EMCrit Project https://emcrit.org Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Mon, 21 Oct 2019 14:06:33 +0000 en-US hourly 1 https://wordpress.org/?v=5.2.4 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 Tox and Hound – Color Me Blue https://emcrit.org/toxhound/colormeblue/ https://emcrit.org/toxhound/colormeblue/#respond Mon, 21 Oct 2019 14:06:08 +0000 https://emcrit.org/?p=468049 by Christine Murphy Alternative Uses for Methylene Blue I like finding alternative uses for existing antidotes. Antidote research is very limited – let's be honest, there isn't a huge market out there for most antidotes. So, anytime an existing antidote's use can be expanded to other indications, I think that is a win. Methylene blue […]

EMCrit Project by Tox & Hound.

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PulmCrit Wee: Do fluid boluses before intubation help? (PREPARE trial) https://emcrit.org/pulmcrit/prepare/ https://emcrit.org/pulmcrit/prepare/#respond Mon, 21 Oct 2019 12:31:59 +0000 https://emcrit.org/?p=467955 I’m afraid she will tank after intubation, could you start some fluid? I brought a liter of fluid, just in case the blood pressure falls after intubation.  He is decompensating!  Run the fluid wide open! We’ve all probably heard and spoken those phrases.  Crystalloid is a traditional therapy in efforts to either prevent or mitigate […]

EMCrit Project by Josh Farkas.

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PulmCrit- Commentary on the new pneumonia guidelines using GIFs & some mini-rants https://emcrit.org/pulmcrit/idsa-cap-guidelines/ https://emcrit.org/pulmcrit/idsa-cap-guidelines/#comments Sat, 19 Oct 2019 09:54:32 +0000 https://emcrit.org/?p=467729 So, the new IDSA guidelines for community acquired pneumonia (CAP) are here.  This post will walk us through the guidelines, focusing primarily on issues that relate to critically ill patients.  Guidelines can get dull, I've added in GIFs to illustrate my feelings about each recommendation & kept things pretty informal.  Come for the GIFs, stay […]

EMCrit Project by Josh Farkas.

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IBCC chapter & cast – Methemoglobinemia https://emcrit.org/pulmcrit/methemoglobinemia/ https://emcrit.org/pulmcrit/methemoglobinemia/#respond Thu, 17 Oct 2019 11:22:53 +0000 https://emcrit.org/?p=467948 Methemoglobinemia is one of my favorite toxicology diagnoses.  The diagnosis can often be made at the bedside based on history and physical examination, which is a satisfying bit of detective work.  Once the diagnosis is made, patients generally respond promptly to a specific antidote (methylene blue).  And this isn't just a parlor trick – diagnosis […]

EMCrit Project by Josh Farkas.

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PulmCrit- Tranexamic acid for traumatic brain injury (CRASH3) https://emcrit.org/pulmcrit/crash3/ https://emcrit.org/pulmcrit/crash3/#comments Mon, 14 Oct 2019 22:01:44 +0000 https://emcrit.org/?p=467810 preamble CRASH-3 is the latest massive, pragmatic multi-center RCT brought to us by the London School of Hygiene and Tropical Medicine Trials Unit.  These investigators have created an extensive network of hospitals throughout the world with the capability of performing truly impressive trials.  Especially in the critical care arena, these trials have uniquely high power […]

EMCrit Project by Josh Farkas.

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EM Nerd-The Case of the Indecisive Antidote https://emcrit.org/emnerd/em-nerd-the-case-of-the-indecisive-antidote/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-indecisive-antidote/#comments Mon, 14 Oct 2019 22:00:16 +0000 https://emcrit.org/?p=467864 Studies examining the use of tranexamic acid (TXA) inescapably seem to pit our methodological rigorous demons against our practical clinical angels.  The CRASH-2 trial published in the Lancet in 2010 by Shakur et al, randomized 20,211 adult trauma patients presenting to 274 hospitals in 40 different countries to receive 1g of TXA over 10 min […]

EMCrit Project by Rory Spiegel.

