PulmCrit (EMCrit)

Hyperosmolar Hyperglycemic State (previously known as “Hyperosmolar Hyperglycemic Nonketotic Syndrome” and, before that, “Hyperosmolar Hyperglycemic Nonketotic Coma”) is a bit of a slippery animal.  Despite being redefined several times, the precise definition remains elusive.  This may cause it to be over-diagnosed in anyone with severe hyperglycemia.  The treatment likewise remains a bit controversial, with different […]

Guillain-Barre Syndrome is the most common cause of acute-onset neuromuscular weakness requiring ICU admission.  COVID-19 appears to be one trigger of Guillain-Barre Syndrome, so this might be even more common in the coming months.  There isn’t much high-quality evidence regarding respiratory support in Guillain-Barre Syndrome, particularly when intubation is indicated.  Consequently, it’s important to use […]

Intracranial hemorrhage is a fairly common problem, which spans the gamut from mild to life-threatening.  Most therapies haven’t been shown to work, so management mostly consists of high-quality neuro-supportive care. The IBCC chapter is located here. The podcast & comments are below. Follow us on iTunes

Catastrophic antiphospholipid syndrome (CAPS) is a truly rare cause of multi-organ failure.  It is usually not considered as a diagnostic possibility, leading it to be mis-diagnosed as septic or cardiogenic shock.  Awareness of this condition and various red flags suggesting its presence might facilitate earlier diagnosis and therapy. The IBCC chapter is located here. The […]

Familiarity breeds contempt.  Fever is so common in the ICU, that we often don’t put much thought into these workups.  Just culture everything, right?  Well, not really.  Excessive cultures frequently lead to false-positive results (representing colonization), which serve only to misdirect attention away from the actual problem.  Meanwhile, inadequate attention to the physical examination and […]