EMCrit Project

en EMCrit Project https://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Thu, 23 Dec 2021 11:59:37 +0000 en-US hourly 1 https://wordpress.org/?v=5.8.2

https://emcrit.org/feed/podcast/

Help me fill in the blanks of the practice of ED Critical Care. In this podcast, we discuss all things related to the crashing, critically ill patient in the Emergency Department. Find the show notes at emcrit.org. Scott D. Weingart, MD FCCM clean episodic Scott D. Weingart, MD FCCM spambin55@gmail.com spambin55@gmail.com (Scott D. Weingart, MD FCCM) 2009- Online Medical Education on Emergency Department (ED) Critical Care, Trauma, & Resuscitation EMCrit Project http://emcrit.org/wp-content/uploads/powerpress/3000x3000-emcrit.jpg https://emcrit.org PulmCrit – Internet Book of Critical Care 1st draft & smartphone app https://emcrit.org/pulmcrit/app/ https://emcrit.org/pulmcrit/app/#comments Thu, 23 Dec 2021 11:59:37 +0000 https://emcrit.org/?p=482314 first draft of IBCC is done! There are now chapters up on the core critical care topics. Nearly all chapters have either been written or updated in 2020-2021, so it's pretty fresh. Ongoing updates will continue to push this date forwards. Of course, the IBCC will never be finished. New chapters will be added over […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/app/feed/ 1 EMCrit – RACC Lit Update 2021-12-22 https://emcrit.org/emcrit/emcrit-racc-lit-update-2021-12-22/ https://emcrit.org/emcrit/emcrit-racc-lit-update-2021-12-22/#respond Wed, 22 Dec 2021 17:28:05 +0000 https://emcrit.org/?p=486994 All the Resus and Acute Crit Care Goodness in 10 minutes

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/emcrit-racc-lit-update-2021-12-22/feed/ 0 EMCrit 313 – Tube Thoracostomy (Chest Tubes) Part 2 https://emcrit.org/emcrit/chest-tubes-2/ https://emcrit.org/emcrit/chest-tubes-2/#comments Fri, 17 Dec 2021 16:52:45 +0000 https://emcrit.org/?p=486629 Chest Tube Insertion (Part 2 of a 2 part series)

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/chest-tubes-2/feed/ 3 IBCC – Pericardial Tamponade https://emcrit.org/pulmcrit/tamponade/ https://emcrit.org/pulmcrit/tamponade/#respond Thu, 16 Dec 2021 10:45:49 +0000 https://emcrit.org/?p=486762 Pericardial tamponade is an uncommon but extremely important cause of cardiogenic shock, because it is highly treatable. Unfortunately, the precise definition of tamponade can be challenging – and patients can rapidly transition from an uncomplicated pericardial effusion towards the development of tamponade. The IBCC chapter is located 👉 here. The podcast & comments are below. […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/tamponade/feed/ 0 IBCC – LV Outflow Tract Obstruction (LVOTO) https://emcrit.org/pulmcrit/lvoto/ https://emcrit.org/pulmcrit/lvoto/#comments Thu, 09 Dec 2021 13:29:31 +0000 https://emcrit.org/?p=486839 Dynamic LV outflow tract causes an inversion of all hemodynamics. Diuresis and inotropes may cause cardiogenic pulmonary edema! Vasoconstrictors and beta-blockers may improve cardiogenic pulmonary edema! Down is up and up is down. As you might imagine, failure to recognize this physiology could easily lead to management strategies that make matters worse. The IBCC chapter […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/lvoto/feed/ 1 IBCC: Type-1 Myocardial Infarction https://emcrit.org/pulmcrit/mi/ https://emcrit.org/pulmcrit/mi/#comments Tue, 07 Dec 2021 13:54:42 +0000 https://emcrit.org/?p=486756 Management of myocardial infarction is the core of cardiovascular critical care. Recent advances in the OMI/NOMI paradigm offer the ability to detect significant infarctions earlier – allowing for prompt triage and management. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/mi/feed/ 1 PulmCrit wee: DDAVP Clamp-Bolus technique for severe hyponatremia https://emcrit.org/pulmcrit/ddavp-clamp-bolus/ https://emcrit.org/pulmcrit/ddavp-clamp-bolus/#comments Sat, 04 Dec 2021 13:28:26 +0000 https://emcrit.org/?p=486677 The DDAVP clamp technique has considerably simplified the management of severe hyponatremia. The fundamentals of the technique are as follows: Before the use of the DDAVP clamp, the primary cause of sodium overcorrection was endogenous free water excretion by the kidneys. For example, patients would present to the hospital with retention of free water due […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/ddavp-clamp-bolus/feed/ 2 EMCrit 312 – Tube Thoracostomy (Chest Tubes) Part 1 Peri-procedural Chest Tube Stuff https://emcrit.org/emcrit/chest-tubes-1/ https://emcrit.org/emcrit/chest-tubes-1/#comments Thu, 02 Dec 2021 21:40:22 +0000 http://emcrit.org/?p=5123 You need to understand and be able to perform perfectly in the rare circumstances that still demand chest tubes

