Critical Care Perspectives in Emergency Medicine Castos https://ccpem.blog Critical Care Guys: The Minds Behind Critical Care Perspectives in Emergency Medicine. 4 Docs come together to discuss current trends in Emergency Medicine. Check out this podcast to stay up-to-date on the goings ons. Wed, 08 Apr 2026 00:46:17 +0000 en-us © 2021 US https://episodes.castos.com/ccpem/images/ccpemlogopod.jpg Critical Care Perspectives in Emergency Medicine https://ccpem.blog Critical Care Guys: The Minds Behind Critical Care Perspectives in Emergency Medicine. 4 Docs come together to discuss current trends in Emergency Medicine. Check out this podcast to stay up-to-date on the goings ons. Critical Care Perspectives in Emergency Medicine episodic Critical Care Guys: The Minds Behind Critical Care Perspectives in Emergency Medicine. 4 Docs come together to discuss current trends in Emergency Medicine. Check out this podcast to stay up-to-date on the goings ons. Critical Care Perspectives in Emergency Medicine ccpemergencymedicine@gmail.com false https://feeds.castos.com/61ov yes <![CDATA[Should We Use NIPPV For Asthma?]]> Wed, 08 Apr 2026 00:46:17 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2415998 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-use-nippv-for-asthma Nearly 200,000 patients are admitted to the hospital each year in the United States for acute asthma exacerbations.  Approximately 2% of patients are intubated and placed on mechanical ventilation. In-hospital mortality is nearly 100 times higher when a patient with acute asthma exacerbation is intubated.  Non-invasive positive pressure ventilation is well known to improve outcomes for patients with an acute COPD exacerbation or with acute cardiogenic pulmonary edema. In contrast, the data on NIPPV for acute asthma is limited and remains debated. In this podcast, we discuss the latest study on the use of NIPPV in acute exacerbations of asthma.

]]> false Nearly 200,000 patients are admitted to the hospital each year in the United States for acute asthma exacerbations.  Approximately 2% of patients are intubated and placed on mechanical ventilation. In-hospital mortality is nearly 100 times higher when a patient with acute asthma exacerbation is intubated.  Non-invasive positive pressure ventilation is well known to improve outcomes for patients with an acute COPD exacerbation or with acute cardiogenic pulmonary edema. In contrast, the data on NIPPV for acute asthma is limited and remains debated. In this podcast, we discuss the latest study on the use of NIPPV in acute exacerbations of asthma.

]]> 00:26:32 <![CDATA[Is This Patient Volume Overloaded?]]> Thu, 12 Mar 2026 18:03:46 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2392454 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/is-this-patient-volume-overloaded Accurate assessment of intravascular volume is critical in managing sick patients in the emergency department or intensive care unit.   In this podcast we discuss a recently published article that evaluates clinical exam, radiographic, point-of-care ultrasound, and laboratory findings in the assessment of intravascular volume overload.

]]> false Accurate assessment of intravascular volume is critical in managing sick patients in the emergency department or intensive care unit.   In this podcast we discuss a recently published article that evaluates clinical exam, radiographic, point-of-care ultrasound, and laboratory findings in the assessment of intravascular volume overload.

]]> 00:24:04 <![CDATA[2025: A Year in Review]]> Wed, 25 Feb 2026 13:15:23 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2373485 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/2025-a-year-in-review Each year, hundreds of articles are published that pertain to the resuscitation and care of critically ill emergency department patients. In this podcast, we review the key articles from the 2025 emergency medicine, resuscitation, and critical care literature that pertain to the care of critically ill ED patients.

]]> false Each year, hundreds of articles are published that pertain to the resuscitation and care of critically ill emergency department patients. In this podcast, we review the key articles from the 2025 emergency medicine, resuscitation, and critical care literature that pertain to the care of critically ill ED patients.

]]> 00:55:05 <![CDATA[Caring for the Patient with ROSC]]> Sat, 22 Nov 2025 14:39:13 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2237094 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/caring-for-the-patient-with-rosc More than 600,000 patients in North America sustain sudden cardiac arrest each year.  When return of spontaneous circulation (ROSC) is achieved, there are a number of critical interventions to consider in order to provide the patient with the best chance of being discharged with meaningful neurologic survival.  In this podcast, we discuss an excellent recent review article on the management of patients with ROSC following cardiac arrest.

]]> false More than 600,000 patients in North America sustain sudden cardiac arrest each year.  When return of spontaneous circulation (ROSC) is achieved, there are a number of critical interventions to consider in order to provide the patient with the best chance of being discharged with meaningful neurologic survival.  In this podcast, we discuss an excellent recent review article on the management of patients with ROSC following cardiac arrest.

]]> 00:46:56 <![CDATA[Critical Issues in ED Intubation]]> Wed, 15 Oct 2025 15:38:39 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2165844 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/critical-issues-in-ed-intubation Emergency physicians intubate critically ill patients daily.  Unfortunately, up to 17% of ED intubations can be complicated by peri-intubation hypoxemia, hypotension, and cardiac arrest. Efforts to optimize patient's physiology prior to rapid sequence intubation are critical in mitigating the risk of potentially disastrous peri-intubation complications.  In this podcast, we discuss a recent Clinical Policy from the American College of Emergency Physicians that addresses critical issues in the management of adult ED patients undergoing endotracheal intubation.  

]]> false Emergency physicians intubate critically ill patients daily.  Unfortunately, up to 17% of ED intubations can be complicated by peri-intubation hypoxemia, hypotension, and cardiac arrest. Efforts to optimize patient's physiology prior to rapid sequence intubation are critical in mitigating the risk of potentially disastrous peri-intubation complications.  In this podcast, we discuss a recent Clinical Policy from the American College of Emergency Physicians that addresses critical issues in the management of adult ED patients undergoing endotracheal intubation.  

