EMCrit Podcast - Critical Care and Resuscitation http://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Tue, 24 May 2016 14:46:20 +0000 en-US hourly 1 https://wordpress.org/?v=4.5.2 http://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 clean Scott D. Weingart, MD spambin55@gmail.com spambin55@gmail.com (Scott D. Weingart, MD) 2009-2013 Online Medical Education on Emergency Department (ED) Critical Care, Trauma, & Resuscitation EMCrit Podcast - Critical Care and Resuscitation http://emcrit.org/wp-content/uploads/powerpress/3000x3000-emcrit.jpg http://emcrit.org SMACC-Back – On Marik and Lactate http://emcrit.org/blogpost/smacc-back-marik-lactate/ Sat, 21 May 2016 20:06:17 +0000 http://emcrit.org/?p=20667 http://emcrit.org/blogpost/smacc-back-marik-lactate/#comments Scott Weingart <p>Banging -- My -- Head -- Against -- Wall -- Repeatedly...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/blogpost/smacc-back-marik-lactate/feed/ 3 Banging -- My -- Head -- Against -- Wall -- Repeatedly...
My friend, Paul Marik, is a mythbuster. He has been vindicated in so many viewpoints that were initially branded as crazy. But… sometimes the weapon he chooses in his war against perceived pseudo-axioms is hyperbole. This was the case in a few instances in his talk from SMACC-Chicago on Lactate:
Understanding Lactate – Paul Marik

 
The Paper Paul Cited
Roberg Article
[1]
The Many Retorts Explaining Its Flaws
If you only read one retort
[2]
[3]
[4]
[5]
 
Now on to the SMACC-Back

References

*
R.A. Robergs, F. Ghiasvand, and D. Parker, "Biochemistry of exercise-induced metabolic acidosis.", American journal of physiology. Regulatory, integrative and comparative physiology, 2004. http://www.ncbi.nlm.nih.gov/pubmed/15308499



*
D. Böning, G. Strobel, R. Beneke, and N. Maassen, "Lactic acid still remains the real cause of exercise-induced metabolic acidosis.", American journal of physiology. Regulatory, integrative and comparative physiology, 2005. http://www.ncbi.nlm.nih.gov/pubmed/16105825



*
G. Kemp, D. Böning, R. Beneke, and N. Maassen, "Explaining pH change in exercising muscle: lactic acid, proton consumption, and buffering vs. strong ion difference.", American journal of physiology. Regulatory, integrative and comparative physiology, 2006. http://www.ncbi.nlm.nih.gov/pubmed/16760335



*
G. Kemp, "Lactate accumulation, proton buffering, and pH change in ischemically exercising muscle.", American journal of physiology. Regulatory, integrative and comparative physiology, 2005. http://www.ncbi.nlm.nih.gov/pubmed/16105824



*
M.I. Lindinger, J.M. Kowalchuk, and G.J.F. Heigenhauser, "Applying physicochemical principles to skeletal muscle acid-base status.", American journal of physiology. Regulatory, integrative and comparative physiology, 2005. http://www.ncbi.nlm.nih.gov/pubmed/16105823





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Scott D. Weingart, MD clean 9:52
Podcast 174 – LaMW – Oxygenation Kills Part II http://emcrit.org/podcasts/lamw-oxygenation-kills-ii/ Sun, 15 May 2016 21:17:58 +0000 http://emcrit.org/?p=20333 http://emcrit.org/podcasts/lamw-oxygenation-kills-ii/#comments Scott Weingart <p>Laryngoscope as a Murder Weapon - Oxygenation Kills Part II</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/lamw-oxygenation-kills-ii/feed/ 2 Laryngoscope as a Murder Weapon - Oxygenation Kills Part II
This is Part II, you need to Watch Part I First!
So I’ve been giving this talk for Grand Rounds for a decade now. I’ve kept it off the podcast so I would have something unheard to discuss when I come to visit a program. I don’t do many grand rounds any more–so the time has come, here is:
Laryngoscope as a Murder Weapon: Oxygenation Kills
There are two other LaMW talks:

* LaMW: Ventilatory Kills
* LaMW: Hemodynamic Kills

Most of the things discussed are elaborated upon on the EMCrit Preox Page.
This will be a two-parter. The things we will cover over the course of these two segments are:

* PreOx (Including VaPoX)
* Preventing Deox with ApOx and Apenic CPAP


* ReOx

Need an Audio-Only Version?
Right Click and Choose Save-As
Now on to the Vodcast…


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Scott D. Weingart, MD clean 18:13 yes
Podcast 173 – LaMW – Oxygenation Kills Part I http://emcrit.org/podcasts/lamw-oxygenation-kills/ Tue, 03 May 2016 00:29:43 +0000 http://emcrit.org/?p=19962 http://emcrit.org/podcasts/lamw-oxygenation-kills/#comments Scott Weingart <p>Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/lamw-oxygenation-kills/feed/ 12 Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I
So I’ve been giving this talk for Grand Rounds for a decade now. I’ve kept it off the podcast so I would have something unheard to discuss when I come to visit a program. I don’t do many grand rounds any more–so the time has come, here is:
Laryngoscope as a Murder Weapon: Oxygenation Kills
There are two other LaMW talks:

* LaMW: Ventilatory Kills
* LaMW: Hemodynamic Kills

Most of the things discussed are elaborated upon on the EMCrit Preox Page.
This will be a two-parter. The things we will cover over the course of these two segments are:

* PreOx (Including VaPoX)
* Preventing Deox with ApOx and Apenic CPAP


* ReOx

See Part II
Part II of LaMW Ox Kills
Need an Audio Only Version
Right-Click here and Choose Save-as
Now on to Part I…


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Scott D. Weingart, MD clean 30:16 yes
Reddit and A Free Sepsis Webinar http://emcrit.org/misc/reddit/ Thu, 21 Apr 2016 19:28:05 +0000 http://emcrit.org/?p=19421 http://emcrit.org/misc/reddit/#comments Scott Weingart <p>G+ is dead, long live reddit</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/misc/reddit/feed/ 6 G+ is dead, long live reddit
Reddit
Google Plus is surely on its last legs. Let’s ditch this dying corpse, my fellow fleas. On to the next corpus: reddit.
CGP Grey on What is Reddit?

so come to emcrit.org/reddit and subscribe to the emcrit subreddit
Subscribe to EMCrit Subreddit

Leave Questions for the Fluid Webinar Here
Questions for Fluids in Sepsis Webinar
 
New York State Partnership for Patients: Fluids in Sepsis Webinar
4/27/2016 at 1400 Eastern Time
Panel Moderator:

• Scott Weingart, M.D., Chief of the Division of Emergency Critical Care at Stony Brook University Medical Center
Panelists:

• Terry P. Clemmer, M.D., Director of Critical Care Medicine, LDS Hospital, Intermountain Healthcare

• David Gaieski, M.D. Co-Director, Early Goal-directed Therapy, Co-Director Clinical Resuscitation, Thomas Jefferson University

• Emanuel Rivers, M.D, M.P.H., Vice Chairman and Research Director, Henry Ford Health System, Department of Emergency Medicine

• Phillippe Rola, M.D., ICU Chief of Service, Santa Cabrini Hospital, Montreal Canada
Register at this Link
 

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Scott D. Weingart, MD clean 7:53
EMCrit Podcast 172d – Enough with the Can you Trust Podcasts/Blogs/New Media http://emcrit.org/podcasts/emcrit-podcast-172d-enough-can-trust-podcastsblogsnew-media/ Sun, 17 Apr 2016 17:52:51 +0000 http://emcrit.org/?p=19329 http://emcrit.org/podcasts/emcrit-podcast-172d-enough-can-trust-podcastsblogsnew-media/#comments Scott Weingart <p>Yes, you can trust medical podcasters</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/emcrit-podcast-172d-enough-can-trust-podcastsblogsnew-media/feed/ 39 Yes, you can trust medical podcasters
This is in response to a bunch of comments from this Wildcast EM episode.
Please let me know what you think!
Update
Response and my comments just posted on the new Wildcast EM Site
Now on to the Podcast…
 

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Scott D. Weingart, MD clean 10:41
EMCrit Podcast 172c – Vent as Bag & VAPOX http://emcrit.org/podcasts/emcrit-wee-vapox/ Sun, 17 Apr 2016 17:52:32 +0000 http://emcrit.org/?p=19234 http://emcrit.org/podcasts/emcrit-wee-vapox/#comments Scott Weingart <p>the BVM is the most dangerous device in medicine--let's do better</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/emcrit-wee-vapox/feed/ 18 the BVM is the most dangerous device in medicine--let's do better
VAPOX and Vent-as-Bag
In a concept piece called Preoxygenation. Reoxygenation and Delayed Sequence Intubation in the Emergency Department, I outlined a concept which I called: the vent as a bag. Why would we use the unpredictable and unmeasured BVM, when instead we could use a purpose-built, strictly internally regulated machine like a ventilator. I had stopped talking about the idea when numerous people told me it was unfeasible in their environment–however, I continued this practice for my own patients throughout my practice.
Recently, Grant et al. published a case series using the same concept–they have dubbed their vision of it VAPOX.

Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator (DOI: 10.1111/1742-6723.12524)[1]

their protocol is very similar to the one I have used:
Non-Invasive SIMV

* Respiratory rate of 6–8 breaths per minute
* Pressure support 0 cm water (I never bothered unless pt had severe acidosis–the authors used PS of 10)
* Positive end expiratory pressure starting at 5 cm water (titrate up to 15 if not getting sats > 95% in preox)
* Fraction inspired oxygen 1.0
* Vt 550 ml
* Inspiratory Flow (30 lpm)


See Grant et al.’s paper for their protocol
Also consider getting some mask straps
And Remember the Nasal Cannula at 15 lpm
For More
See the EMCrit Preoxygenation Page
Now on to the Podcast…
 

References

*
S. Grant, F. Khan, G. Keijzers, M. Shirran, and L. Marneros, "Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator", Emergency Medicine Australasia, vol. 28, pp. 67-72, 2016. http://dx.doi.org/10.1111/1742-6723.12524





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Scott D. Weingart, MD clean 7:09
EMCrit Podcast 172b – MoTR – Get Faster! http://emcrit.org/podcasts/faster/ Sun, 17 Apr 2016 17:52:05 +0000 http://emcrit.org/?p=17669 http://emcrit.org/podcasts/faster/#respond Scott Weingart <p>Slow is Smooth, Smooth is Fast. Now, get faster</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/faster/feed/ 0 Slow is Smooth, Smooth is Fast. Now, get faster
Mind of the Resuscitationist
In a previous wees and lectures, we discussed Chapman’s Dictum: smoothness=speed; slow is smooth, smooth is fast
So go slow!
Update
Love this quote brought to my attention by G. Harrison:
When I say that I learned to take my time in a gunfight, I do not wish to be misunderstood, for the time to be taken was only that split fraction of a second that means the difference between deadly accuracy with a sixgun and a miss. It is hard to make this clear to a man who has never been in a gunfight. Perhaps I can best describe such time taking as going into action with the greatest speed of which a man’s muscles are capable, but mentally unflustered by an urge to hurry or the need for complicated nervous and muscular actions which trick-shooting involves. Mentally deliberate, but muscularly faster than thought, is what I mean
–Wyatt Earp
Now I will extol the virtues of getting faster…
 

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Scott D. Weingart, MD clean 4:03
EMCrit Podcast 172a – The Mind Palace? http://emcrit.org/podcasts/mind-palace/ Sun, 17 Apr 2016 17:51:47 +0000 http://emcrit.org/?p=18360 http://emcrit.org/podcasts/mind-palace/#comments Scott Weingart <p>I want the perfect external mind palace...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/mind-palace/feed/ 22 I want the perfect external mind palace...

The mind palace, also known as the memory palace or the memory theatre, is something I want badly! Ever since I read the incredible book, the Art of Memory by Frances Yates, I have dreamed of building a mind palace. But in medicine, we should be able to externalize the palace–in fact, we must! The method of loci will not suffice.

Technology should surely have advanced to the point where this is simple–the programming requirements are trivial.
My current mind palace is at CrashingPatient.com. It is quite good, but not perfect.
Factors
Storage
We need a place to store all of the literature, books, and internet posts/media we feel will be valuable. The storage must be durable (if an internet site goes down, the work remains). If we lose our paid access, we retain the full text of the literature.
Readability


The medium should allow comfortable reading of the literature, viewing of the media, etc.
Accessibility
Should be immediately accessible offline or online. Should be firewall resistant.
Ease of Commenting/Summarizing
Need to put the take-home message somewhere. Additional thoughts, new findings. Really two separate things:

* We need the ability to comment on, by which I mean literally on the paper (i.e. scribblings, marginalia, highlighting)
* But also the ability to summarize a Topic and add those papers as citations in a way that would link to the scribbled on paper

Ease of the Edit
Front end editing
Open Source
Or at the very least, immediately exportable to open source
Search
All information should be easily retrievable with logic, operator,  and fuzzy logic based searches
Option to Publish
Should you want to share your memory palace
The Mind Palace Cycle

* Discovery
* Storage for to-be-read/to-be-viewed
* Process=Read/Comment/Summarize
* Storage
* Retrieval/Search
* Publish or Protect as Desired

Possibilities

* WordPress
* Evernote
* Zotero
* Papers
* Mendeley

image from memorise.org
Want to read more about memory?
The Art of Memory, mentioned above, is amazing–but oh so dense. For a lighter, contemporary read:

Update
Some additional requirements/desires:

* Self-Updating TOC as frontpage (see crashingpatient.com)
* Search must be browsable by either google or a plug-in and updates in real time
* Need to be able to do edits/additions on firewalled computers in any computer in the hospital.
* Want,]]>
Scott D. Weingart, MD clean 12:51
Podcast 171 – OODA Loops http://emcrit.org/podcasts/ooda-loops/ Sat, 02 Apr 2016 21:08:12 +0000 http://emcrit.org/?p=14229 http://emcrit.org/podcasts/ooda-loops/#comments Scott Weingart <p>Resuscitation is a System I Game...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/ooda-loops/feed/ 12 Resuscitation is a System I Game...
My keynote lecture at SMACC-Chicago was on OODA loops and the supremacy of System I for resuscitation. The lecture was plagued by AV-wankers to the point that I thought the talk was a shambles. I am rerecording the lecture here for EMCrit and the SMACC site. I hope you enjoy–SDW.
The OODA Loop

OODA Loops and John Boyd

* I’m loathe to link to this, but this probably the most accessible description of OODA loops and Boyd Philosophy

Protocols May Cause Harm

* Protocols for the OODA Loop Trilogy

Why I Hate ATLS

* Archaic Trauma Life Support

Guidelines are not for experts
#smaccUS Definition of physician: a healthcare worker authorised to work outside guidelines.-Peter Brindley Yes, observe, analyze, act!
— Manoj Singh (@Drmanoj_s) June 26, 2015

Articles

* Conditions for Intuitive Expertise by Gary Klein
* ED Cognition by Croskerry

Croskerry’s Loop

More to Read and Watch

* Physiology Inside the Loop
* More on OODA
* Klein Ted Talk
* Klein Strategies of Decision Making
* Croskerry Lecture Thinking Straight Lecture from SMACC
* System 1 vs. System 2
* All things John Boyd

The Book to Buy

Streetlights and Shadows: Searching for the Keys to Adaptive Decision Making
Update
Ugggggghhhh. I couldn’t see my notes while rerecording and I said BOyd was a Navy Pilot, when of course he was air force. And it was the air force that has reportedly not embraced his work. Sorry Navy. Thanks, Jim!
The Slides

* From SMACC Chicago

Audio Only Version

* clean 38:56 yes
Podcast 170 – the ER REBOA Catheter with Joe DuBose http://emcrit.org/podcasts/er-reboa/ Mon, 21 Mar 2016 16:49:42 +0000 http://emcrit.org/?p=18083 http://emcrit.org/podcasts/er-reboa/#comments Scott Weingart <p>Resuscitative REBOA is interesting, but was probably too complex for Resus Doctors--well not anymore!</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> http://emcrit.org/podcasts/er-reboa/feed/ 8 Resuscitative REBOA is interesting, but was probably too complex for Resus Doctors--well not anymore!
We’ve discussed REBOA before on the EMCrit Podcast with Megan Brenner. We also featured the first prehospital REBOA case. It was an interesting treatment, but an extremely complex one. That has all changed with the new ER REBOA catheter.
In this podcast, I discuss the new catheter from Prytime and then I interview Dr. Joe DuBose, a trauma and vascular surgeon who performed the first ER REBOA placement that resulted in a survivor.
Conflicts of Interest
Neither Dr. DuBose nor I have any conflicts of interest regarding the ER REBOA catheter or otherwise
Slides from Dr. DuBose’s Case

ER REBOA Visual Tour

ER REBOA Placement Video

Steps to Placement of the ER REBOA Catheter
Gain Access to the Common Femoral Artery with a 7-French Introducer

* Just like normal for an arterial line, except make sure you are hitting common femoral and not superficial femoral artery. The point of entry should be 2 cm below inguinal ligament (estimate ligament by anterior superior iliac to pubic tubercle). This may be much higher than you are used to.

