Archive for category Critical Care

The 2010 ACLS & BCLS Guidelines

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.

[Click Here for the Summary and to Hear the Podcast]

, , , ,

No Comments

That Dizzy Patient may be 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? 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.

[Click Here to Read More and Hear the Podcast]

, , ,

No Comments

The Management of the Intra-Arrest

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. LMAs instead of tubes, IOs instead of central lines, and so much more.

[Click Here to Read More and Hear the Podcast]

, , ,

No Comments

Trauma Resuscitation with Dr. Richard Dutton

photo from trauma.orgThis week on the EMCrit Podcast,  we discuss the resuscitation of the hemorrhagic shock patient with Dr. Richard Dutton, MD. Rick was director of trauma anesthesia at the Shock Trauma Center when I trained there. He is an incredible teacher, clinician, and researcher.

Here are the take home points:

  • Induction agent choice does not matter in these patients; what matters is DOSE! Reduce dose to 1/10 of full intubating dose.
  • Blood products need to be available in the trauma bay for when these patients arrive. If you need to give crystalloid while awaiting the products, give only small amounts just to keep the patients heart beating.
  • A systolic of 80 with good perfusion and normal sized vessels is very different than that same SBP in a patient who is clamped down. The former is a resuscitated state, the latter =spiral of death.
  • The resuscitation fluid for trauma is equal parts PRBC and FFP.

[Click Here to Read More and Listen to the Podcast]

photo from trauma.org

, , , , ,

No Comments

Procedural Sedation in the ED, Part II

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 for the maximal comfort and safety for our patients. This continues the discussion started in Part I, where we discussed etomidate, ketamine, and versed/fentanyl. In this podcast, I discuss propofol, ketofol, and dexmedetomidine.

[Click Here to Read More and to hear the Podcast]

, , , ,

No Comments

Procedural Sedation in the ED, 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 for the maximal comfort and safety for our patients. This brief lecture was originally posted on the defunct EMCrit Lecture Site on 8/7/2009.

I’m reposting it here so that I can post part II sometime this week.

This episode, Part I, covers general concepts on sedation as well as ketamine and etomidate/fentanyl.

[Click Here to Read More and Hear the Lecture]

, , , , ,

1 Comment

Severe CNS Infections

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.

[Click Here to Read More and to hear the Podcast]

, , , , , , ,

1 Comment

Calcium Channel Blocker Overdose

Calcium Channel Blocker Overdose is one of the worst ODs you may see in the ED. There are new therapies that can counter the effects of these meds, but you need to know how and when to use them.

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. In this EMCrit Podcast, Leon and I discuss the severe CCB OD.

[Click here to read more and hear the podcast]

, , ,

1 Comment

Top Ten Tips on Therapeutic Hypothermia

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.

[Click Here to Read More and Hear the Podcast]

, , , ,

No Comments

Dominating the Ventilator: Part II

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.

In this second part, I discuss the strategy of managing the patient with obstructive lungs.

[Click here to read more and hear the podcast]

, , , , ,

No Comments