EMCrit Project https://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Thu, 21 Mar 2019 14:04:35 +0000 en-US hourly 1 https://wordpress.org/?v=5.1.1 https://emcrit.org/feed/podcast/ Help me fill in the blanks of the practice of ED Critical Care. In this podcast, we discuss all things related to the crashing, critically ill patient in the Emergency Department. Find the show notes at emcrit.org. Scott D. Weingart, MD FCCM clean episodic Scott D. Weingart, MD FCCM spambin55@gmail.com spambin55@gmail.com (Scott D. Weingart, MD FCCM) 2009- Online Medical Education on Emergency Department (ED) Critical Care, Trauma, & Resuscitation EMCrit Project http://emcrit.org/wp-content/uploads/powerpress/3000x3000-emcrit.jpg https://emcrit.org EM Nerd-The Case of the Irregular Irregularity Continues https://emcrit.org/emnerd/em-nerd-the-case-of-the-irregular-irregularity-continues/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-irregular-irregularity-continues/#comments Wed, 20 Mar 2019 14:08:07 +0000 https://emcrit.org/?p=460675 Very little about the management of atrial fibrillation is an emergency. And yet we in the Emergency Medicine community have embraced it as such. We gleefully bring to bear the full technological powers available to an Emergency Physician in our attempts to tame its irregular irregularity. Using this aggressive approach, we have proven ourselves quite […]

EMCrit Project by Rory Spiegel.

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Tox and Hound – The Sound of Silence https://emcrit.org/toxhound/sound-of-silence/ https://emcrit.org/toxhound/sound-of-silence/#comments Thu, 14 Mar 2019 17:36:24 +0000 https://emcrit.org/?p=460558 By Diane Calello In 2001, radio talk show host Rush Limbaugh announced to his listeners that he woke up one morning deaf in his right ear and that deafness had progressed to complete hearing loss over 4 months. A tentative diagnosis of autoimmune hearing loss was made, and he received cochlear implants, restoring his hearing. […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Abdominal Compartment Syndrome https://emcrit.org/pulmcrit/abdominal-compartment/ https://emcrit.org/pulmcrit/abdominal-compartment/#comments Thu, 14 Mar 2019 10:00:35 +0000 https://emcrit.org/?p=460536 Abdominal compartment syndrome can result from primary abdominal pathology (e.g. bowel obstruction), but it can also occur due to systemic inflammation combined with large-volume resuscitation.  As such, abdominal compartment syndrome is probably more frequent than generally perceived, functioning as an occult driver of multi-organ failure.  Treatment is based upon physiological properties, involving many therapies aside from simply opening the abdomen. 

EMCrit Project by Josh Farkas.

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EM Nerd-The Case of the Conspicuous Conclusion https://emcrit.org/emnerd/em-nerd-the-case-of-the-conspicuous-conclusion/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-conspicuous-conclusion/#comments Tue, 12 Mar 2019 20:55:38 +0000 https://emcrit.org/?p=460509 The process of rapid sequence induction (RSI) often forces the clinician to choose between two conflicting priorities. Torn between maintaining a safe level of oxygen, rendering the patient apneic, and limiting the amount of positive pressure ventilatory support given prior to obtaining a secure airway in the hopes of minimizing the risk of aspiration. Traditionally […]

EMCrit Project by Rory Spiegel.

https://emcrit.org/emnerd/em-nerd-the-case-of-the-conspicuous-conclusion/feed/ 2
PulmCrit- DEXACET: Four grams of acetaminophen a day keeps the delirium away? https://emcrit.org/pulmcrit/dexacet/ https://emcrit.org/pulmcrit/dexacet/#comments Mon, 11 Mar 2019 10:11:40 +0000 https://emcrit.org/?p=460458 For decades, acetaminophen has been regarded as the first rung of the analgesic ladder.  It has a nearly unparalleled risk/benefit profile when dosed correctly (it’s not tremendously effective, but it is extraordinarily safe).  Theoretically, acetaminophen should be used very broadly among critically ill patients with pain.However, this isn’t the case. 