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Tox and Hound – Up in Smoke https://emcrit.org/toxhound/upinsmoke/ https://emcrit.org/toxhound/upinsmoke/#comments Mon, 14 Oct 2019 16:33:14 +0000 https://emcrit.org/?p=467824 by Trevonne Thompson The Outbreak of Electronic Cigarette Use and Pulmonary Injury There is currently an outbreak of pulmonary injury associated with electronic cigarette use. As of October 8, 2019, the Centers for Disease Control and Prevention (CDC) reports 1,299 cases of lung injury associated with electronic cigarette use from 49 states and 1 U.S. […]

EMCrit Project by Tox & Hound.

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IBCC asthma chapter post-publication peer review by Weingart https://emcrit.org/pulmcrit/asthma-peer-review/ https://emcrit.org/pulmcrit/asthma-peer-review/#comments Fri, 11 Oct 2019 13:49:00 +0000 https://emcrit.org/?p=467782 Sometimes muggles criticize FOAM as lacking peer review, but that simply reflects a misunderstanding of the way peer review works here.  FOAMed operates off a post-publication peer review system.  This typically occurs mostly in the comments section of each blog or chapter (with some on twitter as well).  Unlike journals, anyone is free to leave […]

EMCrit Project by Josh Farkas.

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IBCC chapter & cast – Diffuse alveolar hemorrhage & ANCA vasculitis https://emcrit.org/pulmcrit/dah/ https://emcrit.org/pulmcrit/dah/#respond Thu, 10 Oct 2019 12:08:06 +0000 https://emcrit.org/?p=467751 Diffuse alveolar hemorrhage is encountered uncommonly, but it is useful to have a general understanding of this.  Many etiologies can cause diffuse alveolar hemorrhage, with pulmonary vasculitis being perhaps the most widely feared.  This chapter explores how to sift through the differential diagnosis of diffuse alveolar hemorrhage and, if vasculitis is suspected, how to initiate […]

EMCrit Project by Josh Farkas.

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EMCrit 257 – Pulseless Electrical Activity (PEA) is Stupid https://emcrit.org/emcrit/pea-is-stupid/ https://emcrit.org/emcrit/pea-is-stupid/#comments Wed, 09 Oct 2019 14:21:06 +0000 https://emcrit.org/?p=467317 Pulseless Electrical Activity ( PEA ) is confusing! The diagnosis and treatment of PEA is bogged down by terminology and misunderstandings. Spurred by a recent interview I did with Anton Helman of EM Cases, I lay down some of my thoughts on PEA here. The last time I discussed these issues was 5 years ago […]

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/pea-is-stupid/feed/ 15 Pulseless Electrical Activity ( PEA ) is confusing! The diagnosis and treatment of PEA is bogged down by terminology and misunderstandings. Spurred by a recent interview I did with Anton Helman of EM Cases, I lay down some of my thoughts on PEA here. Pulseless Electrical Activity ( PEA ) is confusing! The diagnosis and treatment of PEA is bogged down by terminology and misunderstandings. Spurred by a recent interview I did with Anton Helman of EM Cases, I lay down some of my thoughts on PEA here.



The last time I discussed these issues was 5 years ago with Zack and Joe on EDECMO 13.



PEA Progression to ROSC







POCUS Pulse



* Carotid POCUS Pulse* Badra et al. on POCUS Pulse







Narrow / Wide doesn't Work



Rory breaks it down on the CCnerd in a post about QRS size in PEA.



What to Do if You Have Compressions/POCUS Pulse but No BP



Prosen on Vasopressin for PEA



Critical Care and Neurocritical Care Boards Review Book







Mayo Clinic Board Review



Just fantastic! (Note: i received a reviewers' copy of this book)



Now on to the Podcast...




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Scott D. Weingart, MD FCCM clean 31:38
EM Nerd-The Case of the Hurried Objective https://emcrit.org/emnerd/em-nerd-the-case-of-the-hurried-objective/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-hurried-objective/#comments Tue, 08 Oct 2019 20:57:14 +0000 https://emcrit.org/?p=467644 In 2015, Centers for Medicare & Medicaid (CMS) published their sepsis core measure (SEP-1). This represented a nationally mandated sepsis management strategy presented in the form of a 3 and 6-hour bundle. Since its publication, the Surviving Sepsis Campaign (SSC) released their own 1-hour bundle (1), adding even more urgency to an already frenetic effort […]

EMCrit Project by Rory Spiegel.

