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
IBCC chapter & cast – Septic Shock
Septic shock is perhaps the defining illness of medical intensive care. As such it is an enormously broad and controversial topic. This chapter attempts to provide a unified and straight-forward approach. However, every physicians has a different approach to septic shock, so it’s impossible to claim that this is the best approach. There will doubtless […]
IBCC chapter & cast – Angioedema
Like so many things in critical care, angioedema is difficult to research since it is uncommon, heterogeneous, and emergent. As such, we have relatively little high-quality evidence regarding this disease (and the high-quality evidence that we do have is largely restricted to pharma-sponsored trials of new and insanely expensive pharmaceuticals). This chapter attempts to create […]
PulmCrit Wee: Reconceptualizing bradykinin-mediated angioedema as a universal vicious spiral
In 2015 I wrote this post on ACEi-induced angioedema. I still think it was a pretty good post (particularly for 2015), but it’s become increasingly clear recently that the post was fundamentally flawed. Let’s try to straighten this out. old model of bradykinin-mediated angioedema This is a conceptual model of how bradykinin-mediated angioedema occurs. Several […]
PulmCrit – Early basal insulin in DKA
The timing of basal insulin administration in DKA has been controversial for years. I posted the following poll on twitter recently to get a sense of current opinion on this: So, it seems that the majority of people are using traditional management (wait for the anion gap to close, give basal insulin, then shut off […]
EMCrit Podcast 252 – Care-Oriented Resus vs. People-Oriented Resus
Are you a people-oriented or care-oriented resus doc?
IBCC chapter & cast – Severe hemoptysis
Severe hemoptysis is a true challenge. Due to the rarity of this condition, there is little high-quality data on it. So you can’t become a hemoptysis whisperer by reading books. Unfortunately, due to the rarity of the condition it’s also difficult to accumulate clinical experience.
EMCrit Wee – Semper Vitae – GRM with Helen Perry
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IBCC chapter & cast – Hyperthermia & heat stroke
Since it looks like the United States is about to go into total meltdown from a heat wave, I dusted off the hyperthermia chapter. This is a bit of an impromptu post, so we don’t have a podcast to go along with it (we will record one eventually – Adam has more experience with the […]
IBCC chapter & cast – Alcohol Withdrawal
Below is a card from one of the first patients I treated for alcohol withdrawal. He lingered in the hospital for days on various benzodiazepine regimens (including a lorazepam infusion), and eventually limped home on an oral chlordiazepoxide taper. He wrote me a thank-you card days after leaving the hospital, but as you can see […]
EMCrit 251 – Philosophical & Psychological Diversions Part II – Naive Reality and the Fundamental Attribution Error
More Philosophical Ramblings…
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