Critical Care Perspectives in Emergency Medicine

More than 1.5 million patients are intubated each year in the United States.  In up to 20% of patients, the first attempt at intubation is not successful and places patients at risk for peri-intubation cardiovascular collapse and death.  In recent years, many providers have used the bougie as either a rescue device for failed attempts or during the initial attempt at intubation...

The COVID-19 pandemic continues to affect millions of patients worldwide.   While the majority of children have milder illness compared with adults, some develop multisystem inflammatory syndrome with a significant increase in morbidity and mortality.   In this podcast, we discuss a recent review article on MIS-C as it pertains to the pediatric patient with COVID-19.

Hyperkalemia is a life-threatening electrolyte disorder that is commonly encountered in the ED and ICU.  In this podcast we review the latest evidence in the management of hyperkalemia based on a recently published consensus-based panel. https://ccpem.blog/wp-content/uploads/2021/11/CCPEM-Hyperkalemia-in-the-Emergency-Department.pdf

In 2009 and 2013 investigators published studies that demonstrated improved outcomes in patients with IHCA who received vasopressin and steroids in addition to epinephrine.   However, both US and European cardiac arrest guidelines have not endorsed these medications due to lack of additional evidence.   In this podcast we discuss the recently published VAM-IHCA trial, which evaluated vasopressin...

Hemodynamic management of patients with cardiogenic shock centers on vasopressors, inotropes, and mechanical circulatory devices.   With respect to inotropic medications, there is little data to guide optimal management and selection of agents.   In this podcast we discuss the results of a recent trial that compared milrinone with dobutamine for patients with cardiogenic shock.   Which agent wa...

The COACT trial demonstrated no improvement in 90-day mortality for post-arrest patients without evidence of an ST-segment elevation MI who were randomized to immediate or delayed coronary angiography.   However, the COACT Trial included only OHCA with a shockable rhythm and overall had a very low number of patients that had an acute thrombus at the time of angiography.   In this podcast, we dis...

The administration of IVFs is nearly universal in critically ill patients.  In recent years, several studies have suggested improved outcomes with the use of balanced crystalloids solutions in contrast to 0.9% NS.  In this podcast, we discuss the recently published BaSICS Trial that evaluated Plasma-Lyte 148 with 0.9% NS in critically ill patients.  Does this study provide practice-...

Traumatic hemothorax has traditionally been treated with a large bore thoracostomy to prevent retained hemothorax and morbidity.  In this podcast we discuss the results of a recent study on the use of small bore thoracostomy (pigtail catheters) for the treatment of traumatic hemothorax.

Ventilated ED patients may be at high risk for awareness with paralysis, thereby increasing the risk of long-term psychological sequelae.  In this podcast, we discuss the results of the recently published ED-AWARENESS Study and its implications for managing the ventilated ED patient.

Current international guidelines recommend TTM for adult patients with ROSC from OHCA who remain comatose or unable to follow verbal commands.   However, the overall level of evidence for this recommendation remains of low certainty.   In this podcast, we discuss the results of the recently published TTM2 Trial and its implications on the management of post-cardiac arrest patients.