The Critical Care Commute Podcast

• Cardiogenic Shock: The SCAI Classification with Dr. Emilie Belley-Côté.

  In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.Dr. Belley-Côté walks us through:The five SCAI stages (A through E): what they mean and how they’re used.How this classification system improves communication between specialties.The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.With Dr. Belley-Côté’s clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.

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• Psychedelics: Is it time to change your mind? With Dr James Downer.

  In this episode, we’re joined by Dr. James Downar, a leading Canadian voice in palliative and critical care, for a wide-ranging discussion on the emerging role of psychedelics in managing psychological and existential distress.Psychedelics have gone from fringe to forefront in recent years, and we dig into what that shift might mean for patients facing critical illness or the end of life.What psychedelics are and how they workSubstances like psilocybin, LSD, ketamine, and MDMAKey effects: altered perception, ego dissolution, and emotional insightRisks and benefits in vulnerable populationsPsychedelic-assisted therapy: structure and processThe three-phase model: preparation, the session itself, and integrationMicro dosing vs. full therapeutic sessionsWhere current evidence standsPotential applications in critical care and palliative medicineHelping patients process fear, isolation, and sufferingHow psychedelics differ from traditional symptom management tools like opioidsLimitations in advanced illness due to physiological concernsResearch and implementation challengesProblems with study design and placebo controlsThe importance of ‘set and setting’Defining success in existential or spiritual distressEthical considerations and clinical integrationBalancing innovation with compassion and cautionAvoiding reductionism: why psychedelics should complement—not replace—human careThe future role of these therapies in ICU and palliative settings

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• Ischemia Reperfusion Syndrome with Prof. Mervyn Singer

  Recorded live at the Canadian Critical Care Forum 2024 in Toronto, this episode dives into the complex world of ischemia-reperfusion syndrome — the paradox where restoring blood flow causes further injury. We explore the underlying mechanisms, clinical implications, and future directions in managing this phenomenon.Joining us for the third time is Prof. Mervyn Singer, ICU physician, researcher, and thought leader in critical care physiology. Known for challenging dogma and making complex science accessible, Prof. Singer unpacks this important topic with clarity and insight.

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• If It Goes by Air, Should a Doctor Not Be There? Pre-Hospital Care with Dr. Mike Christian

  Dr. Mike Christian is a critical care and pre-hospital medicine specialist with extensive experience in aeromedical transport and military medicine. His diverse career spans work as a paramedic, internal medicine and critical care training, and roles as a flight physician with London Air Ambulance and the Canadian military. He is a leading advocate for integrating interprofessional teams and advancing physician-led pre-hospital care in Canada. Currently, he is involved in the MedResponse BC initiative, which aims to enhance critical care delivery outside of hospitals.In this episode, Peter and Leon sit down with Mike to explore the evolving landscape of pre-hospital critical care. From his unconventional career path to the integration of AI in emergency response, he shares insights on improving outcomes in pre-hospital medicine and the lessons Canada can learn from global high-performance systems.Key Topics & ChaptersMike’s Career JourneyFrom paramedic to physician: an unconventional pathMilitary and aviation medicine experienceThe shift to leadership in pre-hospital carePre-Hospital Critical Care: Canada vs. The WorldHow Canada’s HEMS (Helicopter Emergency Medical Services) differs from global modelsLessons from the UK, Australia, and DenmarkThe role of AI in dispatch and triageThe Role of Physicians in Pre-Hospital MedicineThe evolving need for physician-led care outside the hospitalThe impact of interprofessional teams on survival ratesMentorship, coaching, and cultural change in pre-hospital systemsThe Role of the Physician in Pre Hospital Medicine. AI-powered dispatch and GoodSAM app in improving CPR and trauma responseScoop and run vs. stay and play: What actually saves lives?Addressing Canada’s geographical challenges with rural and remote careFuture Directions in Pre-Hospital MedicineThe rise of telemedicine and virtual ICUsDeveloping triage physicians and training programsMedResponse BC: A new model for interprofessional pre-hospital careKeywords:Pre-hospital care, critical care transport, HEMS, trauma response, paramedics, physician-led pre-hospital medicine, telemedicine, AI in emergency medicine, interprofessional teams, rural emergency care, GoodSAM app, London Air Ambulance, MedResponse BC.Links of Interest: CCCF Presentation:  https://youtu.be/MVDHaYaZRSI  (Web view)Recent Publication:  https://doi.org/10.1186/s13049  (Web view)

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• Gender-Based Harassment in the Medical Workplace: Insights from Dr. Elizabeth Viglianti

  In this episode, hosts Leon Byker and Peter Brindley are joined by Dr. Elizabeth Viglianti, an assistant professor at the University of Michigan, Pulmonologist and Critical Care Specialist, to discuss the crucial issue of gender based harassment in medicine. Gender-Based Harassment refers to any unwelcome behavior, comment, or conduct that demeans, intimidates, or disadvantages someone based on their gender or gender identity. This can include derogatory remarks, exclusion, stereotyping, unequal treatment, or threats, whether or not the behavior is sexual in nature. In the workplace, it undermines professional dignity and contributes to a hostile or inequitable environment.Dr. Viglianti shares her personal experience that led her to study this field, detailing the prevalence and impact of such harassment. The discussion covers key findings from the National Academies of Science, Engineering, and Medicine's framework on addressing sexual and gender based harassment, gender disparities, organizational factors contributing to harassment, and her research on the topic. Practical steps and recommendations for institutions to mitigate harassment are also explored.00:00 Introduction and Welcome01:08 Personal Experience with Sexual Harassment03:06 Understanding Gender Based Harassment in Medicine05:34 Organizational Factors and Solutions07:50 Gender Disparities in Academic Medicine17:42 Impact on Trainees and Reporting Challenges24:46 Addressing Patient-Perpetrated Harassment28:59 Practical Strategies and Training32:26 Conclusion and Call to Action

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