Category Archives: Critical Care

Anesthesia, Critical Care, Key Words, Show Notes

Episode 158: Keywords part 8-hepatic disease for the advanced exam and PACU for the basic exam with Gillian Isaac

January 28, 2020 ACCRAC 4 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 158: Keywords part 8-hepatic disease for the advanced exam and PACU for the basic exam with Gillian Isaac

00:00 / 53:12

In this 158th episode we return with another keywords episode with Dr. Gillian Isaac. We discuss hepatic disease for the advanced exam and PACU care for the basic exam.

CME: https://earnc.me/rEmBIA

Show Notes by Dr. Brian Park

Random recs:

Cloud Atlas: https://www.amazon.com/Cloud-Atlas-Novel-Liam-Callanan/dp/0385336950

Wolf Hall: https://www.amazon.com/s?k=wolf+hall+by+hilary+mantel&i=stripbooks&crid=2F978D2O2UCW&sprefix=wolf+hall%2Cstripbooks%2C135&ref=nb_sb_ss_i_1_9

Bottle of Lies: https://www.amazon.com/Bottle-Lies-Inside-Story-Generic-ebook/dp/B07JG49BQW/ref=sr_1_1?keywords=bottle+of+lies&qid=1581089047&s=books&sr=1-1

Thanks to Brian Robinson for pointing out: reversal of rocuronium with Sugammadex can occasionally cause severe bronchospasm, especially in higher doses, and this was one of the reasons its release was delayed in the U.S.

Although most sugammadex hypersensitivity reactions cause mild symptoms such as sneezing, nausea, rash, and urticaria, there is a small but finite risk of anaphylaxis with potentially life-threatening symptoms such as airway edema, bronchospasm, and cardiovascular collapse.
www.apsf.org › article › sugammadex-the-anaphylactic-risk

Anesthesia, Critical Care, ERAS, Nutrition, Physiology

Episode 157: Intermittent Fasting with Mark Mattson

January 21, 2020 ACCRAC 5 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 157: Intermittent Fasting with Mark Mattson

00:00 / 1:10:22

In this 157th episode I welcome Dr. Mark Mattson to the show to discuss the science behind intermittent fasting including in the perioperative period.

CME: https://earnc.me/1dnYNl

Dr. Mattson’s review from NEJM: https://www.nejm.org/doi/full/10.1056/NEJMra1905136

Dr. Mattson’s Tedx Talk: https://www.youtube.com/watch?v=4UkZAwKoCP8

Anesthesia, Critical Care, Key Words, Physiology, Show Notes

Episode 152: Keywords Part 7: MH and Hepatic Disease for the Basic Exam

December 10, 2019 ACCRAC 6 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 152: Keywords Part 7: MH and Hepatic Disease for the Basic Exam

00:00 / 47:48

In this 152nd episode I welcome Dr. Gillian Isaac back for another 2 ABA keywords. We discuss malignant hyperthermia and the portion of hepatic disease that is covered by the Basic Exam. We’ll do the portion covered by the Advanced Exam on the next keywords episode.

CME: https://earnc.me/NU3JPS

Outline By Brian Park Download

Malignant Hyperthermia Website: www.mhaus.org

Great review website where Dr. Isaac gets her questions: http://www.anesthesiahub.com

Atlantic Article: https://www.theatlantic.com/entertainment/archive/2012/03/what-do-fact-checkers-and-anesthesiologists-have-in-common/253838/#note

Critical Care

Episode 151: Advanced Practice Providers in the ICU

December 3, 2019 ACCRAC 1 Comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 151: Advanced Practice Providers in the ICU

00:00 / 45:36

In this 151st episode I welcome Brandon Oto to the show. Brandon is an ICU PA and we discuss the roles and relationships of APPs in the ICU environment.

CME: https://earnc.me/qcZ7cm

Brandon’s blog is http://critcon.org/

Brandon is on Twitter @critconcepts

Cardiac, Critical Care, Procedures

Episode 146: Critical Care Ultrasound with Lee Goeddel

October 29, 2019 ACCRAC 2 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 146: Critical Care Ultrasound with Lee Goeddel

00:00 / 36:23

In this 146th episode I welcome back Dr. Lee Goeddel to the show to discuss critical care ultrasound including how it differs from POCUS and how people can prepare for the new certification exam.

