EMCrit Project: Recent Episodes
Scott D. Weingart, MD FCCM
Dr. Cho Espinosa—surgical intensivist, OB-GYN, and flight doc—joins me to overhaul how we handle catastrophic post-partum hemorrhage. Moving past standard ivory-tower guidelines, Sho dives deep into high-yield uterotonic administration, physical compression techniques, and aggressive coagulopathy management. Learn how to temporize severe obstetric exsanguination when you are the only resuscitationist in the room.
EMCrit Project by Scott Weingart, MD FCCM.
Imagine, for a moment, that targeted temperature management (TTM), the standard of care in post cardiac arrest management for more than two decades, was built on a false premise from the very beginning. Not a hypothesis gradually refined by better evidence, but one whose foundation was fundamentally flawed. The evidentiary basis for TTM rests on […]
EMCrit Project by Rory Spiegel.
As glorious as direct laryngoscopy was, it's time to transition to hyperangulated videolaryngoscopy as the mainstay of intubation among critically ill patients. There are a few reasons for this. [#1/4] People don't do videolaryngoscopy with a MAC blade correctly When videolargynosocopy with a MAC blade came out (hereafter referred to as MAC-VL), it seemed like […]
EMCrit Project by Josh Farkas.
In our previous post, we explored some of the more nuanced considerations when interpreting Bayesian analyses. In Part 2, we’ll apply those concepts to a recently published Bayesian individual patient data (IPD) meta-analysis comparing normal saline with balanced crystalloids in critically ill patients, the BEST-Living meta-analysis by Zampieri et al., published in The Lancet Respiratory […]
EMCrit Project by Rory Spiegel.
Rory and Jerry Hoffman host the inaugural episode of a new podcast
EMCrit Project by Rory Spiegel.
In this episode of EMCrit, Dr. Sarah Crager joins me to break down down-and-dirty bedside shock management, moving beyond simple blood pressure targets to a dynamic "shifting gears" forward-flow mental model. They tackle tough clinical dilemmas, including the debate over lactated Ringer’s in lactic acidosis, the nuanced use of albumin and diuretics in edematous patients, and the real-world application of epinephrine and so much more...
EMCrit Project by Scott Weingart, MD FCCM.
There is a replication crisis in the medical literature. Nearly half of all positive trials, when repeated, do not produce a similar positive result.¹,² While many reasons have been posited for this lack of reproducibility, including publication bias, p-hacking, underpowered studies, and selective reporting, what it ultimately means is that we cannot trust the results […]
EMCrit Project by Rory Spiegel.
The YEARS protocol has gained popularity as a straightforward approach to identify a subset of patients undergoing a workup for suspected pulmonary embolism (PE) who are at sufficiently low risk to safely use a D-dimer threshold of 1000 ng/mL. Despite its success, questions remain about whether this strategy can be safely applied to patients with […]
EMCrit Project by Rory Spiegel.
EMCrit RACC-Lit Review for July 2026
This month:
• Does prehospital whole blood actually improve outcomes?
• Can DSD damage your defibrillator?
• Go big or go home for adenosine & SVT?
and so much more...
EMCrit Project by Scott Weingart, MD FCCM.
In this episode, Scott Weingart introduces the RUSH Exam 2.0, also known as the iRUSH. Moving beyond its original role for the crashing patient, this updated protocol provides a standardized map for comprehensive bedside hemodynamic assessment. Tune in to learn how to synthesize clinical findings with advanced ultrasound modalities to phenotype shock.
EMCrit Project by Scott Weingart, MD FCCM.
Is hyperbaric oxygen for carbon monoxide poisoning an evidence-based lifesaver or an outdated dogmatic practice? In this episode, toxicologist Dr. Chris Tomaszewski breaks down why treating CO is actually a fight against an inflammatory cascade in the brain and heart, rather than a quest to clear a blood level.
EMCrit Project by Scott Weingart, MD FCCM.
In this episode, I break down the major trials debuting at the Critical Care Reviews 2026 meeting, focusing on the game-changing ARISE Fluids trial and its impact on the 30 mL/kg sepsis mandate. I also dive into the latest data on sodium bicarbonate use in cardiac arrest and metabolic shock, before correcting a major acid-base misconception regarding DKA resolution.
EMCrit Project by Scott Weingart, MD FCCM.
REMAP-CAP oseltamivir arm: the data The REMAP-CAP adaptive platform trial recently concluded its investigation of oseltamivir. Its verdict is that oseltamivir is killing critically ill patients. The primary analysis of the data is shown below. The study concludes that the likelihood of causing increased mortality is 98.3%: The first thing to realize when looking at […]
EMCrit Project by Josh Farkas.
Part 2 of Shock Hemodynamic Physio brings Phil and Rory to discuss the 4 Interface Model
EMCrit Project by Scott Weingart, MD FCCM.
Today, we go over two papers advancing our conceptualization of shock physiology.
EMCrit Project by Scott Weingart, MD FCCM.
