CONTENTS Anticholinergic agents Epidemiology Clinical presentation Differential diagnosis Evaluation Management Physostigmine Treatment of agitation Other management issues Management of combined anticholinergic & sodium channel blocker toxicity Podcast Questions & discussion Pitfalls There are hundreds of substances with anticholinergic activity. Below are some of the most common and notable. agents which function predominantly as anticholinergics Atropine. […]
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IBCC – Neuroprognostication after cardiac arrest
CONTENTS Rapid Reference 🚀 Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG Myoclonus SSEPs (Somatosensory evoked potentials) CT scan MRI Neuron-specific enolase Multimodal prognostication Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) timing of tests […]
Neuroprognostication after cardiac arrest
CONTENTS Rapid Reference 🚀 Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG Myoclonus SSEPs (Somatosensory evoked potentials) CT scan MRI Neuron-specific enolase Multimodal prognostication Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) timing of tests […]
Adrenal crisis
CONTENTS Epidemiology: at-risk populations Signs & symptoms Laboratory clues Evaluation of suspected adrenal crisis Clinical definition of adrenal crisis Treatment Prevention Physiology Podcast Questions & discussion Pitfalls Adrenal crisis is a bit like DKA. It can either be caused by chronic adrenal insufficiency plus a trigger, or it can be caused by acute adrenal insufficiency […]
Guide to supportive care in critical illness
CONTENTS Rapid Reference 🚀 The understated importance of high-quality supportive care Medications to avoid in ICU Prophylaxis DVT prophylaxis GI prophylaxis Anemia & transfusion targets Glycemic control Nutrition for the intubated patient Pain, agitation, and delirium Analgesia & pain management Sedation of the intubated patient Delirium prevention Volume status & diuresis Electrolyte management Troponin elevation […]
Critical care nutrition
CONTENTS Rapid Reference: Creating a tube feeding prescription 🚀 General Nutritional physiology in critical illness Nutritional assessment Macronutrient needs Caloric requirement Protein requirement Carbohydrate administration Macronutrient requirements in obesity Enteral nutrition: getting started When to initiate enteral nutrition Enteric tube type & location Selecting a tube feed formulation Intermittent vs. continuous feeding Troubleshooting enteral nutrition […]
ARDS
CONTENTS Rapid Reference 🚀 Diagnosis of ARDS Definition of ARDS Cardiogenic pulmonary edema vs. ARDS Why is the patient in ARDS? Common causes of ARDS Evaluating the cause of ARDS ARDS pathophysiology: Intrapulmonary shunting Treatment: Basics Treating the cause of ARDS Steroid Conservative fluid strategy Treatment: Non-intubated patient High-flow nasal cannula & CPAP/BiPAP Awake proning […]
Thyroid Storm
CONTENTS Rapid Reference 🚀 Approaching the diagnosis Diagnostic criteria Management Evaluation & treatment of any trigger Endocrine manipulations Cardiovascular stabilization Atrial fibrillation in thyroid storm Management of hyperthermia & agitation Refractory thyroid storm Podcast Questions & discussion Pitfalls evaluation 📖 Glucose, electrolytes including Ca/Mg/Phos, complete blood count. TSH, free T4, free T3. Liver function tests. […]
EMCrit 86 – IVC Ultrasound for Fluid Tolerance in Spontaneously Breathing Patients
Can the Inferior Vena Cava Ultrasound guide our fluid administration in the ED? Of course it can!
Viral pneumonia (non-COVID/influenza)
CONTENTS General properties of viral pneumonias Herpesviruses ⍺-herpesviruses HSV VZV β-herpesviruses CMV Paramyxoviruses RSV (respiratory syncytial virus) Parainfluenza Metapneumovirus Adenovirus Rhinovirus Hantavirus Questions & discussion abbreviations used in the pulmonary section: 2 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast Bacilli AIP: Acute interstitial […]
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. […]
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 […]
Nonconvulsive Status Epilepticus (NCSE)
CONTENTS Definition of NCSE Epidemiology and causes of NCSE Various clinical presentations General clues to the diagnosis of NCSE Common differential diagnostic considerations EEG: Indications to obtain an EEG Duration of continuous EEG monitoring Antiepileptic trial for ictal/interictal continuum abnormalities Management of NCSE Subtypes of NCSE NCSE with coma Absence NCSE with onset in adulthood […]
PulmCrit- Alpha-2 agonists: clonidine, guanfacine, lofexidine, and KetaDex
Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion. It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients). The main drawbacks of dexmedetomidine are logistic: it is expensive and can be administered only as an IV infusion within an ED or ICU. Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.
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: […]
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