Critical Care Perspectives in Emergency Medicine

Is This Patient Volume Overloaded?

Critical Care Perspectives in Emergency Medicine — Thu, 12 Mar 2026 18:03:46 +0000

Accurate assessment of intravascular volume is critical in managing sick patients in the emergency department or intensive care unit. In this podcast we discuss a recently published article that evaluates clinical exam, radiographic, point-of-care ultrasound, and laboratory findings in the assessment of intravascular volume overload.

2025: A Year in Review

Critical Care Perspectives in Emergency Medicine — Wed, 25 Feb 2026 13:15:23 +0000

Each year, hundreds of articles are published that pertain to the resuscitation and care of critically ill emergency department patients. In this podcast, we review the key articles from the 2025 emergency medicine, resuscitation, and critical care literature that pertain to the care of critically ill ED patients.

Caring for the Patient with ROSC

Critical Care Perspectives in Emergency Medicine — Sat, 22 Nov 2025 14:39:13 +0000

More than 600,000 patients in North America sustain sudden cardiac arrest each year. When return of spontaneous circulation (ROSC) is achieved, there are a number of critical interventions to consider in order to provide the patient with the best chance of being discharged with meaningful neurologic survival. In this podcast, we discuss an excellent recent review article on the management of patients with ROSC following cardiac arrest.

Critical Issues in ED Intubation

Critical Care Perspectives in Emergency Medicine — Wed, 15 Oct 2025 15:38:39 +0000

Emergency physicians intubate critically ill patients daily. Unfortunately, up to 17% of ED intubations can be complicated by peri-intubation hypoxemia, hypotension, and cardiac arrest. Efforts to optimize patient's physiology prior to rapid sequence intubation are critical in mitigating the risk of potentially disastrous peri-intubation complications. In this podcast, we discuss a recent Clinical Policy from the American College of Emergency Physicians that addresses critical issues in the management of adult ED patients undergoing endotracheal intubation.

Conservative Oxygen Therapy for Ventilated ICU Patients?

Critical Care Perspectives in Emergency Medicine — Fri, 29 Aug 2025 16:51:20 +0000

Oxygen is one of the most used, and misused, therapies delivered to critically ill patients. In recent years, a number of trials have compared the use of a conservative oxygen therapy strategy with a liberal oxygen therapy strategy. These trials have produced mixed results and the optimal oxygen strategy for critically ill patients remains unknown. In this podcast, we discuss the latest study, UK-ROX Trial, to investigate a conservative oxygen therapy strategy with usual oxygen therapy in critically ill ICU patients. Which approach is better?

Dexmedetomidine or Propofol for Sedation in the Critically Ill?

Critical Care Perspectives in Emergency Medicine — Mon, 07 Jul 2025 13:55:51 +0000

Critically ill patients receiving mechanical ventilation require analgesia and sedation. At present, propofol remains the most widely used sedative for intubated/ventilated patients. Recent trials have suggested that dexmedetomidine may reduce delirium and the duration of mechanical ventilation compared with other sedative medications. In fact, recent SCCM guidelines suggest the use of dexmedetomidine over propofol in intubated patients. In this podcast, we discuss a recent randomized trial that compared the effectiveness and safety of a dexmedetomidine-based sedation strategy with a propofol-based sedation strategy in mechanically ventilated critically ill patients.

Palliative Care in the ED

Critical Care Perspectives in Emergency Medicine — Sat, 17 May 2025 19:46:38 +0000

Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death. While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings. As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members. In this podcast, we review the recently published PRIM-ER trial, which evaluated the impact of a robust primary palliative care intervention on hospital admission rates in 29 EDs across the US.

When Should We Start Vasopressin in Septic Shock?

Critical Care Perspectives in Emergency Medicine — Tue, 15 Apr 2025 16:52:49 +0000

Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis. Current guidelines then recommend vasopressin as the second-line vasopressor agent, but the optimal timing of its initiation remains unknown. In this podcast, we discuss a recent article on the use of a machine learning tool for vasopressin administration to optimize short- and long-term outcomes in patients with sepsis.

