Critical Care Perspectives in Emergency Medicine

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CCPEM Blog

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Mechanical Circulatory Support Devices

Peter DeBlieux John Greenwood Mike Winters

What do you do for the patient in cardiogenic shock who is not responding to vasopressors and inotropes?  Should you place a mechanical circulatory support device as a bridge to PCI or CABG? We discuss the pearls and pitfalls of the latest devices.

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An Approach to Refractory Hypoxemia

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

The use of a PEEP recruitment maneuver is common among ventilated patients with refractory hypoxemia.  However, a recent JAMA study questions whether we should be using this in our patients.  In this podcast, we discuss this article and an approach to the patient with refractory hypoxemia while on the ventilator.

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Noninvasive Ventilation for the Emergency Physician

Peter DeBlieux John Greenwood Mike Winters

We know NIV works well for patients with acute COPD or acute CHF exacerbations.  In this episode, we discuss the evidence for NIV not only in COPD and CHF, but also a myriad of other conditions.  Do you know what the latest guidelines say on NIV for asthma, immunocompromised patients, or undifferentiated acute respiratory failure?  Take a listen...

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ED Mechanical Ventilation Pearls

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

In this podcast we discuss the pearls and perils of ED mechanical ventilation.  What are the numbers you NEED to know? We also discuss the critical points of post-intubation analgesia and sedation.  Still providing benzo's to your intubated ED patient?  Better listen to this episode!

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Hyponatremic Encephalopathy

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

Hyponatremia is one of the most common electrolyte disorders encountered in emergency medicine and critical care.  Patients with hyponatremic encephalopathy represent a severe form of hyponatremia that must be rapidly treated.  In this episode, we discuss pearls and pitfalls in treating this critical condition.

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Resuscitating Under Stress!

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

Resuscitations are often chaotic events.  How we perform under pressure can make the difference between life and death.  In this podcast, we discuss a recent article in print in Annals of Emergency Medicine on performing well under stress. This may be one of the most important podcasts of the year!

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Angiotensin II for Vasodilatory Shock?

Mike McCurdy Mike Winters

This month Mike McCurdy rejoins the podcast to discuss the ATHOS-3 trial.  Mike was one of the co-authors on this impressive publication and gives us insight into the study and its results.  Very thought provoking!

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Pediatric and Neonatal Septic Shock

Barrie Bostick Mimi Lu Mike Winters

Peds EM superstars Mimi Lu and Barrie Bostick join CCPEM to review the latest clinical guidelines on hemodynamic support of pediatric and neonatal septic shock.  This episode is loaded with pearls for the resuscitation of your next septic pediatric patient!

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Intubating & Ventilating the Obese Patient

Ken Butler Rory Spiegel Mike Winters

Rory Spiegel and Ken Butler join the podcast to discuss critical issues in intubating and ventilating the obese patient.  What physiologic changes do you NEED to know?  What is appropriate dose of RSI meds in the obese patient?  What are the initial ventilator settings?  These experts answer these questions and so many more!

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Euglycemic DKA

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

We discuss the case of a young patient presenting with euglycemic DKA.  Say what?  How common is this entity and what is the impact of a new class of diabetic medication?  We answer these important questions and much more on this episode.

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Should We Treat Fever in Septic Patients?

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

Several recent articles have challenged the long-held belief that we should treat fever in patients with sepsis.  In this episode we review these recent studies, along with the benefits of fever in patients with an infection.  A very timely and controversial topic!

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Top 10 Pearls for the Critically Ill Elderly Patient

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

The number of critically ill elderly patients continues to increase annually.  In this podcast, we discuss key pearls and pitfalls in resuscitating the sick elderly patient.  A truly great discussion!

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High-Dose NTG in ACPE

Mike Winters Jill Logan

ED Pharmacist extraordinaire Jill Logan joins CCPEM to discuss the use of high-dose nitroglycerin in patients with acute cardiogenic pulmonary edema.  Is it safe?  How much can, and should, you give during the initial resuscitation of these sick patients?