Attach a Syringe to the Balloon Port of the REBOA Catheter

* Use a 25 or 30 ml syringe, filled with 24 ml of NS

Test the Balloon

* Inflate to test patency
* Make sure to fully deflate the balloon. Apply some extra suction to really shrink it down and then lock the balloon stopcock

Attach Transducer

* Attach a pressure transducer to the arterial line port. Zero the transducer to the phlebostatic access

Measure externally

* Zone 1 is measured with the proximal edge of the balloon at the xiphoid, Zone 3 is measured with the proximal edge of the balloon just above the umbilicus.



from J Trauma. 2011 Dec;71(6):1869-72



Insert the REBOA Catheter

* Use the orange sheath to straighten the p-tip
* Insert the orange sheath 1cm into the valve of the 7-french introducer
* Advance the REBOA catheter a few cm into the introducer
* Pull back on the orange sheath
* Advance the REBOA catheter to the predetermined depth

Inflate the Balloon

* Hold the REBOA catheter to prevent it from pushing out
* Open the Stopcock
* Inflate until resistance goes to moderate or the blood pressure on the arterial line tracing of the REBOA Catheter starts to increase. In general, this corresponds to 12-22 mls depending on the size of the aorta–but this must be individualized to the patient. The actual inflation is far harder than you may think. For me, it is the maximal force I can apply with 1 hand.
* Never instill more than 24 mls. Never more than 24
* Close the stopcock

Secure the Catheter

* If the catheter is not secured externally it will migrate out from aortic pressure, especially in zone I
* It will be an institution dependent choice as to how to secure: tape, sutures, the wings from a 7-french triple lumen, etc.