Brilliant EM educator, Dave Carr, with tips & tricks from 20 years in Emergency Medicine
EMCrit Project by Scott Weingart, MD FCCM.
We discuss compassion in medicine and the book, Compassionomics
EMCrit Project by Scott Weingart, MD FCCM.
AHA Guidelines and some new studies strengthen the EMCrit recs for Sick PE management
EMCrit Project by Scott Weingart, MD FCCM.
I keep saying it: you must understand vertigo, but you don't...
EMCrit Project by Scott Weingart, MD FCCM.
HI-PEITHO will be one of the more important PE trials released this decade. Accurate interpretation requires placing this trial within the context of several other RCTs, especially the original PEITHO trial. So let's start there. The original PEITHO trial (PEITHO-1) PEITHO-1 was an RCT involving 1,006 patients with intermediate-high risk PE (defined as RV dysfunction […]
EMCrit Project by Josh Farkas.
We hit the new Surviving Sepsis Campaign Guidelines for 2026
EMCrit Project by Scott Weingart, MD FCCM.
The role of ED Pharmacists in the emergency medicine
EMCrit Project by Scott Weingart, MD FCCM.
what is the NPi (neurological pupil index)? The pupillary light reflex is one of the most fundamental tests of clinical medicine. Unfortunately, traditional techniques for measuring it are error-prone and poorly reproducible. Digital pupillometry solves this problem while simultaneously offering additional data reflective of neurological physiology: There is useful data hidden within these pupillary response […]
EMCrit Project by Josh Farkas.
Have you diagnosed dLVOTO in the past 3 months? If not, then you missed it!
EMCrit Project by Katrina Augustin.
Prognostication is perhaps the most important aspect of treating PE, because it drives treatment intensity. Underestimating risk leads to inadequate treatment. Overestimating risk leads to excessive therapies, which carry their own risks. Prognostication is difficult because PE patients exist along a continuous distribution of risk that changes over time. Nature doesn't neatly package PE patients […]
EMCrit Project by Josh Farkas.
Catheter-directed thrombolysis for PE has always been a silly idea, for numerous reasons: Clots are widely distributed throughout both lungs. 100% of the blood flow goes to the lungs. Blood flow in PE is fast and turbulent, so the thrombolytic released adjacent to the clot is immediately whisked away and sometimes ends up in the […]
EMCrit Project by Josh Farkas.
Members, you had questions--I have answers!!! Here is the 2nd EMCrit Members Q&A episode.
EMCrit Project by Scott Weingart, MD FCCM.
ABSTRACT Beta-blockade is generally regarded as a standard therapy for thyroid storm. However, this practice isn’t evidence-based. Recent studies have emphasized that beta-blockade often cause cardiovascular collapse in this context. Until more evidence is available, thyroid storm with sinus tachycardia shouldn’t be considered an indication for beta-blockade. MANUSCRIPT Guidelines have consistently recommended beta-blockers for thyroid […]
EMCrit Project by Josh Farkas.
Abx choices in sepsis and septic shock--community edition
EMCrit Project by Scott Weingart, MD FCCM.
Theodore Warkentin, a leading world expert on HIT, recently visited Vermont and delivered a talk on emerging concepts in HIT. During his talk, he lamented that it takes ten years for a new idea to make it into Harrison's textbook of internal medicine. Within the next day, I read several of his articles, as well […]
EMCrit Project by Josh Farkas.
An missed PE case leads to an infuriating verdict--we discuss...
EMCrit Project by Scott Weingart, MD FCCM.
Let's talk quickly about Nalbuphine, the Diet Coke of opioids. mechanism Most opioids are basic. They're pure μ-opioid and kappa-opioid agonists. Nalbuphine is more complex: [#1] Partial agonism at μ-opioid receptors: Nalbuphine functions as a partial μ-agonist, similar to buprenorphine. Compared to buprenorphine, nalbuphine seems to stimulate the μ-opioid receptors less strongly. For patients who […]
EMCrit Project by Josh Farkas.
We've all heard a lot about using large language models (LLMs) in medicine, but it's generally in the abstract. I'd like to explore concretely how to apply these models to answer a specific medical question. I make no claim to be an expert in this topic, but rather I would like to propose an approach […]
EMCrit Project by Josh Farkas.
When to pick the nose as your route of intubation... All things NasoTracheal
EMCrit Project by Scott Weingart, MD FCCM.
All the literature goodness for August 2025...
EMCrit Project by Scott Weingart, MD FCCM.
Everything Paracentesis -- If you are going to do it, let's learn to do it quickly, safely, and with the minimum amount of fuss.
EMCrit Project by Scott Weingart, MD FCCM.
Part 1 of the Year in Review for NeuroEMCrit
EMCrit Project by NeuroEMCrit Team (Casey & Neha).
The American Thoracic Society has just released a new guideline on CAP. It's also been a while since I last updated the IBCC chapter on CAP (10/22), so I'm revising the chapter and incorporating the new guidelines. Here are some of my thoughts on the latest developments in severe CAP. ATS and IDSA are… breaking […]
EMCrit Project by Josh Farkas.
