Peritonsillar Abscess Management -Old: I+D all PTA -New: data points towards medical management alone (PMID: 32482146) -For small PTA, non-toxic pt, antibiotics + steroids alone w/ close f/u very reasonable youtube.com/shorts/jARG2... #EMIMCC

PTA Management - Drain or Not? #emergencymedicine

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Procainamide vs Amio in Stable VT -PROCAMIO (27354046) RCT comparing 2 agents -Amio: 32% more likely cause major adverse event(NNH = 3) -Procainamide 30% more likely convert patient(NNT = 3) but, only 67% conversion rate -Electricity 1st still best approach youtube.com/shorts/W9Kwe... #EMIMCC

Procainamide vs Amiodarone in Stable VT #emergencymedicine #criticalcare

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Anatomically Challenging Airways: The key in being ready isn’t assessment tools; it’s assuming every airway is anatomically challenging + preparing appropriately -My setup: SGVL, bougie first, SALAD technique every time -Backup: HAVL, scalpel-bougie-ETT for cric youtube.com/shorts/V7l-V... #EMIMCC

Anatomic Airway Assessment in the ED #emergencymedicine #criticalcare #airway

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Lethal Quadrad of Trauma: Hypothermia, Coagulopathy, Acidosis + HypoCa - HypoCa common in major trauma -Aggressive, prophylactic supplementation is key -Standard: 1 gm CaCl w/ 1st 2 units (don’t wait for level). Give another 1 gm CaCl w/ every additional 4 units youtube.com/shorts/43m17... #EMIMCC

Lethal Quadrad - HypoCa in Trauma #emergencymedicine #criticalcare

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Systemic Lytics in Sick Massive PE -Delay in care can lead to rapid decompensation -My approach: 1/2 dose alteplase: 10 mg bolus then 40 mg over 30 min (can repeat) -Tenecteplase 25 mg bolus -Systemic lytics do not preclude other therapies like thrombectomy youtube.com/shorts/Tx1zu... #EMIMCC

Thrombolytics in Sick Massive PE #emergencymedicine #criticalcare

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Pulmonary HTN Intubation -Avoid if possible but if have to, focus resus on relieving pulmonary HTN/RV strain -Hypoxemia: HFNC -Hypotension: Improved tone + DBP will improve coronary perfusion + RV fxn -Ideal is awake approach: avoid apnea + maintain catecholamines youtube.com/shorts/qi2NY... #EMIMCC

Intubating Pulm HTN #emergencymedicine #criticalcare

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OMI vs STEMI Paradigm -STEMI paradigm flawed: insensitive in detecting acute coronary occlusion (ACO) -Occlusion myocardial infarction (OMI) approach incr early detection ACO requiring immediate cath -Great discussions Steve Smith and Pendell Meyers youtube.com/shorts/DlJHn... #EMIMCC

Occlusion MI (OMI) vs STEMI Criteria #emergencymedicine #criticalcare

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Management of Agitated Trauma Patient bit.ly/3UTG4QR -Multifactorial: injury, hypoperfusion, hypoxemia, intoxication, pain -Treatment depends on severity of trauma + severity of agitation -Critical Injury: Dissociative dose ketamine: 1-2 mg/kg IV or 5 mg/kg IM youtube.com/shorts/lLvE1... #EMIMCC

Agitation in Trauma #emergencymedicine #criticalcare #trauma

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Pulmonary HTN + Airway Management -Induction agents ➡️ catecholamine tone ➡️ hypotension, RV hypoperfusion + drop in RV fxn -Paralysis ➡️ hypercapnea, pulmonary vasoconstriction + drop in RV output -Positive pressure ventilation ⬆️ PA + RV pressure youtube.com/shorts/gJ8cz... #EMIMCC

Dangers in Intubating Patients with Pulmonary HTN #emergencymedicine #criticalcare

