Critical Care Scenarios
An educational podcast presenting practical critical care scenarios for healthcare professionals. Hosted by Brandon Oto, PA-C and Bryan Boling, ACNP, each episode covers real-world clinical cases and management strategies. New episodes are released weekly.
Episodes
Lightning rounds 70: Jumping ship for private industry, with Theresa Human
Theresa Human, former academic clinical pharmacist in neurocritical care and now medical liaison for a large pharmaceutical company, chats about late-career transitions and working for private industry. Check out the Intensive Care Academy here!
Lightning rounds 69: Does PRVC suck? with Nick Ghionni
We step into the ring with Nick Ghionni, pulm/crit attending at MedStar Baltimore Hospital, who tries to convince us that the pressure-targeted, volume-titrated vent mode known as “PRVC” actually sucks. Check out the Intensive Care Academy here!
Lightning rounds 68: Setting PEEP in the obese with Olivia Serigano
EM intensivist Olivia Serigano tells us about their recent publication in Anaesthesia Critical Care & Pain Medicine evaluating the use of two rules (BMI/3 or PEEP 10 in everyone) for setting PEEP in obese patients on the ventilator. Learn more at the Intensive Care Academy! Takeaway pearls
Episode 103: Basic intracranial hemorrhage
We review the basic care and workflow of caring for bread-and-butter intraparenchymal hemorrhage. Learn more at the Intensive Care Academy! Takeaway pearls
Episode 102: Tox files #1 with Andrew Sheen and Jerry Snow
We hear a mystery tox case from Jerry Snow, director of the toxicology fellowship at Banner University Medical Center in Phoenix, and one of his med tox fellows Andrew Sheen. Learn more at the Intensive Care Academy! Takeaway pearls References PATHOPHYSIOLOGY & CLASSIFICATION 1. Lalau JD, Kajbaf F, Protti A, et al. Metformin-associated lactic acidosis … Continue reading "Episode 102: Tox files #1
Lightning rounds 67: IV fluids
We give our general take on IV fluids: when to use them, what to use, when to stop, how to bolus and when to use maintenance fluids, and more. Learn more at the Intensive Care Academy!
Lightning rounds 66: ED vs ICU with Namita Jayaprakash
We discuss the interface between ED and ICU and why we have trouble understanding each other, with Dr. Namita Jayaprakash, dual-trained EM and critical care physician, and medical director of her ED. Learn more at the Intensive Care Academy! References
Lightning rounds 65: Global health with Kwame Boateng
We learn about how to contribute to underserved communities abroad, with Kwame Akuamoh-Boateng, DNP, ACNP-BC, FCCM. Learn more at the Intensive Care Academy! References
Episode 101: Acalculous cholecystitis with Dennis Kim
Dennis Kim, trauma surgeon and surgical intensivist of the Trauma ICU Rounds podcast, weighs in on the diagnosis and management of acalculous cholecystitis. Learn more at the Intensive Care Academy! Takeaway pearls
Episode 100: Autoimmune encephalitis testing with Tammy Smith
Tammy Smith, assistant professor of neurology at the University of Utah within the division of Neuroimmunology and Autoimmune Neurology, and a clinical consultant at ARUP Laboratories, gives us the inside scoop on testing for autoimmune encephalitis syndromes. Learn more at the Intensive Care Academy! CHEST’s Procedural Skills for the Critical Care Clinician, April 23-24 2026 … Continue reading "E
Lightning rounds 64: The new Surviving Sepsis guidelines with Hallie Prescott
Hallie Prescott, pulm/crit physician and co-chair of the recent Surviving Sepsis guideline writing committee, gives some insight into the new document, including a few interesting additions and some points of controversy. For more thoughts, especially from an EM perspective, Scott Weingart also interviewed Hallie over at EMcrit. Learn more at the Intensive Care Academy! Takeaway … Continue reading
Lightning rounds 63: How to be right, with Scott Weingart
Scott Weingart, ED intensivist and seminal educator from the EMCrit podcast, shares his thoughts on how we should be finding truth nowadays: how to read journals, choose experts, use AI, and resolve disagreement. Learn more at the Intensive Care Academy! Takeaway pearls
Episode 99: RV failure in the MICU
We chat about managing a complex MICU patient with RV failure in the setting of renal failure and sepsis, with Amos Dodi, nocturnal intensivist at Einstein/Montefiore and author of a recent narrative review on the RV. Learn more at the Intensive Care Academy! CHEST’s Procedural Skills for the Critical Care Clinician, April 23-24 2026 References … Continue reading "Episode 99: RV failure in the MIC
Lightning rounds 61: Credentialing and privileging, with Christopher Newman
We dive into the confusing rabbit hole of medical staffing, credentialing, and privileging, particularly for the critical care APP, with Chris Newman, pediatric critical care PA and Vice Chair for Clinical Performance at the University of Colorado. Check out the REVIVE conference here! Check out the CHEST Procedural Skills for the Critical Care Clinician course … Continue reading "Lightning rounds
Lightning rounds 60: The nuances of insulin, with Melissa Nestor
We chat with Melissa Nestor, clinical pharmacist in neurocritical care, about tho subtleties of glucose and insulin management in the ICU. Learn more at the Intensive Care Academy!
