ICU Rounds

Pulmonary Physiology and General Anesthesia

Sun, 21 Jun 2009 23:55:00 GMT

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

Caustic Ingestions

Wed, 13 May 2009 02:50:00 GMT

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

IV Fluids (Part 1)

Sun, 3 May 2009 22:21:00 GMT

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

Arterial Blood Gases

Sun, 26 Apr 2009 18:42:00 GMT

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

Pulse Oximetery

Mon, 30 Mar 2009 02:08:00 GMT

Discussion of the technology of the pulse oximeter

Discussion on Fluids: The last Cotton lecture

Thu, 5 Mar 2009 16:38:00 GMT

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

Refeeding Syndrome

Sat, 21 Feb 2009 22:12:00 GMT

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

Hypoxia: physiological causes

Sun, 15 Feb 2009 05:01:00 GMT

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

Hypernatremia

Thu, 12 Feb 2009 03:04:00 GMT

Evaluation and treatment of elevated serum sodium is presented.

Hyponatremia: common but dangerous

Sat, 7 Feb 2009 05:08:00 GMT

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

Prehospital/Battlefield Tourniquet Use

Sun, 1 Feb 2009 18:04:00 GMT

Review of a recent publication from Annals of Surgery

Environmental Hypothermia

Wed, 28 Jan 2009 20:48:00 GMT

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

Peak Inspiratory Pressure: Physiological Determinants

Mon, 19 Jan 2009 12:00:00 GMT

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

Hyperkalemia

Mon, 12 Jan 2009 03:30:00 GMT

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

Some Swan Stuff

Mon, 29 Dec 2008 11:30:00 GMT

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

Therapeutic Hypothermia following Cardiac Arrest

Mon, 22 Dec 2008 18:48:00 GMT

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

Radiation Injury / Nuclear MCI

Fri, 12 Dec 2008 19:28:00 GMT

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

Cardiovascular Risk Reduction for Surgery

Thu, 20 Nov 2008 20:06:00 GMT

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

Meta-analysis of Glucose Control

Mon, 17 Nov 2008 02:00:00 GMT

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

Myocardial Infarction: PCI and medications

Mon, 20 Oct 2008 21:06:00 GMT

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

Disaster Management

Sun, 19 Oct 2008 01:56:00 GMT

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

Traumatic Rhabdomyolyisis / Crush Syndrome

Sun, 19 Oct 2008 00:48:00 GMT

Crush syndrome is a common cause of death following earth quakes, mine and building collapses. Traumatic rhabdomyolysis may also be seen following electrical injury or severe trauma. (This is a reposting due to some previous technical problems with the server.)

Myocardial Infarction: Diagnosis and Thrombolytics

Tue, 9 Sep 2008 16:21:00 GMT

Myocardial Infaction (Part 1): This episode will discuss the diagnosis of MI, STEMI, and non-STEMI. We then discuss the indications and types of thrombolytic agents.

PAIN: a four letter word

Thu, 21 Aug 2008 16:01:00 GMT

The management of pain is a key element of the care of all patients-- ICU or not. Often providers have little understanding of the concepts and medications of pain management. This episode serves as an introduction.

Hypercalcemia

Thu, 14 Aug 2008 01:28:00 GMT

A potentiallylife-threatening electrolyte problem that commonly finds its way into the ICU as well as on exams.

Patient-Ventilator Interactions and ventilator discontinuation

Thu, 7 Aug 2008 16:00:00 GMT

Getting patients comfortable on the ventilator is not an easy task. This podcasts focuses on methods to make patients synchronize with the ventilator as well as a discussion of spontaneous breathing and awake trials

Ventilator Update: avoiding shear trauma

Sun, 3 Aug 2008 15:36:00 GMT

In regards to ventilator care, all the focus has been on low tidal volume and level of peak inspiratory pressure. What level of PEEP shoud we be using to avoid shear trauma and ventilatory induced lung injury.

Abdominal Compartment Syndrome

Sat, 7 Jun 2008 20:00:00 GMT

A discussion of the physiology and presentation of abdominal compartment syndrome.

Extremity Compartment Syndrome

Mon, 19 May 2008 02:00:00 GMT

A limb-threatening complication that might be overlooked by the inexperienced provider.

Surviving Sepsis Campaign (part 2)

Thu, 15 May 2008 14:10:00 GMT

We continue our discussion of the Surviving Sepsis Campaign (SSC). This includes fluids types, steroids, rhAPC (Xigris), and blood sugar control.

Surviving Sepsis Campaign (part 1)

Mon, 12 May 2008 02:45:00 GMT

The Surviving Sepsis Campaign (SSC) is concensus document that attempts to provide the best evidence to assist in the care of the septic patient. All providers who provide care to the septic patient should be aware of the contents of the SSC.

Hemoglobin Based Blood Substitutes: Increased Morbidity and Mortality

Sun, 4 May 2008 15:04:00 GMT

In this week's Journal of the American Medical Association a meta-analysis was published that concluded that use of hemoglobin based blood substitutes result in an increased morbidity and mortality. Included in the same journal is an editorial critical of the method the research has been regulated by the US FDA.

