Category Archives: Critical Care

Episode 104: Sepsis with Pam Lipsett

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 104: Sepsis with Pam Lipsett
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In this 104th episode I welcome Dr. Pam Lipsett to the show to discuss the diagnosis and treatment of sepsis.

CME: https://earnc.me/DtOhNH

References:

Sepsis-3 guidelines from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2492881

Marik Sepsis cocktail: Marik PE et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. 2017: 151(6);1229–1238.

ADRENAL trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1705835

APROCCHSS Trial: https://www.nejm.org/doi/10.1056/NEJMoa1705716

SEPSISPAM Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1312173

Episode 100: Response to Listener Questions

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 100: Response to Listener Questions
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In this 100th episode I respond to questions, both clinical and personal, from ACCRAC listeners.

CME: https://earnc.me/72ibqj

Episode 94: Organ Donation with Clint Burns

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 94: Organ Donation with Clint Burns
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In this episode, episode 94, I welcome Clint Burns to the show.  Clint received a liver transplant in 1994, then went on to go to nursing school, have 4 children, be an ICU nurse, and he now runs the organ and tissue donation program here at Johns Hopkins.  We discuss his story, the process of organ donation, and how providers can help make this process a gift for both donor and recipient.

CME: https://earnc.me/FsS3Ar

Episode 93: CABG with Tom Metkus

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 93: CABG with Tom Metkus
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In the episode, episode 93, I welcome Dr. Tom Metkus back to the show to discuss perioperative considerations for CABG surgery.

CME: https://earnc.me/XJ1pMd

References:

Syntax Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa0804626

STICH Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1100356

ROOBY Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa0902905

CORONARY Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1200388

PREVENT IV Trial: https://www.ncbi.nlm.nih.gov/pubmed/16287955

ART Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1610021

Episode 92: Early Mobility in the PICU with Sapna Kudchadkar

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 92: Early Mobility in the PICU with Sapna Kudchadkar
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In this episode, episode 92, I welcome Dr. Sapna Kudchadkar to the show to discuss her PICU Up program for early mobility in the PICU.  We discuss the benefits of early mobility in general and specifically with pediatric patients, how she started her program, and what has led it to be so successful.

CME: https://earnc.me/zLbZMD

Dr. Kudchadkar can be reached on Twitter at @SapnaKMD and the PICU Up program is at @PICU_Up.

References: Early Mobility References

Episode 87: Aortic Dissection with Tom Metkus

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 87: Aortic Dissection with Tom Metkus
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In this episode, episode 87, I welcome Dr. Tom Metkus to the show.  Dr. Metkus is a cardiologist and intensivist and we discuss the etiology, presentation, management and outcomes of acute aortic dissections.

CME: https://earnc.me/K0NTfX

Outline by Brian Park: Aortic Dissection Outline

Episode 86: Thromboelastography with Bob Sikorski

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 86: Thromboelastography with Bob Sikorski
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In this episode, episode 86, I welcome Dr. Bob Sikorski back to the show to discuss thromboelastography (TEG) and thromboelastometry (ROTEM).  We discuss how they work, what they tell us and how we can use them.

CME: https://earnc.me/hUuIFX

Example TEG:

Episode 77: Reversal of Neuromuscular Blockade

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 77: Reversal of Neuromuscular Blockade
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In this episode, episode 77, I discuss reversal of neuromuscular blockade.  This is a follow up to episode 66 in which I covered neuromuscular blockade.

CME: https://earnc.me/An714h

Outline by Brian Park: NMB Reversal Outline

References:

Miller’s Anesthesia 8th Edition. Reversal (Antagonism) of Neuromuscular Blockade. Murphy GS, de Boer HD, Eriksson LI and Miller RD. Chapter 35, 995-1027.e5.

Appiah-Ankam J, Hunter J.  Pharmacology of neuromuscular blocking drugs.  Cont Educ Anaesthesia Critical Care & Pain.  2004;4(1):2-7.

Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017 Aug 14;8:CD012763.

Keating GM. Sugammadex: A Review of Neuromuscular Blockade Reversal. Drugs. 2016 Jul;76(10):1041-52.

McLean DJ, Diaz-Gil D, Farhan HN, Ladha KS, Kurth T, Eikermann M. Dose-dependent Association between Intermediate-acting Neuromuscular-blocking Agents and Postoperative Respiratory Complications. Anesthesiology. 2015 Jun;122(6):1201-13.

Schaller S, Fink H.  Sugammadex as a reversal agent for neuromuscular block: an evidence-based review.  Core Evidence.  2013;8:57-67.

Episode 69: Intro to Trauma with Bob Sikorski

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 69: Intro to Trauma with Bob Sikorski
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In this episode, Episode 69, I welcome Dr. Bob Sikorski, director of trauma anesthesiology at Johns Hopkins, to the show to discuss a general overview of trauma anesthesia.  We discuss prehospital, ER and OR management and key things to keep in mind when caring for trauma patients.

CME: https://earnc.me/avWKy7

References: Trauma references list

TEG diagram: 

Episode 66: Neuromuscular Blockers

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 66: Neuromuscular Blockers
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In this episode, episode 66, I go through an overview of neuromuscular blockers including how they work, how to use them, and what their adverse effects are.  Happy New Year!

CME: https://earnc.me/9GRFyG

The dose of glycopyrrolate should be 0.01 to 0.015mg/kg, not 0.1 to 0.15.

Outline by Brian Park: Outline

References:

Miller’s Anesthesia 7th edition: Chapter 29: Pharmacology of Muscle Relaxants and Their Antagonists. Naguib M and Lien C.

Rocuronium vs succinylcholine for rapid sequence induction intubation. https://www.ncbi.nlm.nih.gov/pubmed/26512948

Neuromuscular blockade: what was, is and will be: https://www.ncbi.nlm.nih.gov/pubmed/25622380

Reversal of neuromuscular block: https://www.ncbi.nlm.nih.gov/pubmed/19468024