EMCrit Podcast - Critical Care and Resuscitation https://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Wed, 24 May 2017 01:23:36 +0000 en-US hourly 1 https://wordpress.org/?v=4.7.5 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- 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 https://emcrit.org EMCrit Podcast 199 – Management of Massive Hemoptysis with Oren Friedman https://emcrit.org/podcasts/massive-hemoptysis/ Sun, 14 May 2017 19:13:04 +0000 http://emcrit.org/?p=5745 Management of Massive Hemoptysis Management of Massive Hemoptysis
Today, I am joined by my buddy and pulmonary-critical care stud, Oren Friedman, to discuss the management of Massive Hemoptysis
See More from Oren

* Clot Management of Massive and SubMassive PE
* Hemodynamic Management of PE

Some Basics on Massive Hemoptysis

* LitFL
* First10 EM
* Review by Sakkour on Massive Hemoptysis

Intubate Big
Localize
C-XR, chart review, and initial bronch. Remember Oren's tip: if you get in there and can't find any bleeding, temporarily disconnect the vent
Is it Amenable to Bronch Treatment?
If not, Block; preferably at the segmental level
Use a bronchial blocker, not a double lumen tube
Uni Blocker

EZ Blocker

A poor 2nd choice is mainstem intubation
Bougie for selective lung
Then Get a CTA of the Chest
Then go to IR for Bronchial Artery Embolization
95% of the lesions will arrise from the bronchial circulation. The ones that don't are PE, Pulmonary Art Catheter mishaps, and AVMs of the Pulmonary arterial circulation.
If that fails, Surgery or ECMO
Now, On to the Podcast...]]>
Scott D. Weingart, MD clean 24:32
Podcast 198 – Insulin Pumps and Such with Josh Miller, MD https://emcrit.org/podcasts/insulin-pumps/ Mon, 01 May 2017 16:26:22 +0000 http://emcrit.org/?p=18099 Scared of insulin pumps--not anymore Scared of insulin pumps--not anymore

Today, we discuss the topic of insulin pumps. Heralded as a huge advance in the management of insulin-dependent diabetes mellitus (IDDM), they also bring a bit more complexity to the mix. To sort through this confusion, I brought my friend Josh Miller (@glucosedoc) on to the show to discuss.
Josh Miller, MD
Dr. Joshua D. Miller is the Medical Director of Diabetes Care for Stony Brook Medicine and an Assistant Professor of Endocrinology & Metabolism in the Department of Medicine. He is dual board-certified in Internal Medicine and Endocrinology, Diabetes & Metabolism.  Dr. Miller has vast experience helping people with diabetes to conquer the challenges of living with the disease; he has been living with type 1 diabetes for over twenty years. He is an expert in insulin pump and glucose sensor management as well as the transition of care to adult endocrinology for young adults with diabetes.
What we Covered
Tell Us About Insulin Pumps

* Settings (Basal, Bolus)
* What can go wrong
* How do we know if it is functioning
* How to turn it Off
* Site Infection--is this even an issue?
* More on Insulin Pumps

What do We do If Pt with PUMP has DKA?

* Leave It on or
* Supplement or
* Adjust Settings or
* Turn it off--if so how to take pt settings into account

Basal Insulin in the Critically Ill

* How much and how
* Insulin Drip
* Is Lantus Safe-how much and when

Euglycemic DKA

* what agents (SGLT2)
* how to manage
* See also RebelEM

Hypoglycemia with a Pump
from Josh: Hypoglycemia in a patient with diabetes on pump is multifactorial. If the hypoglycemia is so severe as to warrant admission, I would suspend or remove the pump. The patient should undoubtedly be assessed for insulin pump competency and diabetes self management skills. Acutely, patients should know how to temp basal or suspend the pump. Rarely would we treat through the insulin with dextrose and continue 100% basal delivery. If the patient is altered in any way, the pump should be suspended (by someone knowledgeable about pump function) or removed and an alternative SQ insulin regimen should immediately be pursued. The risk of course is forgetting the depot regimen and, once hypoglycemia resolves, causing ketosis.

Take home point: hypoglycemia on pump = call endocrine immediately.

Now on to the Show...]]>
Scott D. Weingart, MD clean 23:03
Ketamine ……. then Rocuronium, DSI & The Timing Principle https://emcrit.org/podcasts/ketamine-rocuronium-dsi-timing-principle/ Tue, 25 Apr 2017 14:47:21 +0000 https://emcrit.org/?p=440556 More on rocketamine... More on rocketamine...

So Josh's post yesterday (Rocketamine vs. keturonium for rapid sequence intubation) sparked much controversy and comment. I wanted to wade into the conflict, hence this wee.
Rocuronium Administration-Prior to Sedative
Administering roc as first drug is a variation of the timing principle demonstrated in a bunch of studies RCTs, here are 4 of them:

* http://www.ncbi.nlm.nih.gov/pubmed/9195356
* http://www.ncbi.nlm.nih.gov/pubmed/9585312
* http://www.ncbi.nlm.nih.gov/pubmed/7923516
* https://www.ncbi.nlm.nih.gov/pubmed/21547177

The most effective way to administer the med is actually to administer the sedative 15 sec after the roc, but most do not go that far. An easier to justify method is:

* Roc
* Induction agent
* Flush

This is my method for etomidate or propofol. For ketamine, I prefer DSI-type administration.
Listen to the Wee to Hear my Thoughts...]]>
Scott D. Weingart, MD clean 10:49
Podcast 197 – The Logistics of the Administration of Massive Transfusion https://emcrit.org/podcasts/logistics-administration-massive-transfusion/ Mon, 17 Apr 2017 16:51:34 +0000 https://emcrit.org/?p=440330 The hands-on of orchestrating a massive transfusion protocol The hands-on of orchestrating a massive transfusion protocol

We've talked about the rationale of massive transfusion a bunch on the EMCrit show:

* EMCrit Podcast 13: Trauma Resus II: Massive Transfusion
* Podcast 71: Critical Questions on Massive Transfusion Protocols with Kenji Inaba
* Podcast 144: The PROPPR trial with John Holcomb
* Podcast 081 - An Interview on Severe Trauma with Karim Brohi
* Hemorrhagic Shock Resus with Rick Dutton

Let's talk about the logistics of the actual administration of a massive transfusion protocol in an exsanguinating patient.
Some of the Stuff Mentioned in the Show

* The Level-1 Rapid Infusion System
* The Belmont Rapid Infuser

Now on to the 'Cast:]]>
Scott D. Weingart, MD clean 25:36
The Sick and the Dead: Evidence-Based Trauma Resuscitation in 2016 by Hicks & Petrosoniak https://emcrit.org/wee/the-sick-and-the-dead/ Tue, 04 Apr 2017 18:46:16 +0000 https://emcrit.org/?p=439783 The sick and the dead from SMACCdub The sick and the dead from SMACCdub
Trauma Year in Review 2016 from SMACCdub
by Chris Hicks and Andrew Petrosoniak
The science of trauma resuscitation has undergone a fairly massive evolution in the past decade.  This talk was our attempt to summarize the best-of-the-best in trauma literature from the past several years, and package it into a series of clinically useful recommendations (i.e., our evidence-based opinions).  This talk was live peer reviewed by trauma surgery deity Karim Brohi, who gave us a thumb’s up (although you kind of had to be there).

 
Here’s a run-down of our take-home points:
Use the Clamshell
Unless you’re a thoracic surgeon, consider the bi-thoracotomy as your initial approach to resuscitative thoracotomy. Don't operate in a hole – give yourself the best exposure, and the best shot at fixing the problem.

* Ref: WJS 2013, 37: 1277-1285
* How-to guide: http://emj.bmj.com/content/22/1/22

Prognosticate with POCUS
Point-of-care ultrasound (POCUS) has an ever-expanding role in trauma resuscitation, including prognosticating in cardiac arrest. In this study, patients with no cardiac activity and no pericardial effusion had no survival.

* Ref: Ann Surgery 2015, 262(3): 512-518

Get with the Guidelines
The EAST thoracotomy guidelines might be the most useful and evidence-based set of recommendations for the management of traumatic cardiac arrest yet. Bottom line: VSA trauma patients with penetrating thoracic injuries and an arrest time of < 10 minutes deserve a resuscitative thoracotomy – these are salvageable patients, and deserve an aggressive approach.

* Ref: Critical Care 2013, 17:308, J Trauma 2015, 79(1): 159-173
* Compare and contrast – WEST guidelines (2012): http://bit.ly/2mFemtM

Skip the Films
Stable patients with a plan for CT imaging don’t need a chest x-ray or pelvis x-ray. Not all patients undergoing CT need the full “pan-scan”. In the middle are assessable patients with reassuring vital signs, POCUS +/- x-ray imaging: they can be admitted for observation, or discharged.

* Ref: http://bit.ly/292tAUm
* In the same spirit – local wound exploration for anterior abdo stab wounds can eliminate the need for CT imaging, admission: https://www.ncbi.nlm.nih.gov/pubmed/22182859

Crystalloids kill
The paradigm of 1-2L of crystalloid boluses in hypotensive trauma patients is harmful and should be abandoned. If PRBCs aren’t immediately available, give small boluses (250 cc at a time) for patients with sBP < 70, altered mental status or loss of peripheral pulses. NICE guidelines restrict crystalloids to pre-hospital only.

* Ref: BJM 2012; 345: 38-42, http://bit.ly/292tAUm

Be Propper PROPPR
PROPPR in a nutshell: A balanced ratio of blood products (approximating 1:1:1) is probably the optimal approach for patients who are bleeding to death; also, platelets are pretty important early in trauma resus.

* Ref: JAMA 2015, 313(5): 471-482

Who Needs Mass Trans?
Predicting the need for massive transfusion in trauma is tricky. Relying on gestalt alone is associated with under-resuscitation in about one third of patients, even when trauma experts are making the call. In tricky situations, use the ABC score or shock index to improve situation awareness.

* Ref: Injury 2015, 46: 807-813, J Trauma 2009, 66: 346-352

Drop the dose
Trauma patients in profound shock don’t need the Full Monty when it comes to induction agents for RSI. Even the all-mighty ketamine can have negative hemod...]]>
Scott D. Weingart, MD clean 29:43
Podcast 196 – Having a Vomit SALAD with Dr. Jim DuCanto – Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding https://emcrit.org/podcasts/having-a-vomit-salad-with-ducanto/ Mon, 03 Apr 2017 14:58:23 +0000 http://emcrit.org/?p=16488 Friend to the show, Jim DuCanto has been obsessed with SALAD. Not the leafy greens delicately touched with a tart emulsion, but with Suction Assisted Laryngoscopy and Airway Decontamination (SALAD). Jim DuCanto, MD  is an anesthesiologist extraordinaire with a constant drive to perfect new airway techniques and document them on video along the way. COI Statement Dr. DuCanto invented and receives royalties on the DuCanto Catheter from SSCOR and the Nasco SALAD mannequin Read More about SALAD from Taming the Sru TtS Post Esophageal Diversion Maneuver (Intentional Esophageal Intubation) deliberately insert the ETT down the esophagus and gently inflate the balloon There is lit for this SALAD Park Maneuver Keep tip of suction catheter in the esophagus on the left side of the mouth SALAD Techniques Meconium Suction Set-Up Here was our original letter (J Clin Anesth, 23 (2011), pp. 518–519) (fulltext) It was recently validated (The Journal of Emergency Medicine Volume 52, Issue 4, April 2017, Pages 433–437)   More Stuff SALAD Facebook Page SSCOR Site Taming the SRU write-up of SALAD DuCanto Suction Catheter General Description of system and demonstration by Jeff Hill of the University of Cincinnati’s EM Program Product page of SALAD Mannequin University of Wisconsin HEMS Fellow with the “Static” Excercise University of Wisconsin HEMS Fellow with the “Dynamic” Excercise University of Wisconsin HEMS Attending takes on the SALAD Simulator Check out the next level of SALAD—SALAD 2.0 Listen to the JellyBean with Jim More from Jim DuCanto on EMCrit Podcast 73 – Airway Tips and Tricks A New Bougie for your Pocket by Jim DuCanto A Guide to Intubating through the Intubating Laryngeal Airway Two New Videos from Jim DuCanto The Oxylator More DuCanto and Pocket Bougie Videos Two OR Intubation Videos How to Custom Bend a Video Stylet for use with the Cookgas AirQ ILA image at the top from J Downham Now on to the Podcast... Friend to the show, Jim DuCanto has been obsessed with SALAD. Not the leafy greens delicately touched with a tart emulsion, but with Suction Assisted Laryngoscopy and Airway Decontamination (SALAD). Jim DuCanto,

Friend to the show, Jim DuCanto has been obsessed with SALAD. Not the leafy greens delicately touched with a tart emulsion, but with Suction Assisted Laryngoscopy and Airway Decontamination (SALAD). Jim DuCanto, MD  is an anesthesiologist extraordinaire with a constant drive to perfect new airway techniques and document them on video along the way.
COI Statement
Dr. DuCanto invented and receives royalties on the DuCanto Catheter from SSCOR and the Nasco SALAD mannequin
Read More about SALAD from Taming the Sru

* TtS Post

Esophageal Diversion Maneuver (Intentional Esophageal Intubation)
deliberately insert the ETT down the esophagus and gently inflate the balloon

There is lit for this
SALAD Park Maneuver
Keep tip of suction catheter in the esophagus on the left side of the mouth
SALAD Techniques

Meconium Suction Set-Up
Here was our original letter (J Clin Anesth, 23 (2011), pp. 518–519) (fulltext)

It was recently validated (The Journal of Emergency Medicine Volume 52, Issue 4, April 2017, Pages 433–437)



 
More Stuff

* SALAD Facebook Page
* SSCOR Site
* Taming the SRU write-up of SALAD
* DuCanto Suction Catheter
* General Description of system and demonstration by Jeff Hill of the University of Cincinnati’s EM Program
* Product page of SALAD Mannequin
* University of Wisconsin HEMS Fellow with the “Static” Excercise
* University of Wisconsin HEMS Fellow with the “Dynamic” Excercise
* University of Wisconsin HEMS Attending takes on the SALAD Simulator
* Check out the next level of SALAD—SALAD 2.0
* Listen to the JellyBean with Jim

More from Jim DuCanto on EMCrit

* Podcast 73 – Airway Tips and Tricks
* A New Bougie for your Pocket by Jim DuCanto
* A Guide to Intubating through the Intubating Laryngeal Airway
* Two New Videos from Jim DuCanto
* The Oxylator
* More DuCanto and Pocket Bougie Videos
* Two OR Intubation Videos
* How to Custom Bend a Video Stylet for use with the Cookgas ...]]>
Scott D. Weingart, MD clean 19:20
EMCrit Wee – Edited Version of Paul Marik on the Metabolic Resuscitation of Sepsis https://emcrit.org/wee/edited-marik-metabolic-sepsis/ Tue, 28 Mar 2017 16:22:20 +0000 https://emcrit.org/?p=439749 Edited interview with Paul Marik Edited interview with Paul Marik
Read Josh's Post on the
Metabolic Resuscitation of Sepsis first, then listen to this interview with Paul Marik:
Note to Listeners:
I took down the original version and put up this edited version. The only difference from the original is some additional comments added at 13:03 to give a more accurate perception of the current level of evidence of this therapy.

Please, please read the Pulmcrit post listed above before listening.
On to the Wee...]]> Scott D. Weingart, MD clean 16:05 Podcast 195 – Management of Tracheostomy (Trach) and Laryngectomy Emergencies https://emcrit.org/podcasts/tracheostomy-emergencies/ Mon, 20 Mar 2017 17:58:51 +0000 http://emcrit.org/?p=5742 Trach Emergencies Trach Emergencies
The Best Paper and the most amazing site
Guidelines for Tracheostomy and Laryngectomy Emergencies (Anaesthesia 2012;67:1025)

from the National Tracheostomy Safety Project (NTSP), the ultimate site for trach emergency management
Bedside Signs


Get the Tracheostomy Sign as double-sided sign for the bedside



Get the Laryngectomy Sign as double-sided sign for the bedside

Here is the version to edit your own signs
Now on to the Podcast...]]>
Scott D. Weingart, MD clean 30:18
Podcast 194 – Definitive Emergent Awake Intubation with George Kovacs https://emcrit.org/podcasts/definitive-emergent-awake-intubation/ Mon, 06 Mar 2017 18:15:12 +0000 https://emcrit.org/?p=438582 Podcast 194 - The Definitive Emergent Awake Intubation Lecture by @kovacsgj Podcast 194 - The Definitive Emergent Awake Intubation Lecture by @kovacsgj

Not enough people are doing awake intubation in the ED or doing it as quickly as possible in the ICU. I have spoken about the technique many times on EMCrit. This lecture was specifically crafted for the EMCrit audience by my friend and airway guru, George Kovacs. I consider it to be the definitive discussion on emergent awake intubation.

