Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

In this episode, episode 39, I interview Dr. Steve Frank, Professor of Anesthesia and Critical Care Medicine at Johns Hopkins, Medical Director of Blood Management for Johns Hopkins Health System and Chief of Adult Anesthesiology about anesthesia for liver transplants. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS...

In this episode, episode 37, I go over crises that can happen in the OR, when to suspect them, and what to do about them.  I draw from two excellent sets of OR crisis checklists that are available for free.  The Stanford Anesthesia Cognitive Aid Group’s lists and the Ariadne Labs/Brigham/Harvard School of Public Health … Continue reading "Episode 37: OR Crises" Our Sponsors: * Check out Be...

In this episode, episode 36, I welcome Dr. Deb Schwengel, one of our pediatric anesthesiologists and our residency program director, to the show to discuss the differences in anatomy and physiology in pediatric versus adult patients. Outline by April Liu: Outline Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and us...

In this episode, number 35, I welcome Dr. David Feller-Kopman to the show.  Dr. Feller-Kopman is an associate professor of medicine and Otolaryngology and the director of Bronchoscopy and Interventional Pulmonology here at Johns Hopkins.  I interview him about pleural effusions including what they are, where they come from, how to categorize them, how to … Continue reading "Episode 35: Pleural...

In this episode, episode 34, I welcome Dr. Tina Tran and Dr. Steve Beaudry to the show to give you two run throughs of an oral board stem.  First Dr. Tran demonstrates some common errors and then Dr. Beaudry demonstrates an example of the “right way” to do it.  We then mention some learning points … Continue reading "Episode 34: Oral Board Prep with Drs. Tran and Beaudry" Our Sponsors: * C...

In this episode, episode 33, I welcome cardiac anesthesiologist Dr. Rosanne (Rosie) Sheinberg to the show to discuss ECMO.  We go through a comprehensive overview of what ECMO is, how it is used, how it is managed, the complications that can be seen and how to manage them and how to wean it off. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.bette...

In this episode, episode 31, I welcome one of our amazing chief residents to the show, Dr. Stephen Freiberg.  Stephen has taken an interest in massive transfusion and he goes over the highlights of when to do it, how to do it, what complications you see from it and how to manage those complications. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.b...

In this episode, episode 30, I discuss the new American College of Cardiology Guidelines for the periprocedural management of anticoagulation for patients with non-valvular atrial fibrillation.  This includes whether to stop, when to stop, whether to bridge, how to bridge, and how and when to restart. Outline by Brian Park: AC for Afib Outline Our Sponsors: * Check out BetterHelp and use my code b...

In this episode, episode 29, I welcome to the show Dr. Glenn Whitman.  Dr. Whitman is a cardiac surgeon and intensivist and runs the cardiac surgical ICU here at Johns Hopkins.  I interview Dr. Whitman about PA catheters.  We discuss when to place them, when not to place them, how to use them and when … Continue reading "Episode 29: PA catheters with Dr. Glenn Whitman" Our Sponsors: * Chec...

In this episode I welcome Dr. Laeben Lester to the show.  Dr. Lester is trained in Emergency Medicine and Anesthesiology and has completed fellowship training in Cardiac Anesthesiology.  He shares with us his “Nearly Needleless 5-Step Approach” to airway topicalization for awake intubation. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp...

In this episode I review the ABA topic of airway management.  This is obviously a huge topic but in this episode I highlight key points about the components of airway management recommended by the ABA including identification of a difficult airway, management of a difficult airway, the difficult airway algorithm, different tools and adjuncts, and … Continue reading "Episode 27: Airway Manageme...

In this episode I welcome Dr. Amit Prabhakar, one of our critical care fellows, to the show to discuss Sugammadex, a relatively recently approved (in the USA) reversal agent for Rocuronium and Vecuronium. Outline by Brian Park: Sugammadex outline Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my code FIGSRX...

In this episode I am joined once again by Dr. Scott Stephens as we review advanced ventilator modes, prone positioning, and ventilation of patients on VV ECMO. Outline by April Liu: Outline The fantastic review article I mentioned is: Mireles-Cabodevila E. Et al. Alternative Modes of mechanical ventilation: A review for the hospitalist. Cleveland Clinic … Continue reading "Episode 25: Advanced...