EMCrit Project by Josh Farkas.

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EMCrit Podcast 242 – ED Nephrology with Joel Topf aka KidneyBoy https://emcrit.org/emcrit/ed-nephrology/ https://emcrit.org/emcrit/ed-nephrology/#comments Sat, 09 Mar 2019 23:30:39 +0000 http://emcrit.org/?p=438940 ED Nephrology with the Kidney Boy, Joel Topf

EMCrit Project by Scott Weingart.

https://emcrit.org/emcrit/ed-nephrology/feed/ 5 ED Nephrology with the Kidney Boy, Joel Topf
Joel Topf is a nephrologist in Detroit working for St Clair Specialty Physicians. He is faculty for the Nephrology Fellowship at St John Providence.

Blog: PBFluids.com

Twitter: @Kidney_Boy

Co-creator: NephMadness, Co-creator: NephJC, Co-creator: DreamRCT
The Case

* Tweetorial on the Case
* Slides for the Case


* Topf thoughts on DDAVP in hypoNa
* DDAVP clamp in hyponatremia
* EMCrit Intro to Hyponatremia
* Curbsiders Hyponatremia Episode
* IBCC Hyponatremia
* Taking control of severe hyponatremia with DDAVP

Joel admits elderly with Na < 130

* Make sure they are not DI and then replete their free water deficit
* Acetazolamide for Nephrogenic DI1
* Hypernatremia is a marker of poor quality ICU Care2
* EMCrit Hypernatremia Episode
* IBCC Hypernatremia

Joel's Furosemide dose is Cr x 20

* Curbsiders on HyperK with Joel
* EMCrit HyperK
* IBCC HyperK
* Recent RCT on Kayexalate3
* The odds ratio for death was 10 at a potassium of 5.5 to 6 mEq/L. It rose to 31 for potassium above 6!4

Who Needs RRT?

* Is A,E,I,O,U still the answer?


* Get Joel's Free Electrolyte and Acid Base Book

Now on to the Podcast...

Gordon CE, Vantzelfde S, Francis JM. Acetazolamide in Lithium-Induced Nephrogenic Diabetes Insipidus. N Engl J Med. 2016;375(20):2008-2009. doi:10.1056/nejmc1609483

Polderman K, Schreuder W, Strack van, Thijs L. Hypernatremia in the intensive care unit: an indicator of quality of care? Crit Care Med. 1999;27(6):1105-1108. [PubMed]

Lepage L, Dufour A-C, Doiron J, et al. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. Clinical Journal of the American Society of Nephrology.]]>
Scott D. Weingart, MD FCCM clean 1:05:38
Tox and Hound – To Bind or Not To Bind https://emcrit.org/toxhound/bindornot/ https://emcrit.org/toxhound/bindornot/#respond Thu, 07 Mar 2019 22:11:17 +0000 https://emcrit.org/?p=460387 by Jeanna Marraffa If you’re the gambling type, then this post is for you! 50/50 are pretty good odds, right? Or are they not and that’s why I never win in Vegas? I digress . . . let’s get back to the poll. Fifty percent of people said that they wouldn’t give digoxin-Fab to a […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Myasthenic Crisis https://emcrit.org/pulmcrit/myasthenia/ https://emcrit.org/pulmcrit/myasthenia/#comments Thu, 07 Mar 2019 10:57:29 +0000 https://emcrit.org/?p=460346 Myasthenic crisis along the fault-line between neurology and critical care medicine.  This creates a potentially dangerous situation, wherein nobody is fully informed or wholly responsible for the patient. 

EMCrit Project by Josh Farkas.

