More on the venous side, especially the microcirculatory stuff. Increasing CVP may ruin perfusion.
PulmCrit – I’m so confused about bamlanivimab
2020 has been a weird year by any standard. So, I shouldn’t be surprised that the bamlanivimab story is so weird. But still. Anyhow, if you’re ready to go down the rabbit hole, here we go… derivation and early testing The story begins with Eli Lilly designing a monoclonal anti-spike antibody to neutralize COVID-19. The […]
PulmCrit – Oscar awards for the best COVID prognostic models
We are continually tasked with triaging COVID patients, a situation which will become more complex as the numbers continue to rise. This involves making educated guesses about which patients are most likely to deteriorate, and which patients may benefit most from critical care. That’s enormously difficult. At this point, we’re quite familiar with individual risk […]
PulmCrit – Heparin resistance in COVID & implications for DVT prophylaxis
background: what is heparin resistance? Heparin works by binding to antithrombin III and thereby activating antithrombin III, an endogenous anticoagulant which inhibits clotting factors (especially Xa). Heparin + Anti-thrombin III → [Heparin-Antithrombin-III complex] → Inhibition of Xa activity Heparin resistance refers to situations where unusually large doses of heparin are required to achieve anticoagulation. This […]
PulmCrit: Why the DAMASK trial is a futile diversion – The limitations of RCTs
When I saw the infographic for the DAMASK trial (below), it was immediately clear to me that the trial was inconclusive (not positive, not negative – inconclusive). According to this study, masks might be totally worthless. Or masks might reduce infection by ~40%. This is an inconclusive study. It yields no answer.
HumanFact0rz – The Future is Simulated: Breaking the Shackles of Bad Clinical Design by Chris Hicks
Your space is your destiny…
IBCC chapter & cast – Toxic Shock Syndrome
Not all septic shock is created equal. Toxic shock syndrome is one of the most fulminant and dangerous forms of septic shock. It is one of the few infectious diseases capable of rapidly killing previously healthy young people. Most importantly, toxic shock syndrome requires targeted therapy – it often fails to respond to conventional therapy […]
EMCrit 285 – More on Palliative Care Conversations in Resuscitation
A meandering conversation on end-of-life palliative care conversations
IBCC chapter & cast – Ventilator Associated Pneumonia (VAP)
VAP is a perennial riddle in the intensive care unit. There are numerous murky diagnostic tests, but no single gold-standard diagnostic test. Consequently, we are usually left wondering whether or not the patient truly has a VAP. This makes VAP an unsatisfying diagnosis, as we are continually walking a blurred line between undertreatment and overtreatment. […]
IBCC chapter & cast – Sedation for the intubated patient
Sedation is one of the details of ICU care which seems unimportant… until it’s not. Over the past decade we’ve seen a burgeoning repertoire of agents used for sedation and agitated delirium. Unfortunately, the number of medications has out-stripped available Level-I evidence regarding how exactly to use them. This chapter attempts to create a framework […]
EMCrit 284 – You are the Product – Delete Your Algorithmic Social Media
Algorithmic Social Media is stealing your joy
IBCC chapter & cast – Lithium intoxication
Lithium intoxication is a tricky issue, with a variety of different forms which may call for different therapies (acute, chronic, or acute-on-chronic intoxication). To further complicate matters, the pathophysiology of lithium toxicity isn’t understood – particularly, how lithium levels might relate to chronic neurotoxicity (SILENT syndrome). Finally, as is often the case in toxicology, there […]
IBCC chapter & cast – Stress hyperglycemia in the ICU
Glycemic control in the ICU is a topic of perpetual controversy. We’ve come full circle in the past 20 years – beginning with permissive hyperglycemia, then moving to tight control, and finally now moving back to permissive hyperglycemia. The final answer remains unknown, but in the interim this chapter attempts to muddle through available evidence. […]
EMCrit 283 – Dexmedetomidine (Precedex) – You’d have to be Delirious Not to Use It
Dexmedetomidine (Precedex) – You’d have to be Delirious Not to Use It –
IBCC chapter & cast – Wernicke encephalopathy
Wernicke encephalopathy is important because it’s surprisingly common, potentially debilitating, and fully treatable. Some patients may present to the hospital due to Wernicke encephalopathy, while many others may develop this while in the ICU as an iatrogenic complication of criical care. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow […]
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