PulmCrit (EMCrit)

background:  what is heparin resistance? Heparin works by binding to antithrombin III and thereby activating antithrombin III, an endogenous anticoagulant which inhibits clotting factors (especially Xa).  Heparin + Anti-thrombin III → [Heparin-Antithrombin-III complex] → Inhibition of Xa activity Heparin resistance refers to situations where unusually large doses of heparin are required to achieve anticoagulation.  This […]

When I saw the infographic for the DAMASK trial (below), it was immediately clear to me that the trial was inconclusive (not positive, not negative – inconclusive). According to this study, masks might be totally worthless. Or masks might reduce infection by ~40%. This is an inconclusive study. It yields no answer.

Not all septic shock is created equal.  Toxic shock syndrome is one of the most fulminant and dangerous forms of septic shock.  It is one of the few infectious diseases capable of rapidly killing previously healthy young people.  Most importantly, toxic shock syndrome requires targeted therapy – it often fails to respond to conventional therapy […]

VAP is a perennial riddle in the intensive care unit.  There are numerous murky diagnostic tests, but no single gold-standard diagnostic test.  Consequently, we are usually left wondering whether or not the patient truly has a VAP.  This makes VAP an unsatisfying diagnosis, as we are continually walking a blurred line between undertreatment and overtreatment. […]

Sedation is one of the details of ICU care which seems unimportant…  until it’s not.  Over the past decade we’ve seen a burgeoning repertoire of agents used for sedation and agitated delirium.  Unfortunately, the number of medications has out-stripped available Level-I evidence regarding how exactly to use them.  This chapter attempts to create a framework […]