Several years ago a mentor suggested that I write a book. I nearly laughed at her. A book?? Inconceivable! Who would buy it? Would they actually read it? Would it be there at 3 AM when they needed it? How could it be updated? A physical book didn’t seem compatible with the breakneck speed of critical care or our internet-based culture.
Search Results for: mental toughness
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 […]
COVID Airway Management Thoughts
additional COVID airway management thoughts
Demystifying the p-value
Introduction 0 The limitations of p-values for null hypothesis testing has been debated since their invention in the 1920s. Unfortunately, statistics textbooks typically whitewash this controversy, presenting null hypothesis testing as the only viable approach to statistics. Recently, the journal of Basic and Applied Social Psychology took this debate a step further, officially banning the […]
EM Nerd-The Case of the Otalgic Squire
As the year draws to a close it is safe to say that it has not been a productive twelve months for antibiotic stewardship in the Emergency Department. A recent example is the latest NEJM publication by Hoberman et al examining the efficacy of antibiotics for children with acute otitis media (OM) (1). Using a […]
Buprenorphine & opioid use disorder
CONTENTS Rapid Reference 🚀 All hands on deck Buprenorphine basics Buprenorphine induction Acute pain in a patient on chronic buprenorphine Podcast Questions & discussion Pitfalls Between 1999-2017, ~400,000 people died from opioid overdose. That’s over half the number of Americans who have ever died from HIV. It is increasingly clear that opioid use disorder (OUD) […]
The Man with the Twisted Lip
As an Emergency Medicine doctor we are trained to function in varying degrees of uncertainty. We work in a world of risk of benefits vs harms. When the benefit to harm ratio reaches a threshold for action we are taught to do so swiftly and decisively. Given this, […]
Launching the Internet Book of Critical Care (IBCC)
Several years ago a mentor suggested that I write a book. I nearly laughed at her. A book?? Inconceivable! Who would buy it? Would they actually read it? Would it be there at 3 AM when they needed it? How could it be updated? A physical book didn’t seem compatible with the breakneck speed of critical […]
The IVC for Fluid Assessment Roundup
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Anaphylaxis
CONTENTS Rapid Reference 🚀 Diagnosis Clinical findings & definition Causes Differential diagnosis Investigation Anaphylaxis vs. bradykinin-mediated angioedema Treatment Source control Components of therapy Epinephrine IV epinephrine infusion Fluid resuscitation Antihistamines Steroid Inhaled beta-2 agonists Overall treatment strategy General treatment strategy Anaphylaxis in the beta-blocked patient Airway management Recovery phase & extubation Disposition Podcast Questions & […]
Bupropion intoxication
CONTENTS Overview Pharmacodynamics Pharmacokinetics Diagnostics & doses Clinical evolution Treatment Activated Charcoal Whole bowel irrigation Neurotoxicity management Cardiotoxicity management Podcast Questions & discussion Pitfalls Bupropion is increasingly used for several indications (depression, tobacco cessation, and ADHD). Unfortunately, it is also a uniquely dangerous and increasingly common source of intoxication (especially the extended-release formulations). For example, […]
PulmCrit- Epinephrine challenge in sepsis: An empiric approach to catecholamines
A 55-year-old woman was admitted with toxic shock syndrome. Her norepinephrine requirement was labile, fluctuating between 15 mcg/min and 30 mcg/min. Bedside echocardiogram showed a dilated inferior vena cava without respiratory variability, and a normal ejection fraction. On examination her extremities were cool and her urine output was marginal.
PulmCrit- Brain death, mimics, and flow scans
As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation. Critical care practitioners must develop a firm grasp of this diagnosis. This post will explore some diagnostic conundrums in brain death diagnosis. The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.
PulmCrit- Nucleic acid microarrays streamline bacteremia management
Verigene is a nucleic acid micro-array which can be used to provide rapid information about positive blood cultures. The array detects genetic information which may reveal the genus/species of bacteria and the presence of various resistance genes.
PulmCrit – Early basal insulin in DKA
The timing of basal insulin administration in DKA has been controversial for years. I posted the following poll on twitter recently to get a sense of current opinion on this: So, it seems that the majority of people are using traditional management (wait for the anion gap to close, give basal insulin, then shut off […]