ICU Rounds

Splitting a Ventilator: Multipatient Ventilation for COVID?

23 Apr 2020

Contributed by Lukas

Throughout the pandemic, there has been considerable discussion about the possibility of running our of ventilators. One potential solution that was b...

Prone Ventilation for ARDS (COVID-19)

12 Apr 2020

Contributed by Lukas

This week we have a brief conversation about prone mechanical ventilation for ARDS. Does it provide a benefit? When should we use it, and why does it ...

ARDS and Mechanical Ventilation / COVID-19 Care

05 Apr 2020

Contributed by Lukas

Today we discuss the approach to oxygenating and mechanically ventilating a patient suffering from ARDS. We will cover elements relevant and essential...

ICU Care of Coronavirus (COVID-19)

29 Mar 2020

Contributed by Lukas

I'm back. I plan on providing you with some useful information when caring for patients infected with COVID-19 (Coronavirus). In this episode, I will ...

Colloids: Details and Myths

09 Jul 2012

Contributed by Lukas

This episode provide some basic description of colloids as will as some myths.  

Random Serum Cortisol Levels are misleading

12 Mar 2012

Contributed by Lukas

A physiological explanation why random cortisol levels are NOT helpful in evaluating adrenal function

EARLY use of Tranexamic Acid may improve survival from bleeding in trauma

20 Feb 2012

Contributed by Lukas

In this episode we talk about the results of the CRASH-2 trial published in Lancet.  This trial showed that the EARLY use of Tranexamic acid may impr...

Pediatric IVC diameter determination with ultrasound

09 Feb 2012

Contributed by Lukas

If you are using ultrasound to evaluate IVC diamter in children, what is considered a normal IVC diameter?   You can determine the IVC/Ao ratio or co...

Takotsubo Cardiomyopathy

31 Jan 2012

Contributed by Lukas

This is a condition that mimics acute coronary syndrome (ACS) that may be caused by acute emotional or physical stress.  Patient's may appear to have...

Necrotizing Soft Tissue Infection (NTSI)

06 Dec 2011

Contributed by Lukas

This episode discusses the pathophysiology, presentation, and treatment of NTSI.

Different Cardiac Output Monitors & Physiology

26 Nov 2011

Contributed by Lukas

This episode will discuss the physiology behind various CO output monitors such as pulmonary artery catheters, PICCO, pulse wave form analysis, and Li...

Lactic Acidosis - Type B

19 Nov 2011

Contributed by Lukas

Now these are the types of lactic acidosis that most people are not familiar.  They can be caused by medications, underlying disease, or inborn error...

Lactate Acidosis - Type A

12 Nov 2011

Contributed by Lukas

This podcast is a description of how lactate is produced and metabolized.  I will discuss the role of lactate in the diagnosis and management of shoc...

Endotracheal tube cuff leaks and self-extubations

03 Aug 2011

Contributed by Lukas

A brief description on what to consider when confronted with a patient with an air leak from the ET tube or a patient that self-extubates.

Pulmonary Embolus

28 Jul 2011

Contributed by Lukas

A description of the risk factors, diagnosis, and treatment of PE.

Smoke Inhalation Injury

06 Jul 2011

Contributed by Lukas

Smoke Inhalation injuries can be deadly.  This episode explains why smoke can be so deadly, and how to care for those patients with suspected smoke i...

Propofol Related Infusion Syndrome

05 Jun 2011

Contributed by Lukas

Propofol Related Infusion Syndrome is a potentially fatal complication of propofol.  If you use this common ICU drug you need this information.

Wedge: Everyone elses favorite Swan number

12 Dec 2010

Contributed by Lukas

Wedge or PAOP is perhaps the most quoted and poorly understood variable generated by a Swan-Ganz.

SVO2 My favorite Swan Number

05 Dec 2010

Contributed by Lukas

The most helpful number for me on a Swan is the SvO2.   This is a brief description of how I use this variable in evaluating critically ill and injur...