clean 18:22 Wee – Cliff Deutschman with Additional Thoughts on Sepsis 3.0 http://emcrit.org/wee/wee-cliff-deutschman-additional-thoughts-sepsis-3-0/ Fri, 11 Mar 2016 17:56:00 +0000 http://emcrit.org/?p=18846 <p>More on Sepsis 3.0</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> More on Sepsis 3.0 clean 27:00 Podcast 169 – Sepsis 3.0 with Merv Singer http://emcrit.org/podcasts/sepsis-3/ Mon, 07 Mar 2016 22:19:46 +0000 http://emcrit.org/?p=18796 <p>Hear from the lead author of the new Sepsis 3.0 definitions</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Hear from the lead author of the new Sepsis 3.0 definitions clean 32:33 Podcast 168 – Kyle Gunnerson and the EC3 http://emcrit.org/podcasts/ec3/ Tue, 23 Feb 2016 16:23:32 +0000 http://emcrit.org/?p=18706 <p>The USA's first stand-alone EDICU, the EC3</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The USA's first stand-alone EDICU, the EC3 clean 32:26 Podcast 167- Emergency Critical Care with Sara Gray http://emcrit.org/podcasts/emergency-critical-care-sara-gray/ Tue, 09 Feb 2016 02:07:12 +0000 http://emcrit.org/?p=18630 <p>Sara Gray is amazing--hear her talk about ED Critical Care from @smaccteam: </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Sara Gray is amazing--hear her talk about ED Critical Care from @smaccteam: clean 18:06 Presentation Mastery from the Teaching Course NYC 2015 http://emcrit.org/wee/presentation-prep-mastery/ Fri, 05 Feb 2016 16:08:12 +0000 http://emcrit.org/?p=16792 <p>How I prepare presentations</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> How I prepare presentations clean 56:26 Podcast 166 – Endocarditis with David Carr http://emcrit.org/podcasts/endocarditis/ Tue, 26 Jan 2016 01:06:40 +0000 http://emcrit.org/?p=16808 <p>Endocarditis in Acutely Ill Patients</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Endocarditis in Acutely Ill Patients clean 33:32 Podcast 165 – The Semantics of End of Life Discussions with Ashley Shreves http://emcrit.org/podcasts/semantics-end-of-life-discussions/ Sun, 10 Jan 2016 20:29:18 +0000 http://emcrit.org/?p=18356 <p>How to have an end of life conversation in the ED</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> How to have an end of life conversation in the ED clean 42:47 Podcast 164 – The Day I Didn’t Use Ultrasound by Mike Mallin http://emcrit.org/podcasts/day-i-didnt-use-ultrasound/ Sat, 26 Dec 2015 23:40:55 +0000 http://emcrit.org/?p=18168 <p>An amazing story from Mike Mallin</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> An amazing story from Mike Mallin clean 33:55 Resuscitation Program and FEMinEM discussion on Women as Conference Speakers and Unconscious Bias http://emcrit.org/blogpost/women-conference-speakers/ Sun, 20 Dec 2015 22:52:00 +0000 http://emcrit.org/?p=17690 <p>ART Program and FEMinEM Hangout</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> ART Program and FEMinEM Hangout clean 2:09 Response to a Letter to the Editor on DSI Study http://emcrit.org/blogpost/response-to-a-letter-dsi/ Sat, 19 Dec 2015 00:41:22 +0000 http://emcrit.org/?p=17995 <p>A response to some DSI questions in the Annals</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A response to some DSI questions in the Annals clean 20:26 Podcast 163 – MotR – The Post-Resuscitation http://emcrit.org/podcasts/post-resuscitation/ Tue, 15 Dec 2015 19:30:40 +0000 http://emcrit.org/?p=16636 <p>You saved a life or blew an airway--Now What? Handling the post-resuscitation on EMCrit # 163: </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> You saved a life or blew an airway--Now What? Handling the post-resuscitation on EMCrit # 163: clean 23:06 Podcast 162 – Assessing Fluid Responsiveness http://emcrit.org/podcasts/assessing-fluid-responsiveness/ Sun, 29 Nov 2015 18:51:06 +0000 http://emcrit.org/?p=5410 <p>yep, more on fluid responsiveness</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> yep, more on fluid responsiveness clean 26:57 Podcast 161 – The New Fluid Assessment in Sepsis with Jean-Francois Lanctot http://emcrit.org/podcasts/new-fluid-assessment-sepsis/ Fri, 20 Nov 2015 16:41:09 +0000 http://emcrit.org/?p=17258 <p>Fluids, Sepsis, Ultrasound, French-Canadian: what more do you want?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Fluids, Sepsis, Ultrasound, French-Canadian: what more do you want? clean 25:52 Podcast 160 – Sepsis smaccDOWN http://emcrit.org/podcasts/sepsis-smaccdown/ Wed, 04 Nov 2015 03:19:09 +0000 http://emcrit.org/?p=16675 <p>An all-star panel of world sepsis experts discuss the controversial areas</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> An all-star panel of world sepsis experts discuss the controversial areas clean 1:18:08 Huge Announcement for EMCrit.org http://emcrit.org/pulmcrit/huge-announcement-for-emcrit-org/ Mon, 02 Nov 2015 20:14:31 +0000 http://emcrit.org/?p=16736 <p>Big news...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Big news... clean 2:05 Podcast 159 – Rounding in the RACC http://emcrit.org/podcasts/rounding-racc/ Fri, 30 Oct 2015 01:26:07 +0000 http://emcrit.org/?p=16690 <p>Rounding on critically ill patients in the ED</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Rounding on critically ill patients in the ED clean 20:01 Podcast 158 – The FELLOW Trial on Apneic Oxygenation in ICU Patients http://emcrit.org/podcasts/fellow-trial/ Tue, 06 Oct 2015 18:07:18 +0000 http://emcrit.org/?p=16581 <p>Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients clean 24:18 Podcast 157 – Central Lines II – Placement Tips http://emcrit.org/podcasts/central-lines-placement-tips/ Sun, 13 Sep 2015 22:43:22 +0000 http://emcrit.org/?p=16270 <p>Part II of the Central Line Series discusses placement tips</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Part II of the Central Line Series discusses placement tips clean 30:12 EMCrit Wee – Central Line MicroSkills (Deliberate Practice) http://emcrit.org/wee/central-line-micro-skills-deliberate-practice/ Sat, 12 Sep 2015 17:08:21 +0000 http://emcrit.org/?p=16417 <p>A break down of the skills needed for Seldinger technique</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A break down of the skills needed for Seldinger technique clean 11:37 Podcast 156 – The Central Line Show – Part I: Avoiding Complications http://emcrit.org/podcasts/central-line-show/ Sat, 29 Aug 2015 19:39:02 +0000 http://emcrit.org/?p=13722 <p>Stop Effing Up Your Central Lines</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Stop Effing Up Your Central Lines clean 31:50 Podcast 155 – Status Epilepticus with Tom Bleck http://emcrit.org/podcasts/status-epilepticus/ Fri, 14 Aug 2015 00:43:03 +0000 http://emcrit.org/?p=11067 <p>Tom Bleck on Status Epilepticus</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Tom Bleck on Status Epilepticus clean 24:11 Podcast 154 – Preemptive Sepsis Panel SmaccBack http://emcrit.org/podcasts/sepsis-panel-smaccback/ Wed, 29 Jul 2015 01:17:11 +0000 http://emcrit.org/?p=15810 <p>A preemptive smaccback on the SMACC Chicago Sepsis Panel</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A preemptive smaccback on the SMACC Chicago Sepsis Panel clean 38:34 Podcast 153 – In Memory – John Hinds, On How He Ran His Unit http://emcrit.org/podcasts/john-hinds-on-how-he-ran-his-unit/ Sun, 05 Jul 2015 16:01:39 +0000 http://emcrit.org/?p=15365 <p>In Memory of Our Friend, John Hinds</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In Memory of Our Friend, John Hinds clean 41:33 Podcast 152 – High Flow Nasal Cannulae – Just Blowin’ Hot Air? http://emcrit.org/podcasts/hfnc/ Mon, 29 Jun 2015 19:50:20 +0000 http://emcrit.org/?p=14930 <p>HFNC--the new hot thing or just blowin' hot air?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> HFNC--the new hot thing or just blowin' hot air? clean 21:49 EMCrit Podcast 151 – Procedural Sedation Part 3 with Jim Miner http://emcrit.org/podcasts/procedural-sedation-3/ Sun, 14 Jun 2015 20:12:56 +0000 http://emcrit.org/?p=15143 <p>Jim Miner discusses the fine points of ED/ICU procedural sedation</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Jim Miner discusses the fine points of ED/ICU procedural sedation clean 23:34 Stuff Update (RCM, Reanimate, Developing EM) http://emcrit.org/podcasts/stuff-update-june-2015/ Tue, 09 Jun 2015 22:13:04 +0000 http://emcrit.org/?p=15069 <p>RCM and 2 Conferneces</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> RCM and 2 Conferneces clean 2:39 Podcast 150 – A Look Back http://emcrit.org/podcasts/a-look-back/ Mon, 01 Jun 2015 17:59:51 +0000 http://emcrit.org/?p=14967 <p>Can't believe we made it this far...and it's all thanks to the emcritters!</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Can't believe we made it this far...and it's all thanks to the emcritters! clean 24:32 The Resuscitation Crisis Manual (RCM) – Authors Needed http://emcrit.org/wee/resuscitation-crisis-manual/ Sun, 24 May 2015 16:11:11 +0000 http://emcrit.org/?p=14855 <p>Want to be involved in an amazing book that will be written by our friends?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Want to be involved in an amazing book that will be written by our friends? clean 4:52 Podcast 149 – Thyroid Storm http://emcrit.org/podcasts/thyroid-storm/ Sat, 16 May 2015 22:17:01 +0000 http://emcrit.org/?p=13728 <p>When hyperthyroidism goes really wrong...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> When hyperthyroidism goes really wrong... clean 20:16 Stuff Update http://emcrit.org/misc/stuff-may-2015/ Tue, 12 May 2015 17:52:30 +0000 http://emcrit.org/?p=14527 <p>A whole bunch of stuff</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A whole bunch of stuff clean 6:07 Podcast 148 – Airway Decisions and Online Etiquette http://emcrit.org/podcasts/airway-decisions/ Mon, 27 Apr 2015 01:52:54 +0000 http://emcrit.org/?p=14481 <p>More on the recent cric case from the perspective of airway decision making</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> More on the recent cric case from the perspective of airway decision making clean 26:28 EMCrit Wee – Mind Blowing Cricothyrotomy Video http://emcrit.org/wee/real-surgical-airway/ Sat, 18 Apr 2015 19:26:26 +0000 http://emcrit.org/?p=14366 <p>An amazing surgical airway case</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> An amazing surgical airway case clean 13:19 EMCrit Podcast 147 – Who Needs an Acute PCI with Steve Smith (Part II) http://emcrit.org/podcasts/who-needs-an-acute-pci-ii/ Sun, 12 Apr 2015 17:09:23 +0000 http://emcrit.org/?p=14193 <p>Finally in one place, all of the STEMI equivalents with Steve Smith--Part II</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Finally in one place, all of the STEMI equivalents with Steve Smith--Part II clean 23:27 EMCrit Podcast 146 – Who Needs an Acute PCI with Steve Smith (Part I) http://emcrit.org/podcasts/who-needs-acute-pci/ Sun, 29 Mar 2015 13:00:57 +0000 http://emcrit.org/?p=10568 <p>Finally in one place, all of the STEMI equivalents with Steve Smith</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Finally in one place, all of the STEMI equivalents with Steve Smith clean 23:49 EMCrit Conference BLAST Winner – Ice Water Baths for Rapid Cooling of Hyperthermia http://emcrit.org/wee/ice-bath-hyperthermia/ Wed, 25 Mar 2015 03:52:40 +0000 http://emcrit.org/?p=14136 <p>How to cool the too hot tox patient</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> How to cool the too hot tox patient clean 7:06 Podcast 145 – Awake Intubation Lecture from SMACC http://emcrit.org/podcasts/awakeintubation/ Mon, 16 Mar 2015 18:14:12 +0000 http://emcrit.org/?p=14059 <p>Awake Intubation from SMACC 2015</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Awake Intubation from SMACC 2015 clean 26:46 EMCrit Wee – The RLA and the Slope of Resuscitation http://emcrit.org/wee/slope-of-resuscitation/ Mon, 02 Mar 2015 17:46:52 +0000 http://emcrit.org/?p=13897 <p>The RLA and Resus Graphs</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The RLA and Resus Graphs clean 14:08 Podcast 144 – The PROPPR trial with John Holcomb http://emcrit.org/podcasts/proppr/ Sun, 22 Feb 2015 18:01:36 +0000 http://emcrit.org/?p=13784 <p>The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author? clean 20:35 Podcast 143 – Hemodynamic Management of Massive Pulmonary Embolism (PE) http://emcrit.org/podcasts/hemodynamic-management-massive-pulmonary-embolism-pe/ Mon, 16 Feb 2015 00:56:32 +0000 http://emcrit.org/?p=13261 <p>Hemodynamic Management of Massive PE</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Hemodynamic Management of Massive PE clean 32:33 Podcast 142 – Airway Things I Learned from George Kovacs at the NYC Airway Course http://emcrit.org/podcasts/airway-kovacs/ Sun, 25 Jan 2015 17:18:04 +0000 http://emcrit.org/?p=11222 <p>In this 3rd post for JanuAirway, I am joined by airway educator extraordinaire: George Kovacs.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In this 3rd post for JanuAirway, I am joined by airway educator extraordinaire: George Kovacs. clean 26:21 EMCrit Wee – Preoxygenation Update 2015 http://emcrit.org/wee/preoxygenation-update/ Thu, 22 Jan 2015 21:00:30 +0000 http://emcrit.org/?p=11337 <p>It's Janu-Airway: Here's a little update on preox (you know the topic I think about 20 hours a day)</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> It's Janu-Airway: Here's a little update on preox (you know the topic I think about 20 hours a day) clean 19:08 Podcast 141 – A Janu-Airway Case Presented Live http://emcrit.org/podcasts/emcrit-live-2015/ Sat, 10 Jan 2015 20:36:44 +0000 http://emcrit.org/?p=13334 <p>A case of anatomically and physiologically difficult airway presented live at #EMCritConf 2015.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A case of anatomically and physiologically difficult airway presented live at #EMCritConf 2015. clean 22:04 Podcast 140 – Top Picks for 2014 http://emcrit.org/podcasts/top-picks-2014/ Wed, 31 Dec 2014 20:33:59 +0000 http://emcrit.org/?p=6429 <p>Welcome to our annual rehash of the goodness of the past year.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Welcome to our annual rehash of the goodness of the past year. clean 9:35 Podcast 139 – Opioid-Free ED with Sergey Motov http://emcrit.org/podcasts/opioid-free-ed/ Sun, 14 Dec 2014 18:56:25 +0000 http://emcrit.org/?p=12200 <p>Can we manage pain more effectively without Opioids?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Can we manage pain more effectively without Opioids? clean 28:35 Podcast 138 – Vasopressor Basics http://emcrit.org/podcasts/vasopressor-basics/ Mon, 01 Dec 2014 17:25:23 +0000 http://emcrit.org/?p=4215 <p>There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation. clean 30:33 EMCrit Podcast 137 – Delayed Sequence Intubation (DSI) Update http://emcrit.org/podcasts/dsi-update/ Mon, 17 Nov 2014 19:25:00 +0000 http://emcrit.org/?p=12269 <p>The DSI study is finally published! Listen to this podcast for a discussion of the paper and the things we have learned since the original DSI podcast.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The DSI study is finally published! Listen to this podcast for a discussion of the paper and the things we have learned since the original DSI podcast. clean 20:56 EMCrit Podcast 136 – Getting Shit Done http://emcrit.org/podcasts/getting-shit-done/ Mon, 03 Nov 2014 18:44:20 +0000 http://emcrit.org/?p=11900 <p>Not quite ED Critical Care, but I hope this discussion of EM/Resus Productivity may be helpful to some of you out there.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Not quite ED Critical Care, but I hope this discussion of EM/Resus Productivity may be helpful to some of you out there. clean 47:34 EMCrit Podcast 135 – Trauma Thoughts with John Hinds http://emcrit.org/podcasts/trauma-thoughts-john-hinds/ Mon, 20 Oct 2014 01:23:38 +0000 http://emcrit.org/?p=11422 <p>John Hinds on Blunt Traumatic Arrest</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> John Hinds on Blunt Traumatic Arrest clean 25:55 EMCrit Wee – I Thought This Would be the One, but Nope…. http://emcrit.org/podcasts/more-on-arise/ Mon, 13 Oct 2014 00:10:38 +0000 http://emcrit.org/?p=11458 <p>Smells like some confirmation bias here</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Smells like some confirmation bias here clean 10:14 Podcast 134 – ARISE has arisen; now where do we stand on Severe Sepsis in 2014 http://emcrit.org/podcasts/arise-trial-sepsis-2014/ Fri, 03 Oct 2014 22:55:35 +0000 http://emcrit.org/?p=11289 <p>the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014 clean 21:53 EMCrit Podcast 133 – The First Prehospital REBOA http://emcrit.org/podcasts/emcrit-podcast-133-first-prehospital-reboa/ Wed, 24 Sep 2014 14:58:07 +0000 http://emcrit.org/?p=11128 <p>London HEMS docs peform REBOA and save a life</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> London HEMS docs peform REBOA and save a life clean 25:54 EMCrit Wee – Aggressiveness and the New Cutdown with Leon Boudourakis, MD http://emcrit.org/wee/aggressiveness-and-the-new-cutdown/ Wed, 17 Sep 2014 22:13:55 +0000 http://emcrit.org/?p=11035 <p>Need access--this may be a way</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Need access--this may be a way clean 9:40 Podcast 132 – MoTR – Toughness Part I with Michael Lauria http://emcrit.org/podcasts/toughness-michael-lauria-i/ Sat, 06 Sep 2014 18:46:02 +0000 http://emcrit.org/?p=10379 <p>Today, I interview Mike Lauria on the concepts of toughness and resilience.