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Family Centered Care in the Critically Ill

Peter DeBlieux Rob Rodriguez Mike Winters John Greenwood

New guidelines have just been published on the care of family members of critically ill patients! So many family members of critically ill patients have significant problems, including PTSD and depression, in the months following the ICU stay of their loved one.  Peter, Rob, Mike, and John review select recommendations of these new guidelines.  Incredibly important content this month!

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Surviving Sepsis Campaign 2016 Update

Mike Winters Peter DeBlieux Rob Rodriguez John Greenwood

The SSC recently published its new recommendations for the management of sepsis and septic shock.  We discuss the key changes and controversies that you need to know regarding these latest guidelines!

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The Complicated Alcohol Withdrawal Patient

Mike Winters Bryan Hayes

Bryan Hayes is back!  In this podcast, we discuss pitfalls in the use of benzodiazepines along with current evidence on adjunctive treatments including propofol, barbiturates, dexmedetomidine, antiepileptics, and ketamine.  Bryan brings us all up to date with this discussion!

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Top Articles of 2016

Peter DeBlieux John Greenwood Rob Rodriguez Mike Winters

It's time for our annual literature update of the best and most discussed articles from 2016!  Simply a great discussion on important topics such as ICH, cardiac arrest, mechanical ventilation, RSI, and sepsis.

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Sepsis Resuscitation Part II: The Microcirculation

Mike Winters John Greenwood

We continue our discussion on sepsis resuscitation by focusing on the microcirculation.  Is ScvO2 dead or can it still provide useful information in select patients?

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Will My Patient Respond to Fluids?

Mike Winters Rob Rodriguez Peter DeBlieux

The administration of IVFs is one of the most common interventions in caring for critically ill ED patients.  But when is enough, enough?  Peter, Rob, and Mike discuss a recent article that summarizes the current evidence on determining who will, and who won't, respond to IVFs.

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The Crashing Patient with Pulmonary Hypertension

Mike Winters Rob Rodriguez Peter DeBlieux

This month we cover the critical pearls and pitfalls in resuscitating the crashing patient with pulmonary hypertension.  These patients are incredibly sick and can crash in minutes.  Miss this episode and you may be left wondering why additional IVFs are actually making this patient more hypotensive!

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Critical Care Quickie: HCAP

John Greenwood

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Sepsis Resuscitation Part I: The Macrocirculation

Mike Winters John Greenwood

John and I kick off an amazing several part series on sepsis resuscitation based on some upcoming articles that are in press.  In this episode we cover the macrocirculatory targets that you've simply go to know when managing your next septic patient.

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Vasopressors in the ED

Mike Winters Peter DeBlieux Rob Rodriguez

Peter gave an outstanding talk at ACEP 16 on vasopressor use in the ED.  In this podcast, we discuss the pearls and pitfalls in the selection of vasoactive agents for select critical illnesses encountered in the ED! Choose wisely!

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Severe CAP - The First 24 Hours

Mike Winters John Greenwood

Is that sick patient with CAP you just admitted crashing?  Mike and John discuss critical decisions in the first 24 hours of care for the patient with severe CAP.

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Controversies in Thrombolytics for Acute PE

Mike Winters Brit Long

Brit Long joins CCPEM to discuss his recent article on the current controversies of thrombolytic use for patients with acute PE.  Who should receive lytics for PE?  Who shouldn't?  Brit reviews all the latest evidence.

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Left Ventricular Outflow Tract Obstruction

John Greenwood Mike Winters

John Greenwood is back and discusses the pearls you need to know about LVOTO in the critically ill patient.  Miss this episode and you may be left wondering why your septic shock patient is not responding to vasopressor therapy!

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Post-Arrest Care

Peter DeBlieux Rob Rodriguez Mike Winters

Though the tendency might be to celebrate when you've obtained ROSC in the patient with cardiac arrest, the real work has only just begun.  Critical care during the early post-arrest period can make the difference between life and death.  Peter, Rob, and Mike discuss the pearls and pitfalls you NEED to know when caring for that patient you just resuscitated from cardiac arrest.