For the equipment links, go to the Rapid Sequence Awake Post
Previous Podcasts on Awake Intubation

* The original method (I've moved away from the teachings here with the availability of better equipment)
* The Rapid Sequence Awake Intubation

Awake in Halifax, Part I - An interview with Ian Morris, Anesthesiologist

More Great Stuff from George Kovacs

* Lights Camera Action: Redirecting Videolaryngoscopy (Guest Post)
* Antifragile in EM by George Kovacs
* George's Self-Intubation

Sign up for REANIMATE4


REANIMATE Site
Now on to the Vodcast...
]]>
Scott D. Weingart, MD clean yes
Podcast 193 – Emergency Medicine is a Failed Paradigm https://emcrit.org/podcasts/podcast-193-emergency-medicine-failed-paradigm/ Mon, 20 Feb 2017 16:26:12 +0000 http://emcrit.org/?p=336999 Yep, EM is indeed a failed paradigm Yep, EM is indeed a failed paradigm
At SmaccDUB, I got to debate my friend and head wizard of St. Emlyns, Simon Carley. Our topic was, Emergency Medicine (EM) is a Failed Paradigm. I took the pro side--it was a ton of fun. Take a watch and then tell me what you think in the comments section below.
The St. Emlyn's Post
Simon wrote a wonderful blogpost about the debate.
The Slides

