Hyperkalemia is bread and butter critical care medicine. However, the therapeutic approach has changed substantially within the past 5 years. Myths about kayexalate and normal saline have been exposed, allowing more effective therapies to take their place.
IBCC chapter & cast: Delirium
Delirium occurs in about half of critically ill patients. Some fairly simple measures may reduce the risk of delirium. When it occurs, delirium is a diagnostic challenge because occasionally it can be a sign of undiagnosed underlying illness. Treatment is challenging, with little evidence to support most of the standard therapies.
PulmCrit: No more antipsychotics for delirium? Not so fast!
Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles.
PulmCrit- Does the HIGH trial debunk high-flow nasal cannula?
High-flow nasal cannula (HFNC) has become popular for the hypoxemic respiratory failure, driven partially by the FLORALI trial.1 Recently, the HIGH trial evaluated the ability of HFNC to reduce mortality among immunocompromised patients with acute hypoxemic respiratory failure.2 HFNC failed to improve mortality or significantly reduce intubation rates. Popular narrative about this trial A common […]
IBCC chapter & cast: Anemia & transfusion targets
Most patients in the ICU will become anemic. This chapter explores prevention, evaluation, and treatment of anemia in the ICU. Causes of new-onset anemia in the ICU are distinct from the causes of anemia seen in the outpatient clinic, so the approach should be appropriately tailored to the critical care environment.
PulmCrit- SUP-ICU: Is pantoprazole the elixir of life? Should it be?
SUP-ICU is a massive, modern RCT of stress ulcer prophylaxis (SUP) in the ICU. With 3298 patients, it is larger than many meta-analyses of SUP. Its primary mortality endpoint is deeply flawed. However, the study still provides a wealth of information about SUP in the ICU.
IBCC chapter & cast: Acute pancreatitis
Management of severe pancreatitis has remained in a state of controlled chaos and persistent debate for years (mirroring evolution in our treatment of septic shock). This confusion shows no signs of abating in the near future. This chapter explores a reasonable approach to pancreatitis, with the caveat that there is very little evidence available to guide our combat against this challenging foe.
PulmCrit- Ketamine for alcohol withdrawal?
Recent publications have explored the role of ketamine in alcohol withdrawal. Ketamine undoubtedly has some outstanding properties, which make it well suited for this task. The challenge is integrating ketamine into a unified, coherent treatment strategy.
IBCC chapter & cast: severe heart failure & cardiogenic shock
Management of severe heart failure and cardiogenic shock is difficult. There is a notable lack of high-quality evidence regarding the sickest patients. Treatment strategies validated among more stable patients may not be applicable to the most unstable heart failure patients.
IBCC chapter & cast – Hypoglycemia
Severe hypoglycemia can be scary, especially when the patient isn’t responding to front-line therapies (e.g. IV dextrose). However, some unconventional tools and an organized approach can make this extremely manageable.
PulmCrit- Alcohol Withdrawal: One order to sedate them all
I should do a formal retrospective cohort study on this, but I don’t have time. Fortunately, the ICU group at Northshore/Long Island Jewish has done exactly that.
IBCC chapter & cast: Bradycardia
Bradycardia emergencies are uncommon, but these cases can go sideways fast. An appropriately aggressive approach is needed to avoid cardiac arrest. Sometimes the answer is as simple as the appropriate epinephrine dose.
IBCC chapter & cast: community-onset pneumonia
Sir William Osler called pneumonia “the captain of the men of death.” Over a century later, pneumonia remains the leading cause of infectious death in the developed world.
PulmCrit- Solving the OPTALYSE PE riddle: We’re dosing tPA wrong
Occasionally in science we encounter a truly bizarre result. Our natural inclination is to ignore the bizarre result. It’s jarring. It creates cognitive dissonance, challenging our understanding of the world. However, struggling to understand the bizarre result can reset our perspective. It’s often the bizarre, unexpected result that changes everything.
IBCC Chapter & Cast: GI Hemorrhage
GI bleeding is bread and butter critical care. However, there are a lot of nuances – especially regarding variceal bleeding and new approaches to hematochezia.
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