Critical Care Time

Join us for this fun and exciting CCT episode where we are joined by the incredible Dr. Sara Crager for an all-expenses paid journey through the world of Ventricular Tachycardia! On this episode we explore the causes and pathophysiology of VT. Building upon that solid foundation, we also discuss different therapeutic approaches using a case-based format that's sure to leave a lasting impression. We hope you listen, learn and leave us a review! And if you feel so inclined, reach out on our socials and let us know what you think!

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Ask and you shall receive! This week Nick & Cyrus bring back Zorses & Hebras from Season 1 - this time focusing on allergy and allergy-related concepts. Give it a listen and let us know what you think! Huge thanks to Integration Health for sponsoring this episode!

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This week on Critical Care Time we take a slight departure from our usual content and turn an eye towards sustainability in the ICU. What low-hanging fruit exists in your ICU in the fight against medical waste? Why reach for a nebulizer when HFAs are so much more convenient? We had a great chat with Dr. Stephanie Maximos and Dr. Hari Shankar where we unpack this emerging concept and discuss options to take great care of your patients AND be mindful of waste and excess in your ICU! Listen, learn and let us know what you think!!

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On this week’s episode, Cyrus and Nick host a spirited discussion with Drs. Rory Spiegel and Max Hockstein where we debate the merits of Airway Pressure Release Ventilation (APRV). What's the rationale for this? When is it appropriate? IS it appropriate… or is it witchcraft? Is it physiologically foolish or a perfectly logical option for hypoxemic respiratory failure? Good for all comer, good for a subset or does it belong with the vials of succinylcholine and DL blades? We may not have all the answers but on this episode we do our best to explore this ventilator mode and help...

In this episode of Critical Care Time, we tackle one of the most complex and high-stakes corners of critical care: the lung transplant patient in the ICU. From evaluating candidates at the edge of respiratory failure to managing the crashing post-transplant patient, we break down the practical bedside decisions that matter most — including bridge strategies, hemodynamics, immunosuppression, infection, rejection, and the complications that can rapidly spiral if you miss them. Whether you work in a transplant center or occasionally inherit these patients in a general ICU, this episode is built to give you a sharper framework, clearer priorities, and mor...

On this week's episode of Critical Care Time, Cyrus & Nick go all-in on DKA and spend a little time talking about alcoholic and starvation ketosis too! In this jam-packed, clinically robust episode, the guys discuss the importance and pathophysiology of DKA before discussing all things treatment. After listening to this - and perusing the show notes - you'll be a DKA master! Check it out and let us know what you think. Special thanks to Integration Health and The Difficult Airway Course: Critical Care for supporting the production of this episode!

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On this week, Cyrus & Nick are joined again by intensivist extraordinaire, Dr. Adam Mora, for a long overdue episode on ICU Toxicology! Together, the three of us embark on a case-based journey covering some of the more common ICU toxidromes as well as some of the more unusual, but can't-miss diagnoses. This is a bit of a longer one but it's super high-yield and very practical for anyone who is studying for their boards and/or participating in the care of the critically ill! Thanks to our tag-team of sponsors for this episode: The Difficult Airway Course: Critical Care...

We've been teasing this one for a while and now it's finally ready! This week we've released our first LIVE podcast from Chest 2025 where we cover cases in cardiogenic shock with our amazing panel of incredible clinicians. Nick & Cyrus moderate a discussion using a choose-your-own-adventure format, leveraging the expertise of our panelists in an hour long, fun-filled and practical discussion where we put some of our earlier CCT content to practice in some real world cases. Check out the YouTube channel or the website if you want to follow along with the slides. Please let us know how you like...

Buckle up because on this week's episode of Critical Care Time we are treated to a master class on Right Heart Failure with world-class educator Dr. Matt Siuba. We are taking a deep dive on diagnosis, management and of course, sharing our love for the PAC! Make sure you clear your schedule and take notes for this one because as far as we are concerned, this is required listening for anyone who cares for the critically ill!

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Folks this right here is a JAM PACKED episode of CCT goodness for you guys to enjoy! In this show for the ages we take a deep dive into the world of Mechanical Circulatory Support (MCS) and Cardiopulmonary Critical Care with one of the best in the biz, Dr. Bindu Akkanti!

We will go through several fictional patients illustrating use cases, pitfalls and pearls of tools such as the balloon pump, ECMO and the microaxial flow devices used in ICUs all over the globe to help care for the sickest of the sick. If these tools...

