the EMCrit Crew

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.org/cpyu

@ThinkingCC @EMNerd_ @SaraCrager @khaycock2 @Jailyn_Avi

EMCrit 429 - RUSH 2.0 - The I-RUSH and CRUSH Exams Finally dropping the RUSH Exam 2.0 on this week's EMCrit Podcast! We're moving past just the crashing patient to bring you the Interface-Informed RUSH. Get ready to standardize your hemodynamic assessments at the bedside. [#FOAMed] emcrit.org/429

In almost every case I agree with Josh (big surprise 😳) I recommend RSI in the original EMCrit post: emcrit.org/emcrit/tube-se… way back in Episode 3 The only time an awake approach may be clever is when the pt is doing a great job compensating and they are being intubated for something like a procedure. In this case, a spontaneous breathing intubation makes sense. Then leave them on PSV/PEEP only mode on the vent. Sedate with ketamine as needed and let them keep doing the work, i.e. never take over for them. Also, Josh, in the studies the rise of PaCO2 in the first minute was always higher something like 4-6.

Disagree - I think the concept that an apnea period during intubation will cause your pCO2 to skyrocket is dogma. During apnea, pCO2 rises by ~3 mm/minute. Anyone who does apnea tests to certify brain death knows this is a slow process (most apnea tests = 10 minutes without a single breath!). For intubating a patient with metabolic acidosis, you surely want to get the tube in quickly. But an experienced operator will have enough time to get the tube in before the pCO2 rises much. I don't think the fear of this apnea period should be driving people to do weird stuff like awake intubation or ketamine-only intubation in these patients. Just do a fast RSI. The real problem is often that it's often impossible to match the patient's endogenous minute ventilation with the ventilator. But this problem exists regardless of the details of intubation.

EMCrit Wee - A Second Opinion on HBO for CO Following up on the Juurlink episode, toxicologist Chris Tomaszewski drops a masterclass on why HBO sn’t about clearing blood—it’s about halting a brutal inflammatory cascade in the brain and heart before it's too late. [#FOAMed for now] emcrit.org/bp2e

EMCrit 428 - A Few Things 🔹 ARISE Fluids: Does the 30 mL/kg sepsis mandate finally crumble? 🔹 BIHCA & SODABIC 🔹 Traumatic Tamponade: Can a 12Fr catheter prevent a thoracotomy in austere settings? 🔹 DKA Guidelines: Why the ADA has it completely backward when it comes to the anion gap. emcrit.org/428

@drterrynguyen You need to take this down--it is incorrect and dangerous! happy to explain why--DM me

1:1 Nursing 009 - Q&A Episode 2 We cover a range of topics in Resus and Acute Critical Care Nursing. [#FOAMed for now] emcrit.org/1to1-009

EMCrit Wee - Phil and Rory on the 4 Interface Model for Shock Physiology. We dive deeper in part 2 of the Shock Physiology Series. [#FOAMed for Now] (@emnerd_ @thinkingcc) emcrit.org/4Int

@ThinkingCC not u yet brother—this is the intro. u r on Monday’s wee.

Thanks for having me!

EMCrit 427 - Advancing Concepts in Shock Physiology. As an intro to a 3-part series, I go over two papers discussing new ways to assess and understand shock hemodynamics. (@emnerd, @thinkingcc, @saracrager) [#MembersOnly] emcrit.org/427

EMCrit Wee - Dr. Glaucomflecken [@DGlaucomflecken] on the amazing Eugene EM Physicians triumph over corporate medicine [#FOAMed for a bit] emcrit.org/glaucomflecken

EMCrit 426 - Dave Carr - Tips & Tricks from his career in Emergency Medicine @davidcarr333 [#FOAMed for a bit] emcrit.org/426

EMCrit Wee - Compassion in Medicine - Compassionomics with Stephen Trzeciak. In less than 60 seconds you can dramatically change your patient's and your own experience in medicine! [#FOAMed for a bit] emcrit.org/compassionomics

EMCrit Wee - How I F*&ked Up at Incrementum 2026 In which I debrief my failure clinically and from a psychological perspective. #Incrementum2026 emcrit.org/awake-frackup

Airway Triage Debate: Today, a debate with an anesthesiologist [@airwaymxacademy] on the use of his airway triage app and whether it is applicable to resus airways... emcrit.org/425

EMCrit Wee - 2026 PE Update F/u with @pulmcrit & Justin Morgenstern [#FOAMed for just a bit] emcrit.org/k173

@DrGermanov I said 16 mg over 6 in my discussion—may be even lower in future

@emcrit Btw great update, thanks! One question I keep thinking about: HI-PEITHO used 9-18 mg, STRATIFY – 20 mg alteplase. Given OPTALYSE and the apparent efficacy/safety balance with lower-dose USAT regimens, do you think 18-20 mg is optimal?

AHA PE Guidelines 2026 are here, so are STRATIFY and HI-PEITHO. I have new takeaways, updated risk stratification, treatment recs, and much more... emcrit.org/424

COHb of 32% — should you dive this patient? The answer is more complicated than your tox textbook lets on. New EMCrit with Dave Juurlink unpacking why it is not the slam dunk you were taught. [#FOAMed for a bit] emcrit.org/423