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 excellen…

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 complicati…

Oxygen is one of the most used, and misused, therapies delivered to critically ill patients. In recent years, a number of trials have compared the use of a conservative oxygen therapy strategy with a liberal oxygen therapy strategy. These trials have produced mixed results and the optimal oxygen strategy for critically ill patients remains unknown.…

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, rec…

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 ed…

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 recommend…

Nearly 4 million patients sustain out-of-hospital cardiac arrest (OHCA) worldwide each year. International guidelines for the resuscitation of patients with OHCA recommend early administration of epinephrine in those with an initial nonshockable rhythm. Both intravenous (IV) and intraosseous (IO) access are routinely attempted to gain vascular acce…

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 alveol…

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…

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 assoc…

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 concentratio…

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 oxyg…

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 …

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-tazobacta…

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 …

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 o…

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 o…

In this podcast we review a few key articles from the 2023 critical care, emergency medicine, and resuscitation literature that pertain to our care of the critically ill ED patient.Por Critical Care Perspectives in Emergency Medicine

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. Notwithst…

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 randomize…

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.…

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 compar…

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 compar…

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 discus…

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 t…

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 t…

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 c…

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 …

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 …

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 recent…