Critical Care Perspectives In Emergency Medicine สาธารณะ
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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 …
 
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…
 
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 componen…
 
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 componen…
 
Approximately 2 million adult patients undergo intubation in the United States each year. Hypotension and cardiovascular collapse may occur in up to 40% of critically ill patients in the ICU who undergo intubation. Guidelines and expert recommendations often suggest the administration of IVFs during RSI to prevent cardiovascular collapse. However, …
 
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…
 
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…
 
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 pres…
 
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 favora…
 
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, lengt…
 
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%…
 
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 i…
 
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,…
 
While COVID continued to be predominant in 2021, a number of important articles that pertained to various aspects of critical care and resuscitation were published. In this podcast, we review a few important trials that were published in 2021 and their impact upon the management of select critical illnesses.…
 
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…
 
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!โดย Critical Care Perspectives in Emergency Medicine
 
More than 1.5 million patients are intubated each year in the United States. In up to 20% of patients, the first attempt at intubation is not successful and places patients at risk for peri-intubation cardiovascular collapse and death. In recent years, many providers have used the bougie as either a rescue device for failed attempts or during the i…
 
The COVID-19 pandemic continues to affect millions of patients worldwide. While the majority of children have milder illness compared with adults, some develop multisystem inflammatory syndrome with a significant increase in morbidity and mortality. In this podcast, we discuss a recent review article on MIS-C as it pertains to the pediatric patient…
 
Hyperkalemia is a life-threatening electrolyte disorder that is commonly encountered in the ED and ICU. In this podcast we review the latest evidence in the management of hyperkalemia based on a recently published consensus-based panel. https://ccpem.blog/wp-content/uploads/2021/11/CCPEM-Hyperkalemia-in-the-Emergency-Department.pdf…
 
In 2009 and 2013 investigators published studies that demonstrated improved outcomes in patients with IHCA who received vasopressin and steroids in addition to epinephrine. However, both US and European cardiac arrest guidelines have not endorsed these medications due to lack of additional evidence. In this podcast we discuss the recently published…
 
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 patien…
 
The COACT trial demonstrated no improvement in 90-day mortality for post-arrest patients without evidence of an ST-segment elevation MI who were randomized to immediate or delayed coronary angiography. However, the COACT Trial included only OHCA with a shockable rhythm and overall had a very low number of patients that had an acute thrombus at the …
 
The administration of IVFs is nearly universal in critically ill patients. In recent years, several studies have suggested improved outcomes with the use of balanced crystalloids solutions in contrast to 0.9% NS. In this podcast, we discuss the recently published BaSICS Trial that evaluated Plasma-Lyte 148 with 0.9% NS in critically ill patients. D…
 
Traumatic hemothorax has traditionally been treated with a large bore thoracostomy to prevent retained hemothorax and morbidity. In this podcast we discuss the results of a recent study on the use of small bore thoracostomy (pigtail catheters) for the treatment of traumatic hemothorax.โดย Critical Care Perspectives in Emergency Medicine
 
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.โดย Critical Care Perspectives in Emergency Medicine
 
Current international guidelines recommend TTM for adult patients with ROSC from OHCA who remain comatose or unable to follow verbal commands. However, the overall level of evidence for this recommendation remains of low certainty. In this podcast, we discuss the results of the recently published TTM2 Trial and its implications on the management of…
 
More than 3 million patients develop ARDS each year across the globe. Like any therapy, mechanical ventilation can induce further lung injury and cause patient harm if misapplied. In this podcast we bring you up to speed on the latest, evidence-based titration of mechanical ventilation in patients with ARDS.…
 
Over 80% of patients with sepsis receive care in the ED. Despite evidence demonstrating the benefits of ED sepsis resuscitation, there remains significant controversies on many aspects of ED sepsis care. In this podcast, we are joined by EM/CCM extraordinaire Dr. Gabe Wardi, who discuss an upcoming article on ED sepsis resuscitation that will have …
 
Airway guru Dr. Ken Butler joins us for this podcast to discuss some great pearls and pitfalls in intubating patients with physiologic derangements that place that at high-risk for peri-intubation catastrophes. If you intubate patients in your ED you simply CAN'T miss this episode!โดย Critical Care Perspectives in Emergency Medicine
 
Despite continued advances in resuscitation, favorable outcomes for patients with OHCA who receive standard resuscitation remain dismal. In recent years there has been significant interest in the use of ECMO for OHCA. However, the evidence demonstrating the efficacy of ECMO in OHCA remains limited. In this podcast we review the recent ARREST Trial,…
 
In recent weeks, there have been several important studies and guidelines published that have served to improve our understanding of treating critically ill patients with COVID-19 infection. In this podcast, we highlight the latest update from the SSC and discuss studies on convalescent plasma and IL-6 antagonists.…
 
Critically ill patients with acute hypoxic respiratory failure receive supplemental oxygen as a component of their treatment. In recent years, exposure to high levels of FiO2 with resultant "hyperoxia" have been associated with increased mortality in critically ill patients. At present, there is no clinical practice guideline on oxygenation targets…
 