Additional Links of Interest
Graham Walker on "Emergentology: Don't Worry; We'll Handle It"
The Video
]]>
Scott D. Weingart, MD clean 27:55 yes
EMCrit Wee – The Golden Fleece, the Golden Hour, and the Golden Rule by Ashley Liebig https://emcrit.org/podcasts/golden-rule-by-ashley-liebig/ Thu, 16 Feb 2017 00:40:32 +0000 https://emcrit.org/?p=438611 Ashley crushes stigma and leaves us acutely aware of how our words and actions affect our colleagues and those that we love Ashley crushes stigma and leaves us acutely aware of how our words and actions affect our colleagues and those that we love Scott D. Weingart, MD clean 24:48 Podcast 192 – Powerpoint and Meth – Presentation Creation from #TTC https://emcrit.org/podcasts/powerpoints-meth/ Mon, 06 Feb 2017 20:02:55 +0000 https://emcrit.org/?p=438242 The slides are not the problem... The slides are not the problem... Scott D. Weingart, MD clean 32:15 Wee – Warning: Nothing Useful Here – Politics and Why I’m “Divorcing” Twitter https://emcrit.org/wee/wee-warning-nothing-useful-politics-im-divorcing-twitter/ Wed, 01 Feb 2017 22:17:23 +0000 http://emcrit.org/?p=437662 if you still want to listen after reading the title if you still want to listen after reading the title Scott D. Weingart, MD clean 13:21 Podcast 191 – Cardiac Arrest Update https://emcrit.org/podcasts/cardiac-arrest-update/ Mon, 23 Jan 2017 13:00:09 +0000 http://emcrit.org/?p=437743 Cardiac Arrest Update & the Syndromes of Arrest Cardiac Arrest Update & the Syndromes of Arrest Scott D. Weingart, MD clean 24:26 Practical Evidence Podcast 015 – Surviving Sepsis Campaign (SSC) Guidelines 2016 (in 2017) https://emcrit.org/practicalevidence/ssc-guidelines-2016/ Sun, 22 Jan 2017 18:47:38 +0000 http://emcrit.org/?p=437733 SSC 2016 Guidelines SSC 2016 Guidelines Scott D. Weingart, MD clean 24:38 Podcast 190 – Emergencies with a Side of Hypertension https://emcrit.org/podcasts/hypertensive-emergencies/ Tue, 10 Jan 2017 02:47:17 +0000 http://emcrit.org/?p=3008 Hypertensive emergencies look like emergencies! Hypertensive emergencies look like emergencies! Scott D. Weingart, MD clean 25:01 EMCrit 189 – End of Year Grab Bag https://emcrit.org/podcasts/end-year-grab-bag/ Wed, 28 Dec 2016 16:38:49 +0000 http://emcrit.org/?p=387430 A brain dump at the end of 2016 A brain dump at the end of 2016 Scott D. Weingart, MD clean 22:05 Podcast 188 – Rudeness Part II (the Brindley Sessions) https://emcrit.org/podcasts/rudeness-ii/ Mon, 12 Dec 2016 18:29:49 +0000 http://emcrit.org/?p=386776 Brindley Session 2 - continuing the rudeness discussion Brindley Session 2 - continuing the rudeness discussion Scott D. Weingart, MD clean 22:22 Podcast 187 – Hypernatremia (Uggggh!) https://emcrit.org/podcasts/hypernatremia/ Mon, 28 Nov 2016 17:24:56 +0000 http://emcrit.org/?p=10134 Hypernatremia -- not sexy, but we gotta get 'im done Hypernatremia -- not sexy, but we gotta get 'im done Scott D. Weingart, MD clean 21:09 Podcast 186 – Coma with Eelco Wijdicks https://emcrit.org/podcasts/coma/ Sun, 13 Nov 2016 16:33:29 +0000 http://emcrit.org/?p=347218 How to Diagnose and Manage Coma How to Diagnose and Manage Coma Scott D. Weingart, MD clean 21:31 Podcast 185 – Disruption, Danger and Droperidol by Reub Strayer https://emcrit.org/podcasts/disruption-danger-droperidol/ Mon, 31 Oct 2016 12:41:00 +0000 http://emcrit.org/?p=283072 Danger, Disruption, and Reub Strayer Danger, Disruption, and Reub Strayer Scott D. Weingart, MD clean 26:09 The Brindley Sessions: Rudeness https://emcrit.org/wee/brindley-sessions-rudeness/ Wed, 26 Oct 2016 15:07:27 +0000 http://emcrit.org/?p=56151 The first Brindley Session is on Rudeness The first Brindley Session is on Rudeness Scott D. Weingart, MD clean 22:08 Response to Letters on my Mechanical Ventilation Article in the Ann Emerg Med https://emcrit.org/wee/response-mechanical-ventilation/ Fri, 21 Oct 2016 17:18:25 +0000 http://emcrit.org/?p=234409 Response to letters to the editor on mechanical ventilation article Response to letters to the editor on mechanical ventilation article Scott D. Weingart, MD clean 30:36 Podcast 184 – Needle Cric (Again) and Transtracheal Jet Ventilation with Laura Duggan https://emcrit.org/podcasts/needle-cric-again/ Sun, 16 Oct 2016 16:22:18 +0000 http://emcrit.org/?p=190532 The needle vs. knife debate rages on, but it looks like the knife may be winning The needle vs. knife debate rages on, but it looks like the knife may be winning Scott D. Weingart, MD clean 21:46 Podcast 183 – Driving Pressure with Dr. Roy Brower https://emcrit.org/podcasts/driving-pressure/ Mon, 03 Oct 2016 18:10:28 +0000 http://emcrit.org/?p=62998 Driving Pressure with Dr. Roy Brower Driving Pressure with Dr. Roy Brower Scott D. Weingart, MD clean 19:25 Podcast 181 – Pulmonary Hypertension and Right Ventricular Failure with Susan Wilcox https://emcrit.org/podcasts/pulmonary-hypertension-right-ventricular-failure/ Mon, 05 Sep 2016 17:46:41 +0000 http://emcrit.org/?p=11368 Pulmonary Hypertension and Acute on Chronic RV Failure Pulmonary Hypertension and Acute on Chronic RV Failure Scott D. Weingart, MD clean 25:26 Podcast 180 – On Argumentation, Fallacies, and Twitter Misery https://emcrit.org/podcasts/argumentation/ Mon, 22 Aug 2016 23:11:21 +0000 http://emcrit.org/?p=96429 A slight diversion to discuss how to argue better A slight diversion to discuss how to argue better Scott D. Weingart, MD clean 24:43 Podcast 179 – An Interview with Gary Klein https://emcrit.org/podcasts/decision-making-gary-klein/ Sun, 07 Aug 2016 19:10:58 +0000 http://emcrit.org/?p=19054 Today, I am joined by my friend, Mike Lauria, to interview Gary Klein, PhD. Dr. Klein is a masterful cognitive psychologist. He is known for many groundbreaking works, including: the Recognition-Primed Decision (RPD) model to describe how people actually make decisions in natural settings; a Data/Frame model of sensemaking; a Management by Discovery model of planning to handle wicked problems; and a Triple-Path model of insight. He has also developed several research and application methods: The Critical Decision method and Knowledge Audit for doing cognitive task analysis; the PreMortem method of risk assessment; the ShadowBox method for training cognitive skills. He was instrumental in founding the field of Naturalistic Decision Making. The Books This is the one that got Mike and I started as Klein Fanboys The absolute best compilation of Dr. Klein's decision-making concepts that are directly applicable to medicine Next up on my reading list Recognition Primed Decisionmaking Wikipedia Link for RPD Sites and Links Dr. Klein's Company Shadowbox Training Articles Mentioned in the Show Kahneman D, Klein G. Conditions for intuitive expertise: a failure to disagree. Am Psychol. 2009 Sep;64(6):515-26. Can We Trust Best Practices? Six Cognitive Challenges of Evidence-Based Approaches. Journal of Cognitive Engineering and Decision Making Additional Related Stuff Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. Effects of reflective practice on the accuracy of medical diagnoses.  Going fast might not induce more error, it's about experience and if you have the patterns to recognize: Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians? Slowing down doesn't help.  Slow is just slow. Smooth is FAST, and smooth is about economy of cognitive resources and movements The relationship between response time and diagnostic accuracy. The etiology of diagnostic errors: a controlled trial of system 1 versus system 2 reasoning. Now on to the Podcast: Today, I am joined by my friend, Mike Lauria, to interview Gary Klein, PhD. Dr. Klein is a masterful cognitive psychologist. He is known for many groundbreaking works, including: the Recognition-Primed Decision (RPD) model to describe how people actual... Scott D. Weingart, MD clean 53:19 Modification of Scalpel Finger Bougie Technique https://emcrit.org/wee/modification-scalpel-finger-bougie-technique/ Mon, 01 Aug 2016 03:52:20 +0000 http://emcrit.org/?p=73030 No more bougie hold-up for scalpel-finger-bougie cric No more bougie hold-up for scalpel-finger-bougie cric Scott D. Weingart, MD clean 9:03 Rapid Sequence Awake – An Awake Intubation Update https://emcrit.org/wee/awake-intubation-update/ Fri, 29 Jul 2016 16:11:03 +0000 http://emcrit.org/?p=5480 Rapid Sequencing of Awake Intubation Rapid Sequencing of Awake Intubation Scott D. Weingart, MD clean 7:59 Podcast 178 – A Better Management Strategy for Symptomatic Hyponatremia (dDAVP Clamp) https://emcrit.org/podcasts/better-management-hyponatremia/ Mon, 25 Jul 2016 20:47:45 +0000 http://emcrit.org/?p=16722 What to actually do (besides nothing) for severe hyponatremia What to actually do (besides nothing) for severe hyponatremia Scott D. Weingart, MD clean 20:30 EMCrit Wee – Should a Nasal Cannula be Part of Denitrogenation / Preoxygenation https://emcrit.org/wee/nasal-cannula-denitrogenation-preoxygenation/ Tue, 19 Jul 2016 21:56:37 +0000 http://emcrit.org/?p=18398 NC: yea or nay NC: yea or nay Scott D. Weingart, MD clean 11:56 Podcast 177 – Chris Hicks on the Fog of War: Training the Resuscitationist Mindset https://emcrit.org/podcasts/chris-hicks-fog-of-war/ Mon, 11 Jul 2016 17:18:46 +0000 http://emcrit.org/?p=61116 Team Performance from Chris Hicks Team Performance from Chris Hicks Scott D. Weingart, MD clean 49:06 How Not to be a #ResusWANKER https://emcrit.org/wee/how-not-to-be-a-resuswanker/ Fri, 01 Jul 2016 14:15:15 +0000 http://emcrit.org/?p=17745 The seven folks that ruin your day... The seven folks that ruin your day... Scott D. Weingart, MD clean 34:43 Podcast 176 – Updated EMCrit Rapid Sequence Intubation Checklist https://emcrit.org/podcasts/intubation-checklist-2-0/ Mon, 27 Jun 2016 17:06:09 +0000 http://emcrit.org/?p=57608 The new improved version of the EMCrit RSI checklist The new improved version of the EMCrit RSI checklist Scott D. Weingart, MD clean 20:30 EMCrit Wee – Vipassana Meditation https://emcrit.org/wee/vipassana-meditation/ Sun, 19 Jun 2016 21:42:12 +0000 http://emcrit.org/?p=55387 My opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation. It will be available in the next few months. Hopefully this wee will tide you over. My opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation. It will be available in the next few months. Hopefully this wee will tide you over. Scott D. Weingart, MD clean 20:26 EMCrit Podcast 175 – A Follow-Up on the Fluids in Sepsis Panel with Phillipe Rola https://emcrit.org/podcasts/fluids-sepsis-rola/ Tue, 31 May 2016 21:07:53 +0000 http://emcrit.org/?p=22004 Fluids in Sepsis Fluids in Sepsis Scott D. Weingart, MD clean 29:31 SMACC-Back – On Marik and Lactate https://emcrit.org/blogpost/smacc-back-marik-lactate/ Sat, 21 May 2016 20:06:17 +0000 http://emcrit.org/?p=20667 Banging -- My -- Head -- Against -- Wall -- Repeatedly... Banging -- My -- Head -- Against -- Wall -- Repeatedly... Scott D. Weingart, MD clean 9:52 Podcast 174 – LaMW – Oxygenation Kills Part II https://emcrit.org/podcasts/lamw-oxygenation-kills-ii/ Sun, 15 May 2016 21:17:58 +0000 http://emcrit.org/?p=20333 Laryngoscope as a Murder Weapon - Oxygenation Kills Part II Laryngoscope as a Murder Weapon - Oxygenation Kills Part II Scott D. Weingart, MD clean 18:13 Podcast 173 – LaMW – Oxygenation Kills Part I https://emcrit.org/podcasts/lamw-oxygenation-kills/ Tue, 03 May 2016 00:29:43 +0000 http://emcrit.org/?p=19962 Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I Scott D. Weingart, MD clean 30:16 Reddit and A Free Sepsis Webinar https://emcrit.org/misc/reddit/ Thu, 21 Apr 2016 19:28:05 +0000 http://emcrit.org/?p=19421 G+ is dead, long live reddit G+ is dead, long live reddit Scott D. Weingart, MD clean 7:53 EMCrit Podcast 172d – Enough with the Can you Trust Podcasts/Blogs/New Media https://emcrit.org/podcasts/emcrit-podcast-172d-enough-can-trust-podcastsblogsnew-media/ Sun, 17 Apr 2016 17:52:51 +0000 http://emcrit.org/?p=19329 Yes, you can trust medical podcasters Yes, you can trust medical podcasters Scott D. Weingart, MD clean 10:41 EMCrit Podcast 172c – Vent as Bag & VAPOX https://emcrit.org/podcasts/emcrit-wee-vapox/ Sun, 17 Apr 2016 17:52:32 +0000 http://emcrit.org/?p=19234 the BVM is the most dangerous device in medicine--let's do better the BVM is the most dangerous device in medicine--let's do better Scott D. Weingart, MD clean 7:09 EMCrit Podcast 172b – MoTR – Get Faster! https://emcrit.org/podcasts/faster/ Sun, 17 Apr 2016 17:52:05 +0000 http://emcrit.org/?p=17669 Slow is Smooth, Smooth is Fast. Now, get faster Slow is Smooth, Smooth is Fast. Now, get faster Scott D. Weingart, MD clean 4:03 EMCrit Podcast 172a – The Mind Palace? https://emcrit.org/podcasts/mind-palace/ Sun, 17 Apr 2016 17:51:47 +0000 http://emcrit.org/?p=18360 I want the perfect external mind palace... I want the perfect external mind palace... Scott D. Weingart, MD clean 12:51 Podcast 171 – OODA Loops https://emcrit.org/podcasts/ooda-loops/ Sat, 02 Apr 2016 21:08:12 +0000 http://emcrit.org/?p=14229 Resuscitation is a System I Game... Resuscitation is a System I Game... Scott D. Weingart, MD clean 38:56 Wee – Cliff Deutschman with Additional Thoughts on Sepsis 3.0 https://emcrit.org/wee/wee-cliff-deutschman-additional-thoughts-sepsis-3-0/ Fri, 11 Mar 2016 17:56:00 +0000 http://emcrit.org/?p=18846 More on Sepsis 3.0 More on Sepsis 3.0 Scott D. Weingart, MD clean 27:00 Podcast 169 – Sepsis 3.0 with Merv Singer https://emcrit.org/podcasts/sepsis-3/ Mon, 07 Mar 2016 22:19:46 +0000 http://emcrit.org/?p=18796 Hear from the lead author of the new Sepsis 3.0 definitions Hear from the lead author of the new Sepsis 3.0 definitions Scott D. Weingart, MD clean 32:33 Podcast 168 – Kyle Gunnerson and the EC3 https://emcrit.org/podcasts/ec3/ Tue, 23 Feb 2016 16:23:32 +0000 http://emcrit.org/?p=18706 The USA's first stand-alone EDICU, the EC3 The USA's first stand-alone EDICU, the EC3 Scott D. Weingart, MD clean 32:26 Podcast 167- Emergency Critical Care with Sara Gray https://emcrit.org/podcasts/emergency-critical-care-sara-gray/ Tue, 09 Feb 2016 02:07:12 +0000 http://emcrit.org/?p=18630 Sara Gray is amazing--hear her talk about ED Critical Care from @smaccteam: Sara Gray is amazing--hear her talk about ED Critical Care from @smaccteam: Scott D. Weingart, MD clean 18:06 Podcast 165 – The Semantics of End of Life Discussions with Ashley Shreves https://emcrit.org/podcasts/semantics-end-of-life-discussions/ Sun, 10 Jan 2016 20:29:18 +0000 http://emcrit.org/?p=18356 How to have an end of life conversation in the ED How to have an end of life conversation in the ED Scott D. Weingart, MD clean 42:47 Podcast 164 – The Day I Didn’t Use Ultrasound by Mike Mallin https://emcrit.org/podcasts/day-i-didnt-use-ultrasound/ Sat, 26 Dec 2015 23:40:55 +0000 http://emcrit.org/?p=18168 An amazing story from Mike Mallin An amazing story from Mike Mallin Scott D. Weingart, MD clean 33:55 Resuscitation Program and FEMinEM discussion on Women as Conference Speakers and Unconscious Bias https://emcrit.org/blogpost/women-conference-speakers/ Sun, 20 Dec 2015 22:52:00 +0000 http://emcrit.org/?p=17690 ART Program and FEMinEM Hangout ART Program and FEMinEM Hangout Scott D. Weingart, MD clean 2:09 Response to a Letter to the Editor on DSI Study https://emcrit.org/blogpost/response-to-a-letter-dsi/ Sat, 19 Dec 2015 00:41:22 +0000 http://emcrit.org/?p=17995 A response to some DSI questions in the Annals A response to some DSI questions in the Annals Scott D. Weingart, MD clean 20:26 Podcast 163 – MotR – The Post-Resuscitation https://emcrit.org/podcasts/post-resuscitation/ Tue, 15 Dec 2015 19:30:40 +0000 http://emcrit.org/?p=16636 You saved a life or blew an airway--Now What? Handling the post-resuscitation on EMCrit # 163: You saved a life or blew an airway--Now What? Handling the post-resuscitation on EMCrit # 163: Scott D. Weingart, MD clean 23:06 Podcast 162 – Assessing Fluid Responsiveness https://emcrit.org/podcasts/assessing-fluid-responsiveness/ Sun, 29 Nov 2015 18:51:06 +0000 http://emcrit.org/?p=5410 yep, more on fluid responsiveness yep, more on fluid responsiveness Scott D. Weingart, MD clean 26:57 Podcast 161 – The New Fluid Assessment in Sepsis with Jean-Francois Lanctot https://emcrit.org/podcasts/new-fluid-assessment-sepsis/ Fri, 20 Nov 2015 16:41:09 +0000 http://emcrit.org/?p=17258 Fluids, Sepsis, Ultrasound, French-Canadian: what more do you want? Fluids, Sepsis, Ultrasound, French-Canadian: what more do you want? Scott D. Weingart, MD clean 25:52 Podcast 160 – Sepsis smaccDOWN https://emcrit.org/podcasts/sepsis-smaccdown/ Wed, 04 Nov 2015 03:19:09 +0000 http://emcrit.org/?p=16675 An all-star panel of world sepsis experts discuss the controversial areas An all-star panel of world sepsis experts discuss the controversial areas Scott D. Weingart, MD clean 1:18:08 Huge Announcement for EMCrit.org https://emcrit.org/pulmcrit/huge-announcement-for-emcrit-org/ Mon, 02 Nov 2015 20:14:31 +0000 http://emcrit.org/?p=16736 Big news... Big news... Scott D. Weingart, MD clean 2:05 Podcast 159 – Rounding in the RACC https://emcrit.org/podcasts/rounding-racc/ Fri, 30 Oct 2015 01:26:07 +0000 http://emcrit.org/?p=16690 Rounding on critically ill patients in the ED Rounding on critically ill patients in the ED Scott D. Weingart, MD clean 20:01 Podcast 158 – The FELLOW Trial on Apneic Oxygenation in ICU Patients https://emcrit.org/podcasts/fellow-trial/ Tue, 06 Oct 2015 18:07:18 +0000 http://emcrit.org/?p=16581 Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients Scott D. Weingart, MD clean 24:18 Podcast 157 – Central Lines II – Placement Tips https://emcrit.org/podcasts/central-lines-placement-tips/ Sun, 13 Sep 2015 22:43:22 +0000 http://emcrit.org/?p=16270 Part II of the Central Line Series discusses placement tips Part II of the Central Line Series discusses placement tips Scott D. Weingart, MD clean 30:12 EMCrit Wee – Central Line MicroSkills (Deliberate Practice) https://emcrit.org/wee/central-line-micro-skills-deliberate-practice/ Sat, 12 Sep 2015 17:08:21 +0000 http://emcrit.org/?p=16417 A break down of the skills needed for Seldinger technique A break down of the skills needed for Seldinger technique Scott D. Weingart, MD clean 11:37 Podcast 156 – The Central Line Show – Part I: Avoiding Complications https://emcrit.org/podcasts/central-line-show/ Sat, 29 Aug 2015 19:39:02 +0000 http://emcrit.org/?p=13722 Stop Effing Up Your Central Lines Stop Effing Up Your Central Lines Scott D. Weingart, MD clean 31:50 Wee – Avoiding Disaster – Endotracheal Tube Cuff Leaks and Tube