PulmCrit (EMCrit)

Severe asthma is a challenging topic, because this spans a lot of different patient phenotypes with varying severity and physiology.  This chapter attempts to outline some general principles to guide management, but ultimately clinical judgement and serial evaluation at the bedside will trump all of this.  The rarity, acuity, and heterogeneity of severe asthma make […]

background Fever is harmful in post-arrest patients.  This creates confusion in studies of hypothermia in post-arrest patients:  is the benefit of hypothermia due to fever avoidance, due to a benefit from hypothermia itself, or perhaps due to both?  Seminal studies in the early 2000s found mortality benefit from application of hypothermia to 33C after cardiac […]

background on IV vitamin C We live in divided times.  Paul Marik’s study on using vitamin C in sepsis was perhaps the most polarizing publication in recent memory (aside from perhaps the Mueller report).  It was lauded by some, yet derided just as strongly by others.  Unfortunately, the kerfuffle surrounding this study overshadowed the larger […]

Metabolic alkalosis is fairly common among hospitalized patients.  The most severe cases are often due to large-volume diuresis (deresuscitation), massive transfusion, or ongoing nasogastric suction.  Many patients will respond to simple resuscitation with normal saline (an acidotic fluid which is perfect here).  However, more severe or complex cases will require a multi-modal strategy which utilizes […]

Today will feature a guest post with Leo Stemp exploring some bleeding-edge concepts.  Very soon, an Internet Book of Critical Care chapter will round things out with a broader look at this disease. Leo Stemp trained first in critical care (including medical school at Harvard, internal medicine residency at Mount Sinai, and a fellowship at […]