Critical Care Perspectives in Emergency Medicine

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Recent blog posts

Steroids for Post Cardiac Arrest Shock?

Mike Winters John Greenwood

Critical Care Quickie: Mike and John discuss a new article on giving steroids for patients who have post arrest shock.

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Cerebral Venous Thrombosis

Mike Winters Rob Rodriguez Peter DeBlieux John Greenwood

In this episode we discuss a commonly missed critical condition, cerebral venous thrombosis.  What are the risk factors, signs, and symptoms of CVT?  How do we make the diagnosis?  More importantly, how do we treat CVT?  Listen to this months pearls and don't be left wondering about that headache patient you just sent home.

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Quickie: Systolic Pulse Variation


John GreenwoodCritical Care Quickie: Systolic Pulse Variation

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Bounce Up Case: Aortic Regurgitation

John Greenwood

In this episode, Mike and John discuss a terrifying case of a young patient presenting in atrial fibrillation and found to have an ascending aortic aneurysm with aortic regurgitation.  Listen in and see how traditional treatment for atrial fibrillation almost killed this patient.

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Status Epilepticus

Debbie Madhok Mike Winters Rob Rodriguez Peter DeBlieux John Greenwood

In this episode Rob interviews neurocritical care expert Debbie Madhok's on the latest guidelines for the diagnosis and management of patients with status epilepticus.  If you miss this episode you may be left wondering if you gave that seizing patient the right medication at the right dose.

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Vancomycin Dosing

Michael Winters Bryan Hayes

March Critical Care Quickie: Vancomycin Dosing in critically ill patients

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Clinical Indicators of the Need for ICU Admission

Mike Winters John Greenwood

Mike and John discuss two recent articles that identify clinical features that may predict the need for ICU admission.  Listen to these great pearls!  Miss this episode and you may be left wondering if that Code Blue was the patient you just sent upstairs.

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Sepsis Guidelines Quickie

Mike Winters John Greenwood

First Critical Care Quickie: no more SIRS.  The Critical Care Guys discuss the new sepsis definition, qSOFA and more!

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Lactic Acidosis

Mike Winters Rob Rodriguez Peter DeBlieux John Greenwood

Lactate has become the most commonly used biomarker to assess tissue perfusion.  Unfortunately, lactate isn't simply produced during states of hypoperfusion and anaerobic metabolism. In this episode, we discuss the current concepts, controversies, and clinical implications of lactate in the critically ill patient.  Listen in and find out why 50% of patients with a normal anion gap may still have elevated lactate levels!

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2015 Year in Review

Mike Winters Rob Rodriguez Peter DeBlieux John Greenwood

This month we start off with our annual review of key articles from the recent EM/CCM literature.  In Part 2, John goes over yet another critical Bounce-Up case with important take home pearls.  Finally, Bryan Hayes brings us home with the latest guidelines for reversing anticoagulants in the setting of acute intracerebral hemorrhage.  This month the pearls come fast and furious!

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Sickle Cell, REBOA, and PLR

Zaffer Qasim Mike Winters Rob Rodriguez Peter DeBlieux

We are ending 2015 with our best podcast of the year!  In this episode we discuss the critically ill sickle cell patient, REBOA, and pearls and pitfalls on passive leg raise for volume responsiveness.  Special guest Zaffer Qasim joins Mike, Peter, Rob, and John on the episode.  This episode is chock full of life-saving pearls!

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Myths in Managing Pain in the Critically Ill

John Greenwood Mike Winters Rob Rodriguez Peter DeBlieux

A ton of pearls and pitfalls this month's podcast.  In Part I, we discuss some common myths and misconceptions in managing pain in the critically ill patient.  In Part 2, John Greenwood is back for Bounce-Up case 2.  In Part 3, Bryan Hayes imparts his pearls of wisdom on the effect of TTM on various resuscitation medications.