On this week’s BONUS episode of Critical Care Time, Cyrus & Nick flip the coin on sleep and discuss the importance of sleep for those of us that have to work nights. We also discuss how to find ways to still get rest even when your whole world is flipped upside down! Be prepared to keep taking excellent care of your patients using some of the tricks we review here. Give it a listen - or a watch and let us know what you think!

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On this episode of Critical Care Time we delve into the fascinating world of sleep with a focus on the importance of sleep in our ICU patients and how we can promote good quality sleep in the sickest patients in the hospital. Try not to sleep through this one as we provide some valuable insights and high quality pearls to get you geared up and ready to be a champion for sleep in your ICU! As always, listen and let us know what you think. Special thanks to The Difficult Airway Course: Critical Care, for sponsoring this episode!

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On this episode of Critical Care Time, we tackle the enigma - shrouded in mystery and caped in uncertainty - know as rheumatologic emergencies in the critically ill patient! We sit down with Dr. Marcela Ferrada - a QUADRUPLE boarded intensivist/rheumatologist/ID specialist and internist - who guides us through her approach to rheumatologic emergencies in the sickest of the sick. As we often do, we approach this via a pragmatic, cased-based journey for your listening pleasure. Please check it out, learn all you can, and as always - let us know your thoughts and leave a review!

This Critical Care Time bonus is our ode to RSI... that is the RSI Trial! In this episode, we'll unpack all the important elements of the recently released RSI Trial by the Pragmatic Critical Care Research Group exploring whether there is a signal favoring etomidate vs ketamine for tracheal intubation of critically ill adults. Does one drug reign supreme? Is this practice changing, practice affirming or perhaps the devil's in the details? Listen, learn and let us know YOUR thoughts!

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This week we drop a journal club extravaganza! Should we do away with the A-Line? Is Bicarb a sure-fire way to treat metabolic acidosis in the setting of AKI? What about selective decontamination and all that capillary refill business!? We tackle all these topics through thoughtful journal discussion, provide our $0.02 and a little witty repartee, of course! Check it out and let us know what you think!

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The importance of leadership in the hospital setting is critically important yet often overlooked. It’s even more important to have sound leaders and adhere to well-founded leadership practices when taking care of the critically ill. Join us as we sit down with Dr. Josh Hartzell - internist, infectious disease physician, author, veteran and physician-leader - as we discuss Leading in the ICU and Beyond!As always, please leave us feedback and let us know what you think! 

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For those who work in an ICU - or with any patients for that matter -the concepts of burnout and moral injury are no stranger. In order to mitigate the effects of these forces, it’s important to understand them. Join Nick and Cyrus, as they sit down with an incredible guest, Dr. Venktesh Ramnath, with the hopes of doing just that. On this episode we step away from the pressors and central lines and focus on the contributors to burn out and moral injury in the medical field while developing some strategies to combat them. Listen, watch, learn and let...

Join Cyrus & Nick as the FINALLY tackle mechanical ventilation. In this episode - first of many we suspect - we lay the foundations for mechanical ventilation. If you stick with us through this one you'll come away with a great introduction to vents to include why we use them, what we adjust, and about a number of the primary vent modes you'll likely seen in your ICU. We've got something for everyone with this episode so please give it a listen and let us know what you think!

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Join Nick and Cyrus as they teach a master class on hypoxemia for everyone and anyone who is ICU adjacent! We discuss why oxygen is so crucial, share some very interesting animal physiology and - perhaps most importantly- discuss the 6 causes of hypoxemia you MUST know… and what you can do about them! Take a listen, let us know what you think, and leave us a review!

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This week on Critical Care Time, Nick & Cyrus discuss the recent article in the Journal of Critical Care titled “Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications.” Is this bunk or is this practice changing? Did they select the right population for this study or is the question they asked and answered... maybe not such a great question? We'll cover all this and more during this week's episode! Please take a listen, react, reach out & as always - don't forget to leave a review!

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Join us this week on Critical Care Time as we take on Airway Controversies with Dr. Jarrod Mosier - course director for The Difficult Airway Course: Critical Care! We talk induction agents, pre-oxygenation and cover so much more in this episode!

If you love this - consider attending the upcoming Difficult Airway Course at the Manchester Grand Hyatt in sunny San Diego, California from November 14th to the 16th and use our Discount Code CCTIME25 at checkout and save $250!

