Grein et al. just published a case series of patients with COVID-19 treated with remdesivir via a compassionate use program. I’ve been expecting this paper with cold dread for some time now. There are several reasons that this publication is a media show, rather than a serious scientific endeavor. #1. Lack of a control group […]
Search Results for: septic shock
PulmCrit- CITRIS-ALI: Can a secondary endpoint stage a coup d’état?
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 […]
Double-coverage of gram negatives with a fluoroquinolone?
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 […]
Hypocaloric Nutrition: Theory, Evidence, Nuts, and Bolts
0 Introduction 0 Until recently there has been little evidence regarding the caloric target for feeding critically ill patients. In the absence of evidence, it has been assumed that we should aim to meet 100% of predicted energy needs. New multicenter RCTs challenge this dogma, particularly the PERMIT trial by Arabi et al. 0 Theory […]
EMCrit 314 – ShadowBoxing Case 1 – In the end, it’s always…
Our first shadowboxing episode…
EMCrit 322 – Shadowboxing Case 2 – Frack the EJ
The 2nd of the shadowboxing cases…
Antibiotics
CONTENTS commonly used antibiotics Aminoglycosides Ampicillin & Ampicillin-Sulbactam Aztreonam Carbapenems (meropenem & ertapenem) Cephalosporins Cephalosporin G1: cefazolin Cephalosporin G3: ceftriaxone Cephalosporin G3: ceftazidime Cephalosporin G4: cefepime Cephalosporin G5: ceftaroline Clindamycin Daptomycin Doxycycline Fluoroquinolones Linezolid Macrolides (Azithromycin, Clarithromycin) Metronidazole Nafcillin Nitrofurantoin Penicillin G Piperacillin-Tazobactam Rifampin Tigecycline Trimethoprim-Sulfamethoxazole Vancomycin specific pathogens Antibiogram & 1st line agents by […]
CT Angiogram for evaluation of severe hematochezia
Introduction 0 Gastrointestinal hemorrhage is a common reason for ICU admission. The approach to severe upper GI bleeding is relatively straightforward (figure below). A predictable approach facilitates planning ahead, and anticipating who needs to be contacted for help when. 0 0 Unfortunately, the approach to severe hematochezia is often less clear. Below is a description […]
EMCrit Shadowboxing Case 3 – Chicken or Egg – Which Organ Failed First?
Shadow Boxing Respiratory Failure Case
Catastrophic Antiphospholipid Syndrome (CAPS)
CONTENTS Rapid Reference – When to consider CAPS? 🚀 Pathophysiology Epidemiology & precipitating factors Clinical presentation Lab tests Testing for antiphospholipid antibody syndrome Laboratory abnormalities seen in CAPS Laboratory panel to investigate for possible CAPS Tissue diagnosis Differential diagnosis Diagnostic criteria Treatment Podcast Questions & discussion Pitfalls Diagnosing CAPS is challenging. A thumbnail of clues […]
Lung abscess
CONTENTS Basics Common causes: Epidemiology & clinical presentation Laboratory investigations Radiology Differential diagnosis Bronchoscopy Treatment Antibiotics Antibiotics for anaerobic abscess due to aspiration Antibiotics for other types of lung abscess Drainage Treatment failure Related: Echinococcosis Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD […]
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 […]
Invasive candidiasis
CONTENTS Introduction Candidemia Clinical manifestations Diagnosis Further investigation after diagnosis Treatment Intra-abdominal candidiasis Candida pneumonia? Candiduria Podcast Questions & discussion Pitfalls candida in the ICU Most cultures of Candida represent colonization (e.g., in the urine or especially in the sputum). Thus, there is a major risk of overtreating candidiasis. However, candida does occasionally cause severe […]
PulmCrit- The hidden fragility of meta-analyses: case study of the IOTA trial
Meta-analyses are widely assumed to be robust, without any attempt to test their fragility. This post describes two techniques to evaluate the fragility of a meta-analysis
Anaphylaxis
CONTENTS Rapid Reference 🚀 Diagnosis Clinical findings & definition Causes Differential diagnosis Investigation Anaphylaxis vs. bradykinin-mediated angioedema Treatment Source control Components of therapy Epinephrine IV epinephrine infusion Fluid resuscitation Antihistamines Steroid Inhaled beta-2 agonists Overall treatment strategy General treatment strategy Anaphylaxis in the beta-blocked patient Airway management Recovery phase & extubation Disposition Podcast Questions & […]
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