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Cardiac Arrest in Pregnancy and "Bounce-Ups"

Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss an incredibly difficult scenario - the pregnant patient who presents in cardiac arrest.  Can you use electricity?  What about vasopressors?  What about targeted temperature management if you get ROSC?  All these pearls and much more in Part 1.  In Part 2, EM/CCM superstar John Greenwood introduces our newest segment - Bounce Ups!  A plethora of pearls and pitfalls in the October podcast.

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Aspiration Pneumonia and Interventions That Matter!

Mike Winters Rob Rodriguez Peter DeBlieux

This month we've got two outstanding discussions!  In Part 1, we discuss recent literature on aspiration pneumonia.  We go over the current organisms, various aspiration syndromes, diagnosis, and treatment of this all too common condition.  My how things have changed!  In Part 2, we review a recent article from Critical Care Medicine on 15 interventions in critically patients that have affected mortality.  Listen in and find out what we should, and should not, be using.

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Hyperoxia in Critical Illness and Resuscitative Thoracotomy

Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss the adverse effects of hyperoxia.  What organ systems are adversely effected?  What's the latest evidence? How should we be titrate oxygen therapy in select critical illnesses?  Can oxygen be too much of a good thing?  In Part 2, we review and discuss the EAST Guidelines for Resuscitative Thoracotomy.  When should you be considering and performing this heroic procedure? Tons of pearls in the August podcast!

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Neurocritical care, cardiac arrest management, and PTSD after ICU discharge

Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss some neurocritical care, cardiac arrest management, and PTSD after ICU discharge.  In Part 1, Rob and Mike discuss the presentation and management of patients who develop neurogenic pulmonary edema.  Can you recognize it, and more importantly, do you know the pitfalls in ventilating these patients?  In Part 2, we focus on PEA and provide a simplified algorithm for your next cardiac arrest resuscitation.  Listen and learn why you may not need to remember all those H's and T's.  Finally, we discuss PTSD after ICU discharge and it's negative impact upon quality of life.  Simply a month chock full of educational pearls!

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Mechanical Ventilation in the ED

Mimi Lu Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss the essentials of mechanical ventilation in the ED.  Rob imparts his pearls and pitfalls in how to manage the ventilator for select critical illnesses.  In Part 2, Mimi Lu is back to discuss the latest research on TTM for pediatrics.  Should we be cooling kids following cardiac arrest? 

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Stress-Induced Cardiomyopathy & Requests for Futile Treatment

Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss two great topics!  In Part 1, we review the presentation, diagnosis, and treatment of patients with stress-induced cardiomyopathy.  Listen in and find out why milrinone may be a better inotropic agent for these patients.  In Part 2, we tackle an incredibly tough scenario that we've all encountered - when a surrogate decision maker requests potentially inappropriate or futile care.  We discuss a recent consensus statement on the topic along with pearls for family negotiations.

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The Crashing Obese Patient

Mike Winters Rob Rodriguez Peter DeBlieux

Up to 30% of ICU patients are considered obese, as defined by BMI.  These patients have altered physiology that impacts their resuscitation, whether they are in the ED or ICU.  This month, we discuss crucial pearls and pitfalls in the resuscitation of the crashing obese patient.  How do you manage the airway?  What ventilator settings do you need? How do you adjust critical medications in the obese patient?  We tackle these questions and much more!

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Things Your Intensivist Wishes You Did For Critical Patients

Bryan Hayes Mike Winters Rob Rodriguez Peter DeBlieux

The March episode is simply loaded with great clinical pearls and pitfalls! We start off by reviewing two articles just published this week in NEJM.  For our main segment, we discuss crucial pearls in the care of critically ill ED patients based on Peter's recent lecture at the 2015 Scientific Assembly of the American Academy of Emergency Medicine.  We finish the month strong with Bryan Hayes (@PharmERToxGuy) discussing pearls in the administration of lipid emulsion for the crashing tox patient.

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