The Internet Book of Critical Care Podcast

Welcome to the origin story of PULMCRIT!    In this episode, we cover how best to practically monitor the balance between oxygenation, oxygen delivery and oxygen consumption. Controversial to say the least. Come take a listen, and learn about the pulsatility index, a space we should all be watching for in the future.

Transcribed - Published: 13 May 2023

We are back! Come dust off our shows spot in your favourite podcast app, and listen to why its important to hunt for SBP like it's the Red October (forgive the Sean Connery reference, I had too). We cover diagnosis (aka tap-y-tap) and treatment.   

Transcribed - Published: 28 April 2023

Annnnnnnnd We are back. Sorry, but after Andor has finally finished we have now got time to discuss the old type 1 MI, aka STEMI aka Occlusive Myocardial Infarction. Come listen for all those basics and some nuances around myocardial infarction in critically unwell patients. We talk when to DAPT, who gets full anticoagulation, hemodynamic support, and when to wake our Cardiology friends up in the night. 

Transcribed - Published: 2 December 2022

Being Dynamic is usally a great thing... but not when youre crushing the only good way out of the left ventrile.  In this episode we cover dynamic obstruction of the LVOT (specifically sub-valvular): what is it? who gets it? What to do about it. We missed ya'll, so come have alisten and brush up on a rare but important phenomena in our critically ill patients.

Transcribed - Published: 2 August 2022

In this beast of a 53 minute podcast, we tackle the approach to prognosticating neurologic function of our patients after cardiac arrest. This is hard! As Dick Cheney taught us, there are lots of known and unknown-unknowns. Read through the chapter, then come listen to all things: nuances around confounders, using structural and functional tests. How imaging can lead us astray. Is there a troponin of the brain? Josh even admits to what he'd take to the proverbial desert island. 

Transcribed - Published: 9 April 2022

In this episode, we follow up with last week's podcast and explain the drivers of hypocapnia and subsequent respiratoy alkalosis. Come listen to a primer for all things ASA, sepsis, encephalopathy or strait mountain biking - induced panic.

Transcribed - Published: 7 March 2022

In this lean and mean episode, we cover the outrageously broad topic of respiratory acidosis. Come listen to help structure your approach to Won't Breathe, Can't Breathe, and Breathing Won't Work.  If you remeber nothing else, its that hypercapnia does not always mean BIPAP

Transcribed - Published: 1 March 2022

In this episode we cover the rare but important driver of your patients respiratory failure:  Pneumocystis Jiroveci Pneumonia. Come listen to why you should always delineate HIV status, how to approach patient workup and treatment via an invasive and non invasive manner, and why heatwaves is just a sick song.

Transcribed - Published: 21 February 2022

In this episode, we cover that terrible T... Tamponade. Sit back, and get your learn on while we go beyond Beck's triad, discussing all things pulses paradox, ultrasound assessment, pitfalls, stabilization, and Josh will even melt your mind with low pressure tamponade.

Transcribed - Published: 15 December 2021

In this episode, we cover all things "Upper(s)." Come listen to all things critical care level cocaine, meth and bath salts. Organ dysfunction, rapid control, immersive cooling and more!

Transcribed - Published: 1 December 2021

In this episode, we cover that scary presentation where your patient goes from seemingly well, to skin melting off and in multi organ failure. Come take a listen for all things clinical presentation, anti-toxin antibiotics regimes, skin cut downs and surgical debridement.

Transcribed - Published: 28 October 2021

We're back... maybe by popular demand? In this episode, we cover those two phenotypes of acute pulmonary edema: the hyper-acute sympathetic crashing acute pulmonary edema (SCAPE) patient, versus that fluid overload sub acute pulmonary edema (FOSPE). Come listen to all things NIV, nitro, and soothing calm clinical approach. 

Transcribed - Published: 25 October 2021

It has been a hot minute, Josh blames Adam. Adam Blames existential crisis, wildfires and the Rona. Come listen to this comeback cast: Hepatorenal Syndrome. We talk all things systemic dilation with renal constriction. We talk newish classification, albumin, pressers and more. So leave your Map goal of 60 behind you, and enjoy these pearls.

Transcribed - Published: 16 August 2021

In this episode, we cover that variable response to when the lab calls with a culture positive for candida. Lines, blood, Urine. Labs, Anti-fungals, imaging... we got it all. 

Transcribed - Published: 29 June 2021

In this episode, we aim to arm you with a basic approach to the rhythm that loves to make the monitors go ping: atrial fibrillation. The age old argument: rate vs rhythm control. What rate is acceptable? Who gets all of the drugs? Why do we love amiodorone? When do you dust off old sparky? Come join us for 42 minutes of Josh giggling and educating us all.

