Anticoagulation Reversal for ICH

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ICH accounts for approximately 15 percent of all strokes.  Despite improvements in neurocritical care, the mortality for patients with ICH can still reach 50 percent at 1-year, with many left with significant residual deficits.  Patients with an ICH who are taking an oral anticoagulant medication tend to have larger ICH volumes, more frequent IVH, and a greater frequency of hematoma expansion.  In this …

Early Post-Cardiac Arrest Catheterization – The COACT Trial

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A critical component to post-arrest care for the patient with ROSC following out-of-hospital cardiac arrest is early coronary angiography. Current guidelines recommend immediate cardiac angiography for patients with evidence of a STEMI on their post-arrest ECG. For the more common scenario of non-diagnostic ECGs, the role of early coronary angiography remains uncertain. In this podcast, superstar Amal Mattu joins us …

Refractory Vasodilatory Shock

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Emergency medicine, critical care, and acute care providers evaluate, resuscitate, and manage patients with shock on a daily basis.  Despite initial efforts, a select number of patients are refractory to fluid and vasopressor administration.  In this podcast, we discuss a rationale approach to vasopressor administration, along with several rescue therapies for the patient with refractory vasodilatory shock.

The ANDROMEDA-SHOCK Trial

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Rory Spiegel (@EMNerd_) joins the podcast this month for an in-depth analysis and discussion of the recently published ANDROMEDA-SHOCK trial.  Should capillary refill time replace serial lactate values for guiding the hemodynamic resuscitation of patients with septic shock? What are the limitations of this potential game-changing study? How will you incorporate its results into your clinical practice?

BMV for ETI in the Critically Ill?

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More than 1.5 million patients undergo endotracheal intubation each year in the U.S.  Endotracheal intubation can be complicated by hypoxemia, which is a known risk factor for peri-intubation cardiac arrest and death.  Rapid sequence intubation typically involves a delay of up to 2 minutes between the administration of sedative/paralytic medications and laryngoscopy.  In this podcast, we discuss a recent article in the New …

ED Sepsis Screening – Is qSOFA Really Better?

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As EDs across the country strive to meet sepsis benchmark metrics, many have implemented a variety of screening tools. With the publication of Sepsis-3, qSOFA is the latest screening tool recommended for patients outside of the ICU setting. In this podcast we review the derivation of qSOFA and discuss recent literature on whether qSOFA is any better than traditional screening tools.

ECLS in the ED

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Extracorporeal life support (ECLS) is being used with increasing frequency in many EDs across the US and across the World. In this podcast, we review the basics of ECLS, as well as discuss the current indications, contraindications, and complications of this critical therapy. In addition, we review some key pearls and pitfalls in the cannulation of patients for ECLS.