Glucometers in the ICU: how accurate are they?

Thu, 24 Apr 2008 21:41:00 GMT

There is a large emphasis on intensive control of blood glucose in the ICU, but how accurate are the monitors we use to follow glucose? This episode reviews someof the limitations of deploying an instrument designed for control of outpatient diabetes management to tight control of blood glucose in the ICU.

Clostridium difficile Colitis

Wed, 16 Apr 2008 20:54:00 GMT

Clostridium difficile colitis is a problematic complication of antibiotic theraoy in hospitalized and critically ill patients. It is increasing in frequency and can be lethal.

Traumatic Shock and Fluid Resuscitation

Tue, 1 Apr 2008 12:16:00 GMT

Fluid resuscitation done poorly can result in significant complications to the patient. This episode will present some of the newer considerations in fluid resuscitation in traumatic shock.

Polypharmacy in the Elderly

Sun, 23 Mar 2008 21:06:00 GMT

Patients are often admitted to the ICU with an entire list of home medications. In this episode I talk about the implications and dangers of polypharmacy.

Drug-induced QT prolongation

Sat, 8 Mar 2008 23:06:00 GMT

Prolonged QT is the most common reason why medications are restricted or removed from the US market. This episode will explain what it is and why you should look for it in your ICU patients.

Do Steroid Improve Survivial in Sepsis? CORTICUS Trial

Thu, 28 Feb 2008 03:59:00 GMT

The results of the CORTICUS trial are discussed.

Atrial Fibrillation

Wed, 20 Feb 2008 03:05:00 GMT

Atrial fibrillation is a common problem in ICU patients, but it is a problem with many potential causes, and not always a well defined treatment.

Pediatric Burns

Wed, 13 Feb 2008 05:01:00 GMT

Pediatric burns: all burns are serious, both big and small. This episode reviews the objectives of burn care to result in the best functional outcome. Also, burn is a very common method of child abuse and we detail how these children are injured and what to look for to identify possible abuse.

Pharmacology of Shock

Fri, 8 Feb 2008 02:36:00 GMT

This is a basic introduction of some of the drugs used in various forms of shock.

Sepsis - Part 2

Fri, 1 Feb 2008 05:01:00 GMT

In this episode we discuss that ICU care of the patient with sepsis. This includes an introduction to various vasopressors.

Sepsis - Part 1

Tue, 11 Dec 2007 04:29:00 GMT

Sepsis is a common cause of death in the intensive care unit. In this episode I present some of the statistics on septic deaths, introduce the definitions, and present the basic science. Part 2 will cover fluid and drug therapy for septic shock.

HIT: Heparin Induced Thrombocytopenia

Sat, 27 Oct 2007 16:02:00 GMT

Large numbers of patients in ICUs are on heparin and what is this complication of heparin induced thrombocytopenia?

Smoke Inhalation Injury: CO and Cyanide Toxicity

Mon, 15 Oct 2007 01:38:00 GMT

The onset of cold weather will bring with it an increase in structure fires. The leading cause of deaths in fires is complications from the inhalation of smoke-- not burns. Learn why smoke is so deadly as well as what are the appropriate methods to treat smoke related asphyxiation.

Blood Products

Mon, 1 Oct 2007 02:46:00 GMT

Blood products: pRBCs, fresh frozen plasma, platelets, cryoprecipitate when and how should we use it? What are the risks? You may order them like IV fluids but do you really know how these potentially deadly products are to be used.

Control of hyperglycemia improves outcomes

Mon, 24 Sep 2007 23:29:00 GMT

A great deal is being presented and published on control of blood sugar in the ICU as well as the postoperative period. How much control is enough and what is the data?

Antibiotic Considerations in the ICU

Fri, 14 Sep 2007 16:03:00 GMT

Why do we choose the antibiotics that we do? How long do we continue the course of therapy? Should we use some antibiotics together? These topics are covered in the episode.

Crush Syndrome

Mon, 20 Aug 2007 00:47:00 GMT

Earthquakes are horrible natural events causing loss of lives in the thousands. Following earthquakes, building collapses, and cave-ins, large number of victims will suffer from renal failure and death following crush syndrome.

Thermal Injuries

Mon, 13 Aug 2007 02:59:00 GMT

An introduction of the biology of thermal injuries and the initial care of the patient with thermal injuries in critical condition.

Metabolic Acidosis in the ICU

Thu, 26 Jul 2007 02:05:00 GMT

A common problem in the ill or injured patient is a metabolic acidosis. In this episode we will review the common etiology of a metabolic acidosis as well as some lesser known causes.

Bomb and Blast Injuries

Fri, 6 Jul 2007 01:06:00 GMT

Bomb and blast injuries: In the past blast injuries were limited to the battlefield of a rare industrial accident. The events of the past week are a reminder that civilian population centers are targets for bombing attacks. Most civilian providers has no to limited knowledge or experience treating patients with such injuries. This episode is dediacated to a discussion of some of the unique properties and injuries associated with blast injuries. In the event of a terrorist attack, like those attempted in London this past week, the injuries will be in the hundreds.

