Enormous attention is committed to the control of pain, with much less being directed to the control of nausea. However, nausea and vomiting can be even more distressing than pain. By understanding the receptor pharmacology of various antiemetics, a rational and effective approach is possible. The IBCC chapter is located here. The podcast & comments […]
EMCrit Wee – Is it Tamponade with Jacob Avila
Ultrasound signs of pericardial tamponade with my buddy, Jacob Avila
IBCC chapter & cast – Analgesia for the critically ill patient
It’s impossible to get through a single shift in the ICU without encountering several patients experiencing pain. Controlling pain is easy – but controlling pain while limiting collateral side-effects can be a challenge. Anesthesiologists have pioneered the best approaches here, which often involve multimodal combinations of various medications carefully titrated to effect. Although intensivists may […]
EMCrit 279 – The Decision to use Ketamine – Disruptive and Dangerous with Reub Strayer
I frequently see both residents and attendings inappropriately using ketamine for agitated patients. Inappropriately both by giving it when it is unecessary and giving it in poor fashion when it is indicated.
IBCC chapter & cast – Inhaled Pulmonary Vasodilators
Inhaled pulmonary vasodilators are generally quite safe. They offer a variety of physiologic benefits to patients with cardiopulmonary failure, including improved oxygenation and right ventricular function. Unfortunately, like so many interventions in critical care, there is a dearth of large, multi-center RCTs proving patient-centered benefit. This chapter attempts to sift through available evidence, in efforts […]
IBCC chapter & cast – Hyperosmolar Hyperglycemic State
Hyperosmolar Hyperglycemic State (previously known as “Hyperosmolar Hyperglycemic Nonketotic Syndrome” and, before that, “Hyperosmolar Hyperglycemic Nonketotic Coma”) is a bit of a slippery animal. Despite being redefined several times, the precise definition remains elusive. This may cause it to be over-diagnosed in anyone with severe hyperglycemia. The treatment likewise remains a bit controversial, with different […]
IBCC chapter & cast: Guillain-Barre Syndrome
Guillain-Barre Syndrome is the most common cause of acute-onset neuromuscular weakness requiring ICU admission. COVID-19 appears to be one trigger of Guillain-Barre Syndrome, so this might be even more common in the coming months. There isn’t much high-quality evidence regarding respiratory support in Guillain-Barre Syndrome, particularly when intubation is indicated. Consequently, it’s important to use […]
EMCrit 278 – Labors of Trauma – Blunt Edition (Part 1)
The complete (hopefully) menu of cognitive and operational tasks for the Trauma Team Leader for sick trauma patients.
IBCC chapter & cast – Intracranial hemorrhage
Intracranial hemorrhage is a fairly common problem, which spans the gamut from mild to life-threatening. Most therapies haven’t been shown to work, so management mostly consists of high-quality neuro-supportive care. The IBCC chapter is located here. The podcast & comments are below. Follow us on iTunes
IBCC chapter & cast – Catastrophic antiphospholipid syndrome (CAPS)
Catastrophic antiphospholipid syndrome (CAPS) is a truly rare cause of multi-organ failure. It is usually not considered as a diagnostic possibility, leading it to be mis-diagnosed as septic or cardiogenic shock. Awareness of this condition and various red flags suggesting its presence might facilitate earlier diagnosis and therapy. The IBCC chapter is located here. The […]
COMM CHECK: More On Resuscitation Communication
If the words of command are not clear and distinct, if the orders are not thoroughly understood, the general is to blame – Sun Tzu Communication During Resuscitation Communication continues to be a major issue in virtually all high-stress, time-sensitive environments. This has been discussed a number of times on EMCrit, most recently in […]
IBCC chapter & cast – Fever workup in the ICU
Familiarity breeds contempt. Fever is so common in the ICU, that we often don’t put much thought into these workups. Just culture everything, right? Well, not really. Excessive cultures frequently lead to false-positive results (representing colonization), which serve only to misdirect attention away from the actual problem. Meanwhile, inadequate attention to the physical examination and […]
EMCrit 277 – COVID Pulmonary Physiology with Martin Tobin
COVID Pulmonary Physiology
IBCC chapter & cast: Catheter-Associated Urinary Tract Infection (CAUTI)
Catheter-associated urinary tract infection (CAUTI) is supposedly one of the most common causes of nosocomial infection. However, it’s dubious to what extent it is truly a disease. It’s increasingly clear that the vast majority of cases of “CAUTI” are likely merely asymptomatic bactiuria, which has been mis-diagnosed as infection (leading to unnecessary treatment and iatrogenic […]
IBCC chapter & cast – Sickle Cell Acute Chest Syndrome
Sickle cell disease affects 100,000 people in the United States and far more internationally. One of the most dangerous manifestations of the disease is acute chest syndrome, which involves a vicious cycle of erythrocyte sickling and respiratory failure. Acute chest syndrome can be a presenting feature upon hospital admission, it can arise as a complication […]
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