An educational podcast presenting practical critical care scenarios. By Brandon Oto, PA-C and Bryan Boling, ACNP. New episodes weekly.
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Episode 73: POCUS for nephrology, with Abhilash Koratala
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We discuss the role of point-of-care ultrasound in evaluating the patient with kidney injury and assessing volume status, with Abhilash Koratala (@nephroP), nephrologist, Director of Clinical Imaging for Nephrology at the Medical College of Wisconsin, and champion of nephrology-focused ultrasound. Find us on Patreon here! Buy your merch here! Takea…
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TIRBO 59: How we make the podcast
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The nuts and bolts of how we produce the show. Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds 39: Understanding flight medicine with Jace Mullen
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We explore critical care transport medicine from both a clinical and career perspective, including helicopters (HEMS), fixed wing jet, and ground ambulance transports, with Jace Mullen, flight paramedic and airway educator out of Denver. Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO 58: Difficult cases
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When do patients deaths bother us?Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 72: CPR-induced consciousness with Jack Howard
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Find us on Patreon here! Buy your merch here! We discuss the phenomenon of CPR-induced consciousness (i.e. patients demonstrating awakeness during resuscitation) with Jack Howard, Intensive Care Paramedic at Ambulance Victoria in the northern suburbs of Melbourne, Australia, and first author on a recent literature review and Delphi-derived expert g…
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TIRBO 57: Volume vs pressure control
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Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds 38: Working in APP leadership, with Jason Wieland
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46:47
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We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC. Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO 56: Transfixing vessels
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You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 71: Transplant medications with Olivia Philippart
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54:52
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We discuss the medications typically used after organ transplant, their impact on critical illness, and how to manage them when these patients show up sick—with Olivia Philippart, transplant clinical pharmacist specializing in liver and kidney transplant at University of Kentucky HealthCare. Find us on Patreon here! Buy your merch here! Takeaway le…
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TIRBO 55: Bowel regimens
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How I make patients poop. Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation. Thanks to Pat Posa, Martha Roberts, Juliana Barr, Kelly Drumright, and Ben Lassow for their input. ResourcesVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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How to document your ultrasound findings. Find us on Patreon here! Buy your merch here!Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 70: Airway evaluation for non-anesthesiologists, with Jed Wolpaw
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We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr. Jed Wolpaw, anesthesiologist and intensivist from Johns Hopkins, anesthesiology residency program director, and host of the ACCRAC podcast. Find us on Patreon here! Buy your merch here! Takeaway lessons Referenc…
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TIRBO 53: Who needs an arterial line?
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Arterial lines are resuscitative tools.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds 36: Nurses are from Venus
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Bedside nurses and providers (physicians, PAs, NPs) tend to see the world differently, much of it driven by their training and the systems they work within. We chat about reconciling this and how to best function as a team.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO 52: Reliable is better than perfect
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In general, medical decisions that avoid error are better than those that optimize care.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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We discuss head and neck surgery with Dr. Alexandra Kejner, otolaryngologist at the Medical University of South Carolina specializing in transoral robotic surgery, reconstructive surgery including microvascular free tissue transfer, salivary neoplasms, and sialoendoscopic procedures. Find us on Patreon here! Buy your merch here! Takeaway lessons Re…
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The core disorders of critical care are mostly syndromes, not diseases. What should this mean to us?Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #35: Brain death updates, with Ariane Lewis and Matthew Kirschen
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Discussing the new 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline, with the joint first authors: Dr. Ariane Lewis, neurointensivist, professor of neurology and neurosurgery at NYU Langone, director of neurocritical care, and chair of the Langone ethics committee, and Dr. Matthew Kirsc…
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If you produce academic work, use the research to produce multiple products. Once is a waste.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 68: Liver transplant with Meera Gupta
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We learn about liver transplant with Dr. Meera Gupta, transplant surgeon at the University of Kentucky Healthcare Transplant Center, and surgical director of the Kidney and Pancreas Transplant Program. We discuss eligibility, triage, the peri-operative course, and important post-op complications. Find us on Patreon here! Buy your merch here! Takeaw…
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Explaining the ultimate expression of prognosis: Morbidity = (Severity x Duration)/ReversibilityVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #34: … When?
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When should you…Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #48: Choosing a line site
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Which site should you select for your central line placement? A discussion of some considerations.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 67: Whipples with Michael Cavnar
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We learn about pancreaticoduodenectomy (the Whipple) with Michael Cavnar (@DrMikeCavnar), surgical oncologist at University of Kentucky, with a fellowship in Complex General Surgical Oncology from Sloan Kettering. He specializes in GI surgical oncology (liver, pancreas, stomach, etc), with ongoing research in GI stromal tumors and hepatic artery in…
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TIRBO #47: Why do we prone?
