CONTENTS Rapid Reference 🚀 Background: HIV(-)PJP vs. HIV(+)PJP Epidemiology Clinical presentation Radiology Chest X-ray Chest CT scan Blood tests HIV evaluation serum beta-D-glucan other labs (LDH, CRP, PCT) Microbiology tests Bronchoscopy Non-bronchoscopic sampling Approach to diagnosis Treatment Antibiotics Steroid Prognosis Podcast Questions & discussion Pitfalls noninvasive PJP pathway: PJP (previously known as Pneumocystis Carinii Pneumonia) […]
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Lung Transplantation
CONTENTS candidacy for lung transplantation General concept of the transplant window Contraindications to lung transplantation Transplant window for various conditions COPD Interstitial lung disease Cystic fibrosis Pulmonary arterial hypertension post-transplantation complications Chronic immunosuppressive regimens PGD (primary graft dysfunction) Acute rejection ACR (acute cellular rejection) AMR (antibody-mediated rejection) CLAD (chronic lung allograft dysfunction) BOS (bronchiolitis obliterans […]
EMCrit 344 – Sleep for the Weary II – General Sleep Stuff
All things Sleep–you will add years to your life if you sleep well, so the time investment to listen to this podcast may be well worth it
Pulmonary embolism diagnosis & treatment of low-risk PE
CONTENTS Rapid reference 🚀 Risk factors and epidemiology Clinical presentation of PE Massive/submassive PE Large central PE Pulmonary infarction DVT Individual tests: D-dimer Arterial blood gas (ABG) DVT ultrasound to evaluate for PE Chest radiograph Radiology CT angiography in pulmonary embolism Causes of a filling defect on CT angiography CT angiography Causes of filling defect: […]
EMCrit 144 – The PROPPR trial with John Holcomb
The biggest news in the management of traumatic hemorrhage is the PROPPR Trial. Want to hear from the lead author?
Post-cardiac arrest management
CONTENTS Rapid Reference 🚀 Cause & investigation Subsequent management: Targeted temperature management (TTM) Shivering management Cardiovascular interventions Coronary artery disease management Antiarrhythmic therapy Bp target Post-CPR complications Ventilator management Aspiration pneumonia & empiric antibiotics Endocrine: steroid Neurologic issues Podcast Questions & discussion Pitfalls investigations ✅ labs Fingerstick glucose. Basic labs (electrolytes including Ca/Mg/Phos, CBC, INR, […]
What is the evidence behind the IVC filter?
Introduction 0 Until recently, recommendations regarding IVC filters have been based predominantly on a singleRCT (PREPIC-1). Last week, a second RCT was released in JAMA (PREPIC-2). This post will review both studies. What is the evidence basis for using IVC filters? 0 PREPIC-1 (Decousus et al. A clinical trial of vena caval filters in the […]
Delirium & antipsychotic pharmacology
Delirium Definition & diagnosis Delirium mimics Causes Diagnostic approach Treatment Antipsychotic use in acute care Antipsychotics – overview Butyrophenones (haloperidol & droperidol) Olanzapine Quetiapine Chlorpromazine Risperidone Lurasidone definition Delirium is acute, generalized brain dysfunction (“cerebral insufficiency”). Key features: Acute (e.g. not dementia). Causes inattention (e.g. disorientation, inability to perform complex tasks). Tends to wax and […]
Community acquired urosepsis
CONTENTS Rapid Reference 🚀 Diagnosis Urinalysis Imaging Management: Resuscitation Decompression & source control Antibiotics General principles Preferred antibiotics for initial broad-spectrum coverage If gram stain is known Podcast Questions & discussion Pitfalls diagnostic tests Urinalysis & urine culture. Blood culture x2. Procalcitonin. Imaging, either: CT scan (especially if >35 YO). Renal ultrasonography (especially if <35 […]
Cryptococcus
CONTENTS Epidemiology Cryptococcal pneumonia Clinical presentation Thoracic radiology Extrapulmonary dissemination: Cryptococcal meningitis & brain imaging Other sites of dissemination Laboratory tests Management Questions & discussion Cryptococcus neoformans: general epidemiology Cryptococcus neoformans is a widespread opportunistic fungus found in soil and bird droppings. Most clinically evident infections might actually represent latent infection that reactivates in the […]
Evidence-based treatment for severe community-acquired pneumonia
Introduction . Community-acquired pneumonia (CAP) remains the leading cause of infectious disease death in developed countries. Described by Sir William Osler as “captain of the men of death,” it dates back to antiquity. However, we are only beginning to understand the best ways to treat it. . Part 1: The Pneumococcal meningitis story . Ceftriaxone […]
PulmCrit – An alternative view of the PEPTIC trial
The PEPTIC multi-center RCT compared histamine-2 receptor blockers (H2RBs) versus proton pump inhibitors (PPIs) for stress ulcer prophylaxis among ventilated ICU patients.1 It’s a landmark trial of unprecedented size and statistical power. PEPTIC was presented at the Critical Care Reviews meeting in Ireland and live-cast around the world (available here). This presentation and the editorials […]
PulmCrit- The Rothman Index: Artificial intelligence or merely a symptom of a broken healthcare system?
We are constantly hunting for newer and better sources of information. This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools. Some of these pan out. Most don’t. Why are these new sources of information generally disappointing? The answer is simple: we’re already doing pretty well. In order […]
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 […]
Preeclampsia & HELLP
Guide to emoji hyperlinks = Link to online calculator. = Link to Medscape monograph about a drug. = Link to IBCC section about a drug. = Link to IBCC section covering that topic. = Link to FOAMed site with related information. = Link to supplemental media. Going further References a dosing contraindications side effects indications […]
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