Devastating Brain Injury - Dr Dan Harvey

The Critical Care Commute Podcast

#Fitness #Medicine #Critical Care Commute

24:42

Episode Notes [01:14] Unexpected Email from Employer [05:49] The Deferred Resignation Program [06:34] Initial Reactions and Concerns [08:01] Evaluating the Offer [08:21] Enhanced Standards of Conduct [08:55] Personal Reflections and Concerns [12:21] Seeking Advice and Making a Decision [13:01] Option One: Do Not Resign [14:56] Option Two: Resign [16:44] Insights from Conversations [21:30] Making The Decision [23:51] Final Thoughts and Gratitude Resources Mentioned Sebastian Junger The Soul of Shame by Curt Thompson Donald Trump Elon Musk Steve Bannon Russell Vought Derek Sivers Sumner Crenshaw Brian Fretwell at Finding Good Chad Littlefield The Thought Leaders Practice by Matt Church Simon Cowell Beauty Pill Producer Ben Ford Questions Asked Is it legitimate, and can it be trusted? How are you feeling? What questions come to your mind? Where does your mind go? Are you seeking safety? Would this have been an adrenaline rush as you raced to send the resignation response? What an "enhanced standard" regarding loyalty and trustworthiness was? What are these new "enhanced standards?" Are they beyond what my Constitutional oath requires? If I don't resign, how bright will the target on my back glow? My leadership has supported all my work, but would termination direction come from higher up the chain of command? What would you recommend if we talked over coffee? What questions would you ask? How would you use listening? How would you use silence? How is this scenario playing out in your mind and body? What is coming to the surface for you? How might that influence what you are about to say to me? What are the chances of my name popping on a list and getting fired? How about the chances of being part of an official Reduction in Force and early retirement? Would the administration make a better offer? What do I know about the pending job market? What did I expect the workplace to be like and did I want to be there as the contractions took place? Will the administration pay me through the end of September or will they renege? Can I sufficiently build the Curated Questions business to transition by 1 October? - Do I have the faith or confidence to step into this future as a sole practitioner and grow Curated Questions into all I envisioned? Was this purpose calling? What would I expect the job market to look like at the end of summer if I hadn't developed the income streams to maintain our lifestyle? What is your recommendation? Did it change from your initial recommendation? Where in your body are you feeling the uncertainty? Are you processing this scenario in parallel with your decision as if you had received the email? What additional questions should I have considered? Who else should I have consulted with? How would you have changed my risk rating? What is the correct length of the pregnant pause before making an important announcement? What processes would you use in my circumstance, and what would be different? What questions are at the top of your list to get to a decision? Who would be the members of your pantheon you would counsel with to gain clarity? Apart from the heady analysis, what other key practices would you include in your journey through a similar situation?…

2 years ago 13:44

M4A•Episode home

Welcome to our "State of the Art 2023 Congress Series," recorded live in Birmingham, UK!

We are absolutely thrilled to bring you the first installment of our podcast series, where we dive deep into groundbreaking topics and innovations discussed right here at this conference.

As we embark on this podcast series, we aim to bring you captivating conversations, enlightening interviews, and thought-provoking discussions straight from the conference floor, background chatter, laughter and tea trolly clanging included!

Our first guest is Dr. Dan Harvey, Professor of Intensive Care Medicine at Nottingham University Hospitals and University of Nottingham. He is Chair of the UK Intensive Care Societies Legal & Ethical Advisory Group, and an author of multiple ICS & FICM guidance documents. Dan has an active research interest with roles including National Lead for Innovation & Research in Organ Donation for NHS Blood and Transplant, Vice Chair of the NIHR’s National Critical Care Group, and is joint Chief Investigator for the SIGNET study, the world’s largest interventional study in organ donation (https://ics.ac.uk/soa23/speakers.html#:~:text=Dr%20Dan%20Harvey,in%20organ%20donation.)

Join us as we talk about devastating brain injury and what it means for patients, health care workers and families.

73 episodes

The Critical Care Commute Podcast

Devastating Brain Injury - Dr Dan Harvey

The Critical Care Commute Podcast

published 2 years ago

M4A•Episode home

Welcome to our "State of the Art 2023 Congress Series," recorded live in Birmingham, UK!

