Critical Matters

Dr. Stephen Lapinsky, a practicing intensivist and professor with expertise in critical illness during pregnancy, sheds light on the complexities of caring for critically ill pregnant patients. He discusses the unique challenges they face, including respiratory and cardiac physiologic changes that complicate ICU care. Lapinsky also elaborates on common ICU indications, the management of hypertensive disorders and obstetric hemorrhage, and the best practices for team coordination in critical situations. His insights are crucial for improving outcomes in maternal care.

John Devlin, a Professor at Northeastern University and lead author of the 2018 SCCM guidelines, dives into critical topics affecting ICU patients. He discusses the updated guidelines for pain, agitation, sedation, and sleep disruption, emphasizing individualized care. The conversation highlights innovative pain management strategies and the importance of early mobilization and sleep hygiene for recovery. Devlin also underscores the collaborative nature of care and how empowering patients can revolutionize ICU practices.

In this episode of Critical Matters, we explore the role of the intensivist in the management of patients with ventricular assist devices. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac & Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Summary of information presented during the episode kindly provided by Dr. John Greenwood: https://bit.ly/2MJdfSa HeartWare Waveforms App for iPad: https://apple.co/2NpyQEr Articles Mentioned In This Episode: Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68: https://bit.ly/2MKr3M6 Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153: https://bit.ly/2NoreC4

In this episode of Critical Matters, we continue the discussion of medical errors in healthcare with a specific focus on how to disclose medical errors to patients. Our guest is Dr. Nitin Puri, a practicing intensivist and medical educator at the Cooper Medical School of Rowan University and the Cooper Health System in Camden, New Jersey. Additional Resources: This is a CNN story on cardiothoracic fellow wrongly accused and sued for lying about a medical error: https://cnn.it/2vFEnLf The Communication and Optimal Resolution (CANDOR) toolkit from the Agency for Healthcare Research and Quality (AHRQ). CANDOR is a process that health care institutions and providers can use to respond in a timely, thorough and fair way when medical errors occur and cause patients harm: https://bit.ly/2m9fch7 A powerful video on the topic of the disclosure of medical errors: https://bit.ly/2DaD6TD Article Mentioned in This Episode: Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts: https://amzn.to/2NorssU

In this episode of Critical Matters, we discuss “Compassionomics” with Dr. Stephen Trzceciak. Dr. Trzeciak is a practicing intensivist and prolific researcher. His research interests have focused recently on the hypothesis that compassion matters for patients, for healthcare outcomes, and for providers. Compassionomics is the revolutionary field of science focusing on caring, and the impact compassion has on healthcare. Additional Resources: How 40 Seconds of Compassion Could Save a Life: https://youtu.be/elW69hyPUuI Compassionomics: Hypothesis and experimental approach: http://compassionomics.net Article Mentioned in This Episode: A Patient’s Story: http://www.theschwartzcenter.org/media/patient_story.pdf

In this episode, we discuss the ABCDEF bundle, a tool used to promote evidence-based care that promotes healing and liberation from critical illness for patients in the ICU. Our guest is Dr. Julia Barr who is currently the Associate Professor of Anesthesia in the Medical Center Line at Stanford Medical School and a staff anesthesiologist and intensivist at the VA Palo Alto Medical Center. Dr. Barr has served as a national faculty member for the SCCM ICU Liberation Campaign ABCDEF Bundle Collaborative and is a member of the SCCM’s ICU Liberation Committee. Additional Resources: Society of Critical Care Medicine’s guidelines on management of pain, agitation and delirium: http://www.sccm.org/Research/Guidelines/Guidelines/Pain,-Agitation,-and-Delirium-in-Adult-Patients-in Society of Critical Care Medicine’s guidelines for Family-Centered Care in the ICU: http://www.sccm.org/Research/Guidelines/Guidelines/Family-Centered-Care-in-the-ICU Books Mentioned in This Episode: The Power of Habit: Why We Do What We Do in Life and Business: https://www.amazon.com/Power-Habit-What-Life-Business-ebook/dp/B0055PGUYU/ref=sr_1_2?ie=UTF8&qid=1530020419&sr=8-2&keywords=the+power+of+habit

