Severe insulin overdose usually occurs as a suicide attempt, but can also result from medication error. Conventional therapy focuses on giving tons of intravenous glucose. This generally works, but it can get messy.
Search Results for: mental toughness
Organizing pneumonia (OP)
CONTENTS Basics Epidemiology & causes of organizing pneumonia Presentation Imaging findings Consolidation Nodule or mass Ground-glass opacities Perilobular opacities Pertinent negatives Laboratory studies Invasive diagnostics Differential diagnosis Management Questions & discussion Organizing pneumonia (OP) is a pathological form of lung response to various injuries. It involves the formation of organized plugs of fibrous tissue within […]
The Adventure of the Impassable Stone
As medical skeptics we have a tendency to revel in the negative study. We bemoan the p-value’s tendency to underestimate the risk of type I error and cite Frequentist statistics’ history of getting it wrong almost as often as it gets it right. Despite these nihilistic inclinations it is important that we are equally vigilant […]
EMCrit 226 – Airway Update – Bougie and Positioning
A discussion of bougie-first, bougie best and hopefully a summary of proper positioning
IBNCC index
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z drug interaction checker IBNCC […]
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.
EMCrit 48 – PhD in EKGs Part II – Left Bundle Branch Block
A few months ago, we had Dr. Stephen Smith on the podcast to discuss a variety of EKG issues. Dr. Smith has an EKG blog that is required reading for every ED and ICU doc. This is Part II and I think it discusses an incredibly important issue: right now major medical societies including the AHA and ACEP are asking us to fibrinolyse or PCI patients with new or presumed new LBBB. However, your interventionalists will tell you that this strategy is a ridiculous waste given how few acute occlusions will actually be found. Why this discrepancy?
The Adventure of the Three Students
There are few things that make emergency medicine nerds more excited than decision rules. So when the Canadian gods of decision instruments, Jeff Perry and Ian Stiell, published the results from the validation cohort of their recently derived SAH decision rules they of course had our full attention. On September 25th 2013 JAMA published this […]
Antifragile in EM by George Kovacs
George Kovacs writes on a book he just finished.
PulmCrit- Liberating the patient with no cuff leak
A new joint practice guideline by the ATS and ACCP addresses how to approach cuff leaks. This guideline recommends a clever compromise between these extremes, which is the basis of the algorithm below. This provides a streamlined, evidence-based pathway to extubate patients without a cuff leak.
PulmCrit – Heparin resistance in COVID & implications for DVT prophylaxis
background: what is heparin resistance? Heparin works by binding to antithrombin III and thereby activating antithrombin III, an endogenous anticoagulant which inhibits clotting factors (especially Xa). Heparin + Anti-thrombin III → [Heparin-Antithrombin-III complex] → Inhibition of Xa activity Heparin resistance refers to situations where unusually large doses of heparin are required to achieve anticoagulation. This […]
“The Adventure of the Missing Three-Quarter”
Since Hector Pope published his now infamous study in the April 2000 NEJM, Emergency Physicians ability to clinically differentiate ACS has been called into question(10). Despite the fact the study’s findings that ED physicians missed an almost flawless 0.18% of chest pain patients who went on to be diagnosed with a MI, we have been […]
Neuroimaging
CONTENTS OF THIS CHAPTER Introduction Radiologic anatomy Cisterns CT anatomy overview Vascular distributions CT radiology CT basics Approach to reading a CT scan MRI Understanding the sequences T1 T1 with contrast T2 & FLAIR DWI & ADC T2* (GRE & SWI) Hematoma evolution on MRI Approach to reading an MRI Selected neuroimaging differentials Leptomeningeal enhancement […]
PulmCrit Wee – Urine toxicology screens should be removed from brain death guidelines
Prior to declaring a patient brain dead, confounding factors which could falsely cause the patient to appear dead must be eliminated. One important confounder is intoxication. Failure to recognize that a patient is intoxicated could lead to an incorrect diagnosis of brain death that in turn can lead to withdrawal of life support – thereby […]
Spinal Epidural Abscess (SEA)
CONTENTS Pathogenesis Epidemiology & risk factors Clinical findings Laboratory studies Imaging studies Antibiotic selection & timing Interventional management Podcast Questions & discussion Pitfalls route of spread Improved imaging techniques have demonstrated that the majority of epidural abscesses occur secondary to tracking from a nearby infected musculoskeletal structure (e.g., septic facet joint, discitis, vertebral osteomyelitis).(31021957) Infection […]
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