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Bounce Ups - Acute Pancreatitis

Mike Winters John Greenwood

John Greenwood is back with another outstanding bounce-up case!  Listen and find out how to use the BISAP ad CT Severity Index.  Most importantly, learn the pearls in identifying that sick patient with pancreatitis who needs a higher level of care.

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Heat Stroke

Mike Winters Peter DeBlieux Rob Rodriguez

Summer is here and so are dangerously high temperatures.  Numerous deaths have already been reported from heat-related illness.  In this podcast, Mike, Peter, and Rob discuss the pearls and pitfalls in cooling patients with heat stroke.  Listen in and find out why those cold IV fluids you may be administering just don't work!

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Capnography in Critical Illness

Mike Winters Peter DeBlieux Rob Rodriguez

In this episode, Mike, Peter, and Rob review the clinical applications of capnography in the critically ill patient.  It's so much more than confirmation of endotracheal tube placement...

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Cardiac Dysfunction After Neuro Injury

Mike Winters John Greenwood

Ever wonder why your SAH patient becomes hypotensive?  Mike and John discuss a recent article on cardiac dysfunction in the neurocritical care patient.  How do you make the diagnosis?  More importantly, what are the critical components in managing these complex patients?

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VTE in Sepsis

Carina Sorenson Mike McCurdy

Drs. Sorenson and McCurdy make their debut appearance on CCPEM to discuss a recent article with some frightening results! Miss this episode and you may be left wondering why that septic patient had a large PE.

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Quickie: Trauma Bounce-ups


John GreenwoodCritical Care Quickie: John gives a great Critical Care Quickie on a recent article regarding trauma bounce-ups and the factors to pay attention to!

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High Flow Nasal Cannula

Mike Winters Mike Allison

Mike Allison rejoins the podcast this month to discuss the hot topic of HFNC.  What's the evidence say about using this device for critically ill patients with acute respiratory failure?  Mike gives some outstanding pearls and pitfalls in using HFNC.

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Driving Pressure - A New Target for Mechanical Ventilation?

Mike Winters John Greenwood

In this episode, Mike and John discuss a potential new target for optimizing mechanical ventilation. This is a can't miss, cutting-edge discussion.  Miss it and you may be left wondering why you are behind the time by just focusing on plateau pressure!

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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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Modern Management of Cardiac Arrest

Joshua Reynolds Mike Winters Rob Rodriguez Peter DeBlieux

This month, Mike interviews resuscitation expert Dr. Joshua Reynolds on the "Modern Management of Cardiac Arrest".  What are the things you need to focus on to maximize your rates of ROSC and optimize neurologic outcomes for patients in cardiac arrest?  Too many lifesaving pearls in this episode to miss!

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2014: A Year in Review

Mike Winters Rob Rodriguez Peter DeBlieux

 
We are starting off 2015 with our annual review of key articles from the EM and CCM literature published over the past year.   Key literature in sepsis, cardiac arrest, post-arrest, RSI, and post-intubation management headline the list.  If you want to know the latest in EM/CCM don't miss this episode!

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Critical Care Management of ICH and Antibiotic Pearls

Evie Marcolini Bryan Hayes Mike Winters Rob Rodriguez Peter DeBlieux

This month we have two returning CCPEM favorites, Dr. Evie Marcolini and Dr. Bryan Hayes.  Evie discusses the latest evidence-based care of patients with acute ICH, while Bryan highlights critical pearls and pitfalls in antibiotic therapy.  We couldn't be ending the year on a stronger note!  A can't miss episode!

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Neutropenic Fever and Ebola Virus Disease

Jenny Wilson Mike Winters Rob Rodriguez Peter DeBlieux

This month we focus on ID and Critical Care.  In Part 1, Rob interviews his EM/CCM colleague Dr. Jenny Wilson on pearls and pitfalls in the patient with neutropenic fever.  In Part 2, we discuss management pearls in the patient with Ebola Virus Disease.  This is an absolute can't miss episode loaded with pearls!

