• Home
  • EMCrit
  • PulmCrit
  • IBCC
  • ODR
  • About
    • About EMCrit
    • PulmCrit – The Full Story
    • EMCrit FAQ
    • Subscribe to the Newsletter
  • Contact
  • Join
    • Why Should I Become a Member?
    • Questions Before Joining (FAQ)
    • Join Now!

PulmCrit (EMCrit)

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

  • PulmCrit – The Full Story
  • Genius General Hospital
  • PulmCrit TOC
  • IBCC TOC
  • IBCC Podcast
You are here: Home / Archives for PULMCrit

CT Angiogram for evaluation of severe hematochezia

April 5, 2015 by Josh Farkas 1 Comment

Introduction 0 Gastrointestinal hemorrhage is a common reason for ICU admission.  The approach to severe upper GI bleeding is relatively straightforward (figure below).  A predictable approach facilitates planning ahead, and anticipating who needs to be contacted for help when.  0 0 Unfortunately, the approach to severe hematochezia is often less clear.  Below is a description […]

Do CT scans cause contrast nephropathy?

March 29, 2015 by Josh Farkas 10 Comments

Introduction 0 In April 2013 a series of articles in Radiology debated whether contrast nephropathy still exists using modern contrast dye.  Two years later, the controversy remains.  This is a daily conundrum when managing critically ill patients: one radiologist will urge us to use contrast, while the next radiologist will caution us against using contrast. […]

Management of severe hyperkalemia in the post-Kayexalate era

March 15, 2015 by Josh Farkas 4 Comments

0 Introduction 0 There is increasing recognition that sodium polystyrene sulfonate (Kayexalate) is ineffective for the immediate management of severe hyperkalemia (Kamel 2012).  With Kayexalate gone, there seems to be a gap in our treatment regimen.  I often encounter residents who know that Kayexalate isn’t helpful, but aren’t sure exactly how to treat hyperkalemia without […]

High-flow nasal cannula for apneic oxyventilation

March 8, 2015 by Josh Farkas 4 Comments

0 Introduction 0 Last summer I wrote a postabout preoxygenation and apneic oxygenation using high-flow nasal cannula (HFNC).  At that point there was no evidence supporting it, so the post was based primarily on the physiology of HFNC.  Recently two papers were published supporting the use of HFNC for preoxygenation and apneic oxygenation (Patel 2015, […]

Hemodynamic access for the crashing patient: The dirty double

March 1, 2015 by Josh Farkas 8 Comments

  0 0 Introduction with a case 0 A 75-year-old man presents in transfer to the ICU for management of bradycardia and hyperkalemia.  His history is notable for hypertension with chronic use of an ACE-inhibitor.  He developed gastroenteritis due to endemic Norovirus some days prior.  Today he presented to the outside hospital with hypotension and […]

Five pearls for the dyspneic patient with Guillain-Barre Syndrome or Myasthenia Gravis

February 22, 2015 by Josh Farkas 2 Comments

0 Introduction 0 Guillain-Barre Syndrome (GBS) and Myasthenia Gravis (MG) are common causes of acute weakness.  About 25% of these patients may develop respiratory failure requiring intubation, so a major concern is determining who requires ICU-level monitoring and whether intubation should be performed.  Ideally it would be possible to predict with 100% accuracy which patients […]

Thrombectomy plus thrombolysis for acute stroke: A word of caution

February 16, 2015 by Josh Farkas Leave a Comment

Introduction: Problem of the premature standard of care 0 This issue has previously been discussed with regards to heparin and thrombolysis for submissive pulmonary embolism.  Heparin was adopted as treatment for PE before the era of evidence-based medicine.  Although heparin prevents further clot formation, it probably doesn’t have any immediate effect on hemodynamic stability.  Regardless, […]

Treatment of ACEi-induced angioedema

February 8, 2015 by Josh Farkas 18 Comments

Introduction 0 ACE-inhibitor induced angioedema (ACEI-AAG) accounts for about a third of angioedema cases presenting to the emergency department.  ACE inhibitors are increasingly popular, with the new JNC 8 guidelines up-grading them to a first-line drug for hypertension.  Thus, ACEI-AAG may represent a growing problem.  Unfortunately, this is often treated incorrectly, with a medication regimen […]

Approaching undifferentiated cardiopulmonary failure: Which tests are most useful?