Therapeutic Hypothermia After Cardiac Arrest

21 Oct 2010

Contributed by Lukas

Therapeutic hypothermia after cardiac arrest is part of ACLS and is used by several EMS agencies around the US.  Despite good data and improved pat...

Pancreatitis - Surgical Indications and Procedures

23 Jul 2010

Contributed by Lukas

This is the third in the series on severe pancreatitis and necrotizing pancreatitis.  This episode reviews the indications for surgery, morbidity and...

Severe Acute Pancreatitis: Part 2 ICU Considerations

02 Jun 2010

Contributed by Lukas

A brief discussion of the considerations of ICU care of the patient with severe pancreatitis, fluid resuscitation, respiratory, renal, and nutrition.

Pancreatitis - Part 1

25 May 2010

Contributed by Lukas

This is an initial presentation of the causes and diagnosis of acute pancreatitis.

That peripheral IV can kill you: Suppurative Thrombophlebitis

25 Feb 2010

Contributed by Lukas

All the recent emphasis on venous catheter infections has been on central lines.   Those peripheral IVs are also dangerous.  

Acute Colonic Pseudoobstruction (Ogilvie's Syndrome)

15 Feb 2010

Contributed by Lukas

Acute Colonic Pseudoobstruction (ACPO) is commonly called Ogilvies Syndrome.  ACPO presents massive dilation in critically ill patients, and might re...

Hemoglobin Based Oxygen Carriers (a.k.a. Artificial Blood)

18 Jan 2010

Contributed by Lukas

A brief summary of what are hemoglobin based oxygen carriers (HBOC) and where are they in development.

Catheter-Related Bloodstream Infection: Diagnosis

24 Sep 2009

Contributed by Lukas

Discussion of what is the difference between a CVC infection and a catheter-related blood stream infection. They are treated differently so it is imp...

Ventilator Associated Pneumonia

17 Sep 2009

Contributed by Lukas

A discussion on nosocomial infections and VAP.

Complications of Dwelling Central Lines

04 Aug 2009

Contributed by Lukas

What horrible things can happen with central lines once they have been inserted.

Central Line Insertion Complications

16 Jul 2009

Contributed by Lukas

A discussion of the potential problems encountered while inserting central venous catheters.

Pulmonary Physiology and General Anesthesia

21 Jun 2009

Contributed by Lukas

This episode discusses the effects and risks of anesthesia on patients with pulmonary disease as well as the effects of anesthesia on pulmonary physio...

Caustic Ingestions

13 May 2009

Contributed by Lukas

Ingestion of caustic materials can be fatal and difficult to evaluate. These patients are often referred to our burn center.

IV Fluids (Part 1)

03 May 2009

Contributed by Lukas

An introduction to the basic science in fluids used to treat hypovolemia.

Arterial Blood Gases

26 Apr 2009

Contributed by Lukas

This episode is a discussion about how to approach an arterial blood gas result.

Pulse Oximetery

30 Mar 2009

Contributed by Lukas

Discussion of the technology of the pulse oximeter

Discussion on Fluids: The last Cotton lecture

05 Mar 2009

Contributed by Lukas

This is an interview that I did on www.medtalknetwork.com with Dr. Brian Cotton. Dr. Cotton recently left Vanderbilt to take a new position at UT Ho...

Refeeding Syndrome

21 Feb 2009

Contributed by Lukas

When and how can providing a starving patient nutrition be potentially deadly.

Hypoxia: physiological causes

15 Feb 2009

Contributed by Lukas

Understanding the root cause of hypoxia will allow for more appropriate treatment.

Hypernatremia

12 Feb 2009

Contributed by Lukas

Evaluation and treatment of elevated serum sodium is presented.

Hyponatremia: common but dangerous

07 Feb 2009

Contributed by Lukas

Hyponatremia or a low serum sodium is a common electrolyte problem that is dangerous if ignored or treated improperly.

