Critical Care Perspectives In Emergency Medicine 公開
[search 0]
もっと

Download the App!

show episodes
 
Loading …
show series
 
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 …
 
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. D…
 
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. Download Companion HandoutDownload…
 
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. Download Companion HandoutDownload…
 
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…
 
More than 3 million patients develop ARDS each year across the globe. Like any therapy, mechanical ventilation can induce further lung injury and cause patient harm if misapplied. In this podcast we bring you up to speed on the latest, evidence-based titration of mechanical ventilation in patients with ARDS. Download Companion HandoutDownload…
 
Over 80% of patients with sepsis receive care in the ED. Despite evidence demonstrating the benefits of ED sepsis resuscitation, there remains significant controversies on many aspects of ED sepsis care. In this podcast, we are joined by EM/CCM extraordinaire Dr. Gabe Wardi, who discuss an upcoming article on ED sepsis resuscitation that will have …
 
Airway guru Dr. Ken Butler joins us for this podcast to discuss some great pearls and pitfalls in intubating patients with physiologic derangements that place that at high-risk for peri-intubation catastrophes. If you intubate patients in your ED you simply CAN’T miss this episode! Download Companion HandoutDownload…
 
Despite continued advances in resuscitation, favorable outcomes for patients with OHCA who receive standard resuscitation remain dismal. In recent years there has been significant interest in the use of ECMO for OHCA. However, the evidence demonstrating the efficacy of ECMO in OHCA remains limited. In this podcast we review the recent ARREST Trial,…
 
In recent weeks, there have been several important studies and guidelines published that have served to improve our understanding of treating critically ill patients with COVID-19 infection. In this podcast, we highlight the latest update from the SSC and discuss studies on convalescent plasma and IL-6 antagonists. Download Companion HandoutDownloa…
 
Critically ill patients with acute hypoxic respiratory failure receive supplemental oxygen as a component of their treatment. In recent years, exposure to high levels of FiO2 with resultant “hyperoxia” have been associated with increased mortality in critically ill patients. At present, there is no clinical practice guideline on oxygenation targets…
 
Patients with severe aortic stenosis who present with acute decompensated heart failure are among the most challenging patients to resuscitate. In this podcast, we discuss the pearls and pitfalls in managing both the hypertensive and hypotensive patient with severe AS and acute heart failure. Download Companion HandoutDownload…
 
To say that 2020 has been a challenging year would be a gross understatement. The courage and determination that all healthcare providers have shown in confronting the COVID-19 pandemic has been nothing short of inspirational. In addition to the thousands of COVID-19 patients, we have also needed to manage many other critical illness conditions tha…
 
The period following ROSC from cardiac arrest is a time when lives can be saved…or lost. A systematic and comprehensive approach to post-arrest care is associated with improved survival to discharge with good neurologic function. In this podcast, we discuss the recently published 2020 AHA Updates to Cardiopulmonary Resuscitation and Emergency Cardi…
 
Approximately 350,000 adults in the US experience an out-of-hospital cardiac arrest (OHCA). Despite numerous potential improvements in treatments, survival from OHCA remains essentially unchanged since 2012. The American Heart Association (AHA) just released its 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. In…
 
Although electrical storm is an uncommon presentation, it is important that we readily recognize and treat these patients to prevent rapid progression to cardiac arrest. Effective management can be complex. In this podcast we discuss the management of patients with unstable and stable electrical storm. Download Companion HandoutDownload…
 
Patients with acute liver failure can be incredibly sick and have an exceedingly high mortality. Early identification and prompt, evidence-based management of the patient with acute liver failure may improve patient-centered outcomes. In this podcast, we discuss updated guidelines for the management of adult patients with acute liver failure. Key r…
 
Ketamine is a well-known anesthetic used commonly in the ED for RSI and procedural sedation. In this podcast, we review the use of ketamine in other critical illness states, such as status asthmaticus, status epilepticus, acute pain management, and acute alcohol withdrawal syndrome. Download Companion HandoutDownload…
 
Emergency department (ED) visits for critically ill patients has nearly doubled over the past decade. Unfortunately, ED boarding of critically ill patients awaiting ICU admission has also risen significantly, and is associated with several adverse patient outcomes. In this podcast, we review a white paper on boarding of the critically ill ED patien…
 
