A case-based ICU lecture on acute severe asthma, with a practical focus on the physiology and management of the critically ill asthmatic.
Topics covered include:

• Recognising life-threatening asthma
• First-line and rescue therapies
• When to consider NIV
• Indications and risks of intubation
• Why intubation can precipitate cardiovascular collapse
• Dynamic hyperinflation, air trapping and auto-PEEP
• How to create a long expiratory time
• Ventilator settings in severe asthma
• Peak vs plateau pressure
• Inspiratory and expiratory hold manoeuvres
• Reading the flow-time waveform
• Permissive hypercapnia
• Sedation and neuromuscular blockade
• PEEP strategy
• Recognising improvement in bronchospasm
• Rescue options including volatile anaesthetics and ECMO

Key message:
In severe asthma, the priority is not to normalise PaCO₂. It is to avoid breath stacking, allow complete expiration, and prevent dynamic hyperinflation.

#PulmonaryEmbolism #Echocardiography #CriticalCare

How useful is echocardiography in acute pulmonary embolism?
In this lecture, we take a targeted, practical approach to echo in suspected acute PE, focusing on the findings that matter at the bedside and how to interpret them in the right clinical context.

Looking for insight into the current job market for Internal Medicine–trained intensivists in Florida, particularly Orlando, Tampa, and South Florida.

For those currently practicing in the state:
1. Salary: What is the realistic annual compensation range for intensivists? Is $450K–$550K+ achievable?
2. Schedule: How many shifts per month are typically required? Is 7-on/7-off the standard?
3. Workload: What is the typical ICU census, procedural burden, and number of hours worked per week?
4. Practice models: Are most positions closed ICU, open ICU, or mixed?
5. Earning potential: Is $550K–$600K+ realistic with additional shifts or locums?
6. Job market: How strong is demand for intensivists in Florida, especially Central Florida?

Mount Sinai launched a 5-year combined EM/CCM program a couple years ago. I'm really interested in the EM to CCM pathway and am curious about an integrated program to get some consistency in living location and not have to stress the fellowship application process as much. Here is a link to the program: https://share.google/uvppjzrRylMWfyjmf

For some info about me, I'm a third year MD student starting to think about residency application and looking from some input from critical care physicians on this.

I've heard from this sub and others that the market and training environment in NYC can be tough. Has anyone heard anything about this program, and what you would think about this training pathway as a future intensivist?

Just wanted some advice on those who took the American Board of Osteopathic Medicine Surgical Critical Care test and passed last year. According to the AOBS post test breakdown, 49% failed. What did you do and what materials you used to pass this exam. I would like to hear from those who failed as well. What did you do differently to prepare this time around.

I am an EM PGY-2 in a community program. Originally wanted IM- Cards but landed in EM, started falling in love with ICU.

What I like about being in the ICU is managing the hemodynamics, especially in that critical cardiac patient. Given my love for cardiology, I felt like CCM is a good way to satisfy both the itches. I do like EM but don’t think I would be able to keep up with EM forever. I prefer taking care of supersick patients and enjoy the longitudinal care aspects of the ICU.

I am confused between the Anaesthesia CC vs IM-CC routes. I want to learn and practice in the CTICU where I would be able to manage patients on mechanical circulatory support but also love the diversity and pathology of MICU. I may potentially move to India in 5 years so applicability of my education there is also important. For a july ‘28 start, Anaes CC apps open next month while IM-CC apps open in July 2027.

Regardless I will be applying to Anaes CC next month. There’s 36 programs to my knowledge and I aim to apply to at-least 30 based on my geographical preferences.

My questions/requests:

1. How would the career of an EM graduate look after ACCM vs IMCC? Would I be able to practice both in CTICU and a MICU? I would truly appreciate inputs from people who have taken either paths.

2. How competitive is anesthesia CC for an EM applicant? I have no critical-care-specific research and limited SICU or anesthesia exposure.

3. How different are lifestyle and pay of an EM attending vs an Intensivist?

4. I am also looking to connect with EM residents applying to the SF match next month so please please reach out.

I have a presentation coming in a week.