]]> 00:34:24 <![CDATA[Dexmedetomidine or Propofol for Sedation in the Critically Ill?]]> Mon, 07 Jul 2025 13:55:51 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2082631 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/dexmedetomidine-or-propofol-for-sedation-in-the-crit7lx Critically ill patients receiving mechanical ventilation require analgesia and sedation.  At present, propofol remains the most widely used sedative for intubated/ventilated patients.  Recent trials have suggested that dexmedetomidine may reduce delirium and the duration of mechanical ventilation compared with other sedative medications.  In fact, recent SCCM guidelines suggest the use of dexmedetomidine over propofol in intubated patients.  In this podcast, we discuss a recent randomized trial that compared the effectiveness and safety of a dexmedetomidine-based sedation strategy with a propofol-based sedation strategy in mechanically ventilated critically ill patients.

]]> false Critically ill patients receiving mechanical ventilation require analgesia and sedation.  At present, propofol remains the most widely used sedative for intubated/ventilated patients.  Recent trials have suggested that dexmedetomidine may reduce delirium and the duration of mechanical ventilation compared with other sedative medications.  In fact, recent SCCM guidelines suggest the use of dexmedetomidine over propofol in intubated patients.  In this podcast, we discuss a recent randomized trial that compared the effectiveness and safety of a dexmedetomidine-based sedation strategy with a propofol-based sedation strategy in mechanically ventilated critically ill patients.

]]> 00:21:54 <![CDATA[Palliative Care in the ED]]> Sat, 17 May 2025 19:46:38 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2041873 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/palliative-care-in-the-ed Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death.  While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings.  As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members.  In this podcast, we review the recently published PRIM-ER trial, which evaluated the impact of a robust primary palliative care intervention on hospital admission rates in 29 EDs across the US.

]]> false Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death.  While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings.  As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members.  In this podcast, we review the recently published PRIM-ER trial, which evaluated the impact of a robust primary palliative care intervention on hospital admission rates in 29 EDs across the US.

]]> 00:26:02 <![CDATA[When Should We Start Vasopressin in Septic Shock?]]> Tue, 15 Apr 2025 16:52:49 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/2013725 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/when-should-we-start-vasopressin-in-septic-shock Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis.  Current guidelines then recommend vasopressin as the second-line vasopressor agent, but the optimal timing of its initiation remains unknown. In this podcast, we discuss a recent article on the use of a machine learning tool for vasopressin administration to optimize short- and long-term outcomes in patients with sepsis.

]]> false Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis.  Current guidelines then recommend vasopressin as the second-line vasopressor agent, but the optimal timing of its initiation remains unknown. In this podcast, we discuss a recent article on the use of a machine learning tool for vasopressin administration to optimize short- and long-term outcomes in patients with sepsis.

]]> 00:25:31 <![CDATA[Is HFNC noninferior to NIV for Acute Respiratory Failure?]]> Fri, 24 Jan 2025 15:43:55 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1949544 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/is-hfnc-noninferior-to-niv-for-acute-respiratory-failure Both NIV and HFNC are used to treat patients with acute respiratory failure.  Current guidelines recommend NIV for acute respiratory failure caused by COPD and acute cardiogenic pulmonary edema.  However, NIV may be hard for some patients to tolerate. When compared to low-flow oxygen therapy, HFNC has been shown to improve oxygenation, improve alveolar recruitment, and enhance clearance of secretions. HFNC may be easier to use and tolerate than NIV, but there remains uncertainty regarding the effectiveness of HFNC compared to NIV for acute hypoxemic respiratory failure. In this podcast, we discuss the RENOVATE trial that sought to compare HFNC with NIV on rates of intubation in patients with acute respiratory failure.

]]> false Both NIV and HFNC are used to treat patients with acute respiratory failure.  Current guidelines recommend NIV for acute respiratory failure caused by COPD and acute cardiogenic pulmonary edema.  However, NIV may be hard for some patients to tolerate. When compared to low-flow oxygen therapy, HFNC has been shown to improve oxygenation, improve alveolar recruitment, and enhance clearance of secretions. HFNC may be easier to use and tolerate than NIV, but there remains uncertainty regarding the effectiveness of HFNC compared to NIV for acute hypoxemic respiratory failure. In this podcast, we discuss the RENOVATE trial that sought to compare HFNC with NIV on rates of intubation in patients with acute respiratory failure.

]]> 00:31:44 <![CDATA[High-Intensity NIPPV for Acute COPD Exacerbations?]]> Thu, 05 Dec 2024 15:24:04 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1914763 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/high-intensity-nippv-for-acute-copd-exacerbations NIPPV is frequently used in the management of critically ill patients presenting with an acute COPD exacerbation, as NIPPV decreases the rates of intubation and is associated with lower in-hospital mortality.  Typically, "low" intensity NIPPV, whereby inspiratory positive airway pressures less than 18 cm H2O are used. More recently, the use of "high" intensity NIPPV, with IPAPs between 20-30 cm H2O, has been shown to improve gas exchange, ventilatory function, and improve arterial PCO2 values.  In this podcast, we review the HAPPEN Trial, which compared low intensity to high intensity NIPPV on the need for intubation in patients with an acute COPD exacerbation and hypercapnia.

]]> false NIPPV is frequently used in the management of critically ill patients presenting with an acute COPD exacerbation, as NIPPV decreases the rates of intubation and is associated with lower in-hospital mortality.  Typically, "low" intensity NIPPV, whereby inspiratory positive airway pressures less than 18 cm H2O are used. More recently, the use of "high" intensity NIPPV, with IPAPs between 20-30 cm H2O, has been shown to improve gas exchange, ventilatory function, and improve arterial PCO2 values.  In this podcast, we review the HAPPEN Trial, which compared low intensity to high intensity NIPPV on the need for intubation in patients with an acute COPD exacerbation and hypercapnia.

]]> 00:25:46 <![CDATA[Naloxone for OHCA?]]> Fri, 01 Nov 2024 17:05:11 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1872456 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/naloxone-for-ohca The incidence of opioid-associated out-of-hospital cardiac arrests continues to rise.  Current guidelines for the resuscitation of patients with OHCA advise the clinician to consider the administration of naloxone of patients with suspected opioid-associated OHCA.  In this podcast, we review a recenlty published study in JAMA that evaluated the association of naloxone with patient outcomes in opioid-associated OHCAs.