Episode 98: Running rapid responses
We discuss the practicalities of running a rapid response, including crowd management, coordinating with primary services, working outside the ICU, and rapidly obtaining and synthesizing diagnostic data. Learn more at the Intensive Care Academy!
Lightning rounds 59: The nuances of nebulizers, with Keith Lamb
We explore the practical intricacies of nebulized medications, including timing, dosing, types of devices, and more, with Keith Lamb (@kdlamb1), RRT, RRT-ACCS, FAARC, FCCM. Learn more at the Intensive Care Academy!
Episode 97: Managing ICP crisis
We explore the practical basics of managing an elevated ICP with impending herniation, including EVD troubleshooting, hyperosmolar therapies, and the role of craniectomy. Learn more at the Intensive Care Academy! References
Episode 96: Understanding ammonia, with Prem Kandiah
With Dr. Prem Kandiah, neurointensivist, transplant intensivist, and ammonia enthusiast, we explore the physiology of hyperammonemia, the nuances of its measurement and interpretation, and unpack some less-recognized causes, including infection by urease-producing organisms and malnutrition/gastric bypass. Learn more at the Intensive Care Academy! References and resources Acute Liver Failure Overa
Academy bites: Do you want to feel special?
Learn more at the Intensive Care Academy!
Lightning rounds 58: Steroids for septic shock with David Janz
We dive into the common dilemma of when to give stress-dose corticosteroids in septic shock, with Dr. David Janz, pulm/crit intensivist with a Masters of Science in Clinical Investigation, former director of the Clinical Research Unit for the critical care section at LSU, founding member of the Pragmatic Critical Care Research Group, and associate Chief … Continue reading "Lightning rounds 58: Ste
Lightning rounds 57: Burn critical care with Clint Leonard
We explore the fascinating intricacies and unique features of the burned critically ill patient, with Clint Leonard, NP in the burn ICU at Vanderbilt and ABLS instructor. Learn more at the Intensive Care Academy! Want to work at the University of Kentucky? UK’s Anesthesia Critical Care department is hosting a hiring webinar on November 20, … Continue reading "Lightning rounds 57: Burn critical car
Episode 95: Spontaneous breathing trials with Martin Tobin
We discuss the evidence and practicalities of spontaneous breathing trials and ventilator weaning with Martin Tobin, pulmonologist and intensivist, author of seven textbooks including “Principles and Practice of Mechanical Ventilation,” researcher, and pioneer of the entire concept of SBT as well as the RSBI (or “Tobin index”). Learn more at the Intensive Care Academy! References … Continue readin
Episode 94: Mastering seizure pharmacology with Tom Bleck
We explore the vagaries and nitty-gritty of drugs for seizure termination, including benzos and ASMs, with the great Tom Bleck, MD MCCM FNCS, neurointensivist, professor, and founding member of the Neurocritical Care Society. Check out the REVIVE conference here! Learn more at the Intensive Care Academy! More reading Takeaway lessons
Episode 93: Fluid in sepsis and the FloPatch, with Jon-Emile Kenny
We dive into fluid resuscitation in sepsis, with Dr. Jon-Emile Kenny, pulmonary and critical care physician, author of the physiology textbook Heart-lung.org, and inventor of the FloPatch device. Disclosures: Dr. Kenny appears here as both a clinician as well as a representative of his company and product, and should be presumed to retain a degree … Continue reading "Episode 93: Fluid in sepsis an
Episode 92: PRIS and propylene glycol toxicity, with Jerry Snow
We discuss propofol infusion syndrome (PRIS) and propylene glycol toxicity from lorazepam infusions, with medical toxicologist Dr. Jerry Snow, director of the toxicology fellowship at Banner University Medical Center in Phoenix. Learn more at the Intensive Care Academy! Takeaway lessons
Episode 91: A simulated goals of care conversation
Brandon and Bryan mock up a goals of care discussion for a critically ill patient, and reflect on the right and wrong ways to execute this complex procedure. Learn more at the Intensive Care Academy! Resources Center to Advance Palliative Care The Conversation Project
Episode 90: Sugammadex in the ICU, with Sara J Hyland
We chat about neuromuscular blockade, monitoring, and reversal in the ICU, including why sugammadex isn’t more widely used, with Sara J Hyland, PharmD, BCCCP, FCCP, researcher and clinical pharmacist in perioperative and emergency medicine. Learn more at the Intensive Care Academy! Takeaway lessons References
Lightning rounds 56: The CHEST Critical Care APP cert, with Leeah Sloan
We chat with Leeah Sloan, PA-C, co-chair of the Critical Care APP Steering Committee for the American College of CHEST Physicians (CHEST), about the newly available CHEST critical care certification for APPs. The Vandalia CAMC Charleston APP critical care fellowship Learn more at the Intensive Care Academy!
