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 […]
PulmCrit – 10 minute talk on hypoxemia physiology
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 […]
IBCC – Right Ventricular failure due to pulmonary hypertension
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 […]
IBCC – Liberation from invasive ventilation
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 […]
PulmCrit Wee – Patient with nonfocal exam and thrombocytopenia
The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock. The patient was previously healthy with no significant medical problems or medications. History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out. Physical examination is unrevealing, with the patient […]
IBCC – Respiratory alkalosis & respiratory acidosis
It’s very difficult to write a good chapter about respiratory alkalosis (hypocapnia) or respiratory acidosis (hypercapnia). These states remind me a bit of grand central station, because each encompasses such a broad range of patients with different conditions – who need enormously different treatments. So any discussion of these conditions is by definition a gross […]
PulmCrit – Is piperacillin-tazobactam safe in patients with penicillin allergy?
Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics – greatly complicating their management.
IBCC – Neuroprognostication after cardiac arrest
Neuroprognostication following cardiac arrest is one of the most important responsibilities of the ICU team. This process begins as soon as ROSC is achieved, with the avoidance of confounding factors (e.g., sedatives and opioids). An organized, multimodal approach is essential. Incidentally, strategies which are aimed at accurate neuroprognostication will also facilitate early awakening – and as […]
IBCC – Subarachnoid Hemorrhage
Subarachnoid hemorrhage remains a challenging disease, with ongoing controversy surrounding several key aspects (including the optimal diagnostic pathway and management of vasospasm). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBCC – Traumatic Brain Injury (TBI)
Traumatic brain injury is an extremely common problem, which is likely to be encountered in any type of intensive care unit. Management is predominantly supportive, illustrating many principles of neurocritical care. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBCC – Posterior Reversible Encephalopathy Syndrome (PRES)
Posterior Reversible Encephalopathy Syndrome (PRES) is a common cause of ICU admission for seizure or altered mental status. Although PRES is commonly associated with hypertension, PRES can occur in the absence of hypertension due to a variety of disorders that impair endothelial function causing vasogenic edema. Thus, PRES encompasses the entity of “hypertensive encephalopathy” – […]
PulmCrit – A history of hypothermia for cardiac arrest, 2002-2021 (RIP)
Let’s start by considering what our pretest probability should be regarding whether hypothermia is beneficial after cardiac arrest. Every enzyme in our body has been evolutionarily designed to function at our normal body temperature. Therefore, hypothermia will affect every chemical pathway. As such, hypothermia is an incredibly blunt tool. It’s hard to think of any […]
IBCC – Reversible Cerebral Vasoconstriction Syndrome (RCVS)
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is an important cause of stroke and intracranial hemorrhage, especially in younger people. This disorder may also complicate other neurologic disorders, especially Posterior Reversible Encephalopathy Syndrome (PRES). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBCC – Paroxysmal sympathetic hyperactivity
Paroxysmal sympathetic hyperactivity (previously known as sympathetic storming) is a pattern of recurrent episodic sympathetic activation which may occur after severe brain injury (most often traumatic or anoxic). Prompt recognition of this diagnosis may facilitate appropriate treatment, thereby stabilizing the patient and avoiding aggravation of the underlying brain injury. The IBCC chapter is located 👉 […]
IBCC – Autoimmune Encephalitis
Autoimmune encephalitis was nearly unknown a few decades ago, but currently it’s estimated that it may be as common as HSV encephalitis. Given that many forms respond well to treatment, prompt diagnosis is critical. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
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