EMCrit Blog - Emergency Department Critical Care

EMCrit 368 – The Acute Critical Care Medication Reconciliation with Josh Farkas2024/02/09

The acute crit care med rec

EMCrit Project by Scott Weingart, MD FCCM .
CV-EMCrit Wee – MCS Minute: ECMO and the DO2/VO2 ratio with Trina Augustin2024/01/31

The first MCS Minute

EMCrit Project by Katrina Augustin .
PulmCrit wee: Polypharmacy in the ICU – when in doubt, deprescribe2024/01/30
Info (Show/Hide)

Polypharmacy is technically defined as taking five or more medications on a daily basis. Polypharmacy is increasingly becoming the norm among adults, due to several factors (an aging population, increasing numbers of medical problems, and increasingly complex regimens available to treat chronic disorders such as heart failure). Indeed, the term “polypharmacy” is arguably antiquated now […]

EMCrit Project by Josh Farkas .
EMCrit 367 – Panel: 4 Quadrant Hemodynamic Ultrasound Integration, IVC Ultrasound and Much More!2024/01/27

a ton of hemodynamic stuff...

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit RACC Lit Review – January 20242024/01/23

All the lit goodness for Jan 2024

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit hot take: VAP prophylaxis (PROPHY-VAP trial)2024/01/22
Info (Show/Hide)

background: ANTHARTIC trial Prophylaxis against VAP (ventilator-associated pneumonia) is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multicenter RCT evaluating 48 hours of therapy with amoxicillin/clavulanate for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free days (further […]

EMCrit Project by Josh Farkas .
EMCrit Wee – Should Patients who “may” decompensate go to the ICU?2024/01/15

Who gets an ICU bed?

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 366 – Should Delayed Sequence Intubation (DSI) become the Standard for Critical Care Intubations?2024/01/11

Should DSI become the new standard?

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit – Validation of my model for converting VBGs to ABGs2024/01/01
Info (Show/Hide)

background and general concept My research project in fellowship was the construction of a mathematical model to convert VBG values into ABG values. The fundamental concept for the model was pretty simple: we can approximate the respiratory quotient (RQ) of tissue in the hand as being constant. This indicates that changes in oxygen content and […]

EMCrit Project by Josh Farkas .
EMCrit 365 – Setting PEEP and Righting the Right Ventricle in ARDS with Matt Siuba2023/12/28

Setting PEEP and Righting the RV in ARDS with Matt Siuba

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit Wee – Zero Warning Resuscitation – Mind of the Resuscitationist2023/12/22

Is your mind ready for no preparation critical care?

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 364 – Emergency Care of Post-Bariatric Procedure Complications2023/12/15

Bariatric operations and how they go bad

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit: New ARDS guidelines reveal a shambolic state of affairs2023/12/10
Info (Show/Hide)

Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine). Don’t be fooled by their names – both of these organizations are fundamentally international in scope. Some authors on the ATS document were from Europe, and similarly some authors […]

EMCrit Project by Josh Farkas .
PulmCrit wee – Loading dose pharmacokinetics for antibiotics2023/12/08
Info (Show/Hide)

A loading dose may be used to rapidly achieve steady-state pharmacokinetics. For drugs with a long half-life, this accelerates the attainment of therapeutic levels: For most drugs with single-compartment pharmacokinetics, a loading dose may be calculated using the following formula: (discussed further here) The graph below illustrates how this equation works: If (dosing interval)/(half life) […]

EMCrit Project by Josh Farkas .
EMCrit Wee – Jason Bartos on the Minneapolis ECPR Experience2023/12/07

The best Resus ECMO Lecture EVER!!!!

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 363 – Retrograde Intubation2023/12/02

Retrograde, in 2023 is basically a backwards way of doing things...

