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 …
In recent years, numerous trials have investigated the administration of corticosteroids in patients with pneumonia and have produced mixed results. 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. Is this a therapy we should look to administer in the ED …
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.  Not surprisingly, these single center studies have limitations that impact the generalizability of these results.  In the current podcast, we discuss the recently published INCEPTION Trial, which is a multicenter, randomized trial that compared the effect …
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 …
Given the increase in critically ill patients who present to the ED in need of resuscitation, along with the increase in those who board in the ED awaiting an ICU bed, it is imperative that the emergency physician be knowledgeable about recent literature in resuscitation and critical care medicine. In this podcast, we discuss important articles published in 2022 that …
More than 350,000 cardiac arrests occur each year in North America. Approximately 100,000 of these arrests are due to shockable rhythms. Unfortunately, many patients have refractory ventricular fibrillation and do not respond to many attempts at standard defibrillation. In this podcast, we discuss a recent study that evaluated double sequential external defibrillation and vector-change defibrillation compared to standard defibrillation in …
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.  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 …
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 …
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.  In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.  In the current podcast, we discuss Part II of the BOX Trial that evaluated …
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.  In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.  In the current podcast, we discuss Part I of the BOX Trial that evaluated …