Lightning rounds #10: Physical examination in the ICU

Bryan and Brandon talk about the physical exam: how we apply it in the ICU, its utility and changing role in the setting of modern diagnostic modalities, and its best and most practical use-cases.


  1. McNamara LC, Kanjee Z. Counterpoint: Routine Daily Physical Exams Add Value for the Hospitalist and Patient. J Hosp Med. 2021 Aug 18. doi: 10.12788/jhm.3671. Epub ahead of print. PMID: 34424193.
  2. Rodman A, Warnock S. Point: Routine Daily Physical Exams in Hospitalized Patients Are a Waste of Time. J Hosp Med. 2021 Aug 18. doi: 10.12788/jhm.3670. Epub ahead of print. PMID: 34424194.

Lightning rounds #9: Notes and documentation

Bryan and Brandon chat about notes: what makes a good one, their many and conflicting purposes, some structures and approaches, system- versus problem-based charting, and more.

Lightning rounds #8: Five things you’re getting wrong

Bryan’s off this week, so Brandon flies solo to explain five wrong-headed notions that many people believe without thinking about them.

  1. Are diuretic infusions more effective than intermittent boluses?
  2. Are antipsychotic (neuroleptic) agents a good treatment for ICU delirium?
  3. Is pressure control or volume control a better form of assist control?
  4. Does renal failure cause chronically elevated troponin levels due to impaired troponin clearance?
  5. If a patient squeezes your hand, does that mean they heard and followed your command?

Lightning rounds #7: Operationalizing clinical skill

Discussing a pickle of a topic: outside of academic milestones, how do we recognize, acknowledge, reward, and move towards clinical excellence in medicine after one’s training is complete? In fact… do we?

Lightning rounds #6: Point of care ultrasound

We chat about focused, clinician-performed point-of-care ultrasound (POCUS) in the ICU. How do you learn it? What are our favorite applications? What are some of the particulars and caveats surrounding credentialing, documentation, and billing? All that and more…

Lightning rounds #5: Career development for critical care APPs

Conceiving, planning, and building your career as a critical care PA or NP. Determining if this field is for you, finding your first job, pinpointing your interests or “niche” during your early career, nurturing your growth during the mid-career period, and some thoughts on life and priorities in your late career.

Episode 34: Lightning rounds #4

Wrapping up our series on procedures with a talk about airway management. Who should manage airways in the ICU? What’s the role of intensivists, APPs, anesthesia, etc? What’s the “correct” balance of expertise, distribution of labor, and training? Our general approach to supraglottic airways, mask ventilation, intubation, cricothyrotomy, drugs, assessing airway anatomy, training, and more.

Episode 32: Lightning rounds #3

Following up from the last lightning rounds on vascular procedures, we look at non-vascular bedside procedures in the ICU: paracentesis, thoracentesis (including chest tubes), lumbar punctures, and bronchoscopy. How do we tap, what are our tricks, what’s the role of ultrasound, who needs a bronch, and more.

Episode 29: Lightning rounds #2

A vascular access roundtable, discussing our practices surrounding arterial lines, central lines, PICC lines and midlines, and PA catheters. When do we place them? When can they come out? What sites do we like? When (and how) do we use ultrasound? What’s up with the axillary site, why does Brandon hate PICCs, the age-old debate on ultrasound probe orientation… all this and more.

Episode 16: Lightning rounds #1

Quick takes on common controversies in the ICU, with Bryan and Brandon:

  1. Stress ulcer prophylaxis: drug selection, candidates, and when to discontinue
  2. Stress dose steroids: candidates, dosing, lab tests, and weaning
  3. Titrating PEEP: considering the disease process, PEEP/FiO2 tables, driving pressure trials, and pragmatic approaches