Critical Care Perspectives in Emergency Medicine

Acute hypoxemic respiratory failure is a leading cause of ICU admission worldwide.  Oxygen is first-line therapy for patients with acute hypoxemic respiratory failure and can be given via nasal cannula (NC), non-rebreather mask (NRB), high-flow nasal cannula (HFNC), or noninvasive ventilation (NIV). At present, the literature is inconsistent on which mode of oxygen therapy reduces mortality.&...

Nearly 200,000 patients are admitted to the hospital each year in the United States for acute asthma exacerbations.  Approximately 2% of patients are intubated and placed on mechanical ventilation. In-hospital mortality is nearly 100 times higher when a patient with acute asthma exacerbation is intubated.  Non-invasive positive pressure ventilation is well known to improve outcomes for patients wi...

Accurate assessment of intravascular volume is critical in managing sick patients in the emergency department or intensive care unit.   In this podcast we discuss a recently published article that evaluates clinical exam, radiographic, point-of-care ultrasound, and laboratory findings in the assessment of intravascular volume overload.

Each year, hundreds of articles are published that pertain to the resuscitation and care of critically ill emergency department patients. In this podcast, we review the key articles from the 2025 emergency medicine, resuscitation, and critical care literature that pertain to the care of critically ill ED patients.

More than 600,000 patients in North America sustain sudden cardiac arrest each year.  When return of spontaneous circulation (ROSC) is achieved, there are a number of critical interventions to consider in order to provide the patient with the best chance of being discharged with meaningful neurologic survival.  In this podcast, we discuss an excellent recent review article on the management of pat...

Emergency physicians intubate critically ill patients daily.  Unfortunately, up to 17% of ED intubations can be complicated by peri-intubation hypoxemia, hypotension, and cardiac arrest. Efforts to optimize patient's physiology prior to rapid sequence intubation are critical in mitigating the risk of potentially disastrous peri-intubation complications.  In this podcast, we discuss a recent Clinic...

Oxygen is one of the most used, and misused, therapies delivered to critically ill patients.  In recent years, a number of trials have compared the use of a conservative oxygen therapy strategy with a liberal oxygen therapy strategy.  These trials have produced mixed results and the optimal oxygen strategy for critically ill patients remains unknown.  In this podcast, we discuss the latest study,...

Critically ill patients receiving mechanical ventilation require analgesia and sedation.  At present, propofol remains the most widely used sedative for intubated/ventilated patients.  Recent trials have suggested that dexmedetomidine may reduce delirium and the duration of mechanical ventilation compared with other sedative medications.  In fact, recent SCCM guidelines suggest the...

Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death.  While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings.  As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members.  In this podcast, we...

Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis.  Curren...

Nearly 4 million patients sustain out-of-hospital cardiac arrest (OHCA) worldwide each year.  International guidelines for the resuscitation of patients with OHCA recommend early administration of epinephrine in those with an initial nonshockable rhythm.  Both intravenous (IV) and intraosseous (IO) access are routinely attempted to gain vascular access to administer medications.  While IV access i...

Both NIV and HFNC are used to treat patients with acute respiratory failure.  Current guidelines recommend NIV for acute respiratory failure caused by COPD and acute cardiogenic pulmonary edema.  However, NIV may be hard for some patients to tolerate. When compared to low-flow oxygen therapy, HFNC has been shown to improve oxygenation, improve alveolar recruitment, and enhance clearance of secreti...

NIPPV is frequently used in the management of critically ill patients presenting with an acute COPD exacerbation, as NIPPV decreases the rates of intubation and is associated with lower in-hospital mortality.  Typically, "low" intensity NIPPV, whereby inspiratory positive airway pressures less than 18 cm H2O are used. More recently, the use of "high" intensity NIPPV, with IPAPs between 20-30 cm H2...

The incidence of opioid-associated out-of-hospital cardiac arrests continues to rise.  Current guidelines for the resuscitation of patients with OHCA advise the clinician to consider the administration of naloxone of patients with suspected opioid-associated OHCA.  In this podcast, we review a recenlty published study in JAMA that evaluated the association of naloxone with patient outcomes in opio...

Timely administration of broad-spectrum antibiotics is a critical pillar in the resuscitation of patients with sepsis.  B-lactam antibiotics are an important class of antibiotics commonly administered to patients with sepsis.  Typically, B-lactam antibiotics are administered over 30 minutes, but optimal bactericidal activity requires the concentration of free drug to be above the MIC of the organi...

Patients with COVID-19 can require supplemental oxygen for acute hypoxemic respiratory failure.  While international guidelines recommend a target SpO2 between 90-96%, a safe oxygenation strategy has not been identified.  In this podcast, we discuss the recently published HOT-COVID Trial, which compared a lower oxygenation strategy with a higher oxygenation strategy in adult ICU patients with COVI...

Over 1 million critically ill patients are intubated each year in the US.  Hypoxemia occurs in up to 20% of patients and can lead to peri-intubation cardiovascular collapse and cardiac arrest.  As such, adequate and appropriate preoxygenation is critical in increasing the safe apnea time and decreasing the risk of hypoxemia.  At present, the majority of patients receive preoxygenati...

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...

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 outc...

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...

In this podcast we review a few key articles from the 2023 critical care, emergency medicine, and resuscitation literature that pertain to our care of the critically ill ED patient.

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 a...

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 surprised...

RSI is one of the most common procedures in critically ill patients.  Despite its frequency, there remains significant practice variation on numerous aspects of RSI in the critically ill.  In this podcast, we review pertinent recommendations from the recently published SCCM Guidelines on RSI in the critically ill patient.

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...