ICU Rounds
also available for free download on iTunes. (http://itunes.apple.com/us/podcast/icu-rounds/id254707344)
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. 
Direct download: Sepsis_prt1.mp3
Category:podcasts -- posted at: 11:29pm EST

Large numbers of patients in ICUs are on heparin and what is this complication of heparin induced thrombocytopenia? 
Direct download: HIT.mp3
Category:podcasts -- posted at: 12:02pm EST

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.  
Direct download: smoke.mp3
Category:podcasts -- posted at: 9:38pm EST

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. 
Direct download: bloodproducts.mp3
Category:podcasts -- posted at: 10:46pm EST

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?
Direct download: hyperglycemia.mp3
Category:podcasts -- posted at: 7:29pm EST

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. 
Direct download: ABXTX.mp3
Category:podcasts -- posted at: 12:03pm EST

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. 

Direct download: CRUSH.mp3
Category:podcasts -- posted at: 8:47pm EST

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

Direct download: thermal_injury.mp3
Category:podcasts -- posted at: 10:59pm EST

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.  
Direct download: metabolic_acidosis.mp3
Category:podcasts -- posted at: 10:05pm EST

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. 
Direct download: bomb.mp3
Category:podcasts -- posted at: 9:06pm EST

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. 

Direct download: early_Ex.mp3
Category:podcasts -- posted at: 8:39pm EST

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. 

Direct download: metabolism.mp3
Category:podcasts -- posted at: 10:23pm EST

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?
Direct download: blood.mp3
Category:podcasts -- posted at: 5:55pm EST

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. 

Direct download: FluidCreep.mp3
Category:podcasts -- posted at: 4:17pm EST

Renal Replacement Therapy: SCUF, SLED, CVVH, CVVHD, IHD--what does it all mean 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. 
Direct download: RRT.mp3
Category:podcasts -- posted at: 2:00am EST

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. 
Direct download: IO_infusion.mp3
Category:podcasts -- posted at: 10:09pm EST

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)?

Direct download: weaning.mp3
Category:podcasts -- posted at: 8:39am EST

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. 
Direct download: ARF.mp3
Category:podcasts -- posted at: 5:11pm EST

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. 

Direct download: APRV.mp3
Category:podcasts -- posted at: 1:00am EST

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)
Direct download: Peep_complications.mp3
Category:podcasts -- posted at: 11:41pm EST

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
Direct download: glutamine.mp3
Category:podcasts -- posted at: 11:24pm EST

Lightning Injuries

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

 

Direct download: lightening.mp3
Category:podcasts -- posted at: 10:49pm EST

A discussion of ventilation, oxygenation, and the role of PEEP.
Direct download: PEEP.mp3
Category:podcasts -- posted at: 3:59pm EST

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)
Direct download: ventmodes.mp3
Category:podcasts -- posted at: 3:00pm EST

What is the role of giving an adult steroids to prevent stridor or reintubation following extubation.    This epidose looks at the data.
Direct download: decadron.mp3
Category:podcasts -- posted at: 2:44pm EST