WhiteBoard Medicine - Emergency And Critical Care

#215 Septic Shock Explained: Diagnosis, Management, and Common Mistakes

Septic shock is one of the most common and deadly emergencies encountered in critical care, yet early missteps in diagnosis and management can dramatically worsen outcomes. In this episode, we walk through septic shock step by step, focusing on how to recognize it, how to manage it effectively, and the most common mistakes clinicians make along the way.
We start by reviewing the physiology of septic shock and how it differs from uncomplicated sepsis, then move into practical bedside diagnosis and perfusion assessment. From there, we discuss fluid resuscitation, vasopressor selection and timing, source control, and reassessment, highlighting where well-intentioned treatments often fail.
This episode is designed as a practical, physiology-based guide for emergency medicine and critical care clinicians who want a structured framework for managing septic shock and avoiding common pitfalls that impact patient outcomes.
 
📚 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.
Link to YouTube video: https://www.youtube.com/watch?v=4duvp0evQ-8 
Podcast Disclaimer
This podcast is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The information discussed reflects general medical concepts and may not apply to individual patients or clinical situations. Clinical decisions should always be made in the context of a licensed healthcare professional’s judgment, institutional protocols, and current clinical guidelines. The views expressed are those of the hosts and do not necessarily represent the views of any affiliated institutions.

#214 ECMO Explained: VA-ECMO, VV-ECMO, and When to Use Each

Extracorporeal membrane oxygenation (ECMO) is one of the most complex and powerful tools in critical care—but also one of the most misunderstood. In this episode, we break down ECMO step by step, focusing on VA-ECMO, VV-ECMO, how they work, and when to use each configuration.
We start with the fundamentals of ECMO physiology and circuit components, then walk through veno-arterial (VA) ECMO for cardiac failure and veno-venous (VV) ECMO for severe respiratory failure. Along the way, we highlight key indications, hemodynamic effects, common pitfalls, and complications clinicians need to recognize at the bedside.
This episode is designed as a practical, physiology-based guide for emergency medicine and critical care clinicians who want a clear mental model for ECMO decision-making—whether you’re encountering it for the first time or looking to solidify your understanding.
 
📚 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.
Link to YouTube video: https://www.youtube.com/watch?v=tpZKcvJiuvc
Podcast Disclaimer
This podcast is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The information discussed reflects general medical concepts and may not apply to individual patients or clinical situations. Clinical decisions should always be made in the context of a licensed healthcare professional’s judgment, institutional protocols, and current clinical guidelines. The views expressed are those of the hosts and do not necessarily represent the views of any affiliated institutions.
 

#213 Most Common Mistakes in Septic Shock Management | Emergency & Critical Care

Septic shock management is complex, and many poor outcomes stem from preventable management errors rather than delayed recognition. In this episode, we break down the most common mistakes clinicians make when managing septic shock, using a physiology-driven framework relevant to both the emergency department and ICU.
We discuss pitfalls related to fluid resuscitation, delayed or inappropriate vasopressor use, treating mean arterial pressure instead of tissue perfusion, missed right ventricular failure, and delays in source control. Throughout the episode, we emphasize reassessment and escalation strategies that help avoid persistent hypoperfusion and organ dysfunction.
This episode is designed for emergency medicine physicians, intensivists, residents, and trainees looking for a practical, bedside-focused approach to septic shock management beyond rigid protocols.
Link to YouTube Video: https://www.youtube.com/watch?v=LktPBGHtn10
📚 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.

#212 Metformin-Associated Lactic Acidosis (MALA) Explained | Symptoms, Pathophys, Diagnosis & Management

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.

#211 Four Common Mistakes in Shock Management | Emergency & Critical Care

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.

#210 VV-ECMO Explained in Under 10 Minutes | Anatomy, Components, & Settings

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.

#209 VA-ECMO Explained in Under 10 Minutes | Anatomy, Components, & Settings

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.

#208 Lactate and Capillary Refill Time | Comprehensive Overview Perfusion Assessment in Shock (ED/ICU)

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.

#207 Pulse Pressure Explained | Physiology, Interpretation, and Shock States in Critical Care

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.

#206 Lactate vs Capillary Refill Time | Which Is Better for Assessing Shock & Perfusion?

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.