Main Content
All the Rest
“B-Sides” in Analgesia
by Meghan Spyres Ketamine was gifted to the world as a result of investigations into its evil older brother: phencyclidine (PCP). PCP, commonly known as ‘angel dust’ (quite the misnomer, Urban Dictionary suggests the use of the more fitting ‘devil dust’. . .) was initially used as a pharmaceutical in the 1950s under trade name […]
IBCC chapter & cast – Toxic Alcohols
The diagnosis of toxic alcohols is a particularly controversial topic, based on recent evidence that the osmolal gap has a fairly awful sensitivity and specificity. This chapter describes an approach to toxic alcohol diagnosis which doesn’t depend on the osmolal gap. Although this may seem radical, this strategy has been previously recommended by other authors […]
PulmCrit – An alternative view of the PEPTIC trial
The PEPTIC multi-center RCT compared histamine-2 receptor blockers (H2RBs) versus proton pump inhibitors (PPIs) for stress ulcer prophylaxis among ventilated ICU patients.1 It’s a landmark trial of unprecedented size and statistical power. PEPTIC was presented at the Critical Care Reviews meeting in Ireland and live-cast around the world (available here). This presentation and the editorials […]
EM Nerd: The Case of the Sour Remedy Continues
The use of IV vitamin C as a therapeutic agent in sepsis has caught the hearts and minds of emergency medicine and critical care clinicians. Since the publication of a small single center before and after study by Marik et al in 2017 (1), we have spent countless hours screaming into the void that is […]
PulmCrit- Metabolic Resuscitation: Was the answer inside us all along?
Now that VITAMINS is published, it’s worth trying to look at the big picture of sepsis treatment with hydrocortisone, ascorbate, and thiamine (HAT). Marik et al. 2017: The beginning HAT therapy began with a single-center, before/after study.1 There was a stark mortality reduction following the routine adoption of HAT therapy in septic shock (figure below, […]