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Hemodynamic-directed Resuscitation and Ultrasound in Critical Care

John Greenwood Haney Mallemot Mike Winters Rob Rodriguez Peter DeBlieux

Dr. John Greenwood discusses hemodynamic-directed resuscitation in cardiac arrest patients.  Dr. Haney Mallemat digs deeper into fluid-responsiveness and discusses the pitfalls in the uses of ultrasound IVC measurements and other dynamic markers you can use at the bedside.

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Thrombolytic Therapy in Submassive PE

Mike Winters Rob Rodriguez Peter DeBlieux

Not sure whether to give thrombolytic therapy to your patient with submassive PE?  Does lytic therapy actually improve outcomes?  What are the risks? This month we discuss the key articles from the 2014 literature on submassive, or intermediate-risk, PE.  

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Cardiogenic Shock and ECPR

Semhar Tewelde Mike Winters Rob Rodriguez Peter DeBlieux

Semhar Tewelde joins the podcast this month to gives us the pearls and pitfalls in managing patients with cardiogenic shock. Next, the boys discuss a hot topic in emergency medicine and critical care, extracorporeal CPR. What's the evidence and indications for this novel therapy?

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Refractory Hypoxemia and New Anticoagulant Reversal

Feras Khan Mike Winters Rob Rodriguez Peter DeBlieux

Feras Khan discusses critical therapies for refractory hypoxemia: what works and what therapies should be put to rest in the critical care graveyard. In addition, we discuss the emergent reversal of new oral anticoagulants for patients presenting with life-threatening hemorrhage. Tons of pearls this month!
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TEG and Pearls and Pitfalls in Dissection

Mark Walsh Robert Crawford Mike Winters Rob Rodriguez Peter DeBlieux

Mark Walsh speaks about thromboelastography (TEG) and why you should be using this test to guide transfusions, especially with the massive transfusion protocol. Vascular Surgeon Dr. Robert Crawford gives his pearls & pitfalls on the management of aortic dissection. Forget about memorizing all those classifications; it's easy with his 4 critical points.

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Ischemic Stroke and Severe Acute Pancreatitis

Wendy Chang Mike Winters Rob Rodriguez Peter DeBlieux

Neurocritical care guru Wendy Chang joins the Critical Care Guys to discuss the critical care management of patients with acute ischemic stroke. In part 2, we discuss the current management of patients with severe acute pancreatitis. Still using the term "hemorrhagic pancreatitis"? Still aggressively fluid resuscitating your patient and providing prophylactic antibiotics?
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Vanc/Zosyn is NOT the Answer to Everything

Brian Hayes Michael Allison Michael Scott Mike Winters Rob Rodriguez Peter DeBlieux

Got a sick septic patient? Ready to write for vancomycin and piperacillin/tazobatam? You might want to think again. This month Bryan Hayes is back to discuss 7 pearls that should immediately impact your practice. Michael Allison and Michael Scott review the evidence for the use of noninvasive ventilation in patients with an acute asthma exacerbation.
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ProCESS, Blood Pressure, and Albumin in Sepsis

Mike Winters Rob Rodriguez Peter DeBlieux

This month we review and discuss critical literature just published in the NEJM pertaining to the resuscitation of patients with septic shock. Should you change your MAP goal? Is albumin still indicated for fluid resuscitation in the septic patient? Should CVP and central venous oxygen saturation measurements be integral to the management of patients with sepsis?
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Acute Liver Failure and Tips & Tricks You've Got to Know

Mike Winters Rob Rodriguez Peter DeBlieux

We start off with a discussion on the patient with acute liver failure. Learn why giving lactulose for encephalopathy in these patients may be harmful. In the second discussion, we officially welcome Haney Mallemat to the CCPEM team and hears his Tips & Tricks Every Resuscitationist Must Know!
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Literature Review 2013

Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss key articles from the 2013 literature that pertain to EM and CCM. Lots of great stuff on cardiac arrest, targeted temperature management, sepsis, transfusions, fluid resuscitation, pulmonary embolism, and sedation and analgesia. Don't get left behind before the year even get's started.
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Pediatric Status Asthmaticus and Status Epilepticus

Mimi Lu Mike Winters Rob Rodriguez Peter DeBlieux

This month we get back to pediatric critical illness. Mimi Lu discusses status asthmaticus while Nate Mick imparts the pearls for treating status epilepticus in sick kids. If you take care of kids, you can't afford to miss this episode!
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Alcohol Withdrawal, Targeted Temperature Management, and Abdominal Catastrophes

Bryan Hayes Mike Winters Rob Rodriguez Peter DeBlieux

Bryan Hayes is back to discuss pearls and pitfalls regarding alcohol withdrawal. We discuss the latest NEJM article that casts doubt on the benefit of cooling patients with ROSC from OHCA to 33C. Finally, we highlight 2 abdominal catastrophes that can easily be missed in the critically ill ICU patient.
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The Sick Transplant Patient

Mike Winters Rob Rodriguez Peter DeBlieux

This month we discuss pearls and pitfalls in the management of critically ill transplant patients. Though we focus on the cardiac transplant patient, much of the discussion on rejection, medications, and infection is applicable to any transplant patient. Do you know how to recognize rejection? What organisms do you need to consider in the transplant patient with sepsis?
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Hypertensive Emergencies

Mike Winters Rob Rodriguez Peter DeBlieux

Often felt to be one of the "most mismanaged conditions in all of medicine", the management of hypertensive emergencies is challenging and can be fraught with disaster. What is the target reduction in blood pressure during the first hour? What agents should you use for select patients and why does hydralazine have no role in the management of hypertensive emergencies?
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Fluid Resuscitation and Critical Management of SAH

Neeraj Badjatia Mike Winters Rob Rodriguez Peter DeBlieux

Recent evidence suggests that the type of fluid selected may impact outcomes. We discuss the acid-base effects of IV fluids, balanced solutions, and the selection of fluids for specific clinical scenarios. Dr. Neeraj Badjatia gives an outstanding talk on the critical care management of patients with SAH. Learn why there is "nothing normal about normal saline".
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The Intubated ED Patient: Mistakes You Don't Want to Make!

Sam Wood Mike Winters Rob Rodriguez Peter DeBlieux

This month Sam Wood joins the podcast and delivers an amazing lecture on caring for the intubated ED patient. Packed with pearls and pitfalls, this podcast is one you'll want to listen to a few times. Miss this episode and you may just find yourself the center of the next M&M conference.
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Critical Care Monitoring and Recent Trauma Articles

Kim Boswell Mike Winters Rob Rodriguez Peter DeBlieux

Peter discusses methods of monitoring and assessing critically ill patients in the ED. Kim Boswell, a rapidly rising star in trauma and critical care, discusses some recent articles from the trauma critical care literature that every emergency physician must know.
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Pediatric Resus and Hyperosmolar Therapy in Neurocritical Care

Mimi Lu Mike Winters Rob Rodriguez Peter DeBlieux

Mimi Lu walks us through the resuscitation of the crashing cardiac kid. The Guys discuss hyperosmolar therapy in neurocritical care. What's a better method to monitor mannitol therapy than serum osmolality? How do you dose the various concentrations of hypertonic saline?
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The Drowning Patient and NMBA Pearls

Rob Rogers Mike Winters Rob Rodriguez Peter DeBlieux

The Critical Care Guys discuss the management of the critically ill drowning patient including use of antibiotics, steroids, and therapeutic hypothermia. How do you ventilate and wean these patients? The boys also review the use of NMBAs in the critically ill and the many factors that will affect your practice.
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Anemia in Critically Ill and Toxicology Pearls

