EMCrit Podcast - Critical Care and Resuscitation

EMCrit Podcast - Critical Care and Resuscitation Podcast

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










EMCrit RACC Wee – Debate re: Idarucizumab with @First10em
So my friend, Justin Morgenstern recently put up a post on Idarucizumab, aka Praxbind. He seemed pretty fired up on the issue, so I got him on the line to talk about it. What follows is a conversation on evidence and what to do when there is not a good amount of it. Schtuff The EM Cases Podcast that partially sparked the debate Justin Wrote an Additional Post after our Discussion On Parachutes and Such On to the Wee......



EMCrit RACC Podcast 217 – The Ultimate “Ultimate” BVM
So in prior posts, I have discussed the jerry-rigged "ultimate" BVM. But there is a better way--the creation of a manufactured BVM that helps us not kill patients. It would have the following characteristics: Facets of the Ultimate BVM     Now on to the Vodcast......











Podcast 196 – Having a Vomit SALAD with Dr. Jim DuCanto – Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding
Friend to the show, Jim DuCanto has been obsessed with SALAD. Not the leafy greens delicately touched with a tart emulsion, but with Suction Assisted Laryngoscopy and Airway Decontamination (SALAD). Jim DuCanto, MD  is an anesthesiologist extraordinaire with a constant drive to perfect new airway techniques and document them on video along the way. COI Statement Dr. DuCanto invented and receives royalties on the DuCanto Catheter from SSCOR and the Nasco SALAD mannequin Read More about SALAD from Taming t...








Podcast 179 – An Interview with Gary Klein
Today, I am joined by my friend, Mike Lauria, to interview Gary Klein, PhD. Dr. Klein is a masterful cognitive psychologist. He is known for many groundbreaking works, including: the Recognition-Primed Decision (RPD) model to describe how people actually make decisions in natural settings; a Data/Frame model of sensemaking; a Management by Discovery model of planning to handle wicked problems; and a Triple-Path model of insight. He has also developed several research and application methods: The Critical De...




EMCrit Wee – Vipassana Meditation
My opening talk at SMACCdub was on meditation: vipassana and stoic negative contemplation. It will be available in the next few months. Hopefully this wee will tide you over....



















Podcast 138 – Vasopressor Basics
There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation....





Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman
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 Surger...





EMCrit Podcast 121 – REBOA
This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta)....


Wee – What the heck is a Mapleson B Circuit and Why You Probably Shouldn’t Care
There is a really smart anesthesiologist out there called Nicholas Chrimes. He along with his mate Peter Fritz invented the Vortex Approach to Airway Management. He also runs a blog called Clinical CrEd. He did a post advocating the Mapleson B Circuit as the Ultimate Preox Device What is the Mapleson B? The Mapleson circuits were used for anesthetics in the good old days. At least in the US, we have move to bigger, and arguably better designs for our operative patients. Many would have thought this de...


Podcast 117 – Everyday Emergency Kits with Keith Conover
If you are an EM:RAP listener, you have probably heard Mel Herbert's story of 2 cars crashing right outside of his house. Mel realized he did not stock a medical kit in his house with the necessary crucial supplies for an emergency scene. I realized I don't either (there is one in my car). So, I reached out to the master of preparedness, Dr. Keith Conover....







SMACC Gold Promo
SMACC Gold is March 18-21st on the Gold Coast of Australia--best ED conference you will ever attend...


Podcast 105 – The Path to Insanity
This was my favorite lecture assigned to me at SMACC 2013. It discusses the search for excellence in our profession. I hope you enjoy!...


Podcast 102 – Don’t Half-Ass your FAST!
I've wanted to discuss tips and pitfalls for the FAST exam for a while now, but I needed a master to talk with. Luckily at Castlefest, I met Laleh Gharahbaghian, MD....








Podcast 92 – EMCrit Intubation Checklist
Since Peter Pronovost's landmark study on how a simple checklist can nearly abolish central line infections, checklists have been the darling of the medical literature...






Podcast 84 – The Post-Intubation Package
There is a ton of stuff to do post-intubation besides confirming the tube and giving the team high-fives. What we do in the ED has ramifications on the patient's course in the hospital....









Severe Pelvic Trauma
Hemodynamically unstable pelvic fractures are a talk-and-die situation. These folks require aggressive, rapid treatment if they are going to survive the injury. Inspired by my mentor, Thomas Scalea, I discuss the management of the unstable pelvic trauma patient....


Podcast 70 – Airway Management with Rich Levitan
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....





Podcast 65 – A Primer on BVM Ventilation with Reuben Strayer
Today I want to talk about proper ventilation with a Bag-Valve-Mask, aka the BVM. I am joined by my friend Reuben Strayer, MD of EM Updates. You'll see Reub's talk from this year's EMCrit ED Critical Care Conference and hear some of my thoughts as well....

