CONTENTS Rapid Reference 🚀 Groundwork: When noninvasive support is less useful Goals & assessment BiPAP & CPAP Interface Contraindications Diseases which respond very well Sedation to tolerate the mask Setting BiPAP in various situations Ventilators used to provide BiPAP or CPAP High flow nasal cannula (HFNC) Indications How to set HFNC Dirty HFNC Selecting which […]
Search Results for: mental toughness
PulmCrit- Ten dubious beliefs in neurocritical care
Recently Geert Meyfroidt published an article in Intensive Care Medicine describing ten false beliefs in neurocritical care shown here: It’s a great article, but I think they could have been more aggressive about challenging neurocritical care dogmas (1). In response, here is a list of ten dubious beliefs that goes farther to challenge the status quo. […]
Extubating COVID Patients with thoughts from Guest EMCritter, Sahar Ahmad
If you put it in, you need to be able to take it out.
COVID 19 Complete Chapter
CONTENTS Basic biology Infection control Transmission Personal protective equipment (PPE) Diagnosis Signs & symptoms Labs Imaging CXR & CT scan Lung ultrasonography General approach to imaging Bronchoscopy Diagnostic approach for admitted patients Treatment: General protocols ED patients getting admitted to the hospital Inpatient management of hypoxemic, non-intubated patients Intubated patients Treatment: Specific anti-viral & immunosuppressive […]
ARDS
CONTENTS Rapid Reference 🚀 Diagnosis of ARDS Definition of ARDS Cardiogenic pulmonary edema vs. ARDS Why is the patient in ARDS? Common causes of ARDS Evaluating the cause of ARDS ARDS pathophysiology: Intrapulmonary shunting Treatment: Basics Treating the cause of ARDS Steroid Conservative fluid strategy Treatment: Non-intubated patient High-flow nasal cannula & CPAP/BiPAP Awake proning […]
PulmCrit- Mastering the dark arts of BiPAP & HFNC
Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn’t comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence. Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that.
Asthma
CONTENTS Rapid Reference 🚀 Non-intubated asthmatic 🚀 Intubated asthmatic 🚀 Initial evaluation Asthma exacerbation diagnosis Risk stratification Non-intubated patients Inhaled bronchodilators Systemic bronchodilators Noninvasive ventilation (BiPAP) Sedation strategies Dexmedetomidine IV haloperidol/droperidol Benzodiazepines Opioids Ketamine Unable to tolerate BiPAP: Heliox vs. HFNC Steroid Other medications Evaluation & goals Beware of asthma treatment pseudofailure Intubation Indications for […]
COVID 19 ICU/stepdown management
CONTENTS: Management of COVID-19 patients admitted to stepdown or ICU Link to full chapter here (more complete – but longer). Preamble & caveats Initial tests to guide management Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Things that don’t work Remdesivir Convalescent […]
Abdominal compartment syndrome
CONTENTS Rapid Reference 🚀 Causes Epidemiology Physiological relationships between various compartments Physiology & manifestations Diagnosis Treatment Hemodynamics Decompress the abdomen Decompress the thorax Sedation & paralysis Podcast Questions & discussion Pitfalls treatment of abdominal compartment syndrome ✅ hemodynamics (more) Target MAP > (60 mm + abdominal compartment pressure). Don’t give additional fluid. Consider diuresis/dialysis, if […]
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 […]
Sickle Cell Acute Chest Syndrome
CONTENTS Rapid Reference 🚀 Background Pathophysiology Epidemiology Presentation & diagnosis Trigger of acute chest syndrome Symptoms Examination & POCUS Radiology Rapid progression & multi-organ failure Definition & differential diagnosis Management Non-transfusion related Aggressive oxygenation & monitoring Volume resuscitation Antibiotics Pain management Transfusion General considerations about transfusion Simple transfusion (top-up transfusion) Exchange transfusion Manual exchange transfusion […]
EMCrit 35 – Extubation in the ED
In this podcast, I discuss extubating patients in the ED. Specifically, I deal with patients who have only been intubated for a few hours in distinction to extubation of the patient who has been lingering in your ED for 2-3 days. The best patients for this short-term extubation are those intox folks with a low GCS and signs of trauma, overdoses, or endoscopy cases.
PulmCrit- Vancomycin pharmacokinetics: Make vanco great again
Traditionally, vancomycin doses have been adjusted to target a specific trough level. However, it is increasingly clear that the trough level is an inadequate measurement of vancomycin exposure. Furthermore, the practice of waiting until the fourth dose to measure the trough level may expose the patient to days of suboptimal therapy.
Acute exacerbation of interstitial lung disease (AE-ILD)
CONTENTS Definition and background Clinical presentation Differential diagnosis Investigation History Physical examination Laboratory studies CT scan Bronchoscopy Treatment Medical therapy D/c potential pneumotoxins Antibiotics Immunosuppressive therapy Diuresis & volume management Antifibrotic therapy Respiratory support Noninvasive respiratory support Invasive mechanical ventilation Lung transplantation Prognosis Questions & discussion abbreviations used in the pulmonary section: AE-ILD: Acute exacerbation […]
EMCrit 314 – ShadowBoxing Case 1 – In the end, it’s always…
Our first shadowboxing episode…
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