RACC Lit Review for Feb 2024
Search Results for: acid base
PulmCrit- Virus Wars: Return of Lopinavir/Ritonavir (along with ribavirin and interferon)
Background Where were we with the Lopinavir/Ritonavir story? Let’s backtrack for a moment. Lopinavir/Ritonavir showed some efficacy against SARS, but as triple therapy in combination with ribavirin. A while ago, some studies tested lopinavir/ritonavir alone against COVID-19 and this didn’t work. Consequently, that was set aside for a while. However, there were lingering questions about […]
EMCrit 66 – …Until they are warm and dead: Severe Accidental Hypothermia
It is winter and that means cardiac arrests coming in with extremely low body temperatures after environmental exposure. How do you treat these patients? How do you rewarm if you don’t have bypass?
Severe community-acquired pneumonia
CONTENTS Rapid Reference 🚀 Definition of severe CAP Diagnosis: Pneumonia diagnosis Differential diagnosis Post-diagnosis evaluation: Laboratory studies Imaging Lobar pneumonia Bronchopneumonia Interstitial pneumonia Necrotizing pneumonia (cavitation) Nodular pneumonia Pleural effusion Pneumothorax Chest wall invasion Septic pulmonary emboli ➡️ Bronchoscopy Triage: who needs ICU? Treatment Antibiotic selection Resuscitation Respiratory support Steroid Effusion management Treatment failure Duration […]
EMCrit 362 – Jonathan Edlow, Lead Author of GRACE-3, on Dizziness
Dizziness and Vertigo with the lead author of GRACE-3
EM Nerd-The Case of the Deceptive Beacon
Let’s face it, we have an unhealthy relationship with antibiotics. We are all aware that we are currently in an antibiotic resistance crisis that is driven by overuse. And despite our enlightenment we cannot seem to stop prescribing antibiotics for complaints that have been clearly shown not to require antibiotics. And so, given our appalling […]
PulmCrit – Early basal insulin in DKA
The timing of basal insulin administration in DKA has been controversial for years. I posted the following poll on twitter recently to get a sense of current opinion on this: So, it seems that the majority of people are using traditional management (wait for the anion gap to close, give basal insulin, then shut off […]
Respiratory manifestations of systemic disorders
CONTENTS Gastroenterology Inflammatory bowel disease Cirrhosis Hepatopulmonary syndrome Hepatic hydrothorax ➡️ Spontaneous bacterial pleuritis ➡️ Portopulmonary hypertension ➡️ Pancreas-related pleural effusions ➡️ Hematology TRALI (transfusion-related acute lung injury) Complications after hematopoietic stem cell transplantation Sickle cell disease Acute chest crisis ➡️ Pulmonary hypertension ➡️ Leukostasis due to leukemia ➡️ Questions & discussion abbreviations used in […]
Renal microvascular hemodynamics in sepsis: a new paradigm
Introduction 0 Traditionally it has been thought that during septic shock, renal blood flow decreases leading to pre-renal kidney injury. This implied that if we could improve the cardiac output and renal blood flow, the kidneys would recover. Recent research challenges these concepts, with interesting therapeutic implications. 0 New paradigm of microvascular physiology in renal acute kidney […]
EMCrit – A Debate on the Use of Cognitive Decision Aids for Resuscitation and why Twitter is absolute, utter Crap
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EMCrit 104 – Laryngoscope as a Murder Weapon (LAMW) Series – Hemodynamic Kills
A lecture from SMACC2013 on how not to kill the shocked patient when intubating
Nausea, emesis, and antiemetics
CONTENTS Rapid Reference 🚀 Differential diagnosis of nausea and vomiting Evaluation Construction of an antiemetic regimen 5HT3 antagonists (especially ondansetron) Butyrophenones (haloperidol & droperidol) ➡️ Phenothiazines (prochlorperazine, chlorpromazine, promethazine) Olanzapine ➡️ Metoclopramide Other agents Podcast Questions & discussion Pitfalls medications which may cause nausea Chemotherapy. Analgesics: Aspirin. NSAIDs. Opioids. Antibiotics: Erythromycin. Sulfonamides. Acyclovir. Cardiovascular: Antiarrhythmics. […]
PulmCrit- Does the HIGH trial debunk high-flow nasal cannula?
High-flow nasal cannula (HFNC) has become popular for the hypoxemic respiratory failure, driven partially by the FLORALI trial.1 Recently, the HIGH trial evaluated the ability of HFNC to reduce mortality among immunocompromised patients with acute hypoxemic respiratory failure.2 HFNC failed to improve mortality or significantly reduce intubation rates. Popular narrative about this trial A common […]
Line infection
CONTENTS Rapid Reference 🚀 Physiology Prevention Clinical features Diagnosis Management Overall strategy Empiric antibiotic selection Treatment duration Persistent bacteremia Specific situations Septic thrombophlebitis Arterial line infection Chest port infection Podcast Questions & discussion Pitfalls various mechanisms of infection: Early infections often arise from the skin: (a) These may occur during line insertion. (b) There may […]
Coccidioidomycosis
CONTENTS Basics Epidemiology Evolution between different forms Different clinical manifestations: Acute pulmonary coccidioidomycosis Chronic pulmonary coccidioidomycosis Disseminated infection CNS involvement Diagnosis Laboratory tests Bronchoscopy Treatment 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 […]
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