CONTENTS Rapid Reference 🚀 Forward Crystalloids vs. colloids Step I: Balanced Crystalloid Choice of balanced crystalloid Step II: pH-guided resuscitation Hypertonic & isotonic bicarbonate Therapeutic alkalinization to augment permissive hypercapnia Podcast Questions & discussion Pitfalls The illustration above may appear a bit amusing, but this actually mirrors various practices that I’ve encountered during my training […]
Search Results for: aprv
Hemophagocytic LymphoHistiocytosis (HLH)
CONTENTS Basics – what is HLH? Clinical features of HLH Laboratory findings Ferritin Lumbar puncture Pathology – Hemophagocytosis Causes of HLH Differential diagnosis – Closest mimics of HLH Approach to the diagnosis of HLH Treatment Treatment of the underlying cause (if possible) Steroid IL1 antagonism JAK inhibition Etoposide Podcast Questions & discussion Pitfalls what is […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
CONTENTS Rapid Reference 🚀 SCAPE vs subacute pulmonary edema Diagnosis Triggers of SCAPE Principles of treatment CPAP or BiPAP Nitroglycerine Oral vasodilators Volume management & diuresis Opioid Podcast Questions & discussion Pitfalls SCAPE dx & rx checklist ✅ central clinical findings of SCAPE (more) Rapid onset of severe dyspnea. Hypoxemia. Hypertension (SBP >160 mm and/or […]
Typical bacterial pneumonias
CONTENTS Streptococcus pneumoniae (pneumococcus) Streptococcus pyogenes (Group A strep) Staphylococcus aureus (MSSA & MRSA) Haemophilus influenzae Moraxella catarrhalis Pseudomonas aeruginosa Klebsiella pneumoniae Other related topics: Rhodococcus equi Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid […]
Toxic Shock Syndrome (TSS)
CONTENTS Rapid Reference 🚀 Pathophysiology Epidemiology Clinical presentation Lab tests Diagnosis Differential diagnosis Overall approach to diagnosis CDC diagnostic criteria Treatment Basic sepsis resuscitation Antibiotics Source control Intravenous immunoglobulin (IVIG) Purpura fulminans Preventing nosocomial transmission Podcast Questions & discussion Pitfalls pathophysiology Some Streptococcus and Staphylococcus species secrete superantigens that causes widespread activation of T-lymphocytes (figure […]
Guillain Barre Syndrome (GBS)
CONTENTS Definition and variants Epidemiology Signs & symptoms Diagnosis Differential diagnosis (neuromuscular chapter) CSF examination Electromyography MRI Ganglioside serology Diagnostic criteria Treatment IVIG versus plasmapheresis Management of dysautonomia Analgesia Monitoring pulmonary function tests Noninvasive respiratory support Intubation GBS in COVID-19 Podcast Questions & discussion Pitfalls Guillain Barre Syndrome (GBS) refers to a group of acute, […]
Spinal Cord
CONTENTS Spinal cord basics Anatomy Recognizing spinal cord injury Lesion localization Bowel and bladder symptoms Spinal cord radiology Patterns of axial involvement Patterns of longitudinal involvement Acute & subacute myelopathy Potential causes Investigation Blood tests CSF evaluation Imaging Specific myelopathies Spinal cord infarction Spinal dural arteriovenous fistula (dAVF) Spinal epidural hematoma Cauda equina syndrome Nitrous […]
Guest Post – Down with STEMI – The OMI Manifesto by Pendell Meyers
Down with STEMI
Hyponatremia
CONTENTS Rapid Reference 🚀 Diagnosis & symptoms Causes Evaluation Lab panel Isotonic fluid challenge Risk stratification Initial treatment (e.g., in ED) Initial hyponatremia package Target rate of increase Subsequent therapeutic strategy Rapidly reversible cause: DDAVP clamp DDAVP clamp-bolus strategy SIADH with persistent cause Heart failure Cirrhosis Hypokalemic hyponatremia Oops, the patient’s sodium over-corrected Why not […]
Coagulation tests (conventional & viscoelastic)
CONTENTS Rapid Reference 🚀 Cell-based coagulation model Traditional tests of enzymatic coagulation INR prolongation with normal PTT PTT prolongation with normal INR Prolongation of both INR & PTT Thrombin Time & fibrinogen “level” (Clauss assay) Thromboelastography (TEG) Strengths and weaknesses of TEG TEG interpretation Using TEG to guide blood product transfusion Platelet dysfunction in critical […]
Pulmonary hypertension (PH)
CONTENTS Symptoms of PH Functional assessment Diagnosis Chest radiograph CT scan Echocardiography Pulmonary artery catheterization (PAC) Vasoreactivity testing Causes of PH Evaluation for PH of unknown etiology Treatment – array of available therapies Basic supportive care for PH Calcium channel blockers Endothelin-receptor antagonists Phosphodiesterase-5 inhibitors & guanylate cyclase stimulators Prostacyclins & prostacyclin receptor agonists Systemic […]
Histoplasmosis
CONTENTS Epidemiology Different forms of clinical disease: Acute (& subacute) pulmonary histoplasmosis Granulomatous mediastinitis Broncholithiasis Fibrosing mediastinitis Chronic cavitary pulmonary histoplasmosis (CCPH) Progressive disseminated histoplasmosis CNS histoplasmosis Diagnostic studies Histoplasma antigen test Histoplasma antibody (serology) Bronchoscopy Tissue biopsy (Fungal culture) Management Pathophysiology Questions & discussion abbreviations used in the pulmonary section: ABPA: Allergic bronchopulmonary aspergillosis […]
Antifungal Agents
CONTENTS Rapid Reference 🚀 Overview Azoles (#1) Choosing your azole: Spectrum & use of each azole Choice of azole for various infections Contraindications & drug-drug interactions (#2) Pharmacology, dosing, and drug levels: Voriconazole Isavuconazole Fluconazole Itraconazole (#3) Toxicity & monitoring Echinocandins (caspofungin, micafungin, anidulafungin) Liposomal amphotericin Podcast Questions & discussion Pitfalls antifungal agents: azole interactions: […]
Atypical pneumonias
CONTENTS Nonzoonotic atypical pneumonias: Legionella Mycoplasma Chlamydia pneumoniae Zoonotic atypical pneumonias: Chlamydia psittaci (psittacosis) Francisella tularensis (tularemia)* Coxiella burnetii (Q fever)* *May fail to respond to azithromycin; doxycycline will cover. Leptospirosis Questions & discussion diagnostic clues 🔍 Lack of upper respiratory features. 🔍 Extrapulmonary involvement (e.g., gastrointestinal, neurological). 🔍 Labs: Procalcitonin is usually moderately elevated. […]