Don’t read this unless you want to be annoyed
Search Results for: acid base
PulmCrit- First placebo-controlled RCT on remdesivir for COVID-19
Remdesivir is being promoted as an anti-viral agent for the treatment of COVID-19. The first randomized, blinded, placebo-controlled trial of remdesivir was just released (Wang et al.). But before we dig into this trial, a little background… Background: Animal studies on Remdesivir Remdesivir is an anti-viral agent with strong efficacy against COVID-19 both in vitro […]
A Case of Shadows Part II
I think we all can agree that the subtleties of the thoracic cavity go far beyond the diagnostic capabilities of our standard two-view chest x-ray. We have robust data that demonstrates the superb diagnostic prowess of bedside ultrasound (US) when compared to the mediocrity of plain films (1, 2,3,4). And yet more information is not […]
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 Wee: My graduation speech – why we resuscitate
Below is my graduation speech. It is about why we are in medicine. As all resuscitationists know – whether nurse, physician, pharmacist, PA, or paramedic – resuscitation is hard work. We all could have chosen easier, safer paths to follow. Ten years down the track I have no regrets. I appreciate the great privilege of being here. Still, though, it’s good to take a moment to remember how we got here, and why it is that we do what we do.
Metformin toxicity
CONTENTS Rapid Reference 🚀 Physiology of metformin-induced lactic acidosis Epidemiology & definitions Clinical presentation Differential diagnosis Prognosis Treatment Decontamination after acute ingestion Evaluate for other causes & consider empiric treatment for sepsis Glucose management & insulin (?) Volume resuscitation Respiratory support Dialysis indications Methylene blue?? Podcast Questions & discussion Pitfalls approach to metformin-associated lactic acidosis […]
EMCrit Shadowboxing Case 6 – A Respiratory Case along with Extra Commentary from Mae West
A pulm-crit shadowboxing case
PulmCrit – Baricitinib for COVID-19: The rise of the jakinibs
Background: JAK-inhibitors (jakinibs) in the greater context Much of the harm from infections is mediated by hyperactive inflammatory reactions. To date, most research has focused on two classes of medications to treat this: Corticosteroids have the advantage of being cheap, widely available, and often effective. The disadvantage is that corticosteroids modulate innumerable molecular pathways, thereby […]
Cervical Artery Dissection
CONTENTS Pathophysiology Epidemiology Clinical presentations Manifestations of internal carotid dissection Manifestations of vertebral dissection Overt trauma complicated by cervical artery dissection Imaging Management Podcast Questions & discussion Pitfalls arterial dissection may begin in two ways: (#1) The true lumen may dissect into the arterial wall. This creates a true lumen and a false lumen (e.g., […]
Preoxygenation, Reoxygenation and Deoxygenation
What is this page about? Scott Weingart, MD and Richard Levitan, MD published an article in the Annals of Emergency Medicine entitled Preoxygenation and Prevention of Desaturation during Emergency Airway Management. This page serves as a repository for supplementary material on the subjects raised in the article. The article is available for free on the […]
Histoplasmosis
CONTENTS Epidemiology Different forms of clinical disease: Acute (& subacute) pulmonary histoplasmosis Granulomatous mediastinitis Broncholithiasis Fibrosing mediastinitis Chronic cavitary pulmonary histoplasmosis (CCPH) Progressive disseminated histoplasmosis CNS histoplasmosis Diagnostic studies Histoplasma antigen test Histoplasma antibody (serology) Bronchoscopy Tissue biopsy (Fungal culture) Management Pathophysiology Questions & discussion abbreviations used in the pulmonary section: ABPA: Allergic bronchopulmonary aspergillosis […]
PulmCrit- Oral vasopressor to accelerate liberation from the ICU
Midodrine is an oral agent which functions as an alpha-1 agonist. It has been used in a variety of situations including autonomic dysfunction, hepatorenal syndrome, and dialysis-induced hypotension. Over the past few years there has been increasing interest in using midodrine to facilitate weaning off vasopressors.
Guest Post – The 3D Printed Endobronchial Trainer by Matt Mac Partlin
Train on massive hemoptysis
PulmCrit- Sepsis Research Rant: More fake news, less real news
The following rant focuses on sepsis research, but these principles are universal. I apologize for the agitated nature of this post, but I just can’t hold it in any longer. If I read one more correlational study which tries to imply causation, I might just explode. In order to prevent burnout, I’m going to journal these thoughts instead. So, hang on to your hats, because things are going to get a bit heated.
Atrial Fibrillation (AF) & Flutter complicating critical illness
CONTENTS Introduction Diagnosis of AF Investigation of the cause of AF Management – Overall approach Emergent cardioversion Is immediate cardioversion indicated? How to perform DC cardioversion (1) Universal AF stabilization package (2) Rate vs. rhythm control decision Rhythm control in critical illness Rate control (3) Anticoagulation Atrial flutter Pharmacopeia for AF in the ICU: Amiodarone […]