EMCrit 422 - SSC 2026 Guidelines: The good, the Bad, and the UGLY

Sun, 29 Mar 2026 14:20:00 -0400

1:1 Nursing 008 – The Stroke Show

Mon, 23 Mar 2026 12:15:00 -0400

EMCrit 421 - A Friendly Debate on the Role of ED Pharmacists - I want their minds, not their hands!

Thu, 19 Mar 2026 11:50:00 -0400

EMCrit Wee - An Airway Discussion with Jonathan St George of the Protected Airway Collaborative

Sun, 15 Mar 2026 09:45:00 -0400

EMCrit 420 - Dynamic Left Ventricular Outflow Tract Obstruction (LVOTO)

Sun, 08 Mar 2026 18:12:00 -0400

EMCrit Wee - ECGs in Acute Pulmonary Embolism

Sun, 01 Feb 2026 20:31:00 -0400

EMCrit 417 - The Antibiotics Show - Community Edition with David Talan

Sun, 25 Jan 2026 13:46:00 -0400

CV-EMCrit Wee - Electrical Storm: Surviving the Storm Part II - Storm on VA-ECMO

Sat, 17 Jan 2026 11:17:00 -0400

EMCrit 416 - JanuAIRWAY - State of the Airway 2026

Sun, 11 Jan 2026 13:17:00 -0400

EMCrit 415 - Medetomidine Overdose and Withdrawal

Fri, 26 Dec 2025 15:24:00 -0400

EMCrit Wee - Opioid Crisis Part 2 - The Opioid Chain of Survival and Nitazene Opioid Adulteration

Mon, 22 Dec 2025 12:37:00 -0400

EMCrit 1:1 Nursing 007 - Resus Nurse Efficiency

Tue, 16 Dec 2025 18:05:00 -0400

EMCrit 414 - HyperCRITical - Farkas on BICARICU-2 and EVERDAC

Fri, 12 Dec 2025 18:37:00 -0400

EMCrit Wee - The RSI Trial

Tue, 09 Dec 2025 19:15:00 -0400

EMCrit Wee - EVERDAC RCT on Arterial Line Placement in the Medically Critically Ill

Wed, 03 Dec 2025 14:13:00 -0400

EMCrit 413 - Translating Recent Sepsis Papers to the Bedside with PulmCrit (Farkas)

Sat, 29 Nov 2025 19:15:00 -0400

EMCrit Wee - A Discussion of Opioid Adulterants with a Harm Reduction Specialist

Fri, 21 Nov 2025 15:51:00 -0400

EMCrit 412 - 2025 AHA ACLS Guidelines with Shel Cheskes

Sat, 15 Nov 2025 18:25:00 -0400

EMCrit Wee - ANDROMEDA-SHOCK-2 Explosion

Tue, 04 Nov 2025 12:52:00 -0400

EMCrit 411 - You Need to Understand the Andromeda-Shock-2 RCT for Septic Shock

Thu, 30 Oct 2025 19:04:00 -0400

EMCrit 1:1 Nursing 006 - Post-Cardiac Arrest (Post-Arrest) Care

Thu, 23 Oct 2025 20:32:00 -0400

EMCrit 410 - What PulmToilet Taught Me About Views on SCAPE (Sigh...)

Sun, 19 Oct 2025 18:07:00 -0400

EMCrit 409 - Pulmonary Embolism (PE) Update 2025 with Jeff Kline

Thu, 02 Oct 2025 18:47:00 -0400

CV-EMCrit Wee - Electrical Storm: Surviving the Storm Part I

Thu, 25 Sep 2025 18:57:00 -0400

EMCrit 1:1 Nursing 005 - Medical Cardiac Arrest

Thu, 18 Sep 2025 14:26:00 -0400

EMCrit 408 - Behind the Scenes of an Infuriating Medical Malpractice Trial

Sat, 13 Sep 2025 15:52:00 -0400

See the ECG
See the Shownotes

EMCrit 407 - Massive Hemorrhage Protocol 2.0 with Petro

Sat, 30 Aug 2025 16:52:00 -0400

EMCrit 1:1 Nursing 004 - Listener Q&A

Tue, 19 Aug 2025 13:41:00 -0400

EMCrit 406 - Awake NasoTracheal Intubation (AFOI)

