PulmCrit (EMCrit)

Treating hypernatremia in the ICU isn’t exciting or particularly difficult.  However, it’s enormously important to provide patients with comfort.  We talk a lot on treating pain, but usually forget about the discomfort caused by thirst.  Remember:  when you intubate a patient and take control of their airway, you’re also taking responsibility to provide them with water.

Why do some patients’ saturation crash during laryngoscopy, whereas other patients are fine?  What can we do to prevent this?

Of all intoxications, salicylates is one of the most important to understand.  These cases can unravel rapidly, with fatal outcome.  However, with prompt management most patients will do fine.  Treatment depends on a solid grasp of the underlying chemistry and renal physiology.

The surviving sepsis campaign (SSC) has had substantial problems dating back to its inception.  The original backbone of the guidelines was a single-center trial by Rivers, which has largely been debunked.1–4  Initially the SSC was slow to let go of invasive early goal-directed therapy.  The SSC has finally started eliminating older dogma (e.g., superior vena cava […]

In critical care, we’ve been treating patients with opioid use disorder for a long time.  If they’re intubated for intoxication, we extubate them and send them home.  If they’re septic with endocarditis, we treat their sepsis.  Unfortunately, this isn’t enough.  We’re treating the complications of opioid use disorder, without addressing the underlying problem. Recently, medication-assisted […]