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Today, I interview Mike Lauria on the concepts of toughness and resilience. clean 31:56 EMCrit Podcast 131 – Cricothyrotomy – Cut to Air: Emergency Surgical Airway http://emcrit.org/podcasts/surgical-airway/ Tue, 26 Aug 2014 20:57:27 +0000 http://emcrit.org/?p=10806 <p>Cut to Air: Crics from SMACC Gold</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Cut to Air: Crics from SMACC Gold clean 29:51 EMCrit Wee – A Case to Threaten Current ECMO Evidence from Sam Ghali http://emcrit.org/wee/prolonged-cpr-case/ Fri, 15 Aug 2014 14:35:53 +0000 http://emcrit.org/?p=7951 <p>Should we be extending ACLS in patients we really want to save?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Should we be extending ACLS in patients we really want to save? clean 5:44 EMCrit Podcast 130 – Hemodynamic-Directed Dosing of Epinephrine for Cardiac Arrest http://emcrit.org/podcasts/hemodynamic-directed-dosing-epinephrine/ Sun, 10 Aug 2014 19:22:21 +0000 http://emcrit.org/?p=9761 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 18:24 MotR – Mike Lauria on “Making the Call” http://emcrit.org/podcasts/motr-mike-lauria/ Thu, 31 Jul 2014 13:26:47 +0000 http://emcrit.org/?p=10394 <p>You'll be hearing more from Mike</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> You'll be hearing more from Mike clean 42:52 Podcast 129 – LAMW: The Neurocritical Care Intubation http://emcrit.org/podcasts/neurocritical-care-intubation/ Sat, 26 Jul 2014 16:36:12 +0000 http://emcrit.org/?p=4458 <p>This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault. clean 31:00 Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman http://emcrit.org/podcasts/pulmonary-embolism-treatment-team/ Mon, 14 Jul 2014 14:24:33 +0000 http://emcrit.org/?p=9513 <p>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.<br /> Cornell Pulmonary Embolism (PE) Advanced Care Team (PEAC), aka the CLOT Team<br /> Oren Friedman MD, Pulm Crit Care; James Horowitz MD, Cardiology; Arash Salemi MD, Cardiac Surgery; Akhilesh Sista MD, Interventional Radiology</p> <p>You can shoot the team an email: peadvancedcare at gmail dot com<br /> Who Should We Treat?</p> <p>30% normotensive patients have RVD; 10% progressed to shock; 5% in hospital mortality<br /> The Better Risk Categories for Pulmonary Embolism</p> <p> Well and Stable Sub-Massive<br /> High-Risk Sub-Massive<br /> Massive</p> <p>PEITHO Trial<br /> NEJM 2014;370(15):1402</p> <p>Full dose tenecteplase with concurrent heparin</p> <p> Death or hemodynamic decompensation occurred in 2.6% of the tenecteplase group as compared with 5.6% of the placebo group<br /> Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P<0.001)<br /> Intracranial Bleed 10 patients (2%) in the tenecteplase group and 1 patient (0.2%) in the placebo group (P=0.003)</p> <p>Also see my bud, Salim Rezaie's post on PEITHO and Konstantinides' prior study </p> <p>Ryan Radecki made some great observations in his post on PEITHO</p> <p> 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.<br /> Not all placebo patients developing hemodynamic collapse received subsequent thrombolysis; likewise, almost half of those who received open-label thrombolysis had no hemodynamic collapse.<br /> Half the deaths in the placebo arm were “sudden unexplained” or “other”, compared with bleeding or stroke complications in the thromboysis arm.</p> <p>TOPCOAT Trial<br /> Jeff Kline's trial was stopped midway through due to an institution change. Complicated primary endpoint with promising, but unusable results </p> <p>For the scoop on this one see the Bottom Line Review post on TOPCOAT<br /> MOPETT Trial<br /> Half-dose alteplase led to a marked reduction in pulmonary hypertension without sig. complications</p> <p>Sharifi M et al. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT trial). (J Cardiol 2013; 111: 273)</p> <p>See this prior EMCrit Wee as well on MOPPETT</p> <p>Update: This meta-analysis states that the half-dose may be appropriate, effective, and safe<br /> Meta-Analysis<br /> Chatterjee et al. have the most current meta-analysis on this topic (JAMA. 2014;311(23):2414-2421)</p> <p>See the Bottom Line Review post on this study</p> <p>Nakamura just published another MA this week; see Rory Spiegel's take on the two here<br /> Is it just in the Oldies?<br /> Markedly lower risk in <75 y/o in PEITHO and <65 in the Meta-Analysis<br /> The Treatment Options<br /> Heparin Alone<br /> 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<br /> Systemic Thrombolysis<br /> With either full or half-dose alteplase or full-dose tenecteplase<br /> Catheter-Based Intra-Arterial Thombolytic Infusion<br /> Angiography guided placement of pulmonary artery catheters allowing a 24-hour infusion of low dose tPA. </p> <p>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. , See the PulmCCM Post on the Circulation RCT of EKOS<br /> Interventional Mechanical Clot Disruption</p> <p>AngioJet-a catheter that breaks up the clot with... 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, clean 33:08 Podcast 127 – The Oxylator with Jim DuCanto http://emcrit.org/podcasts/oxylator/ Sun, 29 Jun 2014 19:15:45 +0000 http://emcrit.org/?p=3881 <p>BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator clean 20:19 SMACC-Back – On the Beliefs of Early Adopters and Straw Men http://emcrit.org/wee/on-the-beliefs-adopters-straw-men/ Tue, 24 Jun 2014 19:45:36 +0000 http://emcrit.org/?p=9899 <p>The First SMACC-Back from SMACCgold</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The First SMACC-Back from SMACCgold clean 16:30 Podcast 126 – TTM Trial Right from Niklas Nielsen’s Mouth http://emcrit.org/podcasts/ttm-trial-niklas-nielsen/ Sun, 15 Jun 2014 19:29:40 +0000 http://emcrit.org/?p=7745 <p>In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial. clean 18:09 EMCrit Wee – Four More Minutes with Rob Mac Sweeney http://emcrit.org/wee/rob-mac-sweeneys-stuff/ Wed, 11 Jun 2014 17:45:26 +0000 http://emcrit.org/?p=9485 <p>I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is... clean 4:32 EMCrit Wee – Rob Mac Sweeney on Intra-Arrest Meds http://emcrit.org/wee/rob-mac-sweeney/ Tue, 10 Jun 2014 18:28:46 +0000 http://emcrit.org/?p=9471 <p>Rob Mac Sweeny on the Intra-Arrest Talk</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Rob Mac Sweeny on the Intra-Arrest Talk clean 16:40 Mind of the Resuscitationist – Errors of Commission and Omission http://emcrit.org/wee/motr-commission-and-omission/ Fri, 06 Jun 2014 18:20:58 +0000 http://emcrit.org/?p=9389 <p>Should we err towards errors of commission or omission?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Should we err towards errors of commission or omission? clean 5:22 Podcast 125 – The New Intra-Arrest from SMACCgold http://emcrit.org/podcasts/new-intra-arrest/ Mon, 02 Jun 2014 15:59:28 +0000 http://emcrit.org/?p=9246 <p>Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care clean 21:11 EMCrit Wee – Cricolol by Dr. John Hinds http://emcrit.org/wee/cricolol/ Wed, 28 May 2014 15:29:42 +0000 http://emcrit.org/?p=9170 <p>My favorite part of SMACCgold; buy some Cricolol</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> My favorite part of SMACCgold; buy some Cricolol clean 8:36 Podcast 124 – The Logistics of Proning for ARDS http://emcrit.org/podcasts/logistics-proning/ Mon, 19 May 2014 00:10:08 +0000 http://emcrit.org/?p=8001 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 23:21 EMCrit Wee – Sean Townsend of the SSC and the ProCESS Trial http://emcrit.org/wee/ssc-process-trial-response/ Fri, 09 May 2014 19:36:30 +0000 http://emcrit.org/?p=8239 <p>I talk with a member of the surviving sepsis campaign steering committee re: ProCESS</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I talk with a member of the surviving sepsis campaign steering committee re: ProCESS clean 17:33 Podcast 123 – Selective Aortic Arch Perfusion (SAAP) with Jim Manning http://emcrit.org/podcasts/selective-aortic-arch-perfusion/ Tue, 06 May 2014 14:50:06 +0000 http://emcrit.org/?p=8441 <p>What if you had a REBOA catheter through which you could give blood and drugs?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> What if you had a REBOA catheter through which you could give blood and drugs? clean 28:31 EMCrit Wee – A Cric Case with Rob Bryant http://emcrit.org/wee/cric-case-rob-bryant/ Thu, 24 Apr 2014 23:07:14 +0000 http://emcrit.org/?p=8147 <p>Rob Bryant presents a case</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Rob Bryant presents a case clean 12:12 Podcast 122 – Cardiac Arrest after the Toxicology of Smoke Inhalation with Lewis Nelson http://emcrit.org/podcasts/cardiac-arrest-after-smoke-inhalation/ Mon, 21 Apr 2014 02:46:07 +0000 http://emcrit.org/?p=8131 <p>What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns? clean 18:01 EMCrit Podcast 121 – REBOA http://emcrit.org/podcasts/reboa/ Sun, 06 Apr 2014 19:05:12 +0000 http://emcrit.org/?p=7061 <p>This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta).</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta). clean 20:31 Podcast 120 – The ProCESS Trial with Derek Angus http://emcrit.org/podcasts/process-trial/ Mon, 24 Mar 2014 23:55:24 +0000 http://emcrit.org/?p=7717 <p>I speak to the lead author of the ProCESS trial, Dr. Derek Angus</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I speak to the lead author of the ProCESS trial, Dr. Derek Angus clean 25:35 Wee – What the heck is a Mapleson B Circuit and Why You Probably Shouldn’t Care http://emcrit.org/wee/what-the-heck-is-a-mapleson-b-circuitu-probably-shouldnt-care/ Tue, 11 Mar 2014 21:47:14 +0000 http://emcrit.org/?p=6781 <p>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.</p> <p>He did a post advocating the Mapleson B Circuit as the Ultimate Preox Device</p> <p>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.</p> <p>My Recommended Approaches<br /> I recommend two approaches to preox: standard and shunt physiology strategies. I outlines these strategies in the paper Rich Levitan and I wrote.</p> <p>Standard: NRB @ >=15 lpm and NC @ 10-15 lpm for 3 minutes</p> <p>Shunt Physio: Choose 1</p> <p> BVM with PEEP Valve & NC @ 10-15 lpm<br /> NIPPV Ventilator with NIPPV Mask or BVM Mask & NC @ 10-15 lpm</p> <p>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.<br /> Automatic Checking<br /> 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.<br /> Multiple BVM Masks<br /> 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.<br /> PEEP<br /> 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.<br /> ApOx<br /> Mapleson may provide this better than BVM, but not as well as a NC, which should be on during any intubation.<br /> ETCO2<br /> No advantage of Mapleson<br /> Low resistance<br /> Maybe this matters, as soon as you put on the PEEP, I can't imagine this difference persisting<br /> Room Air Entrainment<br /> 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.<br /> Troubleshooting Leaks<br /> 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.</p> <p>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).</p> <p>This is the same reason I tell my residents to just train with Macintosh blades.</p> <p>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</p> <p>ETCO2 with a monitor you can see<br /> Is he holding or squeezing?<br /> 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:</p> <p>>15 cmH20 may be entraining gas into the stomach via the LES (in some patients, even 10 cmH20 may be a problem)</p> <p>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)<br /> Two hands ALWAYS on the mask<br /> Recently, 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 ... clean 19:11 Podcast 119 – Rich Levitan on the Surgical Airway http://emcrit.org/podcasts/levitan-surgical-airway/ Mon, 10 Mar 2014 16:50:49 +0000 http://emcrit.org/?p=7174 <p>Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference clean 26:45 Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman http://emcrit.org/podcasts/emcrit-book-club-on-combat-by-grossman/ Sun, 23 Feb 2014 15:00:28 +0000 http://emcrit.org/?p=6686 <p>Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman clean 34:42 Practical Evidence 014 – ACEP Procedural Sedation Update for 2013 http://emcrit.org/practicalevidence/acep-procedural-sedation-update-2013/ Tue, 18 Feb 2014 22:26:30 +0000 http://emcrit.org/?p=6812 <p>This one is really good!</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This one is really good! clean 8:42 Podcast 117 – Everyday Emergency Kits with Keith Conover http://emcrit.org/podcasts/everyday-emergency-kits-keith-conover/ Mon, 10 Feb 2014 16:09:36 +0000 http://emcrit.org/?p=5153 <p>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. </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 30:42 Podcast 116 – the tPA for Ischemic Stroke Debate http://emcrit.org/podcasts/tpa-for-ischemic-stroke-debate/ Mon, 27 Jan 2014 15:30:02 +0000 http://emcrit.org/?p=6532 <p>Dr. Andy Jagoda debates my friend Dr. Anand Swaminathan on the use of tPA for Ischemic Stroke in the Emergency Department</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Dr. Andy Jagoda debates my friend Dr. Anand Swaminathan on the use of tPA for Ischemic Stroke in the Emergency Department clean 52:21 Podcast 115 – A New Paradigm for Post-Intubation Pain, Agitation, and Delirium http://emcrit.org/podcasts/post-intubation-sedation-2014/ Mon, 13 Jan 2014 21:00:48 +0000 http://emcrit.org/?p=4297 <p>What you do in the ED for post-intubation sedation will determine whether your patient lives or dies</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> What you do in the ED for post-intubation sedation will determine whether your patient lives or dies clean 21:21 Best of 2013 – Eight is Enough & Social Media Update http://emcrit.org/wee/best-of-2013/ Tue, 31 Dec 2013 21:43:29 +0000 http://emcrit.org/?p=4657 <p>Best of 2013</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Best of 2013 clean 20:45 Podcast 114 – Post-Arrest Care in 2013 with Stephen Bernard – Part II http://emcrit.org/podcasts/post-arrest-care-2013-ii/ Mon, 16 Dec 2013 18:19:58 +0000 http://emcrit.org/?p=5607 <p>Part 2 of an interview with Stephen Bernard on the Care of the Post-Arrest Patient in 2013</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Part 2 of an interview with Stephen Bernard on the Care of the Post-Arrest Patient in 2013 clean 19:13 Podcast 113 – Post-Cardiac Arrest Care in 2013 with Stephen Bernard – Part I http://emcrit.org/podcasts/post-arrest-care-2013-i/ Sun, 08 Dec 2013 17:14:27 +0000 http://emcrit.org/?p=5453 <p>Dr. Stephen Bernard on the topic of post-arrest care</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Dr. Stephen Bernard on the topic of post-arrest care clean 20:24 Podcast 112 – A Response to the Marik Sepsis Fluids Lecture http://emcrit.org/podcasts/fluids-severe-sepsis/ Sun, 24 Nov 2013 17:36:23 +0000 http://emcrit.org/?p=5407 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 30:31 Five Minutes with Jon Rittenberger on the TTM Trial http://emcrit.org/wee/five-minutes-jon-rittenberger-ttm-trial/ Mon, 18 Nov 2013 22:56:43 +0000 http://emcrit.org/?p=5422 <p>More on TTM Trial</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> More on TTM Trial clean 5:35 EMCrit Wee – The Targeted Temperature Trial Changes Everything http://emcrit.org/podcasts/emcrit-wee-targeted-temperature-trial-changes-everything/ Mon, 18 Nov 2013 20:28:29 +0000 http://emcrit.org/?p=5416 <p>Cold, but not all that cold may be the way</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Cold, but not all that cold may be the way clean 2:53 Podcast 111 – Fluids in Sepsis, A New Paradigm – Paul Marik http://emcrit.org/podcasts/paul-marik-fluids-sepsis/ Sat, 09 Nov 2013 17:50:58 +0000 http://emcrit.org/?p=5394 <p>Our favorite critical care skeptic, Dr. Paul Marik, on fluids in severe sepsis</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Our favorite critical care skeptic, Dr. Paul Marik, on fluids in severe sepsis clean 51:37 SMACC Back 3 – Simon Carley on Leadership http://emcrit.org/wee/simon-carley-on-leadership/ Wed, 06 Nov 2013 20:44:47 +0000 http://emcrit.org/?p=5385 <p>A SMACC back on Simon Carley's talk on Educational Leadership</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A SMACC back on Simon Carley's talk on Educational Leadership clean 7:51 Podcast 110 – Exsanguinating Hemorrhage from Mid-Face Fractures http://emcrit.org/podcasts/exsanguinating-hemorrhage-mid-face-fractures/ Fri, 01 Nov 2013 19:33:56 +0000 http://emcrit.org/?p=5242 <p>Management of Severe Hemorrhage from Mid-Face Blunt Trauma</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Management of Severe Hemorrhage from Mid-Face Blunt Trauma clean 18:39 Practical Evidence 013 – ACEP Management of Asymptomatic Blood Pressure 2013 http://emcrit.org/practicalevidence/2013-acep-management-of-asymptomatic-htn/ Tue, 22 Oct 2013 21:17:17 +0000 http://emcrit.org/?p=5354 <p>Management of asymptomatic markedly elevated blood pressure</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Management of asymptomatic markedly elevated blood pressure clean 10:26 Podcast 109 – Mind of the Resuscitationist from SMACC 2013 http://emcrit.org/podcasts/mind-of-the-resuscitationist-smacc/ Mon, 14 Oct 2013 09:00:13 +0000 http://emcrit.org/?p=5305 <p>Mind of the Resuscitationist Lecture from SMACC 2013 and Blakemore Placement</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Mind of the Resuscitationist Lecture from SMACC 2013 and Blakemore Placement clean 17:07 Blakemore Tube Placement for Massive Upper GI Hemorrhage http://emcrit.org/procedures/blakemore-tube-placement/ Sun, 13 Oct 2013 19:31:45 +0000 http://emcrit.org/?p=5306 <p>How to place a Blakemore tube for esophageal varices with massive bleeding.