EMCrit Project

We are constantly hunting for newer and better sources of information.  This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools.  Some of these pan out.  Most don’t. Why are these new sources of information generally disappointing?  The answer is simple:  we’re already doing pretty well.  In order […]

The diagnosis of toxic alcohols is a particularly controversial topic, based on recent evidence that the osmolal gap has a fairly awful sensitivity and specificity.  This chapter describes an approach to toxic alcohol diagnosis which doesn’t depend on the osmolal gap.  Although this may seem radical, this strategy has been previously recommended by other authors […]

The PEPTIC multi-center RCT compared histamine-2 receptor blockers (H2RBs) versus proton pump inhibitors (PPIs) for stress ulcer prophylaxis among ventilated ICU patients.​1​  It’s a landmark trial of unprecedented size and statistical power.  PEPTIC was presented at the Critical Care Reviews meeting in Ireland and live-cast around the world (available here).  This presentation and the editorials […]

Now that VITAMINS is published, it’s worth trying to look at the big picture of sepsis treatment with hydrocortisone, ascorbate, and thiamine (HAT).  Marik et al. 2017:  The beginning HAT therapy began with a single-center, before/after study.​1​ There was a stark mortality reduction following the routine adoption of HAT therapy in septic shock (figure below, […]

Prevention and treatment of central line infections is a core competency in critical care.  Prevention is the true key here.  Achieving zero central line infections is an unreachable goal, but with diligence the rate can be pushed close to zero. The IBCC chapter is located here. The podcast & comments are below. Follow us on […]