WhiteBoard Medicine - Emergency And Critical Care

Fresh Frozen Plasma (FFP), Prothrombin Complex Concentrate (PCC), and Cryoprecipitate are core coagulation products used in bleeding and coagulopathy management — but knowing which product to choose and when is essential for safe, effective care.

In this episode, we break down the key differences between FFP, PCC, and cryoprecipitate, focusing on composition, indications, and clinical decision-making rather than slide-based teachin...

Cryoprecipitate transfusion is a targeted therapy used to correct hypofibrinogenemia and specific coagulation factor deficiencies in bleeding patients. In this episode, we break down when to give cryoprecipitate, how to dose it, and what fibrinogen targets matter most in everyday clinical practice.

This discussion covers:

• What cryoprecipitate is and what it contains

• Indications for cryoprecipitate transfusion

• Fibrinogen t...

Platelet transfusion is a common intervention in thrombocytopenia, bleeding, and peri-procedural care — but knowing when to transfuse, what thresholds to use, and how to balance risks and benefits is critical.

In this episode, we walk through a practical, evidence-based approach to platelet transfusion decision-making, focusing on real-world clinical scenarios rather than slide-based teaching.

Topics covered include:

• What pla...

Prothrombin Complex Concentrate (PCC) is a powerful, targeted coagulation therapy used in urgent bleeding and anticoagulation reversal. In this episode, we walk through what PCC is, when to use it, how to dose it, and what safety considerations matter most in real-world clinical practice.

This audio-focused discussion covers:

• What Prothrombin Complex Concentrate (PCC) contains

• Common indications, including warfarin and vita...

Shock is a life-threatening state of circulatory failure that requires rapid recognition and a strong understanding of underlying physiology. In this episode, we provide a clear, structured ICU starter guide to shock, focusing on how and why patients deteriorate and how to intervene effectively at the bedside.

We begin with the core physiology of shock and mechanisms of impaired tissue perfusion, then walk through the major shock s...

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 un...

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) E...

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...

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 conce...

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-resuscita...

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 ...

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, fl...

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 • ...

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 pr...

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 refle...

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 • ...

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 ...

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 • Lac...

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 ph...