Critical Matters

Sound Physicians

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Critical Matters

Podcast by Sound Physicians

١٠ جمادى الأولى

Management of Complications Post-Cardiotomy

In this episode, Dr. Sergio Zanotti discusses the management of critically ill patients after cardiac surgery, focusing on the clinical management of two important complications: hemorrhage and cardiac arrest. He is joined by Dr. Christopher Noel, a critical care attending at Cooper University Healthcare. Dr. Noel is also an assistant professor of medicine at Cooper Medical School of Rowan University and associate program director for the Critical Care Medicine Fellowship and the Clerkship Director for Critical Care Medicine Clerkships for Medical Students. Additional resources: American Association for Thoracic Surgery (AATS) TSRA Primer- Critical Care: https://www.aats.org/tsra-primer-post-operative-bleeding https://www.aats.org/tsra-primer-cardiac-arrest-post-cardiotomy The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery. Ann Thorac Surg 2017: https://pubmed.ncbi.nlm.nih.gov/28122680/ Society of Cardiovascular Anesthesiologists clinical practice improvement advisory for the management of perioperative bleeding and hemostasis in cardiac surgery patients. J of Cardiothoracic and Vascular Anesthesia 2019: https://pubmed.ncbi.nlm.nih.gov/31613811/ Music mentioned in this episode: The Outsiders. By Eric Church: https://bit.ly/4fHvxkp Collective Soul. By Collective Soul: https://bit.ly/3AzLcUd

٥٦ من الدقائق
١٩ ربيع الآخر

Hyperglycemic Emergencies

In this episode, Dr. Sergio Zanotti discuss the management of critically ill patients undergoing hyperglycemic emergencies. He is joined by Dr. George Willis, a practicing emergency medicine physician. Dr. Willis is an Associate Professor and Associate Program Director for Emergency Medicine at the University of Texas Health Science Center in San Antonio, where he also serves as Vice Chair of Faculty Affairs. A recognized clinical educator, he holds a particular interest in endocrine emergencies, vascular emergencies, procedural education, and medical education. Additional resources: Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. GE Umpierez, et al. Diabetes Care 2024: https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis. WH Self, et al. JAMA 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670314/ Evaluation and Management of the Critically Ill Adult with Diabetic Ketoacidosis. B Long, GC Willis, S Lentz, et al. J Emerg Med 2020: https://pubmed.ncbi.nlm.nih.gov/32763063/ The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis) Impacts on ED operational Metrics. Acad Emerg Med 2023: https://pubmed.ncbi.nlm.nih.gov/36775281/ Books mentioned in this episode: Kintsugi: Finding Strength in Imperfection. By Celine Santini: https://bit.ly/3NCdAYB

١ س ٤٩ د
٧ ربيع الآخر

Music and Critical Illness

This episode, Dr. Sergio Zanotti discusses music and critical illness and explores the topic through the lens of his guest – Andrew Schulman. Andrew is the first musician to be accepted as a professional Society of Critical Care Medicine (SCCM) member. He is a member of the SCCM ICU Liberation Committee, where he met and had the opportunity to work with Dr. Zanotti. Andrew and his wife Wendy, are the subjects of Josh Aronson's documentary film Andrew & Wendy (2015), which has aired multiple times on PBS-TV. He is the author of Waking The Spirit: A Musician’s Journey Healing Body, Mind, and Soul. Since its release in the U.S. in August 2016, Waking the Spirit has been chosen as an Oliver Sacks Foundation Best Book of the Year Selection, Finalist for the Books for a Better Life Award, and a People Magazine Pick in Nonfiction. Additional Resources: Andrew Schulman’s Website https://andrewschulmanmusic.com/about Books and Albums mentioned in this episode: Waking The Spirit: A Musicians’s Journey Healing Body, Mind and Soul. By Andrew Schulman: https://us.macmillan.com/books/9781250132222 Musicophilia: A Tale of Music and the Brain. By Oliver Sacks: https://bit.ly/4dCTjwv St. Matthew Passion – Johann Sebastian Bach (Composer), Leonard Bernstein (Conductor): https://amzn.to/4eZmgE5 Lute Sonatas Nos. 30 & 39 & 96: 11 Silvius Leopold Weiss (Composer), Robert Barto (Performer): https://bit.ly/3YfXha2