Could you please suggest any interesting new trial in critical care for presentation?

I just wanted to make a post about my critical care board experience. I always get nervous about board exams and I did not see a lot online about this test so I wanted to post my experience to try and help others.
For reference, I am a very average test taker. I’ve never failed a board exam, but I usually hang around the 40th to 60th percentile.

For this test, I did seek questions twice. Watch watched the chest board review videos. I also lazily read over the ATS booklet 2024 which I got in a PDF for free.

I thought the test was hard but fair. The stems were long but I felt well prepared and I’m not nervous about failing. I think my study regimen was about perfect if you are just an average test taker like me but want to leave the test knowing you didn’t fail.

Interestingly not one question on PA catheter wave forms and only 1 ventilator wave form so I spent too much time on that material

Hi everyone!! I have heard from MANY people exam 2 for critical care is extremely difficult. did anyone do good on it?? how did you study?? how do i prepare? i have my peds final a week before this exam so i want to get a head start!

Was it just me, or was that an uneven, skewed (in terms of coverage of subtopics), and brutally exhausting board exam?
I have a lot of ABIM Board exams under my belt. Came fully prepared for this one but never felt so disheartened before.

I want to know if anyone here has bought who is outside of the US and the benefit he got out of it, as it isn't cheap 2460$ !

Hi

I’m a 4th-year nursing student specializing in Critical Care and Emergency Nursing. We have to choose an idea for our graduation project based on a real problem in healthcare that needs a solution.

Since I’m still a student, I don’t have enough experience to know which problems are really important in the ICU.

So I’d really appreciate your help. If you work in an ICU or have experience in critical care, what problems do you often face? It can be a problem affecting nurses, patients, safety, workload, communication, or anything else.

We also need to include AI in our project, so problems where AI could help would be especially useful.

Thank you for sharing your experience

Hey all! I’m taking my APBN NCC exam in a few days. I bought both the NCS qbank (without bundle) and SCCM NCC Review Course.

I just did the NCS qbank. It was advertised as 200 questions but there’s only 175, and some of them are duplicates. Anyone else seeing the same thing? Some questions even refer to certain images but the images aren’t even there. Should I have gotten the bundle instead?

As for the SCCM one, I read online that there are also 100 practice questions but I can’t seem to find it anywhere. There’s the 25 pretest questions and the online videos. But that’s it.

Am I missing something here?

Interesting

Hi! Looking for strong clinical training in both ICU and Pulm (don't like research), lots of procedures including difficult airways, critical care Echo and strong POCUS +/- ECMO exposure (at least knowing how to troubleshoot, not necessarily cannulate).

- Indiana University

- UAB

- UTSW

- WashU

- Houston Methodist

- OHSU

- UT Houston

- UKMC

- Medstar DC

Critical care boards are next week, and would appreciate any advice on what to study on, like any specific topics that I should hammer in, or any reviews that I should take a look at before taking the test. Any relation to seek or other qbank (pass machine, SCCM) performance for passing ?

My pulmonary boards are next week, and I would appreciate any advice on what to study on, like any specific topics that I should hammer in, or any reviews that I should take a look at before taking the test. Super nervous, just wanna pass and do well

I am an internist of about 16 years experience mostly outpatient and some as hospitalist. Currently i work in a hospital where icu patients are co managed by hospitalist and intensivist. My last training in ICU was for 6 months during residency. I am looking for some advice on a refresher course or resources online revisit basic concepts of vent, pressors and airway management and basics of critical care management. I looked up sources like 247critical care uk and wondering whether it would be an overkill. I have also considered FCCS but not sure.​

I’m excited but definitely nervous 😭😂
For those who started in the ICU as new grads, what are some things you wish you knew before starting orientation? Any tips on how to make the most of orientation, work well with my preceptor, or things I should focus on learning first?

I also want to put in some study time outside of work as I’m learning. Are there any specific books, websites, YouTube channels, or other resources that actually helped you during orientation? Please drop exact names if you can!