Prehospital/Battlefield Tourniquet Use

01 Feb 2009

Contributed by Lukas

Review of a recent publication from Annals of Surgery

Environmental Hypothermia

28 Jan 2009

Contributed by Lukas

Following the recent crash of the US Airways in the Hudson River, it is an appropriate time to discuss the clinical manifestations and treatment of hy...

Peak Inspiratory Pressure: Physiological Determinants

19 Jan 2009

Contributed by Lukas

Peak inspiratory pressure (PIP) the center of a great deal of discussion of ventilator management.   Knowing the factors that increase or decrease P...

Hyperkalemia

12 Jan 2009

Contributed by Lukas

Hyperkalemia is a very common and potentially dangerous electrolyte disorder that commonly occurs in ICU patients.

Some Swan Stuff

29 Dec 2008

Contributed by Lukas

A brief discussion regarding some of the commonly used values obtained from a pulmonary artery catheter. 

Therapeutic Hypothermia following Cardiac Arrest

22 Dec 2008

Contributed by Lukas

Therapeutic Hypothermia following cardiac arrest has been demonstrated to improve outcomes.  Starting Jan 1, 2009 Ney York City EMS will dorect patie...

Radiation Injury / Nuclear MCI

12 Dec 2008

Contributed by Lukas

The US government last week released a report that the threat of a nuclear device used in an act of terrorism is high in the next couple of years. I...

Cardiovascular Risk Reduction for Surgery

20 Nov 2008

Contributed by Lukas

This episode explores what is needed to make surgery safer for the patient with cardiovascular disease.

Meta-analysis of Glucose Control

17 Nov 2008

Contributed by Lukas

Tight glucose control has been widely introduced into critical care. This meta-analysis, recently published in JAMA, critically evaluates the effect...

Myocardial Infarction: PCI and medications

20 Oct 2008

Contributed by Lukas

This is the second installment of this topic. In this episode we talk about the role of angioplasty and role of various medications in the treatment ...

Disaster Management

19 Oct 2008

Contributed by Lukas

It is Sunday 8.31.08 and for hurricane Gustav is bearing down on the city of New Orleans.  This podcast will discuss the basic elements of disaster p...

Traumatic Rhabdomyolyisis / Crush Syndrome

19 Oct 2008

Contributed by Lukas

Crush syndrome is a common cause of death following earth quakes, mine and building collapses. Traumatic rhabdomyolysis may also be seen following ele...

Myocardial Infarction: Diagnosis and Thrombolytics

09 Sep 2008

Contributed by Lukas

Myocardial Infaction (Part 1): This episode will discuss the diagnosis of MI, STEMI, and non-STEMI.  We then discuss the indications and types of thr...

PAIN: a four letter word

21 Aug 2008

Contributed by Lukas

The management of pain is a key element of the care of all patients-- ICU or not.  Often providers have little understanding of the concepts and medi...

Hypercalcemia

14 Aug 2008

Contributed by Lukas

A potentiallylife-threatening electrolyte problem that commonly finds its way into the ICU as well as on exams.

Patient-Ventilator Interactions and ventilator discontinuation

07 Aug 2008

Contributed by Lukas

Getting patients comfortable on the ventilator is not an easy task.  This podcasts focuses on methods to make patients synchronize with the ventilato...

Ventilator Update: avoiding shear trauma

03 Aug 2008

Contributed by Lukas

In regards to ventilator care, all the focus has been on low tidal volume and level of peak inspiratory pressure.  What level of PEEP shoud we be usi...

Abdominal Compartment Syndrome

07 Jun 2008

Contributed by Lukas

A discussion of the physiology and presentation of abdominal compartment syndrome.

Extremity Compartment Syndrome

19 May 2008

Contributed by Lukas

A limb-threatening complication that might be overlooked by the inexperienced provider.

