WhiteBoard Medicine - Emergency And Critical Care

Volume control or pressure control—how do you actually choose the right ventilator mode in real clinical practice? In this episode, we break down volume control and pressure control ventilation step-by-step, focusing on settings, scalars, and how to apply both modes at the bedside in the ICU and emergency department. We cover: What you set vs what is guaranteed in volume vs pressure control Key ve...

West zones of the lung are fundamental to understanding how ventilation and perfusion interact in both normal physiology and critical illness. In this episode, we break down the West zones (Zone 1, Zone 2, and Zone 3) in a simple, clinically relevant way so you can understand how blood flow is distributed throughout the lung—and why it matters at the bedside. We cover: The physiology behind the We...

Arterial blood gas (ABG) or venous blood gas (VBG)—what’s the difference, and when should you actually use each? In this episode, we walk through a complete breakdown of ABG and VBG, followed by a direct clinical comparison so you can confidently decide which test to use at the bedside. We cover: What an ABG measures and how to interpret it What a VBG tells you and how it differs Key differences i...

Cardiac output is one of the most important—and most misunderstood—concepts in critical care. In this episode, we break down cardiac output from first principles and connect it directly to cardiogenic shock, so you can understand not just the numbers—but how to apply them at the bedside. We cover: The cardiac output equation (CO = HR × SV) and what it actually means How preload, contractility, and...

The I:E ratio is one of the most important—and most misunderstood—settings in mechanical ventilation. In this episode, we break down the inspiratory-to-expiratory (I:E) ratio in a simple, practical way so you can understand how it impacts ventilation, gas exchange, and patient outcomes in the ICU and emergency department. We cover: What the I:E ratio actually represents How it affects airflow, CO₂...

Arterial blood gas (ABG) or venous blood gas (VBG)—which should you actually use in clinical practice? In this episode, we break down the key differences between ABG and VBG in a clear, practical way so you can understand when each test is appropriate in emergency and critical care settings. While ABGs are often considered the gold standard, VBGs can provide clinically useful information in many s...

In this episode, we break down mechanical ventilation from start to finish—designed specifically for your first week in the ICU. Mechanical ventilation can feel overwhelming early on, with multiple settings, modes, alarms, and physiologic concepts all happening at once. In this episode, we walk through a structured, bedside-relevant framework to help you understand what actually matters when manag...

Respiratory failure is one of the most common and high-stakes problems in emergency and critical care medicine — but understanding the different types can be confusing. In this episode, we break down Type 1–4 respiratory failure into a simple, structured framework you can actually use at the bedside. We focus on the key distinction between hypoxemic vs hypercapnic respiratory failure, how to inter...

Mechanical ventilation is a core skill in critical care and emergency medicine—but the ventilator can feel overwhelming when you’re first learning it. In this episode, we break down the essential ventilator settings—PEEP, FiO₂, respiratory rate (RR), and tidal volume (TV)—in a way that’s simple, practical, and directly applicable at the bedside. We focus on building a clear mental model of how the...

Understanding stressed vs unstressed volume is one of the most important—and most misunderstood—concepts in hemodynamics and shock. In this episode, we break down how venous capacitance, mean systemic filling pressure (MSFP), and venous returnactually work, and why they matter for managing critically ill patients in the ICU and emergency department. We focus on translating physiology into practica...

In this episode, we break down non-invasive fluid assessment at the bedside, focusing on IVC ultrasound, VExUS (Venous Excess Ultrasound Score), and the passive leg raise (PLR). We walk through how to evaluate fluid responsiveness vs fluid tolerance, when each tool works (and when it fails), and how to integrate these approaches into a practical, physiology-based framework for critically ill patie...

In this episode, we break down ventilator-induced lung injury (VILI) and how mechanical ventilation can contribute to lung damage in critically ill patients. We walk through the core mechanisms of VILI—including volutrauma, barotrauma, atelectrauma, and biotrauma—and then build a deeper understanding using the concepts of driving pressure and mechanical power. These frameworks help connect individ...

In this episode, we break down sickle cell crisis and life-threatening complications, including vaso-occlusive crisis (VOC), acute chest syndrome (ACS), splenic sequestration, aplastic crisis, and infection. We walk through the underlying pathophysiology of sickle cell disease, why these emergencies occur, and how to recognize and manage them in the emergency department and ICU. This is a high-yie...

