PulmCrit (EMCrit)

Now that VITAMINS is published, it’s worth trying to look at the big picture of sepsis treatment with hydrocortisone, ascorbate, and thiamine (HAT).  Marik et al. 2017:  The beginning HAT therapy began with a single-center, before/after study.​1​ There was a stark mortality reduction following the routine adoption of HAT therapy in septic shock (figure below, […]

Prevention and treatment of central line infections is a core competency in critical care.  Prevention is the true key here.  Achieving zero central line infections is an unreachable goal, but with diligence the rate can be pushed close to zero. The IBCC chapter is located here. The podcast & comments are below. Follow us on […]

Large-volume diuresis is a topic that isn’t discussed much in critical care curricula or textbooks.  Nonetheless, this is a daily reality for intensivists, especially those living in the United States (where patients continue to be empirically treated with 30 cc/kg fluid as initial fluid bolus, for a broad variety of complaints).  This chapter attempts to […]

The Journal of Thoracic Diseases is about to release a special edition on sepsis, edited by Paul Marik (open access).  It’s deliciously rebellious – just look at the table of contents 👇 My article on using the complete blood count to diagnose sepsis is already available, so I’ll summarize it here (yes, I know, you […]

Myxedema coma is a misleading misnomer.  Most patients don’t have non-pitting edema (myxedema), nor are they frankly comatose.  The best way to think about this disease is simply decompensated hypothyroidism.  Patients with under-treated or untreated hypothyroidism have no metabolic reserve.  Stressors may easily push them into multi-organ failure. Myxedema coma is easily missed, because it […]