EMCrit Podcast - Critical Care and Resuscitation

By Scott D. Weingart, MD FCCM

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Description

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

Episode Date
EMCrit Wee – Getting Things Done 2019 Update
23:57
GTD Update for 2019
Jan 16, 2019
EMCrit 238 – Medical Error Epidemic Craziness with G. Gianoli
17:09
EMCrit 238 - Medical Error Epidemic Craziness with G. Gianoli. Medical Error is the 3rd leading cause of death in the US--or is it?
Dec 12, 2018
EMCrit Podcast 237 – Vent & PreVENT – An Update
24:31
More on Vents
Nov 28, 2018
EMCrit Wee – The Brindley Sessions – Followership
26:48
on followership
Nov 11, 2018
EMCrit 236 – George Kovacs on EVLI Airway Incrementalization
22:07
Approach to steps of laryngoscopy/intubation
Oct 31, 2018
EMCrit #235 – Cardiac Arrest Science with Zack Shinar
33:06
Cardiac Arrest Science
Oct 17, 2018
EMCrit 234 – Pardon Me, I Couldn’t Help but Overhear or How to go from being an Ass-hole to an AYS-hole on Twitter
25:43
Are you saying?...
Oct 03, 2018
EMCrit 233 – EMCrit Failed Airway Algorithm 2018 from ResusTO
37:14
Remixed and Better for 2018
Sep 19, 2018
EMCrit 232 – SteelMan Debate – EMS Field Decisions in Cardiac Arrest with Howie Mell
44:27
Stay or Go with Cardiac Arrest in the Field?
Sep 05, 2018
EMCrit 231 – How to Practice Cricothyroidotomy (Cric)
How to use the cric models and optimal surgical airway technique.
Aug 25, 2018
EMCrit #230 – Resuscitation Communication
20:05
Precise Resuscitation Communication is crucial for patient safety
Aug 08, 2018
EMCrit Podcast 229 – No-Shitters, Boldface, and the Resus QRH
18:22
drum roll please...
Jul 25, 2018
EMCrit Wee – The Mock Trial Verdict and a Discussion with Mike Weinstock
21:30
The verdict is in...
Jul 23, 2018
EMCrit Wee – The Great Beta-Blocker for Cocaine Toxicity Slugfest
34:21
Is it safe to use beta-blockers in cocaine toxicity and is that even the questions...
Jul 22, 2018
EMCrit RACC 228 – Physiology-Guided Cardiac Arrest Management in 2018 with Dr. Robert Sutton
33:53
Physiology-Guided Cardiac Arrest Management in 2018 with Dr. Robert Sutton
Jul 11, 2018
EMCrit RACC – A Refractory Anaphylaxis Mock Trial by Mike Weinstock
1:26:20
A refractory anaphylaxis case presented as a mock trial
Jul 05, 2018
EMCrit Podcast – Acid Base Ep. 7 – Bicarb Updates, Quantitative Approach, and Prof. David Story
25:42
Bicar-ICU changes my practice with bicarb infusions and let's end the great lactate debate on EMCrit 227:
Jun 28, 2018
EMCrit Podcast 226 – Airway Update – Bougie and Positioning
25:26
A discussion of bougie-first, bougie best and hopefully a summary of proper positioning
Jun 13, 2018
EMCrit Podcast 225 – Tox(&Hound)idromes with Howard & Dan
26:56
The real scoop on toxidromes
May 28, 2018
EMCrit Podcast 224 – TTP & DIC with Tom DeLoughery – Part II – Treatment
20:03
Part 2 of DIC vs TTP - Treatment
May 14, 2018
EMCrit – Retract SSC 2018 – You Only Have Yourself to Blame if You Do Not Take Action
17:46
please read this post--if you care about your practice and your patients
May 08, 2018
EMCrit Podcast 223 – TTP & DIC with Tom DeLoughery – Part I – Diagnosis
19:25
Low platelets in the Critically Ill Patient--TTP, DIC, MAHA
Apr 30, 2018
EMCrit RACC Podcast 222 / EDECMO Podcast – Demetris Yannopoulos on ECPR-the Minneapolis Way
1:18:47
Yannopoulos on ECPR
Apr 08, 2018
EMCrit RACC Wee – Debate re: Idarucizumab with @First10em
25:33
So my friend, Justin Morgenstern recently put up a post on Idarucizumab, aka Praxbind. He seemed pretty fired up on the issue, so I got him on the line to talk about it. What follows is a conversation on evidence and what to do when there is not a good amount of it. Schtuff The EM Cases Podcast that partially sparked the debate Justin Wrote an Additional Post after our Discussion On Parachutes and Such On to the Wee...
Apr 05, 2018
EMCrit RACC Podcast 221 – Burns Part II with Dennis Djogovic – Airway, Lungs, Tubes and Stuff
30:04
Part II on Airway and Breathing in Burns
Apr 02, 2018
EMCrit RACC Podcast 220 – Beat the Stress Fool (BtSF) with Mike Lauria — Just In Time Performance-Enhancing Psychological Skills
20:12
Beat The Stress Fool!
Mar 19, 2018
EMCrit RACC Podcast 219 – Critical Burn Patients in the ED/ICU – Part I with Dennis Djogovic
28:47
Burns Part I - Fluid Management
Mar 05, 2018
EMCrit RACC Podcast 218 – Physostigmine with Bryan Hayes
16:48
Physostigmine for Anticholinergic toxicity
Feb 20, 2018
EMCrit RACC Wee – State of the Crit
10:40
what's going on with the EMCrit Project
Feb 17, 2018
EMCrit RACC Podcast 217 – The Ultimate “Ultimate” BVM
16:30
So in prior posts, I have discussed the jerry-rigged "ultimate" BVM. But there is a better way--the creation of a manufactured BVM that helps us not kill patients. It would have the following characteristics: Facets of the Ultimate BVM     Now on to the Vodcast...
Feb 05, 2018
EMCrit RACC Podcast 216 – The Hemodynamically Neutral Intubation
23:13
Even better than Hemodynamic Kills
Jan 22, 2018
EMCrit Wee – Steroids for Septic Shock — PRE-ADRENAL
14:08
Get ready for ADRENAL
Jan 08, 2018
EMCrit Podcast 215 – A Disagreement of Toxicologists with Dantastic Mr. Tox/&Howard
30:09
Dantastic Mr. Tox/&Howard discuss some Tox stuff and Santa Beards
Dec 25, 2017
EMCrit Wee – Advanced Ultrasound Assessment of Volume Status
25:22
Advanced uses of ultrasound to assess volume status
Dec 15, 2017
EMCrit Podcast 214 – When they Stay
25:06
Issues with pts in the ED without an inpatient team yet
Dec 11, 2017
EMCrit Podcast 213 – Controlled Burn for Hypercapneic Encephalopathy in COPD
19:10
Intubation is failure!
Nov 27, 2017
EMCrit Podcast 212 – Thoughts on Deliberate Practice and Expertise
21:27
My thoughts on the recent interview with Anders Ericcson
Nov 12, 2017
EMCrit – Some Weeish Elaboration on my Interview with the Curbsiders
8:05
Why can't we all just get along
Oct 31, 2017
EMCrit Podcast 211 – Expertise with Anders Ericsson
50:51
Expertise & Deliberate Practice with Anders Ericsson and @resuspadawan
Oct 29, 2017
EMCrit Podcast 210(2) – Arterial Lines – Part 2
19:37
Part 2 on Art Lines
Oct 20, 2017
EMCrit Podcast 210 – Arterial Lines (Part 1)
24:25
All things Arterial Lines-Part 1
Oct 16, 2017
EMCrit Wee – Dissemination and Information Transfer (Questions not Answers)
10:49
I need help...
Oct 11, 2017
EMCrit Podcast 209 – GTD Redux – Opportunities, Time, & Future Selves
32:11
More on GTD
Oct 02, 2017
EMCrit Podcast 208 – Felipe Teran on Why We are Doing CPR Wrong
19:21
You are doing CPR wrong
Sep 18, 2017
EMCrit 207 – A Case to Acid Test your Resus Logistics
27:28
Acid Test your Resus
Sep 05, 2017
EMCrit Wee – Central Line MicroSkills – Dilation
9:13
The next in the microskill series
Aug 29, 2017
EMCrit Podcast 206 – ApOx, ENDAO, & PreOx Update
ApOx & PreOx Update
Aug 21, 2017
EMCrit Podcast 205 – Push-Dose Pressors Update
An update on push-dose pressors
Aug 07, 2017
A Wee Bit More on Massive Hemoptysis
8:21
Hemoptysis redux
Jul 31, 2017
EMCrit Wee – An Amazing (Wearable) Cric Trainer from Laura Duggan and the AirwayCollaboration Folks
8:29
The new amazing cric trainer
Jul 25, 2017
Podcast 204 – The Nurse-Led Code with Joe Bellezzo
19:54
Nurses should be leading cardiac arrest management
Jul 24, 2017
Podcast 203 – New Reversals for New Anticoagulants with Nadia Awad
27:44
New agents for Reversal of NOACS
Jul 10, 2017
EMCrit 202 – Blood Bank Essentials with Joe Chaffin
30:42
blood bank stuff: The basics of crit care transfusion medicine
Jun 25, 2017
EMCrit 201 – Deeper on Vasopressors and Athos 3 with Mink Chawla
28:45
A new vasopressor is out there--angio II
Jun 12, 2017
EMCrit Podcast 200 – Orman Grills EMCrit – No Clinical Medicine Here
25:44
My friend Rob Orman Interviews Me for Ep. 200
May 29, 2017
EMCrit Podcast 199 – Management of Massive Hemoptysis with Oren Friedman
24:32
Management of Massive Hemoptysis
May 14, 2017
Podcast 198 – Insulin Pumps and Such with Josh Miller, MD
23:03
Scared of insulin pumps--not anymore
May 01, 2017
Ketamine ……. then Rocuronium, DSI & The Timing Principle
10:49
More on rocketamine...
Apr 25, 2017
Podcast 197 – The Logistics of the Administration of Massive Transfusion
25:36
The hands-on of orchestrating a massive transfusion protocol
Apr 17, 2017
The Sick and the Dead: Evidence-Based Trauma Resuscitation in 2016 by Hicks & Petrosoniak
29:43
The sick and the dead from SMACCdub
Apr 04, 2017
Podcast 196 – Having a Vomit SALAD with Dr. Jim DuCanto – Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding
19:20
Friend to the show, Jim DuCanto has been obsessed with SALAD. Not the leafy greens delicately touched with a tart emulsion, but with Suction Assisted Laryngoscopy and Airway Decontamination (SALAD). Jim DuCanto, MD  is an anesthesiologist extraordinaire with a constant drive to perfect new airway techniques and document them on video along the way. COI Statement Dr. DuCanto invented and receives royalties on the DuCanto Catheter from SSCOR and the Nasco SALAD mannequin Read More about SALAD from Taming the Sru TtS Post Esophageal Diversion Maneuver (Intentional Esophageal Intubation) deliberately insert the ETT down the esophagus and gently inflate the balloon There is lit for this [cite source='pubmed']25943615[/cite] SALAD Park Maneuver Keep tip of suction catheter in the esophagus on the left side of the mouth SALAD Techniques Meconium Suction Set-Up Here was our original letter (J Clin Anesth, 23 (2011), pp. 518–519) (fulltext) It was recently validated (The Journal of Emergency Medicine Volume 52, Issue 4, April 2017, Pages 433–437)   More Stuff SALAD Facebook Page SSCOR Site Taming the SRU write-up of SALAD DuCanto Suction Catheter General Description of system and demonstration by Jeff Hill of the University of Cincinnati’s EM Program Product page of SALAD Mannequin University of Wisconsin HEMS Fellow with the “Static” Excercise University of Wisconsin HEMS Fellow with the “Dynamic” Excercise University of Wisconsin HEMS Attending takes on the SALAD Simulator Check out the next level of SALAD—SALAD 2.0 Listen to the JellyBean with Jim More from Jim DuCanto on EMCrit Podcast 73 – Airway Tips and Tricks A New Bougie for your Pocket by Jim DuCanto A Guide to Intubating through the Intubating Laryngeal Airway Two New Videos from Jim DuCanto The Oxylator More DuCanto and Pocket Bougie Videos Two OR Intubation Videos How to Custom Bend a Video Stylet for use with the Cookgas AirQ ILA image at the top from J Downham Now on to the Podcast...