Dr. Thomas Bleck, a seasoned neurointensivist and professor at Rush University Medical Center, dives deep into the management of seizures in the ICU. He shares insights on the best practices for treating status epilepticus, emphasizing the importance of prompt intervention and proper medication dosing. Dr. Bleck explains how to differentiate between epileptic and non-epileptic seizures using EEG and discusses the significance of continuous EEG monitoring. He also highlights the prognostic implications of seizures post-cardiac arrest and the advancement of neurocritical care.

In this episode of Critical Matters, we discuss the Hour-1 Bundle for sepsis. The Surviving Sepsis Campaign has been working on improving outcomes for patients with sepsis for well over a decade. Today we are fortunate to have one of its leaders as a guest to discuss the 2018 update: The Hour-1 Bundle. Our guest is Mitchell Levy, MD, MCCM. Dr. Levy is Professor of Medicine and Division Chief, Pulmonary and Critical Care Medicine at the Alpert Medical School of Brown University in Providence, Rhode Island. Additional Resources: The Surviving Sepsis Campaign website. A wealth of resources for clinicians interested in improving outcomes for patients with sepsis and septic shock. http://www.survivingsepsis.org/Pages/default.aspx The Surviving Sepsis Campaign Bundle: 2018 Update (The Hour-1-Bundle) http://www.survivingsepsis.org/SiteCollectionDocuments/Surviving-Sepsis-Campaign-Hour-1-Bundle-2018.pdf Books Mentioned in This Episode: Shambhala: The Sacred Path of the Warrior: https://www.amazon.com/Shambhala-Sacred-Warrior-Chogyam-Trungpa/dp/1611802326/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1528317558&sr=8-1

In this episode of Critical Matters, we discuss medical errors in healthcare. Our guest is Dr. Nitin Puri, a practicing intensivist and medical educator at the Cooper Medical School of Rowan University and the Cooper Health System in Camden, New Jersey. We discuss a range of topics related to medical errors in critical care medicine including the incidence of errors in our practice, causes, how to prevent them, and how we should deal with them when they occur. Additional Resources: To Err is Human: Building a Safer Health System. The landmark publication y the Institute of Medicine highlighting medical errors as a critical cause of deaths in the US healthcare system: https://www.ncbi.nlm.nih.gov/pubmed/25077248 Medical error – the third leading cause of death in the US: https://www.ncbi.nlm.nih.gov/pubmed/27143499 Books Mentioned in This Episode: Haroun and the Sea of Stories: https://www.amazon.com/Haroun-Sea-Stories-Salman-Rushdie/dp/0140157379/ref=asap_bc?ie=UTF8 Invisible Man: https://www.amazon.com/Invisible-Vintage-International-Ralph-Ellison-ebook/dp/B003WUYR9K/ref=sr_1_2?ie=UTF8&qid=1525281632&sr=8-2&keywords=invisible+man+ralph+ellison

In this episode of Critical Matters, we discuss the role of noninvasive ventilation and high-flow oxygen nasal cannula in respiratory failure. Our guest, Dr. Pratik Doshi, is an academic intensivist and emergency medicine physician at the University of Texas Health Science Center in Houston, Texas. Dr. Doshi is the lead author and investigator of a recently published multicenter randomized clinical trial evaluating this topic. Additional Resources: Official ERS / ATS Guidelines for non-invasive ventilation (NIV): https://www.ncbi.nlm.nih.gov/pubmed/28860265 High-velocity nasal insufflation in the treatment of respiratory failure: A randomized clinical trial by Doshi P et al: http://www.annemergmed.com/article/S0196-0644(17)31968-6/fulltext Books Mentioned in This Episode: The Alchemist: https://www.amazon.com/Alchemist-Paulo-Coelho-ebook/dp/B00U6SFUSS/ref=sr_1_1?ie=UTF8&qid=1523055572&sr=8-1&keywords=the+alchemist