EMCrit Project http://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Tue, 15 Jan 2019 02:51:53 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.9 https://emcrit.org/feed/podcast/ Help me fill in the blanks of the practice of ED Critical Care. In this podcast, we discuss all things related to the crashing, critically ill patient in the Emergency Department. Find the show notes at emcrit.org. Scott D. Weingart, MD FCCM clean episodic Scott D. Weingart, MD FCCM spambin55@gmail.com spambin55@gmail.com (Scott D. Weingart, MD FCCM) 2009- Online Medical Education on Emergency Department (ED) Critical Care, Trauma, & Resuscitation EMCrit Project http://emcrit.org/wp-content/uploads/powerpress/3000x3000-emcrit.jpg http://emcrit.org Tox and Hound – Some Like It Hot http://emcrit.org/toxhound/likeithot/ http://emcrit.org/toxhound/likeithot/#respond Mon, 14 Jan 2019 18:26:14 +0000 https://emcrit.org/?p=457509 by Meghan Spyres The holidays are over and it’s time for that long stretch of thankless winter before spring is here again. Sounds like the perfect time to plan a trip somewhere tropical! Which also makes it the perfect time to review one of my favorite topics: marine envenomations. Although we typically think of the […]

EMCrit Project by Tox & Hound.

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PulmCrit- Acute infection & myocardial infarction: How afraid should we be? http://emcrit.org/pulmcrit/infection-mi/ http://emcrit.org/pulmcrit/infection-mi/#comments Mon, 14 Jan 2019 13:19:48 +0000 http://emcrit.org/?p=457465 Occasionally, the NEJM publishes a scary article that gets a lot of press, but doesn’t pan out to be valid.  The recent example is the PESIT study, which seemed to imply that everyone admitted with syncope had PE (don’t worry- they don’t). It looks like NEJM might be at it again, with this week’s review article on the relationship between acute infection and MI.

EMCrit Project by Josh Farkas.

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IBCC chapter & cast: Severe influenza http://emcrit.org/pulmcrit/influenza/ http://emcrit.org/pulmcrit/influenza/#comments Thu, 10 Jan 2019 14:24:29 +0000 http://emcrit.org/?p=456787 Initially I wasn't planning to write a chapter on influenza, because there is precious little evidence regarding ICU management.  However, even in the absence of solid evidence, we will be called upon to treat these patients.  Currently flu season is afoot, and it looks like it might be a bad one (with a predominance of […]

EMCrit Project by Josh Farkas.

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COMM CHECK: On Checklists http://emcrit.org/emcrit/comm-check-on-checklists/ http://emcrit.org/emcrit/comm-check-on-checklists/#comments Thu, 03 Jan 2019 16:01:49 +0000 http://emcrit.org/?p=455321 The Checklist that Saved an Aircraft On October 30, 1935 Boeing engineers stood proudly by as their newest technological wonder, the Model 299 was about to demonstrate its capabilities to members of the  top brass of the Army Air Corps.  At the controls of the aircraft was the Army’s chief test pilot, Major Ployer P. […]

EMCrit Project by Mike Lauria.

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IBCC chapter & cast: Acute Kidney Injury http://emcrit.org/pulmcrit/acute-kidney-injury/ http://emcrit.org/pulmcrit/acute-kidney-injury/#comments Wed, 02 Jan 2019 20:51:07 +0000 http://emcrit.org/?p=456607 The importance of avoiding and treating renal failure cannot be overstated.  The kidneys are delicate organs, often the first to be injured by systemic hypoperfusion or other insults.  Severe renal dysfunction leads to a cascade of badness, promoting the failure of other organs and eventual spiraling into multi-organ failure.1  Alternatively, if we are can defend […]

EMCrit Project by Josh Farkas.

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Tox and Hound – A Happy New Year To All! http://emcrit.org/toxhound/happynewyear/ http://emcrit.org/toxhound/happynewyear/#comments Mon, 31 Dec 2018 23:13:33 +0000 https://emcrit.org/?p=456551 7 Cyanide Wishes and Thallium Dreams! Howard – The story of the year? The Tox and The Hound! Toxicology’s foray into the world of FOAM has had an auspicious start. I am obviously biased, but I think that we have a phenomenal team and have put forth some outstanding content. From toxicology·fundamentals, to the classics (including […]

EMCrit Project by Tox & Hound.