In this episode, we break down how to assess fluid status at the bedside using IVC ultrasound and VExUS (Venous Excess Ultrasound Score). We walk through how to interpret IVC diameter and collapsibility, when it works (and when it doesn’t), and how VExUS expands your assessment by integrating hepatic vein, portal vein, and renal venous Doppler to evaluate venous congestion and fluid tolerance. Thi...

In this episode, we break down mechanical power in mechanical ventilation and its role in ventilator-induced lung injury (VILI). We walk through how ventilator settings—including tidal volume, respiratory rate, PEEP, and driving pressure—combine to deliver energy to the lungs, and why thinking in terms of total energy delivery may be key to preventing lung injury in critically ill patients. Rather...

TEG and ROTEM (viscoelastic testing) can fundamentally change how we approach coagulation — but only if we understand how to interpret them and act on the results. In this episode, we break down viscoelastic testing from the ground up, then walk step-by-step through how to choose the right blood product based on real physiology — not guesswork. We cover: What TEG & ROTEM actually measure How t...

Vasopressin is often thought of as just a “second-line pressor” — but its physiology and clinical applications are far more nuanced. In this episode, we break down vasopressin from the ground up, starting with receptor-level physiology and how it differs from catecholamines, then build into a focused deep dive on one of its most important uses: right ventricular (RV) failure and pulmonary hyperten...

In this episode, we break down VExUS ultrasound (Venous Excess Ultrasound Score) and how to assess venous congestion at the bedside in critically ill patients. We walk through the physiology of venous congestion and how to integrate IVC ultrasound, hepatic vein Doppler, portal vein Doppler, and renal venous Doppler into a practical framework for evaluating fluid tolerance vs fluid overload. This i...

Viscoelastic testing with TEG (thromboelastography) and ROTEM (rotational thromboelastometry) is changing how we approach coagulopathy, bleeding, and massive transfusion in the ICU and trauma setting. In this episode, we break down TEG and ROTEM in a simple, practical way so you can confidently interpret results and apply them at the bedside. We cover: The fundamentals of viscoelastic testing phys...

Stress ulcer prophylaxis is one of the most common interventions in the ICU — but also one of the most overused and misunderstood. In this episode, we break down when stress ulcer prophylaxis is actually indicated, what medications to use, and what the evidence really shows so you can make better bedside decisions. We cover: The pathophysiology of stress-related mucosal disease (SRMD) and GI bleed...

Vasopressin plays a unique and often underutilized role in the management of right ventricular (RV) failure, particularly in patients with pulmonary hypertension, massive pulmonary embolism, and RV shock. In this episode, we break down why vasopressin works differently from other vasopressors, how it affects pulmonary vs systemic vascular resistance, and when it may be the preferred agent in right...

ICU pharmacology can feel overwhelming—sedation, vasopressors, fluids, and dozens of medications interacting in critically ill patients. In this episode, we break down ICU pharmacology into three foundational domains that form the backbone of bedside critical care: Sedation and analgesia (propofol, fentanyl, dexmedetomidine) Vasopressors and inotropes (norepinephrine, vasopressin, epinephrine, dop...

In this episode of Whiteboard Medicine, we break down the fundamentals of arterial line monitoring and how to interpret the arterial pressure waveform at the bedside. Arterial lines are one of the most powerful tools for managing critically ill patients in the ICU, emergency department, and operating room, but accurate interpretation requires understanding the underlying hemodynamic physiology. In...

Continuous Renal Replacement Therapy (CRRT) is one of the most important dialysis therapies used in the ICU for critically ill patients with acute kidney injury (AKI), septic shock, metabolic acidosis, and fluid overload. In this complete ICU guide, we cover everything you need to know about CRRT, including: • CRRT basics and core physiology • Indications for CRRT in the ICU • CRRT prescription fu...

Continuous Renal Replacement Therapy (CRRT) is one of the most important dialysis therapies in critical care and the ICU — yet many clinicians struggle to understand the differences between CVVH, CVVHD, and CVVHDF. In this CRRT Masterclass, we provide a complete guide to: • CVVH (convection-based CRRT) • CVVHD (diffusion-based CRRT) • CVVHDF (combined diffusion + convection) • CRRT physiology and...