PulmCrit (EMCrit)

We all want to alleviate pain and suffering. Most critically ill patients are treated with opioids for this reason. Unfortunately, opioids have numerous side-effects including delirium, constipation, vomiting, and delayed extubation. Opioid infusions may eventually lead to withdrawal, causing pain, nausea, and depression. This post explores the optimal use of systemic medications to control pain while minimizing complications.

A new joint practice guideline by the ATS and ACCP addresses how to approach cuff leaks. This guideline recommends a clever compromise between these extremes, which is the basis of the algorithm below. This provides a streamlined, evidence-based pathway to extubate patients without a cuff leak.

In 2014 I wrote a post suggesting an aggressive, streamlined approach to status epilepticus involving early intubation.  The fundamentals of that post remain valid.  However, much has changed over the last few years.  This post aims to refresh and extend the prior post.  It will also serve as a reference to explain my algorithm for […]

Background:  Devil in the details Airway management is a detail-oriented sport.  Minor nuances of patient positioning can be essential.  Or gentle laryngeal manipulation.  Apneic oxygenation can improve first-pass success.  Placing the pulse oximeter on the same arm as the blood pressure cuff can cause real headache.  Failure to recognize and remove dentures is an enormous […]

Follow-up data from the PEITHO trial shows that thrombolytics don’t affect long-term morbidity.  This simplifies management substantially. PEITHO trial & long-term follow up The PEITHO trial was a multi-center RCT investigating the effect of thrombolysis in submassive PE.  Tenecteplase caused an increase in intracranial hemorrhage and a reduction in hemodynamic collapse.  Overall there was a […]