Critical Care Time

In this REBOOTED episodes of Critical Care Time, Cyrus and Nick go beyond the basics of vasopressor management. This thing is jam-packed with high-yield pearls, where we discuss important topics such as how to titrate vasopressors, what can be done when vasopressors seem to be failing and how to wean patients from vasopressors in order to successfully get them out of the ICU and ultimately home. Sit back, relax, and enjoy this hour long master-class on Vasopressors - Beyond the Basics!

In this REBOOTED episodes of Critical Care Time, Cyrus and Nick explore the basic in’s and out’s of vasopressors, providing a framework for understanding them and recommendations for the who, what, when, where and why as it pertains to their use! If you are new to the ICU or work anywhere that vasopressors may be used to treat your patients, this is the episode for you!

On this week's release, Cyrus and Nick revisit one of their favorite topics: Pulmonary Embolism! In this episode - a follow up to our two-parter from season 1 - we sit down with Dr. Rick Channick of UCLA to talk about his approach to PE management with a focus on catheter directed therapies & PE response teams. This episode is packed full of expert insights and practical clinical pearls. Give it a listen and let us know what you think!Risk Stratification MethodologiesWhat is the landscape of risk stratification in Pulmonary Embolism (PE)?Broadly, what interventions does each risk category group warrant?Rule of Thumb: The greater the risk to the patient, the more likely aggressive interventions will be considered.Most patients with PE are low risk:Typically treated with systemic anticoagulationExcellent prognosis High risk PE patients typically have hemodynamic involvement and can present in shock requiring emergent management :No contraindications + shock due to PE systemic thrombolysisAbsolute contraindications:Prior history of ICHKnown cerebrovascular lesionKnown malignant intracranial neoplasmNon-acute ischemic stroke, within the last 3 monthsSuspect aortic dissectionIntermediate risk patients:Management options exist and are tailored to each specific patient.Most, but not all, patients with PE deemed to be at intermediate risk will do well with systemic anticoagulation.Some patients are good candidates for catheter directed therapies such as thrombectomy or thrombolysis.Who? We don’t really know with a high degree of certainty. Considerations should be made for those with numerous risk factors for poor PE-related outcomes OR those with significant cardiopulmonary reserve / excellent functional status who theoretically could benefit from more brisk reversal of their acute pulmonary hypertension.See more in depth show notes at criticalcaretime.com

In this week's episode of Critical Care Time, Cyrus & Nick close out their discussion (for now anyway!) on difficult airways! Here we build upon episode 33 by working through some scenarios we've seen where we've needed to implement some of the strategies previously discussed. We close out by covering 10 pitfalls and pearls when it comes to anatomically difficult airways. As always, give us a listen and let us know what you think!

On this week’s episode of Critical Care Time, Nick & Cyrus return to talk about airway management in the ICU. In season 1 we focused on the physiologically difficult airway. Now we will begin to unravel the anatomically difficult airway. Today we will break things down by covering foundational concepts, discussing some of the physical and cognitive tools you can use to address an airway, and basically set the stage for part II where we will go through some case studies and leave you with our pitfall and pearls for anatomically difficult airways. This episode is packed with clinical pearls that will empower you to take on even the  spiciest  of airways!As always - give us a watch or a listen and let us know what you think! Don’t forget those    reviews!!

On this week’s episode of Critical Care Time, Nick & Cyrus have the honor of hosting Dr. Thanh Neville, MD, MSHS (X @thanh_neville) the director of the 3 Wishes Program out of UCLA. In this moving discussion we explore the importance of dying with dignity when curative intent is no longer a realistic option. We dovetail this with an impassioned exploration Dr. Neville’s incredible work with 3WP which relies on modest funding and the power of humanism to grant priceless gifts - Wishes, if you will - to dying patients and their loved ones in their 11th hour. Please give us a listen and let us know what you think!

Join Nick and Cyrus as they teach a master class on hypoxemia for everyone and anyone who is ICU adjacent! We discuss why oxygen is so crucial, share some very interesting animal physiology and - perhaps most importantly- discuss the 6 causes of hypoxemia you MUST know… and what you can do about them! Take a listen, let us know what you think, and leave us a review!

On this episode - part 2/2 if you will - we continue our discussion of pleural disease with a focus on hemothorax & management of bronchopleural fistulas. Small tube or large tube? When do you call in the reinforcements? What about endobronchial valves for persistent air leaks? Learn the answers to these questions - and so much more -n with Dr. Mike Sobieszczyk our expert interventionalist!