Intensive care medicine

Welcome back to Coriam.

I'm Brian Gabritti, and today we're diving into a high-stakes clinical scenario that sits right at that intersection of dermatology and critical care.

And we're talking about a condition that can look like a simple allergic reaction, but it quickly spirals into multi-organ failure.

And joining me today is Dr. Nir Lavi-Romer, and we're going to be talking about a case and how we should be approaching these types of patients.

cases? For DRESS specifically, it would be a mistake to anchor on anaphylaxis if you're not seeing an adequate response to epinephrine.

In addition, this is a problem that you want to have all hands on deck early.

So get your consultants, dermatology, nephrology, infectious disease, if you're concerned for viral reactivation, ophthalmology, if there's ocular involvement, and of course, critical care.

Get all these folks on board early.

Once you recognize it, you have to move fast.

Delays in initiating antiplasma cell therapy can rapidly narrow the therapeutic window, and that requires tight coordination between cardiology, hematology, and critical care from the moment of diagnosis.

Exactly.

Some diseases do not give you a second chance, and this case is a powerful reminder of that.

And I'm Brian Bowling.

And this is Critical Care Scenarios, the podcast where we use clinical cases, narrative storytelling, and expert guests to unpack how critical care is practiced in the real world.

All right, hello, everybody.

Welcome back to the podcast.

And then, you know, it's probably going to last for like a half hour.

I will credit, you know, Josh Farkas for having done a very nice literature search on this.

And he's got listed on the Internet book of critical care like.

more than a handful of small studies where people have actually looked at this in various patient conditions.

What happens when the nursing career you once loved no longer brings you joy? Is it time to walk away, or could there be another way to reignite your passion? Today I'm joined by Kristine Davidson, an integrative nurse coach, advanced holistic nurse, and founder of Soul Health.

Christine takes us on her journey from critical care to nursing education, integrative nursing, and entrepreneurship, reminding us that our nursing careers can evolve right alongside us.

We explore how she's bringing holistic healing modalities back to the bedside, making integrative wellness more accessible in her community and inspiring nurses to care for themselves as deeply as they care for others.

And through it all, Christine shares a beautiful reminder that we have the power to choose joy, find our purpose, and create a nursing career that truly lights us up.

And I do love the caring piece of it.

And I ended up going into, I was still, you know, I wanted to do OB or mother baby.

Um, and then I ended up being in a toss up between labor and delivery or critical care, but you know, you go through your rotations and critical care just grabbed me by the horns.

And in my mind, I was like, oh, I'll just start in critical care and then I'll go to labor and delivery later.

Why are colds and flu more common in the winter? What other respiratory infections should you be alert for this season?

Our guest is an expert in pulmonary and critical care medicine.

He will explain how to avoid coming down with influenza.

He'll also tell us why we should not reach for ibuprofen, naproxen, or acetaminophen at the first sign of fever.

To learn more about this, we're talking with Dr. Roger Schwelt.

He's Associate Clinical Professor at the University of California, Riverside School of Medicine and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University.

Dr. Schwelt is quadruple board certified in pulmonary diseases, internal medicine, critical care medicine, and sleep medicine through the American Board of Internal Medicine.

Welcome back to the Peebles Pharmacy, Dr. Roger Schwelt.

I'm here with Dr. Haney Malamud, an EM-IM care guru.

He's an associate professor at Cooper Medical School of Rowan University, founder of RecessX and Critical Care Now, and one of the best at making complex critical care concepts clear, practical, and fun.

Thanks so much for having me here, Lauren.

That's a really kind introduction.

adding up to it.

So I would just say you have to go back to the patient.

Again, the best advice I ever got with critical care and resuscitation is sometimes you need to stand there.

Don't just do something because there's always a tendency to do something.

The man of the cloth himself.

They got him in intensive care.

He's unresponsive.

Well, he's got a habit of miraculously bouncing back to health, Carrington said.

Can you believe it? They tore over to the hospital at well over the legal limit.

He's taken a lot more damage, Dr. Ringel said when he met the two detectives at the hospital intake desk.

um is he gonna die guthridge asked because we still have an open investigation we need him to give us some answers honestly i had my doubts at least initially replied dr ringel who is now walking them to the intensive care unit but we managed to get him stabilized you mean more inexplicable voodoo happened in his favor again carrington asked a little worried Nope, it wasn't voodoo that saved his life this time, Dr. Ringel replied.

He surely would have died this time, had it not been for half a dozen very determined medical staff.

That's why Cl- um, both Cleveland Clinic and, uh, UC San Francisco have such great data.

I moved to, um, the University of Chicago as Chair of Anesthesia, Critical Care, Pain Management, and Executive Health, an unusual combination, but that's 'cause I was trained in both anesthesia as well as internal medicine.

And in, uh, executive health, I had seven Nobel Prize winners as patients, one of whom was Gary Becker, who did net present value of investments.

That's what he won his Nobel Prize of.

He has expertise in pulmonary immunology, environmental toxicology, and lipid metabolism.

Dr. Kimberly Goudy is an associate professor at the Ohio State University in the Division of Pulmonary, Critical Care, and Sleep Medicine.

Dr. Goudy is an expert in innate immunity, lipid metabolism, and environmental lung diseases.

Welcome, Dr. Yeager, Dr. Goudy.