As a medical student I rotated through an elite hospital where it was believed that every patient admitted to the medicine service needed a rectal exam. The rationale was to avoid ever missing a case of rectal or prostate cancer. Eventually, the utility of digital rectal examination as a cancer-screening tool was debunked. Thankfully, this practice has fallen out of favor.
Likelihood ratios may be more useful clinically, but sensitivity and specificity are more widely reported. Therefore, it is useful to gain a general understanding of how sensitivity and specificity translate into likelihood ratios.
We all want to alleviate pain and suffering. Most critically ill patients are treated with opioids for this reason. Unfortunately, opioids have numerous side-effects including delirium, constipation, vomiting, and delayed extubation. Opioid infusions may eventually lead to withdrawal, causing pain, nausea, and depression. This post explores the optimal use of systemic medications to control pain while minimizing complications.
A new joint practice guideline by the ATS and ACCP addresses how to approach cuff leaks. This guideline recommends a clever compromise between these extremes, which is the basis of the algorithm below. This provides a streamlined, evidence-based pathway to extubate patients without a cuff leak.
In 2014 I wrote a post suggesting an aggressive, streamlined approach to status epilepticus involving early intubation. The fundamentals of that post remain valid. However, much has changed over the last few years. This post aims to refresh and extend the prior post. It will also serve as a reference to explain my algorithm for […]