Facial Trauma: Who to Transfer? When to Worry? Save your patients frustration and save yourself time!
EMCrit Project by Scott Weingart, MD FCCM.
In episode 3, we discuss the resus nurse's role in intubation
EMCrit Project by Scott Weingart, MD FCCM.
Everything you ever wanted to know about persistent air leaks, bronchopleural fistuale and alveolopleural fistuale...
EMCrit Project by Katrina Augustin.
Josh and I discuss our practice for managing Status Epilepticus in 2025
EMCrit Project by Scott Weingart, MD FCCM.
Your inner voice is making you see the world through crap-covered glasses
EMCrit Project by Scott Weingart, MD FCCM.
Family meetings are often necessary to communicate with families and determine the next steps in caring for patients. For most of these family meetings, the patient may be too ill to participate. Furthermore, the ICU team often has never met the patient before the onset of severe illness. This creates a situation where the patient's […]
EMCrit Project by Josh Farkas.
For years, we have been going super slowly for chronic hyponatremia. But now, literature has raised the question of increased mortality from this slow strategy...
EMCrit Project by Scott Weingart, MD FCCM.
Good post-intubation sedation is the mark of resus nursing excellence
EMCrit Project by Scott Weingart, MD FCCM.
Should we be using ketamine sooner in status epilepticus--we debate the issue...
EMCrit Project by Scott Weingart, MD FCCM.
Pediatric front-of-neck-access is something we all dread to even think about. We might think we can retreat to the cognitive ease of needle based techniques, but they fail!! And if the kiddo is <8 y/o cric won't work--you need to know how to perform a pediatric tracheotomy
EMCrit Project by Scott Weingart, MD FCCM.
For EMCrit Episode 400, I do a Mind of the Resuscitationist Episode. We discuss a bunch of concepts that have been percolating through this resuscitationist's mind. #MotR
EMCrit Project by Scott Weingart, MD FCCM.
Follow-up to our all things defibrillation episode--we discuss seemingly benign diagrams in the NEJM, VC vs. DSD, and recent ERC guidelines that seem like a big mistake...
EMCrit Project by Scott Weingart, MD FCCM.
I'm writing a letter to the editor in response to a recent article in the Journal of Hospital Medicine. I'm posting it here rather than submitting it to the journal to avoid burying it behind a paywall (and because I have the attention span of an intensivist hopped up on lots of coffee). First, I […]
EMCrit Project by Josh Farkas.
Our first episode uses a simple case to act as touch-point for a discussion of resus nursing in the ED...
EMCrit Project by Scott Weingart, MD FCCM.
We dive DEEP into PEA, when to stop CPR, how to know when you have adequate perfusion after ROSC, and a bunch more!!!
EMCrit Project by Scott Weingart, MD FCCM.
Additional exploration of Neuroleptic Malignant Syndrome (NMS) with Eelco Wijdicks
EMCrit Project by Scott Weingart, MD FCCM.
Fall from standing with some pretty concerning symptoms of spinal cord injury...
EMCrit Project by Scott Weingart, MD FCCM.
Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) are relucatantly covered on this week's show
EMCrit Project by Scott Weingart, MD FCCM.
NeuroMuscular Emergencies are tough without neurology, but you can do it and do it well! Casey Albin is here to help...
EMCrit Project by Scott Weingart, MD FCCM.
Let's talk about starting patients on milrinone. Milrinone is part of a group of medications that I would regard as quasi-titratable. They have an awkward half-life of roughly ~0.5-3 hours. Other medications in this group might include diltiazem, labetalol, and perhaps nicardipine. These drugs can be given as a continuous infusion, but they're not easy […]
EMCrit Project by Josh Farkas.
A discussion of some arterial line philosophy, accuracy, and ease of placement.
EMCrit Project by Scott Weingart, MD FCCM.
Part 2 of Inotropes with Trina - we discuss specific scenarios...
EMCrit Project by Scott Weingart, MD FCCM.
EMCrit RACC-Lit for January 2025 All the literature goodness!
EMCrit Project by Scott Weingart, MD FCCM.
All things stabilizing tamponade and performing pericardiocentesis
EMCrit Project by Scott Weingart, MD FCCM.
All the literature goodness for December 2024
EMCrit Project by Scott Weingart, MD FCCM.
I think ICU docs may have developed a bit of an RCT problem; not an addiction, but perhaps a dependency. It all started off fine at first. RCTs are the apex trial design, the only trial capable of proving causality. But we've taken it too far. Currently, a cluster-randomized trial is underway to study whether […]
EMCrit Project by Josh Farkas.
John Holcomb, author of the PROPPR trial, on massive transfusion in 2024
EMCrit Project by Scott Weingart, MD FCCM.
I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it there. I've also received some questions about getting started on BlueSky, so here is a brief guide to moving into MedSky. [1] Set up your account & profile This is essentially […]
EMCrit Project by Josh Farkas.
