PulmCrit (EMCrit)

Endocarditis is a classic disease of emergency medicine, inpatient medicine, and critical care.  The opioid epidemic has caused a surge of endocarditis diagnoses, reminding us of the myriad ways that this disease can present itself. 

We often assume that diagnostic procedures will help patients.  A lot of training goes into learning how to do these procedures.  Procedures are dramatic.  We like performing them.  Patients are impressed, perceiving that we are “doing” something for them.  Everything is awesome.However, when strict evidence-based medicine is applied to procedures, they are often less impressive. 

VT storm refers to recurrent episodes of VT/VF.  Although any individual episode of VT can be broken, the overall process of recurrent arrests (or ICD shocks) creates a vicious cycle.  Aggressive management is required with intubation, deep sedation, antiarrhythmics, and sympatholysis.  Given the rarity of this condition, it’s difficult to obtain high-level evidence or extensive experience. 

Metformin poisoning and lactic acidosis has always been murky.  For years there was debate about whether metformin-induced lactic acidosis exists (short answer:  it obviously does).  However, for an individual patient, it can still be confusing sorting out the contribution of metformin to their critical illness.  A recent re-definition of the condition clarifies things a bit, but substantial confusion persists regarding how to diagnose and treat these patients.  

Recently the concept of extracorporeal CO2 removal has become somewhat popular, with a goal of facilitating ultra low-tidal volume ventilation.  Might there be other means to achieve the same goal?  Let’s start with some basic concepts of mechanical ventilation… Fundamental unanswered questions Permissive hypercapnia refers to the concept of allowing the pCO2 level to increase […]