]]> false The incidence of opioid-associated out-of-hospital cardiac arrests continues to rise.  Current guidelines for the resuscitation of patients with OHCA advise the clinician to consider the administration of naloxone of patients with suspected opioid-associated OHCA.  In this podcast, we review a recenlty published study in JAMA that evaluated the association of naloxone with patient outcomes in opioid-associated OHCAs.

]]> 00:22:22 <![CDATA[Continuous or Intermittent B-Lactam Infusions for Sepsis?]]> Tue, 24 Sep 2024 18:55:47 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1843200 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/continuous-or-intermittent-b-lactam-infusions-for-sepsis Timely administration of broad-spectrum antibiotics is a critical pillar in the resuscitation of patients with sepsis.  B-lactam antibiotics are an important class of antibiotics commonly administered to patients with sepsis.  Typically, B-lactam antibiotics are administered over 30 minutes, but optimal bactericidal activity requires the concentration of free drug to be above the MIC of the organism for 40-70% of the dosing interval.  In this podcast we discuss two recent publications that compare continuous infusions of B-lactam antibiotics with intermittent effusions in patients with sepsis.

]]> false Timely administration of broad-spectrum antibiotics is a critical pillar in the resuscitation of patients with sepsis.  B-lactam antibiotics are an important class of antibiotics commonly administered to patients with sepsis.  Typically, B-lactam antibiotics are administered over 30 minutes, but optimal bactericidal activity requires the concentration of free drug to be above the MIC of the organism for 40-70% of the dosing interval.  In this podcast we discuss two recent publications that compare continuous infusions of B-lactam antibiotics with intermittent effusions in patients with sepsis.

]]> 00:29:51 <![CDATA[What Oxygenation Strategy Should We Use for COVID-19 Patients?]]> Sat, 27 Jul 2024 01:22:54 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1792992 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/what-oxygenation-strategy-should-we-use-for-covid-19-patients Patients with COVID-19 can require supplemental oxygen for acute hypoxemic respiratory failure.  While international guidelines recommend a target SpO2 between 90-96%, a safe oxygenation strategy has not been identified.  In this podcast, we discuss the recently published HOT-COVID Trial, which compared a lower oxygenation strategy with a higher oxygenation strategy in adult ICU patients with COVID-19.

]]> false Patients with COVID-19 can require supplemental oxygen for acute hypoxemic respiratory failure.  While international guidelines recommend a target SpO2 between 90-96%, a safe oxygenation strategy has not been identified.  In this podcast, we discuss the recently published HOT-COVID Trial, which compared a lower oxygenation strategy with a higher oxygenation strategy in adult ICU patients with COVID-19.

]]> 00:20:23 <![CDATA[Should We Use NIPPV for Preoxygenation for All Intubations?]]> Tue, 09 Jul 2024 11:27:31 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1782542 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-use-nippv-for-preoxygenation-for-all-intubations Over 1 million critically ill patients are intubated each year in the US.  Hypoxemia occurs in up to 20% of patients and can lead to peri-intubation cardiovascular collapse and cardiac arrest.  As such, adequate and appropriate preoxygenation is critical in increasing the safe apnea time and decreasing the risk of hypoxemia.  At present, the majority of patients receive preoxygenation through a non-rebreather mask.  In this podcast, we discuss a recent study that evaluated the use of noninvasive ventilation for preoxygenation in critically ill patients.

]]> false Over 1 million critically ill patients are intubated each year in the US.  Hypoxemia occurs in up to 20% of patients and can lead to peri-intubation cardiovascular collapse and cardiac arrest.  As such, adequate and appropriate preoxygenation is critical in increasing the safe apnea time and decreasing the risk of hypoxemia.  At present, the majority of patients receive preoxygenation through a non-rebreather mask.  In this podcast, we discuss a recent study that evaluated the use of noninvasive ventilation for preoxygenation in critically ill patients.

]]> 00:26:28 <![CDATA[Cefepime vs. Piperacillin-Tazobactam for Infection?  The ACORN Trial]]> Fri, 07 Jun 2024 20:19:33 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1758634 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/cefepime-vs-piperacillin-tazobactam-for-infection-the-acorn-trial Timely and appropriate administration of empiric broad-spectrum antibiotics for adult patients with sepsis is critical.  Current guidelines recommend an antipseudomonal antibiotic for those at risk of a resistant gram-negative organism.  The two most common antipseudomonal antibiotics prescribed in this setting are cefepime and piperacillin-tazobactam.  In recent years, observational studies have reported an association with cefepime and neurotoxicity, whereas piperacillin-tazobactam has been associated with AKI especially when given with vancomycin.  In this podcast, we discuss the recently published ACORN Trial, a randomized trial that evaluated cefepime and piperacillin-tazobactam for adult patients with suspected infection.

]]> false Timely and appropriate administration of empiric broad-spectrum antibiotics for adult patients with sepsis is critical.  Current guidelines recommend an antipseudomonal antibiotic for those at risk of a resistant gram-negative organism.  The two most common antipseudomonal antibiotics prescribed in this setting are cefepime and piperacillin-tazobactam.  In recent years, observational studies have reported an association with cefepime and neurotoxicity, whereas piperacillin-tazobactam has been associated with AKI especially when given with vancomycin.  In this podcast, we discuss the recently published ACORN Trial, a randomized trial that evaluated cefepime and piperacillin-tazobactam for adult patients with suspected infection.

]]> 00:22:24 <![CDATA[Are We Ventilating our OHCA Patients?]]> Wed, 24 Apr 2024 16:16:06 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1727595 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/are-we-ventilating-our-ohca-patients In recent years, there has been intense focus on delivering high-quality compressions during the resuscitation of patients with OHCA.  In contrast, ventilation metrics in OHCA resuscitation have not been well studied.  In this podcast, we discuss a recent publication from Circulation that evaluated ventilation waveforms during OHCA resuscitation and the association of these metrics on patient outcomes.  Can we do better?

