Category Archives: Critical Care

Episode 124: POCUS with Lee Goeddel

June 18, 2019 ACCRAC 1 Comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 124: POCUS with Lee Goeddel

00:00 / 44:01

In this 124th episode I welcome Dr. Lee Goeddel to the show to discuss Point Of Care Ultrasound (POCUS). We discuss what it is, what it covers in the cardiac, pulmonary, abdominal and vascular system, and what next steps are for those interested in taking their skills further.

CME: https://earnc.me/aEbwZG

References:

Anesth Analg. 2017 Mar;124(3):753-760. doi: 10.1213/ANE.0000000000001861.The Nuts and Bolts of Performing Focused Cardiovascular Ultrasound (FoCUS).PMID:28207445

J Am Soc Echocardiogr. 2013 Jun;26(6):567-81. doi: 10.1016/j.echo.2013.04.001.Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.Spencer KT1, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ.PMID 23711341

Chest. 2015 Jun;147(6):1659-1670. doi: 10.1378/chest.14-1313.BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Lichtenstein DA1.PMID: 26033127

Surg Clin North Am. 2011 Feb;91(1):195-207. doi: 10.1016/j.suc.2010.10.008.Focused assessment with sonography for trauma: methods, accuracy, and indications.Patel NY1, Riherd JM. PMID: 21184909

Airway, Anesthesia, Critical Care, Procedures, Trauma

Episode 123: Surgical Airway with Andrew Merelman

June 12, 2019 ACCRAC 1 Comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 123: Surgical Airway with Andrew Merelman

00:00 / 27:04

In this 123rd episode I welcome Andrew Merelman to the show. Andrew is a paramedic and medical student with an interest in emergent surgical airway management. We discuss the human factors involved in the procedure, when it is indicated, how to do it and how to practice.

CME: https://earnc.me/kFl0sc

References and Links:

Airway Ap information:

http://www.airwaycollaboration.org/

iOS – https://itunes.apple.com/ca/app/the-airway-app/id1112657910?mt=8

Android- https://play.google.com/store/apps/details?id=com.parse.airway&hl=en

3D printed models – https://link.springer.com/article/10.1007%2Fs12630-017-0926-9 Videos:

https://vimeo.com/132394603

https://vimeo.com/132394747

https://emcrit.org/emcrit/real-surgical-airway/

https://www.airmedicaljournal.com/article/S1067-991X(09)00037-6/fulltext

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727957/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749220/

https://www.ncbi.nlm.nih.gov/pubmed/20491685

https://www.ncbi.nlm.nih.gov/pubmed/30173584
https://journals.lww.com/jtrauma/Citation/2012/09000/Is_bougie_aided_cricothyrotomy_really__extremely.42.aspx

https://www.researchgate.net/publication/253332531_Comparison_of_a_percutaneous_device_and_the_bougie-assisted_surgical_technique_for_emergency_cricothyrotomy_an_experimental_study_on_a_porcine_model_performed_by_air_ambulance_anaesthesiologists

https://www.ncbi.nlm.nih.gov/pubmed/30686312

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078881/

Airway, Anesthesia, Critical Care, Procedures

Episode 121: Difficult Airway Response Team With Lynette Mark

May 30, 2019 ACCRAC 3 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 121: Difficult Airway Response Team With Lynette Mark

00:00 / 45:42

In this 121st episode I welcome Dr. Lynette Mark to the show. Dr. Mark is the founder of our Difficulty Airway Response Team (DART) here at Hopkins and a founding director for the Society of Airway Management. We discuss the origins of the DART program and how to approach a difficult airway.

CME: https://earnc.me/z1E2G1

References:

https://www.criticalcare.theclinics.com/article/S0749-0704(17)30102-1/abstract

Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC): http://sgschallenge.com/2018daarc/

https://wamm2019.com World Airway Management Meeting, Amsterdam, Netherlands, November, 2019. Drs. Mark and Feinleib will be presenting about the DART program.

Dr. Cooper’s article on surgical airway: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2724164

Dr. Mark’s article from A&A and the accompanying editorial:

https://www.ncbi.nlm.nih.gov/pubmed/26086513

https://www.ncbi.nlm.nih.gov/pubmed/26086503

Critical Care, Pharmacology, Resuscitation

Episode 119: STOP-IT Trial with Rob Sawyer

May 13, 2019 ACCRAC 2 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 119: STOP-IT Trial with Rob Sawyer

00:00 / 37:37

In this 119th episode I welcome Dr. Robert Sawyer to the show. Dr. Sawyer was the PI on the STOP-IT trial comparing a short course of antibiotics versus a longer course for complicated intraabdominal infections. We discuss the trial, the outcomes, and what the future of antimicrobial management in the surgical ICU may look like.