Experts' guide to the use of the Bougie for Emergency Airway Management
EMCrit Project by Scott Weingart, MD FCCM.
Medtwitter was great. We met amazing people and exchanged ideas. There were endless arguments about electrolytes and intubation. But the strength of Medtwitter was never the platform – it was the people. Twitter has been deteriorating for years. For example, the algorithm is horrific, the blocking feature has been largely removed, posts from paid users […]
EMCrit Project by Josh Farkas.
All the RACC Literature Goodness for November 2024
EMCrit Project by Scott Weingart, MD FCCM.
Chart to protect yourself and your patients!
EMCrit Project by Scott Weingart, MD FCCM.
All things acute liver failure with a GI Intensivist
EMCrit Project by Scott Weingart, MD FCCM.
When you need to temporize orbital compartment syndrome, there is markedly easier way than Lateral Cantholysis
EMCrit Project by Scott Weingart, MD FCCM.
All things Vascular Access with the Vascular Guy
EMCrit Project by Scott Weingart, MD FCCM.
There is more than one form of differential gas exchange on VA ECMO--remember differential ventilation!
EMCrit Project by Katrina Augustin.
Learn about how to use ultrasound during cardiac arrest
EMCrit Project by Scott Weingart, MD FCCM.
All the Resuscitation and Acute Critical Care goodness in the literature for September 2024
EMCrit Project by Scott Weingart, MD FCCM.
We often joke that the right ventricle is the “forgotten ventricle,” but there is a sad truth behind this joke. Recently, there has been increased recognition of the importance of right ventricle failure and systemic congestion within some circles (e.g., nephrologists and resuscitationists). However, overall the right ventricular failure continues to be commonly overlooked. A […]
EMCrit Project by Josh Farkas.
Getting sued in the maelstrom that is the US malpractice system is horrible!! Let's talk about how to make it better...
EMCrit Project by Scott Weingart, MD FCCM.
Penetrating Neck Trauma and how to leave the zone
EMCrit Project by Scott Weingart, MD FCCM.
Is THAM the better bicarb? Find out in this jam-packed episode in the acid base series...
EMCrit Project by Scott Weingart, MD FCCM.
A great rural medicine critical care cards case
EMCrit Project by Scott Weingart, MD FCCM.
How do you sedate a critically ill patient for a procedure?
EMCrit Project by Scott Weingart, MD FCCM.
We have a tendency to rate control and then send them somewhere else
EMCrit Project by Scott Weingart, MD FCCM.
Sometimes I encounter basic pharmacokinetic questions that don't seem to be readily answered in the immediately available literature. I've found FOAMed to be a useful way to make sure I'm doing this right (e.g., see a prior discussion of the appropriate loading dose based on intermittent maintenance dosing and half-life here). Today I want to […]
EMCrit Project by Josh Farkas.
a unique ventilatory mode unfortunately only available on Hamilton vents
EMCrit Project by Scott Weingart, MD FCCM.
REVISE is the latest multicenter RCT on the use of PPIs for GI prophylaxis in critical illness. I would view this as the triquel following SUP-ICU and PEPTIC. In order to understand REVISE in context, let's briefly review SUP-ICU and PEPTIC trials, before discussing REVISE. Part I: SUP-ICU (2018) This was a large multicenter RCT […]
EMCrit Project by Josh Farkas.
introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […]
EMCrit Project by Josh Farkas.
the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient
EMCrit Project by Scott Weingart, MD FCCM.
Today, we talk about a paper that showed impressive neurologically intact survival for all-rhythms presenting in cardiac arrest, both OHCA and IHCA. It uses a new set of strategies and technologies called CARL. The Paper Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study Supplemental Material […]
EMCrit Project by Scott Weingart, MD FCCM.
intro: the challenge of procedural sedation in critical illness Procedural sedation for critically ill patients is a minefield for several reasons: Patients are already physiologically unstable. Procedures are emergent (a factor widely associated with greater complications). Time constraints often prevent a complete pre-anesthetic evaluation (e.g., medical history and laboratory studies may be unknown). A single […]
EMCrit Project by Josh Farkas.
Today we talk about the debate over whether to give vasopressors as part of a balanced resuscitation in early exsanguination...
EMCrit Project by Scott Weingart, MD FCCM.
Piperacillin-tazobactam is an antibiotic that a lot of people love to hate. Combine this with the conservatism that often (rightfully) surrounds drug safety, and it creates a lot of volatility. Before going further, we should review some recent history regarding piptazo. In the early 2010's, a series of retrospective correlational studies found that patients treated […]
EMCrit Project by Josh Farkas.
How to do a scary procedure that must get done...
EMCrit Project by Scott Weingart, MD FCCM.
A critical care bounce back case with Mike Weinstock
EMCrit Project by Scott Weingart, MD FCCM.
A razor is a rule of thumb that is helpful, although it isn't always correct. In medicine we're familiar with Occam's razor (the rule of parsimony). The cutoff razor states: if a continuous variable is dichotomized using a cutoff, then values near the cutoff provide little information. A simple illustration of the cutoff razor is […]
EMCrit Project by Josh Farkas.