Surviving Sepsis Campaign (part 2)

15 May 2008

Contributed by Lukas

We continue our discussion of the Surviving Sepsis Campaign (SSC).  This includes fluids types, steroids, rhAPC (Xigris), and blood sugar control.

Surviving Sepsis Campaign (part 1)

12 May 2008

Contributed by Lukas

The Surviving Sepsis Campaign (SSC) is concensus document that attempts to provide the best evidence to assist in the care of the septic patient.  Al...

Hemoglobin Based Blood Substitutes: Increased Morbidity and Mortality

04 May 2008

Contributed by Lukas

In this week's Journal of the American Medical Association a meta-analysis was published that concluded that use of hemoglobin based blood substitutes...

Glucometers in the ICU: how accurate are they?

24 Apr 2008

Contributed by Lukas

There is a large emphasis on intensive control of blood glucose in the ICU, but how accurate are the monitors we use to follow glucose?  This episode...

Clostridium difficile Colitis

16 Apr 2008

Contributed by Lukas

Clostridium difficile colitis is a problematic complication of antibiotic theraoy in hospitalized and critically ill patients.  It is increasing in f...

Traumatic Shock and Fluid Resuscitation

01 Apr 2008

Contributed by Lukas

Fluid resuscitation done poorly can result in significant complications to the patient.  This episode will present some of the newer considerations i...

Polypharmacy in the Elderly

23 Mar 2008

Contributed by Lukas

Patients are often admitted to the ICU with an entire list of home medications.   In this episode I talk about the implications and dangers of polyp...

Drug-induced QT prolongation

08 Mar 2008

Contributed by Lukas

Prolonged QT is the most common reason why medications are restricted or removed from the US market.   This episode will explain what it is and why ...

Do Steroid Improve Survivial in Sepsis? CORTICUS Trial

28 Feb 2008

Contributed by Lukas

The results of the CORTICUS trial are discussed.

Atrial Fibrillation

20 Feb 2008

Contributed by Lukas

Atrial fibrillation is a common problem in ICU patients, but it is a problem with many potential causes, and not always a well defined treatment.

Pediatric Burns

13 Feb 2008

Contributed by Lukas

Pediatric burns: all burns are serious, both big and small.   This episode reviews the objectives of burn care to result in the best functional outc...

Pharmacology of Shock

08 Feb 2008

Contributed by Lukas

This is a basic introduction of some of the drugs used in various forms of shock.

Sepsis - Part 2

01 Feb 2008

Contributed by Lukas

In this episode we discuss that ICU care of the patient with sepsis.  This includes an introduction to various vasopressors.

Sepsis - Part 1

11 Dec 2007

Contributed by Lukas

Sepsis is a common cause of death in the intensive care unit.  In this episode I present some of the statistics on septic deaths, introduce the defin...

HIT: Heparin Induced Thrombocytopenia

27 Oct 2007

Contributed by Lukas

Large numbers of patients in ICUs are on heparin and what is this complication of heparin induced thrombocytopenia?

Smoke Inhalation Injury: CO and Cyanide Toxicity

15 Oct 2007

Contributed by Lukas

The onset of cold weather will bring with it an increase in structure fires.  The leading cause of deaths in fires is complications from the inhalati...

Blood Products

01 Oct 2007

Contributed by Lukas

Blood products:   pRBCs, fresh frozen plasma, platelets, cryoprecipitate when and how should we use it?  What are the risks?  You may order them l...

Control of hyperglycemia improves outcomes

24 Sep 2007

Contributed by Lukas

A great deal is being presented and published on control of blood sugar in the ICU as well as the postoperative period.   How much control is enough...

Antibiotic Considerations in the ICU

14 Sep 2007

Contributed by Lukas

Why do we choose the antibiotics that we do?   How long do we continue the course of therapy?   Should we use some antibiotics together?  These t...