Apr 03, 2017
EMCrit Wee – Edited Version of Paul Marik on the Metabolic Resuscitation of Sepsis
16:05
Edited interview with Paul Marik
Mar 28, 2017
Podcast 195 – Management of Tracheostomy (Trach) and Laryngectomy Emergencies
30:18
Trach Emergencies
Mar 20, 2017
Podcast 194 – Definitive Emergent Awake Intubation with George Kovacs
Podcast 194 - The Definitive Emergent Awake Intubation Lecture by @kovacsgj
Mar 06, 2017
Podcast 193 – Emergency Medicine is a Failed Paradigm
27:55
Yep, EM is indeed a failed paradigm
Feb 20, 2017
EMCrit Wee – The Golden Fleece, the Golden Hour, and the Golden Rule by Ashley Liebig
24:48
Ashley crushes stigma and leaves us acutely aware of how our words and actions affect our colleagues and those that we love
Feb 16, 2017
Podcast 192 – Powerpoint and Meth – Presentation Creation from #TTC
32:15
The slides are not the problem...
Feb 06, 2017
Wee – Warning: Nothing Useful Here – Politics and Why I’m “Divorcing” Twitter
13:21
if you still want to listen after reading the title
Feb 01, 2017
Podcast 191 – Cardiac Arrest Update
24:26
Cardiac Arrest Update & the Syndromes of Arrest
Jan 23, 2017
Practical Evidence Podcast 015 – Surviving Sepsis Campaign (SSC) Guidelines 2016 (in 2017)
24:38
SSC 2016 Guidelines
Jan 22, 2017
Podcast 190 – Emergencies with a Side of Hypertension
25:01
Hypertensive emergencies look like emergencies!
Jan 10, 2017
EMCrit 189 – Secret Sixth Cause of Arterial Hypoxemia and Vasoactive Purity
22:05
A brain dump at the end of 2016
Dec 28, 2016
Podcast 188 – Rudeness Part II (the Brindley Sessions)
22:22
Brindley Session 2 - continuing the rudeness discussion
Dec 12, 2016
Podcast 187 – Hypernatremia (Uggggh!)
21:09
Hypernatremia -- not sexy, but we gotta get 'im done
Nov 28, 2016
Podcast 186 – Coma with Eelco Wijdicks
21:31
How to Diagnose and Manage Coma
Nov 13, 2016
Podcast 185 – Disruption, Danger and Droperidol by Reub Strayer
26:09
Danger, Disruption, and Reub Strayer
Oct 31, 2016
The Brindley Sessions: Rudeness
22:08
The first Brindley Session is on Rudeness
Oct 26, 2016
Response to Letters on my Mechanical Ventilation Article in the Ann Emerg Med
30:36
Response to letters to the editor on mechanical ventilation article
Oct 21, 2016
Podcast 184 – Needle Cric (Again) and Transtracheal Jet Ventilation with Laura Duggan
21:46
The needle vs. knife debate rages on, but it looks like the knife may be winning
Oct 16, 2016
Podcast 183 – Driving Pressure with Dr. Roy Brower
19:25
Driving Pressure with Dr. Roy Brower
Oct 03, 2016
Podcast 181 – Pulmonary Hypertension and Right Ventricular Failure with Susan Wilcox
25:26
Pulmonary Hypertension and Acute on Chronic RV Failure
Sep 05, 2016
Podcast 180 – On Argumentation, Fallacies, and Twitter Misery
24:43
A slight diversion to discuss how to argue better
Aug 22, 2016
Podcast 179 – An Interview with Gary Klein
53:19
Today, I am joined by my friend, Mike Lauria, to interview Gary Klein, PhD. Dr. Klein is a masterful cognitive psychologist. He is known for many groundbreaking works, including: the Recognition-Primed Decision (RPD) model to describe how people actually make decisions in natural settings; a Data/Frame model of sensemaking; a Management by Discovery model of planning to handle wicked problems; and a Triple-Path model of insight. He has also developed several research and application methods: The Critical Decision method and Knowledge Audit for doing cognitive task analysis; the PreMortem method of risk assessment; the ShadowBox method for training cognitive skills. He was instrumental in founding the field of Naturalistic Decision Making. The Books This is the one that got Mike and I started as Klein Fanboys The absolute best compilation of Dr. Klein's decision-making concepts that are directly applicable to medicine Next up on my reading list Recognition Primed Decisionmaking Wikipedia Link for RPD Sites and Links Dr. Klein's Company Shadowbox Training Articles Mentioned in the Show Kahneman D, Klein G. Conditions for intuitive expertise: a failure to disagree. Am Psychol. 2009 Sep;64(6):515-26. Can We Trust Best Practices? Six Cognitive Challenges of Evidence-Based Approaches. Journal of Cognitive Engineering and Decision Making Additional Related Stuff Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. Effects of reflective practice on the accuracy of medical diagnoses.  Going fast might not induce more error, it's about experience and if you have the patterns to recognize: Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians? Slowing down doesn't help.  Slow is just slow. Smooth is FAST, and smooth is about economy of cognitive resources and movements The relationship between response time and diagnostic accuracy. The etiology of diagnostic errors: a controlled trial of system 1 versus system 2 reasoning. Now on to the Podcast:
Aug 07, 2016
Modification of Scalpel Finger Bougie Technique
9:03
No more bougie hold-up for scalpel-finger-bougie cric
Aug 01, 2016
Emergency Awake Topicalized (EAT) Intubation – An Awake Intubation Update
7:59
Rapid Sequencing of Awake Intubation
Jul 29, 2016
Podcast 178 – A Better Management Strategy for Symptomatic Hyponatremia (dDAVP Clamp)
20:30
What to actually do (besides nothing) for severe hyponatremia
Jul 25, 2016
EMCrit Wee – Should a Nasal Cannula be Part of Denitrogenation / Preoxygenation
11:56
NC: yea or nay
Jul 19, 2016
Podcast 177 – Chris Hicks on the Fog of War: Training the Resuscitationist Mindset
49:06
Team Performance from Chris Hicks
Jul 11, 2016
How Not to be a #ResusWANKER
34:43
The seven folks that ruin your day...
Jul 01, 2016
Podcast 176 – Updated EMCrit Rapid Sequence Intubation Checklist
20:30
The new improved version of the EMCrit RSI checklist
Jun 27, 2016
EMCrit Wee – Vipassana Meditation
20:26
My opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation. It will be available in the next few months. Hopefully this wee will tide you over.
Jun 19, 2016
EMCrit Podcast 175 – A Follow-Up on the Fluids in Sepsis Panel with Phillipe Rola
29:31
Fluids in Sepsis
May 31, 2016
SMACC-Back – On Marik and Lactate
9:52
Banging -- My -- Head -- Against -- Wall -- Repeatedly...
May 21, 2016
Podcast 174 – LaMW – Oxygenation Kills Part II
18:13
Laryngoscope as a Murder Weapon - Oxygenation Kills Part II
May 15, 2016
Podcast 173 – LaMW – Oxygenation Kills Part I
30:16
Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I
May 03, 2016
Reddit and A Free Sepsis Webinar
7:53
G+ is dead, long live reddit
Apr 21, 2016
EMCrit Podcast 172d – Enough with the Can you Trust Podcasts/Blogs/New Media
10:41
Yes, you can trust medical podcasters
Apr 17, 2016
EMCrit Podcast 172c – Vent as Bag & VAPOX
7:09
the BVM is the most dangerous device in medicine--let's do better
Apr 17, 2016
EMCrit Podcast 172b – MoTR – Get Faster!
4:03
Slow is Smooth, Smooth is Fast. Now, get faster
Apr 17, 2016
EMCrit Podcast 172a – The Mind Palace?
12:51
I want the perfect external mind palace...
Apr 17, 2016
Podcast 171 – OODA Loops
38:56
Resuscitation is a System I Game...
Apr 02, 2016
Wee – Cliff Deutschman with Additional Thoughts on Sepsis 3.0
27:00
More on Sepsis 3.0
Mar 11, 2016
Podcast 169 – Sepsis 3.0 with Merv Singer
32:33
Hear from the lead author of the new Sepsis 3.0 definitions
Mar 07, 2016
Podcast 168 – Kyle Gunnerson and the EC3
32:26
The USA's first stand-alone EDICU, the EC3
Feb 23, 2016
Podcast 167- Emergency Critical Care with Sara Gray
18:06
Sara Gray is amazing--hear her talk about ED Critical Care from @smaccteam:
Feb 09, 2016
Podcast 166 – Endocarditis with David Carr
33:32
Endocarditis in Acutely Ill Patients
Jan 26, 2016
Podcast 165 – The Semantics of End of Life Discussions with Ashley Shreves
42:47
How to have an end of life conversation in the ED
Jan 10, 2016
Podcast 164 – The Day I Didn’t Use Ultrasound by Mike Mallin
33:55
An amazing story from Mike Mallin
Dec 26, 2015
Resuscitation Program and FEMinEM discussion on Women as Conference Speakers and Unconscious Bias
2:09
ART Program and FEMinEM Hangout
Dec 20, 2015
Response to a Letter to the Editor on DSI Study
20:26
A response to some DSI questions in the Annals
Dec 19, 2015
Podcast 163 – MotR – The Post-Resuscitation
23:06
You saved a life or blew an airway--Now What? Handling the post-resuscitation on EMCrit # 163:
Dec 15, 2015
Podcast 162 – Assessing Fluid Responsiveness
26:57
yep, more on fluid responsiveness
Nov 29, 2015
Podcast 161 – The New Fluid Assessment in Sepsis with Jean-Francois Lanctot
25:52
Fluids, Sepsis, Ultrasound, French-Canadian: what more do you want?
Nov 20, 2015
Podcast 160 – Sepsis smaccDOWN
1:18:08
An all-star panel of world sepsis experts discuss the controversial areas
Nov 04, 2015
Huge Announcement for EMCrit.org
2:05
Big news...
Nov 02, 2015
Podcast 159 – Rounding in the RACC
20:01
Rounding on critically ill patients in the ED
Oct 30, 2015
Podcast 158 – The FELLOW Trial on Apneic Oxygenation in ICU Patients
24:18
Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients
Oct 06, 2015
Podcast 157 – Central Lines II – Placement Tips
30:12
Part II of the Central Line Series discusses placement tips
Sep 13, 2015
EMCrit Wee – Central Line MicroSkills (Deliberate Practice)
11:37
A break down of the skills needed for Seldinger technique
Sep 12, 2015
Podcast 156 – The Central Line Show – Part I: Avoiding Complications and Confirmation
31:50
Stop Effing Up Your Central Lines
Aug 29, 2015
Wee – Avoiding Disaster – Endotracheal Tube Cuff Leaks and Tube Exchanges
18:33
It seems simple, but not treating this situation with respect can lead to disaster.
Aug 29, 2015
Podcast 155 – Status Epilepticus with Tom Bleck
24:11
Tom Bleck on Status Epilepticus
Aug 14, 2015
Podcast 154 – Preemptive Sepsis Panel SmaccBack
38:34
A preemptive smaccback on the SMACC Chicago Sepsis Panel
Jul 29, 2015
Podcast 153 – In Memory – John Hinds, On How He Ran His Unit
41:33
In Memory of Our Friend, John Hinds
Jul 05, 2015
Podcast 152 – High Flow Nasal Cannulae – Just Blowin’ Hot Air?
21:49
HFNC--the new hot thing or just blowin' hot air?
