Episodes

1. What is the role of decadron in preventing post extubation stridor? Released 30 Mar 2014 What is the role of giving an adult steroids to prevent stridor or reintubation following extubation.    This epidose looks at the data.
2. Modes of Mechanical Ventilation Released 30 Mar 2014 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 ve...
3. Oxygenation & PEEP Released 30 Mar 2014 A discussion of ventilation, oxygenation, and the role of PEEP.
4. Lightning Injuries Released 30 Mar 2014 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 pre...
5. Glutamine In Critical Illness: what's all the fuss about? Released 30 Mar 2014 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...
6. Complications of PEEP and Auto-PEEP Released 30 Mar 2014 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 P...
7. Airway Pressure Release Ventilation (APRV) or BiVent: What the heck is this? Released 30 Mar 2014 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...
8. Acute RenalFailure Released 30 Mar 2014 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. 
9. Weaning (Liberating) from the mechanical ventilator Released 30 Mar 2014 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 weanin...
10. Intraosseous Vascular Access: not just for the kids anymore Released 30 Mar 2014 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 acces...
11. Renal Replacement Therapy: SCUF, SLED, CVVH, CVVHD, IHD--what does it all mean Released 30 Mar 2014 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 bet...
12. Burns: Fluid Creep Released 30 Mar 2014 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 ...
13. Blood Conservation in the ICU Released 30 Mar 2014 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 ban...
14. Metabolism: Starvation versus Stress Released 30 Mar 2014 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 po...
15. Early Surgery Improves Outcomes Following Critical Burns Released 30 Mar 2014 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 n...
16. Bomb and Blast Injuries Released 30 Mar 2014 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 pop...
17. Metabolic Acidosis in the ICU Released 30 Mar 2014 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...
18. Thermal Injuries Released 30 Mar 2014 An introduction of the biology of thermal injuries and the initial care of the patient with thermal injuries in critical condition.
19. Crush Syndrome Released 30 Mar 2014 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 fr...
20. Antibiotic Considerations in the ICU Released 30 Mar 2014 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. 
21. Control of hyperglycemia improves outcomes Released 30 Mar 2014 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?
22. Blood Products Released 30 Mar 2014 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...
23. Smoke Inhalation Injury: CO and Cyanide Toxicity Released 30 Mar 2014 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.  Le...
24. HIT: Heparin Induced Thrombocytopenia Released 30 Mar 2014 Large numbers of patients in ICUs are on heparin and what is this complication of heparin induced thrombocytopenia? 
25. Sepsis - Part 1 Released 30 Mar 2014 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 basi...
26. Sepsis - Part 2 Released 30 Mar 2014 In this episode we discuss that ICU care of the patient with sepsis.  This includes an introduction to various vasopressors.
27. Pharmacology of Shock Released 30 Mar 2014 This is a basic introduction of some of the drugs used in various forms of shock.  
28. Pediatric Burns Released 30 Mar 2014 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 co...
29. Atrial Fibrillation Released 30 Mar 2014 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. 
30. Do Steroid Improve Survivial in Sepsis? CORTICUS Trial Released 30 Mar 2014 The results of the CORTICUS trial are discussed. 
31. Drug-induced QT prolongation Released 30 Mar 2014 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 you...
32. Polypharmacy in the Elderly Released 30 Mar 2014 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. 
33. Traumatic Shock and Fluid Resuscitation Released 30 Mar 2014 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 tra...
34. Clostridium difficile Colitis Released 30 Mar 2014 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. 
35. Glucometers in the ICU: how accurate are they? Released 30 Mar 2014 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 limitati...
36. Hemoglobin Based Blood Substitutes: Increased Morbidity and Mortality Released 30 Mar 2014 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 mor...
37. Surviving Sepsis Campaign (part 1) Released 30 Mar 2014 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...
38. Surviving Sepsis Campaign (part 2) Released 30 Mar 2014 We continue our discussion of the Surviving Sepsis Campaign (SSC).  This includes fluids types, steroids, rhAPC (Xigris), and blood sugar control.
39. Extremity Compartment Syndrome Released 30 Mar 2014 A limb-threatening complication that might be overlooked by the inexperienced provider.