Bryan Hayes Mike Winters Rob Rodriguez Peter DeBlieux

The Critical Care Guys discuss the management of anemia in the critically ill including the risks of transfusion and the hemoglobin threshold. Dr. Hayes returns to highlight pearls in recent toxicology papers.
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Pediatric Sepsis and Literature Update Part 2

Mike Winters Rob Rodriguez Peter DeBlieux

This month Mike, Peter, and Rob finish their review of key articles from the 2012 EM and CCM literature. Great pearls on fluid resuscitation and ultrasound in cardiac arrest! In the second half of this month, Mike interviews Nathan Mick, Assistant Professor of Emergency Medicine and Pediatrics at Maine Medical Center, on resuscitating the critically ill pediatric patient with sepsis.
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Literature Review 2012 and Critical Procedures

Mike Winters Rob Rodriguez Peter DeBlieux

This month, the critical care guys discuss a few of their favorite articles from the 2012 emergency medicine and critical care literature. In addition, Peter, Rob, and Mike finish their discussion on critical care procedures in the crashing patient. A fantastic podcast to start off 2013!
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Etomidate and Critical Procedures

Ken Butler Haney Mallemat Bryan Hayes Mike Winters Rob Rodriquez Peter DeBlieux

Should we abandon etomidate in sepsis? This month Ken Butler, Haney Mallemat, Bryan Hayes and the boys discuss a recent article in Critical Care Medicine and provide their thoughts on whether etomidate should still be used sepsis. Then, Peter, Rob, and Mike discuss some pearls on a few critical procedures in the crashing patient. An outstanding episode to end 2012!
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Oncologic Emergencies and Bicarbonate Shortage

Mike McCurdy Mike Winters Rob Rodriquez Peter DeBlieux

Mike McCurdy joins the boys this month for a discussion on Oncologic Emergencies. What's in and what's out in the treatment of tumor lysis syndrome. Peter, Rob, and Mike then discuss what to do in the face of a bicarbonate shortage. Is it really needed for most conditions? Lots of great pearls in this month's episode!
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Surviving Sepsis 2012 Guidelines and Toxicology

Philip Dellinger Bryan Hayes Mike Winters Rob Rodriguez Peter DeBlieux

Want to know what's coming in the 2012 Surviving Sepsis Campaign Guidelines? This month, Mike interviews the lead author, R. Philip Dellinger, on key changes that you need to know. In the second half, Mike interviews EM toxicology guru Bryan Hayes on two conditions that your probably missing. A true can't miss episode...
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AKI in the Critically Ill

Rob Rogers Mike Winters Rob Rodriguez

This month the guys discuss a complex and very common condition in the critically ill patient: acute kidney injury. Do you know how to diagnose AKI? What are the most common causes in the critically ill patient? How do you manage patients with AKI? What's the difference between continuous and intermittent renal replacement therapies?
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Pneumothorax, Digoxin Toxicity and Lung Protective Ventilation

Bryan Hayes Rob Rogers Mike Winters Rob Rodriguez

The critical care guys review a recent article in Chest on pneumothorax in the critically ill. Bryan Hayes makes a return this month to discuss how to give DigiFab. Finally, the boys wrap with a recent article in BMJ that shows we are still doing a poor job implementing lung protective ventilation strategies.
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Extremely Hypoxic Patient and Devices for GI Bleed

Rob Rogers Mike Winters Rob Rodriguez

Your patient is intubated and FiO2 is 100%. Your patient's SaO2 continues to tank. What do you do? Rob breaks it down and walks us through a stepwise approach to the extremely hypoxic patient. In part 2, Mike discusses devices and pearls and pitfalls in a crashing GI bleed case.
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Pericardial Tamponade and Sedation & Analgesia

Haney Mallemat Brian Hayes Mike Winters Rob Rodriguez Peter DeBlieux

Dr. Haney Mallemat joins the Critical Care Guys this month to discuss the slowly crashing patient with pericardial tamponade. Dr. Brian Hayes reviews high yield pearls on sedation and analgesia.
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Hyponatremia and Aortic Dissection

