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.
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.
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?
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?
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?
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…
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.
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.
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 pertain to care of critically ill ED patients.
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.