40. Abdominal Compartment Syndrome Released 30 Mar 2014 A discussion of the physiology and presentation of abdominal compartment syndrome.
41. Ventilator Update: avoiding shear trauma Released 30 Mar 2014 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...
42. Patient-Ventilator Interactions and ventilator discontinuation Released 30 Mar 2014 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...
43. Hypercalcemia Released 30 Mar 2014 A potentiallylife-threatening electrolyte problem that commonly finds its way into the ICU as well as on exams.
44. PAIN: a four letter word Released 30 Mar 2014 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. ...
45. Myocardial Infarction: Diagnosis and Thrombolytics Released 30 Mar 2014 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.
46. Traumatic Rhabdomyolyisis / Crush Syndrome Released 30 Mar 2014 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 tr...
47. Disaster Management Released 30 Mar 2014 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. (Thi...
48. Myocardial Infarction: PCI and medications Released 30 Mar 2014 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.
49. Meta-analysis of Glucose Control Released 30 Mar 2014 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 reductio...
50. Cardiovascular Risk Reduction for Surgery Released 30 Mar 2014 This episode explores what is needed to make surgery safer for the patient with cardiovascular disease. 
51. Radiation Injury / Nuclear MCI Released 30 Mar 2014 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 t...
52. Therapeutic Hypothermia following Cardiac Arrest Released 30 Mar 2014 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 ...
53. Some Swan Stuff Released 30 Mar 2014 A brief discussion regarding some of the commonly used values obtained from a pulmonary artery catheter. 
54. Hyperkalemia Released 30 Mar 2014 Hyperkalemia is a very common and potentially dangerous electrolyte disorder that commonly occurs in ICU patients.
55. Peak Inspiratory Pressure: Physiological Determinants Released 30 Mar 2014 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 man...
56. Environmental Hypothermia Released 30 Mar 2014 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.
57. Prehospital/Battlefield Tourniquet Use Released 30 Mar 2014 Review of a recent publication from Annals of Surgery
58. Hyponatremia: common but dangerous Released 30 Mar 2014 Hyponatremia or a low serum sodium is a common electrolyte problem that is dangerous if ignored or treated improperly.
59. Hypernatremia Released 30 Mar 2014 Evaluation and treatment of elevated serum sodium is presented.
60. Hypoxia: physiological causes Released 30 Mar 2014 Understanding the root cause of hypoxia will allow for more appropriate treatment.
61. Refeeding Syndrome Released 30 Mar 2014 When and how can providing a starving patient nutrition be potentially deadly.
62. Discussion on Fluids: The last Cotton lecture Released 30 Mar 2014 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 excellen...
63. Pulse Oximetery Released 30 Mar 2014 Discussion of the technology of the pulse oximeter
64. Arterial Blood Gases Released 30 Mar 2014 This episode is a discussion about how to approach an arterial blood gas result.
65. IV Fluids (Part 1) Released 30 Mar 2014 An introduction to the basic science in fluids used to treat hypovolemia.
66. Caustic Ingestions Released 30 Mar 2014 Ingestion of caustic materials can be fatal and difficult to evaluate. These patients are often referred to our burn center.
67. Pulmonary Physiology and General Anesthesia Released 30 Mar 2014 This episode discusses the effects and risks of anesthesia on patients with pulmonary disease as well as the effects of anesthesia on pulmonary physiology.
68. Central Line Insertion Complications Released 30 Mar 2014 A discussion of the potential problems encountered while inserting central venous catheters.
69. Complications of Dwelling Central Lines Released 30 Mar 2014 What horrible things can happen with central lines once they have been inserted.
70. Ventilator Associated Pneumonia Released 30 Mar 2014 A discussion on nosocomial infections and VAP.
71. Catheter-Related Bloodstream Infection: Diagnosis Released 30 Mar 2014 Discussion of what is the difference between a CVC infection and a catheter-related blood stream infection. They are treated differently so it is important to know the difference.
72. Hemoglobin Based Oxygen Carriers (a.k.a. Artificial Blood) Released 30 Mar 2014 A brief summary of what are hemoglobin based oxygen carriers (HBOC) and where are they in development.
