Rank #1: Best Emergency Medicine literature of the year 2018/19
Ken Milne the author of skeptics guide to emergency medicine SGEM reviews the hottest critical care literature for 2018 2019. Ken reviews articles from the Lomaghi trial on magnesium for rate control in Atrial fibrillation, Expulsive therapy for renal calculi with Tamulosin, Oxygen therapy in critical illness in the Iota trial and finally aromatherapy for nausea and vomiting.
Dec 09 2019
Rank #2: Managing interprofessional conflict at the bedside
Laura Rock and Jenny Rudolph give strategies for managing interprofessional conflict at the bedside in a critical care setting.
Feb 01 2020
Intensive Care Network Podcasts
FOAMcast - Emergency Medicine Core Content
The RAGE Podcast - The Resuscitationist's Awesome Guide to Everything
The Resus Room
The Skeptics Guide to Emergency Medicine
Core EM - Emergency Medicine Podcast
The St.Emlyn's virtual hospital podcast
Mastering Intensive Care
Critical Care Reviews Podcast
Academic Life in Emergency Medicine (ALiEM) Podcast
EMCrit Podcast - Critical Care and Resuscitation
Rank #3: The Great(est) Fluid Debate
Resuscitation fluids save lives in humans with life-threatening hypovolaemia. The fluid of choice should have biochemical characteristics close to the type of fluid lost and replaced at a rate and volume sufficient to correct the severe fluid deficit. Then stop and consider the early use of catecholamines. There are few indications to give critically ill patients resuscitation fluids after 24 hours of admission. There is no place for synthetic colloids of non-physiological crystalloids. The effects of unnecessary fluids last well beyond the initial resuscitation period and are associated with adverse effects and harm to the patient. Fluids are toxic drugs and must be used with great care.
Jan 24 2020
Rank #4: Hardcore EM: Vasopressors in the ED
Hardcore EM: Vasopressors in the ED by John Greenwood
Dec 14 2018
Most Popular Podcasts
Rank #5: Sepsis—The Dark Knight: Prehospital Diagnosis and Treatment - Michael Perlmutter
Sepsis is a difficult diagnosis to make, even in the hospital, where a plethora of tests are available to assist the clinician. However, the diagnosis remains a challenging one, due to the very nature of sepsis: a shadowy shape-shifter notorious for its ability to hide in plain sight, eluding early diagnosis and treatment. For now, even in-hospital, there is no test with perfect sensitivity or specificity for sepsis. This is especially true in the prehospital environment, where we must rely on tools we can bring into the field: physical exam, point of care tests (lactate/venous gas), assessment of end-tidal CO2, and ultrasound. The aim of prehospital sepsis care is twofold: First, early diagnosis of cases ranging from early sepsis to septic shock. Point of care testing is essential. Lactate can assist in identifying occult sepsis and may also be used to prognosticate. Measurement of EtCO2 serves two purposes: first, in systems where point of care lactate is not available, there is evidence suggesting that EtCO2 is a reasonable surrogate for lactate. Secondly, for spontaneously breathing patients, EtCO2 provides an accurate respiratory rate, a vital sign that is notoriously poorly assessed. Respiratory rate plays a key role in both SIRS and SOFA/qSOFA criteria for sepsis, making an accurate count essential. Ultrasound should also play a pivotal role in prehospital sepsis management. Much has been made of the prehospital FAST exam; however, the ability of POCUS to gauge fluid responsiveness and cardiac function is far more useful. Assessment of the IVC may aid in determining the value of volume resuscitation by helping to identify patients who are responsive to volume and those who would be better served by early initiation of vasopressors. Similarly, assessment of cardiac function may prove extremely useful in selecting a pressor. POCUS may also assist in differentiating sepsis from other etiologies by identifying a source, such as pneumonia. The second fundamental aim is treatment equivalent to that available in-hospital, with judicious administration of balanced IV fluids guided by POCUS and clinical assessment of fluid responsiveness, early pressors (including push-dose pressors during RSI), and early antibiotics, particularly where transport times are significant. When sepsis is diagnosed by EMS, a “sepsis alert” should be communicated to the receiving hospital, in order to facilitate ongoing early, aggressive care upon arrival of the retrieval team. Advanced prehospital diagnosis and treatment can produce dramatic reductions in mortality from sepsis.