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On this mini-sode, Cyrus & Nick are once again joined by Dr. Prager as they follow up on last week's episode with some cases & practical pearls to really hammer home some of the points previously discussed. Here we look at practical uses for the volume assessment tools discussed in our prior show, along with some commentary on when such assessments may or may not be warranted. This is a great, practical, rubber-meets-the-road episode for folks looking for a quick review/refresher. Listen and let us know what you think!

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What is the microcirculation? How are terms like volume-status and fluid-responsiveness misleading? Join us as we sit down with Dr. Ross Prager to unpack and de-mystify the concepts of congestion and volume tolerance along with our survey of the tools of the trade as it relates to these terms. On this Critical Care Time episode we really get into the weeds on this stuff and even get theoretical at some points so it's NOT for the faint of heart! However, if you listen to us for the deep dives into physiology and if you want to level-up your ICU patient...

This week, Nick & Cyrus try something a little different with Tales from the ICU. Here, we explore clinical reasoning in the ICU in the context of a mystery case! Don't worry, we'll reveal the diagnosis and go through all the pitfalls, pearls and pathophysiology! This way, you get to play along for a while AND learn some cool medicine. As this is a new episode format, PLEASE leave us feedback and let us know if you like it or if we should send this one to the crypt!

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On this week's episode of Critical Care Time, Dr. David Dulaney rounds out GI bleeds in the ICU by taking on cirrhosis & variceal bleeds! During this show we discuss the unique challenge associated with managing a patient with cirrhosis - specifically focusing on the coagulopathy of advanced liver disease. We then delve into the nuances associated with managing a variceal bleed, both in terms of the unique critical care elements but also the challenges faced by the endoscopist when trying to saves these patients in extremis. Tune in, leave us a review and most importantly - leave us some feedback!<...

Join us on this week's episode of Critical Care Time as we embrace blood-and-guts with Dr. David T. Dulaney, gastroenterologist-extraordinaire! Nick & Cyrus host David for a pearl-laden discussion on non-variceal GI bleeds where we talk guidelines, expert opinion and so much more. Who needs a scope? When do you scope them? Why is stabilizing your patient SO important before GI comes in to save the day? How can we work together effectively with our colleagues in GI to ensure the best outcomes for our patient? We tackle a ton of content on this episode so you'll definitely want to tune...

On this episode of Critical Care Time, Nick & Cyrus embark on a deep dive into the world of lactic acidosis! As it is the beginning of the academic year, we figured this would be a great topic to demystify and disambiguate for our listeners. We discuss why lactic acidosis matters, and deconstruct all the clinically relevant elements from diagnosis to management, so that you are fully equipped with the tools necessary to conquer your next case of lactic acidosis - or maybe your first!! Ring in this new season of CCT with a banger of an episode and let us k...

This week on Critical Care Time, we’re turning the mic over to you, our brilliant listeners!  In this special Q&A episode, Nick and Cyrus read your comments, tackle your toughest clinical questions, and share how your insights have sent them diving back into PubMed, Reddit, and beyond. Whether you’re commuting, charting, or on break in the ICU, this episode is packed with practical pearls, literature deep-dives, and the human stories that make critical care so rewarding. Thank you for helping us learn and grow—let’s jump right in!

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On this week's episode of Critical Care Time, Cyrus & Nick take a deep dive into the wide world of sepsis! This one has been a long time in the making so buckle up for a journey through the history of sepsis and critical care, culminating in a review of our approach to diagnosis and management in 2025 complete with some hot topics and controversies. Please give us a listen or a watch, leave us some feedback and share our show with your friends and colleagues!

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We see fever every day in the ICU but what’s the best approach to diagnosis and when do we need to go on a Zebra hunt? In this episode, we’re joined by Dr. Luis Tatem, a physician triple-boarded in Internal Medicine, Infectious Diseases, and Critical Care — plus certified in Tropical Medicine from the London School of Hygiene & Tropical Medicine. We explore the diagnostic and therapeutic approach to fever in the ICU, including practical pearls for evaluating fevers in patients returning from global travel. We then walk through high-yield case vignettes that illustrate diseases like malaria, dengue, typhoid, leptospirosis, and mor...

On this week's episode of Critical Care Time, we revisit ARDS... sort of! We are joined again by Dr. Whittney Warren & for the first time by Denitza Blagev for a dynamic discussion on ARDS imitators: Things that looks like ARDS but aren't technically ARDS - or are they? It's a bit of a confusing landscape as you'll see, where the lines are blurred and things get a bit murky. We'll unpack diagnoses like EVALI, DAH, AIP and more in the context of ARDS and help you guys come up with a framework for the "ARDS" patient who doesn't seem to res...