]]> false In recent years, there has been intense focus on delivering high-quality compressions during the resuscitation of patients with OHCA.  In contrast, ventilation metrics in OHCA resuscitation have not been well studied.  In this podcast, we discuss a recent publication from Circulation that evaluated ventilation waveforms during OHCA resuscitation and the association of these metrics on patient outcomes.  Can we do better?

]]> 00:18:44 <![CDATA[Steroids in Sepsis, ARDS, and CAP - A Focused Clinical Update]]> Sun, 17 Mar 2024 01:02:41 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1689868 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/steroids-in-sepsis-ards-and-cap-a-focused-clinical-update-1 Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties.  In recent years, several studies have been published on the use of corticosteroids in select critical illnesses.  In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.

]]> false Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties.  In recent years, several studies have been published on the use of corticosteroids in select critical illnesses.  In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.

]]> 00:22:04 <![CDATA[Should We Intubate For GCS < 8?]]> Fri, 29 Dec 2023 17:05:25 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1624511 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-intubate-for-gcs-lt-8 Acute mental status changes after the ingestion of alcohol or other substances are a common presentation to the ED.  Those with severe obtundation may require intubation for airway protection while the substance metabolizes.  In fact, more than 20,000 patients are intubated each year in the United States for acute poisoning or intoxication.  Notwithstanding, intubation and mechanical ventilation are not benign procedures.  In this podcast we discuss the recently published NICO Trial, that evaluated a strategy of withholding intubation in patients with coma due to acute poisoning.

]]> false Acute mental status changes after the ingestion of alcohol or other substances are a common presentation to the ED.  Those with severe obtundation may require intubation for airway protection while the substance metabolizes.  In fact, more than 20,000 patients are intubated each year in the United States for acute poisoning or intoxication.  Notwithstanding, intubation and mechanical ventilation are not benign procedures.  In this podcast we discuss the recently published NICO Trial, that evaluated a strategy of withholding intubation in patients with coma due to acute poisoning.

]]> 00:24:55 <![CDATA[Should We Be Placing REBOA?]]> Thu, 23 Nov 2023 12:48:46 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1602101 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-be-placing-reboa REBOA is a relatively new and novel technique that in animal studies has demonstrated benefit in controlling hemorrhage.  However, the evidence for the efficacy of REBOA in humans remains scant.  In this podcast, we discuss the recently published UK-REBOA Trial, which randomized patients to receive REBOA with standard care compared to those randomized to standard care alone.  You may be surprised by these results!

]]> false REBOA is a relatively new and novel technique that in animal studies has demonstrated benefit in controlling hemorrhage.  However, the evidence for the efficacy of REBOA in humans remains scant.  In this podcast, we discuss the recently published UK-REBOA Trial, which randomized patients to receive REBOA with standard care compared to those randomized to standard care alone.  You may be surprised by these results!

]]> 00:24:31 <![CDATA[SCCM Guidelines for RSI in the Critically Ill]]> Tue, 24 Oct 2023 02:29:18 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1582931 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/sccm-guidelines-for-rsi-in-the-critically-ill RSI is one of the most common procedures in critically ill patients.  Despite its frequency, there remains significant practice variation on numerous aspects of RSI in the critically ill.  In this podcast, we review pertinent recommendations from the recently published SCCM Guidelines on RSI in the critically ill patient.

]]> false RSI is one of the most common procedures in critically ill patients.  Despite its frequency, there remains significant practice variation on numerous aspects of RSI in the critically ill.  In this podcast, we review pertinent recommendations from the recently published SCCM Guidelines on RSI in the critically ill patient.

]]> 00:33:10 <![CDATA[Post-Arrest Care Updates - Are Mild Hypercapnia and a Pan-CT Protocol Useful?]]> Fri, 08 Sep 2023 16:01:53 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1552524 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/post-arrest-care-updates-are-mild-hypercapnia-and-a-pan-ct-protocol-useful Care of the patient with ROSC following OHCA can be complex and typically includes a protocolized approach to optimizing oxygenation, ventilation, hemodynamics, early cardiac catheterization for patients with STEMI, seizure detection, and possibly TTM.  In this podcast, we review two recent articles that focused on the use of mild hypercapnia compared with normocapnia in post arrest patients and the use of a pan-CT protocol to detect critical time sensitive conditions and complications.

]]> false Care of the patient with ROSC following OHCA can be complex and typically includes a protocolized approach to optimizing oxygenation, ventilation, hemodynamics, early cardiac catheterization for patients with STEMI, seizure detection, and possibly TTM.  In this podcast, we review two recent articles that focused on the use of mild hypercapnia compared with normocapnia in post arrest patients and the use of a pan-CT protocol to detect critical time sensitive conditions and complications.

]]> 00:34:29 <![CDATA[Should We Transfuse Platelets Prior to CVC Placement?]]> Fri, 28 Jul 2023 14:37:02 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1524914 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-transfuse-platelets-prior-to-cvc-placement 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 platelet transfusion in patients with severe thrombocytopenia undergoing CVC placement.

]]> false 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 platelet transfusion in patients with severe thrombocytopenia undergoing CVC placement.

]]> 00:26:16 <![CDATA[VL versus DL...And The Winner Is?]]> Fri, 07 Jul 2023 01:06:10 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1512254 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/vl-versus-dland-the-winner-is 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, the DEVICE Trial, that assessed video with direct laryngoscopy.  Which device won?

]]> false 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, the DEVICE Trial, that assessed video with direct laryngoscopy.  Which device won?

]]> 00:28:56 <![CDATA[Do Etomidate and Propofol Increase Mortality in the Critically Ill?]]> Thu, 15 Jun 2023 01:19:20 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1496896 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/do-etomidate-and-propofol-increase-mortality-in-the-critically-ill 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?

]]> false 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?

]]> 00:30:21 <![CDATA[Should We Add Fludrocortisone to Hydrocortisone for Septic Shock?]]> Fri, 28 Apr 2023 16:26:20 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1468216 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-add-fludrocortisone-to-hydrocortisone-for-septic-shock 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 septic shock. In this podcast, we review the latest study that evaluated the combination of hydrocortisone and fludrocortisone in patients with septic shock.  Should we administer this medication with hydrocortisone for our patients with septic shock?