Jun 29, 2015
EMCrit Podcast 151 – Procedural Sedation Part 3 with Jim Miner
23:34
Jim Miner discusses the fine points of ED/ICU procedural sedation
Jun 14, 2015
Podcast 150 – A Look Back
24:32
Can't believe we made it this far...and it's all thanks to the emcritters!
Jun 01, 2015
Podcast 149 – Thyroid Storm
20:16
When hyperthyroidism goes really wrong...
May 16, 2015
Stuff Update
6:07
A whole bunch of stuff
May 12, 2015
Podcast 148 – Airway Decisions and Online Etiquette
26:28
More on the recent cric case from the perspective of airway decision making
Apr 27, 2015
EMCrit Wee – Mind Blowing Cricothyrotomy Video
13:19
An amazing surgical airway case
Apr 18, 2015
EMCrit Podcast 147 – Who Needs an Acute PCI with Steve Smith (Part II)
23:27
Finally in one place, all of the STEMI equivalents with Steve Smith--Part II
Apr 12, 2015
EMCrit Podcast 146 – Who Needs an Acute PCI with Steve Smith (Part I)
23:49
Finally in one place, all of the STEMI equivalents with Steve Smith
Mar 29, 2015
EMCrit Conference BLAST Winner – Ice Water Baths for Rapid Cooling of Hyperthermia
7:06
How to cool the too hot tox patient
Mar 25, 2015
Podcast 145 – Awake Intubation Lecture from SMACC
26:46
Awake Intubation from SMACC 2015
Mar 16, 2015
EMCrit Wee – The RLA and the Slope of Resuscitation
14:08
The RLA and Resus Graphs
Mar 02, 2015
Podcast 144 – The PROPPR trial with John Holcomb
20:35
The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author?
Feb 22, 2015
Podcast 143 – Hemodynamic Management of Massive Pulmonary Embolism (PE)
32:33
Hemodynamic Management of Massive PE
Feb 16, 2015
Podcast 142 – Airway Things I Learned from George Kovacs at the NYC Airway Course
26:21
In this 3rd post for JanuAirway, I am joined by airway educator extraordinaire: George Kovacs.
Jan 25, 2015
EMCrit Wee – Preoxygenation Update 2015
19:08
It's Janu-Airway: Here's a little update on preox (you know the topic I think about 20 hours a day)
Jan 22, 2015
Podcast 141 – A Janu-Airway Case Presented Live
22:04
A case of anatomically and physiologically difficult airway presented live at #EMCritConf 2015.
Jan 10, 2015
Podcast 140 – Top Picks for 2014
9:35
Welcome to our annual rehash of the goodness of the past year.
Dec 31, 2014
Podcast 139 – Opioid-Free ED with Sergey Motov
28:35
Can we manage pain more effectively without Opioids?
Dec 14, 2014
Podcast 138 – Vasopressor Basics
30:33
There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation.
Dec 01, 2014
EMCrit Podcast 136 – Getting Shit Done
47:34
Not quite ED Critical Care, but I hope this discussion of EM/Resus Productivity may be helpful to some of you out there.
Nov 03, 2014
EMCrit Podcast 135 – Trauma Thoughts with John Hinds
25:55
John Hinds on Blunt Traumatic Arrest
Oct 20, 2014
EMCrit Wee – I Thought This Would be the One, but Nope….
10:14
Smells like some confirmation bias here
Oct 13, 2014
Podcast 134 – ARISE has arisen; now where do we stand on Severe Sepsis in 2014
21:53
the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014
Oct 03, 2014
EMCrit Podcast 133 – The First Prehospital REBOA
25:54
London HEMS docs peform REBOA and save a life
Sep 24, 2014
EMCrit Wee – Aggressiveness and the New Cutdown with Leon Boudourakis, MD
9:40
Need access--this may be a way
Sep 17, 2014
Podcast 132 – MoTR – Toughness Part I with Michael Lauria
31:56
Today, I interview Mike Lauria on the concepts of toughness and resilience.
Sep 06, 2014
EMCrit Wee – A Case to Threaten Current ECMO Evidence from Sam Ghali
5:44
Should we be extending ACLS in patients we really want to save?
Aug 15, 2014
EMCrit Podcast 130 – Hemodynamic-Directed Dosing of Epinephrine for Cardiac Arrest
18:24
Today on the podcast, I address the last little bit from my SMACC lecture on the new management of the intra-arrest: hemodynamic, individualized dosing of epinephrine.
Aug 10, 2014
MotR – Mike Lauria on “Making the Call”
42:52
You'll be hearing more from Mike
Jul 31, 2014
Podcast 129 – LAMW: The Neurocritical Care Intubation
31:00
This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault.
Jul 26, 2014
Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman
33:08
We now have way too many treatment options for sub-massive and massive pulmonary embolism (PE) patients who aren't coding in front of you. How do you decide which one is right for your patient? To help answer this question, I am joined today by Oren Friedman, pulmonary critical care doc and one of the members of the Cornell PEAC team. Cornell Pulmonary Embolism (PE) Advanced Care Team (PEAC), aka the CLOT Team Oren Friedman MD, Pulm Crit Care; James Horowitz MD, Cardiology; Arash Salemi MD, Cardiac Surgery; Akhilesh Sista MD, Interventional Radiology You can shoot the team an email: peadvancedcare at gmail dot com Who Should We Treat? 30% normotensive patients have RVD; 10% progressed to shock; 5% in hospital mortality[cite]10859287[/cite] The Better Risk Categories for Pulmonary Embolism Well and Stable Sub-Massive High-Risk Sub-Massive Massive PEITHO Trial NEJM 2014;370(15):1402 Full dose tenecteplase with concurrent heparin Death or hemodynamic decompensation occurred in 2.6% of the tenecteplase group as compared with 5.6% of the placebo group Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P<0.001) Intracranial Bleed 10 patients (2%) in the tenecteplase group and 1 patient (0.2%) in the placebo group (P=0.003) Also see my bud, Salim Rezaie's post on PEITHO and Konstantinides' prior study [cite]12374874[/cite] Ryan Radecki made some great observations in his post on PEITHO The criteria for myocardial injury was a troponin I >0.06 ?g/L or troponin T >0.01 ?g/L.  These may be relatively inclusive thresholds. Not all placebo patients developing hemodynamic collapse received subsequent thrombolysis; likewise, almost half of those who received open-label thrombolysis had no hemodynamic collapse. Half the deaths in the placebo arm were “sudden unexplained” or “other”, compared with bleeding or stroke complications in the thromboysis arm. TOPCOAT Trial Jeff Kline's trial was stopped midway through due to an institution change. Complicated primary endpoint with promising, but unusable results [cite]24484241[/cite] For the scoop on this one see the Bottom Line Review post on TOPCOAT MOPETT Trial Half-dose alteplase led to a marked reduction in pulmonary hypertension without sig. complications Sharifi M et al. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT trial). (J Cardiol 2013; 111: 273) See this prior EMCrit Wee as well on MOPPETT Update: This meta-analysis states that the half-dose may be appropriate, effective, and safe [cite source='pubmed']24412030[/cite] Meta-Analysis Chatterjee et al. have the most current meta-analysis on this topic (JAMA. 2014;311(23):2414-2421) See the Bottom Line Review post on this study Nakamura just published another MA this week; see Rory Spiegel's take on the two here Is it just in the Oldies? Markedly lower risk in <75 y/o in PEITHO and <65 in the Meta-Analysis The Treatment Options Heparin Alone tried and true. but even if some degree of resolution of presenting severe symptoms, there is the question of long-term consequences of leaving a large clot burden--namely, loss of exercise tolerance due to chronic pulmonary hypertension Systemic Thrombolysis With either full or half-dose alteplase or full-dose tenecteplase Catheter-Based Intra-Arterial Thombolytic Infusion Angiography guided placement of pulmonary artery catheters allowing a 24-hour infusion of low dose tPA. [cite]19875060[/cite] A newer therapy is the EKOS catheter. This uses ultrasound to continuously break up the clot during the IA Thrombolysis. Many of us wonder if this is any better than standard catheter-based therapy. [cite]24226805[/cite], [cite]23601295[/cite] See the PulmCCM Post on the Circulation RCT of EKOS Interventional Mechanical Clot Disruption AngioJet-a catheter that breaks up the clot with a high speed jet of saline,...
Jul 14, 2014
Podcast 127 – The Oxylator with Jim DuCanto
20:19
BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator
Jun 29, 2014
SMACC-Back – On the Beliefs of Early Adopters and Straw Men
16:30
The First SMACC-Back from SMACCgold
Jun 24, 2014
Podcast 126 – TTM Trial Right from Niklas Nielsen’s Mouth
18:09
In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial.
Jun 15, 2014
EMCrit Wee – Four More Minutes with Rob Mac Sweeney
4:32
I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is...
Jun 11, 2014
EMCrit Wee – Rob Mac Sweeney on Intra-Arrest Meds
16:40
Rob Mac Sweeny on the Intra-Arrest Talk
Jun 10, 2014
Mind of the Resuscitationist – Errors of Commission and Omission
5:22
Should we err towards errors of commission or omission?
Jun 06, 2014
Podcast 125 – The New Intra-Arrest (Cardiac Arrest Management)
21:11
Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care
Jun 02, 2014
EMCrit Wee – Cricolol by Dr. John Hinds
8:36
My favorite part of SMACCgold; buy some Cricolol
May 28, 2014
Podcast 124 – The Logistics of Proning for ARDS
23:21
Proning is one of the only evidence-based techniques to affect the mortality of ARDS patients. I've been wanting to do an episode on proning for a while.
May 19, 2014
EMCrit Wee – Sean Townsend of the SSC and the ProCESS Trial
17:33
I talk with a member of the surviving sepsis campaign steering committee re: ProCESS
May 09, 2014
Podcast 123 – Selective Aortic Arch Perfusion (SAAP) with Jim Manning
28:31
What if you had a REBOA catheter through which you could give blood and drugs?
May 06, 2014
EMCrit Wee – A Cric Case with Rob Bryant
12:12
Rob Bryant presents a case
Apr 24, 2014
Podcast 122 – Cardiac Arrest after the Toxicology of Smoke Inhalation with Lewis Nelson
18:01
What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns?
Apr 21, 2014
EMCrit Podcast 121 – REBOA
20:31
This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta).