The use of tranexamic acid (TXA) has markedly increased since the results of the CRASH-II trial were published. In addition to its use in trauma, TXA has been evaluated and used in numerous other conditions, including post-partum hemorrhage and epistaxis. Recently, the HALT-IT Trial was published online in the Lancet, which evaluated the use of TXA…
 
There has been an explosion of literature on the evaluation and management of patients with COVID-19 infection. In this podcast, we discuss updates (as of June 2020) in the care of critically ill patients with COVID-19. We touch on non-invasive ventilation, mechanical ventilation, proning, and medication administration. Download Companion HandoutDo…
 
Emergency medicine, critical care, and resuscitationists often use the Shock Index to identify patients with increased mortality. The Shock Index is calculated by dividing heart rate by the systolic blood pressure, with a value > 0.8 identifying a potential critically ill patient. In the setting of sepsis, the use of systolic blood pressure to calc…
 
As we gain more experience managing critically ill patients with COVID-19 infection there has been a shift away from immediate intubation and towards more frequent use of non-invasive ventilatory strategies. Dr. Michael Allison joins CCPEM this podcast to discuss the latest evidence, controversies, and recommendations on the use of HFNC in COVID-19…
 
Currently, there is no approved treatment or proven therapy for COVID-19. As such, many have turned to treatments with little to no supporting evidence. In this podcast, we bring back EM Pharmacy extraordinaire Bryan Hayes to discuss information on the toxicities of potential therapies used in the management of patients with COVID-19. Download Comp…
 
Current guidelines for many critical illnesses recommend targeting a MAP of 65 mm Hg, with consideration of higher MAPs in older patients with chronic HTN. Recent literature, however, suggests increased mortality in older patients who are exposed to larger quantities of vasopressor medications. In this podcast, we do a deep dive into the recently p…
 
Our understanding and management of patients with COVID-19 infection continues to rapidly evolve, almost on a daily basis. In this podcast, we discuss current experience and thoughts on managing the critically ill patient with COVID-19 infection with attention to ventilator management.Critical Care Perspectives in Emergency Medicine による
 
In 2017, Paul Marik published a single-center retrospective before-and-after study that demonstrated significant mortality benefit to patients with septic shock who received a cocktail of steroids, vitamin C, and hydrocortisone. Since that time, many providers have adopted this cocktail for the treatment of septic shock, despite the fact that no ra…
 
The debate on the ideal neuromuscular blocking agent for RSI in emergency intubations rages on. In this podcast, we review the latest randomized trial comparing rocuronium with succinylcholine in out-of-hospital patients needing emergency tracheal intubation – The CURASMUR Trial. Emergency medicine airway guru Dr. Ken Butler takes us through the pa…
 
In recent years, the use of e-cigarette and vaping products has sharply risen. Concomitant with the increased use is an increase in patients presenting with severe respiratory disease associated with these products. In this podcast we review the latest information on the clinical presentation, diagnosis, and treatment of patients presenting with e-…
 
The number of critically ill cancer patients presenting to the ED is increasing. Though many of these patients are critically ill with conditions directly related to their cancer, some are sick as a result of toxicities from new therapies used to treat their cancer. Dr. Sarah Dubbs joins the podcast to discuss what we NEED to know about these new c…
 
A plethora of literature was published during the course of 2019. In this podcast, we review several key articles published in the 2019 critical care literature that pertain to the resuscitation and management of select critically ill patients. Simply a great way to start 2020! Download Companion HandoutDownload…
 
Up to one-third of patients with status epilepticus will not respond to benzodiazepines. Unfortunately, treatment of benzodiazepine-refractory status epilepticus is not well studied. The longer seizures persist, the worse patients do. In this podcast, we discuss the results of the recently completed ESETT trial that evaluated three anticonvulsant m…
 
Amniotic fluid embolism (AFE) is a catastrophic syndrome that occurs very soon after delivery and is a significant cause of morbidity and mortality. Unfortunately, the diagnosis is often missed, or at the very least delayed. In this podcast, we discuss the clinical presentation, diagnosis, and management of this critical illness. Check it out! Down…
 
Up to 25% of critically ill patients who undergo RSI and endotracheal intubation (ETI) may suffer cardiovascular collapse.? Many clinicians administer IVFs during RSI and ETI in hopes of preventing cardiovascular collapse, though this has never been studied…until now.? In this podcast we discuss the results of the recently published PrePARE Trial, …
 