Special announcement: ICA 1-year anniversary
Learn more at the Intensive Care Academy!
Academy bites: Specialization is breadth, not depth
Learn more at the Intensive Care Academy!
Lightning rounds 55: APP fellowships with Melissa Bridges
Melissa Bridges, director of PA fellowships at Atrium Health and president of the Association of Post-graduate PA Programs (APPAP), chats with us (Bryan is president of APGAP, the Association of Post Graduate APRN programs) about PA/NP residencies/fellowships in critical care. Learn more at the Intensive Care Academy!
Lightning rounds 54: Medical musicians with Andrew Schulman
Andrew Schulman, medical musician, former ICU patient, and president of the Medical Musician Initiative, tells us how music can help the critically ill. Learn more at the Intensive Care Academy!
Lightning rounds 53: GI Q&A with Elliot Tapper
From constipation to hepatorenal syndrome. Fan favorite Elliot Tapper (@ebtapper, @ebtapper), gastroenterologist, transplant hepatologist, academic chief of hepatology, and director of the cirrhosis program at the University of Michigan, returns to answer a grab-bag of GI questions. Learn more at the Intensive Care Academy! Takeaway lessons
Special announcement: Academy CME accreditation
Visit the Intensive Care Academy
Lightning rounds 52: Echo tips with Michael Lanspa
We chat with Dr. Michael Lanspa, intensivist and director of the Intermountain Critical Care Echocardiography Core Lab, about common pitfalls among bedside POCUS users and tricks for doing it better. Learn more at the Intensive Care Academy! Find us on Patreon here! Takeaway lessons
Episode 89: Thrombectomy for stroke, with Justin Fraser
We explore the world of thrombectomy for acute ischemic stroke with Justin F. Fraser (@doctorjfred), MD, FAANS, FAHA, Professor and Vice-Chair of Neurological Surgery and Director of Cerebrovascular Surgery and Neuro-interventional Radiology at University of Kentucky, where he specializes in cerebrovascular, endovascular, skull base, and endoscopic transsphenoidal surgery. Learn more at the Intens
Episode 87: Maternal-fetal monitoring with Stephanie Martin
We learn about the basics of fetal monitoring in the critically ill pregnant woman and how to integrate them into our ICU workflows, with Stephanie Martin, MFM obstetrician and host of the Critical Care Obstetrics podcast and teacher at the Critical Care Obstretrics Academy. Learn more at the Intensive Care Academy! Find us on Patreon … Continue reading "Episode 87: Maternal-fetal monitoring with
Academy bites: The power of disagreeing
Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
Episode 86: EEGs in the ICU with Carolina Maciel
We discuss the basics of EEG in the ICU, including when to do it, selecting the appropriate study, and the basics of bedside interpretation, with Carolina B Maciel, MD, MSCR, FAAN, triple boarded in neurology, neurocritical care, and critical care EEG. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your … Continue reading "Episode 86: EEGs in the ICU with Carolina Maciel"
Lightning rounds 51: Hemodynamic interfaces with Philippe Rola
Philippe Rola, intensivist, master of the VEXUS scan, and founder of the Hospitalist and Resuscitationist conference, shares his recent model of four hemodynamic interfaces to describe the entire circulatory system. Register for the H&R conference (May 22-23 2025) here with the discount code provided in the show. (No, we’re not sponsored, just a cool event.) … Continue reading "Lightning rounds 51
Episode 88: ICU Liberation SCCM Congress 2025
A roundup from members of the SCCM’s ICU Liberation committee, recorded at SCCM Congress 2025. Included:
Lightning rounds 50: Mastering PA catheter placement with Matt Siuba
We learn the vanishing art of placing the PA (Swan-Ganz) catheter, with intensivist and friend of the podcast Matt Siuba (@msiuba). Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway points References Insertion video Wedge distance How measurement technique affects diagnosis Thermo in TR review POCUS for … Continue reading "Lightning rounds 50: Masteri
Lightning rounds 49: The Vortex approach with Nicholas Chrimes
We learn about the Vortex approach to airway management, as well as airway algorithms and mental models in general, with Vortex creator and anesthesiologist Dr. Nicholas Chrimes, anaesthetist and cofounder of the Safe Airway Society. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! References
