Does contrast nephropathy exist? Vigorous debate has been ongoing about this dating back to 2013.1 Hundreds of studies on the topic ultimately reveal no convincing evidence that contrast nephropathy exists. However, it’s unethical to perform a prospective RCT, so it’s impossible to ever prove this. This has left us in an evidentiary limbo – we […]
Endocarditis is a classic disease of emergency medicine, inpatient medicine, and critical care. The opioid epidemic has caused a surge of endocarditis diagnoses, reminding us of the myriad ways that this disease can present itself.
We often assume that diagnostic procedures will help patients. A lot of training goes into learning how to do these procedures. Procedures are dramatic. We like performing them. Patients are impressed, perceiving that we are “doing” something for them. Everything is awesome.However, when strict evidence-based medicine is applied to procedures, they are often less impressive.
VT storm refers to recurrent episodes of VT/VF. Although any individual episode of VT can be broken, the overall process of recurrent arrests (or ICD shocks) creates a vicious cycle. Aggressive management is required with intubation, deep sedation, antiarrhythmics, and sympatholysis. Given the rarity of this condition, it’s difficult to obtain high-level evidence or extensive experience.
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.