Sun, 17 Aug 2025 15:45:00 -0400

EMCrit 405 - Paracentesis - the EMCrit (Easy) Way

Sat, 02 Aug 2025 17:55:00 -0400

EMCrit 404 - Facial Trauma

Sat, 19 Jul 2025 14:20:00 -0400

EMCrit 1:1 Nursing 003 - Intubation

Tue, 15 Jul 2025 13:41:00 -0400

CV-EMCrit Wee - Mastering Persistent Air Leaks: Navigating the Management of Pleural Fistulae from Conservative Care to VV ECMO

Thu, 10 Jul 2025 15:25:00 -0400

ODR 014 - UnBurnable Series - Inner Voice

Wed, 02 Jul 2025 18:39:00 -0400

EMCrit 402 - Sea Change on Salt Water

Fri, 20 Jun 2025 14:31:00 -0400

EMCrit 1:1 Nursing Podcast 002 - Post-Intubation Sedation (Pain, Agitation, & Delirium)

Mon, 16 Jun 2025 10:19:00 -0400

EMCrit Wee - Ketamine for Early Status Epilepticus Debate

Thu, 12 Jun 2025 09:44:00 -0400

EMCrit 401 - Pediatric FONA / Tracheostomy with Cliff Reid

Sat, 07 Jun 2025 10:28:00 -0400

EMCrit 400 - Mind of the Resuscitationist

Sat, 24 May 2025 14:53:00 -0400

EMCrit Wee - All Things Defibrillation Follow-Up Ep

Wed, 21 May 2025 14:04:00 -0400

EMCrit 1:1 Nursing 001 - An Easy Case of Sepsis

Thu, 15 May 2025 09:00:00 -0400

EMCrit Ghali Grills 003 - Further Disambiguating "PEA"

Sat, 10 May 2025 18:13:00 -0400

EMCrit Wee - Neuroleptic Malignant Syndrome (NMS) Explosion

Thu, 01 May 2025 08:00:00 -0400

EMCrit Shadowboxing Case 9 - Spinal Cord Injury?

Thu, 24 Apr 2025 13:56:00 -0400

1:1 Nursing Podcast - Episode 0 - The Introduction

Mon, 14 Apr 2025 20:37:00 -0400

EMCrit 398 - NeuroEMCrit - NeuroMuscular Emergencies

Thu, 03 Apr 2025 11:30:00 -0400

EMCrit 396 - Some Philosophy of Surgical Airways (Crics) and What to Do When the Doom is Lower Down (Central Airway Obstruction)

Fri, 07 Mar 2025 12:34:00 -0400

EMCrit 395 - Stellate Ganglion Block - Not Whether, but When?

Sun, 23 Feb 2025 18:13:00 -0400

EMCrit 394 – CV-EMCrit – Inotrope Basics Part 2 - Specific Scenarios

Fri, 07 Feb 2025 18:58:00 -0400

EMCrit 393 - CV-EMCrit - Inotrope Basics Part 1

Sat, 25 Jan 2025 21:12:00 -0400

EMCrit Wee (392.5) - Naughty or Nice? Bad Behavior in Healthcare with Liz Crowe, PhD

Wed, 15 Jan 2025 17:52:00 -0400

EMCrit 392 - All Things Defibrillation with Sheldon Cheskes

Fri, 10 Jan 2025 16:06:00 -0400

EMCrit 390 - Hyperangulated Video Laryngoscopy

Sat, 14 Dec 2024 16:04:00 -0400

EMCrit 389 - Massive Transfusion Update and Hemostatic Resuscitation

Sun, 01 Dec 2024 12:02:00 -0400

EMCrit 388 - Experts' Guide to the Bougie with Barnicle and Driver

Fri, 22 Nov 2024 15:07:00 -0400

EMCrit 387 - Emergency Department Charting for Legal Protection and Patient Safety

