FNCS, FCCM, FAAN, author of the article “Prognostication in Neurocritical Care,” in the Continuum® June 2024 Neurocritical Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Muehlschlegel is a professor (PAR) in the departments of neurology, anesthesiology/critical care medicine and neurosurgery, division of neurosciences critical care at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Prognostication in Neurocritical Care Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @SMuehlschMD Transcript Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic- based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the Journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening. Dr Monteith: This is Dr Tesha Monteith, Associate Editor of Continuum Audio. Today, I'm interviewing doctor Susanne Muehlschlegel about her article on prognostication in neurocritical care, which is part of the June 2024 Continuum issue on neurocritical care. Well, Susanne, thank you so much for coming on the podcast, and thank you for writing that beautiful article. Dr Muehlschlegel: Thank you so much for having me. Excited to be here. Dr Monteith: Why don't we start with you just introducing yourself? Dr Muehlschlegel: Yeah, sure. My name is Susanne Muehlschlegel. I'm a neurointensivist at Johns Hopkins in Baltimore, Maryland. I have been a neurointensivist for about eighteen years or so. I worked previously at the University of Massachusetts and recently arrived here at Hopkins. Dr Monteith: Cool. So, what were you thinking about - What information did you want to convey - when you set out to write your article? Dr Muehlschlegel: Yeah. So, the article about neuroprognostication is really near and dear to my heart and my research focus, and I'm very passionate about that part. And as neurologist and neurointensivist, prognostication, you know, might be considered the bread and butter of what we're asked to do by families and other services, but as the article states, is that we don't usually do a great job (or physicians sometimes believe they do). But when you actually do research and look at data, it's probably not as good as we think, and there's a lot of room for improvement. And, so, the reason for this article really was to shine the light at the fact that I think we need to really make neuroprognostication a science, just like we make prediction models a science - and, so, that is the main topic of my research, as well as the article. Dr Monteith: So, we know about your interest in research in this area, but what got you into critical care to begin with? Dr Muehlschlegel: Yeah. It's, pretty much, a story of always being drawn to what's exciting and what others may want to avoid. So, in medical school, people were afraid of neurology and learning all the anatomy, and I just loved that and loved interacting with these patients. And then, in neurology residency, I was drawn to not just treating the brain and the spinal cord, but also the entire patient (so the lung and the heart and the interaction of all the organs). And then, naturally, I'm a little bit of an impatient person, and so I like the environment of the ICU of rapid change and always having to be on my toes. And so that's what drew me into neurocritical care. It was a very new field when I was training, and so, I was probably, you know, one of the, maybe, first- or second-generation neurointensivists. Dr Monteith: And it sounds like you're maybe okay with uncertainty and a lot of variability? Dr Muehlschlegel: Well, you know, neuroprognostication - I think everyone has to acknowledge that we cannot take away uncertainty, right? So, folks who pretend that they know for sure what's going to happen - I think the only time we can say that is in a patient who's braindead. But everyone else, we really don't know for sure, and all we can do is do the best to our ability to give a rough outlook - but we need to acknowledge uncertainty, that's for sure. Dr Monteith: So, can you just give us a few of the biggest causes of variability when it comes to withdrawing life-sustaining therapies in patients with severe acute brain injuries? Dr Muehlschlegel: So, that's the focus of quite some research. And, of course, there are many epidemiological factors, patient severity of disease, and, you know, how fast someone might arrive to the hospital, ethnic, racial, social demographic factors (and there's research on that), but when you adjust and control for all of those factors, variability remains. And so, what I've observed in my practice and what I also describe in the article is that maybe it's the way physicians describe prognostication or communicate with families, meaning there is potentially the chance for physician bias - that may also drive prognostication. And I can tell you from my own experience, what really drove me into this area is anecdotal experience that probably we've all had of other physicians kind of nihilistically prognosticating, thinking, you know, "This is going to be bad no matter what”, and not even wanting to try to provide aggressive care to patients. So, I think these what we call “self-fulfilling prophecies” we need to be very aware of. So, I think some of the variability