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PulmCrit (EMCrit)

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

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You are here: Home / Archives for PULMCrit

PulmCrit Hot Take: Steroid for severe pneumonia (CAPE COD trial)

March 21, 2023 by Josh Farkas Leave a Comment

Steroid is worthless for pneumonia! Wait, a new study shows it’s beneficial! Hang on, a fresh meta-analysis shows that steroid is useless! And wait, here’s a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What’s going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […]

PulmCrit Blogitorial – SIESTA syndrome:  Sedation Induced EEG Suppression with Transient Agitation

December 19, 2022 by Josh Farkas Leave a Comment

This is SIESTA syndrome.  The patient is locked in a cycle of unconsciousness, punctuated with brief episodes of agitation.  Most of the time the patient is sedated to the point of having minimal EEG activity, which may hinder their ability to regain consciousness.  

PulmCrit Hot Take – Acetazolamide plus furosemide for decongestion of heart failure (ADVOR trial)

August 27, 2022 by Josh Farkas 4 Comments

Historically, many patients admitted with congestion due to heart failure have been treated with furosemide monotherapy.  However, a strategy of furosemide monotherapy has numerous drawbacks:  Furosemide tends to stimulate production of dilute urine, leading to a greater amount of water loss than sodium loss.  Predominant loss of water may cause loss of volume from the […]

IBNCC – Approach to CNS infection

August 15, 2022 by Josh Farkas Leave a Comment

This chapter explores some general aspects of neurological infectious diseases, including important historical features and high-risk groups.  It also includes a more general discussion of lumbar puncture performance and interpretation. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

IBNCC – Approach to neuromuscular disorders

August 3, 2022 by Josh Farkas 1 Comment

This chapter explores the approach to acute neuromuscular weakness in the ICU, as well as selected disorders.  As with any acute presentation, an organized approach is essential.  Understanding the limitations of various tests is also critical (since there is considerable confusion about this). The IBCC chapter is located 👉 here. The podcast & comments are […]

IBNCC – ICU care post craniotomy

July 26, 2022 by Josh Farkas Leave a Comment

Management of the a patient following craniotomy focuses on the fundamentals of supportive neurocritical care.  However, special attention is required to unique postoperative complications that may occur (depending on the procedure). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

PulmCrit – Beware of the risk of ETT exchange

July 25, 2022 by Josh Farkas 3 Comments

Imagine you’re in the ICU and the cuff of an ETT (endotracheal tube) ruptures.  You exchange it for a fresh ETT over a catheter, right?  Easy peasy.  Blind airway exchange over a catheter has been the standard practice in various ICUs that I’ve rotated through.  ETT exchange over a catheter is a simple and effective […]

IBNCC – Nonconvulsive status epilepticus

July 19, 2022 by Josh Farkas 1 Comment

We throw around the term “nonconvulsive status epilepticus” a lot, and generally think that we know what that is.  However, nonconvulsive status epilepticus is an enormously complex and heterogeneous diagnosis.  This chapter attempts to clarify matters based on the most recent definitions, but in some situations the diagnosis may remain murky. The IBCC chapter is […]

PulmCrit Wee – Urine toxicology screens should be removed from brain death guidelines

July 18, 2022 by Josh Farkas Leave a Comment

Prior to declaring a patient brain dead, confounding factors which could falsely cause the patient to appear dead must be eliminated.  One important confounder is intoxication.  Failure to recognize that a patient is intoxicated could lead to an incorrect diagnosis of brain death that in turn can lead  to withdrawal of life support – thereby […]

IBNCC – Traumatic Spinal Cord Injury (SCI)

July 16, 2022 by Josh Farkas Leave a Comment

Traumatic spinal cord injury is extremely common.  In addition to the initial management of patients presenting with trauma, we should be comfortable in managing the longer-term sequelae (e.g., autonomic dysreflexia). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam

July 14, 2022 by Josh Farkas 3 Comments

Most medical myths arose decades ago, prior to the era of modern evidence-based medicine.  When investigating the origin story of those myths, we wind up reading grainy old papers from the 1950s.  Surely, we think, such myths wouldn’t arise today – not in our shiny, interconnected, science-based, hyper-argumentative medical world.  Unfortunately, new myths do continue […]

PulmCrit Wee – What is the correct loading dose?

July 6, 2022 by Josh Farkas Leave a Comment

Question:  Perampanel is an oral antiseizure medication that may occasionally be used for refractory status epilepticus.  It has a half-life of 105 hours.  Different sources recommend three different regimens for its dosing: (a) 18-24 mg load followed by 12 mg/day.(33830480) (b) 32 mg load followed by 12 mg/day.(31565443) (c) 36 mg on day #1, 24 […]

IBNCC – External Ventricular Drains (EVD) & Lumbar Drains

July 2, 2022 by Josh Farkas 1 Comment

External ventricular drains and lumbar drains will generally be managed primarily by the neurosurgical team.  Nonetheless, some general understanding of their management, data interpretation, and potential complications is extremely helpful. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

IBNCC – Neurological complications of COVID

June 25, 2022 by Josh Farkas 1 Comment

The neurological manifestations of COVID is a rapidly moving target.  Different strains of virus, rising levels of immunity, and challenges in sorting out causation from correlation make it impossible to write a perfect chapter on this.  Nonetheless, some patterns and concepts may be helpful. The IBCC chapter is located 👉 here. The podcast & comments […]

IBNCC – Acute Demyelinating Disorders

June 23, 2022 by Josh Farkas Leave a Comment

Acute demyelinating disorders are not a common cause of ICU admission.  However, these are encountered occasionally (especially acute transverse myelitis, acute disseminated encephalomyelitis, and osmotic demyelination syndrome).  Additionally, some of these disorders may be triggered by COVID, so this chapter will help us understand the neurological manifestations of COVID. The IBCC chapter is located 👉 […]

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