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> How to place a Blakemore tube for esophageal varices with massive bleeding. clean 10:30 Podcast 108 – How to Be a Hero with Cliff Reid http://emcrit.org/podcasts/how-to-be-a-hero/ Mon, 30 Sep 2013 18:34:05 +0000 http://emcrit.org/?p=5252 <p>This was my favorite lecture from SMACC 2013. If you are not moved and inspired then your heart is made of stone.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This was my favorite lecture from SMACC 2013. If you are not moved and inspired then your heart is made of stone. clean 24:33 Podcast 107 – Peripheral Vasopressor Infusions and Extravasation http://emcrit.org/podcasts/peripheral-vasopressors-extravasation/ Mon, 16 Sep 2013 14:59:35 +0000 http://emcrit.org/?p=5074 <p>Can we give vasopressors peripherally? And if we do, what if they leak?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Can we give vasopressors peripherally? And if we do, what if they leak? clean 20:08 SMACC Gold Promo http://emcrit.org/misc/smacc-gold-promo/ Sat, 07 Sep 2013 20:20:37 +0000 http://emcrit.org/?p=5164 <p>SMACC Gold is March 18-21st on the Gold Coast of Australia--best ED conference you will ever attend</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> SMACC Gold is March 18-21st on the Gold Coast of Australia--best ED conference you will ever attend clean 8:16 Podcast 106 – Making Things Happen with Cliff Reid http://emcrit.org/podcasts/making-things-happen/ Tue, 03 Sep 2013 00:04:15 +0000 http://emcrit.org/?p=5133 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 24:55 Podcast 105 – The Path to Insanity http://emcrit.org/podcasts/path-to-insanity/ Tue, 20 Aug 2013 13:38:49 +0000 http://emcrit.org/?p=5041 <p>This was my favorite lecture assigned to me at SMACC 2013. It discusses the search for excellence in our profession. I hope you enjoy!</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This was my favorite lecture assigned to me at SMACC 2013. It discusses the search for excellence in our profession. I hope you enjoy! clean 22:57 Podcast 104 – Laryngoscope as a Murder Weapon (LAMW) Series – Hemodynamic Kills http://emcrit.org/podcasts/intubation-patient-shock/ Mon, 05 Aug 2013 19:02:17 +0000 http://emcrit.org/?p=4945 <p>A lecture from SMACC2013 on how not to kill the shocked patient when intubating</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A lecture from SMACC2013 on how not to kill the shocked patient when intubating clean 30:43 EMCrit Wee – Vasopressin, Steroids, and Epinephrine for Cardiac Arrest http://emcrit.org/wee/vasopressin-steroids-epinephrine-for-cardiac-arrest/ Fri, 02 Aug 2013 22:08:02 +0000 http://emcrit.org/?p=4934 <p>New medication therapy for cardiac arrest</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> New medication therapy for cardiac arrest clean 3:54 SMACC Back 2 – IVC for Decisions on Fluid Status http://emcrit.org/wee/ivc-for-decisions-on-fluid-status/ Mon, 29 Jul 2013 15:45:02 +0000 http://emcrit.org/?p=4837 <p>A SMACC Back on Justin Bowra's IVC Ultrasound bashing.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A SMACC Back on Justin Bowra's IVC Ultrasound bashing. clean 17:21 Podcast 103 – Avoiding Resuscitation Medication Errors – Part II http://emcrit.org/podcasts/avoiding-resuscitation-medication-errors-2/ Sun, 21 Jul 2013 20:32:12 +0000 http://emcrit.org/?p=4795 <p>I am joined by Bryan Hayes for Part II of our discussion on the avoidance of critical medication errors during resuscitations.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I am joined by Bryan Hayes for Part II of our discussion on the avoidance of critical medication errors during resuscitations. clean 17:51 Podcast 102 – Don’t Half-Ass your FAST! http://emcrit.org/podcasts/fast-exam/ Sun, 07 Jul 2013 15:58:52 +0000 http://emcrit.org/?p=3902 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 28:27 SMACC-Back – Myburgh on Catecholamines http://emcrit.org/wee/myburgh-on-catecholamines/ Wed, 26 Jun 2013 22:49:57 +0000 http://emcrit.org/?p=4754 <p>SMACC Back 1 on Catecholamines</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> SMACC Back 1 on Catecholamines clean 4:52 Podcast 101 – Avoiding Resuscitation Medication Errors – Part I http://emcrit.org/podcasts/avoiding-resuscitation-medication-errors/ Sun, 23 Jun 2013 17:26:49 +0000 http://emcrit.org/?p=4714 <p>I am joined by Bryan Hayes to discuss the avoidance of critical medication errors during resuscitations.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I am joined by Bryan Hayes to discuss the avoidance of critical medication errors during resuscitations. clean 23:50 Podcast 100 – What is Critical Care and What is EMCrit? http://emcrit.org/podcasts/essence-critical-care/ Sun, 09 Jun 2013 20:06:27 +0000 http://emcrit.org/?p=4702 <p>Keynote from SMACC 2013</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Keynote from SMACC 2013 clean 21:45 EMCrit Wee – Is Lactate Clearance a Flawed Paradigm? http://emcrit.org/wee/lactate-clearance-flawed/ Wed, 05 Jun 2013 20:27:48 +0000 http://emcrit.org/?p=4751 <p>Is lactate clearance a flawed paradigm? I don't think it is.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Is lactate clearance a flawed paradigm? I don't think it is. clean 7:28 Podcast 99 – Combat Aviation Paradigms for Resuscitationists http://emcrit.org/podcasts/combat-aviation-paradigms/ Sun, 26 May 2013 18:42:58 +0000 http://emcrit.org/?p=4720 <p>Aviation is to anesthesia as Combat Aviation is to Resuscitation</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Aviation is to anesthesia as Combat Aviation is to Resuscitation clean 26:06 Podcast 98 – Cyclic (Tricyclic) Antidepressant Overdose http://emcrit.org/podcasts/tricyclic-antidepressant-overdose/ Tue, 14 May 2013 21:44:44 +0000 http://emcrit.org/?p=4633 <p>Tricyclic overdoses are not uncommon and these patients can be incredibly ill.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Tricyclic overdoses are not uncommon and these patients can be incredibly ill. clean 22:39 EMCrit Wee – Janus General and Service Update http://emcrit.org/service/janus-general-service-update/ Mon, 06 May 2013 23:00:23 +0000 http://emcrit.org/?p=4639 <p>Learn about Janus General</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Learn about Janus General clean 7:40 Podcast 97 – Acid-Base VI – Chloride-Free Sodium http://emcrit.org/podcasts/chloride-free-sodium/ Thu, 02 May 2013 17:16:18 +0000 http://emcrit.org/?p=4591 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 18:01 Podcast 96 – Acid Base in the Critically Ill – Part V – Enough with the Bicarb Already http://emcrit.org/podcasts/enough-with-the-bicarb-already/ Sun, 14 Apr 2013 15:33:56 +0000 http://emcrit.org/?p=4572 <p>More on Bicarb in the Critically Ill and a discussion with John Kellum, MD</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> More on Bicarb in the Critically Ill and a discussion with John Kellum, MD clean 20:07 Episode 12 – New Trauma Guidelines: ATLS and Spine http://emcrit.org/practicalevidence/atls-and-spine/ Sun, 14 Apr 2013 02:06:29 +0000 http://practicalevidence.org/?p=318 <p>New Trauma Guidelines: ATLS and Spine</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> New Trauma Guidelines: ATLS and Spine clean 11:37 Podcast 95 – Thomas Scalea on Cutting-Edge ICP Management http://emcrit.org/podcasts/cutting-edge-icp-management/ Tue, 02 Apr 2013 05:46:57 +0000 http://emcrit.org/?p=4563 <p>Thomas Scalea discusses new frontiers in the management of ICP and TBI</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Thomas Scalea discusses new frontiers in the management of ICP and TBI clean 44:34 EMCrit Wee – The Vortex Approach http://emcrit.org/wee/vortex-approach/ Thu, 28 Mar 2013 15:38:44 +0000 http://emcrit.org/?p=4351 <p>The vortex approach is a new paradigm for airway management in all areas of the hospital</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The vortex approach is a new paradigm for airway management in all areas of the hospital clean 9:33 EMCrit Wee – The Holy Grail of Fluid Resuscitation is just a Tin Cup http://emcrit.org/wee/holy-grail-fluid-resuscitation/ Thu, 21 Mar 2013 18:34:07 +0000 http://emcrit.org/?p=4513 <p>Chad Meyers' lecture on fluid resus in severe sepsis</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Chad Meyers' lecture on fluid resus in severe sepsis clean 17:40 EMCrit WEE – SMACC 2013 Summary and Learning Points http://emcrit.org/wee/smacc2013/ Mon, 18 Mar 2013 22:24:17 +0000 http://emcrit.org/?p=4501 <p>SMACC - The best Critical Care Conference...EVER!!</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> SMACC - The best Critical Care Conference...EVER!! clean 19:32 Episode 11 – Ischemic Stroke 2013 http://emcrit.org/practicalevidence/ischemic-stroke-2013/ Mon, 04 Mar 2013 04:26:53 +0000 http://practicalevidence.org/?p=261 <p>2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP clean 15:15 Podcast 94 – Has Video Laryngoscopy Killed the Direct Laryngoscope? http://emcrit.org/podcasts/has-video-laryngoscopy-killed-the-dl-star/ Sun, 03 Mar 2013 23:05:36 +0000 http://emcrit.org/?p=4462 <p>I debate Paul Mayo on whether standard laryngoscopy still has a role in emergency and critical care intubation</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I debate Paul Mayo on whether standard laryngoscopy still has a role in emergency and critical care intubation clean 23:02 Podcast 93 – Critical Care Palliation with Ashley Shreves http://emcrit.org/podcasts/critical-care-palliation/ Mon, 18 Feb 2013 04:40:08 +0000 http://emcrit.org/?p=4412 <p>One of the best palliative care lectures I have ever heard.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> One of the best palliative care lectures I have ever heard. clean 25:03 EMCrit Wee – Tacit Knowledge and Medical Podcasting http://emcrit.org/wee/tacit-knowledge-podcasting/ Wed, 13 Feb 2013 20:36:01 +0000 http://emcrit.org/?p=4400 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 10:46 EMCrit Conference Blast Winner: Peri-Mortem C-Section http://emcrit.org/wee/peri-mortem-c-section/ Tue, 12 Feb 2013 21:02:44 +0000 http://emcrit.org/?p=4378 <p>Peri-Mortem C-Section</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Peri-Mortem C-Section clean 12:55 Join the EMCrit G+ Community Page http://emcrit.org/podcasts/emcrit-google-community-page/ Sun, 10 Feb 2013 18:56:48 +0000 http://emcrit.org/?p=4383 <p>A place for your Clinical Cases and Questions that are not podcast specific</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A place for your Clinical Cases and Questions that are not podcast specific clean 2:38 Podcast 92 – EMCrit Intubation Checklist http://emcrit.org/podcasts/emcrit-intubation-checklist/ Tue, 05 Feb 2013 19:14:18 +0000 http://emcrit.org/?p=3036 <p>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</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 clean 28:36 2012 Surviving Sepsis Campaign Guidelines http://emcrit.org/misc/2012-surviving-sepsis-campaign-guidelines/ Thu, 24 Jan 2013 17:48:23 +0000 http://emcrit.org/?p=4318 <p>2012 Surviving Sepsis Campaign Guidelines from my Practical Evidence Podcast</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 2012 Surviving Sepsis Campaign Guidelines from my Practical Evidence Podcast clean 18:35 Podcast 91 – Treatment of Aortic Dissection http://emcrit.org/podcasts/aortic-dissection/ Thu, 24 Jan 2013 02:25:41 +0000 http://emcrit.org/?p=4298 <p>You can't pick a more critical diagnosis than acute aortic dissection. Mess it up and the patient dies.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> You can't pick a more critical diagnosis than acute aortic dissection. Mess it up and the patient dies. clean 24:01 Episode 10 – Surviving Sepsis Campaign (SSC) Guidelines 2012 http://emcrit.org/practicalevidence/surviving-sepsis-campaign-guidelines-2012/ Thu, 24 Jan 2013 02:12:55 +0000 http://practicalevidence.org/?p=217 <p>SSC Guidelines 2012</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> SSC Guidelines 2012 clean 18:35 Podcast 90 – Mind of the Resuscitationist Series: Cliff Reid’s Own the Resus Room http://emcrit.org/podcasts/own-the-resus-room/ Tue, 08 Jan 2013 00:41:08 +0000 http://emcrit.org/?p=4258 <p>Cliff Reid on owning the resuscitation room</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Cliff Reid on owning the resuscitation room clean 15:23 Natural Seven for 2012 http://emcrit.org/wee/picks-for-2012/ Sun, 30 Dec 2012 23:08:36 +0000 http://emcrit.org/?p=3791 <p>The rundown of things I liked from 2012</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The rundown of things I liked from 2012 clean 6:01 Podcast 89 – Lessons from the STOP Sepsis Collaborative http://emcrit.org/podcasts/lessons-sepsis-collaborative/ Wed, 26 Dec 2012 04:00:25 +0000 http://emcrit.org/?p=4229 <p>We have hit the 10,0000 patient mark in the NYC STOP Sepsis collaborative. Here are some of the lessons learned...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> We have hit the 10,0000 patient mark in the NYC STOP Sepsis collaborative. Here are some of the lessons learned... clean 18:08 EMCrit Wee – MOPETT Trial http://emcrit.org/wee/mopett-trial/ Wed, 12 Dec 2012 01:57:24 +0000 http://emcrit.org/?p=4188 <p>A new trial on half-dose thrombolysis for PE for sub-massive PE</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A new trial on half-dose thrombolysis for PE for sub-massive PE clean 4:08 EMCrit Podcast 88 – Oxygen Physiology with Daniel Davis http://emcrit.org/podcasts/oxygen-physiology/ Mon, 10 Dec 2012 18:00:40 +0000 http://emcrit.org/?p=3471 <p>One of the last few airway topics for a little while: Pulse Ox Lag and an Understanding of the Oxyhemoglobin Dissociation Curve</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> One of the last few airway topics for a little while: Pulse Ox Lag and an Understanding of the Oxyhemoglobin Dissociation Curve clean 19:07 Episode 9 – Blunt Cardiac Injury from EAST http://emcrit.org/practicalevidence/blunt-cardiac-injuries/ Fri, 07 Dec 2012 06:33:59 +0000 http://practicalevidence.org/?p=166 <p>EAST Trauma Guidelines on Blunt Cardiac Injury</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> EAST Trauma Guidelines on Blunt Cardiac Injury clean 8:35 SMACC Conference http://emcrit.org/wee/smacc-conference/ Fri, 07 Dec 2012 00:53:04 +0000 http://emcrit.org/?p=4177 <p>SMACC Conference and SIMWars</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> SMACC Conference and SIMWars clean 4:07 Podcast 87 – Mind of the Resuscitationist: Stop Points http://emcrit.org/podcasts/stop-points/ Mon, 26 Nov 2012 23:40:08 +0000 http://emcrit.org/?p=4147 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 23:32 Podcast 86 – IVC Ultrasound for Fluid Tolerance in Spontaneously Breathing Patients – EAT IT STONE http://emcrit.org/podcasts/ivc-ultrasound-for-fluid-tolerance-in-spontaneously-breathing-patients/ Mon, 12 Nov 2012 00:23:36 +0000 http://emcrit.org/?p=4050 <p>Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can!</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can! clean 20:52 Episode 8 – ACEP Opioid Prescription Policy http://emcrit.org/practicalevidence/acep-opioid-prescription-policy/ Sat, 03 Nov 2012 03:51:17 +0000 http://practicalevidence.org/?p=146 <p>ACEP 2012 Opioid Prescription Policy</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> ACEP 2012 Opioid Prescription Policy clean 9:19 Podcast 85 – A Confirmation of Prejudices: Chloride and Pressure Poisoning http://emcrit.org/podcasts/chloride-pressure-poisoning/ Mon, 29 Oct 2012 22:05:11 +0000 http://emcrit.org/?p=4027 <p>In this Hurricane Sandy episode of the EMCrit podcast, I talk about the confirmation of two of my clinical prejudices.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In this Hurricane Sandy episode of the EMCrit podcast, I talk about the confirmation of two of my clinical prejudices. clean 18:53 Podcast 84 – The Post-Intubation Package http://emcrit.org/podcasts/post-intubation-package/ Tue, 16 Oct 2012 19:00:56 +0000 http://emcrit.org/?p=4003 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 23:46 Podcast 83 – Crack to Cure – ED Thoracotomy http://emcrit.org/podcasts/procedure-of-thoracotomy/ Tue, 02 Oct 2012 05:37:16 +0000 http://emcrit.org/?p=3890 <p>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. </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 37:16 Episode 7 – Rule-Out Criteria and Screening http://emcrit.org/practicalevidence/rule-out-criteria-screening/ Tue, 25 Sep 2012 01:49:41 +0000 http://practicalevidence.org/?p=140 <p>For Ariel...