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/chest-tubes-1/feed/ 3 EMCrit 311 – Adrenal Crisis with Karin Amrein https://emcrit.org/emcrit/adrenal-crisis-2/ https://emcrit.org/emcrit/adrenal-crisis-2/#respond Thu, 18 Nov 2021 22:26:16 +0000 http://emcrit.org/?p=443410 Adrenal crisis can be deadly

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/adrenal-crisis-2/feed/ 0 IBCC – Acute Ischemic Stroke (AIS) https://emcrit.org/pulmcrit/ais/ https://emcrit.org/pulmcrit/ais/#respond Wed, 17 Nov 2021 13:42:17 +0000 https://emcrit.org/?p=486127 Acute ischemic stroke (AIS) is a common cause of admission to the neurological ICU, as well as a complication of critical illness that may occur among patients within any ICU. The stroke neurology team will take the lead in managing these patients (including decisions regarding tPA and endovascular intervention). This chapter focuses more on aspects […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/ais/feed/ 0 NeuroEMCrit – Demystifying the EEG Report https://emcrit.org/emcrit/eeg-terminology/ https://emcrit.org/emcrit/eeg-terminology/#comments Thu, 11 Nov 2021 14:18:36 +0000 https://emcrit.org/?p=485109 EEGs are tougher than EKGs--but you can master the basics

EMCrit Project by NeuroEMCrit Team (Casey & Neha).

]]> https://emcrit.org/emcrit/eeg-terminology/feed/ 7 EMCrit 310 – Transvenous Pacemakers https://emcrit.org/emcrit/transvenous-pacemakers/ https://emcrit.org/emcrit/transvenous-pacemakers/#comments Thu, 04 Nov 2021 21:29:27 +0000 http://emcrit.org/?p=14113 As you might imagine on an EMCrit podcast, there are a ton of logistical details on placing and managing transvenous pacemakers.

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/transvenous-pacemakers/feed/ 6 PulmCrit Wee: COVID STEROID-2: Double the steroid, double the fun? https://emcrit.org/pulmcrit/covid-steroid-2/ https://emcrit.org/pulmcrit/covid-steroid-2/#comments Sat, 23 Oct 2021 13:02:11 +0000 https://emcrit.org/?p=485054 A billion years ago (or so it seems), the RECOVERY trial demonstrated mortality benefit from dexamethasone 6 mg/day for up to 10 days in hypoxemic COVID patients. This rapidly became a standard treatment. It’s a fundamental therapy that has saved lives. Nonetheless, questions linger about the optimal steroid dose. 6 mg/day dexamethasone is equivalent […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/covid-steroid-2/feed/ 5 EMCrit 309 – Critically Ill Diabetic Ketoacidosis (DKA) https://emcrit.org/emcrit/severe-dka/ https://emcrit.org/emcrit/severe-dka/#comments Thu, 21 Oct 2021 17:50:02 +0000 http://emcrit.org/?p=13259 Critically Ill diabetic ketoacidosis is usually a bit of a misnomer

