Acute Liver Failure

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Patients with acute liver failure can be incredibly sick and have an exceedingly high mortality.  Early identification and prompt, evidence-based management of the patient with acute liver failure may improve patient-centered outcomes.  In this podcast, we discuss updated guidelines for the management of adult patients with acute liver failure. Key resuscitation topics include fluid resuscitation, blood pressure targets, vasopressor selection, bleeding and thrombosis risk, and mechanical ventilation.  

Ketamine in the Critically Ill

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Ketamine is a well-known anesthetic used commonly in the ED for RSI and procedural sedation.  In this podcast, we review the use of ketamine in other critical illness states, such as status asthmaticus, status epilepticus, acute pain management, and acute alcohol withdrawal syndrome.

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.