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> For Ariel... clean 10:20 Podcast 82 – Mind of the Resuscitationist with Cliff Reid http://emcrit.org/podcasts/mind-resuscitationist-reid/ Mon, 17 Sep 2012 17:25:24 +0000 http://emcrit.org/?p=3941 <p>Today, I put on my head-shrinker cap (it is a fez) and get Cliff Reid on the coach</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Today, I put on my head-shrinker cap (it is a fez) and get Cliff Reid on the coach clean 29:40 Episode 6 – ACCP Antithrombotics and VTE Guidelines http://emcrit.org/practicalevidence/antithrombotic-therapy/ Fri, 07 Sep 2012 06:47:16 +0000 http://practicalevidence.org/?p=99 <p>Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines from the American College of Chest Physicians</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines from the American College of Chest Physicians clean 8:40 Podcat 081 – An Interview on Severe Trauma with Karim Brohi http://emcrit.org/podcasts/severe-trauma-karim-brohi/ Sun, 02 Sep 2012 21:23:58 +0000 http://emcrit.org/?p=3895 <p>Let's talk trauma. I interview Karim Brohi on traumatic arrest, massive transfusion and hypotensive resuscitation.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Let's talk trauma. I interview Karim Brohi on traumatic arrest, massive transfusion and hypotensive resuscitation. clean 20:21 Podcast 80 – Uhmmmm, Maybe Groin Lines Are Not So Bad with Paul Marik http://emcrit.org/podcasts/femoral-central-lines/ Mon, 20 Aug 2012 00:14:38 +0000 http://emcrit.org/?p=3863 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 27:29 Podcast 79 – Reducing Door to tPA Time in Ischemic Stroke http://emcrit.org/podcasts/reducing-door-to-tpa-time/ Mon, 06 Aug 2012 00:16:36 +0000 http://emcrit.org/?p=3828 <p>Reducing door to tPA time in Ischemic Stroke. Strategies and tips to optimize patient care.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Reducing door to tPA time in Ischemic Stroke. Strategies and tips to optimize patient care. clean 25:17 Podcast 78 – Increased Intra-Cranial Pressure (ICP) and Herniation, aka Brain Code http://emcrit.org/podcasts/high-icp-herniation/ Sun, 22 Jul 2012 23:51:54 +0000 http://emcrit.org/?p=3780 <p>Today we are going to discuss increased intracranial pressure (ICP) and herniation</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Today we are going to discuss increased intracranial pressure (ICP) and herniation clean 23:54 EMCrit Wee – Airway Outsourcing and Suction Henching http://emcrit.org/wee/airway-outsourcing-and-suction-henching/ Mon, 16 Jul 2012 22:00:22 +0000 http://emcrit.org/?p=3764 <p>Further discussion of prepassing the bougie and why fiberoptic laryngoscopy may obviate all of the classic teaching on bimanual laryngoscopy.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Further discussion of prepassing the bougie and why fiberoptic laryngoscopy may obviate all of the classic teaching on bimanual laryngoscopy. clean 4:39 Left Ventricular Assist Devices (LVADS) http://emcrit.org/wee/left-ventricular-assist-devices-lvads-2/ Mon, 09 Jul 2012 00:21:32 +0000 http://emcrit.org/?p=3495 <p>LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier. clean 19:39 Episode 5 – Upper GI Bleed Guidelines http://emcrit.org/practicalevidence/acute-upper-gi-bleeding-guidelines/ Sat, 07 Jul 2012 07:14:32 +0000 http://practicalevidence.org/?p=105 <p>National Institute for Health and Clinical Excellence: Acute upper GI bleeding: NICE guideline</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> National Institute for Health and Clinical Excellence: Acute upper GI bleeding: NICE guideline clean 10:49 EMCrit Wee – Bougie Prepass and CricCon for Difficult Airway http://emcrit.org/wee/bougie-prepass-and-criccon/ Thu, 05 Jul 2012 03:00:35 +0000 http://emcrit.org/?p=3736 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 29:35 Severe Pediatric Trauma with Michael McGonigal http://emcrit.org/podcasts/severe-pediatric-trauma/ Sun, 24 Jun 2012 20:52:59 +0000 http://emcrit.org/?p=3627 <p>I got to speak with Michael McGonigal, MD of the Trauma Professional's Blog about severe pediatric trauma in the ED.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> I got to speak with Michael McGonigal, MD of the Trauma Professional's Blog about severe pediatric trauma in the ED. clean 32:23 Are Extraglottic Airways Harmful in Cardiac Arrest? http://emcrit.org/wee/extraglottic-airways-harmful-cardiac-arrest/ Sun, 17 Jun 2012 21:23:53 +0000 http://emcrit.org/?p=3680 <p>Are we creating a blockage of blood flow to the brain with EGAs in cardiac arrest?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Are we creating a blockage of blood flow to the brain with EGAs in cardiac arrest? clean 7:07 EMCrit Podcast 75 – Live Show # 2 http://emcrit.org/podcasts/emcrit-live-2/ Wed, 13 Jun 2012 05:07:18 +0000 http://emcrit.org/?p=3672 <p>The 2nd EMCrit Live Show</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The 2nd EMCrit Live Show clean 27:57 Episode 4 – Subarachnoid Hemorrhage Guidelines http://emcrit.org/practicalevidence/aha-sah-guidelines-2012/ Thu, 07 Jun 2012 07:19:37 +0000 http://practicalevidence.org/?p=108 <p>The New AHA/ASA SAH Guidelines</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The New AHA/ASA SAH Guidelines clean 10:15 EMCrit Podcast 74 – Who the Heck to Cool after Cardiac Arrest with Ben Abella http://emcrit.org/podcasts/who-to-cool-after-arrest/ Tue, 29 May 2012 00:26:43 +0000 http://emcrit.org/?p=3615 <p> Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest. clean 25:06 Pain and Terror as Effective Pressors http://emcrit.org/wee/pain-terror-pressor/ Wed, 16 May 2012 22:42:58 +0000 http://emcrit.org/?p=3588 <p>Psychic Terror as an Effective Pressor</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Psychic Terror as an Effective Pressor clean 6:24 Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD http://emcrit.org/podcasts/james-ducanto-airway-tips/ Mon, 14 May 2012 00:15:07 +0000 http://emcrit.org/?p=3556 <p>James DuCanto on fiberoptics and airway management in general.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> James DuCanto on fiberoptics and airway management in general. clean 29:59 Episode 3 – ACEP 2012 Management of Early Pregnancy http://emcrit.org/practicalevidence/management-of-early-pregnancy/ Mon, 07 May 2012 07:47:25 +0000 http://practicalevidence.org/?p=110 <p>ACEP's Policy on the Management of Early Pregnancy Presenting to the ED</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> ACEP's Policy on the Management of Early Pregnancy Presenting to the ED clean 16:34 How to Post a Case or Question to EMCrit Google Plus http://emcrit.org/service/post-a-case-emcrit-google-plus/ Tue, 01 May 2012 19:08:13 +0000 http://emcrit.org/?p=3528 <p>How to Post a Case or Question to EMCrit Google Plus</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> How to Post a Case or Question to EMCrit Google Plus clean 5:09 Severe Pelvic Trauma http://emcrit.org/podcasts/severe-pelvic-trauma/ Mon, 30 Apr 2012 20:59:49 +0000 http://emcrit.org/?p=3447 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 traum... clean 26:42 EMCrit Wee – ETCO2 with EGA? http://emcrit.org/wee/emcrit-wee-etco2-with-ega/ Sun, 22 Apr 2012 15:18:18 +0000 http://emcrit.org/?p=3475 <p>Can we monitor ETCO2 with extraglottic airways? The answer is definitively: I don't know.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Can we monitor ETCO2 with extraglottic airways? The answer is definitively: I don't know. clean 5:08 Podcast 71 – Critical Questions on Massive Transfusion Protocols with Kenji Inaba http://emcrit.org/podcasts/massive-transfusion-kenji/ Mon, 16 Apr 2012 16:33:18 +0000 http://emcrit.org/?p=3184 <p>Today, I got to interview Kenji Inaba; an incredibly prolific trauma surgeon from LA County, California.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Today, I got to interview Kenji Inaba; an incredibly prolific trauma surgeon from LA County, California. clean 21:18 Episode 2 – ACEP 2011 Clinical Policy on Pulmonary Embolism (PE) http://emcrit.org/practicalevidence/acep-pulmonary-embolism/ Sat, 07 Apr 2012 07:22:48 +0000 http://practicalevidence.org/?p=111 <p>Welcome to the second episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Welcome to the second episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read. clean 9:57 EMCrit Wee – Abandon Epinephrine? http://emcrit.org/wee/abandon-epinephrine/ Thu, 05 Apr 2012 21:42:02 +0000 http://emcrit.org/?p=3404 <p>Should we stop using Epi in the field for cardiac arrest</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Should we stop using Epi in the field for cardiac arrest clean 5:31 Podcast 70 – Airway Management with Rich Levitan http://emcrit.org/podcasts/rich-levitan-airway-lecture/ Sun, 01 Apr 2012 19:38:05 +0000 http://emcrit.org/?p=3379 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 1:15:13 EMCrit Wee – On Editing Comments and Ad Hominem Attacks http://emcrit.org/wee/editing-comments-and-ad-hominem-attacks/ Mon, 19 Mar 2012 22:15:34 +0000 http://emcrit.org/?p=3333 <p>On the editorial policy of EMCrit</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> On the editorial policy of EMCrit clean 5:05 EMCrit Podcast 69 – The Future of CPR with Keith Lurie and Demetris Yannopoulos http://emcrit.org/podcasts/future-of-cpr/ Mon, 19 Mar 2012 04:16:36 +0000 http://emcrit.org/?p=3195 <p>Drs. Keith Lurie and Demetris Yannopoulos elaborate on the future of CPR</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Drs. Keith Lurie and Demetris Yannopoulos elaborate on the future of CPR clean 25:33 EMCrit Wee – Cliff Reid’s Tips for Occasional Intubators http://emcrit.org/wee/emcrit-wee-cliff-reids-tips-for-occasional-intubators/ Wed, 14 Mar 2012 16:47:16 +0000 http://emcrit.org/?p=3307 <p>Prehospital Doc Cliff Reid's tips for intubation</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Prehospital Doc Cliff Reid's tips for intubation clean 5:01 Episode 1 – Penetrating Neck Trauma Guidelines http://emcrit.org/practicalevidence/penetrating-neck-trauma-guidelines/ Wed, 07 Mar 2012 07:23:34 +0000 http://practicalevidence.org/?p=112 <p>Welcome to the first episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Welcome to the first episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read. clean 9:32 EMCrit Live Show # 1 http://emcrit.org/podcasts/emcrit-live-show-1/ Wed, 07 Mar 2012 04:16:04 +0000 http://emcrit.org/?p=3273 <p>The first ever live EMCrit Podcast</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The first ever live EMCrit Podcast clean 26:38 Podcast 67 – Tranexamic Acid (TXA), Crash 2, & Pragmatism with Tim Coats http://emcrit.org/podcasts/tranexamic-acid-trauma/ Mon, 20 Feb 2012 01:21:51 +0000 http://emcrit.org/?p=3084 <p>One of the most exciting and underutilized therapies for trauma is tranexamic acid (txa).</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> One of the most exciting and underutilized therapies for trauma is tranexamic acid (txa). clean 22:00 EMCrit Wee – More on C-Spine Imaging http://emcrit.org/wee/more-on-c-spine-imaging/ Fri, 17 Feb 2012 21:18:06 +0000 http://emcrit.org/?p=3219 <p>A response to a question on c-spine imaging</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> A response to a question on c-spine imaging clean 3:27 EMCrit Wee: The Lewis Lead and a course in ECGs with Christopher Watford http://emcrit.org/wee/lewis-lead/ Wed, 15 Feb 2012 17:22:25 +0000 http://emcrit.org/?p=2880 <p>The Lewis Lead (S5) allows you detect atrial activity that cannot be discerned on the standard 12-lead</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The Lewis Lead (S5) allows you detect atrial activity that cannot be discerned on the standard 12-lead clean 7:57 Podcast 66 – …Until they are warm and dead: Severe Accidental Hypothermia http://emcrit.org/podcasts/severe-accidental-hypothermia/ Tue, 07 Feb 2012 17:14:18 +0000 http://emcrit.org/?p=3166 <p>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?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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? clean 20:50 Podcast 65 – A Primer on BVM Ventilation with Reuben Strayer http://emcrit.org/podcasts/bvm-ventilation/ Mon, 23 Jan 2012 01:44:26 +0000 http://emcrit.org/?p=3129 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 23:00 Podcast 64 – Fluid Responsiveness with Dr. Paul Marik http://emcrit.org/podcasts/fluid-responsiveness-with-dr-paul-marik/ Sun, 08 Jan 2012 16:43:41 +0000 http://emcrit.org/?p=3003 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 24:07 More on a Diagnostic Strategy for C-Spine Injuries http://emcrit.org/podcasts/why-should-we-kill-off-plain-films-c-spine/ Tue, 03 Jan 2012 00:00:18 +0000 http://emcrit.org/?p=3074 <p>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:</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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: clean 17:28 Podcast 63 – A Pain in the Neck – Part I http://emcrit.org/podcasts/cervical-spine-injuries-i/ Sun, 25 Dec 2011 23:07:04 +0000 http://emcrit.org/?p=3058 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 21:58 EMCrit Podcast – Hard Six – My Picks from 2011 http://emcrit.org/podcasts/emcrit-picks-from-2011/ Sun, 25 Dec 2011 23:05:47 +0000 http://emcrit.org/?p=3055 <p>My favorite discoveries in the medical blogosphere and podcast land</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> My favorite discoveries in the medical blogosphere and podcast land clean 3:14 Replay of the Emergency Ultrasound Podcast – Wall Motion Abnormality Lecture http://emcrit.org/podcasts/replay-emergency-ultrasound-podcast/ Fri, 16 Dec 2011 21:33:30 +0000 http://emcrit.org/?p=3030 <p>Replay of the incredible Wall Motion Abnormality Talk from the Emergency Ultrasound Podcast</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Replay of the incredible Wall Motion Abnormality Talk from the Emergency Ultrasound Podcast clean Podcast 62 – Needle vs. Knife II: Needle Thoracostomy? http://emcrit.org/podcasts/needle-finger-thoracostomy/ Sun, 11 Dec 2011 18:10:24 +0000 http://emcrit.org/?p=1815 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 unidentif... clean 17:21 Podcast 061 – Debate: Paralytics for ICU Intubations? http://emcrit.org/podcasts/paralytics-for-icu-intubations/ Mon, 28 Nov 2011 00:04:38 +0000 http://emcrit.org/?p=2907 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 27:00 Podcast 060 – On Human Bondage and the Art of the Chemical Takedown http://emcrit.org/podcasts/human-bondage-chemical-takedown/ Mon, 14 Nov 2011 01:16:40 +0000 http://emcrit.org/?p=2815 <p> In this episode, I discuss the takedown and restraint of the violent, agitated delirium patient. This is a team sport and requires a coordinated approach for the safety of the patient and staff.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In this episode, I discuss the takedown and restraint of the violent, agitated delirium patient. This is a team sport and requires a coordinated approach for the safety of the patient and staff. clean 18:44 How to generate constant CPAP with a BVM for Preoxygenation and Reoxygenation http://emcrit.org/misc/bvm-preoxygenation-and-reoxygenation/ Fri, 04 Nov 2011 20:09:51 +0000 http://emcrit.org/?p=2785 <p>How to make your crappy BVM into a powerful preoxygenation device--on the cheap.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> How to make your crappy BVM into a powerful preoxygenation device--on the cheap. clean Podcast 059 – Bath Salts with Leon Gussow http://emcrit.org/podcasts/bath-salts/ Wed, 26 Oct 2011 03:35:45 +0000 http://emcrit.org/?p=2713 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 18:02 Podcast 058 – Interview with Cliff Reid – Part II http://emcrit.org/podcasts/ems-physician-2/ Tue, 11 Oct 2011 00:16:05 +0000 http://emcrit.org/?p=2576 <p>Part II of an interview with EMS Physician Cliff Reid of the amazing blog, resus.me.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Part II of an interview with EMS Physician Cliff Reid of the amazing blog, resus.me. clean 23:41 Podcast 057 – Resuscitative Extra-Corporeal Life Support (ECMO) http://emcrit.org/podcasts/ecmo/ Mon, 26 Sep 2011 23:03:16 +0000 http://emcrit.org/?p=2479 <p> 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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 28:03 Podcast 056 – Dr. Rivers on Severe Sepsis – Part III http://emcrit.org/podcasts/rivers-sepsis-iii/ Tue, 13 Sep 2011 06:21:29 +0000 http://emcrit.org/?p=2411 <p>Part III of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis, Septic Shock, and early goal directed therapy.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Part III of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis, Septic Shock, and early goal directed therapy. clean 20:00 Podcast 055 – Dr. Rivers on Severe Sepsis – Part II http://emcrit.org/podcasts/rivers-sepsis-ii/ Tue, 06 Sep 2011 00:17:31 +0000 http://emcrit.org/?p=2388 <p>Part II of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Part II of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis. clean Podcast 054 – Dr. Rivers on Severe Sepsis – Part I http://emcrit.org/podcasts/rivers-sepsis-i/ Mon, 29 Aug 2011 16:40:24 +0000 http://emcrit.org/?p=2196 <p>Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis. clean 24:00 Minh Discusses Three Examples of Airway Management gone Bad http://emcrit.org/misc/three-airway-disasters/ Tue, 09 Aug 2011 23:46:31 +0000 http://emcrit.org/?p=2227 <p>In this podcast short, Minh Le Cong discusses three airway disasters.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In this podcast short, Minh Le Cong discusses three airway disasters. clean 5:59 Podcast 053 – Needle vs. Knife: Part I http://emcrit.org/podcasts/cricothyrotomy-needle-or-knife/ Tue, 09 Aug 2011 05:37:03 +0000 http://emcrit.org/?p=2203 <p>What technique should we use in the can't intubate/can't oxygenate (CICO) situation: Needle Cricothyrotomy vs. Bougie Cricothyrotomy.