Exchanges https://emcrit.org/wee/tube-exchanges/ Sat, 29 Aug 2015 00:15:13 +0000 http://emcrit.org/?p=116699 It seems simple, but not treating this situation with respect can lead to disaster. It seems simple, but not treating this situation with respect can lead to disaster. Scott D. Weingart, MD clean 18:33 Podcast 155 – Status Epilepticus with Tom Bleck https://emcrit.org/podcasts/status-epilepticus/ Fri, 14 Aug 2015 00:43:03 +0000 http://emcrit.org/?p=11067 Tom Bleck on Status Epilepticus Tom Bleck on Status Epilepticus Scott D. Weingart, MD clean 24:11 Podcast 154 – Preemptive Sepsis Panel SmaccBack https://emcrit.org/podcasts/sepsis-panel-smaccback/ Wed, 29 Jul 2015 01:17:11 +0000 http://emcrit.org/?p=15810 A preemptive smaccback on the SMACC Chicago Sepsis Panel A preemptive smaccback on the SMACC Chicago Sepsis Panel Scott D. Weingart, MD clean 38:34 Podcast 153 – In Memory – John Hinds, On How He Ran His Unit https://emcrit.org/podcasts/john-hinds-on-how-he-ran-his-unit/ Sun, 05 Jul 2015 16:01:39 +0000 http://emcrit.org/?p=15365 In Memory of Our Friend, John Hinds In Memory of Our Friend, John Hinds Scott D. Weingart, MD clean 41:33 Podcast 152 – High Flow Nasal Cannulae – Just Blowin’ Hot Air? https://emcrit.org/podcasts/hfnc/ Mon, 29 Jun 2015 19:50:20 +0000 http://emcrit.org/?p=14930 HFNC--the new hot thing or just blowin' hot air? HFNC--the new hot thing or just blowin' hot air? Scott D. Weingart, MD clean 21:49 EMCrit Podcast 151 – Procedural Sedation Part 3 with Jim Miner https://emcrit.org/podcasts/procedural-sedation-3/ Sun, 14 Jun 2015 20:12:56 +0000 http://emcrit.org/?p=15143 Jim Miner discusses the fine points of ED/ICU procedural sedation Jim Miner discusses the fine points of ED/ICU procedural sedation Scott D. Weingart, MD clean 23:34 Stuff Update (RCM, Reanimate, Developing EM) https://emcrit.org/podcasts/stuff-update-june-2015/ Tue, 09 Jun 2015 22:13:04 +0000 http://emcrit.org/?p=15069 RCM and 2 Conferneces RCM and 2 Conferneces Scott D. Weingart, MD clean 2:39 Podcast 150 – A Look Back https://emcrit.org/podcasts/a-look-back/ Mon, 01 Jun 2015 17:59:51 +0000 http://emcrit.org/?p=14967 Can't believe we made it this far...and it's all thanks to the emcritters! Can't believe we made it this far...and it's all thanks to the emcritters! Scott D. Weingart, MD clean 24:32 Podcast 149 – Thyroid Storm https://emcrit.org/podcasts/thyroid-storm/ Sat, 16 May 2015 22:17:01 +0000 http://emcrit.org/?p=13728 When hyperthyroidism goes really wrong... When hyperthyroidism goes really wrong... Scott D. Weingart, MD clean 20:16 Stuff Update https://emcrit.org/misc/stuff-may-2015/ Tue, 12 May 2015 17:52:30 +0000 http://emcrit.org/?p=14527 A whole bunch of stuff A whole bunch of stuff Scott D. Weingart, MD clean 6:07 Podcast 148 – Airway Decisions and Online Etiquette https://emcrit.org/podcasts/airway-decisions/ Mon, 27 Apr 2015 01:52:54 +0000 http://emcrit.org/?p=14481 More on the recent cric case from the perspective of airway decision making More on the recent cric case from the perspective of airway decision making Scott D. Weingart, MD clean 26:28 EMCrit Wee – Mind Blowing Cricothyrotomy Video https://emcrit.org/wee/real-surgical-airway/ Sat, 18 Apr 2015 19:26:26 +0000 http://emcrit.org/?p=14366 An amazing surgical airway case An amazing surgical airway case Scott D. Weingart, MD clean 13:19 EMCrit Podcast 147 – Who Needs an Acute PCI with Steve Smith (Part II) https://emcrit.org/podcasts/who-needs-an-acute-pci-ii/ Sun, 12 Apr 2015 17:09:23 +0000 http://emcrit.org/?p=14193 Finally in one place, all of the STEMI equivalents with Steve Smith--Part II Finally in one place, all of the STEMI equivalents with Steve Smith--Part II Scott D. Weingart, MD clean 23:27 EMCrit Podcast 146 – Who Needs an Acute PCI with Steve Smith (Part I) https://emcrit.org/podcasts/who-needs-acute-pci/ Sun, 29 Mar 2015 13:00:57 +0000 http://emcrit.org/?p=10568 Finally in one place, all of the STEMI equivalents with Steve Smith Finally in one place, all of the STEMI equivalents with Steve Smith Scott D. Weingart, MD clean 23:49 EMCrit Conference BLAST Winner – Ice Water Baths for Rapid Cooling of Hyperthermia https://emcrit.org/wee/ice-bath-hyperthermia/ Wed, 25 Mar 2015 03:52:40 +0000 http://emcrit.org/?p=14136 How to cool the too hot tox patient How to cool the too hot tox patient Scott D. Weingart, MD clean 7:06 Podcast 145 – Awake Intubation Lecture from SMACC https://emcrit.org/podcasts/awakeintubation/ Mon, 16 Mar 2015 18:14:12 +0000 http://emcrit.org/?p=14059 Awake Intubation from SMACC 2015 Awake Intubation from SMACC 2015 Scott D. Weingart, MD clean 26:46 EMCrit Wee – The RLA and the Slope of Resuscitation https://emcrit.org/wee/slope-of-resuscitation/ Mon, 02 Mar 2015 17:46:52 +0000 http://emcrit.org/?p=13897 The RLA and Resus Graphs The RLA and Resus Graphs Scott D. Weingart, MD clean 14:08 Podcast 144 – The PROPPR trial with John Holcomb https://emcrit.org/podcasts/proppr/ Sun, 22 Feb 2015 18:01:36 +0000 http://emcrit.org/?p=13784 The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author? The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author? Scott D. Weingart, MD clean 20:35 Podcast 143 – Hemodynamic Management of Massive Pulmonary Embolism (PE) https://emcrit.org/podcasts/hemodynamic-management-massive-pulmonary-embolism-pe/ Mon, 16 Feb 2015 00:56:32 +0000 http://emcrit.org/?p=13261 Hemodynamic Management of Massive PE Hemodynamic Management of Massive PE Scott D. Weingart, MD clean 32:33 Podcast 142 – Airway Things I Learned from George Kovacs at the NYC Airway Course https://emcrit.org/podcasts/airway-kovacs/ Sun, 25 Jan 2015 17:18:04 +0000 http://emcrit.org/?p=11222 In this 3rd post for JanuAirway, I am joined by airway educator extraordinaire: George Kovacs. In this 3rd post for JanuAirway, I am joined by airway educator extraordinaire: George Kovacs. Scott D. Weingart, MD clean 26:21 EMCrit Wee – Preoxygenation Update 2015 https://emcrit.org/wee/preoxygenation-update/ Thu, 22 Jan 2015 21:00:30 +0000 http://emcrit.org/?p=11337 It's Janu-Airway: Here's a little update on preox (you know the topic I think about 20 hours a day) It's Janu-Airway: Here's a little update on preox (you know the topic I think about 20 hours a day) Scott D. Weingart, MD clean 19:08 Podcast 141 – A Janu-Airway Case Presented Live https://emcrit.org/podcasts/emcrit-live-2015/ Sat, 10 Jan 2015 20:36:44 +0000 http://emcrit.org/?p=13334 A case of anatomically and physiologically difficult airway presented live at #EMCritConf 2015. A case of anatomically and physiologically difficult airway presented live at #EMCritConf 2015. Scott D. Weingart, MD clean 22:04 Podcast 140 – Top Picks for 2014 https://emcrit.org/podcasts/top-picks-2014/ Wed, 31 Dec 2014 20:33:59 +0000 http://emcrit.org/?p=6429 Welcome to our annual rehash of the goodness of the past year. Welcome to our annual rehash of the goodness of the past year. Scott D. Weingart, MD clean 9:35 Podcast 139 – Opioid-Free ED with Sergey Motov https://emcrit.org/podcasts/opioid-free-ed/ Sun, 14 Dec 2014 18:56:25 +0000 http://emcrit.org/?p=12200 Can we manage pain more effectively without Opioids? Can we manage pain more effectively without Opioids? Scott D. Weingart, MD clean 28:35 Podcast 138 – Vasopressor Basics https://emcrit.org/podcasts/vasopressor-basics/ Mon, 01 Dec 2014 17:25:23 +0000 http://emcrit.org/?p=4215 There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation. There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation. Scott D. Weingart, MD clean 30:33 EMCrit Podcast 136 – Getting Shit Done https://emcrit.org/podcasts/getting-shit-done/ Mon, 03 Nov 2014 18:44:20 +0000 http://emcrit.org/?p=11900 Not quite ED Critical Care, but I hope this discussion of EM/Resus Productivity may be helpful to some of you out there. Not quite ED Critical Care, but I hope this discussion of EM/Resus Productivity may be helpful to some of you out there. Scott D. Weingart, MD clean 47:34 EMCrit Podcast 135 – Trauma Thoughts with John Hinds https://emcrit.org/podcasts/trauma-thoughts-john-hinds/ Mon, 20 Oct 2014 01:23:38 +0000 http://emcrit.org/?p=11422 John Hinds on Blunt Traumatic Arrest John Hinds on Blunt Traumatic Arrest Scott D. Weingart, MD clean 25:55 EMCrit Wee – I Thought This Would be the One, but Nope…. https://emcrit.org/podcasts/more-on-arise/ Mon, 13 Oct 2014 00:10:38 +0000 http://emcrit.org/?p=11458 Smells like some confirmation bias here Smells like some confirmation bias here Scott D. Weingart, MD clean 10:14 Podcast 134 – ARISE has arisen; now where do we stand on Severe Sepsis in 2014 https://emcrit.org/podcasts/arise-trial-sepsis-2014/ Fri, 03 Oct 2014 22:55:35 +0000 http://emcrit.org/?p=11289 the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014 the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014 Scott D. Weingart, MD clean 21:53 EMCrit Podcast 133 – The First Prehospital REBOA https://emcrit.org/podcasts/emcrit-podcast-133-first-prehospital-reboa/ Wed, 24 Sep 2014 14:58:07 +0000 http://emcrit.org/?p=11128 London HEMS docs peform REBOA and save a life London HEMS docs peform REBOA and save a life Scott D. Weingart, MD clean 25:54 EMCrit Wee – Aggressiveness and the New Cutdown with Leon Boudourakis, MD https://emcrit.org/wee/aggressiveness-and-the-new-cutdown/ Wed, 17 Sep 2014 22:13:55 +0000 http://emcrit.org/?p=11035 Need access--this may be a way Need access--this may be a way Scott D. Weingart, MD clean 9:40 EMCrit Wee – A Case to Threaten Current ECMO Evidence from Sam Ghali https://emcrit.org/wee/prolonged-cpr-case/ Fri, 15 Aug 2014 14:35:53 +0000 http://emcrit.org/?p=7951 Should we be extending ACLS in patients we really want to save? Should we be extending ACLS in patients we really want to save? Scott D. Weingart, MD clean 5:44 EMCrit Podcast 130 – Hemodynamic-Directed Dosing of Epinephrine for Cardiac Arrest https://emcrit.org/podcasts/hemodynamic-directed-dosing-epinephrine/ Sun, 10 Aug 2014 19:22:21 +0000 http://emcrit.org/?p=9761 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. 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. Scott D. Weingart, MD clean 18:24 MotR – Mike Lauria on “Making the Call” https://emcrit.org/podcasts/motr-mike-lauria/ Thu, 31 Jul 2014 13:26:47 +0000 http://emcrit.org/?p=10394 You'll be hearing more from Mike You'll be hearing more from Mike Scott D. Weingart, MD clean 42:52 Podcast 129 – LAMW: The Neurocritical Care Intubation https://emcrit.org/podcasts/neurocritical-care-intubation/ Sat, 26 Jul 2014 16:36:12 +0000 http://emcrit.org/?p=4458 This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault. This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault. Scott D. Weingart, MD clean 31:00 Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman https://emcrit.org/podcasts/pulmonary-embolism-treatment-team/ Mon, 14 Jul 2014 14:24:33 +0000 http://emcrit.org/?p=9513 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. Cornell Pulmonary Embolism (PE) Advanced Care Team (PEAC), aka the CLOT Team Oren Friedman MD, Pulm Crit Care; James Horowitz MD, Cardiology; Arash Salemi MD, Cardiac Surgery; Akhilesh Sista MD, Interventional Radiology You can shoot the team an email: peadvancedcare at gmail dot com Who Should We Treat? 30% normotensive patients have RVD; 10% progressed to shock; 5% in hospital mortality The Better Risk Categories for Pulmonary Embolism Well and Stable Sub-Massive High-Risk Sub-Massive Massive PEITHO Trial NEJM 2014;370(15):1402 Full dose tenecteplase with concurrent heparin Death or hemodynamic decompensation occurred in 2.6% of the tenecteplase group as compared with 5.6% of the placebo group Extracranial bleeding occurred in 32 patients (6.3%) in the tenecteplase group and 6 patients (1.2%) in the placebo group (P<0.001) Intracranial Bleed 10 patients (2%) in the tenecteplase group and 1 patient (0.2%) in the placebo group (P=0.003) Also see my bud, Salim Rezaie's post on PEITHO and Konstantinides' prior study Ryan Radecki made some great observations in his post on PEITHO 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. Not all placebo patients developing hemodynamic collapse received subsequent thrombolysis; likewise, almost half of those who received open-label thrombolysis had no hemodynamic collapse. Half the deaths in the placebo arm were “sudden unexplained” or “other”, compared with bleeding or stroke complications in the thromboysis arm. TOPCOAT Trial Jeff Kline's trial was stopped midway through due to an institution change. Complicated primary endpoint with promising, but unusable results For the scoop on this one see the Bottom Line Review post on TOPCOAT MOPETT Trial Half-dose alteplase led to a marked reduction in pulmonary hypertension without sig. complications Sharifi M et al. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT trial). (J Cardiol 2013; 111: 273) See this prior EMCrit Wee as well on MOPPETT Update: This meta-analysis states that the half-dose may be appropriate, effective, and safe Meta-Analysis Chatterjee et al. have the most current meta-analysis on this topic (JAMA. 2014;311(23):2414-2421) See the Bottom Line Review post on this study Nakamura just published another MA this week; see Rory Spiegel's take on the two here Is it just in the Oldies? Markedly lower risk in <75 y/o in PEITHO and <65 in the Meta-Analysis The Treatment Options Heparin Alone 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 Systemic Thrombolysis With either full or half-dose alteplase or full-dose tenecteplase Catheter-Based Intra-Arterial Thombolytic Infusion Angiography guided placement of pulmonary artery catheters allowing a 24-hour infusion of low dose tPA. 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 Interventional Mechanical Clot Disruption AngioJet-a catheter that breaks up the clot with a high speed jet of saline, heparin, or tPA that then sucks up clot using Bernoulli physics. Very little systemic drug is delivered. Oren's center doesn't like the device; other centers use it. 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, Scott D. Weingart, MD clean 33:08 Podcast 127 – The Oxylator with Jim DuCanto https://emcrit.org/podcasts/oxylator/ Sun, 29 Jun 2014 19:15:45 +0000 http://emcrit.org/?p=3881 BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator BVMs are ridiculously crappy and downright dangerous. The solution? the Oxylator Scott D. Weingart, MD clean 20:19 SMACC-Back – On the Beliefs of Early Adopters and Straw Men https://emcrit.org/wee/on-the-beliefs-adopters-straw-men/ Tue, 24 Jun 2014 19:45:36 +0000 http://emcrit.org/?p=9899 The First SMACC-Back from SMACCgold The First SMACC-Back from SMACCgold Scott D. Weingart, MD clean 16:30 Podcast 126 – TTM Trial Right from Niklas Nielsen’s Mouth https://emcrit.org/podcasts/ttm-trial-niklas-nielsen/ Sun, 15 Jun 2014 19:29:40 +0000 http://emcrit.org/?p=7745 In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial. In this episode, I speak with Niklas Nielsen on his thoughts on the TTM trial. Scott D. Weingart, MD clean 18:09 EMCrit Wee – Four More Minutes with Rob Mac Sweeney https://emcrit.org/wee/rob-mac-sweeneys-stuff/ Wed, 11 Jun 2014 17:45:26 +0000 http://emcrit.org/?p=9485 I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is... I told you today we would have a bit of discussion on Rob Mac Sweeney's FOAM. Well here it is... Scott D. Weingart, MD clean 4:32 EMCrit Wee – Rob Mac Sweeney on Intra-Arrest Meds https://emcrit.org/wee/rob-mac-sweeney/ Tue, 10 Jun 2014 18:28:46 +0000 http://emcrit.org/?p=9471 Rob Mac Sweeny on the Intra-Arrest Talk Rob Mac Sweeny on the Intra-Arrest Talk Scott D. Weingart, MD clean 16:40 Mind of the Resuscitationist – Errors of Commission and Omission https://emcrit.org/wee/motr-commission-and-omission/ Fri, 06 Jun 2014 18:20:58 +0000 http://emcrit.org/?p=9389 Should we err towards errors of commission or omission? Should we err towards errors of commission or omission? Scott D. Weingart, MD clean 5:22 Podcast 125 – The New Intra-Arrest (Cardiac Arrest Management) https://emcrit.org/podcasts/new-intra-arrest/ Mon, 02 Jun 2014 15:59:28 +0000 http://emcrit.org/?p=9246 Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care Scott D. Weingart, MD clean 21:11 EMCrit Wee – Cricolol by Dr. John Hinds https://emcrit.org/wee/cricolol/ Wed, 28 May 2014 15:29:42 +0000 http://emcrit.org/?p=9170 My favorite part of SMACCgold; buy some Cricolol My favorite part of SMACCgold; buy some Cricolol Scott D. Weingart, MD clean 8:36 Podcast 124 – The Logistics of Proning for ARDS https://emcrit.org/podcasts/logistics-proning/ Mon, 19 May 2014 00:10:08 +0000 http://emcrit.org/?p=8001 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. 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. Scott D. Weingart, MD clean 23:21 EMCrit Wee – Sean Townsend of the SSC and the ProCESS Trial https://emcrit.org/wee/ssc-process-trial-response/ Fri, 09 May 2014 19:36:30 +0000 http://emcrit.org/?p=8239 I talk with a member of the surviving sepsis campaign steering committee re: ProCESS I talk with a member of the surviving sepsis campaign steering committee re: ProCESS Scott D. Weingart, MD clean 17:33 Podcast 123 – Selective Aortic Arch Perfusion (SAAP) with Jim Manning https://emcrit.org/podcasts/selective-aortic-arch-perfusion/ Tue, 06 May 2014 14:50:06 +0000 http://emcrit.org/?p=8441 What if you had a REBOA catheter through which you could give blood and drugs? What if you had a REBOA catheter through which you could give blood and drugs? Scott D. Weingart, MD clean 28:31 EMCrit Wee – A Cric Case with Rob Bryant https://emcrit.org/wee/cric-case-rob-bryant/ Thu, 24 Apr 2014 23:07:14 +0000 http://emcrit.org/?p=8147 Rob Bryant presents a case Rob Bryant presents a case Scott D. Weingart, MD clean 12:12 Podcast 122 – Cardiac Arrest after the Toxicology of Smoke Inhalation with Lewis Nelson https://emcrit.org/podcasts/cardiac-arrest-after-smoke-inhalation/ Mon, 21 Apr 2014 02:46:07 +0000 http://emcrit.org/?p=8131 What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns? What is the proper care for a patient in cardiac arrest or shock after smoke inhalation if they don't have severe burns? Scott D. Weingart, MD clean 18:01 EMCrit Podcast 121 – REBOA https://emcrit.org/podcasts/reboa/ Sun, 06 Apr 2014 19:05:12 +0000 http://emcrit.org/?p=7061 This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta). This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta). Scott D. Weingart, MD clean 20:31 Podcast 120 – The ProCESS Trial with Derek Angus https://emcrit.org/podcasts/process-trial/ Mon, 24 Mar 2014 23:55:24 +0000 http://emcrit.org/?p=7717 I speak to the lead author of the ProCESS trial, Dr. Derek Angus I speak to the lead author of the ProCESS trial, Dr. Derek Angus Scott D. Weingart, MD clean 25:35 Wee – What the heck is a Mapleson B Circuit and Why You Probably Shouldn’t Care https://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 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 as the Ultimate Preox Device 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. My Recommended Approaches I recommend two approaches to preox: standard and shunt physiology strategies. I outlines these strategies in the paper Rich Levitan and I wrote. Standard: NRB @ >=15 lpm and NC @ 10-15 lpm for 3 minutes Shunt Physio: Choose 1 BVM with PEEP Valve & NC @ 10-15 lpm NIPPV Ventilator with NIPPV Mask or BVM Mask & NC @ 10-15 lpm 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. Automatic Checking 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. Multiple BVM Masks 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. PEEP 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. ApOx Mapleson may provide this better than BVM, but not as well as a NC, which should be on during any intubation. ETCO2 No advantage of Mapleson Low resistance Maybe this matters, as soon as you put on the PEEP, I can't imagine this difference persisting Room Air Entrainment 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. Troubleshooting Leaks 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. 