Apr 06, 2014
Podcast 120 – The ProCESS Trial with Derek Angus
25:35
I speak to the lead author of the ProCESS trial, Dr. Derek Angus
Mar 24, 2014
Wee – What the heck is a Mapleson B Circuit and Why You Probably Shouldn’t Care
19:11
There is a really smart anesthesiologist out there called Nicholas Chrimes. He along with his mate Peter Fritz invented the Vortex Approach to Airway Management. He also runs a blog called Clinical CrEd. He did a post advocating the Mapleson B Circuit as the Ultimate Preox Device What is the Mapleson B? The Mapleson circuits were used for anesthetics in the good old days. At least in the US, we have move to bigger, and arguably better designs for our operative patients. Many would have thought this device would have been consigned to the trash heap, but seemingly not. My Recommended Approaches I recommend two approaches to preox: standard and shunt physiology strategies. I outlines these strategies in the paper Rich Levitan and I wrote. Standard: NRB @ >=15 lpm and NC @ 10-15 lpm for 3 minutes Shunt Physio: Choose 1 BVM with PEEP Valve & NC @ 10-15 lpm NIPPV Ventilator with NIPPV Mask or BVM Mask & NC @ 10-15 lpm Nick makes a number of arguments as to the superiority of the Mapleson circuit over these standard techniques. His points are excellent, but I disagree with pretty much all of them--I think it becomes a question of perspective. Automatic Checking Yes, using the same device for reox and preox makes sure the reox device is there and hooked up, but this for me is an inadequate argument to dispense with NRB/NC set-up. Multiple BVM Masks We don't have these readily available in any ED or ICU I've worked in. We have neonate, peds, and adult. Our masks also are not inflatable. PEEP PEEP is good, Mapleson may or may not be a good way to provide this for the reasons I've mentioned in the wee, but a BVM with a PEEP valve or a vent are at least as good. ApOx Mapleson may provide this better than BVM, but not as well as a NC, which should be on during any intubation. ETCO2 No advantage of Mapleson Low resistance Maybe this matters, as soon as you put on the PEEP, I can't imagine this difference persisting Room Air Entrainment Release your seal for even one breath and you have blown denitrogenation. Always, always use a strapped system if possible=NRB/NC, NIV mask, or BVM mask with OR straps. Troubleshooting Leaks This is the real area in which Nick and I differ. Nick makes the point that a good seal in preox guarantees a good seal in reox--this may be true, but it is unimportant. What I care about is does a bad, one-handed seal in preox mean I won't be able to reox with the BVM--this is entirely untrue. If I did to an awake patient what I will do to them when asleep and desaturating, they would, quite rightfully, punch me in the face. Anesthesiologists should use Mapleson B/C; ED/ICU should only use BVM +/- PEEP Valve with two hands and oral airway and a rocking triple maneuver (that no pt should experience if they are conscious) otherwise they should be NIV mask with straps or (BVM mask with straps). This is the same reason I tell my residents to just train with Macintosh blades. Primary and secondary leaks are the main thrust of Nick's love for the old-timey circuits. But all of us have appreciated this easily by squeezing the bag-valve-mask: Easy-squeezy or Hard Squeezy ETCO2 with a monitor you can see Is he holding or squeezing? I can feel compliance with a BVM if I squeezed it, but I don't unless the pt needs it during reox. But are they squeezing the Mapleson? If they are, they may be doing damage. This study (Anesthesiology 2014;120:326) talks about the myths of Gentle Facemask Ventilation: >15 cmH20 may be entraining gas into the stomach via the LES (in some patients, even 10 cmH20 may be a problem) UES will withstand at least 20 cmH20 until NMB at which point again 15 seems to be the number (The latter is why we don't bag during apnea unless we have to) Two hands ALWAYS on the mask Recently, I spent 2 weeks intubating 10-15 patients per day. One hand mask skills got better and better--all for naught. Train how you want to Fight Hands free
Mar 11, 2014
Podcast 119 – Rich Levitan on the Surgical Airway
26:45
Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference
Mar 10, 2014
Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman
34:42
Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman
Feb 23, 2014
Practical Evidence 014 – ACEP Procedural Sedation Update for 2013
8:42
This one is really good!
Feb 18, 2014
Podcast 117 – Everyday Emergency Kits with Keith Conover
30:42
If you are an EM:RAP listener, you have probably heard Mel Herbert's story of 2 cars crashing right outside of his house. Mel realized he did not stock a medical kit in his house with the necessary crucial supplies for an emergency scene. I realized I don't either (there is one in my car). So, I reached out to the master of preparedness, Dr. Keith Conover.
Feb 10, 2014
Podcast 116 – the tPA for Ischemic Stroke Debate
52:21
Dr. Andy Jagoda debates my friend Dr. Anand Swaminathan on the use of tPA for Ischemic Stroke in the Emergency Department
Jan 27, 2014
Podcast 115 – A New Paradigm for Post-Intubation Pain, Agitation, and Delirium (PAD)
21:21
What you do in the ED for post-intubation sedation will determine whether your patient lives or dies
Jan 13, 2014
Best of 2013 – Eight is Enough & Social Media Update
20:45
Best of 2013
Dec 31, 2013
Podcast 114 – Post-Arrest Care in 2013 with Stephen Bernard – Part II
19:13
Part 2 of an interview with Stephen Bernard on the Care of the Post-Arrest Patient in 2013
Dec 16, 2013
Podcast 113 – Post-Cardiac Arrest Care in 2013 with Stephen Bernard – Part I
Dr. Stephen Bernard on the topic of post-arrest care
Dec 08, 2013
Podcast 112 – A Response to the Marik Sepsis Fluids Lecture
30:31
Last week I posted a lecture by Paul Marik on Fluid Management in severe sepsis. The lecture is the equivalaent of a bucket of ice water poured over your head. Now let's give you a towel and discuss.
Nov 24, 2013
Five Minutes with Jon Rittenberger on the TTM Trial
5:35
More on TTM Trial
Nov 18, 2013
EMCrit Wee – The Targeted Temperature Trial Changes Everything
2:53
Cold, but not all that cold may be the way
Nov 18, 2013
Podcast 111 – Fluids in Sepsis, A New Paradigm – Paul Marik
51:37
Our favorite critical care skeptic, Dr. Paul Marik, on fluids in severe sepsis
Nov 09, 2013
SMACC Back 3 – Simon Carley on Leadership
7:51
A SMACC back on Simon Carley's talk on Educational Leadership
Nov 06, 2013
Podcast 110 – Exsanguinating Hemorrhage from Mid-Face Fractures
18:39
Management of Severe Hemorrhage from Mid-Face Blunt Trauma
Nov 01, 2013
Practical Evidence 013 – ACEP Management of Asymptomatic Blood Pressure 2013
10:26
Management of asymptomatic markedly elevated blood pressure
Oct 22, 2013
Podcast 109 – Mind of the Resuscitationist from SMACC 2013
17:07
Mind of the Resuscitationist Lecture from SMACC 2013 and Blakemore Placement
Oct 14, 2013
Blakemore Tube Placement for Massive Upper GI Hemorrhage
10:30
How to place a Blakemore tube for esophageal varices with massive bleeding.
Oct 13, 2013
Podcast 108 – How to Be a Hero with Cliff Reid
24:33
This was my favorite lecture from SMACC 2013. If you are not moved and inspired then your heart is made of stone.
Sep 30, 2013
Podcast 107 – Peripheral Vasopressor Infusions and Extravasation
20:08
Can we give vasopressors peripherally? And if we do, what if they leak?
Sep 16, 2013
SMACC Gold Promo
8:16
SMACC Gold is March 18-21st on the Gold Coast of Australia--best ED conference you will ever attend
Sep 07, 2013
Podcast 106 – Making Things Happen with Cliff Reid
24:55
Cliff Reid runs the amazing Resus.me site and any listener of EMCrit knows that I have an enduring (and purely platonic) love for Cliff and all of his teachings.
Sep 03, 2013
Podcast 105 – The Path to Insanity
22:57
This was my favorite lecture assigned to me at SMACC 2013. It discusses the search for excellence in our profession. I hope you enjoy!
Aug 20, 2013
Podcast 104 – Laryngoscope as a Murder Weapon (LAMW) Series – Hemodynamic Kills
30:43
A lecture from SMACC2013 on how not to kill the shocked patient when intubating
Aug 05, 2013
EMCrit Wee – Vasopressin, Steroids, and Epinephrine for Cardiac Arrest
3:54
New medication therapy for cardiac arrest
Aug 02, 2013
SMACC Back 2 – IVC for Decisions on Fluid Status
17:21
A SMACC Back on Justin Bowra's IVC Ultrasound bashing.
Jul 29, 2013
Podcast 103 – Avoiding Resuscitation Medication Errors – Part II
17:51
I am joined by Bryan Hayes for Part II of our discussion on the avoidance of critical medication errors during resuscitations.
Jul 21, 2013
Podcast 102 – Don’t Half-Ass your FAST!
28:27
I've wanted to discuss tips and pitfalls for the FAST exam for a while now, but I needed a master to talk with. Luckily at Castlefest, I met Laleh Gharahbaghian, MD.
Jul 07, 2013
SMACC-Back – Myburgh on Catecholamines
4:52
SMACC Back 1 on Catecholamines
Jun 26, 2013
Podcast 101 – Avoiding Resuscitation Medication Errors – Part I
23:50
I am joined by Bryan Hayes to discuss the avoidance of critical medication errors during resuscitations.
Jun 23, 2013
Podcast 100 – What is Critical Care and What is EMCrit?
21:45
Keynote from SMACC 2013
Jun 09, 2013
EMCrit Wee – Is Lactate Clearance a Flawed Paradigm?
7:28
Is lactate clearance a flawed paradigm? I don't think it is.
Jun 05, 2013
Podcast 99 – Combat Aviation Paradigms for Resuscitationists
26:06
Aviation is to anesthesia as Combat Aviation is to Resuscitation
May 26, 2013
Podcast 98 – Cyclic (Tricyclic) Antidepressant Overdose
22:39
Tricyclic overdoses are not uncommon and these patients can be incredibly ill.
May 14, 2013
EMCrit Wee – Janus General and Service Update
7:40
Learn about Janus General
May 06, 2013
Podcast 97 – Acid-Base VI – Chloride-Free Sodium
18:01
So last podcast, I bashed on sodium bicarbonate or as John Kellum and David Story call it: chloride-free sodium. This episode I talk about all the good reasons to use NaBicarb.
May 02, 2013
Podcast 96 – Acid Base in the Critically Ill – Part V – Enough with the Bicarb Already
20:07
More on Bicarb in the Critically Ill and a discussion with John Kellum, MD
Apr 14, 2013
Episode 12 – New Trauma Guidelines: ATLS and Spine
11:37
New Trauma Guidelines: ATLS and Spine
Apr 14, 2013
Podcast 95 – Thomas Scalea on Cutting-Edge ICP Management
44:34
Thomas Scalea discusses new frontiers in the management of ICP and TBI
Apr 02, 2013
EMCrit Wee – The Vortex Approach
9:33
The vortex approach is a new paradigm for airway management in all areas of the hospital
Mar 28, 2013
EMCrit Wee – The Holy Grail of Fluid Resuscitation is just a Tin Cup
17:40
Chad Meyers' lecture on fluid resus in severe sepsis
Mar 21, 2013
EMCrit WEE – SMACC 2013 Summary and Learning Points
19:32
SMACC - The best Critical Care Conference...EVER!!
Mar 18, 2013
Episode 11 – Ischemic Stroke 2013
15:15
2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP
Mar 04, 2013
Podcast 94 – Has Video Laryngoscopy Killed the Direct Laryngoscope?
23:02
I debate Paul Mayo on whether standard laryngoscopy still has a role in emergency and critical care intubation
Mar 03, 2013
Podcast 93 – Critical Care Palliation with Ashley Shreves
25:03
One of the best palliative care lectures I have ever heard.
Feb 18, 2013
EMCrit Wee – Tacit Knowledge and Medical Podcasting
10:46
I received a distressed email from a fan who was dismayed that other residents in her program were bashing medical podcasting; this is my response.
Feb 13, 2013
EMCrit Conference Blast Winner: Peri-Mortem C-Section
12:55
Peri-Mortem C-Section
Feb 12, 2013
Join the EMCrit G+ Community Page
2:38
A place for your Clinical Cases and Questions that are not podcast specific
Feb 10, 2013
Podcast 92 – EMCrit Intubation Checklist
28:36
Since Peter Pronovost's landmark study on how a simple checklist can nearly abolish central line infections, checklists have been the darling of the medical literature
Feb 05, 2013
2012 Surviving Sepsis Campaign Guidelines
18:35
2012 Surviving Sepsis Campaign Guidelines from my Practical Evidence Podcast
Jan 24, 2013
Podcast 91 – Treatment of Aortic Dissection
24:01
You can't pick a more critical diagnosis than acute aortic dissection. Mess it up and the patient dies.
Jan 24, 2013
Episode 10 – Surviving Sepsis Campaign (SSC) Guidelines 2012
18:35
SSC Guidelines 2012
Jan 24, 2013
Podcast 90 – Mind of the Resuscitationist Series: Cliff Reid’s Own the Resus Room
15:23
Cliff Reid on owning the resuscitation room
Jan 08, 2013
Natural Seven for 2012
6:01
The rundown of things I liked from 2012
Dec 30, 2012
Podcast 89 – Lessons from the STOP Sepsis Collaborative
18:08
We have hit the 10,0000 patient mark in the NYC STOP Sepsis collaborative. Here are some of the lessons learned...