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A review of the physiological and practical reasons to position patients with ARDS in the prone position.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #33: Transitioning to academics with Janelle Bludorn
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We chat with Janelle Bludorn (@JanelleRBlu), former emergency medicine PA, Assistant Professor and Academic Coordinator at the Duke PA program, about transitioning from clinical work into teaching and academia. Find us on Patreon here! Buy your merch here! ResourcesVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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The value of being curious about practice differences, not judgmental.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 66: Aortic dissection with Travis Hughes
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We explore aortic dissection with Travis Hughes, vascular surgery fellow from the University of Kentucky, including classification, medical management, and nuances of the surgical perspective. Find us on Patreon here! Buy your merch here! Takeaway lessonsVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #45: SBT failure phenotypes
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What are the ways that patients fail breathing trials, and what can they tell us about how to optimize them for next time?Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #32: Creating a POCUS system with Leon Chen
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We chat with Leon Chen about his work setting up infrastructure for clinical POCUS at Memorial Sloan Kettering. Leon is an Adult/Gerontology Acute Care Nurse Practitioner in the ICU, Clinical Program Manager of Research and Simulated Learning, and an Associate Professor at Columbia University School of Nursing. Find us on Patreon here! Buy your mer…
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TIRBO #44: The things I carry
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A brief discussion of the stuff in your pockets as you practice medicine.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 65: Obstructive UTI with Ashley Winter
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We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter (@AshleyGWinter), board certified urologist with a fellowship in male and female sexual medicine, and chief medical officer of Odela Health. Find us on Patreon here! Buy your merch here! Takeaway lessonsVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #43: Lying to ourselves (the clinician’s perspective on end-of-life care)
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From the Critical Concepts blog, thoughts on our personal biases and lack of humility when contemplating end-of-life decision making.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #31: How to not get fired
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Bryan and Brandon chat about holding down jobs, conflict resolution and interpersonal skills, and how to protect yourself as an employee.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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When are patient outcomes your fault?Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 64: Neurologic POCUS with Aarti Sarwal
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We explore the cutting edge practice of point-of-care ultrasound of the brain, including optic nerve sheath measurement, transcranial doppler, assessing midline shift, and more, with Aarti Sarwal, neurologist and neurointensivist, director of the neurocritical care unit at Wake Forest, and director of their neurovascular lab and ultrasound courses.…
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TIRBO #41: Tissue compression and elasticity during procedures
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Dealing with the good and bad aspects of tissue mobility during percutaneous procedures.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #29: Making APP and physician collaboration work, with Matt Siuba
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We chat with friend of the podcast Matt Siuba (@msiuba), Mr. Zentensivist, to share our distinct perspectives on the relationship between APPs (PAs or NPs) and the intensivists we work alongside.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #40: Ventilating the breathing patient
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The dilemma of lung-protective ventilation in patients with strong spontaneous breathing.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 63: Understanding dialysis, with Paul Adams
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We dive into when to initiate renal replacement therapy, the modalities, settings, and physics involved, troubleshooting problems, and more, with Dr. Paul Adams, a dual-trained nephrologist and intensivist at the University of Kentucky. Find us on Patreon here! Buy your merch here! Takeaway lessonsVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #39: 5 rules for clinical excellence
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5 things you pretty much must be doing if you want to be excellent at critical care. See also on the blog: The ten laws of critical care Practicing medicine like an adultVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #28: Online learning with Callie Tennyson
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We chat with Callie Tennyson, DNP, ACNP-BC, AACC, CHSE, assistant professor from the Duke University School of Nursing, about the use of the internet and social media for medical education: trends, challenges, and principles for doing it right.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #38: Why you should follow up
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The value of performing chart checks to see how your patients are doing after your care.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 62: Running a cardiac arrest
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Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessonsVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #37: Remote brains
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The importance of using an app to keep notes and establish a second, more reliable medical memory.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Lightning rounds #27: Burnout and career satisfaction
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We chat about why people get burned out in medicine, how to weigh the pros and cons of our work, and the right perspective on job satisfaction.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #36: Liberty or death
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A brief overview and call to arms around the key concepts of ICU liberation.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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Episode 61: ECPR with Scott Weingart
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We chat with Scott Weingart of Emcrit about the use of crash VA ECMO for the cardiac arrest patient. Check out the REANIMATE course here! Listen to the ED ECMO podcast on ECPR here Find us on Patreon here! Buy your merch here! Takeaway lessonsVon Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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TIRBO #35: Vent double-triggering
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Understanding the causes of doubled vent breaths, including premature/short cycling and reverse triggering, plus a basic approach to managing them.Von Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
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