]]> false 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 septic shock. In this podcast, we review the latest study that evaluated the combination of hydrocortisone and fludrocortisone in patients with septic shock.  Should we administer this medication with hydrocortisone for our patients with septic shock?

]]> 00:27:21 <![CDATA[Should We Administer Steroids in Severe CAP?]]> Thu, 13 Apr 2023 00:49:17 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1457532 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-administer-steroids-in-severe-cap 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 ED based on the results of this trial?  Take a listen and find out...

]]> false 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 ED based on the results of this trial?  Take a listen and find out...

]]> 00:28:58 <![CDATA[ECPR for OHCA? - The INCEPTION Trial]]> Tue, 28 Feb 2023 02:17:30 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1426082 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/ecpr-for-ohca-the-inception-trial 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 multicenter, randomized trial that compared the effect of extracorporeal CPR with conventional CPR in patients with refractory OHCA due to a ventricular arrhythmia.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions]]> false 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 multicenter, randomized trial that compared the effect of extracorporeal CPR with conventional CPR in patients with refractory OHCA due to a ventricular arrhythmia.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions]]> 00:27:55 <![CDATA[Should We Use a Liberal or Restrictive Fluid Strategy in Sepsis - The CLOVERS Trial]]> Thu, 09 Feb 2023 19:26:42 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1405941 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/should-we-use-a-liberal-or-restrictive-fluid-strategy-in-sepsis-the-clovers-trial 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 restrictive fluid strategy in patients with sepsis-induced hypotension.

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]]> false 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 restrictive fluid strategy in patients with sepsis-induced hypotension.

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]]> 00:25:24 <![CDATA[Top Critical Care Articles of 2022]]> Wed, 25 Jan 2023 19:27:17 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1391365 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/top-critical-care-articles-of-2022 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 ill ED patients.

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]]> false 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 ill ED patients.

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]]> 00:45:25 <![CDATA[Double Sequential External Defibrillation for Refractory Ventricular Fibrillation]]> Tue, 13 Dec 2022 01:35:07 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1347990 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/double-sequential-external-defibrillation-for-refractory-ventricular-fibrillation 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 defibrillation compared to standard defibrillation in patients with refractory ventricular fibrillation in OHCA.

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]]> false 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 defibrillation compared to standard defibrillation in patients with refractory ventricular fibrillation in OHCA.

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]]> 00:24:33 <![CDATA[What is the Optimal SpO2 Target in Vented Patients?]]> Thu, 10 Nov 2022 01:10:56 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1315549 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/what-is-the-optimal-spo2-target-in-vented-patients 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 we discuss a recently published study, the PILOT Trial, that evaluated low, intermediate, and high oxygenation targets in critically ill patients.

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]]> false 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 we discuss a recently published study, the PILOT Trial, that evaluated low, intermediate, and high oxygenation targets in critically ill patients.

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]]> 00:25:12 <![CDATA[Does the Timing of Source Control in Sepsis Make a Difference?]]> Fri, 21 Oct 2022 00:26:13 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1298871 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/does-the-timing-of-source-control-in-sepsis-make-a-difference 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.  Though current guidelines identify source control as a “best practice” the optimal timing of source control remains uncertain.  In this podcast, we discuss a recent study that evaluated the timing of source control with mortality in patients with community-acquired sepsis.

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]]> false 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.  Though current guidelines identify source control as a “best practice” the optimal timing of source control remains uncertain.  In this podcast, we discuss a recent study that evaluated the timing of source control with mortality in patients with community-acquired sepsis.

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]]> 00:18:32 <![CDATA[Does a Restrictive Oxygenation Target Make a Difference in the Post-Arrest Patient?]]> Tue, 04 Oct 2022 00:34:56 +0000 Critical Care Perspectives in Emergency Medicine https://permalink.castos.com/podcast/1244/episode/1287536 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/does-a-restrictive-oxygenation-target-make-a-difference-in-the-post-arrest-patient 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 current podcast, we discuss Part II of the BOX Trial that evaluated a restrictive versus liberal oxygenation target in the post-arrest patient.

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]]> false 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 current podcast, we discuss Part II of the BOX Trial that evaluated a restrictive versus liberal oxygenation target in the post-arrest patient.

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]]> 00:25:21 <![CDATA[TAVR Complications You Need to Know!]]> Mon, 18 Jul 2022 19:06:16 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/tavr-complications-you-need-to-know https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/tavr-complications-you-need-to-know 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 recent article on TAVR complications and discuss the things we need to know!

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]]> false 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 recent article on TAVR complications and discuss the things we need to know!

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]]> 00:27:41 <![CDATA[Restrictive Fluid Resuscitation in Sepsis? The CLASSIC Trial]]> Fri, 08 Jul 2022 18:25:09 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/restrictive-fluid-resuscitation-in-sepsis-the-clas1jd https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/restrictive-fluid-resuscitation-in-sepsis-the-clas1jd 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 published CLASSIC Trial, which compared a restrictive fluid strategy to standard care in adult patients admitted to the ICU with sepsis.

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]]> false 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 published CLASSIC Trial, which compared a restrictive fluid strategy to standard care in adult patients admitted to the ICU with sepsis.

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]]> 00:22:56 <![CDATA[Life-Threatening Asthma]]> Fri, 17 Jun 2022 01:00:36 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/life-threatening-asthma https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/life-threatening-asthma 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 exacerbation.

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]]> false 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 exacerbation.

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]]> 00:37:25 <![CDATA[Refractory OHCA - Does ECPR and Early Angiography Improve Outcome?]]> Thu, 19 May 2022 01:45:04 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/refractory-ohca-does-ecpr-and-early-angiography-im1ld https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/refractory-ohca-does-ecpr-and-early-angiography-im1ld 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 refractory OHCA.

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]]> false 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 refractory OHCA.

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]]> 00:22:48 <![CDATA[Low-Tidal Volume Ventilation in the ED - Does it Make a Difference?]]> Wed, 20 Apr 2022 20:49:47 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/low-tidal-volume-ventilation-in-the-ed-does-it-makymi https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/low-tidal-volume-ventilation-in-the-ed-does-it-makymi 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 mechanical ventilation.