Nov 10 2016
Rank #6: Post-Intubation Sedation - Scott Weingart
Scott Weingart discusses Post-Intubation Sedation.
Mar 03 2017
Rank #7: Prognosis and Palliation in TBI
Evie Marcolini talks about an aspect of neurocritical care that we commonly wrestle with: prognostication. Putting the patient at the centre of all conversations is essential.
For more head to: codachange.org/podcasts
Jan 29 2020
Rank #8: How Resuscitation Works - David Halliwell
This talk uses a case study approach to discuss why resuscitation practitioners should focus upon technical accuracy when resuscitating, focussing on all of the facets of a resuscitation, compression, decompression, trans-thoracic impedance. It suggests that many of the smallest of subtleties can have a dramatic effect on patient survival. We focus on the physiological effects of Manual Chest Compression and use historical reference to underpin modern techniques.
Oct 16 2016
Rank #9: Emerging Toxicology - Steve Aks
Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned.
Emerging drugs are highlighted in the context of where we have come from. The phenylethylamine compound structure and corresponding variants are described. The importance of the principles of supportive care as learned in the Scandinavian method is emphasized. Other emerging topics including synthetic cannabinoids, and anti-NMDA receptor antagonists are discussed. Emerging interventions of prescription naloxone, and ED ECMO are outlined. High vigilance for new agents, and innovative treatments will enable clinicians deal with these evolving trends.
Mar 14 2016
Rank #10: Hardcore EM: How an Emergency Physician Thinks
Hardcore EM: How an Emergency Physician Thinks
Mar 02 2019
Rank #11: Prehospital Ketamine – Is there anything it can’t do?
PHARM Physician, Per Bredmose, provides an in-depth look at Ketamine in the prehospital setting. Per discusses the uses, benefits and potential complications of Ketamine, providing tips and tricks from his wealth of experience.
Apr 19 2016
Rank #12: Disruption, danger, and droperidol: emergency management of the agitated patient - Reuben Strayer
Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?
Dec 03 2016
Rank #13: Is the Answer Really “Always Ketamine”? - Peter Brindley interrogates: Reuben Strayer
A no-holes barred series of 6 provocative medical interrogations. We challenge the state of research, social media, pharmacology, social work, women in medicine, medicine in the developed work, and the health of healthcare workers. It should be novel, it may get heated, and it is not scripted. Sometimes to comfort the afflicted you also need to afflict the comfortable. This is why no prisoners will be taken, no topic is out of bounds, and no ego will be pampered. It may even offend: you have been warned.
Apr 29 2018
Rank #14: Don't DSI...Rapid Sequence Airway (RSA)! - Darren Braude
Rapid Sequence Airway (RSA) involves the same preparation and pharmacology as RSI with the immediate planned placement of an extraglottic device (EGD) instead of intubation. Like DSI, RSA is an alternative airway management strategy that may be ideal for preoxygenation of hypoxemic patients as well for prehospital and in-flight use. Depending on the chosen EGD, RSA can facilitate gastric decompression, positive pressure ventilation with PEEP delivered by a ventilator and endoscopic intubation. The speaker presents the evolution of this novel concept in New Mexico, reviews their clinical experience with RSA in both the prehospital and hospital settings and assesses the available literature.
May 03 2017
Rank #15: Assault on the RV – Pulmonary Hypertension and Heart-Lung Interactions - John Greenwood
Pulmonary hypertension (PH) is commonly encountered when managing the patient with an acute critical illness. The impact of PH on cardiac function can be devastating if it is not quickly recognized. The goal of this talk is to arm clinicians with some simple techniques to predict and assess for complications of PH, identify the resuscitation targets in a crashing patient with PH, and finally review some major pitfalls in the management of the patient with PH.
