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.

Hyperkalemia in the ED

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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?

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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?