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> What technique should we use in the can't intubate/can't oxygenate (CICO) situation: Needle Cricothyrotomy vs. Bougie Cricothyrotomy. clean 36:22 Podcast 052 – Organ Donation in the ED http://emcrit.org/podcasts/organ-donation-brain-death/ Wed, 27 Jul 2011 04:53:30 +0000 http://emcrit.org/?p=2092 <p>Organ Donation in the Emergency Department<br /> 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.<br /> Here are the current standards for determining brain death<br /> Wijdicks et al. Evidence-based guideline update: Determining Brain Death in Adults<br /> Brain Death Checklist<br /> brain death statement<br /> Here is a video of Dr. Tawil demonstrating the brain death exam</p> <p>Now on to the Podcast...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 33:30 Podcast # 51: Fibrinolysis in Pulmonary Embolism http://emcrit.org/podcasts/fibrinolysis-in-pulmonary-embolism/ Mon, 11 Jul 2011 05:00:07 +0000 http://emcrit.org/?p=2055 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 30:36 EMCrit Podcast 50 – Acid Base Part IV – Choose the Solution Based on the Problem http://emcrit.org/podcasts/acid-base-4-use-of-fluids/ Mon, 27 Jun 2011 03:16:37 +0000 http://emcrit.org/?p=1817 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 21:23 Hemostatic Resuscitation by Richard Dutton, MD http://emcrit.org/podcasts/hemostatic-resuscitation/ Sun, 12 Jun 2011 01:41:56 +0000 http://emcrit.org/?p=1962 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 51:35 EMCrit Podcast 49 – The Mind of a Resus Doc: Logistics over Strategy http://emcrit.org/podcasts/mind-resus-doc-logistics/ Tue, 07 Jun 2011 05:48:07 +0000 http://emcrit.org/?p=1938 <p>This Part I of the Mind of a Resus Doc Series, in which we delve into the philosophies that make a good resuscitationist.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This Part I of the Mind of a Resus Doc Series, in which we delve into the philosophies that make a good resuscitationist. clean 9:41 EMCrit Podcast 48 – PhD in EKGs Part II: Left Bundle Branch Block http://emcrit.org/podcasts/left-bundle-branch-block/ Mon, 23 May 2011 03:56:35 +0000 http://emcrit.org/?p=1879 <p>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?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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... clean 17:56 EMCrit Podcast 47 – Failure to Plan for Failure: A Discussion of Airway Disasters and the NAP4 Study http://emcrit.org/podcasts/nap4-airway-disasters/ Mon, 09 May 2011 15:42:38 +0000 http://emcrit.org/?p=1771 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 abou... clean 32:57 EMCrit Podcast 46 – Acid Base: Part III http://emcrit.org/podcasts/acid-base-part-iii/ Wed, 04 May 2011 03:00:35 +0000 http://emcrit.org/?p=1789 <p>In part III, we go through 2 cases of acid base abnormalities step by step.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In part III, we go through 2 cases of acid base abnormalities step by step. clean 18:42 Bonus – Passing the Esophageal Temperature Probe http://emcrit.org/misc/passing-the-esophageal-temperature-probe/ Sat, 30 Apr 2011 19:33:14 +0000 http://emcrit.org/?p=1780 <p>It can be a b*tch to pass the esophageal temperature probe for hypothermia. Here's how to get er done.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> It can be a b*tch to pass the esophageal temperature probe for hypothermia. Here's how to get er done. clean EMCrit Podcast 45 – Acid Base: Part II http://emcrit.org/podcasts/acid-base-part-ii/ Sun, 24 Apr 2011 20:59:45 +0000 http://emcrit.org/?p=1758 <p>This second lecture discusses a quantitative approach to acid base management. I lay out the formula I use to approach an acid-base problem.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This second lecture discusses a quantitative approach to acid base management. I lay out the formula I use to approach an acid-base problem. clean EMCrit Podcast 44 – Acid Base: Part I http://emcrit.org/podcasts/acid-base-i/ Mon, 11 Apr 2011 23:02:29 +0000 http://emcrit.org/?p=1714 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 path... clean 25:00 Listener Questions – Episode 1 http://emcrit.org/misc/listener-questions-episode-1/ Wed, 30 Mar 2011 01:47:36 +0000 http://emcrit.org/?p=1686 <p>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:</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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: clean 11:48 Bonus – Is Kayexalate Useless? http://emcrit.org/misc/is-kayexalate-useless/ Wed, 23 Mar 2011 03:58:35 +0000 http://emcrit.org/?p=1661 <p>Dr. Siamak (Mak) Moayedi, MD found nothing to indicate that kayexalate is effective for the acute management of hyperkalemia.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Dr. Siamak (Mak) Moayedi, MD found nothing to indicate that kayexalate is effective for the acute management of hyperkalemia. clean 16:31 Video for Podcast 43 – Inserting the Air-Q http://emcrit.org/misc/air-q-video/ Wed, 16 Mar 2011 21:23:15 +0000 http://emcrit.org/?p=1634 <p>Here is a video to go along with podcast 43 on the insertion and use of the Air-Q intubating laryngeal airway</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Here is a video to go along with podcast 43 on the insertion and use of the Air-Q intubating laryngeal airway clean 6:06 EMCrit Podcast 43 – Laryngeal Airways with Daniel Cook, MD (Part I) http://emcrit.org/podcasts/supraglottic-airway/ Sun, 13 Mar 2011 00:40:50 +0000 http://emcrit.org/?p=1626 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 21:27 EMCrit Podcast 42: A phD in EKG with Steve Smith http://emcrit.org/podcasts/phd-in-ekg/ Sun, 27 Feb 2011 21:34:26 +0000 http://emcrit.org/?p=1564 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 28:30 EMCrit Podcast 41 – Interview with Cliff Reid of RESUS.me http://emcrit.org/podcasts/ems-physician-1/ Mon, 14 Feb 2011 18:04:53 +0000 http://emcrit.org/?p=1538 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 25:00 EMCrit Podcast 40 – Delayed Sequence Intubation (DSI) http://emcrit.org/podcasts/dsi/ Mon, 31 Jan 2011 17:57:51 +0000 http://emcrit.org/?p=1242 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 19:51 EMCrit Podcast 39 – Hyponatremia http://emcrit.org/podcasts/hyponatremia/ Mon, 17 Jan 2011 18:18:14 +0000 http://emcrit.org/?p=1184 <p>Hmm… he’s tasty, but he just needs a little salt! In this podcast, I discuss the management of hyponatremia in the ED.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Hmm… he’s tasty, but he just needs a little salt! In this podcast, I discuss the management of hyponatremia in the ED. clean 21:26 EMCrit Podcast 38 – The ED Critical Care Dirty Dozen for 2010 http://emcrit.org/podcasts/dirty-dozen-2010/ Sun, 02 Jan 2011 22:15:54 +0000 http://emcrit.org/?p=1127 <p>My favorite ED things for 2010...the EMCrit dirty dozen.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> My favorite ED things for 2010...the EMCrit dirty dozen. clean 13:09 EMCrit Podcast 37 – Lactate in Sepsis http://emcrit.org/podcasts/lactate/ Mon, 20 Dec 2010 15:16:14 +0000 http://emcrit.org/?p=1050 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 28:56 EMCrit Podcast 36 – Traumatic Arrest http://emcrit.org/podcasts/traumatic-arrest/ Sat, 04 Dec 2010 23:04:00 +0000 http://emcrit.org/?p=969 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 20:19 EMCrit Podcast 35 – Extubation in the ED http://emcrit.org/podcasts/extubation/ Thu, 18 Nov 2010 22:28:11 +0000 http://emcrit.org/?p=879 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 14:27 EMCrit Podcast 34 – 2010 ACLS Guidelines http://emcrit.org/podcasts/acls-guidelines-2010/ Tue, 26 Oct 2010 03:51:44 +0000 http://emcrit.org/?p=823 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 19:59 Video for Diagnosing Posterior Stroke http://emcrit.org/misc/posterior-stroke-video/ Sun, 10 Oct 2010 03:11:00 +0000 http://emcrit.org/?p=765 <p>This is the video for cerebellar stroke diagnosis. Listen to the podcast first.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This is the video for cerebellar stroke diagnosis. Listen to the podcast first. clean EMCrit Podcast 33 – Diagnosis of Posterior Stroke http://emcrit.org/podcasts/posterior-stroke/ Sun, 10 Oct 2010 02:52:17 +0000 http://emcrit.org/?p=755 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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? clean 11:38 EMCrit Podcast 32 – Treatment of Severe Hyperkalemia http://emcrit.org/podcasts/hyperkalemia/ Wed, 22 Sep 2010 18:36:40 +0000 http://emcrit.org/?p=744 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 12:57 EMCrit Podcast 31 – Intra-Arrest Management http://emcrit.org/podcasts/intra-arrest/ Sun, 05 Sep 2010 21:47:53 +0000 http://emcrit.org/?p=734 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 22:33 ACEP Preview – Hemostasis: Stopping the bleeding in a crashing trauma patient http://emcrit.org/podcasts/hemostasis-acep/ Mon, 23 Aug 2010 03:25:35 +0000 http://emcrit.org/?p=704 <p>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. </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 53:03 EMCrit Podcast 30 – Hemorrhagic Shock Resuscitation http://emcrit.org/podcasts/trauma-resuscitation-dutton/ Sun, 15 Aug 2010 17:33:15 +0000 http://emcrit.org/?p=694 <p>This week we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This week we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD. clean 31:07 EMCrit Podcast 29 – Procedural Sedation, Part II http://emcrit.org/podcasts/procedural-sedation-part-2/ Mon, 02 Aug 2010 00:19:36 +0000 http://emcrit.org/?p=682 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 15:39 Procedural Sedation Guidelines Update http://emcrit.org/misc/procedural-sedation-guidelines/ Mon, 26 Jul 2010 23:51:13 +0000 http://emcrit.org/?p=679 <p>Here is a piece I wrote for EMPGU</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Here is a piece I wrote for EMPGU clean Procedural Sedation, Part I (Audio Only) http://emcrit.org/archive-podcasts/procedural-sedation-i-audio/ Mon, 26 Jul 2010 23:42:44 +0000 http://emcrit.org/?p=677 <p>This is the audio only version of the previous post (Part I of the Sedation Talk).</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This is the audio only version of the previous post (Part I of the Sedation Talk). clean 27:29 Procedural Sedation – Part I http://emcrit.org/archive-podcasts/procedural-sedation-part-1/ Mon, 26 Jul 2010 23:39:01 +0000 http://emcrit.org/?p=669 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 27:14 EMCrit Podcast 28 – Severe CNS Infections http://emcrit.org/podcasts/meningitis/ Tue, 13 Jul 2010 20:25:02 +0000 http://emcrit.org/?p=665 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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... clean 25:33 EMCrit Podcast 27 – Calcium Channel Blocker Overdose http://emcrit.org/podcasts/calcium-channel-blocker-od/ Tue, 29 Jun 2010 16:36:27 +0000 http://emcrit.org/?p=634 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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.... clean 29:48 EMCrit Lecture – Top Ten Hypothermia Tips http://emcrit.org/archive-podcasts/hypothermia-tips/ Wed, 16 Jun 2010 04:07:03 +0000 http://emcrit.org/?p=627 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 ... clean 42:38 EMCrit Lecture – Dominating the Vent: Part II http://emcrit.org/podcasts/vent-part-2/ Tue, 01 Jun 2010 06:12:51 +0000 http://emcrit.org/?p=617 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 managem... clean EMCrit Lecture – Dominating the Vent: Part I http://emcrit.org/archive-podcasts/vent-part-1/ Mon, 24 May 2010 18:22:04 +0000 http://emcrit.org/?p=565 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 managem... clean 30:00 Vent Handout http://emcrit.org/podcasts/vent-handout/ Mon, 24 May 2010 18:10:08 +0000 http://emcrit.org/?p=569 <p>This post is just to place the vent handout into itunes.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> This post is just to place the vent handout into itunes. clean EMCrit Podcast 26 – Patient Controlled Analgesia by Edward Gentile http://emcrit.org/podcasts/gentile-pain/ Wed, 12 May 2010 03:02:23 +0000 http://emcrit.org/?p=553 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 29:19 Service Update – How to get old episodes into Itunes http://emcrit.org/service/old-episodes-itunes/ Sun, 02 May 2010 18:24:26 +0000 http://emcrit.org/?p=544 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean IVC Ultrasound for Non-Invasive Sepsis Protocol http://emcrit.org/procedures/ivc-ultrasound/ Thu, 29 Apr 2010 00:01:28 +0000 http://emcrit.org/?p=521 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 ... clean EMCrit Podcast 25 – End of Life and Palliative Care in the ED http://emcrit.org/podcasts/end-of-life-care/ Sat, 24 Apr 2010 23:18:21 +0000 http://emcrit.org/?p=508 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 29:43 Q&A: The Two Rams http://emcrit.org/podcasts/the-two-rams/ Sat, 17 Apr 2010 21:24:17 +0000 http://emcrit.org/?p=493 <p>Two listener questions answered in 5 minutes. One on awake intubation in trauma and the other on intubating the patient with severe RESP acidosis.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Two listener questions answered in 5 minutes. One on awake intubation in trauma and the other on intubating the patient with severe RESP acidosis. clean 5:04 Bougie-Aided Cricothyrotomy by Darren Braude http://emcrit.org/procedures/bougie-aided-cric/ Tue, 13 Apr 2010 14:45:46 +0000 http://emcrit.org/?p=480 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean Procedure: Fiberoptic Stylet-aided Cricothyrotomy by Seth Manoach http://emcrit.org/procedures/fiberoptic-stylet-cric/ Sun, 11 Apr 2010 17:01:30 +0000 http://emcrit.org/?p=451 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean Procedure: Open Cricothyrotomy for Historical Purposes Only http://emcrit.org/procedures/cricothyrotomy/ Sun, 11 Apr 2010 17:01:01 +0000 http://emcrit.org/?p=444 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean EMCrit Podcast 24 – The Cric Show http://emcrit.org/podcasts/crics/ Sun, 11 Apr 2010 05:31:50 +0000 http://emcrit.org/?p=255 <p>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! </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 24:15 EMCrit Podcast 23 – Awake Intubation for Trauma and Medical Patients http://emcrit.org/podcasts/who-to-intubate/ Sat, 27 Mar 2010 03:45:47 +0000 http://emcrit.org/?p=418 <p>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.</p> <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 15:40 EMCrit Rant – Risk in Emergency Medicine http://emcrit.org/archive-podcasts/risk-in-em/ Sun, 21 Mar 2010 21:44:13 +0000 http://emcrit.org/?p=406 <p>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. </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 12:44 EMCrit Podcast 22 – Non-Invasive Severe Sepsis Care http://emcrit.org/podcasts/non-invasive-sepsis/ Sun, 14 Mar 2010 00:29:36 +0000 http://emcrit.org/?p=394 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 other... clean 21:16 EMCrit Podcast 21 – A Bad Sedation Package Leaves your Patient Trapped in a Nightmare http://emcrit.org/podcasts/post-intubation-sedation/ Fri, 26 Feb 2010 19:55:17 +0000 http://emcrit.org/?p=369 <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 26:40 EMCrit Podcast 20 – The Crashing Atrial Fibrillation Patient http://emcrit.org/podcasts/crashing-a-fib/ Sat, 13 Feb 2010 03:14:51 +0000 http://emcrit.org/?p=324 <p>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???</p> <p>Yeah, yeah the Pavlovian ACLS response--You cardiovert. Wonderful, except it didn't change a thing. Now what?</p> <p>In this episode, I discuss the crashing atrial fibrillation patient.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 9:13 EMCrit Podcast 19 – Non-Invasive Ventilation http://emcrit.org/podcasts/niv/ Fri, 05 Feb 2010 17:32:50 +0000 http://emcrit.org/?p=305 <p>Intubation is a sexy procedure, there is no doubt about it.</p> <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 19:35 EMCrit Podcast 17 – Reversal of Anti-coagulant and Anti-platelet Drugs in Head Bleeds http://emcrit.org/podcasts/reversal-head-bleeds/ Tue, 12 Jan 2010 21:53:51 +0000 http://emcrit.org/?p=263 <p>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?</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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? clean 18:12 EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy http://emcrit.org/podcasts/finger-thoracostomy/ Thu, 24 Dec 2009 03:09:21 +0000 http://emcrit.org/?p=250 <p>Hi folks,</p> <p>Sorry about the voice--got a cold off those damn ED keyboards</p> <p>Thanks to my friend Reuben, this week we'll talk about the asthmatic patient that codes while on the vent</p> <p>The DOPE mnemonic gives you a path to figure out why a patient is desaturating</p> <p>(If anyone knows who created the DOPE mnemonic, please add a comment or send me an email.)</p> <p>If the pt is asthmatic, add an "S" to make DOPES</p> <p>The "S" stands for Stacked Breaths--and it's the first thing to address.</p> <p>Address it by disconnecting the vent circuit. Don't think about it, don't dither, just disconnect the vent.</p> <p>"E" is for equipment. Attach a BVM hooked up to O2 and you'll eliminate ventilator equipment failures.