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The Dantastic Mr. Tox & Howard – S02E08 – Cold Cloth Placed To Brow https://emcrit.org/toxhound/s02e08-cold-cloth-placed-to-brow/ https://emcrit.org/toxhound/s02e08-cold-cloth-placed-to-brow/#respond Mon, 04 Mar 2019 18:33:00 +0000 https://emcrit.org/?p=460303 Making A Medical Murderer with Dr. Brent Furbee Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Brent Furbee about Orville Lynn Majors, Jr. a nurse serial killer who was convicted of the murder of 7 patients, but was likely involved in countless others. Find out why nurses know, doctors deny, and administrators push […]

EMCrit Project by Tox & Hound.

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IBCC chapter & cast: Acetaminophen toxicity https://emcrit.org/pulmcrit/acetaminophen/ https://emcrit.org/pulmcrit/acetaminophen/#respond Thu, 28 Feb 2019 12:00:42 +0000 https://emcrit.org/?p=460237 Acetaminophen is in everyone's medicine cabinet.  This makes it one of the more common intoxications.  At first blush, this might seem like an easy topic:  apply the nomogram, then give acetylcysteine.  Unfortunately, it's not quite that simple.  There are a variety of different presentations (e.g. acute, chronic, delayed), many of which will confound the nomogram.  […]

EMCrit Project by Josh Farkas.

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EMCrit CQiR – IV Bolus Epinephrine for Anaphylaxis: A Double-Edged Sword https://emcrit.org/emcrit/iv-bolus-epinephrine-for-anaphylaxis/ https://emcrit.org/emcrit/iv-bolus-epinephrine-for-anaphylaxis/#comments Wed, 27 Feb 2019 23:04:48 +0000 http://emcrit.org/?p=455920 Is IM still the way to go with epi in anaphylaxis?

EMCrit Project by Ashley Mogul.

https://emcrit.org/emcrit/iv-bolus-epinephrine-for-anaphylaxis/feed/ 8
PulmCrit wee- Five ways to improve live-tweeting at conferences https://emcrit.org/pulmcrit/live-tweeting/ https://emcrit.org/pulmcrit/live-tweeting/#comments Mon, 25 Feb 2019 12:00:31 +0000 https://emcrit.org/?p=460098 For generalists such as myself, there’s almost always a conference of interest going on somewhere in the world.  In the normal course of events, I would miss 99.9% of them.  However, twitter makes it possible for me to gain some insight from all of them. However, conference tweeting is far from perfect.  A large conference […]

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/live-tweeting/feed/ 6
EMCrit Podcast 241 – Sepsis Update 2019 https://emcrit.org/emcrit/emcrit-podcast-241-sepsis-update-2019/ https://emcrit.org/emcrit/emcrit-podcast-241-sepsis-update-2019/#comments Thu, 21 Feb 2019 16:39:43 +0000 http://emcrit.org/?p=459740 New stuff on sepsis resuscitation for 2019

EMCrit Project by Scott Weingart.

https://emcrit.org/emcrit/emcrit-podcast-241-sepsis-update-2019/feed/ 16 New stuff on sepsis resuscitation for 2019
A bunch of fun new ideas re: sepsis for 2019
30 ml/kg may be based on IBW if you write in the chart that that was what you were using
Andromeda-Shock Trial
A fascinating study by Hernandez et al.1

* See Rory's take on it
* The Bottom Line

Censer Trial
Early fixed-dose norepi use was examined in this trial.2

HiTemp Study3

Procalcitonin was poor for differentiating bacterial infections and other causes of fever in the ED.
Now on to the Podcast...

Hernández G, Ospina-Tascón G, Damiani L, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019;321(7):654-664. [PubMed]

Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial. Am J Respir Crit Care Med. February 2019. [PubMed]

van der, Limper M, Jie K, et al. Procalcitonin-guided antibiotic therapy in patients with fever in a general emergency department population: a multicentre non-inferiority randomized clinical trial (HiTEMP study). Clin Microbiol Infect. 2018;24(12):1282-1289. [PubMed]

Scott D. Weingart, MD FCCM clean 19:44
IBCC chapter & cast: Hypernatremia https://emcrit.org/pulmcrit/hypernatremia-2/ https://emcrit.org/pulmcrit/hypernatremia-2/#comments Thu, 21 Feb 2019 12:26:27 +0000 https://emcrit.org/?p=460019 Treating hypernatremia in the ICU isn't exciting or particularly difficult.  However, it's enormously important to provide patients with comfort.  We talk a lot on treating pain, but usually forget about the discomfort caused by thirst.  Remember:  when you intubate a patient and take control of their airway, you're also taking responsibility to provide them with water.

