Throughout the pandemic, there has been considerable discussion about the possibility of running our of ventilators. One potential solution that was brought forward was putting multiple patients on a single ventilator. This is a lot harder than merely attaching a plastic splitter on a ventilator. In this episode, we explain safety and physiological considerations. Also, we briefly discuss specific patient care issues and ventilator settings if your circumstance requires you to adopt this approach.

Splitting a Ventilator: Multipatient Ventilation for COVID?

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 work? I hope this is helpful as prone ventilation has been reported to provide benefit to patients with ARDS secondary to Coronavirus (COVID-19) infection.

Prone Ventilation for ARDS (COVID-19)

Today we discuss the approach to oxygenating and mechanically ventilating a patient suffering from ARDS. We will cover elements relevant and essential in the management of COVID patients and all others with ARDS.

ARDS and Mechanical Ventilation / COVID-19 Care

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 provide you an overview of the current evidence and best practices with some explanation and commentary from the recent Surviving Sepsis COVID-19 guidance.

ICU Care of Coronavirus (COVID-19)

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

Colloids: Details and Myths

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

Random Serum Cortisol Levels are misleading

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.  

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

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.  

Pediatric IVC diameter determination with ultrasound

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.  

Takotsubo Cardiomyopathy

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

Necrotizing Soft Tissue Infection (NTSI)

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

Different Cardiac Output Monitors & Physiology

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.   

Lactic Acidosis - Type B

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.

Lactate Acidosis - Type A

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.

Endotracheal tube cuff leaks and self-extubations

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

Pulmonary Embolus

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.

Smoke Inhalation Injury

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

Propofol Related Infusion Syndrome

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

Wedge: Everyone elses favorite Swan number

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.  

SVO2 My favorite Swan Number

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.

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