CCPEM Podcast Episodes

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 uncertain.  In this podcast, we discuss a recent study that evaluated the timing of source control with mortality in patients with community-acquired sepsis.

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 a restrictive versus liberal oxygenation target in the post-arrest patient.

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 mean arterial blood pressures in the post-arrest patient.

Approximately 2 million adult patients undergo intubation in the United States each year.  Hypotension and cardiovascular collapse may occur in up to 40% of critically ill patients in the ICU who undergo intubation.  Guidelines and expert recommendations often suggest the administration of IVFs during RSI to prevent cardiovascular collapse.  However, a recent trial found that an IVF bolus during induction did not prevent cardiovascular collapse in a population of critically ill patients.  In this podcast, we review and discuss the recently published PREPARE II Trial, which evaluated the administration of IVFs to prevent cardiovascular collapse in critically ill patients undergoing intubation and who were receiving positive pressure ventilation.

Transcatheter aortic valve replacement is now more common than open surgical replacement and may be associated with lower mortality.  Given the significant increase in TAVRs it is imperative to be knowledgeable on the complications that may occur following TAVR and result in patients presenting to acute care settings for evaluation and treatment.  In this podcast we review an outstanding recent article on TAVR complications and discuss the things we need to know!

IVF administration is central to the management of patients with sepsis.  Though the Surviving Sepsis Campaign recently downgraded its recommendation on the amount of initial fluid administration, there are currently no recommendations on a fluid strategy for septic patients who continue to demonstrate hypoperfusion after the initial fluid bolus.  In this podcast we discuss the recently published CLASSIC Trial, which compared a restrictive fluid strategy to standard care in adult patients admitted to the ICU with sepsis.

Approximately 2 million patients present each year to EDs in the United States for acute asthma exacerbations.  Of these, up to 50,000 may require ICU admission for continued care and resuscitation.  The management of critically ill asthmatic patients can be fraught with peril.  In this podcast we discuss the assessment and management of patients presenting with a severe asthma exacerbation.

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.

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.

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.