١ من الساعات
٢٧ ربيع الأول

Albumin in Critical Care

In this episode of Critical Matters, Dr. Zanotti discusses the use of intravenous albumin in critical care. He is joined by Dr. Jeannie Callum, Director of Transfusion Medicine and Professor of Pathology and Molecular Medicine at Queens University in Ontario, Canada. Dr. Callum’s research focuses on blood utilization, hemostasis in the bleeding patient, and transfusion-related errors. She has received numerous awards and published extensively. Dr. Callum is the lead author of “Use of Intravenous Albumin: A Guidelines from the International Collaboration for Transfusion Medicine Guidelines,” published earlier this year in CHEST. Additional Resources: Use of Intravenous Albumin. A Guideline from the International Collaboration for Transfusion Medicine Guidelines. CHEST 2024: https://journal.chestnet.org/article/S0012-3692(24)00285-X/fulltext International Collaboration for Transfusion Medicine Guidelines Website: https://www.ictmg.org/ Ten myths about albumin. M Joannidis, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35247060/ A comparison of albumin and saline for fluid resuscitation in the intensive care unit. SAFE Study Investigators. N Engl J Med 2004: https://pubmed.ncbi.nlm.nih.gov/15163774/ Albumin Replacement in Patients with Severe Sepsis or Septic Shock. ALBIOS Study Investigators. N Engl J .Med 2014: https://www.nejm.org/doi/full/10.1056/NEJMoa1305727 Books mentioned in this episode: Ending Medical Reversal: Improving Outcomes, Saving Lives. By Vinayak K. Prasad: https://bit.ly/4dAimRa The Time Machine. By H.G. Wells: https://amzn.to/4eK4apG

٥٣ من الدقائق
٩ ربيع الأول

Neurological support post-cardiac arrest

Much attention has been paid to targeted temperature management (TTM) in post-cardiac arrest patients. The evidence for this practice continues to evolve, and previous episodes of Critical Matters have covered this topic. In this episode, Dr. Zanotti focuses on other aspects of Neurological Support in the ICU for post-cardiac arrest patients. He is joined by Dr. Edilberto Amorin, a neurologist with subspecialty training in critical care and epilepsy. He has expertise in neurological intensive care, telemedicine, and multimodal brain monitoring with EEG. Dr Amorin is an Assistant Professor of Neurology at UCSF Weill Institute for Neurosciences and directs the Epilepsy and Clinical Neurophysiology Service at the Zuckerberg San Francisco General Hospital. Additional resources: Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation 2024: https://pubmed.ncbi.nlm.nih.gov/38040992/ Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest.TELSTAR Investigators. N Engl J Med 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2115998 Improving Outcomes After Post-Cardiac Arrest Brain Injury: A Scientific Statement from the International Liaison Committee on Resuscitation. ILCOR 2024: https://www.ilcor.org/news/improving-outcomes-after-post-cardiac-arrest-brain-injury Books mentioned in this episode: As Real as it Gets: The Life of a Hospital at the Center of the AIDS Epidemic. By Carol Pogash: https://bit.ly/4d4xHZC C. Miller Fisher: Stroke in the 2oth Century. By LR Caplan: https://bit.ly/3XFw3Jw