Dec 26, 2012
EMCrit Wee – MOPETT Trial
4:08
A new trial on half-dose thrombolysis for PE for sub-massive PE
Dec 12, 2012
EMCrit Podcast 88 – Oxygen Physiology with Daniel Davis
19:07
One of the last few airway topics for a little while: Pulse Ox Lag and an Understanding of the Oxyhemoglobin Dissociation Curve
Dec 10, 2012
Episode 9 – Blunt Cardiac Injury from EAST
8:35
EAST Trauma Guidelines on Blunt Cardiac Injury
Dec 07, 2012
SMACC Conference
4:07
SMACC Conference and SIMWars
Dec 07, 2012
Podcast 87 – Mind of the Resuscitationist: Stop Points
23:32
In this Mind of the Resuscitationist Episode, I discuss stop points: one for when you are using multiple vasopressors and especially about a cognitive stop point whenever things are going south.
Nov 26, 2012
Podcast 86 – IVC Ultrasound for Fluid Tolerance in Spontaneously Breathing Patients – EAT IT STONE
20:52
Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can!
Nov 12, 2012
Episode 8 – ACEP Opioid Prescription Policy
9:19
ACEP 2012 Opioid Prescription Policy
Nov 03, 2012
Podcast 85 – A Confirmation of Prejudices: Chloride and Pressure Poisoning
18:53
In this Hurricane Sandy episode of the EMCrit podcast, I talk about the confirmation of two of my clinical prejudices.
Oct 29, 2012
Podcast 84 – The Post-Intubation Package
23:46
There is a ton of stuff to do post-intubation besides confirming the tube and giving the team high-fives. What we do in the ED has ramifications on the patient's course in the hospital.
Oct 16, 2012
Podcast 83 – Crack to Cure – ED Thoracotomy
37:16
Crack to cure; in the right circumstances you may save a life. ER thoracotomy--do it improperly and you put you and your team at risk.
Oct 02, 2012
Episode 7 – Rule-Out Criteria and Screening
10:20
The difference between screening, rule-out, and risk prediction criteria.
Sep 25, 2012
Podcast 82 – Mind of the Resuscitationist with Cliff Reid
29:40
Today, I put on my head-shrinker cap (it is a fez) and get Cliff Reid on the coach
Sep 17, 2012
Episode 6 – ACCP Antithrombotics and VTE Guidelines
8:40
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines from the American College of Chest Physicians
Sep 07, 2012
Podcat 081 – An Interview on Severe Trauma with Karim Brohi
20:21
Let's talk trauma. I interview Karim Brohi on traumatic arrest, massive transfusion and hypotensive resuscitation.
Sep 02, 2012
Podcast 80 – Uhmmmm, Maybe Groin Lines Are Not So Bad with Paul Marik
27:29
When I read a recent meta-analysis by Paul Marik on femoral central lines, the first thing I did was bang my head against the wall 10 or 20 times.
Aug 20, 2012
Podcast 79 – Reducing Door to tPA Time in Ischemic Stroke
25:17
Reducing door to tPA time in Ischemic Stroke. Strategies and tips to optimize patient care.
Aug 06, 2012
Podcast 78 – Increased Intra-Cranial Pressure (ICP) and Herniation, aka Brain Code
23:54
Today we are going to discuss increased intracranial pressure (ICP) and herniation
Jul 22, 2012
EMCrit Wee – Airway Outsourcing and Suction Henching
4:39
Further discussion of prepassing the bougie and why fiberoptic laryngoscopy may obviate all of the classic teaching on bimanual laryngoscopy.
Jul 16, 2012
Left Ventricular Assist Devices (LVADS)
19:39
LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier.
Jul 09, 2012
Episode 5 – Upper GI Bleed Guidelines
10:49
National Institute for Health and Clinical Excellence: Acute upper GI bleeding: NICE guideline
Jul 07, 2012
EMCrit Wee – Bougie Prepass and CricCon for Difficult Airway
29:35
So my friend, Darren Braude and a colleague had a horrible airway case, which they presented on EM:RAP. I wanted to comment on the case.
Jul 05, 2012
Podcast 76 – Severe Pediatric Trauma with Michael McGonigal
I got to speak with Michael McGonigal, MD of the Trauma Professional's Blog about severe pediatric trauma in the ED.
Jun 24, 2012
Are Extraglottic Airways Harmful in Cardiac Arrest?
7:07
Are we creating a blockage of blood flow to the brain with EGAs in cardiac arrest?
Jun 17, 2012
EMCrit Podcast 75 – Live Show # 2
27:57
The 2nd EMCrit Live Show
Jun 13, 2012
Episode 4 – Subarachnoid Hemorrhage Guidelines
10:15
The New AHA/ASA SAH Guidelines
Jun 07, 2012
EMCrit Podcast 74 – Who the Heck to Cool after Cardiac Arrest with Ben Abella
25:06
Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest.
May 29, 2012
Pain and Terror as Effective Pressors
6:24
Psychic Terror as an Effective Pressor
May 16, 2012
Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD
29:59
James DuCanto on fiberoptics and airway management in general.
May 14, 2012
Episode 3 – ACEP 2012 Management of Early Pregnancy
16:34
ACEP's Policy on the Management of Early Pregnancy Presenting to the ED
May 07, 2012
How to Post a Case or Question to EMCrit Google Plus
5:09
How to Post a Case or Question to EMCrit Google Plus
May 01, 2012
Severe Pelvic Trauma
26:42
Hemodynamically unstable pelvic fractures are a talk-and-die situation. These folks require aggressive, rapid treatment if they are going to survive the injury. Inspired by my mentor, Thomas Scalea, I discuss the management of the unstable pelvic trauma patient.
Apr 30, 2012
EMCrit Wee – ETCO2 with EGA?
5:08
Can we monitor ETCO2 with extraglottic airways? The answer is definitively: I don't know.
Apr 22, 2012
Podcast 71 – Critical Questions on Massive Transfusion Protocols with Kenji Inaba
21:18
Today, I got to interview Kenji Inaba; an incredibly prolific trauma surgeon from LA County, California.
Apr 16, 2012
Episode 2 – ACEP 2011 Clinical Policy on Pulmonary Embolism (PE)
9:57
Welcome to the second episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read.
Apr 07, 2012
EMCrit Wee – Abandon Epinephrine?
5:31
Should we stop using Epi in the field for cardiac arrest
Apr 05, 2012
Podcast 70 – Airway Management with Rich Levitan
1:15:13
Rich Levitan is one of the best teachers on the skills of airway management and laryngoscopy--or as he would probably put it, epiglottoscopy. Here is an hour long lecture he delivered last month at Mount Sinai School of Medicine.
Apr 01, 2012
EMCrit Wee – On Editing Comments and Ad Hominem Attacks
5:05
On the editorial policy of EMCrit
Mar 19, 2012
EMCrit Podcast 69 – The Future of CPR with Keith Lurie and Demetris Yannopoulos
25:33
Drs. Keith Lurie and Demetris Yannopoulos elaborate on the future of CPR
Mar 19, 2012
EMCrit Wee – Cliff Reid’s Tips for Occasional Intubators
5:01
Prehospital Doc Cliff Reid's tips for intubation
Mar 14, 2012
Episode 1 – Penetrating Neck Trauma Guidelines
9:32
Welcome to the first episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read.
Mar 07, 2012
EMCrit Live Show # 1
26:38
The first ever live EMCrit Podcast
Mar 07, 2012
Podcast 67 – Tranexamic Acid (TXA), Crash 2, & Pragmatism with Tim Coats
22:00
One of the most exciting and underutilized therapies for trauma is tranexamic acid (txa).
Feb 20, 2012
EMCrit Wee – More on C-Spine Imaging
3:27
A response to a question on c-spine imaging
Feb 17, 2012
EMCrit Wee: The Lewis Lead and a course in ECGs with Christopher Watford
7:57
The Lewis Lead (S5) allows you detect atrial activity that cannot be discerned on the standard 12-lead
Feb 15, 2012
Podcast 66 – …Until they are warm and dead: Severe Accidental Hypothermia
20:50
It is winter and that means cardiac arrests coming in with extremely low body temperatures after environmental exposure. How do you treat these patients? How do you rewarm if you don't have bypass?
Feb 07, 2012
Podcast 65 – A Primer on BVM Ventilation with Reuben Strayer
23:00
Today I want to talk about proper ventilation with a Bag-Valve-Mask, aka the BVM. I am joined by my friend Reuben Strayer, MD of EM Updates. You'll see Reub's talk from this year's EMCrit ED Critical Care Conference and hear some of my thoughts as well.
Jan 23, 2012
Podcast 64 – Fluid Responsiveness with Dr. Paul Marik
24:07
Today I had the pleasure to interview Dr. Paul Marik, Professor and Division Chief of Pulmonary Critical Care at Eastern Virginia Medical Center. We got to speak on the topic of fluid responsiveness--one of the toughest questions in critical care.
Jan 08, 2012
More on a Diagnostic Strategy for C-Spine Injuries
17:28
Podcast 63 set off some expected controversy given my take that plain films are a dead imaging modality for c-spine injuries. I wanted to briefly outline my impression of the existing evidence:
Jan 03, 2012
Podcast 63 – A Pain in the Neck – Part I
21:58
In this episode, I discuss the diagnosis of c-spine injuries. I argue that we should not send patients to imaging unless we have used the NEXUS rule and then added the Canadian C-spine Rule to the sequence. If we are imaging, it should be with a 3-view reconstructed CT scan. And even after that is done, you still need a clearance exam before removing the collar.
Dec 25, 2011
EMCrit Podcast – Hard Six – My Picks from 2011
3:14
My favorite discoveries in the medical blogosphere and podcast land
Dec 25, 2011
Replay of the Emergency Ultrasound Podcast – Wall Motion Abnormality Lecture
Replay of the incredible Wall Motion Abnormality Talk from the Emergency Ultrasound Podcast
Dec 16, 2011
Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?
17:21
In this podcast, I explain why I don't think needle compression is such a clever idea. Main points are: most people can't find anterior target, most angiocaths won't reach, and if used diagnostically you may not be in the pleura leading to an unidentified pneumo or hemothorax. Also, when used diagnostically, if the chest was negative you just caused a pneumothorax.
Dec 11, 2011
Podcast 061 – Debate: Paralytics for ICU Intubations?
I recently spoke at a symposium at the Greater NY Hospital Assoc's with the title: Controversies in Critical Care. I debated Paul Mayo, MD on the topic of whether paralytics should be used for ICU emergent intubations. Of course, I took the pro side of the debate. Dr. Mayo based his con side on an amazing study that came out of his ICU at LIJ hospital in NY.
Nov 28, 2011
How to generate constant CPAP with a BVM for Preoxygenation and Reoxygenation
How to make your crappy BVM into a powerful preoxygenation device--on the cheap.
Nov 04, 2011
Podcast 059 – Bath Salts with Leon Gussow
18:02
Today I am joined by toxicology master, Leon Gussow to discuss a new quasi-legal class of drugs: Bath Salts. I saw my first OD of this a month ago; despite the drug's name, this patient was neither clean nor pleasantly refreshed. He was violent, agitated, and overheated.
Oct 26, 2011
Podcast 058 – Interview with Cliff Reid – Part II
23:41
Part II of an interview with EMS Physician Cliff Reid of the amazing blog, resus.me.
Oct 11, 2011
Podcast 057 – Resuscitative Extra-Corporeal Life Support (ECMO)
28:03
Joe Bellezzo, MD along with his partner-in-crime, Zack Shinar, MD have started an ED ECMO service at Sharp Memorial Hospital in San Diego. I am so jealous! In this episode of the podcast, I get to talk to Joe about how it works.
Sep 26, 2011
Podcast 056 – Dr. Rivers on Severe Sepsis – Part III
20:00
Part III of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis, Septic Shock, and early goal directed therapy.
