Friends, Over the next several months we’ll be adding ~26 additional chapters to the neurology section of the IBCC.  The ultimate goal is to create a complete neurocritical care textbook that is fully integrated into the IBCC.  (You can preview the final table of contents here.) Why more neurocrit?  The brain is one of the […]

the question Some patients with HSV encephalitis may initially have a negative CSF PCR for HSV, with a repeat being positive some days later.  This has led to confusion regarding who, exactly, needs a repeat lumbar puncture? Montmollin E et al:  HSV encephalitis with initial negative PCR:  Prevalence, associated factors, and clinical impact. This is […]

first draft of IBCC is done! There are now chapters up on the core critical care topics.  Nearly all chapters have either been written or updated in 2020-2021, so it’s pretty fresh.  Ongoing updates will continue to push this date forwards. Of course, the IBCC will never be finished.  New chapters will be added over […]

Pericardial tamponade is an uncommon but extremely important cause of cardiogenic shock, because it is highly treatable.  Unfortunately, the precise definition of tamponade can be challenging – and patients can rapidly transition from an uncomplicated pericardial effusion towards the development of tamponade. The IBCC chapter is located 👉 here. The podcast & comments are below. […]

Dynamic LV outflow tract causes an inversion of all hemodynamics.  Diuresis and inotropes may cause cardiogenic pulmonary edema!  Vasoconstrictors and beta-blockers may improve cardiogenic pulmonary edema!  Down is up and up is down.  As you might imagine, failure to recognize this physiology could easily lead to management strategies that make matters worse. The IBCC chapter […]

Management of myocardial infarction is the core of cardiovascular critical care.  Recent advances in the OMI/NOMI paradigm offer the ability to detect significant infarctions earlier – allowing for prompt triage and management. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

The DDAVP clamp technique has considerably simplified the management of severe hyponatremia.  The fundamentals of the technique are as follows: Before the use of the DDAVP clamp, the primary cause of sodium overcorrection was endogenous free water excretion by the kidneys. For example, patients would present to the hospital with retention of free water due […]

Acute ischemic stroke (AIS) is a common cause of admission to the neurological ICU, as well as a complication of critical illness that may occur among patients within any ICU.  The stroke neurology team will take the lead in managing these patients (including decisions regarding tPA and endovascular intervention).  This chapter focuses more on aspects […]

A billion years ago (or so it seems), the RECOVERY trial demonstrated mortality benefit from dexamethasone 6 mg/day for up to 10 days in hypoxemic COVID patients.  This rapidly became a standard treatment.  It’s a fundamental therapy that has saved lives.   Nonetheless, questions linger about the optimal steroid dose.  6 mg/day dexamethasone is equivalent […]

Quantitative waveform capnography is rapidly becoming a standard of care for any intubated patient.  Although this may appear simple, it provides a host of information about ventilation and cardiac output.  When further integrated with clinical context (such as trends in minute ventilation), there is a potential for fundamentally changing how we monitor our patients.  If […]

SCAPE (Sympathetic Crashing Acute Pulmonary Edema) is a specific form of severe heart failure which is seen predominantly in the emergency department and intensive care unit (as opposed to the outpatient cardiology clinic).  Consequently, there is a tendency to overlook SCAPE in articles and chapters about heart failure. SCAPE is critical to recognize and intervene […]

There probably isn’t much to say about ARDS that hasn’t been said in some form within the past couple years.  We’ve debated continually about the optimal approach to this syndrome, in the absence of much solid evidence (the only large, multi-center RCT which has been replicated in ARDS was ACURASYS – and it failed to […]

Here is a 10-minute video I made for the Cooper Critical Care Conference.  It explores some basic & useful concepts about hypoxemia physiology, including how to apply this at the bedside.  The algorithms in the video aren’t intended to be strictly followed, but rather merely as general conceptual schemas. related For more information about the […]

Right ventricular failure is extremely common among critically ill patients (e.g., affecting a quarter of patients with ARDS).  Unfortunately, this is often overlooked in critical care curricula.  We tend to spend lots of time focusing on pulmonary arterial hypertension (which is far more rare), thereby overlooking the everyday conundrum of right ventricular failure.  It’s called […]

Liberation from invasive ventilation is one of the most important goals of critical care medicine.  Numerous RCTs have improved our understanding of this process, but it remains as much an art as a science.  When in doubt, empirical trials of spontaneous breathing and extubation are more accurate than our predictive ability. The IBCC chapter is […]