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 […]
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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 […]
Purpura Fulminans
CONTENTS Rapid Reference 🚀 Basics of Purpura Fulminans Pathophysiology Common causes Clinical findings Diagnostic tests Diagnosis Treatment Antibiotics & source control Heparin & heparin resistance Protein C concentrates Blood product replacement Vasodilators Surgical debridement Vitamin K supplementation Podcast Questions & discussion Pitfalls basics Purpura fulminans is an extreme thrombotic subtype of disseminated intravascular coagulation, marked […]
Endocarditis
CONTENTS Rapid Reference 🚀 Diagnosis When to suspect endocarditis Lab workup Septic pulmonary emboli Echocardiography (TTE vs TEE) Diagnostic strategies & criteria European Society of Cardiology criteria Manifestations include: Metastatic infection Neurologic complications Septic embolic encephalitis Antibiotics Empiric therapy Definitive therapy Methicillin-sensitive Staph. 📖 Methicillin-resistant Staph. 📖 Enterococcus. 📖 Streptococcus pneumoniae. 📖 Beta-hemolytic Streptococci. 📖 […]
Acalculous cholecystitis
CONTENTS Basics Epidemiology Clinical presentation Differential diagnosis Investigations Labs Ultrasonography CT scan HIDA scan Overall diagnostic approach Treatment Podcast Questions & discussion Pitfalls overview Acalculous cholecystitis is defined as cholecystitis that occurs without a gallstone. This typically occurs in critically ill patients due to a combination of factors (e.g. bile stasis and hypoperfusion). Acalculous cholecystitis […]
PulmCrit Wee: Reconceptualizing bradykinin-mediated angioedema as a universal vicious spiral
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 […]
Hemophagocytic LymphoHistiocytosis (HLH)
CONTENTS Basics – what is HLH? Clinical features of HLH Laboratory findings Ferritin Lumbar puncture Pathology – Hemophagocytosis Causes of HLH Differential diagnosis – Closest mimics of HLH Approach to the diagnosis of HLH Treatment Treatment of the underlying cause (if possible) Steroid IL1 antagonism JAK inhibition Etoposide Podcast Questions & discussion Pitfalls what is […]
Catatonia
CONTENTS Basics Pathophysiology Epidemiology Clinical presentation Differential diagnosis Diagnostic criteria Diagnostic challenge with lorazepam or ketamine Causes of catatonia Investigation for underlying cause Management Podcast Questions & discussion Pitfalls core concepts of catatonia Catatonia is a motor dysregulation syndrome involving difficulty initiating or terminating actions.(19884605) Most commonly this causes periods of physical rigidity, negativism, or […]
EMCrit 146 – Who Needs an Acute PCI with Steve Smith (Part I)
Finally in one place, all of the STEMI equivalents with Steve Smith
Acute Disseminated Intravascular Coagulation (DIC)
CONTENTS Rapid Reference 🚀 Pathophysiology Symptoms Lab studies Causes Differential diagnosis Diagnostic criteria Sepsis-Induced Coagulopathy (SIC) Management Podcast Questions & discussion Pitfalls sepsis induced coagulopathy (SIC): ISTH DIC score: general concept of DIC Normally, clots form locally at sites of vascular damage. These clots are subsequently degraded after tissue damage is repaired. The processes of […]
PulmCrit- Dominating the acidosis in DKA
Management of acidosis in DKA is an ongoing source of confusion. There isn’t much high-quality evidence, nor will there ever be. However, a clear understanding of the physiology of DKA can help us treat this rationally and effectively.
CV-EMCrit 327 – Acute Valve Disasters Part 2 – Management of Critical Aortic Stenosis
Part 2 of crashing valves: aortic stenosis
Episode 11 – Ischemic Stroke 2013
2013 Ischemic Stroke Guidelines from AHA/ASA and ACEP
Approach to beta-lactam allergy in critical care
CONTENTS Rapid Reference 🚀 Getting started Types of drug reaction Allergy history How allergies cause harm Basic science of beta-lactam allergy Techniques for allergy management Skin testing Graded challenge Desensitization General approach to beta-lactam allergy in critical care Groups of antibiotics with cross-allergy: Aminopenicillins & select G1-G2 cephalosporins Cefazolin Nafcillin Piperacillin-tazobactam Cefepime & most G3 […]
PulmCrit- Toxicology dogmalysis: the osmolal gap
I’ve been checking the serum osmolal gap on patients with toxic ingestion for years. However, the osmolal gap has yet to crack a case for me. There have been lots of patients with elevated osmolal gaps due to uremia or ketoacidosis. Meanwhile, the cases of ethylene glycol or methanol intoxication which I have encountered have […]