Jan 03 2017
Rank #16: Defending Bawa-Garba: When Healthcare Becomes a Crime
Delivery of safe healthcare currently faces unprecedented challenges in the UK and globally. This arises, at least partly, from a rising involvement of the criminal law in the investigation of medical errors apparently conflicting with the need to respect a "duty of candour". As a result, doctors face enormous pressures in fear of being blamed for medical errors. David Sellu is a consultant surgeon who was convicted for gross negligence manslaughter in late 2013 after the death of a patient in a private hospital. I (@DrJennyVaughan) was the medical lead for a group of David Sellu's friends as we launched a campaign to overturn his conviction. There has never been a successful 'out of time' appeal in this area of the law so we were dealing with almost impossible odds from the start. The positive result was extraordinary, both for David and our whole profession (www.medicalmanslaughter.co.uk). Since these events, I have supported other doctors facing criminal conviction, such as the paediatrician Dr Hadiza Bawa-Garba, through my work with the Doctors Association UK (DAUK, @TheDA_UK). Thousands of doctors crowd-funded a campaign and successfully overturned a court decision to erase her from the UK medical register. Her case proved to be a lightning rod in the UK for a profession at breaking point. Many healthcare staff are working on critically under-staffed wards and in under-resourced departments, with an increasingly unmanageable workload.
DAUK have since launched a "Learn Not Blame" campaign to improve safety for patients and healthcare professionals. We believe that the involvement of the criminal justice system in these cases often does not allow an appreciation of the interplay of individuals within complex health systems. We also remain particularly concerned that a recent analysis of conviction trends shows an excessive conviction rate of black and minority ethnic (BME) healthcare staff.
Dec 18 2019
Rank #17: Clot retrieval for stroke in the extended time window
A case example of a large vessel obstruction of the brain and our current techniques available to treat it. How we make decisions on endovascular treatment and management points for emergency and intensive care colleagues.
Jan 22 2020
Rank #18: Bad Blood - Deirdre Murphy
Critically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human. When they run riot or the fine balance between pro- and anti-inflammatory states is shifted however there can be significant morbidity and mortality. This acronym-busting talk will focus on some acquired haematological disorders in critically ill patients. Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects about 1% of hospitalised patients. At the most severe end it is associated with bleeding and/or thrombotic complications. Disorders such as thrombotic thrombocytopenia purpura (TTP) and other forms of micro-angiopathic hemolytic anemia (MAHA) will also be described including the role of ADAMST13. HIT is an uncommon but important conditions which is difficult to diagnose in a critically ill patient. An approach to HIT is discussed. Have you always wondered about NETs (neutrophil extracellular traps) and their importance? If so this whistle-stop tour of non-malignant hematology in the ICU is for you!
Oct 25 2016
Rank #19: Anyone Can Intubate, or Not: Teaching airway skills the antifragile way - George Kovacs
Becoming competent in airway management requires good decision making and and technical skills. Ultimately what matters is how your clinical performance impacts patient outcomes. For this we need to have a clear understanding of what defines success ensuring that its more than just 'getting the tube'. Come to this talk and you'll experience a Canadian take on Guinness, adventure sports, flying a plane and how other factors including failure influence airway management outcomes.
May 02 2017
Rank #20: The PEA Paradox - Haney Mallemat
Patients who present with pulseless electrical activity (PEA) arrest have a high mortality. The treatment of PEA requires finding and reversing the underlying cause, therefore a simple and rapid approach is required. Traditionally we were taught to use the H's and the T's, but this diagnostic tool is cumbersome and of questionable utility overall. This talk will discuss the problems with the traditional H's and T's as well as focusing on newer approaches to PEA arrest. The speaker will discuss tools such as bedside ultrasound and using the width of the QRS complex to rapidly workup and treat patients in PEA arrest.
Jan 04 2017