February 1, 2015 by Josh Farkas 9 Comments

  0 Introduction 0 Recently point-of-care ultrasonography (POCUS) has risen in prominence within acute care medicine.  It has been shown to provide immediate and critical information about a variety of conditions ranging from nephrolithiasis to pulmonary edema.  However, POCUS is not without its critics, who point out weaknesses including detection of incidental findings (i.e., small […]

Three myths about Plasmalyte, Normosol, and LR

January 26, 2015 by Josh Farkas 14 Comments

0 Introduction: Selecting the best balanced crystalloid 0 About six months ago, Genius General Hospital added Normosol to its formulary.  For those of you not familiar with Normosol, it is produced by Hospira and is essentially a generic version of Plasmalyte by Baxter (table below).   Although most evidence has been obtained with Plasmalyte, this is […]

The Respiratory Death Airway Algorithm

January 18, 2015 by Josh Farkas 4 Comments

0 Introduction 0 Last week Scott Weingart discussed a case of a profoundly hypoxemic patient with a failed airway which was salvaged by surgical cricothyrotomy (listen to it here).  Despite successfully resuscitating the patient there was some criticism later that perhaps a cricothyrotomy wasn’t absolutely required.  This reminds me of a case I’ve been planning […]

Toxic Shock Syndrome Management: A tale of two patients

January 12, 2015 by Josh Farkas 1 Comment

  0 Introduction  0 Toxic shock syndrome (TSS) is a true resuscitationist’s disease.  It is potentially quite lethal, with many series of streptococcal toxic shock syndrome reporting mortality in the range of 30-50%.  However, recent observational studies suggest that treatment with modern critical care, toxin-suppressive antibiotics, and IVIG may reduce the mortality to 10% (Linner […]

Early suspicion of toxic shock syndrome

January 4, 2015 by Josh Farkas 2 Comments

  0 Introduction 0 Toxic shock syndrome (TSS) is critical to recognize because it can be rapidly lethal and yet is usually treatable.   TSS is a relatively new disease, first described in 1978.   The prevalence has increased over the last few decades due to shifts in the circulating strains of Group A streptococcus (Low 2013).  However, […]

Treating delirium tremens: Pharmacokinetic engineering with diazepam and phenobarbital

December 30, 2014 by Josh Farkas 3 Comments

  0 [PLEASE NOTE:  For the most complete & updated material on alcohol withdrawal, please see the Internet Book of Critical Care Chapter on this topic here] 0 Introduction 0 Recently the New England Journal published a review article about delirium tremens which is somewhat misguided (see a scathing critique by The Poison Review).  The […]

Holiday break & Comic relief

December 21, 2014 by Josh Farkas Leave a Comment

Introduction: Medicine is stressful.   Humor helps.   Here are some of the funniest medical videos I’ve seen.   If there is a video you love that’s not here, drop it in the comments section. Disclaimer:   These videos are intended only for healthcare professionals with intact senses of humor.   They contain some foul language.  Watch them at your […]

  • « Previous Page
  • 1
  • …
  • 28
  • 29
  • 30
  • 31
  • 32
  • 33
  • Next Page »
EMCrit Join

Login

  • Lost Password

Feel Social?

  • Facebook
  • RSS
  • Twitter
  • YouTube
Metasin Coaching
RCM
SCRAM Bag

Other Stuff

  • Have a great idea for the next podcast? Share it here!
  • Tough Questions. Maybe you have an answer!
  • When you're done listening to the podcast,
    check out these great sites.

Who We Are

We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM.

Subscribe by Email

EMCrit is a trademark of Metasin LLC. Copyright 2009-. This site represents our opinions only. See our full disclaimer, our privacy policy, commenting policy and here for credits and attribution.

Insert/edit link

Enter the destination URL

Or link to existing content

    No search term specified. Showing recent items. Search or use up and down arrow keys to select an item.