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IBCC chapter & cast – Asthma https://emcrit.org/pulmcrit/asthma/ https://emcrit.org/pulmcrit/asthma/#comments Tue, 08 Oct 2019 13:56:10 +0000 https://emcrit.org/?p=467631 Severe asthma is a challenging topic, because this spans a lot of different patient phenotypes with varying severity and physiology.  This chapter attempts to outline some general principles to guide management, but ultimately clinical judgement and serial evaluation at the bedside will trump all of this.  The rarity, acuity, and heterogeneity of severe asthma make […]

EMCrit Project by Josh Farkas.

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Tox and Hound – Don’t Wernicke’s, B(1) Happy https://emcrit.org/toxhound/wernickes/ https://emcrit.org/toxhound/wernickes/#comments Mon, 07 Oct 2019 13:49:00 +0000 https://emcrit.org/?p=467575 by Meghan Spyres You take the perilous sign out of a 55-year-old patient with alcohol use disorder (AUD) who came to the ED intoxicated. “He’s just metabolizing” your colleague tells you. A few hours go by and he is now awake and asking to leave. The nurse road tests him and he can walk, but […]

EMCrit Project by Tox & Hound.

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EM Nerd-The Case of the Sour Remedy https://emcrit.org/emnerd/em-nerd-the-case-of-the-sour-remedy/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-sour-remedy/#comments Sat, 05 Oct 2019 01:37:00 +0000 https://emcrit.org/?p=467481 In 2017 Marik et al (1) published an observational before and after study examining the initiation of the sepsis cocktail for ICU patients admitted with sepsis. The authors noted, following the introduction of this cocktail, which included IV vitamin C, thiamine and hydrocortisone, ICU mortality dropped by an extraordinary 31.9% (40.4% to 8.5%). Since this […]

EMCrit Project by Rory Spiegel.

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PulmCrit- Hypothermia for non-shockable arrest: let’s not get hot-headed about this https://emcrit.org/pulmcrit/hyperion/ https://emcrit.org/pulmcrit/hyperion/#comments Thu, 03 Oct 2019 11:03:58 +0000 https://emcrit.org/?p=467437 background Fever is harmful in post-arrest patients.  This creates confusion in studies of hypothermia in post-arrest patients:  is the benefit of hypothermia due to fever avoidance, due to a benefit from hypothermia itself, or perhaps due to both?  Seminal studies in the early 2000s found mortality benefit from application of hypothermia to 33C after cardiac […]

EMCrit Project by Josh Farkas.

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Tox and Hound – Not All Gas Is Funny https://emcrit.org/toxhound/chemical-suicide/ https://emcrit.org/toxhound/chemical-suicide/#respond Wed, 02 Oct 2019 16:25:59 +0000 https://emcrit.org/?p=467410 by Jeanna Marraffa It’s 4:30 in the morning and the emergency department (ED) calls the poison center about multiple patients. A car was found disabled on the highway. When police arrived on scene, they found an unresponsive female in the front seat. Obstructing their view was a sign on the window stating – “Toxic Gas. […]

EMCrit Project by Tox & Hound.

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PulmCrit- CITRIS-ALI: Can a secondary endpoint stage a coup d’état? https://emcrit.org/pulmcrit/pulmcrit-citris-ali-can-a-secondary-endpoint-stage-a-coup-detat/ https://emcrit.org/pulmcrit/pulmcrit-citris-ali-can-a-secondary-endpoint-stage-a-coup-detat/#comments Tue, 01 Oct 2019 15:21:18 +0000 https://emcrit.org/?p=467362 background on IV vitamin C We live in divided times.  Paul Marik’s study on using vitamin C in sepsis was perhaps the most polarizing publication in recent memory (aside from perhaps the Mueller report).  It was lauded by some, yet derided just as strongly by others.  Unfortunately, the kerfuffle surrounding this study overshadowed the larger […]

EMCrit Project by Josh Farkas.