Fri, 01 Nov 2024 17:04:00 -0400

EMCrit 386 - Liver I - Fulminant Acute Liver Failure (ALF) with Tasneem Pirani

Sat, 19 Oct 2024 14:13:00 -0400

EMCrit Wee - Dirty Epi is Dumb, Mildly Messy Epi is OK!

Thu, 10 Oct 2024 17:46:00 -0400

EMCrit 385 - Eye Trauma I - Retrobulbar Hematoma, Orbital Compartment Syndrome, and Paracanthal Decompressions

Sat, 05 Oct 2024 11:17:00 -0400

EMCrit Wee - Did this Really Just HAPPEN? - The HAPPEN Trial Hot Take - NIPPV for COPD

Sun, 29 Sep 2024 17:04:00 -0400

EMCrit 384 - The Vascular Guy on Vascular Access

Mon, 23 Sep 2024 15:48:00 -0400

CV-EMCrit - MCS Minute Series: Differential Gas Exchange on Peripheral Femoral VA ECMO with Trina

Mon, 16 Sep 2024 15:38:00 -0400

EMCrit 383 - The Ultrasound Hierarchy of Needs in Cardiac Arrest with Mike Prats

Fri, 06 Sep 2024 14:49:00 -0400

EMCrit Expert Rounds 1 - Gita Pensa on Doctors and Litigation

Thu, 15 Aug 2024 09:00:00 -0400

EMCrit 381 - Penetrating Neck Trauma - Get Out of the Zones!

Sat, 10 Aug 2024 13:47:00 -0400

EMCrit 380 - Acid Base Part VIII - Tris-Hydroxymethyl Aminomethane (THAM) for Acidosis

Mon, 29 Jul 2024 15:23:00 -0400

EMCrit ShadowBoxing - Casey Parker Rural Medicine Critical Care Case

Thu, 18 Jul 2024 15:38:00 -0400

EMCrit 379 - Procedural Sedation Part IV - the Critically Ill Patient and MidaKet

Fri, 12 Jul 2024 12:12:00 -0400

EMCrit Wee - Don't be so Quick to Blow-Off New-Onset Atrial Fibrillation (A-Fib)

Thu, 04 Jul 2024 13:44:00 -0400

EMCrit 378 - So NSTI - Necrotizing Fasciitis & Life Threatening Soft Tissue Infections

Sat, 29 Jun 2024 18:09:00 -0400

EMCrit Wee - Adaptive Support Ventilation (ASV)

Mon, 24 Jun 2024 10:51:00 -0400

EMCrit Wee - Additional Thoughts on the PREOXI Trial

Sat, 15 Jun 2024 14:05:00 -0400

EMCrit 377 - Break News - The PREOXI Trial changes everything about Preoxygenation for Intubations in the Critically Ill

Thu, 13 Jun 2024 09:00:00 -0400

EMCrit Wee - Controlled Automated Reperfusion of the Whole Body (CARL) ECPR / ECLS Yields Amazing Results

Mon, 03 Jun 2024 14:18:00 -0400

EMCrit 376 - Do We Need ETCO2 (Capnography) for Procedural Sedation in the ED?

Tue, 28 May 2024 11:04:00 -0400

CV-EMCrit - Post-CABG Care

Sat, 25 May 2024 14:30:00 -0400

EMCrit 375 - Vasopressors for Early Hemorrhage?