</p> <p>"D" is for tube displacement. Verify the tube with ETCO2, either qualitative or quantitative.</p> <p>"O" reminds you to check for obstruction of the tube. See if you can put a suction cath all the way down.</p> <p>If all of these don't fix the problem, then consider "P" for pneumothorax.</p> <p>Lung sounds are not always definitive. Throw on the UTS if you have the time.</p> <p>Otherwise perform bilateral finger thoracostomies. What the hell is that, you say?</p> <p>Listen to the podcast.</p> <p>Then you can read more about it in this article</p> <p>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.<br /> Update: Is the tube mainstem, is there a ball-valve obstruction?<br /> Consider reintubation<br /> Consider Bronchoscopy</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 desaturat... clean 17:03 EMCrit Podcast 15 – the Severe Asthmatic http://emcrit.org/podcasts/severe-asthmatic/ Wed, 09 Dec 2009 02:02:48 +0000 http://emcrit.org/?p=232 <p>To PEEP or not to PEEP, that is the question...in the management of the severe asthmatic</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> To PEEP or not to PEEP, that is the question...in the management of the severe asthmatic clean 22:56 Video for the Laryngoscope as a Murder Weapon Lecture http://emcrit.org/misc/preox/ Thu, 26 Nov 2009 03:49:12 +0000 http://emcrit.org/?p=198 <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> clean EMCrit Podcast 14.5 – A bit more on EGDT http://emcrit.org/podcasts/more-on-egdt/ Mon, 23 Nov 2009 07:20:39 +0000 http://emcrit.org/?p=183 <p>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--<br /> 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,<br /> Chris Nickson<br /> ED/ICU Registrar, Perth<br /> So in this brief aside, I respond to Chris' comments and tell you a bit about the EMCrit Podcast EBM philosophy.</p> <p>Here are the links mentioned:</p> <p> Henry Ford Hospital Reply to WSJ - 10.27.2008<br /> New MSSM ED Crit Care Sepsis Protocol</p> <p> MR of Early Quantitative Therapies for Sepsis </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 10:16 EMCrit Podcast 14 – EGDT Tirade http://emcrit.org/podcasts/emcrit-podcast-14-egdt-tirade/ Sat, 21 Nov 2009 04:53:36 +0000 http://emcrit.org/?p=178 <p>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. </p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 20:42 EMCrit Podcast 13 – Trauma Resus II: Massive Transfusion http://emcrit.org/podcasts/massive-trans/ Sat, 31 Oct 2009 21:49:35 +0000 http://emcrit.org/?p=168 <p>On this podcast,</p> <p>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</p> <p>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.</p> <p>What may be the best review of the topic is by Spinella and Holcomb:<br /> (Blood Reviews 2009;23:231-240)<br /> I talk about</p> <p> 1:1:1 transfusion<br /> PCC, Factor VIIa, Cryo<br /> Calcium<br /> IV Access</p> <p>coming up in the next few podcasts: Sedatives for Intubation, Trauma Airway Management, The Crashing A-fib patient</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 ... clean 16:53 EMCrit Podcast 12 – Trauma Resus: Part I http://emcrit.org/podcasts/trauma-resus-part-i/ Wed, 14 Oct 2009 04:10:05 +0000 http://emcrit.org/?p=152 <p>Thought we'd talk about some trauma stuff, specifically the resuscitation of the critically ill hemorrhagic shock patient.</p> <p>There is much to discuss, so this will be a multi-episode affair.</p> <p>Today, we'll concentrate on the Lethal Triad and BP Goals.<br /> Lethal Triad</p> <p>The picture says it all.</p> <p>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.</p> <p>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.<br /> BP Goals<br /> 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.</p> <p>If MAP < 65 - give fluids/products</p> <p>If MAP > 65 - check perfusion</p> <p>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.</p> <p>MAP > 65 & Good Perfusion-stand tight</p> <p>MAP > 65 & Bad Perfusion-give fentanyl 20-25 mcg</p> <p>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.</p> <p>Here are the articles</p> <p>resus of crit ill trauma patients</p> <p>damage_control_anesthesia</p> <p>Next Time: Massive Transfusion Protocols</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 14:33 EMCrit Podcast 11 – Delirium Tremens http://emcrit.org/podcasts/delirium-tremens/ Tue, 29 Sep 2009 05:14:22 +0000 http://emcrit.org/?p=137 <p>The management of severe ETOH withdrawal and Delirium Tremens</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> The management of severe ETOH withdrawal and Delirium Tremens clean 18:48 Podcast 10 – Cardiogenic Shock http://emcrit.org/podcasts/cardiogenic-shock/ Wed, 16 Sep 2009 17:02:43 +0000 http://emcrit.org/?p=128 <p>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).</p> <p>If the patients have pulmonary edema and low BP from a cardiac cause, then they are in<br /> Cardiogenic shock.<br /> First, consider the etiology:</p> <p> Rate-related<br /> Valve Disorder<br /> Ischemic (Right sided infarct, STEMI, NSTEMI)<br /> Cardiomyopathy<br /> Toxicologic</p> <p>At the same time, you are treating the patient with:</p> <p> Inotropes (dobutamine, milrinone, calcium)<br /> Pressors to achieve a MAP > 65 (allows coronary perfusion)<br /> Oxygenation support, most likely with intubation<br /> Optimize O2 carrying capacity (Hb>10)</p> <p>Here is a fantastic set of guidelines to manage these patients</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 ca... clean 13:37 EMCrit Podcast 9 – Can you take sick patients to ct? http://emcrit.org/podcasts/sick-pts-to-c/ Tue, 01 Sep 2009 00:49:52 +0000 http://emcrit.org/?p=122 <p>Does the EM ban on letting sick patients go to CT scan make sense? Listen to the podcast and then register your opinion.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> Does the EM ban on letting sick patients go to CT scan make sense? Listen to the podcast and then register your opinion. clean 7:20 EMCrit Podcast 8 – Subarachnoid Hemorrhage http://emcrit.org/podcasts/sah/ Mon, 17 Aug 2009 01:28:11 +0000 http://emcrit.org/?p=106 <p>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.</p> <p>Best article for EM that I've found, comes out of Columbia</p> <p>For more reviews on mostly ICU issues see here and here.</p> <p>Update: Critical Care Management of Patients Following Aneurysmal SAH Guidelines from NCC<br /> 1. Get a neuro exam before you intubate<br /> 2. Intubation<br /> Give pretreatment, now just lidocaine and fentanyl</p> <p>Etomidate or propofol; plus sux.</p> <p>Most experienced intubater should perform laryngoscopy<br /> 3. Treat Pain<br /> and if intubated, give sedation<br /> 4. Treat Vasospasm<br /> give nimodipine 60 mg PO or NGT<br /> 5. BP Control<br /> place a-line</p> <p>treat pain first</p> <p>Give Labetalol or Nicardipine to achieve the patient's baseline BP if the patient has good mental status</p> <p>if they are obtunded, be a bit more conservative until ICP monitoring is in place</p> <p>If MAP is below 80, give fluids, pressors, and inotropes<br /> 6. Anti-seizure prophylaxis<br /> Load with phenytoin or fosphenytoin<br /> 7. Anti-fibrinolytics<br /> Amicar is the main one these days; ask your neurosurgeon/neurointensivist on a case-by-case basis</p> <p>see ehced.org for drip sheets<br /> 8. Reverse Coagulopathy<br /> 9. Think Heart<br /> these patients can get EKG changes, dysrhythmias, LV stunning, and frank infarcts from their SAH<br /> 10. ICP ASAP<br /> get the neurosurgeons to get the EVD (external ventricular drain) aka IVC (intraventricular catheter) in place as soon as possible</p> <p>keep ICP < 20 and CPP > 55-60<br /> Please Subscribe and Please Comment!<br /> .</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 15:35 EMCrit Podcast 7 – Sedation Tirade http://emcrit.org/podcasts/sedation-tirade/ Thu, 23 Jul 2009 22:52:06 +0000 http://emcrit.org/?p=93 <p>Hi folks,</p> <p>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.</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 3:52 EMCrit Podcast 6 – Push-Dose Pressors http://emcrit.org/podcasts/bolus-dose-pressors/ Fri, 10 Jul 2009 16:43:20 +0000 http://emcrit.org/?p=76 <p>Finally a non-intubation topic!</p> <p>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.</p> <p>They also can act as a bridge to drip pressors while they are being mixed or while a central line is being placed.</p> <p>Click Here for printable sheet with mixing instructions<br /> Epinephrine<br /> Do not give cardiac arrest doses (1 mg) to patients with a pulse</p> <p>Has alpha and beta-1/2 effects so it is an inopressor</p> <p>Onset-1 minute</p> <p>Duration-5-10 minutes</p> <p>Mixing Instructions:</p> <p>Take a 10 ml syringe with 9 ml of normal saline</p> <p>Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml)</p> <p>Now you have 10 mls of Epinephrine 10 mcg/ml</p> <p>Dose:</p> <p>0.5-2 ml every 1-5 minutes (5-20  mcg)</p> <p>No extravasation worries!</p> <p>Mixing Video:</p> <p>Phenylephrine<br /> Phenyl as a bolus dose is clean, quick, and never causes trouble. But...</p> <p>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)</p> <p>Onset-1 minute</p> <p>Duration- 5-10 minutes (usually 5)</p> <p>Mixing Instructions:</p> <p>Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml)</p> <p>Inject this into a 100 ml bag of NS</p> <p>Now you have 100 mls of phenylephrine 100 mcg/ml</p> <p>Draw up some into a syringe; each ml in the syringe is 100 mcg</p> <p>Dose:</p> <p>0.5-2 ml every 1-5 minutes (50-200 mcg)</p> <p>No extravasation worries!</p> <p>Mixing Video:</p> <p>Ephedrine<br /> I don’t use this one, listen to the podcast to hear why. I put it here solely for the anesthesiologists on the blog.</p> <p>Onset-Near Instant</p> <p>Duration-1 hour</p> <p>Mixing Instructions:</p> <p>Take a 10 ml syringe with 9 ml of normal saline</p> <p>Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml)</p> <p>Now you have 10 mls of Ephedrine 5 mg/ml</p> <p>Dose:</p> <p>1-2 ml every 2-5 minutes (5-10 mg)</p> <p>No extravasation worries!<br /> Additional Video of a Real Patient<br /> By Larry Mellick's Crew<br /> Update:<br /> This study compares push-dose phenylephrine to continuous infusion--no difference between the two (Anesthesia Analgesia 21012;115(6):1343)<br /> First article in the ED demonstrates efficacy on blood pressure (The Journal of Emergency Medicine Volume 49, Issue 4, October 2015, Pages 488–494)</p> <p>Now on to the Podcast...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 11:00 EMCrit Podcast 5 – Intubating the Critical GI Bleeder http://emcrit.org/podcasts/intubating-gi-bleeds/ Mon, 22 Jun 2009 00:52:01 +0000 http://emcrit.org/?p=62 <p>We've had a  few gruesome airways in patients with GI bleeds and bellies full of coffee ground emesis.</p> <p>This is a top 10 list encompassing my approach to this difficult situation:<br /> 1. Empty the Stomach<br /> Place a salem sump and suck out all of the stomach contents.<br /> 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)</p> <p>Administer Metoclopramide 10 mg IVSS<br /> 2. Intubate the Patient with HOB at 45°<br /> Semi-Fowler's position will keep the gastric contents from moving up the esophagus<br /> 3. Preoxygenate like mad<br /> You do not want to bag these patients, give yourself a preox cushion<br /> 4. Intubation Meds<br /> Use a sedative that is BP stable, use reduced doses.</p> <p>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).<br /> 5. Gather your equipment to optimize first pass<br /> Use fiberoptic laryngoscopy if you have it (e.g. Glidescope)</p> <p>At the bedside, have a bougie, an LMA, a meconium aspirator (more below), and 2 suction set-ups</p> <p>Wear eye protection!<br /> 6. If you need to bag after a failed attempt...<br /> Bag gently and slowly (10 times a minute)<br /> Consider placing an LMA if you need to bag.<br /> 7. If the patient vomits: Trendelenberg<br /> This potentially keeps the emesis out of the lungs<br /> 8. Meconium Aspirator<br /> 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.</p> <p>9. No ABX for Aspiration<br /> Aspiration in the initial phases is a chemical pneumonitis, not a bacterial pneumonia</p> <p>See Marik's article (NEJM 2001;344(9):665)<br /> 10. SIRS<br /> Expect a sepsis-like syndrome from the aspiration. This folks may need pressors and tons of additional fluid</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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 c... clean 12:25 Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis http://emcrit.org/podcasts/tube-severe-acidosis/ Sat, 23 May 2009 00:22:21 +0000 http://emcrit.org/?p=37 <p>This lecture is part of the Laryngoscope as a Murder Weapon Series:</p> <p> Hemodynamic Kills<br /> Oxygenation Kills<br /> Ventilatory Kills</p> <p>Sorry about the voice--blame the swine flu.<br /> Case<br /> Thanks to Joe Chiang</p> <p>Severe DKA; Obtunded with pH 6.65, PaCO2 18, Bicarb 5<br /> Pt’s mental status is worsening<br /> The decision is made to intubate<br /> Should you give NaBicarb?<br /> 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.<br /> What you need<br /> Properly fitted NIV mask<br /> Ventilator, not a NIV machine<br /> Someone who knows how to work the vent<br /> Normal intubation stuff<br /> If available, Quantitative ETCO2<br /> Procedure</p> <p> Place pt on pseudo-NIV</p> <p>Settings are<br /> Mode Volume SIMV<br /> Vt 550 ml<br /> FiO2 100%<br /> Flow Rate 30 lpm<br /> PSV 5-10<br /> PEEP 5<br /> RR 0</p> <p> Attach ETCO2 and observe value<br /> Push the RSI Meds</p> <p> Turn the Resp Rate to 12<br /> Perform jaw thrust<br /> Wait 45 seconds</p> <p>This violates the tenets of RSI, but keeping the pt alive is probably more crucial right now.<br /> Most experienced operator should intubate the patient</p> <p> Attach the ventilator<br /> Confirm tube placement by observing ETCO2<br /> Immediately increase Respiratory Rate to 30<br /> Change Vt to 8 cc/kg predicted IBW<br /> Change Flow Rate to 60 lpm, this si the normal setting for intubated patients (forgot to mention this in the audio)</p> <p>Why 30 BPM? Listen to the podcast.</p> <p> Make sure ETCO2 is at least as low as it was when you started<br /> Check ABG<br /> Pat yourself on the back</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 8:32 EMCrit Podcast 2 – ETCO2 http://emcrit.org/podcasts/etco2-podcast/ Tue, 05 May 2009 04:51:28 +0000 http://emcrit.org/?p=13 <p>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.</p> <p>Of course the most pervasive and potentially dangerous myth is that ETCO2=PaCO2.<br /> Long story short, in our patients, it doesn't.</p> <p>Listen to the podcast for more...</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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, clean 22:08 EMCrit Podcast 1-Sympathetic Crashing Acute Pulmonary Edema http://emcrit.org/podcasts/scape/ Sat, 25 Apr 2009 18:22:38 +0000 http://emcrit.org/?p=17 <p>Here it is, the 1st EMCrit podcast.</p> <p>It's on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE).</p> <p>To boil it down to 10 seconds:</p> <p> Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-12.<br /> 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.</p> <p>By 10 minutes, your patient should be out of the water.</p> <p>See crashingpatient.com for the references.</p> <p> </p> <p>Here is some info from a handout from a lecture I gave on the topic:<br /> High Dose Nitroglycerin<br /> Homeopathic nitroglycerin does not work so well<br /> Start at 50-100 mcg/min, you can rapidly titrate to 200-400 mcg/min.</p> <p>You must stand at the bedside to use these doses.<br /> Need >120 mcg/min to get sig decreased Pulm Cap Wedge Pressure (Am J Cardio 2004;93:237)<br /> But even this strategy is not as effective as the …<br /> Nitro Bolus First<br /> Can give 400-800 mcg over 1-2 minutes = 400 mcg/min for 1-2 minutes. (Annals EM 1997, 30:382)<br /> How to do it<br /> Standard nitro mix is 200 mcg/ml.<br /> VERIFY YOUR HOSPITAL’S MIX BEFORE USING THESE RECS<br /> In order to give the 400 mcg/min for 2 minutes, set the pump to<br /> Rate: 120 cc/hr<br /> Volume to be Infused: 4 ml (This will deliver 400 mcg/min for 2 minutes and then stop)</p> <p>Or</p> <p>Draw up 4 ml of the nitro and 6 ml of NS and give over 2 minutes</p> <p>After the bolus, I drop the drip to 100 mcg/min and titrate up from there to effect<br /> When the patient gets better, you need to sharply decrease this drip rate<br /> Some folks have gone even further<br /> High dose nitroglycerin for severe decompensated heart failure—2 mg at a time (Ann Emerg Med 2007;50:144)<br /> 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)</p> <p>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)<br /> Update 6-10-12<br /> Piyush Mallick did an amazing study on nitro-bolus to avert intubation</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> 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. clean 10:32 EMCrit Podcast 0 – The Intro http://emcrit.org/podcasts/introduction/ Sun, 01 Mar 2009 04:56:09 +0000 http://emcrit.org/?p=102 <p>In which I introduce you to me and explain what this whole thing is about.</p> <p>(better late than never)</p> <p><a rel="nofollow" href="http://emcrit.org">EMCrit</a> by <a rel="nofollow" href="http://emcrit.org/author/emcrit-2/">Scott Weingart</a>.</p> In which I introduce you to me and explain what this whole thing is about. (better late than never) clean 2:51