Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 170: Lessons from 40 COVID Patients in the ICU with Brian Garibaldi
/
RSS Feed
Share
Link
Embed
In this 170th episode I welcome Dr. Brian Garibaldi to the show to discuss his experience taking care of 40 critically ill COVID patients and what we’ve learned. We got through by system, head to toe, and discuss strategies and approaches.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 169: PPE and Modified Difficult Airway Algorithm for COVID
/
RSS Feed
Share
Link
Embed
In this episode I introduce Dr. Christina Miller’s video, linked below, that goes through PPE considerations including how to safely don and doff, and suggestions for how to handle a difficult airway in COVID patients.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 168: COVID in Pregnancy with Dr. Nixon
/
RSS Feed
Share
Link
Embed
In this 168th episode I welcome Dr. Heather Nixon to the show to discuss what is being done for pregnant women and women in labor who have or are suspected to have COVID-19.
CME: https://earnc.me/IqnBVR
The COVID book for kids by Taylor Purvis: https://playatrickonthecoronas.weebly.com/
Link for Anesthesia Toolbox daily online learning session: https://www.anesthesiatoolbox.com/docs/DOC-5178
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 167: COVID Clinical Care Update
/
RSS Feed
Share
Link
Embed
In this 167th episode I review the most recent changes that we’ve made to our protocols for caring for COVID patients and share a fantastic one page summary sheet that 3 of our ICU fellows put together. Huge thanks to Drs. Navarette, Herekar and Baronos for their work on this. It is available for download below. References are on the second page of the attachment.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 166: COVID Airway Management with Aliaksei Pustavoitau
/
RSS Feed
Share
Link
Embed
In this 166th episode I welcome Dr. Aliaksei Pustavoitau to the show to discuss management of the hypoxemia COVID-19 patient including initial triage, escalating support, endotracheal intubation, and ventilator management.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 165: COVID with Drs. Scott, Cereda and Nacoti
/
RSS Feed
Share
Link
Embed
In this 165th episode I welcome Drs. Scott and Cereda from University of Pennsylvania and Dr. Nacoti from Italy to talk about COVID-19, what it is, what we know about it, what it’s like on the ground in Italy right now, and what we can learn from their experience to try to prevent it from happening here.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. doi:10.1001/jama.2020.4031
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 164: Keywords part 9: Fentanyl and Breathing Circuits
/
RSS Feed
Share
Link
Embed
In this 164th episode I welcome back Dr. Gillian Isaac to do another ABA keywords episode. We discuss fentanyl and breathing systems (Mapleson and Circle systems).
It is actually the case that follow up studies were done in the US on volunteer patients through University of Arizona and Medical College of Wisconsin in the later 1990’s.Ebert, T., Frink, E. and Kharasch, E. Absence of Biochemical Evidence for Renal and Hepatic Dysfunction after 8 Hours of 1.25 Minimum Alveolar Concentration Sevoflurane Anesthesia in Volunteers. Anesthesiology. 1998;88(3):601-610.
Kharasch, E. and Jubert, C. Compound A Uptake and Metabolism to Mercapturic Acids and 3,3,3-Trifluoro-2-fluoromethoxypropanoic Acid during Low-flow Sevoflurane Anesthesia.
The key point of the final article concludes that humans are nearly devoid of renal beta lyase, the key enzyme in directing biodegradation of compound A to the toxic renal thiol. Essentially, this research was done in the late 90’s but the original possibility of renal toxicity in humans from just a few years prior has stuck in peoples’ minds (and therefore textbooks).
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 163: Thoracic Wall Blocks with Barbara Versyck
/
RSS Feed
Share
Link
Embed
In this 163rd episode I welcome Dr. Barbara Versyck to the show to discuss thoracic wall blocks. We discuss the types of blocks, what they are used for, and what the evidence is for their efficacy.
Chin, Ki Jinn. “Thoracic wall blocks: from paravertebral to retrolaminar to serratus to erector spinae and back again–a review of the evidence.” Best Practice & Research Clinical Anaesthesiology (2019).
Versyck, B., G‐J. van Geffen, and K‐J. Chin. “Analgesic efficacy of the Pecs II block: a systematic review and meta‐analysis.” Anaesthesia 74.5 (2019): 663-673.
During our discussion of treatment of eclamptic seizures Dr. Henao said benzos were first line treatment. This is assuming the patient is already getting magnesium. For test questions, the answer for first line treatment should be Mg. In reality, patients will likely get both at the same time.
Serum Mg concentrations can be reported as mmol/L, meq/L or mg/dL. The important ranges to know for testing (though in reality different people may get symptoms at different times) are a therapeutic range of 2-3.5 mmol/L or 4-7 mEq/L or 5-9 mg/dL; A loss of patellar reflexes at >3.5, >7, >9; Respiratory paralysis at >5, >10, >12 and cardiac arrest at >12.5, >25, >30. EKG changes including prolonged PR and widened QRS happen in much the same range as loss of patellar reflexes, maybe a bit before but there is a lot of overlap.
References:
Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):125-138.
Dhariwal NK, Lynde GC. Update in the Management of Patients with Preeclampsia. Anesthesiol Clin. 2017 Mar;35(1):95-106.
Aya AG, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, de La Coussaye JE. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg. 2003 Sep;97(3):867-72.
Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017 Feb;216(2):110-120.
David Chestnut Cynthia Wong Lawrence Tsen Warwick D Ngan Kee Yaakov BeilinJill Mhyre Brian T. Bateman Naveen Nathan. Chestnut’s Obstetric Anesthesia: Principles and Practice. 5th edition. Chapter 36: Hypertensive Disorders. Pg 825-859
Killers of the Flower Moon (Dr. Henao’s random recommendation): https://www.amazon.com/Killers-Flower-Moon-Osage-Murders/dp/0385534248
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 161: Dual Training in Anesthesiology and Emergency Medicine
/
RSS Feed
Share
Link
Embed
In this 161st episode I welcome Drs. Regan and Lester to the show to discuss the country’s first combined Anesthesiology and Emergency Medicine dual training program.
CME: https://earnc.me/5Wuljl
Website for the program: https://www.hopkinsmedicine.org/emergencymedicine/combined-residency/
Anesthesia and Critical Care Reviews and Commentary
