We’ve been all over the road with beta-blockers and COPD. For a long time, there was a belief that beta-blockers were contraindicated in COPD. Eventually that concept fell out of favor. Subsequently, some correlative data suggested that beta-blockers might be beneficial in COPD. This led to the current BLOCK-COPD trial which (spoiler alert) shows that […]
Search Results for: airway
EM Nerd-The Case of the Tell-Tale Heart
We can all agree that the use of bedside ultrasound (US) has changed the practice of Emergency Medicine for the better. But with the addition of such a tool, we are now faced with the question of how best to apply this novel modality into our practice. The emergency management of cardiac arrest seems like […]
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.
EM Nerd-An Addendum to the Case of the Incidental Bystander Part II
Recently I wrote a post discussing overdiagnosis in the workup for pulmonary embolism (PE). In it we discussed a recently published paper, the RESPECT-ED trial. Shortly after posting I was contacted by the lead author, Dr. David Mountain, with a number of comments and concerns on how the trial was represented. I have included it […]
Another Comment from Our Semi-Retired Critical Care Doctor on Fluids and the Lymphatics
More from John, this time the role of the lymphatics
Brain Abscess
CONTENTS Brain abscess Pathophysiology Epidemiology Clinical manifestations Evaluation Neuroimaging Antibiotics Drainage & serial monitoring Adjunctive therapies Related intracranial infections Subdural empyema Epidural empyema Podcast Questions & discussion Pitfalls evolution of an abscess An abscess begins as a localized area of cerebritis. Over about two weeks, this subsequently evolves into an abscess (a purulent collection surrounded […]
Hyperosmolar hyperglycemic state (HHS)
CONTENTS Rapid Reference 🚀 Pathophysiology Definition & diagnosis Evaluation Treatment Overview Step #1 – Volume resuscitation Step #2 – Insulin Step #3 – Water repletion Rhabdomyolysis Podcast Questions & discussion Pitfalls pathogenesis of hyperosmolar hyperglycemic state (HHS) HHS is often triggered by an acute stressor, which increases levels of cortisol and catecholamines (thereby reducing insulin […]
PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0)
Prognostication is tough. The challenge is often not that we have too little data, but rather that we have too much data. There are now about two dozen risk factors for poor outcomes with COVID-19. How are we supposed to integrate all these bits of information at the bedside? Which pieces of information are redundant […]
ABG, VBG, and pulse oximetry
CONTENTS Assessment of oxygenation: Advantages of pulse oximetry over ABG Situations where ABG is needed to assess oxygenation: Poor arterial waveform Dyshemoglobinemia P/F ratio A-a gradient Patients with dark skin Other causes of inaccurate pulse oximetry Assessment of ventilation: VBG to assess pH and ventilation end tidal CO2 (etCO2) Additional topics related to pulse oximetry: […]
The fallacy of time-to-intervention studies
0 Time and tide wait for no intervention – Geoffrey Chaucer 0 We are barraged by time-to-intervention studies (door-to-balloon time, time-to-antibiotics, door-to-needle, etc.). However, it must be kept in mind that these studies are purely correlational in design. Such studies cannot […]
Cerebral venous thrombosis (CVT)
CONTENTS Pathophysiology Clinical features Epidemiology Signs & symptoms Relationship between thrombus location & clinical features Investigations Laboratory studies Imaging Treatment Neurologic deterioration despite treatment Prognosis Podcast Questions & discussion Pitfalls anatomy The superior sagittal and transverse sinuses are most frequently involved (in 60% of patients). The internal jugular and cortical veins are involved less often. […]
PulmCrit- Shrug Technique for US-guided subclavian lines
The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
PulmCrit- Phenobarbital monotherapy for alcohol withdrawal: Reloaded
Currently there is a lorazepam shortage in the United States. This caused a surge of interest into using phenobarbital for alcohol withdrawal. I’ve received several e-mails over the past few weeks about this. It’s been two years since my last post about phenobarbital, so here’s an update focusing on lessons learned in the interim.
Top 10 reasons to stop cooling to 33C
Introduction 0 Following the Nielsen study, many hospitals developed two protocols for temperature management after cardiac arrest (33C or 36C). For example, the 36C protocol could be used for patients with contraindications to hypothermia (33C). With ongoing evidence emerging about hypothermia, many hospitals are abandoning their 33C protocols and using 36C for all post-arrest patients. […]
PulmCrit Wee – Urine toxicology screens should be removed from brain death guidelines
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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