Sep 13, 2011
Podcast 055 – Dr. Rivers on Severe Sepsis – Part II
Part II of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.
Sep 06, 2011
Podcast 054 – Dr. Rivers on Severe Sepsis – Part I
24:00
Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.
Aug 29, 2011
Minh Discusses Three Examples of Airway Management gone Bad
5:59
In this podcast short, Minh Le Cong discusses three airway disasters.
Aug 09, 2011
Podcast 053 – Needle vs. Knife: Part I
36:22
What technique should we use in the can't intubate/can't oxygenate (CICO) situation: Needle Cricothyrotomy vs. Bougie Cricothyrotomy.
Aug 09, 2011
Podcast 052 – Organ Donation in the ED
33:30
Organ Donation in the Emergency Department Though it may not seem as important as some of the things we do in ED Critical Care, managing the potential organ donor can lead to many lives saved. In this episode I interview Isaac Tawil, an Emergency Intensivist of University of New Mexico Health Sciences and associate medical director of New Mexico Organ Donor Services. Here are the current standards for determining brain death Wijdicks et al. Evidence-based guideline update: Determining Brain Death in Adults Brain Death Checklist brain death statement Here is a video of Dr. Tawil demonstrating the brain death exam Now on to the Podcast...
Jul 27, 2011
Podcast # 51: Fibrinolysis in Pulmonary Embolism
30:36
Jeff Kline is the master of all things pulmonary embolism in emergency medicine. This is a lecture he gave on fibrinolysis for pulmonary embolism. He discusses both massive and sub-massive PE.
Jul 11, 2011
EMCrit Podcast 50 – Acid Base Part IV – Choose the Solution Based on the Problem
21:23
This is Part 4 of the Acid Base saga. In this episode, I discuss the acid base effects of fluids and when and how to use sodium bicarbonate.
Jun 27, 2011
Hemostatic Resuscitation by Richard Dutton, MD
51:35
Richard Dutton is a trauma anesthesiologist who was one of the primary formulators of the concept of 1:1:1 resuscitation. Here he is speaking on hemostatic resuscitation.
Jun 12, 2011
EMCrit Podcast 49 – The Mind of a Resus Doc: Logistics over Strategy
9:41
This Part I of the Mind of a Resus Doc Series, in which we delve into the philosophies that make a good resuscitationist.
Jun 07, 2011
EMCrit Podcast 48 – PhD in EKGs Part II: Left Bundle Branch Block
17:56
A few months ago, we had Dr. Stephen Smith on the podcast to discuss a variety of EKG issues. Dr. Smith has an EKG blog that is required reading for every ED and ICU doc. This is Part II and I think it discusses an incredibly important issue: right now major medical societies including the AHA and ACEP are asking us to fibrinolyse or PCI patients with new or presumed new LBBB. However, your interventionalists will tell you that this strategy is a ridiculous waste given how few acute occlusions will actually be found. Why this discrepancy?
May 23, 2011
EMCrit Podcast 47 – Failure to Plan for Failure: A Discussion of Airway Disasters and the NAP4 Study
32:57
Cliff Reid of Resus.Me fame put out an incredible post on NAP4, the audit done on all of the airway complications in Great Britain. It was such a phenomenal post that I got in touch with Cliff and asked if he wanted to come on the podcast to speak about it. He did me one better and got an interview with one of the authors of the Emergency and Critical Care Section.
May 09, 2011
EMCrit Podcast 46 – Acid Base: Part III
18:42
In part III, we go through 2 cases of acid base abnormalities step by step.
May 04, 2011
Bonus – Passing the Esophageal Temperature Probe
It can be a b*tch to pass the esophageal temperature probe for hypothermia. Here's how to get er done.
Apr 30, 2011
EMCrit Podcast 45 – Acid Base: Part II
This second lecture discusses a quantitative approach to acid base management. I lay out the formula I use to approach an acid-base problem.
Apr 24, 2011
EMCrit Podcast 44 – Acid Base: Part I
25:00
This lecture discusses a quantitative approach to acid base management. This is also known as the Fencl-Stewart approach, the strong-ion approach or the physicochemical approach. It provides explanations for why acid base disorders occur in human pathophysiology.
Apr 11, 2011
Listener Questions – Episode 1
11:48
Since we had the Kayexalate episode, I did not want to do a full podcast, so I thought I would just air some listener questions:
Mar 30, 2011
Bonus – Is Kayexalate Useless?
16:31
Dr. Siamak (Mak) Moayedi, MD found nothing to indicate that kayexalate is effective for the acute management of hyperkalemia.
Mar 23, 2011
Video for Podcast 43 – Inserting the Air-Q
6:06
Here is a video to go along with podcast 43 on the insertion and use of the Air-Q intubating laryngeal airway
Mar 16, 2011
EMCrit Podcast 43 – Laryngeal Airways with Daniel Cook, MD (Part I)
21:27
My favorite supraglottic airway is the Cookgas Air-Q; it was created by an anesthesiologist, Dr. Daniel Cook. He just created a new device that allows the placement of an esophageal blocker through the laryngeal airway. I gave him a call to hear about the new product and in the course of that conversation, he gave me a ton of tips on the placement of laryngeal airways. Part II will specifically discuss the new device.
Mar 13, 2011
EMCrit Podcast 42: A phD in EKG with Steve Smith
28:30
Electrocardiograms can be subtle; but you can't miss them or patients die. Today, I interview, Dr. Stephen Smith of the incredible blog: Dr. Smith's EKG Blog.
Feb 27, 2011
EMCrit Podcast 41 – Interview with Cliff Reid of RESUS.me
25:00
I was lucky to cajole Cliff Reid of the amazing blog, resus.me on to the EMCrit program. Cliff is truly a doc after my own heart as you will hear from the cast.
Feb 14, 2011
EMCrit Podcast 40 – Delayed Sequence Intubation (DSI)
19:51
Delayed Sequence Intubation (DSI) is a procedural sedation, the procedure in this case being effective preoxygenation. Give ketamine, put them on the mask, and in 3 minutes paralyze and intubate.
Jan 31, 2011
EMCrit Podcast 39 – Hyponatremia
21:26
Hmm… he’s tasty, but he just needs a little salt! In this podcast, I discuss the management of hyponatremia in the ED.
Jan 17, 2011
EMCrit Podcast 38 – The ED Critical Care Dirty Dozen for 2010
13:09
My favorite ED things for 2010...the EMCrit dirty dozen.
Jan 02, 2011
EMCrit Podcast 37 – Lactate in Sepsis
28:56
When an ED starts providing advanced care for severe sepsis, lactate testing is an absolute requirement. Lactate use brings up a lot of questions, especially if it is not commonly ordered in your department. In this podcast, I discuss all of the lactate questions that have come up in the course of the NYC Sepsis Collaborative.
Dec 20, 2010
EMCrit Podcast 36 – Traumatic Arrest
20:19
Management of traumatic arrest. Many things to do in these patients, but two things you definitely should not be doing are closed-chest CPR or giving ACLS medications. We discuss who gets a thoracotomy, what to do if a thoracotomy is not indicated, and when to stop.
Dec 04, 2010
EMCrit Podcast 35 – Extubation in the ED
14:27
In this podcast, I discuss extubating patients in the ED. Specifically, I deal with patients who have only been intubated for a few hours in distinction to extubation of the patient who has been lingering in your ED for 2-3 days. The best patients for this short-term extubation are those intox folks with a low GCS and signs of trauma, overdoses, or endoscopy cases.
Nov 18, 2010
EMCrit Podcast 34 – 2010 ACLS Guidelines
19:59
The brand new ACLS & BCLS guidelines were published last week. Not huge changes, but some good stuff! The free full text is available at the Circulation website. It takes hours to make your way through all of it. I boiled it down to just the facts and posted a summary on the EMCrit site. In this EMCrit Podcast I discuss some of the highlights that I think are particularly important.
Oct 26, 2010
Video for Diagnosing Posterior Stroke
This is the video for cerebellar stroke diagnosis. Listen to the podcast first.
Oct 10, 2010
EMCrit Podcast 33 – Diagnosis of Posterior Stroke
11:38
What if I told you that I think that patient you just sent home with vertigo may have been a missed cerebellar stroke? Would you be dialing risk management or could you tell me all of the reasons why I'm wrong? Isolated vertigo without other neurological findings can't be a stroke, right? That is true, if you are doing the right exam, but if you are just doing your standard ED neuro screening exam then you might be missing serious pathology. In this episode of the EMCrit podcast, I discuss how to perform the tests that will differentiate a peripheral cause of continuous vertigo from a cerebellar stroke.
Oct 10, 2010
EMCrit Podcast 32 – Treatment of Severe Hyperkalemia
12:57
Hey folks. As I get ready for ACEP, I just wanted to get a quick podcast put up. One of the listeners requested an episode on the treatment of hyperkalemia in the ED.
Sep 22, 2010
EMCrit Podcast 31 – Intra-Arrest Management
22:33
This week we talk about managing the intra-arrest period of cardiac arrest. My paradigm has changed dramatically over the past few years. In the past, I viewed the arrest as a period to teach my residents how to place a subclavian central line, how to intubate when the patient is moving, and how to cram as many drugs as possible into a patient in a short period of time. Looking at how I manage an arrest today, so much has changed.
Sep 05, 2010
ACEP Preview – Hemostasis: Stopping the bleeding in a crashing trauma patient
53:03
I'm lecturing at ACEP in Las Vegas this year. This is one of two lectures I'm giving there. If you are going to the conference and plan on coming to my lecture, don't listen to this lecture; I'd rather you here the real one in person.
Aug 23, 2010
EMCrit Podcast 30 – Hemorrhagic Shock Resuscitation
31:07
This week we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD.
Aug 15, 2010
EMCrit Podcast 29 – Procedural Sedation, Part II
15:39
It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED. We must persevere to provide the best procedural sedation to allow maximal comfort and safety for our patients. This continues the discussion started in Part I.
Aug 02, 2010
Procedural Sedation Guidelines Update
Here is a piece I wrote for EMPGU
Jul 26, 2010
Procedural Sedation, Part I (Audio Only)
27:29
This is the audio only version of the previous post (Part I of the Sedation Talk).
Jul 26, 2010
Procedural Sedation – Part I
27:14
It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED. We must persevere to provide the best procedural sedation to allow maximal comfort and safety for our patients. This brief lecture was originally posted on the defunct EMCrit Lecture Site on 8/7/2009.
Jul 26, 2010
EMCrit Podcast 28 – Severe CNS Infections
25:33
Severe CNS Infections are time dependent diagnoses! You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.
Jul 13, 2010
EMCrit Podcast 27 – Calcium Channel Blocker Overdose
29:48
This week, I am joined by Leon Gussow, MD of the excellent blog: The Poison Review (TPR). TPR is my source for new toxicology articles; I highly recommend it as an incredible read. I got to meet Leon for a few beers a month ago; he is just a great guy. My Canadian pal, Ram, suggested calcium channel blocker OD as a podcast episode. Ram, here you go.
Jun 29, 2010
EMCrit Lecture – Top Ten Hypothermia Tips
42:38
At this stage of the game, if your hospital is not offering hypothermia to out-of-hospital cardiac arrests, you are probably lagging behind optimal care. For shockable rhythms, you essentially double your patient's chances of leaving the hospital with good neurological outcome. However hypothermia can be tough, unless you have done a bunch. Learn from my mistakes in this lecture.
Jun 16, 2010
EMCrit Lecture – Dominating the Vent: Part II
When I was a resident, every vent lecture either put me to sleep or left me dazed and bewildered. I gave a lecture of that ilk when I started working after fellowship--I had become part of the problem. I decided there must be a way to make vent management more understandable and if not interesting, at least bearable.
Jun 01, 2010
EMCrit Lecture – Dominating the Vent: Part I
30:00
When I was a resident, every vent lecture either put me to sleep or left me dazed and bewildered. I gave a lecture of that ilk when I started working after fellowship--I had become part of the problem. I decided there must be a way to make vent management more understandable and if not interesting, at least bearable.
