ICU Rounds

By Jeffrey S. Guy, MD, FACS

Listen to a podcast, please open Podcast Republic app. Available on Google Play Store.

Description

also available for free download on iTunes. (http://itunes.apple.com/us/podcast/icu-rounds/id254707344)

Episode Date
Colloids: Details and Myths
18:20

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

Jul 09, 2012
Random Serum Cortisol Levels are misleading
17:09

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

Mar 12, 2012
EARLY use of Tranexamic Acid may improve survival from bleeding in trauma
19:35

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 improve survivial, but delayed use may be associated with an increased mortality.  

Feb 20, 2012
Pediatric IVC diameter determination with ultrasound
15:52

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 correct the IVC diamter based on the child's body surface area.  

Feb 09, 2012
Takotsubo Cardiomyopathy
12:40

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 profound cardiogenic shock, but these patients have a very high survivial rate with little more than supportive care.  

Jan 31, 2012
Necrotizing Soft Tissue Infection (NTSI)
26:26

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

Dec 06, 2011
Different Cardiac Output Monitors & Physiology
31:01

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

Nov 26, 2011
Lactic Acidosis - Type B
16:30

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

Nov 19, 2011
Lactate Acidosis - Type A
22:08

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 shock.  This podcast will focus on Type A lactic acidosis.

Nov 12, 2011
Endotracheal tube cuff leaks and self-extubations
24:18

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.

Aug 03, 2011
Pulmonary Embolus
33:01

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

Jul 28, 2011
Smoke Inhalation Injury
30:53

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 inhalation injuries.

Jul 06, 2011
Propofol Related Infusion Syndrome
24:06

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

Jun 05, 2011
Wedge: Everyone elses favorite Swan number
25:30

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

Dec 12, 2010
SVO2 My favorite Swan Number
18:46

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 injured patients.  

Dec 05, 2010
Therapeutic Hypothermia After Cardiac Arrest
34:06

Therapeutic hypothermia after cardiac arrest is part of ACLS and is used by several EMS agencies around the US.  Despite good data and improved patient outcomes, many providers fail to used this modality.  This podcast will focus on a presentation of the data, methods of cooling, and potential complications.

Oct 21, 2010
Pancreatitis - Surgical Indications and Procedures
26:23

This is the third in the series on severe pancreatitis and necrotizing pancreatitis.  This episode reviews the indications for surgery, morbidity and mortality of surgery, and what are the surgical options.  

Jul 23, 2010
Severe Acute Pancreatitis: Part 2 ICU Considerations
18:04

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

Jun 02, 2010
Pancreatitis - Part 1
26:04
This is an initial presentation of the causes and diagnosis of acute pancreatitis.  
May 25, 2010
That peripheral IV can kill you: Suppurative Thrombophlebitis
13:44

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

Feb 25, 2010
Acute Colonic Pseudoobstruction (Ogilvie's Syndrome)
32:12

Acute Colonic Pseudoobstruction (ACPO) is commonly called Ogilvies Syndrome.  ACPO presents massive dilation in critically ill patients, and might result in invasive procedures to avoid ischemia or perforation of the colon.

