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Tox and Hound – U(ds) and I
by Howard Greller Recently, I’ve moved offices, and came across a number of old letters. A lot of it was just regular business stuff (e.g., credentialing packets, requests for privileges, a metric ton of menus, etc.), but there was a significant amount of correspondence as well, including some letters of a personal nature. In lieu […]
EMCrit – George Kovacs on Ketamine-Facilitated Intubation (KFI)
Frenemy of the show, Reub Strayer recently posted on a technique he calls Ketamine Only Breathing Intubation (KOBI). This is similar to the technique we have called dissociated awake intubation here at EMCrit. Within Reub’s post was a 9-minute video and an excellent, recent WJEM review article–both are well worth checking out. This sparked a […]
The Case of the Magician’s Sleight
Since the earliest trials examining the efficacy of tPA for acute ischemic stroke there has been a tendency to play it fast and loose with the scientific method. The results of the landmark NINDS-2 trial (1), a moderate sized RCT, with a tenuously positive primary outcome (Fragility Index of 3), were never validated. The results […]
IBCC chapter & cast: hypophosphatemia and hyperphosphatemia
Phosphate is the forgotten electrolyte of critical care. Unlike other electrolytes, phosphate doesn’t participate in the generation of electrochemical gradients (like calcium, magnesium, and potassium) or govern tonicity (like sodium). Thus, moderate perturbations in phosphate are generally asymptomatic. However, phosphate does participate in many essential cellular processes, so true intracellular hyphophosphatemia can cause severe symptoms. […]
PulmCrit: Checkpoint inhibitors… for septic shock??
Background Septic shock is generally conceptualized as a state of pathological immune hyperactivity. Consequently, decades of work on immunomodulation in sepsis have focused on immunosuppressive medications (e.g. steroid, TNF-inhibitors, IL-1 inhibitors). Although most of these interventions haven’t worked, steroid offers some benefits and IL-1 receptor antagonism shows promise for a subset of patients.1 The natural […]
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