Fri, 17 May 2024 11:22:00 -0400

EMCrit Wee - Intraosseous Device Burr Holes (Craniotomy) with Marc Grossman

Sat, 11 May 2024 13:31:00 -0400

EMCrit 374 - ShadowBoxing - An AMAXimally Sick Patient

Thu, 02 May 2024 09:00:00 -0400

EMCrit 373 - Mike Weinstock with another Critical Care Bounceback: "Asymptomatic Hypertension"

Thu, 18 Apr 2024 12:35:00 -0400

EMCrit Wee - Ross Prager on 10 Heuristics for the New ICU Attending

Sat, 13 Apr 2024 10:07:00 -0400

EMCrit 372 - FoundStab Intubation SOP

Fri, 05 Apr 2024 11:52:00 -0400

CV-EMCrit Wee - MCS Minute: ECMO and the DO2/VO2 ratio

Wed, 31 Jan 2024 14:32:00 -0400

EMCrit 367 - Panel: 4 Quadrant Hemodynamic Ultrasound Integration, IVC Ultrasound and Much More!

Sat, 27 Jan 2024 13:05:00 -0400

EMCrit 366 - Should Delayed Sequence Intubation (DSI) become the Standard for Critical Care Intubations?

Thu, 11 Jan 2024 13:26:00 -0400

EMCrit Wee - Zero Warning Resuscitation - Mind of the Resuscitationist

Fri, 22 Dec 2023 12:23:00 -0400

EMCrit Wee - Jason Bartos on the Minneapolis ECPR Experience

Thu, 07 Dec 2023 16:47:00 -0400

EMCrit Shadowboxing Case 6 - A Respiratory Case along with Extra Commentary from Mae West

Thu, 23 Nov 2023 16:53:00 -0400

A brief summary of this episode

EMCrit 360 - A Taxonomy of Key Performance Errors for Emergency Intubation (Primer)

Sat, 21 Oct 2023 16:24:00 -0400

A brief summary of this episode

EMCrit 359 - FoundStab Project - Foundational Stabilization Guideline for Post-Intubation Sedation

Sun, 08 Oct 2023 17:49:00 -0400

A brief summary of this episode

ODR - Should, Must, Won't

Tue, 03 Oct 2023 20:37:00 -0400

On Deeper Reflection Episode on 3 words of dissatisfaction

Should, Must, Won't

EMCrit Shadowboxing Case 5 - NeuroEMCrit Case

Sat, 02 Sep 2023 16:09:00 -0400

A brief summary of this episode

EMCrit 354 - Reduced-Dose Systemic Peripheral Fibrinolysis in Massive Pulmonary Embolism

Sun, 30 Jul 2023 18:48:00 -0400

A brief summary of this episode

EMCrit Wee - The Physiology of Oxygenation with Alex of Deranged Physiology

Thu, 20 Jul 2023 19:41:00 -0400

A brief summary of this episode

EMCrit Wee - Case of Failure of Pulse Ox to Confirm Transcutaneous Pacemaker (TCP) Capture with Mathieu Brunet

Sat, 08 Jul 2023 22:11:00 -0400

A brief summary of this episode

EMCrit Shadowboxing - When to Pull the Trigger

Wed, 28 Jun 2023 19:54:00 -0400

A brief summary of this episode

EMCrit 350 - Mind of the Resuscitationist - Emergency Teams with Dan Dworkis

Thu, 01 Jun 2023 15:47:00 -0400

A brief summary of this episode

EMCrit 349 - The Burnout Model

Thu, 04 May 2023 21:44:00 -0400

A brief summary of this episode

EMCrit 347 - How to Teach & Learn Laryngoscopy

Sun, 09 Apr 2023 18:54:00 -0400

A brief summary of this episode

EMCrit Wee - A New Form of ED Critical Care for Rural Environments - EMSTAT with Eric Klotz

Fri, 17 Mar 2023 22:27:00 -0400

A brief summary of this episode

EMCrit 343 - CV-EMCrit: Who to Refer for VV ECMO

Thu, 09 Feb 2023 17:04:00 -0400

A brief summary of this episode

EMCrit - Ghali Grills 2 - Should You Tube the Patient in Severe Hemorrhagic Shock if there is a Delay to OR?

