#25 Diuresis & Negative Fluid Balance
Diuretics are essential tools used by clinicians to manage volume status in ambulatory patients and in the critically ill… but are we using them correctly? Join Nick & Cyrus as they explore principles of fluid balance and teach a masterclass on how to approach diuresis in the critically ill patient. You won’t want to miss this high-yield episode discussing an evergreen topic in the world of critical care medicine!
#24 Thrombocytopenia in Critical Illness
Thrombocytopenia is a puzzling, yet common problem in the ambulatory setting, on the wards and in critically ill patients! Having an understanding of why it happens, why it matters, and what we should do about it, is of paramount importance. Given that patient care is first and foremost for us at Critical Care Time, we’ve teamed up - once again - with hematologist extraordinaire Matthew Rendo (X: RendOncology) to help us develop a pragmatic approach to managing the patient with thrombocytopenia. Please give it a listen and let us know what you think!
#23 Resuscitative TEE with Dr. Ross Prager
On Critical Care Time we are - of course - HUGE fans of POCUS. On this episode, Nick and Cyrus take this love for POCUS to the next level with our discussion on Resuscitative Transesophageal Echocardiography (Resus-TEE) with Canadian intensivist, Dr. Ross Prager (@ross_prager) a Resus-TEE expert aficionado! On this show, we discuss the basics of Resus-TEE including indications, pitfalls and pearls, the practicality of implementing this modality at your hospital and some of the medico-legal considerations. We had a ton of fun recording his with Ross and hope you enjoy listening to it!
#22 Bronchoscopy Emergencies w/ PulmPEEPs
(blurb)Like that time the Jetsons met the Flintstones or the more recent colab between Lululemon and Peloton, join us for an epic pairing between Critical Care Time hosts Cyrus & Nick and the PulmPEEPS - Drs. Dave Furfaro and Kristina Montemayor. On this show we use a case based approach to answer the question: How can a bronchoscope save your @$$ in the ICU and beyond? We take a practical look at airway bleeds, trach emergencies and so much more with our friends from PulmPEEPs!
#21 Feeding in Critical Illness w/ Dr. Paul Wischmeyer
On this MEGAsode of Critical Care Time, Cyrus & Nick are joined by world-renowned expert in ICU nutrition, Dr. Paul Wischmeyer (X: Paul_Wischmeyer & IG: paul_wischmeyermd) to discuss all things ICU nutrition. This episode is highly fortified with practice changing pearls from soup to nuts! In addition to getting to know who Paul is and why he does what he does, we demystify metabolic carts, talk about protein needs and metabolism in the critically ill, discuss steroids and other supplements - all while dispelling some major ICU myths regarding gastric residuals, TPN and more. Grab a healthy snack, sit back and get ready to enjoy some remarkable content in an oft overlooked field in medicine!
#20 CRRT w/ Dr. Kevin Chung
On this week’s episode of Critical Care Time, Nick and Cyrus discuss continuous renal replacement (or kidney replacement) therapy and acute kidney injury with master intensivist and extra corporeal aficionado, Dr. Kevin Chung. Dr. Chung is a retired colonel in the United States Army, the principal force behind an intensivist-run renal replacement program in San Antonio, and is currently the Chief Medical Officer for our season one sponsor, Seastar Medical.
In this episode, we discuss an approach to acute kidney injury, demystify elements of continuous renal replacement therapy, and then discuss various applications to include blood purification technology in 2024.
#19 Metabolic Acidosis w/ NephMadness
In this Critical Care Time x #NephMadness collab, Nick & Cyrus host Drs. Tim Yau and Jeff Kott for a comprehensive discussion of metabolic acidosis with a focus on critically ill patients. We start by outlining a pragmatic approach to acid/base derangements peppered with some fact finding and myth busting, CCT style! We then turn our attention to working up and treating metabolic acidosis in the ICU. If you are looking for a one stop shop when it comes to metabolic acidosis in the ICU - look no further. You may even figure out what Spanx & sodium bicarb have in common!
#18 Journal Club: VL versus DL
On this week’s installment of Critical Care Time, Nick & Cyrus tackle the recent multicenter, randomized DEVICE Trial, which compared direct vs video laryngoscopy in 17 American ICUs & EDs with the primary outcome of interest being successful intubation on first attempt. During this episode, we’ll take a deep dive into the paper, discuss other literature, and weigh-in ourselves based upon our own experiences and the data that’s available. Give it a listen and let us know what YOU think!
#17 Hyponatremia w/ Dr Joel Topf
Sit back and grab some salty treats as you enjoy the mindful musings of master nephrologist Dr. Joel Topf (X: @Kidney_Boy) who joins Nick & Cyrus to chat about hyponatremia in critical illness - a very common condition. Here we discuss diagnosis and management of hyponatremia with special attention to those in the intensive care unit. Of course, no discussion is complete without plenty of time dedicated to osmotic demyelination syndrome (aka: central pontine myelinolysis) which gets plenty of face-time during this episode. Give it a listen and leave feeling confident in your ability to diagnose and manage a very prevalent condition in our patient population!
#16 Pulmonary Embolism Part 2
in Part II of our discussion of PE, Nick & Cyrus discuss the Pillars of PE Management! We review the literature behind lytics in non-massive PEs, talk about airway management, hemodynamics and more! Make sure you listen to Part I if you missed it as it sets the stage for this fantastic, treatment focused discussion.