We are absolutely thrilled to bring you the first installment of our podcast series, where we dive deep into groundbreaking topics and innovations discussed right here at this conference.

Join us as we talk about devastating brain injury and what it means for patients, health care workers and families.

73 episodes

#Fitness #Medicine #Critical Care Commute

All episodes

The Critical Care Commute Podcast

1
Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen 22:37

5 days ago22:37

22:37

In this episode, recorded live at the Critical Care Canada Forum in Toronto, we dive into extracorporeal life support (ECLS) in cardiogenic shock, with Dr Sean van Diepen. He is an Associate Professor at the University of Alberta, Co-Director of the CCU at the Mazankowski Alberta Heart Institute, and a leading voice in cardiac critical care. Join us as we explore the evolving landscape of mechanical circulatory support, the latest evidence from the DANGER and ECLS-SHOCK trials, and the complexities of patient selection. Key Topics Covered: 1. The Evolution of ECLS in Cardiogenic Shock • The 25-year gap since the last positive cardiogenic shock trial. • How mechanical circulatory support expanded despite limited evidence. 2. The DANGER Trial – Impella in AMI-Associated Cardiogenic Shock • Mechanism and function of the Impella device. • Trial results: 20% mortality reduction at 180 days. • Complications: Limb ischemia, hemolysis, and high costs. • Real-world application: Who actually qualifies? 3. ECLS-SHOCK Trial – ECMO for Cardiogenic Shock • A "negative" trial, but a crucial wake-up call. • No mortality benefit but significantly higher complication rates. • Controversies: Inclusion of cardiac arrest patients and transition to destination therapy. • Future directions: Can patient selection improve outcomes? 4. ECPR – Extracorporeal Support in Refractory Cardiac Arrest • Review of the ARREST, PRAGUE, and INCEPTION trials. • Why the evidence remains unclear and institution-dependent. • The role of high-volume ECMO centers and standardized pathways. 5. The Future of ECLS – Cost, Ethics, and Decision-Making • How should institutions decide who gets ECMO? • The role of cardiogenic shock teams. • Could AI play a role in decision-making? • The challenge of resource allocation in a single-payer system. Key Takeaways: ✅ Impella shows promise in carefully selected AMI shock patients but is costly and high-risk. ✅ ECMO for cardiogenic shock remains controversial—patient selection is key. ✅ ECPR is promising but needs further trials and structured implementation. ✅ Cardiogenic shock management should be a team decision, not an individual one. 🔊 Listen now and join the conversation on the future of cardiac critical care!…

The Critical Care Commute Podcast

1
Combat Medicine: Universal Lessons for the Battlefield and Civilian Streets with Major General Tim Hodgetts CB CBE KHS DL 44:06

21 days ago44:06

44:06

We’re taking a break from our Cardiac Critical Care series to bring you a conversation with one of the most influential figures in medicine. Peter had the huge privilege of interviewing Major General Tim Hodgetts, the recently retired, most senior medical advisor in the UK forces. Hodgetts shares his remarkable journey in transforming emergency medicine from its infancy to maturity, detailing poignant experiences from his early career that steered him towards this specialty. The discussion ranges from Hodgetts' pioneering efforts in combat casualty care, the evolution of battlefield first aid, and innovative medical practices in conflict zones, to his concepts on leadership, international collaborations, and coping with trauma. The segment also touches on Hodgetts' recent retirement and his ongoing contributions to medical and military communities through teaching, charity work, and writing. Chapters: 00:00 Introduction and Guest Overview 02:56 Early Career and Influences 06:25 Pioneering Emergency Medicine in the Military 08:13 Revolutionizing Combat Casualty Care 17:55 International Collaboration and Cultural Insights 30:31 Leadership in Crisis 35:35 Coping with Trauma and Personal Reflections 39:43 Retirement and Legacy 42:29 Conclusion and Final Thoughts This has been one of my absolute favorite podcasts to produce! What an honor to have Major General Tim Hodgetts join us on the Critical Care Commute!…

The Critical Care Commute Podcast

1
Refractory Cardiac Arrest - A Clinical Practice Update with Dr Rebecca Mathew 25:17

5 weeks ago25:17

25:17

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series. Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR. Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for change References: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer: This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.…

The Critical Care Commute Podcast

1
Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care with Dr Janek Senaratne. 29:38

