2010 ACLS Guidelines web site with tons of resources Do not place sheets between patients and cooling blankets history of hypothermia and review (Chest 2008;133;1267-1274) Hypothermia review article Bernard SA, Buist M, Induced hypothermia in critical care medicine: a review. Crit Care Med 2003;31:2041-51. Major clinical trials have been […]
Search Results for: acid base
PulmCrit- Controlled thrombolysis of submassive PE?
Controlled thrombolysis using a slow 25-mg alteplase infusion with protocoled monitoring might offer patients the benefit of lytic therapy with an extremely low risk of severe hemorrhage.
Unconventional therapies for hyponatremia: Thinking outside the collecting duct
. Case: An unusual ICU referral . Some years ago at Genius General Hospital, the ICU was asked to accept a patient from the medicine ward with cirrhosis, confusion, and hyponatremia (Na 125 mM) for hypertonic saline therapy. There was concern that the patient’s confusion was due to his hyponatremia. . Chart review showed […]
ODR 004 – Email is Not the Problem, You Are! [Email Part 1/X]
Email is not the problem!!! You are!
PulmCrit: MidaKet for procedural sedation in critical illness
intro: the challenge of procedural sedation in critical illness Procedural sedation for critically ill patients is a minefield for several reasons: Patients are already physiologically unstable. Procedures are emergent (a factor widely associated with greater complications). Time constraints often prevent a complete pre-anesthetic evaluation (e.g., medical history and laboratory studies may be unknown). A single […]
Does central line position matter? Can we use ultrasonography to confirm line position?
. Introduction . Suppose you just placed the central line shown above. Does it need to be repositioned? . I was trained that the tip of the central line must lie in the lower portion of the superior vena cava. If the line was in the right atrium, it would cause cardiac perforation. If the […]
A Case of Identity Part Two
Our standards for acceptable benefit of antiplatelet agents in the management of ACS have become deplorably low. When ISIS-2 was first published we defined success only by aspirin’s ability to affect mortality. The number commonly cited, 2.4%, only describes aspirin’s absolute benefit to decrease death (1). In the one trial that examined its properties to […]
PulmCrit – Splitting ventilators to provide titrated support to a large group of patients
COVID-19 might out-strip the number of mechanical ventilators available to us. This has led to interest in using a single ventilator to support multiple patients. This post will review the theory and evidence regarding this (with the admission that I don’t have experience with this). basic principles Bedrock principle: Patient-Ventilator Independence Normally, we adjust the […]
Stress Hyperglycemia in the ICU
CONTENTS General concept of stress hyperglycemia Evidentiary basis of lowering glucose in the ICU NICE-SUGAR trial Patients with chronic hyperglycemia What should we do now? Podcast Questions & discussion Pitfalls what is stress hyperglycemia? Stress hyperglycemia refers to elevation of glucose as part of the stress response. Glucose is increased by a variety of factors, […]
Epiglottitis
CONTENTS Signs & symptoms Differential diagnosis Diagnosis Management Medical Management Epiglottic abscess Airway management Indications for intubation Intubation procedure Extubation procedure Podcast Questions & discussion Pitfalls symptoms Sore throat (92%)(31173373) Swallowing problems Odynophagia (82%) Dysphagia (80%) Drooling (18%) Voice change (43%) Hoarseness (26%) Muffled voice (30%) Respiratory dysfunction Stridor (8%) Dyspnea (33%) Inability to lie […]
Blakemore Tube Placement for Massive Upper GI Hemorrhage
How to place a Blakemore tube for esophageal varices with massive bleeding.
EMCrit RACC – Analyzing Difficult Resuscitation Cases #1 from ResusMe
STEPUP for case analysis
Sodium Channel Blocker Toxicity (including tricyclic antidepressants)
CONTENTS Overview – sodium channel blockers & tricyclic antidepressants Pathophysiology and terminology Agents that inhibit cardiac sodium channels Diagnosis EKG findings of sodium channel blockade Clinical manifestations Management – three antidotes #1) Bicarbonate #2) Lidocaine #3) Lipid emulsion Management – clinical approach Intubation if necessary Hypotension Ventricular tachycardia Seizure Podcast Questions & discussion Pitfalls Tricyclic […]
Clostridioides (prev: clostridium) difficile
CONTENTS Rapid Reference – Management of severe C. Difficile 🚀 Prevention and C. Diff-o-genic antibiotics Presentation & diagnosis Lab testing Colonoscopy Imaging Risk-stratification Treatment Non-standard therapies Podcast Questions & discussion Pitfalls Checklist for management of severe C. Difficile ✅ Sepsis resuscitation 📖 Imaging (Abdominal X-ray +/- CT scan) 📖 Consider serial abdominal X-ray to follow […]
The Case of Dubious Squire
I often get the sense that the makers of many biomarkers envision us as helpless damsels in distress drowning in an icy pond or trapped in a monumental tower with no obvious means of descent. I imagine they think in our desperate grasps for aid, we will cling to whatever assistance they may offer, independent […]
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