#15 Pulmonary Embolism Part 1
There are few things in medicine Nick & Cyrus enjoy talking about more than PE! Join the guys from Critical Care Time as they tackle this massive topic via a two-part epic that’ll prove to be the best saga since The Lord of The Rings! In part one they talk about diagnosis, clinical decision support tools and demystify the pathophysiology behind pulmonary emboli. Check it out and be sure to catch the second half in two weeks! We promise you’ll get your money’s worth!
#14 Massive Hemoptysis w/ Dr. Whittney Warren
Hemoptysis can be a scary thing to encounter in medicine and massive hemoptysis - i.e. life threatening hemoptysis - is a serious emergency that often requires cognitive agility and technical prowess. Join Nick & Cyrus as they talk with Dr. Whittney Warren - an intensivist and interventional pulmonologist - who walks us through her pragmatic approach to life-threatening hemoptysis. What medications can we use to stabilize these patients? How would we go about intubating such a patient? What bronchoscopic tools do we have at our disposal? Listen to this first CCT episode of 2024 and find out!
#13 ICU Rounds: Focusing on the Patient
In critical care, it's easy to get distracted. Patients are dynamic, learners are hungry, and families eagerly await updates on their loved ones. As important as all of these elements are - it's the patient that we need to focus on, and sometimes patient care can take a backseat when clinicians lean on the rounding conventions of old. On this episode of Critical Care Time, Nick & Cyrus discuss their opinions on rounding in the ICU and present strategies from their own practice which may enable you to be a more effective - and efficient - educator, communicator, mentor and ICU clinician!
#12 DVT Prophylaxis in the Critically Ill
Every time we admit or care for a critically ill patient, we must consider their risk for deep venous thrombosis, or DVT. Many of our patients are at higher risk for DVT than the general population, but anticoagulants are not wholly benign drugs. What do we do? How do we decide who to treat medically, who to treat with mechanical compressive devices and identify patients who may NOT need anything? When do risks out-weight benefits? What agent is best?Join Nick and Cyrus as they interview hematologist & oncologist Dr. Matthew Rendo (Twitter/X: @Rendoncology) as they do a deep dive into managing DVT prophylaxis in the critically ill patient!
#11 The Physiologically Difficult Airway
Airway management in the critically ill can be one of the most challenging, stressful and rewarding elements of critical care medicine. While the anatomically challenging airway is often the first place our minds go when discussing difficult airways, the physiologically difficult airway is both more common and often requires more savvy to overcome. Join Cyrus & Nick as they take a pragmatic, case-based approach to this topic to equip you with the tools you need to successfully tackle a physiologically difficult airway, or support an airway operator charged with this task!
#10 Pneumothorax & Pleural Disease
Whether you work in the ICU, on the medicine wards or in the prehospital setting, you've got to be familiar with the unsung hero of the thorax - the pleura! On this episode of Critical Care Time, Cyrus & Nick extol the virtues of this humble structure, cover a little comparative physiology and spend the latter half of their chat discussing all things pneumothorax. Sit back, relax and enjoy this episode packed with pulmonary and critical care pearls that will take your breath away!
#9 Leading a Cardiac Arrest
Running a code is a stressful proposition. The code team leader is responsible for conducting an orchestra in a most austere environment, with the goal of guiding the team towards success - defined hopefully by a successful resuscitation. The code team leader needs to have the presence of mind to lead, but also needs to know how to delegate responsibilities and quickly cultivate a shared mental-model between the various team members. Join Nick and Cyrus as they try to demystify some of the elements of leading a code by providing practical pearls and shedding light on potential pitfalls during this episode on Cardiac Arrest and Running a Code
#8 Legal Considerations in Critical Care
The intersection between patient care and the legal system can be a tricky one to navigate. Our duty as members of the healthcare team - irrespective of a patient’s social history - is to provide the best care we can, while protecting a patient’s privacy. Unfortunately, this can sometimes be easier said than done, and traveling such choppy waters can be challenging! Join Nick & Cyrus as they host Drs. Erin DeMartino & Matthew Griffith of Scopes and Shields for a case-based discussion which will hopefully equip you with some knowledge and tools for the next time you have a patient who is in custody or otherwise involved with the legal system.
#7 Vasopressors Part 2: Beyond the Basics
On this episode of Critical Care Time, Cyrus and Nick go beyond the basics of vasopressor management. During this episode - jam-packed with high-yield pearls - we discuss important topics such as how to titrate vasopressors, what can be done when vasopressors seem to be failing a patient and how to wean patients from vasopressors in order to successfully get them out of the ICU and ultimately home. Sit back, relax, and enjoy this hour long master-class on Vasopressors - Beyond the Basics!
#6 Vasopressors Part 1: Pressor Basics
On this episode of Critical Care Time, Cyrus and Nick explore the basics of vasopressors, providing a framework for understanding them. When to start them, how to titrate them, when to use push dose vasopressors, and when a central line is needed. If you use vasopressors to treat your patients, this is the episode for you! Whether you are ordering them, titrating them or looking out for complications associated with their use, Nick & Cyrus have got your back!