Abdominal compartment syndrome can result from primary abdominal pathology (e.g. bowel obstruction), but it can also occur due to systemic inflammation combined with large-volume resuscitation. As such, abdominal compartment syndrome is probably more frequent than generally perceived, functioning as an occult driver of multi-organ failure. Treatment is based upon physiological properties, involving many therapies aside from simply opening the abdomen.
EM Nerd-The Case of the Conspicuous Conclusion
The process of rapid sequence induction (RSI) often forces the clinician to choose between two conflicting priorities. Torn between maintaining a safe level of oxygen, rendering the patient apneic, and limiting the amount of positive pressure ventilatory support given prior to obtaining a secure airway in the hopes of minimizing the risk of aspiration. Traditionally […]
PulmCrit- DEXACET: Four grams of acetaminophen a day keeps the delirium away?
For decades, acetaminophen has been regarded as the first rung of the analgesic ladder. It has a nearly unparalleled risk/benefit profile when dosed correctly (it’s not tremendously effective, but it is extraordinarily safe). Theoretically, acetaminophen should be used very broadly among critically ill patients with pain.However, this isn’t the case.
EMCrit 242 – ED Nephrology with Joel Topf aka KidneyBoy
ED Nephrology with the Kidney Boy, Joel Topf
IBCC chapter & cast: Myasthenic Crisis
Myasthenic crisis along the fault-line between neurology and critical care medicine. This creates a potentially dangerous situation, wherein nobody is fully informed or wholly responsible for the patient.
IBCC chapter & cast: Acetaminophen toxicity
Acetaminophen is in everyone’s medicine cabinet. This makes it one of the more common intoxications. At first blush, this might seem like an easy topic: apply the nomogram, then give acetylcysteine. Unfortunately, it’s not quite that simple. There are a variety of different presentations (e.g. acute, chronic, delayed), many of which will confound the nomogram. […]
EMCrit CQiR – IV Bolus Epinephrine for Anaphylaxis: A Double-Edged Sword
Is IM still the way to go with epi in anaphylaxis?
PulmCrit wee- Five ways to improve live-tweeting at conferences
For generalists such as myself, there’s almost always a conference of interest going on somewhere in the world. In the normal course of events, I would miss 99.9% of them. However, twitter makes it possible for me to gain some insight from all of them. However, conference tweeting is far from perfect. A large conference […]
EMCrit 241 – Sepsis Update 2019
New stuff on sepsis resuscitation for 2019
IBCC chapter & cast: Hypernatremia
Treating hypernatremia in the ICU isn’t exciting or particularly difficult. However, it’s enormously important to provide patients with comfort. We talk a lot on treating pain, but usually forget about the discomfort caused by thirst. Remember: when you intubate a patient and take control of their airway, you’re also taking responsibility to provide them with water.
EM Nerd-The Case of the Deceitful Lantern
Since the publication of the sepsis trilogy, PROMISE, ARISE, and PROCESS 1,2,3, abruptly displaced early goal directed therapy (EGDT) as the cornerstone of sepsis management, we have been searching to fill the therapeutic vacuum its sudden departure left behind. The Center for Medicare and Medicaid Services (CMS) and the Surviving Sepsis Campaign (SSC) have both rushed […]
PulmCrit: Is pure RSI a failed paradigm in critical illness? The primacy of pressure
Why do some patients’ saturation crash during laryngoscopy, whereas other patients are fine? What can we do to prevent this?
IBCC chapter: Salicylate intoxication
Of all intoxications, salicylates is one of the most important to understand. These cases can unravel rapidly, with fatal outcome. However, with prompt management most patients will do fine. Treatment depends on a solid grasp of the underlying chemistry and renal physiology.
Point of Care Ultrasound Handbook – RUSH Chapter
A free chapter from a POC ultrasound book
PulmCrit: The surviving sepsis campaign 1-hour bundle is… back?
The surviving sepsis campaign (SSC) has had substantial problems dating back to its inception. The original backbone of the guidelines was a single-center trial by Rivers, which has largely been debunked.1–4 Initially the SSC was slow to let go of invasive early goal-directed therapy. The SSC has finally started eliminating older dogma (e.g., superior vena cava […]
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