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). This is the same reason I tell my residents to just train with Macintosh blades. 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 ETCO2 with a monitor you can see Is he holding or squeezing? 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: >15 cmH20 may be entraining gas into the stomach via the LES (in some patients, even 10 cmH20 may be a problem) 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) Two hands ALWAYS on the mask Recently, I spent 2 weeks intubating 10-15 patients per day. One hand mask skills got better and better--all for naught. Train how you want to Fight Hands free 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. - Scott D. Weingart, MD clean 19:11 Podcast 119 – Rich Levitan on the Surgical Airway https://emcrit.org/podcasts/levitan-surgical-airway/ Mon, 10 Mar 2014 16:50:49 +0000 http://emcrit.org/?p=7174 Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference Rich Levitan on Surgical Airway from EMCrit/ISMMS 2014 Conference Scott D. Weingart, MD clean 26:45 Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman https://emcrit.org/podcasts/emcrit-book-club-on-combat-by-grossman/ Sun, 23 Feb 2014 15:00:28 +0000 http://emcrit.org/?p=6686 Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman Cliff Reid joins me for the 1st EMCrit book club on the book, On Combat by Dave Grossman Scott D. Weingart, MD clean 34:42 Practical Evidence 014 – ACEP Procedural Sedation Update for 2013 https://emcrit.org/practicalevidence/acep-procedural-sedation-update-2013/ Tue, 18 Feb 2014 22:26:30 +0000 http://emcrit.org/?p=6812 This one is really good! This one is really good! Scott D. Weingart, MD clean 8:42 Podcast 117 – Everyday Emergency Kits with Keith Conover https://emcrit.org/podcasts/everyday-emergency-kits-keith-conover/ Mon, 10 Feb 2014 16:09:36 +0000 http://emcrit.org/?p=5153 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. 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. Scott D. Weingart, MD clean 30:42 Podcast 116 – the tPA for Ischemic Stroke Debate https://emcrit.org/podcasts/tpa-for-ischemic-stroke-debate/ Mon, 27 Jan 2014 15:30:02 +0000 http://emcrit.org/?p=6532 Dr. Andy Jagoda debates my friend Dr. Anand Swaminathan on the use of tPA for Ischemic Stroke in the Emergency Department Dr. Andy Jagoda debates my friend Dr. Anand Swaminathan on the use of tPA for Ischemic Stroke in the Emergency Department Scott D. Weingart, MD clean 52:21 Podcast 115 – A New Paradigm for Post-Intubation Pain, Agitation, and Delirium (PAD) https://emcrit.org/podcasts/post-intubation-sedation-2014/ Mon, 13 Jan 2014 21:00:48 +0000 http://emcrit.org/?p=4297 What you do in the ED for post-intubation sedation will determine whether your patient lives or dies What you do in the ED for post-intubation sedation will determine whether your patient lives or dies Scott D. Weingart, MD clean 21:21 Best of 2013 – Eight is Enough & Social Media Update https://emcrit.org/wee/best-of-2013/ Tue, 31 Dec 2013 21:43:29 +0000 http://emcrit.org/?p=4657 Best of 2013 Best of 2013 Scott D. Weingart, MD clean 20:45 Podcast 114 – Post-Arrest Care in 2013 with Stephen Bernard – Part II https://emcrit.org/podcasts/post-arrest-care-2013-ii/ Mon, 16 Dec 2013 18:19:58 +0000 http://emcrit.org/?p=5607 Part 2 of an interview with Stephen Bernard on the Care of the Post-Arrest Patient in 2013 Part 2 of an interview with Stephen Bernard on the Care of the Post-Arrest Patient in 2013 Scott D. Weingart, MD clean 19:13 Five Minutes with Jon Rittenberger on the TTM Trial https://emcrit.org/wee/five-minutes-jon-rittenberger-ttm-trial/ Mon, 18 Nov 2013 22:56:43 +0000 http://emcrit.org/?p=5422 More on TTM Trial More on TTM Trial Scott D. Weingart, MD clean 5:35 EMCrit Wee – The Targeted Temperature Trial Changes Everything https://emcrit.org/podcasts/emcrit-wee-targeted-temperature-trial-changes-everything/ Mon, 18 Nov 2013 20:28:29 +0000 http://emcrit.org/?p=5416 Cold, but not all that cold may be the way Cold, but not all that cold may be the way Scott D. Weingart, MD clean 2:53 Podcast 111 – Fluids in Sepsis, A New Paradigm – Paul Marik https://emcrit.org/podcasts/paul-marik-fluids-sepsis/ Sat, 09 Nov 2013 17:50:58 +0000 http://emcrit.org/?p=5394 Our favorite critical care skeptic, Dr. Paul Marik, on fluids in severe sepsis Our favorite critical care skeptic, Dr. Paul Marik, on fluids in severe sepsis Scott D. Weingart, MD clean 51:37 SMACC Back 3 – Simon Carley on Leadership https://emcrit.org/wee/simon-carley-on-leadership/ Wed, 06 Nov 2013 20:44:47 +0000 http://emcrit.org/?p=5385 A SMACC back on Simon Carley's talk on Educational Leadership A SMACC back on Simon Carley's talk on Educational Leadership Scott D. Weingart, MD clean 7:51 Podcast 110 – Exsanguinating Hemorrhage from Mid-Face Fractures https://emcrit.org/podcasts/exsanguinating-hemorrhage-mid-face-fractures/ Fri, 01 Nov 2013 19:33:56 +0000 http://emcrit.org/?p=5242 Management of Severe Hemorrhage from Mid-Face Blunt Trauma Management of Severe Hemorrhage from Mid-Face Blunt Trauma Scott D. Weingart, MD clean 18:39 Practical Evidence 013 – ACEP Management of Asymptomatic Blood Pressure 2013 https://emcrit.org/practicalevidence/2013-acep-management-of-asymptomatic-htn/ Tue, 22 Oct 2013 21:17:17 +0000 http://emcrit.org/?p=5354 Management of asymptomatic markedly elevated blood pressure Management of asymptomatic markedly elevated blood pressure Scott D. Weingart, MD clean 10:26 Podcast 109 – Mind of the Resuscitationist from SMACC 2013 https://emcrit.org/podcasts/mind-of-the-resuscitationist-smacc/ Mon, 14 Oct 2013 09:00:13 +0000 http://emcrit.org/?p=5305 Mind of the Resuscitationist Lecture from SMACC 2013 and Blakemore Placement Mind of the Resuscitationist Lecture from SMACC 2013 and Blakemore Placement Scott D. Weingart, MD clean 17:07 Blakemore Tube Placement for Massive Upper GI Hemorrhage https://emcrit.org/procedures/blakemore-tube-placement/ Sun, 13 Oct 2013 19:31:45 +0000 http://emcrit.org/?p=5306 How to place a Blakemore tube for esophageal varices with massive bleeding. How to place a Blakemore tube for esophageal varices with massive bleeding. Scott D. Weingart, MD clean 10:30 Podcast 108 – How to Be a Hero with Cliff Reid https://emcrit.org/podcasts/how-to-be-a-hero/ Mon, 30 Sep 2013 18:34:05 +0000 http://emcrit.org/?p=5252 This was my favorite lecture from SMACC 2013. If you are not moved and inspired then your heart is made of stone. This was my favorite lecture from SMACC 2013. If you are not moved and inspired then your heart is made of stone. Scott D. Weingart, MD clean 24:33 Podcast 107 – Peripheral Vasopressor Infusions and Extravasation https://emcrit.org/podcasts/peripheral-vasopressors-extravasation/ Mon, 16 Sep 2013 14:59:35 +0000 http://emcrit.org/?p=5074 Can we give vasopressors peripherally? And if we do, what if they leak? Can we give vasopressors peripherally? And if we do, what if they leak? Scott D. Weingart, MD clean 20:08 SMACC Gold Promo https://emcrit.org/misc/smacc-gold-promo/ Sat, 07 Sep 2013 20:20:37 +0000 http://emcrit.org/?p=5164 SMACC Gold is March 18-21st on the Gold Coast of Australia--best ED conference you will ever attend SMACC Gold is March 18-21st on the Gold Coast of Australia--best ED conference you will ever attend Scott D. Weingart, MD clean 8:16 Podcast 106 – Making Things Happen with Cliff Reid https://emcrit.org/podcasts/making-things-happen/ Tue, 03 Sep 2013 00:04:15 +0000 http://emcrit.org/?p=5133 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. 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. Scott D. Weingart, MD clean 24:55 Podcast 105 – The Path to Insanity https://emcrit.org/podcasts/path-to-insanity/ Tue, 20 Aug 2013 13:38:49 +0000 http://emcrit.org/?p=5041 This was my favorite lecture assigned to me at SMACC 2013. It discusses the search for excellence in our profession. I hope you enjoy! This was my favorite lecture assigned to me at SMACC 2013. It discusses the search for excellence in our profession. I hope you enjoy! Scott D. Weingart, MD clean 22:57 Podcast 104 – Laryngoscope as a Murder Weapon (LAMW) Series – Hemodynamic Kills https://emcrit.org/podcasts/intubation-patient-shock/ Mon, 05 Aug 2013 19:02:17 +0000 http://emcrit.org/?p=4945 A lecture from SMACC2013 on how not to kill the shocked patient when intubating A lecture from SMACC2013 on how not to kill the shocked patient when intubating Scott D. Weingart, MD clean 30:43 EMCrit Wee – Vasopressin, Steroids, and Epinephrine for Cardiac Arrest https://emcrit.org/wee/vasopressin-steroids-epinephrine-for-cardiac-arrest/ Fri, 02 Aug 2013 22:08:02 +0000 http://emcrit.org/?p=4934 New medication therapy for cardiac arrest New medication therapy for cardiac arrest Scott D. Weingart, MD clean 3:54 SMACC Back 2 – IVC for Decisions on Fluid Status https://emcrit.org/wee/ivc-for-decisions-on-fluid-status/ Mon, 29 Jul 2013 15:45:02 +0000 http://emcrit.org/?p=4837 A SMACC Back on Justin Bowra's IVC Ultrasound bashing. A SMACC Back on Justin Bowra's IVC Ultrasound bashing. Scott D. Weingart, MD clean 17:21 Podcast 103 – Avoiding Resuscitation Medication Errors – Part II https://emcrit.org/podcasts/avoiding-resuscitation-medication-errors-2/ Sun, 21 Jul 2013 20:32:12 +0000 http://emcrit.org/?p=4795 I am joined by Bryan Hayes for Part II of our discussion on the avoidance of critical medication errors during resuscitations. I am joined by Bryan Hayes for Part II of our discussion on the avoidance of critical medication errors during resuscitations. Scott D. Weingart, MD clean 17:51 Podcast 102 – Don’t Half-Ass your FAST! https://emcrit.org/podcasts/fast-exam/ Sun, 07 Jul 2013 15:58:52 +0000 http://emcrit.org/?p=3902 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. 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. Scott D. Weingart, MD clean 28:27 SMACC-Back – Myburgh on Catecholamines https://emcrit.org/wee/myburgh-on-catecholamines/ Wed, 26 Jun 2013 22:49:57 +0000 http://emcrit.org/?p=4754 SMACC Back 1 on Catecholamines SMACC Back 1 on Catecholamines Scott D. Weingart, MD clean 4:52 Podcast 101 – Avoiding Resuscitation Medication Errors – Part I https://emcrit.org/podcasts/avoiding-resuscitation-medication-errors/ Sun, 23 Jun 2013 17:26:49 +0000 http://emcrit.org/?p=4714 I am joined by Bryan Hayes to discuss the avoidance of critical medication errors during resuscitations. I am joined by Bryan Hayes to discuss the avoidance of critical medication errors during resuscitations. Scott D. Weingart, MD clean 23:50 Podcast 100 – What is Critical Care and What is EMCrit? https://emcrit.org/podcasts/essence-critical-care/ Sun, 09 Jun 2013 20:06:27 +0000 http://emcrit.org/?p=4702 Keynote from SMACC 2013 Keynote from SMACC 2013 Scott D. Weingart, MD clean 21:45 EMCrit Wee – Is Lactate Clearance a Flawed Paradigm? https://emcrit.org/wee/lactate-clearance-flawed/ Wed, 05 Jun 2013 20:27:48 +0000 http://emcrit.org/?p=4751 Is lactate clearance a flawed paradigm? I don't think it is. Is lactate clearance a flawed paradigm? I don't think it is. Scott D. Weingart, MD clean 7:28 Podcast 99 – Combat Aviation Paradigms for Resuscitationists https://emcrit.org/podcasts/combat-aviation-paradigms/ Sun, 26 May 2013 18:42:58 +0000 http://emcrit.org/?p=4720 Aviation is to anesthesia as Combat Aviation is to Resuscitation Aviation is to anesthesia as Combat Aviation is to Resuscitation Scott D. Weingart, MD clean 26:06 Podcast 98 – Cyclic (Tricyclic) Antidepressant Overdose https://emcrit.org/podcasts/tricyclic-antidepressant-overdose/ Tue, 14 May 2013 21:44:44 +0000 http://emcrit.org/?p=4633 Tricyclic overdoses are not uncommon and these patients can be incredibly ill. Tricyclic overdoses are not uncommon and these patients can be incredibly ill. Scott D. Weingart, MD clean 22:39 EMCrit Wee – Janus General and Service Update https://emcrit.org/service/janus-general-service-update/ Mon, 06 May 2013 23:00:23 +0000 http://emcrit.org/?p=4639 Learn about Janus General Learn about Janus General Scott D. Weingart, MD clean 7:40 Podcast 97 – Acid-Base VI – Chloride-Free Sodium https://emcrit.org/podcasts/chloride-free-sodium/ Thu, 02 May 2013 17:16:18 +0000 http://emcrit.org/?p=4591 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. 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. Scott D. Weingart, MD clean 18:01 Podcast 96 – Acid Base in the Critically Ill – Part V – Enough with the Bicarb Already https://emcrit.org/podcasts/enough-with-the-bicarb-already/ Sun, 14 Apr 2013 15:33:56 +0000 http://emcrit.org/?p=4572 More on Bicarb in the Critically Ill and a discussion with John Kellum, MD More on Bicarb in the Critically Ill and a discussion with John Kellum, MD Scott D. Weingart, MD clean 20:07 Episode 12 – New Trauma Guidelines: ATLS and Spine https://emcrit.org/practicalevidence/atls-and-spine/ Sun, 14 Apr 2013 02:06:29 +0000 http://practicalevidence.org/?p=318 New Trauma Guidelines: ATLS and Spine New Trauma Guidelines: ATLS and Spine Scott D. Weingart, MD clean 11:37 Podcast 95 – Thomas Scalea on Cutting-Edge ICP Management https://emcrit.org/podcasts/cutting-edge-icp-management/ Tue, 02 Apr 2013 05:46:57 +0000 http://emcrit.org/?p=4563 Thomas Scalea discusses new frontiers in the management of ICP and TBI Thomas Scalea discusses new frontiers in the management of ICP and TBI Scott D. Weingart, MD clean 44:34 EMCrit Wee – The Vortex Approach https://emcrit.org/wee/vortex-approach/ Thu, 28 Mar 2013 15:38:44 +0000 http://emcrit.org/?p=4351 The vortex approach is a new paradigm for airway management in all areas of the hospital The vortex approach is a new paradigm for airway management in all areas of the hospital Scott D. Weingart, MD clean 9:33 EMCrit Wee – The Holy Grail of Fluid Resuscitation is just a Tin Cup https://emcrit.org/wee/holy-grail-fluid-resuscitation/ Thu, 21 Mar 2013 18:34:07 +0000 http://emcrit.org/?p=4513 Chad Meyers' lecture on fluid resus in severe sepsis Chad Meyers' lecture on fluid resus in severe sepsis Scott D. Weingart, MD clean 17:40 EMCrit WEE – SMACC 2013 Summary and Learning Points https://emcrit.org/wee/smacc2013/ Mon, 18 Mar 2013 22:24:17 +0000 http://emcrit.org/?p=4501 SMACC - The best Critical Care Conference...EVER!! SMACC - The best Critical Care Conference...EVER!! Scott D. Weingart, MD clean 19:32 Episode 11 – Ischemic Stroke 2013 https://emcrit.org/practicalevidence/ischemic-stroke-2013/ Mon, 04 Mar 2013 04:26:53 +0000 http://practicalevidence.org/?p=261 2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP 2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP Scott D. Weingart, MD clean 15:15 Podcast 94 – Has Video Laryngoscopy Killed the Direct Laryngoscope? https://emcrit.org/podcasts/has-video-laryngoscopy-killed-the-dl-star/ Sun, 03 Mar 2013 23:05:36 +0000 http://emcrit.org/?p=4462 I debate Paul Mayo on whether standard laryngoscopy still has a role in emergency and critical care intubation I debate Paul Mayo on whether standard laryngoscopy still has a role in emergency and critical care intubation Scott D. Weingart, MD clean 23:02 Podcast 93 – Critical Care Palliation with Ashley Shreves https://emcrit.org/podcasts/critical-care-palliation/ Mon, 18 Feb 2013 04:40:08 +0000 http://emcrit.org/?p=4412 One of the best palliative care lectures I have ever heard. One of the best palliative care lectures I have ever heard. Scott D. Weingart, MD clean 25:03 EMCrit Wee – Tacit Knowledge and Medical Podcasting https://emcrit.org/wee/tacit-knowledge-podcasting/ Wed, 13 Feb 2013 20:36:01 +0000 http://emcrit.org/?p=4400 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. 