8 weeks ago29:38

29:38

Welcome to our first episode in a series on Cardiac Intensive Care, recorded live at the Critical Care Canada Forum 2024. We kick off by looking at the latest Clinical Practice Update on post cardiac arrest care and refractory cardiac arrest. The "Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care" CCS was published in 2024, and provides comprehensive recommendations for the management of patients following cardiac arrest. Join us as Dr Janek Senaratne unpacks this Clinical Practice Update (CPU), and guides us through the evidence for the recommendations made. Dr. Janek Senaratne is a dual-trained cardiologist and intensivist based in Edmonton, Alberta. He serves as an Associate Clinical Professor in the Department of Medicine at the University of Alberta. University of Alberta In his clinical roles, Dr. Senaratne practices at the University of Alberta Hospital and Grey Nuns Hospital, and is one of the Vital Heart Response physicians for the province. Further Reading:…

The Critical Care Commute Podcast

1
How We Think, How We Communicate - Where are we Going? 24:07

9 weeks ago24:07

24:07

Recorded live at the Toronto Critical Care Canada Forum, this episode features a conversation with Prof. Derek Angus, Professor at the University of Pittsburgh, senior editor at JAMA, and Vice Chair of Innovation. We discuss the evolution of healthcare systems, the art of decision-making, the role of AI, and how to inspire the next generation of clinicians. Chapters: Welcome to the Forum Introductions and reflections on the energy of in-person conferences post-COVID. Setting the stage with Dr. Angus and his storied career. Conferences: More Than Just Science The dual role of conferences as spaces for rigorous science and informal discussion. How smaller, focused meetings like CCR foster deeper conversations. How We Communicate Science Reflections on the digital age: Do we risk dumbing things down too much? The balance between simplicity and nuance in medical publishing. The AI Frontier in Medicine Separating hype from reality: Why AI isn’t replacing doctors just yet. The cognitive load of decision-making and where technology fits in. Thinking, Fast and Slow Exploring System One and System Two decision-making. The growing interest in how groups make decisions in critical care settings. Redefining Careers in Medicine Moving beyond traditional roles to focus on leadership, innovation, and teamwork. Advice for the next generation on thinking outside the box. Building Better Healthcare Systems Shifting accountability from individual outcomes to system-wide improvement. Transparency and trust: Why they’re essential for the future of healthcare. Closing Thoughts Dr. Angus reflects on his legacy and hopes for the next wave of clinicians. A heartfelt thanks and a promise for more conversations ahead.…

The Critical Care Commute Podcast

1
Code Green or Code Greed? Dr John Kellum 33:03

13 weeks ago33:03

33:03

Health Economics 101: "Code Green - How the big lie in health care affects us all." Prof. John Kellum, is a Professor of Critical Care Nephrology and now provocative author! Join us as he talks to us about his book: "Code Green - How the Big Lie in Healthcare Affects Us All." Conflict Declaration: The hosts and producers of this podcast declare no financial gain or conflict of interest from this episode or the promotion of Code Green. Our only goal is to share the insights and expertise of Dr. Kellum with our audience. Episode Chapters: Welcome and Introduction Why Code Green? The inspiration behind the book. The Evolution of U.S. Healthcare: From the 1980s to today. The "Big Lie" in Healthcare: How hospitals maintain profits while claiming financial distress. Trust and Its Erosion in Medicine: Exploring the misalignment between physicians, hospitals, and patient care. Burnout or Moral Injury? Understanding the psychological toll of compromised care. Aligning Values with Care: Dr. Kellum’s actionable solutions for a better healthcare system. The Role of Patients in Reform: How patients can become advocates for systemic change. Closing Thoughts and Takeaways: Dr. Kellum’s message to healthcare professionals and patients alike. Further Resources: • Code Green: How the Big Lie in Healthcare Affects Us All…