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PulmCrit- Antibiotics for abscesses, white walkers, and the inherent myopia of science http://emcrit.org/pulmcrit/antibiotics-abscess/ http://emcrit.org/pulmcrit/antibiotics-abscess/#comments Mon, 31 Dec 2018 11:00:04 +0000 http://emcrit.org/?p=456500 There are a number of reasons that an idea may be impossible to test scientifically.  Perhaps the disease state that the idea applies to is extremely rare.  Perhaps it is logistically impossible to test the idea, due to issues with blinding or time constraints.  This post will focus on an insidious reason that ideas are thrown beyond the wall:  the timeframe and study size required to test them are unachievable.

EMCrit Project by Josh Farkas.

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CC Nerd-The Case of the Unknown Quantity http://emcrit.org/emnerd/cc-nerd-the-case-of-the-unknown-quantity/ http://emcrit.org/emnerd/cc-nerd-the-case-of-the-unknown-quantity/#comments Sat, 29 Dec 2018 20:01:11 +0000 http://emcrit.org/?p=456479 Lung-protective ventilation is often considered a simple truth when managing critical care patients on mechanical ventilation. Despite this sense of certainty, the knowledge of exactly how and when to perform such ventilatory strategies is incomplete. The recently published PReVENT adds yet more uncertainty to the true efficacy of low tidal volume ventilation in patients without […]

EMCrit Project by Rory Spiegel.

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Tox and Hound – Fellow Friday – Drug and Toxin-Induced Hepatic Microvesicular Steatosis http://emcrit.org/toxhound/ff-microvesicular-steatosis/ http://emcrit.org/toxhound/ff-microvesicular-steatosis/#respond Fri, 28 Dec 2018 17:58:00 +0000 https://emcrit.org/?p=456420 Drug and Toxin-Induced Hepatic Microvesicular Steatosis From Captain Bligh to Bacillus cereus by Steven Curry, M.D. Department of Medical Toxicology Banner – University Medical Center Phoenix @SteveCurryMD Drug and toxin-induced liver diseases comprise various histologic patterns. A few examples a toxicologist may encounter include perisinusoidal fibrosis with hypervitaminosis A, peliosis hepatis from sex steroids, veno-occlusive […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Community-acquired urosepsis http://emcrit.org/pulmcrit/urosepsis/ http://emcrit.org/pulmcrit/urosepsis/#comments Wed, 26 Dec 2018 18:21:34 +0000 http://emcrit.org/?p=456381 Urosepsis is one of my favorite ICU diagnoses.  In almost all cases, patients will improve dramatically within 12-24 hours and leave the ICU with minimal sequelae.  But that shouldn't lull us into a false sense of security:  careful antibiotic selection, aggressive resuscitation, and (in some cases) emergent drainage may be required for a good outcome.  

EMCrit Project by Josh Farkas.

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The Dantastic Mr. Tox & Howard – S02E06 – The Ergogenic Academic http://emcrit.org/toxhound/s02e06-ergogenic-academic/ http://emcrit.org/toxhound/s02e06-ergogenic-academic/#respond Tue, 25 Dec 2018 13:57:50 +0000 https://emcrit.org/?p=456351 Dantastic Live at NACCT 2018 . . . &Howard That’s not a lump of coal in your stocking . . . Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Dan Rusyniak (@drusyniak) live on stage at the 2018 North American Congress of Clinical Toxicology Pre-Meeting Symposium. Dan cleverly tricked Howard into being the foil […]

EMCrit Project by Tox & Hound.

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Tox and Hound – Reefer Madness http://emcrit.org/toxhound/reefer-madness/ http://emcrit.org/toxhound/reefer-madness/#comments Thu, 20 Dec 2018 22:18:25 +0000 https://emcrit.org/?p=456231 by Diane Calello The decision to move from a system in which cannabis is completely illegal, to one in which it is not only legal for recreational use, but also facilitated with government resources, has many implications in many realms. Advocates point to significant gains in the social justice arena and the relative safety of […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast- Immune-related adverse events from checkpoint inhibitors http://emcrit.org/pulmcrit/checkpoint/ http://emcrit.org/pulmcrit/checkpoint/#respond Wed, 19 Dec 2018 13:40:38 +0000 http://emcrit.org/?p=456183 If you haven't started seeing these yet, you will soon.  Checkpoint inhibitors are a form of immunotherapy being used for an increasingly broad range of malignancies.  They cause a diverse range of adverse events, due to releasing uncontrolled autoimmune hyperactivity.  Clinically this can mimic just about any rheumatologic condition.  Fortunately these events are quite treatable.  However, a high index of suspicion and prompt therapy is important.  

