PulmCrit (EMCrit)

This paper slipped across my twitter feed over the weekend.  It was a bit disquieting to see that it was getting a lot of attention, despite being a methodological train wreck (seriously, MedTwitter, where’s the skepticism??).  This post will briefly walk through some of the main flaws.  There will be a bit of pharmacology, a modicum of methodology, and a lot of ranting.  

Adrenal crisis is a can’t-miss diagnosis.  Prompt identification and proper management will generally lead to rapid improvement.  The most important aspect is maintaining a high index of suspicion.  When in doubt, start empiric therapy first and ask questions later. The IBCC chapter is located here. The podcast & comments are below. Follow us on iTunes

Post-cardiac arrest management has undergone substantial revisions within the past several years, particularly with regards to temperature management.  This remains an area of active controversy and investigation, with the TTM-2 trial currently underway.  Although equipoise still exists, this chapter describes a streamlined 36C approach which is based on evidence, guidelines, and experience with various strategies. […]

Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion.  It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients).  The main drawbacks of dexmedetomidine are logistic:  it is expensive and can be administered only as an IV infusion within an ED or ICU.  Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.

Severe CNS infections are a bit of an orphan disease in critical care.  Unlike more common neurologic disorders (e.g. stroke), CNS infections are too rare to recruit lots of patients into RCTs.  Consequently, conventional treatment of these disorders lags decades behind other neurologic disorders (e.g. in terms of optimizing cerebral perfusion pressure).  Principles of neurocritical […]