May 24, 2010
Vent Handout
This post is just to place the vent handout into itunes.
May 24, 2010
EMCrit Podcast 26 – Patient Controlled Analgesia by Edward Gentile
29:19
Even when we can't cure a patient, we can relieve suffering. On average, we kind of stink at pain control in the ED. One physician, Dr. Ed Gentile, has created a simple path to optimal acute pain control in the ED. I heard this lecture on the EM:RAP podcast and got permission from Drs. Gentile and Herbert to repost it here. This is not a critical care topic per se, but it is applicable to the critically ill, the non-critically ill--basically any patient who is in pain in the ED.
May 12, 2010
Service Update – How to get old episodes into Itunes
I received a bunch of emails asking how to get the old episodes into itunes. I expanded the RSS feed to include them, now you just need to bring them into itunes, this 40 second video shows you how.
May 02, 2010
IVC Ultrasound for Non-Invasive Sepsis Protocol
We're still working on the Greater NY Sepsis Initiative. The next step towards making a non-invasive protocol possible is to teach folks how to use ultrasound of the IVC to assess fluid responsiveness. I developed this video to get ED & ICU docs up to speed. If you can do ANY ultrasound exam, you can do this one.
Apr 29, 2010
EMCrit Podcast 25 – End of Life and Palliative Care in the ED
29:43
Aggressive palliative care is just as important as aggressive critical care in the ED. Sometimes we will be the first physicians to talk to a family about end of life issues, even if their loved one is terminally ill. Now that is not how it should be, but it just means that we must be just as skilled at family palliative care discussions as we are at floating a transvenous pacer. In this podcast, I discuss my vision of how to handle palliative care issues in the ED.
Apr 24, 2010
Q&A: The Two Rams
5:04
Two listener questions answered in 5 minutes. One on awake intubation in trauma and the other on intubating the patient with severe RESP acidosis.
Apr 17, 2010
Bougie-Aided Cricothyrotomy by Darren Braude
Darren Braude, Aiway and EMS master from New Mexico demonstrates the use of a bougie to make the cric procedure MUCH easier. For more great Braude magic, see his site at airway911.com.
Apr 13, 2010
Procedure: Fiberoptic Stylet-aided Cricothyrotomy by Seth Manoach
This video demonstrates the fiberoptic styler-aided cric. In this case he is using a Levitan Scope, but an adult bonfils or any other rigid fiberoptic should work fine.
Apr 11, 2010
Procedure: Open Cricothyrotomy for Historical Purposes Only
Here is my video on performing open cricothyrotomy in 3 situations: with a trach set and an assistant, with a trach set when alone, and when you only have a scalpel.
Apr 11, 2010
EMCrit Podcast 24 – The Cric Show
24:15
Ok, Ok, I promise this is the last airway episode for at least a little while. I am perhaps a bit obsessed. Had this show in the works for a while. The cric is the last barrier between a failed airway and death. EM docs need to be able to perform this procedure without hesitation. This requires training and practice until you can perform the procedure in < 30 seconds literally with your eyes closed!
Apr 11, 2010
EMCrit Podcast 23 – Awake Intubation for Trauma and Medical Patients
15:40
So after the intubation video went up on emrap tv, I got a flurry of emails telling me how cool the concept is, but questioning who this would actually be usable on. To answer that question, we first must discuss who actually requires intubation. If you wait until the patient is apneic, then of course you can't use awake intubation. The idea is to intubate before the patient stops breathing.
Mar 27, 2010
EMCrit Rant – Risk in Emergency Medicine
12:44
Dr. David Schriger gave a fantastic lecture on risk in emergency medicine at the ALL LA Conference. If you have not heard it, go and listen now; it is vitally important to our specialty. This is a brief EMCrit rant on some of my thoughts on the lecture.
Mar 21, 2010
EMCrit Podcast 22 – Non-Invasive Severe Sepsis Care
21:16
Young patient, lactate of 5.2, pneumonia... You know what you're supposed to do--put in the central line and start early goal directed therapy. Problem is, most people can't see sticking a central line in a patient that does not need pressors and otherwise looks well. Yet these patient have an annoying habit of going on to decompensate and perish. Well now there may be another way. Thanks to an article just published in JAMA, we may have a path to non-invasive treatment of severe sepsis. In this EMCrit Podcast, I interview Dr. Alan E. Jones, author of the article, Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. Then I discuss how this article changes the game when it comes to caring for severe sepsis patients.
Mar 14, 2010
EMCrit Podcast 21 – A Bad Sedation Package Leaves your Patient Trapped in a Nightmare
26:40
Pushing some ativan followed by vecuronium is no longer an acceptable strategy to manage post-intubation sedation. A good analgesia and sedation package is essential if you care about your patient's comfort and well-being. We need to move to PAIN-FIRST paradigm. Optimize analgesia and then add in sedative agents as a bonus. In this episode of the EMCrit Podcast, I expand on a previous rant to discuss the optimal way to handle routine post-intubation patients and some special scenarios you may encounter.
Feb 26, 2010
EMCrit Podcast 20 – The Crashing Atrial Fibrillation Patient
9:13
Your patient is pale and diaphoretic. Blood pressure is 70/50. Heart rate is 178. EKG shows atrial fibrillation... What are you going to do??? Yeah, yeah the Pavlovian ACLS response--You cardiovert. Wonderful, except it didn't change a thing. Now what? In this episode, I discuss the crashing atrial fibrillation patient.
Feb 13, 2010
EMCrit Podcast 19 – Non-Invasive Ventilation
19:35
Intubation is a sexy procedure, there is no doubt about it. NIV does not have the glamour; it's not nearly as cinematic. But for the patient, to spend 30 minutes on a NIV mask is preferable to a couple of days on the ventilator. In this episode, I discuss some of the basic ideas and methods of NIV.
Feb 05, 2010
EMCrit Podcast 17 – Reversal of Anti-coagulant and Anti-platelet Drugs in Head Bleeds
18:12
So you have a patient with intracranial bleeding or you have a high pre-ct suspicion of intracranial bleeding and they are taking coumadin, aspirin, or clopidogrel. Should you reverse them? If so, how?
Jan 12, 2010
EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy
17:03
Hi folks, Sorry about the voice--got a cold off those damn ED keyboards Thanks to my friend Reuben, this week we'll talk about the asthmatic patient that codes while on the vent The DOPE mnemonic gives you a path to figure out why a patient is desaturating (If anyone knows who created the DOPE mnemonic, please add a comment or send me an email. An EMCrit listener solved the mystery) If the pt is asthmatic, add an "S" to make DOPES The "S" stands for Stacked Breaths--and it's the first thing to address. Address it by disconnecting the vent circuit. Don't think about it, don't dither, just disconnect the vent. "E" is for equipment. Attach a BVM hooked up to O2 and you'll eliminate ventilator equipment failures. "D" is for tube displacement. Verify the tube with ETCO2, either qualitative or quantitative. "O" reminds you to check for obstruction of the tube. See if you can put a suction cath all the way down. If all of these don't fix the problem, then consider "P" for pneumothorax. Lung sounds are not always definitive. Throw on the UTS if you have the time. Otherwise perform bilateral finger thoracostomies. What the hell is that, you say? Listen to the podcast. Then you can read more about it in this article C.D. Deakin, G. Davies and A. Wilson, Simple thoracostomy avoids chest drain insertion in prehospital trauma, J Trauma 39 (2) (1995), pp. 373–374. Update: Is the tube mainstem, is there a ball-valve obstruction? Consider reintubation Consider Bronchoscopy Finger Thoracostomy BET Emerg Med J 2017;34:417-418.
Dec 24, 2009
EMCrit Podcast 15 – the Severe Asthmatic
22:56
To PEEP or not to PEEP, that is the question...in the management of the severe asthmatic
Dec 09, 2009
Video for the Laryngoscope as a Murder Weapon Lecture
Nov 26, 2009
EMCrit Podcast 14.5 – A bit more on EGDT
10:16
Chris Nickson is an Aussie, oops Kiwi, who is a lead author of a great blog: lifeinthefastlane.com and tweets under the moniker @precordialthump; check him out, he's doing really good stuff. He wrote a comment about the last podcast-- Hey Scott, Great to hear your views and approach to EGDT. I agree with the need for aggressive resuscitation of the septic patient – with fluid, antibiotics, vasopressors (we’re a ‘norad/ norepi shop’ too) and adequate oxygen delivery being the mainstays – and, if nothing else, the Rivers paper deserves credit for bringing this into the spotlight. However, the Rivers study itself is still a cause of concern for me – a single center study that has never been repeated as an RCT, with a very high mortality in the control arm (mid-40s%), and more recently the WSJ allegations about about methodological ‘dodginess’ behind the scenes and concerns about conflicting financial interests (of which I’m not sure what to make). Most ICUs in Australia don’t use CV02 monitoring, yet our mortality rates are substantially better than the Rivers study (ICU sepsis mortality around 20% these days, down from 34% in 1997) – different populations or something else? I’m also uneasy about the blood transfusion phase of the Rivers protocol. Hopefully trials like ARISE and ProCESS will help clear up what actually works. In the mean time, I heed your call to resuscitate! Cheers, Chris Nickson ED/ICU Registrar, Perth So in this brief aside, I respond to Chris' comments and tell you a bit about the EMCrit Podcast EBM philosophy. Here are the links mentioned: Henry Ford Hospital Reply to WSJ - 10.27.2008 New MSSM ED Crit Care Sepsis Protocol MR of Early Quantitative Therapies for Sepsis
Nov 23, 2009
EMCrit Podcast 14 – EGDT Tirade
20:42
In this episode I rant and rave about why for the most part Emergency Medicine has disappointed me by not doing something about our sick septic patients. If you are offering aggressive (Early Goal Directed) therapy in the ED, then good on you.
Nov 21, 2009
EMCrit Podcast 13 – Trauma Resus II: Massive Transfusion
16:53
On this podcast, I recap from last show, especially the concept of bare minimum normotension (called erroneously permissive hypotension by just about everyone else) and why we should keep the MAP higher if there is suspected elevations in intracranial pressure I then talk about massive transfusion. This is probably the best strategy for a patient that will require greater than 8-10 units of PRBCs. What may be the best review of the topic is by Spinella and Holcomb: (Blood Reviews 2009;23:231-240) I talk about 1:1:1 transfusion PCC, Factor VIIa, Cryo Calcium IV Access coming up in the next few podcasts: Sedatives for Intubation, Trauma Airway Management, The Crashing A-fib patient
Oct 31, 2009
EMCrit Podcast 12 – Trauma Resus: Part I
14:33
Thought we'd talk about some trauma stuff, specifically the resuscitation of the critically ill hemorrhagic shock patient. There is much to discuss, so this will be a multi-episode affair. Today, we'll concentrate on the Lethal Triad and BP Goals. Lethal Triad The picture says it all. Bleeding causes acidosis, hypothermia, and coagulopathy. Then the cycle begins as they all beget each other. If this continues for too long, it is irreversible. We can iatrogenically make things worse by keeping our patients exposed and infusing ice cold fluids and products. By diluting their existing clotting factors and platelets with too much fluid and red cells. And by not ensuring adeqaute perfusion to counter acidosis. BP Goals Your goal is a MAP of 65. This is not hypotensive resus, which is still not proven. It is normotensive resuscitation; beyond 65, no additional benefts will be seen, but you do risk increased bleeding and dilutional coagulopathy. If MAP < 65 - give fluids/products If MAP > 65 - check perfusion there are monitors for this such as NIRS measurement of thenar eminence, but at this stage, I recommend using the presence of a nice strong pulse and warm hands. MAP > 65 & Good Perfusion-stand tight MAP > 65 & Bad Perfusion-give fentanyl 20-25 mcg why fentanyl? b/c taking away pain and fear will limit endogenous catecholamines and the pt's bp will drop slightly from vasodilation. Now give fluids/products to take the MAP to > 65. Here are the articles resus of crit ill trauma patients damage_control_anesthesia Next Time: Massive Transfusion Protocols
Oct 14, 2009
EMCrit Podcast 11 – Delirium Tremens
18:48
The management of severe ETOH withdrawal and Delirium Tremens
Sep 29, 2009
Podcast 10 – Cardiogenic Shock
13:37
Mohamed, a listener from Sudan, emailed asking about the treatment of acute pulmonary edema in patients with low blood pressure. This is in distinction to SCAPE patients (see podcast 1). If the patients have pulmonary edema and low BP from a cardiac cause, then they are in Cardiogenic shock. First, consider the etiology: Rate-related Valve Disorder Ischemic (Right sided infarct, STEMI, NSTEMI) Cardiomyopathy Toxicologic At the same time, you are treating the patient with: Inotropes (dobutamine, milrinone, calcium) Pressors to achieve a MAP > 65 (allows coronary perfusion) (Meta-Analysis demonstrates norepi superior to dopamine Medicine. 96(43):e8402, OCT 2017) Oxygenation support, most likely with intubation Optimize O2 carrying capacity (Hb>10) Here is a fantastic set of guidelines to manage these patients Update: Contemporary Management of Cardiogenic Shock Circulation 2017;136:e232
Sep 16, 2009
EMCrit Podcast 9 – Can you take sick patients to ct?
