In the intensive care unit (ICU), emergencies are commonplace. It is vital for the critical care staff to be familiar with these emergencies, as the prompt recognition can impact morbidity and mortality. The articles selected for this issue address several ICU emergencies traversing the various facets of medicine. The articles will allow the reader to become familiar with numerous ICU emergencies, including the clinical presentation, symptoms, physical examination findings, diagnostic modalities, and treatments available. The care of an ICU patient requires a multidisciplinary approach, and prompt recognition of an ICU emergency can be lifesaving.

This intriguing list of articles begins with acute cardiac emergencies. Bucklew, Noory, Okumus, Radhakrishnan, Mahabir, Samra, Dysert, Cheema, and Ivanova describe assessments and responses to cardiac arrest, acute coronary syndrome, cardiac tamponade, acute aortic syndrome, and life-threatening cardiac arrhythmias.

A follow-up article by Khalif, DuMont, and Ranganathan explains cardiogenic shock and temporary mechanical circulatory support. An overview of cardiogenic shock is provided, describing the clinical presentation and a discussion of the role of temporary mechanical circulatory support devices. Other forms of shock also impact critical care patients. Patel, Holden, Calvin, DiSilvio, and DuMont review hypovolemic, distributive, and obstructive shock. The pathophysiology, evaluation, and management of these conditions are explained.

Villgran, Lyons, Nasrullah, Abalos, Bihler, and Alhajhusain discuss acute respiratory failure, one of the most common reasons for an ICU admission. The authors review the various causes of acute respiratory failure, exploring the pathophysiologic mechanism and treatment modalities. They also discuss tension pneumothorax, massive hemoptysis, and pulmonary embolism as associated conditions.

Acute liver failure is a dire emergency that is most commonly caused by acetaminophen overdose and hypoxic-ischemic hepatopathy. These conditions and other less common causes are described. The authors, Ledgerwood, Villgran, Mardirossian, DuMont, and DiSilvio, highlight the diagnostic criteria and emergency management of these life-threatening disorders.

Muaddi, Ledgerwood, Sheridan, DuMont, and Nashar outline multiple aspects of acute renal failure and its complications, the indications for emergent dialysis, and the various dialysis modalities. This article explores the common risks and causes of acute kidney injury, the clinical management, and the lurking consequences of renal failure.

Endocrine emergencies that occur in the ICU are often unrecognized and underdiagnosed. The pathophysiology, clinical presentation, and management of diabetic ketoacidosis, myxedema coma, thyroid storm, and adrenal insufficiency are thoroughly discussed by Nasrullah, Azharuddin, Young, Kejas, and DuMont.

Finally, Chen, Salah and Halpern, present a fascinating case study about a patient with an intracardiac thrombus that occurred in transit. The life-threatening condition was detected by point-of-care ultrasound scan and successfully managed by the intensive care team.

This issue is a "must read" for those caring for intensive care patients since swift recognition of an ICU emergency can indeed be lifesaving. Thanks to all the authors for their insightful contributions, and each of us extend a special note of gratitude to Sharon Mastele for all her hard work in coordinating this project.

-Tiffany DuMont, DO, FCCP

Issue Editor