Transcribed - Published: 21 June 2021

In this episode we cover one of the hallmarks of the poisoned patient, that ECG tracing with a widening QRS. After reading the post, come listen for the nuances around all things hypertonic bicarb for sodium delivery, preventing acidosis with isotonic bicarb, how those sneaky-brilliant toxicologists will use lidocaine, and when to push the "panic button" on intra-lipid.

Transcribed - Published: 3 June 2021

In this episode we cover the obvious, and subtleties around Valproic Acid toxicities. We talk everything from cerebral edema, giving that L-Carnitine and when to spin that IHD machine. 

Transcribed - Published: 10 May 2021

In this episode we summarize the new COVID Chapter (well not so new, but spot on predictions from Jan 26th). Steroids = Yes. Dose... 6mg and keep going up? Toci / Bari = maybe Cocktails / Plasma = Nope Come take a listen for all things anticoagulation, immune modulation and organ support.

Transcribed - Published: 11 March 2021

In this episode we continue on the path of DIC: the scary sub-phenotype that is Purpura Fulminans. When your patient is necrosing everything, you need to act quickly before they start losing organs and digits. Come listen for identification, anticoagulation, protein C and all its goodness, when to give Vitamin K, and why to really be careful about Warfarin.

Transcribed - Published: 19 February 2021

In this episode, we cover disseminated intravascular coagulation. It sounds bad, because it is. Come listen and refresh your skills around supporting the bleed-bleedy versus the cloth-clotty, how to differentiate DIC and chronic liver failure and a few more juicy clinical pearls.

Transcribed - Published: 18 January 2021

In this episode, we cover the spectrum of lithium toxicity, from the acute ingestion, to the patient with saturated brain tissue. Come take a listen to explore the nuances around volume repletion, when or should you reach for dialysis, what SILENT is or does it exist.

Transcribed - Published: 14 January 2021

In this episode we cover those super antigens that cause all the trouble with staph and strep infections. Come take a listen around pathophysiology, identification, antimicrobials and all things IVIG.

Transcribed - Published: 23 December 2020

In this episode, we cover the OG-Farkas description of the age-old interplay between bradycardia / renal failure / AV nodal blocking agent / Shock / and Hyperkalemia. Don't just try and snipe one off at a time, carpet bomb them all at once. 

Transcribed - Published: 15 December 2020

In this episode we cover the crucial approach to what drives hemorrhagic shock: lots of bleeding. Come take a listen for the nuances around an organized approach to 1:1:1 and may we be as bold to say... 1:1:1:1 (fibrinogen, YAY). All things hypocalcemia, hypothermia, acidosis and what lines to use. 

Transcribed - Published: 11 December 2020

We were actively trying to fill your life with non-covid things... but we just had to talk about these big new things. Come take a listen of aerosol transmission, why Remdesivir just doesn't work in the real world, why not to make the same mistake with the -mab du jour, and a few other tid bits.

Transcribed - Published: 4 December 2020

In this episode, we cover that daily issue: Is this a VAP? Come take listen to level up beyond leukocytosis, inflammation, consolidation, worsening oxygenation and positive cultures. Viva la Piptazo - Linezolid/Vanco diad.  

Transcribed - Published: 1 December 2020

In this episode, we cover another great white whale in critical care: Hemophagocytic LymphoHistiocytosis (HLH). When your macrophages turn into paceman and start chomping your own cells, you're in trouble. Com listen about genetic predisposition to unchecked immune response, and a conversation around immunomodulation.

Transcribed - Published: 28 November 2020

In this episode we cover the big picture view of ileus, gastroparesis and colonic pseudo-obstruction. Come take a listen so summarize these issues you will encounter on the daily.

Transcribed - Published: 16 November 2020

In this episode, we cover the DVT of the Brain... Cerebral Venous Thrombosis. Lace up your shoes, start washing those dishes, do whatever you need to do while we remind you about presentation, workup and most of all, treatment. As 1% of all strokes and the most common cause of stroke in young patients, you'll want to know this one cold.

Transcribed - Published: 23 October 2020

In this episode we cover the often overlooked topic of glycemic control in the ICU. What blood sugar should we be targeting? Is that hyperglycaemia a stress response? Insulin resistance? Iatrogenic? All of the above. Come listen to our discussion, and Josh's attempt at clearing up a confused evidence base.

Transcribed - Published: 19 October 2020

We've reached a milestone, 100 episodes! In this podcast, we cover ICU level thiamine deficiency, not just your white-whale of Wernicke encephalopathy. Come take a listen for dosing, clinical features and complications.

Transcribed - Published: 16 October 2020

In this episode, we cover the approach to the   not-so-rare cause of ICU level pancreatitis: hypertriglyceridemia. Come take a listen for nuances around insulin management, and second thoughts around using heparin and plasmapheresis.