may be driven by other factors other than family, patient, or health system factors. Dr Monteith: And you outline that really nicely in the article, so thank you for that. Why don't you just give us an example of a challenging case that maybe you're still thinking about today, that maybe happened years ago, that helps us understand what you go through? Dr Muehlschlegel: Yeah, I'll rephrase the case. I still have, you know, very vivid memories about this, but I tell my residents about this case. When I was a fellow, there was a young patient in his early forties, a father of several children, a young family man who had a big right MCA stroke and really was progressing to the point that it was clear that he needed a hemicraniectomy or he was going to die. Discussed this with my attending, who said I should consult neurosurgery. At the time, the neurosurgical service had a transition to practice service for these emergencies - and so, these were fairly young, chief residents or early-year attendings. And the person came in, went into the patient's room, and I didn't even know about it, and came out and then just said, “Family decided for CMO”. I was very surprised and shocked and was trying to understand how this happened, and this provider, all he said was, “Well, it's all how you put it to the family. I told him that he probably shouldn't be a vegetable. They didn't want him to be a vegetable, and so this was the only option.” And, so, I was very shocked, and the patient did progress to die within a few days. And, so, that was a dire example of how biased prognostication can drive families to maybe an unnecessary outcome. Dr Monteith: And what's CMO? Dr Muehlschlegel: I'm sorry. Comfort measures only - so, essentially, a withdrawal of life-sustaining therapies. Dr Monteith: Yeah. That is a good example of that and how our bias can inform families and maybe not with the exact amount of data to support that, as you outlined so nicely in your article. Dr Muehlschlegel: And I do want to emphasize, I don't want to generalize that all providers are like that, but it is an example that really still sticks in the back of my mind, and I think, you know, we need to shine a light at how we do this and how we do it right or wrong. Dr Monteith: And wouldn't it be nice to just have more objective measures (right?) to guide us? So why don't we talk about existing tools that are used to help guide neuroprognostication? Dr Muehlschlegel: Yeah, so I think, in general, we can break down prognostication to two pieces (and I outline that in the article as well). So, one is, kind of, a derivation of prognostication in the head of a physician or, you know, clinician – and what may go into that is how the patient presented, examination, radiology or other diagnostics, biomarkers, you name it. But, then the second part of it (that also is really important) is how we put it to the family, right? Because we can influence families in a way that we may not even be aware of, and I think we all have unconscious biases, and how we talk to families is really important and may drive what happens to the patient as well. So, I always say there's two pieces to that – so, first of all, how we come up with a prognosis, and then how we disclose that to the family. Dr Monteith: So how can we better handle uncertainty? Dr Muehlschlegel: So, we actually did some research on that and we asked stakeholders, "How do you want physicians to handle uncertainty?”. People are aware that no physician can be certain (again, other than in the case of brain death), and so families are very aware of that. And there's quite some data out there to suggest that if physicians have very absolute statements - you know, want to close the door by saying something very absolute - is that the optimistic bias in families goes up. So, the mistrust in what the physician is saying, coming up with their own (you know, “This is a fighter, and he or she is going to do better than what you're saying”) - and, so, I think, you know, there's no true answer to what's the absolute right way to do it, but some have suggested to maybe fully acknowledge that there is uncertainty. That's actually what families want you to do, based on some qualitative research we've done – is to say, “I do not have a crystal ball. There will be uncertainty”, but then to potentially go into a best/ worst-case scenario. But again, there, all we can do is give a best gross estimate and guess. And so, the work is not really clear at this point. There's research ongoing as to what should be the best way of doing it, but currently, that's what is suggested. Dr Monteith: And in your article, you spoke about some pretty innovative approaches, such as modeling, to help guide shared decision-making. And, so, you know, how reliable is that? Dr Muehlschlegel: That's a good point, right? So, that is up to statisticians or those who are inventing these new models. So, you know, in the old days we used logistic regression, maybe linear regression. Now, there are fancy machine-learning modeling and other Bayesian models that people use, and they certainly have some advantages that I outlined in the article. Bayesian models, for example, may use