Title

New Paradigms in Diagnosis and Treatment of Shock

Document Type

Presentation

Publication Date

10-9-2013

Comments

I have devoted my career to academic medicine since graduating from the Royal Australasian College of Physicians training program in Internal Medicine and Critical Care. As such I have an extensive background in multidisciplinary techniques of organ salvage and preservation, and the diverse management of multisystem organ failure in the critically ill. As a clinician and teacher dedicated solely to the ICU, it has been my goal to emphasize the clinical interpretations of physiologic phenomena while de-emphasizing the heavy reliance on technology. My efforts are aimed at creating a Socratic teaching environment where nurses, residents, students and fellows feel free to raise questions and explore management plans, therapies, interventions and ethical issues in an open forum of discussion and clinical practice.

My clinical contributions have related to novel approaches to the diagnostic and therapeutic challenges faced in a tertiary referral center. This has been associated with the introduction of new therapeutic and diagnostic techniques such as new mechanical ventilatory modes, Near Infra Red Spectroscopy, development of ultrasound guided percutaneous tracheostomy, the concept of Threshold Based Resuscitation etc. Throughout I have also continued to support, mentor and supervise residents, fellows, students and nursing staff.

Research has been based primarily in the development and application of medical technology for the evaluation of local regional metabolic and circulatory phenomena in an attempt to delineate organ reserve in the face of physiologic derangement. The goal being to develop both technologies, for early diagnosis of organ injury, and optimal therapies aimed at organ preservation and recovery. To that end I have established multi disciplinary research relationships, such as with the Departments of Nephrology, Pulmonology, Neonatology, Trauma and Surgery, and Radiation Oncology at Beth Israel Hospital. The latter, leading to the development and submission of an R01 grant in assessing renal oxygen dynamics and perfusion in renal transplantation in both animal and human models using optical techniques. In addition a grant of $ 0.5 million has been won through Covidien Technologies for NIRS evaluation of loco-regional oxygen dynamics in shock and organ transplantation, and the development of new NIRS intellectual property/devices; of which I have numerous original designs.

Abstract

Presentation: 58 minutes

Objectives:

  1. Pathophysiology of shock
  2. Limitations of current diagnostic approaches
  3. New diagnostic approaches