Podcast 64 – Fluid Responsiveness with Dr. Paul Marik
Today I had the pleasure to interview Dr. Paul Marik, Professor and Division Chief of Pulmonary Critical Care at Eastern Virginia Medical Center. We got to speak on the topic of fluid responsiveness--one of the toughest questions in critical care....

More on a Diagnostic Strategy for C-Spine Injuries
Podcast 63 set off some expected controversy given my take that plain films are a dead imaging modality for c-spine injuries. I wanted to briefly outline my impression of the existing evidence:...


Podcast 63 – A Pain in the Neck – Part I
In this episode, I discuss the diagnosis of c-spine injuries. I argue that we should not send patients to imaging unless we have used the NEXUS rule and then added the Canadian C-spine Rule to the sequence. If we are imaging, it should be with a 3-view reconstructed CT scan. And even after that is done, you still need a clearance exam before removing the collar....


Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?
In this podcast, I explain why I don't think needle compression is such a clever idea. Main points are: most people can't find anterior target, most angiocaths won't reach, and if used diagnostically you may not be in the pleura leading to an unidentified pneumo or hemothorax. Also, when used diagnostically, if the chest was negative you just caused a pneumothorax....

Podcast 061 – Debate: Paralytics for ICU Intubations?
I recently spoke at a symposium at the Greater NY Hospital Assoc's with the title: Controversies in Critical Care. I debated Paul Mayo, MD on the topic of whether paralytics should be used for ICU emergent intubations. Of course, I took the pro side of the debate. Dr. Mayo based his con side on an amazing study that came out of his ICU at LIJ hospital in NY....


Podcast 059 – Bath Salts with Leon Gussow
Today I am joined by toxicology master, Leon Gussow to discuss a new quasi-legal class of drugs: Bath Salts. I saw my first OD of this a month ago; despite the drug's name, this patient was neither clean nor pleasantly refreshed. He was violent, agitated, and overheated....



Podcast 052 – Organ Donation in the ED
Organ Donation in the Emergency Department Though it may not seem as important as some of the things we do in ED Critical Care, managing the potential organ donor can lead to many lives saved. In this episode I interview Isaac Tawil, an Emergency Intensivist of University of New Mexico Health Sciences and associate medical director of New Mexico Organ Donor Services. Here are the current standards for determining brain death Wijdicks et al. Evidence-based guideline update: Determining Brain Death in Adul...


Podcast # 51: Fibrinolysis in Pulmonary Embolism
Jeff Kline is the master of all things pulmonary embolism in emergency medicine. This is a lecture he gave on fibrinolysis for pulmonary embolism. He discusses both massive and sub-massive PE....

Hemostatic Resuscitation by Richard Dutton, MD
Richard Dutton is a trauma anesthesiologist who was one of the primary formulators of the concept of 1:1:1 resuscitation. Here he is speaking on hemostatic resuscitation....


EMCrit Podcast 48 – PhD in EKGs Part II: Left Bundle Branch Block
A few months ago, we had Dr. Stephen Smith on the podcast to discuss a variety of EKG issues. Dr. Smith has an EKG blog that is required reading for every ED and ICU doc. This is Part II and I think it discusses an incredibly important issue: right now major medical societies including the AHA and ACEP are asking us to fibrinolyse or PCI patients with new or presumed new LBBB. However, your interventionalists will tell you that this strategy is a ridiculous waste given how few acute occlusions will actually...


EMCrit Podcast 45 – Acid Base: Part II
This second lecture discusses a quantitative approach to acid base management. I lay out the formula I use to approach an acid-base problem....


EMCrit Podcast 44 – Acid Base: Part I
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....

Listener Questions – Episode 1
Since we had the Kayexalate episode, I did not want to do a full podcast, so I thought I would just air some listener questions:...

Bonus – Is Kayexalate Useless?
Dr. Siamak (Mak) Moayedi, MD found nothing to indicate that kayexalate is effective for the acute management of hyperkalemia....


EMCrit Podcast 43 – Laryngeal Airways with Daniel Cook, MD (Part I)
My favorite supraglottic airway is the Cookgas Air-Q; it was created by an anesthesiologist, Dr. Daniel Cook. He just created a new device that allows the placement of an esophageal blocker through the laryngeal airway. I gave him a call to hear about the new product and in the course of that conversation, he gave me a ton of tips on the placement of laryngeal airways. Part II will specifically discuss the new device....


EMCrit Podcast 39 – Hyponatremia
Hmm… he’s tasty, but he just needs a little salt! In this podcast, I discuss the management of hyponatremia in the ED....


EMCrit Podcast 37 – Lactate in Sepsis
When an ED starts providing advanced care for severe sepsis, lactate testing is an absolute requirement. Lactate use brings up a lot of questions, especially if it is not commonly ordered in your department. In this podcast, I discuss all of the lactate questions that have come up in the course of the NYC Sepsis Collaborative....

