In 2015 I wrote this post on ACEi-induced angioedema. I still think it was a pretty good post (particularly for 2015), but it’s become increasingly clear recently that the post was fundamentally flawed. Let’s try to straighten this out. old model of bradykinin-mediated angioedema This is a conceptual model of how bradykinin-mediated angioedema occurs. Several […]
Search Results for: airway
PulmCrit Wee- Extubating the agitated patient: dexmedetomidine vs. cowboy-style?
Dexmedetomidine decreased the duration of ventilation among agitated patients in a recent RCT in JAMA. But did these patients actually require intubation and dexmedetomidine? Or did they merely require extubation?
Episode 11 – Ischemic Stroke 2013
2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP
Valproic Acid Intoxication
CONTENTS Rapid Reference 🚀 Pharmacology & pathophysiology Clinical manifestations Laboratory tests Imaging Treatment General supportive measures Gastrointestinal decontamination Naloxone Carnitine Hemodialysis Carbapenems Additional treatments for hyperammonemia Serial re-assessment For patients on valproate to manage epilepsy Podcast Questions & discussion Pitfalls formulations and absorption Valproic acid is available in immediate-release, delayed-release (q12-hr administration) or extended-release (q24-hr […]
“The Adventure of the Dancing Men”
The illustrious Cardinal Commendoni suffered sixty epileptic paroxysms in the space of 24 hours, under which nature being debilitated and oppress’d he at leangth sank, and died. His skull being immediately taken off, I found his brain affected with a disorder of the hydrocephalous kind. -Gavassetti, 1586 The […]
CC Nerd-The Case of the Unknown Quantity
Lung-protective ventilation is often considered a simple truth when managing critical care patients on mechanical ventilation. Despite this sense of certainty, the knowledge of exactly how and when to perform such ventilatory strategies is incomplete. The recently published PReVENT adds yet more uncertainty to the true efficacy of low tidal volume ventilation in patients without […]
Idiopathic pulmonary fibrosis (IPF)
CONTENTS Basics Epidemiology Clinical presentation Laboratory studies Radiology IPF vs. NSIP (nonspecific interstitial pneumonia) ➡️ Bronchoscopy Biopsy (surgical vs. cryobiopsy) Differential diagnosis Approach to diagnosis Treatment Antifibrotic therapy Pirfenidone Nintedanib Management of pulmonary hypertension Transplantation ➡️ Prognosis Other related topics: Combined pulmonary fibrosis and emphysema (CPFE) Short telomere syndromes Progressive pulmonary fibrosis (PPF) Questions & […]
Blood gas measurements in DKA: Are we searching for a unicorn?
Routinely obtaining an ABG or VBG is widely recommended, for example in both American and British guidelines. Why? Is this helping our patients, or is it something that we do out of a sense of habit or obligation?
PulmCrit Wee: Do fluid boluses before intubation help? (PREPARE trial)
I’m afraid she will tank after intubation, could you start some fluid? I brought a liter of fluid, just in case the blood pressure falls after intubation. He is decompensating! Run the fluid wide open! We’ve all probably heard and spoken those phrases. Crystalloid is a traditional therapy in efforts to either prevent or mitigate […]
NeuroEMCrit – The Perils of the ICH Score
Don’t use the ICH score in isolation to not give aggressive critical care…
Elevated intracranial pressure (ICP)
CONTENTS Rapid Reference 🚀 Physiology Hydrocephalus Different types of edema Focal versus global ICP elevation Causes of ICP elevation Diagnosis Clinical manifestations Ultrasound evaluation for ICP elevation Neuroimaging Single measurement of ICP with lumbar puncture ICP monitoring Indications for continuous ICP monitoring Techniques for continuous ICP monitoring ICP value interpretation CPP value interpretation ICP waveform […]
EM Nerd-The Case of the Elemental Truancy
Much has been written regarding the benefits of apneic oxygenation. The physiological underpinnings are sound with minimal logistical and resource based costs. As such it has enjoyed widespread adoption throughout the Emergency Medicine and Critical Care world. Despite its popularity, the evidence supporting its use has been less inspirational. Recently, a meta-analysis published in Annals […]
Acute Ischemic Stroke (AIS)
CONTENTS Rapid Reference 🚀 Core topics in ICU stroke management Blood pressure control Anticoagulation & antiplatelet therapy Respiratory support Seizure management Dysphagia evaluation & nutritional support Additional supportive measures Specific management situations Neuroworsening in AIS Thrombolytic-induced angioedema Hemorrhagic transformation (including post-thrombolysis) Malignant MCA syndrome Cerebellar stroke & posterior fossa syndrome Basilar artery thrombosis Moyamoya disease […]
Pulmonary involvement in connective tissue diseases
CONTENTS Overview of connective tissue disease-related ILD (CTD-ILD) History & physical Autoantibodies Autoantibody panel Autoantibody profiles of specific diseases ANA (antinuclear antibody) Interstitial pneumonia with autoimmune features (IPAF) Rheumatoid arthritis (RA) Interstitial lung disease Rheumatoid nodules Scleroderma Interstitial lung disease Pulmonary hypertension Lupus Diffuse alveolar hemorrhage Acute lupus pneumonitis Chronic ILD Pulmonary hypertension Shrinking lung […]
Situation Awareness in Resuscitation Part 2: A Force of Habit
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