PulmCrit (EMCrit)

Vocal cord dysfunction is a masquerader of life-threatening pathologies (most notably asthma and anatomic upper airway obstruction).  Vocal cord dysfunction itself is not dangerous, but if not properly diagnosed it may lead to considerable iatrogenic harm (e.g. multiple unnecessary intubations for “asthma”).  On the flip side, incorrect diagnosis of vocal cord dysfunction is also dangerous, […]

Invasive pulmonary aspergillosis was traditionally conceptualized as a rare infection restricted to profoundly immunocompromised patients.  However, over the past decade, it’s become increasingly clear that invasive aspergillosis can also occur as a nosocomial superinfection among patients who aren’t immunocompromised (especially following influenza).  This opens a can of worms regarding how to sift out colonization versus […]

Janus kinases (JAKs) are named after Janus, the Greek god of beginnings, gates, transitions, and duality.  They’re named after Janus because they contain a mirror-image structural element.  However, given their role within the immune system as a multi-functional gateway for cytokine systems, the name seems apt.  The cytokine storm induced by COVID-19 has received considerable […]

Refeeding syndrome is a slippery topic.  It’s probably more common than we recognize, often running underneath the radar (the constellation of electrolyte and clinical abnormalities can easily masquerade as another problem, such as alcohol withdrawal).  However, there is essentially no prospective evidence on how to prevent or treat it.  Indeed, there is no clear consensus […]

Takotsubo’s cardiomyopathy may be perceived as a zebra, but it is extremely common in the ICU (as a secondary consequence of endogenous stress and exogenous catecholamines).  With increasing recognition, Takotsubo cardiomyopathy is also noted to underlie ~1-2% of patients presenting with chest pain and a similar fraction of cath lab activations. The IBCC chapter is […]