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Electrical Alternans Case: 58 yo woman w/ breast CA p/w SOB + BP 90/55 ECG: sinus tach, low voltage + variable QRS complex sizes Electrical alternans + low voltage suggestive of pericardial tamponade Take Home: low voltage = pocus TTE youtube.com/shorts/H1IUP... #EMIMCC

Electrical Alternans #emergencymedicine #criticalcare

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Speeding up the Trial of Void (Tip via David Carr) -Before you pull the foley, instill 250-300 cc of 0.9% saline -Bladder is now full + pt should want to void immediately -If no voiding in 20-30 min, TOV failed: replace foley youtube.com/shorts/bXeQL... #EMIMCC

Trial of Void Hack #emergencymedicine

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Proper BVM Technique as Important as Proper Intubation Technique -BVM requires 2 operators - one to use 2 hands to hold mask, one to bag -Place 1st/2nd digits on top of mask lightly holding in place + 3rd-5th digits posterior to mandible + pull jaw up in to mask youtube.com/shorts/vCsXo... #EMIMCC

BVM Technique #emergencymedicine #criticalcare

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Peripheral (Bell Palsy) vs Central Facial Droop -Upper + Lower facial muscles affected = peripheral CN VII -CN VII responsible taste anterior 2/3 of tongue -Taste only affected in peripheral CN VII palsy -Testing taste can help differentiate in equivocal cases youtube.com/shorts/xDlDL... #EMIMCC

Bell Palsy + Taste #emergencymedicine

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One of the first questions I ask my trainees when they suggest an ABG is if they have ever had one drawn on themselves to see how painful it is. If we are going to be invasive, should make sure the info is worth it to the patient.

ABG can largely be replaced by VBG pH: VBG ~ 0.03 units lower than ABG PCO2: VBG 6-10 mm Hg higher than ABG HCO3: VBG 1-2 mmol lower than ABG Under most circumstances, these differences won’t affect management making ABG unnecessary youtube.com/shorts/OMFEo... #EMIMCC

VBG vs ABG pH, PCO2, HCO3 #emergencymedicine #criticalcare

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Approach to Chest Pain Tips -Ask if sudden/severe/max at onset: pushes to consider dissection -ACS likelihood incr: exertional, radiates R shoulder or b/l shoulders or assoc w/ diaphoresis or vomiting -Pleuritic pain virtually rules out diagnosis of ACS youtube.com/shorts/uRWhk... #EMIMCC

Chest Pain History Tips #emergencymedicine

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You're at the bedside. Bilateral chest tubes placed, 100% FiO2, PEEP 10 — patient still satting 72% and hypotensive. Sara Crager, MD (@teachicu) from ResusX:2026: What do you do next? Have you managed a case like this? Comment to discuss.👇

Cardiac arrest/peri-arrest w/ high suspicion for PE -Systemic thrombolytics clearly indicated -Arrest: alteplase 100 mg IV push or tenecteplase 30-50 mg IV push (weight based) -Peri-arrest: 1/2 dose - alteplase 50 mg IV push w/ option to redose if no improvement youtube.com/shorts/mFRJ8... #EMIMCC

Lytics in PE - Arrest #emergencymedicine #criticalcare

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Resuscitate Before You Intubate: Hypoxemia -Pre-ox w/ NIV: PEEP recruits alveoli improving O2 -Goal: fully denitrogenate: wash out nitrogen + replace w/ O2 -Allowing your pre-ox strategy time to denitrogenate builds O2 reservoir + gives longer safe apneic time youtube.com/shorts/gJVYf... #EMIMCC

Resus Before Intubate - Hypoxemia #emergencymedicine #criticalcare

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Haloperidol is a Fantastic Multi-Tasker -Sedation of the agitated patient -Potent antiemetic particularly in gastroparesis (PMID 28320545) + CHS (PMID: 33160719) -Excellent in migraines (PMID 27510942) -Refractory sickle cell disease pain + chronic abdominal pain youtube.com/shorts/A5Ju5... #EMIMCC