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/severe-dka/feed/ 15 EMCrit 308 – Risk Stratification and Treatment of Pulmonary Embolism (PE) 2021 – Is the PERT Wilted? https://emcrit.org/emcrit/pe-rx-pert/ https://emcrit.org/emcrit/pe-rx-pert/#comments Thu, 07 Oct 2021 21:02:17 +0000 https://emcrit.org/?p=482244 PE is hard--I think we make it harder than it needs to be

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/pe-rx-pert/feed/ 13 IBCC – Waveform capnography https://emcrit.org/pulmcrit/co2/ https://emcrit.org/pulmcrit/co2/#comments Thu, 07 Oct 2021 14:08:10 +0000 https://emcrit.org/?p=484876 Quantitative waveform capnography is rapidly becoming a standard of care for any intubated patient. Although this may appear simple, it provides a host of information about ventilation and cardiac output. When further integrated with clinical context (such as trends in minute ventilation), there is a potential for fundamentally changing how we monitor our patients. If […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/co2/feed/ 2 EMCrit 307 – TTM2 Episode Retort with Ben Abella & Joe Tonna https://emcrit.org/emcrit/ttm2-retort/ https://emcrit.org/emcrit/ttm2-retort/#comments Thu, 23 Sep 2021 19:07:42 +0000 https://emcrit.org/?p=479160 Offering the other side their fair say...

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/ttm2-retort/feed/ 1 ODR 1 – Email Part 1 – Email is Not the Problem, You Are! https://emcrit.org/odr/email-is-not-the-problem/ https://emcrit.org/odr/email-is-not-the-problem/#comments Wed, 22 Sep 2021 17:58:11 +0000 https://emcrit.org/?p=484622 Email is not really the issue--our relationship with email is the problem!

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/odr/email-is-not-the-problem/feed/ 7 IBCC – SCAPE (Sympathetic Crashing Acute Pulmonary Edema) https://emcrit.org/pulmcrit/scape-2/ https://emcrit.org/pulmcrit/scape-2/#comments Tue, 21 Sep 2021 10:07:44 +0000 https://emcrit.org/?p=484608 SCAPE (Sympathetic Crashing Acute Pulmonary Edema) is a specific form of severe heart failure which is seen predominantly in the emergency department and intensive care unit (as opposed to the outpatient cardiology clinic). Consequently, there is a tendency to overlook SCAPE in articles and chapters about heart failure. SCAPE is critical to recognize and intervene […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/scape-2/feed/ 4 NeuroEMCrit – What Every Clinician Should Know about External Ventricular Drains (EVDs) https://emcrit.org/emcrit/external-ventricular-drains-evd/ https://emcrit.org/emcrit/external-ventricular-drains-evd/#comments Thu, 16 Sep 2021 19:55:20 +0000 https://emcrit.org/?p=484416 EVDs, IVCs--all things intracranial monitors...

EMCrit Project by NeuroEMCrit Team (Casey & Neha).

]]> https://emcrit.org/emcrit/external-ventricular-drains-evd/feed/ 12 IBCC – ARDS https://emcrit.org/pulmcrit/ards/ https://emcrit.org/pulmcrit/ards/#comments Thu, 09 Sep 2021 12:34:13 +0000 https://emcrit.org/?p=484528 There probably isn't much to say about ARDS that hasn't been said in some form within the past couple years. We've debated continually about the optimal approach to this syndrome, in the absence of much solid evidence (the only large, multi-center RCT which has been replicated in ARDS was ACURASYS – and it failed to […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/ards/feed/ 6 EMCrit 306 – Critically Ill and Severe Anaphylaxis https://emcrit.org/emcrit/severe-anaphylaxis/ https://emcrit.org/emcrit/severe-anaphylaxis/#comments Wed, 08 Sep 2021 17:25:39 +0000 http://emcrit.org/?p=451912 The management and treatment of severe and critical anaphylaxis