10 heuristics for the new Crit Care doc from Ross Prager
EMCrit Project by Scott Weingart, MD FCCM.
The 2nd FoundStab SOP is on standard intubation...
EMCrit Project by Scott Weingart, MD FCCM.
(A blogitorial is like a tweetorial in blog form, so folks on different platforms can see it). Our approach to risk stratification and management of (sub)massive PE tends to be dominated by CT scan and echocardiography (eye-candy modalities). And these are great. But I think there are situations where ECG can be really helpful – […]
EMCrit Project by Josh Farkas.
Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from non-dominant hemispheric strokes. On superficial examination it will mimic unconsciousness, but upon further examination the patient is awake and able to respond to stimuli with their extremities. I've seen a similar phenomenon of eyelid opening apraxia a few times […]
EMCrit Project by Josh Farkas.
People on twitter absolutely hate the concept of using a central line to resuscitate a GI bleeder. This comes up a couple times per year. I think the source of this hatred is largely three-fold: A central line alone is garbage (without a Level-1 or Belmont infuser). I'll admit that. So if you're working in […]
EMCrit Project by Josh Farkas.
NephMadness hits EMCrit with RRT for the Poisoned Patient
EMCrit Project by Scott Weingart, MD FCCM.
Do you still need to worry about contrast in patients with tenuous renal function?
EMCrit Project by Scott Weingart, MD FCCM.
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.
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.
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.
Setting PEEP and Righting the RV in ARDS with Matt Siuba
EMCrit Project by Scott Weingart, MD FCCM.
Is your mind ready for no preparation critical care?
EMCrit Project by Scott Weingart, MD FCCM.
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.
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.
Retrograde, in 2023 is basically a backwards way of doing things...
EMCrit Project by Scott Weingart, MD FCCM.
Dizziness and Vertigo with the lead author of GRACE-3
EMCrit Project by Scott Weingart, MD FCCM.
Brian Johnson talks about his new book, Arete
EMCrit Project by Scott Weingart, MD FCCM.
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.
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.
We categorized intubation errors and published a paper about it...
EMCrit Project by Scott Weingart, MD FCCM.
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.
The first version of the first guideline in the foundational stabilization project - post-intubation sedation
EMCrit Project by Scott Weingart, MD FCCM.
The explosion follow-up on the AMAX4 protocol for crashing anaphylaxis and asthma with Ben McKenzie [@amax4]
EMCrit Project by Scott Weingart, MD FCCM.
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.
A deeper dive on accidental hypothermia in anticipation of my much awaited winter
EMCrit Project by Scott Weingart, MD FCCM.
Lower dose peripheral infusion for sick pulmonary embolism patients
EMCrit Project by Scott Weingart, MD FCCM.
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.
Massive Hemorrhage Protocol--The Trauma Anesthesiologist Perspective...
EMCrit Project by Scott Weingart, MD FCCM.
Today I am joined by Mathieu Brunet, MD; a EM Doc and Trauma Team Leader. He recently wrote me with a case of Transcutaneous Pacing in which he thought he had mechanical capture due to a perfect matched pulse ox waveform. Well it turned out that was erroneous. Why??? Listen to this episode...
EMCrit Project by Scott Weingart, MD FCCM.
So today we have our June-u-airway update... A bunch of papers and thoughts on how you should be intubating in 2023. DSI for everyone, induction agent choice, apox and much more!
EMCrit Project by Scott Weingart, MD FCCM.
More on the CLOVERS trial from the lead author
EMCrit Project by Scott Weingart, MD FCCM.
My dear pulmonologists, I have some bad news. Santa Claus isn't real. Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD). Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they're one and the same. But they aren't. The ability […]
EMCrit Project by Josh Farkas.
My attempt to model my empirical experience with Burnout
EMCrit Project by Scott Weingart, MD FCCM.
The precise utilization of ABG, VBG, and pulse oximetry remains controversial. Unfortunately, there is little high-level evidence investigating whether these interventions affect patient outcomes (for example, there is precious little evidence to support most of the target values that we're chasing after). This chapter attempts to explore the strengths, weaknesses, and indications for various techniques. […]
EMCrit Project by Josh Farkas.
Is there an easier way to mix up push-dose epinephrine that is still as safe?
EMCrit Project by Scott Weingart, MD FCCM.
CAR-T cell therapy is rapidly expanding as a miraculous therapy for numerous malignancies. However, it also causes a variety of unique and severe side-effects, which frequently cause ICU admission. This chapter explores current approaches to complications including CRS (cytokine release syndrome), HLH (hemophagocytic lymphohistiocytosis), and ICANS (immune effector cell-associated neurotoxicity syndrome). Updates will be needed […]
EMCrit Project by Josh Farkas.
Resistant SCAPE can be scary but you can handle it!
EMCrit Project by Scott Weingart, MD FCCM.
