WhiteBoard Medicine - Emergency And Critical Care

Shock is a life-threatening state of circulatory failure that requires rapid recognition and a strong understanding of underlying physiology. In this episode, we provide a clear, structured ICU starter guide to shock, focusing on how and why patients deteriorate and how to intervene effectively at the bedside. We begin with the core physiology of shock and mechanisms of impaired tissue perfusion,...

Septic shock is one of the most common and deadly emergencies encountered in critical care, yet early missteps in diagnosis and management can dramatically worsen outcomes. In this episode, we walk through septic shock step by step, focusing on how to recognize it, how to manage it effectively, and the most common mistakes clinicians make along the way. We start by reviewing the physiology of sept...

Extracorporeal membrane oxygenation (ECMO) is one of the most complex and powerful tools in critical care—but also one of the most misunderstood. In this episode, we break down ECMO step by step, focusing on VA-ECMO, VV-ECMO, how they work, and when to use each configuration. We start with the fundamentals of ECMO physiology and circuit components, then walk through veno-arterial (VA) ECMO for car...

Septic shock management is complex, and many poor outcomes stem from preventable management errors rather than delayed recognition. In this episode, we break down the most common mistakes clinicians make when managing septic shock, using a physiology-driven framework relevant to both the emergency department and ICU. We discuss pitfalls related to fluid resuscitation, delayed or inappropriate vaso...

Metformin-associated lactic acidosis (MALA) is rare, but when it occurs, it carries significant morbidity and mortality. In this episode, we walk through a practical, clinician-focused approach to recognizing and managing MALA in the emergency department and ICU. We review the pathophysiology behind metformin-related lactic acidosis, common risk factors and precipitating conditions, and the clinic...

Shock management is where small clinical decisions can have outsized consequences. In this episode, we break down four common mistakes clinicians make when managing patients in shock, with a focus on physiology-driven decision making rather than protocol-only care. We discuss the consequences of ignoring right ventricular failure, delaying vasopressors, treating mean arterial pressure instead of t...

Veno-venous ECMO (VV-ECMO) is primarily a respiratory support modality, but its physiology is often oversimplified. In this episode, we walk through VV-ECMO from a practical, clinician-focused perspective. We discuss what VV-ECMO is, how the circuit is configured, key anatomic considerations for cannulation, and the core components of the system. We also review common VV-ECMO settings and how chan...

VA-ECMO explained in under 10 minutes. We cover what VA-ECMO is, vascular anatomy and cannulation, core circuit components, and key ECMO settings used in emergency and critical care medicine. In this episode, we break down: What veno-arterial ECMO (VA-ECMO) is and when it’s used Anatomy & cannulation strategy (venous drainage, arterial return) Core VA-ECMO components (cannulae, pump, oxygenato...

Assessing tissue perfusion is central to managing shock and critical illness. In this comprehensive episode, we review lactate, capillary refill time (CRT), and then directly compare the two bedside perfusion markers, focusing on how to interpret them in emergency and critical care settings. We cover: • Lactate physiology and causes of elevation • Type A vs Type B lactic acidosis • Prognostic valu...

Pulse pressure is an often overlooked but powerful bedside vital sign that provides insight into stroke volume, vascular tone, and shock physiology. In this episode, we break down pulse pressure from first principles, focusing on how to interpret it in emergency and critical care settings. We cover: • What pulse pressure represents physiologically • Normal vs abnormal pulse pressure values • Narro...

Lactate and capillary refill time (CRT) are two of the most commonly used markers to assess tissue perfusion and shock—but they reflect very different physiology. In this episode, we directly compare lactic acid and capillary refill time, exploring what each represents, their strengths and limitations, and how to use them together at the bedside. We cover: • What lactate represents physiologically...

Stress-dose steroids are commonly discussed in emergency medicine but often misunderstood or inconsistently applied. In this episode, we review three high-yield clinical scenarios in the emergency department where stress-dose steroids may be considered, focusing on physiology, evidence, and practical bedside decision-making. We cover: • What stress-dose steroids are and why they are used • Septic...

Capillary refill time (CRT) is a simple bedside exam that provides powerful insight into tissue perfusion and shock physiology. In this comprehensive review, we break down everything folks need to know about CRT, including how to measure it correctly, how to interpret abnormal values, and how it compares to traditional markers of perfusion. We cover: • What capillary refill time represents physiol...

