A few weekends ago during a very chaotic call, my ICU team ordered half-dose alteplase for a patient with a submassive PE without checking his INR. They had performed a thoughtful interview of the patient to look for contraindications to thrombolysis, but somehow this slipped through the cracks. On reviewing all the data together […]
Hypertonic saline infusion rant
0 Clinical Question 0 A patient is admitted status post ischemic stroke with focal edema on CT scan. There is no concern regarding herniation. Is there a role for continuous infusion of hypertonic saline with a goal of maintaining a sustained elevation of sodium? 0 Theoretical Benefit 0 Theoretically, elevating the tonicity of the blood […]
Rapid Sequence Intubation and Procedurization
0 Introduction with a case 0 A otherwise healthy 70 year-old woman presented to Genius General Hospital with multifocal pneumonia. In the ED she was treated with appropriate antibiotics and two liters of crystalloid. During her ED course she was found to have increasing tachypnea to 30-35 breaths/min, and was subsequently transferred to the ICU. […]
Avoiding over-diagnosis and over-treatment of MI in critically ill patients
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 […]
PulmCrit – Four DKA Pearls
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 […]