EMCrit Podcast 36 – Traumatic Arrest
Management of traumatic arrest. Many things to do in these patients, but two things you definitely should not be doing are closed-chest CPR or giving ACLS medications. We discuss who gets a thoracotomy, what to do if a thoracotomy is not indicated, and when to stop....


EMCrit Podcast 35 – Extubation in the ED
In this podcast, I discuss extubating patients in the ED. Specifically, I deal with patients who have only been intubated for a few hours in distinction to extubation of the patient who has been lingering in your ED for 2-3 days. The best patients for this short-term extubation are those intox folks with a low GCS and signs of trauma, overdoses, or endoscopy cases....

EMCrit Podcast 34 – 2010 ACLS 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....


EMCrit Podcast 33 – Diagnosis of Posterior 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 th...

EMCrit Podcast 31 – Intra-Arrest Management
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....


EMCrit Podcast 29 – Procedural Sedation, 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 to allow maximal comfort and safety for our patients. This continues the discussion started in Part I....


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


EMCrit Podcast 28 – 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....

EMCrit Podcast 27 – Calcium Channel Blocker Overdose
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. I got to meet Leon for a few beers a month ago; he is just a great guy. My Canadian pal, Ram, suggested calcium channel blocker OD as a podcast episode. Ram, here you go....

EMCrit Lecture – Top Ten Hypothermia Tips
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....


EMCrit Lecture – Dominating the Vent: 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....

EMCrit Lecture – Dominating the Vent: Part I
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....

Vent Handout
This post is just to place the vent handout into itunes....


EMCrit Podcast 26 – Patient Controlled Analgesia by Edward Gentile
Even when we can't cure a patient, we can relieve suffering. On average, we kind of stink at pain control in the ED. One physician, Dr. Ed Gentile, has created a simple path to optimal acute pain control in the ED. I heard this lecture on the EM:RAP podcast and got permission from Drs. Gentile and Herbert to repost it here. This is not a critical care topic per se, but it is applicable to the critically ill, the non-critically ill--basically any patient who is in pain in the ED....

Service Update – How to get old episodes into Itunes
I received a bunch of emails asking how to get the old episodes into itunes. I expanded the RSS feed to include them, now you just need to bring them into itunes, this 40 second video shows you how....

IVC Ultrasound for Non-Invasive Sepsis Protocol
We're still working on the Greater NY Sepsis Initiative. The next step towards making a non-invasive protocol possible is to teach folks how to use ultrasound of the IVC to assess fluid responsiveness. I developed this video to get ED & ICU docs up to speed. If you can do ANY ultrasound exam, you can do this one....


EMCrit Podcast 25 – End of Life and Palliative Care in the ED
Aggressive palliative care is just as important as aggressive critical care in the ED. Sometimes we will be the first physicians to talk to a family about end of life issues, even if their loved one is terminally ill. Now that is not how it should be, but it just means that we must be just as skilled at family palliative care discussions as we are at floating a transvenous pacer. In this podcast, I discuss my vision of how to handle palliative care issues in the ED....

Q&A: The Two Rams
Two listener questions answered in 5 minutes. One on awake intubation in trauma and the other on intubating the patient with severe RESP acidosis....

Bougie-Aided Cricothyrotomy by Darren Braude
Darren Braude, Aiway and EMS master from New Mexico demonstrates the use of a bougie to make the cric procedure MUCH easier. For more great Braude magic, see his site at airway911.com....


EMCrit Podcast 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 Podcast 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 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 Podcast 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 Podc...


EMCrit Podcast 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 Podcast 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 Podcast 19 – Non-Invasive Ventilation
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....


EMCrit Podcast 16 – Coding Asthmatic, DOPES and Finger Thoracostomy
Hi folks, Sorry about the voice--got a cold off those damn ED keyboards Thanks to my friend Reuben, this week we'll talk about the asthmatic patient that codes while on the vent The DOPE mnemonic gives you a path to figure out why a patient is desaturating (If anyone knows who created the DOPE mnemonic, please add a comment or send me an email. An EMCrit listener solved the mystery) If the pt is asthmatic, add an "S" to make DOPES The "S" stands for Stacked Breaths--and it's the first thin...


EMCrit Podcast 14.5 – A bit more on EGDT
Chris Nickson is an Aussie, oops Kiwi, who is a lead author of a great blog: lifeinthefastlane.com and tweets under the moniker @precordialthump; check him out, he's doing really good stuff. He wrote a comment about the last podcast-- Hey Scott, Great to hear your views and approach to EGDT. I agree with the need for aggressive resuscitation of the septic patient – with fluid, antibiotics, vasopressors (we’re a ‘norad/ norepi shop’ too) and adequate oxygen delivery being the mainstays – and, if nothing els...

