This class will dive deep into the most controversial pharmacotherapy options for critically ill patients. Real cases will be presented along with supporting cutting-edge literature to ensure that attendees are confident in practicing at the top of their game with medications for decompensating patients. The class will discuss the role of ketamine vs. etomidate for induction of RSI as well as the use of delayed sequence intubation (DSI). Norepinephrine vs. epinephrine post ROSC will be discussed and debated. This class will also evaluate the role of metoprolol vs. diltiazem for the management of pre-hospital atrial fibrillation with rapid ventricular response (RVR). We will conclude with one of the hottest debates in pre-hospital critical care pharmacotherapy and discuss the ongoing controversy of rocuronium vs. succinylcholine.