CONTENTS Rapid Reference: Overview & Checklist 🚀 Investigations Diagnosis & bedside evaluation Risk stratification Resuscitation basics Causes Specific bleeding location/types Approach to upper GI bleed Variceal bleed Hematochezia and (presumed) lower GI bleed Podcast Questions & discussion Pitfalls history & physical History: NSAID use? Abdominal pain? Alcoholism? Liver disease? Surgical history: Gastric bypass surgery? AAA […]
Search Results for: septic shock
EMDOCS.net hosted me on Ask Me Anything
EMDOCS.net brought me on for an AMA session
PulmCrit- APRV: Resurrection of the open-lung strategy?
APRV is often used in surgical ICUs, but not medical ICUs. APRV may be viewed as a “new” technique by medical intensivists, whereas it’s been used for decades in surgical ICUs with great results. A fresh RCT may help resolve this.
Acute Demyelinating Disorders
CONTENTS Inflammatory demyelinating disorders Acute disseminated encephalomyelitis (ADEM) & acute hemorrhagic leukoencephalitis (AHLE) Neuromyelitis optica spectrum disorders (NMOSD) Multiple sclerosis Myelitis due to multiple sclerosis Tumefactive Multiple Sclerosis Acute Multiple Sclerosis (Marburg variant) Balo concentric sclerosis GFAP-IgG associated myelitis Idiopathic transverse myelitis Management considerations for inflammatory demyelinating disorders Emergency complications of demyelinating disorders Treatment Other […]
Three myths about Plasmalyte, Normosol, and LR
0 Introduction: Selecting the best balanced crystalloid 0 About six months ago, Genius General Hospital added Normosol to its formulary. For those of you not familiar with Normosol, it is produced by Hospira and is essentially a generic version of Plasmalyte by Baxter (table below). Although most evidence has been obtained with Plasmalyte, this is […]
Takotsubo syndrome
CONTENTS Epidemiology Symptoms Diagnostic studies ECG Phase I: STE Phase II: TWI Reverse Takotsubo Prominent T-waves Echocardiography Cardiac MRI Labs Diagnostic approach Treatment [1] Treat underlying problem [2] Anticoagulation [3] Arrhythmia management [4] Hemodynamic management [4a] Hemodynamically stable patient [4b] Hemodynamically unstable with LVOTO [4c] Hemodynamically unstable without LVOTO Prognosis Pathophysiology Podcast Questions & discussion […]
Hypothermia and Post-Arrest Studies
The Biggies TTM Trial TTM Trial Hemodynamics Polderman Editorial on TTM HACA Trial (NEJM 2002;346(8):549) Bernard RCT (NEJM 2002;346(8):557) Meta-Analysis ILCOR Hypothermia Statement ILCOR Post-Arrest Care Statement Lancet Review by Kees Polderman Nuts & Bolts Review by Kees Polderman (Crit Care Med 2009;37(3):1101-1120) Mechanisms of Hypothermia by Kees Polderman Study by Oddi ( )-Included Asystole […]
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 […]
Immune-related adverse events from checkpoint inhibitors
CONTENTS Rapid reference 🚀 Introduction to checkpoint inhibitors Core principles of immunotherapy-related adverse events Immune-related adverse events in the ICU Specific organ-system involvement Cardiac Pneumonitis Colitis Hepatitis Nephritis Endocrine Neurologic Hematologic Dermatologic Podcast Questions & discussion Pitfalls basic tests to consider in critically ill patient s/p checkpoint inhibitor (more) Labs: CBC with differential, electrolytes. Coagulation […]
Invictus: Survival, Sustainment, and Service in the Era of COVID-19
Invictus – William Ernest Henley These are difficult and challenging times. The current situation with the pandemic is unprecedented. The impact it has imposed in terms of economic cost, human suffering, and strain on our healthcare teams around the globe is unbelievable. Furthermore, while there is a glimmer of hope on the horizon, the […]
Sarcoidosis
CONTENTS Basics Epidemiology Pulmonary sarcoidosis Clinical presentation Radiographic staging (Scadding stage) Chest CT scan Lymphadenopathy ➡️ Nonfibrotic parenchymal abnormalities Fibrotic parenchymal abnormalities Necrotizing sarcoid granulomatosis Pulmonary function tests Reduced DLCO Restriction Obstruction Pleural involvement Pulmonary hypertension Large airway involvement Treatment of pulmonary sarcoid Approach to sarcoidosis patient with cardiopulmonary deterioration Extrapulmonary sarcoidosis Skin Erythema nodosum […]
The Adventure of the Resident Patient
In a properly automated and educated world, then, machines may prove to be the true humanizing influence. It may be that machines will do the work that makes life possible and that human beings will do all the other things that make life pleasant and worthwhile. -ISAAC ASIMOV The term Cyborg, short for […]
Inhaled Pulmonary Vasodilators
CONTENTS Rapid Reference 🚀 Physiologic effects Specific agents Nitric Oxide (NO) Nitroglycerine Epoprostenol Milrinone Oxygen Contraindications & adverse effects Indications Overall concept – temporary bridge ARDS Pulmonary embolism Decompensated chronic pulmonary hypertension Right ventricular myocardial infarction Podcast Questions & discussion Pitfalls Inhaled pulmonary vasodilators yield three physiological advantages: #1) reduced pulmonary vascular resistance Pulmonary vasodilation […]
PulmCrit- Rant: Antimicrobial exposure and risk of delirium
This paper slipped across my twitter feed over the weekend. It was a bit disquieting to see that it was getting a lot of attention, despite being a methodological train wreck (seriously, MedTwitter, where’s the skepticism??). This post will briefly walk through some of the main flaws. There will be a bit of pharmacology, a modicum of methodology, and a lot of ranting.
Neurological examination & neuroanatomy
CONTENTS Rapid Reference 🚀 Neurological examination Global function & mental status Level of consciousness Motor responses to pain Breathing patterns Aphasia Cranial nerves CN2,3 – Pupillary abnormalities Approach to anisocoria Unilateral pupillary abnormalities Horner’s syndrome Bilateral pupillary abnormalities CN3,4,6 – Extraocular movements CN3-Oculomotor nerve CN6-Abducens nerve Testing of horizontal gaze abnormalities Specific abnormalities of horizontal […]