١ س ١٢ د
٢٥ صفر

Vasoplegia after cardiac surgery

Hypotension and shock are both recognized as complications post-cardiac surgery. Some patients may develop more severe shock refractory to fluids and catecholamines. This response is also known as today's podcast episode, topic: vasoplegia after cardiac surgery. For this discussion, Dr. Zanotti is joined by Dr. Iqbal Ratnani, an intensivist who practices at the DeBakey Heart & Vascular Center and the Center for Critical Care at Houston Methodist Hospital. Dr. Ratnani is an Associate Professor of Clinical Anesthesiology & Critical Care for the Department of Anesthesiology and Critical Care at Weill Cornell Medical College. In addition, Dr. Ratnani is the Director of Critical Care Education at the Center for Critical Care. Additional resources: Vasoplegia: A Review. Igbal Ratnani, et al. Methodist DeBakey Cardiovascular Journal 2023: https://pubmed.ncbi.nlm.nih.gov/37547893/ Vasoplegic Syndrome after Cardiopulmonary Bypass in Cardiovascular Surgery: Pathophysiology and Management in Critical Care. Zied Ltaief, et al. Journal of Clinical Medicine 2022: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9658078/ Books mentioned in this episode: Marino’s The ICU Book. By Paul Marino: https://bit.ly/3XmWPGA Every Deep-Drawn Breath. By Wes Ely: https://bit.ly/4cODkeq In Shock: My Journey from Death to Recovery to Redemption. By Rana Awdish: https://bit.ly/3Z4mC7z

٤٦ من الدقائق
٤ صفر

Tracheostomy Emergencies

We pulled out another favorite out this week - Dr. Zanotti's deep-dive on tracheostomy emergencies. Tracheostomies are common in ICU patients. Every intensivist should be capable of recognizing and providing initial management to potentially serious complications associated with tracheostomies. Dr. Zanotti is joined by Drs. Laura Bontempo and Sara Manning, emergency physicians and educators with a special interest in the topic. Dr. Laura Bontempo is an associate professor of emergency medicine and serves as Assistant Director for Faculty Development & Resident Education in the Department of Emergency Medicine at the University of Maryland Medical School. Dr. Sara Manning is an Assistant Professor of Clinical Emergency Medicine, in the Department of Emergency Medicine at the Indiana University School of Medicine. Additional Resources: Tracheostomy Emergencies. LJ Bontempo and SL Manning. Emerg Med Clin N Am 2019: pubmed.ncbi.nlm.nih.gov/30454773/ Link to Onepager on Tracheostomy Emergencies: onepagericu.com/trach-emergencies Bleeding Tracheostomy. Kenji Inaba MD. Presented at Essentials of EM: www.facebook.com/EssentialsofEM/v…163679590380038/ Book Recommendations: Who Moved my Cheese?: An A-Mazing Way to Deal with Change in Your Work and in Your Life. By Spencer Johnson, et al: amzn.to/3pq0CkR Where the Red Fern Grows. By Wilson Rawls: amzn.to/3AawH6a

٥٩ من الدقائق
١٩ محرم

The Forgotten Patient

Today, we are revisiting one of our favorite episodes from last year - The Forgotten Patient. Dr. Zanotti focuses on the loved ones and families of critically ill patients and explores the topic through the lens of a cardiac arrest co-survivor. His guest is Kristin Flanary, a cognitive neuroscientist and social psychologist. Kristin is a co-survivor of cancer(twice) and a co-survivor of sudden cardiac arrest. She is also known for her social media alter ego – Lady Glaucomflecken. In 2022 Kristin co-founded Glaucomflecken LLC, where she works to advocate for caregivers and co-survivors of medical trauma and critical illness, community CPR and AED use, and sudden cardiac arrest survivorship. She has written about her experience as a co-survivor in medical journals and has received an EMS Cardiac Arrest Save Challenge Coin, the Citizen CPR Foundation’s '40 Under 40' award, and the American Heart Association’s Resuscitation Champion award. Additional Resources: The Quiet Place. K. Flanary. Journal of Cardiac Failure, 2021: www.onlinejcf.com/article/S1071-91…00403-6/fulltext Roger. K Flanary. CHEST. 2022: journal.chestnet.org/article/S0012-…029-6/fulltext Life after Cardiac Arrest: The importance of engaging with the “forgotten patient.” K Haywood & K Dainty. Resuscitation, 2018: www.resuscitationjournal.com/article/S0…0195-3/pdf Link to the Glaucomflecken’s website: glaucomflecken.com/ Books Mentioned in this Episode: In Shock. By Rana Awdish: bit.ly/441b0Cx

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