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. Scott D. Weingart, MD clean 10:46 EMCrit Conference Blast Winner: Peri-Mortem C-Section https://emcrit.org/wee/peri-mortem-c-section/ Tue, 12 Feb 2013 21:02:44 +0000 http://emcrit.org/?p=4378 Peri-Mortem C-Section Peri-Mortem C-Section Scott D. Weingart, MD clean 12:55 Join the EMCrit G+ Community Page https://emcrit.org/podcasts/emcrit-google-community-page/ Sun, 10 Feb 2013 18:56:48 +0000 http://emcrit.org/?p=4383 A place for your Clinical Cases and Questions that are not podcast specific A place for your Clinical Cases and Questions that are not podcast specific Scott D. Weingart, MD clean 2:38 Podcast 92 – EMCrit Intubation Checklist https://emcrit.org/podcasts/emcrit-intubation-checklist/ Tue, 05 Feb 2013 19:14:18 +0000 http://emcrit.org/?p=3036 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 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 Scott D. Weingart, MD clean 28:36 2012 Surviving Sepsis Campaign Guidelines https://emcrit.org/misc/2012-surviving-sepsis-campaign-guidelines/ Thu, 24 Jan 2013 17:48:23 +0000 http://emcrit.org/?p=4318 2012 Surviving Sepsis Campaign Guidelines from my Practical Evidence Podcast 2012 Surviving Sepsis Campaign Guidelines from my Practical Evidence Podcast Scott D. Weingart, MD clean 18:35 Podcast 91 – Treatment of Aortic Dissection https://emcrit.org/podcasts/aortic-dissection/ Thu, 24 Jan 2013 02:25:41 +0000 http://emcrit.org/?p=4298 You can't pick a more critical diagnosis than acute aortic dissection. Mess it up and the patient dies. You can't pick a more critical diagnosis than acute aortic dissection. Mess it up and the patient dies. Scott D. Weingart, MD clean 24:01 Episode 10 – Surviving Sepsis Campaign (SSC) Guidelines 2012 https://emcrit.org/practicalevidence/surviving-sepsis-campaign-guidelines-2012/ Thu, 24 Jan 2013 02:12:55 +0000 http://practicalevidence.org/?p=217 SSC Guidelines 2012 SSC Guidelines 2012 Scott D. Weingart, MD clean 18:35 Podcast 90 – Mind of the Resuscitationist Series: Cliff Reid’s Own the Resus Room https://emcrit.org/podcasts/own-the-resus-room/ Tue, 08 Jan 2013 00:41:08 +0000 http://emcrit.org/?p=4258 Cliff Reid on owning the resuscitation room Cliff Reid on owning the resuscitation room Scott D. Weingart, MD clean 15:23 Natural Seven for 2012 https://emcrit.org/wee/picks-for-2012/ Sun, 30 Dec 2012 23:08:36 +0000 http://emcrit.org/?p=3791 The rundown of things I liked from 2012 The rundown of things I liked from 2012 Scott D. Weingart, MD clean 6:01 Podcast 89 – Lessons from the STOP Sepsis Collaborative https://emcrit.org/podcasts/lessons-sepsis-collaborative/ Wed, 26 Dec 2012 04:00:25 +0000 http://emcrit.org/?p=4229 We have hit the 10,0000 patient mark in the NYC STOP Sepsis collaborative. Here are some of the lessons learned... We have hit the 10,0000 patient mark in the NYC STOP Sepsis collaborative. Here are some of the lessons learned... Scott D. Weingart, MD clean 18:08 EMCrit Wee – MOPETT Trial https://emcrit.org/wee/mopett-trial/ Wed, 12 Dec 2012 01:57:24 +0000 http://emcrit.org/?p=4188 A new trial on half-dose thrombolysis for PE for sub-massive PE A new trial on half-dose thrombolysis for PE for sub-massive PE Scott D. Weingart, MD clean 4:08 EMCrit Podcast 88 – Oxygen Physiology with Daniel Davis https://emcrit.org/podcasts/oxygen-physiology/ Mon, 10 Dec 2012 18:00:40 +0000 http://emcrit.org/?p=3471 One of the last few airway topics for a little while: Pulse Ox Lag and an Understanding of the Oxyhemoglobin Dissociation Curve One of the last few airway topics for a little while: Pulse Ox Lag and an Understanding of the Oxyhemoglobin Dissociation Curve Scott D. Weingart, MD clean 19:07 Episode 9 – Blunt Cardiac Injury from EAST https://emcrit.org/practicalevidence/blunt-cardiac-injuries/ Fri, 07 Dec 2012 06:33:59 +0000 http://practicalevidence.org/?p=166 EAST Trauma Guidelines on Blunt Cardiac Injury EAST Trauma Guidelines on Blunt Cardiac Injury Scott D. Weingart, MD clean 8:35 SMACC Conference https://emcrit.org/wee/smacc-conference/ Fri, 07 Dec 2012 00:53:04 +0000 http://emcrit.org/?p=4177 SMACC Conference and SIMWars SMACC Conference and SIMWars Scott D. Weingart, MD clean 4:07 Podcast 87 – Mind of the Resuscitationist: Stop Points https://emcrit.org/podcasts/stop-points/ Mon, 26 Nov 2012 23:40:08 +0000 http://emcrit.org/?p=4147 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. 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. Scott D. Weingart, MD clean 23:32 Podcast 86 – IVC Ultrasound for Fluid Tolerance in Spontaneously Breathing Patients – EAT IT STONE https://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 Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can! Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can! Scott D. Weingart, MD clean 20:52 Episode 8 – ACEP Opioid Prescription Policy https://emcrit.org/practicalevidence/acep-opioid-prescription-policy/ Sat, 03 Nov 2012 03:51:17 +0000 http://practicalevidence.org/?p=146 ACEP 2012 Opioid Prescription Policy ACEP 2012 Opioid Prescription Policy Scott D. Weingart, MD clean 9:19 Podcast 85 – A Confirmation of Prejudices: Chloride and Pressure Poisoning https://emcrit.org/podcasts/chloride-pressure-poisoning/ Mon, 29 Oct 2012 22:05:11 +0000 http://emcrit.org/?p=4027 In this Hurricane Sandy episode of the EMCrit podcast, I talk about the confirmation of two of my clinical prejudices. In this Hurricane Sandy episode of the EMCrit podcast, I talk about the confirmation of two of my clinical prejudices. Scott D. Weingart, MD clean 18:53 Podcast 84 – The Post-Intubation Package https://emcrit.org/podcasts/post-intubation-package/ Tue, 16 Oct 2012 19:00:56 +0000 http://emcrit.org/?p=4003 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. 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. Scott D. Weingart, MD clean 23:46 Podcast 83 – Crack to Cure – ED Thoracotomy https://emcrit.org/podcasts/procedure-of-thoracotomy/ Tue, 02 Oct 2012 05:37:16 +0000 http://emcrit.org/?p=3890 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. 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. Scott D. Weingart, MD clean 37:16 Episode 7 – Rule-Out Criteria and Screening https://emcrit.org/practicalevidence/rule-out-criteria-screening/ Tue, 25 Sep 2012 01:49:41 +0000 http://practicalevidence.org/?p=140 For Ariel... For Ariel... Scott D. Weingart, MD clean 10:20 Podcast 82 – Mind of the Resuscitationist with Cliff Reid https://emcrit.org/podcasts/mind-resuscitationist-reid/ Mon, 17 Sep 2012 17:25:24 +0000 http://emcrit.org/?p=3941 Today, I put on my head-shrinker cap (it is a fez) and get Cliff Reid on the coach Today, I put on my head-shrinker cap (it is a fez) and get Cliff Reid on the coach Scott D. Weingart, MD clean 29:40 Episode 6 – ACCP Antithrombotics and VTE Guidelines https://emcrit.org/practicalevidence/antithrombotic-therapy/ Fri, 07 Sep 2012 06:47:16 +0000 http://practicalevidence.org/?p=99 Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines from the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines from the American College of Chest Physicians Scott D. Weingart, MD clean 8:40 Podcat 081 – An Interview on Severe Trauma with Karim Brohi https://emcrit.org/podcasts/severe-trauma-karim-brohi/ Sun, 02 Sep 2012 21:23:58 +0000 http://emcrit.org/?p=3895 Let's talk trauma. I interview Karim Brohi on traumatic arrest, massive transfusion and hypotensive resuscitation. Let's talk trauma. I interview Karim Brohi on traumatic arrest, massive transfusion and hypotensive resuscitation. Scott D. Weingart, MD clean 20:21 Podcast 80 – Uhmmmm, Maybe Groin Lines Are Not So Bad with Paul Marik https://emcrit.org/podcasts/femoral-central-lines/ Mon, 20 Aug 2012 00:14:38 +0000 http://emcrit.org/?p=3863 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. 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. Scott D. Weingart, MD clean 27:29 Podcast 79 – Reducing Door to tPA Time in Ischemic Stroke https://emcrit.org/podcasts/reducing-door-to-tpa-time/ Mon, 06 Aug 2012 00:16:36 +0000 http://emcrit.org/?p=3828 Reducing door to tPA time in Ischemic Stroke. Strategies and tips to optimize patient care. Reducing door to tPA time in Ischemic Stroke. Strategies and tips to optimize patient care. Scott D. Weingart, MD clean 25:17 Podcast 78 – Increased Intra-Cranial Pressure (ICP) and Herniation, aka Brain Code https://emcrit.org/podcasts/high-icp-herniation/ Sun, 22 Jul 2012 23:51:54 +0000 http://emcrit.org/?p=3780 Today we are going to discuss increased intracranial pressure (ICP) and herniation Today we are going to discuss increased intracranial pressure (ICP) and herniation Scott D. Weingart, MD clean 23:54 EMCrit Wee – Airway Outsourcing and Suction Henching https://emcrit.org/wee/airway-outsourcing-and-suction-henching/ Mon, 16 Jul 2012 22:00:22 +0000 http://emcrit.org/?p=3764 Further discussion of prepassing the bougie and why fiberoptic laryngoscopy may obviate all of the classic teaching on bimanual laryngoscopy. Further discussion of prepassing the bougie and why fiberoptic laryngoscopy may obviate all of the classic teaching on bimanual laryngoscopy. Scott D. Weingart, MD clean 4:39 Left Ventricular Assist Devices (LVADS) https://emcrit.org/wee/left-ventricular-assist-devices-lvads-2/ Mon, 09 Jul 2012 00:21:32 +0000 http://emcrit.org/?p=3495 LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier. LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier. Scott D. Weingart, MD clean 19:39 Episode 5 – Upper GI Bleed Guidelines https://emcrit.org/practicalevidence/acute-upper-gi-bleeding-guidelines/ Sat, 07 Jul 2012 07:14:32 +0000 http://practicalevidence.org/?p=105 National Institute for Health and Clinical Excellence: Acute upper GI bleeding: NICE guideline National Institute for Health and Clinical Excellence: Acute upper GI bleeding: NICE guideline Scott D. Weingart, MD clean 10:49 EMCrit Wee – Bougie Prepass and CricCon for Difficult Airway https://emcrit.org/wee/bougie-prepass-and-criccon/ Thu, 05 Jul 2012 03:00:35 +0000 http://emcrit.org/?p=3736 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. 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. Scott D. Weingart, MD clean 29:35 Are Extraglottic Airways Harmful in Cardiac Arrest? https://emcrit.org/wee/extraglottic-airways-harmful-cardiac-arrest/ Sun, 17 Jun 2012 21:23:53 +0000 http://emcrit.org/?p=3680 Are we creating a blockage of blood flow to the brain with EGAs in cardiac arrest? Are we creating a blockage of blood flow to the brain with EGAs in cardiac arrest? Scott D. Weingart, MD clean 7:07 EMCrit Podcast 75 – Live Show # 2 https://emcrit.org/podcasts/emcrit-live-2/ Wed, 13 Jun 2012 05:07:18 +0000 http://emcrit.org/?p=3672 The 2nd EMCrit Live Show The 2nd EMCrit Live Show Scott D. Weingart, MD clean 27:57 Episode 4 – Subarachnoid Hemorrhage Guidelines https://emcrit.org/practicalevidence/aha-sah-guidelines-2012/ Thu, 07 Jun 2012 07:19:37 +0000 http://practicalevidence.org/?p=108 The New AHA/ASA SAH Guidelines The New AHA/ASA SAH Guidelines Scott D. Weingart, MD clean 10:15 EMCrit Podcast 74 – Who the Heck to Cool after Cardiac Arrest with Ben Abella https://emcrit.org/podcasts/who-to-cool-after-arrest/ Tue, 29 May 2012 00:26:43 +0000 http://emcrit.org/?p=3615 Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest. Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest. Scott D. Weingart, MD clean 25:06 Pain and Terror as Effective Pressors https://emcrit.org/wee/pain-terror-pressor/ Wed, 16 May 2012 22:42:58 +0000 http://emcrit.org/?p=3588 Psychic Terror as an Effective Pressor Psychic Terror as an Effective Pressor Scott D. Weingart, MD clean 6:24 Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD https://emcrit.org/podcasts/james-ducanto-airway-tips/ Mon, 14 May 2012 00:15:07 +0000 http://emcrit.org/?p=3556 James DuCanto on fiberoptics and airway management in general. James DuCanto on fiberoptics and airway management in general. Scott D. Weingart, MD clean 29:59 Episode 3 – ACEP 2012 Management of Early Pregnancy https://emcrit.org/practicalevidence/management-of-early-pregnancy/ Mon, 07 May 2012 07:47:25 +0000 http://practicalevidence.org/?p=110 ACEP's Policy on the Management of Early Pregnancy Presenting to the ED ACEP's Policy on the Management of Early Pregnancy Presenting to the ED Scott D. Weingart, MD clean 16:34 How to Post a Case or Question to EMCrit Google Plus https://emcrit.org/service/post-a-case-emcrit-google-plus/ Tue, 01 May 2012 19:08:13 +0000 http://emcrit.org/?p=3528 How to Post a Case or Question to EMCrit Google Plus How to Post a Case or Question to EMCrit Google Plus Scott D. Weingart, MD clean 5:09 Severe Pelvic Trauma https://emcrit.org/podcasts/severe-pelvic-trauma/ Mon, 30 Apr 2012 20:59:49 +0000 http://emcrit.org/?p=3447 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. 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... Scott D. Weingart, MD clean 26:42 EMCrit Wee – ETCO2 with EGA? https://emcrit.org/wee/emcrit-wee-etco2-with-ega/ Sun, 22 Apr 2012 15:18:18 +0000 http://emcrit.org/?p=3475 Can we monitor ETCO2 with extraglottic airways? The answer is definitively: I don't know. Can we monitor ETCO2 with extraglottic airways? The answer is definitively: I don't know. Scott D. Weingart, MD clean 5:08 Podcast 71 – Critical Questions on Massive Transfusion Protocols with Kenji Inaba https://emcrit.org/podcasts/massive-transfusion-kenji/ Mon, 16 Apr 2012 16:33:18 +0000 http://emcrit.org/?p=3184 Today, I got to interview Kenji Inaba; an incredibly prolific trauma surgeon from LA County, California. Today, I got to interview Kenji Inaba; an incredibly prolific trauma surgeon from LA County, California. Scott D. Weingart, MD clean 21:18 Episode 2 – ACEP 2011 Clinical Policy on Pulmonary Embolism (PE) https://emcrit.org/practicalevidence/acep-pulmonary-embolism/ Sat, 07 Apr 2012 07:22:48 +0000 http://practicalevidence.org/?p=111 Welcome to the second episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read. Welcome to the second episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read. Scott D. Weingart, MD clean 9:57 EMCrit Wee – Abandon Epinephrine? https://emcrit.org/wee/abandon-epinephrine/ Thu, 05 Apr 2012 21:42:02 +0000 http://emcrit.org/?p=3404 Should we stop using Epi in the field for cardiac arrest Should we stop using Epi in the field for cardiac arrest Scott D. Weingart, MD clean 5:31 Podcast 70 – Airway Management with Rich Levitan https://emcrit.org/podcasts/rich-levitan-airway-lecture/ Sun, 01 Apr 2012 19:38:05 +0000 http://emcrit.org/?p=3379 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. 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. Scott D. Weingart, MD clean 1:15:13 EMCrit Wee – On Editing Comments and Ad Hominem Attacks https://emcrit.org/wee/editing-comments-and-ad-hominem-attacks/ Mon, 19 Mar 2012 22:15:34 +0000 http://emcrit.org/?p=3333 On the editorial policy of EMCrit On the editorial policy of EMCrit Scott D. Weingart, MD clean 5:05 EMCrit Podcast 69 – The Future of CPR with Keith Lurie and Demetris Yannopoulos https://emcrit.org/podcasts/future-of-cpr/ Mon, 19 Mar 2012 04:16:36 +0000 http://emcrit.org/?p=3195 Drs. Keith Lurie and Demetris Yannopoulos elaborate on the future of CPR Drs. Keith Lurie and Demetris Yannopoulos elaborate on the future of CPR Scott D. Weingart, MD clean 25:33 EMCrit Wee – Cliff Reid’s Tips for Occasional Intubators https://emcrit.org/wee/emcrit-wee-cliff-reids-tips-for-occasional-intubators/ Wed, 14 Mar 2012 16:47:16 +0000 http://emcrit.org/?p=3307 Prehospital Doc Cliff Reid's tips for intubation Prehospital Doc Cliff Reid's tips for intubation Scott D. Weingart, MD clean 5:01 Episode 1 – Penetrating Neck Trauma Guidelines https://emcrit.org/practicalevidence/penetrating-neck-trauma-guidelines/ Wed, 07 Mar 2012 07:23:34 +0000 http://practicalevidence.org/?p=112 Welcome to the first episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read. Welcome to the first episode of Practical Evidence, a podcast about the evidence you NEED to know but may not have time to read. Scott D. Weingart, MD clean 9:32 EMCrit Live Show # 1 https://emcrit.org/podcasts/emcrit-live-show-1/ Wed, 07 Mar 2012 04:16:04 +0000 http://emcrit.org/?p=3273 The first ever live EMCrit Podcast The first ever live EMCrit Podcast Scott D. Weingart, MD clean 26:38 Podcast 67 – Tranexamic Acid (TXA), Crash 2, & Pragmatism with Tim Coats https://emcrit.org/podcasts/tranexamic-acid-trauma/ Mon, 20 Feb 2012 01:21:51 +0000 http://emcrit.org/?p=3084 One of the most exciting and underutilized therapies for trauma is tranexamic acid (txa). One of the most exciting and underutilized therapies for trauma is tranexamic acid (txa). Scott D. Weingart, MD clean 22:00 EMCrit Wee – More on C-Spine Imaging https://emcrit.org/wee/more-on-c-spine-imaging/ Fri, 17 Feb 2012 21:18:06 +0000 http://emcrit.org/?p=3219 A response to a question on c-spine imaging A response to a question on c-spine imaging Scott D. Weingart, MD clean 3:27 EMCrit Wee: The Lewis Lead and a course in ECGs with Christopher Watford https://emcrit.org/wee/lewis-lead/ Wed, 15 Feb 2012 17:22:25 +0000 http://emcrit.org/?p=2880 The Lewis Lead (S5) allows you detect atrial activity that cannot be discerned on the standard 12-lead The Lewis Lead (S5) allows you detect atrial activity that cannot be discerned on the standard 12-lead Scott D. Weingart, MD clean 7:57 Podcast 66 – …Until they are warm and dead: Severe Accidental Hypothermia https://emcrit.org/podcasts/severe-accidental-hypothermia/ Tue, 07 Feb 2012 17:14:18 +0000 http://emcrit.org/?p=3166 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? 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? Scott D. Weingart, MD clean 20:50 Podcast 65 – A Primer on BVM Ventilation with Reuben Strayer https://emcrit.org/podcasts/bvm-ventilation/ Mon, 23 Jan 2012 01:44:26 +0000 http://emcrit.org/?p=3129 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. 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. Scott D. Weingart, MD clean 23:00 Podcast 64 – Fluid Responsiveness with Dr. Paul Marik https://emcrit.org/podcasts/fluid-responsiveness-with-dr-paul-marik/ Sun, 08 Jan 2012 16:43:41 +0000 http://emcrit.org/?p=3003 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. 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. Scott D. Weingart, MD clean 24:07 More on a Diagnostic Strategy for C-Spine Injuries https://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 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: 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: Scott D. Weingart, MD clean 17:28 Podcast 63 – A Pain in the Neck – Part I https://emcrit.org/podcasts/cervical-spine-injuries-i/ Sun, 25 Dec 2011 23:07:04 +0000 http://emcrit.org/?p=3058 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. 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, Scott D. Weingart, MD clean 21:58 EMCrit Podcast – Hard Six – My Picks from 2011 https://emcrit.org/podcasts/emcrit-picks-from-2011/ Sun, 25 Dec 2011 23:05:47 +0000 http://emcrit.org/?p=3055 My favorite discoveries in the medical blogosphere and podcast land My favorite discoveries in the medical blogosphere and podcast land Scott D. Weingart, MD clean 3:14 Replay of the Emergency Ultrasound Podcast – Wall Motion Abnormality Lecture https://emcrit.org/podcasts/replay-emergency-ultrasound-podcast/ Fri, 16 Dec 2011 21:33:30 +0000 http://emcrit.org/?p=3030 Replay of the incredible Wall Motion Abnormality Talk from the Emergency Ultrasound Podcast Replay of the incredible Wall Motion Abnormality Talk from the Emergency Ultrasound Podcast Scott D. Weingart, MD clean Podcast 62 – Needle vs. Knife II: Needle Thoracostomy? https://emcrit.org/podcasts/needle-finger-thoracostomy/ Sun, 11 Dec 2011 18:10:24 +0000 http://emcrit.org/?p=1815 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. 