IV or IO Vascular Access for OHCA?

Critical Care Perspectives in Emergency Medicine — Mon, 24 Feb 2025 14:32:31 +0000

Nearly 4 million patients sustain out-of-hospital cardiac arrest (OHCA) worldwide each year. International guidelines for the resuscitation of patients with OHCA recommend early administration of epinephrine in those with an initial nonshockable rhythm. Both intravenous (IV) and intraosseous (IO) access are routinely attempted to gain vascular access to administer medications. While IV access is recommended, this is based on very low certainty evidence. In this podcast, we discuss three recently published randomized trials that investigated IO and IV access in patients with OHCA.

Is HFNC noninferior to NIV for Acute Respiratory Failure?

Critical Care Perspectives in Emergency Medicine — Fri, 24 Jan 2025 15:43:55 +0000

Both NIV and HFNC are used to treat patients with acute respiratory failure. Current guidelines recommend NIV for acute respiratory failure caused by COPD and acute cardiogenic pulmonary edema. However, NIV may be hard for some patients to tolerate. When compared to low-flow oxygen therapy, HFNC has been shown to improve oxygenation, improve alveolar recruitment, and enhance clearance of secretions. HFNC may be easier to use and tolerate than NIV, but there remains uncertainty regarding the effectiveness of HFNC compared to NIV for acute hypoxemic respiratory failure. In this podcast, we discuss the RENOVATE trial that sought to compare HFNC with NIV on rates of intubation in patients with acute respiratory failure.

High-Intensity NIPPV for Acute COPD Exacerbations?

Critical Care Perspectives in Emergency Medicine — Thu, 05 Dec 2024 15:24:04 +0000

NIPPV is frequently used in the management of critically ill patients presenting with an acute COPD exacerbation, as NIPPV decreases the rates of intubation and is associated with lower in-hospital mortality. Typically, "low" intensity NIPPV, whereby inspiratory positive airway pressures less than 18 cm H2O are used. More recently, the use of "high" intensity NIPPV, with IPAPs between 20-30 cm H2O, has been shown to improve gas exchange, ventilatory function, and improve arterial PCO2 values. In this podcast, we review the HAPPEN Trial, which compared low intensity to high intensity NIPPV on the need for intubation in patients with an acute COPD exacerbation and hypercapnia.

Naloxone for OHCA?

Critical Care Perspectives in Emergency Medicine — Fri, 01 Nov 2024 17:05:11 +0000

The incidence of opioid-associated out-of-hospital cardiac arrests continues to rise. Current guidelines for the resuscitation of patients with OHCA advise the clinician to consider the administration of naloxone of patients with suspected opioid-associated OHCA. In this podcast, we review a recenlty published study in JAMA that evaluated the association of naloxone with patient outcomes in opioid-associated OHCAs.

Continuous or Intermittent B-Lactam Infusions for Sepsis?

Critical Care Perspectives in Emergency Medicine — Tue, 24 Sep 2024 18:55:47 +0000

Timely administration of broad-spectrum antibiotics is a critical pillar in the resuscitation of patients with sepsis. B-lactam antibiotics are an important class of antibiotics commonly administered to patients with sepsis. Typically, B-lactam antibiotics are administered over 30 minutes, but optimal bactericidal activity requires the concentration of free drug to be above the MIC of the organism for 40-70% of the dosing interval. In this podcast we discuss two recent publications that compare continuous infusions of B-lactam antibiotics with intermittent effusions in patients with sepsis.

What Oxygenation Strategy Should We Use for COVID-19 Patients?

Critical Care Perspectives in Emergency Medicine — Sat, 27 Jul 2024 01:22:54 +0000

Patients with COVID-19 can require supplemental oxygen for acute hypoxemic respiratory failure. While international guidelines recommend a target SpO2 between 90-96%, a safe oxygenation strategy has not been identified. In this podcast, we discuss the recently published HOT-COVID Trial, which compared a lower oxygenation strategy with a higher oxygenation strategy in adult ICU patients with COVID-19.

