The COVID chapter has been updated, overhauled, and refocused on the management of the sickest COVID patients (those requiring admission to ICU or stepdown units). The new chapter removes more basic information about COVID that we’re all probably familiar with at this point (but the original, larger chapter is still available here). The goal of […]
EMCrit 290 – Decompensated Hypothyroidism and Myxedema with Dr. Arti Bhan
Thyroid storm’s boring brother is still a life threat–you need to know it!
IBCC chapter – Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC) is like the ARDS of the hematological system. It’s not really one disorder, but rather a collection of different disorders with some shared features. The diagnosis and optimal treatment remain elusive. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
PulmCrit- RCTs don’t justify using convalescent plasma or antibody cocktails
Passive immunity refers to the infusion of antibodies (either polyclonal antibodies in the form of convalescent plasma, or engineered monoclonal antibodies). The goal is to neutralize viral particles, reduce viral replication, and thereby improve clinical outcomes. This is a promising theory, but it requires evidentiary support in the form of randomized controlled trials. So far, […]
EMCrit 289 – Ketamine Only Intubation Paper with Brian Driver
A discussion of 3-recent NEAR database publications
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. […]
IBCC – Purpura Fulminans
Purpura fulminans is a rare form of disseminated intravascular coagulation which requires specific management. Most commonly it is seen as a complication of septic shock with multi-organ failure. Unfortunately, purpura fulminans is often treated simply with a generic approach for septic shock. The IBCC chapter is located 👉 here. The podcast & comments are below. […]
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 288 – Neurogenic Shock & Should we be Using Vasopressors for Hemorrhagic Shock?
Neurogenic Shock and Vasopressors for Hemorrhagic Shock
PulmCrit – Dismantling the systemic racism of pulse oximetry
Oximetry is fundamental to critical care. Consequently, even small biases in pulse oximetry measurements could have real clinical impact (especially when leveraged across innumerable measurements among thousands of patients). Racial bias in pulse oximetry was the subject of two studies in 2005 and 2007. The topic was then largely ignored over the past 13 years. […]
PulmCrit – I’m upset about the RELAX trial
Some studies have reported a gradual upwards trend in the PEEP being used for intubated patients without ARDS (e.g., from 5 cm to 7 cm). Is this good or bad? That is the question which the RELAX trial embarked upon answering. It’s a complex question which probably doesn’t have a binary answer… but never mind – let’s get to the study.
EMCrit 287 – Thoracotomy Masterclass with Dennis Kim
All things chest crackin’
IBCC chapter & cast – Massive Transfusion Protocol (MTP)
Massive Transfusion Protocols have attracted substantial attention over the past several years, so most folks will be familiar with the general concepts. This chapter reviews a variety of details which may be essential to the success of an MTP – yet can easily get lost in the chaos. The IBCC chapter is located 👉 here. […]
PulmCrit – Does Remdesivir reduce length of stay? SOLIDARITY vs. ACTT-1.
With the publication of the SOLIDARITY trial, there is increasing consensus that remdesivir doesn’t affect mortality. However, there continues to be debate about whether remdesivir affects hospital length of stay. Let’s dig into the data here to try to reconcile differences between ACTT-1 and SOLIDARITY. Did ACTT-1 actually show that remdesivir reduces the hospital length […]
PulmCrit – Want to help stop COVID? Be quiet.
The closed mouth catches no flies Benjamin Franklin, Poor Richard’s Almanac, 1742 We’re hopefully nearing the end of the COVID pandemic, with vaccines coming soon. Unfortunately, vaccines won’t be able to bail us out this winter. Neither will fancy designer pharmaceuticals. The main interventions necessary to keep us safe for now are basic public health […]
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