Dr. Verduzco's interview

Dr. Luis A. Verduzco Intensivist, Anaesthesiologist Dr. Verduzco presents the diagnosis, labs, pathophysiology, and management of sepsis and septic shock.

In this lecture, we review neuroanatomy and neurophysiology as it pertains to traumatic brain injury (TBI). Various subtypes of TBI are described, and the ICU management of such emergencies is delineated. TBI complications are reviewed with a focus on Takotsubo cardiomyopathy.

In this lecture, we review neuroanatomy and neurophysiology as it pertains to traumatic brain injury (TBI). Various subtypes of TBI are described, and the ICU management of such emergencies is delineated. TBI complications are reviewed with a focus on Takotsubo cardiomyopathy.

In this video, we discuss the physiology of potassium homeostasis as well as the mechanisms used by the body to maintain a stable potassium concentration. Three clinical examples of hyperkalemia are noted. The acute and subacute management of this life-threatening disorder is discussed.

Dr. Luis A. Verduzco Intensivist, Anaesthesiologist Dr. Verduzco presents the diagnosis, labs, pathophysiology, and management of sepsis and septic shock.

In this lecture, we review the pathophysiology of abdominal compartment syndrome and outline how it affects multiple organ systems. The clinical presentation and management of this medical emergency are described.

In this lecture, we review sodium homeostasis in the human body as well as hyponatremia. Critical care management of hyponatremia is discussed. The differential diagnosis of hyponatremia will be outlined and an approach to its etiology is reviewed.

In this lecture, we review the physiology of cardiac contraction and the cellular mechanisms involved in that process, including adrenergic receptors. Multiple inotropic and vasoactive agents are discussed in detail. Clinical examples are provided at the end of the lecture

In this lecture, we review the physiology of cardiac contraction and the cellular mechanisms involved in that process, including adrenergic receptors. Multiple inotropic and vasoactive agents are discussed in detail. Clinical examples are provided at the end of the lecture

In this lecture, a PA catheter is shown to describe the various features of the actual catheter; indications and contraindications are noted. Waveform tracings and their relationship to the EKG are, in great detail, described; the critical data obtained from a PA catheter as well as dangerous pitfalls are highlighted. Additional cardivascular physiology principles such as the Fick cardiac output, the mixed venous oxygen tension, the wedge pressure, and the systolic pressure variation are described.

In the perioperative cardiac complications lecture, we describe multiple cardiac and non-cardiac complications of cardiac surgery; an anatomic and organ system approach is taken to describe the cardiac and non-cardiac issues, respectively. A special emphasis is placed on heparin-induced thrombocytopenia as well as intra-aortic balloon pumps. After this lecture, learners should feel significantly more comfortable in the cardio-vascular ICU.

ICU Station and analgesia The armamentarium of the multimodule regiment for the ICU sedation while minimizing adverse effects. Definition Alpha and beta elimination. Context sensitive half-life Sedatives Analgesia Exam questions

In this video, we review clinically pertinent respiratory anatomy and physiology as it relates to obstructive lung disease. Functional residual capacity, hypoxic pulmonary vasoconstriction and flow loops are reviewed. Obstructive pulmonary disease is discussed with an emphasis on emphysema and its pathophysiology, diagnosis and acute treatment during exacerbations.

Dr. Luis Verduzco presents following topics in Medical Fallacies How the teaching may be based on poor data or empirical mindset. Crystalloids for Blood Tx. Platelets and Fluid Wamers. GI Prophylaxis in the ICU. Renal Failure and Crystalloids. Hypertoxic Harm. Lactic Acidosis. Ketamine and the Brain. Allen's Test.

In this lecture Dr. Crawford presents the definition of coma, the most common etiologies, and uses a case to highlight clinical management strategies.

Case

A 73 year-old female is transferred to the hospital from her nursing home after being found unresponsive. 

Topics

• Definition of coma
• Anatomy of awareness
• Three broad categories of coma etiologies
• Brief review of the pathophysiology of comatose states
• Initital evaluation
• Diagnosis
• Management

Recording of the live webinar by Dr. Mobeen in the series of neurological examination of a patient in coma. This video presents glasgow coma scale.