Current guidelines for post-cardiac arrest management recommend TTM (32C to 36C) for all patients with coma after resuscitation from cardiac arrest. The benefit of TTM is primarily seen in patients who present with a shockable rhythm. However, nonshockable rhythms are now the most common presenting rhythm in patients with cardiac arrest. The use of…
 
Given the development of ED-ICUs and the ever increasing boarding of critically ill patients in the ED, extubation in the ED has become a more common practice. Selecting the appropriate patient and following a practical, organized approach is paramount to safely and successfully performing this procedure. In this podcast, we discuss the pearls and …
 
Over the past decade, the annual hours of critical care delivered in US emergency departments has sharply risen. Undoubtedly, many critically ill patients remain in the ED for numerous hours awaiting an ICU bed. In an attempt to improve the delivery of critical care to boarding ED patients, several hospitals and health care systems have recently im…
 
Over 500,000 patients suffer sudden cardiac arrest each year in the United States. Though survival rates are improving, there remains significant variation in outcomes by region. In recent years, numerous advances in post-resuscitation care have been associated with improved outcomes. In this podcast, we discuss the key elements of post-arrest care…
 
The World’s population is aging. By 2030, 20 percent of the US population will be over the age of 65 years. Older patients have a number of age-related physiologic changes that impact their disease presentation and resuscitation. In this podcast, we review common physiologic changes in the geriatric patient and provide critical resuscitation pearls…
 
With increasing water temperatures, there is a rise in the incidence of V.vulnificus infections in non-endemic regions. Patients with V.vulnificus infection are often critically ill, can quickly decompensate, and crash within hours. In this podcast, we discuss the clinical characteristics of this serious infection, along with the current treatments…
 
ICH accounts for approximately 15 percent of all strokes. Despite improvements in neurocritical care, the mortality for patients with ICH can still reach 50 percent at 1-year, with many left with significant residual deficits. Patients with an ICH who are taking an oral anticoagulant medication tend to have larger ICH volumes, more frequent IVH, an…
 
A critical component to post-arrest care for the patient with ROSC following out-of-hospital cardiac arrest is early coronary angiography. Current guidelines recommend immediate cardiac angiography for patients with evidence of a STEMI on their post-arrest ECG. For the more common scenario of non-diagnostic ECGs, the role of early coronary angiogra…
 
Emergency medicine, critical care, and acute care providers evaluate, resuscitate, and manage patients with shock on a daily basis. Despite initial efforts, a select number of patients are refractory to fluid and vasopressor administration. In this podcast, we discuss a rationale approach to vasopressor administration, along with several rescue the…
 
Bryan Hayes rejoins the podcast to discuss some great pearls and pitfalls with select medications used to resuscitate and treat critically ill patients. This episode contains numerous pearls that you can’t afford to miss! Download Companion HandoutDownloadCritical Care Perspectives in Emergency Medicine による
 
Renal transplants are one of the most common organ transplants worldwide. Renal transplant patients can quickly succumb to illness and present to the ED or be admitted to the ICU in need of urgent resuscitation. In this podcast, we discuss critical pearls and pitfalls in managing the renal transplant patient. Download Companion HandoutDownload…
 
Rory Spiegel (@EMNerd_) joins the podcast this month for an in-depth analysis and discussion of the recently published ANDROMEDA-SHOCK trial. Should capillary refill time replace serial lactate values for guiding the hemodynamic resuscitation of patients with septic shock? What are the limitations of this potential game-changing study? How will you…
 
More than 1.5 million patients undergo endotracheal intubation each year in the U.S. Endotracheal intubation can be complicated by hypoxemia, which is a known risk factor for peri-intubation cardiac arrest and death. Rapid sequence intubation typically involves a delay of up to 2 minutes between the administration of sedative/paralytic medications …
 
Respiratory distress in the patient with a tracheostomy can incite fear in even the most seasoned emergency physician or intensivist. In this episode, we review the initial management of respiratory distress in the trach patient, along with a review of common tracheostomy emergencies that are likely to present to your ED or ICU. Download Companion …
 
As bitter cold temperatures grip the Northeast, many struggle to stay warm and often resort to nontraditional methods of heating. As a result, there has been an increase in the number of cases of CO toxicity. In this episode, we cover what you NEED to know about diagnosing and managing the critically ill patient with CO exposure. Download Companion…
 
Loading …

クイックリファレンスガイド

Google login Twitter login Classic login