In this episode I first suggest you take a look at the recently published (ahead of print) VANCS study on the use of vasopressin as a sole agent in the treatment of vasoplegic shock.  Then I review the reasons never to use sodium bicarbonate in lactic acidosis. The Vancs study: https://www.ncbi.nlm.nih.gov/pubmed/27841822 The two articles I recommend … Continue reading "Episode 24: The Evils o...

In this episode I welcome Dr. Scott Stephens, Pulmonary Critical Care Physician at Johns Hopkins to the show. Dr. Stephens and I discuss basic ventilator settings, how to appropriately ventilate patients with hypoxemic vs. hypercarbic respiratory failure and how to think about weaning patients off of the ventilator. Outline by Brian Park: Outline Our Sponsors: * Check out BetterHelp and use my cod...

In this episode I interview Dr. Joseph Hughes, one of our neuro anesthesiologists, about the history, etiology, pathophysiology and prevention of postoperative visual loss. We refer to a thromboelastogram which looks like this.  It is the fibrinolysis portion that can be prevented with tranexamic acid (TXA): High Yield Outline by Brian Park can be found … Continue reading "Episode 22: Postop V...

In this episode I interview Dr. Chris Wu, professor of anesthesiology and pain medicine and internationally renowned expert in Enhanced Recovery After Surgery (ERAS) pathways.  We discuss the different aspects of ERAS pathways and the evidence for improved outcomes. The ERAS society website can be found here: http://erassociety.org Check out this fantastic outline of the episode … Continue reading...

In this episode I review two methods for managing arterial blood gasses in hypothermic patients, usually during cardiac surgery–pH Stat and Alpha Stat. Check out this fantastic episode recap put together by Brian Park from Drexel Medical School: Show recap Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my co...

In this episode I review the receptors that vasoactive drugs act on.  I then review the main vasoactive medications used in the OR and the ICU to treat acute hypotension and the ones used to treat acute hypertension. Outline by April Liu: Outline Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my code FIGSRX...

In this episode I go over some tips and tricks for maximizing your success with peripheral IVs, arterial lines, central venous catheters and pulmonary artery catheters (Swan Ganz catheters). The New England Journal videos that I recommend you take a look at for detailed reviews of each of these are here: Peripheral IV: http://www.nejm.org/doi/full/10.1056/NEJMvcm0706789 Arterial: … Continue readin...

In this episode I discuss awake intubation.  I discuss the indications, techniques, nerve blocks, sedation and different methods of performing awake intubation. Slides to go along with the podcast are here: awake intubation slides The youtube video of the MGH anesthesiologist intubating himself is here: self-intubation   Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a gre...

In this episode I welcome back Dr. David Mintz, neuroanesthesiologist, to discuss the treatment of increased intracranial pressure in the perioperative period and brain relaxation during neurosurgery.  Dr. Mintz will be back in the future to talk about the physiology of increased ICP. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com *...

In this episode I discuss the use of IV fluids for perioperative use including how to decide when to give fluid, the downsides of over resuscitation, whether to use crystalloid or colloid, and whether to use saline or a balanced salt solution such as LR.   Slides to go along with this episode are here: IV … Continue reading "Episode 15: IV Fluids" Our Sponsors: * Check out BetterHelp and u...

This is the second of two episodes about opioid medications.  In this episode I cover the pharmacokinetics and pharmacodynamics of opioids, some of the common uses for these medications, mixed agonist-antagonist compounds, opioid antagonists, and opioid interaction with other medications. Slides to go along with this episode are here: Opioids part 2 Our Sponsors: * Check out BetterHelp and use my...

This is the first of a 2 part series on opioid medications.  In this first episode I will talk about how opioids are categorized and their effects on the different body systems.  In the next episode I will discuss their pharmacokinetics and pharmacodynamics as well as their various uses and some details on mixed agonist/antagonists. … Continue reading "Episode 13: Opioids part 1" Our Spons...