Patients with severe aortic stenosis who present with acute decompensated heart failure are among the most challenging patients to resuscitate. In this podcast, we discuss the pearls and pitfalls in managing both the hypertensive and hypotensive patient with severe AS and acute heart failure.โดย Critical Care Perspectives in Emergency Medicine
 
To say that 2020 has been a challenging year would be a gross understatement. The courage and determination that all healthcare providers have shown in confronting the COVID-19 pandemic has been nothing short of inspirational. In addition to the thousands of COVID-19 patients, we have also needed to manage many other critical illness conditions tha…
 
The period following ROSC from cardiac arrest is a time when lives can be saved...or lost. A systematic and comprehensive approach to post-arrest care is associated with improved survival to discharge with good neurologic function. In this podcast, we discuss the recently published 2020 AHA Updates to Cardiopulmonary Resuscitation and Emergency Car…
 
Approximately 350,000 adults in the US experience an out-of-hospital cardiac arrest (OHCA). Despite numerous potential improvements in treatments, survival from OHCA remains essentially unchanged since 2012. The American Heart Association (AHA) just released its 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. In…
 
Although electrical storm is an uncommon presentation, it is important that we readily recognize and treat these patients to prevent rapid progression to cardiac arrest. Effective management can be complex. In this podcast we discuss the management of patients with unstable and stable electrical storm.…
 
Patients with acute liver failure can be incredibly sick and have an exceedingly high mortality. Early identification and prompt, evidence-based management of the patient with acute liver failure may improve patient-centered outcomes. In this podcast, we discuss updated guidelines for the management of adult patients with acute liver failure. Key r…
 
Ketamine is a well-known anesthetic used commonly in the ED for RSI and procedural sedation. In this podcast, we review the use of ketamine in other critical illness states, such as status asthmaticus, status epilepticus, acute pain management, and acute alcohol withdrawal syndrome.โดย Critical Care Perspectives in Emergency Medicine
 
Emergency department (ED) visits for critically ill patients has nearly doubled over the past decade. Unfortunately, ED boarding of critically ill patients awaiting ICU admission has also risen significantly, and is associated with several adverse patient outcomes. In this podcast, we review a white paper on boarding of the critically ill ED patien…
 
The use of tranexamic acid (TXA) has markedly increased since the results of the CRASH-II trial were published. In addition to its use in trauma, TXA has been evaluated and used in numerous other conditions, including post-partum hemorrhage and epistaxis. Recently, the HALT-IT Trial was published online in the Lancet, which evaluated the use of TXA…
 
There has been an explosion of literature on the evaluation and management of patients with COVID-19 infection. In this podcast, we discuss updates (as of June 2020) in the care of critically ill patients with COVID-19. We touch on non-invasive ventilation, mechanical ventilation, proning, and medication administration.…
 
Emergency medicine, critical care, and resuscitationists often use the Shock Index to identify patients with increased mortality. The Shock Index is calculated by dividing heart rate by the systolic blood pressure, with a value > 0.8 identifying a potential critically ill patient. In the setting of sepsis, the use of systolic blood pressure to calc…
 
As we gain more experience managing critically ill patients with COVID-19 infection there has been a shift away from immediate intubation and towards more frequent use of non-invasive ventilatory strategies. Dr. Michael Allison joins CCPEM this podcast to discuss the latest evidence, controversies, and recommendations on the use of HFNC in COVID-19…
 
Currently, there is no approved treatment or proven therapy for COVID-19. As such, many have turned to treatments with little to no supporting evidence. In this podcast, we bring back EM Pharmacy extraordinaire Bryan Hayes to discuss information on the toxicities of potential therapies used in the management of patients with COVID-19.…
 
Current guidelines for many critical illnesses recommend targeting a MAP of 65 mm Hg, with consideration of higher MAPs in older patients with chronic HTN. Recent literature, however, suggests increased mortality in older patients who are exposed to larger quantities of vasopressor medications. In this podcast, we do a deep dive into the recently p…
 
Our understanding and management of patients with COVID-19 infection continues to rapidly evolve, almost on a daily basis. In this podcast, we discuss current experience and thoughts on managing the critically ill patient with COVID-19 infection with attention to ventilator management.โดย Critical Care Perspectives in Emergency Medicine
 
In 2017, Paul Marik published a single-center retrospective before-and-after study that demonstrated significant mortality benefit to patients with septic shock who received a cocktail of steroids, vitamin C, and hydrocortisone. Since that time, many providers have adopted this cocktail for the treatment of septic shock, despite the fact that no ra…
 
In December 2019 a novel coronavirus (now named COVID-19) was identified as responsible for a cluster of pneumonia cases in Wuhan, China. As of March 2020, over 50 countries have identified patients who have tested (+) for COVID-19, with over 90,000 identified cases and more than 3000 deaths to date. As the discussion regarding COVID-19 rapidly evo…
 
The debate on the ideal neuromuscular blocking agent for RSI in emergency intubations rages on. In this podcast, we review the latest randomized trial comparing rocuronium with succinylcholine in out-of-hospital patients needing emergency tracheal intubation - The CURASMUR Trial. Emergency medicine airway guru Dr. Ken Butler takes us through the pa…
 
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