PulmCrit (EMCrit)

Hypercalcemia isn’t a particularly common cause of critical illness, but when encountered this requires immediate treatment.  Fortunately, advances in the treatment for hypercalemia have clarified how to do this safely and definitively.  Forced diuresis with furosemide has largely fallen by the wayside, simplifying fluid and electrolyte management.  The cornerstone of therapy is generally simultaneous initiation of calcitonin and an IV bisphosphonate.

Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis.  Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients.  This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]

Serotonin syndromes comes up a lot in critical care medicine.  Sometimes we are admitting patients because of a primary diagnosis of serotonin syndrome.  Other times we are afraid of causing serotonin syndrome ourselves, due to polypharmacy.  In both scenarios, there may be uncertainty regarding whether or not a patient has serotonin syndrome. This chapter explores […]

It’s spring in Vermont… when a young intensivist’s thoughts go from fancy to tick-borne diseases.  Climate shifts are causing an increase in tick-borne illnesses, such that these are now considered emerging infections in many areas (including the northeast United States and Canada).  These diseases can be extremely difficult to diagnose, as they will often present with a nonspecific flu-like illness and may subsequently progress to multi-organ failure.  Misdiagnosis of a tick-borne illness as bacterial septic shock would lead to inadequate treatment, as these diseases require specific antibiotic therapy (usually doxycycline).  This chapter focuses on diagnosis and empiric therapy for these very challenging infections.  

For centuries, medical experts practiced bloodletting for a variety of ailments. This was widely believed to rid the body of evil humors. When patients didn’t respond well, this was believed to reflect an inadequate or delayed bloodletting. Practitioners competed to see who could partake in the most rapid and aggressive bloodletting.