73. Acute Colonic Pseudoobstruction (Ogilvie's Syndrome) Released 30 Mar 2014 Acute Colonic Pseudoobstruction (ACPO) is commonly called Ogilvies Syndrome.  ACPO presents massive dilation in critically ill patients, and might result in invasive procedures ...
74. That peripheral IV can kill you: Suppurative Thrombophlebitis Released 30 Mar 2014 All the recent emphasis on venous catheter infections has been on central lines.   Those peripheral IVs are also dangerous.  
75. Pancreatitis - Part 1 Released 30 Mar 2014 This is an initial presentation of the causes and diagnosis of acute pancreatitis.  
76. Severe Acute Pancreatitis: Part 2 ICU Considerations Released 30 Mar 2014 A brief discussion of the considerations of ICU care of the patient with severe pancreatitis, fluid resuscitation, respiratory, renal, and nutrition.
77. Pancreatitis - Surgical Indications and Procedures Released 30 Mar 2014 This is the third in the series on severe pancreatitis and necrotizing pancreatitis.  This episode reviews the indications for surgery, morbidity and mortality of surgery, and w...
78. Therapeutic Hypothermia After Cardiac Arrest Released 30 Mar 2014 Therapeutic hypothermia after cardiac arrest is part of ACLS and is used by several EMS agencies around the US.  Despite good data and improved patient outcomes, many provider...
79. SVO2 My favorite Swan Number Released 30 Mar 2014 The most helpful number for me on a Swan is the SvO2.   This is a brief description of how I use this variable in evaluating critically ill and injured patients.  
80. Wedge: Everyone elses favorite Swan number Released 30 Mar 2014 Wedge or PAOP is perhaps the most quoted and poorly understood variable generated by a Swan-Ganz.
81. Propofol Related Infusion Syndrome Released 30 Mar 2014 Propofol Related Infusion Syndrome is a potentially fatal complication of propofol.  If you use this common ICU drug you need this information.
82. Smoke Inhalation Injury Released 30 Mar 2014 Smoke Inhalation injuries can be deadly.  This episode explains why smoke can be so deadly, and how to care for those patients with suspected smoke inhalation injuries.
83. Pulmonary Embolus Released 30 Mar 2014 A description of the risk factors, diagnosis, and treatment of PE.
84. Endotracheal tube cuff leaks and self-extubations Released 30 Mar 2014 A brief description on what to consider when confronted with a patient with an air leak from the ET tube or a patient that self-extubates.
85. Lactate Acidosis - Type A Released 30 Mar 2014 This podcast is a description of how lactate is produced and metabolized.  I will discuss the role of lactate in the diagnosis and management of shock.  This podcast will focus ...
86. Lactic Acidosis - Type B Released 30 Mar 2014 Now these are the types of lactic acidosis that most people are not familiar.  They can be caused by medications, underlying disease, or inborn errors of metabolism.   
87. Different Cardiac Output Monitors & Physiology Released 30 Mar 2014 This episode will discuss the physiology behind various CO output monitors such as pulmonary artery catheters, PICCO, pulse wave form analysis, and LiDCO.  
88. Necrotizing Soft Tissue Infection (NTSI) Released 30 Mar 2014 This episode discusses the pathophysiology, presentation, and treatment of NTSI.
89. Takotsubo Cardiomyopathy Released 30 Mar 2014 This is a condition that mimics acute coronary syndrome (ACS) that may be caused by acute emotional or physical stress.  Patient's may appear to have profound cardiogenic shock,...
90. Pediatric IVC diameter determination with ultrasound Released 30 Mar 2014 If you are using ultrasound to evaluate IVC diamter in children, what is considered a normal IVC diameter?   You can determine the IVC/Ao ratio or correct the IVC diamter based ...
91. EARLY use of Tranexamic Acid may improve survival from bleeding in trauma Released 30 Mar 2014 In this episode we talk about the results of the CRASH-2 trial published in Lancet.  This trial showed that the EARLY use of Tranexamic acid may improve survivial, but delayed u...
92. Random Serum Cortisol Levels are misleading Released 30 Mar 2014 A physiological explanation why random cortisol levels are NOT helpful in evaluating adrenal function
93. Colloids: Details and Myths Released 30 Mar 2014 This episode provide some basic description of colloids as will as some myths.