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... Scott D. Weingart, MD clean 17:21 Podcast 061 – Debate: Paralytics for ICU Intubations? https://emcrit.org/podcasts/paralytics-for-icu-intubations/ Mon, 28 Nov 2011 00:04:38 +0000 http://emcrit.org/?p=2907 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. 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, Scott D. Weingart, MD clean How to generate constant CPAP with a BVM for Preoxygenation and Reoxygenation https://emcrit.org/misc/bvm-preoxygenation-and-reoxygenation/ Fri, 04 Nov 2011 20:09:51 +0000 http://emcrit.org/?p=2785 How to make your crappy BVM into a powerful preoxygenation device--on the cheap. How to make your crappy BVM into a powerful preoxygenation device--on the cheap. Scott D. Weingart, MD clean Podcast 059 – Bath Salts with Leon Gussow https://emcrit.org/podcasts/bath-salts/ Wed, 26 Oct 2011 03:35:45 +0000 http://emcrit.org/?p=2713 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. 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, Scott D. Weingart, MD clean 18:02 Podcast 058 – Interview with Cliff Reid – Part II https://emcrit.org/podcasts/ems-physician-2/ Tue, 11 Oct 2011 00:16:05 +0000 http://emcrit.org/?p=2576 Part II of an interview with EMS Physician Cliff Reid of the amazing blog, resus.me. Part II of an interview with EMS Physician Cliff Reid of the amazing blog, resus.me. Scott D. Weingart, MD clean 23:41 Podcast 057 – Resuscitative Extra-Corporeal Life Support (ECMO) https://emcrit.org/podcasts/ecmo/ Mon, 26 Sep 2011 23:03:16 +0000 http://emcrit.org/?p=2479 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. 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. Scott D. Weingart, MD clean 28:03 Podcast 056 – Dr. Rivers on Severe Sepsis – Part III https://emcrit.org/podcasts/rivers-sepsis-iii/ Tue, 13 Sep 2011 06:21:29 +0000 http://emcrit.org/?p=2411 Part III of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis, Septic Shock, and early goal directed therapy. Part III of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis, Septic Shock, and early goal directed therapy. Scott D. Weingart, MD clean 20:00 Podcast 055 – Dr. Rivers on Severe Sepsis – Part II https://emcrit.org/podcasts/rivers-sepsis-ii/ Tue, 06 Sep 2011 00:17:31 +0000 http://emcrit.org/?p=2388 Part II of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis. Part II of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis. Scott D. Weingart, MD clean Podcast 054 – Dr. Rivers on Severe Sepsis – Part I https://emcrit.org/podcasts/rivers-sepsis-i/ Mon, 29 Aug 2011 16:40:24 +0000 http://emcrit.org/?p=2196 Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis. Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis. Scott D. Weingart, MD clean 24:00 Minh Discusses Three Examples of Airway Management gone Bad https://emcrit.org/misc/three-airway-disasters/ Tue, 09 Aug 2011 23:46:31 +0000 http://emcrit.org/?p=2227 In this podcast short, Minh Le Cong discusses three airway disasters. In this podcast short, Minh Le Cong discusses three airway disasters. Scott D. Weingart, MD clean 5:59 Podcast 053 – Needle vs. Knife: Part I https://emcrit.org/podcasts/cricothyrotomy-needle-or-knife/ Tue, 09 Aug 2011 05:37:03 +0000 http://emcrit.org/?p=2203 What technique should we use in the can't intubate/can't oxygenate (CICO) situation: Needle Cricothyrotomy vs. Bougie Cricothyrotomy. What technique should we use in the can't intubate/can't oxygenate (CICO) situation: Needle Cricothyrotomy vs. Bougie Cricothyrotomy. Scott D. Weingart, MD clean 36:22 Podcast 052 – Organ Donation in the ED https://emcrit.org/podcasts/organ-donation-brain-death/ Wed, 27 Jul 2011 04:53:30 +0000 http://emcrit.org/?p=2092 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, an Emergency Intensivist of University of New Mexico Health Sciences and associate medical director of New Mexico Organ Donor Services. Here are the current standards for determining brain death Wijdicks et al. Evidence-based guideline update: Determining Brain Death in Adults Brain Death Checklist brain death statement Here is a video of Dr. Tawil demonstrating the brain death exam Now on to the Podcast... 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, Scott D. Weingart, MD clean 33:30 Podcast # 51: Fibrinolysis in Pulmonary Embolism https://emcrit.org/podcasts/fibrinolysis-in-pulmonary-embolism/ Mon, 11 Jul 2011 05:00:07 +0000 http://emcrit.org/?p=2055 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. 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. Scott D. Weingart, MD clean 30:36 EMCrit Podcast 50 – Acid Base Part IV – Choose the Solution Based on the Problem https://emcrit.org/podcasts/acid-base-4-use-of-fluids/ Mon, 27 Jun 2011 03:16:37 +0000 http://emcrit.org/?p=1817 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. 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. Scott D. Weingart, MD clean 21:23 Hemostatic Resuscitation by Richard Dutton, MD https://emcrit.org/podcasts/hemostatic-resuscitation/ Sun, 12 Jun 2011 01:41:56 +0000 http://emcrit.org/?p=1962 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. 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. Scott D. Weingart, MD clean 51:35 EMCrit Podcast 49 – The Mind of a Resus Doc: Logistics over Strategy https://emcrit.org/podcasts/mind-resus-doc-logistics/ Tue, 07 Jun 2011 05:48:07 +0000 http://emcrit.org/?p=1938 This Part I of the Mind of a Resus Doc Series, in which we delve into the philosophies that make a good resuscitationist. This Part I of the Mind of a Resus Doc Series, in which we delve into the philosophies that make a good resuscitationist. Scott D. Weingart, MD clean 9:41 EMCrit Podcast 48 – PhD in EKGs Part II: Left Bundle Branch Block https://emcrit.org/podcasts/left-bundle-branch-block/ Mon, 23 May 2011 03:56:35 +0000 http://emcrit.org/?p=1879 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? 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... Scott D. Weingart, MD clean 17:56 EMCrit Podcast 47 – Failure to Plan for Failure: A Discussion of Airway Disasters and the NAP4 Study https://emcrit.org/podcasts/nap4-airway-disasters/ Mon, 09 May 2011 15:42:38 +0000 http://emcrit.org/?p=1771 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. 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... Scott D. Weingart, MD clean 32:57 EMCrit Podcast 46 – Acid Base: Part III https://emcrit.org/podcasts/acid-base-part-iii/ Wed, 04 May 2011 03:00:35 +0000 http://emcrit.org/?p=1789 In part III, we go through 2 cases of acid base abnormalities step by step. In part III, we go through 2 cases of acid base abnormalities step by step. Scott D. Weingart, MD clean 18:42 Bonus – Passing the Esophageal Temperature Probe https://emcrit.org/misc/passing-the-esophageal-temperature-probe/ Sat, 30 Apr 2011 19:33:14 +0000 http://emcrit.org/?p=1780 It can be a b*tch to pass the esophageal temperature probe for hypothermia. Here's how to get er done. It can be a b*tch to pass the esophageal temperature probe for hypothermia. Here's how to get er done. Scott D. Weingart, MD clean EMCrit Podcast 45 – Acid Base: Part II https://emcrit.org/podcasts/acid-base-part-ii/ Sun, 24 Apr 2011 20:59:45 +0000 http://emcrit.org/?p=1758 This second lecture discusses a quantitative approach to acid base management. I lay out the formula I use to approach an acid-base problem. This second lecture discusses a quantitative approach to acid base management. I lay out the formula I use to approach an acid-base problem. Scott D. Weingart, MD clean EMCrit Podcast 44 – Acid Base: Part I https://emcrit.org/podcasts/acid-base-i/ Mon, 11 Apr 2011 23:02:29 +0000 http://emcrit.org/?p=1714 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. 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... Scott D. Weingart, MD clean 25:00 Listener Questions – Episode 1 https://emcrit.org/misc/listener-questions-episode-1/ Wed, 30 Mar 2011 01:47:36 +0000 http://emcrit.org/?p=1686 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: 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: Scott D. Weingart, MD clean 11:48 Bonus – Is Kayexalate Useless? https://emcrit.org/misc/is-kayexalate-useless/ Wed, 23 Mar 2011 03:58:35 +0000 http://emcrit.org/?p=1661 Dr. Siamak (Mak) Moayedi, MD found nothing to indicate that kayexalate is effective for the acute management of hyperkalemia. Dr. Siamak (Mak) Moayedi, MD found nothing to indicate that kayexalate is effective for the acute management of hyperkalemia. Scott D. Weingart, MD clean 16:31 Video for Podcast 43 – Inserting the Air-Q https://emcrit.org/misc/air-q-video/ Wed, 16 Mar 2011 21:23:15 +0000 http://emcrit.org/?p=1634 Here is a video to go along with podcast 43 on the insertion and use of the Air-Q intubating laryngeal airway Here is a video to go along with podcast 43 on the insertion and use of the Air-Q intubating laryngeal airway Scott D. Weingart, MD clean 6:06 EMCrit Podcast 43 – Laryngeal Airways with Daniel Cook, MD (Part I) https://emcrit.org/podcasts/supraglottic-airway/ Sun, 13 Mar 2011 00:40:50 +0000 http://emcrit.org/?p=1626 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. 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. Scott D. Weingart, MD clean 21:27 EMCrit Podcast 42: A phD in EKG with Steve Smith https://emcrit.org/podcasts/phd-in-ekg/ Sun, 27 Feb 2011 21:34:26 +0000 http://emcrit.org/?p=1564 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. 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. Scott D. Weingart, MD clean 28:30 EMCrit Podcast 41 – Interview with Cliff Reid of RESUS.me https://emcrit.org/podcasts/ems-physician-1/ Mon, 14 Feb 2011 18:04:53 +0000 http://emcrit.org/?p=1538 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. 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. Scott D. Weingart, MD clean 25:00 EMCrit Podcast 40 – Delayed Sequence Intubation (DSI) https://emcrit.org/podcasts/dsi/ Mon, 31 Jan 2011 17:57:51 +0000 http://emcrit.org/?p=1242 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. 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. Scott D. Weingart, MD clean 19:51 EMCrit Podcast 39 – Hyponatremia https://emcrit.org/podcasts/hyponatremia/ Mon, 17 Jan 2011 18:18:14 +0000 http://emcrit.org/?p=1184 Hmm… he’s tasty, but he just needs a little salt! In this podcast, I discuss the management of hyponatremia in the ED. Hmm… he’s tasty, but he just needs a little salt! In this podcast, I discuss the management of hyponatremia in the ED. Scott D. Weingart, MD clean 21:26 EMCrit Podcast 38 – The ED Critical Care Dirty Dozen for 2010 https://emcrit.org/podcasts/dirty-dozen-2010/ Sun, 02 Jan 2011 22:15:54 +0000 http://emcrit.org/?p=1127 My favorite ED things for 2010...the EMCrit dirty dozen. My favorite ED things for 2010...the EMCrit dirty dozen. Scott D. Weingart, MD clean 13:09 EMCrit Podcast 37 – Lactate in Sepsis https://emcrit.org/podcasts/lactate/ Mon, 20 Dec 2010 15:16:14 +0000 http://emcrit.org/?p=1050 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. 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, Scott D. Weingart, MD clean 28:56 EMCrit Podcast 36 – Traumatic Arrest https://emcrit.org/podcasts/traumatic-arrest/ Sat, 04 Dec 2010 23:04:00 +0000 http://emcrit.org/?p=969 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. 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, Scott D. Weingart, MD clean 20:19 EMCrit Podcast 35 – Extubation in the ED https://emcrit.org/podcasts/extubation/ Thu, 18 Nov 2010 22:28:11 +0000 http://emcrit.org/?p=879 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. 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. Scott D. Weingart, MD clean 14:27 EMCrit Podcast 34 – 2010 ACLS Guidelines https://emcrit.org/podcasts/acls-guidelines-2010/ Tue, 26 Oct 2010 03:51:44 +0000 http://emcrit.org/?p=823 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. 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. Scott D. Weingart, MD clean 19:59 Video for Diagnosing Posterior Stroke https://emcrit.org/misc/posterior-stroke-video/ Sun, 10 Oct 2010 03:11:00 +0000 http://emcrit.org/?p=765 This is the video for cerebellar stroke diagnosis. Listen to the podcast first. This is the video for cerebellar stroke diagnosis. Listen to the podcast first. Scott D. Weingart, MD clean EMCrit Podcast 33 – Diagnosis of Posterior Stroke https://emcrit.org/podcasts/posterior-stroke/ Sun, 10 Oct 2010 02:52:17 +0000 http://emcrit.org/?p=755 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. 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? Scott D. Weingart, MD clean 11:38 EMCrit Podcast 32 – Treatment of Severe Hyperkalemia https://emcrit.org/podcasts/hyperkalemia/ Wed, 22 Sep 2010 18:36:40 +0000 http://emcrit.org/?p=744 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. 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. Scott D. Weingart, MD clean 12:57 EMCrit Podcast 31 – Intra-Arrest Management https://emcrit.org/podcasts/intra-arrest/ Sun, 05 Sep 2010 21:47:53 +0000 http://emcrit.org/?p=734 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. 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, Scott D. Weingart, MD clean 22:33 ACEP Preview – Hemostasis: Stopping the bleeding in a crashing trauma patient https://emcrit.org/podcasts/hemostasis-acep/ Mon, 23 Aug 2010 03:25:35 +0000 http://emcrit.org/?p=704 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. 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. Scott D. Weingart, MD clean 53:03 EMCrit Podcast 30 – Hemorrhagic Shock Resuscitation https://emcrit.org/podcasts/trauma-resuscitation-dutton/ Sun, 15 Aug 2010 17:33:15 +0000 http://emcrit.org/?p=694 This week we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD. This week we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD. Scott D. Weingart, MD clean 31:07 EMCrit Podcast 29 – Procedural Sedation, Part II https://emcrit.org/podcasts/procedural-sedation-part-2/ Mon, 02 Aug 2010 00:19:36 +0000 http://emcrit.org/?p=682 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. 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. Scott D. Weingart, MD clean 15:39 Procedural Sedation Guidelines Update https://emcrit.org/misc/procedural-sedation-guidelines/ Mon, 26 Jul 2010 23:51:13 +0000 http://emcrit.org/?p=679 Here is a piece I wrote for EMPGU Here is a piece I wrote for EMPGU Scott D. Weingart, MD clean Procedural Sedation, Part I (Audio Only) https://emcrit.org/archive-podcasts/procedural-sedation-i-audio/ Mon, 26 Jul 2010 23:42:44 +0000 http://emcrit.org/?p=677 This is the audio only version of the previous post (Part I of the Sedation Talk). This is the audio only version of the previous post (Part I of the Sedation Talk). Scott D. Weingart, MD clean 27:29 Procedural Sedation – Part I https://emcrit.org/archive-podcasts/procedural-sedation-part-1/ Mon, 26 Jul 2010 23:39:01 +0000 http://emcrit.org/?p=669 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. 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. Scott D. Weingart, MD clean 27:14 EMCrit Podcast 28 – Severe CNS Infections https://emcrit.org/podcasts/meningitis/ Tue, 13 Jul 2010 20:25:02 +0000 http://emcrit.org/?p=665 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. 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... Scott D. Weingart, MD clean 25:33 EMCrit Podcast 27 – Calcium Channel Blocker Overdose https://emcrit.org/podcasts/calcium-channel-blocker-od/ Tue, 29 Jun 2010 16:36:27 +0000 http://emcrit.org/?p=634 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. 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.... Scott D. Weingart, MD clean 29:48 EMCrit Lecture – Top Ten Hypothermia Tips https://emcrit.org/archive-podcasts/hypothermia-tips/ Wed, 16 Jun 2010 04:07:03 +0000 http://emcrit.org/?p=627 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. 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 ... Scott D. Weingart, MD clean 42:38 EMCrit Lecture – Dominating the Vent: Part II https://emcrit.org/podcasts/vent-part-2/ Tue, 01 Jun 2010 06:12:51 +0000 http://emcrit.org/?p=617 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. 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... Scott D. Weingart, MD clean EMCrit Lecture – Dominating the Vent: Part I https://emcrit.org/archive-podcasts/vent-part-1/ Mon, 24 May 2010 18:22:04 +0000 http://emcrit.org/?p=565 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. 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... Scott D. Weingart, MD clean 30:00 Vent Handout https://emcrit.org/podcasts/vent-handout/ Mon, 24 May 2010 18:10:08 +0000 http://emcrit.org/?p=569 This post is just to place the vent handout into itunes. This post is just to place the vent handout into itunes. Scott D. Weingart, MD clean EMCrit Podcast 26 – Patient Controlled Analgesia by Edward Gentile https://emcrit.org/podcasts/gentile-pain/ Wed, 12 May 2010 03:02:23 +0000 http://emcrit.org/?p=553 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. 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. Scott D. Weingart, MD clean 29:19 Service Update – How to get old episodes into Itunes https://emcrit.org/service/old-episodes-itunes/ Sun, 02 May 2010 18:24:26 +0000 http://emcrit.org/?p=544 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. 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. Scott D. Weingart, MD clean IVC Ultrasound for Non-Invasive Sepsis Protocol https://emcrit.org/procedures/ivc-ultrasound/ Thu, 29 Apr 2010 00:01:28 +0000 http://emcrit.org/?p=521 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. 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 ... Scott D. Weingart, MD clean EMCrit Podcast 25 – End of Life and Palliative Care in the ED https://emcrit.org/podcasts/end-of-life-care/ Sat, 24 Apr 2010 23:18:21 +0000 http://emcrit.org/?p=508 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. 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, Scott D. Weingart, MD clean 29:43 Q&A: The Two Rams https://emcrit.org/podcasts/the-two-rams/ Sat, 17 Apr 2010 21:24:17 +0000 http://emcrit.org/?p=493 Two listener questions answered in 5 minutes. One on awake intubation in trauma and the other on intubating the patient with severe RESP acidosis. Two listener questions answered in 5 minutes. One on awake intubation in trauma and the other on intubating the patient with severe RESP acidosis. Scott D. Weingart, MD clean 5:04 Bougie-Aided Cricothyrotomy by Darren Braude https://emcrit.org/procedures/bougie-aided-cric/ Tue, 13 Apr 2010 14:45:46 +0000 http://emcrit.org/?p=480 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. 