Imagine you’re in the ICU and the cuff of an ETT (endotracheal tube) ruptures. You exchange it for a fresh ETT over a catheter, right? Easy peasy. Blind airway exchange over a catheter has been the standard practice in various ICUs that I’ve rotated through. ETT exchange over a catheter is a simple and effective […]
IBNCC – Nonconvulsive status epilepticus
We throw around the term “nonconvulsive status epilepticus” a lot, and generally think that we know what that is. However, nonconvulsive status epilepticus is an enormously complex and heterogeneous diagnosis. This chapter attempts to clarify matters based on the most recent definitions, but in some situations the diagnosis may remain murky. The IBCC chapter is […]
PulmCrit Wee – Urine toxicology screens should be removed from brain death guidelines
Prior to declaring a patient brain dead, confounding factors which could falsely cause the patient to appear dead must be eliminated. One important confounder is intoxication. Failure to recognize that a patient is intoxicated could lead to an incorrect diagnosis of brain death that in turn can lead to withdrawal of life support – thereby […]
IBNCC – Traumatic Spinal Cord Injury (SCI)
Traumatic spinal cord injury is extremely common. In addition to the initial management of patients presenting with trauma, we should be comfortable in managing the longer-term sequelae (e.g., autonomic dysreflexia). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam
Most medical myths arose decades ago, prior to the era of modern evidence-based medicine. When investigating the origin story of those myths, we wind up reading grainy old papers from the 1950s. Surely, we think, such myths wouldn’t arise today – not in our shiny, interconnected, science-based, hyper-argumentative medical world. Unfortunately, new myths do continue […]
PulmCrit Wee – What is the correct loading dose?
Question: Perampanel is an oral antiseizure medication that may occasionally be used for refractory status epilepticus. It has a half-life of 105 hours. Different sources recommend three different regimens for its dosing: (a) 18-24 mg load followed by 12 mg/day.(33830480) (b) 32 mg load followed by 12 mg/day.(31565443) (c) 36 mg on day #1, 24 […]
IBNCC – External Ventricular Drains (EVD) & Lumbar Drains
External ventricular drains and lumbar drains will generally be managed primarily by the neurosurgical team. Nonetheless, some general understanding of their management, data interpretation, and potential complications is extremely helpful. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBNCC – Neurological complications of COVID
The neurological manifestations of COVID is a rapidly moving target. Different strains of virus, rising levels of immunity, and challenges in sorting out causation from correlation make it impossible to write a perfect chapter on this. Nonetheless, some patterns and concepts may be helpful. The IBCC chapter is located 👉 here. The podcast & comments […]
IBNCC – Acute Demyelinating Disorders
Acute demyelinating disorders are not a common cause of ICU admission. However, these are encountered occasionally (especially acute transverse myelitis, acute disseminated encephalomyelitis, and osmotic demyelination syndrome). Additionally, some of these disorders may be triggered by COVID, so this chapter will help us understand the neurological manifestations of COVID. The IBCC chapter is located 👉 […]
IBNCC – EEG interpretation and ictal-interictal continuum
EEG is an increasingly utilized tool among critically ill patients. This chapter explores how to interpret the clinical significance of various EEG patterns which are commonly encountered in the ICU. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBNCC – Neuro-oncology emergencies
Neuro-oncologic emergencies are commonly encountered in critical care. Rapidly evolving biological therapies for cancer offer patients exciting benefits, but have also created new sets of complications (e.g., checkpoint inhibitor-induced encephalitis). Patients may be suffering from complications of the malignancy itself, complications of therapy, or wholly unrelated problems. The IBCC chapter is located 👉 here. The […]
PulmCrit – Systemic racism of pulse oximetry: Even worse than we thought?
One and a half years ago, a landmark study by Sjoding et al. found that critically ill Black patients were more likely than White patients to have falsely reassuring pulse oximetry measurements (discussed here).1 Subsequently, six sizable studies have been published on this topic. Since this is of critical importance to acute care medicine, it’s […]
IBNCC – Movement disorder emergencies
Movement disorders are encountered more frequently in the critical care unit than one might realize. For example Parkinson’s disease alone affects ~1% of patients over sixty years old (often requiring careful consideration in medication management, to avoid either psychosis or Parkinsonism-hyperpyrexia syndrome). Other disorders are less common, but their recognition may be critical (e.g., propofol […]
IBNCC – Cervical artery dissection
Carotid or vertebral artery dissection are important considerations in trauma and also common causes of ischemic stroke among younger patients. Variable presentations and a plethora of different diagnostic modalities can make this tricky. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBNCC – Neurologic emergencies in pregnancy
Neurologic emergencies in pregnancy are challenging as there is very little high-quality evidence regarding them. This chapter attempts to review available information, but large gaps remain. Ideally, such gaps may be filled by using multidisciplinary teams which personalize care for each individual patient. The IBCC chapter is located 👉 here. The podcast & comments are […]
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