serial data as it comes in throughout the patient's hospital course - and that's kind of how we do it in real life. But, I think what's really important before we apply models is that we know that there's always outliers, and we don't know if this one patient might be the outlier, and that we need to validate these models, and most importantly, look at calibration. So, I talk in the article about how, you know, all models always report the what's called “area under the receiver-operating curve (the AUC)”, which is discrimination. But, what's actually more important for a model to be applied to a patient at the bedside is calibration, meaning how well does it actually predict a potential outcome. And, you know, there's a lot of research into that, that only maybe half of the papers that report on a new model actually report calibration - so, I think it's really important to pay attention to that (has the model been validated and calibrated before we actually use these models?). I think prediction models have definitely a important role. But, then again, as the article says, we also have to think about how we then apply that to the patient and how we do it in individual patients. Dr Monteith: And then, of course, there's some variability between institutions. Dr Muehlschlegel: That's for sure. You know, there's these systematic approaches or system-based cultures in certain institutions. And then, of course, you know, there's still this model of learning from a role model or a mentor or an attending - meaning you look at how this person does it and then you may adapt it to your own practice. I think we need to critically examine whether we need to continue with that kind of apprenticeship model of learning how to neuroprognosticate, or whether we need to have other educational ways of doing that. So, especially in the field of palliative care, there's a lot of education now around communication - and I think med students get that exposure, and residents may get that exposure, too - but I think we need to practice it and study it systematically, whether having a standardized approach to do this leads to more patient-congruent decisions. Dr Monteith: And, you know, we do have a lot of trainees, residents, and fellows that listen in. So, what are some key messages that you want to make sure gets conveyed? Dr Muehlschlegel: Key messages is that, I think, we need to move away from looking at a patient the first one or two weeks and then concluding that we will know what will happen to this patient in six months or a year or further down the line. I think there's not a lot of longitudinal studies out there now that show that patients actually probably do better than expected if they're allowed to live. And what I mean by that is many studies allow early withdrawal of life-sustaining therapies within the first three days or maybe two weeks - but if we actually allow these patients to live, people wake up more than we thought, people may do better than we thought. So, referring to the article, I discuss in detail some twelve-month data from the TRACK-TBI study or very interesting results from South Korea where withdrawal of life-sustaining therapies is forbidden by law. And, so, you can actually do a true natural-history study of what happens with these patients if you allow them to live. And, surprisingly, a lot of people that, you know, within the first two weeks were still comatose actually ended up waking up. And, I think it's really important to look at those studies and to continue to conduct those studies so that we know better what might happen. I always shudder a little bit when I hear, “We need an MRI in the first few days or first week for neuroprognostication”. And then I always question, “Well, what is it really going to tell you about that patient who clearly isn't brain dead and still has certain, you know, exam findings?” and “Shouldn't we just give those patients time?”. I think some of those were a bit too quick to provide poor prognostication if we really don't know. Dr Monteith: And, so, I want to know how did you get into research? You know, it can be competitive to get funding, grant funding - so, tell us about that in terms of, you know, your day-to-day, what's it like? And then, also, what makes you most excited about research happening in this area? Dr Muehlschlegel: Yeah, I mean, there's a lot of research happening in that area. I think there's a huge focus on biomarkers and models and all sorts of new diagnostic tools to predict outcome, big push over decades now to do large longitudinal epidemiological studies - and all of those are very, very important, you know. I just mentioned as an example, the TRACK-TBI study is one of many other examples. I'm also excited about doing research in the second part of neuroprognostication that I mentioned - the communication and disclosure part - and the potential of bias as we speak to families. So, I get very excited about that part. It's not easy to get funding, but I think what's important is to focus on the potential impact. And, of course, then you try to convince funders that this is important research that has to be done in addition to funding model development and large