One and a half years ago, a landmark study by Sjoding et al. found that critically ill Black patients were more likely than White patients to have falsely reassuring pulse oximetry measurements (discussed here).​1​  Subsequently, six sizable studies have been published on this topic.  Since this is of critical importance to acute care medicine, it’s […]

Movement disorders are encountered more frequently in the critical care unit than one might realize.  For example Parkinson’s disease alone affects ~1% of patients over sixty years old (often requiring careful consideration in medication management, to avoid either psychosis or Parkinsonism-hyperpyrexia syndrome).  Other disorders are less common, but their recognition may be critical (e.g., propofol […]

Carotid or vertebral artery dissection are important considerations in trauma and also common causes of ischemic stroke among younger patients.  Variable presentations and a plethora of different diagnostic modalities can make this tricky. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Neurologic emergencies in pregnancy are challenging as there is very little high-quality evidence regarding them.  This chapter attempts to review available information, but large gaps remain.  Ideally, such gaps may be filled by using multidisciplinary teams which personalize care for each individual patient. The IBCC chapter is located 👉 here. The podcast & comments are […]

Catatonia is an important cause of altered mental status which is often overlooked among critically ill patients.  Although traditionally associated with schizophrenia, catatonia can result from a variety of psychiatric, neurologic, and medical problems (similar to delirium).  It is important to diagnose catatonia, because otherwise patients are likely to be incorrectly labeled as having delirium […]

Neurogenic pulmonary edema isn’t particularly common, but it’s probably more common than we realize.  Most cases are likely mistaken as cardiogenic pulmonary edema or aspiration pneumonitis.  Treatment is predominantly supportive, with a focus on defending the injured brain (rather than focusing too much on the lungs). The IBCC chapter is located 👉 here. The podcast […]

Spinal Epidural Abscess is rare, but it is increasingly encountered (especially within the context of the opioid epidemic, and an aging population with increasing comorbidity).  SEA may be part of the patient’s initial presentation to the ICU, or it may arise during the course of a prolonged ICU admission. The IBCC chapter is located 👉 […]

Baclofen is one of the most effective treatments for spasticity, but also perhaps the most toxic.  Baclofen intoxication may lead to severe mental status suppression requiring intubation and occasionally hemodialysis.  However, intrathecal baclofen withdrawal is more difficult to treat if it’s not possible to immediately re-institute intrathecal therapy. The IBCC chapter is located 👉 here. […]

Friends, Over the next several months we’ll be adding ~26 additional chapters to the neurology section of the IBCC.  The ultimate goal is to create a complete neurocritical care textbook that is fully integrated into the IBCC.  (You can preview the final table of contents here.) Why more neurocrit?  The brain is one of the […]

the question Some patients with HSV encephalitis may initially have a negative CSF PCR for HSV, with a repeat being positive some days later.  This has led to confusion regarding who, exactly, needs a repeat lumbar puncture? Montmollin E et al:  HSV encephalitis with initial negative PCR:  Prevalence, associated factors, and clinical impact. This is […]

first draft of IBCC is done! There are now chapters up on the core critical care topics.  Nearly all chapters have either been written or updated in 2020-2021, so it’s pretty fresh.  Ongoing updates will continue to push this date forwards. Of course, the IBCC will never be finished.  New chapters will be added over […]

Pericardial tamponade is an uncommon but extremely important cause of cardiogenic shock, because it is highly treatable.  Unfortunately, the precise definition of tamponade can be challenging – and patients can rapidly transition from an uncomplicated pericardial effusion towards the development of tamponade. The IBCC chapter is located 👉 here. The podcast & comments are below. […]

Dynamic LV outflow tract causes an inversion of all hemodynamics.  Diuresis and inotropes may cause cardiogenic pulmonary edema!  Vasoconstrictors and beta-blockers may improve cardiogenic pulmonary edema!  Down is up and up is down.  As you might imagine, failure to recognize this physiology could easily lead to management strategies that make matters worse. The IBCC chapter […]

Management of myocardial infarction is the core of cardiovascular critical care.  Recent advances in the OMI/NOMI paradigm offer the ability to detect significant infarctions earlier – allowing for prompt triage and management. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

The DDAVP clamp technique has considerably simplified the management of severe hyponatremia.  The fundamentals of the technique are as follows: Before the use of the DDAVP clamp, the primary cause of sodium overcorrection was endogenous free water excretion by the kidneys. For example, patients would present to the hospital with retention of free water due […]