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“The real process of education should be the process of learning to think through the application of real problems.”
On April 18 & 19, 2018, I had the pleasure of participating in the inaugural conference “The Hospitalist and the Resuscitationist” in Montreal. The entirety of this meeting was organized by Dr. Philippe Rola [@thinkingCC] who is an intensivist at Santa Cabrini Hospital, an affiliate of the Universite de Montreal. I spoke alongside and participated in case discussions with a group of inspiring and supremely intelligent physicians including Drs. Rory Spiegel [@EMNerd_], Josh Farkas [@pulmcrit], Kylie Baker [@kyliebaker888], Segun Olusanya [@iceman_ex], Lawrence Lynn [@PatientStormDoc], Andre Denault and many others.
While the lectures at the conference were meant to be rapid and high-yield, mine were slightly long and a touch dry. Fortunately, the speakers who flanked my talks lubricated the sessions like warm sips of herbal tea between bites of a desiccate madeleine. The following represent my crunchy contributions with suggestions for further reading. The talks are meant to be viewed in order; they all consider the same case from differing and evolving physiological perspectives.
Lecture 1 - My patient is blue; what do I do? A clinical-mechanical approach to hypoxemia & work of breathing
For further reading around this talk, please consider the following articles and posts: The Pathomechanics of Extubation Failure, A Great Lecture on Applied Respiratory Physiology and Weaning-Induced Cardiac Dysfunction
Lecture 2 - Back to the Acid-Basics: is ‘lactic acidosis’ a myth?
For further reading around this talk, please consider the following posts: The Great Lactate Debate Parts 1 & 2, Rising Lactate and the Art of Venous Blood Gas Interpretation.
Lecture 3 - When Should I Give Intravenous Fluids? Musings on volume status, volume responsiveness & volume tolerance
Notably, following a series of lectures on this topic, an audience member created a summary graphic shown as Figure 1 below.
For further reading around this lecture, please consider the following posts: Inspiratory Collapse of the IVC, That Fallible IVC, In Defense of the CVP, The Mean Systemic Filling Pressure Part 1, Venous Doppler and Volume Tolerance
Lecture 4 - Airway Pressure: at what are we driving?
For further reading around this lecture, please consider the following posts: Driving Pressure and Stress Index
Lecture 5 – Prone to Success: mechanisms of benefit in ARDS
For additional learning activities on much of the aforementioned topics, I have created a number of free and open-access learning modules found here. The foundation of these modules are firmly entrenched in social constructivism; they were formed as a part of my Master’s thesis in medical education at the Karolinska Institutet, in Stockholm.
Thanks for viewing,
Dr. Kenny is the cofounder and Chief Medical Officer of Flosonics Medical; he is also the creator and author of a free hemodynamic curriculum at heart-lung.org