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. Scott D. Weingart, MD clean Procedure: Fiberoptic Stylet-aided Cricothyrotomy by Seth Manoach https://emcrit.org/procedures/fiberoptic-stylet-cric/ Sun, 11 Apr 2010 17:01:30 +0000 http://emcrit.org/?p=451 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. 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. Scott D. Weingart, MD clean Procedure: Open Cricothyrotomy for Historical Purposes Only https://emcrit.org/procedures/cricothyrotomy/ Sun, 11 Apr 2010 17:01:01 +0000 http://emcrit.org/?p=444 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. 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. Scott D. Weingart, MD clean EMCrit Podcast 24 – The Cric Show https://emcrit.org/podcasts/crics/ Sun, 11 Apr 2010 05:31:50 +0000 http://emcrit.org/?p=255 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! 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. Scott D. Weingart, MD clean 24:15 EMCrit Podcast 23 – Awake Intubation for Trauma and Medical Patients https://emcrit.org/podcasts/who-to-intubate/ Sat, 27 Mar 2010 03:45:47 +0000 http://emcrit.org/?p=418 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. 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. 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. Scott D. Weingart, MD clean 15:40 EMCrit Rant – Risk in Emergency Medicine https://emcrit.org/archive-podcasts/risk-in-em/ Sun, 21 Mar 2010 21:44:13 +0000 http://emcrit.org/?p=406 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. 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. Scott D. Weingart, MD clean 12:44 EMCrit Podcast 22 – Non-Invasive Severe Sepsis Care https://emcrit.org/podcasts/non-invasive-sepsis/ Sun, 14 Mar 2010 00:29:36 +0000 http://emcrit.org/?p=394 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. 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... Scott D. Weingart, MD clean 21:16 EMCrit Podcast 21 – A Bad Sedation Package Leaves your Patient Trapped in a Nightmare https://emcrit.org/podcasts/post-intubation-sedation/ Fri, 26 Feb 2010 19:55:17 +0000 http://emcrit.org/?p=369 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. 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. Scott D. Weingart, MD clean 26:40 EMCrit Podcast 20 – The Crashing Atrial Fibrillation Patient https://emcrit.org/podcasts/crashing-a-fib/ Sat, 13 Feb 2010 03:14:51 +0000 http://emcrit.org/?p=324 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. Now what? In this episode, I discuss the crashing atrial fibrillation patient. 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. Scott D. Weingart, MD clean 9:13 EMCrit Podcast 19 – Non-Invasive Ventilation https://emcrit.org/podcasts/niv/ Fri, 05 Feb 2010 17:32:50 +0000 http://emcrit.org/?p=305 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, I discuss some of the basic ideas and methods of NIV. 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, Scott D. Weingart, MD clean 19:35 EMCrit Podcast 17 – Reversal of Anti-coagulant and Anti-platelet Drugs in Head Bleeds https://emcrit.org/podcasts/reversal-head-bleeds/ Tue, 12 Jan 2010 21:53:51 +0000 http://emcrit.org/?p=263 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? 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? Scott D. Weingart, MD clean 18:12 EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy https://emcrit.org/podcasts/finger-thoracostomy/ Thu, 24 Dec 2009 03:09:21 +0000 http://emcrit.org/?p=250 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 desaturating (If anyone knows who created the DOPE mnemonic, please add a comment or send me an email.) If the pt is asthmatic, add an "S" to make DOPES The "S" stands for Stacked Breaths--and it's the first thing to address. Address it by disconnecting the vent circuit. Don't think about it, don't dither, just disconnect the vent. "E" is for equipment. Attach a BVM hooked up to O2 and you'll eliminate ventilator equipment failures. "D" is for tube displacement. Verify the tube with ETCO2, either qualitative or quantitative. "O" reminds you to check for obstruction of the tube. See if you can put a suction cath all the way down. If all of these don't fix the problem, then consider "P" for pneumothorax. Lung sounds are not always definitive. Throw on the UTS if you have the time. Otherwise perform bilateral finger thoracostomies. What the hell is that, you say? Listen to the podcast. Then you can read more about it in this article 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. Update: Is the tube mainstem, is there a ball-valve obstruction? Consider reintubation Consider Bronchoscopy 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... Scott D. Weingart, MD clean 17:03 EMCrit Podcast 15 – the Severe Asthmatic https://emcrit.org/podcasts/severe-asthmatic/ Wed, 09 Dec 2009 02:02:48 +0000 http://emcrit.org/?p=232 To PEEP or not to PEEP, that is the question...in the management of the severe asthmatic To PEEP or not to PEEP, that is the question...in the management of the severe asthmatic Scott D. Weingart, MD clean 22:56 Video for the Laryngoscope as a Murder Weapon Lecture https://emcrit.org/misc/preox/ Thu, 26 Nov 2009 03:49:12 +0000 http://emcrit.org/?p=198 Scott D. Weingart, MD clean EMCrit Podcast 14.5 – A bit more on EGDT https://emcrit.org/podcasts/more-on-egdt/ Mon, 23 Nov 2009 07:20:39 +0000 http://emcrit.org/?p=183 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, 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, Chris Nickson ED/ICU Registrar, Perth So in this brief aside, I respond to Chris' comments and tell you a bit about the EMCrit Podcast EBM philosophy. Here are the links mentioned: Henry Ford Hospital Reply to WSJ - 10.27.2008 New MSSM ED Crit Care Sepsis Protocol MR of Early Quantitative Therapies for Sepsis 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, Scott D. Weingart, MD clean 10:16 EMCrit Podcast 14 – EGDT Tirade https://emcrit.org/podcasts/emcrit-podcast-14-egdt-tirade/ Sat, 21 Nov 2009 04:53:36 +0000 http://emcrit.org/?p=178 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. 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. Scott D. Weingart, MD clean 20:42 EMCrit Podcast 13 – Trauma Resus II: Massive Transfusion https://emcrit.org/podcasts/massive-trans/ Sat, 31 Oct 2009 21:49:35 +0000 http://emcrit.org/?p=168 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 pressure 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. What may be the best review of the topic is by Spinella and Holcomb: (Blood Reviews 2009;23:231-240) I talk about 1:1:1 transfusion PCC, Factor VIIa, Cryo Calcium IV Access coming up in the next few podcasts: Sedatives for Intubation, Trauma Airway Management, The Crashing A-fib patient 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 intracrani... Scott D. Weingart, MD clean 16:53 EMCrit Podcast 12 – Trauma Resus: Part I https://emcrit.org/podcasts/trauma-resus-part-i/ Wed, 14 Oct 2009 04:10:05 +0000 http://emcrit.org/?p=152 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. Lethal Triad The picture says it all. 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. 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. BP Goals 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. If MAP < 65 - give fluids/products If MAP > 65 - check perfusion 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. MAP > 65 & Good Perfusion-stand tight MAP > 65 & Bad Perfusion-give fentanyl 20-25 mcg 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. Here are the articles resus of crit ill trauma patients damage_control_anesthesia Next Time: Massive Transfusion Protocols 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... Scott D. Weingart, MD clean 14:33 EMCrit Podcast 11 – Delirium Tremens https://emcrit.org/podcasts/delirium-tremens/ Tue, 29 Sep 2009 05:14:22 +0000 http://emcrit.org/?p=137 The management of severe ETOH withdrawal and Delirium Tremens The management of severe ETOH withdrawal and Delirium Tremens Scott D. Weingart, MD clean 18:48 Podcast 10 – Cardiogenic Shock https://emcrit.org/podcasts/cardiogenic-shock/ Wed, 16 Sep 2009 17:02:43 +0000 http://emcrit.org/?p=128 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 Disorder Ischemic (Right sided infarct, STEMI, NSTEMI) Cardiomyopathy Toxicologic At the same time, you are treating the patient with: Inotropes (dobutamine, milrinone, calcium) Pressors to achieve a MAP > 65 (allows coronary perfusion) Oxygenation support, most likely with intubation Optimize O2 carrying capacity (Hb>10) Here is a fantastic set of guidelines to manage these patients 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... Scott D. Weingart, MD clean 13:37 EMCrit Podcast 9 – Can you take sick patients to ct? https://emcrit.org/podcasts/sick-pts-to-c/ Tue, 01 Sep 2009 00:49:52 +0000 http://emcrit.org/?p=122 Does the EM ban on letting sick patients go to CT scan make sense? Listen to the podcast and then register your opinion. Does the EM ban on letting sick patients go to CT scan make sense? Listen to the podcast and then register your opinion. Scott D. Weingart, MD clean 7:20 EMCrit Podcast 8 – Subarachnoid Hemorrhage https://emcrit.org/podcasts/sah/ Mon, 17 Aug 2009 01:28:11 +0000 http://emcrit.org/?p=106 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. Update: Critical Care Management of Patients Following Aneurysmal SAH Guidelines from NCC 1. Get a neuro exam before you intubate 2. Intubation Give pretreatment, now just lidocaine and fentanyl Etomidate or propofol; plus sux. Most experienced intubater should perform laryngoscopy 3. Treat Pain and if intubated, give sedation 4. Treat Vasospasm give nimodipine 60 mg PO or NGT 5. BP Control place a-line treat pain first Give Labetalol or Nicardipine to achieve the patient's baseline BP if the patient has good mental status if they are obtunded, be a bit more conservative until ICP monitoring is in place If MAP is below 80, give fluids, pressors, and inotropes 6. Anti-seizure prophylaxis Load with phenytoin or fosphenytoin 7. Anti-fibrinolytics Amicar is the main one these days; ask your neurosurgeon/neurointensivist on a case-by-case basis see ehced.org for drip sheets 8. Reverse Coagulopathy 9. Think Heart these patients can get EKG changes, dysrhythmias, LV stunning, and frank infarcts from their SAH 10. ICP ASAP get the neurosurgeons to get the EVD (external ventricular drain) aka IVC (intraventricular catheter) in place as soon as possible keep ICP < 20 and CPP > 55-60 Please Subscribe and Please Comment! . 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. - Scott D. Weingart, MD clean 15:35 EMCrit Podcast 7 – Sedation Tirade https://emcrit.org/podcasts/sedation-tirade/ Thu, 23 Jul 2009 22:52:06 +0000 http://emcrit.org/?p=93 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. 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. Scott D. Weingart, MD clean 3:52 EMCrit Podcast 6 – Push-Dose Pressors https://emcrit.org/podcasts/bolus-dose-pressors/ Fri, 10 Jul 2009 16:43:20 +0000 http://emcrit.org/?p=76 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 they are being mixed or while a central line is being placed. Click Here for printable sheet with mixing instructions Epinephrine Do not give cardiac arrest doses (1 mg) to patients with a pulse Has alpha and beta-1/2 effects so it is an inopressor Onset-1 minute Duration-5-10 minutes Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml) Now you have 10 mls of Epinephrine 10 mcg/ml Dose: 0.5-2 ml every 1-5 minutes (5-20  mcg) No extravasation worries! Mixing Video: Phenylephrine Phenyl as a bolus dose is clean, quick, and never causes trouble. But... 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) Onset-1 minute Duration- 5-10 minutes (usually 5) Mixing Instructions: Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml) Inject this into a 100 ml bag of NS Now you have 100 mls of phenylephrine 100 mcg/ml Draw up some into a syringe; each ml in the syringe is 100 mcg Dose: 0.5-2 ml every 1-5 minutes (50-200 mcg) No extravasation worries! Mixing Video: Ephedrine I don’t use this one, listen to the podcast to hear why. I put it here solely for the anesthesiologists on the blog. Onset-Near Instant Duration-1 hour Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml) Now you have 10 mls of Ephedrine 5 mg/ml Dose: 1-2 ml every 2-5 minutes (5-10 mg) No extravasation worries! Additional Video of a Real Patient By Larry Mellick's Crew Update: This study compares push-dose phenylephrine to continuous infusion--no difference between the two (Anesthesia Analgesia 21012;115(6):1343) First article in the ED demonstrates efficacy on blood pressure (The Journal of Emergency Medicine Volume 49, Issue 4, October 2015, Pages 488–494) Here is a review article from the nursing literature Now on to the Podcast... 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. Scott D. Weingart, MD clean 11:00 EMCrit Podcast 5 – Intubating the Critical GI Bleeder https://emcrit.org/podcasts/intubating-gi-bleeds/ Mon, 22 Jun 2009 00:52:01 +0000 http://emcrit.org/?p=62 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 Feb;59(2):172-8, and Anesth Analg 1988;67:283) Administer Metoclopramide 10 mg IVSS 2. Intubate the Patient with HOB at 45° Semi-Fowler's position will keep the gastric contents from moving up the esophagus 3. Preoxygenate like mad You do not want to bag these patients, give yourself a preox cushion 4. Intubation Meds Use a sedative that is BP stable, use reduced doses. 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). 5. Gather your equipment to optimize first pass Use fiberoptic laryngoscopy if you have it (e.g. Glidescope) At the bedside, have a bougie, an LMA, a meconium aspirator (more below), and 2 suction set-ups Wear eye protection! 6. If you need to bag after a failed attempt... Bag gently and slowly (10 times a minute) Consider placing an LMA if you need to bag. 7. If the patient vomits: Trendelenberg This potentially keeps the emesis out of the lungs 8. Meconium Aspirator 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. 9. No ABX for Aspiration Aspiration in the initial phases is a chemical pneumonitis, not a bacterial pneumonia See Marik's article (NEJM 2001;344(9):665) 10. SIRS Expect a sepsis-like syndrome from the aspiration. This folks may need pressors and tons of additional fluid 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 stom... Scott D. Weingart, MD clean 12:25 Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis https://emcrit.org/podcasts/tube-severe-acidosis/ Sat, 23 May 2009 00:22:21 +0000 http://emcrit.org/?p=37 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, 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, they won’t increase their pH significantly. What you need Properly fitted NIV mask Ventilator, not a NIV machine Someone who knows how to work the vent Normal intubation stuff If available, Quantitative ETCO2 Procedure Place pt on pseudo-NIV Settings are Mode Volume SIMV Vt 550 ml FiO2 100% Flow Rate 30 lpm PSV 5-10 PEEP 5 RR 0 Attach ETCO2 and observe value Push the RSI Meds Turn the Resp Rate to 12 Perform jaw thrust Wait 45 seconds This violates the tenets of RSI, but keeping the pt alive is probably more crucial right now. Most experienced operator should intubate the patient Attach the ventilator Confirm tube placement by observing ETCO2 Immediately increase Respiratory Rate to 30 Change Vt to 8 cc/kg predicted IBW Change Flow Rate to 60 lpm, this si the normal setting for intubated patients (forgot to mention this in the audio) Why 30 BPM? Listen to the podcast. Make sure ETCO2 is at least as low as it was when you started Check ABG Pat yourself on the back 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, Scott D. Weingart, MD clean 8:32 EMCrit Podcast 2 – ETCO2 https://emcrit.org/podcasts/etco2-podcast/ Tue, 05 May 2009 04:51:28 +0000 http://emcrit.org/?p=13 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... 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, Scott D. Weingart, MD clean 22:08 EMCrit Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema (SCAPE) https://emcrit.org/podcasts/scape/ Sat, 25 Apr 2009 18:22:38 +0000 http://emcrit.org/?p=17 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 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. By 10 minutes, your patient should be out of the water. See crashingpatient.com for the references.   Here is some info from a handout from a lecture I gave on the topic: High Dose Nitroglycerin Homeopathic nitroglycerin does not work so well Start at 50-100 mcg/min, you can rapidly titrate to 200-400 mcg/min. You must stand at the bedside to use these doses. Need >120 mcg/min to get sig decreased Pulm Cap Wedge Pressure (Am J Cardio 2004;93:237) But even this strategy is not as effective as the … Nitro Bolus First Can give 400-800 mcg over 1-2 minutes = 400 mcg/min for 1-2 minutes. (Annals EM 1997, 30:382) How to do it Standard nitro mix is 200 mcg/ml. VERIFY YOUR HOSPITAL’S MIX BEFORE USING THESE RECS In order to give the 400 mcg/min for 2 minutes, set the pump to Rate: 120 cc/hr Volume to be Infused: 4 ml (This will deliver 400 mcg/min for 2 minutes and then stop) Or Draw up 4 ml of the nitro and 6 ml of NS and give over 2 minutes After the bolus, I drop the drip to 100 mcg/min and titrate up from there to effect When the patient gets better, you need to sharply decrease this drip rate Some folks have gone even further High dose nitroglycerin for severe decompensated heart failure—2 mg at a time (Ann Emerg Med 2007;50:144) 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) 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) Update 6-10-12 Piyush Mallick did an amazing study on nitro-bolus to avert intubation Someone finally put the term into the literature (Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med 2016;20:719-23) 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. Scott D. Weingart, MD clean 10:32 EMCrit Podcast 0 – The Intro https://emcrit.org/podcasts/introduction/ Sun, 01 Mar 2009 04:56:09 +0000 http://emcrit.org/?p=102 In which I introduce you to me and explain what this whole thing is about. (better late than never) In which I introduce you to me and explain what this whole thing is about. - (better late than never) Scott D. Weingart, MD clean 2:51