Should We Use NIPPV for Preoxygenation for All Intubations?

Critical Care Perspectives in Emergency Medicine — Tue, 09 Jul 2024 11:27:31 +0000

Over 1 million critically ill patients are intubated each year in the US. Hypoxemia occurs in up to 20% of patients and can lead to peri-intubation cardiovascular collapse and cardiac arrest. As such, adequate and appropriate preoxygenation is critical in increasing the safe apnea time and decreasing the risk of hypoxemia. At present, the majority of patients receive preoxygenation through a non-rebreather mask. In this podcast, we discuss a recent study that evaluated the use of noninvasive ventilation for preoxygenation in critically ill patients.

Cefepime vs. Piperacillin-Tazobactam for Infection? The ACORN Trial

Critical Care Perspectives in Emergency Medicine — Fri, 07 Jun 2024 20:19:33 +0000

Timely and appropriate administration of empiric broad-spectrum antibiotics for adult patients with sepsis is critical. Current guidelines recommend an antipseudomonal antibiotic for those at risk of a resistant gram-negative organism. The two most common antipseudomonal antibiotics prescribed in this setting are cefepime and piperacillin-tazobactam. In recent years, observational studies have reported an association with cefepime and neurotoxicity, whereas piperacillin-tazobactam has been associated with AKI especially when given with vancomycin. In this podcast, we discuss the recently published ACORN Trial, a randomized trial that evaluated cefepime and piperacillin-tazobactam for adult patients with suspected infection.

Are We Ventilating our OHCA Patients?

Critical Care Perspectives in Emergency Medicine — Wed, 24 Apr 2024 16:16:06 +0000

In recent years, there has been intense focus on delivering high-quality compressions during the resuscitation of patients with OHCA. In contrast, ventilation metrics in OHCA resuscitation have not been well studied. In this podcast, we discuss a recent publication from Circulation that evaluated ventilation waveforms during OHCA resuscitation and the association of these metrics on patient outcomes. Can we do better?

Steroids in Sepsis, ARDS, and CAP – A Focused Clinical Update

Critical Care Perspectives in Emergency Medicine — Sun, 17 Mar 2024 01:02:41 +0000

Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties. In recent years, several studies have been published on the use of corticosteroids in select critical illnesses. In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.

A Year in Review – The 2023 Critical Care and Resuscitation Literature

Critical Care Perspectives in Emergency Medicine — Wed, 31 Jan 2024 01:37:18 +0000

In this podcast we review a few key articles from the 2023 critical care, emergency medicine, and resuscitation literature that pertain to our care of the critically ill ED patient.

Should We Intubate For GCS < 8?

Critical Care Perspectives in Emergency Medicine — Fri, 29 Dec 2023 17:05:25 +0000

Acute mental status changes after the ingestion of alcohol or other substances are a common presentation to the ED. Those with severe obtundation may require intubation for airway protection while the substance metabolizes. In fact, more than 20,000 patients are intubated each year in the United States for acute poisoning or intoxication. Notwithstanding, intubation and mechanical ventilation are not benign procedures. In this podcast we discuss the recently published NICO Trial, that evaluated a strategy of withholding intubation in patients with coma due to acute poisoning.

Should We Be Placing REBOA?

Critical Care Perspectives in Emergency Medicine — Thu, 23 Nov 2023 12:48:46 +0000

REBOA is a relatively new and novel technique that in animal studies has demonstrated benefit in controlling hemorrhage. However, the evidence for the efficacy of REBOA in humans remains scant. In this podcast, we discuss the recently published UK-REBOA Trial, which randomized patients to receive REBOA with standard care compared to those randomized to standard care alone. You may be surprised by these results!

SCCM Guidelines for RSI in the Critically Ill

Critical Care Perspectives in Emergency Medicine — Tue, 24 Oct 2023 02:29:18 +0000

RSI is one of the most common procedures in critically ill patients. Despite its frequency, there remains significant practice variation on numerous aspects of RSI in the critically ill. In this podcast, we review pertinent recommendations from the recently published SCCM Guidelines on RSI in the critically ill patient.