EMCrit Project by Josh Farkas.

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PulmCrit- Rant: Antimicrobial exposure and risk of delirium http://emcrit.org/pulmcrit/antibiotics-delirium/ http://emcrit.org/pulmcrit/antibiotics-delirium/#comments Mon, 17 Dec 2018 13:00:59 +0000 http://emcrit.org/?p=456119 This paper slipped across my twitter feed over the weekend.  It was a bit disquieting to see that it was getting a lot of attention, despite being a methodological train wreck (seriously, MedTwitter, where’s the skepticism??).  This post will briefly walk through some of the main flaws.  There will be a bit of pharmacology, a modicum of methodology, and a lot of ranting.  

EMCrit Project by Josh Farkas.

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EMCrit 238 – Medical Error Epidemic Craziness with G. Gianoli http://emcrit.org/emcrit/medical-error-epidemic-craziness/ http://emcrit.org/emcrit/medical-error-epidemic-craziness/#comments Wed, 12 Dec 2018 16:43:58 +0000 http://emcrit.org/?p=452087 EMCrit 238 - Medical Error Epidemic Craziness with G. Gianoli. Medical Error is the 3rd leading cause of death in the US--or is it?

EMCrit Project by Scott Weingart.

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http://emcrit.org/emcrit/medical-error-epidemic-craziness/feed/ 6 EMCrit 238 - Medical Error Epidemic Craziness with G. Gianoli. Medical Error is the 3rd leading cause of death in the US--or is it?
You and your brethren are the 3rd leading cause of death in the United States. Medical error is rampant, why are you not doing anything about this problem?
How many times have you heard these statistics and others like them? How many times have you been berated by patient safety experts using these very statistics as their foundation and their whip. Have you ever wondered how these statistics could possibly be true when it doesn't jibe at all with your day-to-day experience.

I know I have wondered...

Today, we get to the bottom of this craziness.
Gerard Gianoli, MD
He did an internship in General Surgery and an internship in Pediatrics. Following a residency in Otolaryngology- Head and Neck Surgery, he completed a fellowship in Otology, Neurotology and Skull Base Surgery at the Michigan Ear Institute. He was a full-time Associate Professor at Tulane Medical School until July 2000 when he joined Ear and Balance Institute. He still maintains a Clinical Associate Professor appointment at Tulane in both the Department of Otolaryngology-Head and Neck Surgery and the Department of Pediatrics. He has published and lectured extensively in the field of Neurotology and serves on multiple Editorial Review Boards for the fields of Neurotology and Otolaryngology.
Dr. Gianoli's Two Pieces on the Medical Error Studies

* Medical Error Hysteria1
* Unreliable Research on Error-Related Hospital Deaths in America - Gianoli and Dunn2

The Makary and Daniel article

* From the BMJ

More...

* Additional reanalysis from Shojania

Now on to the Podcast...





1.
Gianoli G. Medical Error Epidemic Hysteria. Am J Med. 2016;129(12):1239-1240. [PubMed]




2.
Gianoli G. Unreliable Research on Error-Related Hospital Deaths in America. JPANDS. 2016;21(4):104-108. http://jpands.org/vol21no4/gianoli.pdf.



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Scott D. Weingart, MD FCCM clean 17:09
IBCC chapter & cast- Adrenal crisis http://emcrit.org/pulmcrit/adrenal-crisis/ http://emcrit.org/pulmcrit/adrenal-crisis/#comments Wed, 12 Dec 2018 13:00:27 +0000 http://emcrit.org/?p=456002 Adrenal crisis is a can't-miss diagnosis.  Prompt identification and proper management will generally lead to rapid improvement.  The most important aspect is maintaining a high index of suspicion.  When in doubt, start empiric therapy first and ask questions later. The IBCC chapter is located here. The podcast & comments are below. Follow us on iTunes

EMCrit Project by Josh Farkas.