Episode 85: Tracheostomy basics with Vinciya Pandian
We discuss the basics of evaluation for tracheostomy placement, periprocedural care, and post-procedure complications with Vinciya Pandian, PhD, ACNP, FCCM, tracheostomy nurse practitioner and researcher. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
Academy bites: You were here when we were not
Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
Episode 84: Acute liver failure with Sergio Navarrete
We discuss assessment, monitoring, medical stabilization, and when to consider transplant of the patient with acute liver failure. We are joined by Dr. Sergio Navarrete, anesthesiologist and intensivist with fellowship training in transplant anesthesia. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons References
Episode 83: Cardiac arrest with Scott Weingart
We talk about the nitty-gritty details of a well-run cardiac arrest, with Scott Weingart of Emcrit (@emcrit), ED intensivist. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons Resources
Lightning rounds 48: Complete airway closure with Thomas Piraino
We talk about the phenomenon of airway closure during mechanical ventilation, with Thomas Piraino, RRT, FCSRT, FAARC, adjunct lecturer for the Department of Anesthesia at McMaster University, editor of The Centre of Excellence in Mechanical Ventilation Blog, and a member of the editorial board of Respiratory Care. Learn more at the Intensive Care Academy! Find us on … Continue reading "Lightning r
Episode 82: When it goes wrong
Our approach to common problems and troubleshooting: Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
Lightning rounds 47: Post-op care transitions
We chat about the post-op transition of care from the OR to the ICU, including questions to ask, workflows, and pitfalls. Check out the Intensive Care Academy here! Bryan’s textbook: Concepts in Surgical Critical Care Find us on Patreon here! Buy your merch here!
Episode 81: Bacterial meningitis with Casey Albin
We talk about diagnosis, treatment, and subsequent care of the patient with bacterial meningitis, with Emory neurointensivist Casey Albin, MD (@caseyalbin). Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons Resources
Lightning rounds 46: Nick Ghionni on combating cognitive bias
We chat with Nick Ghionni, pulm/crit attending at MedStar Baltimore Hospital, about identifying and combating cognitive biases in our clinical decision-making. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!
Episode 80: Implementing the A-F bundle with Kali Dayton
We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC (@daytonicu), host of the Walking Home from the ICU podcast, and consultant to ICUs working on these issues. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here!
Lightning rounds 45: Noelia Bischoff on transitioning nursing roles
We chat with Noelia Bischoff, recently off orientation in the medical ICU at Johns Hopkins as a nurse practitioner, about the transition from her role as a bedside ICU nurse. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!
Episode 79: Transfusion reactions with Joe Chaffin
We discuss transfusion reactions, risks, and management, including infection, consent, TRALI, TACO, and hemolytic reactions—with Dr. Joe Chaffin (@bloodbankguy), the “Blood Bank Guy” and transfusion medicine specialist. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons
Lightning rounds 44: Post-intubation sedation roundup
Experts in critical care share their approach to post-intubation sedation. Contributors: Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!
Episode 78: Echoing the RV with Matt Siuba
We talk the nitty-gritty of assessing the right heart using echocardiography, with our friend Matt Siuba (@msiuba), intensivist at the Cleveland Clinic and master of zentensivism. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! Takeaway lessons
Lightning rounds 43: AI in medicine, with Nawar Shara
We explore the fascinating world of artificial intelligence and its role in medicine, with Nawar Shara (@NawarShara), PhD, Chief of Research Data Science at Medstar Health Research Institute and cofounding director of the AI Collab between Medstar and Georgetown. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here!