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EMCrit Wee – Farkas and I Discuss his Recent PulmCrit Guest Post on Asthma https://emcrit.org/emcrit/discussion-guest-post-on-asthma/ https://emcrit.org/emcrit/discussion-guest-post-on-asthma/#comments Fri, 27 Sep 2019 14:30:41 +0000 https://emcrit.org/?p=467335 A polite discussion about a controversial post

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/discussion-guest-post-on-asthma/feed/ 1 A polite discussion about a controversial post

So, Josh recently published a guest post on PulmCrit discussing some interesting ideas on the treatment of asthma. This post nearly gave me a stroke. Luckily I had some tPA sitting in my medicine cabinet and just took some empirically, b/c as the stroke neuro folks that respond to Swami's posts tell me, "It can't hurt."

As soon as I read Josh's post, I knew we must discuss this on the podcast to flesh out some of the issues raised.

You should read the post first:

* PulmCrit The Crashing Asthmatic with Leo Stemp

If you are interested in my Crashing Asthma Cast it is here:

* EMCrit 15 Asthma
* My response to Lew Rubinson's Comment

Then you can listen to this EMCrit wee....]]>
Scott D. Weingart, MD FCCM clean 47:34
IBCC chapter & cast – Metabolic Alkalosis https://emcrit.org/pulmcrit/metabolic-alkalosis/ https://emcrit.org/pulmcrit/metabolic-alkalosis/#respond Thu, 26 Sep 2019 09:57:01 +0000 https://emcrit.org/?p=467218 Metabolic alkalosis is fairly common among hospitalized patients.  The most severe cases are often due to large-volume diuresis (deresuscitation), massive transfusion, or ongoing nasogastric suction.  Many patients will respond to simple resuscitation with normal saline (an acidotic fluid which is perfect here).  However, more severe or complex cases will require a multi-modal strategy which utilizes […]

EMCrit Project by Josh Farkas.

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PulmCrit – The Crashing Asthmatic with Leo Stemp https://emcrit.org/pulmcrit/crashing-asthmatic/ https://emcrit.org/pulmcrit/crashing-asthmatic/#comments Wed, 25 Sep 2019 09:54:56 +0000 https://emcrit.org/?p=467174 Today will feature a guest post with Leo Stemp exploring some bleeding-edge concepts.  Very soon, an Internet Book of Critical Care chapter will round things out with a broader look at this disease. Leo Stemp trained first in critical care (including medical school at Harvard, internal medicine residency at Mount Sinai, and a fellowship at […]

EMCrit Project by Josh Farkas.

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Tox and Hound – Plumbus Amongus https://emcrit.org/toxhound/lead/ https://emcrit.org/toxhound/lead/#respond Tue, 24 Sep 2019 20:18:01 +0000 https://emcrit.org/?p=467281 by Diane Calello Washington, DC. Flint. Pittsburgh. Detroit. Newark. Every time you turn around, another US city develops a drinking water crisis stemming from the discovery of elevated lead levels. While the water crisis in Flint, Michigan captured national attention when it became clear that increased water lead levels were reaching the city’s children, it […]

EMCrit Project by Tox & Hound.

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EMCrit Wee – Zero Point Survey Video by Cliff Reid https://emcrit.org/emcrit/emcrit-wee-zero-point-survey-video-by-cliff-reid/ https://emcrit.org/emcrit/emcrit-wee-zero-point-survey-video-by-cliff-reid/#respond Tue, 24 Sep 2019 14:39:12 +0000 http://emcrit.org/?p=448883 There is survey before the primary...

EMCrit Project by Scott Weingart.

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EM Nerd-The Case of the Microscopic Imperative https://emcrit.org/emnerd/em-nerd-the-case-of-the-microscopic-imperative/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-microscopic-imperative/#comments Fri, 20 Sep 2019 01:22:21 +0000 https://emcrit.org/?p=467186 In the management of sepsis, the acquisition of blood cultures prior to the administration of antibiotics has been a long-held dictum, even before it gained the regulatory support due to its place in the SEP-1 3-hour bundle. But how much is lost if we defer the acquisition of blood cultures until after the administration of […]

EMCrit Project by Rory Spiegel.

