Pulmonology & Critical Care Episodes

In this special episode, Dr. Mitchell Charap, longtime IM residency program director and master clinician at NYU Langone, walks us through a mystery case that defies expectations. Together, he and host Emily Gutowski explore how illness scripts can both guide and sometimes mislead our diagnostic reasoning, and why the physical exam remains an indispensable tool.

Critical care attending Dr. Maria Sunseri and critical care pharmacist Dr. Brynna Crovetto join Emily Gutowski for a deep dive into sedation and analgesia in the ICU. They explain how to assess agitation, titrate sedation depth using the RASS scale, compare analgesia vs. anesthesia, and choose between agents like fentanyl, propofol, dexmedetomidine, and ketamine. They also share practical pearls for safe weaning from sedation and interdisciplinary extubation planning.

Dr. Vikramjit Mukherjee, critical care physician at NYU and Bellevue, joins Dr. Emily Gutowski for a review of septic shock management. They first review the diagnosis of SIRS vs. sepsis vs. severe sepsis vs. septic shock. Additional topics include identifying possible sources of infection, recognizing red flags, and initiating timely, adequate fluid resuscitation, including in special patient populations (e.g., CKD and CHF). Lastly, they briefly review the use of vasopressors in septic shock.

Dr. Allison Greco, pulmonary and critical care specialist at Bellevue Hospital, sits down with Dr. Emily Gutowski and discusses the initial presentation, workup, and management of a patient with a pulmonary embolism. They go through diagnostic modalities, scoring systems, and the various treatment options for patients depending on their risk profile. They discuss provoked vs. unprovoked PEs, and recommendations for longer term anticoagulation.

Dr. Alexis "AC" Gomez, a second year fellow at the combined MGH, Brigham and Women's, and Boston Children's nephrology program, discusses acid-base disorders with Dr. Joyce Zhou, a RTL host. She defines acid-base disorders, shares common etiologies, and offers a 5-step approach to characterizing these abnormalities.

Dr. Daniela Lamas, an Instructor in Medicine at Harvard Medical School and an attending physician in Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital chats with Blake Smith (host) about a career in Pulm/CCM. They talk together about the field of Pulm/CCM at large - from outpatient pulmonary clinic (COPD, asthma) to the ICU - in addition to sub-specializing in specific genetic diseases (CF), lung transplants, or interstitial lung diseases. They also talk about what it's been l...

Dr. Morgan Soffler, a Pulmonologist and ICU intensivist at Beth Israel Deaconess Medical Center (BIDMC), and an Assistant Professor at Harvard Medical School, continue a discussion of a patient with hypoxia in the setting of acute respiratory distress (from Ep. 73) with RTL host, Dr. Navin Kumar. Together, they talk through ARDS definition, etiology, pathophysiology, and ventilatory support.

Dr. Morgan Soffler, a Pulmonologist and ICU intensivist at Beth Israel Deaconess Medical Center (BIDMC), and an Assistant Professor at Harvard Medical School, discusses a case of a patient with hypoxia in the setting of acute respiratory distress with RTL host, Dr. Navin Kumar. Dr. Soffler begins with a broad differential and provides a framework of timing, tempo, and medical history, along with labs and imaging, to sift through the myriad causes of hypoxia. Together, they walk through different...

Dr. Brady, an ICU intensivist and the director of the critical care medicine clerkship at Beth Israel Deaconess Medical Center (BIDMC), discusses vasopressors and inotropes with RTL host, Dr. Navin Kumar. Together, they use the previous episode's (Ep. 71: Approach to Shock) case of an elderly patient with suspected distributive shock secondary to urosepsis as a framework to approach pressor requirements. Dr. Brady walks through establishing access, how to choose a pressor based on adrenergic phy...

Dr. Brady, an ICU intensivist and the director of critical care medicine at Beth Israel Deaconess Medical Center (BIDMC), explains how to categorize the four major types of shock with RTL host, Dr. Navin Kumar. Together, they discuss a case of an elderly patient with suspected urosepsis and walk through how to reconcile a patient’s history, physical exam, and lab findings along with the ongoing clinical picture. They touch on key decision points for patients in the ICU and end with some clinical...

Dr. Walker, a Pulmonologist and Critical Care specialist at Brigham and Women's Hospital, explains how she diagnoses and manages COPD. They help breakdown a number of topics, including PFTs, severity classification, principles of outpatient and inpatient management, and how to talk about prognosis with your patients.

Dr. Jefferson, an Assistant Professor of Pediatrics in the division of Allergy & Immunology and bioethicist at the University of Arkansas for Medical Sciences, discusses the care of both pediatric and adult patients with asthma with host Dr. Walker Redd. Together, they define asthma and cover its triggers, diagnosis, and stepwise therapy plans. They also discuss how upstream factors - from environmental exposures to housing issues - can both exacerbate and affect access to appropriate care for p...

In this episode, host Joyce Zhou speaks with Dr. Jeremy Richards, a pulmonologist and critical care physician at the Beth Israel Deaconness Medical Center (BIDMC) and a medical educator who teaches the introduction to cardiopulmonary physiology course at Harvard Medical School. He grounds his framework for this common presenting concern in physiology and uses a case to discuss his take on diagnostic approaches.

Dr. Mary Montgomery, an Infectious Diseases specialist at Brigham and Women's Hospital, teaches host Walker Redd how she diagnoses and manages pneumonia. They discuss IDSA guidelines, classification, diagnostic studies, empiric antibiotics, complications, pathophysiology, and more.

Dr. Ari Moskowitz, the Associate ICU Director in the division of pulmonary and critical care medicine at Beth Israel Deaconess Medical Center, talks with Dr. Navin Kumar about the management of patients with severe COVID-19. The two examine which patients require escalation to ICU-level care, in addition to the complications of severe COVID-19 and which organ systems can be affected. They discuss how to identify hypoxemic respiratory failure, the utility of the physical exam in the process, and ...

Dr. Ankit Patel takes us through his approach to working through acid-base disorders. The episode begins with a general framework and concludes with four case vignettes, each describing a different physiology: metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis.