CONTENTS Rapid Reference: Initial management 🚀 Epidemiology, causes, & location Epidemiology Causes of SAH based on blood distribution Diffuse or basal SAH Convexity SAH Perimesencephalic SAH Presentation Thunderclap headache – causes & approach Grading scales Diagnostic approach Diagnosis of SAH Noncontrast CT CT angiography Lumbar puncture MRI & MRA Invasive angiography Overall diagnostic algorithm Diagnosis […]
Search Results for: septic shock
The Adventure of the Blanched Soldier
So often in the management of the critically ill we are forced to choose between the lesser of two evils. The transfusion of blood products in the face of hemorrhagic shock is in some ways the best compromise of less than ideal choices. Every drop of resuscitative fluid given that does not mimic the […]
PulmCrit: Is pure RSI a failed paradigm in critical illness? The primacy of pressure
Why do some patients’ saturation crash during laryngoscopy, whereas other patients are fine? What can we do to prevent this?
Old Chapter from Crashingpatient.com
2010 ACLS Guidelines web site with tons of resources Do not place sheets between patients and cooling blankets history of hypothermia and review (Chest 2008;133;1267-1274) Hypothermia review article Bernard SA, Buist M, Induced hypothermia in critical care medicine: a review. Crit Care Med 2003;31:2041-51. Major clinical trials have been […]
NeuroEMCrit – Everything you wanted to know about Hyperosmolar agents for the Management of ICP and Cerebral Edema
Everything you wanted to know about Hyperosmolar agents for the Management of ICP and Cerebral Edema
Spinal Cord
CONTENTS Spinal cord basics Anatomy Recognizing spinal cord injury Lesion localization Bowel and bladder symptoms Spinal cord radiology Patterns of axial involvement Patterns of longitudinal involvement Acute & subacute myelopathy Potential causes Investigation Blood tests CSF evaluation Imaging Specific myelopathies Spinal cord infarction Spinal dural arteriovenous fistula (dAVF) Spinal epidural hematoma Cauda equina syndrome Nitrous […]
Ethylene glycol & methanol poisoning
CONTENTS Rapid Reference 🚀 Background Biochemistry Clinical features Epidemiology Symptoms Diagnostic tests Osmolal gap Anion gap Lactate gap Other lab clues of ethylene glcyol toxicity Specific tests for methanol or ethylene glycol Neuroimaging Treatment Decontamination Alcohol dehydrodgenase blockade (e.g., fomepizole) Hemodialysis Fluids & electrolytes Vitamins Methanol-induced brain death Podcast Questions & discussion Pitfalls labs to […]
PulmCrit: No more antipsychotics for delirium? Not so fast!
Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles.
Deresuscitation: Dominating the Diuresis
CONTENTS Rapid Reference 🚀 Intro Are diuretics nephrotoxic? Specific agents Acetazolamide Loop diuretics Thiazide diuretics Spironolactone Amiloride Triamterene (& why not to use it) Osmotic diuretics General strategies & problem-shooting Volume removal from pleura or peritoneum Large-volume diuresis Diuretic resistance Addressing common problems which arise Hypernatremia Metabolic alkalosis Hypokalemia & hypomagnesemia Hypotension Rising creatinine Podcast […]
Letter to the Editor – High-Sensitivity Troponin is not a Myth, and “Myth-busting” is often another Myth to be Busted
Shots fired…
Management of severe hyperkalemia in the post-Kayexalate era
0 Introduction 0 There is increasing recognition that sodium polystyrene sulfonate (Kayexalate) is ineffective for the immediate management of severe hyperkalemia (Kamel 2012). With Kayexalate gone, there seems to be a gap in our treatment regimen. I often encounter residents who know that Kayexalate isn’t helpful, but aren’t sure exactly how to treat hyperkalemia without […]
PulmCrit: pH-guided fluid resuscitation & BICAR-ICU
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it’s unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura of ignorance and failure. Consequently, bicarbonate is underutilized in some situations where it might actually help.
Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
CONTENTS Rapid Reference 🚀 SCAPE vs subacute pulmonary edema Diagnosis Triggers of SCAPE Principles of treatment CPAP or BiPAP Nitroglycerine Oral vasodilators Volume management & diuresis Opioid Podcast Questions & discussion Pitfalls SCAPE dx & rx checklist ✅ central clinical findings of SCAPE (more) Rapid onset of severe dyspnea. Hypoxemia. Hypertension (SBP >160 mm and/or […]
PulmCrit- Phenobarbital monotherapy for alcohol withdrawal: Reloaded
Currently there is a lorazepam shortage in the United States. This caused a surge of interest into using phenobarbital for alcohol withdrawal. I’ve received several e-mails over the past few weeks about this. It’s been two years since my last post about phenobarbital, so here’s an update focusing on lessons learned in the interim.
PulmCrit: Fighting refractory ARDS with physiologic jujitsu
Jui-jitsu is a Japanese martial art based on flexibility and technique, rather than a directly confronting an opponent with force. In the spirit of jui-jitsu, this post explores how to support ARDS patients without directly confronting lung dysfunction. This is useful in refractory ARDS, when frontal assault has failed.