Crash Cart Emergency Medicine

About Crash Cart Emergency Medicine

The voice of Emergency Medicine at The Ohio State University

Publisher

The Ohio State University

Category

education · health & fitness

Language

en

Explicit

No

First episode

21 Aug 2024

Latest episode

30 Sept 2026

Latest episodes

27 episodes in the feed.

1. 

   30 Sept 2026

   Amniotic Fluid Embolism

   A patient in labor suddenly becomes hypoxic and hypotensive. Minutes later, she arrests and then begins bleeding uncontrollably. Amniotic fluid embolism (AFE) is rare, unpredictable, and potentially catastrophic. AFE requiring rapid recognition and a coordinated resuscitation before the diagnosis is ever certain. In this episode, Drs. Caroline Bank and Kim Bambach discuss a practical approach to recognizing and managing AFE, including the clinical clues that distinguish it from other causes of maternal collapse, pregnancy-modified resuscitation, management of right ventricular failure and coagulopathy, and the importance of early multidisciplinary activation. They also discuss what happens after survival, from team debriefing to communicating with patients after a traumatic birth. This episode is part of the Ohio CORES (Collaborative Obstetric Resuscitation Education and Simulation) series at The Ohio State University, supported by a grant from the Ohio Department of Children and Youth. Guest: Caroline Bank, MD; Host: Kim Bambach, MD; Editor: Nick Roesel Key Learning Points 1. Think of the “3 Bs”: Breathing, Blood Pressure, and Bleeding AFE is a clinical diagnosis. Consider it when a laboring or recently postpartum patient develops sudden: Hypoxia Hypotension Altered mental status Cardiovascular collapse or cardiac arrest Coagulopathy or unexpected bleeding The Amniotic Fluid Embolism Foundation describes the classic presentation using the 3 Bs: Breathing, Blood Pressure, and Bleeding. Symptoms like anxiety, restlessness, chills, or dyspnea, may precede cardiovascular collapse. 2. Timing and early coagulopathy are important clues The differential for maternal cardiovascular collapse is broad and includes pulmonary embolism, hemorrhage, eclampsia, and other causes of cardiac arrest. Two clues should particularly raise suspicion for AFE: Timing: AFE typically occurs during labor or shortly after delivery. Early coagulopathy: Sudden cardiopulmonary collapse accompanied by early DIC is particularly concerning. In hemorrhagic shock, coagulopathy generally develops as bleeding progresses and clotting factors are depleted. In AFE, coagulopathy may precede the major hemorrhage. 3. Resuscitate first, even if there is diagnostic uncertainty. When AFE is suspected: Secure the airway and optimize oxygenation. Establish adequate IV access. Support circulation with vasopressors, blood products, and appropriately selected fluids. Activate OB, anesthesia, the resuscitation/code team, and blood bank early. Anticipate rapidly evolving coagulopathy and hemorrhage. 4. If cardiac arrest occurs, use pregnancy-modified resuscitation Prioritize: High-quality CPR Airway and oxygenation Manual left uterine displacement Rapid preparation for resuscitative hysterotomy when indicated Maternal resuscitation remains the priority. The interventions that improve maternal circulation also improve fetal perfusion. 5. Think about the right ventricle Bedside echo can help identify right ventricular strain or dysfunction. Consider: Vasopressors Inotropic support Pulmonary vasodilators when available and appropriate Avoiding excessive fluid administration that may worsen RV overload 6. Activate ECMO early when available In refractory cardiovascular collapse, involve the ECMO team early rather than waiting until other options have been exhausted. Concern for hemorrhage or DIC does not necessarily preclude ECMO. Extracorporeal support can initially be initiated without anticoagulation while a patient is profoundly coagulopathic. 7. AFE resuscitation is multidisciplinary A critically ill postpartum patient may simultaneously require maternal resuscitation, hemorrhage control, massive transfusion, neonatal resuscitation, and advanced cardiovascular support. Clearly divide responsibilities according to team expertise: ED: code leadership, airway, vascular access, resuscitation OB: uterine and hemorrhage management NICU/neonatal team: neonatal resuscitation ECMO team: advanced mechanical circulatory support when indicated Early role assignment allows multiple critical interventions to occur simultaneously rather than sequentially. 8. The resuscitation does not end with ROSC Survivors of AFE may face substantial physical and psychological consequences. Coordinated post-arrest care, rehabilitation, and support for both patients and clinicians following a traumatic delivery. Further Resources Amniotic Fluid Embolism Foundation (https://afesupport.org/)

2. 