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/hypernatremia-2/feed/ 9
EM Nerd-The Case of the Deceitful Lantern https://emcrit.org/emnerd/em-nerd-the-case-of-the-deceitful-lantern/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-deceitful-lantern/#comments Tue, 19 Feb 2019 14:12:12 +0000 https://emcrit.org/?p=459923 Since the publication of the sepsis trilogy, PROMISE, ARISE, and PROCESS 1,2,3, abruptly displaced early goal directed therapy (EGDT) as the cornerstone of sepsis management, we have been searching to fill the therapeutic vacuum its sudden departure left behind. The Center for Medicare and Medicaid Services (CMS) and the Surviving Sepsis Campaign (SSC) have both rushed […]

EMCrit Project by Rory Spiegel.

https://emcrit.org/emnerd/em-nerd-the-case-of-the-deceitful-lantern/feed/ 6
PulmCrit: Is pure RSI a failed paradigm in critical illness? The primacy of pressure https://emcrit.org/pulmcrit/pressure-rsi/ https://emcrit.org/pulmcrit/pressure-rsi/#comments Tue, 19 Feb 2019 13:12:16 +0000 https://emcrit.org/?p=459880 Why do some patients' saturation crash during laryngoscopy, whereas other patients are fine?  What can we do to prevent this?

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/pressure-rsi/feed/ 21
Tox and Hound – Talking Back to a Talking Antidote https://emcrit.org/toxhound/talkingantidote/ https://emcrit.org/toxhound/talkingantidote/#respond Mon, 18 Feb 2019 19:29:40 +0000 https://emcrit.org/?p=459857 By Andrew Stolbach Author’s note: I sat down to discuss the role of the out-of-hospital naloxone administration with Evzio® (Kaleo Pharmaceuticals), the world’s only talking naloxone auto-injector. Our interview is presented below in its entirety. AS: Thanks for coming today. Evzio®: To Inject. Place black end against outer thigh. Then press firmly. 5, 4, 3, […]

EMCrit Project by Tox & Hound.

https://emcrit.org/toxhound/talkingantidote/feed/ 0
IBCC chapter: Salicylate intoxication https://emcrit.org/pulmcrit/salicylates/ https://emcrit.org/pulmcrit/salicylates/#respond Thu, 14 Feb 2019 11:45:37 +0000 http://emcrit.org/?p=459801 Of all intoxications, salicylates is one of the most important to understand.  These cases can unravel rapidly, with fatal outcome.  However, with prompt management most patients will do fine.  Treatment depends on a solid grasp of the underlying chemistry and renal physiology.

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/salicylates/feed/ 0
Point of Care Ultrasound Handbook – RUSH Chapter https://emcrit.org/emcrit/point-of-care-ultrasound-rush/ https://emcrit.org/emcrit/point-of-care-ultrasound-rush/#comments Wed, 13 Feb 2019 01:27:52 +0000 http://emcrit.org/?p=449170 A free chapter from a POC ultrasound book

EMCrit Project by Guest Author.

