Methemoglobinemia is one of my favorite toxicology diagnoses. The diagnosis can often be made at the bedside based on history and physical examination, which is a satisfying bit of detective work. Once the diagnosis is made, patients generally respond promptly to a specific antidote (methylene blue). And this isn’t just a parlor trick – diagnosis […]
PulmCrit- Tranexamic acid for traumatic brain injury (CRASH3)
preamble CRASH-3 is the latest massive, pragmatic multi-center RCT brought to us by the London School of Hygiene and Tropical Medicine Trials Unit. These investigators have created an extensive network of hospitals throughout the world with the capability of performing truly impressive trials. Especially in the critical care arena, these trials have uniquely high power […]
EM Nerd-The Case of the Indecisive Antidote
Studies examining the use of tranexamic acid (TXA) inescapably seem to pit our methodological rigorous demons against our practical clinical angels. The CRASH-2 trial published in the Lancet in 2010 by Shakur et al, randomized 20,211 adult trauma patients presenting to 274 hospitals in 40 different countries to receive 1g of TXA over 10 min […]
IBCC asthma chapter post-publication peer review by Weingart
Sometimes muggles criticize FOAM as lacking peer review, but that simply reflects a misunderstanding of the way peer review works here. FOAMed operates off a post-publication peer review system. This typically occurs mostly in the comments section of each blog or chapter (with some on twitter as well). Unlike journals, anyone is free to leave […]
IBCC chapter & cast – Diffuse alveolar hemorrhage & ANCA vasculitis
Diffuse alveolar hemorrhage is encountered uncommonly, but it is useful to have a general understanding of this. Many etiologies can cause diffuse alveolar hemorrhage, with pulmonary vasculitis being perhaps the most widely feared. This chapter explores how to sift through the differential diagnosis of diffuse alveolar hemorrhage and, if vasculitis is suspected, how to initiate […]
EMCrit 257 – Pulseless Electrical Activity ( PEA ) is Stupid
PEA is so so stupid!!!!
EM Nerd-The Case of the Hurried Objective
In 2015, Centers for Medicare & Medicaid (CMS) published their sepsis core measure (SEP-1). This represented a nationally mandated sepsis management strategy presented in the form of a 3 and 6-hour bundle. Since its publication, the Surviving Sepsis Campaign (SSC) released their own 1-hour bundle (1), adding even more urgency to an already frenetic effort […]
IBCC chapter & cast – Asthma
Severe asthma is a challenging topic, because this spans a lot of different patient phenotypes with varying severity and physiology. This chapter attempts to outline some general principles to guide management, but ultimately clinical judgement and serial evaluation at the bedside will trump all of this. The rarity, acuity, and heterogeneity of severe asthma make […]
EM Nerd-The Case of the Sour Remedy
In 2017 Marik et al (1) published an observational before and after study examining the initiation of the sepsis cocktail for ICU patients admitted with sepsis. The authors noted, following the introduction of this cocktail, which included IV vitamin C, thiamine and hydrocortisone, ICU mortality dropped by an extraordinary 31.9% (40.4% to 8.5%). Since this […]
PulmCrit- Hypothermia for non-shockable arrest: let’s not get hot-headed about this
background Fever is harmful in post-arrest patients. This creates confusion in studies of hypothermia in post-arrest patients: is the benefit of hypothermia due to fever avoidance, due to a benefit from hypothermia itself, or perhaps due to both? Seminal studies in the early 2000s found mortality benefit from application of hypothermia to 33C after cardiac […]
PulmCrit- CITRIS-ALI: Can a secondary endpoint stage a coup d’état?
background on IV vitamin C We live in divided times. Paul Marik’s study on using vitamin C in sepsis was perhaps the most polarizing publication in recent memory (aside from perhaps the Mueller report). It was lauded by some, yet derided just as strongly by others. Unfortunately, the kerfuffle surrounding this study overshadowed the larger […]
EMCrit Wee – Farkas and I Discuss his Recent PulmCrit Guest Post on Asthma
A polite discussion about a controversial post
IBCC chapter & cast – Metabolic Alkalosis
Metabolic alkalosis is fairly common among hospitalized patients. The most severe cases are often due to large-volume diuresis (deresuscitation), massive transfusion, or ongoing nasogastric suction. Many patients will respond to simple resuscitation with normal saline (an acidotic fluid which is perfect here). However, more severe or complex cases will require a multi-modal strategy which utilizes […]
PulmCrit – The Crashing Asthmatic with Leo Stemp
Today will feature a guest post with Leo Stemp exploring some bleeding-edge concepts. Very soon, an Internet Book of Critical Care chapter will round things out with a broader look at this disease. Leo Stemp trained first in critical care (including medical school at Harvard, internal medicine residency at Mount Sinai, and a fellowship at […]
EMCrit Wee – Zero Point Survey Video by Cliff Reid
There is survey before the primary…
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