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Tox and Hound – Enter Clonidine http://emcrit.org/toxhound/enterclonidine/ http://emcrit.org/toxhound/enterclonidine/#respond Mon, 10 Dec 2018 19:24:52 +0000 https://emcrit.org/?p=455929 by Sarah Shafer As promised in my last post, where I discussed the utility of naloxone in clonidine overdose, we’re going to spend some time today talking about clonidine in opioid withdrawal. Is it a useful therapy for treating opioid withdrawal, or like Claudius in Hamlet, a gaslighting distractor? Before we dive in, let me […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Post-cardiac arrest management http://emcrit.org/pulmcrit/post-arrest/ http://emcrit.org/pulmcrit/post-arrest/#comments Wed, 05 Dec 2018 14:35:50 +0000 http://emcrit.org/?p=455859 Post-cardiac arrest management has undergone substantial revisions within the past several years, particularly with regards to temperature management.  This remains an area of active controversy and investigation, with the TTM-2 trial currently underway.  Although equipoise still exists, this chapter describes a streamlined 36C approach which is based on evidence, guidelines, and experience with various strategies. […]

EMCrit Project by Josh Farkas.

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PulmCrit- Alpha-2 agonists: clonidine, guanfacine, lofexidine, and KetaDex http://emcrit.org/pulmcrit/ketadex/ http://emcrit.org/pulmcrit/ketadex/#comments Mon, 03 Dec 2018 13:50:06 +0000 http://emcrit.org/?p=455808 Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion.  It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients).  The main drawbacks of dexmedetomidine are logistic:  it is expensive and can be administered only as an IV infusion within an ED or ICU.  Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.

EMCrit Project by Josh Farkas.

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The Dantastic Mr. Tox & Howard – S02E05 – Don’t Call Her Czarina http://emcrit.org/toxhound/dmths02e05-czarina/ http://emcrit.org/toxhound/dmths02e05-czarina/#respond Thu, 29 Nov 2018 19:15:30 +0000 https://emcrit.org/?p=455772 The Opioid Crisis with UMass Chief Opioid Officer, Dr. Kavita Babu Join Dan (@drusyniak) &Howard (@heshiegreshie) as they welcome the first Chief Opioid Officer at UMass Memorial Health Care, Dr. Kavita Babu (@kavitababu) and talk about tackling the opioid crisis as toxicologists from boots on the ground to the halls of government. Get involved and […]

EMCrit Project by Tox & Hound.

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EMCrit Podcast 237 – Vent & PreVENT – An Update http://emcrit.org/emcrit/vent-prevent/ http://emcrit.org/emcrit/vent-prevent/#comments Wed, 28 Nov 2018 19:39:36 +0000 http://emcrit.org/?p=455055 More on Vents

EMCrit Project by Scott Weingart.

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http://emcrit.org/emcrit/vent-prevent/feed/ 6 More on Vents PreVENT Trial

* PreVENT Trial
* The Bottom Line on the PreVENT Study

Dominating the Vent Series

* EMCrit Lecture – Dominating the Vent: Part I
* EMCrit Lecture – Dominating the Vent: Part II
* Response to Letters on my Mechanical Ventilation Article in the Ann Emerg Med

PRVC Refs

* A rabbit study1
* PC vs. PRVC in Brain Injury Patients2
* Work of Breathing Analysis
* Small Study demonstrating that you are not getting the Vt you think you are3
* Small Crossover Trial4

Now on to the Podcast

References




1.
Porra L, Bayat S, Malaspinas I, et al. Pressure-regulated volume control vs. volume control ventilation in healthy and injured rabbit lung: An experimental study. Eur J Anaesthesiol. 2016;33(10):767-775. [PubMed]




2.
Schirmer-Mikalsen K, Vik A, Skogvoll E, Moen K, Solheim O, Klepstad P. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocrit Care. 2016;24(3):332-341. [PubMed]




3.
Kallet R, Campbell A, Dicker R, Katz J, Mackersie R. Work of breathing during lung-protective ventilation in patients with acute lung injury and acute respiratory distress syndrome: a comparison between volume and pressure-regulated breathing modes. Respir Care. 2005;50(12):1623-1631. [PubMed]