Sat, 21 Jan 2023 21:42:00 -0400

A brief summary of this episode

EMCrit ShadowBoxing Case - Chicken or the Egg - Which Organ Failed First?

Sun, 08 Jan 2023 18:45:00 -0400

A brief summary of this episode

EMCrit 337 - Procedural Deep Dive - Lumbar Puncture (LP)

Fri, 18 Nov 2022 18:57:00 -0400

A brief summary of this episode

EMCrit Wee - CardioVascular Critical Care as a New Critical Care Subspecialty

Thu, 21 Jul 2022 18:23:20 -0400

A brief summary of this episode

EMCrit 327 - Aortic Stenosis with Trina Augustin [Full Ep Free]

Fri, 01 Jul 2022 16:53:16 -0400

EMCrit Wee - Follow-up To the Ghali Grills Ep on APRV

Sat, 11 Jun 2022 18:31:30 -0400

A brief summary of this episode

EMCrit - Ghali Grills 1- Who Should Get APRV?

Thu, 09 Jun 2022 23:50:24 -0400

A brief summary of this episode

EMCrit 323 - Trauma Resus Update with Brohi

Sun, 08 May 2022 20:35:07 -0400

A brief summary of this episode

EMCrit 322 - Shadowboxing 2 - Frack the EJ

Wed, 20 Apr 2022 18:34:45 -0400

A brief summary of this episode

EMCrit Wee - Saving EM: Is Less More? with Atikinson and Innes

Sun, 17 Apr 2022 21:01:59 -0400

A brief summary of this episode

EMCrit 321 - Valve Disasters - Regurg

Thu, 07 Apr 2022 17:43:27 -0400

A brief summary of this episode

EMCrit 320 - MotR - Tension & Relaxation | Flow & Burnout

Mon, 28 Mar 2022 16:53:17 -0400

A brief summary of this episode

EMCrit 319 - Safe and Smart Reversal of Anticoagulation / Anti-platelet Agents in 2022

Tue, 15 Mar 2022 21:30:35 -0400

A brief summary of this episode

On Deeper Reflection 11 - Email Tactics

Fri, 04 Mar 2022 16:50:10 -0400

A brief summary of this episode

EMCrit 318 - Surviving Sepsis Guidelines 2021 and Sepsis Update 2022

Sun, 27 Feb 2022 18:05:09 -0400

A brief summary of this episode

EMCrit 316 - Vertigo with Peter John

Fri, 28 Jan 2022 15:04:00 -0400

EMCrit 315 - EEGs with Casey Albin

Thu, 13 Jan 2022 21:08:17 -0400

A brief summary of this episode

EMCrit 314 - Shadowboxing Ep.1 (Free for Learners of all Ilks)

Thu, 30 Dec 2021 16:53:20 -0400

EMCrit 313 - Chest Tubes Part 2 - Chest Tube Insertion

Fri, 17 Dec 2021 17:21:37 -0400

A brief summary of this episode

FULL FREE EPISODE - On Deeper Reflection - NonViolent Communication

Tue, 14 Dec 2021 18:07:49 -0400

A brief summary of this episode

EMCrit 312 - Chest Tubes Part 1 - Periprocedural Stuff

Thu, 02 Dec 2021 21:42:16 -0400

A brief summary of this episode

EMCrit 311 - Adrenal Crisis with Karin Amrein

Thu, 18 Nov 2021 22:30:41 -0400

A brief summary of this episode

EMCrit 310 - Transvenous Pacemakers

Thu, 04 Nov 2021 19:41:31 -0400

A brief summary of this episode

EMCrit 309 - Severe DKA

Thu, 21 Oct 2021 17:43:49 -0400

A brief summary of this episode

EMCrit 308 - PE Treatment, Fibrinolysis, PERT Teams -- Let's See How Many People I Can Piss Off