EMCrit Project by Scott Weingart, MD FCCM .
ODR 013 – Should, Must, & Won’t2023/11/25

These 3 words are the path to burnout

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit Shadowboxing Case 6 – A Respiratory Case along with Extra Commentary from Mae West2023/11/23

A pulm-crit shadowboxing case

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 362 – Jonathan Edlow, Lead Author of GRACE-3, on Dizziness2023/11/17

Dizziness and Vertigo with the lead author of GRACE-3

EMCrit Project by Scott Weingart, MD FCCM .
ODR 012 – Arete, Ancient Wisdom, and Flourishing with Brian Johnson2023/11/13

Brian Johnson talks about his new book, Arete

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 361 – Life Threatening Tox and Toxicologic Cardiac Arrests from the AHA2023/11/04

AHA Guidelines on Critical Care Toxicology

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit RACC Lit Review – October 20232023/10/28

All the lit goodness for Oct 2023

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit blogitorial: Why I don’t believe the AMIKINHAL trial2023/10/27

Some folks on twitter asked my thoughts on AMIKINHAL trial, so I thought I'd jot them here. AMIKINHAL is a multi-center RCT that evaluated the ability of inhaled amikacin to prevent VAP (ventilator-associated pneumonia) among patients who had been intubated for three days. It's available here at NEJM. It was a positive trial, which is […]

EMCrit Project by Josh Farkas .
PulmCrit Blogitorial – New IDSA/SCCM guidelines on fever evaluation in ICU2023/10/24
Info (Show/Hide)

More guidelines! Today we'll walk through some interesting bits of the new IDSA/SCCM guideline on evaluation of new fever in the adult ICU patient (available free here). how should temperature be evaluated? This is frankly a mess. Bladder catheter or esophageal probe are best, but usually not used. Rectal temperature is 2nd best, but unwieldy […]

EMCrit Project by Josh Farkas .
EMCrit 360 – A Taxonomy of Key Performance Errors for Emergency Intubation (Primer)2023/10/21

We categorized intubation errors and published a paper about it...

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit Blogitorial – Why the new brain death guidelines are unacceptable2023/10/13
Info (Show/Hide)

Hello fellow nerds, let's take a look at the new American Association of Neurology (AAN) brain death guidelines. Instead of a tweetorial, I'll jot my thoughts here, so they're accessible to everyone. Disclaimer: the following discussion applies only to adult medicine. Most of these guidelines are consistent with the 2020 World Brain Death Project, so […]

EMCrit Project by Josh Farkas .
EMCrit 359 – FoundStab Project – Foundational Stabilization Provisional Guideline for Post-Intubation Sedation2023/10/08

The first version of the first guideline in the foundational stabilization project - post-intubation sedation

EMCrit Project by Scott Weingart, MD FCCM .
ODR 011 – Kettlebells for the Brain – Meditation2023/10/01

A slightly different kind of topic was my inspiration for the John Hinds Keynote at SMACC

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit Hot Take: Aggressive glycemic control is dead (TGC-Fast Trial)2023/09/28

background Today the Van de Bergh group in Belgium released a RCT investigating tight versus liberal glycemic control in the ICU. Before diving into this study, let's take a walk down memory lane. Major interest in tight glycemic control in the ICU began in 2001 with an RCT by the same group of investigators, also […]

EMCrit Project by Josh Farkas .
EMCrit 358 – Dizziness Makes Me Dizzy Still! – GRACE-3 and more with Peter Johns2023/09/24

Do you still cringe when a dizzy patient appears on your board? If so, we need to fix that and Peter Johns is here to help!

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit RACC Lit Review – September 20232023/09/17

All the amazing RACC literature for September 2023

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit – Lessons from a Master Trainer – Cliff Reid on Training Team Performance2023/09/11

Another amazing lecture from Cliff Reid

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 357 – AMAX4 Crashing Anaphylaxis Explosion with Ben McKenzie2023/09/10

The explosion follow-up on the AMAX4 protocol for crashing anaphylaxis and asthma with Ben McKenzie [@amax4]

EMCrit Project by Scott Weingart, MD FCCM .
PulmCrit – Introducing the IBPH (Internet Book of Hospital Pulmonology)2023/09/03
Info (Show/Hide)

In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation. Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it's becoming impossible […]

EMCrit Project by Josh Farkas .
EMCrit Shadowboxing Case 5 – NeuroEMCrit Case2023/09/02

A NeuroEMCrit Shadowboxing Case

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 356 – More on Accidental Hypothermia with Ken Zafren2023/08/29

A deeper dive on accidental hypothermia in anticipation of my much awaited winter

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit RACC-Lit for July & August 20232023/08/17

all the lit goodness...