Post-Arrest Care Updates – Are Mild Hypercapnia and a Pan-CT Protocol Useful?

Critical Care Perspectives in Emergency Medicine — Fri, 08 Sep 2023 16:01:53 +0000

Care of the patient with ROSC following OHCA can be complex and typically includes a protocolized approach to optimizing oxygenation, ventilation, hemodynamics, early cardiac catheterization for patients with STEMI, seizure detection, and possibly TTM. In this podcast, we review two recent articles that focused on the use of mild hypercapnia compared with normocapnia in post arrest patients and the use of a pan-CT protocol to detect critical time sensitive conditions and complications.

Should We Transfuse Platelets Prior to CVC Placement?

Critical Care Perspectives in Emergency Medicine — Fri, 28 Jul 2023 14:37:02 +0000

Central venous catheter (CVC) placement is common in critically ill patients for a variety of indications. Thrombocytopenia is also quite common in critically ill patients. Unfortunately, literature and guideline recommendations vary on the threshold for prophylactic platelet transfusion in patients undergoing a procedure. In this podcast we discuss a recent trial that evaluated prophylactic platelet transfusion in patients with severe thrombocytopenia undergoing CVC placement.

VL versus DL…And The Winner Is?

Critical Care Perspectives in Emergency Medicine — Fri, 07 Jul 2023 01:06:10 +0000

Over 1 million critically ill patients undergo intubation each year in the United States. Though direct laryngoscopy remains the most common technique worldwide for intubation, the use of video laryngoscopy has significantly increased. Studies evaluating video to direct laryngoscopy have thus far produced mixed results. In this podcast, we review the latest randomized trial, the DEVICE Trial, that assessed video with direct laryngoscopy. Which device won?

Do Etomidate and Propofol Increase Mortality in the Critically Ill?

Critical Care Perspectives in Emergency Medicine — Thu, 15 Jun 2023 01:19:20 +0000

Both etomidate and propofol are commonly used sedative agents in critically ill patients. Recent literature has suggested that these agents may result in increased harm and mortality. In this podcast, we discuss the most recent two systematic reviews and meta-analyses that evaluated etomidate and propofol in critically ill patients. Do we need to change our practice?

Should We Add Fludrocortisone to Hydrocortisone for Septic Shock?

Critical Care Perspectives in Emergency Medicine — Fri, 28 Apr 2023 16:26:20 +0000

The use of steroids in patients with sepsis and septic shock has been controversial for decades. At present, the Surviving Sepsis Campaign recommends the administration of corticosteroids to patients with persistent shock despite fluid and vasopressor administration. In recent years, several trials have evaluated the addition of fludrocortisone, a potent mineralocorticoid, to hydrocortisone in septic shock. In this podcast, we review the latest study that evaluated the combination of hydrocortisone and fludrocortisone in patients with septic shock.Â Should we administer this medication with hydrocortisone for our patients with septic shock?

Should We Administer Steroids in Severe CAP?

Critical Care Perspectives in Emergency Medicine — Thu, 13 Apr 2023 00:49:17 +0000

In recent years,Â numerous trials have investigated the administration of corticosteroids in patients with pneumonia and have produced mixed results.Â In this podcast, we discuss the latest randomized trial, the CAPE COD trial, that evaluated whether the administration of hydrocortisone to ICU patients with severe CAP reduced mortality.Â Is this a therapy we should look to administer in the ED based on the results of this trial?Â Take a listen and find out...

ECPR for OHCA? – The INCEPTION Trial

Critical Care Perspectives in Emergency Medicine — Mon, 27 Feb 2023 23:07:58 +0000

In recent years, several single center trials have demonstrated positive outcomes in patients with OHCA randomized to receive ECPR compared with patients who received standard resuscitation.Â Â Not surprisingly, these single center studies have limitations that impact the generalizability of these results.Â Â In the current podcast, we discuss the recently published INCEPTION Trial, which is a multicenter, randomized trial that compared the effect of extracorporeal CPR with conventional CPR in patients with refractory OHCA due to a ventricular arrhythmia.