Transcribed - Published: 13 October 2020

In this episode we simplify the approach to covering your invasive fungal infections in critically unwell patients.  Yeast vs Mold vs Endemic Mycoses Azoles vs Echinocandins vs Amphotericin

Transcribed - Published: 14 September 2020

Its the rare occasion you go one complete day without treating Nausea and vomiting in the ICU. In this episode, we cover the ddx you can't miss, and the multiple receptors to target in your patients.

Transcribed - Published: 12 September 2020

In this episode, we cover the essentials of analgesia for your critically ill patients. Spoiler alert, multimodal approaches are the way to go. If your MAR only has opiates on it, there may be a problem.    Come listen for a new twist on the ladder approach, all things ketamine / precedes and lidocaine... with much much more.

Transcribed - Published: 28 August 2020

In this episode we cover the widely use, but poorly supported inhaled pulmonary vasodilators: -Oxygen -Nitroglycerin / Nitric Oxide -Epoprostenol -Milrinone

Transcribed - Published: 8 August 2020

In this episode, we cover the more sinister twin of DKA... HONK aka HHS (Hyperosmolar Hyperglycemic State). Come listen to how not to blow up your patients brain in the tug-of-war between glucose and sodium.

Transcribed - Published: 6 August 2020

In this episode we cover Guillain-Barre Syndrome. Everything from presentation, to why you should stop checking negative inspiratory pressure and just stick with FVC. Read the post then come take a listen.

Transcribed - Published: 28 July 2020

In this episode we cover one of the most fatal and moribund conditions we see regularly, Intracranial hemorrhage. Etiology, diagnosis and treatment (of course we spend time on BP goals).

Transcribed - Published: 23 July 2020

In this episode we cover Catastrophic Antiphospholipid Syndrome. A very rare and often missed diagnosis. Come take a listen to brush up on high risk patient population, clinical diagnosis, labs, steroids / anticoagulation and more treatment options.

Transcribed - Published: 22 July 2020

In this episode we talk about fever... fever in the ICU... ICU acquired fever. It is not all VTE or VAPS, Chole or CLABSI. We cover a thoughtful approach to not just sending pan culture, and adding piptazo-vanco.

Transcribed - Published: 18 July 2020

In this episode, we cover the sasquatch of ICU derived fever: catheter associated urinary track infection. Farkas is on the fence whether it is clinically relevent: Come listen for those pearls: IDSA diagnostic criteria. Treatment coverage. Purple bag syndrome, and more!

Transcribed - Published: 10 July 2020

In this episode we cover a major cause of mortality for our sickle cell patients: Acute Chest Syndrome. This is a very serious entity you must keep a low clinical threshold for working up and treating. Diagnosis Pain Control, Volume Resuscitation Antimicrobials Exchange transfusions and more

Transcribed - Published: 8 July 2020

In this episode, we cover the rare but life threatening Epiglottitis.  Highlights: Presentation not as you learned in medical school Vast majority do not need intubation, but for those that due it can be catastrophic Nasolaryngoscopy, Steroids, broad spectrum antibiotics and early airway plans are the way to go

Transcribed - Published: 2 July 2020

In this episode, we cover ICU level Pneumocystic Jirovicii Pneumonia (previously known as Pneumocystic Carinii Pneumonia). Suggested approach: HIV +(ve) vs HIV -(ve) Invasive vs Non invasive diagnostic strategy Treatment w. Septra vs other line therapies

Transcribed - Published: 29 June 2020

In this episode, we cover the lesser of evil stridor aetiologies: Vocal cord dysfunction, a.k.a paradoxical vocal cord motion, a.k.a Paradoxical Vocal Fold Movement. Read the post, then listen to review approach, diagnostic modalities (fibre-optic visualization, CT scan to rule out other entities) and treatment.

Transcribed - Published: 22 June 2020

In this episode we cover that not so friendly-Fingi: Aspergillus Come get acquinted with the two forms: angioinvasive (think neutropenia) vs bronchoinvasive (the not so immunosuppressed). Don't forget to add this to your Ddx for nosocomial post-influenza & COVID-19.  

Transcribed - Published: 15 June 2020

In this episode we cover the often overlooked entity that is re-feeding syndrome. High Risk populations Signs & Symptoms Insulin mediated edema, and more

Transcribed - Published: 8 June 2020

In this episode, we cover the presentation, clinical signs / symptoms and workup of takotsubo cardiomyopathy. Come take a listen so you'll never miss that octopus-trap of a clinical confounder, with juicy pearls around LVOT obstruction.

Transcribed - Published: 1 June 2020

In this episode we cover the work horses we use daily in critical care patients: anticoagulants: Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin. We also cover BID dosing of LMWH prophylaxis and the essential section here is on heparin resistance. Enjoy!

Transcribed - Published: 26 May 2020