Vasopressin and Steroids for IHCA?

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

Milrinone or Dobutamine for Cardiogenic Shock?

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

The TOMAHAWK Study

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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.  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.  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.  Should this study change our post-arrest management of OHCA patients with a non-diagnostic ECG?

The BaSICS Trial – Implications for Fluid Resuscitation

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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?

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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

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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

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

Early ED Sepsis Care

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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!

The Physiologically Difficult Airway

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Airway guru Dr. Ken Butler joins us for this podcast to discuss some great pearls and pitfalls in intubating patients with physiologic derangements that place that at high-risk for peri-intubation catastrophes.  If you intubate patients in your ED you simply CAN’T miss this episode!