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/severe-anaphylaxis/feed/ 4 PulmCrit – 10 minute talk on hypoxemia physiology https://emcrit.org/pulmcrit/hypoxemia-physiology/ https://emcrit.org/pulmcrit/hypoxemia-physiology/#comments Wed, 08 Sep 2021 16:01:00 +0000 https://emcrit.org/?p=484500 Here is a 10-minute video I made for the Cooper Critical Care Conference. It explores some basic & useful concepts about hypoxemia physiology, including how to apply this at the bedside. The algorithms in the video aren't intended to be strictly followed, but rather merely as general conceptual schemas. related For more information about the […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/hypoxemia-physiology/feed/ 1 NeuroEMCrit – The Many Aliases and Uses of ADH by Casey Albin https://emcrit.org/emcrit/uses-adh/ https://emcrit.org/emcrit/uses-adh/#comments Tue, 07 Sep 2021 12:27:36 +0000 https://emcrit.org/?p=484300 Spend any time in the NeuroICU and you will encounter an abundance of ADH.

EMCrit Project by Casey Albin.

]]> https://emcrit.org/emcrit/uses-adh/feed/ 2 IBCC – Right Ventricular failure due to pulmonary hypertension https://emcrit.org/pulmcrit/rv/ https://emcrit.org/pulmcrit/rv/#comments Sat, 04 Sep 2021 12:10:02 +0000 https://emcrit.org/?p=484323 Right ventricular failure is extremely common among critically ill patients (e.g., affecting a quarter of patients with ARDS). Unfortunately, this is often overlooked in critical care curricula. We tend to spend lots of time focusing on pulmonary arterial hypertension (which is far more rare), thereby overlooking the everyday conundrum of right ventricular failure. It's called […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/rv/feed/ 1 EMCrit 305 – Post-Cardiac Arrest Hypothermia (or not) – TTM2 Synthesis with Niklas Nielsen and Josef Dankiewicz https://emcrit.org/emcrit/ttm2-trial/ https://emcrit.org/emcrit/ttm2-trial/#comments Sun, 29 Aug 2021 16:42:55 +0000 https://emcrit.org/?p=483186 The TTM2 trial changes game for post-cardiac arrest management. I am joined today with the study's authors to discuss this amazing paper.

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/ttm2-trial/feed/ 1 An Opportunity, a Change, a Request, & an Amazing Upgrade https://emcrit.org/emcrit/change-message/ https://emcrit.org/emcrit/change-message/#comments Sat, 28 Aug 2021 14:08:13 +0000 https://emcrit.org/?p=484120 An Opportunity, a Change, a Request, & an Amazing Upgrade Hi There Emcritters: For over a dozen years, I have been putting out Resuscitation and Acute Critical Care education on the EMCrit podcast. And you have been the best audience in the imaginable universe. Together, we have reached a crossroads–the time has come for a […]

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/change-message/feed/ 11 IBCC – Liberation from invasive ventilation https://emcrit.org/pulmcrit/liberation/ https://emcrit.org/pulmcrit/liberation/#respond Tue, 17 Aug 2021 13:55:23 +0000 https://emcrit.org/?p=483957 Liberation from invasive ventilation is one of the most important goals of critical care medicine. Numerous RCTs have improved our understanding of this process, but it remains as much an art as a science. When in doubt, empirical trials of spontaneous breathing and extubation are more accurate than our predictive ability. The IBCC chapter is […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/liberation/feed/ 0 EMCrit Wee – Breaking News on Fluid Choice and Rate – The BaSICS Trial https://emcrit.org/emcrit/basics-trial/ https://emcrit.org/emcrit/basics-trial/#comments Tue, 10 Aug 2021 22:27:37 +0000 https://emcrit.org/?p=483835 BaSICs Trial Results on Fluid Choice and Rate of Administration

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/basics-trial/feed/ 4 BaSICs Trial Results on Fluid Choice and Rate of Administration
Trial Publication on the JAMA
BaSICS Trial (Fluid Rate)

BaSICS Trial (Fluid Choice)

Zampieri et al.

