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:

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.

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:

1. Welcome and Introduction
2. Why Code Green? The inspiration behind the book.
3. The Evolution of U.S. Healthcare: From the 1980s to today.
4. The "Big Lie" in Healthcare: How hospitals maintain profits while claiming financial distress.
5. Trust and Its Erosion in Medicine: Exploring the misalignment between physicians, hospitals, and patient care.
6. Burnout or Moral Injury? Understanding the psychological toll of compromised care.
7. Aligning Values with Care: Dr. Kellum’s actionable solutions for a better healthcare system.
8. The Role of Patients in Reform: How patients can become advocates for systemic change.
9. 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

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.

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.

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:

1. Elliot’s cancer journey since his last appearance.
2. Transition from curative treatment to a palliative diagnosis.
3. The emotional challenges of facing terminal illness.
4. Acceptance of reality and choosing how to live each day.
5. The role of gratitude in maintaining emotional well-being.
6. Coping with the loss of professional identity.
7. Legacy-building and leaving meaningful gifts for loved ones.
8. The importance of honest conversations about death.
9. Support systems: family, friends, and the medical community.
10. 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

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!

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.