Thu, 07 Oct 2021 20:17:35 -0400

A brief summary of this episode

ODR Podcast 1 - Email is Not the Problem

Wed, 22 Sep 2021 17:49:17 -0400

A brief summary of this episode

EMCrit Teaser for 306 - Severe Anaphylaxis - A discussion of the Dose Forms of Epi for Anaphylaxis

Wed, 08 Sep 2021 17:21:52 -0400

A brief summary of this episode

EMCrit Podcast 305 - TEASER: TTM2 Trial with Niklas Nielsen and Josef Dankiewicz

Thu, 02 Sep 2021 21:02:16 -0400

A brief summary of this episode

EMCrit Wee - BaSICS Trial Results

Tue, 10 Aug 2021 22:24:34 -0400

A brief summary of this episode

EMCrit Podcast 304 - CVT with Casey Albin

Thu, 05 Aug 2021 15:23:11 -0400

A brief summary of this episode

EMCrit Podcast 279 - Dangerous and Disruptive with Reub Strayer

Sun, 09 Aug 2020 18:50:39 -0400

A brief summary of this episode

EMCrit Podcast 275 - Neurocritical Care with Neha

Wed, 10 Jun 2020 15:54:30 -0400

A brief summary of this episode

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

Wed, 13 Nov 2019 13:47:30 -0400

Taking Cardiogenic Shock Management to the next level...

EMCrit 256 – RUSH Redux with Jacob Avila

Wed, 18 Sep 2019 11:00:10 -0400

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

EMCrit Podcast 205 – Push-Dose Pressors Update

Mon, 07 Aug 2017 16:00:49 -0400

An update on push-dose pressors

EMCrit 202 – Blood Bank Essentials with Joe Chaffin

Sun, 25 Jun 2017 18:11:03 -0400

blood bank stuff: The basics of crit care transfusion medicine

Podcast 197 – The Logistics of the Administration of Massive Transfusion

Mon, 17 Apr 2017 16:51:34 -0400

The hands-on of orchestrating a massive transfusion protocol

Podcast 149 – Thyroid Storm

Sat, 16 May 2015 22:17:01 -0400

When hyperthyroidism goes really wrong...

Podcast 125 – The New Intra-Arrest (Cardiac Arrest Management)

Mon, 02 Jun 2014 15:59:28 -0400

Enough with cook book medicine and courses for dermatologists--let's provide cutting edge intra-arrest care

EMCrit Wee – Cricolol by Dr. John Hinds

Wed, 28 May 2014 15:29:42 -0400

My favorite part of SMACCgold; buy some Cricolol

Podcast 107 – Peripheral Vasopressor Infusions and Extravasation

Mon, 16 Sep 2013 14:59:35 -0400

Can we give vasopressors peripherally? And if we do, what if they leak?

Podcast 66 – …Until they are warm and dead: Severe Accidental Hypothermia

Tue, 07 Feb 2012 17:14:18 -0400

It is winter and that means cardiac arrests coming in with extremely low body temperatures after environmental exposure. How do you treat these patients? How do you rewarm if you don't have bypass?