Should We Use a Liberal or Restrictive Fluid Strategy in Sepsis – The CLOVERS Trial

Critical Care Perspectives in Emergency Medicine — Tue, 07 Feb 2023 15:32:28 +0000

Intravenous fluid (IVF) administration is a central tenet to the resuscitation of patients with sepsis and sepsis-induced hypotension. At present, the administration of large volumes of IVF is common, though based on low quality of evidence. In this podcast, we review and interpret the recently published CLOVERS Trial, which compared the use of a liberal fluid strategy with a restrictive fluid strategy in patients with sepsis-induced hypotension.

Double Sequential External Defibrillation for Refractory Ventricular Fibrillation

Critical Care Perspectives in Emergency Medicine — Mon, 12 Dec 2022 14:35:36 +0000

More than 350,000 cardiac arrests occur each year in North America.Â Approximately 100,000 of these arrests are due to shockable rhythms.Â Unfortunately, many patients have refractory ventricular fibrillation and do not respond to many attempts at standard defibrillation.Â In this podcast, we discuss a recent study that evaluated double sequential external defibrillation and vector-change defibrillation compared to standard defibrillation in patients with refractory ventricular fibrillation in OHCA.

What is the Optimal SpO2 Target in Vented Patients?

Critical Care Perspectives in Emergency Medicine — Wed, 09 Nov 2022 15:45:29 +0000

Approximately 3 million critically ill patients are intubated and initiated on mechanical ventilation each year in the United States. A critical component of mechanical ventilation is the adjustment of FiO2 to maintain adequate arterial oxygen saturation.Â Â However, the optimal oxygenation target in critically ill adult patients receiving mechanical ventilation remains uncertain. In this podcast we discuss a recently published study, the PILOT Trial, that evaluated low, intermediate, and high oxygenation targets in critically ill patients.

Does the Timing of Source Control in Sepsis Make a Difference?

Critical Care Perspectives in Emergency Medicine — Thu, 20 Oct 2022 02:59:08 +0000

The emergency department resuscitation of patients with sepsis focuses on early recognition, timely administration of appropriate antibiotics, appropriate fluid resuscitation, early vasopressor initiation for patients with sepsis-induced hypoperfusion, and hemodynamic monitoring. Source control is also an important component in the resuscitation of patients with sepsis. Though current guidelines identify source control as a "best practice" the optimal timing of source control remains uncertain. In this podcast, we discuss a recent study that evaluated the timing of source control with mortality in patients with community-acquired sepsis.

Does a Restrictive Oxygenation Target Make a Difference in the Post-Arrest Patient?

Critical Care Perspectives in Emergency Medicine — Mon, 03 Oct 2022 13:37:01 +0000

The care of patients with return of spontaneous circulation following cardiac arrest centers on optimizing oxygenation and ventilation, optimizing hemodynamics, identifying patients that require immediate coronary angiography, detecting seizures, and targeted temperature management.Â Â In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.Â Â In the current podcast, we discuss Part II of the BOX Trial that evaluated a restrictive versus liberal oxygenation target in the post-arrest patient.

Does a Higher MAP in the Post-Arrest Patient Make a Difference?

Critical Care Perspectives in Emergency Medicine — Wed, 14 Sep 2022 12:21:26 +0000

The care of patients with return of spontaneous circulation following cardiac arrest centers on optimizing oxygenation and ventilation, optimizing hemodynamics, identifying patients that require immediate coronary angiography, detecting seizures, and targeted temperature management.Â Â In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.Â Â In the current podcast, we discuss Part I of the BOX Trial that evaluated mean arterial blood pressures in the post-arrest patient.