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 355 – AMAX4 for Crashing Anaphylaxis and Asthma – Part I Primer2023/08/10

AMAX4 for crashing anaphylaxis and asthma

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit 354 – Reduced-Dose Systemic Peripheral Fibrinolysis in Massive Pulmonary Embolism2023/07/30

Lower dose peripheral infusion for sick pulmonary embolism patients

EMCrit Project by Scott Weingart, MD FCCM .
EMCrit Wee – The Physiology of Oxygenation with Alex of Deranged Physiology2023/07/20

So we used a mean guy on twitter to spur a discussion on Oxygenation Physiology and talk about when PaO2s are necessary and you can't use the pulse ox (hint: not often). My discussant is Alex Yartsev.

EMCrit Project by Scott Weingart, MD FCCM .

EMCrit Project
https://emcrit.org/Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

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EMCrit Blog - Emergency Department Critical Care EMCrit 368 – The Acute Critical Care Medication Reconciliation with Josh Farkas2024/02/09 The acute crit care med rec EMCrit Project by Scott Weingart, MD FCCM . CV-EMCrit Wee – MCS Minute: ECMO and the DO2/VO2 ratio with Trina Augustin2024/01/31 The first MCS Minute EMCrit Project by Katrina Augustin . PulmCrit wee: Polypharmacy in the ICU – when in doubt, deprescribe2024/01/30 Info (Show/Hide) Polypharmacy is technically defined as taking five or more medications on a daily basis. Polypharmacy is increasingly becoming the norm among adults, due to several factors (an aging population, increasing numbers of medical problems, and increasingly complex regimens available to treat chronic disorders such as heart failure). Indeed, the term “polypharmacy” is arguably antiquated now […] EMCrit Project by Josh Farkas . EMCrit 367 – Panel: 4 Quadrant Hemodynamic Ultrasound Integration, IVC Ultrasound and Much More!2024/01/27 a ton of hemodynamic stuff... EMCrit Project by Scott Weingart, MD FCCM . EMCrit RACC Lit Review – January 20242024/01/23 All the lit goodness for Jan 2024 EMCrit Project by Scott Weingart, MD FCCM . PulmCrit hot take: VAP prophylaxis (PROPHY-VAP trial)2024/01/22 Info (Show/Hide) background: ANTHARTIC trial Prophylaxis against VAP (ventilator-associated pneumonia) is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multicenter RCT evaluating 48 hours of therapy with amoxicillin/clavulanate for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free days (further […] EMCrit Project by Josh Farkas . EMCrit Wee – Should Patients who “may” decompensate go to the ICU?2024/01/15 Who gets an ICU bed? EMCrit Project by Scott Weingart, MD FCCM . EMCrit 366 – Should Delayed Sequence Intubation (DSI) become the Standard for Critical Care Intubations?2024/01/11 Should DSI become the new standard? EMCrit Project by Scott Weingart, MD FCCM . PulmCrit – Validation of my model for converting VBGs to ABGs2024/01/01 Info (Show/Hide) background and general concept My research project in fellowship was the construction of a mathematical model to convert VBG values into ABG values. The fundamental concept for the model was pretty simple: we can approximate the respiratory quotient (RQ) of tissue in the hand as being constant. This indicates that changes in oxygen content and […] EMCrit Project by Josh Farkas . EMCrit 365 – Setting PEEP and Righting the Right Ventricle in ARDS with Matt Siuba2023/12/28 Setting PEEP and Righting the RV in ARDS with Matt Siuba EMCrit Project by Scott Weingart, MD FCCM . EMCrit Wee – Zero Warning Resuscitation – Mind of the Resuscitationist2023/12/22 Is your mind ready for no preparation critical