PulmCrit (EMCrit)

Most books give bupropion a couple paragraphs, but it arguably deserves its own chapter.  With a decrease in the use of tricyclics and increasing use of bupropion XR for depression, bupropion is becoming the most common cause of life-threatening antidepressant overdose.  Bupropion has a uniquely dangerous property of blocking gap junctions between cardiomyocytes at high […]

background Pneumonia after cardiac arrest is problematic for several reasons: Many patients aspirate during cardiac arrest. Patients are intubated and mechanically ventilated, usually with poor mental status – conditions which do not promote secretion clearance. Early diagnosis of pneumonia is impossible for many reasons (inability to measure a fever due to therapeutic temperature monitoring, inability […]

Acalculous cholecystitis is a slippery beast.  It’s pretty uncommon, lurking among the myriad of sick ICU patients with moderately abnormal gallbladders.  It is likely both under-diagonsed and over-diagonsed at various times.  Indeed, since surgical cholecystectomy is currently rare, it is frequently unclear whether a patient ever had acalculous cholecystitis!  (For example, if a cholecystostomy drain […]

example 1: anti-emetics Let’s get started with a RCT comparing droperidol versus ondansetron for the treatment of nausea in the emergency department.  Meek et. al randomized 144 nauseated patients to receive either droperidol or ondansetron.​1​  The rates of symptom improvement were indistinguishable (75% vs 80%).  So, you might conclude that these drugs are equally efficacious. […]

In the northern hemisphere, Winter is Coming.  Folks are firing up their furnaces – some of which may have an inadequate oxygen supply, thereby generating carbon monoxide.  Unfortunately, the diagnosis of carbon monoxide poisoning is extremely hard to make, mimicking many different conditions.  In particular, carbon monoxide poisoning can mimimic influenza – which is also […]