Apr 232018
 

'Starling Curve' courtesy of @kyliebaker888

Jon-Emile S. Kenny MD [@heart_lung]

The real process of education should be the process of learning to think through the application of real problems.”

-John Dewey

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.

Figure 1: courtesy of @LouisMullie

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 5Prone to Success: mechanisms of benefit in ARDS

For additional reading here, consider the following: ARDS Parts 1 – 3, The Hemodynamics of Prone, Visualizing Heart-Lung Interactions

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,

JE

Dr. Kenny is the cofounder and Chief Medical Officer of Flosonics Medical; he also the creator and author of a free hemodynamic curriculum at heart-lung.org

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Lectures from the Inaugural ‘Hospitalist and the Resuscitationist’ Conference in Montreal, Canada