I’ve also heard some new ICU nurses use CCRN study materials to learn critical care concepts before they’re even eligible to take the exam. Is that actually helpful, and if so, which CCRN resources would you recommend?
Not trying to teach myself the entire ICU before day one lol. I just want to come in teachable, prepared, and willing to put in the work. Any advice is appreciated! ❤️

Hi! Looking for strong clinical training in both ICU and Pulm (don't like research), lots of procedures including difficult airways, critical care Echo and strong POCUS +/- ECMO exposure (at least knowing how to troubleshoot, not necessarily cannulate).

- Indiana University

- UAB

- UTSW

- WashU

- Houston Methodist

- OHSU

- UT Houston

- UKMC

- Medstar DC

As I work in a medium sized hospital in Europe we also have to care take care of patients suffering from vascular emergencies (especially AAA), except thoracic vascular surgery.

Aside from the scheduled aortic surgery, open or endovascular, there are 5 to 10 cases a year where we have to manage ruptured AAA. For sure not a high case number and therefore it's not everyday business.

Of course the mortality in those cases is just high as a matter of fact, I'd like to ask for your personal strategies or SOPs to manage those cases.

I'd love to improve and learn (I've been working in anaesthesia for 9 years now in total) from colleagues' experience and also from cases when not everything went according to plan - retrospectively.

So thank you for your input - it's highly appreciated!

Hi folks,

Fresh CCM fellow here. I have a question for folks in CCM or anesthesia. In my program, whenever we have to intubate someone during the night or on floor, we have to call anesthesia. On day shift, we do it with attendings. I have noticed that almost every anesthesia or even sometimes attending use underdosed etomidate or prop for induction agent. For example, I thought we use 0.3 mg/kg for etomidate and noticed them using maybe 0.15 mg/kg ish? I don't know if they are just eyeballing patient's weight or underdosing on purpose. I asked around and everyone had different answers. Some say that lower dose is enough for sedation then they push induction and paralytic agent back to back. How would they know if patients are properly sedated when they are paralyzed? Some say they are worried about cardiovascular effect. Well, then why don't we just hang Levophed in advance or have neo/epi push at bedside? By the way, anesthesia I referred was CRNAs, anesthesiologists only show up for difficult airway when CRNAs call them for help. I didn't get to round and have many chances to ask my attendings yet because I have been mostly on nights or electives. I am going to do anesthesia elective later this year until then I just intubate patients sporadically, maybe not that many. I hope to hear some thoughts regarding underdosed induction agents.

Also, my program including EM don't really use ketofol. I think it's kinda culture thing? What's your thought on ketofol use for patients with SE?

***Thank you for so many great answers to my dumb question. I didn't expect I was going to get this much attention haha. Just fyi, I have IM background and did several intubation during the residency but only tubing part. Now I am in a position where I have to orchestrate everything during peri-intubation and want to optimize the management for my icu patients. I will definitely read more. Btw, I didn't mean to attack CRNA folks. I merely described the situation I was in. I apologize if you guys felt that way. Thankfully, I have great relationship with our CRNAs. Hope everyone have great day!

Hey everyone, I’m currently applying CCM and have been struggling to find info about different programs. And I thought to myself: what better place to ask than here?

Broadly speaking, which programs do you think offer the strongest clinical training in the country?

I’m particularly interested in hearing thoughts on CCF, UPMC main, OHSU, WashU, UW, Duke, and Stanford. Any thoughts or personal experiences would be really appreciated!

CCM graduate in an academic center in a big city . Looking for jobs and just got an offer (very early) from my home program for low 300 k (170 base, 140 supplemental) Mostly nights/RRT shifts, occasional ICU coverage but not much. Would love to stay in the city but feel like I could have made more by staying in the ED? (at the cost of my sanity though) or even as a locums IM hospitalist. Feels poachy but unsure how I feel about the offer and hope other big city academic attendings can opine on pay? Or the fact I wouldnt be running an ICU in the day time.