~11,000 patient trial

90 Day Mortality was the primary

The mean (SD) volume infused as boluses on day 1 was 1162 mL (916 mL) for slower infusion vs 1252 mL (1009 mL) for control infusion rate.

did not randomize fluid received before ICU

Take Home Message
There was no statistically significant difference between the 2 groups with respect to fluid choice (NS vs. Plyte 148) or infusion rate (333 mL/h vs. 999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design.
Now on to the Wee...
]]> Scott D. Weingart, MD FCCM 12:24 PulmCrit Wee – Patient with nonfocal exam and thrombocytopenia https://emcrit.org/pulmcrit/shocky-thrombocytopenia/ https://emcrit.org/pulmcrit/shocky-thrombocytopenia/#comments Mon, 09 Aug 2021 12:59:05 +0000 https://emcrit.org/?p=483295 The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock. The patient was previously healthy with no significant medical problems or medications. History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out. Physical examination is unrevealing, with the patient […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/shocky-thrombocytopenia/feed/ 1 IBCC – Respiratory alkalosis & respiratory acidosis https://emcrit.org/pulmcrit/resp-co2/ https://emcrit.org/pulmcrit/resp-co2/#comments Sat, 07 Aug 2021 12:39:46 +0000 https://emcrit.org/?p=483313 It's very difficult to write a good chapter about respiratory alkalosis (hypocapnia) or respiratory acidosis (hypercapnia). These states remind me a bit of grand central station, because each encompasses such a broad range of patients with different conditions – who need enormously different treatments. So any discussion of these conditions is by definition a gross […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/resp-co2/feed/ 2 EMCrit 304 – Cerebral Venous Thrombosis (CVT) https://emcrit.org/emcrit/cerebral-venous-thrombosis/ https://emcrit.org/emcrit/cerebral-venous-thrombosis/#comments Thu, 05 Aug 2021 15:31:32 +0000 http://emcrit.org/?p=57491 Atypical headache=SAH w/u right? Except sometimes it is CVT. This is a critical diagnosis to make and to treat properly. Today I interview @caseyalbin on EMCrit 304 - cerebral venous thrombosis

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/cerebral-venous-thrombosis/feed/ 3 PulmCrit – Is piperacillin-tazobactam safe in patients with penicillin allergy? https://emcrit.org/pulmcrit/piptazo-allergy/ https://emcrit.org/pulmcrit/piptazo-allergy/#comments Wed, 28 Jul 2021 12:43:38 +0000 https://emcrit.org/?p=482987 Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics - greatly complicating their management.

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/piptazo-allergy/feed/ 1 EMCrit 303 – A Bounceback Case with Mike Weinstock https://emcrit.org/emcrit/tamponade-bounceback/ https://emcrit.org/emcrit/tamponade-bounceback/#comments Fri, 23 Jul 2021 14:11:11 +0000 https://emcrit.org/?p=483001 A case from the new book by Mike Weinstock and a case of near-death after trauma

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/tamponade-bounceback/feed/ 8 IBCC – Neuroprognostication after cardiac arrest https://emcrit.org/pulmcrit/np/ https://emcrit.org/pulmcrit/np/#respond Tue, 20 Jul 2021 13:54:02 +0000 https://emcrit.org/?p=482945 Neuroprognostication following cardiac arrest is one of the most important responsibilities of the ICU team. This process begins as soon as ROSC is achieved, with the avoidance of confounding factors (e.g., sedatives and opioids). An organized, multimodal approach is essential. Incidentally, strategies which are aimed at accurate neuroprognostication will also facilitate early awakening – and as […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/np/feed/ 0 EMCrit 302 – Pain Management Update with Sergey Motov https://emcrit.org/emcrit/pain-management-update/ https://emcrit.org/emcrit/pain-management-update/#comments Thu, 15 Jul 2021 21:51:48 +0000 https://emcrit.org/?p=482845 An update on opioids and pain