   1 Jul 2026

   Critical Brain Resuscitation

   A patient with an intracranial hemorrhage can look surprisingly stable…until they suddenly don’t. Recognizing the subtle signs of rising intracranial pressure before herniation occurs is one of the most time-critical skills in emergency medicine. In this episode, Drs. James Nardini, Mike Prats, and Kim Bambach discuss a practical, evidence-based approach to critical brain resuscitation, from recognizing early deterioration to implementing tiered ICP management, choosing hyperosmolar therapy, optimizing sedation, and avoiding common pitfalls. Based on the Emergency Neurological Life Support (ENLS) framework, this episode provides a systematic approach you can apply on your next shift. Guest: James Nardini, MD, MS; Host: Mike Prats, MD and Kim Bambach, MD; Editor: Kim Bambach, MD Key Learning Points 1. Recognize deterioration early Elevated ICP often begins with nonspecific symptoms (headache, vomiting, confusion, gait disturbance). Serial neurologic examinations are more valuable than a single assessment. Track: Glasgow Coma Scale (watch for declining scores) Pupillary size and reactivity New focal neurologic deficits Mental status changes A >1 mm change in pupil size may be an early sign of herniation. 2. Understand herniation syndromes Subfalcine: contralateral leg weakness (ACA compression) Uncal (transtentorial): ipsilateral fixed dilated pupil decreased consciousness contralateral hemiparesis Tonsillar: occipital headache neck stiffness progressive brainstem compression eventual Cushing triad 3. Cushing triad is a late finding Hypertension Bradycardia Irregular respirations Waiting for the full triad means the patient is already critically decompensating. 4. Follow a tiered approach (Emergency Neurological Life Support) Tier 0: Optimize physiology ABCDE assessment Protect airway, maintain oxygenation and ventilation Normalize glucose Treat fever BP management Elevate head of bed (when appropriate) Provide analgesia and sedation Obtain urgent non-contrast head CT Minimize secondary brain injur Tier 1: Temporize while arranging for definitive care Hyperosmolar therapy Brief controlled hyperventilation if actively herniating Early neurosurgical consultation and if needed arrange transfer for neurosurgical consultation. You can advocate for your patient. 5. Hypertonic saline vs. mannitol Both improve outcomes and are reasonable first-line agents. Hypertonic saline may provide: more sustained ICP reduction better cerebral perfusion pressure superior ICP control in several studies Don’t delay treatment simply because one agent is unavailable. In selected critically ill patients, both therapies may be used. 6. Monitor sodium carefully Obtain a baseline sodium on patient arrival. Check sodium frequently after hypertonic saline. Typical therapeutic target: 145–155 mEq/L 6. Propofol is the preferred sedative Benefits: Decreases cerebral metabolic demand Reduces cerebral blood volume Lowers ICP Suppresses seizures Watch for: Hypotension Reduced cerebral perfusion pressure Maintain adequate blood pressure while sedating. 7. Common pitfalls A common pitfall is waiting too long to initiate hyperosmolar therapy. If you’re seriously asking whether the patient needs hypertonic therapy, that may be the moment to act rather than waiting for unmistakable herniation. 8. Emergency physicians are the bridge to definitive care The goal is to: Recognize deterioration Prevent secondary injury Optimize physiology Initiate temporizing therapies Rapidly connect patients with neurosurgical intervention 9. Ultrasound pearl Bedside ultrasound may provide additional information: optic nerve sheath diameter measurement optic disc elevation transcranial ultrasound (experienced users) Further Resources Emergency Neurological Life Support Course (https://www.neurocriticalcare.org/NCS-Learning-Center/ENLS) Emergency Neurological Life Support Intracranial Hypertension and Herniation Protocol (https://www.neurocriticalcare.org/Portals/0/ENLS%205.0/ENLS%206.0/Protocol%20V6_0_Intracranial%20Hypertension%20and%20Herniation.pdf?ver=oGpOZQ2sI6-mgzJhEgTtTg%3D%3D) Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients- Neuro Critical Care Society (https://www.neurocriticalcare.org/Portals/0/Docs/Resources/Cook2020_Article_GuidelinesForTheAcuteTreatment.pdf?utm_source=chatgpt.com)

3. 

   30 Jun 2026

   Day in the Life of… an EM Chair

   What does it actually take to become the chair of an academic emergency medicine department? In this episode, Dr. Edleda James, PGY3 and future simulation fellow interviews Dr. Jeffrey Caterino, Professor of Emergency and Internal Medicine and Chair of Emergency Medicine at The Ohio State University. He shares his career journey to become department chair, the realities of leading a large academic department, and the leadership skills that aren’t taught during residency. They discusses mentorship, developing financial and administrative expertise, intentionally building leadership skills, and practical advice for trainees and junior faculty interested in future leadership roles. Guest: Jeffrey Caterino, MD, MPH; Host: Edleda James, MD; Editor: Kim Bambach, MD; Audio Editor: Nick Roesel Key Learning Points Leadership is rarely a straight path. Career interests often develop after becoming faculty and gaining insight into how departments function. Mentorship remains essential at every career stage, including for department chairs. Peer mentorship can be just as valuable as traditional mentor-mentee relationships. Seek advice broadly. Leadership is a learnable skillset that requires intentional development, including: Running effective meetings Hiring and personnel management Delivering difficult feedback Motivating teams Financial literacy Organizational leadership Experiential learning is invaluabl. Serve on committees, observe leaders, and gain exposure to departmental operations before stepping into leadership roles. Leadership courses offered through institutions and professional organizations can provide practical skills and invaluable insights from experienced leaders, such as leadership courses from SAEM. An MBA or administrative fellowship can be helpful, particularly for hospital leadership, but they are not prerequisites for becoming a department chair. The key is acquiring the necessary business and leadership skills by any effective pathway. If you’re considering a leadership role: Talk with multiple people currently doing the job. Learn what skills they actually use. Intentionally build those competencies before you need them. Final leadership advice: pursue opportunities with “magnitude and direction“. Be intentional about the experiences and skills you choose so they align with your long-term goals. Further Resources Administration Fellowship at The Ohio State University (https://medicine.osu.edu/departments/emergency-medicine/education/fellowships/administration-fellowship) SAEM Chair Development Program (https://www.saem.org/about-saem/academies-interest-groups-affiliates2/aacem/chair-mentorship/cdp-program) SAEM Emerging Leader Development Program (https://www.saem.org/education/saem-educational-courses/emerging-leader-development-program-(elead)) EM Resident- What You Need to Know About EM Administration Fellowships (https://emresident.org/administrative-fellowships)

Who has been a guest on Crash Cart Emergency Medicine

Names identified in recent episode analyses. Showing up to five guests.

• Katie Connell
• Thomas Connell
• Cynthia Shellhaas
• Kimberly Bambach
• Sheryl Pfeil

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

Apple Podcasts (US)

4.6 / 5

17 ratings

Podcast Authority Score: 29 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

37

Social presence

0

YouTube

0

Engagement

51

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