Special episode: The Intensive Care Academy
We share our grand new project, the Intensive Care Academy, an online, video-based, subscriber-only educational platform. Check it out at icu101.com!
Episode 77: Mastering APRV with Rory Spiegel
We discuss the practicalities of using airway pressure release ventilation (APRV) with Dr. Rory Spiegel (@EMnerd_), emergency physician and intensivist at MedStar Washington Hospital Center (and EMNerd at Emcrit). Find us on Patreon here! Buy your merch here! Takeaway lessons
Lightning rounds 42: Hospital chaplains, with Christine V. Davies
We learn about the training, role, and benefits of hospital chaplains, with Christine V. Davies, MDiv, MSW, Director of Chaplaincy at Robert Wood Johnson University Hospital. Find us on Patreon here! Buy your merch here!
Episode 76: Rehabilitation psychology, with Megan Hosey
We discuss the field of rehabilitation psychology, and how it can help patients with persistent critical illness, with Dr. Megan Hosey (@DrMeganHoseyPhD), clinical psychologist and assistant professor at Johns Hopkins School of Medicine, where she practices in the medical ICU. Find us on Patreon here! Buy your merch here! Takeaway lessons Resources
Lightning rounds 41: Respiratory therapy with Keith Lamb
We explore the profession of respiratory therapy in the US, including their role and training and how to optimize our clinical relationships, with Keith Lamb (@kdlamb1), RRT, RRT-ACCS, FAARC, FCCM. Keith is an RT at the University of Virginia in Charlottesville, working clinically in neuro/surgical/trauma critical care, who has been active in research and has … Continue reading "Lightning rounds 4
TIRBO 62: The sweet spot for learning
Responsible self-directed learning occurs in a zone between comfort and novelty. Find us on Patreon here! Buy your merch here!
Episode 75: Automatic tube compensation, with Ben Fabry
We discuss the principles and application of automatic tube compensation (ATC) on modern ventilators, with its creator Ben Fabry. Dr. Fabry is a professor and chair of biophysics at University of Erlangen-Nuremberg, originally trained as an electrical engineer, who originally developed ATC as part of his PhD program. Find us on Patreon here! Buy your … Continue reading "Episode 75: Automatic tube
TIRBO 61: How to use POCUS (our expert consensus)
Brandon summarizes his recent publication describing best practices for performing POCUS. Read the paper open access at POCUS Journal. Find us on Patreon here! Buy your merch here!
Episode 74: Obstructive shock, with Sarah Lorenzini (Nurses’ Podcrawl 2024)
Our collaboration with Sarah Lorenzini of the Rapid Response RN podcast, discussing a case and general principles for diagnosing and managing obstructive shock. Check out the other episodes on shock in the Nurses’ Podcrawl 2024! Find us on Patreon here! Buy your merch here!
Lightning rounds 40: Critical care medicine fellowships with Nicholas Ghionni
We chat about pulmonary/critical care medicine fellowship with recent graduate Nicholas Ghionni (@pulmtoilet), a first-year attending at the MedStar Baltimore Hospital system. He completed PCCM fellowship at MedStar Washington Hospital Center where he also served as chief fellow. Find us on Patreon here! Buy your merch here!
TIRBO 60: They don’t care about you
The difference between people and institutions. Find us on Patreon here! Buy your merch here!
Episode 73: POCUS for nephrology, with Abhilash Koratala
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! Takeaway lessons References Episode 4 with … Continue r
TIRBO 59: How we make the podcast
The nuts and bolts of how we produce the show. Find us on Patreon here! Buy your merch here!
Lightning rounds 39: Understanding flight medicine with Jace Mullen
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!
TIRBO 58: Difficult cases
When do patients deaths bother us?
Episode 72: CPR-induced consciousness with Jack Howard
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 guideline on CPRIC management. Takeaway lessons … C
TIRBO 57: Volume vs pressure control
Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here!
Lightning rounds 38: Working in APP leadership, with Jason Wieland
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!
TIRBO 56: Transfixing vessels
You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here!
Episode 71: Transplant medications with Olivia Philippart
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 lessons References From: Fishman … Continue reading
TIRBO 55: Bowel regimens
How I make patients poop. Find us on Patreon here! Buy your merch here!
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