A common approach to TdP is shown above. The initial episode is controlled with magnesium and perhaps defibrillation. The patient is sent to ICU for close observation. Usually the patient will be fine, but sometimes TdP does recur. Recurrence triggers second-tier therapies, often including overdrive pacing.
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it’s unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura of ignorance and failure. Consequently, bicarbonate is underutilized in some situations where it might actually help.
No high-quality evidence exists on fibrinogen monitoring in PE. Most practitioners don’t check fibrinogen levels for patients getting TPA for PE. This is a bit paradoxical, because fibrinogen is usually monitored in patients receiving catheter-directed thrombolysis – a procedure involving lower doses of TPA with a markedly lower risk of intracranial hemorrhage.
Every hospital and pharmacopeia have their own “maximum dose” of vasopressors. Which one is correct?
Recently Geert Meyfroidt published an article in Intensive Care Medicine describing ten false beliefs in neurocritical care shown here: It’s a great article, but I think they could have been more aggressive about challenging neurocritical care dogmas (1). In response, here is a list of ten dubious beliefs that goes farther to challenge the status quo. […]