The opioid epidemic has caused us all to become far more familiar with opioid intoxication than we ever wanted to be. However, some nuances still remain (e.g., management of methadone and loperamide intoxications). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBCC – Sodium channel blocker toxicity (including tricyclic antidepressants)
Blockade of the fast cardiac sodium channels is an important component of cardiotoxicity due to many intoxicants. Historically the most common cause of sodium channel blockade has been tricyclic antidepressant poisoning, but a wide variety of xenobiotics can affect the sodium channels. Fortunately, close attention to the EKG may be sufficient to reach an accurate […]
IBCC – Anticholinergic intoxication
Anticholinergic intoxication has been a moving target recently, with a resurgence in the popularity of physostigmine. The thoughtful administration of physostigmine has much to offer these patients, but it must be provided within the context of a systematic approach. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on […]
IBCC – Neuroleptic Malignant Syndrome (NMS)
Neuroleptic malignant syndrome is rare, but this will be encountered in the ICU. Particularly with the rising utilization of antipsychotics for a variety of indications (e.g., emesis, agitation), we should be cognizant of this entity. Another relevent cause of NMS is abrupt withdrawal of Parkinson’s medications (e.g., due to NPO status). The IBCC chapter is […]
PulmCrit – ACEP task force on septic shock should replace the Surviving Sepsis Campaign
The critical care community has long been plagued by a series of antiquated, overbearing guidelines created by the Surviving Sepsis Campaign (SSC). The campaign was originally sponsored by Eli Lilly and Edwards Life Sciences, as a commercial marketing campaign. The backbone of the original guidelines was a single center trial by Rivers, which has failed […]
IBCC – Local Anesthetic Systemic Toxicity (LAST)
Local Anesthetic Systemic Toxicity (LAST) is fortunately extremely rare. However, with the ongoing expansion of nerve blocks and lidocaine infusions in a variety of different contexts, this is likely to be seen more often over time. Prompt recognition and antidotal therapy are essential. The IBCC chapter is located 👉 here. The podcast & comments are […]
IBCC – Calcium channel blocker & beta blocker poisoning
Calcium channel blocker poisoning is one of the most formidable intoxications encountered critical care. As for most topics in toxicology, there is no level-I evidence regarding this. This chapter explores treatment options for beta blocker and calcium channel blocker poisoning, with the admitted limitation that it’s impossible to know which treatments are optimal and in […]
IBCC – Necrotizing Fasciitis
Let’s be honest, necrotizing fasciitis is a perennial source of errors. This is a difficult diagnosis to make. It can be tedious to continually maintain a high level of suspicion for it, but suspicion and early diagnosis are critical. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on […]
IBCC – Sympathomimetic intoxication
Sympathomimetic intoxication is increasingly common (e.g., with increasing use of methamphetamine). Although this is a classic topic in toxicology, recent controversy has surrounded the optimal therapy for acute intoxication (benzodiazepines vs. antipsychotics). This chapter will attempt to provide a general approach to sympathomimetics, recognizing that in many cases it may be impossible to determine precisely […]
IBCC – Malignant Hyperthermia
Malignant hyperthermia is a rare diagnosis, but nonetheless one worth being aware of. Very rarely, malignant hyperthermia may be triggered by succinylcholine, causing it to present initially in the emergency department or ICU. Far more often, malignant hyperthermia will be diagnosed in the operating room – with intensivists involved in providing follow-up care. The IBCC […]
IBCC – Interpreting coagulation labs
We obtain coagulation labs on nearly every critically ill patient. However, our understanding of these labs remains relatively superficial. Meanwhile, the addition of thromboelastography (TEG) has rendered matters even more complex, by providing an alternative strategy for monitoring coagulation. This chapter attempts to sift through a rational approach to coagulation labs, but much work remains […]
IBCC – Alcoholic hepatitis
We are seeing an increased volume of alcoholic liver disease due to the COVID pandemic. Previously admissions to ICU for alcoholic hepatitis were rare, but these are now occurring with regularity. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
IBCC – Stupor & Coma
Stupor and coma can be a challenging presentation, because it has a broad differential filled with very severe diseases. An organized approach is essential. One core feature of that approach is the coma neurologic examination, which remains central to the evaluation even in the era of abundant CT and MRI scanning. The IBCC chapter is […]
PulmCrit Rant – Intermediate DVT prophylaxis in COVID: We need for better pants
COVID will eventually lead to many improvements in our approach to critical illness. I’ve been hoping that one of these would be an improved understanding of venous thromboembolism (VTE) prophylaxis, but perhaps that was overly optimistic. We provide VTE prophylaxis to nearly every patient in the ICU. Consequently, even tiny changes in our VTE prophylaxis […]
IBCC – Acute Eosinophilic Pneumonia (AEP)
Acute Eosinophilic Pneumonia is rare, but it definitely happens. It typically causes relatively rapid-onset ARDS, frequently leading to mechanical ventilation. Prompt recognition is critical, because AEP responds beautifully tosteroid therapy. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
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