Episode 57: Bugs and Drugs Part 2 With Rachel Kruer

In this episode, episode 57, I welcome back Rachel Kruer, our amazing SICU pharmacist and we complete our two part series on bugs and drugs in the ICU.  We discuss different infections that are commonly seen in ICUs and how to treat them.

Episode Notes

Episode 56: Bugs and Drugs Part 1 with Rachel Kruer

In this episode, episode 56, I welcome Rachel Kruer to the show.  Rachel is one of our amazing ICU pharmacists and we discuss common bacteria and the drugs we use to treat them.  This is part 1 of a 2 part series that I’ll be doing with Rachel on this topic.


Skip to specific topics:

Pharmacodynamics vs. Pharmacokinetics (1:08)
Categorizing Bacteria (7:10)
Beta-Lactams (12:10)
Aztreonam (19:40)
Carbapenems (21:20)
Case Examples (24:20)
Fluoroquinolones (30:36)
Vancomycin (33:15)
Aminoglycosides (35:31)
Macrolides (39:45)
Linezolid (40:33)
Daptomycin (43:05)
Sulfonamide Antibiotics (44:05)
Clindamycin (45:49)
Colistin (47:17)
Glycylcycline (48:43)
Metronidazole (Flagyl) (49:55)
Vancomycin Resistant Enterococcus (51:11)
Surgical Prophylaxis (53:40)

Outline by April Liu
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Episode 55: Term Pregnancy Part 2 with Mike Hofkamp

In this episode, episode 55, I welcome back frequent guest of the show Dr. Mike Hofkamp to pick up where I left off last time with Dr. Jacqueline Galvan as we discuss problems that can occur with pregnancy at term (part 2) including complications of labor and delivery.

Outline by Brian Park: Outline

Episode 53: Analgesia for C-section with Mike Hofkamp

In this episode, episode 53, I welcome back Dr. Mike Hofkamp to discuss analgesia for cesarean delivery.  We discuss indications for C-section, urgent and emergent sections, anesthetic techniques and associated complications, how to approach the difficult airway in a pregnant patient, and aspiration prophylaxis.

Additional information:

Episode 52: Diastolic Heart Failure with Todd Dorman

In this episode, episode 52, I welcome Dr. Todd Dorman to the show.  Dr. Dorman is a professor of anesthesiology here at Johns Hopkins, is the Vice Chair for Critical Care, and is the immediate past president of the Society of Critical Care Medicine (SCCM).  Dr. Dorman and I discuss diastolic heart failure or heart failure with preserved ejection fraction (HFPEF), how it differs from systolic heart failure or heart failure with reduced ejection fraction (HFREF), how it presents, and how to manage it perioperatively.

References for peripheral vasopressors:

  1. Medlej K et al. Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study. JEM 2018. PMID: 29110979
  2. http://rebelem.com/peripheral-vasopressors-safe-dangerous/

Outline by April Liu

Episode 51: Labor Analgesia with Jacqueline Galvan

In this episode, episode 51, I welcome back Dr. Jacqueline Galvan to discuss labor analgesia.  We cover opioids including remifentanil, nitrous oxide, neuraxial anesthesia and other nerve blocks.

References:

  • Hess PE, et al. An association between severe labor pain and cesarean delivery. Anesth Analg. 2000 Apr;90(4):881-6
  • Van den Bussche E. Why women prefer epidural analgesia during childbirth: the role of beliefs about epidural analgesia and pain catastrophizing. Eur J Pain. 2007 Apr;11(3):275-82.
  • Varposhti MR et al. Comparison of remifentanil: Entonox with Entonox alone in labor analgesia. Adv Biomed Res. 2013 Nov 30;2:87

Episode 50: CSE vs Epidural Debate with Mike Hofkamp and Jacqueline Galvan

In this episode, episode 50, I welcome back Dr. Mike Hofkamp, and, for the first time, I welcome Dr. Jacqueline Galvan to the show.  Drs. Hofkamp and Galvan go head to head in a debate over which is a better, more evidence-based technique, the traditional epidural or the CSE (combined spinal epidural).

All of the articles that were referenced can be found here: References

Episode 49: High Reliability with Peter Pronovost

In this episode, episode 49, I welcome Dr. Peter Pronovost to the show to discuss the high reliability movement and how it relates to healthcare.  Dr. Pronovost is one of the world’s foremost experts on patient safety and we discuss how a hospital can be as reliably safe as an aircraft carrier and how best to approach an angry patient in the ICU.

Episode 48: TAVRs with Clint Tippett

In this episode, episode 48, I welcome Dr. Clint Tippett to the show.  Dr. Tippett is a cardiac anesthesiologist with an interest in anesthesia for Transcutaneous Aortic Valve Replacement (TAVR) and we discuss the approach to anesthesia for these cases including preoperative planning, intraoperative management, and post-operative concerns.

Regarding stroke risk here is an editorial (Thanks to Stephen Freiberg for providing this link): http://circinterventions.ahajournals.org/content/8/6/e002801

And Dr. Tippett wanted to add that early studies of the 1st and second generation valves had higher stroke rates than SAVR, however the most current genreration valves(Edwards Sapien 3 and Medtronic Evolut R) both have been shown to have not significantly different stroke rates from TAVR.(Surtavi trial and this observational study http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30073-3.pdf).

Finally, when discussing benefits of TAVR, we should have mentioned a significantly lower risk of post-op AFib in addition to lower bleeding risk and lower rates of AKI.