PulmCrit (EMCrit)

The use of an inhaled pulmonary vasodilator is a logical strategy for stabilization of PE patients (especially nitric oxide, which may be depleted in this situation). Previously inhaled nitric oxide has only been supported by case series.

We spend a lot of time obsessing over the finer details of critical care:  which fluid is best?  which vasopressor is best?  will another liter of fluid help?  These details are important, but for a septic patient something more important than any of these details is choosing the right antibiotic(s).  In septic shock, source control and […]

Shock is the next-door neighbor of death.  Shock can present in a myriad of different forms, making early recognition challenging.  However, early diagnosis is essential.  Shock can be caused by a broad differential of serious illnesses.  Unlike most differential diagnosis lists, every item on this differential is life-threatening.  Fortunately, many causes of shock are reversible […]

Traditionally, vancomycin doses have been adjusted to target a specific trough level.  However, it is increasingly clear that the trough level is an inadequate measurement of vancomycin exposure.  Furthermore, the practice of waiting until the fourth dose to measure the trough level may expose the patient to days of suboptimal therapy.

Occasionally, the NEJM publishes a scary article that gets a lot of press, but doesn’t pan out to be valid.  The recent example is the PESIT study, which seemed to imply that everyone admitted with syncope had PE (don’t worry- they don’t). It looks like NEJM might be at it again, with this week’s review article on the relationship between acute infection and MI.