IVFs to Prevent Cardiovascular Collapse During RSI – The PREPARE II Trial

Critical Care Perspectives in Emergency Medicine — Wed, 03 Aug 2022 04:41:08 +0000

Approximately 2 million adult patients undergo intubation in the United States each year.Â Hypotension and cardiovascular collapse may occur in up to 40% of critically ill patients in the ICU who undergo intubation.Â Guidelines and expert recommendations often suggest the administration of IVFs during RSI to prevent cardiovascular collapse.Â However, a recent trial found that an IVF bolus during induction did not prevent cardiovascular collapse in a population of critically ill patients.Â In this podcast, we review and discuss the recently published PREPARE II Trial, which evaluated the administration of IVFs to prevent cardiovascular collapse in critically ill patients undergoing intubation and who were receiving positive pressure ventilation.

TAVR Complications You Need to Know!

Critical Care Perspectives in Emergency Medicine — Mon, 18 Jul 2022 13:38:49 +0000

Transcatheter aortic valve replacement is now more common than open surgical replacement and may be associated with lower mortality.Â Given the significant increase in TAVRs it is imperative to be knowledgeable on the complications that may occur following TAVR and result in patients presenting to acute care settings for evaluation and treatment.Â In this podcast we review an outstanding recent article on TAVR complications and discuss the things we need to know!

Restrictive Fluid Resuscitation in Sepsis? The CLASSIC Trial

Critical Care Perspectives in Emergency Medicine — Tue, 05 Jul 2022 12:26:52 +0000

IVF administration is central to the management of patients with sepsis. Though the Surviving Sepsis Campaign recently downgraded its recommendation on the amount of initial fluid administration, there are currently no recommendations on a fluid strategy for septic patients who continue to demonstrate hypoperfusion after the initial fluid bolus. In this podcast we discuss the recently published CLASSIC Trial, which compared a restrictive fluid strategy to standard care in adult patients admitted to the ICU with sepsis.

Life-Threatening Asthma

Critical Care Perspectives in Emergency Medicine — Sun, 12 Jun 2022 19:53:40 +0000

Approximately 2 million patients present each year to EDs in the United States for acute asthma exacerbations. Of these, up to 50,000 may require ICU admission for continued care and resuscitation. The management of critically ill asthmatic patients can be fraught with peril. In this podcast we discuss the assessment and management of patients presenting with a severe asthma exacerbation.

Refractory OHCA – Does ECPR and Early Angiography Improve Outcome?

Critical Care Perspectives in Emergency Medicine — Wed, 18 May 2022 12:41:39 +0000

In a recent podcast we reviewed the ARREST Trial,Â which demonstrated significant improvement in survival among OHCA patients at a single center randomized to ECPR and early coronary angiography upon arrival.Â In this podcast we discuss the latest trial to investigate whether a bundle of early transport, ECPR, and coronary angiography improves favorable neurologic survival in patients with refractory OHCA.

Low-Tidal Volume Ventilation in the ED – Does it Make a Difference?

Critical Care Perspectives in Emergency Medicine — Wed, 20 Apr 2022 20:49:45 +0000

Though low-tidal volume ventilation has been shown to decreased mortality in patients with ARDS, the use of these settings in mechanically ventilated ED patients has been variable.Â In this podcast, we discuss a recent systematic review that examined the effect of low-tidal volume ventilation in the ED on clinical outcomes including mortality, length of stay, occurrence of ARDS, and duration of mechanical ventilation.

The PLUS Study

Critical Care Perspectives in Emergency Medicine — Tue, 29 Mar 2022 12:57:39 +0000

Though we've discussed the use of balanced solutions in the resuscitation of critically ill patients numerous times on CCPEM, the literature remains controversial with mixed results as to which IVFs are superior. In this podcast, we discuss the latest randomized trial, the PLUS Study, comparing the use of balanced multielectrolyte solution and 0.9% normal saline.

The Critically Ill Patient with HHS

Critical Care Perspectives in Emergency Medicine — Tue, 08 Mar 2022 16:50:44 +0000

Hyperglycemic hyperosmolar syndrome (HHS) is a potentially life-threatening hyperglycemic emergency that has a mortality that can be 10 times as high compared with patients who have diabetic ketoacidosis. Resuscitation of these complex patients can be fraught with peril and result in patient harm and poor outcomes. In this podcast, we discuss the identification and resuscitation of patients with HHS.

