Introduction 0 There has been exciting research into submassive PE (a.k.a., intermediate-risk PE) recently with the release of MOPETT, PEITHO, TOPCOAT, and ULTIMA. In a prior blog post I discussed these studies in detail and suggested that our approach to PE is based on tradition rather than evidence. In summary, heparin is viewed as the […]
Cardiogenic shock following cardioversion of atrial flutter
0 Introduction with a case 0 Once upon a time at Genius General Hospital a 63-year-old woman was admitted with lower extremity edema and orthopnea. Her past medical history was unremarkable. She was noted to be in atrial flutter with a heart rate in the 120s and a blood pressure ranging from 100-120 mm systolic. She […]
Errors of commission vs. errors of omission
Introduction 0 I just heard Scott Weingart’s new podcast about errors of omission compared to errors of commission. The podcast was inspired by a patient with aortic dissection and hemopericardium who arrested and died, without any attempt made to drain the pericardium. This raised the question of whether our culture of “do no harm” has […]
Rapid Sequence Termination (RST) of status epilepticus
[PLEASE NOTE: This post has been updated with a new post. If you have time, consider reading them in sequence, starting with this post first] 0 Introduction 0 Status Epilepticus is our favorite neurologic emergency. If managed correctly, patients will often have excellent neurologic outcomes and short ICU stays. Incorrect management increases risk of […]
Contraindication checklist for thrombolysis in PE
A few weekends ago during a very chaotic call, my ICU team ordered half-dose alteplase for a patient with a submassive PE without checking his INR. They had performed a thoughtful interview of the patient to look for contraindications to thrombolysis, but somehow this slipped through the cracks. On reviewing all the data together […]