Haloperidol is Great #emergencymedicine

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Phenobarbital a game changer in EtOH w/d -Option 1: No benzos given. Load 10 mg/kg over 30 min + wait 30 min for effect -Option 2: post-escalating BZD. Give phenobarbital 130 mg IV q15 until adequate sedation achieved -Early phenobarbital use can avoid intubation youtube.com/shorts/IMcT7... #EMIMCC

Phenobarbital in EtOH Withdrawal #emergencymedicine #criticalcare

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Resuscitate Before you Intubate: BP/Perfusion support -BP will drop w/ induction meds -Vasoactives better than fluids: incr peripheral tone + contractility/cardiac output + improve venous tone -Consider pushing MAP to 75-80 mm Hg (no data) to give extra cushion youtube.com/shorts/ZrDsO... #EMIMCC

Resuscitate Before You Intubate - BP Support #emergencymedicine #criticalcare

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Beta blockade in sepsis? -Early, tachycardia compensatory mechanism to increase CO + perfusion -Persistent tachycardia after resus may indicate exaggerated sympathetic response that can cause cardiac dysfunction youtube.com/shorts/nLmSy... #EMIMCC

Esmolol in Sepsis #emergencymedicine #criticalcare

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Nicardipine: great for htn emergency but, can see transient hypotension even w/ slow titration -Key is to load + drip -Start 5 mg/hr + titrate up 2.5 mg/hr q5 min -When reach target BP, drop dose back to 5 mg/hr + retitrate infusion until get to steady state youtube.com/shorts/2F0-1... #EMIMCC

Nicardipine Titration #emergencymedicine #criticalcare

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Airway Plan Verbalization -Going through your primary, secondary + tertiary plans is a key step in preparation -Use “when” not “if” language: communicates to team that challenges and progression to secondary + tertiary approaches expected youtube.com/shorts/vHbB9... #EMIMCC

Verbalizing Airway Plan #emergencymedicine #criticalcare #intubation

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Painless Monocular Vision Loss -Dx: CRAO, retinal + post vitreous detachment, vitreous hemorrhage -POCUS: If see eye pathology - you’re done. May see retrobulbar spot sign(diagnostic CRAO) -If don’t see clear eye cause or you’re not sure, default to stroke workup youtube.com/shorts/ZVheS... #EMIMCC

Painless Monocular Vision Loss #emergencymedicine #criticalcare #neurology

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Hypokalemia is a big killer in DKA: -Total body depleted regardless of serum level (acidosis shifts K from cells) - Above 3.5 can start insulin and K simultaneously - Below 3.5 replete K aggressively before adding insulin youtube.com/shorts/qBmL3... #EMIMCC

Potassium in DKA #emergencymedicine #criticalcare #dka

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Bougie Steering -Bougie use in expert hands improves 1st pass success (PMID 29800096) -Common obstacle is steering the tip -Key: use scissor grip: hold bougie between 3rd + 4th digits. Apply upward force w/ 4th digit using 3rd digit as a fulcrum youtube.com/shorts/2dqYl... #EMIMCC

Bougie Tip Steering #emergencymedicine #criticalcare #airway

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Refractory migraine: consider haloperidol/droperidol -Butyrophenones extremely effective in headache + nausea management -Haloperidol 5 mg IV or droperidol 2.5 mg IV rapid acting + safe (PMID: 27510942) -Single dose highly unlikely to have significant QTc effect youtube.com/shorts/KsvE7... #EMIMCC

Haldol + Droperidol in Migraine #emergencymedicine

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You're already on norepinephrine. Pt tanks after the antibiotic you just hung. Anand Swaminathan, MD (@emswami) from ResusX:ReUnion: Do you go vasopressin — or epinephrine? If there's any chance this is iatrogenic anaphylaxis, the answer might surprise you. What's your move?👇