66. Rheumatology Emergencies with Dr. Marcela Ferrada

This podcast addresses rheumatologic emergencies in the ICU, emphasizing the need for intensivists to recognize and appropriately manage these complex conditions to save lives. Dr. Marcy Farada, a quadruple-board certified physician, shares her expertise and personal experiences with relapsing polychondritis, highlighting the importance of considering rheumatologic diseases in cases of acute renal failure, unusual manifestations in young patients, and lung-kidney involvement. The discussion covers differentiating autoimmune from autoinflammatory diseases, balancing empiric antimicrobial treatment with immunosuppression, and utilizing specific antibody tests for diagnosis. Cases involving scleroderma crisis, HLH, and microscopic polyangiitis illustrate diagnostic and therapeutic challenges, including the nuanced use of steroids and the importance of multidisciplinary collaboration.

Outlines

Part 1: Introduction, Guest Background

Part 2: Clinical Framework, Definitions

Part 3: Diagnostics, Lab Markers

Part 4: Steroids, Therapeutic Interventions

Part 5: Case Studies: Scleroderma, HLH

Part 6: Case Studies: Vasculitis, Lupus, VEXAS

Part 7: Summary, Closing

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Critical Care Time

Part 1: Introduction, Guest Background

The Importance of Rheumatology Knowledge for Intensivists: Saving Lives

Introduction to Rheumatology Emergencies in the ICU and Guest Dr. Marcy Farada

Dr. Farada's Journey: From Hospital "Daycare" to Rheumatology Expert

The Physician as Patient: Gaining Empathy and Understanding

Balancing Multiple Specialties and Prioritizing Self-Care

Part 2: Clinical Framework, Definitions

The Importance of Recognizing Rheumatologic Diseases in the ICU

Identifying Rheumatologic Emergencies: Key Indicators and Challenges

Defining Rheumatologic, Autoimmune, and Autoinflammatory Diseases

Balancing Infection and Immunosuppression in the ICU

Part 3: Diagnostics, Lab Markers

The Role of Labs in Diagnosing Rheumatologic Conditions

Inflammatory Markers: ESR, CRP, and Ferritin

Complements, Cryoglobulins, and the Timing of Consultant Involvement

Part 4: Steroids, Therapeutic Interventions

Empiric Steroid Use: Dosage, Considerations, and Side Effects

Choosing Steroid Agents and Thanking Sponsor Seastar Medical

Part 5: Case Studies: Scleroderma, HLH

Case 1: Scleroderma Crisis and the Importance of ACE Inhibitors

Intubation Challenges in Scleroderma and Transition to Next Case

Case 2: Systemic Juvenile Idiopathic Arthritis and HLH

Diagnosing and Treating HLH: Bone Marrow Biopsy and Treatment Options

Steroids vs. Targeted Therapies: A Broader Perspective on Immune Modulation

Part 6: Case Studies: Vasculitis, Lupus, VEXAS

Case 3: Microscopic Polyangiitis and Diffuse Alveolar Hemorrhage

Plasma Exchange and Rapidly Progressive Glomerulonephritis

Case 4: Systemic Lupus Erythematosus and New Onset Seizures

Addressing Non-Adherence and Considering Social Factors

Case 5: Relapsing Polychondritis and VEXAS Syndrome

VEXAS Syndrome: Clinical Manifestations, Diagnosis, and Treatment

Part 7: Summary, Closing

Closing Thoughts and Summary

66. Rheumatology Emergencies with Dr. Marcela Ferrada

Critical Care Time

Part 1: Introduction, Guest Background

00:39The Importance of Rheumatology Knowledge for Intensivists: Saving Lives

The Importance of Rheumatology Knowledge for Intensivists: Saving Lives

01:20Introduction to Rheumatology Emergencies in the ICU and Guest Dr. Marcy Farada