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]]> false 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 mechanical ventilation.

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]]> 00:20:58 <![CDATA[The PLUS Study]]> Thu, 31 Mar 2022 03:26:51 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-plus-study https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-plus-study 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.

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]]> false 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.

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]]> 00:20:50 <![CDATA[The Critically Ill Patient with HHS]]> Fri, 18 Mar 2022 21:55:19 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-critically-ill-patient-with-hhs https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-critically-ill-patient-with-hhs 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 patients with HHS.

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]]> false 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 patients with HHS.

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]]> 00:30:35 <![CDATA[Ketamine or Etomidate for RSI?]]> Mon, 21 Feb 2022 23:25:41 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/ketamine-or-etomidate-for-rsi https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/ketamine-or-etomidate-for-rsi 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 for RSI in emergency endotracheal intubations.

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]]> false 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 for RSI in emergency endotracheal intubations.

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]]> 00:24:01 <![CDATA[EM-STAT!]]> Tue, 01 Feb 2022 13:53:19 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/em-stat https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/em-stat 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.

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]]> false 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.

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]]> 00:20:19 <![CDATA[Bicarbonate Therapy in the Critically Ill Patient]]> Fri, 21 Jan 2022 01:04:12 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/bicarbonate-therapy-in-the-critically-ill-patient https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/bicarbonate-therapy-in-the-critically-ill-patient 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!

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]]> false 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!

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]]> 00:41:39 <![CDATA[The BOUGIE Trial]]> Fri, 31 Dec 2021 03:03:25 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-bougie-trial https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-bougie-trial 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.  In this podcast, we discuss the BOUGIE Trial, a recently published study that compared the effect of using a bougie to endotracheal tube with stylet on outcomes in patients undergoing tracheal intubation.ReplyReply allForward

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]]> false 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.  In this podcast, we discuss the BOUGIE Trial, a recently published study that compared the effect of using a bougie to endotracheal tube with stylet on outcomes in patients undergoing tracheal intubation.ReplyReply allForward

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]]> 00:25:01 <![CDATA[Hyperkalemia in the ED]]> Mon, 15 Nov 2021 03:04:20 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/hyperkalemia-in-the-ed https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/hyperkalemia-in-the-ed 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

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]]> false 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

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]]> 00:28:29 <![CDATA[Vasopressin and Steroids for IHCA?]]> Tue, 26 Oct 2021 17:44:59 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/vasopressin-and-steroids-for-ihca https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/vasopressin-and-steroids-for-ihca 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 and steroids for patients with IHCA.  Should we now be administering this combination of medications along with epinephrine for IHCA? 

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]]> false 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 and steroids for patients with IHCA.  Should we now be administering this combination of medications along with epinephrine for IHCA? 

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]]> 00:26:40 <![CDATA[Milrinone or Dobutamine for Cardiogenic Shock?]]> Mon, 27 Sep 2021 09:56:20 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/milrinone-or-dobutamine-for-cardiogenic-shock https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/milrinone-or-dobutamine-for-cardiogenic-shock 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 was the winner?

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false 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 was the winner?

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:25:40 <![CDATA[The TOMAHAWK Study]]> Thu, 16 Sep 2021 15:25:50 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-tomahawk-study https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-tomahawk-study 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 discuss the recently published TOMAHAWK study that evaluated OHCA patients due to either a shockable or nonshockable rhythm and had no evidence of a STEMI.  Should this study change our post-arrest management of OHCA patients with a non-diagnostic ECG?

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false 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 discuss the recently published TOMAHAWK study that evaluated OHCA patients due to either a shockable or nonshockable rhythm and had no evidence of a STEMI.  Should this study change our post-arrest management of OHCA patients with a non-diagnostic ECG?

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:29:18 <![CDATA[The BaSICS Trial - Implications for Fluid Resuscitation]]> Sun, 29 Aug 2021 08:20:30 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-basics-trial-implications-for-fluid-resuscitation https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-basics-trial-implications-for-fluid-resuscitation 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-changing evidence to make that switch?

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false 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-changing evidence to make that switch?

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:22:03 <![CDATA[Pigtail Catheters for Traumatic Hemothorax?]]> Thu, 05 Aug 2021 16:08:58 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/pigtail-catheters-for-traumatic-hemothorax https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/pigtail-catheters-for-traumatic-hemothorax 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.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:23:56 <![CDATA[The ED-AWARENESS Study]]> Fri, 16 Jul 2021 10:38:13 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-ed-awareness-study https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-ed-awareness-study 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.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:22:20 <![CDATA[The TTM2 Trial]]> Thu, 01 Jul 2021 08:52:27 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-ttm2-trial https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-ttm2-trial 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.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:26:54 <![CDATA[Mechanical Ventilation in the Patient with ARDS]]> Thu, 10 Jun 2021 10:49:18 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/mechanical-ventilation-in-the-patient-with-ards https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/mechanical-ventilation-in-the-patient-with-ards 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:34:56 <![CDATA[Early ED Sepsis Care]]> Mon, 10 May 2021 14:34:59 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/early-ed-sepsis-care https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/early-ed-sepsis-care 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 a significant impact the care we provide to our patients.  You cannot afford to miss this episode!

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]]> false 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 a significant impact the care we provide to our patients.  You cannot afford to miss this episode!

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]]> 00:39:02 <![CDATA[The Physiologically Difficult Airway]]> Tue, 20 Apr 2021 08:59:44 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-physiologically-difficult-airway https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-physiologically-difficult-airway 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!

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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!