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IBCC chapter & cast – Non-Anion Gap Metabolic Acidosis (NAGMA) https://emcrit.org/pulmcrit/nagma/ https://emcrit.org/pulmcrit/nagma/#comments Thu, 19 Sep 2019 11:38:04 +0000 https://emcrit.org/?p=467155 Non-Anion Gap Metabolic Acidosis (NAGMA) has a broad differential diagnosis.  Often the cause is obvious, but otherwise this leads to a rat's nest of various forms of renal tubular acidosis (RTA).  Fortunately, appropriate treatment generally doesn't require immediate diagnosis of the specific cause of the NAGMA.  So have no fear – give the evaluation an […]

EMCrit Project by Josh Farkas.

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EMCrit 256 – RUSH Redux with Jacob Avila https://emcrit.org/emcrit/rush-redux/ https://emcrit.org/emcrit/rush-redux/#respond Wed, 18 Sep 2019 11:00:10 +0000 https://emcrit.org/?p=467045 Some dozen years ago, a couple of my buddies and I created the RUSH exam. Today, I give you an update:

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/rush-redux/feed/ 0 Some dozen years ago, a couple of my buddies and I created the RUSH exam. Today, I give you an update:

Some dozen years ago, a couple of my buddies and I created the RUSH exam. Today, I give you an update:

To keep me from saying something stupid regarding ultrasound, I wanted to get a master of all things ED POCUS to act as chaperone. There is no better person to fill this role than...
Jacob Avila
Host of the 5minutesono podcast and cohost of the ultrasound podcast, Jacob is an incredible ultrasound educator. He is soon to be taking over as the director of ultrasound in the ED at the University of Kentucky. We also recorded a second episode that will air soon on EMCrit.
RUSH Updates
since we sent this exam into the wild, there have been many misconceptions and alterations of the vision of the exam. Some of these have led to beneficial evolution and some of them are messing s&*t up. Hopefully, this episode clears up some of the latter.
Now on to the podcast...


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Scott D. Weingart, MD FCCM clean 29:09
IBCC chapter & cast: Anion-Gap Metabolic Acidosis https://emcrit.org/pulmcrit/agma/ https://emcrit.org/pulmcrit/agma/#respond Tue, 17 Sep 2019 11:21:45 +0000 https://emcrit.org/?p=467088 Anion gap metabolic acidosis is generally the most worrisome pH abnormality.  Many of the causes of anion gap elevation reflect a life-threatening problem (e.g. hyperlactatemia, shock, diabetic ketoacidosis, toxic alcohol poisoning).  Particularly if the anion gap elevation is a new finding, this mandates immediate investigation (and sometimes, simultaneous resuscitation).  This chapter explores the causes of […]

EMCrit Project by Josh Farkas.

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IBCC chapter & cast – Approach to pH diagnosis https://emcrit.org/pulmcrit/ph/ https://emcrit.org/pulmcrit/ph/#respond Thu, 12 Sep 2019 09:53:46 +0000 https://emcrit.org/?p=467008 According to Albert Einstein, “Everything should be made as simple as possible, but not simpler.”  This is a similar sentiment to Occam's Razor.  Acid-base analysis is a good example of this principle.  It's possible to make things extraordinarily fancy and complex.  To analyze pH status we could obtain an ABG, complete blood count, calcium, magnesium, […]

EMCrit Project by Josh Farkas.

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The Dantastic Mr. Tox & Howard – S02E12 – More Beans, Mr. Taggart? https://emcrit.org/toxhound/s02e12-beans/ https://emcrit.org/toxhound/s02e12-beans/#respond Thu, 12 Sep 2019 01:45:35 +0000 https://emcrit.org/?p=467020 Kidney injury and dialysis in toxicology with Dr. Josh King Join Dan (@drusyniak) &Howard (@heshiegreshie) as they get deep into the nephron with Dr. Josh King (@nephrotox). Gather round as we quote Homer Smith, learn why we have a heart (to pump blood to the kidneys, ‘natch), trigger Howard about lithium, and always remember to […]

EMCrit Project by Tox & Hound.

