WhiteBoard Medicine - Emergency And Critical Care

Metformin-associated lactic acidosis (MALA) is rare, but when it occurs, it carries significant morbidity and mortality. In this episode, we walk through a practical, clinician-focused approach to recognizing and managing MALA in the emergency department and ICU.
We review the pathophysiology behind metformin-related lactic acidosis, common risk factors and precipitating conditions, and the clinical features that should raise concern for MALA. We also discuss the diagnostic approach, key laboratory findings, and management strategies, including supportive care and considerations for dialysis.
This episode is designed for emergency medicine and critical care clinicians, residents, and trainees who want a clear mental model for evaluating unexplained lactic acidosis in patients taking metformin.
Link to YouTube Video: https://www.youtube.com/watch?v=4jmgU9u9Ba8
📚 Download the PDF study guide for this video: 👉 https://www.patreon.com/c/WhiteBoardMedicine 
Patreon members get access to mini-courses, study guides, practice questions, ad-free videos, and in-depth educational discussions designed for emergency and critical care clinicians.
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Shock management is where small clinical decisions can have outsized consequences. In this episode, we break down four common mistakes clinicians make when managing patients in shock, with a focus on physiology-driven decision making rather than protocol-only care.
We discuss the consequences of ignoring right ventricular failure, delaying vasopressors, treating mean arterial pressure instead of tissue perfusion, and over-resuscitating patients with intravenous fluids. Each mistake is explored through the lens of bedside assessment and hemodynamic reasoning, highlighting how these errors can perpetuate hypoperfusion and organ dysfunction.
This episode is designed for emergency medicine physicians, intensivists, residents, and trainees looking for a practical, high-yield framework to approach undifferentiated shock in the emergency department and ICU.
Link to YouTube Video: https://www.youtube.com/watch?v=IxW-DlMxeeU
📚 Download the PDF study guide for this video: 👉 https://www.patreon.com/c/WhiteBoardMedicine
Patreon members get access to mini-courses, study guides, practice questions, ad-free videos, and in-depth educational discussions designed for emergency and critical care clinicians.
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Veno-venous ECMO (VV-ECMO) is primarily a respiratory support modality, but its physiology is often oversimplified. In this episode, we walk through VV-ECMO from a practical, clinician-focused perspective.
We discuss what VV-ECMO is, how the circuit is configured, key anatomic considerations for cannulation, and the core components of the system. We also review common VV-ECMO settings and how changes in flow, sweep gas, and oxygen fraction impact oxygenation and carbon dioxide clearance.
This episode is intended for emergency medicine and critical care clinicians, residents, and medical students who want a clear mental model of VV-ECMO and how it supports patients with severe respiratory failure.
Link to YouTube Video: https://www.youtube.com/watch?v=IN9lj5OVobk 
📚 Download the PDF study guide for this video: 👉 https://www.patreon.com/c/WhiteBoardMedicine
Patreon members get access to mini-courses, study guides, practice questions, ad-free videos, and in-depth educational discussions designed for emergency and critical care clinicians.
This is a fast, high-yield overview designed for emergency medicine, critical care, ICU clinicians, residents, and medical students.
 
