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.
EMCrit 24 – The Cric Show
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!
EMCrit 23 – Awake Intubation for Trauma and Medical Patients
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.
EMCrit Wee – Rant – Risk in Emergency Medicine
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.
EMCrit 22 – Non-Invasive Severe Sepsis Care
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.
EMCrit 21 – A Bad Sedation Package Leaves your Patient Trapped in a Nightmare
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.
EMCrit 20 – 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. Now what?
In this episode, I discuss the crashing atrial fibrillation patient.
EMCrit 19 – Non-Invasive Positive Pressure Ventilation (NIPPV)
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.
Downstairs Patients, Upstairs
The Utopian College of Emergency for Medicine with the help of the lifeinthefastlane blog, has taken my Upstairs Care, Downstairs philosophy to its next logical conclusion. I can’t believe I did not see this myself.
EMCrit 18 – The Infamous Awake Intubation Video
For historical purposes only…
EMCrit 17 – Reversal of Anti-coagulant and Anti-platelet Drugs in Head Bleeds
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?
EMCrit 16 – Coding Asthmatic, DOPES and Finger Thoracostomy
DOPES will save your butt on crashing vent pts
EMCrit 15 – The Severe Asthmatic
To PEEP or not to PEEP, that is the question…in the management of the severe asthmatic
Video for the Laryngoscope as a Murder Weapon Lecture
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EMCrit 14 – EGDT Tirade (Historical Use Only)
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.