Critical Care Time

On this end-of-year episode, Nick & Cyrus boldly go where no Critical Care Podcasters have gone before - into space! Join us, as we adventure into the great beyond with astronaut extraordinaire, Dr. Shawna Pandya - the first female Canadian commercial astronaut, who also happens to be a rural emergency medicine physician among SO many other things. We spend an hour with her discussing space physiology, medical applications of space tech, chatting about ICU corollaries, her experiences training for her upcoming mission, and exploring the challenges facing space exploration in 2025 and beyond. Hop aboard and and enjoy this exciting content and let us know what you think. This super accessible episode is loads of fun for ICU junkies and space-nerds alike so kick back, give it a listen, and as always, let us know what you think!

On this week's episode of Critical Care Time, Cyrus & Nick sit down with Dr. Alin Gragossian - intensivist, patient advocate, acclaimed blogger and heart transplant recipient and Dr. Paul Wischmeyer - a prior guest on CCT who is a world-renowned intensive care nutrition expert, tenured professor and no stranger to prolonged bouts with critical illness and life-threatening disease. These two incredible people share their stories and perspectives as physicians who have spent considerable time both behind the drape and beneath the drape: Being on the receiving end of countless procedures and life-saving interventions. They share with us their thoughts on where we are succeeding as a healthcare team, and where we can strive to improve at the bedside. Join us as we embark on this emotional and thoughtful journey with Alin & Paul. We hope you will listen to their stories and come away with a new appreciation for the patient experience and how privileged we are to care for the patients we care for.Please be sure to check out Alin's blog www.achangeofthe.art and follow her on Instagram (@a_change_of_heart_blog). Give Paul some follows where he's most active on Instagram (@paulwischmeyermd), X (Paul_Wischmeyer) and LinkedIn (Paul Wischmeyer). As always, listen and let us know what you think, and make sure to leave us a 5-star review on your favorite podcast app! 

On this week's episode of Critical Care Time, Cyrus & Nick are honored to be joined by palliative care expert, Dr. Anand Iyer. Together they explore the intricacies of palliation in the ICU, exploring the challenge and nuances of addressing this critical element of care amongst the sickest patients in the hospital. How do you begin these discussions? How do you ensure your patients and families feel heard? How do you help them realize palliation is part of the care process and not that you are giving up on a loved one? What terms should we avoid using? We cover all of this and more with Dr. Iyer so make sure to give this episode a listen and leave us some feedback!

Get excited for a new episode jam-packed with Critical Care goodness! Nick & Cyrus deconstruct, demystify and unpack inotropes. These medications are essential in the world of critical care when we have to manage cardiogenic shock. What are the different inotropes? How can you decide which one is right for your patient? And... what's the difference between an Inotropic and an Ionotropic agent? You'll learn all this and so much more on this week's episode of Critical Care Time: The Podcast for Everyone Who Cares for the Critically Ill!

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!