EM Quick Hits 72 EMC²: Peds Neurocritical Care, Pulmonary Hypertension, Cytokine Release Syndrome, Peds Wrist Fracture, Bradycardia ECG Interpretation, Coaching the EM Mind Part 2

July 21, 2026

AI Summary

5 min read

Coaching the EM Mind: Stress Management and Safety on Shift

In a high-stakes moment—a pregnant trauma patient in cardiac arrest, CPR in progress, five minutes out—most emergency physicians feel their heart rate climb. That physiological jolt is stress, not burnout. Dr. Sarah Gray draws a clear distinction: stress is a short-term reaction to a specific challenge that increases energy and focus; burnout is a chronic state of exhaustion, depersonalization, and cynicism that a weekend off cannot fix. The goal is not to eliminate stress—impossible in emergency medicine—but to manage it so you stay in the optimal performance zone.

Four In-the-Moment Strategies for Stress Regulation

When the wheels start coming off—when decisions feel impossible, when you snap at someone, when the board looks overwhelming—Gray recommends four moves that can be executed in seconds. First, take a break, even if it is one minute in the bathroom. Second, use a breathing exercise like box breathing (inhale four seconds, hold four, exhale four, hold four). The key is practice: Gray notes that with regular repetition, she can induce a relaxation response in under ten seconds. Third, ground yourself with a subtle physical anchor—planting feet into the floor, clasping hands together, feeling a wedding ring. These five-second actions connect you to the present moment and dampen emotional int

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What you'll learn

1 (02:09) **Pediatric Neurocritical Care Case - Sick Child with Altered LOC** - Dr. Amna Karabogovic presents a real case of a 5-year-old with vomiting and altered level of consciousness, walking through the team preparation and differential diagnosis.
2 (09:27) **CT Results and ICP Management: Hypertonic Saline is First-Line** - The CT shows extensive intracranial hemorrhage with hydrocephalus, and the patient develops bradycardia, a red flag for rising ICP.
3 (14:13) **Airway Considerations in Pediatric Neuro Patients** - The team calls for the most qualified provider for first-pass success, using video laryngoscopy and specific pre-treatment to mitigate the risks of intubation.
4 (16:23) **Pediatric ICH: Etiology and Blood Pressure Targets** - The discussion shifts to the unique causes of spontaneous ICH in children and the lack of evidence for blood pressure targets.
5 (22:09) **Key Takeaways from the Pediatric Neuro Case** - A recap of the most actionable pearls for managing a crashing pediatric neuro patient.
6 (24:34) **Pulmonary Hypertension: The Delicate Teeter-Totter** - A rapid-fire overview of managing acute pulmonary hypertension, emphasizing the high risk of intubation and the need for fast pulmonary vasodilation.
7 (26:23) **Pulmonary Vasodilators: Inhaled Nitroglycerin is Your ED Workhorse** - Since fancy drugs like nitric oxide are rarely available in the ED, inhaled nitroglycerin is a practical and effective alternative.

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Show Notes

In this month’s EM Quick Hits Podcast, Amna Karabegovic joins us for an EMC² case of pediatric altered LOA and neurocritical care, Anand Swaminathan simplifies the high-risk management of pulmonary hypertension and right ventricular failure, and Brit Long reviews how to recognize and treat Cytokine Release Syndrome. Plus, Andrew Tagg on whether uncomplicated pediatric distal radius fractures need reduction, Jesse McLaren on a systematic approach to ECG interpretation in the bradycardic patient, and Sara Gray and Katie Lin return for Part 2 of “Coaching the EM Mind,” with practical strategies for managing stress and optimizing psychological safety on shift…

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