The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock.  The patient was previously healthy with no significant medical problems or medications.  History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out.  Physical examination is unrevealing, with the patient […]

It’s very difficult to write a good chapter about respiratory alkalosis (hypocapnia) or respiratory acidosis (hypercapnia).  These states remind me a bit of grand central station, because each encompasses such a broad range of patients with different conditions – who need enormously different treatments.  So any discussion of these conditions is by definition a gross […]

Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics – greatly complicating their management.

Neuroprognostication following cardiac arrest is one of the most important responsibilities of the ICU team.  This process begins as soon as ROSC is achieved, with the avoidance of confounding factors (e.g., sedatives and opioids).  An organized, multimodal approach is essential.  Incidentally, strategies which are aimed at accurate neuroprognostication will also facilitate early awakening – and as […]

Subarachnoid hemorrhage remains a challenging disease, with ongoing controversy surrounding several key aspects (including the optimal diagnostic pathway and management of vasospasm). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Traumatic brain injury is an extremely common problem, which is likely to be encountered in any type of intensive care unit.  Management is predominantly supportive, illustrating many principles of neurocritical care. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Posterior Reversible Encephalopathy Syndrome (PRES) is a common cause of ICU admission for seizure or altered mental status.  Although PRES is commonly associated with hypertension, PRES can occur in the absence of hypertension due to a variety of disorders that impair endothelial function causing vasogenic edema.  Thus, PRES encompasses the entity of “hypertensive encephalopathy” – […]

Let’s start by considering what our pretest probability should be regarding whether hypothermia is beneficial after cardiac arrest.  Every enzyme in our body has been evolutionarily designed to function at our normal body temperature.  Therefore, hypothermia will affect every chemical pathway.  As such, hypothermia is an incredibly blunt tool.  It’s hard to think of any […]

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is an important cause of stroke and intracranial hemorrhage, especially in younger people.  This disorder may also complicate other neurologic disorders, especially Posterior Reversible Encephalopathy Syndrome (PRES). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Paroxysmal sympathetic hyperactivity (previously known as sympathetic storming) is a pattern of recurrent episodic sympathetic activation which may occur after severe brain injury (most often traumatic or anoxic).  Prompt recognition of this diagnosis may facilitate appropriate treatment, thereby stabilizing the patient and avoiding aggravation of the underlying brain injury. The IBCC chapter is located 👉 […]

Autoimmune encephalitis was nearly unknown a few decades ago, but currently it’s estimated that it may be as common as HSV encephalitis.  Given that many forms respond well to treatment, prompt diagnosis is critical. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

ICP elevation is an important dimension of many neuroICU patients.  Unfortunately, it remains unclear precisely who might benefit from ICP monitoring, or exactly what the optimal ICP targets should be. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Critical care nutrition is a perpetually challenging topic, due to the difficulty in performing high-quality research on it.  This chapter aims to describe reasonable practices, based largely on the 2019 ESPEN guidelines. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Cardiac glycoside poisoning continues to be a relevent topic, due to both digoxin and plants containing cardiac glycosides.  As with all things toxicologic, ongoing debate surrounds the precise dosing and indications for anti-digoxin antibody fragments. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Poisoning is one of the most common causes of ICU admission.  The vast majority of these patients do fine, with minimal supportive therapy and observation.  However, occasional patients will progress to organ failures and potentially death.  This chapter explores how to approach these patients, with an eye towards identification and prompt treatment of the critically […]