WhiteBoard Medicine - Emergency And Critical Care

#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
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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.

#205 When to Use Stress-Dose Steroids in the ED | 3 High-Yield Clinical Scenarios

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.

#204 Capillary Refill Time Explained | How to Measure CRT and Assess Shock at the Bedside

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.

#203 Lactate Explained | Lactic Acidosis, Type A vs Type B, and Prognosis in Critical Illness

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.

#201 Refractory Hypoxemia Explained | Pulmonary Embolism With Right-to-Left Cardiac Shunt (ED/ICU Case)

Refractory hypoxemia that does not improve with supplemental oxygen should immediately raise concern for a right-to-left shunt. In this ED and ICU case review, we walk through a patient with acute pulmonary embolism causing severe hypoxemia due to intracardiac shunting, reviewing the underlying physiology, diagnostic approach, and management considerations.
We break down: • Mechanisms of refractory hypoxemia • Pulmonary embolism physiology and RV failure • Right-to-left shunt (including PFO physiology) • Why oxygen and ventilation may fail • ED and ICU diagnostic pearls • Management considerations in critically ill patients
 
Link to video: https://www.youtube.com/watch?v=Qey9aRZRGk0 
 
📚 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 in our WBM Emergency Critical Care
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.

#200 Eight Common Ventilator Mistakes To Avoid That May Harm Patients!

Mechanical ventilation saves lives — but small ventilator mistakes can cause major patient harm.
In this episode, we break down 8 common ventilator mistakes that clinicians frequently make in the ICU and emergency department, and explain why they matter physiologically. We cover errors related to tidal volume, PEEP, oxygenation vs ventilation, respiratory rate, patient–ventilator dyssynchrony, hemodynamics, and more — all through a clinically practical, physiology-focused lens.
📌 Topics include: Lung-protective ventilation mistakes Over-oxygenation and oxygen toxicity Mismanagement of PEEP and compliance Ventilator settings that worsen hemodynamics Missed patient–ventilator dyssynchrony Common ICU and ED ventilator pitfalls
Link to video version: https://www.youtube.com/watch?v=PG3ofKVttbY
📚 DOWNLOAD MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS in our WBM Emergency Critical Care Patreon Community - Join Today!! https://www.patreon.com/c/WhiteBoardMedicine
DISCLAIMER THIS PODCAST DOES NOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, audio, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read, watched, or listened to on this video, or any other videos, reports, texts tweets or other sources.

#199 PEEP Explained: Oxygenation, Compliance & Hemodynamics

Positive end-expiratory pressure (PEEP) is one of the most powerful — and misunderstood — tools in mechanical ventilation. In this episode, we break down how PEEP works, why it improves oxygenation, and when it can actually harm patients.
We’ll walk through: • How PEEP recruits alveoli and improves oxygenation • The relationship between PEEP, lung compliance, and overdistension • How excessive PEEP affects venous return, cardiac output, and blood pressure • The concept of optimal PEEP and how to think about titration at the bedside • Common mistakes clinicians make when setting PEEP
📚 DOWNLOAD MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS in our WBM Emergency Critical Care Patreon Community - Join Today!! https://www.patreon.com/c/WhiteBoardMedicine
Link to this video: https://www.youtube.com/watch?v=SYdB1ciFNgs
DISCLAIMER THIS PODCAST DOES NOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, audio, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read, watched, or listened to on this video, or any other videos, reports, texts tweets or other sources.

#198 Occult Cardiogenic Shock Explained | The Shock You’re Missing at the Bedside

Occult cardiogenic shock is one of the most commonly missed shock states in Emergency Medicine and Critical Care. These patients may appear “stable” — with near-normal blood pressure — yet have severe cardiac dysfunction, low cardiac output, and poor tissue perfusion.
In this episode, we break down: 🔹 What occult cardiogenic shock actually is 🔹 Why blood pressure alone is misleading 🔹 The underlying physiology of low cardiac output shock 🔹 How to recognize occult cardiogenic shock at the bedside 🔹 The role of bedside ultrasound, lactate, ScvO₂, and clinical clues 🔹 Practical management principles in the ED and ICU
📚 MINI COURSES, STUDY GUIDES (for this video), PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS in our WBM Emergency Critical Care Patreon Community - Join Today!! https://www.patreon.com/c/WhiteBoardMedicine
Playlist on Shock: https://youtube.com/playlist?list=PLf5bMa9_tvRjunk4I-rQZYPZn3qHqWFqW&si=kserFPPm7RYuhul-
DISCLAIMER THIS PODCAST DOES NOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, audio, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read, watched, or listened to on this video, or any other videos, reports, texts tweets or other sources.

#197 Comparing Shock States | Hypovolemic vs Cardiogenic vs Distributive vs Obstructive

Shock is a life-threatening condition encountered daily in Emergency Medicine, Critical Care, and the ICU — yet it’s often taught in fragmented algorithms rather than unified physiology.
In this episode, we break down all major shock states in a clear, structured way:
🔹 Hypovolemic shock
🔹 Cardiogenic shock
🔹 Obstructive shock
🔹 Distributive shock (septic, anaphylactic, neurogenic)
📚 MINI COURSES, STUDY GUIDES (for this video), PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS in our WBM Emergency Critical Care Patreon Community - Join Today!! https://www.patreon.com/c/WhiteBoardMedicine
Playlist on Shock: https://youtube.com/playlist?list=PLf5bMa9_tvRjunk4I-rQZYPZn3qHqWFqW&si=kserFPPm7RYuhul-
DISCLAIMER THIS PODCAST DOES NOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, audio, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read, watched, or listened to on this video, or any other videos, reports, texts tweets or other sources.

#196 The Ultimate ICU Basics Guide | Ventilation, Shock, Pressors & Renal Replacement

This episode is a comprehensive, high-yield guide to ICU basics, designed for medical students, nurses, APCs, interns, residents, emergency medicine physicians, intensivists, and critical care trainees.
We walk step-by-step through the core foundations of ICU care, focusing on physiology-driven decision-making and practical bedside management. Topics include mechanical ventilation, shock, vasopressors and inotropes, and renal replacement therapy—all explained in a clear, clinically relevant framework.
This episode is intended as a big-picture ICU overview and pairs well with deeper dives on each topic. Whether you’re starting ICU rotations or refining your critical care fundamentals, this guide will help build a strong mental model of ICU physiology and management.
📚 DOWNLOAD MINI COURSES, STUDY GUIDES, PRACTICE QUESTIONS, AD FREE VIDEOS, EDUCATIONAL DISCUSSIONS in our WBM Emergency Critical Care Patreon Community - Join Today!! https://www.patreon.com/c/WhiteBoardMedicine
DISCLAIMER THIS PODCAST DOES NOT PROVIDE MEDICAL ADVICE. The information, including but not limited to, audio, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read, watched, or listened to on this video, or any other videos, reports, texts tweets or other sources.