EMCrit Podcast 6 – Push-Dose Pressors

Fri, 10 Jul 2009 16:43:20 -0400

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 line is being placed. Click Here for printable sheet with mixing instructions Epinephrine Do not give cardiac arrest doses (1 mg) to patients with a pulse Has alpha and beta-1/2 effects so it is an inopressor Onset-1 minute Duration-5-10 minutes Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml) Now you have 10 mls of Epinephrine 10 mcg/ml Dose: 0.5-2 ml every 1-5 minutes (5-20 mcg) No extravasation worries! Mixing Video: Phenylephrine Phenyl as a bolus dose is clean, quick, and never causes trouble. But... It is pure alpha, so no intrinsic inotropy; it may increase coronary perfusion which can improve cardiac output. I only use this in tachycardic patients (and even then, only sometimes) Onset-1 minute Duration- 5-10 minutes (usually 5) Mixing Instructions: Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml) Inject this into a 100 ml bag of NS Now you have 100 mls of phenylephrine 100 mcg/ml Draw up some into a syringe; each ml in the syringe is 100 mcg Dose: 0.5-2 ml every 1-5 minutes (50-200 mcg) No extravasation worries! Mixing Video: Ephedrine I don’t use this one, listen to the podcast to hear why. I put it here solely for the anesthesiologists on the blog. Onset-Near Instant Duration-1 hour Mixing Instructions: Take a 10 ml syringe with 9 ml of normal saline Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml) Now you have 10 mls of Ephedrine 5 mg/ml Dose: 1-2 ml every 2-5 minutes (5-10 mg) No extravasation worries! Additional Video of a Real Patient By Larry Mellick's Crew Update: This study compares push-dose phenylephrine to continuous infusion--no difference between the two (Anesthesia Analgesia 21012;115(6):1343) First article in the ED demonstrates efficacy on blood pressure (The Journal of Emergency Medicine Volume 49, Issue 4, October 2015, Pages 488–494) Here is a review article from the nursing literature Now on to the Podcast...

EMCrit Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema (SCAPE)

Sat, 25 Apr 2009 18:22:00 -0400

Here it is, the 1st EMCrit podcast. It's on the topic of Sympathetic Crashing Acute Pulmonary Edema (SCAPE). This condition is on a very different part of the disease spectrum from FOPE (Fluid-Overload Pulmonary Edema, an acronum I first saw used by by @Cameronks) 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 needed. By 10 minutes, your patient should be out of the water. See crashingpatient.com for the references. Here is some info from a handout from a lecture I gave on the topic: High Dose Nitroglycerin Homeopathic nitroglycerin does not work so well Start at 50-100 mcg/min, you can rapidly titrate to 200-400 mcg/min. You must stand at the bedside to use these doses. Need >120 mcg/min to get sig decreased Pulm Cap Wedge Pressure (Am J Cardio 2004;93:237) But even this strategy is not as effective as the … Nitro Bolus First Can give 400-800 mcg over 1-2 minutes = 400 mcg/min for 1-2 minutes. (Annals EM 1997, 30:382) How to do it Standard nitro mix is 200 mcg/ml. VERIFY YOUR HOSPITAL’S MIX BEFORE USING THESE RECS In order to give the 400 mcg/min for 2 minutes, set the pump to Rate: 120 cc/hr Volume to be Infused: 4 ml (This will deliver 400 mcg/min for 2 minutes and then stop) Or Draw up 4 ml of the nitro and 6 ml of NS and give over 2 minutes After the bolus, I drop the drip to 100 mcg/min and titrate up from there to effect When the patient gets better, you need to sharply decrease this drip rate Some folks have gone even further High dose nitroglycerin for severe decompensated heart failure—2 mg at a time (Ann Emerg Med 2007;50:144) Cotter gave isosorbide 3 mg q 5 minutes with good results in his study. This is equivalent to nitro 600 mcg/min. (Lancet 1998 351:9100, 389-393) Bolus intravenous nitroglycerin predominantly reduces afterload in patients with excessive arterial elastance (Journal of the American College of Cardiology Volume 22, Issue 1, July 1993, Pages 251–257) Update Piyush Mallick did an amazing study on nitro-bolus to avert intubation Someone finally put the term into the literature (Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med 2016;20:719-23) 1-2 mg bolus doses are safe and effective (American Journal of Emergency Medicine 2017, 35 (1): 126-131) How you set-up the drip sig. affects time to med (Douma MJ, O'Dochartaigh D, Corry A, et al How intravenous nitroglycerine transit time from bag-to-bloodstream can be affected by infusion technique: a simulation study Emerg Med J 2015;32:498-500.)

EMCrit Podcast 0 – The Intro

Sun, 01 Mar 2009 04:56:09 -0400

In which I introduce you to me and explain what this whole thing is about. (better late than never)