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PulmCrit: The surviving sepsis campaign 1-hour bundle is… back? https://emcrit.org/pulmcrit/ssc-1-hour/ https://emcrit.org/pulmcrit/ssc-1-hour/#comments Tue, 12 Feb 2019 11:47:21 +0000 http://emcrit.org/?p=459475 The surviving sepsis campaign (SSC) has had substantial problems dating back to its inception.  The original backbone of the guidelines was a single-center trial by Rivers, which has largely been debunked.1–4  Initially the SSC was slow to let go of invasive early goal-directed therapy.  The SSC has finally started eliminating older dogma (e.g., superior vena cava […]

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/ssc-1-hour/feed/ 3
The Case of the Scientific Ruse https://emcrit.org/emnerd/the-case-of-the-scientific-ruse/ https://emcrit.org/emnerd/the-case-of-the-scientific-ruse/#comments Mon, 11 Feb 2019 21:22:32 +0000 http://emcrit.org/?p=459723 February 7th 2019 marked a auspicious day in the history of the NEJM and its relationship with the pharmaceutical industry. In 2015, the NEJM shifted their significant weight in support of a strong union between industry and medicine1,2,3. With the simultaneous publication of four pharmaceutical sponsored trials, each brimming with its own unique form of […]

EMCrit Project by Rory Spiegel.

https://emcrit.org/emnerd/the-case-of-the-scientific-ruse/feed/ 16
Tox and Hound – No GABA GABA! https://emcrit.org/toxhound/no-gaba-gaba/ https://emcrit.org/toxhound/no-gaba-gaba/#comments Mon, 11 Feb 2019 16:57:57 +0000 https://emcrit.org/?p=459649 by Howard Greller We rarely stop and appreciate the beauty that is reflected in our physiology. It’s not until something goes wrong that we recognize how well things were working. For example, our brains . . . An analogy I like is that our brains are like a car (I definitely need to upgrade to […]

EMCrit Project by Tox & Hound.

https://emcrit.org/toxhound/no-gaba-gaba/feed/ 1
IBCC chapter: Buprenorphine & opioid use disorder https://emcrit.org/pulmcrit/buprenorphine/ https://emcrit.org/pulmcrit/buprenorphine/#comments Mon, 11 Feb 2019 11:45:50 +0000 http://emcrit.org/?p=459692 In critical care, we’ve been treating patients with opioid use disorder for a long time.  If they’re intubated for intoxication, we extubate them and send them home.  If they’re septic with endocarditis, we treat their sepsis.  Unfortunately, this isn’t enough.  We’re treating the complications of opioid use disorder, without addressing the underlying problem. Recently, medication-assisted […]

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/buprenorphine/feed/ 1
EMCrit Podcast 240 – Renal Compartment Syndrome & It’s all about the Venous Side and We’ve Been Fracking it up for Years https://emcrit.org/emcrit/renal-compartment-syndrome-chf/ https://emcrit.org/emcrit/renal-compartment-syndrome-chf/#comments Sun, 10 Feb 2019 14:38:23 +0000 http://emcrit.org/?p=459590 Renal Compartment Syndrome, Venous Congestion, CHF, and POCUS.

EMCrit Project by Scott Weingart.

https://emcrit.org/emcrit/renal-compartment-syndrome-chf/feed/ 9 Renal Compartment Syndrome, Venous Congestion, CHF, and POCUS. Newest Member of the EMCrit Team: Phillippe Rola

Internist-Intensivist in Montreal, Canada, Mad Sonographer, Proud Daddy and Husband, and sometimes jiujitero.

Editor-in-Chief of ThinkingCriticalCare.com
POCUS Portal Vein from the Case

More on the Discussion in the Podcast on Thinking Critical Care

* Physiological Resuscitation
POCUS, Mythology and Hemodynamic Awesomeness

H&R 2019 Conference

* All info
Scott D. Weingart, MD FCCM clean 21:26
IBCC chapter: Thyroid storm https://emcrit.org/pulmcrit/thyroid-storm-2/ https://emcrit.org/pulmcrit/thyroid-storm-2/#comments Thu, 07 Feb 2019 12:33:37 +0000 http://emcrit.org/?p=459525 Thyroid storm is a bit of a zebra.  It can mimic a variety of common conditions (e.g. sepsis, delirium, heart failure).  Unfortunately, if you're not looking for it, you probably won't find it.   Once identified, an organized multimodal treatment regimen will generally get the job done.  But be careful - these patients may have varying physiology, so blindly following the same rubric for every single patient isn't the answer.

