Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties.  In recent years, several studies have been published on the use of corticosteroids in select critical illnesses.  In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.

In this podcast we review a few key articles from the 2023 critical care, emergency medicine, and resuscitation literature that pertain to our care of the critically ill ED patient.

Acute mental status changes after the ingestion of alcohol or other substances are a common presentation to the ED.  Those with severe obtundation may require intubation for airway protection while the substance metabolizes.  In fact, more than 20,000 patients are intubated each year in the United States for acute poisoning or intoxication.  Notwithstanding, intubation and mechanical ventilation are not benign procedures.  In this podcast we discuss the recently published NICO Trial, that evaluated a strategy of withholding intubation in patients with coma due to acute poisoning.

REBOA is a relatively new and novel technique that in animal studies has demonstrated benefit in controlling hemorrhage.  However, the evidence for the efficacy of REBOA in humans remains scant.  In this podcast, we discuss the recently published UK-REBOA Trial, which randomized patients to receive REBOA with standard care compared to those randomized to standard care alone.  You may be surprised by these results!

RSI is one of the most common procedures in critically ill patients.  Despite its frequency, there remains significant practice variation on numerous aspects of RSI in the critically ill.  In this podcast, we review pertinent recommendations from the recently published SCCM Guidelines on RSI in the critically ill patient.

Care of the patient with ROSC following OHCA can be complex and typically includes a protocolized approach to optimizing oxygenation, ventilation, hemodynamics, early cardiac catheterization for patients with STEMI, seizure detection, and possibly TTM.  In this podcast, we review two recent articles that focused on the use of mild hypercapnia compared with normocapnia in post arrest patients and the use of a pan-CT protocol to detect critical time sensitive conditions and complications.

Care of the patient with ROSC following OHCA can be complex and typically includes a protocolized approach to optimizing oxygenation, ventilation, hemodynamics, early cardiac catheterization for patients with STEMI, seizure detection, and possibly TTM.  In this podcast, we review two recent articles that focused on the use of mild hypercapnia compared with normocapnia in post arrest patients and the use of a pan-CT protocol to detect critical time sensitive conditions and complications.

Central venous catheter (CVC) placement is common in critically ill patients for a variety of indications.  Thrombocytopenia is also quite common in critically ill patients.  Unfortunately, literature and guideline recommendations vary on the threshold for prophylactic platelet transfusion in patients undergoing a procedure.  In this podcast we discuss a recent trial that evaluated prophylactic platelet transfusion in patients with severe thrombocytopenia undergoing CVC placement.

Over 1 million critically ill patients undergo intubation each year in the United States.  Though direct laryngoscopy remains the most common technique worldwide for intubation, the use of video laryngoscopy has significantly increased.  Studies evaluating video to direct laryngoscopy have thus far produced mixed results.  In this podcast, we review the latest randomized trial, the DEVICE Trial, that assessed video with direct laryngoscopy.  Which device won?

Over 1 million critically ill patients undergo intubation each year in the United States.  Though direct laryngoscopy remains the most common technique worldwide for intubation, the use of video laryngoscopy has significantly increased.  Studies evaluating video to direct laryngoscopy have thus far produced mixed results.  In this podcast, we review the latest randomized trial, the DEVICE Trial, that assessed video with direct laryngoscopy.  Which device won?