Ketamine or Etomidate for RSI?

Critical Care Perspectives in Emergency Medicine — Mon, 21 Feb 2022 16:24:06 +0000

Etomidate and ketamine are frequently used for RSI in critically ill patients.Â Recent articles have raised concern about an increased incidence of post-intubation hypotension in patients who receive ketamine for RSI.Â Notwithstanding, is either agent superior for RSI in the critically ill?Â In this podcast we discuss the recently published EvK trial, which evaluated etomidate and ketamine for RSI in emergency endotracheal intubations.

The 2021 Critical Care Literature – A Year in Review

Critical Care Perspectives in Emergency Medicine — Wed, 09 Feb 2022 15:44:39 +0000

While COVID continued to be predominant in 2021, a number of important articles that pertained to various aspects of critical care and resuscitation were published.Â In this podcast, we review a few important trials that were published in 2021 and their impact upon the management of select critical illnesses.

EM-STAT!

Critical Care Perspectives in Emergency Medicine — Mon, 31 Jan 2022 14:00:54 +0000

Resuscitating the sick patient and providing ongoing critical care is incredibly challenging in critical access locations and resource limited EDs. In this podcast, we interview Dr. Eric Klotz who has runs a hugely successful mobile critical care team that provides ongoing critical care and resuscitation to patients requiring transfer from resource limited settings.

Bicarbonate Therapy in the Critically Ill Patient

Critical Care Perspectives in Emergency Medicine — Thu, 20 Jan 2022 16:15:15 +0000

In this podcast we are joined by EM/CCM superstars Dr. Gabe Wardi and Dr. Kit Tainter, who discuss the physiologic effects of metabolic acidosis, the rationale for sodium bicarbonate administration, and its use in select critical illness states. An awesome podcast to start of 2022!

The BOUGIE Trial

Critical Care Perspectives in Emergency Medicine — Tue, 28 Dec 2021 18:30:24 +0000

More than 1.5 million patients are intubated each year in the United States. In up to 20% of patients, the first attempt at intubation is not successful and places patients at risk for peri-intubation cardiovascular collapse and death. In recent years, many providers have used the bougie as either a rescue device for failed attempts or during the initial attempt at intubation. In this podcast, we discuss the BOUGIE Trial, a recently published study that compared the effect of using a bougie to endotracheal tube with stylet on outcomes in patients undergoing tracheal intubation.ReplyReply allForward

MIS-C in COVID-19

Critical Care Perspectives in Emergency Medicine — Thu, 02 Dec 2021 18:10:27 +0000

The COVID-19 pandemic continues to affect millions of patients worldwide.Â Â While the majority of children have milder illness compared with adults, some develop multisystem inflammatory syndrome with a significant increase in morbidity and mortality.Â Â In this podcast, we discuss a recent review article on MIS-C as it pertains to the pediatric patient with COVID-19.

Hyperkalemia in the ED

Critical Care Perspectives in Emergency Medicine — Wed, 10 Nov 2021 19:16:30 +0000

Hyperkalemia is a life-threatening electrolyte disorder that is commonly encountered in the ED and ICU. In this podcast we review the latest evidence in the management of hyperkalemia based on a recently published consensus-based panel. https://ccpem.blog/wp-content/uploads/2021/11/CCPEM-Hyperkalemia-in-the-Emergency-Department.pdf

Vasopressin and Steroids for IHCA?

Critical Care Perspectives in Emergency Medicine — Mon, 25 Oct 2021 16:10:46 +0000

In 2009 and 2013 investigators published studies that demonstrated improved outcomes in patients with IHCA who received vasopressin and steroids in addition to epinephrine.Â However, both US and European cardiac arrest guidelines have not endorsed these medications due to lack of additional evidence.Â In this podcast we discuss the recently published VAM-IHCA trial, which evaluated vasopressin and steroids for patients with IHCA.Â Should we now be administering this combination of medications along with epinephrine for IHCA?Â

Milrinone or Dobutamine for Cardiogenic Shock?