EMCrit Podcast 14 – EGDT Tirade
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....


EMCrit Podcast 13 – Trauma Resus II: Massive Transfusion
On this podcast, I recap from last show, especially the concept of bare minimum normotension (called erroneously permissive hypotension by just about everyone else) and why we should keep the MAP higher if there is suspected elevations in intracranial pressure I then talk about massive transfusion. This is probably the best strategy for a patient that will require greater than 8-10 units of PRBCs. What may be the best review of the topic is by Spinella and Holcomb: (Blood Reviews 2009;23:231-240) ...

EMCrit Podcast 12 – Trauma Resus: Part I
Thought we'd talk about some trauma stuff, specifically the resuscitation of the critically ill hemorrhagic shock patient. There is much to discuss, so this will be a multi-episode affair. Today, we'll concentrate on the Lethal Triad and BP Goals. Lethal Triad The picture says it all. Bleeding causes acidosis, hypothermia, and coagulopathy. Then the cycle begins as they all beget each other. If this continues for too long, it is irreversible. We can iatrogenically make things worse by keep...


Podcast 10 – Cardiogenic Shock
Mohamed, a listener from Sudan, emailed asking about the treatment of acute pulmonary edema in patients with low blood pressure. This is in distinction to SCAPE patients (see podcast 1). If the patients have pulmonary edema and low BP from a cardiac cause, then they are in Cardiogenic shock. First, consider the etiology: Rate-related Valve Disorder Ischemic (Right sided infarct, STEMI, NSTEMI) Cardiomyopathy Toxicologic At the same time, you are treating the patient with: Inotr...

EMCrit Podcast 8 – Subarachnoid Hemorrhage
This week's podcast is on the management of a the patient with SAH. It's not a complete review, just some tips and reminders. Best article for EM that I've found, comes out of Columbia For more reviews on mostly ICU issues see here and here. Update: Critical Care Management of Patients Following Aneurysmal SAH Guidelines from NCC 1. Get a neuro exam before you intubate 2. Intubation Give pretreatment, now just lidocaine and fentanyl Etomidate or propofol; plus sux. Most experienced intubat...


EMCrit Podcast 7 – Sedation Tirade
Hi folks, this podcast is really brief--I gave a lecture at Jacobi last week (thanks for having me Jacobites!), and in response to a question I gave this rant on my vision of sedation after intubation....

EMCrit Podcast 6 – Push-Dose Pressors
Note: Please listen to the PDP update episode either before or immediately after listening to this one Finally a non-intubation topic! Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation. They also can act as a bridge to drip pressors while they are being mixed or while a central l...

EMCrit Podcast 5 – Intubating the Critical GI Bleeder
We've had a  few gruesome airways in patients with GI bleeds and bellies full of coffee ground emesis. This is a top 10 list encompassing my approach to this difficult situation: 1. Empty the Stomach Place a salem sump and suck out all of the stomach contents. Varices are not a contraindication (see: Digest Dis 1973;18(12):1032, Gastrointest Endosc. 2004 Feb;59(2):172-8, and Anesth Analg 1988;67:283) Administer Metoclopramide 10 mg IVSS 2. Intubate the Patient with HOB at 45° Semi-Fowler's positi...


Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis
This lecture is part of the Laryngoscope as a Murder Weapon Series: Hemodynamic Kills Oxygenation Kills Ventilatory Kills Sorry about the voice--blame the swine flu. Case Thanks to Joe Chiang Severe DKA; Obtunded with pH 6.65, PaCO2 18, Bicarb 5 Pt’s mental status is worsening The decision is made to intubate Should you give NaBicarb? Probably won’t help as patient is already breathing at their maximum. Unless they blow off the Bicarb-generated CO2, they won’t increase their pH signif...

EMCrit Podcast 2 – ETCO2
I did a spot on ETCO2 for Amal Mattu's podcast a couple of weeks ago. I try to clear up some of the myths on the use of ETCO2. Of course the most pervasive and potentially dangerous myth is that ETCO2=PaCO2. Long story short, in our patients, it doesn't. Listen to the podcast for more......

EMCrit Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
Here it is, the 1st EMCrit podcast. It's on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE). To boil it down to 10 seconds: Start patient on Non-invasive ventilation with a PEEP of 6-8; quickly titrate to a PEEP of 10-12. Start the patient on a nitroglycerin drip. Administer a loading dose of 4oo mcg/min for 2 minutes (120 ml/hour on the pump for 2 minutes with the standard nitro concentration of 200 mcg/ml.) Then drop the dose to 100 mcg/min and titrate it up from there as nee...


EMCrit Podcast 0 – The Intro
In which I introduce you to me and explain what this whole thing is about. (better late than never)...