Feb 15, 2010
Hemoglobin Based Oxygen Carriers (a.k.a. Artificial Blood)
23:59
A brief summary of what are hemoglobin based oxygen carriers (HBOC) and where are they in development.
Jan 18, 2010
Catheter-Related Bloodstream Infection: Diagnosis
18:46
Discussion of what is the difference between a CVC infection and a catheter-related blood stream infection. They are treated differently so it is important to know the difference.
Sep 24, 2009
Ventilator Associated Pneumonia
34:02
A discussion on nosocomial infections and VAP.
Sep 17, 2009
Complications of Dwelling Central Lines
34:28
What horrible things can happen with central lines once they have been inserted.
Aug 04, 2009
Central Line Insertion Complications
32:01
A discussion of the potential problems encountered while inserting central venous catheters.
Jul 16, 2009
Pulmonary Physiology and General Anesthesia
30:24
This episode discusses the effects and risks of anesthesia on patients with pulmonary disease as well as the effects of anesthesia on pulmonary physiology.
Jun 21, 2009
Caustic Ingestions
38:46
Ingestion of caustic materials can be fatal and difficult to evaluate. These patients are often referred to our burn center.
May 13, 2009
IV Fluids (Part 1)
36:31
An introduction to the basic science in fluids used to treat hypovolemia.
May 03, 2009
Arterial Blood Gases
36:41
This episode is a discussion about how to approach an arterial blood gas result.
Apr 26, 2009
Pulse Oximetery
29:45
Discussion of the technology of the pulse oximeter
Mar 30, 2009
Discussion on Fluids: The last Cotton lecture
24:34
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 Houston. He is an excellent teacher and his opinions on fluids resuscitation are cutting edge.
Mar 05, 2009
Refeeding Syndrome
27:27
When and how can providing a starving patient nutrition be potentially deadly.
Feb 21, 2009
Hypoxia: physiological causes
23:33
Understanding the root cause of hypoxia will allow for more appropriate treatment.
Feb 15, 2009
Hypernatremia
16:16
Evaluation and treatment of elevated serum sodium is presented.
Feb 12, 2009
Hyponatremia: common but dangerous
23:54
Hyponatremia or a low serum sodium is a common electrolyte problem that is dangerous if ignored or treated improperly.
Feb 07, 2009
Prehospital/Battlefield Tourniquet Use
14:08
Review of a recent publication from Annals of Surgery
Feb 01, 2009
Environmental Hypothermia
28:38
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 hypothermia.
Jan 28, 2009
Peak Inspiratory Pressure: Physiological Determinants
27:10
Peak inspiratory pressure (PIP) the center of a great deal of discussion of ventilator management.   Knowing the factors that increase or decrease PIP are important to those managing critically ill patient.  This podcast is steeped in physiology and perhaps more difficult than my typical podcasts.  PIP=  [Tv/ (Compliance Lung & Thorax)] + (Resistance of airway + flow )
Jan 19, 2009
Hyperkalemia
28:40
Hyperkalemia is a very common and potentially dangerous electrolyte disorder that commonly occurs in ICU patients.
Jan 12, 2009
Some Swan Stuff
24:39

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

Dec 29, 2008
Therapeutic Hypothermia following Cardiac Arrest
19:22
Therapeutic Hypothermia following cardiac arrest has been demonstrated to improve outcomes.  Starting Jan 1, 2009 Ney York City EMS will dorect patients to those hospitals able to delivery such care. 
Dec 22, 2008
Radiation Injury / Nuclear MCI
28:50
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. In this episode we discuss the some concepts of the medical care required to those exposed to radiation as well as blast injuries. I hope this is information that none of you will ever need.
Dec 12, 2008
Cardiovascular Risk Reduction for Surgery
29:57
This episode explores what is needed to make surgery safer for the patient with cardiovascular disease. 
Nov 20, 2008
Meta-analysis of Glucose Control
21:49
Tight glucose control has been widely introduced into critical care. This meta-analysis, recently published in JAMA, critically evaluates the effects of these trials in reduction of sepsis as well as mortality. The results might surprise you.
Nov 17, 2008
Myocardial Infarction: PCI and medications
25:55
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 of the patient having an MI.
Oct 20, 2008
Disaster Management
38:35
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 planning and management. (This was reposted due to some technical problems with the server.)
Oct 19, 2008
Traumatic Rhabdomyolyisis / Crush Syndrome
27:28
Crush syndrome is a common cause of death following earth quakes, mine and building collapses. Traumatic rhabdomyolysis may also be seen following electrical injury or severe trauma. (This is a reposting due to some previous technical problems with the server.)
Oct 19, 2008
Myocardial Infarction: Diagnosis and Thrombolytics
28:23
Myocardial Infaction (Part 1): This episode will discuss the diagnosis of MI, STEMI, and non-STEMI.  We then discuss the indications and types of thrombolytic agents.
Sep 09, 2008
PAIN: a four letter word
40:18
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 medications of pain management. This episode serves as an introduction. 
Aug 21, 2008
Hypercalcemia
21:05
A potentiallylife-threatening electrolyte problem that commonly finds its way into the ICU as well as on exams.
Aug 14, 2008
Patient-Ventilator Interactions and ventilator discontinuation
19:53
Getting patients comfortable on the ventilator is not an easy task.  This podcasts focuses on methods to make patients synchronize with the ventilator as well as a discussion of spontaneous breathing and awake trials
Aug 07, 2008
Ventilator Update: avoiding shear trauma
19:49

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 using to avoid shear trauma and ventilatory induced lung injury.

