Introduction 0 It’s common for critically ill patients to be screened for MI using troponin.   Troponin levels are often positive.   One thing leads to another, and before you know it the frail 99-year-old lady you admitted for a COPD exacerbation has an intracranial hemorrhage from the heparin drip she was put on because her troponin […]

Introduction I have a confession to make: I love treating DKA.   It’s satisfying to take a patient from severe acidosis, electrolytic disarray, and hypovolemia to normal physiology during an ICU shift.   Although it’s usually straightforward, there are some pitfalls and a few tricks that may help your patients improve faster.0 Pearl #1: Avoid normal saline […]

0 PART 1:  Fluid selection for resuscitation of hypovolemic, hyperkalemic renal failure 0 Introduction with a case 0 An elderly man on an ACE inhibitor and NSAIDs presents to the emergency department after a few days of severe norovirus gastroenteritis with a creatinine of 5 mg/dL, a bicarbonate of 15 mEq/L, and a potassium of […]

Introduction 0 Submassive PE can be challenging. Most patients do fine with heparin, but occasional patients suddenly arrest and others are left with longstanding pulmonary hypertension.1 Thrombolytics generally cause dramatic improvement, but may cause hemorrhage as well. Recent studies may seem to point in opposite directions. 0 Background: Heparin vs. Alteplase 0 Treatment centers around […]