In this Hurricane Sandy episode of the EMCrit podcast, I talk about the confirmation of two of my clinical prejudices.
Search Results for: acid base
EMCrit 242 – ED Nephrology with Joel Topf aka KidneyBoy
ED Nephrology with the Kidney Boy, Joel Topf
You Don’t Understand the Osm Gap – Guest Post by Rory Spiegel
Think you understand the Osm Gap–you don’t
Salicylate intoxication
CONTENTS Rapid Reference 🚀 Diagnosis Epidemiology Signs & symptoms General laboratory abnormalities Salicylate level Treatment Airway management & decontamination Delirium & dysglycemia Alkalinization Volume resuscitation Hemodialysis Lab monitoring When to stop Podcast Questions & discussion Pitfalls Salicylate intoxication checklist ✅ Labs & targets (cycle q2hr until resolution) 📖 Glucose: Target >80-100 mg/dL if altered mental […]
EMCrit 369 – Iodinated Contrast Issues: Part 1 – Is Contrast-Induced Nephropathy (CIN) a Thing in Patients with Tenuous Renal Function
Do you still need to worry about contrast in patients with tenuous renal function?
Table of Contents
SYSTEMS Cardiology Endocrinology Gastroenterology Hematology & Oncology Infectious diseases Nephrology Neurology Obstetrics Pulmonology Rheumatology Toxicology & Temperature Overview: Guide to supportive care in critical illness Medication reconciliation in the ICU About this book How to create your own IBCC smartphone app 📲 General Approaches to problems Cardiac arrest 🔜 Chest pain Hypertensive emergency SCAPE (Sympathetic […]
PulmCrit: pH-guided fluid resuscitation & BICAR-ICU
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it’s unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura of ignorance and failure. Consequently, bicarbonate is underutilized in some situations where it might actually help.
Respiratory alkalosis (hypocapnia)
CONTENTS How important is hypocapnia? Definition & diagnosis Clinical features Causes of hypocapnia Evaluation Consequences of hypocapnia Management Podcast Questions & discussion Pitfalls Hypocapnia is the most common acid-base disorder among critically ill patients.(12097540) This shouldn’t be surprising, since hypocapnia may be caused by almost any pulmonary disease, pain/anxiety, or sepsis – exceedingly common conditions […]
Anion-gap metabolic acidosis
CONTENTS Diagnosis Causes of elevated anion gap Evaluation Evaluation of elevated anion gap Evaluation & treatment of elevated lactate Treatment Podcast Questions & discussion Pitfalls Anion gap should be evaluated on every electrolyte panel. Ideally the computer will do this automatically; otherwise, it should be calculated. Anion gap is calculated as (Na – Cl – […]
PulmCrit Table of Contents (TOC)
TOPICS airway & procedures cardiology endocrinology gastroenterology hematology/oncology infectious diseases nephrology neurology pulmonology rheumatology toxicology methodology & miscellaneous Airway pharmacology Medication sequence: rocketamine vs. keturonium Ketamine-tolerant patient Catastrophic complications, ROC vs. SUX Arterial lines: wrist versus the groin? Cricothyrotomy in asphyxial cardiac arrest Difficult airway communication via allergy list Drowned airway Large-bore suction strategies & […]
EMCrit 309 – Critically Ill Diabetic Ketoacidosis (DKA)
Critically Ill diabetic ketoacidosis is usually a bit of a misnomer
Metabolic alkalosis
CONTENTS Diagnosis Symptoms Causes Investigation Treatment When to treat? Multimodal therapy Hydrochloric acid Podcast Questions & discussion Pitfalls Metabolic alkalosis may be diagnosed in two situations (red arrows above): (1) If the serum bicarbonate is elevated (>28 mM), this alone reveals a metabolic alkalosis. (2) If the anion gap is elevated but the reduction in […]
CC Nerd-The Case of the Neutral Documents
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 […]
Blood gas measurements in DKA: Are we searching for a unicorn?
Routinely obtaining an ABG or VBG is widely recommended, for example in both American and British guidelines. Why? Is this helping our patients, or is it something that we do out of a sense of habit or obligation?
PulmCrit- Get SMART: Nine reasons to quit using normal saline for resuscitation
Saline vs. balanced solutions has been a topic of ongoing debate. Two fresh studies will illuminate this: the SMART and SALT-ED trials. This post summarizes current knowledge, beginning with physiology and working our way to fresh trials. Reason #1. There is no physiologic rationale for using “normal” saline (NS). Saline is a hypertonic, acidotic fluid […]
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