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:29:53 <![CDATA[ECMO for Cardiac Arrest and Massive PE]]> Mon, 29 Mar 2021 08:41:49 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/ecmo-for-cardiac-arrest-and-massive-pe https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/ecmo-for-cardiac-arrest-and-massive-pe 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, which evaluated ECMO-facilitated resuscitation in OHCA.  In addition, we also discuss a recent systematic review on VA-ECMO for massive PE.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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, which evaluated ECMO-facilitated resuscitation in OHCA.  In addition, we also discuss a recent systematic review on VA-ECMO for massive PE.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:26:01 <![CDATA[COVID-19 Updates March 2021]]> Mon, 08 Mar 2021 09:14:46 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/covid-19-updates-march-2021 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/covid-19-updates-march-2021 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:28:05 <![CDATA[The HOT-ICU Study]]> Tue, 16 Feb 2021 09:22:12 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-hot-icu-study https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-hot-icu-study 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 for adult patients with hypoxic respiratory failure.  In this podcast, we discuss the recently published HOT-ICU trial that evaluated a lower versus high oxygenation target in adult patients with acute hypoxic respiratory failure.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 for adult patients with hypoxic respiratory failure.  In this podcast, we discuss the recently published HOT-ICU trial that evaluated a lower versus high oxygenation target in adult patients with acute hypoxic respiratory failure.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:19:11 <![CDATA[The Critically Ill Patient with Aortic Stenosis]]> Tue, 26 Jan 2021 08:46:02 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-critically-ill-patient-with-aortic-stenosis https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-critically-ill-patient-with-aortic-stenosis 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:22:57 <![CDATA[2020 - A Year in Review]]> Mon, 11 Jan 2021 09:56:10 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/2020-a-year-in-review https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/2020-a-year-in-review 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 that have presented to our various settings.  In this annual podcast, we review key articles published in 2020 on various aspects of select critical conditions.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions! ]]> false 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 that have presented to our various settings.  In this annual podcast, we review key articles published in 2020 on various aspects of select critical conditions.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions! ]]> 00:43:58 <![CDATA[2020 AHA Updates: Post-Arrest Care]]> Fri, 11 Dec 2020 08:28:14 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/2020-aha-updates-post-arrest-care https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/2020-aha-updates-post-arrest-care 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 Cardiovascular Care with attention to Post-Arrest care.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 Cardiovascular Care with attention to Post-Arrest care.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:35:50 <![CDATA[2020 AHA Guidelines for Cardiopulmonary Resuscitation]]> Mon, 23 Nov 2020 10:29:07 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/2020-aha-guidelines-for-cardiopulmonary-resuscitation https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/2020-aha-guidelines-for-cardiopulmonary-resuscitation 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 this podcast, we review the key updates and recommendations that impact the acute care provider managing the patient in cardiac arrest.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 this podcast, we review the key updates and recommendations that impact the acute care provider managing the patient in cardiac arrest.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:41:34 <![CDATA[Electrical Storm]]> Tue, 20 Oct 2020 10:44:20 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/electrical-storm https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/electrical-storm 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:31:24 <![CDATA[Acute Liver Failure]]> Tue, 29 Sep 2020 10:39:24 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/acute-liver-failure https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/acute-liver-failure 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 resuscitation topics include fluid resuscitation, blood pressure targets, vasopressor selection, bleeding and thrombosis risk, and mechanical ventilation.  

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 resuscitation topics include fluid resuscitation, blood pressure targets, vasopressor selection, bleeding and thrombosis risk, and mechanical ventilation.  

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:36:03 <![CDATA[Ketamine in the Critically Ill]]> Fri, 28 Aug 2020 15:53:49 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/ketamine-in-the-critically-ill https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/ketamine-in-the-critically-ill 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:25:38 <![CDATA[The Critically Ill ED Boarder]]> Mon, 03 Aug 2020 08:13:43 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-critically-ill-ed-boarder https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-critically-ill-ed-boarder 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 patient just published in Critical Care Medicine by a joint task force from ACEP and SCCM.  If you care for the critically ill ED boarder in your ED, you CAN’T afford to miss this discussion!

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 patient just published in Critical Care Medicine by a joint task force from ACEP and SCCM.  If you care for the critically ill ED boarder in your ED, you CAN’T afford to miss this discussion!

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:38:27 <![CDATA[TXA for GI Bleeds? The HALT-IT Trial]]> Wed, 15 Jul 2020 08:57:13 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/txa-for-gi-bleeds-the-halt-it-trial https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/txa-for-gi-bleeds-the-halt-it-trial 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 in patients with acute gastrointestinal bleeding.  In this podcast we discuss the HALT-IT Trial and its implications for clinical practice. 

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 in patients with acute gastrointestinal bleeding.  In this podcast we discuss the HALT-IT Trial and its implications for clinical practice. 

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:26:28 <![CDATA[Updates in the Critical Care Management of COVID-19 Patients]]> Thu, 02 Jul 2020 09:20:38 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/updates-in-the-critical-care-management-of-covid-19-patients https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/updates-in-the-critical-care-management-of-covid-19-patients 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:46:15 <![CDATA[Diastolic Shock Index]]> Mon, 15 Jun 2020 08:20:52 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/diastolic-shock-index https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/diastolic-shock-index 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 calculate the Shock Index may be less sensitive.  In this podcast, we review a recent article that suggests the use of the Diastolic Shock Index may be better in identifying septic patients who require earlier initiation of vasopressor medications.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 0.8 identifying a potential critically ill patient.  In the setting of sepsis, the use of systolic blood pressure to calculate the Shock Index may be less sensitive.  In this podcast, we review a recent article that suggests the use of the Diastolic Shock Index may be better in identifying septic patients who require earlier initiation of vasopressor medications. Download Companion HandoutDownload You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 calculate the Shock Index may be less sensitive.  In this podcast, we review a recent article that suggests the use of the Diastolic Shock Index may be better in identifying septic patients who require earlier initiation of vasopressor medications.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 0.8 identifying a potential critically ill patient.  In the setting of sepsis, the use of systolic blood pressure to calculate the Shock Index may be less sensitive.  In this podcast, we review a recent article that suggests the use of the Diastolic Shock Index may be better in identifying septic patients who require earlier initiation of vasopressor medications. Download Companion HandoutDownload You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:24:08 <![CDATA[HFNC in COVID-19 Patients - Helpful or Harmful?]]> Tue, 26 May 2020 09:13:41 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/hfnc-in-covid-19-patients-helpful-or-harmful https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/hfnc-in-covid-19-patients-helpful-or-harmful 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 patients.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions Play episode here! ]]> false 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 patients.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions Play episode here! ]]> 00:27:09 <![CDATA[COVID-19: Toxicities of Potential Therapies]]> Wed, 13 May 2020 09:18:17 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/covid-19-toxicities-of-potential-therapies https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/covid-19-toxicities-of-potential-therapies 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:21:18 <![CDATA[Vasopressors & The Older Patient - The 65 Trial]]> Mon, 27 Apr 2020 08:43:31 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/vasopressors-the-older-patient-the-65-trial https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/vasopressors-the-older-patient-the-65-trial 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 published 65 Trial, which sought to evaluate the effect of permissive hypotension in older patients with vasodilatory hypotension.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> false 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 published 65 Trial, which sought to evaluate the effect of permissive hypotension in older patients with vasodilatory hypotension.

