CONTENTS Rapid Reference 🚀 Diagnosis When to suspect endocarditis Lab workup Septic pulmonary emboli Echocardiography (TTE vs TEE) Diagnostic strategies & criteria European Society of Cardiology criteria Manifestations include: Metastatic infection Neurologic complications Septic embolic encephalitis Antibiotics Empiric therapy Definitive therapy Methicillin-sensitive Staph. 📖 Methicillin-resistant Staph. 📖 Enterococcus. 📖 Streptococcus pneumoniae. 📖 Beta-hemolytic Streptococci. 📖 […]
Search Results for: cardiac arrest
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 […]
Neuro-ultrasound
CONTENTS Intracranial pressure 2D imaging of the brain: Initial 2D image – midbrain Hydrocephalus Midline shift Intracranial hematoma Transcranial Doppler Basic views & technique Pulsatility index Vasospasm Brain death Acute ischemic stroke Podcast Questions & discussion Pitfalls optic nerve sheath diameter The optic nerve sheath is part of the dura surrounding the brain.(35001377) When intracranial […]
Immunosuppressive therapies in pulmonology & transplantation
CONTENTS Disclaimer – Still consult transplant medicine Mycophenolate Azathioprine Calcineurin inhibitors (tacrolimus, cyclosporine) Sirolimus 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 pneumonia (Hamman-Rich syndrome) 📖 ANA: Antinuclear antibody 📖 […]
EMCrit 285 – More on Palliative Care Conversations in Resuscitation
A meandering conversation on end-of-life palliative care conversations
Hypertensive emergency
CONTENTS Background Use the MAP Pathophysiology of malignant hypertension (1) Is there a known cause of the HTN? (2) Is this actually a hypertensive emergency? (3) Re-evaluation for an underlying cause of the HTN. (4) Control Bp with IV antihypertensive agents. Nicardipine Clevidipine IV Labetalol (Medications to avoid) (5) Transition to oral antihypertensives. Calcium channel […]
PulmCrit- APRV: Resurrection of the open-lung strategy?
APRV is often used in surgical ICUs, but not medical ICUs. APRV may be viewed as a “new” technique by medical intensivists, whereas it’s been used for decades in surgical ICUs with great results. A fresh RCT may help resolve this.
NeuroEMCrit – The Perils of the ICH Score
Don’t use the ICH score in isolation to not give aggressive critical care…
“The Adventure of the Greek Interpreter Revisited”
If our affair with thrombolytics had not started off with the success it did, we may not still be trying to nostalgically relive our yesteryears of throbolytic glory. Whether it was streptokinase, alteplase or tenectoplase (TNK), thrombolytics have consistently demonstrated a mortality benefit when used in patients experiencing an ST-elevation infarction (1). If it […]
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 […]
The Third Annotation of a Case of Identity
So often in modern medicine we mistake science for truth. In doing so we have become enamored with the p-value and view it as the major determinant of relevance in scientific inquiry. An almost arbitrary selected value of 0.05 is independently responsible for defining what is considered beneficial, and what will be discarded as medical […]
Sleep-disordered breathing
CONTENTS Sleep-disordered breathing basics Obstructive sleep apnea (OSA) Epidemiology (including causes & consequences) Clinical features & assessment Diagnosis Treatment Obesity hypoventilation syndrome (OHS) Chronic OHS Epidemiology Signs & symptoms Evaluation & diagnosis Treatment Acute exacerbation of OHS (AEOHS) Definition Causes & patient evaluation Treatment Central sleep apnea (CSA) overview Hypercapnic CSA Nonhypercapnic CSA CSA due […]
EMCrit 146 – Who Needs an Acute PCI with Steve Smith (Part I)
Finally in one place, all of the STEMI equivalents with Steve Smith
EMCrit – Overdiagnosis of uncomplicated pericarditis often leads to more harm than good
On waste basket diagnoses – Pericarditis
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, […]