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EMCrit Podcast - Critical Care and Resuscitation

Updated 2 days ago

Rank #5 in Medicine category

Society & Culture
Philosophy
Health & Fitness
Medicine
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Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

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Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

iTunes Ratings

1406 Ratings
Average Ratings
1317
34
29
15
11

OMI lecture

By Bobbi-in-the-hole - Aug 03 2019
Read more
Opened my eyes and helped me help my patients-great lecture

Love these!!!!!!

By Irinadvm - Jun 11 2019
Read more
This is my favorite podcast!!! Please do a follow up for the 246!!!

iTunes Ratings

1406 Ratings
Average Ratings
1317
34
29
15
11

OMI lecture

By Bobbi-in-the-hole - Aug 03 2019
Read more
Opened my eyes and helped me help my patients-great lecture

Love these!!!!!!

By Irinadvm - Jun 11 2019
Read more
This is my favorite podcast!!! Please do a follow up for the 246!!!
Cover image of EMCrit Podcast - Critical Care and Resuscitation

EMCrit Podcast - Critical Care and Resuscitation

Latest release on Jan 26, 2020

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Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

Rank #1: EMCrit 259 – Cardiogenic Shock — The Next Level & Mechanical Circulatory Support with Jenelle Badulak

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Taking Cardiogenic Shock Management to the next level...

Nov 13 2019

38mins

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Rank #2: EMCrit #235 – Cardiac Arrest Science with Zack Shinar

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Cardiac Arrest Science

Oct 17 2018

33mins

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Rank #3: Podcast 173 – LaMW – Oxygenation Kills Part I

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Laryngoscope as a Murder Weapon - Oxygenation Kills, Part I

May 03 2016

30mins

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Rank #4: EMCrit RACC Podcast 219 – Critical Burn Patients in the ED/ICU – Part I with Dennis Djogovic

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Burns Part I - Fluid Management

Mar 05 2018

28mins

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Rank #5: Podcast 79 – Reducing Door to tPA Time in Ischemic Stroke

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Reducing door to tPA time in Ischemic Stroke. Strategies and tips to optimize patient care.

Aug 06 2012

25mins

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Rank #6: Podcast 111 – Fluids in Sepsis, A New Paradigm – Paul Marik

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Our favorite critical care skeptic, Dr. Paul Marik, on fluids in severe sepsis

Nov 09 2013

51mins

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Rank #7: Podcast 70 – Airway Management with Rich Levitan

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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.

Apr 01 2012

1hr 15mins

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Rank #8: Podcast 116 – the tPA for Ischemic Stroke Debate

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Dr. Andy Jagoda debates my friend Dr. Anand Swaminathan on the use of tPA for Ischemic Stroke in the Emergency Department

Jan 27 2014

52mins

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Rank #9: EMCrit 257 – Pulseless Electrical Activity (PEA) is Stupid

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Pulseless Electrical Activity ( PEA ) is confusing! The diagnosis and treatment of PEA is bogged down by terminology and misunderstandings. Spurred by a recent interview I did with Anton Helman of EM Cases, I lay down some of my thoughts on PEA here.
The last time I discussed these issues was 5 years ago with Zack and Joe on EDECMO 13.
PEA Progression to ROSC
POCUS Pulse
Carotid POCUS PulseBadra et al. on POCUS Pulse
Narrow / Wide doesn't Work
Rory breaks it down on the CCnerd in a post about QRS size in PEA.
What to Do if You Have Compressions/POCUS Pulse but No BP
Prosen on Vasopressin for PEA
Critical Care and Neurocritical Care Boards Review Book
Mayo Clinic Board Review
Just fantastic! (Note: i received a reviewers' copy of this book)
Updates
More on PEA on the EM Cases Blog - I speak with Anton Helman on the topic
The Right Heart being Big doesn't mean PE during Arrest (from Ultrasound Podcast)
Now on to the Podcast...

Oct 09 2019

31mins

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Rank #10: EMCrit Podcast 241 – Sepsis Update 2019

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New stuff on sepsis resuscitation for 2019

Feb 21 2019

19mins

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Rank #11: Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD

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James DuCanto on fiberoptics and airway management in general.

