Post-extubation HFNC has helped us aggressively liberate patients from mechanical ventilation while simultaneously reducing our reintubation rate. One remaining question is determining which patients benefit from this. My practice has generally been to use HFNC in patients felt to be at higher risk for reintubation. A fresh RCT in JAMA will revise this.
Search Results for: airway
How to Place and Secure an IO in a Peds Patient
Tips from someone who knows–A Crit Care Paramedic
PulmCrit- Rigorous vs. lenient spontaneous breathing trials: The answer at last?
background There has long been debate about exactly how to design a spontaneous breathing trial. If the trial is made too easy, then patients would be extubated before being ready (leading to re-intubation). Alternatively, if the trial is too hard, that would prolong mechanical ventilation beyond the point of being beneficial. The figure above shows […]
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 […]
Movement disorder emergencies
CONTENTS Hypokinetic Parkinson’s disease Managing Parkinson’s medications in the ICU Parkinsonism-hyperpyrexia syndrome Acute parkinsonism Psychosis in Parkinson’s disease Neuroleptic malignant syndrome (NMS) Catatonia Baclofen withdrawal Hyperkinetic Acute ballismus or chorea Akathisia Myoclonus Dystonia Acute dystonia Dystonic storm Post-hypoxic myoclonus Tetanus Propofol frenzy Podcast Questions & discussion Pitfalls general challenges (1) Parkinson’s medications must generally be […]
answers to ABG/VBG questions
Here are the answers to todays discussion questions on ABG & VBG. A woman with history of heart failure, COPD, and recent international plane travel presents with dyspnea to the ED. ABG shows 7.52/29/65/23. What does this test reveal about her diagnosis? (2/6) — 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 (he/him) 💊 (@PulmCrit) September 4, 2019 (1) Answer = […]
EM Nerd-The Case of the Inferior Superiority
A perfect trial would require minimal statistical tools to assist in its analysis. Such a trial would be so large that the sample approached the true likeness of the broader population it intended to emulate, thus the risk of sampling error would be minimal. The confidence intervals surrounding the point estimates would be so minute, […]
EMCrit CQiR – IV Bolus Epinephrine for Anaphylaxis: A Double-Edged Sword
Is IM still the way to go with epi in anaphylaxis?
PulmCrit wee – Why the SCCM/AARC/ASA/APSF/AACN/CHEST joint statement on split ventilators is wrong.
The story began in early March. With COVID-19 bearing down upon us, it became clear that we could run out of ventilators. This sparked interest in the concept of splitting ventilators between several patients. Some articles and videos were circulated on twitter describing how this could be done. These mostly described splitting a ventilator set […]
Five pearls for the dyspneic patient with Guillain-Barre Syndrome or Myasthenia Gravis
0 Introduction 0 Guillain-Barre Syndrome (GBS) and Myasthenia Gravis (MG) are common causes of acute weakness. About 25% of these patients may develop respiratory failure requiring intubation, so a major concern is determining who requires ICU-level monitoring and whether intubation should be performed. Ideally it would be possible to predict with 100% accuracy which patients […]
PulmCrit- Ketamine for alcohol withdrawal?
Recent publications have explored the role of ketamine in alcohol withdrawal. Ketamine undoubtedly has some outstanding properties, which make it well suited for this task. The challenge is integrating ketamine into a unified, coherent treatment strategy.
The Problem of Thor Bridge
Disclosure: This post is unusually full of hearsay and conjecture. Like a secondary endpoint that flirts with statistical significance it should be viewed purely as hypothesis generating. For a more reasoned and experienced view of the following data please read Josh Farkas’s wonderful post on pulmcrit.org. Damage control ventilation is not a novel concept. It functions […]
EMCrit RACC Lit Review – February 2023
All the lit goodness for Feb 2023
Smoking-related interstitial lung diseases
CONTENTS RBILD (respiratory bronchiolitis interstitial lung disease) DIP (desquamative interstitial pneumonia) Other smoking-related lung diseases covered in other chapters: PLCH (pulmonary Langerhans cell histiocytosis) ➡️ AEP (acute eosinophilic pneumonia) ➡️ COPD (chronic obstructive pulmonary disease) ➡️ IPF (idiopathic pulmonary fibrosis) ➡️ CPFE (combined pulmonary fibrosis and emphysema) ➡️ Questions & discussion abbreviations used in the […]
Bupropion intoxication
CONTENTS Overview Pharmacodynamics Pharmacokinetics Diagnostics & doses Clinical evolution Treatment Activated Charcoal Whole bowel irrigation Neurotoxicity management Cardiotoxicity management Podcast Questions & discussion Pitfalls Bupropion is increasingly used for several indications (depression, tobacco cessation, and ADHD). Unfortunately, it is also a uniquely dangerous and increasingly common source of intoxication (especially the extended-release formulations). For example, […]
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