EMCrit Project by Josh Farkas.

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Tox and Hound – Not For Human Consumption https://emcrit.org/toxhound/not-for-human-consumption/ https://emcrit.org/toxhound/not-for-human-consumption/#comments Mon, 04 Feb 2019 17:20:11 +0000 https://emcrit.org/?p=459459 by Dan Rusyniak At my poison center we have seen an increasing number of a calls related to a drug I had never heard of – Tianeptine. Tianewhat? Yes, I thought the same. Although I had not heard of it, this is a drug that has been around since the 1970’s. Synthesized in the 60’s […]

EMCrit Project by Tox & Hound.

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The Case of the Incidental Bystander Continues https://emcrit.org/emnerd/the-case-of-the-incidental-bystander-continues/ https://emcrit.org/emnerd/the-case-of-the-incidental-bystander-continues/#comments Fri, 01 Feb 2019 13:48:29 +0000 http://emcrit.org/?p=459437 In October 2016 the Emergency Medicine community was faced with the publication of the now infamous PESIT trial, and the symbolic wrench its authors carelessly tossed into the already indecisive diagnostic work up of patients presenting to the Emergency Department following a syncopal event1. Published in the NEJM, Prandoni et al enrolled patients who were admitted […]

EMCrit Project by Rory Spiegel.

https://emcrit.org/emnerd/the-case-of-the-incidental-bystander-continues/feed/ 3
IBCC chapter & cast: thrombocytopenia & HITT https://emcrit.org/pulmcrit/thrombocytopenia/ https://emcrit.org/pulmcrit/thrombocytopenia/#comments Thu, 31 Jan 2019 11:11:45 +0000 http://emcrit.org/?p=459418 Thrombocytopenia is extremely common in critical illness.  It's generally a consequence rather than a cause of illness, predicting increased mortality.  However, we must remain alert for cases where serious hematologic disease is afoot.  The major concern here is the ever-looming possibility of heparin-induced thrombocytopenia and thrombosis (HITT).  This chapter explores thrombocytopenia and provides an evidence-based […]

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/thrombocytopenia/feed/ 3
The Case of the False Dichotomy https://emcrit.org/emnerd/the-case-of-the-false-dichotomy/ https://emcrit.org/emnerd/the-case-of-the-false-dichotomy/#comments Wed, 30 Jan 2019 00:47:35 +0000 http://emcrit.org/?p=459390 Often in the interpretation of medical literature we are forced into false dichotomies. Compelled to choose between two hypotheses, neither of which are representative of the data presented. Such is the case with a recent trial published in Intensive Care Medicine in which Guitton et al1 examine the efficacy of apneic oxygenation during RSI in critically […]

EMCrit Project by Rory Spiegel.

https://emcrit.org/emnerd/the-case-of-the-false-dichotomy/feed/ 3
The Dantastic Mr. Tox & Howard – S02E07 – Release the Kratom https://emcrit.org/toxhound/s02e07-release-the-kratom-2/ https://emcrit.org/toxhound/s02e07-release-the-kratom-2/#respond Tue, 29 Jan 2019 06:40:37 +0000 https://emcrit.org/?p=459377 Alternative treatments for opioid use disorder and music with Dr. Ed Boyer Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Ed Boyer about therapies for opioid use disorder, including kratom, ibogaine, and loperamide. Great stuff, deep science and a dispelling of some myths while recognizing some less than savvy science out there. . […]

EMCrit Project by Tox & Hound.

https://emcrit.org/toxhound/s02e07-release-the-kratom-2/feed/ 0
PulmCrit- Inhaled NO for submassive PE: iNOPE or iYEP? https://emcrit.org/pulmcrit/inope/ https://emcrit.org/pulmcrit/inope/#comments Mon, 28 Jan 2019 11:47:08 +0000 http://emcrit.org/?p=459337 The use of an inhaled pulmonary vasodilator is a logical strategy for stabilization of PE patients (especially nitric oxide, which may be depleted in this situation). Previously inhaled nitric oxide has only been supported by case series.

