0 Introduction with a case 0 Once upon a time at Genius General Hospital a 63-year-old woman was admitted with lower extremity edema and orthopnea. Her past medical history was unremarkable. She was noted to be in atrial flutter with a heart rate in the 120s and a blood pressure ranging from 100-120 mm systolic. She […]
Search Results for: procedural sedation
EMCrit Guest Post – COVID – The anticipated difficult and protected airway: A case study
Case report of a COVID airway with discussion and checklists
High-flow nasal cannula for apneic oxyventilation
0 Introduction 0 Last summer I wrote a postabout preoxygenation and apneic oxygenation using high-flow nasal cannula (HFNC). At that point there was no evidence supporting it, so the post was based primarily on the physiology of HFNC. Recently two papers were published supporting the use of HFNC for preoxygenation and apneic oxygenation (Patel 2015, […]
COMM CHECK: Sterile Cockpit
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PulmCrit- New guidelines simplify ICU nutrition
Introduction to nutritional dogma Everyone has strong opinions about food. We all feel that we have some special, intuitive understanding of nutrition. Nonsense. Such intuitions have historically created a wide array of dogma regarding nutrition, complicating matters immensely. Fortunately, the 2016 SCCM/ASPEN guidelines have stripped away much of the nonsense involved in nutritional support. This […]
Additional References for Podcast 104
Griesdale D. Etomidate for intubation of patients who have sepsis or septic shock-where do we go from here? Critical Care [Internet] 2012;Available from: http://ccforum.com/content/16/6/189/abstract Heffner AC, Swords D, Kline JA, Jones AE. The frequency and significance of postintubation hypotension during emergency airway management. Journal of critical care [Internet] 2012;27(4):417.e9-13. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=22033053&retmode=ref&cmd=prlinks Dewhirst E, Frazier […]
Aspiration syndromes
CONTENTS Management of aspiration itself: Risk factors for aspiration Investigation Prevention Aspiration syndromes: Aspiration pneumonitis Aspiration pneumonia Lung abscess ➡️ Lipoid pneumonia Foreign body aspiration Aspiration-induced interstitial lung disease Aspiration bronchiolitis ➡️ Questions & discussion abbreviations used in the pulmonary section: 8 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute […]
Delirium
CONTENTS Definition & diagnosis Delirium mimics Causes Diagnostic approach Treatment Antipsychotics Butyrophenones (haloperidol & droperidol) Olanzapine Quetiapine Chlorpromazine Risperidone Lurasidone Podcast Questions & discussion Pitfalls definition Delirium is acute, generalized brain dysfunction (“cerebral insufficiency”). Key features: Acute (e.g. not dementia). Causes inattention (e.g. disorientation, inability to perform complex tasks). Tends to wax and wane: may […]
Rapid Sequence Intubation and Procedurization
0 Introduction with a case 0 A otherwise healthy 70 year-old woman presented to Genius General Hospital with multifocal pneumonia. In the ED she was treated with appropriate antibiotics and two liters of crystalloid. During her ED course she was found to have increasing tachypnea to 30-35 breaths/min, and was subsequently transferred to the ICU. […]
Alcohol withdrawal
CONTENTS Rapid Reference 🚀 Preamble & disclaimer Diagnosis Alcohol withdrawal vs. hepatic encephalopathy Therapeutic target (CIWA vs RASS) Treatment: Phenobarbital monotherapy Phenobarbital pharmacology Advantages of phenobarbital over benzodiazepines Contraindications to phenobarbital ➡️ Phenobarbital guideline Checking phenobarbital levels? ➡️ Pitfalls of phenobarbital Alternative agents Benzodiazepines Valproic acid Antipsychotics & alpha-2 agonists (dexmedetomidine, clonidine, guanfacine) Ketamine Other […]
Acute Ischemic Stroke (AIS)
CONTENTS Rapid Reference 🚀 Core topics in ICU stroke management Blood pressure control Anticoagulation & antiplatelet therapy Respiratory support Seizure management Dysphagia evaluation & nutritional support Additional supportive measures Specific management situations Neuroworsening in AIS Thrombolytic-induced angioedema Hemorrhagic transformation (including post-thrombolysis) Malignant MCA syndrome Cerebellar stroke & posterior fossa syndrome Basilar artery thrombosis Moyamoya disease […]
PulmCrit Blogitorial – SIESTA syndrome: Sedation Induced EEG Suppression with Transient Agitation
This is SIESTA syndrome. The patient is locked in a cycle of unconsciousness, punctuated with brief episodes of agitation. Most of the time the patient is sedated to the point of having minimal EEG activity, which may hinder their ability to regain consciousness.
EMCrit 92 – EMCrit Intubation Checklist
Since Peter Pronovost’s landmark study on how a simple checklist can nearly abolish central line infections, checklists have been the darling of the medical literature
PulmCrit Wee- Extubating the agitated patient: dexmedetomidine vs. cowboy-style?
Dexmedetomidine decreased the duration of ventilation among agitated patients in a recent RCT in JAMA. But did these patients actually require intubation and dexmedetomidine? Or did they merely require extubation?
PulmCrit – Beware of the risk of ETT exchange
Imagine you’re in the ICU and the cuff of an ETT (endotracheal tube) ruptures. You exchange it for a fresh ETT over a catheter, right? Easy peasy. Blind airway exchange over a catheter has been the standard practice in various ICUs that I’ve rotated through. ETT exchange over a catheter is a simple and effective […]
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