Critical Care Perspectives in Emergency Medicine — Mon, 27 Sep 2021 13:56:20 +0000

Hemodynamic management of patients with cardiogenic shock centers on vasopressors, inotropes, and mechanical circulatory devices.Â With respect to inotropic medications, there is little data to guide optimal management and selection of agents.Â In this podcast we discuss the results of a recent trial that compared milrinone with dobutamine for patients with cardiogenic shock.Â Which agent was the winner?

The TOMAHAWK Study

Critical Care Perspectives in Emergency Medicine — Thu, 16 Sep 2021 19:25:50 +0000

The COACT trial demonstrated no improvement in 90-day mortality for post-arrest patients without evidence of an ST-segment elevation MI who were randomized to immediate or delayed coronary angiography.Â However, the COACT Trial included only OHCA with a shockable rhythm and overall had a very low number of patients that had an acute thrombus at the time of angiography.Â In this podcast, we discuss the recently published TOMAHAWK study that evaluated OHCA patients due to either a shockable or nonshockable rhythm and had no evidence of a STEMI.Â Should this study change our post-arrest management of OHCA patients with a non-diagnostic ECG?

The BaSICS Trial – Implications for Fluid Resuscitation

Critical Care Perspectives in Emergency Medicine — Sun, 29 Aug 2021 12:20:30 +0000

The administration of IVFs is nearly universal in critically ill patients. In recent years, several studies have suggested improved outcomes with the use of balanced crystalloids solutions in contrast to 0.9% NS. In this podcast, we discuss the recently published BaSICS Trial that evaluated Plasma-Lyte 148 with 0.9% NS in critically ill patients. Does this study provide practice-changing evidence to make that switch?

Pigtail Catheters for Traumatic Hemothorax?

Critical Care Perspectives in Emergency Medicine — Thu, 05 Aug 2021 20:08:58 +0000

Traumatic hemothorax has traditionally been treated with a large bore thoracostomy to prevent retained hemothorax and morbidity. In this podcast we discuss the results of a recent study on the use of small bore thoracostomy (pigtail catheters) for the treatment of traumatic hemothorax.

The ED-AWARENESS Study

Critical Care Perspectives in Emergency Medicine — Fri, 16 Jul 2021 14:38:13 +0000

Ventilated ED patients may be at high risk for awareness with paralysis, thereby increasing the risk of long-term psychological sequelae. In this podcast, we discuss the results of the recently published ED-AWARENESS Study and its implications for managing the ventilated ED patient.

The TTM2 Trial

Critical Care Perspectives in Emergency Medicine — Thu, 01 Jul 2021 12:52:27 +0000

Current international guidelines recommend TTM for adult patients with ROSC from OHCA who remain comatose or unable to follow verbal commands.Â However, the overall level of evidence for this recommendation remains of low certainty.Â In this podcast, we discuss the results of the recently published TTM2 Trial and its implications on the management of post-cardiac arrest patients.

Mechanical Ventilation in the Patient with ARDS

Critical Care Perspectives in Emergency Medicine — Thu, 10 Jun 2021 14:49:18 +0000

More than 3 million patients develop ARDS each year across the globe. Like any therapy, mechanical ventilation can induce further lung injury and cause patient harm if misapplied. In this podcast we bring you up to speed on the latest, evidence-based titration of mechanical ventilation in patients with ARDS.

Early ED Sepsis Care

Critical Care Perspectives in Emergency Medicine — Mon, 10 May 2021 18:34:59 +0000

Over 80% of patients with sepsis receive care in the ED. Despite evidence demonstrating the benefits of ED sepsis resuscitation, there remains significant controversies on many aspects of ED sepsis care. In this podcast, we are joined by EM/CCM extraordinaire Dr. Gabe Wardi, who discuss an upcoming article on ED sepsis resuscitation that will have a significant impact the care we provide to our patients. You cannot afford to miss this episode!