IBCC Episode 110 - Disseminated Intravascular Coagulation
Play • 35 min

In this episode, we cover disseminated intravascular coagulation. It sounds bad, because it is. Come listen and refresh your skills around supporting the bleed-bleedy versus the cloth-clotty, how to differentiate DIC and chronic liver failure and a few more juicy clinical pearls.

Rob Orman, MD
41. Cognitive Reframing
We have a choice in how we perceive and act on any situation. Using that knowledge in an intentional way to shift perspective is at the core of cognitive reframing. Epictetus, the great Stoic philosopher, said it best, "It is our attitude toward events, not events themselves, which we can control." Listen on: * iTunes * Spotify * Stitcher Guest Bio: Jaime Hope, MD is an attending emergency physician at Beaumont hospital in Detroit, Michigan. She is the author of Habit That!: How You Can Health Up in Just 5 Minutes a Day, leads the Better Health Habits online course, and teaches the Behavior Change and Motivational Interviewing Courses to future physicians at Oakland University William Beaumont School of Medicine. Essentials of Emergency Medicine, the conference I host each year, is happening May 25-27, 2021. Early bird discount ends April 3. For an additional $100 off registration, use the code 'orman' at the bottom of the checkout page. We discuss: * Reframing, a psychological technique which involves thinking about something from a different perspective [04:30]; * How reframing can be used in the ED when you’re engaging with a patient or a patient’s family member who is hostile and upset [07:50]; * Discussing comfort measures with the family of a dying patient [12:12]; * 'Status dramaticus' -- the loud, demonstrative patient who catastrophizes their (often relatively minor) symptoms, triggering irritation for many providers [14:30]; * Reframing when treating patients who suffer from addiction [16:30]; * Ways to reframe yourself and your job to offset burnout [20:00]; * Advice to first year medical students [25:40]; * And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx
27 min
Freely Filtered, a NephJC Podcast
Freely Filtered, a NephJC Podcast
NephJC Team
Freely Filtered 029: Belimumab for lupus nephritis
The Filtrate: Matt Sparks Jennie Lin Samira Farouk Joel Topf Swapnil Hiremath And two special guests: Dawn J. Caster, Assistant Professor at University of Louisville Alfred Kim, Assistant Professor of Medicine at Washington University (Twitter) Show Notes: NephJC coverage of the trial: The Bliss trial In the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2001180 Turtles all the way down: https://en.wikipedia.org/wiki/Turtles_all_the_way_down Nature previews Nephrology on BAFF: https://www.nature.com/articles/nri844 Phase III trial results with blisibimod, a selective inhibitor of B-cell activating factor, in subjects with systemic lupus erythematosus (SLE): results from a randomised, double-blind, placebo-controlled trial: https://pubmed.ncbi.nlm.nih.gov/29563108/ BRIGHT-SC: Blisibimod Response in IgA Nephropathy Following At-Home Treatment by Subcutaneous Administration: https://clinicaltrials.gov/ct2/show/NCT02062684 Guideline for naming monoclonal drugs: https://www.antibodysociety.org/wordpress/wp-content/uploads/2017/07/INN-2017-Reference-20.pdf A long-term study of hydroxychloroquine withdrawal on exacerbations in systemic lupus erythematosus. The Canadian Hydroxychloroquine Study Group: https://pubmed.ncbi.nlm.nih.gov/9541091/ Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis https://pubmed.ncbi.nlm.nih.gov/25757867/ A Day In The Life Of Dr. Anthony Fauci: https://www.huffpost.com/entry/anthony-fauci-fighting-covid-19_n_5fc7fed7c5b61bea2b14e3ee MC Arbatin MD FPCP FPSN @mcamd: the glomerulus tree: https://twitter.com/mcamd/status/1337744822543605760 finished product: https://twitter.com/mcamd/status/1338429211963322371
1 hr 9 min
Mastering Intensive Care
Mastering Intensive Care
Andrew Davies
Episode 66: Todd Rice - Learning and teaching how to “not just do something, stand there”
This wide-ranging episode, covering many angles of how we should consider doing less interventions to our patients and more transparent communication to their families, features US intensivist Todd Rice. Dr Todd Rice, is an Associate Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. Todd is a clinical intensivist, the Director of the Medical ICU (MICU) and the Medical ECMO Program, and leads VUMC’s MICU strategy for the care of COVID-19 patients. In addition, Todd leads a substantial research program as a clinician scientist, and is co-chair of the Learning Healthcare System at Vanderbilt where the motto is "Learn What We Do and Do What We Learn." Professionally, he is proud of the evidence he has generated to improve the care of critically ill patients and the mentorship he has provided to other physician scientists. He loves ice hockey (watching, not playing) and is completely into enjoying life with his two sons. Todd graduated from the University of Notre Dame and completed Internal Medicine residency at Indiana University School of Medicine. He completed Pulmonary and Critical Care Medicine fellowship training at Vanderbilt University where he obtained a Master’s of Science in Clinical Investigation. Other roles Todd serves in include: * President of the American Society of Parenteral and Enteral Nutrition * Vice President for Clinical Trial Innovation and Operations in the Vanderbilt Institute for Clinical and Translational Research (VICTR) * Critical care principal investigator for the Prevention and Early Treatment of Acute Lung injury (PETAL) clinical center at VUMC * Medical Director of VUMC’s Human Research Protections Program Todd and I recorded this conversation in March 2020, just before the COVID-19 impacted fully in our respective countries. I didn’t feel I should put this episode out during the crisis of 2020 so I held it back until now. I also asked Todd if I could interview him a second time now (in February 2021) to freshen up the interview with some perspectives on how COVID-19 has affected he and his colleagues in Nashville. I hope you will gain immense value from what Todd speaks about on this episode, including: * Why he’s considered an ICU junkie and how he’s changed over the years * The principle of “Don’t just do something, stand there” * Understanding the confidence/competence balance * His 4 box method of understanding a critically ill patient’s situation * The concept of the second victim with mistakes * How transparency to families builds substantial trust * Why he praises nurses in front of patient’s families * The structure of the ward round at his ICU * The importance of empowering nurses to ask questions * His note-writing practice, and it’s benefits and risks * His practice to look after himself during periods of clinical service * The benefit of a mix of clinical and research work * The importance of pragmatic trials studying things we are already doing * His institution’s Learning Healthcare System and how it is used * Some overall career tips * How COVID-19 has affected his ICU * How the ICU team is taking care of each other * His ICUs struggle with harsh visitor restrictions and how they relaxed these safely Please enjoy listening to Todd Rice. Andrew Davies -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. -------------------- Links related to Todd Rice Todd Rice Todd Rice on Twitter @toddrice_icu Links to other resources (in order of mentioning) ANZICS Clinical Trials Group ARDSnet low tidal volume strategy study EDEN study TARGET study PERMIT study Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies Audio Producer Chris Burke Burke Sound & Media
1 hr 34 min
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