Recently, two sets of guidelines for neuroprognostication following cardiac arrest were released – almost simultaneously. In a perfect world, two evidence-based guidelines based on the same evidence would be the same. But of course, this isn't actually the case. The guidelines differ significantly. The Neurocritical Care Society guidelines recommended this general approach:(36949360) Meanwhile, the Canadian […]
EMCrit Project by Josh Farkas.
How to teach and learn intubation and laryngoscopy
EMCrit Project by Scott Weingart, MD FCCM.
(Blogitorials are short, informal blogs that are written in the spirit of a tweetorial). Stress hyperglycemia is an everyday occurence in the ICU, but we hardly know how to treat it. I've been waiting years for this topic to be clarified… but I've realized that such clarity will probably never be reached. Why? The traditional […]
EMCrit Project by Josh Farkas.
Hayden Richards is a communications maven...
EMCrit Project by Scott Weingart, MD FCCM.
Steroid is worthless for pneumonia! Wait, a new study shows it's beneficial! Hang on, a fresh meta-analysis shows that steroid is useless! And wait, here's a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What's going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […]
EMCrit Project by Josh Farkas.
A new format of ED Critical Care perfectly suited to rural environments
EMCrit Project by Scott Weingart, MD FCCM.
CLOVERS Trial Primer and Fluids in Septic Shock
EMCrit Project by Scott Weingart, MD FCCM.
All things Sleep--you will add years to your life if you sleep well, so the time investment to listen to this podcast may be well worth it
EMCrit Project by Scott Weingart, MD FCCM.
More cardiac arrest mastery with the sonorambler
EMCrit Project by Scott Weingart, MD FCCM.
Today, we speak about a mode of NIPPV that you should know about (but probably don't): AVAPS
EMCrit Project by Scott Weingart, MD FCCM.
For this last podcast of the year, I had a couple of pieces that were going to become Wees, but I thought I would combine them for synergistic goodness and make this end-of-year podcast. Today, we speak about some tips from a EM Surgical Intensivist and discussion of a brand new sedative, Remimazolam.
EMCrit Project by Scott Weingart, MD FCCM.
All the resus/acute critical care literature goodness for December 2022
EMCrit Project by Scott Weingart, MD FCCM.
This is SIESTA syndrome. The patient is locked in a cycle of unconsciousness, punctuated with brief episodes of agitation. Most of the time the patient is sedated to the point of having minimal EEG activity, which may hinder their ability to regain consciousness.
EMCrit Project by Josh Farkas.
Making good decisions is the heart of Emergency Medicine and Critical Care...
EMCrit Project by Scott Weingart, MD FCCM.
Rounding up the questions from the past few months
EMCrit Project by Scott Weingart, MD FCCM.
Lumbar Puncture This seemingly simple procedure seems to be the Achilles's heel or many resus docs! If you have a good baseline knowledge of how to do the lumbar puncture correctly, it is super easy. If you have bad habits, then you will make your poor patient look like a pin cushion.
EMCrit Project by Scott Weingart, MD FCCM.
Is there evidence for the classically taught nix on this medication?
EMCrit Project by Scott Weingart, MD FCCM.
Is there evidence for the classically taught nix on this medication?
EMCrit Project by Scott Weingart, MD FCCM.
Every Resus doc should be able to crash a patient on to APRV for lung rescue...
EMCrit Project by Scott Weingart, MD FCCM.
A review on dealing with HeartMate 3 (most common LVAD you will see) Emergencies
EMCrit Project by Scott Weingart, MD FCCM.
3 great cases from the NeuroEMCrit Team
EMCrit Project by NeuroEMCrit Team (Casey & Neha).
All of the resuscitation and acute critical care goodness for Sept 2022
EMCrit Project by Scott Weingart, MD FCCM.
Today, the errors and procedural missteps I commonly observe while teaching 100 docs per year how to cannulate for ECMO (but the lessons are not about ECMO, they are about all vascular access in the femoral vessels.)
EMCrit Project by Scott Weingart, MD FCCM.
Sleep for Shift Workers--this info may add years to your life and keep you performing optimally
EMCrit Project by Scott Weingart, MD FCCM.
Historically, many patients admitted with congestion due to heart failure have been treated with furosemide monotherapy. However, a strategy of furosemide monotherapy has numerous drawbacks: Furosemide tends to stimulate production of dilute urine, leading to a greater amount of water loss than sodium loss. Predominant loss of water may cause loss of volume from the […]
EMCrit Project by Josh Farkas.
It is unacceptable to have the rates of Awareness during Paralysis seen in a recent ED sedation study--We are better than this
EMCrit Project by Scott Weingart, MD FCCM.
So much literature goodness for the scorching summer heat…
EMCrit Project by Scott Weingart, MD FCCM.
This chapter explores some general aspects of neurological infectious diseases, including important historical features and high-risk groups. It also includes a more general discussion of lumbar puncture performance and interpretation. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
EMCrit Project by Josh Farkas.
