Critical Care Archives - The Emergency Medical Minute

Critical Care

Podcast 568: Shock ‘em! 

Contributor: John Winkler, MD Educational Pearls: Unstable ventricular tachycardia (VT) typically manifests with syncope, shortness of breath, diaphoresis and/or chest pain with hemodynamic instability Electrical cardioversion of unstable ventricular tachycardia is first line treatment Starting with a higher energy level (or just using the maximum) when performing cardioversion may set you up for better success…

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Podcast 567: Mechanical CPR….Not So Fast

Contributor: Aaron Lessen, MD Educational Pearls: Mechanical CPR (machine assisted compression devices) remains a hot topic of debate in emergency medicine Machine assisted CPR has been advocated to provide more consistent compressions in cardiac arrest and free up staff for other tasks. However, multiple studies have shown mechanical CPR provides no significant survival benefit yet…

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Podcast 558:  Rapid ARDS Review

Contributor: Don Stader, MD Educational Pearls: Acute respiratory distress syndrome (ARDS) is a catch all term for when lung injury leads to fluid collection in the air spaces of the lungs  Ventilatory management in ARDS patients involves lower FiO2 and PEEP than other patients and relies on lung protective ventilation strategies to prevent barotrauma Proning…

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Podcast 553: Airway Management in the Hypoxic COVID-19 Patient(Recorded 4/3/20)

Contributor: Dylan Luyten, MD Educational pearls: Clinical management of COVID-19 is rapidly evolving, relying on case reports and clinical experience In just a month, the consensus around management of COVID patients with severe hypoxia has shifted from an early intubation strategy to other, non-invasive means Intubating early can quickly consume ventilator resources, require increased intensive…

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Podcast 520:  Approach to the arresting patient

Contributor: Peter Bakes, MD Educational Pearls: Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical  The differential for near cardiac arrest includes the “H’s and T’s”, just as in true cardiac arrest  The 6 H’s include: hypoxia, hypo/hyperkalemia, hypovolemia (including shock states), hydrogen (acidosis), hypothermia  The…

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Podcast #500: 2018-19 Rapid Fire EM Literature Review

Author: Dave Saintsing Educational Pearls: Poor sleep is an independent risk factor for development of health problems such as type 2 diabetes.  A 2019 study, randomized participants to 3 groups: 9 hours of sleep, 5 hours of sleep with weekend catch-up sleep, and 5 hours of sleep without catch-up sleep.  In the sleep deprived (5…

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Podcast # 484: Elevated ICP

Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma.  While definite treatment is to remove the offending cause, there are emergency medicine   Non-pharmacologic methods include elevating head of bed and removing noxious stimuli Pharmacologic options include mannitol and hypertonic saline Hypertonic saline is best delivered through…

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Podcast # 461: Breath Stacking

Author: Gretchen Hinson, MD Educational Pearls: Breath stacking occurs when a patient is unable to expire fully before another inspiration In intubated/ventilated patients, this is because adequate time has not passed before exhalation Asthmatics are susceptible due to the prolonged expiratory phase Complications can include reduction in cardiac preload and cardiovascular collapse Pursed-lip breathing can…

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Podcast # 457: Stroke Scores

Author: Jared Scott, MD Educational Pearls:   Modified Rankin Score:  measure of disability often used to qualify outcomes following stroke  = no disability, 6=dead, 0-1 indicate good outcome) 0-6 Scale 0-1 indicative of good outcome ASPECT score: uses CT to quantify the extent of changes in the brain due to ischemia 0-10 Scale 10 areas…

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Podcast # 456 Hypoglycemia: Not feeling so sweet

Author: Jared Scott, MD Educational Pearls:   Beta-blockers can mask the effects of hypoglycemia Prolonged/refractory hypoglycemia should raise a suspicion for sulfonylurea (or other oral hypoglycemic) overdose Interventions to reverse hypoglycemia include feeding the patient, IV dextrose, glucagon Octreotide can be used as an antidote with sulfonylurea ingestion Editor’s note: Here is an interesting case…

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