PulmCrit (EMCrit)

background There has long been debate about exactly how to design a spontaneous breathing trial.  If the trial is made too easy, then patients would be extubated before being ready (leading to re-intubation).  Alternatively, if the trial is too hard, that would prolong mechanical ventilation beyond the point of being beneficial.  The figure above shows […]

Based on this polling data, 42% of you will hate this chapter.  It’s a good thing I’m not running for president. Seriously though, fluid selection remains controversial.  This chapter presents an approach which makes sense physiologically and is supported by a substantial amount of animal and human data. 

Hypercalcemia isn’t a particularly common cause of critical illness, but when encountered this requires immediate treatment.  Fortunately, advances in the treatment for hypercalemia have clarified how to do this safely and definitively.  Forced diuresis with furosemide has largely fallen by the wayside, simplifying fluid and electrolyte management.  The cornerstone of therapy is generally simultaneous initiation of calcitonin and an IV bisphosphonate.

Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis.  Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients.  This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]

Serotonin syndromes comes up a lot in critical care medicine.  Sometimes we are admitting patients because of a primary diagnosis of serotonin syndrome.  Other times we are afraid of causing serotonin syndrome ourselves, due to polypharmacy.  In both scenarios, there may be uncertainty regarding whether or not a patient has serotonin syndrome. This chapter explores […]