This chapter explores the approach to acute neuromuscular weakness in the ICU, as well as selected disorders. As with any acute presentation, an organized approach is essential. Understanding the limitations of various tests is also critical (since there is considerable confusion about this). The IBCC chapter is located 👉 here. The podcast & comments are […]
EMCrit Project by Josh Farkas.
Don't use the ICH score in isolation to not give aggressive critical care...
EMCrit Project by NeuroEMCrit Team (Casey & Neha).
We need to be ready to resuscitate any patient that comes to our EDs and ICUs. Being Resus Ready for bariatric patients requires forethought and planning. Let's discuss some resuscitation strategies for the obese patient.
EMCrit Project by Scott Weingart, MD FCCM.
Management of the a patient following craniotomy focuses on the fundamentals of supportive neurocritical care. However, special attention is required to unique postoperative complications that may occur (depending on the procedure). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
EMCrit Project by Josh Farkas.
Imagine you’re in the ICU and the cuff of an ETT (endotracheal tube) ruptures. You exchange it for a fresh ETT over a catheter, right? Easy peasy. Blind airway exchange over a catheter has been the standard practice in various ICUs that I’ve rotated through. ETT exchange over a catheter is a simple and effective […]
EMCrit Project by Josh Farkas.
We throw around the term “nonconvulsive status epilepticus” a lot, and generally think that we know what that is. However, nonconvulsive status epilepticus is an enormously complex and heterogeneous diagnosis. This chapter attempts to clarify matters based on the most recent definitions, but in some situations the diagnosis may remain murky. The IBCC chapter is […]
EMCrit Project by Josh Farkas.
Prior to declaring a patient brain dead, confounding factors which could falsely cause the patient to appear dead must be eliminated. One important confounder is intoxication. Failure to recognize that a patient is intoxicated could lead to an incorrect diagnosis of brain death that in turn can lead to withdrawal of life support – thereby […]
EMCrit Project by Josh Farkas.
Traumatic spinal cord injury is extremely common. In addition to the initial management of patients presenting with trauma, we should be comfortable in managing the longer-term sequelae (e.g., autonomic dysreflexia). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
EMCrit Project by Josh Farkas.
things I've learned from my own mistakes and 2 decades of training residents
EMCrit Project by Scott Weingart, MD FCCM.
Most medical myths arose decades ago, prior to the era of modern evidence-based medicine. When investigating the origin story of those myths, we wind up reading grainy old papers from the 1950s. Surely, we think, such myths wouldn’t arise today – not in our shiny, interconnected, science-based, hyper-argumentative medical world. Unfortunately, new myths do continue […]
EMCrit Project by Josh Farkas.
Question: Perampanel is an oral antiseizure medication that may occasionally be used for refractory status epilepticus. It has a half-life of 105 hours. Different sources recommend three different regimens for its dosing: (a) 18-24 mg load followed by 12 mg/day.(33830480) (b) 32 mg load followed by 12 mg/day.(31565443) (c) 36 mg on day #1, 24 […]
EMCrit Project by Josh Farkas.
External ventricular drains and lumbar drains will generally be managed primarily by the neurosurgical team. Nonetheless, some general understanding of their management, data interpretation, and potential complications is extremely helpful. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
EMCrit Project by Josh Farkas.
The neurological manifestations of COVID is a rapidly moving target. Different strains of virus, rising levels of immunity, and challenges in sorting out causation from correlation make it impossible to write a perfect chapter on this. Nonetheless, some patterns and concepts may be helpful. The IBCC chapter is located 👉 here. The podcast & comments […]
EMCrit Project by Josh Farkas.
Acute demyelinating disorders are not a common cause of ICU admission. However, these are encountered occasionally (especially acute transverse myelitis, acute disseminated encephalomyelitis, and osmotic demyelination syndrome). Additionally, some of these disorders may be triggered by COVID, so this chapter will help us understand the neurological manifestations of COVID. The IBCC chapter is located 👉 […]
EMCrit Project by Josh Farkas.
NeuroEMCrit dissects the new ASA sICH Guidelines
EMCrit Project by Scott Weingart, MD FCCM.
EEG is an increasingly utilized tool among critically ill patients. This chapter explores how to interpret the clinical significance of various EEG patterns which are commonly encountered in the ICU. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
EMCrit Project by Josh Farkas.
The first of a recurring segment: Ghali Grills me on APRV
EMCrit Project by Scott Weingart, MD FCCM.
Hypoxemic patients will try to die on you...
EMCrit Project by Scott Weingart, MD FCCM.
Neuro-oncologic emergencies are commonly encountered in critical care. Rapidly evolving biological therapies for cancer offer patients exciting benefits, but have also created new sets of complications (e.g., checkpoint inhibitor-induced encephalitis). Patients may be suffering from complications of the malignancy itself, complications of therapy, or wholly unrelated problems. The IBCC chapter is located 👉 here. The […]
EMCrit Project by Josh Farkas.