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EMCrit Wee – First Study of the Benefits of an EDICU https://emcrit.org/emcrit/ec3-study/ https://emcrit.org/emcrit/ec3-study/#comments Tue, 10 Sep 2019 17:11:59 +0000 https://emcrit.org/?p=466993 Michigan's EC3

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/ec3-study/feed/ 10 Michigan's EC3
On Podcast 168, I discussed Michigan's EC3 stand-alone EDICU. The folks from the EC3 recently published on their first 2.5 years of operation in a before and after trial.

Gunnerson et al. EC3 Study

I gathered a bunch of my EC3 buddies to discuss the article.

 

On the call, you will hear:

* Bob Neumar, Chair of EM
* Kyle Gunnerson, Division Chief of Emergency Critical Care and Director of the EC3
* Ben Bassin, Operations Director for the EC3
* Renee Havey, CNS for the EC3
* Nate Haas, EC3 Faculty

Tell us what you think below
Now on to the Wee...]]>
Scott D. Weingart, MD FCCM clean 23:15
EMCrit Guest Post – Drawing Circles for Bougie Hangup by Neil Dasgupta https://emcrit.org/emcrit/drawing-circles/ https://emcrit.org/emcrit/drawing-circles/#respond Fri, 06 Sep 2019 15:38:11 +0000 https://emcrit.org/?p=459866 A new technique to deal with bougie hold-up

EMCrit Project by Guest Author.

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EM Nerd-The Case of the Optical Misperception https://emcrit.org/emnerd/em-nerd-the-case-of-the-optical-misperception/ https://emcrit.org/emnerd/em-nerd-the-case-of-the-optical-misperception/#comments Thu, 05 Sep 2019 16:16:43 +0000 https://emcrit.org/?p=466876 Whether we like it or not, high-sensitivity troponin assays, recently approved by the FDA, will soon replace the 4th generation assays currently in operation. And while many claims have been made regarding their clinical utility, the implications for our standard chest pain workflow are unclear.  A recent publication by Chew et al, provides us a […]

EMCrit Project by Rory Spiegel.

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IBCC chapter & cast – Submassive & Massive PE https://emcrit.org/pulmcrit/pe/ https://emcrit.org/pulmcrit/pe/#comments Thu, 05 Sep 2019 12:04:11 +0000 https://emcrit.org/?p=466852 PE is the third leading cause of vascular mortality, after myocardial infarction and stroke.  It is an enormously heterogeneous and unpredictable disease, which makes treatment difficult.  As such, it should not be surprising that PE therapy remains highly controversial.  For example, the new European Society of Cardiology guidelines recommend anticoagulation and watchful waiting for high-risk […]

EMCrit Project by Josh Farkas.

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EMCrit – The Pigtail Video https://emcrit.org/emcrit/pigtail-video/ Thu, 05 Sep 2019 02:57:28 +0000 https://emcrit.org/?p=466839 Pigtail Insertion

EMCrit Project by Scott Weingart.

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EMCrit 255 – Pigtails for Pleural Problems (Percutaneous Thoracostomy) https://emcrit.org/emcrit/pigtails/ https://emcrit.org/emcrit/pigtails/#comments Wed, 04 Sep 2019 17:11:55 +0000 https://emcrit.org/?p=466828 Pigtails are just plain nicer

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/pigtails/feed/ 20 Pigtails are just plain nicer
Pigtails should replace chest tubes for most pneumothoraces and pleural effusions requiring drainage. In this episode, I discuss points on use and placement. The next post will be a video on an actual placement. Please put your comments and thoughts below.

For a video of the procedure,

come on over here:

EMCrit -  The Pigtail Video
Updates:

* See a real-time ultrasound placement from ThinkingCC
* ThinkingCC's thoughts on Pigtails

Now on to the Podcast...]]>
Scott D. Weingart, MD FCCM clean 30:08
IBCC chapter & cast – Anticoagulation reversal https://emcrit.org/pulmcrit/anticoagulation-reversal/ https://emcrit.org/pulmcrit/anticoagulation-reversal/#comments Thu, 29 Aug 2019 11:45:10 +0000 https://emcrit.org/?p=466695 We are frequently faced with patients who require reversal of anticoagulation due to hemorrhage or an emergent procedure.  This has grown rather complicated, due to the emergence of numerous new anticoagulants and reversal agents.  Furthermore, new evidence is emerging regarding the reversal of old agents (e.g. the PATCH trial regarding platelet transfusion in patients on aspirin). 

