PulmCrit (EMCrit)

It’s spring in Vermont… when a young intensivist’s thoughts go from fancy to tick-borne diseases.  Climate shifts are causing an increase in tick-borne illnesses, such that these are now considered emerging infections in many areas (including the northeast United States and Canada).  These diseases can be extremely difficult to diagnose, as they will often present with a nonspecific flu-like illness and may subsequently progress to multi-organ failure.  Misdiagnosis of a tick-borne illness as bacterial septic shock would lead to inadequate treatment, as these diseases require specific antibiotic therapy (usually doxycycline).  This chapter focuses on diagnosis and empiric therapy for these very challenging infections.  

For centuries, medical experts practiced bloodletting for a variety of ailments. This was widely believed to rid the body of evil humors. When patients didn’t respond well, this was believed to reflect an inadequate or delayed bloodletting. Practitioners competed to see who could partake in the most rapid and aggressive bloodletting.

Hepatic encephalopathy is a common cause of ICU admission, as well as a common complication of ICU admission for other indications (e.g. gastrointestinal hemorrhage).  At first the intubated patient with hepatic encephalopathy may seem a bit bewildering (will they ever wake up??).  However, an organized and aggressive strategy combined with some patience is generally sufficient […]

introduction The neutrophil/lymphocyte ratio (NLR) has been gaining increasing attention across many fields of medicine within the past five years.  Currently, there are 2,230 publications about this in PubMed, mostly within the past few years.  This post will attempt to create a framework for understanding this ratio. overview definition & physiology The NLR is simply […]

Background Kimberly Blumenthal and colleagues at the Massachusetts General Hospital have been performing groundbreaking work on beta-lactam allergies.  Their work forms the foundation for much of the IBCC chapter on beta-lactam allergies (you might want to read it before this post, but if you don’t have time, a one-minute synopsis is below). One fundamental technique […]