care? EMCrit Project by Scott Weingart, MD FCCM . EMCrit 364 – Emergency Care of Post-Bariatric Procedure Complications2023/12/15 Bariatric operations and how they go bad EMCrit Project by Scott Weingart, MD FCCM . PulmCrit: New ARDS guidelines reveal a shambolic state of affairs2023/12/10 Info (Show/Hide) Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine). Don’t be fooled by their names – both of these organizations are fundamentally international in scope. Some authors on the ATS document were from Europe, and similarly some authors […] EMCrit Project by Josh Farkas . PulmCrit wee – Loading dose pharmacokinetics for antibiotics2023/12/08 Info (Show/Hide) A loading dose may be used to rapidly achieve steady-state pharmacokinetics. For drugs with a long half-life, this accelerates the attainment of therapeutic levels: For most drugs with single-compartment pharmacokinetics, a loading dose may be calculated using the following formula: (discussed further here) The graph below illustrates how this equation works: If (dosing interval)/(half life) […] EMCrit Project by Josh Farkas . EMCrit Wee – Jason Bartos on the Minneapolis ECPR Experience2023/12/07 The best Resus ECMO Lecture EVER!!!! EMCrit Project by Scott Weingart, MD FCCM . EMCrit 363 – Retrograde Intubation2023/12/02 Retrograde, in 2023 is basically a backwards way of doing things... EMCrit Project by Scott Weingart, MD FCCM . ODR 013 – Should, Must, & Won’t2023/11/25 These 3 words are the path to burnout EMCrit Project by Scott Weingart, MD FCCM . EMCrit Shadowboxing Case 6 – A Respiratory Case along with Extra Commentary from Mae West2023/11/23 A pulm-crit shadowboxing case EMCrit Project by Scott Weingart, MD FCCM . EMCrit 362 – Jonathan Edlow, Lead Author of GRACE-3, on Dizziness2023/11/17 Dizziness and Vertigo with the lead author of GRACE-3 EMCrit Project by Scott Weingart, MD FCCM . ODR 012 – Arete, Ancient Wisdom, and Flourishing with Brian Johnson2023/11/13 Brian Johnson talks about his new book, Arete EMCrit Project by Scott Weingart, MD FCCM . EMCrit 361 – Life Threatening Tox and Toxicologic Cardiac Arrests from the AHA2023/11/04 AHA Guidelines on Critical Care Toxicology EMCrit Project by Scott Weingart, MD FCCM . EMCrit RACC Lit Review – October 20232023/10/28 All the lit goodness for Oct 2023 EMCrit Project by Scott Weingart, MD FCCM . PulmCrit blogitorial: Why I don’t believe the AMIKINHAL trial2023/10/27 Some folks on twitter asked my thoughts on AMIKINHAL trial, so I thought I'd jot them here. AMIKINHAL is a multi-center RCT that evaluated the ability of inhaled amikacin to prevent VAP (ventilator-associated pneumonia) among patients who had been intubated for three days. It's available here at NEJM. It was a positive trial, which is […] EMCrit Project by Josh Farkas . PulmCrit Blogitorial – New IDSA/SCCM guidelines on fever evaluation in ICU2023/10/24 Info (Show/Hide) More guidelines! Today we'll walk through some interesting bits of the new IDSA/SCCM guideline on evaluation of new fever in the adult ICU patient (available free here). how should temperature be evaluated? This is frankly a mess. Bladder catheter or esophageal probe are best, but usually not used. Rectal temperature is 2nd best, but unwieldy […] EMCrit Project by Josh Farkas . EMCrit 360 – A Taxonomy of Key Performance Errors for Emergency Intubation (Primer)2023/10/21 We categorized intubation errors and published a paper about it... EMCrit Project by Scott Weingart, MD FCCM . PulmCrit Blogitorial – Why the new brain death guidelines are unacceptable2023/10/13 Info (Show/Hide) Hello fellow nerds, let's take a look at