Our ECPR is different…
PulmCrit- WHO guidelines regarding fluid administration for coronarvirus are dangerously misguided
The Surviving Sepsis Campaign is a blight on modern, evidence-based medicine.1 It’s been clear for some years that its fundamentals were flawed (centering around rapid, large-volume fluid resuscitation). Rather than adapt guidelines to modern evidence, the campaign recently doubled down on immediate administration of fluid and antibiotics within one hour. This provoked widespread protest, including […]
EMCrit 268 – Midlines Part 2-Explosion with Rory Spiegel
Midlines part 2 with @emnerd
IBCC chapter & cast – Hypocalcemia
Hypocalcemia in the ICU is one of the more confusing electrolyte abnormalities, because it’s frankly unclear exactly what to do with it. Most patients in ICU are hypocalcemic, but there is little evidence that trying to “replete” hypocalcemia back to euboxia is beneficial (or even feasible). Of course, there are some patients who have severe […]
EMCrit 264 – Case Discussion of Combined CCB and BB Overdose
A case as a means of discussing severe CCB and BB OD
PulmCrit- The Rothman Index: Artificial intelligence or merely a symptom of a broken healthcare system?
We are constantly hunting for newer and better sources of information. This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools. Some of these pan out. Most don’t. Why are these new sources of information generally disappointing? The answer is simple: we’re already doing pretty well. In order […]
IBCC chapter & cast – Toxic Alcohols
The diagnosis of toxic alcohols is a particularly controversial topic, based on recent evidence that the osmolal gap has a fairly awful sensitivity and specificity. This chapter describes an approach to toxic alcohol diagnosis which doesn’t depend on the osmolal gap. Although this may seem radical, this strategy has been previously recommended by other authors […]
PulmCrit – An alternative view of the PEPTIC trial
The PEPTIC multi-center RCT compared histamine-2 receptor blockers (H2RBs) versus proton pump inhibitors (PPIs) for stress ulcer prophylaxis among ventilated ICU patients.1 It’s a landmark trial of unprecedented size and statistical power. PEPTIC was presented at the Critical Care Reviews meeting in Ireland and live-cast around the world (available here). This presentation and the editorials […]
EM Nerd: The Case of the Sour Remedy Continues
The use of IV vitamin C as a therapeutic agent in sepsis has caught the hearts and minds of emergency medicine and critical care clinicians. Since the publication of a small single center before and after study by Marik et al in 2017 (1), we have spent countless hours screaming into the void that is […]
PulmCrit- Metabolic Resuscitation: Was the answer inside us all along?
Now that VITAMINS is published, it’s worth trying to look at the big picture of sepsis treatment with hydrocortisone, ascorbate, and thiamine (HAT). Marik et al. 2017: The beginning HAT therapy began with a single-center, before/after study.1 There was a stark mortality reduction following the routine adoption of HAT therapy in septic shock (figure below, […]
EMCrit 263 – The Venous Side – Part 1 – VEXUS Score with Phillipe Rola
The VEXUS Score – A way to quantitate how badly you overloaded your patient…
IBCC chapter & cast – Central line infection
Prevention and treatment of central line infections is a core competency in critical care. Prevention is the true key here. Achieving zero central line infections is an unreachable goal, but with diligence the rate can be pushed close to zero. The IBCC chapter is located here. The podcast & comments are below. Follow us on […]
IBCC chapter & cast – Deresuscitation (Dominating the Diuresis)
Large-volume diuresis is a topic that isn’t discussed much in critical care curricula or textbooks. Nonetheless, this is a daily reality for intensivists, especially those living in the United States (where patients continue to be empirically treated with 30 cc/kg fluid as initial fluid bolus, for a broad variety of complaints). This chapter attempts to […]
PulmCrit- Sepsis special edition & CBC to diagnose septic shock
The Journal of Thoracic Diseases is about to release a special edition on sepsis, edited by Paul Marik (open access). It’s deliciously rebellious – just look at the table of contents 👇 My article on using the complete blood count to diagnose sepsis is already available, so I’ll summarize it here (yes, I know, you […]
EMCrit Guest Post – Bougie Lessons from the Literature and Experience by George Kovacs
George Kovacs’ take on Bougie Use
- « Previous Page
- 1
- …
- 25
- 26
- 27
- 28
- 29
- …
- 92
- Next Page »