Early Surgery Improves Outcomes Following Critical Burns

Fri, 29 Jun 2007 00:39:00 GMT

Early surgical excision is likely to be the most significant individual variable to imporve the outcome of a patient (adult or child) with a critical burn. Nevertheless, many nonburn physicians still want to apply to 1970 treatment paradigms to this population of injured patients. This episode will hopefull replace these falsehoods with fact supported in the literature.

Metabolism: Starvation versus Stress

Wed, 20 Jun 2007 02:23:00 GMT

Not feeding an injured or ill patient is not that same as a normal individual who is fasting. A pound of weight loss in the stress patient is significantly different than a pound of weight loss in someone on a diet. A basic understanding of stress metabolism is needed prior to a discussion of nutrition.

Blood Conservation in the ICU

Thu, 14 Jun 2007 21:55:00 GMT

When should a patient receive a transfuse of blood? What is an acceptable hemoglobin concentration in an ICU patient and should we use EPO? Summer is a time when the blood banks often have a single day's worth of blood. Perhaps with more conservative transfusion practices we can avoid or certainly help with some of the blood shortages. Everyone wants to put patients on Epo, but does it increase the hemoglobin concentration enough to off set its high cost?

Burns: Fluid Creep

Thu, 7 Jun 2007 20:17:00 GMT

Excessive fluid resuscitations lead to horrible complications such as abdominal compartment syndrome. This article takes a critical look and challanges many of our practices in fluid resuscitation of burn patients.

Renal Replacement Therapy: SCUF, SLED, CVVH, CVVHD, IHD--what does it all mean

Fri, 1 Jun 2007 06:00:00 GMT

Renal replacement therapy (RRT) is rather a confusing topic. What do all those initials mean and why use one therapy over another? This podcast will explain the difference between intermittent and continous. What are the various forms of continuous and how do they differ? What are the concepts of ultrafiltration, diffusion, and convection? These questions will be answered in this introduction to renal replacement.

Intraosseous Vascular Access: not just for the kids anymore

Tue, 29 May 2007 02:09:00 GMT

Intraosseous vascular access was was developed for use in adult trauma patients over 80 years ago. Only recently has this technique regained popularity for rapid and safe access to the vascular space in patients in extremis.

Weaning (Liberating) from the mechanical ventilator

Fri, 25 May 2007 12:39:00 GMT

Don't wean people from their ventilators-- liberate them!! When are people ready to come off the ventilator? What are weaning parameters? How does one do a spontaneous weaning trial? What is the role of noninvasive ventilation (NIV)?

Acute RenalFailure

Tue, 22 May 2007 21:11:00 GMT

Acute renal failure is a dreaded complication in the ICU. This podcast will review the various types of acute renal failure, the etiology, as well as acute management.

Airway Pressure Release Ventilation (APRV) or BiVent: What the heck is this?

Sun, 20 May 2007 05:00:00 GMT

Airway pressure release ventilation (APRV) is not a new mode of mechanical ventilation, but it seems to be gaining a great deal of popularity lately. Many people find this mode very complicated and thick that it is reserved only for the very ill. Neither one of these assumptions are corrrect. This mode is very easy to learn and use. Furthermore, this mode is very physiological and tolerated by all types of patients.

Complications of PEEP and Auto-PEEP

Sat, 19 May 2007 03:41:00 GMT

Virtually all patients on ventilators are on PEEP. PEEP has several interactions with various organ systems and some can result in profound complications. An understanding of PEEP and auto-PEEP are required before we can understand modes of ventilation like APRV (Bi-Vent)

Glutamine In Critical Illness: what's all the fuss about?

Fri, 18 May 2007 03:24:00 GMT

All surgical residents know that glutamine is the amino acid known as the fuel for the gut. But what is all the fuss about? The episode will look at the data on glutamine. Does glutamine improve outcomes, and if so and in who? How much should we use and what are the hazards? Enteral versus parenteral. www.burndoc.com

Lightning Injuries

Tue, 15 May 2007 02:49:00 GMT

Lightning injuries are rare, but when you do treat a patient they can have facinating presentations. This lecture follows a patient we treated at Vanderbilt. The patient present to a local ED with stroke like symptoms following the lightning strike. Initially, physicians were confused by the presentation, but in this lecture you will learn that his presentation was near textbook. www.burndoc.com

Oxygenation & PEEP

Sun, 13 May 2007 19:59:00 GMT

A discussion of ventilation, oxygenation, and the role of PEEP.

Modes of Mechanical Ventilation

Sun, 13 May 2007 19:00:00 GMT

A discussion of the various types of ventilators with a focus on the various ventilator modes and types of ventilator cycles. Also presented is the topic of pressure support ventilation (PSV)

What is the role of decadron in preventing post extubation stridor?

Sun, 13 May 2007 18:44:00 GMT

What is the role of giving an adult steroids to prevent stridor or reintubation following extubation. This epidose looks at the data.