Help me fill in the blanks of the practice of ED Critical Care. In this podcast, we discuss all things related to the crashing, critically ill patient in the Emergency Department. Find the show notes at emcrit.org.
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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?
The podcast explores the use of bolus dose pressors for rapidly correcting temporary hypotension, a common practice in anesthesiology not yet fully adopted in emergency medicine. It details the preparation and safe administration of epinephrine and phenylephrine, emphasizing their distinct actions and ideal clinical scenarios. The host advocates for these tools to maintain perfusion and bridge to continuous infusions, highlighting their ease of use and rapid onset.
The inaugural EMCrit podcast focuses on Sympathetic Crashing Acute Pulmonary Edema (SCAPE), a critical condition distinct from fluid-overload. It highlights the urgent need for intervention, emphasizing rapid diagnosis based on clinical signs like brawls and high blood pressure. The core treatment involves immediate application of non-invasive ventilation with optimized PEEP and a specific regimen of high-dose nitroglycerin, often including a loading bolus, to prevent intubation by aggressively reducing afterload. The episode also touches on the clinician's role in direct medication administration and adjunctive therapies for patient comfort.