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/inope/feed/ 5
EMCrit 239 – Vent Alarms = Code Blue https://emcrit.org/emcrit/vent-alarms/ https://emcrit.org/emcrit/vent-alarms/#comments Sat, 26 Jan 2019 22:00:59 +0000 http://emcrit.org/?p=459293 All things Vent Alarms

EMCrit Project by Scott Weingart.

https://emcrit.org/emcrit/vent-alarms/feed/ 8 All things Vent Alarms Vent Alarms should be Regarded as Code Blue
If you cannot instill this into your culture, patients will die

If they are crashing, do DOPES
ETCO2 on any Vented Pt
This is what the real alarm should be
High (Peak) Pressure

Peak Only

* Check the circuit

* fluid pooling in circuit
* fluid pooling in filter
* kinking of circuit

* Tube too small or biofilmed
* Bronchospasm
* Biting on ETT

Peak & Plat High

* Tube in Mainstem
* Pneumothorax
* Bad Lungs >> Turn down the Vt
* Abd Compartment

Low Peak Pressure

* Disconnect
* ETT Cuff Deflated
* Pt effort

Low Ve/Vt

* Cuff Issues (See EMCrit Wee )
* Bronchopleural Fistula

Low O2 Alarm

* Not hooked Up
* Gases Messed Up
* Sensor Messed up

What to Do with Continued Alarms Despite Sedation, Equipment Check, Suctioning

* Consider Bronchoscopic Assessment
* If Patient begins to crash, consider tube exchange if bronch not available

Breakdown on Alarm Types
Article on Vent Alarm Stats 1

See More
High-Peek on ALIEM

Cvach M, Stokes J, Manzoor S, et al. Ventilator Alarms in Intensive Care Units: Frequency, Duration, Priority, and Relationship to Ventilator Parameters. Anesth Analg. September 2018. [PubMed]

Scott D. Weingart, MD FCCM clean 21:27
IBCC chapter: Antibiotics for the critically ill patient https://emcrit.org/pulmcrit/antibiotics/ https://emcrit.org/pulmcrit/antibiotics/#comments Thu, 24 Jan 2019 14:25:34 +0000 http://emcrit.org/?p=459313 We spend a lot of time obsessing over the finer details of critical care:  which fluid is best?  which vasopressor is best?  will another liter of fluid help?  These details are important, but for a septic patient something more important than any of these details is choosing the right antibiotic(s).  In septic shock, source control and […]

EMCrit Project by Josh Farkas.

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IBCC chapter & cast: Undifferentiated shock https://emcrit.org/pulmcrit/shock/ https://emcrit.org/pulmcrit/shock/#comments Thu, 17 Jan 2019 15:06:03 +0000 http://emcrit.org/?p=458596 Shock is the next-door neighbor of death.  Shock can present in a myriad of different forms, making early recognition challenging.  However, early diagnosis is essential.  Shock can be caused by a broad differential of serious illnesses.  Unlike most differential diagnosis lists, every item on this differential is life-threatening.  Fortunately, many causes of shock are reversible […]

EMCrit Project by Josh Farkas.

https://emcrit.org/pulmcrit/shock/feed/ 11
EMCrit Wee – Getting Things Done 2019 Update https://emcrit.org/emcrit/gtd2019/ https://emcrit.org/emcrit/gtd2019/#comments Wed, 16 Jan 2019 22:50:06 +0000 http://emcrit.org/?p=456498 GTD Update for 2019

EMCrit Project by Scott Weingart.

https://emcrit.org/emcrit/gtd2019/feed/ 5 GTD Update for 2019 Original GTD (Gettin' Sh*t Done) Posts

* EMCrit Podcast 136 - Getting Shit Done
* EMCrit Podcast 209 - GTD Redux - Opportunities, Time, & Future Selves

