The Critically Ill ED Boarder

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Emergency department (ED) visits for critically ill patients has nearly doubled over the past decade.  Unfortunately, ED boarding of critically ill patients awaiting ICU admission has also risen significantly, and is associated with several adverse patient outcomes.  In this podcast, we review a white paper on boarding of the critically ill ED patient just published in Critical Care Medicine by a joint task force from ACEP and SCCM.  If you care for the critically ill ED boarder in your ED, you CAN’T afford to miss this discussion!

TXA for GI Bleeds? The HALT-IT Trial

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The use of tranexamic acid (TXA) has markedly increased since the results of the CRASH-II trial were published.  In addition to its use in trauma, TXA has been evaluated and used in numerous other conditions, including post-partum hemorrhage and epistaxis.  Recently, the HALT-IT Trial was published online in the Lancet, which evaluated the use of TXA in patients with acute gastrointestinal bleeding.  In this podcast we discuss the HALT-IT Trial and its implications for clinical practice. 

Diastolic Shock Index

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Emergency medicine, critical care, and resuscitationists often use the Shock Index to identify patients with increased mortality.  The Shock Index is calculated by dividing heart rate by the systolic blood pressure, with a value > 0.8 identifying a potential critically ill patient.  In the setting of sepsis, the use of systolic blood pressure to calculate the Shock Index may be less sensitive.  In this podcast, we review a recent article that suggests the use of the Diastolic Shock Index may be better in identifying septic patients who require earlier initiation of vasopressor medications.

HFNC in COVID-19 Patients – Helpful or Harmful?

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As we gain more experience managing critically ill patients with COVID-19 infection there has been a shift away from immediate intubation and towards more frequent use of non-invasive ventilatory strategies.  Dr. Michael Allison joins CCPEM this podcast to discuss the latest evidence, controversies, and recommendations on the use of HFNC in COVID-19 patients.

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COVID-19: Toxicities of Potential Therapies

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Currently, there is no approved treatment or proven therapy for COVID-19. As such, many have turned to treatments with little to no supporting evidence. In this podcast, we bring back EM Pharmacy extraordinaire Bryan Hayes to discuss information on the toxicities of potential therapies used in the management of patients with COVID-19.

Vasopressors & The Older Patient – The 65 Trial

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Current guidelines for many critical illnesses recommend targeting a MAP of 65 mm Hg, with consideration of higher MAPs in older patients with chronic HTN. Recent literature, however, suggests increased mortality in older patients who are exposed to larger quantities of vasopressor medications.  In this podcast, we do a deep dive into the recently published 65 Trial, which sought to evaluate the effect of permissive hypotension in older patients with vasodilatory hypotension.

Critical Care Management COVID-19 Update – March 30, 2020

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Our understanding and management of patients with COVID-19 infection continues to rapidly evolve, almost on a daily basis.  In this podcast, we discuss current experience and thoughts on managing the critically ill patient with COVID-19 infection with attention to ventilator management.

Vitamin C for Septic Shock?

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In 2017, Paul Marik published a single-center retrospective before-and-after study that demonstrated significant mortality benefit to patients with septic shock who received a cocktail of steroids, vitamin C, and hydrocortisone.  Since that time, many providers have adopted this cocktail for the treatment of septic shock, despite the fact that no randomized trial has evaluated this regimen.  In this podcast, we welcome EM/CCM superstar Dr. Gabriel Wardi to review the VITAMINS trial, a randomized clinical trial evaluating this cocktail among patients with septic shock.

COVID-19 Update – March 2020

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In December 2019 a novel coronavirus (now named COVID-19) was identified as responsible for a cluster of pneumonia cases in Wuhan, China. As of March 2020, over 50 countries have identified patients who have tested (+) for COVID-19, with over 90,000 identified cases and more than 3000 deaths to date. As the discussion regarding COVID-19 rapidly evolves, it is important for clinicians to prepare locally and to review standards for prevention, diagnosis, and treatment. In this podcast, we review the latest information on identification, diagnosis, and treatment of patients with COVID-19 infection.