CME: https://earnc.me/jeCfMt

Reference:

STOP-IT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1411162

Airway, Anesthesia, Critical Care, Procedures

Episode 115: The Contaminated Airway with Steve Freiberg

April 15, 2019 ACCRAC 4 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 115: The Contaminated Airway with Steve Freiberg

00:00 / 23:44

In this 115th episode I welcome Dr. Steven Freiberg back to the show to discuss management of the contaminated airway.

CME: https://earnc.me/lDqJUu

References:

Han, S; Fisher, J. Airway Management During Persistent Flooding Of the Oropharyngeal Airway. Anesthesiology News. 2016. March.

Joshi, R; Hypes, C; et al. Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit. Ann Am Thorac Soc. 2017 Mar;14(3):368-375

Stockton, E.; Lockey, D; et. al. Contamination of the airway in pre-hospital trauma patients. European Journal of Anaesthesiology. 2008. May; 25:188

Uday, J; McCunn, M; et al. Management of the Traumatized Airway. Anesthesiology. 2016, Vol.124, 199-206

PulmCrit: Large-bore suction for intubation: strategies & devices

Airway, Anesthesia, Critical Care, Procedures

Episode 111: Tracheostomies, Cricothyrotomies and ENT surgery with Dr. Zandy Hillel

March 4, 2019 ACCRAC 3 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 111: Tracheostomies, Cricothyrotomies and ENT surgery with Dr. Zandy Hillel

00:00 / 53:03

In this 111th episode I welcome Dr. Zandy Hillel to the show. Dr. Hillel is an otolaryngologist here at Johns Hopkins and we discuss tracheostomies, Cricothyrotomies, laryngeal surgery and difficult airways.

CME: https://earnc.me/beqG3N

References:

Crichothyrotomies:

https://www.ncbi.nlm.nih.gov/pubmed/30054081

https://www.ncbi.nlm.nih.gov/pubmed/30726035

Difficult Airway Response Teams:

https://www.ncbi.nlm.nih.gov/pubmed/26086513

Anesthesia, Critical Care, Fluids, Resuscitation

Episode 106: Hydroxyethyl Starches with Marius Fassbinder

January 27, 2019 ACCRAC 8 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 106: Hydroxyethyl Starches with Marius Fassbinder

00:00
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51:18

In this 106th episode I welcome Dr. Marius Fassbinder to the show to discuss the use of hydroxyethyl starches.

CME: https://earnc.me/sFF08C

References:

1. Woodcock, T. E. & Woodcock, T. M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an

improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia 108, 384–394 (2012).

2. Westphal, M. et al. Hydroxyethyl starches: different products–different effects. Anesthesiology 111, 187–202 (2009).

3. Brunkhorst, F. M. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N. Engl. J. Med. 358, 125–139

(2008).

4. Perner, A. et al. Hydroxyethyl Starch 130/0.42 versus Ringer’s Acetate in Severe Sepsis. N. Engl. J. Med. 367, 124–134 (2012).

6. Myburgh, J. A. et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N. Engl. J. Med. 367, 1901–1911

(2012).

7. Annane, D. et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with

hypovolemic shock: the CRISTAL randomized trial. JAMA 310, 1809–1817 (2013).

8. Joosten, A. et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A

Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery. Anesthesiology 128, 55–66 (2018).

9. Gillies, M. A. et al. Incidence of postoperative death and acute kidney injury associated with 6% hydroxyethyl starch use: systematic review and meta-analysis. British Journal of Anaesthesia 112, 25–34 (2014).

Critical Care, Fluids, Physiology, Resuscitation

Episode 104: Sepsis with Pam Lipsett

January 11, 2019 ACCRAC 8 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 104: Sepsis with Pam Lipsett

00:00
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50:42

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

Anesthesia, Critical Care, Life Lessons

Episode 100: Response to Listener Questions

December 11, 2018 ACCRAC 3 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 100: Response to Listener Questions

00:00
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54:46

In this 100th episode I respond to questions, both clinical and personal, from ACCRAC listeners.

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

Critical Care, Education

Episode 94: Organ Donation with Clint Burns

October 5, 2018 ACCRAC 4 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 94: Organ Donation with Clint Burns

00:00
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42:02

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