PulmCrit (EMCrit)

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 […]

Thyroid storm is a bit of a zebra.  It can mimic a variety of common conditions (e.g. sepsis, delirium, heart failure).  Unfortunately, if you’re not looking for it, you probably won’t find it.   Once identified, an organized multimodal treatment regimen will generally get the job done.  But be careful – these patients may have varying physiology, so blindly following the same rubric for every single patient isn’t the answer.

Thrombocytopenia is extremely common in critical illness.  It’s generally a consequence rather than a cause of illness, predicting increased mortality.  However, we must remain alert for cases where serious hematologic disease is afoot.  The major concern here is the ever-looming possibility of heparin-induced thrombocytopenia and thrombosis (HITT).  This chapter explores thrombocytopenia and provides an evidence-based […]