4.
Guldager H, Nielsen S, Carl P, Soerensen M. A comparison of volume control and pressure-regulated volume control ventilation in acute respiratory failure. Crit Care. 1997;1(2):75-77. [PubMed]



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Scott D. Weingart, MD FCCM clean 24:31
IBCC chapter & cast: Meningitis and encephalitis http://emcrit.org/pulmcrit/meningitis-2/ http://emcrit.org/pulmcrit/meningitis-2/#comments Wed, 28 Nov 2018 11:44:48 +0000 http://emcrit.org/?p=455732 Severe CNS infections are a bit of an orphan disease in critical care.  Unlike more common neurologic disorders (e.g. stroke), CNS infections are too rare to recruit lots of patients into RCTs.  Consequently, conventional treatment of these disorders lags decades behind other neurologic disorders (e.g. in terms of optimizing cerebral perfusion pressure).  Principles of neurocritical […]

EMCrit Project by Josh Farkas.

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Tox and Hound – The Worst of Both Worlds http://emcrit.org/toxhound/worst-of-both-worlds/ http://emcrit.org/toxhound/worst-of-both-worlds/#comments Mon, 26 Nov 2018 17:02:13 +0000 https://emcrit.org/?p=455675 A very special welcome to our newest hound, Jeanna Marraffa, PharmD, DABAT! You can learn more about her here . . . by Jeanna Marraffa Circa Feb 2012 Poison Center: “Um, Jeanna, there is a doc on the line that has a quick question for you. I’m going to send it through to your line.” […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Torsades de Pointes http://emcrit.org/pulmcrit/tdp/ http://emcrit.org/pulmcrit/tdp/#comments Wed, 21 Nov 2018 13:51:08 +0000 http://emcrit.org/?p=455493 Torsades de pointes is an uncommon cause of cardiac arrest.  It is generally quite treatable, but if treated inadequately it will often recur (in some cases leading to repeated salvos of ventricular tachycardia, one form an electrical storm).  A structured approach incorporating a pre-emptive protocoled magnesium infusion is generally quite effective. The IBCC chapter is […]

EMCrit Project by Josh Farkas.

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IBCC: Guide to supportive care in critical illness http://emcrit.org/pulmcrit/guide/ http://emcrit.org/pulmcrit/guide/#comments Mon, 19 Nov 2018 15:10:35 +0000 http://emcrit.org/?p=455440 This chapter gives an overview of how to provide high-quality supportive care to the sickest patients.  It summarizes about a dozen chapters within the IBCC.  This is intended as a quick guide for folks who don't work full-time in an ICU (e.g. residents rotating through the unit).  

EMCrit Project by Josh Farkas.

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IBCC chapter & cast: Hyperkalemia http://emcrit.org/pulmcrit/hyperk/ http://emcrit.org/pulmcrit/hyperk/#comments Wed, 14 Nov 2018 11:09:04 +0000 http://emcrit.org/?p=455366 Hyperkalemia is bread and butter critical care medicine.  However, the therapeutic approach has changed substantially within the past 5 years. Myths about kayexalate and normal saline have been exposed, allowing more effective therapies to take their place.  

EMCrit Project by Josh Farkas.

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EMCrit Wee – The Brindley Sessions – Followership http://emcrit.org/emcrit/followership/ http://emcrit.org/emcrit/followership/#comments Sun, 11 Nov 2018 22:14:31 +0000 http://emcrit.org/?p=451181 on followership

EMCrit Project by Scott Weingart.

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http://emcrit.org/emcrit/followership/feed/ 5 on followership

Another iteration of the Brindley Sessions:
The Article
Followership by Leung, Lucas, Brindley et al.
The Table

Figure 1: Robert Kelley’s Followership dimensions and styles, adapted from Kellerman (2008)1



in the podcast, the passive followers are described as yes-people
from: https://www.medicalprotection.org

More Sparks for Ideas

* Kelley's followership model with discussion
* A related discussion we published in BMJ
* A discussion on culture (including nations) by Geert Hofstede
* And a darn good book about cultivating "eulogy virtues" rather than "resume virtues"
* NOLS 4 leadership roles

Listen to the Rest of the Brindley Sessions
More from Peter
Now on to the Session...
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Scott D. Weingart, MD FCCM clean 26:48
IBCC chapter & cast: Delirium http://emcrit.org/pulmcrit/delirium/ http://emcrit.org/pulmcrit/delirium/#comments Wed, 07 Nov 2018 13:50:19 +0000 http://emcrit.org/?p=455234 Delirium occurs in about half of critically ill patients.  Some fairly simple measures may reduce the risk of delirium.  When it occurs, delirium is a diagnostic challenge because occasionally it can be a sign of undiagnosed underlying illness.  Treatment is challenging, with little evidence to support most of the standard therapies.

