The hard part about playing chicken is knowing when to flinch – Bart Mancousco, The Hunt for the Red October Epiglottitis is often a game of chicken. The great majority of adult patients don’t require intubation, so the best management for them is steroid and antibiotic (plus close observation and the ability to intubate if […]
IBCC chapter & cast – Pneumocystis Jirovicii Pneumonia
Pneumocystic Jirovicii Pneumonia (previously Pneumocystic Carinii Pneumonia) remains an important opportunistic infection in critical care. Improved treatment for HIV has reduced the frequency of PJP due to AIDS, but meanwhile the development of increasingly sophisticated immunosuppressive regimens for other patient populations has increased the incidence of non-HIV PJP. New diagnostic tests are improving our ability […]
EMCrit 276 – The Rapid Code Status Conversation with Kei Ouchi
Rapid Code Status Conversations are essential to render proper and compassionate care…
PulmCrit – Dexamethasone & COVID – a study in immunopathology, evidence-based medicine, and ourselves
Early in the COVID epidemic, it became clear that the virus often causes a cytokine storm, leading to immunopathological organ damage. The first major study to suggest benefit from steroid in COVID was a retrospective study by Wang et al. released in early March, which found reduced mortality among COVID patients with ARDS who were […]
IBCC chapter & cast – Vocal cord dysfunction
Vocal cord dysfunction is a masquerader of life-threatening pathologies (most notably asthma and anatomic upper airway obstruction). Vocal cord dysfunction itself is not dangerous, but if not properly diagnosed it may lead to considerable iatrogenic harm (e.g. multiple unnecessary intubations for “asthma”). On the flip side, incorrect diagnosis of vocal cord dysfunction is also dangerous, […]
IBCC chapter & cast – Invasive pulmonary aspergillosis
Invasive pulmonary aspergillosis was traditionally conceptualized as a rare infection restricted to profoundly immunocompromised patients. However, over the past decade, it’s become increasingly clear that invasive aspergillosis can also occur as a nosocomial superinfection among patients who aren’t immunocompromised (especially following influenza). This opens a can of worms regarding how to sift out colonization versus […]
EMCrit 275 – NeuroCritical Care with Neha Dangayach
A Q&A format discussion of neurological emergencies
PulmCrit Wee – Multicenter RCT evaluating ruxolitinib (a JAK inhibitor) for COVID-19
Janus kinases (JAKs) are named after Janus, the Greek god of beginnings, gates, transitions, and duality. They’re named after Janus because they contain a mirror-image structural element. However, given their role within the immune system as a multi-functional gateway for cytokine systems, the name seems apt. The cytokine storm induced by COVID-19 has received considerable […]
IBCC chapter & cast – Refeeding syndrome
Refeeding syndrome is a slippery topic. It’s probably more common than we recognize, often running underneath the radar (the constellation of electrolyte and clinical abnormalities can easily masquerade as another problem, such as alcohol withdrawal). However, there is essentially no prospective evidence on how to prevent or treat it. Indeed, there is no clear consensus […]
IBCC chapter & cast – Takotsubo’s Cardiomyopathy
Takotsubo’s cardiomyopathy may be perceived as a zebra, but it is extremely common in the ICU (as a secondary consequence of endogenous stress and exogenous catecholamines). With increasing recognition, Takotsubo cardiomyopathy is also noted to underlie ~1-2% of patients presenting with chest pain and a similar fraction of cath lab activations. The IBCC chapter is […]
EMCrit Team Roundtable – COVID Vent Updates
Rory’s 2 weeks in the COVID ICU
PulmCrit: Remdesivir 5-day vs. 10-day trial raises some red flags?
So, Gilead’s first RCT on remdesivir was just published, and it’s very interesting.1 Gilead’s, you say? Yep. The study was designed, monitored, analyzed, and written by Gilead: Before getting into the study, let’s take a moment and think about what Gilead’s first RCT could look like. Gilead knows more about remdesivir than anyone (they built […]
EMCrit 274 – Team Leadership with Cliff Reid
Cliff Reid on Team Leadership
IBCC chapter & cast – Parenteral anticoagulants
Anticoagulation is ubiquitous in critical care. Considering the use of DVT prophylaxis, the majority of critically ill patients will receive some form of anticoagulation during their ICU stay. Anticoagulants are potentially high-risk medications, with relatively narrow therapeutic windows. Thus, it’s important to understand the pharmacology of various agents to select and monitor anticoagulation optimally. The […]
PulmCrit – Mythbusting 40 mg enoxaparin daily for DVT prophylaxis in critical illness
The basics often aren’t exciting, but it’s important to get them right. DVT prophylaxis is a good example of this. Most critically ill patients will receive DVT prophylaxis at some point during their ICU stay (that’s 5 million patients per year in the United States alone). Thus, even minor tweaks in the optimal treatment for […]
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