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

VA-ECMO explained in under 10 minutes. We cover what VA-ECMO is, vascular anatomy and cannulation, core circuit components, and key ECMO settings used in emergency and critical care medicine.
In this episode, we break down:
What veno-arterial ECMO (VA-ECMO) is and when it’s used Anatomy & cannulation strategy (venous drainage, arterial return)
Core VA-ECMO components (cannulae, pump, oxygenator)
Common VA-ECMO settings: RPM, flow, sweep gas, and FiO₂
How ECMO supports cardiac output and systemic perfusion
Link to YouTube Video: https://www.youtube.com/watch?v=_QtYW6cq1uo 
📚 Download the PDF study guide for this video: 👉 https://www.patreon.com/c/WhiteBoardMedicine
Patreon members get access to mini-courses, study guides, practice questions, ad-free videos, and in-depth educational discussions designed for emergency and critical care clinicians.
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Assessing tissue perfusion is central to managing shock and critical illness. In this comprehensive episode, we review lactate, capillary refill time (CRT), and then directly compare the two bedside perfusion markers, focusing on how to interpret them in emergency and critical care settings.
We cover: • Lactate physiology and causes of elevation • Type A vs Type B lactic acidosis • Prognostic value of lactate in critical illness • Capillary refill time physiology and measurement • Normal vs abnormal CRT values • CRT in septic and non-septic shock • Strengths and limitations of lactate vs CRT • Evidence comparing lactate-guided and CRT-guided resuscitation • Practical ED and ICU decision-making
Link to video: https://www.youtube.com/watch?v=1x1yCM4Q5O8
📚 DOWNLOAD PDF FOR THIS VIDEO AT LINK BELOW https://www.patreon.com/c/WhiteBoardMedicine
We also have MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS Consider joining our patreon community today!
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Pulse pressure is an often overlooked but powerful bedside vital sign that provides insight into stroke volume, vascular tone, and shock physiology. In this episode, we break down pulse pressure from first principles, focusing on how to interpret it in emergency and critical care settings.
We cover: • What pulse pressure represents physiologically • Normal vs abnormal pulse pressure values • Narrow vs wide pulse pressure • Pulse pressure in different shock states • Pulse pressure and stroke volume • Common ED and ICU pitfalls when interpreting pulse pressure • Practical bedside examples
Link to video: https://www.youtube.com/watch?v=Xn_8CW4m5ME
📚 DOWNLOAD PDF FOR THIS VIDEO AT LINK BELOW https://www.patreon.com/c/WhiteBoardMedicine
We also have MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS Consider joining our patreon community today!
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Lactate and capillary refill time (CRT) are two of the most commonly used markers to assess tissue perfusion and shock—but they reflect very different physiology. In this episode, we directly compare lactic acid and capillary refill time, exploring what each represents, their strengths and limitations, and how to use them together at the bedside.
We cover: • What lactate represents physiologically • What capillary refill time reflects about perfusion • CRT vs lactate in septic and non-septic shock • Advantages and limitations of each marker • Evidence comparing CRT-guided vs lactate-guided resuscitation • Practical ED and ICU decision-making
Link to video: https://www.youtube.com/watch?v=EWyaoPzbp-k
📚 DOWNLOAD PDF FOR THIS VIDEO AT LINK BELOW https://www.patreon.com/c/WhiteBoardMedicine
We also have MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS Consider joining our patreon community today!
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Stress-dose steroids are commonly discussed in emergency medicine but often misunderstood or inconsistently applied. In this episode, we review three high-yield clinical scenarios in the emergency department where stress-dose steroids may be considered, focusing on physiology, evidence, and practical bedside decision-making.
We cover: • What stress-dose steroids are and why they are used • Septic shock and refractory hypotension • Severe pneumonia and ARDS • Dosing considerations and common pitfalls • When steroids may not be beneficial
Link to video: https://www.youtube.com/watch?v=JiEcszvn5JI
📚 DOWNLOAD PDF FOR THIS VIDEO AT LINK BELOW https://www.patreon.com/c/WhiteBoardMedicine
We also have MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS Consider joining our patreon community today!
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Capillary refill time (CRT) is a simple bedside exam that provides powerful insight into tissue perfusion and shock physiology. In this comprehensive review, we break down everything folks need to know about CRT, including how to measure it correctly, how to interpret abnormal values, and how it compares to traditional markers of perfusion.
We cover: • What capillary refill time represents physiologically • How to properly measure CRT at the bedside • Normal vs abnormal CRT values • CRT in septic, distributive, cardiogenic, and hypovolemic shock • Limitations and pitfalls of CRT • CRT compared to lactate and other perfusion markers • Evidence supporting CRT-guided resuscitation
Link to video: https://www.youtube.com/watch?v=KRQ_SMpqwsA 
📚 DOWNLOAD PDF FOR THIS VIDEO AT LINK BELOW https://www.patreon.com/c/WhiteBoardMedicine
We also have MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS Consider joining our patreon community today!
 
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.

Lactate is one of the most commonly ordered labs in emergency medicine and critical care—yet it’s often misunderstood. In this comprehensive review, we break down everything clinicians need to know about lactate and lactic acidosis, from basic physiology to prognostic significance in critical illness.
We cover: • What lactate is and how it’s produced • Aerobic vs anaerobic lactate generation • Type A vs Type B lactic acidosis • Lactate in sepsis, shock, and hypoperfusion • Non-hypoxic causes of elevated lactate • Lactate clearance and trends • Prognostic value of lactate in critical illness • Common misconceptions about lactic acidosis
Link to video: https://www.youtube.com/watch?v=5JdbyQgdxUY
📚 DOWNLOAD PDF FOR THIS VIDEO AT LINK BELOW https://www.patreon.com/c/WhiteBoardMedicine
We also have MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS 
Consider joining our patreon community today!
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Clinical decisions should be made by licensed healthcare professionals using their clinical judgment, institutional protocols, and current evidence. Whiteboard Medicine assumes no responsibility for clinical outcomes.