PulmCrit (EMCrit)

Initially I wasn’t planning to write a chapter on influenza, because there is precious little evidence regarding ICU management.  However, even in the absence of solid evidence, we will be called upon to treat these patients.  Currently flu season is afoot, and it looks like it might be a bad one (with a predominance of […]

The importance of avoiding and treating renal failure cannot be overstated.  The kidneys are delicate organs, often the first to be injured by systemic hypoperfusion or other insults.  Severe renal dysfunction leads to a cascade of badness, promoting the failure of other organs and eventual spiraling into multi-organ failure.1  Alternatively, if we are can defend […]

There are a number of reasons that an idea may be impossible to test scientifically.  Perhaps the disease state that the idea applies to is extremely rare.  Perhaps it is logistically impossible to test the idea, due to issues with blinding or time constraints.  This post will focus on an insidious reason that ideas are thrown beyond the wall:  the timeframe and study size required to test them are unachievable.

Urosepsis is one of my favorite ICU diagnoses.  In almost all cases, patients will improve dramatically within 12-24 hours and leave the ICU with minimal sequelae.  But that shouldn’t lull us into a false sense of security:  careful antibiotic selection, aggressive resuscitation, and (in some cases) emergent drainage may be required for a good outcome.  

If you haven’t started seeing these yet, you will soon.  Checkpoint inhibitors are a form of immunotherapy being used for an increasingly broad range of malignancies.  They cause a diverse range of adverse events, due to releasing uncontrolled autoimmune hyperactivity.  Clinically this can mimic just about any rheumatologic condition.  Fortunately these events are quite treatable.  However, a high index of suspicion and prompt therapy is important.