EMCrit Project by Josh Farkas.

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Tox and Hound – Twisted Interactions http://emcrit.org/toxhound/twisted-interactions/ http://emcrit.org/toxhound/twisted-interactions/#comments Wed, 07 Nov 2018 03:11:17 +0000 https://emcrit.org/?p=455223 by Andrew Stolbach     I. Depolarization Medicine should center on the patient, so I start this story with an anonymous person dropping dead.1 Perhaps this person first heard about the medication from a friend who raved about his new allergy pill. Then, the day of a routine doctor’s appointment, our patient saw an advertisement for […]

EMCrit Project by Tox & Hound.

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COMM CHECK: Sterile Cockpit http://emcrit.org/emcrit/comm-check-sterile-cockpit/ http://emcrit.org/emcrit/comm-check-sterile-cockpit/#comments Tue, 06 Nov 2018 20:30:48 +0000 http://emcrit.org/?p=455116 Post is coauthored by Ashley Keiler-Green MD, EM/Critical Care Attending, University of New Mexico School of Medicine This post is part of the COMM CHECK series on communication during resuscitation.   Silence is a source of great strength -Lao Tzu The Sterile Cockpit Communication is a key aspect of safe and efficient task execution in all high-risk […]

EMCrit Project by Mike Lauria.

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PulmCrit: No more antipsychotics for delirium? Not so fast! http://emcrit.org/pulmcrit/antipsychotics-delirium/ http://emcrit.org/pulmcrit/antipsychotics-delirium/#comments Mon, 05 Nov 2018 13:29:14 +0000 http://emcrit.org/?p=455111 Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness.  Before jumping into the results of this study, it will help to establish a couple of foundational principles.

EMCrit Project by Josh Farkas.

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PulmCrit- Does the HIGH trial debunk high-flow nasal cannula? http://emcrit.org/pulmcrit/pulmcrit-does-the-high-trial-debunk-high-flow-nasal-cannula/ http://emcrit.org/pulmcrit/pulmcrit-does-the-high-trial-debunk-high-flow-nasal-cannula/#comments Thu, 01 Nov 2018 13:01:45 +0000 http://emcrit.org/?p=455050 High-flow nasal cannula (HFNC) has become popular for the hypoxemic respiratory failure, driven partially by the FLORALI trial.1  Recently, the HIGH trial evaluated the ability of HFNC to reduce mortality among immunocompromised patients with acute hypoxemic respiratory failure.2  HFNC failed to improve mortality or significantly reduce intubation rates. Popular narrative about this trial A common […]

EMCrit Project by Josh Farkas.

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EMCrit 236 – George Kovacs on EVLI Airway Incrementalization http://emcrit.org/emcrit/evli/ http://emcrit.org/emcrit/evli/#comments Wed, 31 Oct 2018 17:45:25 +0000 http://emcrit.org/?p=455075 Approach to steps of laryngoscopy/intubation

EMCrit Project by Scott Weingart.

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http://emcrit.org/emcrit/evli/feed/ 4 Approach to steps of laryngoscopy/intubation
A video lecture from my friend and airway guru,  Prof. George Kovacs. He has been obsessed with airway for decades. This lecture discusses breaking down the steps of airway management into chunks.
George's Site

* AIME Airway

More from George on EMCrit

* The Psychologically Difficult Airway by George Kovacs
* Definitive Emergent Awake Intubation with George Kovacs
* Airway Things I Learned from George Kovacs at the NYC Airway Course
* Antifragile in EM by George Kovacs

Now on to the Vodcast...


