Anyone who has spent some time in a cardiac intensive care unit understands the physiologic appeal of the intra-aortic balloon pump (IABP). Anecdotally its use improves multiple clinical endpoints that for years have been considered surrogates for patient important outcomes. And yet, despite these physiologic advantages when examined in a rigorous fashion, IABPs have failed […]
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Endocarditis
CONTENTS Rapid Reference 🚀 Diagnosis When to suspect endocarditis Lab workup Septic pulmonary emboli Echocardiography (TTE vs TEE) Diagnostic strategies & criteria European Society of Cardiology criteria Manifestations include: Metastatic infection Neurologic complications Septic embolic encephalitis Antibiotics Empiric therapy Definitive therapy Methicillin-sensitive Staph. 📖 Methicillin-resistant Staph. 📖 Enterococcus. 📖 Streptococcus pneumoniae. 📖 Beta-hemolytic Streptococci. 📖 […]
Salicylate intoxication
CONTENTS Rapid Reference 🚀 Diagnosis Epidemiology Signs & symptoms General laboratory abnormalities Salicylate level Treatment Airway management & decontamination Delirium & dysglycemia Alkalinization Volume resuscitation Hemodialysis Lab monitoring When to stop Podcast Questions & discussion Pitfalls Salicylate intoxication checklist ✅ Labs & targets (cycle q2hr until resolution) 📖 Glucose: Target >80-100 mg/dL if altered mental […]
COMM CHECK: More On Resuscitation Communication
If the words of command are not clear and distinct, if the orders are not thoroughly understood, the general is to blame – Sun Tzu Communication During Resuscitation Communication continues to be a major issue in virtually all high-stress, time-sensitive environments. This has been discussed a number of times on EMCrit, most recently in […]
EMCrit Shadowboxing Case 3 – Chicken or Egg – Which Organ Failed First?
Shadow Boxing Respiratory Failure Case
Community acquired biliary sepsis (ascending cholangitis & calculus cholecystitis)
CONTENTS Rapid Reference 🚀 Introduction Clinical presentation & differential diagnosis Diagnostic tests Labs Ultrasonography CT scan HIDA scan Diagnostic criteria Treatment Antibiotics Interventional tx for ascending cholangitis Interventional tx for cholecystitis Interventional tx for combined cholecystitis & cholangitis Podcast Questions & discussion Pitfalls community-acquired biliary sepsis checklist ✅ investigations Electrolytes, CBC with differential, coags. Liver […]
Acute Promyelocytic Leukemia (APL)
CONTENTS Rapid Reference 🚀 Primer Basic physiology of APL Why APL is important in critical care Diagnosis Epidemiology Clinical presentation Diagnostic studies Treatment Early initiation of ATRA Coagulopathy of APL Differentiation syndrome Sepsis Complications from arsenic trioxide Pseudotumor cerebri Podcast Questions & discussion Pitfalls Acute Promyelocytic Leukemia (APL) management ✅ basic workup & monitoring 📖 […]
Evidence for the Protocols
Evidence for Non-Invasive Protocol The paper that allowed us to start non-invasive protocols=gamechanger. [1. Jones AE, Shapiro NI, et al.; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb;303(8):739?46.] Is septic shock without lactate elevation as sick […]
EMCrit 330 – Rural Resus Explosion
more on rural resus
Sympathomimetic intoxication
CONTENTS Overview Clinical presentation Evaluation Management Serotonergic medications to avoid Agitation Seizures Hyperthermia Hypertension Chest pain & acute coronary syndrome Arrhythmia Atrial fibrillation Monomorphic ventricular tachycardia QT prolongation & torsade de pointes Hepatic failure Respiratory complications Rhabdomyolysis Hyponatremia Podcast Questions & discussion Pitfalls common sympathomimetic intoxications: Cocaine. Methamphetamine: Illicit “crystal meth.” Medicinally prescribed methamphetamine, used […]
Severe community-acquired pneumonia
CONTENTS Rapid Reference 🚀 Definition of severe CAP Diagnosis: Pneumonia diagnosis Differential diagnosis Post-diagnosis evaluation: Laboratory studies Imaging Lobar pneumonia Bronchopneumonia Interstitial pneumonia Necrotizing pneumonia (cavitation) Nodular pneumonia Pleural effusion Pneumothorax Chest wall invasion Septic pulmonary emboli ➡️ Bronchoscopy Triage: who needs ICU? Treatment Antibiotic selection Resuscitation Respiratory support Steroid Effusion management Treatment failure Duration […]
Post-cardiac arrest management
CONTENTS Rapid Reference 🚀 Cause & investigation Subsequent management: Targeted temperature management (TTM) Shivering management Cardiovascular interventions Pulmonary optimization ID: Aspiration pneumonia & antibiotics Endocrine: steroid Neurologic issues Podcast Questions & discussion Pitfalls investigations ✅ labs Fingerstick glucose. Basic labs (electrolytes including Ca/Mg/Phos, CBC, INR, PTT). Lactate. Troponin. Blood cultures if concern for sepsis. Pregnancy […]
Pericardial tamponade
CONTENTS Rapid Reference 🚀 Causes of tamponade Symptoms Physical exam Pulsus paradoxus Kussmaul’s sign EKG Radiology Echocardiography Diagnosis: Overall approach Low pressure tamponade Management Initial stabilization measures Ultrasound-guided pericardial drainage Interventional radiology or surgical drainage Tamponade patient in cardiac arrest Finer points: Limitations of this chapter Physiology Podcast Questions & discussion Pitfalls Key tests to […]
Type-1 Myocardial Infarction (OMI & NOMI)
CONTENTS diagnosis Nomenclature & types of MI Diagnosis DDx of MI EKG findings in MI Anterior OMI Inferior OMI RV OMI (RVMI, including management) Posterior OMI High lateral OMI OMI in LBBB or RV-pacing OMI vs aneurysm Hyperacute T-waves & de Winter pattern Wellens patterns Subendocardial ischemia patterns Risk stratification management General supportive care PCI […]
Mold infections (aspergillosis, mucormycosis)
CONTENTS Invasive pulmonary aspergillosis: Rapid Reference – Overall approach to the diagnosis 🚀 Basics Epidemiology Presentation Investigations Galactomannan Beta-D-Glucan Sputum culture & fungal stain PCR Radiology Bronchoscopy Tissue diagnosis Treatment Other forms of aspergillus infection: Aspergillus tracheobronchitis Aspergilloma Chronic cavitary pulmonary aspergillosis Other mold infections: Invasive pulmonary mucormycosis Podcast Questions & discussion Pitfalls #1/3: some […]
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