The Critical Care Commute Podcast

1
Hyperbaric Medicine: A Deep Dive with Dr Jeff Kerrie 30:33

15 weeks ago30:33

30:33

In this episode, we dive into the fascinating world of Hyperbaric medicine with Dr. Jeff Kerrie, a Hyperbaric specialist from British Columbia, Canada. Dr. Kerrie takes us through the science, history, and practical applications of Hyperbaric oxygen therapy (HBOT) as we explore the approved indications, physiological effects, and logistics of managing hyperbaric chambers. Episode Chapters: Introduction Meet Dr. Jeff Kerrie and learn about his journey in hyperbaric medicine and the unique setup of Vancouver Island’s hyperbaric program. History of Hyperbaric Medicine A look at the origins of hyperbaric therapy, from 1600s pressurized chambers to its modern evolution. The Physiology of HBOT Understanding the effects of supra-physiologic oxygen pressures on microcirculation, angiogenesis, and inflammation. Indications and Evidence: Decompression Sickness The mechanisms of treating “the bends” and why HBOT works so effectively. Air or Gas Embolism Insights into diagnosing and treating air embolism, including critical resuscitation tips. Carbon Monoxide Poisoning How HBOT prevents long-term neurological damage, with considerations for pregnant patients and associated toxins like cyanide. Necrotizing Soft Tissue Infections The role of HBOT in treating Fournier’s gangrene and clostridial infections alongside surgery. Crush Injuries and Anemia Exploring HBOT’s utility in tissue salvage and sustaining oxygenation in severe anemia. Newer Indications: Sudden Hearing and Vision Loss The emerging role of HBOT in sudden sensorineural hearing loss and central retinal artery occlusion. Risks and Safety in the Chamber Barotrauma, oxygen toxicity, fire safety, and managing emergencies during dives. Logistics of Hyperbaric Medicine A behind-the-scenes look at hyperbaric chamber setups, patient care protocols, and equipment considerations. Closing Thoughts Dr. Kerrie’s perspective on the future of hyperbaric medicine and ongoing research opportunities. Key Indications for HBOT: 1. Decompression sickness ("The Bends") 2. Air or gas embolism 3. Carbon monoxide poisoning 4. Necrotizing soft tissue infections 5. Crush injuries and compartment syndromes 6. Severe anemia (e.g., in patients unable to receive transfusions) 7. Radiation tissue injury (e.g., osteoradionecrosis) 8. Sudden sensorineural hearing loss Resources and Links: • Undersea and Hyperbaric Medical Society Approved Indications for Hyperbaric Oxygen Therapy - Oceanside Hyperbaric • Hyperbaric Medicine | © 2018 The Royal College of Physicians and Surgeons of Canada. All rights reserved. Disclaimer: This episode provides general information and is not a substitute for professional medical advice. Always consult with a specialist for specific clinical decisions.…

The Critical Care Commute Podcast

1
Critical Care in Australasia: A Past Presidential Address and a Devil of a Good Time Expected in Tasmania 30:38

17 weeks ago30:38

30:38

In this episode, Peter Brindley and Leon Byker sit down with Dr. Rob Bevan, immediate past president of the College of Intensive Care Medicine (CICM) and Critical Care Director at Auckland City Hospital, Auckland, New Zealand. Dr. Bevan shares his journey through leadership in intensive care, the role of intensive care colleges, and the evolution of critical care training. He also explores the political, social, and ethical dimensions of critical care, from workforce sustainability to the unique role of intensivists as brokers of care. Episode Highlights: The Evolution of CICM: History of the CICM and the differences between the CICM and similar organizations globally. Training for Critical Care: The training pipeline in Australasia. Advocacy and Political Engagement: The role of the CICM in advocating for intensive care resources. The Value of College Convocations: Celebrating new fellows and their families and the role of meaningful ceremonies. The Intensivist as a Broker of Care: Defining the role of the ICU specialist in complex patient care. The Future of Critical Care Workforce: Addressing workforce challenges and it's sustainability. The Upcoming CICM Annual Meeting: Highlights of the upcoming 2025 meeting in Tasmania. Reflections on Leadership and Administration: Dr Bevan's Journey into administration and why it matters.…