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Scott D. Weingart, MD FCCM clean 22:07 yes
IBCC chapter & cast: Anemia & transfusion targets http://emcrit.org/pulmcrit/transfusion/ http://emcrit.org/pulmcrit/transfusion/#comments Wed, 31 Oct 2018 12:26:30 +0000 http://emcrit.org/?p=455063 Most patients in the ICU will become anemic.  This chapter explores prevention, evaluation, and treatment of anemia in the ICU.  Causes of new-onset anemia in the ICU are distinct from the causes of anemia seen in the outpatient clinic, so the approach should be appropriately tailored to the critical care environment.   

EMCrit Project by Josh Farkas.

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PulmCrit- SUP-ICU: Is pantoprazole the elixir of life? Should it be? http://emcrit.org/pulmcrit/sup-icu/ http://emcrit.org/pulmcrit/sup-icu/#comments Tue, 30 Oct 2018 11:43:13 +0000 http://emcrit.org/?p=455011 SUP-ICU is a massive, modern RCT of stress ulcer prophylaxis (SUP) in the ICU. With 3298 patients, it is larger than many meta-analyses of SUP. Its primary mortality endpoint is deeply flawed.  However, the study still provides a wealth of information about SUP in the ICU.

EMCrit Project by Josh Farkas.

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CC Nerd-The Case of the Subjective Truth http://emcrit.org/emnerd/cc-nerd-the-case-of-the-subjective-truth/ http://emcrit.org/emnerd/cc-nerd-the-case-of-the-subjective-truth/#comments Sun, 28 Oct 2018 15:21:05 +0000 http://emcrit.org/?p=454989 A recent post examining the utility of cricoid pressure and how to interpret non-inferiority trials stimulated discussion on Bayesian analysis and the question of whether a formal quantitative analysis is necessary or if an informal qualitative assessment is adequate. A recent reanalysis of the EOLIA trial published in JAMA by Goligher et al1 allows us to […]

EMCrit Project by Rory Spiegel.

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IBCC chapter & cast: Acute pancreatitis http://emcrit.org/pulmcrit/pancreatitis/ http://emcrit.org/pulmcrit/pancreatitis/#comments Thu, 25 Oct 2018 19:29:15 +0000 http://emcrit.org/?p=454895 Management of severe pancreatitis has remained in a state of controlled chaos and persistent debate for years (mirroring evolution in our treatment of septic shock).  This confusion shows no signs of abating in the near future.  This chapter explores a reasonable approach to pancreatitis, with the caveat that there is very little evidence available to guide our combat against this challenging foe.  

EMCrit Project by Josh Farkas.

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Tox and Hound – Dust To Dust http://emcrit.org/toxhound/dust-to-dust/ http://emcrit.org/toxhound/dust-to-dust/#comments Tue, 23 Oct 2018 02:38:39 +0000 http://emcrit.org/?p=454855 by Howard Greller Sudden sniffing death and myocardial sensitization I will show you fear in a handful of dust. – T.S. Eliot Little Johnny was having a hard time. Dumped by his girlfriend of eight glorious weeks, he was despondent. There wasn’t any alcohol in the house, and he didn’t have a fake ID or the […]

EMCrit Project by Tox & Hound.

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PulmCrit- Ketamine for alcohol withdrawal? http://emcrit.org/pulmcrit/ketamine-alcohol-withdrawal/ http://emcrit.org/pulmcrit/ketamine-alcohol-withdrawal/#comments Mon, 22 Oct 2018 11:55:42 +0000 http://emcrit.org/?p=454836 Recent publications have explored the role of ketamine in alcohol withdrawal.  Ketamine undoubtedly has some outstanding properties, which make it well suited for  this task.  The challenge is integrating ketamine into a unified, coherent treatment strategy. 

EMCrit Project by Josh Farkas.

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EM Nerd-The Case of the Inferior Superiority http://emcrit.org/emnerd/em-nerd-the-case-of-the-inferior-superiority/ http://emcrit.org/emnerd/em-nerd-the-case-of-the-inferior-superiority/#comments Thu, 18 Oct 2018 18:26:05 +0000 http://emcrit.org/?p=454766 A perfect trial would require minimal statistical tools to assist in its analysis. Such a trial would be so large that the sample approached the true likeness of the broader population it intended to emulate, thus the risk of sampling error would be minimal. The confidence intervals surrounding the point estimates would be so minute, […]

EMCrit Project by Rory Spiegel.

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