PulmCrit (EMCrit)

Foreword This post is about a research project I did as a pulmonary critical care fellow in 2011.  To understand it, you need to know a bit of the story behind it.I had some ideas for converting VBG values into ABG values.  To investigate further, I requested post-publication data from several researchers who had published studies comparing ABG vs. VBG data.  Many … [Read more...]

The potential role for IV olanzapine was examined in a post last year.  The following conclusions were reached:IV olanzapine appears to be safe. IV olanzapine has equal potency compared to IV droperidol and about twice the potency of IV haloperidol. Olanzapine doesn't affect QT interval or cause torsade de pointes.Two articles were just published in the Annals … [Read more...]

Background:  Creation of dogma via inappropriate generalization. This is how it happens:First, RCTs are performed to test a new intervention.  Studies are meticulously designed to include only patients who are expected to benefit the most.  A list of exclusion criteria avoids patients who might not benefit. The RCTs show benefit, leading to use of the intervention. … [Read more...]

Antiviral therapy for influenza is a sore subject.  Oseltamavir was initially felt to be a silver bullet.  Unfortunately, it turned out that its efficacy was overblown by publication bias.  Discordance between guidelines, practice, and evidence remains frustrating.Regardless, flu seasons is upon us again.  A recent paper in CHEST provides some tantalizing evidence about … [Read more...]

Introduction with a case A 70-year-old man was admitted with sepsis due to liver abscess.  Over the first two hospital days his platelet count decreased from 122 to 39.  Prophylactic heparin was held due to concerns about bleeding risk.  Additional coagulation studies showed a D-dimer of 1221 ng/ml, a fibrinogen of 672 mg/dL, and the following thromboelastograph:As a … [Read more...]