Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation
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Mohamed, a listener from Sudan, emailed asking about the treatment of acute pulmonary edema in patients with low blood pressure. This is in distinction to SCAPE patients (see podcast 1). If the patients have pulmonary edema and low BP from a cardiac cause, then they are in cardiogenic shock. First, consider the etiology: Rate-related Valve [...]
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Does the EM ban on letting sick patients go to CT scan make sense? Listen to the podcast and then register your opinion.
Continue reading...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. Podcast: Play in new window | Download (2.7MB) | Embed
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Finally a non-intubation topic! Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation. They also can act as a bridge to drip pressors while [...]
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We’ve had a few gruesome airways in patients with GI bleeds and bellies full of coffee ground emesis. This is a top 10 list encompassing my approach to this difficult situation: 1. Empty the Stomach Place a salem sump and suck out all of the stomach contents. Varices are not a contraindication (see: Digest Dis 1973;18(12):1032, Gastrointest Endosc. 2004 [...]
Continue reading...The video for this lecture is up at this link. Awake intubation can save your butt. It requires forethought and humility–you must be able to say to yourself, “I am not sure I will be able to successfully intubate this patient.” However, the payoff for this thought process is enormous. You can try an intubation [...]
Continue reading...Sorry about the voice–blame the swine flu. Case Thanks to Joe Chiang Severe DKA; Obtunded with pH 6.65, PaCO2 18, Bicarb 5 Pt’s mental status is worsening The decision is made to intubate Should you give NaBicarb? Probably won’t help as patient is already breathing at their maximum. Unless they blow off the Bicarb-generated CO2, [...]
Continue reading...I did a spot on ETCO2 for Amal Mattu’s podcast a couple of weeks ago. I try to clear up some of the myths on the use of ETCO2. Of course the most pervasive and potentially dangerous myth is that ETCO2=PaCO2. Long story short, in our patients, it doesn’t. Listen to the podcast for more… [...]
Continue reading...Here it is, the 1st EMCrit podcast. It’s on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE). To boil it down to 10 seconds: Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-12. Start the patient on a nitroglycerin drip. Administer a loading dose of 4oo [...]
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Hi, my name is Scott Weingart.
I am an ED Intensivist from New York City. My career goal and the purpose of this blog and podcast is to bring Upstairs Care, Downstairs-–that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.
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Best Medical Weblog of 2010 from the folks at Medgadget.com
