Over the past year, the five papers below were published regarding the use of phenobarbital in alcohol withdrawal. These studies aren’t massive, glittering multicenter RCTs (and, realistically, it’s dubious whether such a study will happen). However, these papers bring some unique and interesting perspectives to the table. This post will summarize them briefly – a bit like a sampler flight of beers (figure above).
IBCC chapter & cast: Ascending cholangitis & calculus cholecystitis (community-acquired biliary sepsis)
Biliary infection is a fairly common cause of septic shock (especially ascending cholangitis). Evidence isn’t terrific regarding exactly when and how interventions should be done to obtain source control (particularly among cholecystitis). This chapter attempts to reach some clarity on the topic but honestly, it remains a bit murky.
IBCC chapter & cast – Clostridioides Difficile
Clostridioides (previously clostridium) difficile is an inescapable problem within the critical care arena. This may arise as a nosocomial complication, in which case it is usually diagnosed early and treated successfully. It may also be the primary cause of admission to the ICU, in which case it is generally more severe.
Dual External Defibrillation: Close, but Not Touching by Mark Ramzy
The scoop on dual defibrillation
PulmCrit- Rigorous vs. lenient spontaneous breathing trials: The answer at last?
background There has long been debate about exactly how to design a spontaneous breathing trial. If the trial is made too easy, then patients would be extubated before being ready (leading to re-intubation). Alternatively, if the trial is too hard, that would prolong mechanical ventilation beyond the point of being beneficial. The figure above shows […]
EMCrit 250 – The OMI Manifesto Lecture by Pendell Meyers
A video version of the rebellion’s attempts to overthrow the STEMI Empire
IBCC chapter & cast – Fluid selection & pH-guided fluid resuscitation
Based on this polling data, 42% of you will hate this chapter. It’s a good thing I’m not running for president. Seriously though, fluid selection remains controversial. This chapter presents an approach which makes sense physiologically and is supported by a substantial amount of animal and human data.
IBCC chapter & cast: Hypercalcemia
Hypercalcemia isn’t a particularly common cause of critical illness, but when encountered this requires immediate treatment. Fortunately, advances in the treatment for hypercalemia have clarified how to do this safely and definitively. Forced diuresis with furosemide has largely fallen by the wayside, simplifying fluid and electrolyte management. The cornerstone of therapy is generally simultaneous initiation of calcitonin and an IV bisphosphonate.
PulmCrit- TEG for cirrhotic coagulopathy: Time for clinical implementation?
Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis. Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients. This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]
The Case of the False Imprisonment
In the FOAM community a great deal of time is spent discussing the appropriate manner of transitioning critically ill patients onto mechanical ventilation. A far larger portion of the practice of critical care is spent determining how best to liberate our patients from the ventilatory shackles with which we have bound them. The specifics of […]
EMCrit 249 – You Can Either Learn or You Can Blame – Fixing the Morbidity and Mortality Conference with George Douros
How to make your M&M conference important and useful
IBCC chapter & cast: Serotonin syndrome
Serotonin syndromes comes up a lot in critical care medicine. Sometimes we are admitting patients because of a primary diagnosis of serotonin syndrome. Other times we are afraid of causing serotonin syndrome ourselves, due to polypharmacy. In both scenarios, there may be uncertainty regarding whether or not a patient has serotonin syndrome. This chapter explores […]
IBCC chapter & cast: Tick-borne infections
It’s spring in Vermont… when a young intensivist’s thoughts go from fancy to tick-borne diseases. Climate shifts are causing an increase in tick-borne illnesses, such that these are now considered emerging infections in many areas (including the northeast United States and Canada). These diseases can be extremely difficult to diagnose, as they will often present with a nonspecific flu-like illness and may subsequently progress to multi-organ failure. Misdiagnosis of a tick-borne illness as bacterial septic shock would lead to inadequate treatment, as these diseases require specific antibiotic therapy (usually doxycycline). This chapter focuses on diagnosis and empiric therapy for these very challenging infections.
EMCrit 248 – How to Teach Surgical Airways–you knows, Crics: The One-Hour Cricothyrotomy Course
Lessons learned from teaching hundreds of people to cric
PulmCrit: Myth-busting the fluid bolus
For centuries, medical experts practiced bloodletting for a variety of ailments. This was widely believed to rid the body of evil humors. When patients didn’t respond well, this was believed to reflect an inadequate or delayed bloodletting. Practitioners competed to see who could partake in the most rapid and aggressive bloodletting.
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