In the management of sepsis, the acquisition of blood cultures prior to the administration of antibiotics has been a long-held dictum, even before it gained the regulatory support due to its place in the SEP-1 3-hour bundle. But how much is lost if we defer the acquisition of blood cultures until after the administration of […]
IBCC chapter & cast – Non-Anion Gap Metabolic Acidosis (NAGMA)
Non-Anion Gap Metabolic Acidosis (NAGMA) has a broad differential diagnosis. Often the cause is obvious, but otherwise this leads to a rat’s nest of various forms of renal tubular acidosis (RTA). Fortunately, appropriate treatment generally doesn’t require immediate diagnosis of the specific cause of the NAGMA. So have no fear – give the evaluation an […]
EMCrit 256 – RUSH Redux with Jacob Avila
Some dozen years ago, a couple of my buddies and I created the RUSH exam. Today, I give you an update:
IBCC chapter & cast: Anion-Gap Metabolic Acidosis
Anion gap metabolic acidosis is generally the most worrisome pH abnormality. Many of the causes of anion gap elevation reflect a life-threatening problem (e.g. hyperlactatemia, shock, diabetic ketoacidosis, toxic alcohol poisoning). Particularly if the anion gap elevation is a new finding, this mandates immediate investigation (and sometimes, simultaneous resuscitation). This chapter explores the causes of […]
IBCC chapter & cast – Approach to pH diagnosis
According to Albert Einstein, “Everything should be made as simple as possible, but not simpler.” This is a similar sentiment to Occam’s Razor. Acid-base analysis is a good example of this principle. It’s possible to make things extraordinarily fancy and complex. To analyze pH status we could obtain an ABG, complete blood count, calcium, magnesium, […]
EMCrit Wee – First Study of the Benefits of an EDICU
Michigan’s EC3
EMCrit Guest Post – Drawing Circles for Bougie Hangup by Neil Dasgupta
A new technique to deal with bougie hold-up
EM Nerd-The Case of the Optical Misperception
Whether we like it or not, high-sensitivity troponin assays, recently approved by the FDA, will soon replace the 4th generation assays currently in operation. And while many claims have been made regarding their clinical utility, the implications for our standard chest pain workflow are unclear. A recent publication by Chew et al, provides us a […]
IBCC chapter & cast – Submassive & Massive PE
PE is the third leading cause of vascular mortality, after myocardial infarction and stroke. It is an enormously heterogeneous and unpredictable disease, which makes treatment difficult. As such, it should not be surprising that PE therapy remains highly controversial. For example, the new European Society of Cardiology guidelines recommend anticoagulation and watchful waiting for high-risk […]
EMCrit – The Pigtail Video
Pigtail Insertion
EMCrit 255 – Pigtails for Pleural Problems (Percutaneous Thoracostomy)
Pigtails are just plain nicer
IBCC chapter & cast – Anticoagulation reversal
We are frequently faced with patients who require reversal of anticoagulation due to hemorrhage or an emergent procedure. This has grown rather complicated, due to the emergence of numerous new anticoagulants and reversal agents. Furthermore, new evidence is emerging regarding the reversal of old agents (e.g. the PATCH trial regarding platelet transfusion in patients on aspirin).
PulmCrit- How to use IV epinephrine for anaphylaxis
When treating anaphylaxis, epinephrine is generally given via an intramuscular (IM) route. This is well established to be effective and life-saving. One advantage of IM administration is immediate use (without requiring intravenous access), including by patient auto-injection. IM epinephrine is doubtless the best approach for patient self-treatment, for first responders, and for immediate treatment in […]
EMCrit 254 – Central Line Tips and Tricks with Robby O and Me from EEM 2019
Central Line Tips and Tricks
IBCC chapter & cast: Tumor Lysis Syndrome
Tumor lysis syndrome isn’t encountered very often in critical care, but we will see the most extreme extent of this illness. Within the last decade, rasburicase has been a game-changer here. Understanding some basic physiology will guide the optimal diagnosis and treatment of tumor lysis syndrome in the post-rasburicase era. The IBCC chapter is located […]
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