Aug 03, 2008
Abdominal Compartment Syndrome
33:02
A discussion of the physiology and presentation of abdominal compartment syndrome.
Jun 07, 2008
Extremity Compartment Syndrome
28:51

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

May 19, 2008
Surviving Sepsis Campaign (part 2)
34:08
We continue our discussion of the Surviving Sepsis Campaign (SSC).  This includes fluids types, steroids, rhAPC (Xigris), and blood sugar control.
May 15, 2008
Surviving Sepsis Campaign (part 1)
31:39
The Surviving Sepsis Campaign (SSC) is concensus document that attempts to provide the best evidence to assist in the care of the septic patient.  All providers who provide care to the septic patient should be aware of the contents of the SSC. 
May 12, 2008
Hemoglobin Based Blood Substitutes: Increased Morbidity and Mortality
25:00
In this week's Journal of the American Medical Association a meta-analysis was published that concluded that use of hemoglobin based blood substitutes result in an increased morbidity and mortality.  Included in the same journal is an editorial critical of the method the research has been regulated by the US FDA.  
May 04, 2008
Glucometers in the ICU: how accurate are they?
19:34
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 reviews someof the limitations of deploying an instrument designed for control of outpatient diabetes management to tight control of blood glucose in the ICU. 
Apr 24, 2008
Clostridium difficile Colitis
24:56
Clostridium difficile colitis is a problematic complication of antibiotic theraoy in hospitalized and critically ill patients.  It is increasing in frequency and can be lethal. 
Apr 16, 2008
Traumatic Shock and Fluid Resuscitation
42:20
Fluid resuscitation done poorly can result in significant complications to the patient.  This episode will present some of the newer considerations in fluid resuscitation in traumatic shock. 
Apr 01, 2008
Polypharmacy in the Elderly
29:15
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 polypharmacy. 
Mar 23, 2008
Drug-induced QT prolongation
26:19

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 you should look for it in your ICU patients. 

Mar 08, 2008
Do Steroid Improve Survivial in Sepsis? CORTICUS Trial
23:27
The results of the CORTICUS trial are discussed. 
Feb 28, 2008
Atrial Fibrillation
38:40
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. 
Feb 20, 2008
Pediatric Burns
47:31
Pediatric burns: all burns are serious, both big and small.   This episode reviews the objectives of burn care to result in the best functional outcome.  Also, burn is a very common method of child abuse and we detail how these children are injured and what to look for to identify possible abuse.
Feb 13, 2008
Pharmacology of Shock
38:25
This is a basic introduction of some of the drugs used in various forms of shock.  
Feb 08, 2008
Sepsis - Part 2
33:23
In this episode we discuss that ICU care of the patient with sepsis.  This includes an introduction to various vasopressors.
Feb 01, 2008
Sepsis - Part 1
34:08
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 definitions, and present the basic science.  Part 2 will cover fluid and drug therapy for septic shock. 
Dec 11, 2007
HIT: Heparin Induced Thrombocytopenia
19:40
Large numbers of patients in ICUs are on heparin and what is this complication of heparin induced thrombocytopenia? 
Oct 27, 2007
Smoke Inhalation Injury: CO and Cyanide Toxicity
38:38
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 inhalation of smoke-- not burns.  Learn why smoke is so deadly as well as what are the appropriate methods to treat smoke related asphyxiation.  
Oct 15, 2007
Blood Products
37:58
Blood products:   pRBCs, fresh frozen plasma, platelets, cryoprecipitate when and how should we use it?  What are the risks?  You may order them like IV fluids but do you really know how these potentially deadly products are to be used. 
Oct 01, 2007
Control of hyperglycemia improves outcomes
33:40
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 and what is the data?
Sep 24, 2007
Antibiotic Considerations in the ICU
54:26
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 topics are covered in the episode. 
Sep 14, 2007
Crush Syndrome
18:42

Earthquakes are horrible natural events causing loss of lives in the thousands.   Following earthquakes, building collapses, and cave-ins, large number of victims will suffer from renal failure and death following crush syndrome. 