epidemiological studies. What my day-to-day looks like? Well, you know, we have several ongoing projects (I won't get into details on that), but to get involved would probably be the best time as a trainee - so, I have medical students working with us, residents and fellows (although their time can be limited). And then to continue to just be curious and ask questions. Dr Monteith: And what do you find most exciting about the work that you do? Just, kind of, overall? Dr Muehlschlegel: I mean, without a doubt, the potential impact, right? So, changing the field a little bit. I'm not claiming that my research is doing that - I hope it might. But, most importantly, it's the potential impact on families and patients. I think our goal is not to have less withdrawal of care (although, sometimes, I just think we need to give people more time), but I think it's important to focus and ask about what patients might want, and then really focus families onto that. I think that can be difficult, because patients don't always tell families what they would want or families want something different than what they know the patient might want - and so, we spend quite some time on that when we speak to families. And then, I also talk about the disability paradox. So, you know, at one point, the family might say, “Well, he would not want to live if he can't walk”, but then, patients, as they learn to live with this new normal, may actually later say, “Well, it's not as bad as I expected it to be, and I'm actually very happy to be alive, even if I'm not able to walk”. And so, that's something that others are doing research on, and that's also important to consider. Dr Monteith: Yeah, that's cool. Thinking about outside of the ICU, right? Dr Muehlschlegel: For sure. Yes. Dr Monteith: Great. Thank you so much for being on our podcast. I know that our listeners are going to really enjoy reading your article and all the thought that you put into that. Dr Muehlschlegel: Thank you so much for having me.   Dr Monteith: Again, today, we've been interviewing Dr Susanne Muehlschlegel whose article on prognostication in neurocritical care appears in the most recent issue of Continuum on neurocritical care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is doctor Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this episode. Thank you for listening to Continuum Audio.

Dr. Kochanek is internationally respected for his expertise in and research on traumatic brain injury and cardiopulmonary arrest, as well as for his leadership of the Safar Center for Resuscitation Research. As director for 25 years, he has established the Safar Center as one of the leading sites in the world for the investigation of traumatic brain injury and cardiopulmonary arrest. The Safar Center focuses on bench to bedside investigations for TBI and CA related to mechanisms involved in the evolution of secondary brain injury, translational neuroscience, and the development of novel therapies and interventions that can be implemented at any point in the chain of survival—from the field through to rehabilitation.

Dr. Marik is an accomplished physician with special knowledge in a diverse set of medical fields, with specific training in Internal Medicine, Critical Care, Neurocritical Care, Pharmacology, Anesthesia, Nutrition, and Tropical Medicine and Hygiene. He is a former tenured Professor of Medicine and Chief of the Division of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School (EVMS) in Norfolk, Virginia.In January 2022 Dr. Marik retired from EVMS to focus on continuing his leadership of the FLCCC and has already co-authored over 10 papers on therapeutic aspects of treating COVID-19. In March 2022 Dr. Marik received a commendation by unanimous vote by the Virginia House of Delegates for “his courageous treatment of critically ill COVID-19 patients and his philanthropic efforts to share his effective treatment protocols with physicians around the world.”In this conversation at the FLCCC conference, Dr. Marik and I discuss fraud and corruption in medical institutions, as well as the distrust in Big Pharma after the pandemic. More from Dr. Paul Marik:Dr. Marik on XBooks by Dr. MarikMore about the Front Line COVID-19 Critical Care Alliance (FLCCC):Substack The FLCCC Alliance CommunityWatch panels and discussions where this interview was filmed here.Peter Boghossian's talk at the FLCCC ConferenceA recent huge win for the FLCCC regarding Ivermectin Watch this episode on YouTube.

Trial of the Week: Levetiracetam Rapid IV Push Special Guest: Olivia Morgan, PharmD, BCCCP, BCGP   I'm joined by Olivia Morgan to discuss her first author 2020 Neurocritical Care article entitled “Safety and Tolerability of Rapid Administration Undiluted Levetiracetam.” We review previous administration techniques and discussing how this study came to be before highlighting all the findings from this Trial of the Week. Then we discuss how the protocol has changed since this study, administering other ASM via rapid IV push, and much, much more.   Reference list:  https://pharmacytodose.files.wordpress.com/2024/03/keppra-rapid-ivp-references.pdf   PharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices