PulmCrit (EMCrit)

Large-volume diuresis is a topic that isn’t discussed much in critical care curricula or textbooks.  Nonetheless, this is a daily reality for intensivists, especially those living in the United States (where patients continue to be empirically treated with 30 cc/kg fluid as initial fluid bolus, for a broad variety of complaints).  This chapter attempts to […]

The Journal of Thoracic Diseases is about to release a special edition on sepsis, edited by Paul Marik (open access).  It’s deliciously rebellious – just look at the table of contents 👇 My article on using the complete blood count to diagnose sepsis is already available, so I’ll summarize it here (yes, I know, you […]

Myxedema coma is a misleading misnomer.  Most patients don’t have non-pitting edema (myxedema), nor are they frankly comatose.  The best way to think about this disease is simply decompensated hypothyroidism.  Patients with under-treated or untreated hypothyroidism have no metabolic reserve.  Stressors may easily push them into multi-organ failure. Myxedema coma is easily missed, because it […]

Noninvasive respiratory support is among the greatest recent advances in critical care.  When used properly, these techniques may facilitate avoidance of intubation, reduced length of stay, and better outcomes.  Unfortunately, our knowledge of exactly how to use these devices remains woefully incomplete.  In particular, there are rather few RCTs directly comparing BiPAP versus HFNC. In […]

Recently Sara Crager released a video on EM-RAP recommending inhaled milrinone or nitroglycerin as an emergency therapy for massive pulmonary embolism (in case you don’t have access to EM-RAP, an audio clip from the video is below).  This is the first that I’ve heard of using inhaled nitroglycerin.  It seems like a pretty neat idea, […]