Resuscitation
Ep 216 Cardiac Arrest Update: Beyond the 2025 ACLS Guidelines Part 2 – Medications, Airway, Termination and Post-ROSC Care
In this Part 2 or our 2-part EM Cases podcast series on Cardiac Arrest Update, Dr. Sheldon Cheskes and Dr. Rob Simard take us beyond the algorithms and into the real-world decision-making of cardiac arrest care. We answer questions like: Do vasopressin and steroids improve survival or just ROSC? Should we be giving amiodarone earlier—and is lidocaine just as good? When should we use calcium, bicarbonate, or magnesium, and when should we avoid them? What role does ketamine play in CPR-induced consciousness? How should we choose between supraglottic airways and endotracheal intubation? What are the pitfalls of waveform capnography (ETCO2) to help guide CPR quality, detect ROSC, and inform prognosis? What is the role of PoCUS and TEE during cardiac arrest? When should we terminate resuscitation—and how do ETCO2 and POCUS factor into that decision? Should we widen the criteria to consider thrombolytics and who should go to the cath lab, and should we be ordering whole-body CT after ROSC for everyone who isn't going to the cath lab or getting ECMO? And finally, what are the key post-ROSC targets that actually impact neurologic outcomes in cardiac arrest patients? and many more...Please consider a donation to EM Cases to support ongoing high quality Free Open Access Medical Education https://emergencymedicinecases.com/donation/
Ep 215 Cardiac Arrest Update: Beyond the 2025 Guidelines Part 1: CPR, Defibrillation and Ventilation
In this EM Cases update on cardiac arrest management, Dr. Sheldon Cheskes and Dr. Rob Simard join Anton to walk us through the evolving science and bedside practicalities of cardiac arrest management in the wake of the 2025 ACLS Guidelines. They answer questions such as: What are the most common failures in CPR quality, and how can we recognize and correct them in real time? Should we employ head up CPR, and if so how? How should we interpret ETCO₂ during cardiac arrest, and why shouldn’t we chase a single number? How can we minimize peri-shock pauses and optimize defibrillation success at the bedside? Is the traditional two-minute CPR cycle too rigid, and should we be shocking earlier in cases of refibrillation? What is the evidence behind dual sequential external defibrillation (DSED), and when should we use it? After 3 shocks or earlier? How does hyperventilation during cardiac arrest harm patients, and what strategies can reliably prevent it? What is compression-adjusted ventilation (CAV), and how can it improve ventilation consistency during resuscitation? What is the optimal dose of epinephrine in patient with Ventricular Fibrillation? and many more... Please donate to EM Cases to ensure ongoing Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/ This is a deep dive into the critical inflection points in resuscitation where small changes in technique and decision-making may have the greatest impact on outcomes.
Ep 213 Update in Management of Status Epilepticus
Convulsive status epilepticus is one of the most morbid neurologic emergencies we manage in the ED, and outcomes depend far more on speed than drug selection. Like ventricular fibrillation, each minute of ongoing convulsions worsens hypoxia, acidosis, cardiovascular instability, and neuronal injury, while making seizures progressively harder to terminate. Modern definitions are intentionally time-compressed to force early, parallel, clock-anchored action. Any patient still convulsing when you reach the bedside should be treated as evolving status epilepticus. In this EM Cases podcast with Dr. Sara Gray, we take a practical, time-based approach to convulsive status epilepticus, focusing on early, adequately dosed benzodiazepines, avoiding common escalation and dosing pitfalls, anticipating post-ictal cardiovascular collapse, and knowing when to escalate to second-line agents, airway control, and anesthetic-dose therapy. We also address the transition to non-convulsive status epilepticus and how to recognize ongoing seizures when EEG is not immediately available. We answer questions such as: Why does time to first benzodiazepine matter more than the drug or route? What critical actions should occur in parallel with the first dose? What are 3 key actions to do in parallel with the first benzodiazepine? Why is underdosing second-line antiseizure medications—especially levetiracetam—a common and dangerous pitfall? When should persistent seizures trigger intubation and anesthetic-dose therapy? How can we identify non-convulsive status epilepticus once tonic-clonic activity stops? And many more (we also include a high yield status epilepticus management algorithm in the show notes!)... If you find EM Cases helpful in your clinical practice, please consider supporting our work so we can continue producing free, high-quality emergency medicine education for clinicians around the world. Make a donation here: https://emergencymedicinecases.com/donation/
EM Quick Hits 70 MedMal Cases Upper Back Pain, Traumatic Pneumothorax/Hemothorax Decision Making, Risk Stratification of ICH for Consultation, Post-Circumcision Bleeds, IV Contrast Allergy, Emotional Contagion
In this month's EM Quick Hits podcast: Mike Weinstock discusses with Anton a case of upper back pain in this month's Medmal Cases, Andrew Petrosoniak on traumatic pneumothorax and hemothorax decision making: risk stratification, imaging cutoffs and chest tube choices, Justin Morgenstern on brain injury guidelines risk stratification for neurosurgical consult, repeat imaging and admission, Andrew Tagg on management of post-circumcision bleeding and when to escalate care, Hans Rosenberg & Ariel Hendin on evaluation and management of CT contrast allergy and why steroids are out, Shawn Seregren on emotional contagion in resuscitation teams: how tone, pace and volume of your voice and body language effect team rescucitation dynamics and outcomes...
Ep 211 Thyrotoxicosis and Thyroid Storm: Recognition and Management
In this Part 2 of our 2-part podcast series on thyroid emergencies Anton, Dr. George Willis and Dr. Alyssa Louis answer questions such as: When a patient presents with “sepsis without a source,” what bedside features should trigger you to prioritize thyrotoxicosis? How can PoCUS help you decide whether tachycardia is dangerous — or lifesaving — before starting β-blockade? Why can TSH and free T4 be falsely reassuring in a crashing patient, and what labs actually matter early? In which patients does propranolol increase the risk of cardiovascular collapse — and why is esmolol the safer first line medication? Why does the order β-blocker → thionamide → steroid → iodine matter, and what happens if you get it wrong? When is not giving a β-blocker the safest decision in thyroid storm, even in a profoundly tachycardic patient? In an agitated, hyperthermic patient with thyrotoxicosis, why might intubation be more dangerous than helpful in the first hour? How does amiodarone-induced thyrotoxicosis fundamentally change your management — and why can iodine make it worse? and many more...
Ep 210 Decompensated Hypothyroidism Recognition and Management
In the ED, we regularly care for sick patients presenting acutely with abnormal vital signs, altered mental status, and end organ dysfunction. Oftentimes, the culprit ends up being sepsis, or overdose, or organ failure. But it is important that we consider rarer endocrine presentations like decompensated hypothyroidism. In this Part 1 of this two-part podcast with Dr George Willis and Dr Alyssa Louis, we answer questions like: Why is the term myxedema coma a misnomer and should be abandoned? How can we differentiate between sepsis or environmental hypothermia or toxidrome from decompensated hypothyroidism at the bedside? When is it appropriate to order a TSH, a T4 and T3? What are the most important life-threatening triggers that need to be addressed in patients with decompensated hypothyroidism? Why is it important to test for cortisol levels and consider stress-dose steroids in all patients with decompensated hypothyroidism? Why is endotracheal intubation particularly dangerous in decompensated hypothyroidsm? What is the best way to manage hypothermia? Why is the order of medications for treatment of decompensated hypothyroidism so important? and many more... Please consider a donation to EM Cases to ensure continuing Free Open Access Medical Education: https://emergencymedicinecases.com/donation/