the new American Association of Neurology (AAN) brain death guidelines. Instead of a tweetorial, I'll jot my thoughts here, so they're accessible to everyone. Disclaimer: the following discussion applies only to adult medicine. Most of these guidelines are consistent with the 2020 World Brain Death Project, so […] EMCrit Project by Josh Farkas . EMCrit 359 – FoundStab Project – Foundational Stabilization Provisional Guideline for Post-Intubation Sedation2023/10/08 The first version of the first guideline in the foundational stabilization project - post-intubation sedation EMCrit Project by Scott Weingart, MD FCCM . ODR 011 – Kettlebells for the Brain – Meditation2023/10/01 A slightly different kind of topic was my inspiration for the John Hinds Keynote at SMACC EMCrit Project by Scott Weingart, MD FCCM . PulmCrit Hot Take: Aggressive glycemic control is dead (TGC-Fast Trial)2023/09/28 background Today the Van de Bergh group in Belgium released a RCT investigating tight versus liberal glycemic control in the ICU. Before diving into this study, let's take a walk down memory lane. Major interest in tight glycemic control in the ICU began in 2001 with an RCT by the same group of investigators, also […] EMCrit Project by Josh Farkas . EMCrit 358 – Dizziness Makes Me Dizzy Still! – GRACE-3 and more with Peter Johns2023/09/24 Do you still cringe when a dizzy patient appears on your board? If so, we need to fix that and Peter Johns is here to help! EMCrit Project by Scott Weingart, MD FCCM . EMCrit RACC Lit Review – September 20232023/09/17 All the amazing RACC literature for September 2023 EMCrit Project by Scott Weingart, MD FCCM . EMCrit – Lessons from a Master Trainer – Cliff Reid on Training Team Performance2023/09/11 Another amazing lecture from Cliff Reid EMCrit Project by Scott Weingart, MD FCCM . EMCrit 357 – AMAX4 Crashing Anaphylaxis Explosion with Ben McKenzie2023/09/10 The explosion follow-up on the AMAX4 protocol for crashing anaphylaxis and asthma with Ben McKenzie [@amax4] EMCrit Project by Scott Weingart, MD FCCM . PulmCrit – Introducing the IBPH (Internet Book of Hospital Pulmonology)2023/09/03 Info (Show/Hide) In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation. Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it's becoming impossible […] EMCrit Project by Josh Farkas . EMCrit Shadowboxing Case 5 – NeuroEMCrit Case2023/09/02 A NeuroEMCrit Shadowboxing Case EMCrit Project by Scott Weingart, MD FCCM . EMCrit 356 – More on Accidental Hypothermia with Ken Zafren2023/08/29 A deeper dive on accidental hypothermia in anticipation of my much awaited winter EMCrit Project by Scott Weingart, MD FCCM . EMCrit RACC-Lit for July & August 20232023/08/17 all the lit goodness... EMCrit Project by Scott Weingart, MD FCCM . EMCrit 355 – AMAX4 for Crashing Anaphylaxis and Asthma – Part I Primer2023/08/10 AMAX4 for crashing anaphylaxis and asthma EMCrit Project by Scott Weingart, MD FCCM . EMCrit 354 – Reduced-Dose Systemic Peripheral Fibrinolysis in Massive Pulmonary Embolism2023/07/30 Lower dose peripheral infusion for sick pulmonary embolism patients EMCrit Project by Scott Weingart, MD FCCM . EMCrit Wee – The Physiology of Oxygenation with Alex of Deranged Physiology2023/07/20 So we used a mean guy on twitter to spur a discussion on Oxygenation Physiology and talk about when PaO2s are necessary and you can't use the pulse ox (hint: not often). My discussant is Alex Yartsev. EMCrit Project by Scott Weingart, MD FCCM . EMCrit Project https://emcrit.org/Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

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