This is the second part of the neurological examination.
Definition of Stupor and Coma
We will discuss the immediate management approach of a comatose patient.
We will discuss Glasgow Coma Scale (GCS)

Notes

• Every hospital (at least in the US) has their own guidelines towards the assessment, labeling, and the management approach of the patients that may have neurological disorders especially in an acute state.
• Make sure that you consult your hospital’s guidelines and approaches towards the assessment and management protocols.
• Your hospital’s guidelines will supersede the approaches discussed here. The information in this lecture is for educational purpose only.

Presentation is here

Ventricular Fibrillation is a terminal event for a dying heart. This talk discusses the:

• Primary pathophysiology
• Signs and symptoms
• EKG changes
• Management approach
• Potential outcomes

Basic Assessment and Management of the Burns

In this webinar, Dr. Zeshaan Maan discusses the basic approach to manage a patient with burns.

He discusses the basic structure of the skin, the largest organ in the human body. 

Skin consists of an epidermal layer and a dermal layer. It also contains structures like hair follicles, sweat, and sebaceous glands. These structures reside in the deepest part of the dermis along with the blood vessels and the nerve endings. These are part of the invaginations of the epidermis in the dermis. Proliferating epithelium and the keratinocytes are present here as well. These cells, in turn, are essential to resurface the injured areas of the skin.

Skin provides a barrier function to help protect the body from the pathogens outside. It also prevents the loss of fluids from the internal environment of the body.

After discussing the normal structures and functions of the skin, Dr. Maan discusses the pathophysiology of the burns and various zones that form in burn injuries. 

He discusses zones of:

1. Coagulation
2. Stasis
3. Hyperemia

Following the pathophysiology, he discusses the method to measure the total body surface area of the burn.

Cardiovascular system instability, fluid loss, vasoconstriction, and myocardial contractility reduction due to the tumor necrosis factor alpha is discussed.

Respiratory changes, for example, adult respiratory distress syndrome and metabolic changes like increased metabolic rate and splanchnic hypoperfusion are discussed.

Following this discussion, the classification of the burns is presented.

Burns are classified as:

1. Superficial
2. Superficial partial thickness
3. Deep partial thickness
4. Full thickness

A discussion of the possible outcome, healing process, and the scar formation in various classes are discussed.

A rigorous discussion of the calculation of the percent total body surface area (TBSA) burnt is presented. Palmer method and the rules of 9 method are discussed.

Classification of burns based on the causative agent is discussed next. Following important types are presented:

1. Thermal
2. Chemical
3. Electrical

Management Approach

1. First Aid
   1. Removal of the hot, burnt, or chemical infused clothing
   2. Cooling or irrigation of the burnt area
   3. Maintenance of the patient's body temperature
   4. Understanding that the trauma is an important factor to consider in a burns' patient. In fact, in the ATLS protocol, the burns are considered a distracting injury.
2. ATLS Protocol
   1. The airway is to be secured
   2. Consider the edema/swelling of the upper airway.
   3. Breathing and ventilation managed
   4. Circulatory system management. 
   5. Consideration for the escherotomy
   6. ETc.

Following management techniques are discussed in detail:

1. Parkland formula for the burns' management is discussed.
2. Topical applications of various creams, drugs, and grafts, etc. are discussed.
3. Surgical approach to the management is discussed in depth.
4. Split thickness skin grafting is discussed next.
5. Donor site choices, considerations, and limitations are discussed.
6. More modern approaches such as sprayed skin, cell culture to form skin, etc. are discussed.

A question-answer session is conducted at the end.

Part 2 of this Q&A will be published next.

In this session, we ask Dr. Zeshaan Maan questions about burn management. Our audience submitted questions and here are the questions that are discussed:
1. Robert Adams If we could boil down the early intervention to the simplest strategies, what early treatments confer the biggest “bang for our buck” in terms of survival and quality of life?
2. Dr. Zunira Ikram asks, my question is practically  what's the age criteria of burn for which a person can survive ??? & also is this dependent on management or not?
3. Rachell NP asks, in ER or urgent care when is a burn specialist needed?
4. Asadullah Yousafzai asks, I/V fluids and prophylactic antibiotics?
5. mhoppis65 asks, to pop or not to pop (blisters that is)?
6. Robert Adams asks, Ok, last question, as a burn specialist are there any new treatments or medicines or really anything new in the treatment of burns that particularly excites you or shows great promise ? What’s coming out that will be worth taking a look at?

Ahmed Zaafran MD presents Burns Types of burns Pathophysiology Fluid shifts, infections, and electrolyte imbalances Differential diagnosis Management