A brief editorial aside: Both Josh and Scott have commented on the BICAR-ICU Trial in previous posts, each presenting well thought out erudite analyses. I recommend reading/listening to them. EMCrit: Acid Base Episode 7 PulmCrit: pH-guided fluid resuscitation & BICAR-ICU The overwhelming need for euboxia has inspired a multitude of therapeutic endeavors, including the use of […]
Search Results for: cardiac arrest
Announcement: Launching the Internet Book of Critical Care (IBCC)
Several years ago a mentor suggested that I write a book. I nearly laughed at her. A book?? Inconceivable! Who would buy it? Would they actually read it? Would it be there at 3 AM when they needed it? How could it be updated? A physical book didn’t seem compatible with the breakneck speed of critical care or our internet-based culture.
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
Launching the Internet Book of Critical Care (IBCC)
Several years ago a mentor suggested that I write a book. I nearly laughed at her. A book?? Inconceivable! Who would buy it? Would they actually read it? Would it be there at 3 AM when they needed it? How could it be updated? A physical book didn’t seem compatible with the breakneck speed of critical […]
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. […]
Anemia & transfusion targets
CONTENTS Rapid Reference – Approach to falling hemoglobin 🚀 Acute anemia: Physiology Causes Evaluation Gradual anemia: the ICU drift Transfusion targets for stable patients Managing Jehovah’s Witness patients Podcast Questions & discussion Pitfalls evaluation 📖 FAST exam if hemothorax or hemoperitoneum are suspected (e.g., s/p trauma – including CPR). Labs: Repeat complete blood count to […]
EMCrit 330 – Rural Resus Explosion
more on rural resus
The Case of the Balanced Solution
Saline-based resuscitation strategies were first proposed as far back as 1831 during the Cholera Epidemic. In an article published in the Lancet in 1831, Dr. O’Shaughnessy suggests the use of injected salts into the venous system as a means of combating the dramatic dehydration seen in patients afflicted with this bacterial infection(1). Saline’s potential harms […]
The Case of the Thirteen Watches
Door-to-balloon time is probably the most overstated, but least understood surrogate outcome measured in Emergency Medicine today. No sooner does the patient with midsternal chest pressure and ST elevations set foot in the emergency department, when they are packaged up and swept away to the cath lab by a gang of cardiology fellows and attendings. Now with […]
Approach to new fever or rigors in the ICU patient
CONTENTS Definition & classification of fever Common causes of fever Evaluation Management Specific fever types Drug fever Neurogenic fever Podcast Questions & discussion Pitfalls definition of a fever Fever is a bedrock concept in medicine, yet its precise definition remains a bit elusive. The Infectious Disease Society of America defined fever in the ICU as […]
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 […]
Neurological examination & neuroanatomy
CONTENTS Rapid Reference 🚀 Neurological examination Global function & mental status Level of consciousness Motor responses to pain Breathing patterns Aphasia Cranial nerves CN2,3 – Pupillary abnormalities Approach to anisocoria Unilateral pupillary abnormalities Horner’s syndrome Bilateral pupillary abnormalities CN3,4,6 – Extraocular movements CN3-Oculomotor nerve CN6-Abducens nerve Testing of horizontal gaze abnormalities Specific abnormalities of horizontal […]
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.
PulmCrit- Inhaled NO for submassive PE: iNOPE or iYEP?
The use of an inhaled pulmonary vasodilator is a logical strategy for stabilization of PE patients (especially nitric oxide, which may be depleted in this situation). Previously inhaled nitric oxide has only been supported by case series.
Cystic Lung Diseases
CONTENTS Definitions of cystic & cavitary lung lesions Approach to diffuse/multiple lung cysts Clinical features Radiologic features List of causes of pulmonary cysts Specific cystic lung diseases: PLCH (Pulmonary Langerhans Cell Histiocytosis) LAM (Lymphangioleimyomatosis) Tuberous sclerosis BHD (Birt-Hogg-Dube syndrome) LCDD (Light chain deposition disease) CPAM (Congenital pulmonary airway malformation) Pneumatocele Incidental cyst(s) Questions & discussion […]