The Critical Care Commute Podcast

1
Coping with dying and saying what needs to be heard: Elliot Sprague 43:35

21 weeks ago43:35

43:35

Coping with dying and saying what needs to be heard: Elliot Sprague Introduction: In this emotional episode, Peter Brindley, Leon Byker, and Elliot Sprague revisit Elliot’s journey with metastatic cancer, a year after his initial appearance on the podcast, Elliot reflects on the impact of living with a terminal illness, sharing life lessons, and offering insights on how he continues to thrive despite a difficult prognosis. This episode Elliot talks about acceptance, gratitude, and the importance of living each moment fully. Topics Discussed: Elliot’s cancer journey since his last appearance. Transition from curative treatment to a palliative diagnosis. The emotional challenges of facing terminal illness. Acceptance of reality and choosing how to live each day. The role of gratitude in maintaining emotional well-being. Coping with the loss of professional identity. Legacy-building and leaving meaningful gifts for loved ones. The importance of honest conversations about death. Support systems: family, friends, and the medical community. Practical tools for mindfulness and mental well-being. Timeline: 00:00 - 01:30 : Introduction and re-welcoming Elliot Sprague to the show. 01:31 - 05:20 : Elliot updates on his cancer journey, including treatment successes and setbacks. 05:21 - 10:00 : The shift from a curative approach to palliative care. 10:01 - 15:45 : Acceptance, gratitude, and how Elliot thrives with his diagnosis. 15:46 - 20:55 : Discussing HyPEC surgery and reflecting on end-of-life realities. 20:56 - 25:30 : Legacy-building, gratitude practice, and leaving meaningful messages for loved ones. 25:31 - 30:10 : Coping with family grief and how Elliot's wife Danielle plays a crucial role. 30:11 - 35:50 : The power of mindfulness in Elliot’s journey and how it changed his outlook. 35:51 - 40:15 : The role of humor and connection in facing terminal illness. 40:16 - 45:00 : Final reflections, messages of gratitude, and an emotional conclusion. Thank you Elliot for joining us! https://www.gofundme.com/f/dr-elliott-sprague-and-family?attribution_id=sl:c52d4c83-2649-4ce0-a003-651776f01205&utm_campaign=man_sharesheet_ft&utm_medium=customer&utm_source=email…

The Critical Care Commute Podcast

1
Ferguson and Scales on Research and Conferences 24:44

24 weeks ago24:44

24:44

In this episode, we sit down with Dr. Damon Scales and Dr. Niall Ferguson at the Canadian Critical Care Forum. We dive into a little bit of ARDS and spend a whole lot of time talking about the evolving landscape of conferences and critical care research. Tune in for insights from two leaders in the field!…

The Critical Care Commute Podcast

1
Obstetric ICU: A primer for the acute care doctor and nurse. 21:38

27 weeks ago21:38

21:38

Join us as Prof. Stephen Lapinski answers our questions on Obstetric critical care. Stephen Lapinsky is Director of the Intensive Care Unit at Mount Sinai Hospital, Toronto and Professor of Medicine at the University of Toronto. He graduated from the University of the Witwatersrand, Johannesburg, and trained in Pulmonary and Critical Care Medicine. His clinical practice includes general Critical Care Medicine and ambulatory Respirology. He has a clinical and research interest in critical illness and respiratory disease in the pregnant patient. He is an officer of the North American Society of Obstetric Medicine (NASOM) and is co-Editor-in-Chief of the international journal Obstetric Medicine.…

The Critical Care Commute Podcast

1
Professor Charlotte Summers: ARDS, Research and Life. 21:37

29 weeks ago21:37

21:37

Join us as we discuss ARDS, Research and balancing life as a researcher with Professor Charlotte summers, Director of the Heart and Lung Research Institute (HLRI).

The Critical Care Commute Podcast

1
Medical Assistance in Dying: Your Questions Answered... Maybe... Hopefully! 47:02

31 weeks ago47:02

47:02

Join James Downar Head of Palliative and End of Life Care and a Critical Care Doc in Ottawa. He has walked the walk on this topic since before its introduction in Canada. Nobody is better qualified to discuss this thorny topic.

The Critical Care Commute Podcast

1
Building your Ultrasound Skills: Bigger, Better, Buchanan! 24:00

34 weeks ago24:00

24:00

Join Brian Buchanan, Associate Professor and ultrasound guru, for a dose of iconoclasm and provocation. Recorded at the Critical Care Canada Forum in Toronto, and following a 2024 JICS publication by Brindley et al.

The Critical Care Commute Podcast

1
From Lab to Bedside: Former NEJM Editor Jeff Drazen on Making Research Clinically Relevant 31:05

37 weeks ago31:05