Cefepime vs. Piperacillin-Tazobactam for Infection?  The ACORN Trial

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Timely and appropriate administration of empiric broad-spectrum antibiotics for adult patients with sepsis is critical.  Current guidelines recommend an antipseudomonal antibiotic for those at risk of a resistant gram-negative organism.  The two most common antipseudomonal antibiotics prescribed in this setting are cefepime and piperacillin-tazobactam.  In recent years, observational studies have reported an association with cefepime and neurotoxicity, whereas piperacillin-tazobactam has …

Are We Ventilating our OHCA Patients?

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In recent years, there has been intense focus on delivering high-quality compressions during the resuscitation of patients with OHCA.  In contrast, ventilation metrics in OHCA resuscitation have not been well studied.  In this podcast, we discuss a recent publication from Circulation that evaluated ventilation waveforms during OHCA resuscitation and the association of these metrics on patient outcomes.  Can we do …

Steroids in Sepsis, ARDS, and CAP – A Focused Clinical Update

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Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties.  In recent years, several studies have been published on the use of corticosteroids in select critical illnesses.  In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.

Should We Intubate For GCS < 8?

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Acute mental status changes after the ingestion of alcohol or other substances are a common presentation to the ED.  Those with severe obtundation may require intubation for airway protection while the substance metabolizes.  In fact, more than 20,000 patients are intubated each year in the United States for acute poisoning or intoxication.  Notwithstanding, intubation and mechanical ventilation are not benign …

Should We Be Placing REBOA?

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REBOA is a relatively new and novel technique that in animal studies has demonstrated benefit in controlling hemorrhage.  However, the evidence for the efficacy of REBOA in humans remains scant.  In this podcast, we discuss the recently published UK-REBOA Trial, which randomized patients to receive REBOA with standard care compared to those randomized to standard care alone.  You may be …

Post-Arrest Care Updates – Are Mild Hypercapnia and a Pan-CT Protocol Useful?

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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 …

Should We Transfuse Platelets Prior to CVC Placement?

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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 …

VL versus DL…And The Winner Is?

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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 …