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Myth-busting: Lactated Ringers is safe in hyperkalemia, and is superior to NS.

September 29, 2014 by Josh Farkas 26 Comments

Introduction   0 Several months ago I gave a grand rounds on pH-guided resuscitation which was summarized in this post.   This included a discussion that Lactated Ringers (LR) is safe in hyperkalemia.   However, myth-busting is hard work.   The dogma that LR should be avoided in hyperkalemia continues to replicate, both locally and on twitter.   This […]

Large volume thoracentesis: How much can safely be removed?

September 24, 2014 by Josh Farkas 12 Comments

0 Introduction 0 Completely draining a pleural effusion has many benefits including symptomatic improvement, avoiding multiple procedures, faster disposition home, and imaging the chest with the lung inflated.   However, complete drainage is usually avoided to due to fear of re-expansion pulmonary edema.   What is the evidence behind this?   0 Traditional model of reexpansion pulmonary edema (RPE) 0 […]

Pneumothorax ex vacuo: Post-thoracentesis pneumothorax in the ultrasound era

September 17, 2014 by Josh Farkas 4 Comments

CT showing pneumothorax ex vacuo due to trapped lung (Pereyra 2013) 0 Introduction 0 A recent review article by Wilcox in JAMA questions whether ultrasound guidance truly reduces the risk of pneumothorax.   Bedside ultrasound reduced pneumothorax (OR = 0.55) but this reduction was statistically insignificant due to a huge confidence interval of 0.06-5.3.   Another meta-analysis found […]

Double-coverage of gram negatives with a fluoroquinolone?

September 3, 2014 by Josh Farkas 2 Comments

  0 Introduction 0 The benefit of empirically using two antibiotics to cover gram negative bacilli is a perpetual controversy.   For patients in septic shock, failure to provide effective initial antimicrobial therapy correlates with increased mortality.   Using two drugs may increase the likelihood of an including at least one antibiotic which covers the pathogen.   This […]

What does it mean if a patient is “allergic” to haloperidol?

August 27, 2014 by Josh Farkas 12 Comments

0 Introduction with a case 0 Once upon a time at Genius General Hospital, a 25-year old man was admitted to the ICU for agitation.   After exclusion of an acute medical or neurologic process, it became clear that he was suffering from schizophrenia with medication nonadherence.   Unfortunately, his electronic medical record indicated that he had […]

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