CME: https://earnc.me/AnFeQx

References:

CCEeXAM-Content-Outline Download

CCEeXAM_Cert_App-2019 Download

Pears and Pitfalls in Critical Care Ultrasonography: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693549/

Anesthesia, Critical Care, ERAS, Fluids, Physiology, Resuscitation

Episode 143: Fluid management and cardiac output monitors in ERAS with Michael Scott

October 15, 2019 ACCRAC 1 Comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 143: Fluid management and cardiac output monitors in ERAS with Michael Scott

00:00 / 55:36

In this 143rd episode I welcome Dr. Michael Scott to the show to discuss fluid management in ERAS cases and how cardiac output monitoring may help us do that well.

CME: https://earnc.me/wcjdkb

Topmedtalk: https://www.topmedtalk.com

Anesthesia, Critical Care, Physiology, Pulmonary

Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo

October 8, 2019 ACCRAC 4 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo

00:00 / 52:02

In this 142nd episode I welcome Dr. Marcos Vidal Melo to the show to discuss Driving Pressure and Transpulmonary pressure. We discuss what they are, how they differ from plateau pressure, and how they may help guide safe mechanical ventilation.

CME: https://earnc.me/IVPnjN

References:

Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation? Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Anesthesiology. 2019 Jul;131(1):155-163.
Loring SH, Topulos GP, Hubmayr RD: Transpulmonary pressure: The importance of precise definitions and limiting assumptions. Am J Respir Crit Care Med 2016; 194:1452–7
Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J; PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine): Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016; 42:1360–73
Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, Guérin C, Patroniti N, Ranieri VM, Gattinoni L, Nava S, Terragni PP, Pesenti A, Tobin M, Mancebo J, Brochard L; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine): The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 2014; 189:520–31

Critical Care, Nutrition, Physiology

Episode 141: Nutrition in the ICU with Paul Wischmeyer

October 1, 2019 ACCRAC 1 Comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 141: Nutrition in the ICU with Paul Wischmeyer

00:00 / 57:25

In this 141st episode I welcome Dr. Paul Wischmeyer to the show to discuss nutrition for critically ill patients with a focus on the question of whether to give enteral feeds to patients on pressors. You can follow Dr. Wischmeyer on twitter @Paul_Wischmeyer.

CME: https://earnc.me/xPgtPv

References:

Dr. Wischmeyer’s article on enteral nutrition for patients on vasopressors: https://journals.lww.com/ccmjournal/Citation/onlinefirst/Enteral_Nutrition_Can_Be_Given_to_Patients_on.95859.aspx

Additional References Download

Anesthesia, Cardiac, Critical Care, Resuscitation

Episode 140: Transfusion Triggers and The TRICS 3 Trial with David Mazer

September 24, 2019 ACCRAC Leave a comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 140: Transfusion Triggers and The TRICS 3 Trial with David Mazer

00:00 / 37:58

In this 140th episode I welcome Dr. David Mazer to the show. Dr. Mazer was the PI and first author on the TRICS 3 trial looking at liberal versus restrictive transfusion strategies in moderate to high risk cardiac surgery patients published in the NEJM in 2017.

CME: https://earnc.me/6SR7cb

Dr. Mazer would like to add the following random recommendation: For a great combination of live jazz and good food and drinks in Toronto, check out the Jazz Bistro just up the street from St. Michael’s Hospital.

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa1711818

Dr. Mazer can be reached at David.Mazer@UnityHealth.To

Anesthesia, Critical Care, Resuscitation

Episode 135: A Case For Low Dose Norepinephrine

August 21, 2019 ACCRAC 7 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 135: A Case For Low Dose Norepinephrine

00:00 / 26:20

In this 135th episode I discuss my argument for using low dose norepinephrine to treat or even prevent hypotension in the OR and ICU. I discuss the CENSER trial looking at early norepinephrine in sepsis as well as a paper looking at preemptive norepinephrine in open cystectomies and a review article of trials looking at pressor use in free flap surgery. Join in the conversation here with your comments and on the ACCRAC Facebook page and Twitter @accracpodcast and @jwolpaw.

CME: https://earnc.me/nkqZ0P

References:

CENSER: https://www.atsjournals.org/doi/full/10.1164/rccm.201806-1034OC

Cystectomies: https://www.ncbi.nlm.nih.gov/pubmed/24012203

Free Flaps: https://www.ncbi.nlm.nih.gov/pubmed/26340760