EMCrit Project by Josh Farkas.

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Tox and Hound – Don’t Be Shellfish https://emcrit.org/toxhound/shellfish/ https://emcrit.org/toxhound/shellfish/#comments Mon, 26 Aug 2019 15:17:32 +0000 https://emcrit.org/?p=466549 by Howard Greller In the late 1880’s, University of Hamburg Professor Ludwig von schlechte Schalentiere was convicted for the shocking and untimely deaths of tens of his fellow Hamburgers. Proclaiming his innocence until his death in prison, he would never live to see his name cleared. What led to the suspected poisoning deaths of so […]

EMCrit Project by Tox & Hound.

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PulmCrit- How to use IV epinephrine for anaphylaxis https://emcrit.org/pulmcrit/iv-epinephrine-anaphylaxis/ https://emcrit.org/pulmcrit/iv-epinephrine-anaphylaxis/#comments Mon, 26 Aug 2019 13:28:11 +0000 https://emcrit.org/?p=466626 When treating anaphylaxis, epinephrine is generally given via an intramuscular (IM) route.  This is well established to be effective and life-saving.  One advantage of IM administration is immediate use (without requiring intravenous access), including by patient auto-injection.  IM epinephrine is doubtless the best approach for patient self-treatment, for first responders, and for immediate treatment in […]

EMCrit Project by Josh Farkas.

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EMCrit 254 – Central Line Tips and Tricks with Robby O and Me from EEM 2019 https://emcrit.org/emcrit/emcrit-254-central-line-tips-and-tricks-with-robby-o-and-me-from-eem-2019/ https://emcrit.org/emcrit/emcrit-254-central-line-tips-and-tricks-with-robby-o-and-me-from-eem-2019/#comments Thu, 22 Aug 2019 15:08:31 +0000 https://emcrit.org/?p=466298 Central Line Tips and Tricks

EMCrit Project by Scott Weingart.

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https://emcrit.org/emcrit/emcrit-254-central-line-tips-and-tricks-with-robby-o-and-me-from-eem-2019/feed/ 3 Central Line Tips and Tricks
I always have a great time at the Essentials of Emergency Medicine conference, not just because it is an amazing conference, but because I get to hang out with my buddy, Rob Orman. This year, we did a on-stage demo of central line tips and tricks. Hope you enjoy:
Here's the Vid:


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Scott D. Weingart, MD FCCM clean 15:51 yes
IBCC chapter & cast: Tumor Lysis Syndrome https://emcrit.org/pulmcrit/tumor-lysis-syndrome/ https://emcrit.org/pulmcrit/tumor-lysis-syndrome/#respond Thu, 22 Aug 2019 11:36:31 +0000 https://emcrit.org/?p=466472 Tumor lysis syndrome isn't encountered very often in critical care, but we will see the most extreme extent of this illness.  Within the last decade, rasburicase has been a game-changer here.  Understanding some basic physiology will guide the optimal diagnosis and treatment of tumor lysis syndrome in the post-rasburicase era. The IBCC chapter is located […]

EMCrit Project by Josh Farkas.

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Tox and Hound – Lifeguard Lessons https://emcrit.org/toxhound/lifeguard-lessons/ https://emcrit.org/toxhound/lifeguard-lessons/#comments Mon, 19 Aug 2019 16:04:04 +0000 https://emcrit.org/?p=466424 by Andrew Stolbach Toxicology and swimming pool management are both applied forms of chemistry. My six summers as a lifeguard and pool operator prepared me to be a doctor as well as any class in medical school (I’m looking at you, histology.) I now work in an emergency department and specialize in toxicology. And, while […]

EMCrit Project by Tox & Hound.

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