Rob Rogers Mike Winters Rob Rodriguez Peter DeBlieux

The Critical Care Guys discuss a case of hyponatremia. Dr. Rob Rogers joins the Critical Care Guys to review a critically ill patient with aortic dissection.
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Critical Care Quickies

Mike Winters Rob Rodriguez Peter DeBlieux

The Critical Care Guys review some very high yield clinical pearls you can use on your next shift!
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Acetaminophen Toxicity and Literature Review

Bryan Hayes Michael Allison Mike Winters Rob Rodriquez Peter DeBlieux

Drs. Bryan Hayes and Mike Allison discuss the pearls and pitfalls of acetaminophen overdose. The Critical Care Guys continue the literature update from Feb episode.
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Literature Review

Mike Winters Rob Rodriquez Peter DeBlieux

The Critical Care Guys review select emergency medicine literature including lactate clearance vs SCVO2 as goals of early sepsis, peri-shock pause as a predictor of survival during cardiac arrest, IV vs IO access in cardiac arrest and much more!
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Critically Ill Burn Patient and Tracheostomy Respiratory Distress

Ken Butler John Greenwood Mike Winters Rob Rodriguez Peter DeBlieux

Dr. Ken Butler joins us this month to discuss the care of the critically ill burn patient. Dr. John Greenwood discusses the management of patients with tracheostomy complications.
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Pulmonary Hypertension

Mike Winters Rob Rodriguez Peter DeBlieux

This month the Critical Care Guys discuss what to do with the patient with pulmonary hypertension. How much fluid do you give? When do you start vasopressors and inotropes? Is there a role for pulmonary vasodilators? What do you need to think about when these patients crash in the ED? The answers to these questions and much more in this episode!
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Critically Ill HIV Patient and Crashing Pediatric Patient

Monica Gandhi Mimi Lu Mike Winters Rob Rodriquez Peter DeBlieux

Two features this month! In the first, Rob discusses a case of a critically ill patient with HIV with Dr. Monica Gandhi. In the second, Mike interviews Dr. Mimi Lu about some important recent updates to resuscitating the crashing pediatric patient.
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Necrotizing Soft Tissue Infections

Mike Winters Rob Rodriquez Peter DeBlieux

This month the boys discuss the critically ill patient with a necrotizing soft tissue infection. What organisms do you need to know? Is an x-ray sufficient for the diagnosis? What is the single greatest predictor of survival when treating these patients? Are you giving the right antibiotics? Listen in for these answers and much, much more!
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Heat Stroke and Noninvasive Ventilation

Michael Allison Mike Winters Rob Rodriquez Peter DeBlieux

This month Dr. Michael Allison joins us for a case discussion on heat stroke. What is the best mechanism for getting the core temperature down? What complications should you expect? In the second part, we discuss noninvasive ventilation. What are the modes, the indications, the predictors of success, and the complications of this critical therapy?
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Antibiotics Pearls and Caring for the Critically Ill Patient with ESLD

Ellen Slaven Mike Winters Rob Rodriquez Peter DeBlieux

Peter DeBlieux and Dr. Slaven discuss infectious disease pearls including the management for unknown source of infection and healthcare associated infections. The Critical Care Guys discuss the management of the critically ill end-stage liver patient.
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ECMO and Abdominal Compartment Syndrome

Haney Mallemat Ken Butler Mike Winters Rob Rodriguez Peter DeBlieux

Dr. Mallemat joins the Critical Care Guys to discuss ECMO in the ED and Dr. Ken Butler returns to discuss management of abdominal compartment syndrome.
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The Crashing Patient

Amal Mattu Mike Winters Rob Rodriguez Peter DeBlieux

Emergency cardiology guru Amal Mattu joins the Critical Care Guys to discuss a stepwise method you can do between the ABC's and CBC's to keep your patient from crashing.
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