Refractory OHCA – Does ECPR and Early Angiography Improve Outcome?

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In a recent podcast we reviewed the ARREST Trial, which demonstrated significant improvement in survival among OHCA patients at a single center randomized to ECPR and early coronary angiography upon arrival.  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?

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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.  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

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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

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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?

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

EM-STAT!

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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.

The BOUGIE Trial

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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

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