Critical Care Perspectives in Emergency Medicine

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 pl...

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,...

Both etomidate and propofol are commonly used sedative agents in critically ill patients.  Recent literature has suggested that these agents may result in increased harm and mortality.  In this podcast, we discuss the most recent two systematic reviews and meta-analyses that evaluated etomidate and propofol in critically ill patients.  Do we need to change our practice?

The use of steroids in patients with sepsis and septic shock has been controversial for decades. At present, the Surviving Sepsis Campaign recommends the administration of corticosteroids to patients with persistent shock despite fluid and vasopressor administration. In recent years, several trials have evaluated the addition of fludrocortisone, a potent mineralocorticoid, to hydrocortisone in sep...

In recent years,  numerous trials have investigated the administration of corticosteroids in patients with pneumonia and have produced mixed results.   In this podcast, we discuss the latest randomized trial, the CAPE COD trial, that evaluated whether the administration of hydrocortisone to ICU patients with severe CAP reduced mortality.   Is this a therapy we should look to administer in the E...

In recent years, several single center trials have demonstrated positive outcomes in patients with OHCA randomized to receive ECPR compared with patients who received standard resuscitation.   Not surprisingly, these single center studies have limitations that impact the generalizability of these results.   In the current podcast, we discuss the recently published INCEPTION Trial, which is a m...

Intravenous fluid (IVF) administration is a central tenet to the resuscitation of patients with sepsis and sepsis-induced hypotension.  At present, the administration of large volumes of IVF is common, though based on low quality of evidence.  In this podcast, we review and interpret the recently published CLOVERS Trial, which compared the use of a liberal fluid strategy with a restricti...

Given the increase in critically ill patients who present to the ED in need of resuscitation, along with the increase in those who board in the ED awaiting an ICU bed, it is imperative that the emergency physician be knowledgeable about recent literature in resuscitation and critical care medicine. In this podcast, we discuss important articles published in 2022 that pertain to care of critically...

More than 350,000 cardiac arrests occur each year in North America.   Approximately 100,000 of these arrests are due to shockable rhythms.   Unfortunately, many patients have refractory ventricular fibrillation and do not respond to many attempts at standard defibrillation.   In this podcast, we discuss a recent study that evaluated double sequential external defibrillation and vector-change de...

Approximately 3 million critically ill patients are intubated and initiated on mechanical ventilation each year in the United States. A critical component of mechanical ventilation is the adjustment of FiO2 to maintain adequate arterial oxygen saturation.   However, the optimal oxygenation target in critically ill adult patients receiving mechanical ventilation remains uncertain. In this podcast...

The emergency department resuscitation of patients with sepsis focuses on early recognition, timely administration of appropriate antibiotics, appropriate fluid resuscitation, early vasopressor initiation for patients with sepsis-induced hypoperfusion, and hemodynamic monitoring.  Source control is also an important component in the resuscitation of patients with sepsis.  Thoug...

The care of patients with return of spontaneous circulation following cardiac arrest centers on optimizing oxygenation and ventilation, optimizing hemodynamics, identifying patients that require immediate coronary angiography, detecting seizures, and targeted temperature management.   In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.   In...

The care of patients with return of spontaneous circulation following cardiac arrest centers on optimizing oxygenation and ventilation, optimizing hemodynamics, identifying patients that require immediate coronary angiography, detecting seizures, and targeted temperature management.   In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.   In...

Approximately 2 million adult patients undergo intubation in the United States each year.   Hypotension and cardiovascular collapse may occur in up to 40% of critically ill patients in the ICU who undergo intubation.   Guidelines and expert recommendations often suggest the administration of IVFs during RSI to prevent cardiovascular collapse.   However, a recent trial found that an IVF bolus du...

Transcatheter aortic valve replacement is now more common than open surgical replacement and may be associated with lower mortality.   Given the significant increase in TAVRs it is imperative to be knowledgeable on the complications that may occur following TAVR and result in patients presenting to acute care settings for evaluation and treatment.   In this podcast we review an outstanding recen...

IVF administration is central to the management of patients with sepsis.  Though the Surviving Sepsis Campaign recently downgraded its recommendation on the amount of initial fluid administration, there are currently no recommendations on a fluid strategy for septic patients who continue to demonstrate hypoperfusion after the initial fluid bolus.  In this podcast we discuss the recently...

Approximately 2 million patients present each year to EDs in the United States for acute asthma exacerbations.  Of these, up to 50,000 may require ICU admission for continued care and resuscitation.  The management of critically ill asthmatic patients can be fraught with peril.  In this podcast we discuss the assessment and management of patients presenting with a severe asthma exac...

In a recent podcast we reviewed the ARREST Trial, which demonstrated significant improvement in survival among OHCA patients at a single center randomized to ECPR and early coronary angiography upon arrival.   In this podcast we discuss the latest trial to investigate whether a bundle of early transport, ECPR, and coronary angiography improves favorable neurologic survival in patients with refra...

Though low-tidal volume ventilation has been shown to decreased mortality in patients with ARDS, the use of these settings in mechanically ventilated ED patients has been variable.   In this podcast, we discuss a recent systematic review that examined the effect of low-tidal volume ventilation in the ED on clinical outcomes including mortality, length of stay, occurrence of ARDS, and duration of...

Though we've discussed the use of balanced solutions in the resuscitation of critically ill patients numerous times on CCPEM, the literature remains controversial with mixed results as to which IVFs are superior.  In this podcast, we discuss the latest randomized trial, the PLUS Study, comparing the use of balanced multielectrolyte solution and 0.9% normal saline.

Hyperglycemic hyperosmolar syndrome (HHS) is a potentially life-threatening hyperglycemic emergency that has a mortality that can be 10 times as high compared with patients who have diabetic ketoacidosis. Resuscitation of these complex patients can be fraught with peril and result in patient harm and poor outcomes.  In this podcast, we discuss the identification and resuscitation of pati...

Etomidate and ketamine are frequently used for RSI in critically ill patients.   Recent articles have raised concern about an increased incidence of post-intubation hypotension in patients who receive ketamine for RSI.  Notwithstanding, is either agent superior for RSI in the critically ill?   In this podcast we discuss the recently published EvK trial, which evaluated etomidate and ketamine fo...

While COVID continued to be predominant in 2021, a number of important articles that pertained to various aspects of critical care and resuscitation were published.   In this podcast, we review a few important trials that were published in 2021 and their impact upon the management of select critical illnesses.

Resuscitating the sick patient and providing ongoing critical care is incredibly challenging in critical access locations and resource limited EDs.  In this podcast, we interview Dr. Eric Klotz who has runs a hugely successful mobile critical care team that provides ongoing critical care and resuscitation to patients requiring transfer from resource limited settings.

In this podcast we are joined by EM/CCM superstars Dr. Gabe Wardi and Dr. Kit Tainter, who discuss the physiologic effects of metabolic acidosis, the rationale for sodium bicarbonate administration, and its use in select critical illness states.  An awesome podcast to start of 2022!