CONTENTS Rapid Reference 🚀 Diagnosis Presentation Differential diagnosis Evaluation Naloxone basics Treatment overview Opioid naive pathway Doing OK pathway Too Sleepy pathway Dying pathway Intubated pathway Additional treatment may be needed for certain agents: Methadone Loperamide Podcast Questions & discussion Pitfalls opioid toxidrome – key features Somnolence Reduced respiratory rate This is the most important […]
Search Results for: mental toughness
EMCrit 314 – ShadowBoxing Case 1 – In the end, it’s always…
Our first shadowboxing episode…
EMCrit 322 – Shadowboxing Case 2 – Frack the EJ
The 2nd of the shadowboxing cases…
The myth of large-volume resuscitation in acute pancreatitis
Introduction 0 Severe pancreatitis causes fluid extravasation from the vasculature, sometimes causing shock. Traditionally this has been managed by administration of large volumes of crystalloid. For example, the 2013 American College of Gastroenterology Guideline recommended providing 250-500 ml/hour of crystalloid for the first 12-24 hours of hospitalization. They recommended targeting fluid resuscitation to achieve dilution […]
Hospital-Acquired Pneumonia (HAP)
CONTENTS Basics Epidemiology & risk factors Stepwise general approach to HAP: (1) Initial consideration for the possibility of HAP (2) Consider CT scan (3) Diagnosis & treatment of probable HAP (4) Data review over 24-72 hours (5) Ongoing management of HAP Other aspects of HAP management: Approach to treatment failure Bronchoscopy in HAP Questions & […]
PulmCrit- The gag reflex shouldn’t be tested in living patients
As a medical student I rotated through an elite hospital where it was believed that every patient admitted to the medicine service needed a rectal exam. The rationale was to avoid ever missing a case of rectal or prostate cancer. Eventually, the utility of digital rectal examination as a cancer-screening tool was debunked. Thankfully, this practice has fallen out of favor.
Vasopressors
CONTENTS Rapid Reference 🚀 Core agents Inodilators (milrinone, dobutamine, isoproterenol) Pure vasopressors Inopressors (norepinephrine, epinephrine, dopamine) Peripheral vasopressors Midodrine Methylene Blue Podcast Questions & discussion Pitfalls classic inodilators (milrinone, dobutamine) Mechanism Dobutamine stimulates mostly beta-receptors, with very little stimulation of alpha-receptors. Milrinone inhibits intracellular adenylyl cyclase, thereby increasing intracellular cyclic AMP levels. Physiologic effect Primary […]
PulmCrit – The 65 trial: Is 60 the new 65?
The 65 trial compares MAP targets of >65 mm to >60 mm in treating vasodilatory hypotension. This trial challenges decades of protocols which have targeted a MAP >65 mm. As such, it is a courageous and practice-changing study. However, we need to be realistic about the study’s limitations. trial overview This multi-center RCT was […]
EMCrit 124 – The Logistics of Proning for ARDS
Proning is one of the only evidence-based techniques to affect the mortality of ARDS patients. I’ve been wanting to do an episode on proning for a while.
Pulmonary complications from malignancy and its treatments
CONTENTS Approach to pulmonary dysfunction in a patient with cancer Specific disorders Parenchymal lung metastases Leukostasis Pulmonary leukemic infiltrates Airway metastases Malignant pleural effusion (MPE) ➡️ Lymphangitic carcinomatosis Pulmonary tumor emboli Pulmonary tumor thrombotic microangiopathy (PTTM) Pulmonary tumor macroemboli ➡️ Benign metastasizing leiomyoma (BML) Iatrogenic: Radiation pneumonitis Checkpoint inhibitor pneumonitis Other topics: Pulmonary complications from […]
Approach to Stupor & Coma
CONTENTS Front matter: Most clinically relevant: Rapid Reference – Clinical approach 🚀 Causes of stupor & coma Definitions Distinctive states that mimic coma: Locked-in syndrome Abulia and akinetic mutism Hypokinetic catatonia Functional unresponsiveness Malingering Management – some additional comments Airway management Related Coma syndromes (section of Exam chapter) Podcast Questions & discussion Pitfalls diagnostic approach […]
CC Nerd*-The Case of the Afflicted Kidney
Recently two trials examining the efficacy of the early utilization of renal replacement therapy (RRT) in critically ill adults with acute kidney injury (AKI) in the ICU were published. Despite examining very similar patient populations, undergoing very similar modes of therapy, these trials produced drastically divergent results. The following is a brief exploration of each […]
Traumatic Spinal Cord Injury (SCI)
CONTENTS Rapid Reference 🚀 Epidemiology Physiology Clinical presentation Evaluation of the injury Spinal shock Imaging Management Airway & breathing Blood pressure targets Dysautonomia: Neurogenic shock Vagal hyperactivity Autonomic dysreflexia Orthostatic hypotension Sphincter dysfunction DVT prophylaxis Steroid Surgery Podcast Questions & discussion Pitfalls common causes of spinal cord trauma (33896529) Motor vehicle collisions, especially among the […]
Diabetic Ketoacidosis (DKA)
CONTENTS Rapid Reference 🚀 Getting started Evaluating anion gap & ketoacidosis Definition & severity of DKA Evaluating the cause of DKA Core components of DKA resuscitation Fluid administration Electrolyte management Insulin infusion Long-acting, basal insulin Management of severe or refractory ketoacidosis NAGMA management Monitoring & management of DKA recurrence Special situations DKA in a hemodialysis […]
Pulmonary & cardiac complications of pregnancy
CONTENTS GENERAL APPROACH History & symptoms Dyspnea Chest pain Cough Hemoptysis ➡️ Palpitations Peripheral edema Physical examination Laboratory tests Common laboratory tests ABG interpretation Radiology Pharmacologic issues in pregnancy Antibiotic ➡️ Anticoagulation & antiplatelets Cardiac medications Steroid Uterotonic medications SPECIFIC DISEASE STATES Airway Asthma Cardiac Acute coronary syndrome (ACS) Aortic dissection Arrhythmias SVT (supraventricular tachycardia) […]
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