Michigan’s EC3
EMCrit Guest Post – Drawing Circles for Bougie Hangup by Neil Dasgupta
A new technique to deal with bougie hold-up
EM Nerd-The Case of the Optical Misperception
Whether we like it or not, high-sensitivity troponin assays, recently approved by the FDA, will soon replace the 4th generation assays currently in operation. And while many claims have been made regarding their clinical utility, the implications for our standard chest pain workflow are unclear. A recent publication by Chew et al, provides us a […]
IBCC chapter & cast – Submassive & Massive PE
PE is the third leading cause of vascular mortality, after myocardial infarction and stroke. It is an enormously heterogeneous and unpredictable disease, which makes treatment difficult. As such, it should not be surprising that PE therapy remains highly controversial. For example, the new European Society of Cardiology guidelines recommend anticoagulation and watchful waiting for high-risk […]
EMCrit – The Pigtail Video
Pigtail Insertion
EMCrit 255 – Pigtails for Pleural Problems (Percutaneous Thoracostomy)
Pigtails are just plain nicer
IBCC chapter & cast – Anticoagulation reversal
We are frequently faced with patients who require reversal of anticoagulation due to hemorrhage or an emergent procedure. This has grown rather complicated, due to the emergence of numerous new anticoagulants and reversal agents. Furthermore, new evidence is emerging regarding the reversal of old agents (e.g. the PATCH trial regarding platelet transfusion in patients on aspirin).
PulmCrit- How to use IV epinephrine for anaphylaxis
When treating anaphylaxis, epinephrine is generally given via an intramuscular (IM) route. This is well established to be effective and life-saving. One advantage of IM administration is immediate use (without requiring intravenous access), including by patient auto-injection. IM epinephrine is doubtless the best approach for patient self-treatment, for first responders, and for immediate treatment in […]
EMCrit 254 – Central Line Tips and Tricks with Robby O and Me from EEM 2019
Central Line Tips and Tricks
IBCC chapter & cast: Tumor Lysis Syndrome
Tumor lysis syndrome isn’t encountered very often in critical care, but we will see the most extreme extent of this illness. Within the last decade, rasburicase has been a game-changer here. Understanding some basic physiology will guide the optimal diagnosis and treatment of tumor lysis syndrome in the post-rasburicase era. The IBCC chapter is located […]
IBCC chapter: Vaping Associated Pulmonary Injury (VAPI)
There is currently an outbreak of vaping associated pulmonary injury spanning several states, which is under intense investigation by the Centers for Disease Control. We will certainly be learning more about this in the coming weeks to months. However, for now, how should we manage patients who present in respiratory distress following vaping? This chapter […]
IBCC chapter & cast: hypomagnesemia & hypermagnesemia
Magnesium might be the darling ion of critical care. It has an interesting array of therapeutic applications ranging from asthma to Torsade de Pointes to preeclampsia. This pair of chapters discusses the evaluation of both hypomagnesemia and hypermagnesemia. IBCC chapter on hypomagnesemia is located here. IBCC chapter on hypermagnesemia is located here. The podcast & comments […]
PulmCrit- Large volume thora: Can we drain ‘em dry?
How much fluid can safely be removed from a pleural effusion during a thoracentesis? Much has been written about this, but solid evidence remains elusive.
EM Nerd-The Case to the Ecological Ambiguity
With each publication from Maitland et al we are granted a brief glimpse of a greater medical truth. Only our view is obstructed, as we peer through the constricted aperture created by the questions regarding its external validity. In 2011, Maitland et al published the FEAST trial in the NEJM (1). This landmark trial called […]
EMCrit 253 – Kovacs Kata to Optimize a Failing Laryngoscopy Attempt
dedicated to my friend, George Kovacs
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