PulmCrit (EMCrit)

Hyperdiuresis involves combining hypertonic saline with a loop diuretic for management of diuretic-resistant volume overload.  This may seem a bit counter-intuitive, but there are several reasons why it might work:  Hypochloremia promotes sodium retention; this could be reversed with hypertonic saline.  Hypertonic saline could osmotically pull fluid into the intravascular space, thereby promoting diuresis without […]

Status epilepticus is one of the true neurologic emergencies, where minutes may actually count.  Prompt and definitive treatment often yields excellent outcomes, whereas sluggish or inappropriate treatment can have severe consequences.  Management has changed substantially over the past decade including a new definition of convulsive status epilepticus (>5 minutes of seizing, rather than >30 minutes) […]

The Surviving Sepsis Campaign is a blight on modern, evidence-based medicine.​1​  It’s been clear for some years that its fundamentals were flawed (centering around rapid, large-volume fluid resuscitation).  Rather than adapt guidelines to modern evidence, the campaign recently doubled down on immediate administration of fluid and antibiotics within one hour.  This provoked widespread protest, including […]

Hypocalcemia in the ICU is one of the more confusing electrolyte abnormalities, because it’s frankly unclear exactly what to do with it.  Most patients in ICU are hypocalcemic, but there is little evidence that trying to “replete” hypocalcemia back to euboxia is beneficial (or even feasible).  Of course, there are some patients who have severe […]

We are constantly hunting for newer and better sources of information.  This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools.  Some of these pan out.  Most don’t. Why are these new sources of information generally disappointing?  The answer is simple:  we’re already doing pretty well.  In order […]