Aug 20, 2007
Thermal Injuries
40:28

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

Aug 13, 2007
Metabolic Acidosis in the ICU
36:56
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 as well as some lesser known causes.  
Jul 26, 2007
Bomb and Blast Injuries
32:15
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 a reminder that civilian population centers are targets for bombing attacks.   Most civilian providers has no to limited knowledge or experience treating patients with such injuries.   This episode is dediacated to a discussion of some of the unique properties and injuries associated with blast injuries.  In the event of a terrorist attack, like those attempted in London this past week, the injuries will be in the hundreds. 
Jul 06, 2007
Early Surgery Improves Outcomes Following Critical Burns
24:14

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 burn.  Nevertheless, many nonburn physicians still want to apply to 1970 treatment paradigms to this population of injured patients.   This episode will hopefull replace these falsehoods with fact supported in the literature. 

Jun 29, 2007
Metabolism: Starvation versus Stress
28:44

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 significantly different than a pound of weight loss in someone on a diet.  A basic understanding of stress metabolism is needed prior to a discussion of nutrition. 

Jun 20, 2007
Blood Conservation in the ICU
28:12
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 is a time when the blood banks often have a single day's worth of blood.  Perhaps with more conservative transfusion practices we can avoid or certainly help with some of the blood shortages.   Everyone wants to put patients on Epo, but does it increase the hemoglobin concentration enough to off set its high cost?
Jun 14, 2007
Burns: Fluid Creep
21:55

Excessive fluid resuscitations lead to horrible complications such as abdominal compartment syndrome. This article takes a critical look and challanges many of our practices in fluid resuscitation of burn patients. 

Jun 07, 2007
Renal Replacement Therapy: SCUF, SLED, CVVH, CVVHD, IHD--what does it all mean
31:43
Renal replacement therapy (RRT) is rather a confusing topic.  What do all those initials mean and why use one therapy over another?  This podcast will explain the difference between intermittent and continous.   What are the various forms of continuous and how do they differ?   What are the concepts of ultrafiltration, diffusion, and convection?  These questions will be answered in this introduction to renal replacement. 
Jun 01, 2007
Intraosseous Vascular Access: not just for the kids anymore
17:30
Intraosseous vascular access was was developed for use in adult trauma patients over 80 years ago.  Only recently has this technique regained popularity for rapid and safe access to the vascular space in patients in extremis. 
May 29, 2007
Weaning (Liberating) from the mechanical ventilator
26:28

Don't wean people from their ventilators-- liberate them!!  When are people ready to come off the ventilator?  What are weaning parameters?  How does one do a spontaneous weaning trial?   What is the role of noninvasive ventilation (NIV)?

May 25, 2007
Acute RenalFailure
42:21
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 as acute management. 
May 22, 2007
Airway Pressure Release Ventilation (APRV) or BiVent: What the heck is this?
22:48

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.  Many people find this mode very complicated and thick that it is reserved only for the very ill.   Neither one of these assumptions are corrrect.  This mode is very easy to learn and use.  Furthermore, this mode is very physiological and tolerated by all types of patients. 

May 20, 2007
Complications of PEEP and Auto-PEEP
18:44
Virtually all patients on ventilators are on PEEP.  PEEP has several interactions with various organ systems and some can result in profound complications. An understanding of PEEP and auto-PEEP are required before we can understand modes of ventilation like APRV (Bi-Vent)
May 19, 2007
Glutamine In Critical Illness: what's all the fuss about?
11:10
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 at the data on glutamine. Does glutamine improve outcomes, and if so and in who?   How much should we use and what are the hazards?  Enteral versus parenteral.  www.burndoc.com
May 18, 2007
Lightning Injuries
10:54

Lightning injuries are rare, but when you do treat a patient they can have facinating presentations.   This lecture follows a patient we treated at Vanderbilt.   The patient present to a local ED with stroke like symptoms following the lightning strike.   Initially, physicians were confused by the presentation, but in this lecture you will learn that his presentation was near textbook. www.burndoc.com

 

May 15, 2007
Oxygenation & PEEP
26:13
A discussion of ventilation, oxygenation, and the role of PEEP.
May 13, 2007
Modes of Mechanical Ventilation
23:54
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 topic of pressure support ventilation (PSV)
May 13, 2007
What is the role of decadron in preventing post extubation stridor?
08:32
What is the role of giving an adult steroids to prevent stridor or reintubation following extubation.    This epidose looks at the data.
May 13, 2007