One and a half years ago, a landmark study by Sjoding et al. found that critically ill Black patients were more likely than White patients to have falsely reassuring pulse oximetry measurements (discussed here).1 Subsequently, six sizable studies have been published on this topic. Since this is of critical importance to acute care medicine, it's […]
EMCrit Project by Josh Farkas.
Movement disorders are encountered more frequently in the critical care unit than one might realize. For example Parkinson's disease alone affects ~1% of patients over sixty years old (often requiring careful consideration in medication management, to avoid either psychosis or Parkinsonism-hyperpyrexia syndrome). Other disorders are less common, but their recognition may be critical (e.g., propofol […]
EMCrit Project by Josh Farkas.
Carotid or vertebral artery dissection are important considerations in trauma and also common causes of ischemic stroke among younger patients. Variable presentations and a plethora of different diagnostic modalities can make this tricky. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
EMCrit Project by Josh Farkas.
Neurologic emergencies in pregnancy are challenging as there is very little high-quality evidence regarding them. This chapter attempts to review available information, but large gaps remain. Ideally, such gaps may be filled by using multidisciplinary teams which personalize care for each individual patient. The IBCC chapter is located 👉 here. The podcast & comments are […]
EMCrit Project by Josh Farkas.
Karim Brohi and I discuss the state of Trauma Resus in 2022
EMCrit Project by Scott Weingart, MD FCCM.
Which would you want?? The evidence may change your mind...
EMCrit Project by Casey Albin.
Catatonia is an important cause of altered mental status which is often overlooked among critically ill patients. Although traditionally associated with schizophrenia, catatonia can result from a variety of psychiatric, neurologic, and medical problems (similar to delirium). It is important to diagnose catatonia, because otherwise patients are likely to be incorrectly labeled as having delirium […]
EMCrit Project by Josh Farkas.
Neurogenic pulmonary edema isn't particularly common, but it's probably more common than we realize. Most cases are likely mistaken as cardiogenic pulmonary edema or aspiration pneumonitis. Treatment is predominantly supportive, with a focus on defending the injured brain (rather than focusing too much on the lungs). The IBCC chapter is located 👉 here. The podcast […]
EMCrit Project by Josh Farkas.
Spinal Epidural Abscess is rare, but it is increasingly encountered (especially within the context of the opioid epidemic, and an aging population with increasing comorbidity). SEA may be part of the patient's initial presentation to the ICU, or it may arise during the course of a prolonged ICU admission. The IBCC chapter is located 👉 […]
EMCrit Project by Josh Farkas.
Baclofen is one of the most effective treatments for spasticity, but also perhaps the most toxic. Baclofen intoxication may lead to severe mental status suppression requiring intubation and occasionally hemodialysis. However, intrathecal baclofen withdrawal is more difficult to treat if it's not possible to immediately re-institute intrathecal therapy. The IBCC chapter is located 👉 here. […]
EMCrit Project by Josh Farkas.
Friends, Over the next several months we'll be adding ~26 additional chapters to the neurology section of the IBCC. The ultimate goal is to create a complete neurocritical care textbook that is fully integrated into the IBCC. (You can preview the final table of contents here.) Why more neurocrit? The brain is one of the […]
EMCrit Project by Josh Farkas.
Reversal of Anti-Coag and Anti-PLT is confusing and essential!
EMCrit Project by Scott Weingart, MD FCCM.
It has been a while since we did a sepsis and septic shock update, so the time has come! No better framework for the discussion than the most recent iteration of the Surviving Sepsis Campaign Guidelines. Foreshadowing: they don't suck as hard as in prior years.
EMCrit Project by Scott Weingart, MD FCCM.
the question Some patients with HSV encephalitis may initially have a negative CSF PCR for HSV, with a repeat being positive some days later. This has led to confusion regarding who, exactly, needs a repeat lumbar puncture? Montmollin E et al: HSV encephalitis with initial negative PCR: Prevalence, associated factors, and clinical impact. This is […]
EMCrit Project by Josh Farkas.
You need a structured approach to prognostication after ROSC. If you are winging it--then you are screwing over your patients!
EMCrit Project by Scott Weingart, MD FCCM.
Vertigo--you hate it! Which means you are bad at it. Get-Better-Here&Now!
EMCrit Project by Scott Weingart, MD FCCM.
All the juiciest new Resuscitation and Acute Critical Care Literature updates for Jan 2022
EMCrit Project by Scott Weingart, MD FCCM.
EEGs: What to do when you have them and also when you don't!!
EMCrit Project by Scott Weingart, MD FCCM.
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.
All the Resus and Acute Crit Care Goodness in 10 minutes
EMCrit Project by Scott Weingart, MD FCCM.
Chest Tube Insertion (Part 2 of a 2 part series)
EMCrit Project by Scott Weingart, MD FCCM.
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.
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.
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.
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.
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.
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.
EEGs are tougher than EKGs--but you can master the basics
EMCrit Project by NeuroEMCrit Team (Casey & Neha).
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.
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.
Critically Ill diabetic ketoacidosis is usually a bit of a misnomer
EMCrit Project by Scott Weingart, MD FCCM.