Lactate is one of the most commonly ordered labs in emergency medicine and critical care—yet it’s often misunderstood. In this comprehensive review, we break down everything clinicians need to know about lactate and lactic acidosis, from basic physiology to prognostic significance in critical illness. We cover: • What lactate is and how it’s produced • Aerobic vs anaerobic lactate generation • Typ...

Refractory hypoxemia that does not improve with supplemental oxygen should immediately raise concern for a right-to-left shunt. In this ED and ICU case review, we walk through a patient with acute pulmonary embolism causing severe hypoxemia due to intracardiac shunting, reviewing the underlying physiology, diagnostic approach, and management considerations. We break down: • Mechanisms of refractor...

Mechanical ventilation saves lives — but small ventilator mistakes can cause major patient harm. In this episode, we break down 8 common ventilator mistakes that clinicians frequently make in the ICU and emergency department, and explain why they matter physiologically. We cover errors related to tidal volume, PEEP, oxygenation vs ventilation, respiratory rate, patient–ventilator dyssynchrony, hem...

Positive end-expiratory pressure (PEEP) is one of the most powerful — and misunderstood — tools in mechanical ventilation. In this episode, we break down how PEEP works, why it improves oxygenation, and when it can actually harm patients. We’ll walk through: • How PEEP recruits alveoli and improves oxygenation • The relationship between PEEP, lung compliance, and overdistension • How excessive PEE...

Occult cardiogenic shock is one of the most commonly missed shock states in Emergency Medicine and Critical Care. These patients may appear “stable” — with near-normal blood pressure — yet have severe cardiac dysfunction, low cardiac output, and poor tissue perfusion. In this episode, we break down: 🔹 What occult cardiogenic shock actually is 🔹 Why blood pressure alone is misleading 🔹 The under...

Shock is a life-threatening condition encountered daily in Emergency Medicine, Critical Care, and the ICU — yet it’s often taught in fragmented algorithms rather than unified physiology. In this episode, we break down all major shock states in a clear, structured way: 🔹 Hypovolemic shock 🔹 Cardiogenic shock 🔹 Obstructive shock 🔹 Distributive shock (septic, anaphylactic, neurogenic) 📚 MINI COU...

This episode is a comprehensive, high-yield guide to ICU basics, designed for medical students, nurses, APCs, interns, residents, emergency medicine physicians, intensivists, and critical care trainees. We walk step-by-step through the core foundations of ICU care, focusing on physiology-driven decision-making and practical bedside management. Topics include mechanical ventilation, shock, vasopres...

Hypovolemic shock is a life-threatening condition caused by a critical reduction in intravascular volume, leading to decreased preload, reduced cardiac output, and impaired tissue perfusion. One of the most severe and common forms is hemorrhagic shock. In this episode, we begin with a high-yield overview of hypovolemic shock, reviewing core physiology, compensatory mechanisms, hemodynamic patterns...

Understanding oxygen content is essential to interpreting pulse oximetry, arterial blood gases, and tissue oxygen delivery. In this video, we walk step-by-step through capillary gas exchange, oxygen content, hemoglobin physiology, and the oxyhemoglobin dissociation curve, tying physiology directly to clinical practice. 📚 MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL...

Mechanical ventilation doesn’t have to feel overwhelming. In this episode, we break down mechanical ventilation from the big-picture perspective, focusing on how all the pieces fit together rather than memorizing isolated settings. We cover the core concepts that actually matter at the bedside, including: • How mechanical ventilation works • Common ventilator modes (AC, PC, APRV, pressure support)...

Heart failure and cardiogenic shock exist on the same disease spectrum, yet they’re often taught separately. In this episode, we bring them together into a single, cohesive framework that explains how heart failure progresses to cardiogenic shock — and how to manage both at the bedside. Topics covered include: • Heart failure pathophysiology (HFrEF vs HFpEF) • Preload, afterload, contractility, an...

Mechanical ventilation has many different modes and settings. In this video we dive into the foundational settings that everyone should know - PEEP, FiO2, Respiratory Rate, Tidal Volume, and Inspiratory Pressure. We touch on how these settings may differ between modes of ventilation, such as volume control and pressure control. We talk about normal values and ranges of values. We also discuss whic...