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/pain-management-update/feed/ 7 An update on opioids and pain

Today an update on pain management in the ED. Sergey is a great friend and a previous guest on the show when he discussed the Opioid-Free ED.
Sergey Motov, MD
Sergey is an Emergency Medicine Physician practicing in the Department of Emergency Medicine at Maimonides Medical Center, Brooklyn, New York. He graduated from Medical Academy of Latvia and completed his EM residency at Maimonides Medical Center. Dr. Motov is a Research Director who is passionate about safe and effective pain management in the ED. He has numerous publications on the subject of opioid alternatives in pain management, and is actively involved in growing this body of work both nationally and globally.
The Pain-Free ED
Sergey has an amazing site, with resources and lectures: The Pain-Free ED
A Brief Discussion of the Advantages of Morphine over Hydromorphone and Fentanyl from a Euphoria Perspective in Patients with Intact Organs
This is far more an issue for what you send these patients home on.

Sergey recommends MSIR tablets 7.5-10 mg Q 6 hrs for 3 days for most acute pain indications in patients without organ failure. There is also liquid 10 mg/5 ml, so 1/2 tsp gets you 5 mg.

Consider diclofenac gel in the appropriate patient. Now available over the counter. Apply twice/day.
Giving Fentanyl For Longer Duration Pain Means the Patient will be in Pain Again Soon

* Consider a regimen that matches the duration of pain

Kidney Failure

* Do Not Use Morphine
* Hydromorphone--avoid in ESRD, If you feel the need to use it in more mild renal failure, Drop Dose by 75% (e.g. from 1mg to 0.25 mg per dose)and extend dosing regimen (from q4-6 hrs extended to q8-12hrs)
* In the ED, you should probably use Fentanyl. Still reduce dose by 75% of standard and extend dosing intervals
* When you need to send the patient home, do not use tramadol. Mild to moderate, use oxycodone with sig. dose reduction. In the future, buprenorphine may be the agent of choice.

Liver Failure

* Very low dose morphine, but probably the better idea is:
* Fentanyl with a dose reduction and interval extension
* For sending a patient home, Oxycodone consider half dose with extension of intervals

Ketamine

* Recent trial compared 0.15 mg/kg to 0.3 mg/kg with no difference
* Breath-Actuated Nebulized Ketamine

Sergey does not Like IM Pain Meds

* Causing pain to relieve pain doesn't make a ton of sense

More from Sergey

* More on Kidney and Liver Failure Pain Management
* Pain Pearls on Opioids
* Handout on Analgesics for Hepatic and Renal Failure

Do a Virtual Resus Fellowship
Resus Leadership Academy
Now on to the Podcast...]]> Scott D. Weingart, MD FCCM 33:33 IBCC – Subarachnoid Hemorrhage https://emcrit.org/pulmcrit/subarachnoid/ https://emcrit.org/pulmcrit/subarachnoid/#comments Mon, 05 Jul 2021 12:32:47 +0000 https://emcrit.org/?p=482563 Subarachnoid hemorrhage remains a challenging disease, with ongoing controversy surrounding several key aspects (including the optimal diagnostic pathway and management of vasospasm). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/subarachnoid/feed/ 6 EMCrit 301 – The Five Fears with Rob Orman (Mind of the Resuscitationist) https://emcrit.org/emcrit/emcrit-301-the-five-fears-with-rob-orman-mind-of-the-resuscitationist/ https://emcrit.org/emcrit/emcrit-301-the-five-fears-with-rob-orman-mind-of-the-resuscitationist/#comments Thu, 01 Jul 2021 22:35:46 +0000 https://emcrit.org/?p=482488 We need to carry fear, but we do not need to be afraid...

EMCrit Project by Scott Weingart, MD FCCM.