7:20
Does the EM ban on letting sick patients go to CT scan make sense? Listen to the podcast and then register your opinion.
Sep 01, 2009
EMCrit Podcast 8 – Subarachnoid Hemorrhage
15:35
This week's podcast is on the management of a the patient with SAH. It's not a complete review, just some tips and reminders. Best article for EM that I've found, comes out of Columbia For more reviews on mostly ICU issues see here and here. Update: Critical Care Management of Patients Following Aneurysmal SAH Guidelines from NCC 1. Get a neuro exam before you intubate 2. Intubation Give pretreatment, now just lidocaine and fentanyl Etomidate or propofol; plus sux. Most experienced intubater should perform laryngoscopy 3. Treat Pain and if intubated, give sedation 4. Treat Vasospasm give nimodipine 60 mg PO or NGT 5. BP Control place a-line treat pain first Give Labetalol or Nicardipine to achieve the patient's baseline BP if the patient has good mental status if they are obtunded, be a bit more conservative until ICP monitoring is in place If MAP is below 80, give fluids, pressors, and inotropes 6. Anti-seizure prophylaxis Load with phenytoin or fosphenytoin 7. Anti-fibrinolytics Amicar is the main one these days; ask your neurosurgeon/neurointensivist on a case-by-case basis see ehced.org for drip sheets 8. Reverse Coagulopathy 9. Think Heart these patients can get EKG changes, dysrhythmias, LV stunning, and frank infarcts from their SAH 10. ICP ASAP get the neurosurgeons to get the EVD (external ventricular drain) aka IVC (intraventricular catheter) in place as soon as possible keep ICP < 20 and CPP > 55-60 Please Subscribe and Please Comment! .
Aug 17, 2009
EMCrit Podcast 7 – Sedation Tirade
3:52
Hi folks, this podcast is really brief--I gave a lecture at Jacobi last week (thanks for having me Jacobites!), and in response to a question I gave this rant on my vision of sedation after intubation.
Jul 23, 2009
EMCrit Podcast 6 – Push-Dose Pressors
11:00
Note: Please listen to the PDP update episode either before or immediately after listening to this one Finally a non-intubation topic! Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation. They also can act as a bridge to drip pressors while they are being mixed or while a central line is being placed. Click Here for printable sheet with mixing instructions Epinephrine Do not give cardiac arrest doses (1 mg) to patients with a pulse Has alpha and beta-1/2 effects so it is an inopressor Onset-1 minute Duration-5-10 minutes Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml) Now you have 10 mls of Epinephrine 10 mcg/ml Dose: 0.5-2 ml every 1-5 minutes (5-20  mcg) No extravasation worries! Mixing Video: Phenylephrine Phenyl as a bolus dose is clean, quick, and never causes trouble. But... It is pure alpha, so no intrinsic inotropy; it may increase coronary perfusion which can improve cardiac output. I only use this in tachycardic patients (and even then, only sometimes) Onset-1 minute Duration- 5-10 minutes (usually 5) Mixing Instructions: Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml) Inject this into a 100 ml bag of NS Now you have 100 mls of phenylephrine 100 mcg/ml Draw up some into a syringe; each ml in the syringe is 100 mcg Dose: 0.5-2 ml every 1-5 minutes (50-200 mcg) No extravasation worries! Mixing Video: Ephedrine I don’t use this one, listen to the podcast to hear why. I put it here solely for the anesthesiologists on the blog. Onset-Near Instant Duration-1 hour Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml) Now you have 10 mls of Ephedrine 5 mg/ml Dose: 1-2 ml every 2-5 minutes (5-10 mg) No extravasation worries! Additional Video of a Real Patient By Larry Mellick's Crew Update: This study compares push-dose phenylephrine to continuous infusion--no difference between the two (Anesthesia Analgesia 21012;115(6):1343) First article in the ED demonstrates efficacy on blood pressure (The Journal of Emergency Medicine Volume 49, Issue 4, October 2015, Pages 488–494) Here is a review article from the nursing literature Now on to the Podcast...
Jul 10, 2009
EMCrit Podcast 5 – Intubating the Critical GI Bleeder
12:25
We've had a  few gruesome airways in patients with GI bleeds and bellies full of coffee ground emesis. This is a top 10 list encompassing my approach to this difficult situation: 1. Empty the Stomach Place a salem sump and suck out all of the stomach contents. Varices are not a contraindication (see: Digest Dis 1973;18(12):1032, Gastrointest Endosc. 2004 Feb;59(2):172-8, and Anesth Analg 1988;67:283) Administer Metoclopramide 10 mg IVSS 2. Intubate the Patient with HOB at 45° Semi-Fowler's position will keep the gastric contents from moving up the esophagus 3. Preoxygenate like mad You do not want to bag these patients, give yourself a preox cushion 4. Intubation Meds Use a sedative that is BP stable, use reduced doses. These patients NEED paralytics. You need to optimize first pass success. Paralytic agents actually increase the lower esophageal sphincter tone (Br J Anaesth 1984;56:37). 5. Gather your equipment to optimize first pass Use fiberoptic laryngoscopy if you have it (e.g. Glidescope) At the bedside, have a bougie, an LMA, a meconium aspirator (more below), and 2 suction set-ups Wear eye protection! 6. If you need to bag after a failed attempt... Bag gently and slowly (10 times a minute) Consider placing an LMA if you need to bag. 7. If the patient vomits: Trendelenberg This potentially keeps the emesis out of the lungs 8. Meconium Aspirator If the normal suction is too slow, attach the meconium aspirator to your ET tube. See this post on a novel ETT suction set-up for the full description. 9. No ABX for Aspiration Aspiration in the initial phases is a chemical pneumonitis, not a bacterial pneumonia See Marik's article (NEJM 2001;344(9):665) 10. SIRS Expect a sepsis-like syndrome from the aspiration. This folks may need pressors and tons of additional fluid
Jun 22, 2009
Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis
8:32
This lecture is part of the Laryngoscope as a Murder Weapon Series: Hemodynamic Kills Oxygenation Kills Ventilatory Kills Sorry about the voice--blame the swine flu. Case Thanks to Joe Chiang Severe DKA; Obtunded with pH 6.65, PaCO2 18, Bicarb 5 Pt’s mental status is worsening The decision is made to intubate Should you give NaBicarb? Probably won’t help as patient is already breathing at their maximum. Unless they blow off the Bicarb-generated CO2, they won’t increase their pH significantly. What you need Properly fitted NIV mask Ventilator, not a NIV machine Someone who knows how to work the vent Normal intubation stuff If available, Quantitative ETCO2 Procedure Place pt on pseudo-NIV Settings are Mode Volume SIMV Vt 550 ml FiO2 100% Flow Rate 30 lpm PSV 5-10 PEEP 5 RR 0 Attach ETCO2 and observe value Push the RSI Meds Turn the Resp Rate to 12 Perform jaw thrust Wait 45 seconds This violates the tenets of RSI, but keeping the pt alive is probably more crucial right now. Most experienced operator should intubate the patient Attach the ventilator Confirm tube placement by observing ETCO2 Immediately increase Respiratory Rate to 30 Change Vt to 8 cc/kg predicted IBW Change Flow Rate to 60 lpm, this si the normal setting for intubated patients (forgot to mention this in the audio) Why 30 BPM? Listen to the podcast. Make sure ETCO2 is at least as low as it was when you started Check ABG Pat yourself on the back
May 23, 2009
EMCrit Podcast 2 – ETCO2
22:08
I did a spot on ETCO2 for Amal Mattu's podcast a couple of weeks ago. I try to clear up some of the myths on the use of ETCO2. Of course the most pervasive and potentially dangerous myth is that ETCO2=PaCO2. Long story short, in our patients, it doesn't. Listen to the podcast for more...
May 05, 2009
EMCrit Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
10:32
Here it is, the 1st EMCrit podcast. It's on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE). To boil it down to 10 seconds: Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-12. Start the patient on a nitroglycerin drip. Administer a loading dose of 4oo mcg/min for 2 minutes (120 ml/hour on the pump for 2 minutes with the standard nitro concentration of 200 mcg/ml.) Then drop the dose to 100 mcg/min and titrate it up from there as needed. By 10 minutes, your patient should be out of the water. See crashingpatient.com for the references.   Here is some info from a handout from a lecture I gave on the topic: High Dose Nitroglycerin Homeopathic nitroglycerin does not work so well Start at 50-100 mcg/min, you can rapidly titrate to 200-400 mcg/min. You must stand at the bedside to use these doses. Need >120 mcg/min to get sig decreased Pulm Cap Wedge Pressure (Am J Cardio 2004;93:237) But even this strategy is not as effective as the … Nitro Bolus First Can give 400-800 mcg over 1-2 minutes = 400 mcg/min for 1-2 minutes. (Annals EM 1997, 30:382) How to do it Standard nitro mix is 200 mcg/ml. VERIFY YOUR HOSPITAL’S MIX BEFORE USING THESE RECS In order to give the 400 mcg/min for 2 minutes, set the pump to Rate: 120 cc/hr Volume to be Infused: 4 ml (This will deliver 400 mcg/min for 2 minutes and then stop) Or Draw up 4 ml of the nitro and 6 ml of NS and give over 2 minutes After the bolus, I drop the drip to 100 mcg/min and titrate up from there to effect When the patient gets better, you need to sharply decrease this drip rate Some folks have gone even further High dose nitroglycerin for severe decompensated heart failure—2 mg at a time (Ann Emerg Med 2007;50:144) Cotter gave isosorbide 3 mg q 5 minutes with good results in his study. This is equivalent to nitro 600 mcg/min. (Lancet 1998 351:9100, 389-393) Bolus intravenous nitroglycerin predominantly reduces afterload in patients with excessive arterial elastance (Journal of the American College of Cardiology  Volume 22, Issue 1, July 1993, Pages 251–257) Update Piyush Mallick did an amazing study on nitro-bolus to avert intubation Someone finally put the term into the literature (Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med 2016;20:719-23) 1-2 mg bolus doses are safe and effective (American Journal of Emergency Medicine 2017, 35 (1): 126-131) How you set-up the drip sig. affects time to med (Douma MJ, O'Dochartaigh D, Corry A, et al How intravenous nitroglycerine transit time from bag-to-bloodstream can be affected by infusion technique: a simulation study Emerg Med J 2015;32:498-500.)
Apr 25, 2009
EMCrit Podcast 0 – The Intro
2:51
In which I introduce you to me and explain what this whole thing is about. (better late than never)
Mar 01, 2009