May 14 2012

29mins

Play

Rank #12: Podcast 169 – Sepsis 3.0 with Merv Singer

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Hear from the lead author of the new Sepsis 3.0 definitions

Mar 07 2016

32mins

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Rank #13: EMCrit Podcast 44 – Acid Base: Part I

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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.

Apr 11 2011

25mins

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Rank #14: Episode 5 – Upper GI Bleed Guidelines

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National Institute for Health and Clinical Excellence: Acute upper GI bleeding: NICE guideline

Jul 07 2012

10mins

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Rank #15: Podcast 181 – Pulmonary Hypertension and Right Ventricular Failure with Susan Wilcox

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Pulmonary Hypertension and Acute on Chronic RV Failure

Sep 05 2016

25mins

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Rank #16: EMCrit Podcast 75 – Live Show # 2

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The 2nd EMCrit Live Show

Jun 13 2012

27mins

Play

Rank #17: EMCrit Podcast 74 – Who the Heck to Cool after Cardiac Arrest with Ben Abella

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Today we are joined by Benjamin Abella, MD to discuss who to cool after cardiac arrest.

May 29 2012

25mins

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Rank #18: Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman

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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?
Wood 2002 PE Mortality Curve

30% normotensive patients have RVD; 10% progressed to shock; 5% in hospital mortality[cite]10859287[/cite]
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 [cite]12374874[/cite]

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 [cite]24484241[/cite]

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 [cite source='pubmed']24412030[/cite]
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. [cite]19875060[/cite]

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. [cite]24226805[/cite], [cite]23601295[/cite] See the PulmCCM Post on the Circulation RCT of EKOS
Interventional Mechanical Clot Disruption
Angiojet

Jul 14 2014

33mins

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Rank #19: Podcast 155 – Status Epilepticus with Tom Bleck

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Tom Bleck on Status Epilepticus

Aug 14 2015

24mins

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Rank #20: Podcast 160 – Sepsis smaccDOWN

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An all-star panel of world sepsis experts discuss the controversial areas

Nov 04 2015

1hr 18mins

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EMCrit 264 – Case Discussion of Combined CCB and BB Overdose

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A case as a means of discussing severe CCB and BB OD

Jan 26 2020

34mins

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EMCrit Podcast 263 – The Venous Side – Part 1 – VEXUS Score with Phillipe Rola

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The VEXUS Score - A way to quantitate how badly you overloaded your patient...

Jan 14 2020

24mins

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EMCrit 262 – Midlines – Part 1

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Midlines can change your vascular access practice

Dec 27 2019

24mins

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EMCrit 261 – Thrombolysis during Cardiac Arrest

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Who should we thrombolyse during cardiac arrest?

Dec 12 2019

21mins

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EMCrit 260 – Thoughts on the NEJM Acute Upper Airway Obstruction Review

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Thoughts on a recent NEJM review on upper airway obstruction

Nov 30 2019

21mins

Play

EMCrit 259 – Cardiogenic Shock — The Next Level & Mechanical Circulatory Support with Jenelle Badulak

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Taking Cardiogenic Shock Management to the next level...

Nov 13 2019

38mins

Play

EMCrit 258 – Should Andexxa be added to a Hospital’s Formulary?

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Should hospitals stock Andexxa?

Oct 26 2019

19mins

Play

EMCrit 257 – Pulseless Electrical Activity (PEA) is Stupid

Podcast cover
Read more
Pulseless Electrical Activity ( PEA ) is confusing! The diagnosis and treatment of PEA is bogged down by terminology and misunderstandings. Spurred by a recent interview I did with Anton Helman of EM Cases, I lay down some of my thoughts on PEA here.
The last time I discussed these issues was 5 years ago with Zack and Joe on EDECMO 13.
PEA Progression to ROSC
POCUS Pulse
Carotid POCUS PulseBadra et al. on POCUS Pulse
Narrow / Wide doesn't Work
Rory breaks it down on the CCnerd in a post about QRS size in PEA.
What to Do if You Have Compressions/POCUS Pulse but No BP
Prosen on Vasopressin for PEA
Critical Care and Neurocritical Care Boards Review Book
Mayo Clinic Board Review
Just fantastic! (Note: i received a reviewers' copy of this book)
Updates
More on PEA on the EM Cases Blog - I speak with Anton Helman on the topic
The Right Heart being Big doesn't mean PE during Arrest (from Ultrasound Podcast)
Now on to the Podcast...

