CONTENTS Rapid Reference 🚀 Physiology of metformin-induced lactic acidosis Epidemiology & definitions Clinical presentation Differential diagnosis Prognosis Treatment Decontamination after acute ingestion Evaluate for other causes & consider empiric treatment for sepsis Glucose management & insulin (?) Volume resuscitation Respiratory support Dialysis indications Methylene blue?? Podcast Questions & discussion Pitfalls approach to metformin-associated lactic acidosis […]
Search Results for: metformin
IBCC chapter & cast: Metformin-induced lactic acidosis, et al.
Metformin poisoning and lactic acidosis has always been murky. For years there was debate about whether metformin-induced lactic acidosis exists (short answer: it obviously does). However, for an individual patient, it can still be confusing sorting out the contribution of metformin to their critical illness. A recent re-definition of the condition clarifies things a bit, but substantial confusion persists regarding how to diagnose and treat these patients.
Anion-gap metabolic acidosis
CONTENTS Diagnosis Causes of elevated anion gap Evaluation Evaluation of elevated anion gap Evaluation & treatment of elevated lactate Treatment Podcast Questions & discussion Pitfalls Anion gap should be evaluated on every electrolyte panel. Ideally the computer will do this automatically; otherwise, it should be calculated. Anion gap is calculated as (Na – Cl – […]
PulmCrit Instagram Links
Welcome to the PulmCrit Instagram page. This has recent posts with links for further information. –Cheers, josh HYPERION trial on therapeutic hypothermia for patients with non-shockable cardiac arrest: Link to PulmCrit blog. CITRIS-ALI: Fresh multi-center RCT of vitamin C in sepsis-induced ARDS: Link to PulmCrit blog The crashing asthmatic with Leo Stemp: Link to fresh […]
Vasopressors
CONTENTS Rapid Reference 🚀 Core agents Inodilators (milrinone, dobutamine, isoproterenol) Pure vasopressors Inopressors (norepinephrine, epinephrine, dopamine) Peripheral vasopressors Midodrine Methylene Blue Podcast Questions & discussion Pitfalls classic inodilators (milrinone, dobutamine) Mechanism Dobutamine stimulates mostly beta-receptors, with very little stimulation of alpha-receptors. Milrinone inhibits intracellular adenylyl cyclase, thereby increasing intracellular cyclic AMP levels. Physiologic effect Primary […]
Understanding lactate in sepsis & Using it to our advantage
Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock. Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. […]
Table of Contents
SYSTEMS Cardiology Endocrinology Gastroenterology Hematology & Oncology Infectious diseases Nephrology Neurology Obstetrics Pulmonology Rheumatology Toxicology & Temperature Overview: Guide to supportive care in critical illness Medication reconciliation in the ICU About this book How to create your own IBCC smartphone app 📲 General Approaches to problems Cardiac arrest 🔜 Chest pain Hypertensive emergency SCAPE (Sympathetic […]
Hypoglycemia
CONTENTS Rapid Reference 🚀 Why hypoglycemia is dangerous Symptoms Diagnosis Causes Investigation Treatment Severe hypoglycemia Mild & able to take PO Glucagon is generally not helpful Prevention of hypoglycemia in the ICU patient Persistent hypoglycemic encephalopathy Podcast Questions & discussion Pitfalls Prolonged severe hypoglycemia can cause permanent brain damage, similar to anoxic brain injury. Hypoglycemia […]
Medication Reconciliation at ICU admission
CONTENTS Introduction Basic principles of medication reconciliation Specific medications: Cardiology Pulmonology Gastroenterology Hematology Endocrinology Neurology Transplantation Questions & discussion When a patient is admitted to the ICU, which of their outpatient medications should be continued? This is a rather mundane task, one which is often delegated to junior team members. However, these decisions can be […]
EMCrit 368 – The Acute Critical Care Medication Reconciliation with Josh Farkas
The acute crit care med rec
Approach to the critically ill poisoned patient
CONTENTS History Exam Labs Urine toxicology panel EKG Other diagnostic interventions Management Airway management Activated charcoal Agitation management Obtundation management Hyperthermia management Seizure management Bradycardia management Monomorphic VT management Poison control consultation Podcast Questions & discussion Pitfalls Toxicology histories are notoriously unreliable. Key bits of information: Any available medical records, especially medication lists. Timing & […]
Fluid selection & pH-guided fluid resuscitation
CONTENTS Rapid Reference 🚀 Forward Crystalloids vs. colloids Step I: Balanced Crystalloid Choice of balanced crystalloid Step II: pH-guided resuscitation Hypertonic & isotonic bicarbonate Therapeutic alkalinization to augment permissive hypercapnia Podcast Questions & discussion Pitfalls The illustration above may appear a bit amusing, but this actually mirrors various practices that I’ve encountered during my training […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
Guide to supportive care in critical illness
CONTENTS Rapid Reference 🚀 The understated importance of high-quality supportive care Medications to avoid in ICU Prophylaxis DVT prophylaxis GI prophylaxis Anemia & transfusion targets Glycemic control Nutrition for the intubated patient Pain, agitation, and delirium Analgesia & pain management Sedation of the intubated patient Delirium prevention Volume status & diuresis Electrolyte management Troponin elevation […]