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You can get CME credit for this episode here!Click here for CME Account Creation Instructions ]]> 00:22:04 <![CDATA[ED Sepsis Screening - Is qSOFA Really Better?]]> Tue, 05 Feb 2019 14:53:20 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/ed-sepsis-screening-is-qsofa-really-better https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/ed-sepsis-screening-is-qsofa-really-better As EDs across the country strive to meet sepsis benchmark metrics, many have implemented a variety of screening tools. With the publication of Sepsis-3, qSOFA is the latest screening tool recommended for patients outside of the ICU setting.  In this podcast we review the derivation of qSOFA and discuss recent literature on whether qSOFA is any better than traditional screening tools.

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You can get CME credit for this episode here! Click here for CME Account Creation Instructions ]]> false As EDs across the country strive to meet sepsis benchmark metrics, many have implemented a variety of screening tools. With the publication of Sepsis-3, qSOFA is the latest screening tool recommended for patients outside of the ICU setting.  In this podcast we review the derivation of qSOFA and discuss recent literature on whether qSOFA is any better than traditional screening tools.

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You can get CME credit for this episode here! Click here for CME Account Creation Instructions ]]> 00:30:53 <![CDATA[Episode 2]]> Tue, 29 Jan 2019 14:30:02 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/episode-2-4 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/episode-2-4 [mepr-active rule="1" ifallowed="hide"]Anything in-between gets protected[/mepr-active]

hey

]]> false [mepr-active rule="1" ifallowed="hide"]Anything in-between gets protected[/mepr-active]

hey

]]> 00:30:02 <![CDATA[ECLS in the ED]]> Tue, 29 Jan 2019 14:21:08 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/-24612 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/-24612 Extracorporeal life support (ECLS) is being used with increasing frequency in many EDs across the US and across the World. In this podcast, we review the basics of ECLS, as well as discuss the current indications, contraindications, and complications of this critical therapy. In addition, we review some key pearls and pitfalls in the cannulation of patients for ECLS.

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]]> false Extracorporeal life support (ECLS) is being used with increasing frequency in many EDs across the US and across the World. In this podcast, we review the basics of ECLS, as well as discuss the current indications, contraindications, and complications of this critical therapy. In addition, we review some key pearls and pitfalls in the cannulation of patients for ECLS.

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]]> 00:30:02 <![CDATA[Top Articles of 2018]]> Mon, 31 Dec 2018 20:34:56 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/top-articles-of-2018 https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/top-articles-of-2018 A plethora of great articles pertaining to the care of critically ill patients were published in 2018.  In this podcast, we review some of the key articles you NEED to know from the 2018 emergency medicine and critical care literature.

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You can get CME credit for this episode here! Click here for CME Account Creation Instructions ]]> false A plethora of great articles pertaining to the care of critically ill patients were published in 2018.  In this podcast, we review some of the key articles you NEED to know from the 2018 emergency medicine and critical care literature.

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You can get CME credit for this episode here! Click here for CME Account Creation Instructions ]]> 00:37:34 <![CDATA[The Post-Cardiac Surgery Patient in Your ED!]]> Sun, 25 Nov 2018 20:37:12 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/the-post-cardiac-surgery-patient-in-your-ed https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/the-post-cardiac-surgery-patient-in-your-ed More than 200,000 patients per year undergo coronary artery bypass graft (CABG) surgery. Up to 20 percent of these patients will require readmission within 30-days.  Many of these patients present to our EDs with numerous complications that we must be able to recognize and treat.  In this podcast, John leads an outstanding discussion on the 3 most common complications and reasons these patients present to the ED.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> false More than 200,000 patients per year undergo coronary artery bypass graft (CABG) surgery. Up to 20 percent of these patients will require readmission within 30-days.  Many of these patients present to our EDs with numerous complications that we must be able to recognize and treat.  In this podcast, John leads an outstanding discussion on the 3 most common complications and reasons these patients present to the ED.

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You can get CME credit for this episode hereClick here for CME Account Creation Instructions ]]> 00:22:59 <![CDATA[Analgesia & Sedation in the Critically Ill]]> Thu, 25 Oct 2018 20:44:26 +0000 Critical Care Perspectives in Emergency Medicine https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/podcasts/1244/episodes/analgesia-sedation-in-the-critically-ill https://critical-care-perspectives-in-emergency-medicine-1-1.castos.com/episodes/analgesia-sedation-in-the-critically-ill Untreated pain, anxiety, and agitation have both short- and long-term consequences for our critically ill patients.  More importantly, it is well-known that patients remember the pain experienced during their critical illness.  New guidelines for the assessment and management of pain, agitation, delirium, immobility, and sleep were just published.  In this podcast, we review the latest guideline and discuss pearls and pitfalls of analgesia and sedation in the critically ill.

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You can get CME credit for this episode here! Click here for CME Account Creation Instructions ]]> false Untreated pain, anxiety, and agitation have both short- and long-term consequences for our critically ill patients.  More importantly, it is well-known that patients remember the pain experienced during their critical illness.  New guidelines for the assessment and management of pain, agitation, delirium, immobility, and sleep were just published.  In this podcast, we review the latest guideline and discuss pearls and pitfalls of analgesia and sedation in the critically ill.

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You can get CME credit for this episode here! Click here for CME Account Creation Instructions ]]> 00:29:40