Critical Care Scenarios

Hallie Prescott, pulmonary and critical care physician and guideline co-chair, walks through the new Surviving Sepsis guideline update. She highlights changes like pre-hospital antibiotic criteria, limits on anaerobic coverage, blood pressure and fluid guidance, selective digestive decontamination, and how recommendations were prioritized and graded. Short, practical discussion on application across resource settings.

Scott Weingart, an ED intensivist and creator of EMCrit known for clear critical care teaching. He discusses how to read papers by focusing on methods, ways to choose trustworthy experts, and the value of seeking disconfirming views. Conversation covers reconciling clinical experience with trials, using AI for literature search, and building local standards to improve decision making.

Amos Dodi, nocturnal intensivist at Einstein/Montefiore and author on right ventricular failure, joins to unpack management of RV failure in the MICU. They walk through bedside ultrasound use, interpreting chronic versus acute RV findings, practical hemodynamic monitoring, vasopressor and inotrope choices, and high-risk intubation and fluid removal strategies. Practical, case-driven clinical talk.

We dive into the confusing rabbit hole of medical staffing, credentialing, and privileging, particularly for the critical care APP, with Chris Newman, pediatric critical care PA and Vice Chair for Clinical Performance at the University of Colorado. Check out the REVIVE conference here! Check out the CHEST Procedural Skills for the Critical Care Clinician course … Continue reading "Lightning rounds 61: Credentialing and privileging, with Christopher Newman"

Melissa Nestor, a clinical pharmacist in neurocritical care, explains glucose and insulin management in the ICU. She covers who needs monitoring and the role of A1C on admission. Topics include when to escalate to infusions, pros and cons of sliding scale versus scheduled or basal insulin, and safety-first tactics to prevent hypoglycemia.

Practical tips for running rapid responses on the wards. Crowd and scene management strategies to keep teams effective and calm. How to gather and synthesize fast diagnostic data like chest x‑rays, ABGs, and bedside ultrasound. Decision points for choosing respiratory support and whether to transfer to higher care. Communication techniques for negotiating with primary teams and updating families.

Delve into the world of nebulizers and their vital role in inpatient care. Discover why nebulizers often outperform inhalers in patients with dyspnea. Learn about continuous albuterol therapy and the logistics behind it. Hear contrasting insights on small-volume vs. vibrating mesh nebulizers and their efficiency. Explore the complexities of dose, dilution, and optimal delivery methods. Join a lively debate on the role of bronchodilators in secretion clearance and the importance of tailored therapy for better resource stewardship.

Dive into the intricacies of managing elevated intracranial pressure with expert insights. Discover the importance of assessing the true nature of ICP spikes and the critical role of cerebral perfusion pressure. EVD troubleshooting tips reveal common complications while hyperosmolar therapies like 3% saline and mannitol are compared. Learn when to escalate care, the considerations for craniectomy, and the impacts of thoracoabdominal pressures on cerebral drainage. Plus, explore team communication during crises and strategies for optimizing patient outcomes.

Dr. Prem Kandiah, a neurointensivist and ammonia expert, dives deep into the complexities of ammonia physiology and its critical care implications. The discussion highlights the unique ways ammonia can affect the brain, including mechanisms of injury and the importance of timely measurement. Kandiah explores less-known causes of hyperammonemia, such as urease-producing infections and malnutrition, especially in post-bariatric patients. He also offers practical tips for accurate ammonia testing and discusses acute management strategies.

Learn more at the Intensive Care Academy!