Oct 09 2019

31mins

Play

EMCrit Wee – Farkas and I Discuss his Recent PulmCrit Guest Post on Asthma

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A polite discussion about a controversial post

Sep 27 2019

47mins

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EMCrit 256 – RUSH Redux with Jacob Avila

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Some dozen years ago, a couple of my buddies and I created the RUSH exam. Today, I give you an update:

Sep 18 2019

29mins

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EMCrit Wee – First Study of the Benefits of an EDICU

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Michigan's EC3

Sep 10 2019

23mins

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EMCrit 255 – Pigtails for Pleural Problems (Percutaneous Thoracostomy)

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Pigtails are just plain nicer

Sep 04 2019

30mins

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EMCrit 254 – Central Line Tips and Tricks with Robby O and Me from EEM 2019

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Central Line Tips and Tricks

Aug 22 2019

15mins

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EMCrit 253 – Kovacs Kata to Optimize a Failing Laryngoscopy Attempt

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dedicated to my friend, George Kovacs

Aug 09 2019

19mins

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EMCrit Podcast 252 – Care-Oriented Resus vs. People-Oriented Resus

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Are you a people-oriented or care-oriented resus doc?

Jul 28 2019

20mins

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EMCrit Wee – Semper Vitae – GRM with Helen Perry

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There is a group of clinicians operating on the front line of war zones with no other purpose than to save lives. Global Response Management's Helen Perry comes on the show to discuss their work.
Helen Perry ACNP-BC, MSN, RN, CCRN, CEN
Their motto is semper vitae--always life. Their mission is to provide life saving emergency and prehospital care to those impacted by war and conflict.
Find Global Response

The website is www.global-response.org
Instagram global.response
Facebook
Twitter @GRM_Global

Volunteer
We are always looking for qualified volunteers and we use Paramedics and above. EMTs are welcome to apply, but they may not be working in a clinical capacity due to World Health Organization minimum operating standards. We even need non-medical folks (social media marketing, finance, smart computer people, grant writers, etc.)
Donate
They are a registered not-for-profit (501c3) and their admin budget is super low. Please consider helping these folks.
Note
I have had to close this post to comments b/c there have been a number of comments made by folks with false names and/or false contact information. The policy of this site is that all commenters must use their real identity linked to a real email address. There seems to be a group of folks out there that doubts the veracity of the GRM. If you have verifiable information on that, please get in touch by the contact link above.
Now on to the Wee...

Jul 20 2019

26mins

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EMCrit 251 – Philosophical & Psychological Diversions Part II – Naive Reality and the Fundamental Attribution Error

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More Philosophical Ramblings...

Jul 16 2019

25mins

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EMCrit Podcast 250 – The OMI Manifesto Lecture by Pendell Meyers

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A video version of the rebellion's attempts to overthrow the STEMI Empire

Jun 27 2019

53mins

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EMCrit 249 – You Can Either Learn or You Can Blame – Fixing the Morbidity and Mortality Conference with George Douros

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How to make your M&M conference important and useful

Jun 13 2019

26mins

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EMCrit 248 – How to Teach Surgical Airways–you knows, Crics: The One-Hour Cricothyrotomy Course

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Lessons learned from teaching hundreds of people to cric

Jun 04 2019

15mins

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iTunes Ratings

1406 Ratings
Average Ratings
1317
34
29
15
11

OMI lecture

By Bobbi-in-the-hole - Aug 03 2019
Read more
Opened my eyes and helped me help my patients-great lecture

Love these!!!!!!

By Irinadvm - Jun 11 2019
Read more
This is my favorite podcast!!! Please do a follow up for the 246!!!