]]> https://emcrit.org/emcrit/emcrit-301-the-five-fears-with-rob-orman-mind-of-the-resuscitationist/feed/ 9 We need to carry fear, but we do not need to be afraid...
“Fear is beneficial. It happens for a reason. Everything we have in our heads is evolutionarily beneficial for the most part. The benefit of fear is it allows you to predict the evil sh*t that's going to happen and avoid it.”
This is another episode from Rob Orman's Stimulus Podcast. Rob is my best buddy and the best interviewer in the business. In this episode, we discuss:
The distinction between carrying fear and being afraid

Good doctors carry fear with them. Those who don’t carry a healthy dose of respect for the risks of their actions can be dangerous.

Fear should be your friend. It should be one of many internal voices that you listen to and to which you decide whether you want to regard or ignore.

Fear should not be your limiter. “If fear is your primary internal theme, then you're afraid. And that's a problem.”

The importance of embracing the idea that sick patients don’t take a joke

The sicker the patient, the less room you have for error. Be very careful.

The Five Fears
1. Scott’s fear number one: lawyers

This is a healthy fear as long as you use it the right way. Shared decision-making and good documentation help to keep this fear positive.

It’s a bad fear if it prompts you to practice defensive medicine and do things that patients don’t need or want (such as order unnecessary tests or procedures).

When you document, be sure to show that you thought of the life-threatening diagnosis and why you did not think it was the cause of the patient’s complaint.

2. A common fear that Scott does not personally experience: being an imposter

This is the inner voice that says negative things about your performance and capability of getting the job done.

Scott’s mindset has always been to assume that his baseline skill level at anything is zero until there is external calibration. With this cognitive assumption, he has never had an inner voice speaking negatively to him.

In emergency medicine there are plenty of opportunities to externally calibrate your skill set (eg. following up on patients to see if your diagnosis was correct or keeping a log of your first-pass intubation success rate).

3. Fear of Monday morning quarterbacking

This is a useful fear to have because it allows you to foreshadow what you're going to experience tomorrow and the chance to fix the situation today.

While Monday morning quarterbacking can yield strategies for improvement when done in a positive fashion, it can also be done badly and be an opportunity to serve insults.

“The fear of Monday morning quarterbacking should drive your documentation more than it drives your practice.” And if you can anticipate what the Monday morning quarterback is going to harp upon, it should drive you to take actions to have the appearance of due diligence.

4. Fear of procedural complications

Procedural complications can be prevented by breaking them down into distinct micro skills that can be individually mastered.

No matter how adroit one is at procedures, having a certain level of fear of the potential complications is healthy. That fear makes you question whether the procedure is truly necessary, or whether it would be safer done in another setting such as the OR.

]]> Scott D. Weingart, MD FCCM 43:10 IBCC – Traumatic Brain Injury (TBI) https://emcrit.org/pulmcrit/tbi/ https://emcrit.org/pulmcrit/tbi/#comments Mon, 28 Jun 2021 12:16:39 +0000 https://emcrit.org/?p=482365 Traumatic brain injury is an extremely common problem, which is likely to be encountered in any type of intensive care unit. Management is predominantly supportive, illustrating many principles of neurocritical care. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/tbi/feed/ 3 IBCC – Posterior Reversible Encephalopathy Syndrome (PRES) https://emcrit.org/pulmcrit/pres/ https://emcrit.org/pulmcrit/pres/#comments Mon, 21 Jun 2021 10:44:35 +0000 https://emcrit.org/?p=482231 Posterior Reversible Encephalopathy Syndrome (PRES) is a common cause of ICU admission for seizure or altered mental status. Although PRES is commonly associated with hypertension, PRES can occur in the absence of hypertension due to a variety of disorders that impair endothelial function causing vasogenic edema. Thus, PRES encompasses the entity of “hypertensive encephalopathy” – […]

EMCrit Project by Josh Farkas.

]]> https://emcrit.org/pulmcrit/pres/feed/ 1