Switched to Todoist

* Todoist Summary
* Integration with Gcal
* IFTTT and Zapier

Massive Action Planning by Tony Robbins

* Write down the results you want to achieve. (be specific, quantitate if possible)
* Write down your purpose (compelling reasons why you want to accomplish this goal--use trigger words, emotion)
* Develop a sequence of priority actions.

or as Carl Pullein discusses, OPA:

Outcome, Purpose, Actions

Inboxes are Deadly
Prune, prune, prune

Use email inbox for everything (shortcut/workflow on ios & boomerang on firefox)
Inbox Zero
Subconscious Cognitive Bandwidth
It is not the time, it is the weight

If anything you do is:

1. Fiddly &

2. Infrequent

Make a checklist
Directly Responsible Person (DRI)
Who is the the DRI directly responsible individual from Jobs/Apple

Problem for Future Homer
Why we don't care about our future selves

Now on to the Wee...]]>
Scott D. Weingart, MD FCCM clean 23:57
PulmCrit- Vancomycin pharmacokinetics: Make vanco great again https://emcrit.org/pulmcrit/vanco/ https://emcrit.org/pulmcrit/vanco/#comments Wed, 16 Jan 2019 14:36:22 +0000 http://emcrit.org/?p=457864 Traditionally, vancomycin doses have been adjusted to target a specific trough level.  However, it is increasingly clear that the trough level is an inadequate measurement of vancomycin exposure.  Furthermore, the practice of waiting until the fourth dose to measure the trough level may expose the patient to days of suboptimal therapy.

EMCrit Project by Josh Farkas.

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Tox and Hound – Some Like It Hot https://emcrit.org/toxhound/likeithot/ https://emcrit.org/toxhound/likeithot/#comments Mon, 14 Jan 2019 18:26:14 +0000 https://emcrit.org/?p=457509 by Meghan Spyres The holidays are over and it’s time for that long stretch of thankless winter before spring is here again. Sounds like the perfect time to plan a trip somewhere tropical! Which also makes it the perfect time to review one of my favorite topics: marine envenomations. Although we typically think of the […]

EMCrit Project by Tox & Hound.

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PulmCrit- Acute infection & myocardial infarction: How afraid should we be? https://emcrit.org/pulmcrit/infection-mi/ https://emcrit.org/pulmcrit/infection-mi/#comments Mon, 14 Jan 2019 13:19:48 +0000 http://emcrit.org/?p=457465 Occasionally, the NEJM publishes a scary article that gets a lot of press, but doesn’t pan out to be valid.  The recent example is the PESIT study, which seemed to imply that everyone admitted with syncope had PE (don’t worry- they don’t). It looks like NEJM might be at it again, with this week’s review article on the relationship between acute infection and MI.

EMCrit Project by Josh Farkas.

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IBCC chapter & cast: Severe influenza https://emcrit.org/pulmcrit/influenza/ https://emcrit.org/pulmcrit/influenza/#comments Thu, 10 Jan 2019 14:24:29 +0000 http://emcrit.org/?p=456787 Initially I wasn't planning to write a chapter on influenza, because there is precious little evidence regarding ICU management.  However, even in the absence of solid evidence, we will be called upon to treat these patients.  Currently flu season is afoot, and it looks like it might be a bad one (with a predominance of […]

EMCrit Project by Josh Farkas.

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COMM CHECK: On Checklists https://emcrit.org/emcrit/comm-check-on-checklists/ https://emcrit.org/emcrit/comm-check-on-checklists/#comments Thu, 03 Jan 2019 16:01:49 +0000 http://emcrit.org/?p=455321 The Checklist that Saved an Aircraft On October 30, 1935 Boeing engineers stood proudly by as their newest technological wonder, the Model 299 was about to demonstrate its capabilities to members of the  top brass of the Army Air Corps.  At the controls of the aircraft was the Army’s chief test pilot, Major Ployer P. […]

EMCrit Project by Mike Lauria.

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