ICU Rounds

de Jeffrey Guy

ICU Rounds Podcast

Episodios

Splitting a Ventilator: Multipatient Ventilation for COVID?

por Jeffrey Guy

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.

Prone Ventilation for ARDS (COVID-19)

por Jeffrey Guy

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.

ARDS and Mechanical Ventilation / COVID-19 Care

por Jeffrey Guy

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.

ICU Care of Coronavirus (COVID-19)

por Jeffrey Guy

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.

Colloids: Details and Myths

por Jeffrey Guy

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

Random Serum Cortisol Levels are misleading

por Jeffrey Guy

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

por Jeffrey Guy

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.  

Pediatric IVC diameter determination with ultrasound

por Jeffrey Guy

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.  

Takotsubo Cardiomyopathy

por Jeffrey Guy

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.  

Necrotizing Soft Tissue Infection (NTSI)

por Jeffrey Guy

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

Different Cardiac Output Monitors & Physiology

por Jeffrey Guy

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

Lactic Acidosis - Type B

por Jeffrey Guy

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.   

Lactate Acidosis - Type A

por Jeffrey Guy

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.

Endotracheal tube cuff leaks and self-extubations

por Jeffrey Guy

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

por Jeffrey Guy

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

Smoke Inhalation Injury

por Jeffrey Guy

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.

Propofol Related Infusion Syndrome

por Jeffrey Guy

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

por Jeffrey Guy

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

SVO2 My favorite Swan Number

por Jeffrey Guy

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.  

Therapeutic Hypothermia After Cardiac Arrest

por Jeffrey Guy

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.

Pancreatitis - Surgical Indications and Procedures

por Jeffrey Guy

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.  

Severe Acute Pancreatitis: Part 2 ICU Considerations

por Jeffrey Guy

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

Pancreatitis - Part 1

por Jeffrey Guy

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

That peripheral IV can kill you: Suppurative Thrombophlebitis

por Jeffrey Guy

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)

por Jeffrey Guy

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.

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

por Jeffrey Guy

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

Catheter-Related Bloodstream Infection: Diagnosis

por Jeffrey Guy

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.

Ventilator Associated Pneumonia

por Jeffrey Guy

A discussion on nosocomial infections and VAP.

Complications of Dwelling Central Lines

por Jeffrey Guy

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

Central Line Insertion Complications

por Jeffrey Guy

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

Pulmonary Physiology and General Anesthesia

por Jeffrey Guy

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

Caustic Ingestions

por Jeffrey Guy

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

IV Fluids (Part 1)

por Jeffrey Guy

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

Arterial Blood Gases

por Jeffrey Guy

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

Pulse Oximetery

por Jeffrey Guy

Discussion of the technology of the pulse oximeter