Introduction to Rheumatology Emergencies in the ICU and Guest Dr. Marcy Farada

03:53Dr. Farada's Journey: From Hospital "Daycare" to Rheumatology Expert

Dr. Farada's Journey: From Hospital "Daycare" to Rheumatology Expert

07:59The Physician as Patient: Gaining Empathy and Understanding

The Physician as Patient: Gaining Empathy and Understanding

10:40Balancing Multiple Specialties and Prioritizing Self-Care

Balancing Multiple Specialties and Prioritizing Self-Care

Part 2: Clinical Framework, Definitions

15:11The Importance of Recognizing Rheumatologic Diseases in the ICU

The Importance of Recognizing Rheumatologic Diseases in the ICU

19:38Identifying Rheumatologic Emergencies: Key Indicators and Challenges

Identifying Rheumatologic Emergencies: Key Indicators and Challenges

24:24Defining Rheumatologic, Autoimmune, and Autoinflammatory Diseases

Defining Rheumatologic, Autoimmune, and Autoinflammatory Diseases

27:37Balancing Infection and Immunosuppression in the ICU

Balancing Infection and Immunosuppression in the ICU

Part 3: Diagnostics, Lab Markers

31:41The Role of Labs in Diagnosing Rheumatologic Conditions

The Role of Labs in Diagnosing Rheumatologic Conditions

35:32Inflammatory Markers: ESR, CRP, and Ferritin

Inflammatory Markers: ESR, CRP, and Ferritin

40:25Complements, Cryoglobulins, and the Timing of Consultant Involvement

Complements, Cryoglobulins, and the Timing of Consultant Involvement

Part 4: Steroids, Therapeutic Interventions

45:00Empiric Steroid Use: Dosage, Considerations, and Side Effects

Empiric Steroid Use: Dosage, Considerations, and Side Effects

49:34Choosing Steroid Agents and Thanking Sponsor Seastar Medical

Choosing Steroid Agents and Thanking Sponsor Seastar Medical

Part 5: Case Studies: Scleroderma, HLH

52:09Case 1: Scleroderma Crisis and the Importance of ACE Inhibitors

Case 1: Scleroderma Crisis and the Importance of ACE Inhibitors

55:58Intubation Challenges in Scleroderma and Transition to Next Case

Intubation Challenges in Scleroderma and Transition to Next Case

1:00:26Case 2: Systemic Juvenile Idiopathic Arthritis and HLH

Case 2: Systemic Juvenile Idiopathic Arthritis and HLH

1:03:07Diagnosing and Treating HLH: Bone Marrow Biopsy and Treatment Options

Diagnosing and Treating HLH: Bone Marrow Biopsy and Treatment Options

1:07:31Steroids vs. Targeted Therapies: A Broader Perspective on Immune Modulation

Steroids vs. Targeted Therapies: A Broader Perspective on Immune Modulation

Part 6: Case Studies: Vasculitis, Lupus, VEXAS

1:10:03Case 3: Microscopic Polyangiitis and Diffuse Alveolar Hemorrhage

Case 3: Microscopic Polyangiitis and Diffuse Alveolar Hemorrhage

1:14:03Plasma Exchange and Rapidly Progressive Glomerulonephritis

Plasma Exchange and Rapidly Progressive Glomerulonephritis

1:15:20Case 4: Systemic Lupus Erythematosus and New Onset Seizures

Case 4: Systemic Lupus Erythematosus and New Onset Seizures

1:19:21Addressing Non-Adherence and Considering Social Factors

Addressing Non-Adherence and Considering Social Factors

1:22:33Case 5: Relapsing Polychondritis and VEXAS Syndrome

Case 5: Relapsing Polychondritis and VEXAS Syndrome

1:27:01VEXAS Syndrome: Clinical Manifestations, Diagnosis, and Treatment

VEXAS Syndrome: Clinical Manifestations, Diagnosis, and Treatment

Part 7: Summary, Closing

1:32:02Closing Thoughts and Summary

Closing Thoughts and Summary