Crush Syndrome

20 Aug 2007

Contributed by Lukas

Earthquakes are horrible natural events causing loss of lives in the thousands.   Following earthquakes, building collapses, and cave-ins, large num...

Thermal Injuries

13 Aug 2007

Contributed by Lukas

An introduction of the biology of thermal injuries and the initial care of the patient with thermal injuries in critical condition.

Metabolic Acidosis in the ICU

26 Jul 2007

Contributed by Lukas

A common problem in the ill or injured patient is a metabolic acidosis.   In this episode we will review the common etiology of a metabolic acidosis...

Bomb and Blast Injuries

06 Jul 2007

Contributed by Lukas

Bomb and blast injuries:  In the past blast injuries were limited to the battlefield of a rare industrial accident.  The events of the past week are...

Early Surgery Improves Outcomes Following Critical Burns

29 Jun 2007

Contributed by Lukas

Early surgical excision is likely to be the most significant individual variable to imporve the outcome of a patient (adult or child) with a critical ...

Metabolism: Starvation versus Stress

20 Jun 2007

Contributed by Lukas

Not feeding an injured or ill patient is not that same as a normal individual who is fasting.   A pound of weight loss in the stress patient is sign...

Blood Conservation in the ICU

14 Jun 2007

Contributed by Lukas

When should a patient receive a transfuse of blood? What is an acceptable hemoglobin concentration in an ICU patient and should we use EPO?   Summer...

Burns: Fluid Creep

07 Jun 2007

Contributed by Lukas

Excessive fluid resuscitations lead to horrible complications such as abdominal compartment syndrome. This article takes a critical look and challange...

Renal Replacement Therapy: SCUF, SLED, CVVH, CVVHD, IHD--what does it all mean

01 Jun 2007

Contributed by Lukas

Renal replacement therapy (RRT) is rather a confusing topic.  What do all those initials mean and why use one therapy over another?  This podcast wi...

Intraosseous Vascular Access: not just for the kids anymore

29 May 2007

Contributed by Lukas

Intraosseous vascular access was was developed for use in adult trauma patients over 80 years ago.  Only recently has this technique regained popular...

Weaning (Liberating) from the mechanical ventilator

25 May 2007

Contributed by Lukas

Don't wean people from their ventilators-- liberate them!!  When are people ready to come off the ventilator?  What are weaning parameters?  How do...

Acute RenalFailure

22 May 2007

Contributed by Lukas

Acute renal failure is a dreaded complication in the ICU.  This podcast will review the various types of acute renal failure, the etiology, as well a...

Airway Pressure Release Ventilation (APRV) or BiVent: What the heck is this?

20 May 2007

Contributed by Lukas

Airway pressure release ventilation (APRV) is not a new mode of mechanical ventilation, but it seems to be gaining a great deal of popularity lately. ...

Complications of PEEP and Auto-PEEP

19 May 2007

Contributed by Lukas

Virtually all patients on ventilators are on PEEP.  PEEP has several interactions with various organ systems and some can result in profound complica...

Glutamine In Critical Illness: what's all the fuss about?

18 May 2007

Contributed by Lukas

All surgical residents know that glutamine is the amino acid known as the fuel for the gut. But what is all the fuss about?  The episode will look ...

Lightning Injuries

15 May 2007

Contributed by Lukas

Lightning injuries are rare, but when you do treat a patient they can have facinating presentations.   This lecture follows a patient we treated at ...

Oxygenation & PEEP

13 May 2007

Contributed by Lukas

A discussion of ventilation, oxygenation, and the role of PEEP.

Modes of Mechanical Ventilation

13 May 2007

Contributed by Lukas

A discussion of the various types of ventilators with a focus on the various ventilator modes and types of ventilator cycles.  Also presented is the ...

What is the role of decadron in preventing post extubation stridor?

13 May 2007

Contributed by Lukas

What is the role of giving an adult steroids to prevent stridor or reintubation following extubation.    This epidose looks at the data.