In this episode of Critical Care Time, Dr. Joshua Boster joins Cyrus and Nick to explore how interventional pulmonary (IP) skills can be life-saving in the ICU. From managing malignant central airway obstruction with rigid bronchoscopy to navigating pleural disease, persistent air leaks, and even life-threatening hemoptysis, Dr. Boster shares practical insights from the front lines. Listeners will learn how IP tools can transform critical care decision-making and offer meaningful interventions when time and options are limited. Whether you're an intensivist, a trainee, or just IP-curious, this episode highlights procedures that not only restore patency—but restore hope. Give it a l...

On this week's episode of Critical Care Time, Nick & Cyrus tackle extubation. Join them for a pragmatic, soup-to-nuts approach on liberation from mechanical ventilation. You'll learn about the pre-extubation assessment, pitfalls and pears of the RSBI, who benefits from extubation to positive-pressure support and so much more! Give us a listen and let us know what you think! Be sure to head over to www.criticalcaretime.com for show notes on this episode and many of our other recordings!

We are also happy to introduce our new, limited sponsorship with Airway Management Education Center: The Difficult Air...

It’s well known that many of the problems we encounter on a daily basis in medicine are related to ineffective communication. When caring for the critically ill, it’s vital that such lapses in communication are minimized. Join us along with Genae Christensen- a current MS-2, active critical care flight nurse and prior ECMO program coordinator as we delve into some important communication pitfalls and pearls. We will cover topics such as the authority gradient and how to navigate that, where misunderstandings may stem from, and how using structured communication systems may help you stay out of trouble. Give us a...

On Critical Care Time we are no strangers to topics that make us uncomfortable. There may be no topic in the world of critical care more stress provoking than OB emergencies! Now… We didn’t say we are tackling this alone! Join us as we explore the wide world obstetrics in the ICU with Drs. Stephanie Levine and Adam Mora! Together we review the physiologic changes in pregnancy, unique considerations when it comes to general ICU management of the OB patient and then we delve into some OB cases where we tackle things like postpartum hemorrhage, cardiac arrest and more! Give us a...

The critical care landscape is a dynamic one, filled with team members with all sorts of backgrounds who have various skill sets and experiences to bring to the table. In this episode of Critical Care Time we focus on the role NPs & PAs - sometimes referred to collectively as APPs - play in the ICU. To help us explore this we sat down with Gary Macy of Duke University a Critical Care NP in their Neuroscience ICU who has many years of experience working as an ICU NP. During our discussion we explored numerous topics such as the concerns r...

The idea that movement is medicine doesn’t stop with the critically ill. On this week’s episode of Critical Care Time we sit down with Kali Dayton, a critical care NP with a passion for ICU mobility. We talk all things mobility in the critically ill: The roles of bedside nurses and clinicians, how we can implement best mobility practices with our patients, the financial and patient-care benefits of fostering a culture of movement in your ICU and what it means to be an “ICU Revolutionist” - along with so much more! If you truly care for the critically ill you cannot...

On this week’s episode of Critical Care Time, we sit down with two brilliant early-career ECMOlogists for an “intro-plus” to VV and VA ECMO. Not only do we cover the basics, but we couldn’t help ourselves and went on some deep dives along the way that you guys will hopefully find interesting! With the help of our good friends Nick Villalobos and Kha Dinh, we review indications for ECMO, approaches to configuration and management, touch on some of the complications and… even spend some time demystifying the European unit for girth! We hope you guys will have as much fun li...

If you thought ARDS was a long episode... get ready for a marathon! This week on Critical Care Time, Cyrus and Nick take on the unenviable task of trying to cover everything you need to know about cardiogenic shock - at least in broad strokes - in ONE episode! That's right, this is your one-stop-shop for all things cardiogenic shock. While we will have some deep dives on RV and LV failure, as well as ECMO and other mechanical circulatory support options - this episode has a little bit of it all to wet your whistle and then some! We...

In anticipation of some exciting new content where we take deep dives into shock physiology and treatment modalities, we wanted to wet appetites, prime engines and get any of our new listeners up to speed by rebooting some of our heavy hitters from Season 1.

We've already discussed how to identify shock, or how to assess a patient whom you are worried may be in shock... but what's next? Listen as Nick & Cyrus discuss the Pump, Pipe & Tank framework for determining the type of shock your patient is suffering from. In this episode we discuss the pathophysiology...