CONTENTS Basics Causes of ARDS ARDS due to DAD ARDS without DAD Clinical presentation Radiology Bronchoscopy Investigation Diagnosis Management Questions & discussion abbreviations used in the pulmonary section: ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: Antinuclear antibody 📖 […]
Search Results for: septic shock
Demystifying the p-value
Introduction 0 The limitations of p-values for null hypothesis testing has been debated since their invention in the 1920s. Unfortunately, statistics textbooks typically whitewash this controversy, presenting null hypothesis testing as the only viable approach to statistics. Recently, the journal of Basic and Applied Social Psychology took this debate a step further, officially banning the […]
Baclofen: therapy, intoxication, & withdrawal
CONTENTS Pharmacology Baclofen toxicity Diagnosis Management Baclofen withdrawal Symptoms & investigation Management: Oral baclofen withdrawal Intrathecal baclofen withdrawal Without intrathecal baclofen Podcast Questions & discussion Pitfalls pharmacokinetics Oral baclofen has a bioavailability of 70-85%, with absorption occurring within a few hours. It distributes to both the brain (where it causes sedation) and also the spinal […]
Atrial Fibrillation (AF) & Flutter complicating critical illness
CONTENTS Introduction Diagnosis of AF Investigation of the cause of AF Management – Overall approach Emergent cardioversion Is immediate cardioversion indicated? How to perform DC cardioversion (1) Universal AF stabilization package (2) Rate vs. rhythm control decision Rhythm control in critical illness Rate control (3) Anticoagulation Atrial flutter Pharmacopeia for AF in the ICU: Amiodarone […]
EMCrit 280 – Who Should Get Angiotensin II with Rinaldo Bellomo
When should you pull the trigger on Angiotensin II for vasodilatory shock?
PulmCrit – Six RCTs to answer one question: what is the role of tocilizumab in COVID-19?
The REMAP-CAP trial recently detected mortality benefit from tocilizumab in patients with COVID-19. However, several other RCTs have failed to find substantial benefit from tocilizumab. This begs the question: Has REMAP-CAP discovered a uniquely beneficial way to use tocilizumab, or is this simply a statistical outlier? evidence roundup: RCTs on tocilizumab Let’s review the trials. […]
ABG, VBG, and pulse oximetry
CONTENTS Assessment of oxygenation: Advantages of pulse oximetry over ABG Situations where ABG is needed to assess oxygenation: Poor arterial waveform Dyshemoglobinemia P/F ratio A-a gradient Patients with dark skin Other causes of inaccurate pulse oximetry Assessment of ventilation: VBG to assess pH and ventilation end tidal CO2 (etCO2) Additional topics related to pulse oximetry: […]
PulmCrit – Optimizing the respiratory drive to avoid failure
Scott Weingart just posted a podcast about management of the hypercapneic, obtunded COPD patient who is failing BiPAP. Do we need to intubate these patients, or could we somehow clear their CO2 noninvasively? This post will start off by exploring respiratory drive as a mediator of disease. With that groundwork, we’ll explore the obtunded COPD patient.
Submassive & Massive PE
CONTENTS Most useful material: Crashing patient: Massive PE resuscitation guide 🚀 General approach to (sub)massive PE: (#1) Investigation package (#2) Risk stratification (#3) Thrombolytic contraindications (#4) Treatment approach Resuscitation of massive PE Avoid procedures if possible Fluid management Inotropes & vasopressors Inhaled pulmonary vasodilator(s) Hematologic management: Anticoagulation (heparin) Thrombolysis Regimens: Full dose Half dose Quarter […]
PulmCrit – Baricitinib for COVID-19: The rise of the jakinibs
Background: JAK-inhibitors (jakinibs) in the greater context Much of the harm from infections is mediated by hyperactive inflammatory reactions. To date, most research has focused on two classes of medications to treat this: Corticosteroids have the advantage of being cheap, widely available, and often effective. The disadvantage is that corticosteroids modulate innumerable molecular pathways, thereby […]
EMCrit 296 – The French Connection, Part 1 – Resuscitation Geography, Logistics, & Ergonomics
A new series on the philosophy and psychology of resuscitation…
Acetaminophen toxicity
CONTENTS Rapid Review 🚀 Epidemiology & pharmacokinetics Clinical evolution Patient evaluation Decontamination Who needs treatment? Acetylcysteine Massive acetaminophen poisoning Management of established hepatic failure Management of renal failure Podcast Questions & discussion Pitfalls key pieces of information 📖 History: Dose? Formulation (immediate or extended release)? Timing? Coingestants? Other medications the patient is taking? History of […]
Original RUSH Article
This concept was first conceived by the authors above in 2006 and discussed in national lectures in 2007 and on. It has been available on emcrit.org since March 2008 and was the first hit on a google search of ‘RUSH Exam’ from this date on. It was published on Emedhome in May 2009. Rapid […]
EMCrit 112 – A Response to the Marik Sepsis Fluids Lecture
Last week I posted a lecture by Paul Marik on Fluid Management in severe sepsis. The lecture is the equivalaent of a bucket of ice water poured over your head. Now let’s give you a towel and discuss.
Neuroprognostication after cardiac arrest
CONTENTS Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG EEG background Findings superimposed on the background Myoclonus SSEPs (Somatosensory evoked potentials) CT scan Qualitative CT scan Quantitative CT scan MRI Neuron-specific enolase Multimodal prognostication Related topics Delayed post-hypoxic […]
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